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Cantrell A, Booth A, Chambers D. A systematic review case study of urgent and emergency care configuration found citation searching of Web of Science and Google Scholar of similar value. Health Info Libr J 2024; 41:166-181. [PMID: 35289476 DOI: 10.1111/hir.12428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Supplementary search methods, including citation searching, are essential if systematic reviews are to avoid producing biased conclusions. Little evidence exists on how to prioritise databases for citation searching or to establish whether using multiple sources is beneficial. OBJECTIVES A systematic review examining urgent and emergency care reconfiguration was used to investigate the utility of citation searching on Web of Science (WOS) and/or Google Scholar (GS). METHODS This case study investigated numbers of studies, additional studies and unique studies retrieved from both sources. In addition, the time to search, the ease of adding references to reference management software and obtaining abstracts of studies for screening are briefly considered. RESULTS WOS retrieved 62 references after deduplication of the results, 52 being additional references not retrieved during the database searching. GS retrieved 134 unique references with 63 additional references. WOS and GS retrieved the same three additional included studies. WOS was less time intensive to search given the facility to restrict to English language papers and availability of abstracts. CONCLUSIONS In a single systematic review case study, citation searching was required to identify all included studies. Citation searching on WOS is more efficient, where a subscription is available. Both databases identified the same studies but GS required additional time to remove non-English language studies and locate abstracts.
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Affiliation(s)
- Anna Cantrell
- Health Economics and Decision Science Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- Health Economics and Decision Science Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- Public Health Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Stoll K, Bendyshe-Walton TA, Av-Gay G, Parajulee A, Humber N, Williams K, Skinner T, Kornelsen J. Perinatal Outcomes at Rural Hospitals That Participated in the Rural Surgical and Obstetrical Networks (RSON) of British Columbia (2016-2021). JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102280. [PMID: 37949367 DOI: 10.1016/j.jogc.2023.102280] [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: 03/02/2023] [Revised: 10/25/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The goal of the Rural Surgical and Obstetrical Networks (RSON) of British Columbia was to support safe and appropriate surgery, operative birth, and perinatal care closer to home for rural communities. Family physicians with enhanced obstetrical and/or surgical skills provide cesarean delivery and family practice anesthetists manage anesthesia for labour pain and operative births at RSON-supported hospitals, with the involvement of a local specialist at one site. OBJECTIVES The objectives of the study were to: (1) compare perinatal outcomes at hospitals participating in the RSON initiative with outcomes at referral hospitals and (2) examine temporal changes in the proportion of childbearing people who resided in RSON communities and gave birth locally. METHODS Poisson regression analysis was used to model the effect of hospital type (RSON vs. referral) on perinatal outcomes. We restricted the analysis to singleton births and controlled for differences in maternal characteristics, obstetric history, and pregnancy complications. RESULTS Childbearing people who gave birth at RSON-supported hospitals (n = 3498) had a 10% lower incidence of adverse maternal-newborn outcomes compared to those who gave birth at referral hospitals (n = 14 772), after controlling for referral bias. We found a small increase (3.2 %) in the proportion of local births over the study period. CONCLUSION Findings provide evidence that childbearing people can safely give birth at smaller rural hospitals in British Columbia and that investments in rural hospitals contribute to service stability. Stabilizing local birth services in rural communities benefits the whole region because it reduces surgical overload in regional referral centres.
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Affiliation(s)
- Kathrin Stoll
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver, BC.
