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Willcox ML, Okello IA, Maidwell-Smith A, Tura AK, van den Akker T, Knight M, Dumont A, Muller I. Determinants of behaviors influencing implementation of maternal and perinatal death surveillance and response in low- and middle-income countries: A systematic review of qualitative studies. Int J Gynaecol Obstet 2024; 165:586-600. [PMID: 37727893 DOI: 10.1002/ijgo.15132] [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: 05/05/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Maternal and Perinatal Death Surveillance and Review (MPDSR) can reduce mortality but its implementation is often suboptimal, especially in low- and middle-income countries (LMICs). OBJECTIVES To understand the determinants of behaviors influencing implementation of MPDSR in LMICs (through a systematic review of qualitative studies), in order to plan an intervention to improve its implementation. SEARCH STRATEGY Terms for maternal or perinatal death reviews and qualitative studies. SELECTION CRITERIA Qualitative studies regarding implementation of MPDSR in LMICs. DATA COLLECTION AND ANALYSIS We coded the included studies using the Theoretical Domains Framework and COM-B model of behavior change (Capability, Opportunity, Motivation). We developed guiding principles for interventions to improve implementation of MPDSR. MAIN RESULTS Fifty-nine studies met our inclusion criteria. Capabilities required to conduct MPDSR (knowledge and technical/leadership skills) increase cumulatively from community to health facility and leadership levels. Physical and social opportunities depend on adequate data, human and financial resources, and a blame-free environment. All stakeholders were motivated to avoid negative consequences (blame, litigation, disciplinary action). CONCLUSIONS Implementation of MPDSR could be improved by (1) introducing structural changes to reduce negative consequences, (2) strengthening data collection tools and information systems, (3) mobilizing adequate resources, and (4) building capabilities of all stakeholders.
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Affiliation(s)
- Merlin L Willcox
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Immaculate A Okello
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Alice Maidwell-Smith
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Thomas van den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | | | - Ingrid Muller
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
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Kashililika C, Millanzi WC, Moshi FV. Predictors of health workers' knowledge of maternal and perinatal deaths surveillance and response system in Morogoro region, Tanzania: An analytical cross-sectional study. Medicine (Baltimore) 2024; 103:e37764. [PMID: 38608061 PMCID: PMC11018231 DOI: 10.1097/md.0000000000037764] [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: 11/15/2023] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
This study aimed at assessing the predictors of knowledge about the Maternal and Perinatal Deaths Surveillance and Response (MPDSR) system among health workers in the Morogoro region. It was an analytical cross-sectional study, conducted from April 27 to May 29, 2020. A multistage sampling technique was used to recruit 360 health workers. A semi-structured questionnaire was used to collect the data. Statistical Package for Social Science (SPSS v.20) software was used for data entry and analysis. Bivariate and multivariate logistic regression analyses were used to assess factors associated with knowledge of MPDSR. A total of 105 (29.2%) health workers in the Morogoro region had adequate knowledge of the MPDSR system. After controlling for confounders, predictors of knowledge on the MPDSR system were the level of health facility a health worker was working (n [hospital [adjusted odds ratio [AOR] = 2.668 at 95% confidence intervals [CI] = 1.497-4.753, P = .001]), level of education of a health worker (diploma [AOR = 0.146 at 95% CI = 0.038-0.561, P = .005]), and status of training on MPDSR (trained [AOR = 7.253 at 95% CI = 3.862-13.621, P ≤ .001]). The proportion of health workers with adequate knowledge about the MPDSR system in the Morogoro region is unacceptably low. Factors associated with adequate knowledge were those working in hospitals with higher levels of professional training and those who had ever had training in MPDSR. A cost-effective strategy to improve the level of knowledge regarding MPDSR in this region is highly recommended.
