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Taye BK, Gezie LD, Atnafu A, Mengiste SA, Kaasbøll J, Gullslett MK, Tilahun B. Effect of Performance-Based Nonfinancial Incentives on Data Quality in Individual Medical Records of Institutional Births: Quasi-Experimental Study. JMIR Med Inform 2024; 12:e54278. [PMID: 38578684 PMCID: PMC11031696 DOI: 10.2196/54278] [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: 11/03/2023] [Revised: 01/20/2024] [Accepted: 02/05/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Despite the potential of routine health information systems in tackling persistent maternal deaths stemming from poor service quality at health facilities during and around childbirth, research has demonstrated their suboptimal performance, evident from the incomplete and inaccurate data unfit for practical use. There is a consensus that nonfinancial incentives can enhance health care providers' commitment toward achieving the desired health care quality. However, there is limited evidence regarding the effectiveness of nonfinancial incentives in improving the data quality of institutional birth services in Ethiopia. OBJECTIVE This study aimed to evaluate the effect of performance-based nonfinancial incentives on the completeness and consistency of data in the individual medical records of women who availed institutional birth services in northwest Ethiopia. METHODS We used a quasi-experimental design with a comparator group in the pre-post period, using a sample of 1969 women's medical records. The study was conducted in the "Wegera" and "Tach-armacheho" districts, which served as the intervention and comparator districts, respectively. The intervention comprised a multicomponent nonfinancial incentive, including smartphones, flash disks, power banks, certificates, and scholarships. Personal records of women who gave birth within 6 months before (April to September 2020) and after (February to July 2021) the intervention were included. Three distinct women's birth records were examined: the integrated card, integrated individual folder, and delivery register. The completeness of the data was determined by examining the presence of data elements, whereas the consistency check involved evaluating the agreement of data elements among women's birth records. The average treatment effect on the treated (ATET), with 95% CIs, was computed using a difference-in-differences model. RESULTS In the intervention district, data completeness in women's personal records was nearly 4 times higher (ATET 3.8, 95% CI 2.2-5.5; P=.02), and consistency was approximately 12 times more likely (ATET 11.6, 95% CI 4.18-19; P=.03) than in the comparator district. CONCLUSIONS This study indicates that performance-based nonfinancial incentives enhance data quality in the personal records of institutional births. Health care planners can adapt these incentives to improve the data quality of comparable medical records, particularly pregnancy-related data within health care facilities. Future research is needed to assess the effectiveness of nonfinancial incentives across diverse contexts to support successful scale-up.
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Affiliation(s)
- Biniam Kefiyalew Taye
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Ministry of Health, The Federal Democratic Republic of Ethiopia, Addis Ababa, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Jens Kaasbøll
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Monika Knudsen Gullslett
- Faculty of Health & Social Sciences, Science Center Health & Technology, University of South-Eastern Norway, Notodden, Norway
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Cross JH, Bohne C, Ngwala SK, Shabani J, Wainaina J, Dosunmu O, Kassim I, Penzias RE, Tillya R, Gathara D, Zimba E, Ezeaka VC, Odedere O, Chiume M, Salim N, Kawaza K, Lufesi N, Irimu G, Tongo OO, Malla L, Paton C, Day LT, Oden M, Richards-Kortum R, Molyneux EM, Ohuma EO, Lawn JE. Neonatal inpatient dataset for small and sick newborn care in low- and middle-income countries: systematic development and multi-country operationalisation with NEST360. BMC Pediatr 2023; 23:567. [PMID: 37968588 PMCID: PMC10652643 DOI: 10.1186/s12887-023-04341-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 10/02/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Every Newborn Action Plan (ENAP) coverage target 4 necessitates national scale-up of Level-2 Small and Sick Newborn Care (SSNC) (with Continuous Positive Airway Pressure (CPAP)) in 80% of districts by 2025. Routine neonatal inpatient data is important for improving quality of care, targeting equity gaps, and enabling data-driven decision-making at individual, district, and national-levels. Existing neonatal inpatient datasets vary in purpose, size, definitions, and collection processes. We describe the co-design and operationalisation of a core inpatient dataset for use to track outcomes and improve quality of care for small and sick newborns in high-mortality settings. METHODS A three-step systematic framework was used to review, co-design, and operationalise this novel neonatal inpatient dataset in four countries (Malawi, Kenya, Tanzania, and Nigeria) implementing with the Newborn Essential Solutions and Technologies (NEST360) Alliance. Existing global and national datasets were identified, and variables were mapped according to categories. A priori considerations for variable inclusion were determined by clinicians and policymakers from the four African governments by facilitated group discussions. These included prioritising clinical care and newborn outcomes data, a parsimonious variable list, and electronic data entry. The tool was designed and refined by > 40 implementers and policymakers during a multi-stakeholder workshop and online interactions. RESULTS Identified national and international datasets (n = 6) contained a median of 89 (IQR:61-154) variables, with many relating to research-specific initiatives. Maternal antenatal/intrapartum history was the largest variable category (21, 23.3%). The Neonatal Inpatient Dataset (NID) includes 60 core variables organised in six categories: (1) birth details/maternal history; (2) admission details/identifiers; (3) clinical complications/observations; (4) interventions/investigations; (5) discharge outcomes; and (6) diagnosis/cause-of-death. Categories were informed through the mapping process. The NID has been implemented at 69 neonatal units in four African countries and links to a facility-level quality improvement (QI) dashboard used in real-time by facility staff. CONCLUSION The NEST360 NID is a novel, parsimonious tool for use in routine information systems to inform inpatient SSNC quality. Available on the NEST360/United Nations Children's Fund (UNICEF) Implementation Toolkit for SSNC, this adaptable tool enables facility and country-level comparisons to accelerate progress toward ENAP targets. Additional linked modules could include neonatal at-risk follow-up, retinopathy of prematurity, and Level-3 intensive care.
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Affiliation(s)
- James H Cross
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - Christine Bohne
- Rice360 Institute for Global Health Technologies, Rice University, Texas, USA
- Ifakara Health Institute, Ifakara, Tanzania
| | - Samuel K Ngwala
- Research Support Center, School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - John Wainaina
- Kenya Medical Research Institute, Wellcome Trust Research Program, Nairobi, Kenya
| | | | | | - Rebecca E Penzias
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | - David Gathara
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
- Kenya Medical Research Institute, Wellcome Trust Research Program, Nairobi, Kenya
| | - Evelyn Zimba
- Rice360 Institute for Global Health Technologies, Rice University, Texas, USA
| | | | - Opeyemi Odedere
- Rice360 Institute for Global Health Technologies, Rice University, Texas, USA
- APIN Public Health Initiatives, Abuja, Nigeria
| | - Msandeni Chiume
- Department of Paediatrics, Kamuzu University of Health Sciences (Formerly College of Medicine, University of Malawi), Blantyre, Malawi
- Kamuzu Central Hospital, Lilongwe, Malawi
| | - Nahya Salim
- Ifakara Health Institute, Ifakara, Tanzania
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Kondwani Kawaza
- Department of Paediatrics, Kamuzu University of Health Sciences (Formerly College of Medicine, University of Malawi), Blantyre, Malawi
| | - Norman Lufesi
- Department of Curative and Medical Rehabilitation, Ministry of Health, Lilongwe, Malawi
| | - Grace Irimu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Olukemi O Tongo
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Lucas Malla
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Paton
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Information Science, University of Otago, Dunedin, New Zealand
| | - Louise T Day
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
- Maternal and Newborn Health Group, Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Oden
- Rice360 Institute for Global Health Technologies, Rice University, Texas, USA
| | | | - Elizabeth M Molyneux
- Department of Paediatrics, Kamuzu University of Health Sciences (Formerly College of Medicine, University of Malawi), Blantyre, Malawi
| | - Eric O Ohuma
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
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McCarthy KJ, Blanc AK, Warren CE, Bajracharya A, Bellows B. Exploring the accuracy of self-reported maternal and newborn care in select studies from low and middle-income country settings: do respondent and facility characteristics affect measurement? BMC Pregnancy Childbirth 2023; 23:448. [PMID: 37328744 DOI: 10.1186/s12884-023-05755-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 06/02/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Accurate data on the receipt of essential maternal and newborn health interventions is necessary to interpret and address gaps in effective coverage. Validation results of commonly used content and quality of care indicators routinely implemented in international survey programs vary across settings. We assessed how respondent and facility characteristics influenced the accuracy of women's recall of interventions received in the antenatal and postnatal periods. METHODS We synthesized reporting accuracy using data from a known sample of validation studies conducted in Sub-Saharan Africa and Southeast Asia, which assessed the validity of women's self-report of received antenatal care (ANC) (N = 3 studies, 3,169 participants) and postnatal care (PNC) (N = 5 studies, 2,462 participants) compared to direct observation. For each study, indicator sensitivity and specificity are presented with 95% confidence intervals. Univariate fixed effects and bivariate random effects models were used to examine whether respondent characteristics (e.g., age group, parity, education level), facility quality, or intervention coverage level influenced the accuracy of women's recall of whether interventions were received. RESULTS Intervention coverage was associated with reporting accuracy across studies for the majority (9 of 12) of PNC indicators. Increasing intervention coverage was associated with poorer specificity for 8 indicators and improved sensitivity for 6 indicators. Reporting accuracy for ANC or PNC indicators did not consistently differ by any other respondent or facility characteristic. CONCLUSIONS High intervention coverage may contribute to higher false positive reporting (poorer specificity) among women who receive facility-based maternal and newborn care while low intervention coverage may contribute to false negative reporting (lower sensitivity). While replication in other country and facility settings is warranted, results suggest that monitoring efforts should consider the context of care when interpreting national estimates of intervention coverage.
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Affiliation(s)
- Katharine J McCarthy
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Blavatnik Women's Health Research Institute, New York, NY, USA.
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Li H, Ning W, Zhang N, Zhang J, He R, Mao Y, Zhu B. Association between maternal depression and neonatal outcomes: Evidence from a survey of nationally representative longitudinal studies. Front Public Health 2022; 10:893518. [PMID: 36159263 PMCID: PMC9500377 DOI: 10.3389/fpubh.2022.893518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/22/2022] [Indexed: 01/22/2023] Open
Abstract
Background and aims Maternal depression before and after delivery has dramatically increased in China. Therefore, this study aimed to examine the association between antepartum and postpartum depression and neonatal outcomes. Design A population-based retrospective cohort study. Setting China. Participants Data were obtained from China Family Panel Studies (CFPS). Different mother-child/infant samples were included in this study. Mother in CFPS2012 and CFPS2016 were linked with 1-2-year-old children in CFPS2014 and CFPS2018, respectively. Besides, and mothers in CFPS2012, CFPS2016, and CFPS2018 were linked with 0-1-year-old infants in CFPS2012, CFPS2016, and CFPS2018, respectively. Methods Maternal depression was measured using the Center for Epidemiologic Studies Depression Scale. The neonatal outcomes included duration of gestational days, preterm birth, birth weight, birth weight z-score, weight, weight z-score, illness in the past month, and hospitalization in the past year. Propensity score matching was used to balance maternal, family, and infant/child characteristics between the maternal depression and non-maternal depression groups. Results Multivariable regression analysis of matched samples estimated that antepartum depression was associated with a shorter duration of gestation by 3.99 days (95% confidence interval [CI] = -7.21, -0.78). The association between antepartum depression and preterm birth, birth weight and birth weight z-score were not statistically significant. Postpartum depression was associated with more episodes of illness in the last month by 0.23 times (95% CI = 0.11, 0.36) and a higher odd of hospitalization in the previous year (OR = 1.59, 95% CI = 1.15, 2.20). The association between postpartum depression and weight or the weight z-score was not significant. Conclusion Maternal depression appears to be associated with worse neonatal outcomes.
