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Nakisige C, de Fouw M, Nakalembe M, Orem J, Atukonyera D, Musheshe M, Koot J, de Zeeuw J, Beltman J, Stekelenburg J. Baseline knowledge on risk factors, symptoms and intended behavior of women and men towards screening and treatment of cervical cancer in rural Uganda: a cross-sectional study. BMC Cancer 2024; 24:450. [PMID: 38605317 PMCID: PMC11008004 DOI: 10.1186/s12885-024-12223-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Knowledge of risk factors and symptoms of cervical cancer has been found to promote uptake of screening of cervical cancer. Most interventions targeted women without much involvement of men (husbands/decision makers) who are often decision makers in many low- and middle-income countries. This study aimed at assessing baseline knowledge and intended behavior of both women and men to enable design specific targeted messages to increase uptake of cervical cancer screening and promote early detection of women with symptoms. METHODS This cross-sectional study was conducted in two districts in Western Uganda using the modified African Women Awareness of CANcer (AWACAN) questionnaire. Women aged 30-49 years and their husbands/decision makers were interviewed. Knowledge on risk factors and symptoms, intended behavior and barriers towards participation in cervical cancer screening and treatment were assessed. Descriptive and logistic regression analyses were done to establish the association between knowledge levels and other factors comparing women to men. RESULTS A total of 724 women and 692 men were enrolled. Of these, 71.0% women and 67.2% men had ever heard of cervical cancer and 8.8% women had ever been screened. Knowledge of risk factors and symptoms of cervical cancer was high and similar for both women and men. Lack of decision making by women was associated with low knowledge of risk factors (X2 = 14.542; p = 0.01), low education (X2 = 36.05, p < 0.01) and older age (X2 = 17.33, p < 0.01). Men had better help seeking behavior than women (X2 = 64.96, p < 0.01, OR = 0.39, 95% CI: 0.31-0.50) and were more confident and skilled in recognising a sign or symptom of cervical cancer (X2 = 27.28, p < 0.01, OR = 0.52, CI (0.40-0.67). CONCLUSION The baseline knowledge for cervical cancer was high in majority of participants and similar in both women and men. Their intended behavior towards screening was also positive but screening uptake was very low. This study suggests developing messages on multiple interventions to promote screening behavior in addition to education, consisting of male involvement, women empowerment and making services available, accessible and women friendly.
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Affiliation(s)
- Carolyn Nakisige
- Department of Gynaecologic-Oncology, Uganda Cancer Institute, Kampala, Uganda.
| | - Marlieke de Fouw
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Jackson Orem
- Department of Gynaecologic-Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Dan Atukonyera
- Uganda Rural Development Training Program, Kagadi, Uganda
| | | | - Jaap Koot
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Janine de Zeeuw
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jogchum Beltman
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynecology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Tura AK, Knight M, Girma S, Ahmed R, Yuya M, Bekele D, Hassen TA, Stekelenburg J, van den Akker T. Characteristics and outcomes of pregnant women hospitalized with severe maternal outcomes in eastern Ethiopia: Results from the Ethiopian Obstetric Surveillance System study. Int J Gynaecol Obstet 2024; 164:714-720. [PMID: 37961999 PMCID: PMC10952177 DOI: 10.1002/ijgo.15240] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE The aim of the present study was to identify facility-based incidence of severe obstetric complications through a newly established obstetric surveillance system in eastern Ethiopia. METHODS Monthly registration of obstetric hemorrhage, eclampsia, uterine rupture, severe anemia and sepsis was introduced in 13 maternity units in eastern Ethiopia. At each hospital, a designated clinician reported details of women admitted during pregnancy, childbirth or within 42 days of termination of pregnancy from April 01, 2021 to March 31, 2022 developing any of these conditions. Detailed data on sociodemographic characteristics, obstetric complications and status at discharge were collected by trained research assistants. RESULTS Among 38 782 maternities during the study period, 2043 (5.3%) women had any of the five conditions. Seventy women died, representing a case fatality rate of 3.4%. The three leading reasons for admission were obstetric hemorrhage (972; 47.6%), severe anemia (727; 35.6%), and eclampsia (438; 21.4%). The majority of the maternal deaths were from obstetric hemorrhage (27/70; 38.6%) followed by eclampsia (17/70; 24.3%). CONCLUSION Obstetric hemorrhage, severe anemia and eclampsia were the leading causes of severe obstetric complications in eastern Ethiopia. Almost one in 29 women admitted with obstetric complications died. Audit of quality of care is indicated to design tailored interventions to improve maternal survival and obstetric complications.
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Affiliation(s)
- Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical SciencesHaramaya UniversityHararEthiopia
- Department of Obstetrics and GynecologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Marian Knight
- National Perinatal Epidemiology UnitUniversity of OxfordOxfordUK
| | - Sagni Girma
- School of Nursing and Midwifery, College of Health and Medical SciencesHaramaya UniversityHararEthiopia
- Department of Obstetrics and GynecologyLeiden University Medical CenterLeidenThe Netherlands
| | - Redwan Ahmed
- Department of Obstetrics and GynecologyHiwot Fana Specialized University HospitalHararEthiopia
| | - Mohammed Yuya
- Department of Obstetrics and GynecologyLeiden University Medical CenterLeidenThe Netherlands
- School of Public Health, College of Health and Medical Sciences, Haramaya UniversityHararEthiopia
| | - Delayehu Bekele
- Department of Obstetrics and GynecologySt. Paul's Hospital Millennium Medical CollegeAddis AbabaEthiopia
| | - Tahir Ahmed Hassen
- Center for Women's Health ResearchUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Jelle Stekelenburg
- Department of Health Sciences, Global HealthUniversity Medical Center Groningen, University of GroningenThe Netherlands
- Department of Obstetrics and GynecologyLeeuwarden Medical CenterLeeuwardenThe Netherlands
| | - Thomas van den Akker
- National Perinatal Epidemiology UnitUniversity of OxfordOxfordUK
- Department of Obstetrics and GynecologyLeiden University Medical CenterLeidenThe Netherlands
- Athena Institute, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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Manalai P, Ansari N, Tappis H, Kim YM, Stekelenburg J, van Roosmalen J, Currie S. Women's experience of childbirth care in health facilities: a qualitative assessment of respectful maternity care in Afghanistan. BMC Pregnancy Childbirth 2024; 24:48. [PMID: 38200450 PMCID: PMC10777596 DOI: 10.1186/s12884-023-06234-9] [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] [Received: 05/09/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Respectful maternity care (RMC) remains a key challenge in Afghanistan, despite progress on improving maternal and newborn health during 2001-2021. A qualitative study was conducted in 2018 to provide evidence on the situation of RMC in health facilities in Afghanistan. The results are useful to inform strategies to provide RMC in Afghanistan in spite of the humanitarian crisis due to Taliban's takeover in 2021. METHODS Focus group discussions were conducted with women (4 groups, 43 women) who had used health facilities for giving birth and with providers (4 groups, 21 providers) who worked in these health facilities. Twenty key informant interviews were conducted with health managers and health policy makers. Motivators for, deterrents from using, awareness about and experiences of maternity care in health facilities were explored. RESULTS Women gave birth in facilities for availability of maternity care and skilled providers, while various verbal and physical forms of mistreatment were identified as deterrents from facility use by women, providers and key informants. Low awareness, lack of resources and excessive workload were identified among the reasons for violation of RMC. CONCLUSION Violation of RMC is unacceptable. Awareness of women and providers about the rights of women to respectful maternity care, training of providers on the subject, monitoring of care to prevent mistreatment, and conditioning any future technical and financial assistance to commitments to RMC is recommended.
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Affiliation(s)
| | | | - Hannah Tappis
- Jhpiego - Johns Hopkins University Affiliate, Baltimore, USA
| | - Young Mi Kim
- Jhpiego - Johns Hopkins University Affiliate, Baltimore, USA
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen, Groningen, Netherlands
| | | | - Sheena Currie
- Jhpiego - Johns Hopkins University Affiliate, Baltimore, USA
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Dejene D, Ayalew F, Yigzaw T, Woretaw A, Versluis M, Stekelenburg J. Assessment of clinical competence of graduating medical students and associated factors in Ethiopia. BMC Med Educ 2024; 24:17. [PMID: 38172922 PMCID: PMC10765545 DOI: 10.1186/s12909-023-04939-1] [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] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Ethiopia has scaled up medical education to improve access to healthcare which presented challenges to maintaining training quality. We conducted a study to assess the clinical competence of graduating medical students and the associated factors. METHODS AND MATERIALS A pretest assessment of a quasi-experimental study was conducted in 10 medical schools with a sample size of 240 students. We randomly selected 24 students per school. Clinical competence was assessed in a 12-station objective structured clinical examination. The clinical learning environment (CLE), simulation training, and practice exposure were self-rated. Mean scores for clinical competence, and satisfaction in the CLE and simulation training were calculated. Proportions of students with practice exposure, and who agreed on CLE and simulation items were done. Independent t-tests were used to look at competence differences among subgroups. Bivariate and multiple linear regression models were fitted for the outcome variable: competence score. A 95% statistical confidence interval and p-value < 0.05 were used for making statistical decisions. A 75% cut-off score was used to compare competence scores. RESULTS Graduating medical students had a mean competence score of 72%. Low scores were reported in performing manual vacuum aspiration (62%), lumbar puncture (64%), and managing childbirth (66%). Female students (73%) had a significantly higher competence score than males (70%). Higher cumulative grade point average (CGPA), positive appraisal of the CLE, and conducting more clinical procedures were associated with greater competence scores. Nearly half of the students were not satisfied with the clinical practice particularly due to the large student number and issues affecting the performance assessment. About two-thirds of the students were not satisfied with the sufficiency of models and equipment, and the quality of feedback during simulation training. Nearly one-third of the students never performed lumbar puncture, manual vacuum aspiration, and venipuncture. CONCLUSIONS Medical students had suboptimal clinical competence. A better clinical learning environment, higher cumulative GPA, and more practice exposure are associated with higher scores. There is a need to improve student clinical practice and simulation training. Strengthening school accreditation and graduates' licensing examinations is also a way forward.
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Affiliation(s)
- Daniel Dejene
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, Netherlands.
- Jhpiego Ethiopia, P.O. Box:2881, code, 1250, Addis Ababa, Ethiopia.
| | - Firew Ayalew
- Jhpiego Ethiopia, P.O. Box:2881, code, 1250, Addis Ababa, Ethiopia
| | - Tegbar Yigzaw
- Jhpiego Ethiopia, P.O. Box:2881, code, 1250, Addis Ababa, Ethiopia
| | | | - Marco Versluis
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, Netherlands
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Moughalian C, Almansa J, Vogt T, Biesma R, Täuber S, Rao A, Srivastava A, Stekelenburg J. The impact of accredited social health activists in India on uptake of modern contraception: A nationally representative multilevel modelling study. Glob Public Health 2024; 19:2329216. [PMID: 38626242 DOI: 10.1080/17441692.2024.2329216] [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] [Received: 10/03/2023] [Accepted: 03/06/2024] [Indexed: 04/18/2024]
Abstract
The government of India introduced the Accredited Social Health Activist (ASHA) programme in 2006 to connect marginalised communities to the health system. ASHAs are mandated to increase the uptake of modern contraception through the doorstep provision of services. There is currently no evidence on the impact of ASHAs on the uptake of contraception at the national level. This paper examines the impact of ASHAs on the uptake of modern contraception using nationally representative National and Family Health Survey data collected in 2019-21 in India. A multilevel logistic regression analysis was performed to determine the effect of contact with ASHAs on the uptake of modern contraception, controlling for regional variability and socio-demographic variables. The data provide strong evidence that ASHAs have succeeded in increasing modern contraceptive use. Women exposed to ASHAs had twice the odds of being current users of modern contraception compared to those with no contact, even after controlling for household and individual characteristics. However, only 28.1% of women nationally reported recent contact with ASHA workers. The ASHA programme should remain central to the strategy of the government of India and should be strengthened to achieve universal access to modern contraception and meet sustainable development goals by 2030.
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Affiliation(s)
- Catherine Moughalian
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen, Groningen, the Netherlands
| | - Josué Almansa
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen, Groningen, the Netherlands
| | - Tobias Vogt
- Faculty of Spatial Sciences, Population Research Centre, University of Groningen, Groningen, the Netherlands
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Regien Biesma
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen, Groningen, the Netherlands
| | - Susanne Täuber
- Sociology Department, University of Amsterdam, Amsterdam, the Netherlands
| | - Arathi Rao
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Ashish Srivastava
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen, Groningen, the Netherlands
- Jhpiego - An Affiliate of Johns Hopkins University, Jhpiego, New Delhi, India
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen, Groningen, the Netherlands
- Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
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Tayebwa E, Gatimu SM, Kalisa R, Kim YM, van Dillen J, Stekelenburg J. Provider and client perspectives on the use of maternity waiting homes in rural Rwanda. Glob Health Action 2023; 16:2210881. [PMID: 37190999 DOI: 10.1080/16549716.2023.2210881] [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: 05/17/2023] Open
Abstract
BACKGROUND The World Health Organization recommends the implementation of maternity waiting homes (MWH) to reduce delays in access to obstetric care, particularly for high-risk pregnancies and mothers living far from health facilities, and as a result, several countries have rolled out MWHs. However, Rwanda has not implemented this recommendation on a large scale. There is only one MWH in the country, hence a gap in knowledge regarding the potential utilisation and benefits of MWHs. OBJECTIVE To explore providers' and clients' perspectives on facilitators and barriers to the use of MWH in rural Rwanda. METHODS We conducted a qualitative study to explore health providers' and clients' perspectives on facilitators and barriers to the use of MWH in Rwanda, between December 2020 and January 2021. We used key informant interviews and focus group discussions to collect data. Data were analysed using NVivo qualitative analysis software version 11. RESULTS Facilitators included perceptions that the MWH offered either a peaceful and home-like environment, good-quality services, or timely obstetric services, and was associated with good maternal and neonatal outcomes. Barriers included limited awareness of the MWH among pregnant women, fear of health providers to operate the MWH at full capacity, women's lack of autonomy, uncertainty over funding for the MWH, and perceived high user fees. CONCLUSION The Ruli MWH offers a peaceful environment for pregnant women while providing quality and timely obstetric care, resulting in positive maternal and neonatal outcomes for women. However, its existence and benefits are not widely known, and its use is limited due to inadequate resources. There is a need for increased awareness of the MWH among healthcare providers and the community, and lessons from this MWH could inform the scale up of MWHs in Rwanda.
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Affiliation(s)
- Edwin Tayebwa
- Department of Health Sciences, Global Health, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Richard Kalisa
- School of Public Health, University of Rwanda, Kigali, Rwanda
| | - Young-Mi Kim
- Jhpiego, Johns Hopkins University, Baltimore, MD, USA
| | - Jeroen van Dillen
- Amalia Children's Hospital, Radboudumc Nijmegen, Nijmegen, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
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Heemelaar S, Callard B, Shikwambi H, Ellmies J, Kafitha W, Stekelenburg J, van den Akker T, Mackenzie S. Confidential Enquiry into Maternal Deaths in Namibia, 2018-2019: A Local Approach to Strengthen the Review Process and a Description of Review Findings and Recommendations. Matern Child Health J 2023; 27:2165-2174. [PMID: 37777707 PMCID: PMC10618300 DOI: 10.1007/s10995-023-03771-9] [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] [Accepted: 09/01/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES First objective was to strengthen the national maternal death review, by addressing local challenges with each step of the review cycle. Second objective was to describe review findings and compare these with available findings of previous reviews. METHODS Confidential Enquiry into Maternal Deaths methodology was used to review maternal deaths. To improve reporting, the national committee focussed on addressing fear of blame among healthcare providers. Second focus was on dissemination of findings and acting on recommendations forthcoming the review. Reviewed were reported maternal deaths, that occurred between 1 April 2018 and 31 March 2019. RESULTS Seventy maternal deaths were reported; for 69 (98.6%) medical records were available, compared to 80/119 (67.2%) in 2012-2015. Reported maternal mortality ratio increased with 48% (92/100,000 live births compared to 62/100,000 in 2012-2015). Obstetric haemorrhage was leading cause of death in the past three reviews. The "no name, no blame" policy, aiming to identify health system failures, rather than mistakes of individuals, was repeatedly explained to healthcare providers during facility visits. Recommendations based on findings of the review, such as retaining experienced staff, continuous in-service training and guidance, were shared with decision makers at regional and national levels. Healthcare providers received training based on review findings, which resulted in improved management of similar cases. CONCLUSIONS FOR PRACTICE Enhanced implementation of Confidential Enquiry into Maternal Deaths was possible after addressing local challenges. Focussing on obtaining trust of healthcare providers and feeding back findings, resulted in better reporting and prevention of potential maternal deaths.