| | | | - Gal Av-Gay
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Anshu Parajulee
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Nancy Humber
- Rural Coordination Center of British Columbia, Vancouver, BC
| | - Kim Williams
- Rural Coordination Center of British Columbia, Vancouver, BC
| | - Tom Skinner
- Rural Coordination Center of British Columbia, Vancouver, BC
| | - Jude Kornelsen
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver, BC
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Woldegeorgis BZ, Gebrekidan AY, Kassie GA, Azeze GA, Asgedom YS, Alemu HB, Obsa MS. Neonatal birth trauma and associated factors in low and middle-income countries: A systematic review and meta-analysis. PLoS One 2024; 19:e0298519. [PMID: 38512995 PMCID: PMC10957092 DOI: 10.1371/journal.pone.0298519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/26/2024] [Indexed: 03/23/2024] Open
Abstract
Neonatal birth trauma, although it has steadily decreased in industrialized nations, constitutes a significant health burden in low-resource settings. Keeping with this, we sought to determine the pooled cumulative incidence (incidence proportion) of birth trauma and identify potential contributing factors in low and middle-income countries. Besides, we aimed to describe the temporal trend, clinical pattern, and immediate adverse neonatal outcomes of birth trauma. We searched articles published in the English language in the Excerpta Medica database, PubMed, Web of Science, Google, African Journals Online, Google Scholar, Scopus, and in the reference list of retrieved articles. Literature search strategies were developed using medical subject headings and text words related to the outcomes of the study. The Joana Briggs Institute quality assessment tool was employed and articles with appraisal scores of seven or more were deemed suitable to be included in the meta-analysis. Data were analyzed using the random-effect Dersimonian-Laird model. The full search identified a total of 827 articles about neonatal birth trauma. Of these, 37 articles involving 365,547 participants met the inclusion criteria. The weighted pooled cumulative incidence of birth trauma was estimated at 34 per 1,000 live births (95% confidence interval (CI) 30.5 to 38.5) with the highest incidence observed in Africa at 52.9 per 1,000 live births (95% CI 46.5 to 59.4). Being born to a mother from rural areas (odds ratio (OR), 1.61; 95% CI1.18 to 2.21); prolonged labor (OR, 5.45; 95% CI 2.30, 9.91); fetal malpresentation at delivery (OR, 4.70; 95% CI1.75 to 12.26); shoulder dystocia (OR, 6.11; 95% CI3.84 to 9.74); operative vaginal delivery (assisted vacuum or forceps extraction) (OR, 3.19; 95% CI 1.92 to 5.31); and macrosomia (OR, 5.06; 95% CI 2.76 to 9.29) were factors associated with neonatal birth trauma. In conclusion, we found a considerably high incidence proportion of neonatal birth trauma in low and middle-income countries. Therefore, early identification of risk factors and prompt decisions on the mode of delivery can potentially contribute to the decreased magnitude and impacts of neonatal birth trauma and promote the newborn's health.
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Affiliation(s)
- Beshada Zerfu Woldegeorgis
- School of Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amanuel Yosef Gebrekidan
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Gedion Asnake Azeze
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Sidama Region, Ethiopia
| | - Yordanos Sisay Asgedom
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Henok Berhanu Alemu
- School of Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Auger N, Bilodeau-Bertrand M, Lafleur N, Lewin A. Underlying Causes of Ethnocultural Inequality in Pregnancy Outcomes: Role of Hospital Proximity. J Immigr Minor Health 2024; 26:54-62. [PMID: 37733167 DOI: 10.1007/s10903-023-01545-7] [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] [Accepted: 09/02/2023] [Indexed: 09/22/2023]
Abstract
We evaluated the contribution of place of birth to ethnocultural inequality in pregnancy outcomes. We analyzed a cohort of 1,487,723 births between 1998 and 2019 among minority Anglophones and majority Francophones in Quebec, Canada. We estimated the association (adjusted risk ratio, RR; 95% confidence interval, CI) of language with preterm birth and stillbirth, and incorporated interaction terms to determine the contribution of place of birth and distance traveled. Compared with Francophones, minority Anglophones had a greater risk of preterm birth (RR 1.03; 95% CI 1.01-1.06) and were less likely to deliver farther from home (RR 0.95; 95% CI 0.94-0.95). Anglophones who delivered close to home had a higher risk of preterm birth (RR 1.07; 95% CI 1.04-1.11), whereas Anglophones who delivered farther had a lower risk (RR 0.69; 95% CI 0.64-0.75). Patterns were similar for stillbirth. Ethnocultural inequality in adverse birth outcomes may be influenced by place of birth.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Canada.
- Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, QC, H2P 1E2, Canada.
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
| | - Marianne Bilodeau-Bertrand
- University of Montreal Hospital Research Centre, Montreal, Canada
- Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, QC, H2P 1E2, Canada
| | - Nahantara Lafleur
- University of Montreal Hospital Research Centre, Montreal, Canada
- Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, QC, H2P 1E2, Canada
| | - Antoine Lewin
- Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Canada
- Medical Affairs and Innovation, Héma-Québec, Saint-Laurent, Canada
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Levaillant M, Garabédian C, Legendre G, Soula J, Hamel JF, Vallet B, Lamer A. In France, the organization of perinatal care has a direct influence on the outcome of the mother and the newborn: Contribution from a French nationwide study. Int J Gynaecol Obstet 2024; 164:210-218. [PMID: 37485702 DOI: 10.1002/ijgo.15004] [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: 03/03/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To investigate maternal and neonatal outcomes after a delivery in France in 2019, according to hospital characteristics and the impact of distance and time of travel on mother and newborn. METHODS All parturients above 18 years of age who delivered in 2019 and were identified in the French health insurance database were included, with their newborns, in this retrospective cohort study. Main outcome measures were Severe Maternal Morbidity score and the Neonatal Adverse Outcome Indicator (NAOI). RESULTS Among the 733 052 pregnancies included, 10 829 presented a severe maternal morbidity (1.48%) and 77 237 had a neonatal adverse outcome (10.4%). Factors associated with an unfavorable maternal or neonatal outcome were Obstetric Comorbidity Index, primiparity, and cesarean or instrumental delivery. Prematurity was associated with less severe maternal morbidity but more neonatal adverse outcomes. Time of travel above 30 min was associated with a higher NAOI rate. CONCLUSIONS Results suggest the efficiency of regionalization of perinatal care in France, although a difference in both outcomes persists according to unit volume, suggesting the need for a further step in concentrating perinatal care. Perinatal care organization should focus on mapping the territory with high-level, high-volume maternity throughout the territory; this suggests closing down high-volume units and improving low-volume ones to maintain coherent mapping.