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Affiliation(s)
- Haoran Li
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Wei Ning
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Ning Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Jingya Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Rongxin He
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Ying Mao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China,*Correspondence: Ying Mao
| | - Bin Zhu
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China,Bin Zhu
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Rahman AE, Jabeen S, Fernandes G, Banik G, Islam J, Ameen S, Ashrafee S, Hossain AT, Alam HMS, Majid T, Saberin A, Ahmed A, A N M EK, Chisti MJ, Ahmed S, Khan M, Jackson T, Dockrell DH, Nair H, El Arifeen S, Islam MS, Campbell H. Introducing pulse oximetry in routine IMCI services in Bangladesh: A context-driven approach to influence policy and programme through stakeholder engagement. J Glob Health 2022; 12:04029. [PMID: 35486705 PMCID: PMC9079780 DOI: 10.7189/jogh.12.04029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background An estimated 7 million episodes of severe newborn infections occur annually worldwide, with half a million newborn deaths, most occurring in low- and middle-income countries. Whilst injectable antibiotics are necessary to treat the infection, supportive care is also crucial in ending preventable mortality and morbidity. This study uses multi-country data to assess gaps in coverage, quality, and documentation of supportive care, considering implications for measurement. Methods The EN-BIRTH study was conducted in five hospitals in Bangladesh, Nepal, and Tanzania (July 2017-July 2018). Newborns with an admission diagnosis of clinically-defined infection (sepsis, meningitis, and/or pneumonia) were included. Researchers extracted data from inpatient case notes and interviews with women (usually the mothers) as the primary family caretakers after discharge. The interviews were conducted using a structured survey questionnaire. We used descriptive statistics to report coverage of newborn supportive care components such as oxygen use, phototherapy, and appropriate feeding, and we assessed the validity of measurement through survey-reports using a random-effects model to generate pooled estimates. In this study, key supportive care components were assessment and correction of hypoxaemia, hyperbilirubinemia, and hypoglycaemia. Results Among 1015 neonates who met the inclusion criteria, 89% had an admission clinical diagnosis of sepsis. Major gaps in documentation and care practices related to supportive care varied substantially across the participating hospitals. The pooled sensitivity was low for the survey-reported oxygen use (47%; 95% confidence interval (CI) = 30%-64%) and moderate for phototherapy (60%; 95% CI = 44%-75%). The pooled specificity was high for both the survey-reported oxygen use (85%; 95% CI = 80%-89%) and phototherapy (91%; 95% CI = 82%-97%). Conclusions The women's reports during the exit survey consistently underestimated the coverage of supportive care components for managing infection. We have observed high variability in the inpatient documents across facilities. A standardised ward register for inpatient small and sick newborn care may capture selected supportive care data. However, tracking the detailed care will require standardised individual-level data sets linked to newborn case notes. We recommend investments in assessing the implementation aspects of a standardised inpatient register in resource-poor settings.
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Affiliation(s)
- Ahmed Ehsanur Rahman
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Sabrina Jabeen
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Genevie Fernandes
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Goutom Banik
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Jahurul Islam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Shafiqul Ameen
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Sabina Ashrafee
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Aniqa Tasnim Hossain
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Husam Md Shah Alam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Tamanna Majid
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Ashfia Saberin
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | | | - Mohammod Jobayer Chisti
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | | | | | - Tracy Jackson
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - David H Dockrell
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Harish Nair
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Shams El Arifeen
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Muhammad Shariful Islam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Harry Campbell
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
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Baumgartner JN, Headley J, Kirya J, Guenther J, Kaggwa J, Kim MK, Aldridge L, Weiland S, Egger J. Impact evaluation of a maternal and neonatal health training intervention in private Ugandan facilities. Health Policy Plan 2021; 36:1103-1115. [PMID: 34184060 PMCID: PMC8359744 DOI: 10.1093/heapol/czab072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 04/20/2021] [Accepted: 06/26/2021] [Indexed: 11/14/2022] Open
Abstract
Global and country-specific targets for reductions in maternal and neonatal mortality in low-resource settings will not be achieved without improvements in the quality of care for optimal facility-based obstetric and newborn care. This global call includes the private sector, which is increasingly serving low-resource pregnant women. The primary aim of this study was to estimate the impact of a clinical and management-training programme delivered by a non-governmental organization [LifeNet International] that partners with clinics on adherence to global standards of clinical quality during labour and delivery in rural Uganda. The secondary aim included describing the effect of the LifeNet training on pre-discharge neonatal and maternal mortality. The LifeNet programme delivered maternal and neonatal clinical trainings over a 10-month period in 2017-18. Direct clinical observations of obstetric deliveries were conducted at baseline (n = 263 pre-intervention) and endline (n = 321 post-intervention) for six faith-based, not-for-profit primary healthcare facilities in the greater Masaka area of Uganda. Direct observation comprised the entire delivery process, from initial client assessment to discharge, and included emergency management (e.g. postpartum haemorrhage and neonatal resuscitation). Data were supplemented by daily facility-based assessments of infrastructure during the study periods. Results showed positive and clinically meaningful increases in observed handwashing, observed delayed cord clamping, partograph use documentation and observed 1- and/or 5-minute APGAR assessments (rapid scoring system for assessing clinical status of newborn), in particular, between baseline and endline. High-quality intrapartum facility-based care is critical for reducing maternal and early neonatal mortality, and this evaluation of the LifeNet intervention indicates that their clinical training programme improved the practice of quality maternal and neonatal healthcare at all six primary care clinics in Uganda, at least over a relatively short-term period. However, for several of these quality indicators, the adherence rates, although improved, were still far from 100% and could benefit from further improvement via refresher trainings and/or a closer examination of the barriers to adherence.
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Affiliation(s)
- Joy Noel Baumgartner
- School of Social Work, University of North Carolina, 325 Pittsboro Street, Chapel Hill, NC 27599-3550, USA
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Jennifer Headley
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Julius Kirya
- LifeNet International, 64-25 Ring Road, Muyenga PO Box 21189, Kampala, Uganda
| | - Josh Guenther
- LifeNet International, 64-25 Ring Road, Muyenga PO Box 21189, Kampala, Uganda
| | - James Kaggwa
- LifeNet International, 64-25 Ring Road, Muyenga PO Box 21189, Kampala, Uganda
| | - Min Kyung Kim
- Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Luke Aldridge
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | | | - Joseph Egger
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
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Ciccone EJ, Tilly AE, Chiume M, Mgusha Y, Eckerle M, Namuku H, Crouse HL, Mkaliainga TB, Robison JA, Schubert CJ, Mvalo T, Fitzgerald E. Lessons learned from the development and implementation of an electronic paediatric emergency and acute care database in Lilongwe, Malawi. BMJ Glob Health 2021; 5:bmjgh-2020-002410. [PMID: 32675067 PMCID: PMC7368472 DOI: 10.1136/bmjgh-2020-002410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/23/2020] [Accepted: 05/09/2020] [Indexed: 11/29/2022] Open
Abstract
As the field of global child health increasingly focuses on inpatient and emergency care, there is broad recognition of the need for comprehensive, accurate data to guide decision-making at both patient and system levels. Limited financial and human resources present barriers to reliable and detailed clinical documentation at hospitals in low-and-middle-income countries (LMICs). Kamuzu Central Hospital (KCH) is a tertiary referral hospital in Malawi where the paediatric ward admits up to 3000 children per month. To improve availability of robust inpatient data, we collaboratively designed an acute care database on behalf of PACHIMAKE, a consortium of Malawi and US-based institutions formed to improve paediatric care at KCH. We assessed the existing health information systems at KCH, reviewed quality care metrics, engaged clinical providers and interviewed local stakeholders who would directly use the database or be involved in its collection. Based on the information gathered, we developed electronic forms collecting data at admission, follow-up and discharge for children admitted to the KCH paediatric wards. The forms record demographic information, basic medical history, clinical condition and pre-referral management; track diagnostic processes, including laboratory studies, imaging modalities and consults; and document the final diagnoses and disposition obtained from clinical files and corroborated through review of existing admission and death registries. Our experience with the creation of this database underscores the importance of fully assessing existing health information systems and involving all stakeholders early in the planning process to ensure meaningful and sustainable implementation.
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Affiliation(s)
- Emily J Ciccone
- Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Alyssa E Tilly
- Departments of Medicine and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Msandeni Chiume
- Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Yamikani Mgusha
- Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Michelle Eckerle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Howard Namuku
- Department of Information Communication Technology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Heather L Crouse
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Jeff A Robison
- Division of Pediatric Emergency Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Charles J Schubert
- Departments of Pediatrics and Family/Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Tisungane Mvalo
- UNC Project-Malawi, Lilongwe, Malawi.,Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Elizabeth Fitzgerald
- Division of Emergency Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Ameen S, Siddique AB, Peven K, Rahman QSU, Day LT, Shabani J, Kc A, Boggs D, Shamba D, Tahsina T, Rahman AE, Zaman SB, Hossain AT, Ahmed A, Basnet O, Malla H, Ruysen H, Blencowe H, Arnold F, Requejo J, Arifeen SE, Lawn JE. Survey of women's report for 33 maternal and newborn indicators: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:238. [PMID: 33765956 PMCID: PMC7995710 DOI: 10.1186/s12884-020-03425-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Population-based household surveys, notably the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), remain the main source of maternal and newborn health data for many low- and middle-income countries. As part of the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study, this paper focuses on testing validity of measurement of maternal and newborn indicators around the time of birth (intrapartum and postnatal) in survey-report. METHODS EN-BIRTH was an observational study testing the validity of measurement for selected maternal and newborn indicators in five secondary/tertiary hospitals in Bangladesh, Nepal and Tanzania, conducted from July 2017 to July 2018. We compared women's report at exit survey with the gold standard of direct observation or verification from clinical records for women with vaginal births. Population-level validity was assessed by validity ratios (survey-reported coverage: observer-assessed coverage). Individual-level accuracy was assessed by sensitivity, specificity and percent agreement. We tested indicators already in DHS/MICS as well as indicators with potential to be included in population-based surveys, notably the first validation for small and sick newborn care indicators. RESULTS 33 maternal and newborn indicators were evaluated. Amongst nine indicators already present in DHS/MICS, validity ratios for baby dried or wiped, birthweight measured, low birthweight, and sex of baby (female) were between 0.90-1.10. Instrumental birth, skin-to-skin contact, and early initiation of breastfeeding were highly overestimated by survey-report (2.04-4.83) while umbilical cord care indicators were massively underestimated (0.14-0.22). Amongst 24 indicators not currently in DHS/MICS, two newborn contact indicators (kangaroo mother care 1.00, admission to neonatal unit 1.01) had high survey-reported coverage amongst admitted newborns and high sensitivity. The remaining indicators did not perform well and some had very high "don't know" responses. CONCLUSIONS Our study revealed low validity for collecting many maternal and newborn indicators through an exit survey instrument, even with short recall periods among women with vaginal births. Household surveys are already at risk of overload, and some specific clinical care indicators do not perform well and may be under-powered. Given that approximately 80% of births worldwide occur in facilities, routine registers should also be explored to track coverage of key maternal and newborn health interventions, particularly for clinical care.
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Affiliation(s)
- Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
| | - Abu Bakkar Siddique
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Kimberly Peven
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Ashish Kc
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Dorothy Boggs
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Omkar Basnet
- Research Division, Golden Community, Lalitpur, Nepal
| | - Honey Malla
- Research Division, Golden Community, Lalitpur, Nepal
| | - Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Fred Arnold
- Demographic and Health Survey Program, ICF, Rockville, MD, USA
| | - Jennifer Requejo
- Division of Data, Analysis, Planning and Monitoring, United Nations Children's Fund, Headquarters, New York, New York, USA
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
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Shamba D, Day LT, Zaman SB, Sunny AK, Tarimo MN, Peven K, Khan J, Thakur N, Talha MTUS, K C A, Haider R, Ruysen H, Mazumder T, Rahman MH, Shaikh MZH, Sæbø JI, Hanson C, Singh NS, Schellenberg J, Vaz LME, Requejo J, Lawn JE. Barriers and enablers to routine register data collection for newborns and mothers: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:233. [PMID: 33765963 PMCID: PMC7995573 DOI: 10.1186/s12884-020-03517-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Policymakers need regular high-quality coverage data on care around the time of birth to accelerate progress for ending preventable maternal and newborn deaths and stillbirths. With increasing facility births, routine Health Management Information System (HMIS) data have potential to track coverage. Identifying barriers and enablers faced by frontline health workers recording HMIS source data in registers is important to improve data for use. METHODS The EN-BIRTH study was a mixed-methods observational study in five hospitals in Bangladesh, Nepal and Tanzania to assess measurement validity for selected Every Newborn coverage indicators. We described data elements required in labour ward registers to track these indicators. To evaluate barriers and enablers for correct recording of data in registers, we designed three interview tools: a) semi-structured in-depth interview (IDI) guide b) semi-structured focus group discussion (FGD) guide, and c) checklist assessing care-to-documentation. We interviewed two groups of respondents (January 2018-March 2019): hospital nurse-midwives and doctors who fill ward registers after birth (n = 40 IDI and n = 5 FGD); and data collectors (n = 65). Qualitative data were analysed thematically by categorising pre-identified codes. Common emerging themes of barriers or enablers across all five hospitals were identified relating to three conceptual framework categories. RESULTS Similar themes emerged as both barriers and enablers. First, register design was recognised as crucial, yet perceived as complex, and not always standardised for necessary data elements. Second, register filling was performed by over-stretched nurse-midwives with variable training, limited supervision, and availability of logistical resources. Documentation complexity across parallel documents was time-consuming and delayed because of low staff numbers. Complete data were valued more than correct data. Third, use of register data included clinical handover and monthly reporting, but little feedback was given from data users. CONCLUSION Health workers invest major time recording register data for maternal and newborn core health indicators. Improving data quality requires standardised register designs streamlined to capture only necessary data elements. Consistent implementation processes are also needed. Two-way feedback between HMIS levels is critical to improve performance and accurately track progress towards agreed health goals.
