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Duncan SM, Sawchuck D, Marcellus L, Maclaren J. Sustaining and Inspiring the Capacity of the Nursing Profession: The Case for Transformative Practice Education Models. Nurs Leadersh (Tor Ont) 2023; 36:33-45. [PMID: 37552516 DOI: 10.12927/cjnl.2023.27125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Decades of commissioned reports have pointed to solutions for nurturing nursing practice environments as essential to sustaining a nursing workforce. Beyond salary compensation and other solutions, we discuss the critical need for collaborative leadership in practice and education as a priority policy agenda aimed at confronting the shortage of nurses. The COVID-19 pandemic has intensified the nursing shortage and shortage of capacity in practice education, and we explore some learning in this context. Our paper draws on two initiatives in the province of British Columbia: the development of a transformative practice education model and an expanded Collaborative Learning Unit initiative. We propose building the following learning cultures: formal collaborative governance processes, intentional supports for graduate transitions and implementation of advanced nursing practice leadership and educator roles across the system. While transformative solutions are a tough sell in crisis-oriented contexts, this paper is a call for nurse leaders in all sectors to advance deep policy solutions with lasting impact on sustainable nursing human resources.
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Affiliation(s)
- Susan M Duncan
- Professor, School of Nursing University of Victoria Victoria, BC
| | - Diane Sawchuck
- Lead, Evidence, Evaluation and Knowledge Translation Island Health, Co-Director, Centre for Evidence-Informed Nursing and Healthcare, University of Victoria, Victoria, BC
| | - Lenora Marcellus
- Professor, School of Nursing, University of Victoria, Victoria, BC
| | - Joanne Maclaren
- Director Office of the Vice President Quality, Research and Chief Nursing and Allied Health Officer Island Health, Adjunct Assistant Professor, School of Nursing, University of Victoria, Victoria, BC
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Robinson D, Campbell K, Hobson SR, MacDonald WK, Sawchuck D, Wagner B. Directive clinique n o 432c : Déclenchement artificiel du travail. J Obstet Gynaecol Can 2023; 45:78-85.e3. [PMID: 36725135 DOI: 10.1016/j.jogc.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIFS Présenter des données probantes et des recommandations sur la maturation cervicale et le déclenchement artificiel du travail. Fournir de l'information aux professionnels accoucheurs et aux personnes enceintes sur les soins périnataux optimaux et la prévention des interventions obstétricales inutiles. POPULATION CIBLE Toutes les patientes enceintes. BéNéFICES, RISQUES ET COûTS: La mise en application interprofessionnelle et cohérente de la présente directive, l'équipement adéquat et le personnel compétent améliorent la sécurité des soins per partum. Les personnes enceintes et leurs personnes de soutien doivent être informées des risques et bénéfices du déclenchement artificiel du travail. DONNéES PROBANTES: La littérature publiée jusqu'en mars 2022 a été passée en revue. Une recherche a été effectuée dans les bases de données PubMed, CINAHL et Cochrane Library pour répertorier des revues systématiques, des essais cliniques randomisés et des études observationnelles sur la maturation cervicale et le déclenchement artificiel du travail. La littérature grise (non publiée) a été obtenue à l'aide de recherches menées dans des sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, des registres d'essais cliniques et des sites Web de sociétés de spécialité médicale nationales et internationales. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). PROFESSIONNELS CONCERNéS: Tous les fournisseurs de soins obstétricaux. DÉCLARATIONS SOMMAIRESMISOPROSTOL: OCYTOCINE: RECOMMANDATIONS.
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Robinson D, Campbell K, Hobson SR, MacDonald WK, Sawchuck D, Wagner B. Guideline No. 432c: Induction of Labour. J Obstet Gynaecol Can 2023; 45:70-77.e3. [PMID: 36725134 DOI: 10.1016/j.jogc.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES This guideline presents evidence and recommendations for cervical ripening and induction of labour. It aims to provide information to birth attendants and pregnant individuals on optimal perinatal care while avoiding unnecessary obstetrical intervention. TARGET POPULATION All pregnant patients. BENEFITS, RISKS, AND COSTS Consistent interprofessional use of the guideline, appropriate equipment, and trained professional staff enhance safe intrapartum care. Pregnant individuals and their support person(s) should be informed of the benefits and risks of induction of labour. EVIDENCE Literature published to March 2022 was reviewed. PubMed, CINAHL, and the Cochrane Library were used to search for systematic reviews, randomized control trials, and observational studies on cervical ripening and induction labour. Grey (unpublished) literature was identified by searching the websites of health technology assessment and health technology related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All providers of obstetrical care. SUMMARY STATEMENTS Misoprostol OXYTOCIN: RECOMMENDATIONS.
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Robinson D, Campbell K, Hobson SR, MacDonald WK, Sawchuck D, Wagner B. Guideline No. 432b: Cervical Ripening. J Obstet Gynaecol Can 2023; 45:56-62.e1. [PMID: 36725131 DOI: 10.1016/j.jogc.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE This guideline presents evidence and recommendations for cervical ripening and induction of labour. It aims to provide information to birth attendants and pregnant individuals on optimal perinatal care while avoiding unnecessary obstetrical intervention. TARGET POPULATION All pregnant patients. BENEFITS, HARMS, AND COSTS Consistent interprofessional use of the guideline, appropriate equipment, and trained professional staff enhance safe intrapartum care. Pregnant individuals and their support person(s) should be informed of the benefits and risks of induction of labour. EVIDENCE Literature published to March 2022 was reviewed. PubMed, CINAHL, and the Cochrane Library were used to search for systematic reviews, randomized controlled trials, and observational studies on cervical ripening and induction of labour. Grey (unpublished) literature was identified by searching the websites of health technology assessment and health technology related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All providers of obstetrical care. RECOMMANDATIONS
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Robinson D, Campbell K, Hobson SR, MacDonald WK, Sawchuck D, Wagner B. Directive clinique n o 432b : Maturation cervicale. J Obstet Gynaecol Can 2023; 45:63-69.e1. [PMID: 36725133 DOI: 10.1016/j.jogc.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIF Présenter des données probantes et des recommandations sur la maturation cervicale et le déclenchement artificiel du travail. Fournir de l'information aux professionnels accoucheurs et aux personnes enceintes sur les soins périnataux optimaux et la prévention des interventions obstétricales inutiles. POPULATION CIBLE Toutes les patientes enceintes. BéNéFICES, RISQUES ET COûTS: La mise en application interprofessionnelle et cohérente de la présente directive, l'équipement adéquat et le personnel compétent améliorent la sécurité des soins per partum. Les personnes enceintes et leurs personnes de soutien doivent être informées des risques et bénéfices du déclenchement artificiel du travail. DONNéES PROBANTES: La littérature publiée jusqu'en mars 2022 a été passée en revue. Une recherche a été effectuée dans les bases de données PubMed, CINAHL et Cochrane Library pour répertorier des revues systématiques, des essais cliniques randomisés et des études observationnelles sur la maturation cervicale et le déclenchement artificiel du travail. La littérature grise (non publiée) a été obtenue à l'aide de recherches menées dans des sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, des registres d'essais cliniques et des sites Web de sociétés de spécialité médicale nationales et internationales. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). PROFESSIONNELS CONCERNéS: Tous les fournisseurs de soins obstétricaux. RECOMMANDATIONS
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Robinson D, Campbell K, Hobson SR, MacDonald WK, Sawchuck D, Wagner B. Guideline No. 432a: Cervical Ripening and Induction of Labour - General Information. J Obstet Gynaecol Can 2023; 45:35-44.e1. [PMID: 36725128 DOI: 10.1016/j.jogc.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This guideline presents evidence and recommendations for cervical ripening and induction of labour. It aims to provide information to birth attendants and pregnant individuals on optimal perinatal care while avoiding unnecessary obstetrical intervention. TARGET POPULATION All pregnant patients. BENEFITS, HARMS, AND COSTS Consistent interprofessional use of the guideline, appropriate equipment, and trained professional staff enhance safe intrapartum care. Pregnant individuals and their support person(s) should be informed of the benefits and risks of induction of labour. EVIDENCE Literature published to March 2022 was reviewed. PubMed, CINAHL, and the Cochrane Library were used to search for systematic reviews, randomized controlled trials, and observational studies on cervical ripening and induction of labour. Grey (unpublished) literature was identified by searching the websites of health technology assessment and health technology related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All providers of obstetrical care. RECOMMANDATIONS
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Robinson D, Campbell K, Hobson SR, MacDonald WK, Sawchuck D, Wagner B. Directive clinique n o 432a : Maturation cervicale et déclenchement artificiel du travail - Information générale. J Obstet Gynaecol Can 2023; 45:45-55.e1. [PMID: 36725130 DOI: 10.1016/j.jogc.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIF Présenter des données probantes et des recommandations sur la maturation cervicale et le déclenchement artificiel du travail. Fournir de l'information aux professionnels accoucheurs et aux personnes enceintes sur les soins périnataux optimaux et la prévention des interventions obstétricales inutiles. POPULATION CIBLE Toutes les patientes enceintes. BéNéFICES, RISQUES ET COûTS: La mise en application interprofessionnelle et cohérente de la présente directive, l'équipement adéquat et le personnel compétent améliorent la sécurité des soins per partum. Les personnes enceintes et leurs personnes de soutien doivent être informées des risques et bénéfices du déclenchement artificiel du travail. DONNéES PROBANTES: La littérature publiée jusqu'en mars 2022 a été passée en revue. Une recherche a été effectuée dans les bases de données PubMed, CINAHL et Cochrane Library pour répertorier des revues systématiques, des essais cliniques randomisés et des études observationnelles sur la maturation cervicale et le déclenchement artificiel du travail. La littérature grise (non publiée) a été obtenue à l'aide de recherches menées dans des sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, des registres d'essais cliniques et des sites Web de sociétés de spécialité médicale nationales et internationales. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). PROFESSIONNELS CONCERNéS: Tous les fournisseurs de soins obstétricaux. RECOMMANDATIONS
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Tricco AC, Khalil H, Holly C, Feyissa G, Godfrey C, Evans C, Sawchuck D, Sudhakar M, Asahngwa C, Stannard D, Abdulahi M, Bonnano L, Aromataris E, McInerney P, Wilson R, Pang D, Wang Z, Cardoso AF, Peters MDJ, Marnie C, Barker T, Pollock D, McArthur A, Munn Z. Rapid reviews and the methodological rigor of evidence synthesis: a JBI position statement. JBI Evid Synth 2022; 20:944-949. [PMID: 35124684 DOI: 10.11124/jbies-21-00371] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
ABSTRACT The demand for rapid reviews has exploded in recent years. A rapid review is an approach to evidence synthesis that provides timely information to decision-makers (eg, health care planners, providers, policymakers, and patients) by simplifying the evidence synthesis process. A rapid review is particularly appealing for urgent decisions.JBI is a world-renowned international collaboration for evidence synthesis and implementation methodologies. The principles for JBI evidence synthesis include comprehensiveness, rigor, transparency, and a focus on applicability to clinical practice. As such, JBI has not yet endorsed a specific approach for rapid reviews.In this paper, we compare rapid reviews versus other types of evidence synthesis, provide a range of rapid evidence products, outline how to appraise the quality of rapid reviews, and present the JBI position on rapid reviews. JBI-affiliated Centers conduct rapid reviews for decision-makers in specific circumstances, such as limited time or funding constraints. A standardized approach is not used for these cases; instead, the evidence synthesis methods are tailored to the needs of the decision-maker.The urgent need to deliver timely evidence to decision-makers poses challenges to JBI's mission to produce high quality, trustworthy evidence. However, JBI recognizes the value of rapid reviews as part of the evidence synthesis ecosystem. As such, it is recommended that rapid reviews be conducted with the same methodological rigor and transparency expected of JBI reviews. Most importantly, transparency is essential, and the rapid review should clearly report where any simplification in the steps of the evidence synthesis process have been taken.
