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Ahmed AT, Farah AE, Ali HN, Ibrahim MO. Determinants of early neonatal mortality (hospital based retrospective cohort study in Somali region of Ethiopia). Sci Rep 2023; 13:1114. [PMID: 36670231 PMCID: PMC9859816 DOI: 10.1038/s41598-023-28357-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
Early neonatal mortality occurs when a newborn dies within the first seven days of life. Despite interventions, neonatal mortality remains public health problem over time in Ethiopia (33 per 1000 live births). Determinants varies on level of neonatal mortality. The study's goal was to determine magnitude of early newborn death, as well as its determinants and causes in Newborn Intensive Care Unit of Referral hospital in Ethiopia's Somali region. Health facility based retrospective study review was conducted between May 2019 to May 2021 in Shiek Hassan Yabare Referral Hospital of Jigjiga University of Ethiopia. All neonates admitted at neonatal intensive care unit (NICU) with complete data and get registered using the new NICU registration book from May 2019 to May 2021 were included. Kobo toolkit was used for data collection and analyzed in SPSS 20. The magnitude of early neonatal mortality rate was defined as death between 0 and 7 days. Logistic regression model was used to estimate maternal and neonatal characteristics as a determinant variables on neonatal mortality. The statistical significance was considered at P-value < 0.05. The magnitude of early neonatal mortality rate of Ethiopia's Somali region is estimated to be 130 per 1000 live births-that is say 130 newborn couldn't celebrate their seventh day in every 1000 live births. Hypothermia, prematurity, maternal death at birth and shorter length of stay in NICU were increasing the chance of neonatal mortality at early stage while neonatal resuscitation had shown protective effect against neonatal mortality. Similarly birth asphyxia, preterm, sepsis, and congenital abnormalities were major causes of admission and death in the NICU. The magnitude of early neonatal mortality is considerable and most of the determinants are preventable. Enhancing quality of intra-partum and NICU care including infection prevention, managing hypothermia and neonatal resuscitation as per the national standard within the first golden hour is key.
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Affiliation(s)
- Ahmed Tahir Ahmed
- Public Health Department, College of Medicine and Health Science, Jigjiga University, P.O.Box: 1020, Jigjiga, Ethiopia. .,Pediatric and child health Specialty Department, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia.
| | | | - Hussein Nooh Ali
- Public Health Department, College of Medicine and Health Science, Jigjiga University, P.O.Box: 1020, Jigjiga, Ethiopia.,Pediatric and child health Specialty Department, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Muse Obsiye Ibrahim
- Public Health Department, College of Medicine and Health Science, Jigjiga University, P.O.Box: 1020, Jigjiga, Ethiopia.,Pediatric and child health Specialty Department, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
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Roder-DeWan S, Nimako K, Twum-Danso NAY, Amatya A, Langer A, Kruk M. Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap. BMJ Glob Health 2021; 5:bmjgh-2020-002539. [PMID: 33055093 PMCID: PMC7559116 DOI: 10.1136/bmjgh-2020-002539] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/04/2020] [Accepted: 08/19/2020] [Indexed: 01/21/2023] Open
Abstract
Large disparities in maternal and neonatal mortality exist between low- and high-income countries. Mothers and babies continue to die at high rates in many countries despite substantial increases in facility birth. One reason for this may be the current design of health systems in most low-income countries where, unlike in high-income countries, a substantial proportion of births occur in primary care facilities that cannot offer definitive care for complications. We argue that the current inequity in care for childbirth is a global double standard that limits progress on maternal and newborn survival. We propose that health systems need to be redesigned to shift all deliveries to hospitals or other advanced care facilities to bring care in line with global best practice. Health system redesign will require investing in high-quality hospitals with excellent midwifery and obstetric care, boosting quality of primary care clinics for antenatal, postnatal, and newborn care, decreasing access and financial barriers, and mobilizing populations to demand high-quality care. Redesign is a structural reform that is contingent on political leadership that envisions a health system designed to deliver high-quality, respectful care to all women giving birth. Getting redesign right will require focused investments, local design and adaptation, and robust evaluation.