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Affiliation(s)
- Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK.
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Menna Narcis Tarimo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Kimberly Peven
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Jasmin Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Md Taqbir Us Samad Talha
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashish K C
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Rajib Haider
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - Tapas Mazumder
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Hafizur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Ziaul Haque Shaikh
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Claudia Hanson
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
- Global Public Health Karolinska Institutet, Stockholm, Sweden
| | - Neha S Singh
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - Joanna Schellenberg
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - Lara M E Vaz
- International Programs, Population Reference Bureau, Washington DC, USA
| | | | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
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Tahsina T, Hossain AT, Ruysen H, Rahman AE, Day LT, Peven K, Rahman QSU, Khan J, Shabani J, Kc A, Mazumder T, Zaman SB, Ameen S, Kong S, Amouzou A, Lincetto O, El Arifeen S, Lawn JE. Immediate newborn care and breastfeeding: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:237. [PMID: 33765946 PMCID: PMC7995709 DOI: 10.1186/s12884-020-03421-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Immediate newborn care (INC) practices, notably early initiation of breastfeeding (EIBF), are fundamental for newborn health. However, coverage tracking currently relies on household survey data in many settings. "Every Newborn Birth Indicators Research Tracking in Hospitals" (EN-BIRTH) was an observational study validating selected maternal and newborn health indicators. This paper reports results for EIBF. METHODS The EN-BIRTH study was conducted in five public hospitals in Bangladesh, Nepal, and Tanzania, from July 2017 to July 2018. Clinical observers collected tablet-based, time-stamped data on EIBF and INC practices (skin-to-skin within 1 h of birth, drying, and delayed cord clamping). To assess validity of EIBF measurement, we compared observation as gold standard to register records and women's exit-interview survey reports. Percent agreement was used to assess agreement between EIBF and INC practices. Kaplan Meier survival curves showed timing. Qualitative interviews were conducted to explore barriers/enablers to register recording. RESULTS Coverage of EIBF among 7802 newborns observed for ≥1 h was low (10.9, 95% CI 3.8-21.0). Survey-reported (53.2, 95% CI 39.4-66.8) and register-recorded results (85.9, 95% CI 58.1-99.6) overestimated coverage compared to observed levels across all hospitals. Registers did not capture other INC practices apart from breastfeeding. Agreement of EIBF with other INC practices was high for skin-to-skin (69.5-93.9%) at four sites, but fair/poor for delayed cord-clamping (47.3-73.5%) and drying (7.3-29.0%). EIBF and skin-to-skin were the most delayed and EIBF rarely happened after caesarean section (0.5-3.6%). Qualitative findings suggested that focusing on accuracy, as well as completeness, contributes to higher quality with register reporting. CONCLUSIONS Our study highlights the importance of tracking EIBF despite measurement challenges and found low coverage levels, particularly after caesarean births. Both survey-reported and register-recorded data over-estimated coverage. EIBF had a strong agreement with skin-to-skin but is not a simple tracer for other INC indicators. Other INC practices are challenging to measure in surveys, not included in registers, and are likely to require special studies or audits. Continued focus on EIBF is crucial to inform efforts to improve provider practices and increase coverage. Investment and innovation are required to improve measurement.
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Affiliation(s)
- Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Louise T Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Kimberly Peven
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Jasmin Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Ashish Kc
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Tapas Mazumder
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Stefanie Kong
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Agbessi Amouzou
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | | | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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11
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Kc A, Peven K, Ameen S, Msemo G, Basnet O, Ruysen H, Zaman SB, Mkony M, Sunny AK, Rahman QSU, Shabani J, Bastola RC, Assenga E, Kc NP, El Arifeen S, Kija E, Malla H, Kong S, Singhal N, Niermeyer S, Lincetto O, Day LT, Lawn JE. Neonatal resuscitation: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:235. [PMID: 33765958 PMCID: PMC7995695 DOI: 10.1186/s12884-020-03422-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Annually, 14 million newborns require stimulation to initiate breathing at birth and 6 million require bag-mask-ventilation (BMV). Many countries have invested in facility-based neonatal resuscitation equipment and training. However, there is no consistent tracking for neonatal resuscitation coverage. METHODS The EN-BIRTH study, in five hospitals in Bangladesh, Nepal, and Tanzania (2017-2018), collected time-stamped data for care around birth, including neonatal resuscitation. Researchers surveyed women and extracted data from routine labour ward registers. To assess accuracy, we compared gold standard observed coverage to survey-reported and register-recorded coverage, using absolute difference, validity ratios, and individual-level validation metrics (sensitivity, specificity, percent agreement). We analysed two resuscitation numerators (stimulation, BMV) and three denominators (live births and fresh stillbirths, non-crying, non-breathing). We also examined timeliness of BMV. Qualitative data were collected from health workers and data collectors regarding barriers and enablers to routine recording of resuscitation. RESULTS Among 22,752 observed births, 5330 (23.4%) babies did not cry and 3860 (17.0%) did not breathe in the first minute after birth. 16.2% (n = 3688) of babies were stimulated and 4.4% (n = 998) received BMV. Survey-report underestimated coverage of stimulation and BMV. Four of five labour ward registers captured resuscitation numerators. Stimulation had variable accuracy (sensitivity 7.5-40.8%, specificity 66.8-99.5%), BMV accuracy was higher (sensitivity 12.4-48.4%, specificity > 93%), with small absolute differences between observed and recorded BMV. Accuracy did not vary by denominator option. < 1% of BMV was initiated within 1 min of birth. Enablers to register recording included training and data use while barriers included register design, documentation burden, and time pressure. CONCLUSIONS Population-based surveys are unlikely to be useful for measuring resuscitation coverage given low validity of exit-survey report. Routine labour ward registers have potential to accurately capture BMV as the numerator. Measuring the true denominator for clinical need is complex; newborns may require BMV if breathing ineffectively or experiencing apnoea after initial drying/stimulation or subsequently at any time. Further denominator research is required to evaluate non-crying as a potential alternative in the context of respectful care. Measuring quality gaps, notably timely provision of resuscitation, is crucial for programme improvement and impact, but unlikely to be feasible in routine systems, requiring audits and special studies.
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Affiliation(s)
- Ashish Kc
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Kimberly Peven
- Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Georgina Msemo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Omkar Basnet
- Research Division, Golden Community, Lalitpur, Nepal
| | - Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Martha Mkony
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Ram Chandra Bastola
- Pokhara Academy of Health Sciences, Pokhara, Nepal
- Ministry of Health and Population, Kathmandu, Nepal
| | - Evelyne Assenga
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania
| | - Naresh P Kc
- Society of Public Health Physicians Nepal, Kathmandu, Nepal
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Edward Kija
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Honey Malla
- Research Division, Golden Community, Lalitpur, Nepal
| | - Stefanie Kong
- Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Nalini Singhal
- Department of Paediatrics, University of Calgary, Calgary, Canada
| | - Susan Niermeyer
- University of Colorado School of Medicine, Colorado School of Public Health, Aurora, CO, USA
| | - Ornella Lincetto
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Louise T Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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12
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Gladstone ME, Salim N, Ogillo K, Shamba D, Gore-Langton GR, Day LT, Blencowe H, Lawn JE. Birthweight measurement processes and perceived value: qualitative research in one EN-BIRTH study hospital in Tanzania. BMC Pregnancy Childbirth 2021; 21:232. [PMID: 33765959 PMCID: PMC7995566 DOI: 10.1186/s12884-020-03356-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Globally an estimated 20.5 million liveborn babies are low birthweight (LBW) each year, weighing less than 2500 g. LBW babies have increased risk of mortality even beyond the neonatal period, with an ongoing risk of stunting and non-communicable diseases. LBW is a priority global health indicator. Now almost 80% of births are in facilities, yet birthweight data are lacking in most high-mortality burden countries and are of poor quality, notably with heaping especially on values ending in 00. We aimed to undertake qualitative research in a regional hospital in Dar es Salaam, Tanzania, observing birthweight weighing scales, exploring barriers and enablers to weighing at birth as well as perceived value of birthweight data to health workers, women and stakeholders. METHODS Observations were undertaken on type of birthweight scale availability in hospital wards. In-depth semi-structured interviews (n = 21) were conducted with three groups: women in postnatal and kangaroo mother care wards, health workers involved in birthweight measurement and recording, and stakeholders involved in data aggregation in Temeke Hospital, Tanzania, a site in the EN-BIRTH study. An inductive thematic analysis was undertaken of translated interview transcripts. RESULTS Of five wards that were expected to have scales, three had functional scales, and only one of the functional scales was digital. The labour ward weighed the most newborns using an analogue scale that was not consistently zeroed. Hospital birthweight data were aggregated monthly for reporting into the health management information system. Birthweight measurement was highly valued by all respondents, notably families and healthcare workers, and local use of data was considered an enabler. Perceived barriers to high quality birthweight data included: gaps in availability of precise weighing devices, adequate health workers and imprecise measurement practices. CONCLUSION Birthweight measurement is valued by families and health workers. There are opportunities to close the gap between the percentage of babies born in facilities and the percentage accurately weighed at birth by providing accurate scales, improving skills training and increasing local use of data. More accurate birthweight data are vitally important for all babies and specifically to track progress in preventing and improving immediate and long-term care for low birthweight children.
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Affiliation(s)
- Miriam E Gladstone
- Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Nahya Salim
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Karama Ogillo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Georgia R Gore-Langton
- Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
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13
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Reed S, Shabani J, Boggs D, Salim N, Ng'unga S, Day LT, Peven K, Kong S, Ruysen H, Jackson D, Shamba D, Lawn JE. Counting on birth registration: mixed-methods research in two EN-BIRTH study hospitals in Tanzania. BMC Pregnancy Childbirth 2021; 21:236. [PMID: 33765957 PMCID: PMC7995691 DOI: 10.1186/s12884-020-03357-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Birth registration marks a child’s right to identity and is the first step to establishing citizenship and access to services. At the population level, birth registration data can inform effective programming and planning. In Tanzania, almost two-thirds of births are in health facilities, yet only 26% of children under 5 years have their births registered. Our mixed-methods research explores the gap between hospital birth and birth registration in Dar es Salaam, Tanzania. Methods The study was conducted in the two Tanzanian hospital sites of the Every Newborn-Birth Indicators Research Tracking in Hospitals (EN-BIRTH) multi-country study (July 2017–2018). We described the business processes for birth notification and registration and collected quantitative data from women’s exit surveys after giving birth (n = 8038). We conducted in-depth interviews (n = 21) to identify barriers and enablers to birth registration among four groups of participants: women who recently gave birth, women waiting for a birth certificate at Temeke Hospital, hospital employees, and stakeholders involved in the national birth registration process. We synthesized findings to identify opportunities to improve birth registration. Results Standard national birth registration procedures were followed at Muhimbili Hospital; families received birth notification and were advised to obtain a birth certificate from the Registration, Insolvency, and Trusteeship Agency (RITA) after 2 months, for a fee. A pilot programme to improve birth registration coverage included Temeke Hospital; hand-written birth certificates were issued free of charge on a return hospital visit after 42 days. Among 2500 women exit-surveyed at Muhimbili Hospital, 96.3% reported receiving a birth notification form and nearly half misunderstood this to be a birth certificate. Of the 5538 women interviewed at Temeke Hospital, 33.0% reported receiving any documentation confirming the birth of their child. In-depth interview respondents perceived birth registration to be important but considered both the standard and pilot processes in Tanzania complex, burdensome and costly to both families and health workers. Conclusion Birth registration coverage in Tanzania could be improved by further streamlining between health facilities, where most babies are born, and the civil registry. Families and health workers need support to navigate processes to register every child.