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Affiliation(s)
- Mathieu Levaillant
- Université Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- Methodology and Biostatistics Department, Angers University Hospital, University of Angers, Angers, France
| | | | - Guillaume Legendre
- Faculté de Santé, Département de Médecine, CHU d'Angers, Angers, France
- Service de Gynécologie-Obstétrique, CHU d'Angers, Angers, France
| | - Julien Soula
- Université Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Jean-François Hamel
- Methodology and Biostatistics Department, Angers University Hospital, University of Angers, Angers, France
- UMR_S1085, University of Angers, CHU Angers, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), Angers, France
| | - Benoît Vallet
- Université Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Antoine Lamer
- Université Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- F2RSM Psy - Fédération Régionale de Recherche en Psychiatrie et Santé Mentale Hauts-de-France, Lille, France
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Hoffmann J, Dresbach T, Hagenbeck C, Scholten N. Factors associated with the closure of obstetric units in German hospitals and its effects on accessibility. BMC Health Serv Res 2023; 23:342. [PMID: 37020222 PMCID: PMC10077609 DOI: 10.1186/s12913-023-09204-1] [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: 09/30/2022] [Accepted: 02/20/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND An increase in regionalization of obstetric services is being observed worldwide. This study investigated factors associated with the closure of obstetric units in hospitals in Germany and aimed to examine the effect of obstetric unit closure on accessibility of obstetric care. METHODS Secondary data of all German hospital sites with an obstetrics department were analyzed for 2014 and 2019. Backward stepwise regression was performed to identify factors associated with obstetrics department closure. Subsequently, the driving times to a hospital site with an obstetrics department were mapped, and different scenarios resulting from further regionalization were modelled. RESULTS Of 747 hospital sites with an obstetrics department in 2014, 85 obstetrics departments closed down by 2019. The annual number of live births in a hospital site (OR = 0.995; 95% CI = 0.993-0.996), the minimal travel time between two hospital sites with an obstetrics department (OR = 0.95; 95% CI = 0.915-0.985), the availability of a pediatrics department (OR = 0.357; 95% CI = 0.126-0.863), and population density (low vs. medium OR = 0.24; 95% CI = 0.09-0.648, low vs. high OR = 0.251; 95% CI = 0.077-0.822) were observed to be factors significantly associated with the closure of obstetrics departments. Areas in which driving times to the next hospital site with an obstetrics department exceeded the 30 and 40 min threshold slightly increased from 2014 to 2019. Scenarios in which only hospital sites with a pediatrics department or hospital sites with an annual birth volume of ≥ 600 were considered resulted in large areas in which the driving times would exceed the 30 and 40 min threshold. CONCLUSION Close distances between hospital sites and the absence of a pediatrics department at the hospital site associate with the closure of obstetrics departments. Despite the closures, good accessibility is maintained for most areas in Germany. Although regionalization may ensure high-quality care and efficiency, further regionalization in obstetrics will have an impact on accessibility.
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Affiliation(s)
- Jan Hoffmann
- Faculty of Medicine and University Hospital Cologne, Faculty of Human Sciences, Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Eupener Str. 129, 50933, Cologne, Germany.