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Affiliation(s)
| | - Kojo Nimako
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Nana A Y Twum-Danso
- Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Archana Amatya
- Health and Nutrition, Save the Children, Kathmandu, Nepal
| | - Ana Langer
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Margaret Kruk
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Nsaghurwe A, Dwivedi V, Ndesanjo W, Bamsi H, Busiga M, Nyella E, Massawe JV, Smith D, Onyejekwe K, Metzger J, Taylor P. One country's journey to interoperability: Tanzania's experience developing and implementing a national health information exchange. BMC Med Inform Decis Mak 2021; 21:139. [PMID: 33926428 PMCID: PMC8086308 DOI: 10.1186/s12911-021-01499-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Robust, flexible, and integrated health information (HIS) systems are essential to achieving national and international goals in health and development. Such systems are still uncommon in most low and middle income countries. This article describes a first-phase activity in Tanzania to integrate the country's vertical health management information system with the help of an interoperability layer that enables cross-program data exchange. METHODS From 2014 to 2019, the Tanzanian government and partners implemented a five-step procedure based on the "Mind the GAPS" (governance, architecture, program management, and standards) framework and using both proprietary and open-source tools. In collaboration with multiple stakeholders, the team developed the system to address major data challenges via four fully documented "use case scenarios" addressing data exchange among hospitals, between services and the supply chain, across digital data systems, and within the supply chain reporting system. This work included developing the architecture for health system data exchange, putting a middleware interoperability layer in place to facilitate the exchange, and training to support use of the system and the data it generates. RESULTS Tanzania successfully completed the five-step procedure for all four use cases. Data exchange is currently enabled among 15 separate information systems, and has resulted in improved data availability and significant time savings. The government has adopted the health information exchange within the national strategy for health care information, and the system is being operated and managed by Tanzanian officials. CONCLUSION Developing an integrated HIS requires a significant time investment; but ultimately benefit both programs and patients. Tanzania's experience may interest countries that are developing their HIS programs.
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Affiliation(s)
- Alpha Nsaghurwe
- USAID's Maternal and Child Survival Program/John Snow Inc., Dar es Salam, Tanzania
| | - Vikas Dwivedi
- USAID's Maternal and Child Survival Program/John Snow Inc., Arlington, USA.
| | - Walter Ndesanjo
- Information, Communication and Technology (ICT) Unit, Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC), Dar es Salam, Tanzania
| | - Haji Bamsi
- Information, Communication and Technology (ICT) Unit, Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC), Dar es Salam, Tanzania
| | - Moses Busiga
- USAID, Health System Strengthening, Dar es Salam, Tanzania
| | - Edwin Nyella
- USAID's Maternal and Child Survival Program/John Snow Inc., Dar es Salam, Tanzania
| | | | - Dasha Smith
- USAID's Maternal and Child Survival Program/John Snow Inc., Arlington, USA
| | - Kate Onyejekwe
- USAID's Maternal and Child Survival Program/John Snow Inc., Arlington, USA
| | | | - Patricia Taylor
- USAID's Maternal and Child Survival Program/John Snow Inc., Arlington, USA
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Ljungblad LW, Sandvik SO, Lyberg A. The impact of skilled birth attendants trained on newborn resuscitation in Tanzania: A literature review. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2019.100168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Yahya T, Mohamed M. Raising a mirror to quality of care in Tanzania: the five-star assessment. LANCET GLOBAL HEALTH 2018; 6:e1155-e1157. [PMID: 30196094 DOI: 10.1016/s2214-109x(18)30348-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Talhiya Yahya
- Quality Management Unit, Ministry of Health, Dar es Salaam 11101, Tanzania.
| | - Mohamed Mohamed
- Health Quality Assurance Department, Ministry of Health, Dar es Salaam 11101, Tanzania
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Ntoimo LF, Okonofua FE, Ogu RN, Galadanci HS, Gana M, Okike ON, Agholor KN, Abdus-Salam RA, Durodola A, Abe E, Randawa AJ. Prevalence and risk factors for maternal mortality in referral hospitals in Nigeria: a multicenter study. Int J Womens Health 2018; 10:69-76. [PMID: 29440934 PMCID: PMC5798564 DOI: 10.2147/ijwh.s151784] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction While reports from individual hospitals have helped to provide insights into the causes of maternal mortality in low-income countries, they are often limited for policymaking at national and subnational levels. This multisite study was designed to determine maternal mortality ratios (MMRs) and identify the risk factors for maternal deaths in referral health facilities in Nigeria. Methods A pretested study protocol was used over a 6-month period (January 1–June 30, 2014) to obtain clinical data on pregnancies, births, and maternal deaths in eight referral hospitals across eight states and four geopolitical zones of Nigeria. Data were analyzed centrally using univariate, bivariate, and multivariate statistics. Results The results show an MMR of 2,085 per 100,000 live births in the hospitals (range: 877–4,210 per 100,000 births). Several covariates were identified as increasing the odds for maternal mortality; however, after adjustment for confounding, five factors remained significant in the logistic regression model. These include delivery in a secondary health facility as opposed to delivery in a tertiary hospital, non-booking for antenatal and delivery care, referral as obstetric emergency from nonhospital sources of care, previous experience by women of early pregnancy complications, and grandmultiparity. Conclusion MMR remains high in referral health facilities in Nigeria due to institutional and patient-related factors. Efforts to reduce MMR in these health facilities should include the improvement of emergency obstetric care, public health education so that women can seek appropriate and immediate evidence-based pregnancy care, the socioeconomic empowerment of women, and the strengthening of the health care system.