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Affiliation(s)
- Sarah Reed
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK.
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Dorothy Boggs
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK
| | - Nahya Salim
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania.,Department of Paediatrics and Child Health, Muhimbili Hospital University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania
| | - Sillanoga Ng'unga
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Louise T Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK.
| | - Kimberly Peven
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK.,Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, London, UK
| | - Stefanie Kong
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK
| | - Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK
| | - Debra Jackson
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK.,Implementation Research & Delivery Science Unit, Health Section, UNICEF, New York, NY, USA.,School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK
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Zaman SB, Siddique AB, Ruysen H, Kc A, Peven K, Ameen S, Thakur N, Rahman QSU, Salim N, Gurung R, Tahsina T, Rahman AE, Coffey PS, Rawlins B, Day LT, Lawn JE, Arifeen SE. Chlorhexidine for facility-based umbilical cord care: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:239. [PMID: 33765947 PMCID: PMC7995704 DOI: 10.1186/s12884-020-03338-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Umbilical cord hygiene prevents sepsis, a leading cause of neonatal mortality. The World Health Organization recommends 7.1% chlorhexidine digluconate (CHX) application to the umbilicus after home birth in high mortality contexts. In Bangladesh and Nepal, national policies recommend CHX use for all facility births. Population-based household surveys include optional questions on CHX use, but indicator validation studies are lacking. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) was an observational study assessing measurement validity for maternal and newborn indicators. This paper reports results regarding CHX. METHODS The EN-BIRTH study (July 2017-July 2018) included three public hospitals in Bangladesh and Nepal where CHX cord application is routine. Clinical-observers collected tablet-based, time-stamped data regarding cord care during admission to labour and delivery wards as the gold standard to assess accuracy of women's report at exit survey, and of routine-register data. We calculated validity ratios and individual-level validation metrics; analysed coverage, quality and measurement gaps. We conducted qualitative interviews to assess barriers and enablers to routine register-recording. RESULTS Umbilical cord care was observed for 12,379 live births. Observer-assessed CHX coverage was very high at 89.3-99.4% in all 3 hospitals, although slightly lower after caesarean births in Azimpur (86.8%), Bangladesh. Exit survey-reported coverage (0.4-45.9%) underestimated the observed coverage with substantial "don't know" responses (55.5-79.4%). Survey-reported validity ratios were all poor (0.01 to 0.38). Register-recorded coverage in the specific column in Bangladesh was underestimated by 0.2% in Kushtia but overestimated by 9.0% in Azimpur. Register-recorded validity ratios were good (0.9 to 1.1) in Bangladesh, and poor (0.8) in Nepal. The non-specific register column in Pokhara, Nepal substantially underestimated coverage (20.7%). CONCLUSIONS Exit survey-report highly underestimated observed CHX coverage in all three hospitals. Routine register-recorded coverage was closer to observer-assessed coverage than survey reports in all hospitals, including for caesarean births, and was more accurately captured in hospitals with a specific register column. Inclusion of CHX cord care into registers, and tallied into health management information system platforms, is justified in countries with national policies for facility-based use, but requires implementation research to assess register design and data flow within health information systems.
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Affiliation(s)
- Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
| | - Abu Bakkar Siddique
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Harriet Ruysen
- The Maternal, Adolescent, Reproductive, & Child, Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Kimberly Peven
- The Maternal, Adolescent, Reproductive, & Child, Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | | | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Rejina Gurung
- Research Division, Golden Community, Lalitpur, Nepal
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | | | - Barbara Rawlins
- Maternal and Child Survival Program, jhpiego, Baltimore, MD, USA
| | - Louise T Day
- The Maternal, Adolescent, Reproductive, & Child, Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Joy E Lawn
- The Maternal, Adolescent, Reproductive, & Child, Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
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15
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Rahman AE, Hossain AT, Zaman SB, Salim N, K C A, Day LT, Ameen S, Ruysen H, Kija E, Peven K, Tahsina T, Ahmed A, Rahman QSU, Khan J, Kong S, Campbell H, Hailegebriel TD, Ram PK, Qazi SA, El Arifeen S, Lawn JE. Antibiotic use for inpatient newborn care with suspected infection: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:229. [PMID: 33765948 PMCID: PMC7995687 DOI: 10.1186/s12884-020-03424-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND An estimated 30 million neonates require inpatient care annually, many with life-threatening infections. Appropriate antibiotic management is crucial, yet there is no routine measurement of coverage. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aimed to validate maternal and newborn indicators to inform measurement of coverage and quality of care. This paper reports validation of reported antibiotic coverage by exit survey of mothers for hospitalized newborns with clinically-defined infections, including sepsis, meningitis, and pneumonia. METHODS EN-BIRTH study was conducted in five hospitals in Bangladesh, Nepal, and Tanzania (July 2017-July 2018). Neonates were included based on case definitions to focus on term/near-term, clinically-defined infection syndromes (sepsis, meningitis, and pneumonia), excluding major congenital abnormalities. Clinical management was abstracted from hospital inpatient case notes (verification) which was considered as the gold standard against which to validate accuracy of women's report. Exit surveys were conducted using questions similar to The Demographic and Health Surveys (DHS) approach for coverage of childhood pneumonia treatment. We compared survey-report to case note verified, pooled across the five sites using random effects meta-analysis. RESULTS A total of 1015 inpatient neonates admitted in the five hospitals met inclusion criteria with clinically-defined infection syndromes. According to case note verification, 96.7% received an injectable antibiotic, although only 14.5% of them received the recommended course of at least 7 days. Among women surveyed (n = 910), 98.8% (95% CI: 97.8-99.5%) correctly reported their baby was admitted to a neonatal ward. Only 47.1% (30.1-64.5%) reported their baby's diagnosis in terms of sepsis, meningitis, or pneumonia. Around three-quarters of women reported their baby received an injection whilst in hospital, but 12.3% reported the correct antibiotic name. Only 10.6% of the babies had a blood culture and less than 1% had a lumbar puncture. CONCLUSIONS Women's report during exit survey consistently underestimated the denominator (reporting the baby had an infection), and even more so the numerator (reporting known injectable antibiotics). Admission to the neonatal ward was accurately reported and may have potential as a contact point indicator for use in household surveys, similar to institutional births. Strengthening capacity and use of laboratory diagnostics including blood culture are essential to promote appropriate use of antibiotics. To track quality of neonatal infection management, we recommend using inpatient records to measure specifics, requiring more research on standardised inpatient records.
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Affiliation(s)
- Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Nahya Salim
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania
| | - Ashish K C
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise T Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Edward Kija
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania
| | - Kimberly Peven
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Jasmin Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Stefanie Kong
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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16
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Salim N, Shabani J, Peven K, Rahman QSU, Kc A, Shamba D, Ruysen H, Rahman AE, Kc N, Mkopi N, Zaman SB, Shirima K, Ameen S, Kong S, Basnet O, Manji K, Kabuteni TJ, Brotherton H, Moxon SG, Amouzou A, Hailegebriel TD, Day LT, Lawn JE. Kangaroo mother care: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:231. [PMID: 33765950 PMCID: PMC7995571 DOI: 10.1186/s12884-020-03423-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Kangaroo mother care (KMC) reduces mortality among stable neonates ≤2000 g. Lack of data tracking coverage and quality of KMC in both surveys and routine information systems impedes scale-up. This paper evaluates KMC measurement as part of the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study. METHODS The EN-BIRTH observational mixed-methods study was conducted in five hospitals in Bangladesh, Nepal and Tanzania from 2017 to 2018. Clinical observers collected time-stamped data as gold standard for mother-baby pairs in KMC wards/corners. To assess accuracy, we compared routine register-recorded and women's exit survey-reported coverage to observed data, using different recommended denominator options (≤2000 g and ≤ 2499 g). We analysed gaps in quality of provision and experience of KMC. In the Tanzanian hospitals, we assessed daily skin-to-skin duration/dose and feeding frequency. Qualitative data were collected from health workers and data collectors regarding barriers and enablers to routine register design, filling and use. RESULTS Among 840 mother-baby pairs, compared to observed 100% coverage, both exit-survey reported (99.9%) and register-recorded coverage (92.9%) were highly valid measures with high sensitivity. KMC specific registers outperformed general registers. Enablers to register recording included perceptions of data usefulness, while barriers included duplication of data elements and overburdened health workers. Gaps in KMC quality were identified for position components including wearing a hat. In Temeke Tanzania, 10.6% of babies received daily KMC skin-to-skin duration/dose of ≥20 h and a further 75.3% received 12-19 h. Regular feeding ≥8 times/day was observed for 36.5% babies in Temeke Tanzania and 14.6% in Muhimbili Tanzania. Cup-feeding was the predominant assisted feeding method. Family support during admission was variable, grandmothers co-provided KMC more often in Bangladesh. No facility arrangements for other family members were reported by 45% of women at exit survey. CONCLUSIONS Routine hospital KMC register data have potential to track coverage from hospital KMC wards/corners. Women accurately reported KMC at exit survey and evaluation for population-based surveys could be considered. Measurement of content, quality and experience of KMC need consensus on definitions. Prioritising further KMC measurement research is important so that high quality data can be used to accelerate scale-up of high impact care for the most vulnerable.
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Affiliation(s)
- Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania.
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Kimberly Peven
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, London, UK
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Naresh Kc
- Ministry of Health, Department of Health Services, Kathmandu, Nepal
| | - Namala Mkopi
- Department of Paediatrics and Child Health, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Kizito Shirima
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Stefanie Kong
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | | | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Theopista John Kabuteni
- Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization (WHO), Dar Es Salaam, Tanzania
| | - Helen Brotherton
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah G Moxon
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Agbessi Amouzou
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
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Peven K, Day LT, Ruysen H, Tahsina T, Kc A, Shabani J, Kong S, Ameen S, Basnet O, Haider R, Rahman QSU, Blencowe H, Lawn JE. Stillbirths including intrapartum timing: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:226. [PMID: 33765942 PMCID: PMC7995570 DOI: 10.1186/s12884-020-03238-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND An estimated >2 million babies stillborn around the world each year lack visibility. Low- and middle-income countries carry 84% of the burden yet have the least data. Most births are now in facilities, hence routine register-recording presents an opportunity to improve counting of stillbirths, but research is limited, particularly regarding accuracy. This paper evaluates register-recorded measurement of hospital stillbirths, classification accuracy, and barriers and enablers to routine recording. METHODS The EN-BIRTH mixed-methods, observational study took place in five hospitals in Bangladesh, Nepal and Tanzania (2017-2018). Clinical observers collected time-stamped data on perinatal care and birth outcomes as gold standard. To assess accuracy of routine register-recorded stillbirth rates, we compared birth outcomes recorded in labour ward registers to observation data. We calculated absolute rate differences and individual-level validation metrics (sensitivity, specificity, percent agreement). We assessed misclassification of stillbirths with neonatal deaths. To examine stillbirth appearance (fresh/macerated) as a proxy for timing of death, we compared appearance to observed timing of intrauterine death based on heart rate at admission. RESULTS 23,072 births were observed including 550 stillbirths. Register-recorded completeness of birth outcomes was > 90%. The observed study stillbirth rate ranged from 3.8 (95%CI = 2.0,7.0) to 50.3 (95%CI = 43.6,58.0)/1000 total births and was under-estimated in routine registers by 1.1 to 7.3 /1000 total births (register: observed ratio 0.9-0.7). Specificity of register-recorded birth outcomes was > 99% and sensitivity varied between hospitals, ranging from 77.7-86.1%. Percent agreement between observer-assessed birth outcome and register-recorded birth outcome was very high across all hospitals and all modes of birth (> 98%). Fresh or macerated stillbirth appearance was a poor proxy for timing of stillbirth. While there were similar numbers of stillbirths misclassified as neonatal deaths (17/430) and neonatal deaths misclassified as stillbirths (21/36), neonatal deaths were proportionately more likely to be misclassified as stillbirths (58.3% vs 4.0%). Enablers to more accurate register-recording of birth outcome included supervision and data use. CONCLUSIONS Our results show these routine registers accurately recorded stillbirths. Fresh/macerated appearance was a poor proxy for intrapartum stillbirths, hence more focus on measuring fetal heart rate is crucial to classification and importantly reduction in these preventable deaths.
