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Agarwal A, Surti V, Terry MA. Recommendations to improve maternal mortality among Rohingya women in Bangladeshi refugee camps. Health Care Women Int 2024:1-12. [PMID: 38743403 DOI: 10.1080/07399332.2024.2349820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
Despite current humanitarian efforts, The Rohingya in Bangladesh's refugee camps have among the highest maternal mortality worldwide. The authors review maternal mortality within Rohingya refugee populations in Bangladesh, citing the camp conditions and cultural norms that affect the Maternal Mortality Ratio (MMR). Next, the authors review current humanitarian efforts made by the UNFPA toward improving reproductive health. Finally, the authors recommend a three-pronged approach to reducing maternal mortality among the Rohingya in Bangladeshi refugee camps. We suggest using Maternity Waiting Homes, Mama Rickshaws, and Traditional Birth Attendants to improve maternal health. These solutions address the three-delays model and place ownership into the community. Ultimately, the authors address a much-needed gap in the literature addressing Rohingya maternal mortality.
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Affiliation(s)
| | - Vidya Surti
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Aranda Z, Caamal V, Montaño M, Bernal D, Meneses S. Exploring how non-clinical factors in childbirth care shape users' experiences in public health facilities in rural Chiapas, Mexico: a qualitative study using the WHO health systems responsiveness framework. BMC Pregnancy Childbirth 2024; 24:173. [PMID: 38424565 PMCID: PMC10905866 DOI: 10.1186/s12884-024-06357-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Many Mexicans face barriers to receive delivery care from qualified professionals, especially indigenous and poor sectors of the population, which represent most of the population in the state of Chiapas. When access to institutional delivery care is an option, experiences with childbirth care are often poor. This underscores the need for evidence to improve the quality of services from the user's perspective. The present study was conceived with the objective of understanding how non-clinical aspects of care shape women's birthing experiences in public health institutions in Chiapas. METHODS We conducted an exploratory qualitative study. Data collection consisted in 20 semi-structured interviews to women who had delivered in a public health facility in Chiapas during the last six months prior to the interview. For the design of the interview guide we used the WHO health system responsiveness framework, which focus on the performance of the health system in terms of the extent to which it delivers services according to the "universally legitimate expectations of individuals" and focuses on the non-financial and non-clinical qualities of care. The resulting data were analyzed using thematic analysis methodology. RESULTS We identified a total of 16 themes from the data, framed in eight categories which followed the eight domains of the WHO health systems responsiveness framework: Choice of the provider and the facility, prompt attention, quality of basic amenities, access to social support, respectful treatment, privacy, involvement in decisions, and communication. We shed light on the barriers women face in receiving prompt care, aspects of health facilities that impact women's comfort, the relevance of being provided with adequate food and drink during institutional delivery, how accompaniment contributes positively to the birthing experience, the aspects of childbirth that women find important to decide on, and how providers' interpersonal behaviors affect the birthing experience. CONCLUSIONS We have identified non-clinical aspects of childbirth care that are important to the user experience and that are not being satisfactorily addressed by public health institutions in Chiapas. This evidence constitutes a necessary first step towards the design of strategies to improve the responsiveness of the Chiapas health system in childbirth care.
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Affiliation(s)
- Zeus Aranda
- Partners In Health Mexico (Compañeros En Salud), Ángel Albino Corzo, Calle Primera Pte. Sur 25, Colonia Centro, 30370 Ángel Albino Corzo, Chiapas, México.
| | - Viviana Caamal
- Partners In Health Mexico (Compañeros En Salud), Ángel Albino Corzo, Calle Primera Pte. Sur 25, Colonia Centro, 30370 Ángel Albino Corzo, Chiapas, México
| | - Mariana Montaño
- Partners In Health Mexico (Compañeros En Salud), Ángel Albino Corzo, Calle Primera Pte. Sur 25, Colonia Centro, 30370 Ángel Albino Corzo, Chiapas, México
| | - Daniel Bernal
- Escuela de Gobierno y Transformación Pública, Instituto Tecnológico y de Estudios Superiores de Monterrey, Ciudad de México, México
| | - Sergio Meneses
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, México
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Ticku S, Watrous O, Burgess D, Luo YL, DSouza S, Simpson C, King K, Riedy CA, Seymour B. A Three Delays theoretical framework to describe social determinants as barriers to dental care. Community Dent Oral Epidemiol 2024. [PMID: 38425183 DOI: 10.1111/cdoe.12949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/19/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES The Three Delays model is a well-established global public health framework for the utilization of obstetric services where each delay represents a series of factors affecting utilization: (1) Delay #1-Deciding to seek care, (2) Delay #2-Reaching an appropriate facility and (3) Delay #3-Receiving adequate care. The aim of this qualitative study was to explore the application of the Three Delays model to dental service utilization and describe factors attributed to delayed utilization within this framework. METHODS This study utilized a framework analysis, underpinned by the Three Delays model, to examine delays in dental care utilization. A criterion purposive sample of English-speaking adults (18+ years) in Massachusetts and Florida, USA with limited dental care access was recruited. Data were collected via semi-structured interviews conducted in two phases: 17 individual interviews, followed by interviews with a subset of five participants over 3 months (a total of 18 interviews). The analysis involved inductive thematic coding and systematic organization within the framework. RESULTS Major themes and subthemes were constructed from the participants' narratives, identified and categorized as factors in the Three Delays framework. Each of the delays was interrelated to the other two, and Delay #1 was the most common delay based on the participants' interviews. The themes and subthemes contributing to one or more delays included interpersonal communication, prior dental experience, financial considerations, childcare costs, social connection, technology literacy, time constraints, competing priorities, stressors such as eviction and immigration status and microaggressions including racism and stigma. CONCLUSION The Three Delays model was applicable to the study of dental care utilization and factors that impact the decision to seek dental care, reaching an appropriate dental facility and receiving adequate dental care in this study context.
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Affiliation(s)
- Shenam Ticku
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Olivia Watrous
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Danielle Burgess
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Yuanyuan Laura Luo
- Department of Pediatric Dentistry, New York University College of Dentistry, New York, New York, USA
| | - Sabina DSouza
- The University of Chicago College, Chicago, Illinois, USA
| | | | - Kareem King
- Harvard College, Cambridge, Massachusetts, USA
| | - Christine A Riedy
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Brittany Seymour
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Nankabirwa V, Mukunya D, Ndeezi G, Odongkara B, Arach AA, Achora V, Mugenyi L, Sebit MB, Wandabwa JN, Waako P, Tylleskär T, Tumwine JK. Can an integrated intervention package including peer support increase the proportion of health facility births? A cluster randomised controlled trial in Northern Uganda. BMJ Open 2024; 14:e070798. [PMID: 38326267 PMCID: PMC10860059 DOI: 10.1136/bmjopen-2022-070798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE To assess the effect of an integrated intervention package compared with routine government health services on the frequency of health facility births. SETTING Three subcounties of Lira district in Northern Uganda. DESIGN A cluster randomised controlled trial where a total of 30 clusters were randomised in a ratio of 1:1 to intervention or standard of care. PARTICIPANTS Pregnant women at ≥28 weeks of gestation. INTERVENTIONS Participants in the intervention arm received an integrated intervention package of peer support, mobile phone messaging and birthing kits during pregnancy while those in the control arm received routine government health services ('standard of care'). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the proportion of women giving birth at a health facility in the intervention arm compared with the control arm. Secondary outcomes were perinatal and neonatal deaths. RESULTS In 2018-2019, 995 pregnant women were included in 15 intervention clusters and 882 in 15 control clusters. The primary outcome was ascertained for all except one participant who died before childbirth. In the intervention arm, 754/994 participants (76%) gave birth at a health facility compared with 500/882 (57%) in the control arm. Participants in the intervention arm were 35% more likely to give birth at a health facility compared with participants in the control arm, (risk ratio 1.35 (95% CI 1.20 to 1.51)) and (risk difference 0.20 (95% CI 0.13 to 0.27)). Adjusting for baseline differences generated similar results. There was no difference in secondary outcomes (perinatal or neonatal mortality or number of postnatal visits) between arms. CONCLUSION The intervention was successful in increasing the proportion of facility-based births but did not reduce perinatal or neonatal mortality. TRIAL REGISTRATION NUMBER NCT02605369.