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Affiliation(s)
- Steffie Heemelaar
- National Maternal Death, Stillbirth and Neonatal Death Review Committee, Division of Quality Assurance, Ministry of Health and Social Services, Windhoek, Namibia.
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Beatrix Callard
- National Maternal Death, Stillbirth and Neonatal Death Review Committee, Division of Quality Assurance, Ministry of Health and Social Services, Windhoek, Namibia
| | - Hilma Shikwambi
- National Maternal Death, Stillbirth and Neonatal Death Review Committee, Division of Quality Assurance, Ministry of Health and Social Services, Windhoek, Namibia
- Department of Nursing and Midwifery, International University of Management, Windhoek, Namibia
| | - Jana Ellmies
- National Maternal Death, Stillbirth and Neonatal Death Review Committee, Division of Quality Assurance, Ministry of Health and Social Services, Windhoek, Namibia
- Independent Midwives Association of Namibia, Windhoek, Namibia
| | - Wilhelmina Kafitha
- Division of Quality Assurance, Ministry of Health and Social Services, Windhoek, Namibia
| | - Jelle Stekelenburg
- Department of Health Science, Global Health, University Medical Center Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynaecology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - Shonag Mackenzie
- National Maternal Death, Stillbirth and Neonatal Death Review Committee, Division of Quality Assurance, Ministry of Health and Social Services, Windhoek, Namibia
- Department of Obstetrics and Gynaecology, University of Namibia, Windhoek, Namibia
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Nakisige C, de Fouw M, Kabukye J, Sultanov M, Nazrui N, Rahman A, de Zeeuw J, Koot J, Rao AP, Prasad K, Shyamala G, Siddharta P, Stekelenburg J, Beltman JJ. Artificial intelligence and visual inspection in cervical cancer screening. Int J Gynecol Cancer 2023; 33:1515-1521. [PMID: 37666527 PMCID: PMC10579490 DOI: 10.1136/ijgc-2023-004397] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/07/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Visual inspection with acetic acid is limited by subjectivity and a lack of skilled human resource. A decision support system based on artificial intelligence could address these limitations. We conducted a diagnostic study to assess the diagnostic performance using visual inspection with acetic acid under magnification of healthcare workers, experts, and an artificial intelligence algorithm. METHODS A total of 22 healthcare workers, 9 gynecologists/experts in visual inspection with acetic acid, and the algorithm assessed a set of 83 images from existing datasets with expert consensus as the reference. Their diagnostic performance was determined by analyzing sensitivity, specificity, and area under the curve, and intra- and inter-observer agreement was measured using Fleiss kappa values. RESULTS Sensitivity, specificity, and area under the curve were, respectively, 80.4%, 80.5%, and 0.80 (95% CI 0.70 to 0.90) for the healthcare workers, 81.6%, 93.5%, and 0.93 (95% CI 0.87 to 1.00) for the experts, and 80.0%, 83.3%, and 0.84 (95% CI 0.75 to 0.93) for the algorithm. Kappa values for the healthcare workers, experts, and algorithm were 0.45, 0.68, and 0.63, respectively. CONCLUSION This study enabled simultaneous assessment and demonstrated that expert consensus can be an alternative to histopathology to establish a reference standard for further training of healthcare workers and the artificial intelligence algorithm to improve diagnostic accuracy.
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Affiliation(s)
| | - Marlieke de Fouw
- Gynecology, Leiden University Medical Center department of Gynecology, Leiden, Zuid-Holland, Netherlands
| | | | - Marat Sultanov
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands, Groningen, Netherlands
| | | | - Aminur Rahman
- ICDDRB Public Health Sciences Division, Dhaka, Dhaka District, Bangladesh
| | - Janine de Zeeuw
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands, Groningen, Netherlands
| | - Jaap Koot
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands, Groningen, Netherlands
| | - Arathi P Rao
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India, Manipal, India
| | - Keerthana Prasad
- Manipal Academy of Higher Education School of Life Sciences, Manipal, Karnataka, India
| | - Guruvare Shyamala
- Manipal Academy of Higher Education - Mangalore Campus, Mangalore, Karnataka, India
| | - Premalatha Siddharta
- Gynecological Oncology, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Jelle Stekelenburg
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands, Groningen, Netherlands
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Hulsbergen M, Abera B, Adefris M, Kassahun D, Meulenbeld M, van Nievelt S, Ameh C, Bruinooge M, Rijken MJ, Stekelenburg J. Evaluation of the Emergency Obstetric and Newborn Care training in Gondar, Ethiopia; a mixed methods study. PLOS Glob Public Health 2023; 3:e0000889. [PMID: 37751409 PMCID: PMC10522022 DOI: 10.1371/journal.pgph.0000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/31/2023] [Indexed: 09/28/2023]
Abstract
In Ethiopia maternal and perinatal morbidity and mortality remains high. Timely access to quality emergency obstetric and neonatal care is essential for the prevention of adverse outcomes. Training healthcare providers can play an important role in improving quality of care, thereby reducing maternal and perinatal mortality and morbidity. The aim of this study was to evaluate change of knowledge, skills and behaviour in health workers who attended a postgraduate Emergency Obstetric and Newborn Care training in Gondar, Ethiopia. A descriptive study with before-after approach, using a mix of quantitative and qualitative data, based on Kirkpatrick's model for training evaluation was conducted. The evaluation focussed on reaction, knowledge, skills, and change in behaviour in clinical practice of health care providers and facilitator's perspectives on performance. A 'lessons learned approach' was included to summarize facilitators' perspectives. Health care providers reacted positively to the Emergency Obstetric and Newborn Care training with significant improvement in knowledge and skills. Of the 56 participants who attended the training, 44 (79%) were midwives. The main evaluation score for lectures was 4,51 (SD 0,19) and for breakout sessions was 4,52 (SD 0.18) on scale of 1-5. There was a statistically significant difference in the pre and post knowledge (n = 28, mean difference 13.8%, SD 13.5, t = 6.216, p<0.001) and skills assessments (n = 23, mean difference 27.4%, SD 22.1%, t = 5.941, p<0.001). The results were the same for every component of the skills and knowledge assessment. Overall, they felt more confident in performing skills after being trained. Local sustainability, participant commitment and local context were identified as challenging factors after introducing a new training program. In Gondar Ethiopia, the Emergency Obstetric and Newborn Care training has the potential to increase skilled attendance at birth and improve quality of care, both vital to the reduction of maternal and perinatal mortality and morbidity.
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Affiliation(s)
- Myrrith Hulsbergen
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
- Center for Evidence Based Education, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Gynaecology Department, Women’s Healthcare Center, Amsterdam, The Netherlands
| | - Birhanu Abera
- Department of Obstetrics and Gynecology, University of Global Health Equity (UGHE), Kigali, Rwanda
| | - Mulat Adefris
- Department of Obstetrics and Gynaecology, University of Gondar, Gondar, Ethiopia
| | - Dawit Kassahun
- Department of Obstetrics and Gynaecology, University of Gondar, Gondar, Ethiopia
| | - Marieke Meulenbeld
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
| | - Sabine van Nievelt
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
- Department of Obstetrics and Gynaecology, Haaglanden Medical Centre, Hague, The Netherlands
| | - Charles Ameh
- International Public Health Department Liverpool School of Tropical Medicine, Emergency Obstetric Care and Quality of Care Unit, Liverpool, United Kingdom
| | - Mimosa Bruinooge
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
- Department of Obstetrics and Gynaecology, Admiraal de Ruyter Ziekenhuis, Goes, The Netherlands
| | - Marcus J. Rijken
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Jelle Stekelenburg
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
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10
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Jima GH, Stekelenburg J, Fekadu H, Sendekie TY, Biesma R. Effect of contacts with health professionals on modern contraceptives uptake during the first 6 weeks after child birth: a prospective cohort study in Arsi Zone. Contracept Reprod Med 2023; 8:37. [PMID: 37464388 DOI: 10.1186/s40834-023-00237-9] [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] [Received: 01/26/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Healthy timing and spacing of pregnancy refers to the spacing between deliveries and subsequent pregnancies. The World Health Organization recommends waiting at least 24 months between the date of the live birth and the conception of the subsequent pregnancy in order to lower the risk of unfavorable maternal, perinatal, and newborn outcomes. Low use of contraception contributes to the high level of short inter-pregnancy intervals. Different studies conclusively demonstrate that this is a reality existing in Ethiopia right now. Limited data is available regarding the effects of contacts with health professionals on the use of contraception during the postnatal period. METHODS A prospective cohort study was performed from October 01, 2020 to March 01, 2021. The study included 418 postnatal women who gave birth during the previous week. They were followed throughout the full postnatal period. A pre-tested structured questionnaire was used to gather the data. Data were gathered twice: once during the first week following birth and once again from the eighth to the 42nd day after birth. Epi-Info version 7 was used to enter data, which was subsequently exported to SPSS version 21 for analysis. The effect of contacts with health professionals where contraceptives were discussed on contraception uptake was measured using adjusted relative risk and its 95% confidence interval. RESULTS Modern contraceptive uptake rate during the postnatal period was 16% (95% CI: 12.50-19.50%). Contraceptive use was 3.56 times more likely in women who were counseled about contraceptives during a contacts with health professionals at a health facility compared to those who did not have a contact (aRR = 3.56, 95% CI: 1.97-6.32). Women's age, place of residence, knowledge of whether they can become pregnant before menses return, menses return after birth, and resuming sexual activity after birth were all significantly associated with contraceptive use during the first six weeks following child birth. CONCLUSIONS Modern contraceptive uptake rate during the postnatal period among women in the study area was low. Contacts with health professionals where contraception is discussed was the main factor associated with contraception uptake during the postnatal period. We recommend that the Arsi Zone Health Office, the Weardas Health Office in the Arsi Zone, and the health care providers in the Arsi Zone health facilities strengthen contraceptive counseling in postnatal health services to reduce the proportion of women with short inter-pregnancy intervals.
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Affiliation(s)
- Gebi Husein Jima
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia.
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen, Groningen, the Netherlands.
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen, Groningen, the Netherlands
- Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Hailu Fekadu
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | | | - Regien Biesma
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen, Groningen, the Netherlands
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11
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van Braam EJ, McRae DN, Portela AG, Stekelenburg J, Penn-Kekana L. Stakeholders' perspectives on the acceptability and feasibility of maternity waiting homes: a qualitative synthesis. Reprod Health 2023; 20:101. [PMID: 37407983 PMCID: PMC10324180 DOI: 10.1186/s12978-023-01615-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/25/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Maternity waiting homes (MHWs) are recommended to help bridge the geographical gap to accessing maternity services. This study aimed to provide an analysis of stakeholders' perspectives (women, families, communities and health workers) on the acceptability and feasibility of MWHs. METHODS A qualitative evidence synthesis was conducted. Studies that were published between January 1990 and July 2020, containing qualitative data on the perspectives of the stakeholder groups were included. A combination of inductive and deductive coding and thematic synthesis was used to capture the main perspectives in a thematic framework. RESULTS Out of 4,532 papers that were found in the initial search, a total of 38 studies were included for the thematic analysis. Six themes emerged: (1) individual factors, such as perceived benefits, awareness and knowledge of the MWH; (2) interpersonal factors and domestic responsibilities, such as household and childcare responsibilities, decision-making processes and social support; (3) MWH characteristics, such as basic services and food provision, state of MWH infrastructure; (4) financial and geographical accessibility, such as transport availability, costs for MWH attendance and loss of income opportunity; (5) perceived quality of care in the MWH and the adjacent health facility, including regular check-ups by health workers and respectful care; and (6) Organization and advocacy, for example funding, community engagement, governmental involvement. The decision-making process of women and their families for using an MWH involves balancing out the gains and losses, associated with all six themes. CONCLUSION This systematic synthesis of qualitative literature provides in-depth insights of interrelating factors that influence acceptability and feasibility of MWHs according to different stakeholders. The findings highlight the potential of MWHs as important links in the maternal and neonatal health (MNH) care delivery system. The complexity and scope of these determinants of utilization underlines the need for MWH implementation strategy to be guided by context. Better documentation of MWH implementation, is needed to understand which type of MWH is most effective in which setting, and to ensure that those who most need the MWH will use it and receive quality services. These results can be of interest for stakeholders, implementers of health interventions, and governmental parties that are responsible for MNH policy development to implement acceptable and feasible MWHs that provide the greatest benefits for its users. Trial registration Systematic review registration number: PROSPERO 2020, CRD42020192219.
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Affiliation(s)
| | - Daphne N McRae
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Anayda G Portela
- Department of Maternal, Newborn, Child, and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
- Department Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Loveday Penn-Kekana
- Department of Maternal Health and Health Systems, London School of Hygiene and Tropical Medicine, London, UK
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12
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Tura AK, Girma S, Dessie Y, Bekele D, Stekelenburg J, van den Akker T, Knight M. Establishing the Ethiopian Obstetric Surveillance System for Monitoring Maternal Outcomes in Eastern Ethiopia: A Pilot Study. Glob Health Sci Pract 2023; 11:GHSP-D-22-00281. [PMID: 37116928 PMCID: PMC10141431 DOI: 10.9745/ghsp-d-22-00281] [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] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 02/21/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Although the majority of maternal deaths and complications occur in low-resource settings, almost all existing strong registration and confidential enquiry systems are found in high-resource settings. We developed and piloted the Ethiopian Obstetric Surveillance System (EthOSS), based on the successful United Kingdom Obstetric Surveillance System (UKOSS) methodology, in 3 regions in Ethiopia to improve ongoing surveillance and tracking of maternal morbidities and deaths, as well as confidential enquiry, compared to the currently used maternal death surveillance and response program in Ethiopia. METHODS We launched the EthOSS monthly case notification system in 13 hospitals in eastern Ethiopia in April 2021. Study participants included women admitted to the hospitals from April to September 2021 with major adverse obstetric conditions during pregnancy, childbirth, or within 42 days of termination of pregnancy. Designated clinicians at the hospitals used a simple online system to report the number of cases and maternal deaths monthly to the EthOSS team. We present findings on the incidence and case fatality rates for adverse conditions included in the EthOSS. RESULTS Over the 6-month pilot period, 904 women with at least 1 EthOSS condition were included in the study, of whom 10 died (case fatality rate, 1.1%). Almost half (46.6%, 421/904) sustained major obstetric hemorrhage, 38.7% (350/904) severe anemia, 29.5% (267/904) eclampsia, 8.8% (80/904) sepsis, and 2.2% (20/904) uterine rupture. To enable care improvement alongside surveillance, the local committee received training on confidential enquiry into maternal deaths from internal and external experts. CONCLUSIONS In this facility-based project, data on severe adverse obstetric conditions were captured through voluntary reporting by clinicians. Further analysis is essential to assess the robustness of these data, and confidential enquiry into maternal deaths for specific cases is planned to investigate the appropriateness of care.
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Affiliation(s)
- Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - Sagni Girma
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Delayehu Bekele
- Department of Obstetrics and Gynaecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, the Netherlands
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
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13
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Jima GH, Kaso MK, Biesma-Blanco RG, Sendekie TY, Stekelenburg J. Factors associated with modern contraceptives uptake during the first year after birth in Ethiopia: A systematic review and meta-analysis. PLoS One 2023; 18:e0270055. [PMID: 36749759 PMCID: PMC9904466 DOI: 10.1371/journal.pone.0270055] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/02/2022] [Indexed: 02/08/2023] Open
Abstract
Though postpartum family planning helps women to achieve the recommended birth interval before next pregnancy, its utilization in Ethiopia is low. Understanding drivers and barriers is key to improve postpartum family planning uptake. The aim of this systematic review and meta-analysis is to analyze and summarize predictors of postpartum family planning uptake, during the first year after birth, in Ethiopia. We conducted a systematic review and meta-analysis of observational studies published in English before April 16, 2021. We searched electronic sources like PubMed, MEDLINE, CINHAL Embase, Google and supplemented it with manual search. Two reviewers appraised independently the studies using the Joanna Briggs Institute Quality Assessment Tool for the observational studies. Data synthesis and analysis were conducted using Review Manager Version 5.3. The Cochrane Q test statistic and I2 tests were used to assess the heterogeneity among the included studies. A random-effects and fixed effect model were used to calculate pooled Odds Ratio and its 95% CI. A total of 22 studies were included in the review. Better educational status of women[OR = 2.60; 95% CI: 2.15, 3.14], women's marital status [OR = 4.70; 95% CI: 1.51, 14.60], resumption of sexual intercourse [OR = 6.22; 95% CI: 3.01, 12.86], menses return [OR = 3.72; 95% CI: 1.98, 6.99], PPFP discussion with partner [OR = 2.53; 95% CI: 2.00, 3.20], women's previous PPFP information [OR = 4.93; 95% CI: 2.26, 10.76], PPFP counseling during ANC [OR = 3.95; 95% CI: 2.50, 6.23], having PNC [OR = 4.22; 95% CI: 2.80, 6.34], having experience of modern contraceptive use [OR = 2.90; 95% CI: 1.62, 5.19], facility birth [OR = 6.70; 95% CI: 3.15, 14.25], and longer interval after last delivery [OR = 0.37; 95% CI: 0.32, 0.43] were significantly associated with modern contraceptive uptake during postpartum period. Our systematic review identified modifiable factors and estimated their association with PPFP uptake. Since most of these factors are related to reproductive health characteristics and MNCH services, integrating PPFP into MNCH services particularly at primary health care unit may improve contraceptive uptake during postpartum period. Systematic review registration: PROSPERO: 2020: CRD42020159470.