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Affiliation(s)
- Lorretta F Ntoimo
- WHO Implementation Research Group, The Women's Health and Action Research Centre, Benin City, Edo State.,Department of Demography and Social Statistics, Federal University Oye-Ekiti, Ekiti State
| | - Friday E Okonofua
- WHO Implementation Research Group, The Women's Health and Action Research Centre, Benin City, Edo State.,Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Edo State.,Vice Chancellors Office, University of Medical Sciences, Ondo City, Ondo State
| | - Rosemary N Ogu
- WHO Implementation Research Group, The Women's Health and Action Research Centre, Benin City, Edo State.,Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Edo State.,Department of Obstetrics and Gynaecology, University of Port Harcourt, Port Harcourt, Rivers State
| | | | | | - Ola N Okike
- Karshi General Hospital, Federal Capital Territory, Abuja
| | | | | | | | - Eghe Abe
- Central Hospital, Benin City, Edo State
| | - Abdullahi J Randawa
- Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
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Hanson C, Manzi F, Mkumbo E, Shirima K, Penfold S, Hill Z, Shamba D, Jaribu J, Hamisi Y, Soremekun S, Cousens S, Marchant T, Mshinda H, Schellenberg D, Tanner M, Schellenberg J. Effectiveness of a Home-Based Counselling Strategy on Neonatal Care and Survival: A Cluster-Randomised Trial in Six Districts of Rural Southern Tanzania. PLoS Med 2015; 12:e1001881. [PMID: 26418813 PMCID: PMC4587813 DOI: 10.1371/journal.pmed.1001881] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/20/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND We report a cluster-randomised trial of a home-based counselling strategy, designed for large-scale implementation, in a population of 1.2 million people in rural southern Tanzania. We hypothesised that the strategy would improve neonatal survival by around 15%. METHODS AND FINDINGS In 2010 we trained 824 female volunteers to make three home visits to women and their families during pregnancy and two visits to them in the first few days of the infant's life in 65 wards, selected randomly from all 132 wards in six districts in Mtwara and Lindi regions, constituting typical rural areas in Southern Tanzania. The remaining wards were comparison areas. Participants were not blinded to the intervention. The primary analysis was an intention-to-treat analysis comparing the neonatal mortality (day 0-27) per 1,000 live births in intervention and comparison wards based on a representative survey in 185,000 households in 2013 with a response rate of 90%. We included 24,381 and 23,307 live births between July 2010 and June 2013 and 7,823 and 7,555 live births in the last year in intervention and comparison wards, respectively. We also compared changes in neonatal mortality and newborn care practices in intervention and comparison wards using baseline census data from 2007 including 225,000 households and 22,243 births in five of the six intervention districts. Amongst the 7,823 women with a live birth in the year prior to survey in intervention wards, 59% and 41% received at least one volunteer visit during pregnancy and postpartum, respectively. Neonatal mortality reduced from 35.0 to 30.5 deaths per 1,000 live births between 2007 and 2013 in the five districts, respectively. There was no evidence of an impact of the intervention on neonatal survival (odds ratio [OR] 1.1, 95% confidence interval [CI] 0.9-1.2, p = 0.339). Newborn care practices reported by mothers were better in intervention than in comparison wards, including immediate breastfeeding (42% of 7,287 versus 35% of 7,008, OR 1.4, CI 1.3-1.6, p < 0.001), feeding only breast milk for the first 3 d (90% of 7,557 versus 79% of 7,307, OR 2.2, 95% CI 1.8-2.7, p < 0.001), and clean hands for home delivery (92% of 1,351 versus 88% of 1,799, OR 1.5, 95% CI 1.0-2.3, p = 0.033). Facility delivery improved dramatically in both groups from 41% of 22,243 in 2007 and was 82% of 7,820 versus 75% of 7,553 (OR 1.5, 95% CI 1.2-2.0, p = 0.002) in intervention and comparison wards in 2013. Methodological limitations include our inability to rule out some degree of leakage of the intervention into the comparison areas and response bias for newborn care behaviours. CONCLUSION Neonatal mortality remained high despite better care practices and childbirth in facilities becoming common. Public health action to improve neonatal survival in this setting should include a focus on improving the quality of facility-based childbirth care. TRIAL REGISTRATION ClinicalTrials.gov NCT01022788.
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Affiliation(s)
- Claudia Hanson
- Faculty of Infectious & Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Public Health Sciences, Global health - Health systems and policy, Karolinska Institutet, Stockholm, Sweden
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | | | - Suzanne Penfold
- Faculty of Infectious & Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zelee Hill
- Institute of Global Health, University College London, London, United Kingdom
| | - Donat Shamba
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Yuna Hamisi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Seyi Soremekun
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Simon Cousens
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tanya Marchant
- Faculty of Infectious & Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hassan Mshinda
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Tanzania Commission for Science and Technology (COSTECH), Dar es Salaam, Tanzania
| | - David Schellenberg
- Faculty of Infectious & Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marcel Tanner
- Swiss Tropical & Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Joanna Schellenberg
- Faculty of Infectious & Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
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