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Affiliation(s)
- Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.; Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto ON, Canada.; Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, School of Nursing, Queen's University, Kingston, ON, Canada School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Melbourne, Vic, Australia The Northeast Institute for Evidence Synthesis and Translation (NEST): A JBI Centre of Excellence, Rutgers University School of Nursing, Newark, NJ, USA Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, School of Nursing, Queen's University, Kingston, ON, Canada The Nottingham Centre for Evidence Based Healthcare: JBI Centre of Excellence, School of Health Sciences, University of Nottingham, Nottingham, UK University of Victoria (UVic) Centre for Evidence-informed Nursing and Healthcare (CEiNHC): A JBI Centre of Excellence, University of Victoria, Victoria, BC, Canada Ethiopian Evidence Based Health Care Centre, Department of Health, Behaviour and Society, Public Health Faculty, Jimma Institute of Health, Jimma University, Jimma, Ethiopia The Cameroon Centre for Evidence Based Health Care: A JBI Centre of Excellence, Yaounde, Cameroon San Francisco State University School of Nursing, San Francisco, CA, USA. Department of Population and Family Health, Public Health Faculty, Jimma Institute of Health, Jimma University, Jimma, Ethiopia The Louisiana Centre for Promoting Optimal Health Outcomes: A JBI Centre of Excellence, Louisiana State University Health Sciences Center, New Orleans School of Nursing, New Orleans, LA, USA JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia The Wits JBI-Affiliated Centre for Evidence-Based Practice, University of the Witwatersrand, Johannesburg, South Africa Peking University Health Science Centre for Evidence-based Nursing: A JBI Affiliated Group, Peking University, Beijing, P. R. China Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Portugal Rosemary Bryant AO Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia; Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; The Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, SA, Australia Rosemary Bryant AO Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
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Marcellus L, Jantzen D, Humble R, Sawchuck D, Gordon C. Characteristics and processes of the dedicated education unit practice education model for undergraduate nursing students: a scoping review. JBI Evid Synth 2021; 19:2993-3039. [PMID: 34725312 DOI: 10.11124/jbies-20-00462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective was to review literature related to the dedicated education unit practice education model for undergraduate nursing students, and identify common characteristics and processes for implementing and sustaining this model. INTRODUCTION Although practice education is central to undergraduate nursing education, evidence-informed practices for learning in the clinical setting remain elusive. Changes to health care over the past decades related to the role and scope of practice for nurses, gradual shifts to community- and population-based care delivery, and expectations for interprofessional practice require forward-looking education models. The dedicated education unit model was developed in 1997 as a potential solution to globally recognized challenges in nursing education amidst discourses of nursing resource scarcity. Despite more than two decades of innovation and expansion, there is still limited understanding of the effectiveness of the dedicated education unit as a solution to those challenges, or for the anticipated benefits for students and patients, through enhanced evidence-informed health care. This analysis of the characteristics and processes of the model is timely for evaluating and sustaining implementation of the dedicated education unit across nursing practice and education settings. INCLUSION CRITERIA English-only publications related to the dedicated education unit practice education model for undergraduate nursing students in baccalaureate and associate degree programs using qualitative, quantitative, or mixed methods research, and quality improvement, program evaluation, and opinion publications were included. METHODS Using selected keywords including "dedicated education unit," we searched CINAHL, Google Scholar, MEDLINE, Academic Premier Search, ERIC, Cochrane Database of Systematic Reviews, JBI EBP Database, and ProQuest Dissertations and Theses. Two independent reviewers screened titles and abstracts against inclusion criteria. We reviewed reference lists for gray literature and additional references. Data were extracted from the included articles and categorized for characteristics and processes. Eighty-two publications from January 1997 to May 2020 were included. The findings were presented descriptively with tables and figures to support the data. RESULTS Dedicated education unit models were based on five characteristics and four processes. Characteristics of the dedicated education unit model included effective academic-practice partnership, adaptability to diverse contexts, unit culture of educational excellence, responsive and supportive unit leadership, and clarity of roles and responsibilities. Processes included building nurse and faculty capacity, facilitating student learning, communicating regularly at systems and unit levels, and evaluating and sustaining the model. CONCLUSIONS Evidence demonstrated that the dedicated education unit practice education model is well-established. However, there were existing gaps in this evidence, specifically evaluation and economic analyses. There was also limited attention to long-term sustainability of the model. The common characteristics and processes identified in this review may be used to support planning, implementation, and evaluation, including development and validation of evaluation tools. Although administrative infrastructure was noted as central to the dedicated education unit strategy, it was rarely acknowledged as part of management and thus also requires further study.
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Affiliation(s)
- Lenora Marcellus
- School of Nursing, University of Victoria, Victoria, BC Canada.,The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): A JBI Centre of Excellence, University of Victoria, Victoria, BC, Canada
| | - Darlaine Jantzen
- The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): A JBI Centre of Excellence, University of Victoria, Victoria, BC, Canada.,School of Nursing, Trinity Western University, Langley, BC, Canada
| | - Robin Humble
- The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): A JBI Centre of Excellence, University of Victoria, Victoria, BC, Canada.,Department of Nursing, Camosun College, Victoria, BC, Canada
| | - Diane Sawchuck
- The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): A JBI Centre of Excellence, University of Victoria, Victoria, BC, Canada.,Research and Capacity Building, Island Health, Victoria, BC, Canada
| | - Carol Gordon
- The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): A JBI Centre of Excellence, University of Victoria, Victoria, BC, Canada.,Libraries, University of Victoria, Victoria, BC, Canada
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Dore S, Ehman W, Azzam H, Basso M, Bow M, Morin F, Mundle W, Rivard L, Sawchuck D, Wilson K, Young D. Erratum dans la « N o 396 - Surveillance du bien-être fœtal : Directive clinique de consensus des soins intrapartum » [Journal of Obstetrics and Gynaecology Canada 42 (2020) 349-384.E10]. J Obstet Gynaecol Can 2021; 43:1119. [PMID: 34481582 DOI: 10.1016/j.jogc.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
OBJECTIVE This guideline provides new recommendations pertaining to the application and documentation of fetal surveillance in the intrapartum period that will decrease the incidence of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention. Pregnancies with and without risk factors for adverse perinatal outcomes are considered. This guideline presents an alternative classification system for antenatal fetal non-stress testing and intrapartum electronic fetal surveillance to what has been used previously. This guideline is intended for use by all health professionals who provide intrapartum care in Canada. OPTIONS Consideration has been given to all methods of fetal surveillance currently available in Canada. OUTCOMES Short- and long-term outcomes that may indicate the presence of birth asphyxia were considered. The associated rates of operative and other labour interventions were also considered. EVIDENCE A comprehensive review of randomized controlled trials published between January 1996 and March 2007 was undertaken, and MEDLINE and the Cochrane Database were used to search the literature for all new studies on fetal surveillance antepartum. The level of evidence has been determined using the criteria and classifications of the Canadian Task Force on Preventive Health Care (Table 1). SPONSOR This consensus guideline was jointly developed by the Society of Obstetricians and Gynaecologists of Canada and the British Columbia Perinatal Health Program (formerly the British Columbia Reproductive Care Program or BCRCP) and was partly supported by an unrestricted educational grant from the British Columbia Perinatal Health Program. RECOMMENDATION 1: LABOUR SUPPORT DURING ACTIVE LABOUR: RECOMMENDATION 2: PROFESSIONAL ONE-TO ONE CARE AND INTRAPARTUM FETAL SURVEILLANCE: RECOMMENDATION 3: INTERMITTENT AUSCULTATION IN LABOUR: RECOMMENDATION 4: ADMISSION FETAL HEART TEST: RECOMMENDATION 5: INTRAPARTUM FETAL SURVEILLANCE FOR WOMEN WITH RISK FACTORS FOR ADVERSE PERINATAL OUTCOME: When a normal tracing is identified, it may be appropriate to interrupt the electronic fetal monitoring tracing for up to 30 minutes to facilitate periods of ambulation, bathing, or position change, providing that (1) the maternal-fetal condition is stable and (2) if oxytocin is being administered, the infusion rate is not increased (III-B). RECOMMENDATION 6: DIGITAL FETAL SCALP STIMULATION: RECOMMENDATION 7: FETAL SCALP BLOOD SAMPLING: RECOMMENDATION 8: UMBILICAL CORD BLOOD GASES: RECOMMENDATION 9: FETAL PULSE OXIMETRY: RECOMMENDATION 10: ST WAVEFORM ANALYSIS: RECOMMENDATION 11: INTRAPARTUM FETAL SCALP LACTATE TESTING.
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Liston R, Sawchuck D, Young D. No. 197c-Maintaining Standards in Antenatal and Intrapartum Fetal Surveillance: Quality Improvement and Risk Management. J Obstet Gynaecol Can 2019; 40:e353-e358. [PMID: 29680086 DOI: 10.1016/j.jogc.2018.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Liston R, Sawchuck D, Young D. N° 197b-Surveillance du bien-être fœtal : Directive consensus d'intrapartum. J Obstet Gynaecol Can 2019; 40:e323-e352. [PMID: 29680085 DOI: 10.1016/j.jogc.2018.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Liston R, Sawchuck D, Young D. N° 197c-Maintien des normes dans le cadre de la surveillance fœtale intrapartum et prénatale : amélioration de la qualité et gestion du risque. J Obstet Gynaecol Can 2019; 40:e359-e365. [PMID: 29680087 DOI: 10.1016/j.jogc.2018.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Marcellus L, Jantzen D, Sawchuck D, Gordon C, Humble R. Characteristics of the collaborative learning unit practice education model for undergraduate nursing students: a scoping review protocol. JBI Database System Rev Implement Rep 2019; 17:1051-1059. [PMID: 31021976 DOI: 10.11124/jbisrir-d-18-00011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
What evidence on characteristics and processes of the collaborative learning unit practice education model for undergraduate nursing students is available?
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Affiliation(s)
- Lenora Marcellus
- School of Nursing, Faculty of Human and Social Development, University of Victoria, Victoria, Canada
- The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): a Joanna Briggs Institute Affiliated Group
| | - Darlaine Jantzen
- Nursing Department, School of Health and Human Services, Camosun College, Victoria, Canada
- The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): a Joanna Briggs Institute Affiliated Group
| | - Diane Sawchuck
- School of Nursing, Faculty of Human and Social Development, University of Victoria, Victoria, Canada
- The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): a Joanna Briggs Institute Affiliated Group
| | - Carol Gordon
- School of Nursing, Faculty of Human and Social Development, University of Victoria, Victoria, Canada
- The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): a Joanna Briggs Institute Affiliated Group
| | - Robin Humble
- Nursing Department, School of Health and Human Services, Camosun College, Victoria, Canada
- The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): a Joanna Briggs Institute Affiliated Group
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17
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Sheikh S, Qureshi RN, Raza F, Memon J, Ahmed I, Vidler M, Payne BA, Lee T, Sawchuck D, Magee L, von Dadelszen P, Bhutta Z. Self-reported maternal morbidity: Results from the community level interventions for pre-eclampsia (CLIP) baseline survey in Sindh, Pakistan. Pregnancy Hypertens 2019; 17:113-120. [PMID: 31487626 PMCID: PMC6734112 DOI: 10.1016/j.preghy.2019.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/24/2019] [Accepted: 05/17/2019] [Indexed: 11/30/2022]
Abstract
Community-based estimates of maternal/perinatal death and morbidity are reported. Stillbirth led to increased self-report of hypertensive complications in the index pregnancy. Self-reported seizure and pregnancy hypertension is prone to error in regions of low literacy.
Objective Community-based data regarding maternal and perinatal morbidity and mortality are scarce in less-developed countries. The aim of the study was to collect representative community-level demographic health information to provide socio-demographic and health outcome data. Methods A retrospective household survey of women of reproductive age (15–49 years) living in two districts of Sindh Province, Pakistan was conducted. Pregnancy incidence over the past 12 months and during each woman’s lifetime; maternal, fetal, infant and child deaths in the past 12 months; and rates of hypertension and seizures in pregnancy were calculated. Results From June to September 2013, 88,410 households were surveyed with 1.2 (±0.6) women of reproductive age per household. 19,584 women (11.9%) reported pregnancies in the preceding 12 months; 83.0% had live births, 3.5% resulting in stillbirths and 13.6% in miscarriages. 34.2% of deliveries occurred at home. Out of all women who reported a pregnancy in past 12 months, 62.1% reported high blood pressure and 11.9% reported seizures complicating her most recent pregnancy. Blood pressure was not measured during survey to confirm hypertension. The perinatal, neonatal and maternal mortality ratios were 64.7/1000, 39/1000 and 166/100,000 livebirths, respectively. Conclusion This study estimated population-level mortality ratios that can be used for the planning of health interventions in these regions. Self-reported pregnancy hypertension and seizures was inaccurate, reflecting limited community understanding of these disorders. Mortality estimates are comparable to those reported by the World Health Organization for maternal mortality ratio and neonatal mortality rate of 170/100,000 and 36/1000 live births, respectively.