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Affiliation(s)
- Kimberly Peven
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Louise T Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Stefanie Kong
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Omkar Basnet
- Research Division, Golden Community, Lalitpur, Nepal
| | - Rajib Haider
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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18
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Ruysen H, Shabani J, Hanson C, Day LT, Pembe AB, Peven K, Rahman QSU, Thakur N, Shirima K, Tahsina T, Gurung R, Tarimo MN, Moran AC, Lawn JE. Uterotonics for prevention of postpartum haemorrhage: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:230. [PMID: 33765962 PMCID: PMC7995712 DOI: 10.1186/s12884-020-03420-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Postpartum haemorrhage (PPH) is a leading cause of preventable maternal mortality worldwide. The World Health Organization (WHO) recommends uterotonic administration for every woman after birth to prevent PPH. There are no standardised data collected in large-scale measurement platforms. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) is an observational study to assess the validity of measurement of maternal and newborn indicators, and this paper reports findings regarding measurement of coverage and quality for uterotonics. METHODS The EN-BIRTH study took place in five hospitals in Bangladesh, Nepal and Tanzania, from July 2017 to July 2018. Clinical observers collected tablet-based, time-stamped data. We compared observation data for uterotonics to routine hospital register-records and women's report at exit-interview survey. We analysed the coverage and quality gap for timing and dose of administration. The register design was evaluated against gap analyses and qualitative interview data assessing the barriers and enablers to data recording and use. RESULTS Observed uterotonic coverage was high in all five hospitals (> 99%, 95% CI 98.7-99.8%). Survey-report underestimated coverage (79.5 to 91.7%). "Don't know" replies varied (2.1 to 14.4%) and were higher after caesarean (3.7 to 59.3%). Overall, there was low accuracy in survey data for details of uterotonic administration (type and timing). Register-recorded coverage varied in four hospitals capturing uterotonics in a specific column (21.6, 64.5, 97.6, 99.4%). The average coverage measurement gap was 18.1% for register-recorded and 6.0% for survey-reported coverage. Uterotonics were given to 15.9% of women within the "right time" (1 min) and 69.8% within 3 min. Women's report of knowing the purpose of uterotonics after birth ranged from 0.4 to 64.9% between hospitals. Enabling register design and adequate staffing were reported to improve routine recording. CONCLUSIONS Routine registers have potential to track uterotonic coverage - register data were highly accurate in two EN-BIRTH hospitals, compared to consistently underestimated coverage by survey-report. Although uterotonic coverage was high, there were gaps in observed quality for timing and dose. Standardisation of register design and implementation could improve data quality and data flow from registers into health management information reporting systems, and requires further assessment.
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Affiliation(s)
- Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK.
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Claudia Hanson
- Public Health Sciences - Global Health - Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
| | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania
| | - Kimberly Peven
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Kizito Shirima
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rejina Gurung
- Research division, Golden Community, Lalitpur, Nepal
| | - Menna Narcis Tarimo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
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Ruysen H, Rahman AE, Gordeev VS, Hossain T, Basnet O, Shirima K, Rahman QSU, Zaman SB, Rana N, Salim N, Tahsina T, Gore-Langton GR, Ameen S, Boggs D, Kong S, Day LT, El Arifeen S, Lawn JE. Electronic data collection for multi-country, hospital-based, clinical observation of maternal and newborn care: EN-BIRTH study experiences. BMC Pregnancy Childbirth 2021; 21:234. [PMID: 33765951 PMCID: PMC7995708 DOI: 10.1186/s12884-020-03426-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Observation of care at birth is challenging with multiple, rapid and potentially concurrent events occurring for mother, newborn and placenta. Design of electronic data (E-data) collection needs to account for these challenges. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) was an observational study to assess measurement of indicators for priority maternal and newborn interventions and took place in five hospitals in Bangladesh, Nepal and Tanzania (July 2017-July 2018). E-data tools were required to capture individually-linked, timed observation of care, data extraction from hospital register-records or case-notes, and exit-survey data from women. METHODS To evaluate this process for EN-BIRTH, we employed a framework organised around five steps for E-data design, data collection and implementation. Using this framework, a mixed methods evaluation synthesised evidence from study documentation, standard operating procedures, stakeholder meetings and design workshops. We undertook focus group discussions with EN-BIRTH researchers to explore experiences from the three different country teams (November-December 2019). Results were organised according to the five a priori steps. RESULTS In accordance with the five-step framework, we found: 1) Selection of data collection approach and software: user-centred design principles were applied to meet the challenges for observation of rapid, concurrent events around the time of birth with time-stamping. 2) Design of data collection tools and programming: required extensive pilot testing of tools to be user-focused and to include in-built error messages and data quality alerts. 3) Recruitment and training of data collectors: standardised with an interactive training package including pre/post-course assessment. 4) Data collection, quality assurance, and management: real-time quality assessments with a tracking dashboard and double observation/data extraction for a 5% case subset, were incorporated as part of quality assurance. Internet-based synchronisation during data collection posed intermittent challenges. 5) Data management, cleaning and analysis: E-data collection was perceived to improve data quality and reduce time cleaning. CONCLUSIONS The E-Data system, custom-built for EN-BIRTH, was valued by the site teams, particularly for time-stamped clinical observation of complex multiple simultaneous events at birth, without which the study objectives could not have been met. However before selection of a custom-built E-data tool, the development time, higher training and IT support needs, and connectivity challenges need to be considered against the proposed study or programme's purpose, and currently available E-data tool options.
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Affiliation(s)
- Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Vladimir Sergeevich Gordeev
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Omkar Basnet
- Research Division, Golden Community, Lalitpur, Nepal
| | - Kizito Shirima
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nisha Rana
- Research Division, Golden Community, Lalitpur, Nepal
| | - Nahya Salim
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Georgia R Gore-Langton
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dorothy Boggs
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Stefanie Kong
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Louise T Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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20
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Kong S, Day LT, Zaman SB, Peven K, Salim N, Sunny AK, Shamba D, Rahman QSU, K.C. A, Ruysen H, El Arifeen S, Mee P, Gladstone ME, Blencowe H, Lawn JE. Birthweight: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:240. [PMID: 33765936 PMCID: PMC7995711 DOI: 10.1186/s12884-020-03355-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Accurate birthweight is critical to inform clinical care at the individual level and tracking progress towards national/global targets at the population level. Low birthweight (LBW) < 2500 g affects over 20.5 million newborns annually. However, data are lacking and may be affected by heaping. This paper evaluates birthweight measurement within the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study. METHODS The EN-BIRTH study took place in five hospitals in Bangladesh, Nepal and Tanzania (2017-2018). Clinical observers collected time-stamped data (gold standard) for weighing at birth. We compared accuracy for two data sources: routine hospital registers and women's report at exit interview survey. We calculated absolute differences and individual-level validation metrics. We analysed birthweight coverage and quality gaps including timing and heaping. Qualitative data explored barriers and enablers for routine register data recording. RESULTS Among 23,471 observed births, 98.8% were weighed. Exit interview survey-reported weighing coverage was 94.3% (90.2-97.3%), sensitivity 95.0% (91.3-97.8%). Register-reported coverage was 96.6% (93.2-98.9%), sensitivity 97.1% (94.3-99%). Routine registers were complete (> 98% for four hospitals) and legible > 99.9%. Weighing of stillbirths varied by hospital, ranging from 12.5-89.0%. Observed LBW rate was 15.6%; survey-reported rate 14.3% (8.9-20.9%), sensitivity 82.9% (75.1-89.4%), specificity 96.1% (93.5-98.5%); register-recorded rate 14.9%, sensitivity 90.8% (85.9-94.8%), specificity 98.5% (98-99.0%). In surveys, "don't know" responses for birthweight measured were 4.7%, and 2.9% for knowing the actual weight. 95.9% of observed babies were weighed within 1 h of birth, only 14.7% with a digital scale. Weight heaping indices were around two-fold lower using digital scales compared to analogue. Observed heaping was almost 5% higher for births during the night than day. Survey-report further increased observed birthweight heaping, especially for LBW babies. Enablers to register birthweight measurement in qualitative interviews included digital scale availability and adequate staffing. CONCLUSIONS Hospital registers captured birthweight and LBW prevalence more accurately than women's survey report. Even in large hospitals, digital scales were not always available and stillborn babies not always weighed. Birthweight data are being captured in hospitals and investment is required to further improve data quality, researching of data flow in routine systems and use of data at every level.
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Affiliation(s)
- Stefanie Kong
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Louise T. Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kimberly Peven
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | | | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Qazi Sadeq-ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashish K.C.
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Paul Mee
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Miriam E. Gladstone
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Joy E. Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
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21
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Moran AC, Requejo J. Count every newborn: EN-BIRTH study improving facility-based coverage and quality measurement in routine information systems. BMC Pregnancy Childbirth 2021; 21:227. [PMID: 33765953 PMCID: PMC7995686 DOI: 10.1186/s12884-020-03427-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Jennifer Requejo
- Division of Data, Analysis, Planning and Monitoring, United Nations Children's Fund, Headquarters, New York, NY, USA.
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22
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Melkamu Asaye M, Gelaye KA, Matebe YH, Lindgren H, Erlandsson K. Assessment of content validity for a Neonatal Near miss Scale in the context of Ethiopia. Glob Health Action 2021; 14:1983121. [PMID: 34694977 PMCID: PMC8547862 DOI: 10.1080/16549716.2021.1983121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The concept of neonatal near miss is used to identify neonates who nearly died but survived a life-threatening complication in the first 28 days of life. Neonatal mortality is the tip of the iceberg. Quality improvement through utilization of a validated scale and reduction in adverse neonatal outcome is a priority for achieving sustainable development goals. Objectives To develop and assess the content validity of neonatal near-miss scale in the public health hospitals in Amhara Regional State, northwest Ethiopia. Methods A literature review was performed prior to the development of the neonatal near-miss assessment scale. An expert panel committee was formed by health facility practitioners and by the members of the academia. Two rounds of meetings were conducted with the expert panel to reach consensus on the face and content validity. The content validity index, Kappa statistics, and the content validity ratio were computed to estimate the content validity scale of neonatal near miss. Results In this study, four domains (pragmatic, clinical, management, and lab-investigations) with 32 items were identified. The item-level content validity index ranged from 0.7 to 1. The overall scale content validity (S-CVI) (average) for the domains (pragmatic, clinical, management, and lab-investigations) were 0.98, 0.95, 0.96, and 0.96, respectively. The overall S-CVI (universal) was 0.78 to 1, whereas the overall S-CVI (average) of neonatal near miss assessment scale was found to be 0.96. The content validity ratio and Kappa statistics values ranged from 0.6 to 1 and 0.9 to 1 for the respective domains. Conclusion The identified four domains and the respective items were valid enough (content-wise) to be used as identification criteria for neonatal near-miss cases. The scale will contribute to neonatal near-miss identification and also improve the quality of neonatal management care.
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Affiliation(s)
- Mengstu Melkamu Asaye
- Department of Women and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Hailu Matebe
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, KarolinskaInstitute, Solna, Sweden
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, KarolinskaInstitute and Institution for Health and Welfare, Dalarna University, Solna, Sweden
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23
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Ding X, Wang L, Msellem MI, Hu Y, Qiu J, Liu S, Zhang M, Zhu L, Latour JM. Evaluation of a Neonatal Resuscitation Training Programme for Healthcare Professionals in Zanzibar, Tanzania: A Pre-post Intervention Study. Front Pediatr 2021; 9:693583. [PMID: 34262890 PMCID: PMC8273261 DOI: 10.3389/fped.2021.693583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/03/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Neonatal mortality rates remain high in Sub-Saharan African countries. Improving the newborn resuscitation skills of healthcare professionals is important in addressing this challenge. The aim of this study was to evaluate a neonatal resuscitation training programme delivered over a two-year period for healthcare professionals in Zanzibar, Tanzania. Methods: A pre- and post-intervention study was designed. We delivered neonatal resuscitation training over a 2-day period in 2017 and 2 days of refresher training in 2018. Knowledge was evaluated by a self-designed survey (11 items with a total score of 22) before and after the two training periods, and skills were evaluated by a skills checklist (six domains with 25 items with a total score of 50) completed by the trainers based on their observations. Statistical analysis included differences in the knowledge and skills scores before and after the training sessions and between the two periods. Results: A total of 23 healthcare professionals participated and completed both neonatal resuscitation training sessions. The knowledge mean scores before and after the training in 2017 increased from 9.60 to 13.60 (95% CI: -5.900; -2.099, p < 0.001), and in 2018, the scores increased from 10.80 to 15.44 (95% CI: -6.062; -3.217, p < 0.001). The mean knowledge scores post-training over time were 13.60 in 2017 and 15.44 in 2018 (95% CI: -3.489; 0.190, p = 0.030). The resuscitation skills performance between the two time periods increased from a mean of 32.26 (SD = 2.35) to a mean of 42.43 (SD = 1.73) (95% CI: -11.402; -8.945, p < 0.001). Conclusion: The neonatal resuscitation training programme increased the theoretical knowledge and resuscitation skills before and after the two training sessions and over time after a 9-month period. Continuous neonatal resuscitation training based on the local needs in resource-limited countries is essential to provide confidence in healthcare professionals to initiate resuscitation and to improve newborn outcomes.