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Affiliation(s)
- Victoria Nankabirwa
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
- Centre for International Health, University of Bergen, Bergen, Norway
| | | | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Beatrice Odongkara
- Department of Paediatrics and Child Health, Gulu University, Gulu, Uganda
| | - Agnes A Arach
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Vicentina Achora
- Department of Obstetrics and Gynaecology, Gulu University, Gulu, Uganda
| | - Levi Mugenyi
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | | | - Thorkild Tylleskär
- Centre for International health, Universitetet i Bergen, Bergen, Norway
- University of Bergen Centre for Intervention Science for Maternal and Child Health, Bergen, Norway
| | - James K Tumwine
- Paediatrics and Child Health, Makerere University CHS, Kampala, Uganda
- Kabale University, Kabale, Uganda
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Gelaw KA, Atalay YA, Zerefu F, Gebeyehu NA. Delays in the decision to seek care and associated factors among mothers who delivered in rural health centers in Wolaita Zone, Southern Ethiopia. Front Glob Womens Health 2024; 4:1236242. [PMID: 38273874 PMCID: PMC10808602 DOI: 10.3389/fgwh.2023.1236242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
Background Delays in seeking care in health facilities during pregnancy and childbirth can potentially lead to adverse outcomes for women with obstetric complications. These complications lead to maternal mortality and morbidity in developing countries such as Ethiopia. The magnitude and underlying causes of maternal first delay in Ethiopia, particularly in rural areas of the country, are not well documented. This study aims to assess the magnitude of delay in the decision to seek care and associated factors among mothers who gave birth in rural health centers in Wolaita Zone, Southern Ethiopia. Method and materials A facility-based cross-sectional study was undertaken among mothers who gave birth in rural health centers of Wolaita Zone, Southern Ethiopia, from 30 June 2020 to 30 July 2022. A sample size of 410 study participants was selected from each public health center using the systematic random sampling method. Data were collected from a pretested and structured questionnaire using an Open Data Kit; analysis was carried out using SPSS version 25. The determining factors for the first delay were identified using binary logistic regression. Variables with a p-value of less than 0.25 in binary analysis were selected for a multivariable analysis. Variables with a p-value of less than 0.05 were considered statistically significant. Results The magnitude of delay in the decision to seek care in health facilities was 42.1% among mothers who gave birth in rural health centers in the Wolaita Zone, Southern Ethiopia. Unemployed mothers (Adjusted Odd Ratio, 2,529; 95% CI, 1.546, 4.136), husbands with no formal education (Adjusted Odd Ratio, 1.290; 95% CI, 1.029, 1.616), mothers who had negative attitudes towards seeking care in health facilities, and (Adjusted Odd Ratio; 1.695; 95% CI, 1.061, 2.709) were significantly associated with a delay in the decision to seek care at a health facility. Conclusion The magnitude of the first maternal decision to seek care at health facilities among mothers was high in the study area. Efforts should be made to strengthen the literacy level of the husbands of mothers and increase household income through various income-generating approaches. In addition, the dissemination of health information could effectively raise community awareness of the importance of institutional delivery.
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Affiliation(s)
- Kelemu Abebe Gelaw
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, WolaitaSodo, Ethiopia
| | - Yibeltal Assefa Atalay
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Firehiwot Zerefu
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Natnael Atnafu Gebeyehu
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, WolaitaSodo, Ethiopia
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Campbell R, Kernohan G, Dornan L, Sinclair M. An ethnographic study evaluating emergency obstetric care education and training in a remote, fragile region of Southeast Asia: Study protocol. Nurs Open 2023; 10:7860-7870. [PMID: 37837268 PMCID: PMC10643822 DOI: 10.1002/nop2.2034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 06/02/2023] [Accepted: 09/17/2023] [Indexed: 10/15/2023] Open
Abstract
AIM To evaluate emergency obstetric care education and training within a medical assistant training program, being delivered in a remote, fragile region of Southeast Asia. This will aid in the identification of potential areas of enhancement to improve the management of obstetric emergencies. DESIGN An ethnographic study, adopting a multi-methods approach. METHODS Emergency obstetric care education and training will be assessed through documentary analysis and interviews (online or face-to-face) with educators and trainers (N ~ 6-7). Student experiences will be explored using in-person focus groups, facilitated by an external trainer involved in delivering the program (N ~ 10-12). A reflective field diary will provide insight into the lived experience of postgraduate students (N ~ 4-5). Data will be collected between May 2022 and May 2023. The full data set will be triangulated and analysed using the READ approach; (1) ready your materials, (2) extract data, (3) analyse data and (4) distil your findings. Institutional ethical approval was obtained from a university in October 2021, and inter-country regional access was gained following adherence to their local ethical requirements. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE The findings from this study may help to inform the future design of the medical assistant training program. It is anticipated that the knowledge gained from this study will enhance the education and training of mid-level health providers at local, national, and international levels. This work intends to contribute to addressing Sustainable Development Goal 3, Target 1 of reducing maternal mortality to 70:100,000 live births in low-income countries. REPORTING METHOD This protocol adhered to the Standards for Reporting Qualitative Research (SRQR) checklist. PATIENT OR PUBLIC CONTRIBUTION No formal PPI has been undertaken; however, stakeholders involved in delivering the education and training have been consulted.
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Affiliation(s)
- Rachel Campbell
- The Centre for Maternal, Fetal and Infant ResearchInstitute of Nursing and Health Research, Ulster UniversityBelfastUK
| | - George Kernohan
- The Centre for Maternal, Fetal and Infant ResearchInstitute of Nursing and Health Research, Ulster UniversityBelfastUK
| | - Lesley Dornan
- The Centre for Maternal, Fetal and Infant ResearchInstitute of Nursing and Health Research, Ulster UniversityBelfastUK
| | - Marlene Sinclair
- The Centre for Maternal, Fetal and Infant ResearchInstitute of Nursing and Health Research, Ulster UniversityBelfastUK
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Glenzer MM, Correia M, Nhantumbo V, Barnes RF, Luis E, Boaventura I, Manguele N, Silva P, von Drygalski A. Postpartum hemorrhage in Sub-Saharan Africa-a prospective study in metropolitan Mozambique. J Thromb Haemost 2023; 21:3463-3476. [PMID: 37709148 DOI: 10.1016/j.jtha.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/12/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Estimates indicate approximately ≈500 to 1000 maternal deaths per 100,000 live births in Sub-Saharan Africa (SSA) (vs ≈5-20 in developed countries). Postpartum hemorrhage (PPH) seems a major contributor to maternal mortality (MM), but there are no comprehensive data for the region. OBJECTIVES Analyze MM, PPH, and associated risk factors. METHODS We collected prospective data on MM, PPH, and associated risk factors in metropolitan Mozambique. We recorded consecutive deliveries at the Maputo Central Hospital between February 2019 and January 2021. Data included age, HIV status, parity, delivery mode, notes, vital signs, laboratory values, and fetal parameters. PPH was determined by charted diagnosis, blood loss of >500 mL, transfusion, and/or notes indicating significant bleeding. RESULTS Of 8799 deliveries, ≈40% occurred in women residing outside Maputo City ("nonlocal"), with similar demographic characteristics between local and nonlocal women. However, compared with local women, nonlocal women had worse outcomes, including higher rates of MM (1.52% vs 0.78%; P =.0012) and PPH (16.51% vs 12.39%; P <.0001), whereby PPH was strongly associated with MM (adjusted odds ratio = 5.56; P <.0001). Almost all women with uterine atony (≈1%) experienced PPH. For women receiving laboratory tests on admission (drawn only if in distress; local, n = 561; nonlocal, n = 514), both cohorts revealed similar distributions of hemoglobin levels and platelet counts. Prepartum anemia (≈57%) and thrombocytopenia (≈21%) were prominent risk factors for PPH; risk increased with increasing severity and was additive in the presence of both. CONCLUSIONS PPH is a serious problem in Maputo province, a metropolitan area of SSA, portending high MM. Identification of correctable risk factors, including anemia, should catalyze the development of region-specific prevention protocols.