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Affiliation(s)
- Sana Sheikh
- Division of Women & Child Health, Department of Obstetrics and Gynaecology, 2(nd) Floor Private Wing, Aga Khan University, Stadium Road, Karachi 74800, Pakistan.
| | - Rahat Najam Qureshi
- Division of Women & Child Health, Department of Obstetrics and Gynaecology, 2(nd) Floor Private Wing, Aga Khan University, Stadium Road, Karachi 74800, Pakistan.
| | - Farrukh Raza
- Division of Women & Child Health, Department of Obstetrics and Gynaecology, 2(nd) Floor Private Wing, Aga Khan University, Stadium Road, Karachi 74800, Pakistan.
| | - Javed Memon
- Division of Women & Child Health, Department of Obstetrics and Gynaecology, 2(nd) Floor Private Wing, Aga Khan University, Stadium Road, Karachi 74800, Pakistan.
| | - Imran Ahmed
- Division of Women & Child Health, Department of Obstetrics and Gynaecology, 2(nd) Floor Private Wing, Aga Khan University, Stadium Road, Karachi 74800, Pakistan.
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada.
| | - Beth A Payne
- Department of Obstetrics and Gynaecology, University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada; Centre for International Child Health, BC Children's Hospital Research Institute, 950 W 28th Ave, Vancouver, BC V5Z 4H4, Canada.
| | - Tang Lee
- Department of Obstetrics and Gynaecology, University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada.
| | - Diane Sawchuck
- Vancouver Island Health Authority, 2334 Trent Street, Suite 643 Victoria, Canada.
| | - Laura Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, Strand, London WC2R 2LS, UK.
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, Strand, London WC2R 2LS, UK.
| | - Zulfiqar Bhutta
- Division of Women & Child Health, Department of Obstetrics and Gynaecology, 2(nd) Floor Private Wing, Aga Khan University, Stadium Road, Karachi 74800, Pakistan; Program for Global Pediatric Research, Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.
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18
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MacKinnon K, Pauly B, Shahram S, Wallace B, Urbanoski K, Gordon C, Raworth R, MacDonald M, Marcellus L, Sawchuck D, Pagan F, Strosher H, Inglis D, Macevicius C, Strayed N. Health equity-oriented approaches to inform responses to opioid overdoses. ACTA ACUST UNITED AC 2019; 17:640-653. [DOI: 10.11124/jbisrir-2017-003933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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19
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Magee LA, De Silva DA, Sawchuck D, Synnes A, von Dadelszen P. No 376 - Recours au sulfate de magnésium aux fins de neuroprotection fœtale. Journal of Obstetrics and Gynaecology Canada 2019; 41:523-542. [DOI: 10.1016/j.jogc.2018.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Katageri G, Charantimath U, Joshi A, Vidler M, Ramadurg U, Sharma S, Bannale S, Payne BA, Rakaraddi S, Karadiguddi C, Mungarwadi G, Kavi A, Sawchuck D, Derman R, Goudar S, Mallapur A, Bellad M, Magee LA, Qureshi R, von Dadelszen P. Availability and use of magnesium sulphate at health care facilities in two selected districts of North Karnataka, India. Reprod Health 2018; 15:91. [PMID: 29945665 PMCID: PMC6020005 DOI: 10.1186/s12978-018-0531-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-eclampsia and eclampsia are major causes of maternal morbidity and mortality. Magnesium sulphate is accepted as the anticonvulsant of choice in these conditions and is present on the WHO essential medicines list and the Indian National List of Essential Medicines, 2015. Despite this, magnesium sulphate is not widely used in India for pre-eclampsia and eclampsia. In addition to other factors, lack of availability may be a reason for sub-optimal usage. This study was undertaken to assess the availability and use of magnesium sulphate at public and private health care facilities in two districts of North Karnataka, India. METHODS A facility assessment survey was undertaken as part of the Community Level Interventions for Pre-eclampsia (CLIP) Feasibility Study which was undertaken prior to the CLIP Trials (NCT01911494). This study was undertaken in 12 areas of Belagavi and Bagalkote districts of North Karnataka, India and included a survey of 88 facilities. Data were collected in all facilities by interviewing the health care providers and analysed using Excel. RESULTS Of the 88 facilities, 28 were public, and 60 were private. In the public facilities, magnesium sulphate was available in six out of 10 Primary Health Centres (60%), in all eight taluka (sub-district) hospitals (100%), five of eight community health centres (63%) and both district hospitals (100%). Fifty-five of 60 private facilities (92%) reported availability of magnesium sulphate. Stock outs were reported in six facilities in the preceding six months - five public and one private. Twenty-five percent weight/volume and 50% weight/volume concentration formulations were available variably across the public and private facilities. Sixty-eight facilities (77%) used the drug for severe pre-eclampsia and 12 facilities (13.6%) did not use the drug even for eclampsia. Varied dosing schedules were reported from facility to facility. CONCLUSIONS Poor availability of magnesium sulphate was identified in many facilities, and stock outs in some. Individual differences in usage were identified. Ensuring a reliable supply of magnesium sulphate, standard formulations and recommendations of dosage schedules and training may help improve use; and decrease morbidity and mortality due to pre-eclampsia/ eclampsia. TRIAL REGISTRATION The CLIP trial was registered with ClinicalTrials.gov ( NCT01911494 ).
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Affiliation(s)
- Geetanjali Katageri
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka, India
| | - Umesh Charantimath
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, Karnataka, India.
| | - Anjali Joshi
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, Karnataka, India
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Umesh Ramadurg
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka, India
| | - Sumedha Sharma
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Sheshidhar Bannale
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka, India
| | - Beth A Payne
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Sangamesh Rakaraddi
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka, India
| | | | - Geetanjali Mungarwadi
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, Karnataka, India
| | - Avinash Kavi
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, Karnataka, India
| | - Diane Sawchuck
- Department of Research, Vancouver Island Health Authority, British Columbia, Canada
| | - Richard Derman
- Global Affairs, Thomas Jefferson University, Philadelphia, USA
| | - Shivaprasad Goudar
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, Karnataka, India
| | - Ashalata Mallapur
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka, India
| | - Mrutyunjaya Bellad
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, Karnataka, India
| | - Laura A Magee
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rahat Qureshi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Peter von Dadelszen
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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21
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Charanthimath U, Vidler M, Katageri G, Ramadurg U, Karadiguddi C, Kavi A, Joshi A, Mungarwadi G, Bannale S, Rakaraddi S, Sawchuck D, Qureshi R, Sharma S, Payne BA, von Dadelszen P, Derman R, Magee LA, Goudar S, Mallapur A, Bellad M, Bhutta Z, Naik S, Mulla A, Kamle N, Dhamanekar V, Drebit SK, Kariya C, Lee T, Li J, Lui M, Khowaja AR, Tu DK, Revankar A. The feasibility of task-sharing the identification, emergency treatment, and referral for women with pre-eclampsia by community health workers in India. Reprod Health 2018; 15:101. [PMID: 29945662 PMCID: PMC6019995 DOI: 10.1186/s12978-018-0532-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Hypertensive disorders are the second highest direct obstetric cause of maternal death after haemorrhage, accounting for 14% of maternal deaths globally. Pregnancy hypertension contributes to maternal deaths, particularly in low- and middle-income countries, due to a scarcity of doctors providing evidence-based emergency obstetric care. Task-sharing some obstetric responsibilities may help to reduce the mortality rates. This study was conducted to assess acceptability by the community and other healthcare providers, for task-sharing by community health workers (CHW) in the identification and initial care in hypertensive disorders in pregnancy. METHODS This study was conducted in two districts of Karnataka state in south India. A total of 14 focus group discussions were convened with various community representatives: women of reproductive age (N = 6), male decision-makers (N = 2), female decision-makers (N = 3), and community leaders (N = 3). One-to-one interviews were held with medical officers (N = 2), private healthcare OBGYN specialists (N = 2), senior health administrators (N = 2), Taluka (county) health officers (N = 2), and obstetricians (N = 4). All data collection was facilitated by local researchers familiar with the setting and language. Data were subsequently transcribed, translated and analysed thematically using NVivo 10 software. RESULTS There was strong community support for home visits by CHW to measure the blood pressure of pregnant women; however, respondents were concerned about their knowledge, training and effectiveness. The treatment with oral antihypertensive agents and magnesium sulphate in emergencies was accepted by community representatives but medical practitioners and health administrators had reservations, and insisted on emergency transport to a higher facility. The most important barriers for task-sharing were concerns regarding insufficient training, limited availability of medications, the questionable validity of blood pressure devices, and the ability of CHW to correctly diagnose and intervene in cases of hypertensive disorders of pregnancy. CONCLUSION Task-sharing to community-based health workers has potential to facilitate early diagnosis of the hypertensive disorders of pregnancy and assist in the provision of emergency care. We identified some facilitators and barriers for successful task-sharing of emergency obstetric care aimed at reducing mortality and morbidity due to hypertensive disorders of pregnancy.
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Affiliation(s)
- Umesh Charanthimath
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
| | - Geetanjali Katageri
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | - Umesh Ramadurg
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | | | - Avinash Kavi
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Anjali Joshi
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Geetanjali Mungarwadi
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Sheshidhar Bannale
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | - Sangamesh Rakaraddi
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | - Diane Sawchuck
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
| | - Rahat Qureshi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
| | - Sumedha Sharma
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
| | - Beth A. Payne
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
| | - Peter von Dadelszen
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
| | - Richard Derman
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Laura A. Magee
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
| | - Shivaprasad Goudar
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Ashalata Mallapur
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | - Mrutyunjaya Bellad
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - and the Community Level Interventions for Pre-eclampsia (CLIP) India Feasibility Working Group
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Zulfiqar Bhutta
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Sheela Naik
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Anis Mulla
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Namdev Kamle
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Vaibhav Dhamanekar
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Sharla K. Drebit
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Chirag Kariya
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Tang Lee
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Jing Li
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Mansun Lui
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Asif R. Khowaja
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Domena K. Tu
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Amit Revankar
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
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Ramadurg U, Vidler M, Charanthimath U, Katageri G, Bellad M, Mallapur A, Goudar S, Bannale S, Karadiguddi C, Sawchuck D, Qureshi R, von Dadelszen P, Derman R. Community health worker knowledge and management of pre-eclampsia in rural Karnataka State, India. Reprod Health 2016; 13:113. [PMID: 27719678 PMCID: PMC5056468 DOI: 10.1186/s12978-016-0219-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background In India, the hypertensive disorders of pregnancy and postpartum haemorrhage are responsible for nearly 40 % of all maternal deaths. Most of these deaths occur in primary health settings which frequently lack essential equipment and medication, are understaffed, and have limited or no access to specialist care. Community health care workers are regarded as essential providers of basic maternity care; and the quality of care they provide is dependent on the level of knowledge and skills they possess. However, there is limited research regarding their ability to manage pregnancy complications. This study aims to describe the current state of knowledge regarding pre-eclampsia and eclampsia among community health care workers (auxiliary nurse midwives, accredited social health activists, staff nurses) in northern Karnataka, India. Furthermore, this study describes the treatment approaches used by various cadres of community health workers for these conditions. The findings of this study can help plan focussed training sessions to build upon their strengths and to address the identified gaps. Methods Data were collected as part of a larger study aimed at assessing the feasibility of community-based treatment for pre-eclampsia. Eight focus group discussions were conducted in 2012–2013 in northern Karnataka State: four with staff nurses and auxiliary nurse midwives and four with accredited social health activists. In addition, twelve auxiliary nurse midwives and staff nurses completed questionnaires to explore their competence and self-efficacy in managing pre-eclampsia. Qualitative data were audio-recorded, transcribed verbatim and translated for thematic analysis using NVivo 10. Results Community health workers described their understanding of the origins of hypertension and seizures in pregnancy. Psychological explanations of hypertension were most commonly reported: stress, tension, and fear. The most common explanation for eclampsia was not receiving a tetanus vaccination. Despite some common misperceptions regarding aetiology, these community health workers demonstrated a good grasp of the potential consequences of hypertension in pregnancy. According to auxiliary nurse midwives and staff nurses, if hypertension was detected they encouraged rest, decreased salt intake, iron supplementation and tetanus vaccination. In addition, some staff nurses administered antihypertensives, MgSO4, or other anticonvulsants. All auxiliary nurse midwives had some awareness of MgSO4, but none had administered it themselves. Conclusions This study showed that knowledge regarding the aetiology of pre-eclampsia was limited. Nevertheless, their basic knowledge and skills could be strengthened to more effectively manage the hypertensive disorders of pregnancy in their communities. Trial registration NCT01911494 Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0219-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Umesh Ramadurg
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Navanagar, 587102, India
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, V5Z 4H4, Canada.