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Affiliation(s)
- Christina Kashililika
- Department of Clinical Nursing, School of Nursing and Public Health of the University of Dodoma, Dodoma, Tanzania
| | - Walter C. Millanzi
- Department of Nursing Management and Education, School of Nursing and Public Health of the University of Dodoma, Dodoma, Tanzania
| | - Fabiola Vincent Moshi
- Department of Clinical Nursing, School of Nursing and Public Health of the University of Dodoma, Dodoma, Tanzania
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Johnston JC, Sartwelle TP, Zebenigus M, Arda B, Beran RG. Global Neurology: The Good, the Bad, and the Ugly. Neurol Clin 2023; 41:549-568. [PMID: 37407107 DOI: 10.1016/j.ncl.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Global health programs engaging in isolated or short-term medical missions can and do cause harm, reinforce health care disparities, and impede medical care in the regions where it is so desperately needed. Related ethical, medical, and legal concerns are reviewed in this article. The authors recommend abandoning these ill-considered missions and focusing attention and resources on advancing neurology through ethically congruent, multisectoral, collaborative partnerships to establish sustainable, self-sufficient training programs within low- and middle-income countries.
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Affiliation(s)
- James C Johnston
- Auckland, New Zealand and San Antonio, TX, USA; Department of Neurology, Addis Ababa University School of Medicine, Ethiopia.
| | | | - Mehila Zebenigus
- Department of Neurology, Addis Ababa University School of Medicine, Ethiopia; Yehuleshet Higher Clinic, Addis Ababa, Ethiopia
| | - Berna Arda
- Department of Medical Ethics, Faculty of Medicine, Ankara University, Turkey
| | - Roy G Beran
- University of New South Wales, Sydney, Australia; Western Sydney University, Sydney, Australia; School of Medicine, Griffith University, Queensland, Australia
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Serbanescu F, Monet JP, Whiting-Collins L, Moran AC, Hsia J, Brun M. Maternal death surveillance efforts: notification and review coverage rates in 30 low-income and middle-income countries, 2015-2019. BMJ Open 2023; 13:e066990. [PMID: 36806138 PMCID: PMC9944275 DOI: 10.1136/bmjopen-2022-066990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE Performance of maternal death surveillance and response (MDSR) relies on the system's ability to identify and notify all maternal deaths and its ability to review all maternal deaths by a committee. Unified definitions for indicators to assess these functions are lacking. We aim to estimate notification and review coverage rates in 30 countries between 2015 and 2019 using standardised definitions. DESIGN Repeat cross-sectional surveys provided the numerators for the coverage indicators; United Nations (UN)-modelled expected country maternal deaths provided the denominators. SETTING 30 low-income and middle-income countries responding to the Maternal Health Thematic Fund annual surveys conducted by the UN Population Fund between 2015 and 2019. OUTCOME MEASURES Notification coverage rate ([Formula: see text]) was calculated as the proportion of expected maternal deaths that were notified at the national level annually; review coverage rate ([Formula: see text]) was calculated as the proportion of expected maternal deaths that were reviewed annually. RESULTS The average annual [Formula: see text] for all countries increased from 17% in 2015 to 28% in 2019; the average annual [Formula: see text] increased from 8% to 13%. Between 2015 and 2019, 22 countries (73%) reported increases in the [Formula: see text]-with an average increase of 20 (SD 18) percentage points-and 24 countries (80%) reported increases in [Formula: see text] by 7 (SD 11) percentage points. Low values of [Formula: see text] contrasts with country-published review rates, ranging from 46% to 51%. CONCLUSION MDSR systems that count and review all maternal deaths can deliver real-time information that could prompt immediate actions and may improve maternal health. Consistent and systematic documentation of MDSR efforts may improve national and global monitoring. Assessing the notification and review functions using coverage indicators is feasible, not affected by fluctuations in data completeness and reporting, and can objectively capture progress.