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Affiliation(s)
- Michael M Glenzer
- Department of Medicine, University of California San Diego, San Diego, California, USA.
| | - Momade Correia
- Department of Gynecology/Obstetrics, Universidade Eduardo Mondlane, Hospital, Central Maputo, Maputo, Mozambique
| | - Virgilio Nhantumbo
- Department of Hematology, Universidade Eduardo Mondlane, Hospital, Central Maputo, Maputo, Mozambique
| | - Richard Fw Barnes
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Elvira Luis
- Department of Gynecology/Obstetrics, Universidade Eduardo Mondlane, Hospital, Central Maputo, Maputo, Mozambique
| | - Ines Boaventura
- Department of Gynecology/Obstetrics, Universidade Eduardo Mondlane, Hospital, Central Maputo, Maputo, Mozambique
| | - Nelia Manguele
- Department of Hematology, Universidade Eduardo Mondlane, Hospital, Central Maputo, Maputo, Mozambique
| | - Patricia Silva
- Department of Hematology, Universidade Eduardo Mondlane, Hospital, Central Maputo, Maputo, Mozambique
| | - Annette von Drygalski
- Department of Medicine, University of California San Diego, San Diego, California, USA
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Keshri VR, Abimbola S, Parveen S, Mishra B, Roy MP, Jain T, Peden M, Jagnoor J. Navigating health systems for burn care: Patient journeys and delays in Uttar Pradesh, India. Burns 2023; 49:1745-1755. [PMID: 37032275 DOI: 10.1016/j.burns.2023.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/17/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND India has one of the highest burden of burns. The health systems response to burn care is sometimes patchy and highly influenced by social determinants. Delay in access to acute care and rehabilitation adversely affects recovery outcomes. Evidence on underlying factors for delays in care are limited. In this study, we aim to explore patients' journeys to analyse their experiences in accessing burn care in Uttar Pradesh, India. METHODS We conducted qualitative inquiry using the patient journey mapping approach and in-depth interviews (IDI). We purposively selected a referral burn centre in Uttar Pradesh, India and included a diverse group of patients. A chronological plot of the patient's journey was drawn and confirmed with respondents at the end of the interview. A detailed patient journey map was drawn for each patient based on interview transcripts and notes. Further analysis was done in NVivo 12 using a combination of inductive and deductive coding. Similar codes were categorised into sub-themes, which were distributed to one of the major themes of the 'three delays' framework. RESULTS Six major burns patients (4 female and 2 males) aged between 2 and 43 years were included in the study. Two patients had flame burns, and one had chemical, electric, hot liquid, and blast injury, respectively. Delay in seeking care (delay 1) was less common for acute care but was a concern for rehabilitation. Accessibility and availability of services, costs of care and lack of financial support influenced delay (1) for rehabilitation. Delay in reaching an appropriate facility (delay 2) was common due to multiple referrals before reaching an appropriate burn facility. Lack of clarity on referral systems and proper triaging influenced this delay. Delay in getting adequate care (delay 3) was mainly due to inadequate infrastructure at various levels of health facilities, shortage of skilled health providers, and high costs of care. COVID-19-related protocols and restrictions influenced all three delays. CONCLUSIONS Burn care pathways are adversely affected by barriers to timely access. We propose using the modified 3-delays framework to analyse delays in burns care. There is a need to strengthen referral linkage systems, ensure financial risk protection, and integrate burn care at all levels of health care delivery systems.
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Affiliation(s)
- Vikash Ranjan Keshri
- The George Institute for Global Health, India; The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The George Institute for Global Health, Sydney, Australia
| | - Samina Parveen
- The George Institute for Global Health, India; Ipas Development Foundation, New Delhi, India
| | - Brijesh Mishra
- Department of Plastic Surgery, King George's Medical University, Lucknow, India
| | - Manas Pratim Roy
- Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, India
| | - Tanu Jain
- Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, India
| | - Margie Peden
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, London, United Kingdom; School of Public Health, Imperial College London, United Kingdom
| | - Jagnoor Jagnoor
- The George Institute for Global Health, India; The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
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Jean-Baptiste M, Millien C, Pognon PR, Casella Jean-Baptiste M. Reframing the Three Delays framework: factors influencing referrals to facilities by matrones in rural Haiti. BMJ Glob Health 2023; 8:e011957. [PMID: 37967901 PMCID: PMC10693684 DOI: 10.1136/bmjgh-2023-011957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 10/01/2023] [Indexed: 11/17/2023] Open
Abstract
In Haiti, there has been limited research on the experiences of traditional birth attendants/matrones when they decide to refer and accompany pregnant women to the facility for giving birth. Understanding this contextualised experience could help to strengthen programming aimed at improving maternal, neonatal, and child health (MNCH) outcomes in rural Haiti. This paper describes the qualitative findings from seven focus group discussions (FGDs) with matrones regarding their experience of referring pregnant women to facilities in Haiti's Central Plateau. Each FGD was conducted in Haitian Kreyol and audio recorded. Recordings were transcribed, translated to English, and thematically analysed. A conceptual model visualising factors influencing matrone decision-making was then developed using an adapted version of the Three Delays framework. Findings from this study show that matrones face a complex, multilayered web of intertwining factors related to attitudes and beliefs around their role, resource availability, and perceptions around quality of care and treatment. Each factor corresponds to a delay in the Three Delays framework. The factors can occur at the same time or each can occur individually at different times, and influence the decision to refer. The complexity of factors identified reflects the need to reassess the Three Delays framework so that it accounts for the intertwining, cyclical complexities faced by those trying to access the facility amidst the backdrop of both time and the community/social contexts. Results further reflect the need for strengthened health systems that better facilitate matrone facility-based referrals, improving outcomes for all parties involved and bridging the gap between homes/ communities and facilities. This calls for better integration of the matrones into the formal health system to systematically strengthen the continuum of MNCH health services provided from home to facility.
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Affiliation(s)
- Milenka Jean-Baptiste
- Department of Health Behavior, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Christophe Millien
- Medical Direction, Hopital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Pierre Ricard Pognon
- Strategic Health Information System (SHIS), Partners In Health - Sierra Leone, Freetown, Sierra Leone
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Miller FA, Dulal S, Rai A, Gram L, Harris-Fry H, Saville NM. "Can't live willingly": A thematic synthesis of qualitative evidence exploring how early marriage and early pregnancy affect experiences of pregnancy in South Asia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002279. [PMID: 37871001 PMCID: PMC10593245 DOI: 10.1371/journal.pgph.0002279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/13/2023] [Indexed: 10/25/2023]
Abstract
In South Asia, early marriage has been associated with a range of adverse outcomes during pregnancy and infancy. This may partly be explained by early marriage leading to a younger maternal age, however it remains unclear which other factors are involved. This review aimed to synthesise the qualitative evidence on experiences of pregnancy following early marriage or early pregnancy in South Asia, to inform our understanding of the mechanisms between early marriage and adverse pregnancy outcomes. We searched MEDLINE, EMBASE, Scopus, Global Index Medicus, CINAHL, PsycINFO, Web of Science, and grey literature on 29/11/2022 to identify papers on experiences of pregnancy among those who married or became pregnant early in South Asia (PROSPERO registration number: CRD42022304336, funded by an MRC doctoral training grant). Seventy-nine papers from six countries were included after screening. We appraised study quality using an adapted version of the Critical Appraisal Skills Programme tool for qualitative research. Reporting of reflexivity and theoretical underpinnings was poor. We synthesised findings thematically, presenting themes alongside illustrative quotes. We categorised poor pregnancy experiences into: care-seeking challenges, mental health difficulties, and poor nutritional status. We identified eight inter-connected themes: restrictive social hierarchies within households, earning social position, disrupted education, social isolation, increased likelihood of and vulnerability to abuse, shaming of pregnant women, normalisation of risk among younger women, and burdensome workloads. Socioeconomic position and caste/ethnic group also intersected with early marriage to shape experiences during pregnancy. While we found differences between regions, the heterogeneity of the included studies limits our ability to draw conclusions across regions. Pregnancy experiences are largely determined by social hierarchies and the quality of relationships within and outside of the household. These factors limit the potential for individual factors, such as education and empowerment, to improve experiences of pregnancy for girls married early.