| | - Umesh Charanthimath
- KLE University's Jawaharlal Nehru Medical College, Neharu Nagar, Belgaum, 590010, India
| | - Geetanjali Katageri
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Navanagar, 587102, India
| | - Mrutyunjaya Bellad
- KLE University's Jawaharlal Nehru Medical College, Neharu Nagar, Belgaum, 590010, India
| | - Ashalata Mallapur
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Navanagar, 587102, India
| | - Shivaprasad Goudar
- KLE University's Jawaharlal Nehru Medical College, Neharu Nagar, Belgaum, 590010, India
| | - Shashidhar Bannale
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Navanagar, 587102, India
| | | | - Diane Sawchuck
- Department of Research, Vancouver Island Health Authority, Victoria, V8R 1J8, Canada
| | - Rahat Qureshi
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Peter von Dadelszen
- Molecularand Clinical Sciences Research Institute, St George's, University of London, and Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, SW17 0RE, UK
| | - Richard Derman
- Department of Obstetrics and Gynaecology, Thomas Jefferson University, Philadelphia, 19107, USA
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23
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Akeju DO, Vidler M, Sotunsa JO, Osiberu MO, Orenuga EO, Oladapo OT, Adepoju AA, Qureshi R, Sawchuck D, Adetoro OO, von Dadelszen P, Dada OA. Human resource constraints and the prospect of task-sharing among community health workers for the detection of early signs of pre-eclampsia in Ogun State, Nigeria. Reprod Health 2016; 13:111. [PMID: 27719681 PMCID: PMC5056470 DOI: 10.1186/s12978-016-0216-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The dearth of health personnel in low income countries has attracted global attention. Ways as to how health care services can be delivered in a more efficient and effective way using available health personnel are being explored. Task-sharing expands the responsibilities of low-cadre health workers and allows them to share these responsibilities with highly qualified health care providers in an effort to best utilize available human resources. This is appropriate in a country like Nigeria where there is a shortage of qualified health professionals and a huge burden of maternal mortality resulting from obstetric complications like pre-eclampsia. This study examines the prospect for task-sharing among Community Health Extension Workers (CHEW) for the detection of early signs of pre-eclampsia, in Ogun State, Nigeria. Methods This study is part of a larger community-based trial evaluating the acceptability of community treatment for severe pre-eclampsia in Ogun State, Nigeria. Data was collected between 2011 and 2012 using focus group discussions; seven with CHEWs (n = 71), three with male decision-makers (n = 35), six with community leaders (n = 68), and one with member of the Society of Obstetricians and Gynaecologists of Nigeria (n = 9). In addition, interviews were conducted with the heads of the local government administration (n = 4), directors of planning (n = 4), medical officers (n = 4), and Chief Nursing Officers (n = 4). Qualitative data were analysed using NVivo version 10.0 3 computer software. Results The non-availability of health personnel is a major challenge, and has resulted in a high proportion of facility-based care performed by CHEWs. As a result, CHEWs often take on roles that are designated for senior health workers. This role expansion has exposed CHEWs to the basics of obstetric care, and has resulted in informal task-sharing among the health workers. The knowledge and ability of CHEWs to perform basic clinical assessments, such as measure blood pressure is not in doubt. Nevertheless, there were divergent views by senior and junior cadres of health practitioners about CHEWs’ abilities in providing obstetric care. Similarly, there were concerns by various stakeholders, particularly the CHEWs themselves, on the regulatory restrictions placed on them by the Standing Order. Conclusion Generally, the extent to which obstetric tasks could be shifted to community health workers will be determined by the training provided and the extent to which the observed barriers are addressed. Trial registration NCT01911494 Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0216-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David O Akeju
- Department of Sociology, University of Lagos, Lagos, Nigeria.
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, V5Z 4H4, Canada
| | - J O Sotunsa
- Department of Obstetrics and Gynaecology, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | - M O Osiberu
- Centre for Research in Reproductive Health, Sagamu, Nigeria
| | - E O Orenuga
- Centre for Research in Reproductive Health, Sagamu, Nigeria
| | | | - A A Adepoju
- Centre for Research in Reproductive Health, Sagamu, Nigeria
| | - Rahat Qureshi
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Diane Sawchuck
- Department of Research, Vancouver Island Health Authority, Victoria, V8R 1 J8, Canada
| | - Olalekan O Adetoro
- Department of Obstetrics and Gynaecology, OlabisiOnabanjo University, Sagamu, Nigeria
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, St George's University London, London, SW17 0RE, UK
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Boene H, Vidler M, Augusto O, Sidat M, Macete E, Menéndez C, Sawchuck D, Qureshi R, von Dadelszen P, Munguambe K, Sevene E. Community health worker knowledge and management of pre-eclampsia in southern Mozambique. Reprod Health 2016; 13:105. [PMID: 27719683 PMCID: PMC5056526 DOI: 10.1186/s12978-016-0220-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Mozambique has drastically improved an array of health indicators in recent years, including maternal mortality rates which decreased 63 % from 1990–2013 but the rates still high. Pre-eclampsia and eclampsia constitute the third major cause of maternal death in the country. Women in rural areas, with limited access to health facilities are at greatest risk. This study aimed to assess the current state of knowledge and the regular practices regarding pre-eclampsia and eclampsia by community health workers in southern Mozambique. Methods This mixed methods study was conducted from 2013 to 2014, in Maputo and Gaza Provinces, southern Mozambique. Self-administered questionnaires, in-depth interviews and focus group discussions were conducted with CHWs, district medical officers, community health workers’ supervisors, Gynaecologists-Obstetricians and matrons. Quantitative data were entered into a database written in REDCap and subsequently analyzed using Stata 13. Qualitative data was imported into NVivo10 for thematic analysis. Results Ninety-three percent of CHW had some awareness of pregnancy complications. Forty-one percent were able to describe the signs and symptoms of hypertension. In cases of eclampsia, CHWs reported to immediately refer the women. The vast majority of the CHWs surveyed reported that they could neither measure blood pressure nor proteinuria (90 %). Fewer reported confidence in providing oral antihypertensives (14 %) or injections in pregnancy (5 %). The other community health care providers are matrons. They do not formally offer health services, but assists pregnant women in case of an emergency. Regarding pre-eclampsia and eclampsia, matrons were unable to recognise these biomedical terms. Conclusions Although CHWs are aware of pregnancy complications, they hold limited knowledge specific to pre-eclampsia and eclampsia. There is a need to promote studies to evaluate the impact of enhancing their training to include additional content related to the identification and management of pre-eclampsia and eclampsia. Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0220-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helena Boene
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, 950 West 28th Avenue, Vancouver, V5Z4H4, Canada
| | - Orvalho Augusto
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique.,Universidade Eduardo Mondlane, Faculdade de Medicina, Av. Salvador Allende, 702 R/C, Maputo, Moçambique
| | - Mohsin Sidat
- Universidade Eduardo Mondlane, Faculdade de Medicina, Av. Salvador Allende, 702 R/C, Maputo, Moçambique
| | - Eusébio Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique.,Ministério da Saúde, Av. Eduardo Mondlane, Maputo, 1008, Moçambique
| | - Clara Menéndez
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique.,Barcelona Institute for Global Health (ISGlobal) /Hospital Clinic - Universitat de Barcelona, Calle Rosselló, 132, Barcelona, 08036, Spain
| | - Diane Sawchuck
- Department of Research, Vancouver Island Health Authority, Victoria, V8R 1J8, Canada
| | - Rahat Qureshi
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, St George's University London, London, SW17 0RE, UK
| | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique.,Universidade Eduardo Mondlane, Faculdade de Medicina, Av. Salvador Allende, 702 R/C, Maputo, Moçambique
| | - Esperança Sevene
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique. .,Universidade Eduardo Mondlane, Faculdade de Medicina, Av. Salvador Allende, 702 R/C, Maputo, Moçambique.
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25
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Salam RA, Qureshi RN, Sheikh S, Khowaja AR, Sawchuck D, Vidler M, von Dadelszen P, Zaidi S, Bhutta Z. Potential for task-sharing to Lady Health Workers for identification and emergency management of pre-eclampsia at community level in Pakistan. Reprod Health 2016; 13:107. [PMID: 27719680 PMCID: PMC5056493 DOI: 10.1186/s12978-016-0214-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background An estimated 276 Pakistani women die for every 100,000 live births; with eclampsia accounting for about 10 % of these deaths. Community health workers contribute to the existing health system in Pakistan under the banner of the Lady Health Worker (LHW) Programme and are responsible to provide a comprehensive package of antenatal services. However, there is a need to increase focus on early identification and prompt diagnosis of pre-eclampsia in community settings, since women with mild pre-eclampsia often present without symptoms. This study aims to explore the potential for task-sharing to LHWs for the community-level management of pre-eclampsia and eclampsia in Pakistan. Methods A qualitative exploratory study was undertaken February-July 2012 in two districts, Hyderabad and Matiari, in the southern province of Sindh, Pakistan. Altogether 33 focus group discussions (FGDs) were conducted and the LHW curriculum and training materials were also reviewed. The data was audio-recorded, then transcribed verbatim for thematic analysis using QSR NVivo-version10. Results Findings from the review of the LHW curriculum and training program describe that in the existing community delivery system, LHWs are responsible for identification of pregnant women, screening women for danger signs and referrals for antenatal care. They are the first point of contact for women in pregnancy and provide nutritional counselling along with distribution of iron and folic acid supplements. Findings from FGDs suggest that LHWs do not carry a blood pressure device or antihypertensive medications; they refer to the nearest public facility in the event of a pregnancy complication. Currently, they provide tetanus toxoid in pregnancy. The health advice provided by lady health workers is highly valued and accepted by pregnant women and their families. Many Supervisors of LHWs recognized the need for increased training regarding pre-eclampsia and eclampsia, with a focus on identifying women at high risk. The entire budget of the existing lady health worker Programme is provided by the Government of Pakistan, indicating a strong support by policy makers and the government for the tasks undertaken by these providers. Conclusion There is a potential for training and task-sharing to LHWs for providing comprehensive antenatal care; specifically for the identification and management of pre-eclampsia in Pakistan. However, the implementation needs to be combined with appropriate training, equipment availability and supervision. Trial registration ClinicalTrial.gov, NCT01911494 Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0214-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rehana A Salam
- Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan
| | - Rahat Najam Qureshi
- Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan. .,Department of Obstetrics and Gynaecology, Aga Khan University, Stadium Road, Karachi, Pakistan.