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Affiliation(s)
- Gebi Husein Jima
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
- Department of Health Sciences, Global health, University of Groningen/University Medical Centre Groningen, Groningen, The Netherlands
| | - Muhammedawel Kaso Kaso
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - R G Biesma-Blanco
- Department of Health Sciences, Global health, University of Groningen/University Medical Centre Groningen, Groningen, The Netherlands
| | | | - J Stekelenburg
- Department of Health Sciences, Global health, University of Groningen/University Medical Centre Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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14
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Dejene D, Stekelenburg J, Versluis M, Ayalew F, Molla Y. Assessment of core teaching competency of health professional educators in Ethiopia: an institution-based cross-sectional study. BMJ Open 2022; 12:e059502. [PMID: 36171038 PMCID: PMC9528671 DOI: 10.1136/bmjopen-2021-059502] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Understanding the competency of educators is key to informing faculty development, recruitment and performance monitoring. This study aimed to assess the core teaching competency of nursing, midwifery and biomedical educators, and associated factors in Ethiopia. DESIGN An institution-based cross-sectional study was conducted in January 2020 using structured tools adapted from the WHO's nurse and midwifery educator competency frameworks. SETTING Two health science colleges and nine student practice sites in Ethiopia. PARTICIPANTS All classroom instructors and clinical preceptors of nursing, midwifery and biomedical technician training programmes, and all the graduating class students. MEASURES Overall teaching competency scores, teaching domain competency scores, competency gaps and performance gaps of educators were outcome measures. Past training on teaching skills courses, teaching experiences and sociodemographic characteristics of educators are associated factors. RESULTS Most educators were not trained in teaching methods (82%). The teaching competency scores of classroom instructors and clinical preceptors were 61.1% and 52.5%, respectively. Competency gaps were found in using active learning methods, performance assessment, feedback and digital learning. Professional background of classroom instructors had a significant and strong association with their competency score (p=0.004; V=0.507). Age and teaching experience of clinical preceptors had significant associations with their competency score (p=0.023 and p=0.007, respectively) and had strong associations (V=0.280 and 0.323, respectively). Sex of students and their perceptions of how well the educators give education resources had a significant and strong association (p<0.001; V = 0.429). CONCLUSIONS Nursing, midwifery and biomedical educators lacked the competency to undertake important teaching roles, which could contribute to the low quality of education. More attention should be given to strengthening faculty development.
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Affiliation(s)
- Daniel Dejene
- Department of Health Sciences, Groningen University Medical Center, Groningen, The Netherlands
- Health Workforce Improvement Program, Jhpiego-Ethiopia, Addis Ababa, Ethiopia
| | - Jelle Stekelenburg
- Department of Obstetrics and Gynaecology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
- Department of Health Sciences, Global Health, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
| | - Marco Versluis
- Department of Health Sciences, Groningen University, Groningen, The Netherlands
| | - Firew Ayalew
- Health workforce improvment program, Jhpiego, Addis Ababa, Ethiopia
| | - Yohannes Molla
- Health workforce improvment program, Jhpiego, Addis Ababa, Ethiopia
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15
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Alemu SM, Tura AK, do Amaral GSG, Moughalian C, Weitkamp G, Stekelenburg J, Biesma R. How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review. J Glob Health 2022; 12:04066. [PMID: 35939400 PMCID: PMC9359463 DOI: 10.7189/jogh.12.04066] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Sub-Saharan Africa (SSA) has the world's highest maternal and neonatal morbidity and mortality and has shown the slowest progress in reducing them. In addition, there is substantial inequality in terms of maternal and neonatal morbidity and mortality in the region. Geospatial studies can help prioritize scarce resources by pinpointing priority areas for implementation. This systematic review was conducted to explore the application of geospatial analysis to maternal and neonatal morbidity and mortality in SSA. Methods A systematic search of PubMed, SCOPUS, EMBASE, and Web of Science databases was performed. All observational and qualitative studies that reported on maternal or neonatal health outcomes were included if they used a spatial analysis technique and were conducted in a SSA country. After removing duplicates, two reviewers independently reviewed each study's abstract and full text for inclusion. Furthermore, the quality of the studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Finally, due to the heterogeneity of studies, narrative synthesis was used to summarize the main findings, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was strictly followed to report the review results. A total of 56 studies were included in the review. Results We found that geospatial analysis was used to identify inequalities in maternal and neonatal morbidity, mortality, and health care utilization and to identify gaps in the availability and geographic accessibility of maternal health facilities. In addition, we identified a few studies that used geospatial analysis for modelling intervention areas. We also detected challenges and shortcomings, such as unrealistic assumptions used by geospatial models and a shortage of reliable, up-to-date, small-scale georeferenced data. Conclusions The use of geospatial analysis for maternal and neonatal health in SSA is still limited, and more detailed spatial data are required to exploit the potential of geospatial technologies fully.
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Affiliation(s)
- Sisay Mulugeta Alemu
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, Groningen, the Netherlands
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Gabriel S Gurgel do Amaral
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Catherine Moughalian
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerd Weitkamp
- Department of Cultural Geography, Faculty of Spatial Sciences, University of Groningen, Groningen, the Netherlands
| | - Jelle Stekelenburg
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, Groningen, the Netherlands.,Department Obstetrics & Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - Regien Biesma
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, Groningen, the Netherlands
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16
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Heemelaar S, Agapitus N, van den Akker T, Stekelenburg J, Mackenzie S, Hugo‐Hamman C, Auala T. Experiences of a dedicated Heart and Maternal Health Service providing multidisciplinary care to pregnant women with cardiac disease in a tertiary centre in Namibia. Trop Med Int Health 2022; 27:803-814. [PMID: 36053884 PMCID: PMC9543594 DOI: 10.1111/tmi.13804] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives Methods Results Conclusions
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Affiliation(s)
- S. Heemelaar
- Department of Obstetrics & Gynaecology Windhoek Central Hospital Windhoek Namibia
- Department of Obstetrics and Gynaecology Leiden University Medical Center Leiden The Netherlands
| | - N. Agapitus
- Department of Cardiology Windhoek Central Hospital Windhoek Namibia
| | - T. van den Akker
- Department of Obstetrics and Gynaecology Leiden University Medical Center Leiden The Netherlands
- Athena Institute VU University Amsterdam The Netherlands
| | - J. Stekelenburg
- Department of Health Science, Global Health University Medical Center Groningen Groningen The Netherlands
- Department of Obstetrics and Gynaecology Medical Center Leeuwarden Leeuwarden The Netherlands
| | - S. Mackenzie
- Department of Obstetrics & Gynaecology Windhoek Central Hospital Windhoek Namibia
| | - C. Hugo‐Hamman
- Department of Cardiology Windhoek Central Hospital Windhoek Namibia
| | - T. Auala
- Department of Cardiology Windhoek Central Hospital Windhoek Namibia
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17
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Sultanov M, Zeeuw JD, Koot J, der Schans JV, Beltman JJ, Fouw MD, Majdan M, Rusnak M, Nazrul N, Rahman A, Nakisige C, Rao AP, Prasad K, Guruvare S, Biesma R, Versluis M, de Bock GH, Stekelenburg J. Investigating feasibility of 2021 WHO protocol for cervical cancer screening in underscreened populations: PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC). BMC Public Health 2022; 22:1356. [PMID: 35840949 PMCID: PMC9284962 DOI: 10.1186/s12889-022-13488-z] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background High-risk human papillomavirus (hrHPV) testing has been recommended by the World Health Organization as the primary screening test in cervical screening programs. The option of self-sampling for this screening method can potentially increase women’s participation. Designing screening programs to implement this method among underscreened populations will require contextualized evidence. Methods PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC) will use a multi-method approach to investigate the feasibility of implementing a cervical cancer screening strategy with hrHPV self-testing as the primary screening test in Bangladesh, India, Slovak Republic and Uganda. The primary outcomes of study include uptake and coverage of the screening program and adherence to follow-up. These outcomes will be evaluated through a pre-post quasi-experimental study design. Secondary objectives of the study include the analysis of client-related factors and health system factors related to cervical cancer screening, a validation study of an artificial intelligence decision support system and an economic evaluation of the screening strategy. Discussion PRESCRIP-TEC aims to provide evidence regarding hrHPV self-testing and the World Health Organization’s recommendations for cervical cancer screening in a variety of settings, targeting vulnerable groups. The main quantitative findings of the project related to the impact on uptake and coverage of screening will be complemented by qualitative analyses of various determinants of successful implementation of screening. The study will also provide decision-makers with insights into economic aspects of implementing hrHPV self-testing, as well as evaluate the feasibility of using artificial intelligence for task-shifting in visual inspection with acetic acid. Trial registration ClinicalTrials.gov, NCT05234112. Registered 10 February 2022 Supplementary Information The online version contains supplementary material available at (10.1186/s12889-022-13488-z).
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Affiliation(s)
- Marat Sultanov
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
| | - Janine de Zeeuw
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jaap Koot
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jurjen van der Schans
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Jogchum J Beltman
- Department of Gynecology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | - Marlieke de Fouw
- Department of Gynecology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | - Marek Majdan
- Institute for Global Health and Epidemiology, Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Martin Rusnak
- Institute for Global Health and Epidemiology, Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | | | - Aminur Rahman
- Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | | | - Arathi P Rao
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Keerthana Prasad
- Manipal School of Information Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Shyamala Guruvare
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Regien Biesma
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marco Versluis
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden, Netherlands
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18
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Ramler PI, Beenakkers ICM, Bloemenkamp KWM, Van der Bom JG, Braams-Lisman BAM, Cornette JMJ, Kallianidis AF, Kuppens SMI, Rietveld AL, Schaap TP, Schutte JM, Stekelenburg J, Zwart JJ, Van den Akker T. Nationwide confidential enquiries into maternal deaths because of obstetric hemorrhage in the Netherlands between 2006 and 2019. Acta Obstet Gynecol Scand 2022; 101:450-460. [PMID: 35238018 DOI: 10.1111/aogs.14321] [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] [Received: 10/04/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Obstetric hemorrhage-related deaths are rare in high income countries. Yet, with increasing incidences of obstetric hemorrhage in these countries, it is of utmost importance to learn lessons from each obstetric hemorrhage-related death to improve maternity care. Our objective was to calculate the obstetric hemorrhage-related maternal mortality ratio (MMR), assess causes of obstetric hemorrhage-related deaths, and identify lessons learned. MATERIAL AND METHODS Nationwide mixed-methods prospective case-series with confidential enquiries into maternal deaths due to obstetric hemorrhage in the Netherlands from January 1, 2006 to December 31, 2019. RESULTS The obstetric hemorrhage-related MMR in the Netherlands in 2006-2019 was 0.7 per 100 000 livebirths and was not statistically significantly different compared with the previous MMR of 1.0 per 100 000 livebirths in 1993-2005 (odds ratio 0.70, 95% confidence interval 0.38-1.30). Leading underlying cause of hemorrhage was retained placenta. Early recognition of persistent bleeding, prompt involvement of a senior clinician and timely management tailored to the cause of hemorrhage with attention to coagulopathy were prominent lessons learned. Also, timely recourse to surgical interventions, including hysterectomy, in case other management options fail to stop bleeding came up as an important lesson in several obstetric hemorrhage-related deaths. CONCLUSIONS The obstetric hemorrhage-related MMR in the Netherlands in 2006-2019 has not substantially changed compared to the MMR of the previous enquiry in 1993-2005. Although obstetric hemorrhage is commonly encountered by maternity care professionals, it is important to remain vigilant for possible adverse maternal outcomes and act upon an ongoing bleeding following birth in a more timely and adequate manner. Our confidential enquiries still led to important lessons learned with clinical advice to professionals as how to improve maternity care and avoid maternal deaths. Drawing lessons from maternal deaths should remain a qualitative and moral imperative.
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Affiliation(s)
- Paul I Ramler
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ingrid C M Beenakkers
- Department of Anesthesiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Birth Center, Wilhelmina Children's Hospital Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johanna G Van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jérôme M J Cornette
- Department of Obstetrics and Gynecology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Athanasios F Kallianidis
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Simone M I Kuppens
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Anna L Rietveld
- Department of Obstetrics and Gynecology, Amsterdam VU University Medical Center, Amsterdam, the Netherlands
| | - Timme P Schaap
- Department of Obstetrics, Birth Center, Wilhelmina Children's Hospital Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joke M Schutte
- Department of Obstetrics and Gynecology, Isala Hospital, Zwolle, the Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Obstetrics and Gynecology, Leeuwarden Medical Center, Leeuwarden, the Netherlands
| | - Joost J Zwart
- Department of Obstetrics and Gynecology, Deventer Hospital, Deventer, the Netherlands
| | - Thomas Van den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.,Athena Institute, Faculty of Science, VU University, Amsterdam, the Netherlands.,National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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19
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Kallianidis AF, Schutte JM, Schuringa LEM, Beenakkers ICM, Bloemenkamp KWM, Braams-Lisman BAM, Cornette J, Kuppens SM, Rietveld AL, Schaap T, Stekelenburg J, Zwart JJ, van den Akker T. Confidential enquiry into maternal deaths in the Netherlands, 2006-2018. Acta Obstet Gynecol Scand 2022; 101:441-449. [PMID: 35352820 DOI: 10.1111/aogs.14312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/30/2021] [Accepted: 12/20/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To calculate the maternal mortality ratio (MMR) for 2006-2018 in the Netherlands and compare this with 1993-2005, and to describe women's characteristics, causes of death and improvable factors. MATERIAL AND METHODS We performed a nationwide, cohort study of all maternal deaths between January 1, 2006 and December 31, 2018 reported to the Audit Committee Maternal Mortality and Morbidity. Main outcome measures were the national MMR and causes of death. RESULTS Overall MMR was 6.2 per 100 000 live births, a decrease from 12.1 in 1993-2005 (risk ratio [RR] 0.5). Women with a non-western ethnic background had an increased MMR compared with Dutch women (MMR 6.5 vs. 5.0, RR 1.3). The MMR was increased among women with a background from Surinam/Dutch Antilles (MMR 14.7, RR 2.9). Half of all women had an uncomplicated medical history (79/161, 49.1%). Of 171 pregnancy-related deaths within 1 year postpartum, 102 (60%) had a direct and 69 (40%) an indirect cause of death. Leading causes within 42 days postpartum were cardiac disease (n = 21, 14.9%), hypertensive disorders (n = 20, 14.2%) and thrombosis (n = 19, 13.5%). Up to 1 year postpartum, the most common cause of death was cardiac disease (n = 32, 18.7%). Improvable care factors were identified in 76 (47.5%) of all deaths. CONCLUSIONS Maternal mortality halved in 2006-2018 compared with 1993-2005. Cardiac disease became the main cause. In almost half of all deaths, improvable factors were identified and women with a background from Surinam/Dutch Antilles had a threefold increased risk of death compared with Dutch women without a background of migration.