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Affiliation(s)
- Faith A. Miller
- Institute for Global Health, University College London, London, United Kingdom
| | - Sophiya Dulal
- School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Anjana Rai
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Lu Gram
- Institute for Global Health, University College London, London, United Kingdom
| | - Helen Harris-Fry
- Department of Population Health, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Naomi M. Saville
- Institute for Global Health, University College London, London, United Kingdom
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Tadesse T, Regassa N, Kifle D, Jara D, Abegaz KH. Framework for maternal morbidity and mortality interventions in Ethiopia: a systematic review protocol. BMJ Open 2023; 13:e075879. [PMID: 37816568 PMCID: PMC10565278 DOI: 10.1136/bmjopen-2023-075879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Maternal morbidity and mortality remain critical public health challenges in Ethiopia with limited evidence on the effectiveness of interventions and health promotion strategies. A scoping review of the existing literature on maternal morbidity and mortality interventions and health promotion in Ethiopia can provide a comprehensive overview of the current evidence, identify research gaps and establish a framework for successful maternal morbidity and mortality interventions. OBJECTIVE The systematic review seeks to assess the existing literature on maternal morbidity and mortality interventions in Ethiopia to develop an evidence-based framework for effective interventions. METHOD The methodology for this study adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines for systematic review protocol. A comprehensive search strategy will be devised, in compliance with the highly sensitive search guidelines of Cochrane, which will involve using both snowball methods to identify relevant articles and searching electronic databases using specific key search terms. The following databases will be searched for studies to be included in the systematic review: MEDLINE (via PubMed), Embase, Scopus, Google Scholar, Web of Science, Science Direct and African Journals Online (AJOL).The search will be restricted to English language publications starting from January 2010 to May 2023. In a comprehensive review process, independent reviewers will meticulously assess titles, abstracts and full texts of studies, ensuring alignment with predetermined inclusion and exclusion criteria at each stage of selection.Quality evaluation instruments appropriate for each research design will be used to assess the quality of the selected studies. The findings from the included studies will be analysed and summarised using a narrative synthesis approach. ETHICS AND DISSEMINATION Since this systematic review is based on the reviewing of existing literature and will not involve the collection of primary data, ethical approval is not required. The results will be disseminated through peer-reviewed publication and conference presentations. PROSPERO REGISTRATION NUMBER CRD42023420990.
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Affiliation(s)
- Trhas Tadesse
- Public Health, Yekatit 12 Hospital, Addis Ababa, Ethiopia
- Public Health, Frontieri Consult Plc, Addis Ababa, Ethiopia
| | - Nigatu Regassa
- Public Health, Frontieri Consult Plc, Addis Ababa, Ethiopia
| | - Dereje Kifle
- Public Health, Frontieri Consult Plc, Addis Ababa, Ethiopia
| | - Dube Jara
- Public Health, Frontieri Consult Plc, Addis Ababa, Ethiopia
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Ekwuazi EK, Chigbu CO, Ngene NC. Reducing maternal mortality in low- and middle-income countries. Case Rep Womens Health 2023; 39:e00542. [PMID: 37954228 PMCID: PMC10636262 DOI: 10.1016/j.crwh.2023.e00542] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 11/14/2023] Open
Affiliation(s)
- Emeka Kingsley Ekwuazi
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Nsukka, Nigeria
| | - Chibuike O. Chigbu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Nsukka, Nigeria
| | - Nnabuike Chibuoke Ngene
- Department of Obstetrics and Gynecology, Leratong Hospital, Krugersdorp, South Africa
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Munishi C, Mateshi G, Mlunde LB, Njiro BJ, Ngowi JE, Kengia JT, Kapologwe NA, Deng L, Timbrell A, Kitinya W, Pembe AB, Sunguya BF. Community-based transport system in Shinyanga, Tanzania: A local innovation averting delays to access health care for maternal emergencies. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001487. [PMID: 37531348 PMCID: PMC10395988 DOI: 10.1371/journal.pgph.0001487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/11/2023] [Indexed: 08/04/2023]
Abstract
In achieving the sustainable development goal 3.1, Tanzania needs substantial investment to address the three delays which responsible for most of maternal deaths. To this end, the government of Tanzania piloted a community-based emergency transport intervention to address the second delay through m-mama program. This study examined secondary data to determine the cost-effectiveness of this intervention in comparison to the standard ambulance system alone. The m-mama program was implemented in six councils of Shinyanga region. The m-mama program data analyzed included costs of referral services using the Emergency Transportation System (EmTS) compared with the standard ambulance system. Analysis was conducted using Microsoft Excel, whose data was fed into a TreeAge Pro Healthcare 2022 model. The cost and effectiveness data were discounted at 5% to make a fair comparison between the two systems. During m-mama program implementation a total of 989 referrals were completed. Of them, 30.1% used the standard referral system using ambulance, while 69.9% used the EmTS. The Emergency transport system costed USD 170.4 per a completed referral compared to USD 472 per one complete referral using ambulance system alone. The introduction of m-mama emergency transportation system is more cost effective compared to standard ambulance system alone in the context of Shinyanga region. Scaling up of similar intervention to other regions with similar context and burden of maternal mortality may save cost of otherwise normal emergency ambulance system. Through lessons learned while scaling up, the intervention may be improved and tailored to local challenges and further improve its effectiveness.
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Affiliation(s)
- Castory Munishi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gilbert Mateshi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Linda B Mlunde
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Belinda J Njiro
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jackline E Ngowi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - James T Kengia
- President's Office Regional Administration and Local Government, Dodoma, Tanzania
| | - Ntuli A Kapologwe
- President's Office Regional Administration and Local Government, Dodoma, Tanzania
| | | | | | | | - Andrea B Pembe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno F Sunguya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Eshetu D, Aschalew Z, Bante A, Fikedu G, Abebe M, Gomora D, Silesh E, Belay R, Getachew T, Acha A, Mersha A. Delay in receiving emergency obstetric care and associated factors among mothers who gave birth in public hospitals of Bale and East Bale zones, Oromia region, South East Ethiopia: Facility based cross-sectional study. Heliyon 2023; 9:e18217. [PMID: 37501971 PMCID: PMC10368818 DOI: 10.1016/j.heliyon.2023.e18217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction Delays in timely seeking care, failure to reach health institutions and receiving ineffective health care cause maternal mortality in developing countries. The three maternal delay was used to identify contributing factors to maternal death. There was limited data on the maternal delay in receiving emergency obstetric care services in the study area. Therefore, the aim of this study was to assess the magnitude of delay in receiving emergency obstetric care and associated factors among postnatal mothers in the Bale and east Bale zones. Methods A facility-based cross-sectional study was conducted among 407 postnatal women from April 6 to May 6, 2022. A systematic random sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariate and multivariable analyses were done by using a binary logistic regression model to identify factors associated with delay in receiving emergency obstetric care services. Statistical significance was declared at P-value < 0.05. Results In this study, the magnitude of delay in receiving institutional delivery service utilization was 34.6% with [95% CI (30.0_39.5)]. Delay one was found to be statistically associated with maternal delay in receiving institutional delivery services (AOR = 2.07; 95% CI: 1.21, 3.53). Mothers with low monthly income had shown higher odds of delay (AOR = 1.79; 95% CI: 1.03, 3.10). Moreover, the delay in receiving emergency obstetric care was 89% less likely among mothers who had not been referred multiple times than among those who had been referred many times (AOR = 0.10; 95% CI: 0.06, 0.18). Conclusion This study showed that the magnitude of the delay in receiving the utilization of emergency obstetric care services in the study area was high. Factors such as delay one, average monthly income and multiple referrals of mothers were found significant factors for delay in receiving care. Therefore, it is important to reduce delay in receiving institutional delivery by working on promoting road accessibility, transport mechanisms and building health education on key danger signs.