| | - Sana Sheikh
- Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan
| | - Asif Raza Khowaja
- Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan
| | - Diane Sawchuck
- Department of Research, Vancouver Island Health Authority, Victoria, V8R1J8, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, V5Z 4H4, Canada
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, St George's, University of London, London, SW17 0RE, UK
| | - Shujaat Zaidi
- Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan
| | - Zulfiqar Bhutta
- Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.,Centre for Global Child Health, The Hospital for Sick Children, Toronto, M5G 2L3, Canada
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Sheikh S, Qureshi RN, Khowaja AR, Salam R, Vidler M, Sawchuck D, von Dadelszen P, Zaidi S, Bhutta Z. Health care provider knowledge and routine management of pre-eclampsia in Pakistan. Reprod Health 2016; 13:104. [PMID: 27719673 PMCID: PMC5056497 DOI: 10.1186/s12978-016-0215-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Maternal mortality ratio is 276 per 100,000 live births in Pakistan. Eclampsia is responsible for one in every ten maternal deaths despite the fact that management of this disease is inexpensive and has been available for decades. Many studies have shown that health care providers in low and middle-income countries have limited training to manage patients with eclampsia. Hence, we aimed to explore the knowledge of different cadres of health care providers regarding aetiology, diagnosis and treatment of pre-eclampsia and eclampsia and current management practices. Methods We conducted a mixed method study in the districts of Hyderabad and Matiari in Sindh province, Pakistan. Focus group discussions and interviews were conducted with community health care providers, which included Lady Health Workers and their supervisors; traditional birth attendants and facility care providers. In total seven focus groups and 26 interviews were conducted. NVivo 10 was used for analysis and emerging themes and sub-themes were drawn. Results All participants were providing care for pregnant women for more than a decade except one traditional birth attendant and two doctors. The most common cause of pre-eclampsia mentioned by community health care providers was stress of daily life: the burden of care giving, physical workload, short birth spacing and financial constraints. All health care provider groups except traditional birth attendants correctly identified the signs, symptoms, and complications of pre-eclampsia and eclampsia and were referring such women to tertiary health facilities. Only doctors were aware that magnesium sulphate is recommended for eclampsia management and prevention; however, they expressed fears regarding its use at first and secondary level health facilities. Conclusion This study found several gaps in knowledge regarding aetiology, diagnosis and treatment of pre-eclampsia among health care providers in Sindh. Findings suggest that lesser knowledge regarding management of pre-eclampsia is due to lack of refresher trainings and written guidelines for management of pre-eclampsia and presentation of fewer pre-eclamptic patients at first and secondary level health care facilities. We suggest to include management of pre-eclampsia in regular trainings of health care providers and to provide management protocols at all health facilities. Trial registration NCT01911494 Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0215-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sana Sheikh
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Asif Raza Khowaja
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan.,Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, Vancouver, V5Z 4H4, Canada
| | - Rehana Salam
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, Vancouver, V5Z 4H4, Canada
| | - Diane Sawchuck
- Department of Research, Vancouver Island Health Authority, Victoria, V8R 1J8, Canada
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, St George's, University of London, London, SW17 0RE, UK
| | - Shujat Zaidi
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar Bhutta
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan.,Program for Global Pediatric Research, Hospital for Sick Children, Toronto, M5G 2L3, Canada
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Boene H, Vidler M, Sacoor C, Nhama A, Nhacolo A, Bique C, Alonso P, Sawchuck D, Qureshi R, Macete E, Menéndez C, von Dadelszen P, Sevene E, Munguambe K. Community perceptions of pre-eclampsia and eclampsia in southern Mozambique. Reprod Health 2016; 13 Suppl 1:33. [PMID: 27357840 PMCID: PMC4943502 DOI: 10.1186/s12978-016-0135-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Sub-Saharan Africa has the highest maternal mortality ratio at 500 deaths per 100,000 live births. In Mozambique maternal mortality is estimated at 249-480 per 100,000 live births and eclampsia is the third leading cause of death. The objective of this study was to describe the community understanding of pre-eclampsia and eclampsia, as a crucial step to improve maternal and perinatal health in southern Mozambique. Methods This qualitative study was conducted in Maputo and Gaza Provinces of southern Mozambique. Twenty focus groups were convened with pregnant women, partners and husbands, matrons and traditional birth attendants, and mothers and mothers-in-law. In addition, ten interviews were conducted with traditional healers, matrons, and a traditional birth attendant. All discussions were audio-recorded, translated from local language (Changana) to Portuguese and transcribed verbatim prior to analysis with QSR NVivo 10. A thematic analysis approach was taken. Results The conditions of “pre-eclampsia” and “eclampsia” were not known in these communities; however, participants were familiar with hypertension and seizures in pregnancy. Terms linked with the biomedical concept of pre-eclampsia were high blood pressure, fainting disease and illness of the heart, whereas illness of the moon, snake illness, falling disease, childhood illness, illness of scaresand epilepsy were used to characterizeeclampsia. The causes of hypertension in pregnancy were thought to include mistreatment by in-laws, marital problems, and excessive worrying. Seizures in pregnancy were believed to be caused by a snake living inside the woman’s body. Warning signs thought to be common to both conditions were headache, chest pain, weakness, dizziness, fainting, sweating, and swollen feet. Conclusion Local beliefs in southern Mozambique, regarding the causes, presentation, outcomes and treatment of pre-eclampsia and eclampsia were not aligned with the biomedical perspective. The community was often unaware of the link between hypertension and seizures in pregnancy. The numerous widespread myths and misconceptions concerning pre-eclampsia and eclampsiamay induceinappropriatetreatment-seeking and demonstrate a need for increased community education regarding pregnancy and associated complications. Trial Registration NCT01911494 Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0135-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helena Boene
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charfudin Sacoor
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Abel Nhama
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Cassimo Bique
- Ministério da Saúde, Maputo, Mozambique.,Hospital Central de Maputo, Maputo, Mozambique
| | - Pedro Alonso
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.,Barcelona Institute for Global Health (ISGlobal)/Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Diane Sawchuck
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rahat Qureshi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Eusébio Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.,Ministério da Saúde, Maputo, Mozambique
| | - Clara Menéndez
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.,Barcelona Institute for Global Health (ISGlobal)/Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, British Columbia, Canada
| | - Esperança Sevene
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.,Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique. .,Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Mozambique.
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Vidler M, Ramadurg U, Charantimath U, Katageri G, Karadiguddi C, Sawchuck D, Qureshi R, Dharamsi S, Joshi A, von Dadelszen P, Derman R, Bellad M, Goudar S, Mallapur A. Utilization of maternal health care services and their determinants in Karnataka State, India. Reprod Health 2016; 13 Suppl 1:37. [PMID: 27356502 PMCID: PMC4943501 DOI: 10.1186/s12978-016-0138-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Karnataka State continues to have the highest rates of maternal mortality in south India at 144/100,000 live births, but lower than the national estimates of 190-220/100,000 live births. Various barriers exist to timely and appropriate utilization of services during pregnancy, childbirth and postpartum. This study aimed to describe the patterns and determinants of routine and emergency maternal health care utilization in rural Karnataka State, India. METHODS This study was conducted in Karnataka in 2012-2013. Purposive sampling was used to convene twenty three focus groups and twelve individual interviews with community and health system representatives: Auxiliary Nurse Midwives and Staff Nurses, Accredited Social Health Activists, community leaders, male decision-makers, female decision-makers, women of reproductive age, medical officers, private health care providers, senior health administrators, District health officers, and obstetricians. Local researchers familiar with the setting and language conducted all focus groups and interviews, these researchers were not known to community participants. All discussions were audio recorded, transcribed, and translated to English for analysis. A thematic analysis approach was taken utilizing an a priori thematic framework as well as inductive identification of themes. RESULTS Most women in the focus groups reported regular antenatal care attendance, for an average of four visits, and more often for high-risk pregnancies. Antenatal care was typically delivered at the periphery by non-specialised providers. Participants reported that sought was care women experienced danger signs of complications. Postpartum care was reportedly rare, and mainly sought for the purpose of neonatal care. Factors that influenced women's care-seeking included their limited autonomy, poor access to and funding for transport for non-emergent conditions, perceived poor quality of health care facilities, and the costs of care. CONCLUSIONS Rural south Indian communities reported regular use of health care services during pregnancy and for delivery. Uptake of maternity care services was attributed to new government programmes and increased availability of maternity services; nevertheless, some women delayed disclosure of pregnancy and first antenatal visit. Community-based initiatives should be enhanced to encourage early disclosure of pregnancies and to provide the community information regarding the importance of facility-based care. Health facility infrastructure in rural Karnataka should also be enhanced to ensure a consistent power supply and improved cleanliness on the wards. TRIAL REGISTRATION NCT01911494.
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Affiliation(s)
- Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada.
| | - Umesh Ramadurg
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka, India
| | - Umesh Charantimath
- KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Geetanjali Katageri
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka, India
| | | | - Diane Sawchuck
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada
| | - Rahat Qureshi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Shafik Dharamsi
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anjali Joshi
- KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada
| | - Richard Derman
- Department of Obstetrics, Christiana Care, Newark, DE, USA
| | - Mrutyunjaya Bellad
- KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Shivaprasad Goudar
- KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Ashalata Mallapur
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka, India
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Akeju DO, Vidler M, Oladapo OT, Sawchuck D, Qureshi R, von Dadelszen P, Adetoro OO, Dada OA. Community perceptions of pre-eclampsia and eclampsia in Ogun State, Nigeria: a qualitative study. Reprod Health 2016; 13 Suppl 1:57. [PMID: 27357695 PMCID: PMC4943493 DOI: 10.1186/s12978-016-0134-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-eclampsia is a complication of pregnancy responsible for high rates of morbidity and mortality, particularly in sub-Saharan Africa. When undetected or poorly managed, it may progress to eclampsia which further worsens the prognosis. While most studies examining pre-eclampsia have used a bio-medical model, this study recognizes the role of the socio-cultural environment, in order to understand perceptions of pre-eclampsia within the community. METHODS The study was conducted in Ogun State, Nigeria in 2011-2012. Data were obtained through twenty-eight focus group discussions; seven with pregnant women (N = 80), eight with new mothers (N = 95), three with male decision-makers (N = 35), six with community leaders (N = 68), and three with traditional birth attendants (N = 36). Interviews were also conducted with the heads of the local traditional birth attendants (N = 4) and with community leaders (N = 5). Data were transcribed verbatim and analysed in NVivo 10 software. RESULTS There was no terminology reportedly used for pre-eclampsia in the native language - Yoruba; however, hypertension has several terms independent of pregnancy status. Generally, 'gìrì âlábôyún' describes seizures specific to pregnancy. The cause of hypertension in pregnancy was thought to be due to depressive thoughts as a result of marital conflict and financial worries, while seizures in pregnancy were perceived to result from prolonged exposure to cold. There seemed to be no traditional treatment for hypertension. However for seizures the use of herbs, concoctions, incisions, and topical application of black soap were widespread. CONCLUSION This study illustrates that knowledge of pre-eclampsia and eclampsia are limited amongst communities of Ogun State, Nigeria. Findings reveal that pre-eclampsia was perceived as a stress-induced condition, while eclampsia was perceived as a product of prolonged exposure to cold. Thus, heat-related local medicines and herbal concoctions were the treatment options. Perceptions anchored on cultural values and lack of adequate and focused public health awareness is a major constraint to knowledge of the aetiology and treatment of the conditions. A holistic approach is recommended for sensitization at the community level and the need to change the community perceptions of pre-eclampsia remains a challenge. TRIAL REGISTRATION NCT01911494 .
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Affiliation(s)
- David O Akeju
- Department of Sociology, University of Lagos, Lagos, Nigeria.
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology and the Child and Family Research Unit, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olufemi T Oladapo
- 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
| | - Diane Sawchuck
- Department of Obstetrics and Gynaecology and the Child and Family Research Unit, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rahat Qureshi
- Department of Obstetrics and Gynaecology, Aga Khan University, Aga Khan, Pakistan
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology and the Child and Family Research Unit, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olalekan O Adetoro
- Department of Obstetrics and Gynaecology, Olabisi Onabanjo University, Sagamu, Ogun State, Nigeria.,Centre for Research in Reproductive Health, Sagamu, Ogun State, Nigeria
| | - Olukayode A Dada
- Centre for Research in Reproductive Health, Sagamu, Ogun State, Nigeria
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Khowaja AR, Qureshi RN, Sheikh S, Zaidi S, Salam R, Sawchuck D, Vidler M, von Dadelszen P, Bhutta Z. Community's perceptions of pre-eclampsia and eclampsia in Sindh Pakistan: a qualitative study. Reprod Health 2016; 13 Suppl 1:36. [PMID: 27357953 PMCID: PMC4943481 DOI: 10.1186/s12978-016-0136-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Maternal mortality is of global public health concern and >99 % of maternal deaths occur in less developed countries. The common causes of direct maternal death are hemorrhage, sepsis and pre-eclampsia/eclampsia. In Pakistan, pre-eclampsia/eclampsia deaths represents one-third of maternal deaths reported at the tertiary care hospital settings. This study explored community perceptions, and traditional management practices about pre-eclampsia/eclampsia. METHODS A qualitative study was conducted in Sindh Province of Pakistan from February to July 2012. Twenty-six focus groups were conducted, 19 with women of reproductive age/mothers-in-law (N = 173); and 7 with husbands/fathers-in-law (N = 65). The data were transcribed verbatim in Sindhi and Urdu, then analyzed for emerging themes and sub-themes using NVivo version 10 software. RESULTS Pre-eclampsia in pregnancy was not recognized as a disease and there was no name in the local languages to describe this. Women however, knew about high blood pressure and were aware they can develop it during pregnancy. It was widely believed that stress and weakness caused high blood pressure in pregnancy and it caused symptoms of headache. The perception of high blood pressure was not based on measurement but on symptoms. Self-medication was often used for headaches associated with high blood pressure. They were also awareness that severely high blood pressure could result in death. CONCLUSIONS Community-based participatory health education strategies are recommended to dispel myths and misperceptions regarding pre-eclampsia and eclampsia. The educational initiatives should include information on the presentation, progression of illness, danger signs associated with pregnancy, and appropriate treatment.