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Affiliation(s)
- Xiang Ding
- International Affairs, Hunan Children's Hospital, Changsha, China
| | - Li Wang
- International Affairs, Hunan Children's Hospital, Changsha, China
| | | | - Yaojia Hu
- Nursing School, Hunan University of Chinese Medicine, Changsha, China
| | - Jun Qiu
- Editing Office, Journal of Clinical Pediatric Surgery, Hunan Children's Hospital, Changsha, China
| | - Shiying Liu
- International Affairs, Hunan Children's Hospital, Changsha, China
| | - Mi Zhang
- Neonatal Department, Hunan Children's Hospital, Changsha, China
| | - Lihui Zhu
- International Affairs, Hunan Children's Hospital, Changsha, China.,Nursing Department, Hunan Children's Hospital, Changsha, China
| | - Jos M Latour
- International Affairs, Hunan Children's Hospital, Changsha, China.,Faculty of Health, University of Plymouth, Plymouth, United Kingdom
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24
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Vaz LME, Franco L, Guenther T, Simmons K, Herrera S, Wall SN. Operationalising health systems thinking: a pathway to high effective coverage. Health Res Policy Syst 2020; 18:132. [PMID: 33143734 PMCID: PMC7641804 DOI: 10.1186/s12961-020-00615-8] [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: 11/01/2019] [Accepted: 08/03/2020] [Indexed: 01/25/2023] Open
Abstract
Background The global health community has recognised the importance of defining and measuring the effective coverage of health interventions and their implementation strength to monitor progress towards global mortality and morbidity targets. Existing health system models and frameworks guide thinking around these measurement areas; however, they fall short of adequately capturing the dynamic and multi-level relationships between different components of the health system. These relationships must be articulated for measurement and managed to effectively deliver health interventions of sufficient quality to achieve health impacts. Save the Children’s Saving Newborn Lives programme and EnCompass LLC, its evaluation partner, developed and applied the Pathway to High Effective Coverage as a health systems thinking framework (hereafter referred to as the Pathway) in its strategic planning, monitoring and evaluation. Methods We used an iterative approach to develop, test and refine thinking around the Pathway. The initial framework was developed based on existing literature, then shared and vetted during consultations with global health thought leaders in maternal and newborn health. Results The Pathway is a robust health systems thinking framework that unpacks system, policy and point of intervention delivery factors, thus encouraging specific actions to address gaps in implementation and facilitate the achievement of high effective coverage. The Pathway includes six main components – (1) national readiness; (2) system structures; (3) management capacity; (4) implementation strength; (5) effective coverage; and (6) impact. Each component is comprised of specific elements reflecting the range of facility-, community- and home-based interventions. We describe applications of the Pathway and results for in-country strategic planning, monitoring of progress and implementation strength, and evaluation. Conclusions The Pathway provides a cohesive health systems thinking framework that facilitates assessment and coordinated action to achieve high coverage and impact. Experiences of its application show its utility in guiding strategic planning and in more comprehensive and effective monitoring and evaluation as well as its potential adaptability for use in other health areas and sectors.
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Affiliation(s)
- Lara M E Vaz
- Population Reference Bureau, 1875 Connecticut Avenue, NW Suite 520, Washington, DC, 20009, United States of America.
| | - Lynne Franco
- EnCompass LLC, 1451 Rockville Pike Suite 600, Rockville, MD, 20852, USA
| | - Tanya Guenther
- Formerly with Save the Children US, 899 North Capitol St NE Suite 900, Washington DC, 20001, USA
| | - Kelsey Simmons
- Ford Foundation, 320 E 43rd St, New York, NY, 10017, USA
| | - Samantha Herrera
- Save the Children US, 899 North Capitol St NE Suite 900, Washington DC, 20001, USA
| | - Stephen N Wall
- Save the Children US, 899 North Capitol St NE Suite 900, Washington DC, 20001, USA
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25
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Charpak N, Angel MI, Banker D, Bergh A, María Bertolotto A, De Leon‐Mendoza S, Godoy N, Lincetto O, Lozano JM, Ludington‐Hoe S, Mazia G, Mokhachane M, Montealegre A, Ramirez E, Sirivansanti N, Solano JM, Day LT, Uy ME. Strategies discussed at the XIIth international conference on Kangaroo mother care for implementation on a countrywide scale. Acta Paediatr 2020; 109:2278-2286. [PMID: 32027398 PMCID: PMC7687100 DOI: 10.1111/apa.15214] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Abstract
AIM Building strategies for the country-level dissemination of Kangaroo mother care (KMC) to reduce the mortality rate in preterm and low birth weight babies and improve quality of life. KMC is an evidence-based healthcare method for these infants. However, KMC implementation at the global level remains low. METHODS The international network in Kangaroo mother brought 172 KMC professionals from 33 countries together for a 2-day workshop held in conjunction with the XIIth International KMC Conference in Bogota, Colombia, in November 2018. Participants worked in clusters to formulate strategies for country-level dissemination and scale-up according to seven pre-established objectives. RESULTS The minimum set of indicators for KMC scale-up proposed by the internationally diverse groups is presented. The strategies for KMC integration and implementation at the country level, as well as the approaches for convincing healthcare providers of the safety of KMC transportation, are also described. Finally, the main aspects concerning KMC follow-up and KMC for term infants are presented. CONCLUSION In this collaborative meeting, participants from low-, middle- and high-income countries combined their knowledge and experience to identify the best strategies to implement KMC at a countrywide scale.
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Affiliation(s)
| | | | - Deepa Banker
- SMT NHL Municipal Medical College Ahmedabad India
| | - Anne‐Marie Bergh
- SAMRC Unit for Maternal and Infant Health Care Strategies University of Pretoria Pretoria South Africa
| | | | | | | | - Ornella Lincetto
- Maternal Newborn Child and Adolescent Health Department World Health Organization Geneva Switzerland
| | - Juan M. Lozano
- Department of Medical and Population Health Sciences Research Herbert Wertheim College of Medicine Florida International University Miami FL USA
| | - Susan Ludington‐Hoe
- FP Bolton School of Nursing Case Western Reserve University Cleveland OH USA
| | - Goldy Mazia
- Global Health Department Save the Children Washington D.C. USA
| | - Mantoa Mokhachane
- Unit of Undergraduate Medical Education (UUME) Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Adriana Montealegre
- Fundación Canguro Bogotá Colombia
- Department of Pediatrics Pontificia Universidad Javeriana Bogotá Colombia
| | - Erika Ramirez
- Department of Sexuality Sexual Rights and Reproductive Rights Ministry of Health Bogotá Colombia
| | - Nicole Sirivansanti
- Department of Maternal, Newborn and Child Health Bill and Melinda Gates Foundation Seattle WA USA
| | | | - Louise-Tina Day
- MARCH Centre for Maternal, Adolescent Reproductive & Child Health London School of Hygiene & Tropical Medicine London UK
| | - Maria Esterlita Uy
- Institute of Child Health and Human Development National Institutes of Health University of the Philippines Manila Manila Philippines
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Hailegebriel TD, Bergh AM, Zaka N, Roh JM, Gohar F, Rizwan S, Asfaw AG, Heidarzadeh M, Zeck W. Improving the implementation of kangaroo mother care. Bull World Health Organ 2020; 99:69-71. [PMID: 33658737 DOI: 10.2471/blt.20.252361] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/08/2020] [Accepted: 07/22/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Anne-Marie Bergh
- UP/SAMRC Unit for Maternal and Infant Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Bophelo Road, Prinshof 349-Jr, Pretoria 0084, South Africa
| | - Nabila Zaka
- Health Services Academy, Islamabad, Pakistan
| | - Jung Min Roh
- Columbia University School of Social Work, Columbia University, New York, USA
| | - Fatima Gohar
- United Nations Children's Fund, Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | - Samia Rizwan
- United Nations Children's Fund, Pakistan Country Office, Islamabad, Pakistan
| | | | - Mohammad Heidarzadeh
- Neonatal Health Office, Ministry of Health and Medical Education, Tehran, Islamic Republic of Iran
| | - Willibald Zeck
- Health Section, United Nations Children's Fund, New York, United States of America (USA)
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Hanson C, Atuhairwe S, Lucy Atim J, Marrone G, Morris JL, Kaharuza F. Effects of the Helping Mothers Survive Bleeding after Birth training on near miss morbidity and mortality in Uganda: A cluster-randomized trial. Int J Gynaecol Obstet 2020; 152:386-394. [PMID: 32981091 PMCID: PMC7894512 DOI: 10.1002/ijgo.13395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/15/2020] [Accepted: 09/22/2020] [Indexed: 12/26/2022]
Abstract
Objective To assess the effect of Helping Mothers Survive Bleeding after Birth training on postpartum hemorrhage (PPH) near miss and case fatality rates in Uganda. Methods Training was evaluated using a cluster‐randomized design between June 2016 and September 2017 in 18 typical rural districts (clusters) in Eastern and Central Uganda of which nine districts were randomly assigned to the intervention. The main outcome was PPH near miss defined using the World Health Organization’s disease and management‐based approach. Interrupted time series analysis was performed to estimate the difference in the change of outcomes. Results Outcomes of 58 000 and 95 455 deliveries during the 6‐month baseline and 10‐month endline periods, respectively, were included. A reduction of PPH near misses was observed in the intervention compared to the comparison districts (difference‐in‐difference of slopes 4.19, 95% CI, –7.64 to –0.74); P<0.05). There was an increase in overall reported near miss cases (difference‐in‐difference 1.24, 95% CI, 0.37–2.10; P<0.001) and an increase in PPH case fatality rate (difference‐in‐difference 2.13, 95% CI, 0.14–4.12; P<0.05). Conclusion This pragmatic cluster‐randomized trial conducted in typical rural districts of Uganda indicated a reduction of severe PPH cases while case fatality did not improve, suggesting that this basic training needs to be complemented by additional measures for sustained mortality reduction. Trial registration: PACTR201604001582128.
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Affiliation(s)
- Claudia Hanson
- Department of Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Susan Atuhairwe
- Directorate of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda.,Association of Obstetricians and Gynaecologists of Uganda, Kampala, Uganda
| | - Joyce Lucy Atim
- Mbale Regional Referral Hospital, Mbale, Uganda.,Uganda Nurses and Midwives Union, Kampala, Uganda
| | - Gaetano Marrone
- Department of Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jessica L Morris
- FIGO (International Federation of Gynecology and Obstetrics), London, UK
| | - Frank Kaharuza
- Association of Obstetricians and Gynaecologists of Uganda, Kampala, Uganda.,Makerere University School of Public Health, Kampala, Uganda
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Bucher SL, Cardellichio P, Muinga N, Patterson JK, Thukral A, Deorari AK, Data S, Umoren R, Purkayastha S. Digital Health Innovations, Tools, and Resources to Support Helping Babies Survive Programs. Pediatrics 2020; 146:S165-S182. [PMID: 33004639 DOI: 10.1542/peds.2020-016915i] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
The Helping Babies Survive (HBS) initiative features a suite of evidence-based curricula and simulation-based training programs designed to provide health workers in low- and middle-income countries (LMICs) with the knowledge, skills, and competencies to prevent, recognize, and manage leading causes of newborn morbidity and mortality. Global scale-up of HBS initiatives has been rapid. As HBS initiatives rolled out across LMIC settings, numerous bottlenecks, gaps, and barriers to the effective, consistent dissemination and implementation of the programs, across both the pre- and in-service continuums, emerged. Within the first decade of expansive scale-up of HBS programs, mobile phone ownership and access to cellular networks have also concomitantly surged in LMICs. In this article, we describe a number of HBS digital health innovations and resources that have been developed from 2010 to 2020 to support education and training, data collection for monitoring and evaluation, clinical decision support, and quality improvement. Helping Babies Survive partners and stakeholders can potentially integrate the described digital tools with HBS dissemination and implementation efforts in a myriad of ways to support low-dose high-frequency skills practice, in-person refresher courses, continuing medical and nursing education, on-the-job training, or peer-to-peer learning, and strengthen data collection for key newborn care and quality improvement indicators and outcomes. Thoughtful integration of purpose-built digital health tools, innovations, and resources may assist HBS practitioners to more effectively disseminate and implement newborn care programs in LMICs, and facilitate progress toward the achievement of Sustainable Development Goal health goals, targets, and objectives.