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Affiliation(s)
- Derese Eshetu
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Zeleke Aschalew
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Agegnehu Bante
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Genet Fikedu
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Mesfin Abebe
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Degefa Gomora
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Eden Silesh
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Rediet Belay
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Tewodros Getachew
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Aregash Acha
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Abera Mersha
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Imani Ramazani BE, Mabakutuvangilanga Ntala SD, Katuashi Ishoso D, Rothan-Tondeur M. Knowledge of Obstetric Danger Signs among Pregnant Women in the Eastern Democratic Republic of the Congo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085593. [PMID: 37107875 PMCID: PMC10139184 DOI: 10.3390/ijerph20085593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
A lack of awareness regarding obstetric danger signs (ODS) is one of the factors that delay a pregnant woman's decision to seek emergency obstetric care. In developing countries, this delay can lead to high morbidity and mortality among pregnant women. In eastern Democratic Republic of Congo (DRC), very few studies have been conducted to assess the level of knowledge of pregnant women about ODS. Therefore, this study aimed to assess the knowledge of pregnant women about ODS in health facilities in eastern DRC. This quantitative cross-sectional, descriptive, and analytical study was conducted in 19 health facilities in the Kasongo health zone in the south Maniema Province of eastern DRC. A total of 624 pregnant women aged 12-49 years were interviewed in this study. Of these, 60.6% were secondary school graduates, >99% were married, 85.5% were cultivators, and 67.9% were Muslims. The knowledge of ODS among pregnant women was low (21.9%). The most cited danger signs during pregnancy, labor/delivery, and postpartum included severe abdominal pain and severe vaginal bleeding. Additionally, pregnant women aged 30-39 years (p = 0.015) and those who had given birth once (p = 0.049), twice (p = 0.003), 3-5 times (p = 0.004), and >5 times (p = 0.009) were more likely to be aware of ODS than others. Our findings indicated that pregnant women have little knowledge of ODS, which makes it difficult for them to take prompt decisions to seek emergency obstetric care. Thus, strategies to increase the knowledge of pregnant women about obstetrical danger signs by healthcare providers during prenatal consultations (antenatal care) must be developed to improve their rapid decision-making skills during pregnancy, labor, and postpartum.
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Affiliation(s)
- Bin-Eradi Imani Ramazani
- Nursing Sciences Research Chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, University Paris, Sorbonne Paris Cite, F-93017 Bobigny, France; (S.-D.M.N.); (M.R.-T.)
- Nursing Sciences Section, Institut Supérieur des Techniques Médicales de Kindu (ISTM-KINDU), PB.304, Kindu P.O. Box 9912, Democratic Republic of the Congo
- Center for Research in Nursing Sciences and Health Innovation (CReSIIS), K-012, Kinshasa P.O. Box 11850, Democratic Republic of the Congo;
- Correspondence: ; Tel.:+243-81-14-89-176
| | - Simon-Decap Mabakutuvangilanga Ntala
- Nursing Sciences Research Chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, University Paris, Sorbonne Paris Cite, F-93017 Bobigny, France; (S.-D.M.N.); (M.R.-T.)
- Center for Research in Nursing Sciences and Health Innovation (CReSIIS), K-012, Kinshasa P.O. Box 11850, Democratic Republic of the Congo;
- Section of Nursing Sciences, Institut Supérieur des Techniques Médicales de Kinshasa, BP 774 Lemba, Kinshasa P.O. Box 11850, Democratic Republic of the Congo
| | - Daniel Katuashi Ishoso
- Center for Research in Nursing Sciences and Health Innovation (CReSIIS), K-012, Kinshasa P.O. Box 11850, Democratic Republic of the Congo;
- Department of Community Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo
| | - Monique Rothan-Tondeur
- Nursing Sciences Research Chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, University Paris, Sorbonne Paris Cite, F-93017 Bobigny, France; (S.-D.M.N.); (M.R.-T.)
- Center for Research in Nursing Sciences and Health Innovation (CReSIIS), K-012, Kinshasa P.O. Box 11850, Democratic Republic of the Congo;
- Assistance Publique-Hôpitaux de Paris (AP-HP), Nursing Sciences Research Chair, F-75005 Paris, France
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Tesfay N, Tariku R, Zenebe A, Mohammed F, Woldeyohannes F. Area of focus to handle delays related to maternal death in Ethiopia. PLoS One 2022; 17:e0274909. [PMID: 36121828 PMCID: PMC9484697 DOI: 10.1371/journal.pone.0274909] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Maternal delay factors, together with medical factors, have a substantial role in determining maternity outcomes. Although several studies were conducted on delay factors that contribute to maternal death in Ethiopia, the studies were mostly focused either on an individual or at a provincial level factor with a limited number of study participants. In response to this gap, this study is aimed at exploring the magnitude and factors related to delay factors that contribute to maternal death in Ethiopia.
Methods
The study used maternal death surveillance data collected from different regions of Ethiopia, compiled between 2013 and 2021. A total of 4530 maternal deaths were reviewed during the study period. A Multilevel multinomial logistic regression model was applied to examine factors associated with delays related to maternal death. An adjusted relative risk ratio with a 95% confidence interval was stated and variables with p-values less than 0.05 were declared as significant predictors of maternal delay.
Result
Delay three (delay in receiving adequate and appropriate care once reached a health facility) has contributed to 36.3% of maternal deaths followed by delay one (delay in deciding to seek care when experiencing an obstetric emergency) and delay two (delay in reaching to an appropriate obstetric facility) where each of them contributed to 36.1% and 27.6% of maternal deaths respectively. In the multivariate multilevel multinomial model, maternal age, education status, and place of death were among the individual level factors associated with both delay two and delay three. Conversely, marital status and ANC follow-up were associated with delay two alone, while the timing of maternal death was associated with delay three. Residence and type of facility were provincial-level factors linked with both delay two and delay three, while the type of region was related to delay three of maternal death.
Conclusion
Both delay one and three have a major contribution to maternal death in Ethiopia. Individual and provincial level factors played an important role in determining delays related to maternal death. Therefore, it is crucial to account for measures that provide emphasis on the area of raising awareness on the utilization of Antenatal care (ANC) service, improving facility readiness to handle obstetrics emergencies, and narrowing down inequality among regions in service provision.
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Affiliation(s)
- Neamin Tesfay
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
- * E-mail:
| | - Rozina Tariku
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Alemu Zenebe
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fetiya Mohammed
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Mediratta S, Lepard JR, Barthélemy EJ, Corley J, Park KB. Barriers to neurotrauma care in low- to middle-income countries: an international survey of neurotrauma providers. J Neurosurg 2022; 137:789-798. [PMID: 34952519 DOI: 10.3171/2021.9.jns21916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Delays along the neurosurgical care continuum are associated with poor outcomes and are significantly greater in low- to middle-income countries (LMICs), with timely access to neurotrauma care remaining one of the most significant unmet neurosurgical needs worldwide. Using Lancet Global Surgery metrics and the Three Delays framework, the authors of this study aimed to identify and characterize the most significant barriers to the delivery of neurotrauma care in LMICs from the perspective of local neurotrauma providers. METHODS The authors conducted a cross-sectional study through the dissemination of a web-based survey to neurotrauma providers across all World Health Organization geographic regions. Responses were analyzed with descriptive statistics and Kruskal-Wallis testing, using World Bank data to provide estimates of populations at risk. RESULTS Eighty-two (36.9%) of 222 neurosurgeons representing 47 countries participated in the survey. It was estimated that 3.9 billion people lack access to neurotrauma care within 2 hours. Nearly 3.4 billion were estimated to be at risk for impoverishing expenditure and 2.9 billion were at risk of catastrophic expenditure as a result of paying for care for neurotrauma injuries. Delays in seeking care were rated as slightly common (p < 0.001), those in reaching care were very common (p < 0.001), and those in receiving care were slightly common (p < 0.05). The most significant causes for delays were associated with reaching care, including geographic distance from a facility, lack of ambulance service, and lack of finances for travel. All three delays were correlated to income classification and geographic region. CONCLUSIONS While expanding the global neurosurgical workforce is of the utmost importance, the study data suggested that it may not be entirely sufficient in gaining access to care for the emergent neurosurgical patient. Significant income and region-specific variability exists with regard to barriers to accessing neurotrauma care. Highlighting these barriers and quantifying worldwide access to neurotrauma care using metrics from the Lancet Commission on Global Surgery provides essential insight for future initiatives aiming to strengthen global neurotrauma systems.