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Affiliation(s)
- Asif Raza Khowaja
- />Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
- />Department of Obstetrics and Gynecology, Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Rahat Najam Qureshi
- />Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sana Sheikh
- />Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shujaat Zaidi
- />Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rehana Salam
- />Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Diane Sawchuck
- />Department of Obstetrics and Gynecology, Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Marianne Vidler
- />Department of Obstetrics and Gynecology, Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Peter von Dadelszen
- />Department of Obstetrics and Gynecology, Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Zulfiqar Bhutta
- />Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
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Munguambe K, Boene H, Vidler M, Bique C, Sawchuck D, Firoz T, Makanga PT, Qureshi R, Macete E, Menéndez C, von Dadelszen P, Sevene E. Barriers and facilitators to health care seeking behaviours in pregnancy in rural communities of southern Mozambique. Reprod Health 2016; 13 Suppl 1:31. [PMID: 27356968 PMCID: PMC4943506 DOI: 10.1186/s12978-016-0141-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In countries, such as Mozambique, where maternal mortality remains high, the greatest contribution of mortality comes from the poor and vulnerable communities, who frequently reside in remote and rural areas with limited access to health care services. This study aimed to understand women's health care seeking practices during pregnancy, taking into account the underlying social, cultural and structural barriers to accessing timely appropriate care in Maputo and Gaza Provinces, southern Mozambique. METHODS This ethnographic study collected data through in-depth interviews and focus group discussions with women of reproductive age, including pregnant women, as well as household-level decision makers (partners, mothers and mothers-in-law), traditional healers, matrons, and primary health care providers. Data was analysed thematically using NVivo 10. RESULTS Antenatal care was sought at the heath facility for the purpose of opening the antenatal record. Women without antenatal cards feared mistreatment during labour. Antenatal care was also sought to resolve discomforts, such as headaches, flu-like symptoms, body pain and backache. However, partners and husbands considered lower abdominal pain as the only symptom requiring care and discouraged women from revealing their pregnancy early in gestation. Health care providers for pregnant women often included those at the health facility, matrons, elders, traditional birth attendants, and community health workers. Although seeking care from traditional healers was discouraged during the antenatal period, they did provide services during pregnancy and after delivery. Besides household-level decision-makers, matrons, community health workers, and neighbours were key actors in the referral of pregnant women. The decision-making process may be delayed and particularly complex if an emergency occurs in their absence. Limited access to transport and money makes the decision-making process to seek care at the health facility even more complex. CONCLUSIONS Women do seek antenatal care at health facilities, despite the presence of other health care providers in the community. There are important factors that prevent timely care-seeking for obstetric emergencies and delivery. Unfamiliarity with warning signs, especially among partners, discouragement from revealing pregnancy early in gestation, complex and untimely decision-making processes, fear of mistreatment by health-care providers, lack of transport and financial constraints were the most commonly cited barriers. Women of reproductive age would benefit from community saving schemes for transport and medication, which in turn would improve their birth preparedness and emergency readiness; in addition, pregnancy follow-up should include key family members, and community-based health care providers should encourage prompt referrals to health facilities, when appropriate. TRIAL REGISTRATION NCT01911494.
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Affiliation(s)
- Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Mozambique.
| | - Helena Boene
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Diane Sawchuck
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tabassum Firoz
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, British Columbia, Canada
| | - Prestige Tatenda Makanga
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Rahat Qureshi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Eusébio Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- Ministério da Saúde, Maputo, Mozambique
| | - Clara Menéndez
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, British Columbia, Canada
| | - Esperança Sevene
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Mozambique
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Khowaja AR, Qureshi RN, Sawchuck D, Oladapo OT, Adetoro OO, Orenuga EA, Bellad M, Mallapur A, Charantimath U, Sevene E, Munguambe K, Boene HE, Vidler M, Bhutta ZA, von Dadelszen P. The feasibility of community level interventions for pre-eclampsia in South Asia and Sub-Saharan Africa: a mixed-methods design. Reprod Health 2016; 13 Suppl 1:56. [PMID: 27357579 PMCID: PMC4943500 DOI: 10.1186/s12978-016-0133-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, pre-eclampsia and eclampsia are major contributors to maternal and perinatal mortality; of which the vast majority of deaths occur in less developed countries. In addition, a disproportionate number of morbidities and mortalities occur due to delayed access to health services. The Community Level Interventions for Pre-eclampsia (CLIP) Trial aims to task-shift to community health workers the identification and emergency management of pre-eclampsia and eclampsia to improve access and timely care. Literature revealed paucity of published feasibility assessments prior to initiating large-scale community-based interventions. Arguably, well-conducted feasibility studies can provide valuable information about the potential success of clinical trials prior to implementation. Failure to fully understand the study context risks the effective implementation of the intervention and limits the likelihood of post-trial scale-up. Therefore, it was imperative to conduct community-level feasibility assessments for a trial of this magnitude. METHODS A mixed methods design guided by normalization process theory was used for this study in Nigeria, Mozambique, Pakistan, and India to explore enabling and impeding factors for the CLIP Trial implementation. Qualitative data were collected through participant observation, document review, focus group discussion and in-depth interviews with diverse groups of community members, key informants at community level, healthcare providers, and policy makers. Quantitative data were collected through health facility assessments, self-administered community health worker surveys, and household demographic and health surveillance. RESULTS Refer to CLIP Trial feasibility publications in the current and/or forthcoming supplement. CONCLUSIONS Feasibility assessments for community level interventions, particularly those involving task-shifting across diverse regions, require an appropriate theoretical framework and careful selection of research methods. The use of qualitative and quantitative methods increased the data richness to better understand the community contexts. TRIAL REGISTRATION NCT01911494.
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Affiliation(s)
- Asif Raza Khowaja
- />Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
- />Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | | | - Diane Sawchuck
- />Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Olufemi T. Oladapo
- />Centre for Research in Reproductive Health (CRRH), Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State Nigeria
| | - Olalekan O. Adetoro
- />Centre for Research in Reproductive Health (CRRH), Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State Nigeria
| | - Elizabeth A. Orenuga
- />Centre for Research in Reproductive Health (CRRH), Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State Nigeria
| | - Mrutyunjaya Bellad
- />KLE University’s JN Medical College, Belgaum & SN Medical College, Bagalkot, India
| | - Ashalata Mallapur
- />KLE University’s JN Medical College, Belgaum & SN Medical College, Bagalkot, India
| | - Umesh Charantimath
- />KLE University’s JN Medical College, Belgaum & SN Medical College, Bagalkot, India
| | - Esperança Sevene
- />Manhiça Health Research Centre (CISM), Mozambique and Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Khátia Munguambe
- />Manhiça Health Research Centre (CISM), Mozambique and Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Helena Edith Boene
- />Manhiça Health Research Centre (CISM), Mozambique and Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Marianne Vidler
- />Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Zulfiqar A. Bhutta
- />Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Peter von Dadelszen
- />Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - CLIP Working Group
- />Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
- />Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, Vancouver, Canada
- />Centre for Research in Reproductive Health (CRRH), Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State Nigeria
- />KLE University’s JN Medical College, Belgaum & SN Medical College, Bagalkot, India
- />Manhiça Health Research Centre (CISM), Mozambique and Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
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Vidler M, Charantimath U, Katageri G, Ramadurg U, Karadiguddi C, Sawchuck D, Qureshi R, Dharamsi S, von Dadelszen P, Derman R, Goudar S, Mallapur A, Bellad M. Community perceptions of pre-eclampsia in rural Karnataka State, India: a qualitative study. Reprod Health 2016; 13 Suppl 1:35. [PMID: 27358068 PMCID: PMC4943492 DOI: 10.1186/s12978-016-0137-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Maternal deaths have been attributed in large part to delays in recognition of illness, timely transport to facility, and timely treatment once there. As community perceptions of pregnancy and their complications are critical to averting maternal morbidity and mortality, this study sought to contribute to the literature and explore community-based understandings of pre-eclampsia and eclampsia. Methods The study was conducted in rural Karnataka State, India, in 2012–2013. Fourteen focus groups were held with the following community stakeholders: three with community leaders (n = 27), two with male decision-makers (n = 19), three with female decision-makers (n = 41), and six with reproductive age women (n = 132). Focus groups were facilitated by local researchers with clinical and research expertise. Discussions were audio-recorded, transcribed verbatim and translated to English for thematic analysis using NVivo 10. Results Terminology exists in the local language (Kannada) to describe convulsions and hypertension, but there were no terms that are specific to pregnancy. Community participants perceived stress, tension and poor diet to be precipitants of hypertension in pregnancy. Seizures in pregnancy were thought to be brought on by anaemia, poor medical adherence, lack of tetanus toxoid immunization, and exposure in pregnancy to fire or water. Sweating, fatigue, dizziness-unsteadiness, swelling, and irritability were perceived to be signs of hypertension, which was recognized to have the potential to lead to eclampsia or death. Home remedies, such as providing the smell of onion, placing an iron object in the hands, or squeezing the fingers and toes, were all used regularly to treat seizures prior to accessing facility-based care although transport is not delayed. Conclusions It is evident that ‘pre-eclampsia’ and ‘eclampsia’ are not well-known; instead hypertension and seizures are perceived as conditions that may occur during or outside pregnancy. Improving community knowledge about, and modifying attitudes towards, hypertension in pregnancy and its complications (including eclampsia) has the potential to address community-based delays in disease recognition and delays in treatment that contribute to maternal and perinatal morbidity and mortality. Advocacy and educational initiatives should be designed to target knowledge gaps and potentially harmful practices, and respond to cultural understandings of disease. Trial registration NCT01911494 Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0137-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada.
| | - Umesh Charantimath
- KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Geetanjali Katageri
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka, India
| | - Umesh Ramadurg
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka, India
| | | | - Diane Sawchuck
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada
| | - Rahat Qureshi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Shafik Dharamsi
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada
| | - Richard Derman
- Department of Obstetrics, Christiana Care, Wilmington, Delaware, United States
| | - Shivaprasad Goudar
- KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Ashalata Mallapur
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka, India
| | - Mrutyunjaya Bellad
- KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
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Qureshi RN, Sheikh S, Khowaja AR, Hoodbhoy Z, Zaidi S, Sawchuck D, Vidler M, Bhutta ZA, von Dadeslzen P. Health care seeking behaviours in pregnancy in rural Sindh, Pakistan: a qualitative study. Reprod Health 2016; 13 Suppl 1:34. [PMID: 27356863 PMCID: PMC4943512 DOI: 10.1186/s12978-016-0140-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pakistan has alarmingly high numbers of maternal mortality along with suboptimal care-seeking behaviour. It is essential to identify the barriers and facilitators that women and families encounter, when deciding to seek maternal care services. This study aimed to understand health-seeking patterns of pregnant women in rural Sindh, Pakistan. METHODS A qualitative study was undertaken in rural Sindh, Pakistan as part of a large multi-country study in 2012. Thirty three focus group discussions and 26 in-depth interviews were conducted with mothers [n = 173], male decision-makers [n = 64], Lady Health Workers [n = 64], Lady Health Supervisors [n = 10], Women Medical Officers [n = 9] and Traditional Birth Attendants [n = 7] in the study communities. A set of a priori themes regarding care-seeking during pregnancy and its complications as well as additional themes as they emerged from the data were used for analysis. Qualitative analysis was done using NVivo version 10. RESULTS Women stated they usually visited health facilities if they experienced pregnancy complications or danger signs, such as heavy bleeding or headache. Findings revealed the importance of husbands and mothers-in-law as decision makers regarding health care utilization. Participants expressed that poor availability of transport, financial constraints and the unavailability of chaperones were important barriers to seeking care. In addition, private facilities were often preferred due to the perceived superior quality of services. CONCLUSION Maternal care utilization was influenced by social, economic and cultural factors in rural Pakistani communities. The perceived poor quality care at public hospitals was a significant barrier for many women in accessing health services. If maternal lives are to be saved, policy makers need to develop processes to overcome these barriers and ensure easily accessible high-quality care for women in rural communities. TRIAL REGISTRATION NCT01911494.