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Affiliation(s)
- Florina Serbanescu
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jean-Pierre Monet
- Technical Division, United Nations Population Fund, New York, New York, USA
| | - Lillian Whiting-Collins
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - A C Moran
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Jason Hsia
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michel Brun
- Technical Division, United Nations Population Fund, New York, New York, USA
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Willcox ML, Okello IA, Maidwell-Smith A, Tura AK, van den Akker T, Knight M. Maternal and perinatal death surveillance and response: a systematic review of qualitative studies. Bull World Health Organ 2023; 101:62-75G. [PMID: 36593778 PMCID: PMC9795385 DOI: 10.2471/blt.22.288703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 01/04/2023] Open
Abstract
Objective To understand the experiences and perceptions of people implementing maternal and/or perinatal death surveillance and response in low- and middle-income countries, and the mechanisms by which this process can achieve its intended outcomes. Methods In June 2022, we systematically searched seven databases for qualitative studies of stakeholders implementing maternal and/or perinatal death surveillance and response in low- and middle-income countries. Two reviewers independently screened articles and assessed their quality. We used thematic synthesis to derive descriptive themes and a realist approach to understand the context-mechanism-outcome configurations. Findings Fifty-nine studies met the inclusion criteria. Good outcomes (improved quality of care or reduced mortality) were underpinned by a functional action cycle. Mechanisms for effective death surveillance and response included learning, vigilance and implementation of recommendations which motivated further engagement. The key context to enable effective death surveillance and response was a blame-free learning environment with good leadership. Inadequate outcomes (lack of improvement in care and mortality and discontinuation of death surveillance and response) resulted from a vicious cycle of under-reporting, inaccurate data, and inadequate review and recommendations, which led to demotivation and disengagement. Some harmful outcomes were reported, such as inappropriate referrals and worsened staff shortages, which resulted from a fear of negative consequences, including blame, disciplinary action or litigation. Conclusion Conditions needed for effective maternal and/or perinatal death surveillance and response include: separation of the process from litigation and disciplinary procedures; comprehensive guidelines and training; adequate resources to implement recommendations; and supportive supervision to enable safe learning.
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Affiliation(s)
- Merlin L Willcox
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Aldermoor Close, SouthamptonSO16 5SE, England
| | - Immaculate A Okello
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Aldermoor Close, SouthamptonSO16 5SE, England
| | - Alice Maidwell-Smith
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Aldermoor Close, SouthamptonSO16 5SE, England
| | - Abera K Tura
- School of Nursing and Midwifery, Haramaya University, Harar, Ethiopia
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, England
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Abouchadi S, Godin I, Zhang WH, De Brouwere V. Eight-year experience of maternal death surveillance in Morocco: qualitative study of stakeholders’ views at a subnational level. BMC Public Health 2022; 22:2111. [DOI: 10.1186/s12889-022-14556-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Since 2009, Morocco has been implementing the Maternal Death Surveillance System (MDSS). The results obtained indicate significant regional variations in terms of implementation stage, completeness of maternal death reporting, and information use for action. The objective of this research is to better understand the contextual factors involved in the implementation process and use of MDSS, with a focus on the facilitators and barriers, as experienced by stakeholders in health regions.
Methods
Evaluation research was conducted in 2017 based on a descriptive qualitative study using semi-structured in-depth interviews, in four out of the twelve health regions of Morocco. A total of thirty-one in-depth interviews were held with members of regional committees of maternal death reviews (RC-MDR) and other key informant staff. Interviews focused on participants’ views and their experiences with the MDSS since the introduction in 2009. We conducted thematic analysis relied on inductive and deductive approaches. Applying the Consolidated Framework for Implementation Research guided data analysis and reporting findings.
Findings
Engaging leadership at all health system levels, regular training of district and regional MDSS coordinators and supportive supervision at a national level were the most important MDSS implementation facilitators. Reported barriers were essentially related to the review system: Irregular review meetings, blame culture, high turn-over of RC-MDR members, lack of analytical capacity to inform the review process and formulate recommendations, finally limited accountability for recommendation follow-up. While financial incentives boosted MDSS adoption, they were nonetheless a substantial barrier to its sustainability.
Conclusions
The MDSS is a complex process that requires taking numerous steps, including the commitment of multiple stakeholders with varying roles as well as information sharing across health system levels. Contextual factors that influence MDSS implementation at the sub-national level are to be considered. Horizontal and vertical communication about MDSS goals and feedback is crucial to strengthen stakeholders’ commitment, hence improving quality and use of MDSS. Furthermore, health regions should place emphasis on making high-quality recommendations in partnerships between the regional management teams, RC-MDR members and external stakeholders.