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Affiliation(s)
- Athanasios F Kallianidis
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Joke M Schutte
- Department of Obstetrics and Gynecology, Isala Hospital, Zwolle, the Netherlands
| | - Louise E M Schuringa
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ingrid C M Beenakkers
- Department of Anesthesiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Kitty W M Bloemenkamp
- Division Woman and Baby, Department of Obstetrics, Birth Center Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Jerome Cornette
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Simone M Kuppens
- Department of Obstetrics and Gynecology, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Anna L Rietveld
- Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Timme Schaap
- Division Woman and Baby, Department of Obstetrics, Birth Center Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Obstetrics and Gynecology, Leeuwarden Medical Center, Leeuwarden, the Netherlands
| | - Joost J Zwart
- Department of Obstetrics and Gynecology, Deventer Hospital, Deventer, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.,Athena Institute, VU, Amsterdam, the Netherlands
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20
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Manalai P, Currie S, Jafari M, Ansari N, Tappis H, Atiqzai F, Kim YM, van Roosmalen J, Stekelenburg J. Quality of pre-service midwifery education in public and private midwifery schools in Afghanistan: a cross sectional survey. BMC Med Educ 2022; 22:39. [PMID: 35034654 PMCID: PMC8761336 DOI: 10.1186/s12909-021-03056-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Midwives are the key skilled birth attendants in Afghanistan. Rapid assessment of public and private midwifery education schools was conducted in 2017 to examine compliance with national educational standards. The aim was to assess midwifery education to inform Afghanistan Nurses and Midwives Council and other stakeholders on priorities for improving quality of midwifery education. METHODS A cross-sectional assessment of midwifery schools was conducted from September 12-December 17, 2017. The Midwifery Education Rapid Assessment Tool was used to assess 29 midwifery programs related to infrastructure, management, teachers, preceptors, clinical practice sites, curriculum and students. A purposive sample of six Institute of Health Sciences schools, seven Community Midwifery Education schools and 16 private midwifery schools was used. Participants were midwifery school staff, students and clinical preceptors. RESULTS Libraries were available in 28/29 (97%) schools, active skills labs in 20/29 (69%), childbirth simulators in 17/29 (59%) and newborn resuscitation models in 28/29 (97%). School managers were midwives in 21/29 (72%) schools. Median numbers of students per teacher and students per preceptor were 8 (range 2-50) and 6 (range 2-20). There were insufficient numbers of teachers practicing midwifery (132/163; 81%), trained in teaching skills (113/163; 69%) and trained in emergency obstetric and newborn care (88/163; 54%). There was an average of 13 students at clinical sites in each shift. Students managed an average of 15 births independently during their training, while 40 births are required. Twenty-four percent (7/29) of schools used the national 2015 curriculum alone or combined with an older one. Ninety-one percent (633/697) of students reported access to clinical sites and skills labs. Students mentioned, however, insufficient clinical practice due to low case-loads in clinical sites, lack of education materials, transport facilities and disrespect from school teachers, preceptors and clinical site providers as challenges. CONCLUSIONS Positive findings included availability of required infrastructure, amenities, approved curricula in 7 of the 29 midwifery schools, appropriate clinical sites and students' commitment to work as midwives upon graduation. Gaps identified were use of different often outdated curricula, inadequate clinical practice, underqualified teachers and preceptors and failure to graduate all students with sufficient skills such as independently having supported 40 births.
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Affiliation(s)
- Partamin Manalai
- Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Sheena Currie
- Jhpiego, 1615 Thames Street, Baltimore, MD, 21231, USA
| | - Massoma Jafari
- Afghan Midwives Association, HNO5, Baharistan, 2th District, Kabul, Afghanistan
| | | | - Hannah Tappis
- Jhpiego, 1615 Thames Street, Baltimore, MD, 21231, USA
| | | | - Young Mi Kim
- Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, PO Box 196, 9700, AD, Groningen, The Netherlands
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Henri Dunantweg 2, 8934, AD, Leeuwarden, The Netherlands
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21
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Heemelaar S, Hangula AL, Chipeio ML, Josef M, Stekelenburg J, van den Akker TH, Pischke S, Mackenzie SBP. Maternal and fetal outcomes of pregnancies complicated by acute hepatitis E and the impact of HIV status: A cross-sectional study in Namibia. Liver Int 2022; 42:50-58. [PMID: 34623734 PMCID: PMC9298024 DOI: 10.1111/liv.15076] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/26/2021] [Accepted: 09/27/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Namibia has been suffering from an outbreak of hepatitis E genotype 2 since 2017. As nearly half of hepatitis E-related deaths were among pregnant and postpartum women, we analysed maternal and fetal outcomes of pregnancies complicated by acute hepatitis E and assessed whether HIV-status impacted on outcome. METHODS A retrospective cross-sectional study was performed at Windhoek Hospital Complex. Pregnant and postpartum women, admitted between 13 October 2017 and 31 May 2019 with reactive IgM for Hepatitis E, were included. Outcomes were acute liver failure (ALF), maternal death, miscarriage, intra-uterine fetal death and neonatal death. Odds ratios (OR) and 95% confidence interval (CI) were calculated. RESULTS Seventy women were included. ALF occurred in 28 (40.0%) of whom 13 died amounting to a case fatality rate of 18.6%. Sixteen women (22.9%) were HIV infected, compared to 16.8% among the general pregnant population (OR 1.47, 95% CI 0.84-2.57, P = .17). ALF occurred in 4/5 (80%) HIV infected women not adherent to antiretroviral therapy compared to 1/8 (12.5%) women adherent to antiretroviral therapy (OR 28.0, 95% CI 1.4-580.6). There were 10 miscarriages (14.3%), five intra-uterine fetal deaths (7.1%) and four neonatal deaths (5.7%). CONCLUSIONS One in five pregnant women with Hepatitis E genotype 2 died, which is comparable to genotype 1 outbreaks. Despite small numbers, HIV infected women receiving antiretroviral therapy appear to be less likely to develop ALF in contrast with HIV infected women not on treatment. As there is currently no curative treatment, this phenomenon needs to be assessed in larger cohorts.
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Affiliation(s)
- Steffie Heemelaar
- Department of Obstetrics and GynaecologyKatutura State HospitalWindhoekNamibia,Present address:
Department of Obstetrics and GynaecologyLeiden University Medical CenterLeidenThe Netherlands
| | - Anna L. Hangula
- Department of Obstetrics and GynaecologyKatutura State HospitalWindhoekNamibia
| | - Melody L. Chipeio
- Department of Obstetrics and GynaecologyKatutura State HospitalWindhoekNamibia
| | - Mirjam Josef
- Department of Obstetrics and GynaecologyKatutura State HospitalWindhoekNamibia
| | - Jelle Stekelenburg
- Department of Health SciencesGlobal Health UnitUniversity Medical Center GroningenGroningenThe Netherlands,Department of Obstetrics and GynaecologyMedical Center LeeuwardenLeeuwardenThe Netherlands
| | - Thomas H. van den Akker
- Department of Obstetrics and GynaecologyLeiden University Medical CenterLeidenThe Netherlands,Faculty of ScienceVU UniversityAthena InstituteAmsterdamThe Netherlands
| | - Sven Pischke
- Department of MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Shonag B. P. Mackenzie
- Department of Obstetrics and GynaecologyKatutura State HospitalWindhoekNamibia,Present address:
Department of Obstetrics and GynaecologyBorders General HospitalMelroseUnited Kingdom
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22
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Klatter CK, van Ravesteyn LM, Stekelenburg J. Is collaborative care a key component for treating pregnant women with psychiatric symptoms (and additional psychosocial problems)? A systematic review. Arch Womens Ment Health 2022; 25:1029-1039. [PMID: 36163596 PMCID: PMC9734206 DOI: 10.1007/s00737-022-01251-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/23/2022] [Indexed: 12/14/2022]
Abstract
Mental disorders during pregnancy are common, with long-lasting negative effects on mother and child. Treatment of these women is challenging, because of the high incidence of additional psychosocial problems and barriers on population and healthcare level. Collaborative care, collaboration between mental health and obstetric care professionals, may help to overcome these problems. The aim of this review is to review antenatal mental health interventions and analyse the impact of collaborative care. Two independent reviewers searched for RCT's in PubMed, Embase and PsycINFO. Trials studying the effect of psychological or pharmacological interventions on the mental health of pregnant women with psychiatric symptoms (and psychosocial problems) were eligible for inclusion. Two reviewers independently abstracted data and assessed study quality and risk of bias. Each study was scored on collaborative care criteria: multi-professional approach to patient care, structured management plan, scheduled patient follow-ups and enhanced interprofessional communication. Thirty-five studies were included. Most trials studied the effect of cognitive behavioural therapy and interpersonal psychotherapy on antenatal depression. Almost all interventions met at least one collaborative care criteria. Interventions were mostly provided by multiple professionals, but interprofessional communication rarely took place. Interventions that met more criteria did not more often show a positive effect on maternal mental health. There is lack of research on antenatal psychiatric disorders other than depressive and on long-term treatment outcomes. Collaborative care is partly implemented in most current interventions, but more trials (including interprofessional communication) are needed to be conclusive whether collaborative care is a key component in antenatal mental healthcare.
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Affiliation(s)
- Celine K Klatter
- Department of Global Health, Medical Sciences, University of Groningen/University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands.
| | - Leontien M van Ravesteyn
- Department of Global Health, Medical Sciences, University of Groningen/University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Jelle Stekelenburg
- Department of Global Health, Medical Sciences, University of Groningen/University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
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23
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Tankink JB, Verschuuren AEH, Postma IR, van der Lans PJA, de Graaf JP, Stekelenburg J, Mesman AW. Childbirths and the Prevalence of Potential Risk Factors for Adverse Perinatal Outcomes among Asylum Seekers in The Netherlands: A Five-Year Cross-Sectional Study. Int J Environ Res Public Health 2021; 18:ijerph182412933. [PMID: 34948540 PMCID: PMC8700803 DOI: 10.3390/ijerph182412933] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/26/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022]
Abstract
This five-year cross-sectional study mapped the prevalence of several known risk factors for adverse perinatal outcomes in asylum-seeking women in The Netherlands. Characteristics of 2831 registered childbirths among residents of asylum seekers centers (ASCs) in The Netherlands from 2016 to 2020 were included. Results showed a high general and teenage birthrate (2.15 and 6.77 times higher compared to the Dutch, respectively). Most mothers were pregnant upon arrival, and the number of births was highest in the second month of stay in ASCs. Another peak in births between 9 and 12 months after arrival suggested that many women became pregnant shortly after arrival in The Netherlands. Furthermore, 69.5 percent of all asylum-seeking women were relocated between ASCs at least once during pregnancy, which compromises continuity of care. The high prevalence of these risk factors in our study population might explain the increased rate of adverse pregnancy outcomes in asylum seekers compared to native women found in earlier studies. Incorporating migration-related indicators in perinatal health registration is key to support future interventions, policies, and research. Ultimately, our findings call for tailored and timely reproductive and perinatal healthcare for refugee women who simultaneously face the challenges of resettlement and pregnancy.
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Affiliation(s)
- Julia B. Tankink
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands;
- Correspondence: (J.B.T.); (A.E.H.V.)
| | - Anouk E. H. Verschuuren
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Correspondence: (J.B.T.); (A.E.H.V.)
| | - Ineke R. Postma
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Peggy J. A. van der Lans
- Department of Obstetrics and Gynecology, Hospital Twente ZGT/MST, 7512 KZ Enschede, The Netherlands;
| | - Johanna P. de Graaf
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands;
| | - Jelle Stekelenburg
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands
| | - Annelies W. Mesman
- Netherlands Association for Community Health Services (GGD GHOR Nederland), Zwarte Woud 2, 3524 SJ Utrecht, The Netherlands;
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24
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Maruf F, Tappis H, Stekelenburg J, van den Akker T. Quality of Maternal Death Documentation in Afghanistan: A Retrospective Health Facility Record Review. Front Glob Womens Health 2021; 2:610578. [PMID: 34816182 PMCID: PMC8593965 DOI: 10.3389/fgwh.2021.610578] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: To assess the quality of health facility documentation related to maternal deaths at health facilities in Afghanistan. Methods: Analysis of a subset of findings from the 2016 National Maternal and Newborn Health Quality of Care Assessment in Afghanistan. At each facility, maternity registers were reviewed to obtain data related to maternity caseload, and number and causes of maternal deaths in the year preceding the survey. Detailed chart reviews were conducted for up to three maternal deaths per facility. Analyses included completeness of charts, quality of documentation, and cause of death using WHO application of International Statistical Classification of Disease to deaths during pregnancy, childbirth and the puerperium. Key findings: Only 129/226 (57%) of facilities had mortality registers available for review on the day of assessment and 41/226 (18%) had charts documenting maternal deaths during the previous year. We reviewed 68 maternal death cases from the 41 facilities. Cause of death was not recorded in nearly half of maternal death cases reviewed. Information regarding mode of birth was missing in over half of the charts, and one third did not capture gestational age at time of death. Hypertensive disorders of pregnancy and obstetric hemorrhage were the most common direct causes of death, followed by maternal sepsis and unanticipated complications of clinical management including anesthesia-related complications. Documented indirect causes of maternal deaths were anemia, cardiac arrest, kidney and hepatic failure. Charts revealed at least eight maternal deaths from indirect causes that were not captured in register books, indicating omission or misclassification of registered deaths. Conclusion: Considerable gaps in quality of recordkeeping exist in Afghanistan, including underreporting, misclassification and incompleteness. This hampers efforts to improve quality of maternal and newborn health data and priority setting.
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Affiliation(s)
- Farzana Maruf
- Global Financing Facility, World Bank Group, Kabul, Afghanistan.,Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Jelle Stekelenburg
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen/University of Groningen, Groningen, Netherlands.,Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, Netherlands
| | - Thomas van den Akker
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
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25
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Tayebwa E, Kalisa R, Ndibaza AF, Cornelissen L, Teeselink EK, Kim YM, van Dillen J, Stekelenburg J. Maternal and Perinatal Outcomes among Maternity Waiting Home Users and Non-Users in Rural Rwanda. Int J Environ Res Public Health 2021; 18:ijerph182111211. [PMID: 34769730 PMCID: PMC8583170 DOI: 10.3390/ijerph182111211] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022]
Abstract
Most maternal and perinatal deaths could be prevented through timely access to skilled birth attendants. Women should access appropriate obstetric care during pregnancy, labor, and puerperium. Maternity waiting homes (MWHs) permit access to emergency obstetric care when labor starts. This study compared maternal and perinatal outcomes among MWH users and non-users through a retrospective cohort study. Data were collected through obstetric chart reviews and analyzed using STATA version 15. Of the 8144 deliveries reported between 2015 and 2019, 1305 women had high-risk pregnancies and were included in the study. MWH users had more spontaneous vaginal deliveries compared to non-users (38.6% versus 16.8%) and less cesarean sections (57.7% versus 76.7%). Maternal morbidities such as postpartum hemorrhage occurred less frequently among users than non-users (2.13% versus 5.64%). Four women died among non-users while there was no death among users. Non-users had more stillbirths than users (7.68% versus 0.91%). The MWH may have contributed to the observed differences in outcomes. However, many women with high risk pregnancies did not use the MWH, indicating a probable gap in awareness, usefulness, or their inability to stay due to other responsibilities at home. Use of MWHs at scale could improve maternal and perinatal outcomes in Rwanda.
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Affiliation(s)
- Edwin Tayebwa
- University Medical Centre Groningen, Department of Health Sciences, Global Health, University of Groningen, 9700 RB Groningen, The Netherlands;
- Correspondence: (E.T.); (R.K.)
| | - Richard Kalisa
- IntraHealth International, Kigali 6639, Rwanda;
- School of Public Health, University of Rwanda, Kigali 3286, Rwanda
- Correspondence: (E.T.); (R.K.)
| | | | - Lisa Cornelissen
- Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands;
| | - Eefje Klein Teeselink
- Amalia Children’s Hospital, Radboudumc Nijmegen, 6500 HB Nijmegen, The Netherlands; (E.K.T.); (J.v.D.)
| | - Young-Mi Kim
- Jhpiego, Johns Hopkins University, Baltimore, MD 21231, USA;
| | - Jeroen van Dillen
- Amalia Children’s Hospital, Radboudumc Nijmegen, 6500 HB Nijmegen, The Netherlands; (E.K.T.); (J.v.D.)
| | - Jelle Stekelenburg
- University Medical Centre Groningen, Department of Health Sciences, Global Health, University of Groningen, 9700 RB Groningen, The Netherlands;
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, 8934 AD Leeuwarden, The Netherlands
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26
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Mooij R, Kapanga RR, Mwampagatwa IH, Mgalega GC, van Dillen J, Stekelenburg J, de Kok BC. Role of male partners in the long-term well-being of women who have experienced severe pre-eclampsia and eclampsia in rural Tanzania: a qualitative study. J OBSTET GYNAECOL 2021; 42:906-913. [PMID: 34558378 DOI: 10.1080/01443615.2021.1958766] [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: 10/20/2022]
Abstract
Men can be essential sources of support in maternal health, even more so in case of severe acute maternal morbidity (SAMM), affecting 1-2% of childbearing women in low-resource settings. In a qualitative study using semi-structured interviews, we explored the perspectives of nine male partners of women who suffered from (pre-)eclampsia six to seven years earlier in rural Tanzania. Male partners considered their role to be pivotal regarding finances, decision-making in healthcare-seeking and family planning and provided physical and emotional support. After SAMM, households may be affected in the long run. Some men took over their female partner's household duties until up to two years after birth. Providing men with more information on complication readiness and birth preparedness would enable them to extend their role in maternal morbidity prevention.IMPACT STATEMENTWhat is already known on this subject? The essential role of male partners in maternal health in low- and middle-income countries is well-studied in relation to its impact on care-seeking behaviour. After childbirth, the long-term role of male partners has not yet been studied.What do the results of this study add? We demonstrated the important role of men during, but also after SAMM. Households may be affected years after women suffered from SAMM. For women with the most urgent support needs, this study suggest that at least some men feel responsible for their partner and have different pivotal roles.What are the implications of these findings for clinical practice and/or further research? Because of their motivation to support their female partner, strategies to reduce recurring complications in subsequent pregnancies should include targeting male partners, for example, by increasing birth preparedness and complication readiness. Further studies should confirm the results from our innovative but small-scale study, as well as investigate the long-term role of male partners after uncomplicated births. Other studies could investigate the separation of couples after SAMM, family planning decisions after SAMM and strategies for involving men and increasing complication readiness and birth preparedness.