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Affiliation(s)
| | - Sana Sheikh
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Asif Raza Khowaja
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan.,Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Zahra Hoodbhoy
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Shujaat Zaidi
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Diane Sawchuck
- Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Zulfiqar A Bhutta
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan.,Program for Global Pediatric Research, Hospital for Sick Children, Toronto, Canada
| | - Peter von Dadeslzen
- Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, Vancouver, Canada
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Akeju DO, Oladapo OT, Vidler M, Akinmade AA, Sawchuck D, Qureshi R, Solarin M, Adetoro OO, von Dadelszen P. Determinants of health care seeking behaviour during pregnancy in Ogun State, Nigeria. Reprod Health 2016; 13 Suppl 1:32. [PMID: 27356754 PMCID: PMC4943510 DOI: 10.1186/s12978-016-0139-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Nigeria, women too often suffer the consequences of serious obstetric complications that may lead to death. Delay in seeking care (phase I delay) is a recognized contributor to adverse pregnancy outcomes. This qualitative study aimed to describe the health care seeking practices in pregnancy, as well as the socio-cultural factors that influence these actions. METHODS The study was conducted in Ogun State, in south-western Nigeria. Data were collected through focus group discussions with pregnant women, recently pregnant mothers, male decision-makers, opinion leaders, traditional birth attendants, health workers, and health administrators. A thematic analysis approach was used with QSR NVivo version 10. RESULTS Findings show that women utilized multiple care givers during pregnancy, with a preference for traditional providers. There was a strong sense of trust in traditional medicine, particularly that provided by traditional birth attendants who are long-term residents in the community. The patriarchal c influenced health-seeking behaviour in pregnancy. Economic factors contributed to the delay in access to appropriate services. There was a consistent concern regarding the cost barrier in accessing health services. The challenges of accessing services were well recognised and these were greater when referral was to a higher level of care which in most cases attracted unaffordable costs. CONCLUSION While the high cost of care is a deterrent to health seeking behaviour, the cost of death of a woman or a child to the family and community is immeasurable. The use of innovative mechanisms for health care financing may be beneficial for women in these communities to reduce the barrier of high cost services. To reduce maternal deaths all stakeholders must be engaged in the process including policy makers, opinion leaders, health care consumers and providers. Underlying socio-cultural factors, such as structure of patriarchy, must also be addressed to sustainably improve maternal health. TRIAL REGISTRATION NCT01911494.
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Affiliation(s)
- David O. Akeju
- />Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Olufemi T. Oladapo
- />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
| | - Marianne Vidler
- />Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC Canada
| | | | - Diane Sawchuck
- />Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC Canada
| | - Rahat Qureshi
- />Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan
| | - Muftaut Solarin
- />Directorate Division of Medical and Health Care Services, Ijebu Ode Local Government Secretariat, Ijebu Ode, Ogun State Nigeria
| | - Olalekan O. Adetoro
- />Centre for Research in Reproductive Health, Sagamu, Ogun State Nigeria
- />Department of Obstetrics and Gynaecology, Olabisi Onabanjo University, Sagamu, Ogun State Nigeria
| | - Peter von Dadelszen
- />Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC Canada
| | - and the CLIP Nigeria Feasibility Working Group
- />Department of Sociology, University of Lagos, Lagos, Nigeria
- />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
- />Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC Canada
- />Centre for Research in Reproductive Health, Sagamu, Ogun State Nigeria
- />Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan
- />Directorate Division of Medical and Health Care Services, Ijebu Ode Local Government Secretariat, Ijebu Ode, Ogun State Nigeria
- />Department of Obstetrics and Gynaecology, Olabisi Onabanjo University, Sagamu, Ogun State Nigeria
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De Silva DA, Sawchuck D, von Dadelszen P, Basso M, Synnes AR, Liston RM, Magee LA. Magnesium Sulphate for Eclampsia and Fetal Neuroprotection: A Comparative Analysis of Protocols Across Canadian Tertiary Perinatal Centres. J Obstet Gynaecol Can 2016; 37:975-87. [PMID: 26629718 DOI: 10.1016/s1701-2163(16)30047-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Magnesium sulphate (MgSO4) has been recommended for fetal neuroprotection to prevent cerebral palsy, with national societies adopting new guidelines for its use. A knowledge translation project to implement Canadian guidelines is ongoing. Discussion about MgSO4 for fetal neuroprotection could not occur distinct from MgSO4 for eclampsia prophylaxis and treatment. Thus, in order to explore standardization of MgSO4 use in Canada, we sought to compare local protocols for eclampsia and fetal neuroprotection across tertiary perinatal centres. METHODS Twenty-five Canadian tertiary perinatal centres were asked to submit their protocols for use of MgSO4 for eclampsia prophylaxis/treatment and fetal neuroprotection. Information abstracted included date of protocol, definitions of indications for treatment, details of MgSO4 administration, maternal and fetal monitoring, antidote for toxicity, and abnormal signs requiring physician attention. Descriptive analyses were used to compare site protocols with known definitions of preeclampsia. Data from the Canadian Perinatal Network (CPN) were used to verify what was done in clinical practice. RESULTS Twenty-two of the 25 centres submitted protocols for eclampsia prevention/treatment. Eleven of these provided a definition of preeclampsia that warranted treatment; five of the 22 advised treatment of severe preeclampsia only. Criteria for treatment and monitoring procedures varied across centres. Sixteen of the 22 sites with protocols had data from the CPN. Of 635 women with pre-eclampsia, 422 (66.5%) received MgSO4. Twenty of 25 centres provided protocols for fetal neuroprotection. Definitions of indications were consistent across sites, except for gestational age cut-off. CONCLUSION This study suggests that local protocols are often inconsistent with published evidence. While this may be related to local institutional practices, relevant processes must be put in place to maximize uniformity of practice and improve patient care.
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Affiliation(s)
- Dane A De Silva
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC
| | - Diane Sawchuck
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC
| | - Melanie Basso
- Children's and Women's Health Centre of British Columbia, Vancouver BC
| | - Anne R Synnes
- Child and Family Research Institute, University of British Columbia, Vancouver BC; Department of Pediatrics, University of British Columbia, Vancouver BC
| | - Robert M Liston
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC
| | - Laura A Magee
- Child and Family Research Institute, University of British Columbia, Vancouver BC; Department of Medicine, University of British Columbia, Vancouver BC; Department of Medicine, British Columbia Women's Hospital and Health Centre, Vancouver BC
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Teela KC, De Silva DA, Chapman K, Synnes AR, Sawchuck D, Basso M, Liston RM, von Dadelszen P, Magee LA. Magnesium sulphate for fetal neuroprotection: benefits and challenges of a systematic knowledge translation project in Canada. BMC Pregnancy Childbirth 2015; 15:347. [PMID: 26694323 PMCID: PMC4688933 DOI: 10.1186/s12884-015-0785-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 12/10/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Administration of magnesium sulphate (MgSO4) to women with imminent preterm birth at <34 weeks is an evidence-based antenatal neuroprotective strategy to prevent cerebral palsy. Although a Society of Obstetricians and Gynaecologists of Canada (SOGC) national guideline with practice recommendations based on relevant clinical evidence exists, ongoing controversies about aspects of this treatment remain. Given this, we anticipated managed knowledge translation (KT) would be needed to facilitate uptake of the guidelines into practice. As part of the Canadian Institutes of Health Research (CIHR)-funded MAG-CP (MAGnesium sulphate to prevent Cerebral Palsy) project, we aimed to compare three KT methods designed to impact both individual health care providers and the organizational systems in which they work. METHODS The KT methods undertaken were an interactive online e-learning module available to all SOGC members, and at MAG-CP participating sites, on-site educational rounds and focus group discussions, and circulation of an anonymous 'Barriers and Facilitators' survey for the systematic identification of facilitators and barriers for uptake of practice change. We compared these strategies according to: (i) breadth of respondents reached; (ii) rates and richness of identified barriers, facilitators, and knowledge needed; and (iii) cost. RESULTS No individual KT method was superior to the others by all criteria, and in combination, they provided richer information than any individual method. The e-learning module reached the most diverse audience of health care providers, the site visits provided opportunity for iterative dialogue, and the survey was the least expensive. Although the site visits provided the most detailed information around individual and organizational barriers, the 'Barriers and Facilitators' survey provided more detail regarding social-level barriers. The facilitators identified varied by KT method. The type of knowledge needed was further defined by the e-learning module and surveys. CONCLUSIONS Our findings suggest that a multifaceted approach to KT is optimal for translating national obstetric guidelines into clinical practice. As audit and feedback are essential parts of the process by which evidence to practice gaps are closed, MAG-CP is continuing the iterative KT process described in this paper concurrent with tracking of MgSO4 use for fetal neuroprotection and maternal and child outcomes until September 2015; results are anticipated in 2016.
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Affiliation(s)
| | - Dane A De Silva
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada.
- Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
| | - Katie Chapman
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada.
| | - Anne R Synnes
- Division of Neonatology, Department of Paediatrics, University of British Columbia, Vancouver, Canada.
| | - Diane Sawchuck
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada.
| | - Melanie Basso
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada.
| | - Robert M Liston
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada.
| | - Peter von Dadelszen
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada.
- Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
| | - Laura A Magee
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada.
- Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
- Department of Medicine, University of British Columbia and British Columbia Women's Hospital and Health Centre, Vancouver, Canada.
- University of London, Cranmer Terrace, Rm J0.27, Jenner Wing, St. George's, SW17, London, 0RE, UK.
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Akeju DO, Vidler M, Oladapo OT, Sawchuck D, Qureshi R, von Dadelszen P, Adetoro OO, Dada K. [202-POS]. Pregnancy Hypertens 2015. [DOI: 10.1016/j.preghy.2014.10.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Vidler M, Charanthimath U, Katageri G, Ramadurg U, Karadiguddi C, Sawchuck D, Qureshi R, Dharamsi S, Dadelszen PV, Derman R, Goudar S, Mallapur A, Bellad M. [211-POS]. Pregnancy Hypertens 2015. [DOI: 10.1016/j.preghy.2014.10.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nensi A, De Silva DA, von Dadelszen P, Sawchuck D, Synnes AR, Crane J, Magee LA. Effect of Magnesium Sulphate on Fetal Heart Rate Parameters: A Systematic Review. Journal of Obstetrics and Gynaecology Canada 2014; 36:1055-1064. [DOI: 10.1016/s1701-2163(15)30382-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gordon R, Magee LA, Payne B, Firoz T, Sawchuck D, Tu D, Vidler M, de Silva D, von Dadelszen P. Magnesium sulphate for the management of preeclampsia and eclampsia in low and middle income countries: a systematic review of tested dosing regimens. J Obstet Gynaecol Can 2014; 36:154-163. [PMID: 24518915 DOI: 10.1016/s1701-2163(15)30662-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To review systematically the magnesium sulphate (MgSO4) dosing regimens tested in low and middle income countries (LMICs) for women with preeclampsia (prevention) and/or eclampsia (treatment). DATA SOURCES We searched Medline, EMBASE, IPA, CINAHL, CDSR, and CENTRAL databases for relevant English language publications. STUDY SELECTION Our search yielded 753 publications, of which 26 (10 randomized controlled trials and 16 observational studies) evaluated MgSO4 for preeclampsia and/or eclampsia in World Bank-classified LMICs. DATA EXTRACTION Independent, by two authors. DATA SYNTHESIS Twenty-five studies were conducted in hospital settings and one in the community. Rates of eclampsia were usually < 5% (median 3.0%, range 0.0% to 26.5%) even when MgSO4 was administered for eclampsia. When dosage varied from the standard Pritchard or Zuspan regimens, almost all (n = 22) reduced the dose or duration of treatment, most commonly because of concerns about maternal safety, cost, or resource availability. Four trials of a loading dose only (4 g IV + 10 g IM) versus loading plus maintenance dosing of 5 g/4 hr IM found no difference in eclampsia recurrence (RR 1.64; 95% CI 0.48 to 5.65, n = 396). One study documented less eclampsia recurrence associated with community administration of a MgSO4 loading dose before referral to a care facility versus treatment in a care facility (RR 0.23; 95% CI 0.11 to 0.49, n = 265). CONCLUSION Use of MgSO4 for eclampsia treatment and prevention has been well-studied in LMICs, but concern remains about potential toxicity. Further studies are needed to identify the minimum effective dosage of MgSO4 for management of preeclampsia and eclampsia and whether MgSO4 loading can be safely administered in the community.