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Affiliation(s)
- Sherri L Bucher
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana; .,Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana
| | | | - Naomi Muinga
- Kenya Medical Research Institute Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jackie K Patterson
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok K Deorari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Santorino Data
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rachel Umoren
- Division of Neonatology, Department of Pediatrics, School of Medicine, Seattle, Washington.,Department of Global Health, School of Medicine, University of Washington, Seattle, Washington; and
| | - Saptarshi Purkayastha
- Department of Data Science and Health Informatics, School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
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Ehret DEY, Patterson JK, Kc A, Worku B, Kamath-Rayne BD, Bose CL. Helping Babies Survive Programs as an Impetus for Quality Improvement. Pediatrics 2020; 146:S183-S193. [PMID: 33004640 DOI: 10.1542/peds.2020-016915j] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
Achieving the ambitious reduction in global neonatal mortality targeted in the Sustainable Development Goals and Every Newborn Action Plan will require reducing geographic disparities in newborn deaths through targeted implementation of evidence-based practices. Helping Babies Survive, a suite of educational programs targeting the 3 leading causes of neonatal mortality, has been commonly used to educate providers in evidence-based practices in low-resource settings. Quality improvement (QI) can play a pivotal role in translating this education into improved care. Measurement of key process and outcome indicators, derived from the algorithms ("Action Plans") central to these training programs, can assist health care providers in understanding the baseline quality of their care, identifying gaps, and assessing improvement. Helping Babies Survive has been the focus of QI programs in Kenya, Nepal, Honduras, and Ethiopia, with critical lessons learned regarding the challenge of measurement, necessity of facility-based QI mentorship and multidisciplinary teams, and importance of systemic commitment to improvement in promoting a culture of QI. Complementing education with QI strategies to identify and close remaining gaps in newborn care will be essential to achieving the Sustainable Development Goals and Every Newborn Action Plan targets in the coming decade.
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Affiliation(s)
- Danielle E Y Ehret
- Department of Pediatrics, Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, Vermont; .,Vermont Oxford Network, Burlington, Vermont
| | - Jackie K Patterson
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Ashish Kc
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia; and
| | | | - Carl L Bose
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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30
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Patterson J, Niermeyer S, Lowman C, Singhal N, Kak LP. Neonatal Resuscitation Training and Systems Strengthening to Reach the Sustainable Development Goals. Pediatrics 2020; 146:S226-S229. [PMID: 33004645 DOI: 10.1542/peds.2020-016915o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Susan Niermeyer
- Section of Neonatology, School of Medicine, University of Colorado, Aurora, Colorado
| | - Casey Lowman
- American Academy of Pediatrics, Itasca, Illinois
| | - Nalini Singhal
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; and
| | - Lily P Kak
- US Agency for International Development, Washington, District of Columbia
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Nambiar D, Sankar H, Negi J, Nair A, Sadanandan R. Field-testing of primary health-care indicators, India. Bull World Health Organ 2020; 98:747-753. [PMID: 33177771 PMCID: PMC7607472 DOI: 10.2471/blt.19.249565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To develop a primary health-care monitoring framework and health outcome indicator list, and field-test and triangulate indicators designed to assess health reforms in Kerala, India, 2018–2019. Methods We used a modified Delphi technique to develop a 23-item indicator list to monitor primary health care. We used a multistage cluster random sampling technique to select one district from each of four district clusters, and then select both a family and a primary health centre from each of the four districts. We field-tested and triangulated the indicators using facility data and a population-based household survey. Findings Our data revealed similarities between facility and survey data for some indicators (e.g. low birth weight and pre-check services), but differences for others (e.g. acute diarrhoeal diseases in children younger than 5 years and blood pressure screening). We made four critical observations: (i) data are available at the facility level but in varying formats; (ii) established global indicators may not always be useful in local monitoring; (iii) operational definitions must be refined; and (iv) triangulation and feedback from the field is vital. Conclusion We observe that, while data can be used to develop indices of progress, interpretation of these indicators requires great care. In the attainment of universal health coverage, we consider that our observations of the utility of certain health indicators will provide valuable insights for practitioners and supervisors in the development of a primary health-care monitoring mechanism.
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Affiliation(s)
- Devaki Nambiar
- The George Institute for Global Health, 311-312, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi 110025, India
| | - Hari Sankar
- The George Institute for Global Health, 311-312, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi 110025, India
| | | | - Arun Nair
- ACCESS Health International, New Delhi, India
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Day LT, Gore-Langton GR, Rahman AE, Basnet O, Shabani J, Tahsina T, Poudel A, Shirima K, Ameen S, K.C. A, Salim N, Zaman SB, Shamba D, Blencowe H, Ruysen H, El Arifeen S, Boggs D, Gordeev VS, Rahman QSU, Hossain T, Joshi E, Thapa S, Poudel RP, Poudel D, Chaudhary P, Karki R, Chitrakar B, Mkopi N, Wisiko A, Kitende AP, Shirati MR, Chingalo C, Semhando AO, Mtei C, Mwenisongole V, Bakuza JM, Kombo J, Mbaruku G, Lawn JE. Labour and delivery ward register data availability, quality, and utility - Every Newborn - birth indicators research tracking in hospitals (EN-BIRTH) study baseline analysis in three countries. BMC Health Serv Res 2020; 20:737. [PMID: 32787852 PMCID: PMC7422224 DOI: 10.1186/s12913-020-5028-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 02/24/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Countries with the highest burden of maternal and newborn deaths and stillbirths often have little information on these deaths. Since over 81% of births worldwide now occur in facilities, using routine facility data could reduce this data gap. We assessed the availability, quality, and utility of routine labour and delivery ward register data in five hospitals in Bangladesh, Nepal, and Tanzania. This paper forms the baseline register assessment for the Every Newborn-Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study. METHODS We extracted 21 data elements from routine hospital labour ward registers, useful to calculate selected maternal and newborn health (MNH) indicators. The study sites were five public hospitals during a one-year period (2016-17). We measured 1) availability: completeness of data elements by register design, 2) data quality: implausibility, internal consistency, and heaping of birthweight and explored 3) utility by calculating selected MNH indicators using the available data. RESULTS Data were extracted for 20,075 births. Register design was different between the five hospitals with 10-17 of the 21 selected MNH data elements available. More data were available for health outcomes than interventions. Nearly all available data elements were > 95% complete in four of the five hospitals and implausible values were rare. Data elements captured in specific columns were 85.2% highly complete compared to 25.0% captured in non-specific columns. Birthweight data were less complete for stillbirths than live births at two hospitals, and significant heaping was found in all sites, especially at 2500g and 3000g. All five hospitals recorded count data required to calculate impact indicators including; stillbirth rate, low birthweight rate, Caesarean section rate, and mortality rates. CONCLUSIONS Data needed to calculate MNH indicators are mostly available and highly complete in EN-BIRTH study hospital routine labour ward registers in Bangladesh, Nepal and Tanzania. Register designs need to include interventions for coverage measurement. There is potential to improve data quality if Health Management Information Systems utilization with feedback loops can be strengthened. Routine health facility data could contribute to reduce the coverage and impact data gap around the time of birth.
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Affiliation(s)
- Louise Tina Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Georgia R. Gore-Langton
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Kizito Shirima
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashish K.C.
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Nahya Salim
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dorothy Boggs
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Vladimir S. Gordeev
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Population Health Sciences, Queen Mary University of London, Mile End Road, London, E1 4NS UK
| | - Qazi Sadeq-ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | | | | | | | | | | | - Namala Mkopi
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
| | - Anna Wisiko
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Alodear Patrick Kitende
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Christostomus Chingalo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Cleopatra Mtei
- Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
| | | | - John Mathias Bakuza
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Japhet Kombo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Godfrey Mbaruku
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Joy E. Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
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Kc A, Lawn JE, Zhou H, Ewald U, Gurung R, Gurung A, Sunny AK, Day LT, Singhal N. Not Crying After Birth as a Predictor of Not Breathing. Pediatrics 2020; 145:peds.2019-2719. [PMID: 32398327 DOI: 10.1542/peds.2019-2719] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Worldwide, every year, 6 to 10 million infants require resuscitation at birth according to estimates based on limited data regarding "nonbreathing" infants. In this article, we aim to describe the incidence of "noncrying" and nonbreathing infants after birth, the need for basic resuscitation with bag-and-mask ventilation, and death before discharge. METHODS We conducted an observational study of 19 977 infants in 4 hospitals in Nepal. We analyzed the incidence of noncrying or nonbreathing infants after birth. The sensitivity of noncrying infants with nonbreathing after birth was analyzed, and the risk of predischarge mortality between the 2 groups was calculated. RESULTS The incidence of noncrying infants immediately after birth was 11.1%, and the incidence of noncrying and nonbreathing infants was 5.2%. Noncrying after birth had 100% sensitivity for nonbreathing infants after birth. Among the "noncrying but breathing" infants, 9.5% of infants did not breathe at 1 minute and 2% did not to breathe at 5 minutes. Noncrying but breathing infants after birth had almost 12-fold odds of predischarge mortality (adjusted odds ratio 12.3; 95% confidence interval, 5.8-26.1). CONCLUSIONS All nonbreathing infants after birth do not cry at birth. A proportion of noncrying but breathing infants at birth are not breathing by 1 and 5 minutes and have a risk for predischarge mortality. With this study, we provide evidence of an association between noncrying and nonbreathing. This study revealed that noncrying but breathing infants require additional care. We suggest noncrying as a clinical sign for initiating resuscitation and a possible denominator for measuring coverage of resuscitation.
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Affiliation(s)
- Ashish Kc
- Uppsala University, Uppsala, Sweden; .,Society of Public Health Physicians Nepal, Kathmandu, Nepal.,Contributed equally as co-first authors
| | - Joy E Lawn
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,Contributed equally as co-first authors
| | - Hong Zhou
- Peking University Health Science Center, Peking University, Beijing, China
| | | | | | | | | | - Louise Tina Day
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Benova L, Moller AB, Hill K, Vaz LME, Morgan A, Hanson C, Semrau K, Al Arifeen S, Moran AC. What is meant by validity in maternal and newborn health measurement? A conceptual framework for understanding indicator validation. PLoS One 2020; 15:e0233969. [PMID: 32470019 PMCID: PMC7259779 DOI: 10.1371/journal.pone.0233969] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 05/15/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Rigorous monitoring supports progress in achieving maternal and newborn mortality and morbidity reductions. Recent work to strengthen measurement for maternal and newborn health highlights the existence of a large number of indicators being used for this purpose. The definitions and data sources used to produce indicator estimates vary and challenges exist with completeness, accuracy, transparency, and timeliness of data. The objective of this study is to create a conceptual overview of how indicator validity is defined and understood by those who develop and use maternal and newborn health indicators. METHODS A conceptual framework of validity was developed using mixed methods. We were guided by principles for conceptual frameworks and by a review of the literature and key maternal and newborn health indicator guidance documents. We also conducted qualitative semi-structured interviews with 32 key informants chosen through purposive sampling. RESULTS We categorised indicator validity into three main types: criterion, convergent, and construct. Criterion or diagnostic validity, comparing a measure with a gold standard, has predominantly been used to assess indicators of care coverage and content. Studies assessing convergent validity quantify the extent to which two or more indicator measurement approaches, none of which is a gold-standard, relate. Key informants considered construct validity, or the accuracy of the operationalisation of a concept or phenomenon, a critical part of the overall assessment of indicator validity. CONCLUSION Given concerns about the large number of maternal and newborn health indicators currently in use, a more consistent understanding of validity can help guide prioritization of key indicators and inform development of new indicators. All three types of validity are relevant for evaluating the performance of maternal and newborn health indicators. We highlight the need to establish a common language and understanding of indicator validity among the various global and local stakeholders working within maternal and newborn health.