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Affiliation(s)
- Rob Mooij
- Ndala Hospital, Ndala, Tanzania.,University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
| | - Ruth R Kapanga
- Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands
| | | | | | - Jeroen van Dillen
- Department of Gynaecology and Obstetrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jelle Stekelenburg
- University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands.,Department of Gynaecology and Obstetrics, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Bregje C de Kok
- Anthropology Department, University of Amsterdam, Amsterdam, The Netherlands
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Ontiri S, Kabue M, Biesma R, Stekelenburg J, Gichangi P. Assessing quality of family planning counseling and its determinants in Kenya: Analysis of health facility exit interviews. PLoS One 2021; 16:e0256295. [PMID: 34506509 PMCID: PMC8432739 DOI: 10.1371/journal.pone.0256295] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/03/2021] [Indexed: 12/02/2022] Open
Abstract
Background Available evidence suggests that provision of quality of care in family planning services is crucial to increasing uptake and continuation of use of contraception. Kenya achieved a modern contraceptive prevalence rate of 60% in 2018, surpassing its 2020 target of 58%. With the high prevalence, focus is geared towards improved quality of family planning services. The objective of this study is to examine the quality of family planning counseling and its associated factors in health facilities in Kenya. Methods We conducted a secondary analysis of the 2019 Kenya Performance Monitoring and Action, client exit data of women who had received family planning services. Quality of counseling was assessed using the Method Information Index Plus. We conducted a multivariable ordinal logistic regression analysis of data from 3,731 women to establish determinants of receiving quality family planning services. Results The Method Information Index Plus score for higher-quality counseling was 56.7%, lower-quality counseling 32.4%, and no counseling 10.9%. Women aged 15–24 years (aOR = 0.69, 95% CI = 0.56–0.86, p = 0.001) had lower odds of receiving better counseling compared to women aged 35 years and above. Those with no education (aOR = 0.52, 95% CI = 0.33–0.82, p = 0.005), primary (aOR = 0.56, 95% CI = 0.44–0.71, p<0.001) and secondary (aOR = 0.79, 95% CI = 0.65–0.98, p = 0.028) were less likely to receive better counseling compared to those with tertiary education. Women who received long acting and reversible contraception methods (aOR = 1.75, 95% CI = 1.42–2.17, p<0.001), and those who were method switchers (aOR = 1.24, 95% CI = 1.03–1.50, p = 0.027), had a higher likelihood of receiving better quality of counseling as compared to those on short-term methods and those who were continuers, respectively. Conclusion The quality of family planning counseling in Kenya is still sub-optimal considering that some women receive no form of counseling at service delivery point. There is need to review the existing FP guidelines and training packages to increase focus on the quality of counseling services offered by health providers. Social accountability strategies that empower women to demand quality services should be included in community-level family planning interventions.
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Affiliation(s)
- Susan Ontiri
- Department of Health Sciences/Global Health Unit, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Mark Kabue
- Department of Monitoring Evaluation and Research, Jhpiego, Johns Hopkins University Affiliate, Nairobi, Kenya
| | - Regien Biesma
- Department of Health Sciences/Global Health Unit, University Medical Center Groningen, Groningen, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences/Global Health Unit, University Medical Center Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Peter Gichangi
- Department of Research, Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium
- International Centre for Reproductive Health Kenya (ICRH-K), Mombasa, Kenya
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Maruf F, Tappis H, Lu E, Yaqubi GS, Stekelenburg J, van den Akker T. Health facility capacity to provide postabortion care in Afghanistan: a cross-sectional study. Reprod Health 2021; 18:160. [PMID: 34321023 PMCID: PMC8317397 DOI: 10.1186/s12978-021-01204-w] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Afghanistan has one of the highest burdens of maternal mortality in the world, estimated at 638 deaths per 100,000 live births in 2017. Infections, obstetric hemorrhage, and unsafe abortion are the three leading causes of maternal death. Contraceptive prevalence rate has fluctuated between 10 and 20% since 2006. The 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment evaluated facility readiness to provide quality routine and emergency obstetric and newborn care, including postabortion care services. Methods Accessible public health facilities with at least five births per day (n = 77), a nationally representative sample of public health facilities with fewer than five births per day (n = 149), and 20 purposively selected private health facilities were assessed. Assessment components examining postabortion care included a facility inventory and record review tool to verify drug, supply, equipment, and facility record availability, and an interview tool to collect information on skilled birth attendants’ knowledge and perceptions. Results Most facilities had supplies, equipment, and drugs to manage postabortion care, including family planning counseling and services provision. At public facilities, 36% of skilled birth attendants asked to name essential actions to address abortion complications mentioned manual vacuum aspiration (23% at private facilities); fewer than one-quarter mentioned counseling. When asked what information should be given to postabortion clients, 73% described family planning counseling need (70% at private facilities). Nearly all high-volume public health facilities with an average of five or more births per day and less than 5% of low volume public health facilities with an average of 0–4 deliveries per day reported removal of retained products of conception in the past 3 months. Among the 77 high volume facilities assessed, 58 (75%) reported using misoprostol for removal of retained products of conception, 59 (77%) reported using manual vacuum aspiration, and 67 (87%) reported using dilation and curettage. Conclusions This study provides evidence that there is room for improvement in postabortion care services provision in Afghanistan health facilities including post abortion family planning. Access to high-quality postabortion care needs additional investments to improve providers’ knowledge and practice, availability of supplies and equipment. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01204-w. Afghanistan has one of the highest burdens of maternal mortality in the world. Infections, bleeding around childbirth, and unsafe abortion are the three leading causes of mortality in the country. The uptake of contraceptives is low, and only one-fifth of married women use contraceptives. A National Maternal and Newborn Health Quality of Care Assessment was conducted in 2016 at a selected number of public and private health facilities (n = 226; n = 20) to evaluate health facilities’ capacity to provide postabortion care, and skilled birth attendants’ knowledge and perceptions with regard to such care. Postabortion care is an essential package of services to make women survive complications of miscarriage and abortion and reduce unplanned pregnancies by providing postabortion family planning counseling and services, community empowerment, and mobilization. The result of this study showed that most facilities had supplies, equipment, and drugs to give postabortion care, including family planning services provision. However, there are gaps in birth attendants’ knowledge and their capacity to deliver high-quality postabortion care services at public and private facilities. This study provides evidence that there is room for improvement in postabortion care services provision at health facilities in Afghanistan. Access to high-quality postabortion care needs additional investments to improve providers’ knowledge and practice, and availability of supplies.
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Affiliation(s)
- Farzana Maruf
- Jhpiego Afghanistan, Kabul, Afghanistan. .,Global Financing Facility, World Bank Group, Kabul, Afghanistan. .,Athena Institute, Vrije Universitate, Amsterdam, The Netherlands.
| | | | | | | | - Jelle Stekelenburg
- University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands.,Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Thomas van den Akker
- Athena Institute, Vrije Universitate, Amsterdam, The Netherlands.,Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
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Charurat E, Kennedy S, Qomariyah S, Schuster A, Christofield M, Breithaupt L, Kariuki E, Muthamia M, Kabue M, Omanga E, Stekelenburg J. Study protocol for Post Pregnancy Family Planning Choices, an operations research study examining the effectiveness of interventions in the public and private sectors in Indonesia and Kenya. Gates Open Res 2021; 4:89. [PMID: 33693315 PMCID: PMC7919138 DOI: 10.12688/gatesopenres.13147.2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Global evidence suggests many postpartum and postabortion women have an unmet need for family planning (FP) after delivery or receiving care following loss of a pregnancy. Post Pregnancy Family Planning Choices, an operations research study, aims to examine the effectiveness of a package of postpregnancy FP interventions, inclusive of postpartum and postabortion FP. The interventions are being implemented in selected public and private facilities in Indonesia and Kenya and focus on quality FP counseling and service provision prior to discharge. This manuscript presents the study protocol, documenting how the study team intends to determine key factors that influence uptake of postpregnancy FP. Methods: This is a multi-country, quasi-experimental three-year operations research study in Brebes and Batang Districts of Indonesia and Meru and Kilifi Counties of Kenya. Quantitative and qualitative data is collected longitudinally through interviews and health facility assessments at multiple time points. Data is gathered from 22 health facilities; 8,796 antenatal, postpartum, and postabortion clients; and key informants at national, subnational, facility, and community levels. Quantitative study data is collected and managed using REDCap (Research Electronic Data Capture). Once data are thoroughly cleaned and reviewed, regression models and multilevel analyses will explore quantitative data. Qualitative study data is collected using audio recordings and transcribed to Microsoft Word, then analyzed using ATLAS.ti. Qualitative datasets will be analyzed using grounded theory methods. Discussion: The ultimate goals of the study are to generate and disseminate actionable evidence of positive drivers, barriers, and activities that do not yield results with regard to increasing postpregnancy FP programmatic activities, and to institutionalize postpregnancy FP in the public and private sectors in Indonesia and Kenya. We hope these learnings and experience will contribute to global efforts to advance and scale up postpregnancy FP in similar settings beyond these two countries. Trial registration: ClinicalTrials.gov
NCT03333473
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Ontiri S, Mutea L, Naanyu V, Kabue M, Biesma R, Stekelenburg J. A qualitative exploration of contraceptive use and discontinuation among women with an unmet need for modern contraception in Kenya. Reprod Health 2021; 18:33. [PMID: 33563304 PMCID: PMC7871615 DOI: 10.1186/s12978-021-01094-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 09/10/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Addressing the unmet need for modern contraception underpins the goal of all family planning and contraception programs. Contraceptive discontinuation among those in need of a method hinders the attainment of the fertility desires of women, which may result in unintended pregnancies. This paper presents experiences of contraceptive use, reasons for discontinuation, and future intentions to use modern contraceptives. METHODS Qualitative data were collected in two rural counties in Kenya in 2019 from women with unmet need for contraception who were former modern contraceptive users. Additional data was collected from male partners of some of the women interviewed. In-depth interviews and focus group discussions explored previous experience with contraceptive use, reasons for discontinuation, and future intentionality to use. Following data collection, digitally recorded data were transcribed verbatim, translated, and coded using thematic analysis through an inductive approach. RESULTS Use of modern contraception to prevent pregnancy and plan for family size was a strong motivator for uptake of contraceptives. The contraceptive methods used were mainly sourced from public health facilities though adolescents got them from the private sector. Reasons for discontinued use included side effects, method failure, peer influence, gender-based violence due to covert use of contraceptives, and failure within the health system. Five reasons were provided for those not willing to use in the future: fear of side effects, cost of contraceptive services, family conflicts over the use of modern contraceptives, reduced need, and a shift to traditional methods. CONCLUSION This study expands the literature by examining reasons for contraceptive discontinuation and future intentionality to use among women in need of contraception. The results underscore the need for family planning interventions that incorporate quality of care in service provision to address contraceptive discontinuation. Engaging men and other social influencers in family planning programs and services will help garner support for contraception, rather than focusing exclusively on women. The results of this study can inform implementation of family planning programs in Kenya and beyond to ensure they address the concerns of former modern contraception users.
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Affiliation(s)
- Susan Ontiri
- Jhpiego Corporation, Johns Hopkins University Affiliate, Nairobi, Kenya. .,Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands.
| | | | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - Mark Kabue
- Jhpiego Corporation, Johns Hopkins University Affiliate, Baltimore, MD, USA
| | - Regien Biesma
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands.,Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
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Sheferaw ED, Bakker R, Taddele T, Geta A, Kim YM, van den Akker T, Stekelenburg J. Status of institutional-level respectful maternity care: Results from the national Ethiopia EmONC assessment. Int J Gynaecol Obstet 2020; 153:260-267. [PMID: 33119887 PMCID: PMC8246788 DOI: 10.1002/ijgo.13452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 05/30/2020] [Revised: 08/22/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022]
Abstract
Objective To assess the availability of an institutional‐level respectful maternity care (RMC) index, its components, and associated factors. Methods A cross‐sectional study design was applied to a 2016 census of 3804 health facilities in Ethiopia. The availability of an institutional‐level RMC index was computed as the availability of all nine items identified as important aspects of institutional‐level RMC during childbirth. Logistic regression analysis was used to identify factors associated with availability of the index. Results Three components of the institutional‐level RMC index were identified: “RMC policy,” “RMC experience,” and “facility for provision of RMC.” Overall, 28% of facilities (hospitals, 29.9%; health centers, 27.8%) reported availability of the institutional‐level RMC index. Facility location urbanization (urban region), percentage of maternal and newborn health workers trained in basic emergency obstetric and newborn care, and availability of maternity waiting homes in health facilities were positively associated with availability of the institutional‐level RMC index. Conclusion Only one in three facilities reported availability of the institutional‐level RMC index. The Ethiopian government should consider strengthening support mechanisms in different administrative regions (urban, pastoralist, and agrarian), implementing the provision training for health workers that incorporates RMC components, and increasing the availability of maternity waiting homes. In Ethiopia, only one in three facilities reported availability of an institutional‐level respectful maternity care index. Factors associated with availability of the index were identified.
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Affiliation(s)
- Ephrem D Sheferaw
- Department of Health Sciences, Global Health, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rena Bakker
- Department of Health Sciences, Global Health, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tefera Taddele
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abiyu Geta
- Ministry of Health, Addis Ababa, Ethiopia
| | - Young-Mi Kim
- Department of Health Sciences, Global Health, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Jhpiego, an affiliate of Johns Hopkins University, Baltimore, MD, USA
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.,Athena Institute, VU University, Amsterdam, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Obstetrics and Gynecology, Leeuwarden Medical Center, Leeuwarden, The Netherlands
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Srivastava A, Chhibber G, Bhatnagar N, Nash-Mercado A, Samal J, Trivedi B, Srivastava V, Rawlins B, Yadav V, Sood B, Biesma R, Kim YM, Stekelenburg J. Effectiveness of a quality improvement intervention to increase adherence to key practices during female sterilization services in Chhattisgarh and Odisha states of India. PLoS One 2020; 15:e0244088. [PMID: 33362284 PMCID: PMC7757870 DOI: 10.1371/journal.pone.0244088] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/03/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In response to longstanding concerns around the quality of female sterilization services provided at public health facilities in India, the Government of India issued standards and quality assurance guidelines for female sterilization services in 2014. However, implementation remains a challenge. The Maternal and Child Survival Program rolled out a package of competency-based trainings, periodic mentoring, and easy-to-use job aids in parts of five states to increase service providers' adherence to key practices identified in the guidelines. METHODS The study employed a before-and-after quasi-experimental design with a matched comparison arm to examine the effect of the intervention on provider practices in two states: Odisha and Chhattisgarh. Direct observations of female sterilization services were conducted in selected public health facilities, using a checklist of 30 key practices, at two points in time. Changes in adherence to key practices from baseline to endline were compared at 12 intervention and 12 comparison facilities using a difference in difference analysis. RESULTS Several key practices were well-established prior to the intervention, with adherence levels over 90% at baseline, including hemoglobin and urine testing, use of sterile surgical gloves and instruments, and recommended surgical technique. However, adherence to many other practices was extremely low at baseline. The program significantly increased adherence to nine practices, including those related to ascertaining client's medical eligibility, client-provider interaction, the consent process, and post-operative care. The greatest improvement was observed in the provision of written instructions for clients prior to discharge. At endline, however, adherence remained below 50% for 14 practices. CONCLUSION Low adherence to key practices at baseline confirmed the need for quality improvement interventions in female sterilization services. While the intervention improved adherence to certain practices around admission and post-operative care, inadequate human resources and infrastructure, among other factors, may have blunted the impact of the intervention.