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Affiliation(s)
- Rebecca Gordon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC
| | - Beth Payne
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Department of Medicine, University of British Columbia, Vancouver BC
| | - Tabassum Firoz
- Department of Medicine, University of British Columbia, Vancouver BC
| | - Diane Sawchuck
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC
| | - Domena Tu
- Child and Family Research Institute, University of British Columbia, Vancouver BC
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC
| | - Dane de Silva
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Department of Medicine, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC
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Bickford CD, Magee LA, Mitton C, Kruse M, Synnes AR, Sawchuck D, Basso M, Senikas VM, von Dadelszen P. Magnesium sulphate for fetal neuroprotection: a cost-effectiveness analysis. BMC Health Serv Res 2013; 13:527. [PMID: 24350635 PMCID: PMC3878233 DOI: 10.1186/1472-6963-13-527] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 12/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the cost-effectiveness of administering magnesium sulphate to patients in whom preterm birth at < 32+0 weeks gestation is either imminent or threatened for the purpose of fetal neuroprotection. METHODS Multiple decision tree models and probabilistic sensitivity analyses were used to compare the administration of magnesium sulphate with the alternative of no treatment. Two separate cost perspectives were utilized in this series of analyses: a health system and a societal perspective. In addition, two separate measures of effectiveness were utilized: cases of cerebral palsy (CP) averted and quality-adjusted life years (QALYs). RESULTS From a health system and a societal perspective, respectively, a savings of $2,242 and $112,602 is obtained for each QALY gained and a savings of $30,942 and $1,554,198 is obtained for each case of CP averted when magnesium sulphate is administered to patients in whom preterm birth is imminent. From a health system perspective and a societal perspective, respectively, a cost of $2,083 is incurred and a savings of $108,277 is obtained for each QALY gained and a cost of $28,755 is incurred and a savings of $1,494,500 is obtained for each case of CP averted when magnesium sulphate is administered to patients in whom preterm birth is threatened. CONCLUSIONS Administration of magnesium sulphate to patients in whom preterm birth is imminent is a dominant (i.e. cost-effective) strategy, no matter what cost perspective or measure of effectiveness is used. Administration of magnesium sulphate to patients in whom preterm birth is threatened is a dominant strategy from a societal perspective and is very likely to be cost-effective from a health system perspective.
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Affiliation(s)
- Celeste D Bickford
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Leduc D, Biringer A, Lee L, Dy J, Corbett T, Leduc D, Biringer A, Duperron L, Dy J, Lange I, Lee L, Muise S, Parish B, Regush L, Wilson K, Yeung G, Crane J, Gagnon R, Sawchuck D, Senikas V. Déclenchement du travail. Journal of Obstetrics and Gynaecology Canada 2013. [DOI: 10.1016/s1701-2163(15)30843-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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von Dadelszen P, Sawchuck D, Justus Hofmeyr G, Magee LA, Bracken H, Mathai M, Tsigas EZ, Teela KC, Donnay F, Roberts JM. PRE-EMPT (PRE-eclampsia-Eclampsia Monitoring, Prevention and Treatment): A low and middle income country initiative to reduce the global burden of maternal, fetal and infant death and disease related to pre-eclampsia. Pregnancy Hypertens 2013; 3:199-202. [PMID: 26103796 DOI: 10.1016/j.preghy.2013.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 06/04/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Peter von Dadelszen
- Department of Obstetrics and Gynaecology and Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada.
| | - Diane Sawchuck
- Department of Obstetrics and Gynaecology and Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - G Justus Hofmeyr
- Effective Care Research Unit, University of Witwatersrand and Fort Hare, Eastern Cape Department of Health, South Africa
| | - Laura A Magee
- Department of Obstetrics and Gynaecology and Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | - James M Roberts
- Magee-Women's Research Institute, Department of Obstetrics and Gynecology, Epidemiology and Clinical and Translational Research, University of Pittsburgh, Pittsburgh, PA, USA
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von Dadelszen P, Firoz T, Donnay F, Gordon R, Justus Hofmeyr G, Lalani S, Payne BA, Roberts JM, Teela KC, Vidler M, Sawchuck D, Magee LA. Preeclampsia in Low and Middle Income Countries—Health Services Lessons Learned From the PRE-EMPT (PRE-Eclampsia–Eclampsia Monitoring, Prevention & Treatment) Project. Journal of Obstetrics and Gynaecology Canada 2012; 34:917-926. [DOI: 10.1016/s1701-2163(16)35405-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Firoz T, Magee L, Lalani S, Sawchuck D, Payne B, Vidler M, Gordon R, von Dadelszen P. PP088. Oral antihypertensive therapy for severe hypertension in pregnancy. Pregnancy Hypertens 2012; 2:288. [DOI: 10.1016/j.preghy.2012.04.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gordon RM, Payne B, Firoz T, Magee L, Sawchuck D, Tu D, Vidler M, von Dadelszen P. PP164. Magnesium sulphate for prevention and treatment of eclampsia in low and middle income countries: Systematic review of tested regimens. Pregnancy Hypertens 2012; 2:328. [PMID: 26105485 DOI: 10.1016/j.preghy.2012.04.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Magnesium sulphate (MgSO4) is regarded as the most effective prophylactic and therapeutic agent for eclampsia. Although well studied and widely used in high income countries (HICs), MgSO4 is under utilized in low and middle income countries (LMICs) due to many factors including lack of adequately trained health care providers, supplies for administration, or the MgSO4 itself, in addition to fear of potential adverse effects. OBJECTIVES To systematically review the dosing and effectiveness of MgSO4 regimens administered in LMICs to women with pre-eclampsia or eclampsia. METHODS We searched Medline, EMBASE, IPA, CINAHL, CDSR and CENTRAL databases for English language randomized controlled trials (RCT) and observational studies of MgSO4 regimens administered in LMICs to women with pre-eclampsia or eclampsia. Two authors independently reviewed search results and extracted relevant data from eligible studies. No quality assessment was performed. RESULTS Twenty two papers (7 RCT and 15 observational studies) from 12 LMIC met our inclusion criteria, of which 21 were conducted in hospital settings. Two studied MgSO4 for eclampsia prevention ,14 for eclampsia treatment and 6 studied MgSO4 for both. In 20 studies, both loading and maintenance MgSO4 dosing was administered, with intravenous (IV) or combined IV and intramuscular (IM) loading doses of 4-15g and IV or IM maintenance doses up to 2g/h. Five studies used only the IV route of administration, while the remainder coupled IV with IM administration. All studies were effective at preventing the initiation and/or recurrence of eclamptic seizures. One study of 265 women with eclampsia found that MgSO4 loading dose administration in the community (4g IV over 20min plus 3g IM in each buttock) before referral and administration of maintenance therapy in hospital was more effective in decreasing recurrent eclampsia compared with the standard practice of referral to hospital where the initial dose of MgSO4 was administered [RR of 0.23, 95% CI 0.11, 0.49]. The two studies of 4g IV plus 10g IM loading dose-only regimens did not show a significant reduction in eclamptic seizures compared with identical loading dose plus 5g/4h IM maintenance dose regimens [RR of 1.38, 95% CI of 0.23, 8.45]. However the combined sample size was small (N=180 women). CONCLUSION In LMICs, most studies of MgSO4 for pre-eclampsia or eclampsia were conducted in high level health care facilities and administered MgSO4 by the IV route, at least in part. The one study of community administration of a MgSO4 loading dose showed this approach to be effective. There are limited data to support loading dose-only regimens.
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Affiliation(s)
- R M Gordon
- Obstetrics and Gynaecology, Vancouver, Canada
| | - B Payne
- Obstetrics and Gynaecology, Vancouver, Canada
| | - T Firoz
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - L Magee
- Department of Medicine, The University of British Columbia, Vancouver, Canada; Department of Specialized Women's Health, British Columbia Women's Hospital & Health Centre, Vancouver, Canada; Child and Family Research Institute, Vancouver, Canada
| | - D Sawchuck
- Obstetrics and Gynaecology, Vancouver, Canada
| | - D Tu
- Child and Family Research Institute, Vancouver, Canada
| | - M Vidler
- Obstetrics and Gynaecology, Vancouver, Canada
| | - P von Dadelszen
- Obstetrics and Gynaecology, Vancouver, Canada; Child and Family Research Institute, Vancouver, Canada; Maternal and Fetal Medicine, British Columbia Women's Hospital & Health Centre, Vancouver, Canada
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Lalani S, Firoz T, Magee LA, Lowe R, Sawchuck D, Payne B, Gordon R, Vidler M, von Dadelszen P. OS032. Pharmacotherapy for pre-eclampsia in low and middle income countries: An analysis of essential medicines lists (EMLS). Pregnancy Hypertens 2012; 2:193-4. [PMID: 26105246 DOI: 10.1016/j.preghy.2012.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
INTRODUCTION Pre-eclampsia is the second leading cause of maternal mortality in low and middle income countries (LMIC). Pharmacological management of pre-eclampsia has five major components including antihypertensive therapy for severe and non-severe hypertension, magnesium sulphate for prevention or treatment of eclampsia, treatment of pre-eclampsia-related end-organ complications, antenatal corticosteroids for acceleration of fetal pulmonary maturity given iatrogenic preterm delivery for maternal and/or fetal indications, and labour induction for such indicated deliveries. Essential medicines are defined by the World Health Organization (WHO) as "drugs that satisfy the health care needs of the majority of the population". Essential Medicines Lists (EMLs) detail these essential medicines within an individual country and support the argument that the medication should be routinely available. OBJECTIVES To determine how many drugs required for comprehensive pre-eclampsia management are listed in national EMLs of LMIC. METHODS We conducted a descriptive analysis of relevant drug prevalence on identified EMLs. We searched for the national EMLs of the 144 LMIC identified by the World Bank. EMLs were collected by broad based internet searches and in collaboration with the WHO. The EMLs were surveyed for therapies for the different aspects of pre-eclampsia management: hypertension (non-severe and severe with oral or parenteral agents), eclampsia, pre-eclampsia complications (e.g., pulmonary oedema, thrombosis), preterm birth, and labour induction. RESULTS EMLs were located and reviewed for 58(40.3%) of LMIC. One or more parenteral antihypertensive agents were listed in 51(87.9%) EMLs. The most common agents were: hydralazine (67.2%), verapamil (58.6%), propranolol (39.7%) and sodium nitroprusside (37.9%); parenteral labetalol was listed by only 19.0% of EMLs. The most prevalent oral antihypertensive therapies listed were: nifedipine (96.6%, usually 10 or 20mg intermediate-acting tablets), methyldopa (94.8%), propranolol (89.7%), and atenolol (87.9%). Captopril, enalapril, hydrochlorothiazide and spironolactone were commonly listed. Magnesium sulphate for prevention and management of eclampsia was present in 86.2% of EMLs (and its antidote, calcium gluconate in 82.8%). To manage complications of pre-eclampsia, oral frusemide was listed in 94.8% of EMLs and parenteral heparin in 91.4%. Most EMLs listed parenteral dexamethasone (91.4%) for acceleration of fetal pulmonary maturity and oxytocin (98.3%) or a prostanoid (usually misoprostol, 39.7%) for labour induction. CONCLUSION EMLs of LMIC provide comprehensive coverage of all aspects of recommended pre-eclampsia pharmacotherapy. These EMLs may be used as advocacy tools to ensure the availability of these therapies within each country.
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Affiliation(s)
| | | | - L A Magee
- Clinical Professor of Medicine; Child and Family Research Institute; Obstetric Medicine, Children's and Women's Hospital and Health Centre, Vancouver, Canada
| | - R Lowe
- Maternal and Child Health Integrated Program, Washington, D.C., United States
| | - D Sawchuck
- Child and Family Research Institute; Obstetrics and Gynaecology, University of British Columbia
| | - B Payne
- Obstetrics and Gynaecology, University of British Columbia
| | - R Gordon
- Obstetrics and Gynaecology, University of British Columbia
| | - M Vidler
- Obstetrics and Gynaecology, University of British Columbia
| | - P von Dadelszen
- Obstetrics and Gynaecology, University of British Columbia; Maternal Fetal Medicine-Obstetrics and Gynaecology, Children's and Women's Health Centre of BC, Vancouver, Canada
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Magee L, Sawchuck D, Synnes A, von Dadelszen P, Basso M, Crane JM, Doyle L, Ehman W, Gagnon R, Grobman W, Helewa M, Joseph K, Martel J, Miller S, Okun N, Rouse D, Senikas V, Sherlock R, Skoll A, Smith G, Wagner B, Wavrant S, Douglas Wilson R, Hutcheon J, Gagnon R, Hudon L, Basso M, Bos H, Crane JM, Davies G, Delisle MF, Menticoglou S, Mundle W, Ouellet A, Pressey T, Pylypjuk C, Roggensack A, Sanderson FL. Archivée: Recours au sulfate de magnésium à des fins de neuroprotection fœtale. Journal of Obstetrics and Gynaecology Canada 2011. [DOI: 10.1016/s1701-2163(16)34887-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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von Dadelszen P, Sawchuck D, McMaster R, Saunders S, Liston R, Magee L. O981 The active management of guidelines: assessing the implementation of regional guidelines for the diagnosis and management of the hypertensive disorders of pregnancy. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61354-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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