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Tesfay N, Tariku R, Zenebe A, Dejene Z, Woldeyohannes F. Cause and risk factors of early neonatal death in Ethiopia. PLoS One 2022; 17:e0275475. [PMID: 36174051 PMCID: PMC9521835 DOI: 10.1371/journal.pone.0275475] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background Globally, three fourth of neonatal deaths occur during the early neonatal period, this makes it a critical time to reduce the burden of neonatal death. The survival status of a newborn is determined by the individual (neonatal and maternal), and facility-level factors. Several studies were conducted in Ethiopia to assess early neonatal death; however, most of the studies had limited participants and did not well address the two main determinant factors covered in this study. In response to this gap, this study attempted to examine factors related to early neonatal death based on perinatal death surveillance data in consideration of all the possible determinants of early neonatal death. Methods The national perinatal death surveillance data were used for this study. A total of 3814 reviewed perinatal deaths were included in the study. Bayesian multilevel parametric survival analysis was employed to identify factors affecting the survival of newborns during the early neonatal period. Adjusted time ratio (ATR) with 95% Bayesian credible intervals (CrI) was reported and log-likelihood was used for model comparison. Statistical significance was declared based on the non-inclusion of 1.0 in the 95% CrI. Result More than half (52.4%) of early neonatal deaths occurred within the first two days of birth. Per the final model, as gestational age increases by a week the risk of dying during the early neonatal period is reduced by 6% [ATR = 0.94,95%CrI:(0.93–0.96)]. There was an increased risk of death during the early neonatal period among neonates deceased due to birth injury as compared to neonates who died due to infection [ATR = 2.05,95%CrI:(1.30–3.32)]; however, perinates who died due to complication of an intrapartum event had a lower risk of death than perinates who died due to infection [ATR = 0.87,95%CrI:(0.83–0.90)]. As the score of delay one and delay three increases by one unit, the newborn’s likelihood of surviving during the early neonatal period is reduced by 4% [ATR = 1.04,95%CrI:(1.01–1.07)] and 21% [ATR = 1.21,95%CrI:(1.15–1.27)] respectively. Neonates born from mothers living in a rural area had a higher risk of dying during the early neonatal period than their counterparts living in an urban area [ATR = 3.53,95%CrI:(3.34–3.69)]. As compared to neonates treated in a primary health facility, being treated in secondary [ATR = 1.14,95%CrI:(1.02–1.27)] and tertiary level of care [ATR = 1.15,95%CrI:(1.04–1.25)] results in a higher risk of death during the early neonatal period. Conclusion The survival of a newborn during the early neonatal period is determined by both individual (gestational age, cause of death, and delay one) and facility (residence, type of health facility and delay three) level factors. Thus, to have a positive early neonatal outcome, a tailored intervention is needed for the three major causes of death (i.e Infection, birth injury, and complications of the intrapartum period). Furthermore, promoting maternal health, improving the health-seeking behaviour of mothers, strengthening facility readiness, and narrowing down inequalities in service provision are recommended to improve the newborn’s outcomes during the early neonatal period.
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Affiliation(s)
- Neamin Tesfay
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
- * E-mail:
| | - Rozina Tariku
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Alemu Zenebe
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Zewdnesh Dejene
- Centre 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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Cetin K, Worku D, Demtse A, Melberg A, Miljeteig I. "Death audit is a fight" - provider perspectives on the ethics of the Maternal and Perinatal Death Surveillance and Response (MPDSR) system in Ethiopia. BMC Health Serv Res 2022; 22:1214. [PMID: 36175949 PMCID: PMC9524002 DOI: 10.1186/s12913-022-08568-0] [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: 03/09/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal and neonatal health are regarded as important indicators of health in most countries. Death auditing through, for example, the Maternal and Perinatal Death Surveillance and Response (MPDSR) is viewed as key to preventing maternal and newborn mortality. However, little is known about the implications of implementing perinatal auditing for healthcare professionals in low-income contexts. This study aimed to explore the ethical and practical consequences clinicians experience concerning MPDSR reporting practices in Ethiopia. METHODS: Qualitative semi-structured in-depth individual interviews were conducted with 16 healthcare workers across professions at selected facilities in Ethiopia. The interview questions were related to clinicians' experiences with, and perceptions of, death auditing. Their strategies for coping with newborn losses and the related reporting practices were also explored. The material was analyzed following systematic text condensation, and the NVivo11 software was used for organizing and coding the data material. RESULTS Participants experienced fear of punishment and blame in relation to the perinatal death auditing process. They found that auditing did not contribute to reducing perinatal deaths and that their motivation to stick to the obligation was negatively affected by this. Performing audits without available resources to provide optimal care or support in the current system was perceived as unfair. Some hid information or misreported information in order to avoid accusations of misconduct when they felt they were not to blame for the baby's death. Coping strategies such as engaging in exceedingly larger work efforts, overtreating patients, or avoiding complicated medical cases were described. CONCLUSIONS Experiencing perinatal death and death reporting constitutes a double burden for the involved healthcare workers. The preventability of perinatal death is perceived as context-dependent, and both clinicians and the healthcare system would benefit from a safe and blame-free reporting environment. To support these healthcare workers in a challenging clinical reality, guidelines and action plans that are specific to the Ethiopian context are needed.