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Affiliation(s)
- Ashish Srivastava
- Jhpiego India, New Delhi, India
- Department of Health Sciences/Global Health, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | | | | | | | | | | | | | - Regien Biesma
- Department of Health Sciences/Global Health, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - Young-Mi Kim
- Jhpiego, Baltimore, Maryland, United States of America
| | - Jelle Stekelenburg
- Department of Health Sciences/Global Health, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynecology, Leeuwarden Medical Center, Leeuwarden, The Netherlands
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Tura AK, Scherjon S, van Roosmalen J, Zwart J, Stekelenburg J, van den Akker T. Surviving mothers and lost babies - burden of stillbirths and neonatal deaths among women with maternal near miss in eastern Ethiopia: a prospective cohort study. J Glob Health 2020; 10:01041310. [PMID: 32373341 PMCID: PMC7182357 DOI: 10.7189/jogh.10.010413] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Indexed: 11/29/2022] Open
Abstract
Background Although maternal near miss (MNM) is often considered a ‘great save’ because the woman survived life-threatening complications, these complications may have resulted in loss of a child or severe neonatal morbidity. The objective of this study was to assess proportion of perinatal mortality (stillbirths and early neonatal deaths) in a cohort of women with MNM in eastern Ethiopia. In addition, we compared perinatal outcomes among women who fulfilled the World Health Organization (WHO) and the sub-Saharan African (SSA) MNM criteria. Methods In a prospective cohort design, women with potentially life-threatening conditions (PLTC) (severe postpartum hemorrhage, severe pre-(eclampsia), sepsis/severe systemic infection, and ruptured uterus) were identified every day from January 1st, 2016, to April 30th, 2017, and followed until discharge in the two main hospitals in Harar, Ethiopia. Maternal and perinatal outcomes were collected using both sets of criteria. Numbers and proportions of stillbirths and early neonatal deaths were computed and compared. Results Of 1054 women admitted with PTLC during the study period, 594 women fulfilled any of the MNM criteria. After excluding near misses related to abortion, ectopic pregnancy or among undelivered women, 465 women were included, in whom 149 (32%) perinatal deaths occurred: 132 (88.6%) stillbirths and 17 (11.4%) early neonatal deaths. In absolute numbers, the SSA criteria picked up more perinatal deaths compared to the WHO criteria, but the proportion of perinatal deaths was lower in SSA group compared to the WHO (149/465, 32% vs 62/100, 62%). Perinatal mortality was more likely among near misses with antepartum hemorrhage (adjusted odds ratio (aOR) = 4.81; 95% CI = 1.76-13.20), grand multiparous women (aOR = 4.31; 95% confidence interval CI = 1.23-15.25), and women fulfilling any of the WHO near miss criteria (aOR = 4.89; 95% CI = 2.17-10.99). Conclusion WHO MNM criteria pick up fewer perinatal deaths, although perinatal mortality occurred in a larger proportion of women fulfilling the WHO MNM criteria compared to the SSA MNM criteria. As women with MNM have increased risk of perinatal deaths (in both definitions), a holistic care addressing the needs of the mother and baby should be considered in management of women with MNM.
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Affiliation(s)
- Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Sicco Scherjon
- Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Jos van Roosmalen
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, the Netherlands.,Athena Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Joost Zwart
- Department of Obstetrics and Gynecology, Deventer Ziekenhuis, Deventer, the Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.,Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, the Netherlands.,Athena Institute, Vrije Universiteit Amsterdam, the Netherlands
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Tura AK, Aboul-Ela Y, Fage SG, Ahmed SS, Scherjon S, van Roosmalen J, Stekelenburg J, Zwart J, van den Akker T. Introduction of Criterion-Based Audit of Postpartum Hemorrhage in a University Hospital in Eastern Ethiopia: Implementation and Considerations. Int J Environ Res Public Health 2020; 17:E9281. [PMID: 33322495 PMCID: PMC7764538 DOI: 10.3390/ijerph17249281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/06/2020] [Accepted: 12/09/2020] [Indexed: 01/10/2023]
Abstract
With postpartum hemorrhage (PPH) continuing to be the leading cause of maternal mortality in most low-resource settings, an audit of the quality of care in health facilities is essential. The purpose of this study was to identify areas of substandard care and establish recommendations for the management of PPH in Hiwot Fana Specialized University Hospital, eastern Ethiopia. Using standard criteria (n = 8) adapted to the local hospital setting, we audited 45 women with PPH admitted from August 2018 to March 2019. Four criteria were agreed as being low: IV line-setup (32 women, 71.1%), accurate postpartum vital sign monitoring (23 women, 51.1%), performing typing and cross-matching (22 women, 48.9%), and fluid intake/output chart maintenance (6 women, 13.3%). In only 3 out of 45 women (6.7%), all eight standard criteria were met. Deficiencies in the case of note documentation and clinical monitoring, non-availability of medical resources and blood for transfusion, as well as delays in clinical management were identified. The audit created awareness, resulting in self-reflection of current practice and promoted a sense of responsibility to improve care among hospital staff. Locally appropriate recommendations and an intervention plan based on available resources were formulated.
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Affiliation(s)
- Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235 Harar, Ethiopia;
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands;
| | - Yasmin Aboul-Ela
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands; (Y.A.-E.); (J.v.R.); (T.v.d.A.)
| | - Sagni Girma Fage
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235 Harar, Ethiopia;
| | - Semir Sultan Ahmed
- Department of Obstetrics and Gynaecology, Hiwot Fana Specialized University Hospital, P.O. Box 235 Harar, Ethiopia;
| | - Sicco Scherjon
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands;
| | - Jos van Roosmalen
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands; (Y.A.-E.); (J.v.R.); (T.v.d.A.)
- Athena Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen, 9700 AD Groningen, The Netherlands;
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, 8934 AD Leeuwarden, The Netherlands
| | - Joost Zwart
- Department of Obstetrics and Gynaecology, Deventer Ziekenhuis, 7416 SE Deventer, The Netherlands;
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands; (Y.A.-E.); (J.v.R.); (T.v.d.A.)
- Athena Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
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Mooij R, Kapanga RR, Mwampagatwa IH, Mgalega GC, van Dillen J, Stekelenburg J, de Kok BC. Beyond severe acute maternal morbidity: a mixed-methods study on the long-term consequences of (severe pre-)eclampsia in rural Tanzania. Trop Med Int Health 2020; 26:33-44. [PMID: 33151624 DOI: 10.1111/tmi.13507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/13/2022]
Abstract
OBJECTIVES To explore the long-term (perceived) consequences of (severe pre-)eclampsia in rural Tanzania. METHODS Women were traced for this mixed-methods study 6-7 years after the diagnosis of (severe pre-)eclampsia. Demographic and obstetric characteristics were noted, and blood pressure was recorded. Questionnaires were used to assess physical and mental health. The qualitative part consisted of semi-structured interviews (SSI). A reference group consisted of women without hypertensive disorders of pregnancy. RESULTS Of 74 patients, 25 (34%) were available for follow-up, and 24 were included. Five (20%) had suffered from (pre-)eclampsia twice. Hypertension was more common after (pre-)eclampsia than in the reference group (29% vs. 13%). Thirteen women (56%) had feelings of anxiety and depression, compared to 30% in the reference group. In SSIs, experiences during the index pregnancy were explored, as well as body functions, reproductive life course and limitations in daily functioning, which were shown to be long-lasting. CONCLUSIONS Women who suffered from (severe pre-)eclampsia may experience long-term sequelae, including hypertension, depression and anxiety. Women lack information about their condition, and some are worried to conceive again. To address their specific needs, a strategy along the continuum of care is needed for women following a complicated pregnancy, starting with a late postnatal care visit 6 weeks after giving birth.
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Affiliation(s)
- R Mooij
- Ndala Hospital, Ndala, Nzega region, Tanzania.,Department of Gynaecology and Obstetrics, Beatrix Hospital, Gorinchem, The Netherlands.,University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
| | - R R Kapanga
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - I H Mwampagatwa
- College of Health Sciences, University of Dodoma, Dodoma, Tanzania
| | - G C Mgalega
- Ndala Hospital, Ndala, Nzega region, Tanzania.,Nzega District Hospital, Nzega, Tanzania
| | - J van Dillen
- Department of Gynaecology and Obstetrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J Stekelenburg
- University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands.,Department of Gynaecology and Obstetrics, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - B C de Kok
- Anthropology Department, University of Amsterdam, Amsterdam, The Netherlands
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Ontiri S, Were V, Kabue M, Biesma-Blanco R, Stekelenburg J. Patterns and determinants of modern contraceptive discontinuation among women of reproductive age: Analysis of Kenya Demographic Health Surveys, 2003-2014. PLoS One 2020; 15:e0241605. [PMID: 33151972 PMCID: PMC7643986 DOI: 10.1371/journal.pone.0241605] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 06/28/2020] [Accepted: 10/19/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives This study aimed to examine patterns and determinants of modern contraceptive discontinuation among women in Kenya. Methods Secondary analysis was conducted using national representative Kenya Demographic and Health Surveys of 2003, 2008/9, and 2014. These household cross-sectional surveys targeted women of reproductive age from 15 to 49 years who had experienced an episode of modern contraceptive use within five years preceding the surveys from 2003 (n = 2686), 2008/9 (n = 2992), and 2014 (5919). The contraceptive discontinuation rate was defined as the number of episodes discontinued divided by the total number of episodes. Weighted descriptive statistics, multivariable logistic regression analysis, and Cox proportional hazards analysis were used to examine the determinants of contraceptive discontinuation. Results The 12-month contraceptive discontinuation rate for all methods declined from 37.5% in 2003 and 36.7% in 2008/9 to 30.5% in 2014. Consistently across the three surveys, intrauterine devices had the lowest 12-month discontinuation rate (6.4% in 2014) followed by implants (8.0%, in 2014). In 2014, higher rates were seen for pills (44.9%) and male condoms (42.9%). The determinants of contraceptive discontinuation among women of reproductive age in the 2003 survey included users of short-term contraception methods, specifically for those who used male condoms (hazard ratio [HR] = 3.30, 95% confidence interval [CI] = 2.13–5.11) and pills (HR = 2.68; 95CI = 1.79–4.00); and younger women aged 15–19 year (HR = 2.07; 95% CI = 1.49–2.87) and 20–24 years (HR = 1.94; 95% CI = 1.61–2.35). The trends in the most common reasons for discontinuation from 2003 to 2014 revealed an increase among those reporting side effects (p = 0.0002) and those wanting a more effective method (p<0.0001). A decrease was noted among those indicating method failure (p<0.0001) and husband disapproval (p<0.0001). Conclusions Family planning programs should focus on improving service quality to strengthen the continuation of contraceptive use among those in need. Women should be informed about potential side effects and reassured on health concerns, including being provided options for method switching. The health system should avail a wider range of contraceptive methods and ensure a constant supply of commodities for women to choose from. Short-term contraceptive method users and younger women may need greater support for continued use.
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Affiliation(s)
- Susan Ontiri
- Jhpiego, Johns Hopkins University Affiliate, Nairobi, Kenya.,Department of Health Sciences/Global Health, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - Vincent Were
- Health Economics Research Unit, Kenya Medical Research Institute-Wellcome Trust, Nairobi, Kenya
| | - Mark Kabue
- Jhpiego, Johns Hopkins University Affiliate, Baltimore, Maryland, United States of America
| | - Regien Biesma-Blanco
- Department of Health Sciences/Global Health, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences/Global Health, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands.,Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
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Begum T, Saif-Ur-Rahman KM, Yaqoot F, Stekelenburg J, Anuradha S, Biswas T, Doi SA, Mamun AA. Global incidence of caesarean deliveries on maternal request: a systematic review and meta-regression. BJOG 2020; 128:798-806. [PMID: 32929868 DOI: 10.1111/1471-0528.16491] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Caesarean delivery on maternal request (CDMR) is considered a significant contributor to the unprecedented increase in caesarean deliveries (CDs) for nonclinical reasons. Current literature lacks a reliable assessment of the rate of CDMR, which hinders the planning and delivery of appropriate interventions for reducing CDMR rates. OBJECTIVES To conduct a systematic review of the literature and meta-regression to explore the global incidence of CDMR. SEARCH STRATEGY PubMed, Embase, CINAHL, Medline, Google scholar and grey literature were searched from January 1985 to May 2019. SELECTION CRITERIA Observational studies that report CDMR data were included. We excluded non-English articles, case notes, editorial reviews and articles reporting elective CDs from pregnancy risk factors. DATA COLLECTION AND ANALYSIS Two reviewers independently conducted the screening and quality appraisal using a validated tool. The weighted average of CDMR over total deliveries (absolute proportion) and by total CDs (relative proportion) were generated. Quality-effects meta-regression was used to explain the variability of the CDMR estimates by moderators, including study methodology and demography of study participants. MAIN RESULTS We identified 31 articles from 14 countries that include 5 million total births. The absolute proportion of CDMR varies between 0.2 and 42.0%, with significant variations across studies and subgroups. The economic status of the country and study year together explained 84% of the absolute and 76% of the relative proportion of CDMR variation. CONCLUSIONS An appropriate reporting of CDMR should be a key priority in maternal health policies and practices. TWEETABLE ABSTRACT Globally, the proportion of maternal requested caesarean delivery has mostly been influenced by the economic status of the country.
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Affiliation(s)
- T Begum
- Institute for Social Science Research, The University of Queensland, Indooroopilly, Queensland, Australia.,Australian Research Council (ARC), Centre of Excellence for Children and Families over the Life Course Centre, The University of Queensland, Indooroopilly, Queensland, Australia.,Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - K M Saif-Ur-Rahman
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh.,Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - F Yaqoot
- Institute for Social Science Research, The University of Queensland, Indooroopilly, Queensland, Australia.,Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia
| | - J Stekelenburg
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, Groningen, the Netherlands.,Department Obstetrics & Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - S Anuradha
- School of Public Health, The University of Queensland, Indooroopilly, Queensland, Australia
| | - T Biswas
- Institute for Social Science Research, The University of Queensland, Indooroopilly, Queensland, Australia.,Australian Research Council (ARC), Centre of Excellence for Children and Families over the Life Course Centre, The University of Queensland, Indooroopilly, Queensland, Australia
| | - S A Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - A A Mamun
- Institute for Social Science Research, The University of Queensland, Indooroopilly, Queensland, Australia.,Australian Research Council (ARC), Centre of Excellence for Children and Families over the Life Course Centre, The University of Queensland, Indooroopilly, Queensland, Australia
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Mooij R, Mwampagatwa IH, van Dillen J, Stekelenburg J. Association between surgical technique, adhesions and morbidity in women with repeat caesarean section: a retrospective study in a rural hospital in Western Tanzania. BMC Pregnancy Childbirth 2020; 20:582. [PMID: 33012289 PMCID: PMC7534160 DOI: 10.1186/s12884-020-03229-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 11/25/2018] [Accepted: 09/01/2020] [Indexed: 11/18/2022] Open
Abstract
Background The worldwide incidence of birth by Caesarean Section (CS) is rising. Many births after a previous CS are by repeat surgery, either by an elective CS or after a failed trial of labour. Adhesion formation is associated with increased maternal morbidity in patients with repeat CSs. In spite of large-scale studies the relation between the incidence of adhesion formation and CS surgical technique is unclear. This study aims to assess maternal and neonatal morbidity and mortality after repeat CSs in a rural hospital in a low-income country (LIC) and to analyse the effect of surgical technique on the formation of adhesions. Methods A cross-sectional, retrospective medical records study of all women undergoing CS in Ndala Hospital in 2011 and 2012. Results Of the 3966 births, 450 were by CS (11.3%), of which 321 were 1st CS, 80 2nd CS, 36 3rd CS, 12 4th and one 5th CS (71, 18, 8, 3 and 0.2% respectively). Adhesions were considered to be severe in 56% of second CSs and 64% of third CSs. In 2nd CSs, adhesions were not associated with closure of the peritoneum at 1st CS, but were associated with the prior use of a midline skin incision. There was no increase in maternal morbidity when severe adhesions were present. Adverse neonatal outcome was more prevalent when severe adhesions were present, but this was statistically non-significant (16% vs 6%). Conclusions Our results give insight into the practice of repeat CS in our rural hospital. Adhesions after CSs are common and occur more frequently after midline skin incision at 1st CS compared to a transverse incision. Reviewing local data is important to evaluate quality of care and to compare local outcomes to the literature.