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Affiliation(s)
- Saniya Mediratta
- 1Faculty of Medicine, Imperial College London, South Kensington Campus, London
- 2NIHR Global Health Research Group on Neurotrauma, University of Cambridge, United Kingdom
| | - Jacob R Lepard
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
- 4Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ernest J Barthélemy
- 4Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 5Department of Neurosurgery, Mount Sinai Health System, New York, New York; and
| | - Jacquelyn Corley
- 4Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 6Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Kee B Park
- 4Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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Zewde HK. Quality and timeliness of emergency obstetric care and its association with maternal outcome in Keren Hospital, Eritrea. Sci Rep 2022; 12:14614. [PMID: 36028743 PMCID: PMC9418268 DOI: 10.1038/s41598-022-18685-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/17/2022] [Indexed: 11/11/2022] Open
Abstract
Despite the critical role quality comprehensive emergency obstetric care (CEmOC) plays in ensuring safe motherhood, only a few studies have attempted to measure the impact of substandard and delayed care on maternal outcome thus far. This study evaluates the association between various process and timeliness indicators of CEmOC and adverse maternal outcome in Keren Hospital. This study compared women with potentially life-threatening condition (PLTC) and women with severe maternal outcome (SMO) with respect to various process and timeliness indicators. Logistic regression analysis was employed to assess the association of timeliness and process indicators with SMO using SPSS version-22 computer software. In this study, we included 491 cases of PLTC and 210 cases of SMO (171 maternal near misses and 39 maternal deaths). The following process indicators showed significant association with SMO: failure to give uterotonics for the treatment of postpartum hemorrhage, failure to administer prophylactic antibiotics, and delayed laporatomy for uterine rupture. Moreover, delays in referral, triaging, seeing an obstetrician, and receiving definitive treatement were strongly associated with SMO. The following causes of delay were also found to be independently associated with SMO: erroneous diagnosis, inappropriate management, multiple referrals between health facilities, unavailability of a senior obstetrician, and poor communication during referral. Among the miscellaneous factors, nighttime admission and referral during the rainy season showed significant association with SMO. Findings of this study indicate that huge gap exists in providing quality and timely care in Keren Hospital. In general, most incidents of substandard and delayed care were due to poor referral system, insufficiency of medical staff, inadequacy of drugs and equipment, and unavailability of standard management protocol. Improving the referral system, upgrading the technical skills of health professionals, making sure life-saving drugs and equipment are available all the time, and posting standard treatment and management protocols in the maternity and emergency rooms will play a vital role in reducing the occurrence of SMO in Keren Hospital.
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Affiliation(s)
- Henos Kiflom Zewde
- Department of Family and Community Health, Ministry of Health Anseba Province, Keren, Anseba, Eritrea.
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Healthcare providers experiences of comprehensive emergency obstetric care in Somaliland: An explorative study with focus on cesarean deliveries. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100768. [DOI: 10.1016/j.srhc.2022.100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/06/2022] [Accepted: 08/15/2022] [Indexed: 11/21/2022]
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Ramazani IBE, Ntela SDM, Ahouah M, Ishoso DK, Monique RT. Maternal mortality study in the Eastern Democratic Republic of the Congo. BMC Pregnancy Childbirth 2022; 22:452. [PMID: 35641954 PMCID: PMC9153209 DOI: 10.1186/s12884-022-04783-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The reduction of maternal mortality in developing countries such as the Democratic Republic of Congo (DRC) still raises many questions. Indeed, this large country in the heart of Africa ranks 4th among the eight countries that alone account for more than 50% of maternal deaths in the world, behind India, Nigeria and Pakistan. However, there is no up-to-date data on maternal mortality in eastern DRC. This study measures the mortality rate rate in health facilities in eastern DRC and identifies the associated risk factors.
Methods
This analytical epidemiological study was based on retrospective data materna deaths recorded in 59 health facilities, in three health zones in the southern part of Maniema province in east DRC. The study was conducted from July 1, 2015 to June 30, 2020. Descriptive, bi and multivariate analyses were used.
Results
The maternal mortality rate was estimated at 620 deaths per 100,000 live births, of which 46% of maternal deaths were related to a parturients’ delayed decision in seeking healthcare in time (first delay). Maternal deaths were significantly associated with extreme ages (≤ 19 years and ≥ 40 years: p = < 0.001), patient parity (in primigravidas and in large multiparas: p = 0.001), complications such as hemorrhagic, (p = < 0.001), uterine ruptures:(p = < 0.001), infections, (p = < 0.001), and dystocia (p = < 0.001).
Conclusion
Despite the efforts made by the DRC and its partners in the fight against maternal mortality, women continue to lose their lives when they decide to give birth. The results imply that it is imperative to strengthen both women and health professionals’ knowledge about pregnancy and maternal health and their power to reduce instances of first delay by supporting women in formulating their birth plans.
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Goyal LD, Garg P, Verma M, Kaur N, Bakshi D, Arora J. Effect of restrictions imposed due to COVID-19 pandemic on the antenatal care and pregnancy outcomes: a prospective observational study from rural North India. BMJ Open 2022; 12:e059701. [PMID: 35387835 PMCID: PMC8987212 DOI: 10.1136/bmjopen-2021-059701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To assess the difficulties faced by the pregnant women in seeking appropriate antenatal care due to the restrictions imposed during the COVID-19 pandemic; assess the difficulties encountered during delivery and postpartum period; the suitability of the teleconsultation services offered; effect of COVID-19 infection on pregnancy outcomes and the effect of restrictions on the nutrition profile of the pregnant women. DESIGN Prospective observational study. SETTING AND PARTICIPANTS We included 1374 pregnant women from the rural areas of three districts of Punjab, India registered at government health centres before the implementation of lockdown due to the COVID-19 pandemic on 24 March 2020. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the difficulties faced by the women during their pregnancies due to restrictions imposed during the lockdown. The secondary outcomes included the effect of COVID-19 infections on pregnancy outcomes, satisfaction from the telemedicine services and restrictions on the nutrition profile of the pregnant women. RESULTS One-third of the women (38.4%) considered their last pregnancy unplanned. Women faced difficulties due to the restrictions in getting adequate nutrition (76.5%), accessing transportation facilities (35.4%), consultations from doctors (22.4%) or getting an ultrasonography scan (48.7%). One-fifth (21.9%) of women could not access safe abortion services. Only 3.6% of respondents ever took any teleconsultation services offered by the government. Most of them felt unsatisfied compared with routine visits (77.5%). COVID-19-infected women were primarily asymptomatic (76.1%), but there was a high incidence of preterm birth (42.8%). Frontline workers could visit 64.3% of the women in the postpartum period despite restrictions. CONCLUSIONS Lockdown compromised the antenatal care in our study area while the frontline workers attempted to minimise the inconvenience. Telemedicine services did not prove to be of many benefits to pregnant women and should only work as a supplement to the existing protocols of antenatal care.