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Affiliation(s)
- Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ann-Beth Moller
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Kathleen Hill
- Maternal Child Survival Program, Jhpiego, Washington, DC, United States of America
| | - Lara M. E. Vaz
- Population Reference Bureau, Washington, DC, United States of America
| | - Alison Morgan
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Claudia Hanson
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Katherine Semrau
- Division of Global Health Equity Brigham & Women’s Hospital, Department of Medicine, Ariadne Labs, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shams Al Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Allisyn C. Moran
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Bhattacharya AA, Allen E, Umar N, Usman AU, Felix H, Audu A, Schellenberg JR, Marchant T. Monitoring childbirth care in primary health facilities: a validity study in Gombe State, northeastern Nigeria. J Glob Health 2019; 9:020411. [PMID: 31360449 PMCID: PMC6657002 DOI: 10.7189/jogh.09.020411] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Improving the quality of facility-based births is a critical strategy for reducing the high burden of maternal and neonatal mortality and morbidity across all settings. Accurate data on childbirth care is essential for monitoring progress. In northeastern Nigeria, we assessed the validity of childbirth care indicators in a rural primary health care context, as documented by health workers and reported by women at different recall periods. METHODS We compared birth observations (gold standard) to: (i) facility exit interviews with observed women; (ii) household follow-up interviews 9-22 months after childbirth; and (iii) health worker documentation in the maternity register. We calculated sensitivity, specificity, and area under the receiver operating curve (AUC) to determine individual-level reporting accuracy. We calculated the inflation factor (IF) to determine population-level validity. RESULTS Twenty-five childbirth care indicators were assessed to validate health worker documentation and women's self-reports. During exit interviews, women's recall had high validity (AUC≥0.70 and 0.75 CONCLUSIONS In addition to standard household surveys, monitoring of facility-based childbirth care should consider drawing from and linking multiple data sources, including routine health facility data and exit interviews with recently delivered women.
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Affiliation(s)
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Nasir Umar
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Habila Felix
- State Primary Health Care Development Agency, Gombe, Nigeria
| | - Ahmed Audu
- State Primary Health Care Development Agency, Gombe, Nigeria
| | | | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
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36
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Kc A, Berkelhamer S, Gurung R, Hong Z, Wang H, Sunny AK, Bhattarai P, Poudel PG, Litorp H. The burden of and factors associated with misclassification of intrapartum stillbirth: Evidence from a large scale multicentric observational study. Acta Obstet Gynecol Scand 2019; 99:303-311. [PMID: 31600823 DOI: 10.1111/aogs.13746] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Global estimates suggest 2.6 million stillbirths and 2.5 million neonatal deaths occur annually worldwide. The majority of these deaths occur in low resource settings where analysis of health metrics and outcomes measurements may be challenging. We examined the misclassification of documented intrapartum stillbirth and factors associated with misclassification. MATERIAL AND METHODS A prospective observational study was performed in 12 public hospitals in Nepal. Data were extracted from the medical records of all births that occurred during the 6-month period of the study. For the study purpose, we classified birth outcome based on the presence of fetal heart sound (FHS) at admission and use of neonatal resuscitation. The health worker-documented intrapartum stillbirths were considered potentially misclassified when there were FHS present at admission and no resuscitation initiated after birth. The association between potentially misclassified intrapartum stillbirth and complications during labor, birthweight and gestational age was assessed using Pearson's chi-square test, bivariate and multivariate logistic regression. RESULTS A total of 39 562 mother-infant dyads were enrolled in the study, all of whom had FHS at admission. Among the 391 intrapartum stillbirths recorded during the study, 180 (46.0%) of them had FHS at admission with no resuscitation initiated after birth and were considered potentially misclassified intrapartum stillbirths. Among these potentially misclassified intrapartum stillbirths, 170 (43.5%) had FHS present 15 minutes before birth and 10 had no FHS 15 minutes before birth Among the potentially misclassified intrapartum stillbirths, 23.3% had complications during labor, 93.3% had birthweight less than 2500 g and 90.0% were born preterm. The risk of intrapartum misclassification was nearly four times higher among low birthweight babies (adjusted odds ratio [aOR] 3.5, 95% confidence interval [CI] 1.8 to 7.0, P < 0.001) and five times higher among preterm babies (aOR 5.3, 95% CI 3.0 to 9.3, P < 0.001). CONCLUSIONS We estimate that 46% of intrapartum stillbirths were potentially misclassified intrapartum stillbirths. Improving quality of both FHS monitoring and neonatal resuscitation as well as measurement of the care will reduce the risk of potentially misclassified intrapartum stillbirth and consequently intrapartum stillbirth.
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Affiliation(s)
- Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sara Berkelhamer
- Department of Pediatrics, University at Buffalo, Buffalo, NY, USA
| | | | - Zhou Hong
- Department of Maternal and Child Health, Peking University of Health Sciences, Peking, China
| | - Haijun Wang
- Department of Maternal and Child Health, Peking University of Health Sciences, Peking, China
| | | | | | - Pragya G Poudel
- Golden Community, Lalitpur, Nepal.,Department of Public Health, University of Tennessee, Knoxville, TN, USA
| | - Helena Litorp
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Benova L, Moller AB, Moran AC. "What gets measured better gets done better": The landscape of validation of global maternal and newborn health indicators through key informant interviews. PLoS One 2019; 14:e0224746. [PMID: 31689328 PMCID: PMC6830807 DOI: 10.1371/journal.pone.0224746] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background A large number of indicators are currently used to monitor the state of maternal and newborn health, including those capturing dimensions of health system and input, care access and availability, care quality and safety, coverage and outcomes, and impact. Validity of these indicators is a key issue in the process of assessing indicator performance and suitability. This paper aims to understand the meaning of indicator validity in the field of maternal and newborn health, and to identify key recommendations for future research. Methods This qualitative study used purposive sampling to identify key informants until thematic saturation was achieved. We interviewed 32 respondents from a variety of backgrounds using semi-structured interviews covering five themes: the meaning of indicator validity, methodological approaches to assessing validity, acceptable levels of indicator validity, gaps in validation research, and recommendations for addressing these gaps. Interview transcripts were analysed data using thematic content approach. Results Three conceptually different definitions of indicator validity were described by respondents. They considered indicator validity to encompass meaning and potential to spur action, going beyond diagnostic validity. Indicator validation was seen as an ongoing process of building and synthesising a wide range of evidence rather than a one-size-fits-all cut-off in diagnostic validity tests. Gaps identified included assessing validity of indicators of quality of care and indicators based on facility-level data, as well as expanding studies to a broader range of global settings. The key recommendation was to develop a coordinated approach to summarising and evaluating research on indicator validity, including capacity building in appraising and communicating the available evidence for country-specific needs. Conclusion The findings will inform future recommendations around indicator testing and validation.
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Affiliation(s)
- Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | - Ann-Beth Moller
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Allisyn C. Moran
- Department of Maternal, Newborn, Child and Adolescent Health World Health Organization, Geneva, Switzerland
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38
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Baschieri A, Gordeev VS, Akuze J, Kwesiga D, Blencowe H, Cousens S, Waiswa P, Fisker AB, Thysen SM, Rodrigues A, Biks GA, Abebe SM, Gelaye KA, Mengistu MY, Geremew BM, Delele TG, Tesega AK, Yitayew TA, Kasasa S, Galiwango E, Natukwatsa D, Kajungu D, Enuameh YAK, Nettey OE, Dzabeng F, Amenga-Etego S, Newton SK, Manu AA, Tawiah C, Asante KP, Owusu-Agyei S, Alam N, Haider MM, Alam SS, Arnold F, Byass P, Croft TN, Herbst K, Kishor S, Serbanescu F, Lawn JE. "Every Newborn-INDEPTH" (EN-INDEPTH) study protocol for a randomised comparison of household survey modules for measuring stillbirths and neonatal deaths in five Health and Demographic Surveillance sites. J Glob Health 2019; 9:010901. [PMID: 30820319 PMCID: PMC6377797 DOI: 10.7189/jogh.09.010901] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Under-five and maternal mortality were halved in the Millennium Development Goals (MDG) era, with slower reductions for 2.6 million neonatal deaths and 2.6 million stillbirths. The Every Newborn Action Plan aims to accelerate progress towards national targets, and includes an ambitious Measurement Improvement Roadmap. Population-based household surveys, notably Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys, are major sources of population-level data on child mortality in countries with weaker civil registration and vital statistics systems, where over two-thirds of global child deaths occur. To estimate neonatal/child mortality and pregnancy outcomes (stillbirths, miscarriages, birthweight, gestational age) the most common direct methods are: (1) the standard DHS-7 with Full Birth History with additional questions on pregnancy losses in the past 5 years (FBH+) or (2) a Full Pregnancy History (FPH). No direct comparison of these two methods has been undertaken, although descriptive analyses suggest that the FBH+ may underestimate mortality rates particularly for stillbirths. METHODS This is the protocol paper for the Every Newborn-INDEPTH study (INDEPTH Network, International Network for the Demographic Evaluation of Populations and their Health Every Newborn, Every Newborn Action Plan), aiming to undertake a randomised comparison of FBH+ and FPH to measure pregnancy outcomes in a household survey in five selected INDEPTH Network sites in Africa and South Asia (Bandim in urban and rural Guinea-Bissau; Dabat in Ethiopia; IgangaMayuge in Uganda; Kintampo in Ghana; Matlab in Bangladesh). The survey will reach >68 000 pregnancies to assess if there is ≥15% difference in stillbirth rates. Additional questions will capture birthweight, gestational age, birth/death certification, termination of pregnancy and fertility intentions. The World Bank's Survey Solutions platform will be tailored for data collection, including recording paradata to evaluate timing. A mixed methods assessment of barriers and enablers to reporting of pregnancy and adverse pregnancy outcomes will be undertaken. CONCLUSIONS This large-scale study is the first randomised comparison of these two methods to capture pregnancy outcomes. Results are expected to inform the evidence base for survey methodology, especially in DHS, regarding capture of stillbirths and other outcomes, notably neonatal deaths, abortions (spontaneous and induced), birthweight and gestational age. In addition, this study will inform strategies to improve health and demographic surveillance capture of neonatal/child mortality and pregnancy outcomes.
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Affiliation(s)
- Angela Baschieri
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Vladimir S Gordeev
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Joseph Akuze
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine, London, United Kingdom
- School of Public Health, Makerere University, Kampala, Uganda
- INDEPTH Network Maternal, Newborn and Child Health Working Group Technical Secretariat
| | - Doris Kwesiga
- School of Public Health, Makerere University, Kampala, Uganda
- INDEPTH Network Maternal, Newborn and Child Health Working Group Technical Secretariat
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Simon Cousens
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
- INDEPTH Network Maternal, Newborn and Child Health Working Group Technical Secretariat
| | - Ane B Fisker
- Bandim Health Project, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sanne M Thysen
- Bandim Health Project, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Center for Global Health, Department of Public Health, Aarhus University Denmark, Aarhus, Denmark
| | | | - Gashaw A Biks
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon M Abebe
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun A Gelaye
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Y Mengistu
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bisrat M Geremew
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse G Delele
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adane K Tesega
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Temesgen A Yitayew
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Simon Kasasa
- School of Public Health, Makerere University, Kampala, Uganda
- IgangaMayuge HDSS, Uganda
| | - Edward Galiwango
- School of Public Health, Makerere University, Kampala, Uganda
- IgangaMayuge HDSS, Uganda
| | - Davis Natukwatsa
- School of Public Health, Makerere University, Kampala, Uganda
- IgangaMayuge HDSS, Uganda
| | - Dan Kajungu
- School of Public Health, Makerere University, Kampala, Uganda
- IgangaMayuge HDSS, Uganda
| | - Yeetey AK Enuameh
- Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
- Kintampo Health Research Centre, Kintampo, Ghana
| | | | | | | | - Sam K Newton
- Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
- Kintampo Health Research Centre, Kintampo, Ghana
| | | | | | | | - Seth Owusu-Agyei
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine, London, United Kingdom
- University of Health and Allied Sciences, Kintampo Health Research Centre, Kintampo, Ghana
- Malaria Centre, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Nurul Alam
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - M M Haider
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Sayed S Alam
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | | | - Peter Byass
- Department of Epidemiology & Global Health, Umeå University, Umeå, Sweden
| | | | | | | | - Florina Serbanescu
- Centers for Disease Control and Prevention, Division of reproductive Health, USA
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine, London, United Kingdom
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