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Affiliation(s)
- R Mooij
- Ndala Hospital, 15, Ndala, Tanzania. .,Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands.
| | - I H Mwampagatwa
- College of Health Sciences, University of Dodoma, 395, Dodoma, Tanzania
| | - J van Dillen
- Radboud University Medical Centre, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - J Stekelenburg
- Leeuwarden Medical Centre, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands.,University Medical Centre Groningen/University of Groningen, Antonius Deusinglaan 1, 9700 AD, Groningen, The Netherlands
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Charurat E, Kennedy S, Qomariyah S, Schuster A, Christofield M, Breithaupt L, Kariuki E, Muthamia M, Kabue M, Omanga E, Stekelenburg J. Study protocol for Post Pregnancy Family Planning Choices, an operations research study examining the effectiveness of interventions in the public and private sectors in Indonesia and Kenya. Gates Open Res 2020; 4:89. [DOI: 10.12688/gatesopenres.13147.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Global evidence suggests many postpartum and postabortion women have an unmet need for family planning (FP) after delivery or receiving care following loss of a pregnancy. Post Pregnancy Family Planning Choices, an operations research study, aims to examine the effectiveness of a package of postpregnancy FP interventions, inclusive of postpartum and postabortion FP. The interventions are being implemented in selected public and private facilities in Indonesia and Kenya and focus on quality FP counseling and service provision prior to discharge. This manuscript presents the study protocol, documenting how the study team intends to determine key factors that influence uptake of postpregnancy FP. Methods: This is a multi-country, quasi-experimental operations research study in Brebes and Batang Districts of Indonesia and Meru and Kilifi Counties of Kenya. Quantitative and qualitative data is collected from multiple data sources and participants through interviews and assessments at multiple time points. Participants include health facilities; antenatal, postpartum, and postabortion clients; and key informants at national, subnational, facility, and community levels. Quantitative study data is collected and managed through the use of REDCap (Research Electronic Data Capture). Once data are thoroughly cleaned and reviewed, regression models and multilevel analyses will explore quantitative data. Qualitative study data is collected using audio recordings and transcribed to Microsoft Word, then analyzed using ATLAS.ti. Qualitative datasets will be analyzed using grounded theory methods. Discussion: The ultimate goals of the study are to generate and disseminate actionable evidence of positive drivers, barriers, and activities that do not yield results with regard to increasing postpregnancy FP programmatic activities, and to institutionalize postpregnancy FP in the public and private sectors in Indonesia and Kenya. We hope these learnings and experience will contribute to global efforts to advance and scale up postpregnancy FP in similar settings beyond these two countries. Trial registration: ClinicalTrials.gov NCT03333473
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Heemelaar S, Josef M, Diener Z, Chipeio M, Stekelenburg J, van den Akker T, Mackenzie S. Maternal near-miss surveillance, Namibia. Bull World Health Organ 2020; 98:548-557. [PMID: 32773900 PMCID: PMC7411319 DOI: 10.2471/blt.20.251371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 01/22/2020] [Revised: 04/26/2020] [Accepted: 06/04/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To analyse and improve the Namibian maternity care system by implementing maternal near-miss surveillance during 1 October 2018 and 31 March 2019, and identifying the challenges and benefits of such data collection. Methods From the results of an initial feasibility study, we adapted the World Health Organization’s criteria defining a maternal near miss to the Namibian health-care system. We visited most (27 out of 35) participating facilities before implementation and provided training on maternal near-miss identification and data collection. We visited all facilities at the end of the surveillance period to verify recorded data and to give staff the opportunity to provide feedback. Findings During the 6-month period, we recorded 37 106 live births, 298 maternal near misses (8.0 per 1000 live births) and 23 maternal deaths (62.0 per 100 000 live births). We observed that obstetric haemorrhage and hypertensive disorders were the most common causes of maternal near misses (each 92/298; 30.9%). Of the 49 maternal near misses due to pregnancies with abortive outcomes, ectopic pregnancy was the most common cause (36/298; 12.1%). Fetal or neonatal outcomes were poor; only 50.3% (157/312) of the infants born to maternal near-miss mothers went home with their mother. Conclusion Maternal near-miss surveillance is a useful intervention to identify within-country challenges, such as lack of access to caesarean section or hysterectomy. Knowledge of these challenges can be used by policy-makers and programme managers in the development of locally tailored targeted interventions to improve maternal outcome in their setting.
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Affiliation(s)
- Steffie Heemelaar
- Department of Obstetrics & Gynaecology, Katutura State Hospital, PO Box 86237, Eros, Windhoek, Namibia
| | - Mirjam Josef
- Department of Obstetrics & Gynaecology, Katutura State Hospital, PO Box 86237, Eros, Windhoek, Namibia
| | - Zoe Diener
- Department of Obstetrics & Gynaecology, University of North Carolina, North Carolina, United States of America
| | - Melody Chipeio
- Department of Obstetrics & Gynaecology, Katutura State Hospital, PO Box 86237, Eros, Windhoek, Namibia
| | - Jelle Stekelenburg
- Department of Health Science, Global Health, University Medical Center Groningen, Groningen, Netherlands
| | | | - Shonag Mackenzie
- Department of Obstetrics & Gynaecology, University of Namibia, Windhoek, Namibia
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Tayebwa E, Sayinzoga F, Umunyana J, Thapa K, Ajayi E, Kim YM, van Dillen J, Stekelenburg J. Assessing Implementation of Maternal and Perinatal Death Surveillance and Response in Rwanda. Int J Environ Res Public Health 2020; 17:ijerph17124376. [PMID: 32570817 PMCID: PMC7345772 DOI: 10.3390/ijerph17124376] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/16/2022]
Abstract
Maternal deaths remain a major public health concern in low- and middle-income countries. Implementation of maternal and perinatal deaths surveillance and response (MPDSR) is vital to reduce preventable deaths. The study aimed to assess implementation of MPDSR in Rwanda. We applied mixed methods following the six-step audit cycle for MPDSR to determine the level of implementation at 10 hospitals and three health centers. Results showed various stages of implementation of MPDSR across facilities. Maternal death audits were conducted regularly, and facilities had action plans to address modifiable factors. However, perinatal death audits were not formally done. Implementation was challenged by lack of enough motivated staff, heavy workload, lack of community engagement, no linkages with existing quality improvement efforts, no guidelines for review of stillbirths, incomplete medical records, poor classification of cause of death, and no sharing of feedback among others. Implementation of MPDSR varied from facility to facility indicating varying capacity gaps. There is need to integrate perinatal death audits with maternal death audits and ensure the process is part of other quality improvement initiatives at the facility level. More efforts are needed to support health facilities to improve implementation of MPDSR and contribute to achieving sustainable development goal (SDG) 3.
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Affiliation(s)
- Edwin Tayebwa
- IntraHealth International, P.O. Box 6639 Kigali, Rwanda;
- University Medical Centre Groningen, Department of Health Sciences, Global Health, University of Groningen, 9700 RB Groningen, The Netherlands;
- Correspondence:
| | | | | | - Kusum Thapa
- Jhpiego, An Affiliate of Johns Hopkins University, Baltimore, MD 21231, USA; (K.T.); (E.A.); (Y.-M.K.)
| | - Efugbaike Ajayi
- Jhpiego, An Affiliate of Johns Hopkins University, Baltimore, MD 21231, USA; (K.T.); (E.A.); (Y.-M.K.)
- Maternal and Child Survival Program, Washington, DC 20036, USA
| | - Young-Mi Kim
- Jhpiego, An Affiliate of Johns Hopkins University, Baltimore, MD 21231, USA; (K.T.); (E.A.); (Y.-M.K.)
| | - Jeroen van Dillen
- Amalia Children’s Hospital, Radboudumc Nijmegen, 6500 HB Nijmegen, The Netherlands;
| | - Jelle Stekelenburg
- University Medical Centre Groningen, Department of Health Sciences, Global Health, University of Groningen, 9700 RB Groningen, The Netherlands;
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, 8934 AD Leeuwarden, The Netherlands
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Ansari N, Maruf F, Manalai P, Currie S, Soroush MS, Amin SS, Higgins-Steele A, Kim YM, Stekelenburg J, van Roosmalen J, Tappis H. Quality of care in prevention, detection and management of postpartum hemorrhage in hospitals in Afghanistan: an observational assessment. BMC Health Serv Res 2020; 20:484. [PMID: 32487154 PMCID: PMC7265625 DOI: 10.1186/s12913-020-05342-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/03/2018] [Accepted: 05/20/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hemorrhage is the leading cause of maternal mortality worldwide and accounts for 56% of maternal deaths in Afghanistan. Postpartum hemorrhage (PPH) is commonly caused by uterine atony, genital tract trauma, retained placenta, and coagulation disorders. The purpose of this study is to examine the quality of prevention, detection and management of PPH in both public and private hospitals in Afghanistan in 2016, and compare the quality of care in district hospitals with care in provincial, regional, and specialty hospitals. METHODS This study uses a subset of data from the 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment. It covers a census of all accessible public hospitals, including 40 district hospitals, 27 provincial hospitals, five regional hospitals, and five specialty hospitals, as well as 10 purposively selected private hospitals. RESULTS All public and private hospitals reported 24 h/7 days a week service provision. Oxytocin was available in 90.0% of district hospitals, 89.2% of provincial, regional and specialty hospitals and all 10 private hospitals; misoprostol was available in 52.5% of district hospitals, 56.8% of provincial, regional and specialty hospitals and in all 10 private hospitals. For prevention of PPH, 73.3% women in district hospitals, 71.2% women at provincial, regional and specialty hospitals and 72.7% women at private hospital received uterotonics. Placenta and membranes were checked for completeness in almost half of women in all hospitals. Manual removal of placenta was performed in 97.8% women with retained placenta. Monitoring blood loss during the immediate postpartum period was performed in 48.4% of women in district hospitals, 36.9% of women in provincial, regional and specialty hospitals, and 43.3% in private hospitals. The most commonly observed cause of PPH was retained placenta followed by genital tract trauma and uterine atony. CONCLUSION Gaps in performance of skilled birth attendants are substantial across public and private hospitals. Improving and retaining skills of health workers through on-site, continuous capacity development approaches and encouraging a culture of audit, learning and quality improvement may address clinical gaps and improve quality of PPH prevention, detection and management.
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Affiliation(s)
- Nasratullah Ansari
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, the Netherlands
| | - Farzana Maruf
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, the Netherlands
- Global Financing Facility, World Bank Group, Kabul, Afghanistan
| | - Partamin Manalai
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, the Netherlands
- Jhpiego, Kabul, Afghanistan
| | | | - Mohammad Samim Soroush
- Reproductive, Maternal, Newborn, Child and Adolescent Health Department, Ministry of Public Health, Masood Square, Kabul, Afghanistan
| | | | | | | | - Jelle Stekelenburg
- University Medical Centre Groningen, Department of Health Sciences, Global Health, University of Groningen, Groningen, the Netherlands
- Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - Jos van Roosmalen
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, the Netherlands
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Verschuuren AEH, Postma IR, Riksen ZM, Nott RL, Feijen-de Jong EI, Stekelenburg J. Pregnancy outcomes in asylum seekers in the North of the Netherlands: a retrospective documentary analysis. BMC Pregnancy Childbirth 2020; 20:320. [PMID: 32450845 PMCID: PMC7249627 DOI: 10.1186/s12884-020-02985-x] [Citation(s) in RCA: 6] [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] [Received: 04/24/2019] [Accepted: 05/04/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND With more than 20,000 asylum seekers arriving every year, healthcare for this population has become an important issue. Pregnant asylum seekers seem to be at risk of poor pregnancy outcomes. This study aimed to assess the difference in pregnancy outcomes between asylum seekers and the local Dutch population and to identify potential substandard factors of care. METHODS Using a retrospective study design we compared pregnancy outcomes of asylum-seeking and Dutch women who gave birth in a northern region of the Netherlands between January 2012 and December 2016. The following data were compared: perinatal mortality, maternal mortality, gestational age at delivery, preterm delivery, birth weight, small for gestational age children, APGAR score, intrauterine foetal death, mode of delivery and the need for pain medication. Cases of perinatal mortality in asylum seekers were reviewed for potential substandard factors. RESULTS A total of 344 Asylum-seeking women and 2323 Dutch women were included. Asylum seekers had a higher rate of perinatal mortality (3.2% vs. 0.6%, p = 0.000) including a higher rate of intrauterine foetal death (2.3% vs. 0.2%, p = 0.000), higher gestational age at birth (39 + 4 vs. 38 + 6 weeks, p = 0.000), labour was less often induced (36.9 vs. 43.8, p = 0.016), postnatal hospitalization was longer (2.24 vs. 1.72 days p = 0.006) and they received more opioid analgesics (27.3% vs. 22%, p = 0.029). Babies born from asylum-seeking women had lower birth weights (3265 vs. 3385 g, p = 0.000) and were more often small for gestational age (13.9% vs. 8.4%, p = 0.002). Multivariate analysis showed that the increased risk of perinatal mortality in asylum-seeking women was independent of parity, birth weight and gestational age at birth. Review of the perinatal mortality cases in asylum seekers revealed possible substandard factors, such as late initiation of antenatal care, missed appointments because of transportation problems, not recognising alarm symptoms, not knowing who to contact and transfer to other locations during pregnancy. CONCLUSION Pregnant asylum seekers have an increased risk of adverse pregnancy outcomes. More research is needed to identify which specific risk factors are involved in poor perinatal outcomes in asylum seekers and to identify strategies to improve perinatal care for this group of vulnerable women.
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Affiliation(s)
- A E H Verschuuren
- Department of Obstetrics and Gynaecology and Department of Health Sciences, Global Health, University Medical Center Groningen/University of Groningen, Hanzeplein, 19713 GZ, Groningen, the Netherlands.
| | - I R Postma
- Department of Obstetrics and Gynaecology and Department of Health Sciences, Global Health, University Medical Center Groningen/University of Groningen, Hanzeplein, 19713 GZ, Groningen, the Netherlands
| | - Z M Riksen
- Refaja ziekenhuis Stadskanaal, Boerhaavestraat, 19501 HE, Stadskanaal, the Netherlands
| | - R L Nott
- New Life, Sperwerlaan, 179561 BG, Ter Apel, the Netherlands
| | - E I Feijen-de Jong
- Department of General Practice & Elderly Medicine, University Medical Center Groningen, University of Groningen, Dirk Huizingastraat 3, 59713 GL, Groningen, the Netherlands
| | - J Stekelenburg
- Department of Obstetrics and Gynaecology and Department of Health Sciences, Global Health, University Medical Center Groningen/University of Groningen, Hanzeplein, 19713 GZ, Groningen, the Netherlands.,Department Obstetrics and Gynaecology, Medical center Leeuwarden, Henri Dunantweg 2, AD, 8934, Leeuwarden, the Netherlands
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Tura AK, Scherjon S, Stekelenburg J, van Roosmalen J, van den Akker T, Zwart J. Severe Hypertensive Disorders of Pregnancy in Eastern Ethiopia: Comparing the Original WHO and Adapted sub-Saharan African Maternal Near-Miss Criteria. Int J Womens Health 2020; 12:255-263. [PMID: 32308499 PMCID: PMC7152537 DOI: 10.2147/ijwh.s240355] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/21/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To assess life-threatening complications among women admitted with severe hypertensive disorders of pregnancy and compare applicability of World Health Organization (WHO) maternal near-miss (MNM) criteria and the recently adapted sub-Saharan African (SSA) MNM criteria in eastern Ethiopia. METHODS Of 1,054 women admitted with potentially life-threatening conditions between January 2016 and April 2017, 562 (53.3%) had severe preeclampsia/eclampsia. We applied the definition of MNM according to the WHO MNM criteria and the SSA MNM criteria. Logistic regression was performed to identify factors associated with severe maternal outcomes (MNMs and maternal deaths). RESULTS The SSA MNM criteria identified 285 cases of severe maternal outcomes: 271 MNMs and 14 maternal deaths (mortality index 4.9%). The WHO criteria identified 50 cases of severe maternal outcomes: 36 MNMs and 14 maternal deaths (mortality index 28%). The MNM ratio was 36.6 per 1,000 livebirths according to the SSA MNM criteria and 4.9 according to the WHO criteria. More than 80% of women in both groups had MNM events on arrival or within 12 hours after admission. Women without antenatal care, from rural areas, referred from other facilities, and with concomitant hemorrhage more often developed severe maternal outcomes. CONCLUSION Regarding hypertensive disorders of pregnancy, the SSA tool is more inclusive than the WHO tool, while still maintaining a considerably high mortality index indicating severity of included cases. This may enable more robust audits. Strengthening the referral system and improving prevention and management of obstetric hemorrhage in women with hypertensive disorders of pregnancy are required to avert severe maternal outcomes.