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Affiliation(s)
- Kaya Cetin
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway.
| | - Dawit Worku
- Addis Center for Ethics and Priority Setting, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asrat Demtse
- Addis Center for Ethics and Priority Setting, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andrea Melberg
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway
| | - Ingrid Miljeteig
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway
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Bai Y, Yang J, Cheng Z, Zhang D, Wang R, Zhang R, Bai Z, Zheng S, Wang M, Yin C, Hu X, Wang Y, Xu L, Chen Y, Li J, Li S, Hu Y, Li N, Zhang W, Liu Y, Li J, Ren X, Kang F, Wu X, Ding J, Cheng N. Cohort Profile Update: the China Metal-Exposed workers Cohort Study (Jinchang Cohort). Eur J Epidemiol 2022; 37:641-649. [PMID: 35713795 DOI: 10.1007/s10654-022-00875-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
The Jinchang Cohort was an ongoing 20-year ambispective cohort with unique metal exposures to an occupational population. From January 2014 to December 2019, the Jinchang Cohort has completed three phases of follow-up. The baseline cohort was completed from June 2011 to December 2013, and a total of 48 001 people were included. Three phases of follow-ups included 46 713, 41 888, and 40 530 participants, respectively. The death data were collected from 2001 to 2020. The epidemiological, physical examination, physiological, and biochemical data of the cohort were collected at baseline and during follow-up. Biological specimens were collected on the baseline to establish a biological specimen bank. The concentrations of metals in urine and serum were detected by inductively coupled plasma mass spectrometry (ICP-MS). The new areas of research aim to study the all-cases mortality, the burden of diseases, heavy metals and diseases, and the course of the chain from disease to high-risk outcomes using a combination of macro and micro means, which provided a scientific basis to explore the pathogenesis of multi-etiology and multi-disease and to evaluate the effects of the intervention measures in the population.
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Affiliation(s)
- Yana Bai
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China.
| | - Jingli Yang
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
| | - Zhiyuan Cheng
- School of Public Health and Emergency Management, Southern University of Science and Technology, 518055, Shenzhen, Guangdong, P.R. China
| | - Desheng Zhang
- Workers' Hospital of Jinchuan Corporation, Jinchuan Group CO., LTD, 737100, Jinchuan, Gansu, P.R. China
| | - Ruonan Wang
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
| | - Rui Zhang
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
| | - Zhao Bai
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
| | - Shan Zheng
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
| | - Minzhen Wang
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
| | - Chun Yin
- Workers' Hospital of Jinchuan Corporation, Jinchuan Group CO., LTD, 737100, Jinchuan, Gansu, P.R. China
| | - Xiaobin Hu
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
| | - Yufeng Wang
- Workers' Hospital of Jinchuan Corporation, Jinchuan Group CO., LTD, 737100, Jinchuan, Gansu, P.R. China
| | - Lulu Xu
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
| | - Yarong Chen
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
| | - Jing Li
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
| | - Siyu Li
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
| | - Yujia Hu
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
| | - Na Li
- Workers' Hospital of Jinchuan Corporation, Jinchuan Group CO., LTD, 737100, Jinchuan, Gansu, P.R. China
| | - Wenling Zhang
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
| | - Yanyan Liu
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
| | - Juansheng Li
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
| | - Xiaowei Ren
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
| | - Feng Kang
- Workers' Hospital of Jinchuan Corporation, Jinchuan Group CO., LTD, 737100, Jinchuan, Gansu, P.R. China
| | - Xijiang Wu
- Workers' Hospital of Jinchuan Corporation, Jinchuan Group CO., LTD, 737100, Jinchuan, Gansu, P.R. China
| | - Jiao Ding
- Workers' Hospital of Jinchuan Corporation, Jinchuan Group CO., LTD, 737100, Jinchuan, Gansu, P.R. China
| | - Ning Cheng
- School of Basic Medical Science, Lanzhou University, 730000, Lanzhou, Gansu, P.R. China
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10