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Affiliation(s)
- Lajya Devi Goyal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences-Bathinda, Bathinda, Punjab, India
| | - Priyanka Garg
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences-Bathinda, Bathinda, Punjab, India
| | - Madhur Verma
- Department of Community and Family Medicine, All India Institute of Medical Sciences-Bathinda, Bathinda, Punjab, India
| | - Navdeep Kaur
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences-Bathinda, Bathinda, Punjab, India
| | - Dapinder Bakshi
- Punjab State Council for Science and Technology, Chandigarh, India
| | - Jatinder Arora
- Punjab State Council for Science and Technology, Chandigarh, India
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Avoka CK, McArthur E, Banke-Thomas A. Interventions to improve obstetric emergency referral decision making, communication and feedback between health facilities in sub-Saharan Africa: A systematic review. Trop Med Int Health 2022; 27:494-509. [PMID: 35322914 PMCID: PMC9321161 DOI: 10.1111/tmi.13747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective The objective of the study was to review the evidence on interventions to improve obstetric emergency referral decision making, communication and feedback between health facilities in sub‐Saharan Africa (SSA). Methods A systematic search of PubMed, Embase, Cochrane Register and CINAHL Plus was conducted to identify studies on obstetric emergency referral in SSA. Studies were included based on pre‐defined eligibility criteria. Details of reported referral interventions were extracted and categorised. The Joanna Biggs Institute Critical Appraisal checklists were used for quality assessment of included studies. A formal narrative synthesis approach was used to summarise findings guided by the WHO's referral system flow. Results A total of 14 studies were included, with seven deemed high quality. Overall, 7 studies reported referral decision‐making interventions including training programmes for health facility and community health workers, use of a triage checklist and focused obstetric ultrasound, which resulted in improved knowledge and practice of recognising danger signs for referral. 9 studies reported on referral communication using mobile phones and referral letters/notes, resulting in increased communication between facilities despite telecommunication network failures. Referral decision making and communication interventions achieved a perceived reduction in maternal mortality. 2 studies focused on referral feedback, which improved collaboration between health facilities. Conclusion There is limited evidence on how well referral interventions work in sub‐Saharan Africa, and limited consensus regarding the framework underpinning the expected change. This review has led to the proposition of a logic model that can serve as the base for future evaluations which robustly expose the (in)efficiency of referral interventions.
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Affiliation(s)
- Cephas K Avoka
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Aduragbemi Banke-Thomas
- School of Human Sciences, University of Greenwich, London, UK.,LSE Health, London School of Economics and Political Science, London, UK
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Mendonça IM, Silva JBFD, Conceição JFFD, Fonseca SC, Boschi-Pinto C. Tendência da mortalidade materna no Estado do Rio de Janeiro, Brasil, entre 2006 e 2018, segundo a classificação CID-MM. CAD SAUDE PUBLICA 2022; 38:e00195821. [DOI: 10.1590/0102-311x00195821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022] Open
Abstract
O objetivo foi analisar a tendência da razão de mortalidade materna (RMM) segundo a classificação CID-Mortalidade Materna (CID-MM) no Estado do Rio de Janeiro, Brasil, no período de 2006 a 2018. Foi realizado estudo de tendência temporal da RMM no Rio de Janeiro segundo tipo de óbito - direto ou indireto - e grupos de causas da classificação CID-MM, da Organização Mundial da Saúde (OMS). A RMM foi calculada com dados do Sistema de Informações sobre Mortalidade (SIM) e do Sistema de Informações sobre Nascidos Vivos (SINASC). As tendências foram estimadas pelo Joinpoint Regression Program. Dos 2.192 óbitos maternos no estado, 61% foram por causas diretas, 34% indiretas e 5% não especificadas. A tendência da RMM total e por causas diretas foi de declínio: 1,2% (IC95%: -2,3; -0,1) ao ano e 3,8% (IC95%: -4,9; -2,6) entre 2006 e 2015, respectivamente. Para causas diretas, segundo a CID-MM, o grupo 2 (causas hipertensivas) foi preponderante, mas houve declínio da eclâmpsia. Seguiram-se o grupo 5 (outras complicações, das quais se destacaram a categoria O90 e a subcategoria O90.3 - cardiomiopatia no puerpério) e o grupo 1 (gravidez que termina em aborto). As causas indiretas apresentaram estabilidade e a maioria pertencia à categoria O99 e suas subcategorias, relacionadas a doenças cardiovasculares e respiratórias. A RMM no Rio de Janeiro apresentou tendência de declínio entre 2006 e 2018, porém distante do recomendado pela OMS e com diferentes comportamentos entre as causas. A classificação CID-MM foi útil para identificar grandes grupos de causas, mas é preciso desagregar por subcategorias, para o adequado conhecimento da etiologia da morte materna.
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Laisser R, Woods R, Bedwell C, Kasengele C, Nsemwa L, Kimaro D, Kuzenza F, Lyangenda K, Shayo H, Tuwele K, Wakasiaka S, Ringia P, Lavender T. The tipping point of antenatal engagement: A qualitative grounded theory in Tanzania and Zambia. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 31:100673. [PMID: 34775355 DOI: 10.1016/j.srhc.2021.100673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 09/06/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Effective antenatal care is fundamental to the promotion of positive maternal and new-born outcomes. International guidance recommends an initial visit in the first trimester of pregnancy, with a minimum of four antenatal visits in total: the optimum schedule being eight antenatal contacts. In low- and middle-income countries, many women do not access antenatal care until later in pregnancy and few have the recommended number of contacts. AIM To gain understanding of women's antenatal experiences in Tanzania and Zambia, and the factors that influence antenatal engagement. METHODS The study was underpinned by Strauss's grounded theory methodology. Interviews were conducted with 48 women, 16 partners, 21 health care providers and 11 stakeholders, and analysed using constant comparison. FINDINGS The core category was 'The tipping point of antenatal engagement', supported by four categories: awareness of health benefits, experiential motivators, influential support, and environmental challenges. Although participants recognised the importance of antenatal care to health outcomes, individual motivations and external influences determined attendance or non-attendance. The 'tipping point' for antenatal engagement occurred when women believed that any negative impact could be offset by tangible gain. For some women non-attendance was a conscious decision, for others it was an unchallenged cultural norm. CONCLUSION A complex interplay of factors determines antenatal engagement. Short-term modifiable factors to encourage attendance include the development of strategies for increasing respectful care; use of positive women's narratives, and active community engagement. Further research is required to develop innovative, cost-effective care models that improve health literacy and meet women's needs.
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Affiliation(s)
- Rose Laisser
- Midwifery and Women's Health, Archibishop Antony Mayalla School of Nursing, Catholic University of Health and Allied Sciences, PO Box 1464, Bugando, Mwanza, Tanzania.