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Affiliation(s)
- Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sicco Scherjon
- Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Jos van Roosmalen
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thomas van den Akker
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joost Zwart
- Department of Obstetrics and Gynaecology, Deventer Ziekenhuis, Deventer, The Netherlands
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Bakker R, Sheferaw ED, Stekelenburg J, Yigzaw T, de Kroon MLA. Development and use of a scale to assess gender differences in appraisal of mistreatment during childbirth among Ethiopian midwifery students. PLoS One 2020; 15:e0227958. [PMID: 31945110 PMCID: PMC6964878 DOI: 10.1371/journal.pone.0227958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 04/20/2019] [Accepted: 01/03/2020] [Indexed: 11/18/2022] Open
Abstract
Mistreatment during childbirth occurs across the globe and endangers the well-being of pregnant women and their newborns. A gender-sensitive approach to mistreatment during childbirth seems relevant in Ethiopia, given previous research among Ethiopian midwives and patients suggesting that male midwives provide more respectful maternity care, which is possibly mediated by self-esteem and stress. This study aimed a) to develop a tool that assesses mistreatment appraisal from a provider's perspective and b) to assess gender differences in mistreatment appraisal among Ethiopian final-year midwifery students and to analyze possible mediating roles of self-esteem and stress. First, we developed a research tool (i.e. a quantitative scale) to assess mistreatment appraisal from a provider's perspective, on the basis of scientific literature and the review of seven experts regarding its relevance and comprehensiveness. Second, we utilized this scale, the so-called Mistreatment Appraisal Scale, among 390 Ethiopian final-year midwifery students to assess their mistreatment appraisal, self-esteem (using the Rosenberg Self-Esteem Scale), stress (using the Perceived Stress Scale) and various background characteristics. The scale's internal consistency was acceptable (α = .75), corrected item-total correlations were acceptable (.24 - .56) and inter-item correlations were mostly acceptable (.07 - .63). Univariable (B = 3.084, 95% CI [-.005, 6.173]) and multivariable (B = 1.867, 95% CI [-1.472, 5.205]) regression analyses did not show significant gender differences regarding mistreatment appraisal. Mediation analyses showed that self-esteem (a1b1 = -.030, p = .677) and stress (a2b2 = -.443, p = .186) did not mediate the effect of gender on mistreatment appraisal. The scale to assess mistreatment appraisal appears to be feasible and reliable. No significant association between gender and mistreatment appraisal was observed and self-esteem and stress were not found to be mediators. Future research is needed to evaluate the scale's criterion validity and to assess determinants and consequences of mistreatment during childbirth from various perspectives.
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Affiliation(s)
- Rena Bakker
- Department of Health Sciences, Global Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ephrem D. Sheferaw
- Department of Health Sciences, Global Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Jhpiego Ethiopia, Addis Ababa, Ethiopia
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | | | - Marlou L. A. de Kroon
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Heemelaar S, Kabongo L, Ithindi T, Luboya C, Munetsi F, Bauer AK, Dammann A, Drewes A, Stekelenburg J, van den Akker T, Mackenzie S. Measuring maternal near-miss in a middle-income country: assessing the use of WHO and sub-Saharan Africa maternal near-miss criteria in Namibia. Glob Health Action 2019; 12:1646036. [PMID: 31405363 PMCID: PMC6713162 DOI: 10.1080/16549716.2019.1646036] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 11/17/2022] Open
Abstract
Background: Namibia, a middle-income country in sub-Saharan Africa (SSA), plans to use the Maternal Near Miss (MNM) approach. Adaptations of the World Health Organization (WHO) MNM defining criteria (‘WHO MNM criteria’) were previously proposed for low-income settings in sub-Saharan Africa (‘SSA MNM criteria’), but whether these adaptations are required in middle-income settings is unknown. Objective: To establish MNM criteria suitable for use in Namibia, a middle-income country in SSA. Methods: Cross-sectional study from 1 March 2018 to 31 May 2018 in four Namibian hospitals. Pregnant women or within 42 days of termination of pregnancy or birth, fulfilling at least one WHO or SSA MNM criterion were included. Records of women identified by either only WHO criteria or only SSA criteria were assessed in detail. Results: 194 Women fulfilled any MNM criterion. WHO criteria identified 61 MNM, the SSA criteria 184 MNM. Of women who only fulfilled any of the unique SSA MNM criteria, 18 fulfilled the criterion ‘eclampsia’, one ‘uterine rupture’ and five ‘laparotomy’. These women were assessed to be MNM. Thresholds for blood transfusion to define MNM due to haemorrhage were two units in the SSA and five in WHO set. Two or three units were given to 95 women for mild/moderate haemorrhage or chronic anaemia who did not fulfil any WHO criterion and were not considered MNM. Fourteen women who were assessed to be MNM from severe haemorrhage received four units. Conclusions: WHO MNM criteria may underestimate and SSA MNM criteria overestimate the prevalence of MNM in a middle-income country such as Namibia, where MNM criteria ‘in between’ may be more appropriate. Namibia opts to apply a modification of the WHO criteria, including eclampsia, uterine rupture, laparotomy and a lower threshold of four units of blood to define MNM. We recommend that other middle-income countries validate our criteria for their setting.
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Affiliation(s)
- Steffie Heemelaar
- a Department of Obstetrics and Gynaecology, Katutura State Hospital , Windhoek , Namibia.,b Department of Obstetrics, Leiden University Medical Center , Leiden , The Netherlands
| | - Leonard Kabongo
- c Department of Obstetrics and Gynaecology, Gobabis State Hospital , Gobabis , Namibia
| | - Taati Ithindi
- d National Maternal Death, Stillbirth and Neonatal Death Review Committee, Ministry of Health and Social Services , Windhoek , Namibia
| | - Christian Luboya
- e Department of Obstetrics and Gynaecology, Rundu Intermediate Hospital , Rundu , Namibia
| | - Fidelis Munetsi
- f Department of Obstetrics and Gynaecology, Okahandja State Hospital , Okahandja , Namibia
| | - Ann-Kathrin Bauer
- g Department of Health Science, Global Health, University of Groningen/University Medical Centre Groningen , Groningen , The Netherlands
| | - Amelie Dammann
- g Department of Health Science, Global Health, University of Groningen/University Medical Centre Groningen , Groningen , The Netherlands
| | - Anna Drewes
- g Department of Health Science, Global Health, University of Groningen/University Medical Centre Groningen , Groningen , The Netherlands
| | - Jelle Stekelenburg
- g Department of Health Science, Global Health, University of Groningen/University Medical Centre Groningen , Groningen , The Netherlands.,h Department of Obstetrics and Gynaecology, Medical Center Leeuwarden , Leeuwarden , The Netherlands
| | - Thomas van den Akker
- b Department of Obstetrics, Leiden University Medical Center , Leiden , The Netherlands
| | - Shonag Mackenzie
- i Department of Obstetrics and Gynaecology, University of Namibia , Windhoek , Namibia
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Ansari N, Tappis H, Manalai P, Anwari Z, Kim YM, van Roosmalen JJM, Stekelenburg J. Readiness of emergency obstetric and newborn care in public health facilities in Afghanistan between 2010 and 2016. Int J Gynaecol Obstet 2019; 148:361-368. [PMID: 31811740 DOI: 10.1002/ijgo.13076] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/05/2019] [Accepted: 12/06/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess changes in readiness to provide emergency obstetric and newborn care (EmONC) in health facilities in Afghanistan between 2010 and 2016. METHODS A secondary analysis was performed of a subset of data from cross-sectional health facility assessments conducted in December 2009 to February 2010 and May 2016 to January 2017. Interviews with health providers, facility inventory, and record review were conducted in both assessments. Descriptive statistics and χ2 tests were used to compare readiness of EmONC at 59 public health facilities expected to provide comprehensive EmONC. RESULTS The proportion of facilities reporting provision of uterotonic drugs, anticonvulsants, parenteral antibiotics, newborn resuscitation, and cesarean delivery did not change significantly between 2010 and 2016. Provision of assisted vaginal deliveries increased from 78% in 2010 to 98% in 2016 (P<0.001). Fewer health facilities had amoxicillin (61% in 2016 vs 90% in 2010; P<0.001) and gentamicin (74% in 2016 vs 95% in 2010; P<0.002). The number of facilities with at least one midwife on duty 24 hours a day/7 days a week significantly declined (88% in 2016 vs 98% in 2010; P=0.028). CONCLUSION Despite a few positive changes, readiness of EmONC services in Afghanistan in 2016 had declined from 2010 levels.
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Affiliation(s)
- Nasratullah Ansari
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | - Zelaikha Anwari
- Reproductive, Maternal, Newborn, Child and Adolescent Health Department, Ministry of Public Health, Kabul, Afghanistan
| | | | - Jos J M van Roosmalen
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
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Ayalew F, Kibwana S, Shawula S, Misganaw E, Abosse Z, van Roosmalen J, Stekelenburg J, Kim YM, Teshome M, Mariam DW. Understanding job satisfaction and motivation among nurses in public health facilities of Ethiopia: a cross-sectional study. BMC Nurs 2019; 18:46. [PMID: 31636508 PMCID: PMC6794848 DOI: 10.1186/s12912-019-0373-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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] [Received: 01/12/2018] [Accepted: 10/02/2019] [Indexed: 11/18/2022] Open
Abstract
Background Poor job conditions and limited resources are reducing job satisfaction and motivation among nurses in low-income countries, which may affect the quality of services and attrition rates. The objective of this study was to examine job satisfaction, motivation and associated factors among nurses working in the public health facilities of Ethiopia, with the aim of improving performance and productivity in the health care system. Methods The study employed a cross-sectional two-stage cluster sampling design. From a random sample of 125 health facilities, 424 nurses were randomly selected for face-to-face interviews in all regions of Ethiopia. Nurses responded to questions about their overall job satisfaction and job conditions, including items related to intrinsic and extrinsic motivation, using a 5-point Likert scale. Multilevel analysis was performed to adjust for different clustering effects. Satisfaction levels (percent of respondents who were satisfied) were calculated for individual items, and composite mean scores (range: 1–5) were calculated for motivational factors. Adjusted odds ratios were computed to examine the association of these factors with overall job satisfaction. Results Overall, 60.8% of nurses expressed satisfaction with their job. Composite mean scores for intrinsic and extrinsic motivational factors were 3.5 and 3.0, respectively. Job satisfaction levels were significantly higher for female nurses (65.6%, p = 0.04), those older than 29 years (67.8%, p = 0.048) and had over 10 years work experiences (68.8%, p = 0.007). Satisfaction with remuneration (AOR = 2.04, 95% CI = 1.36, 3.06), recognition (AOR = 2.21; 95% CI = 1.38, 3.53), professional advancement (AOR = 1.54; 95% CI = 1.06, 2.29), features of the work itself (AOR = 1.65; 95% CI = 1.20, 2.91) and nurses’ work experiences from 5 to 10 years (AOR = 0.37, 95% CI = 0.17, 0.79) were significantly associated with overall job satisfaction after controlling for other predictors. Conclusions The study findings are signals for the Ministry of Health to strengthen the human resource management system and practices to improve nurses’ overall job satisfaction and motivation, especially among nurses with 5 to 10 years of experience on the job. Expanded recognition systems and opportunities for advancement are required to increase nurses’ job satisfaction and motivation. Equitable salary and fringe benefits are also needed to reduce their dissatisfaction with the job.
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Affiliation(s)
| | | | | | | | - Zeine Abosse
- Management Sciences for Health, Addis Ababa, Ethiopia
| | | | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.,Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - Young Mi Kim
- Jhpiego, 1615 Thames St # 200, Baltimore, MD 21231 USA
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Mooij R, Jurgens EMJ, van Dillen J, Stekelenburg J. The contribution of Dutch doctors in Global Health and Tropical Medicine to research in global health in low- and middle-income countries: an exploration of the evidence. Trop Doct 2019; 50:43-49. [DOI: 10.1177/0049475519878335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Results from medical research from high-income countries may not apply to low- and middle-income countries. Some expatriate physicians combine clinical duties with research. We present global health research conducted by Dutch medical doctors in Global Health and Tropical Medicine in low- and middle-income countries and explore the value of their research. We included all research conducted in the last 30 years by medical doctors in Global Health and Tropical Medicine in a low- and middle-income country, resulting in a PhD thesis. Articles and co-authors were found through Medline. More than half of the 18 identified PhD theses concerned maternal health and obstetrics, and the majority of the research was conducted in low-income countries, mostly in rural hospitals. Over 70 local co-authors were involved. Different aspects of these studies are discussed.
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Affiliation(s)
- Rob Mooij
- Medical Officer, Ndala Hospital, Ndala, United Republic of Tanzania
- Consultant, Department of Gynaecology and Obstetrics, Beatrix Hospital, Gorinchem, The Netherlands
- Researcher, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
| | - Esther MJ Jurgens
- Consultant Global Health and Policy Advisor, The Netherlands Society for Tropical Medicine and International Health, The Netherlands
- Researcher, Department of Health, Ethics, and Society, Maastricht University, Maastricht, The Netherlands
| | - Jeroen van Dillen
- Consultant, Department of Gynaecology and Obstetrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jelle Stekelenburg
- Consultant, Department of Gynaecology and Obstetrics, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
- Professor, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
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Rahman A, Begum T, Ashraf F, Akhter S, Hoque DME, Ghosh TK, Rahman M, Stekelenburg J, Das SK, Fatima P, Anwar I. Feasibility and effectiveness of electronic vs. paper partograph on improving birth outcomes: A prospective crossover study design. PLoS One 2019; 14:e0222314. [PMID: 31589625 PMCID: PMC6779270 DOI: 10.1371/journal.pone.0222314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/26/2019] [Indexed: 01/27/2023] Open
Abstract
Background The partograph has been endorsed by World Health Organization (WHO) since 1994 which presents an algorithm for assessing maternal and foetal conditions and labor progression. Monitoring labour with a partograph can reduce adverse pregnancy outcomes such as prolonged labor, emergency C-sections, birth asphyxia and stillbirths. However, partograph use is still very low, particularly in low and middle income countries (LMICs). In Bangladesh the reported partograph user rate varies from 1.4% to 33.0%. Recently, an electronic version of the partograph, with the provision of online data entry and user aid for emergency clinical support, has been tested successfully in different settings. With this proven evidence, we conducted and operations research to test the feasibility and effectiveness of implementing an e-partograph, for the first time, in 2 public hospitals in Bangladesh Methods We followed a prospective crossover design. Two secondary level referral hospitals, Jessore and Kushtia District Hospital (DH) were the study sites. All pregnant women who delivered in the study hospitals were the study participants. All nurse-midwives working in the labor ward of study hospitals were trained on appropriate use of both types of partograph along with standard labour management guidelines. Collected quantitative data was analyzed using SPSS 23 statistical software. Discrete variables were expressed as percentages and presented as frequency distribution and cross tabulations. Chi square tests were employed to test the association between exposure and outcome variables. Potential confounding factors were adjusted using multivariate binary logistic regression methods. Ethical approval was obtained from the institutional review board of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b). Findings In total 2918 deliveries were conducted at Jessore DH and 2312 at Kushtia DH during one-year study period. Of them, 1012 (506 in each facility) deliveries were monitored using partograph (paper or electronic). The trends of facility based C-section rates was downwards in both the hospitals; 43% to 37% in Jessore and from 36% to 25% in Kushtia Hospital. There was a significant reduction of prolonged labour with e-partograph use. In Kushtia DH, the prolonged labour rate was 42% during phase 1 with the paper version which came down to 29% during phase-2 with the e-partograph use. The similar result was observed in Jessore DH where the prolonged labour rate reduced to 7% with paper partograph from the reported 30% prolonged labour with e-partograph. The e-partograph user rate was higher than the paper partograph during both phases (phase 1: 3.31, CI: 2.04–5.38, p < .001 and in phase 2: 15.20 CI: 6.36–36.33, p < .001) after adjusting for maternal age, parity, gestational age, religion, mother’s education, husband’s education, and fetal sex Conclusion The partograph user rate has significantly improved with the e- partograph and was associated with an overall reduction in cesarean births. Use of the e-partograph was also associated with reduced rates of prolonged labour. This study has added to the growing body of evidence on the positive impact of e-partograph use. We recommend implementing e-partograph intervention at scale in both public and private hospitals in Bangladesh. Trial registration ClinicalTrials.gov NCT03509103.
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Affiliation(s)
- Aminur Rahman
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmina Begum
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
- * E-mail:
| | - Fatema Ashraf
- Department of Obstetrics and Gynaecology, Shaheed Suhrawardi Medical College & Hospital, Dhaka, Bangladesh
| | - Sadika Akhter
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Tarun Kanti Ghosh
- Department of Obstetrics and Gynaecology, Kushtia Medical College & Hospital, Kushtia, Bangladesh
| | - Monjur Rahman
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre/University of Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Sumon Kumar Das
- Clinical and Nutrition Sciences Division, icddr,b, Dhaka, Bangladesh
| | - Parveen Fatima
- Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Iqbal Anwar
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
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