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Tesfay N, Legesse F, Kebede M, Woldeyohannes F. Determinants of stillbirth among reviewed perinatal deaths in Ethiopia. Front Pediatr 2022; 10:1030981. [PMID: 36518781 PMCID: PMC9743177 DOI: 10.3389/fped.2022.1030981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The global burden of stillbirth has declined over time. However, the problem is still prominent in South Asian and Sub-Saharan African countries. Ethiopia is one of the top stillbirth-reporting countries worldwide. Despite several measures taken to reduce the burden of stillbirth; the pace of decline was not as good as the post-neonatal death. Thus, this study is aimed at identifying potential factors related to stillbirth in Ethiopia based on nationally reviewed perinatal deaths. METHOD The national perinatal death surveillance data were used for this study. A total of 3,814 reviewed perinatal death were included in the study. Two model families,namely generalized estimating equation, and alternating logistic regression models from marginal model family were employed to investigate the risk factors of stillbirth. The alternating logistic regression model was selected as the best fit for the final analysis. RESULT Among reviewed perinatal deaths nearly forty percent (37.4%) were stillbirths. The findings from the multivariate analysis demonstrated that the place of birth (in transit and at home), cause of death (infection, and congenital and chromosomal abnormalities), maternal health condition (women with complications of pregnancy, placenta, and cord), delay one (delay in deciding to seek care) and delay three (delay in receiving adequate care) were associated with an increased risk of having a stillbirth. On the other hand, maternal education (women with primary and above education level) and the type of health facility (women who were treated in secondary and tertiary health care) were associated with a decreased risk of having a stillbirth. CONCLUSION The study identified that both individual (place of delivery, cause of death, maternal health condition, maternal education, and delay one) and facility level (type of health facility and delay three) factors contributed to stillbirth outcome. Therefore, policies that are aimed at encouraging institutional delivery, improving health seeking behavior, and strengthening facility-level readiness should be devised to reduce the high burden of stillbirth in Ethiopia.
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Affiliation(s)
- Neamin Tesfay
- Center of Public Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Frehiwot Legesse
- Center of Public Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Mandefro Kebede
- Center of Public 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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Said A, Sirili N, Massawe S, Pembe AB, Hanson C, Malqvist M. Mismatched ambition, execution and outcomes: implementing maternal death surveillance and response system in Mtwara region, Tanzania. BMJ Glob Health 2021; 6:bmjgh-2021-005040. [PMID: 34020994 PMCID: PMC8144036 DOI: 10.1136/bmjgh-2021-005040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/07/2022] Open
Abstract
Background Since 2015, Tanzania has been implementing the Maternal Death Surveillance and Response (MDSR) system. The system employs interactions of health providers and managers to identify, notify and review maternal deaths and recommend strategies for preventing further deaths. We aimed to analyse perceptions and experiences of health providers and managers in implementing the MDSR system. Methods An exploratory qualitative study was carried out with 30 purposively selected health providers and 30 health managers in four councils from the Mtwara region between June and July 2020. Key informant interviews and focus group discussions were used to collect data. Inductive thematic analysis was used to analyse data. Results Two main themes emerged from this study: ‘Accomplishing by ambitions’ and ‘A flawed system’. The themes suggest that health providers and managers have a strong desire to make the MDSR system work by making deliberate efforts to implement it. They reported working hard to timely notify, review death and implement action plans from meetings. Health providers and managers reported that MDSR has produced changes in care provision such as behavioural changes towards maternal care, increased accountability and policy changes. The system was however flawed by lack of training, organisational problems, poor coordination with other reporting and quality improvements systems, assigning blame and lack of motivation. Conclusion The implementation of the MDSR system in Tanzania faces systemic, contextual and individual challenges. However, our results indicate that health providers and managers are willing and committed to improve service delivery to avoid maternal deaths. Empowering health providers and managers by training and addressing the flaws will improve the system and quality of care.
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Affiliation(s)
- Ali Said
- Department of Women and Children's Health, Uppsala University, Uppsala, Sweden .,Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Nathanael Sirili
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Siriel Massawe
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Andrea B Pembe
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Mats Malqvist
- Department of Women and Children's Health, Uppsala University, Uppsala, Sweden
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