| | - Rebecca Woods
- Midwifery and Women's Health, Archibishop Antony Mayalla School of Nursing, Catholic University of Health and Allied Sciences, PO Box 1464, Bugando, Mwanza, Tanzania
| | - Carol Bedwell
- Midwifery and Women's Health, Archibishop Antony Mayalla School of Nursing, Catholic University of Health and Allied Sciences, PO Box 1464, Bugando, Mwanza, Tanzania
| | - Chowa Kasengele
- Midwifery and Women's Health, Archibishop Antony Mayalla School of Nursing, Catholic University of Health and Allied Sciences, PO Box 1464, Bugando, Mwanza, Tanzania
| | - Livuka Nsemwa
- Midwifery and Women's Health, Archibishop Antony Mayalla School of Nursing, Catholic University of Health and Allied Sciences, PO Box 1464, Bugando, Mwanza, Tanzania
| | - Debora Kimaro
- Midwifery and Women's Health, Archibishop Antony Mayalla School of Nursing, Catholic University of Health and Allied Sciences, PO Box 1464, Bugando, Mwanza, Tanzania
| | - Flora Kuzenza
- Midwifery and Women's Health, Archibishop Antony Mayalla School of Nursing, Catholic University of Health and Allied Sciences, PO Box 1464, Bugando, Mwanza, Tanzania
| | - Kutemba Lyangenda
- Midwifery and Women's Health, Archibishop Antony Mayalla School of Nursing, Catholic University of Health and Allied Sciences, PO Box 1464, Bugando, Mwanza, Tanzania
| | - Happiness Shayo
- Midwifery and Women's Health, Archibishop Antony Mayalla School of Nursing, Catholic University of Health and Allied Sciences, PO Box 1464, Bugando, Mwanza, Tanzania
| | - Khuzuet Tuwele
- Midwifery and Women's Health, Archibishop Antony Mayalla School of Nursing, Catholic University of Health and Allied Sciences, PO Box 1464, Bugando, Mwanza, Tanzania
| | - Sabina Wakasiaka
- Midwifery and Women's Health, Archibishop Antony Mayalla School of Nursing, Catholic University of Health and Allied Sciences, PO Box 1464, Bugando, Mwanza, Tanzania
| | - Prisca Ringia
- Midwifery and Women's Health, Archibishop Antony Mayalla School of Nursing, Catholic University of Health and Allied Sciences, PO Box 1464, Bugando, Mwanza, Tanzania
| | - Tina Lavender
- Midwifery and Women's Health, Archibishop Antony Mayalla School of Nursing, Catholic University of Health and Allied Sciences, PO Box 1464, Bugando, Mwanza, Tanzania
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Bam V, Lomotey AY, Kusi-Amponsah Diji A, Budu HI, Bamfo-Ennin D, Mireku G. Factors influencing decision-making to accept elective caesarean section: A descriptive cross-sectional study. Heliyon 2021; 7:e07755. [PMID: 34430742 PMCID: PMC8365447 DOI: 10.1016/j.heliyon.2021.e07755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/09/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022] Open
Abstract
Elective caesarean sections (CS) that have medical indications contribute to better pregnancy outcomes but women have to consent for the procedure to be performed within reasonable time limits for the desired outcomes. This study aimed to determine the factors that influence women's decision-making and the duration of the decision-making process to accept primary or repeat elective CS in a district hospital in Ghana. A descriptive cross-sectional study was conducted among 163 purposively-sampled postnatal women in a hospital, who had experienced a CS. A questionnaire was used to collect data after the women gave their consent to participate. Data was analyzed using SPSS version 25.0 and presented using appropriate descriptive statistics. Chi-square test of independence was done to determine the association between any two categorical variables. Major factors that influenced women's decision-making to accept elective CS were support from their husband/partner/relatives (39.3 %), their baby's life being at risk (24.5 %), history of previous CS and knowledge about the procedure (19.6 %). Age and parity had significant relationship with the influencing factors. However, age was only significant for the influence of husband/partner/relative in the decision-making to accept CS (p < 0.01). Age (R2 = 0.19, p < 0.001); previous CS (R2 = 0.14, p < 0.001) are the major predictors of the duration of the decision-making process. Women's decision-making in consultation with relatives is the main influencer to accept elective caesarean section. There is the need to involve relatives during the antenatal care period in order for younger women in particular to be readily supported to make timely decisions to avoid preventable complications and allay client's fears.
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Affiliation(s)
- Victoria Bam
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
| | | | | | - Hayford Isaac Budu
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
| | - Dorothy Bamfo-Ennin
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
| | - Georgina Mireku
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
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Ooi SZY, Sichimba D, Dalle DU, Higginbotham G, Takoutsing BD, Bankole NDA, Egiz A, Kotecha J, de Koning R, Nguembu S, Zolo Y, Dokponou YCH, Chilawa S, Bandyopadhyay S, Kanmounye US. Management and Outcomes of Paediatric Intracranial Suppurations in Low- and Middle-Income Countries: A Scoping Review. Front Surg 2021; 8:690895. [PMID: 34466410 PMCID: PMC8403063 DOI: 10.3389/fsurg.2021.690895] [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: 04/04/2021] [Accepted: 07/12/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: Intracranial suppurations account for a significant proportion of intracranial masses in low- and middle-income countries (LMICs), particularly among children. The development of better imaging equipment, antibiotics, and surgical techniques has enabled significant progress in detecting and treating intracranial abscesses. However, it is unclear whether these advances are accessible and utilised by LMICs. In this review, we aimed to describe the landscape of paediatric intracranial suppurations in LMICs. Methods: This scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, WHO Global Index Medicus, AJOL and Google scholar were searched for relevant articles from database inception to January 18th, 2021. Publications in English and French were included. Results: Of the 1,011 records identified, 75 were included. The studies, on average, included 18.8 (95% CI = 8.4-29.1) children (mean age: 8.2 years). Most children were male (62.2%, 95% CI = 28.7-95.7%). Intracranial suppurations were most commonly (46.5%) located in the supratentorial brain parenchyma. The most prevalent causative mechanism was otitis (37.4%) with streptococcus species being the most common causative organism (19.4%). CT scan (71.2%) was most commonly used as a diagnostic tool and antibiotics were given to all patients. Symptoms resolved in 23.7% and improved in 15.3% of patients. The morbidity rate was 6.9%, 18.8% of patients were readmitted, and the mortality rate was 11.0%. Conclusion: Most intracranial suppurations were complications of preventable infections and despite MRI being the gold standard for detecting intracranial suppurations, CT scans were mostly used in LMICs. These differences are likely a consequence of inequities in healthcare and have resulted in a high mortality rate in LMICs.
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Relyea B, Wringe A, Afaneh O, Malamas I, Teodoro N, Ghafour M, Scott J. Stakeholders' Perspectives on the Challenges of Emergency Obstetric Referrals and the Feasibility and Acceptability of an mHealth Intervention in Northern Iraq. Front Glob Womens Health 2021; 2:662256. [PMID: 34816217 PMCID: PMC8594019 DOI: 10.3389/fgwh.2021.662256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/06/2021] [Indexed: 11/15/2022] Open
Abstract
The health system in northern Iraq has been weakened by conflict and the internal displacement of over three million people. Mobile phone-based interventions (mHealth) may improve maternal and neonatal health outcomes by enabling emergency referrals, facilitating communication between patients and providers, and improving patient data management; however, they have not been sufficiently studied in conflict-affected settings. We explored stakeholders' perspectives on challenges to obstetric referrals and the feasibility and acceptability of a mobile phone-based application to reduce delays in reaching emergency obstetric care in order to inform its development. We conducted a qualitative study in the Kurdistan region of northern Iraq from May to July, 2018. Using purposive sampling, we carried out 15 semi-structured interviews with coordination actors including healthcare management staff, government health officials, non-government health program managers and ambulance staff. The interviews explored obstetric care delivery, referral processes, mobile phone usage and mHealth implementation strategies. Eleven focus group discussions, which incorporated participatory activities on similar topics, were conducted with ambulance drivers, hospital and primary health center staff. Audio-recorded, transcribed and translated data were coded iteratively to identify emerging concepts, and analyzed thematically. Sixty-eight stakeholders (36 women and 32 men) participated. Challenges regarding the referral system included resource limitations, security concerns, costs and women's reluctance to be transported in male-staffed ambulances. In terms of obstetric care and decision-making, participants noted gaps in communication and coordination of services with the current paper-based system between health care providers, ambulance drivers, and hospital staff. Ambulance drivers reported incurring delays through lack of patient information, poor road conditions, and security issues. A prototype mobile phone application was found to be acceptable based on perceived usefulness to address some of the challenges to safe obstetric care and focused on phone usage, access to information, Global Positioning System (GPS), connectivity, cost, and user-friendliness. However, the feasibility of the innovation was considered in relation to implementation challenges that were identified, including poor connectivity, and digital literacy. Implementation of the app would need to account for the humanitarian context, cultural and gender norms regarding obstetric care, and would require substantial commitment and engagement from policymakers and practitioners.
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Affiliation(s)
- Bridget Relyea
- Women and Health Alliance International, Erbil, Iraq
- Women and Health Alliance International, Paris, France
| | - Alison Wringe
- Women and Health Alliance International, Paris, France
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Osama Afaneh
- Women and Health Alliance International, Erbil, Iraq
- Women and Health Alliance International, Paris, France
- École des hautes études en santé publique, Rennes, France
| | - Ioannis Malamas
- Women and Health Alliance International, Erbil, Iraq
- Women and Health Alliance International, Paris, France
| | - Nicholas Teodoro
- Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | | | - Jennifer Scott
- Women and Health Alliance International, Paris, France
- Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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