| | - Till Dresbach
- University Hospital Bonn, Department of Neonatology and Pediatric Intensive Care Medicine, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Carsten Hagenbeck
- Department of Obstetrics and Gynecology, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Nadine Scholten
- Faculty of Medicine and University Hospital Cologne, Faculty of Human Sciences, Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
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7
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Olsen O, Clausen JA. Planned hospital birth compared with planned home birth for pregnant women at low risk of complications. Cochrane Database Syst Rev 2023; 3:CD000352. [PMID: 36884026 PMCID: PMC9994459 DOI: 10.1002/14651858.cd000352.pub3] [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] [Indexed: 03/09/2023]
Abstract
BACKGROUND Observational studies of increasingly better quality and in different settings suggest that planned hospital birth in many places does not reduce mortality and morbidity but increases the frequency of interventions and complications. Euro-Peristat (part of the European Union's Health Monitoring Programme) has raised concerns about iatrogenic effects of obstetric interventions, and the World Health Organization (WHO) has raised concern that the increasing medicalisation of childbirth tends to undermine women's own capability to give birth and negatively impacts their childbirth experience. This is an update of a Cochrane Review first published in 1998, and previously updated in 2012. OBJECTIVES To compare the effects of planned hospital birth with planned home birth attended by a midwife or others with midwifery skills and backed up by a modern hospital system in case a transfer to hospital should turn out to be necessary. The primary focus is on women with an uncomplicated pregnancy and low risk of medical intervention during birth. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register (which includes trials from CENTRAL, MEDLINE, Embase, CINAHL, WHO ICTRP, and conference proceedings), ClinicalTrials.gov (16 July 2021), and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing planned hospital birth with planned home birth in low-risk women as described in the objectives. Cluster-randomised trials, quasi-randomised trials, and trials published only as an abstract were also eligible. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked the data for accuracy. We contacted study authors for additional information. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included one trial involving 11 participants. This was a small feasibility study to show that well-informed women - contrary to common beliefs - were prepared to be randomised. This update did not identify any additional studies for inclusion, but excluded one study that had been awaiting assessment. The included study was at high risk of bias for three out of seven risk of bias domains. The trial did not report on five of the seven primary outcomes, and reported zero events for one primary outcome (caesarean section), and non-zero events for the remaining primary outcome (baby not breastfed). Maternal mortality, perinatal mortality (non-malformed), Apgar < 7 at 5 minutes, transfer to neonatal intensive care unit, and maternal satisfaction were not reported. The overall certainty of the evidence for the two reported primary outcomes was very low according to our GRADE assessment (downgraded two levels for high overall risk of bias (due to high risk of bias arising from lack of blinding, high risk of selective reporting and lack of ability to check for publication bias) and two levels for very serious imprecision (single study with few events)). AUTHORS' CONCLUSIONS: This review shows that for selected, low-risk pregnant women, the evidence from randomised trials to support that planned hospital birth reduces maternal or perinatal mortality, morbidity, or any other critical outcome is uncertain. As the quality of evidence in favour of home birth from observational studies seems to be steadily increasing, it might be just as important to prepare a regularly updated systematic review including observational studies as described in the Cochrane Handbook for Systematic Reviews of Interventions as to attempt to set up new RCTs. As women and healthcare practitioners may be aware of evidence from observational studies, and as the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives collaboratively conclude that there is strong evidence that out-of-hospital birth supported by a registered midwife is safe, equipoise may no longer exist, and randomised trials may now thus be considered unethical or hardly feasible.
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Affiliation(s)
- Ole Olsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
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Carrel M, Keino BC, Novak NL, Ryckman KK, Radke S. Bypassing of nearest labor & delivery unit is contingent on rurality, wealth, and race. Birth 2023; 50:5-10. [PMID: 36752116 DOI: 10.1111/birt.12712] [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: 06/22/2022] [Revised: 01/02/2023] [Accepted: 01/13/2023] [Indexed: 02/09/2023]
Abstract
Patient decisions to bypass the closest labor & delivery (L&D) facility in favor of other birthing locations can have consequences for the provision of health care in rural and micropolitan areas as patient volumes decline and payer mixes change. Among 220 589 uncomplicated births in Iowa, we document characteristics of birth parents who bypass their closest birthing facility, show how this bypassing behavior results in changed travel times to delivery facilities across the rural/urban divide, and indicate the parts of the state where bypassing behavior is most prevalent. From 2013 to 2019, 55.2% of deliveries occurred in facilities that were further from birthing parents' residences than the closest L&D facility. Bypassing is associated with White, non-Hispanic race/ethnicity, and private insurance status. Although bypassing is least common among micropolitan birth parents, this group has the greatest travel burden to birthing facilities and exhibits increasing rates of bypassing over time. Perinatal quality improvement programs can target locations and populations where low-risk birthing parents can be encouraged to deliver close to home if medically appropriate, particularly in small towns and rural areas. This can potentially alleviate the risk of obstetric deserts by ensuring L&D units maintain patient volumes necessary to continue operations.
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Affiliation(s)
- Margaret Carrel
- Department of Geographical & Sustainability Sciences, University of Iowa, Iowa City, Iowa, USA.,Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Barbara C Keino
- Department of Geographical & Sustainability Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Nicole L Novak
- Department of Community & Behavioral Health, University of Iowa, Iowa City, Iowa, USA
| | - Kelli K Ryckman
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Stephanie Radke
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, Iowa, USA
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Carrel M, Keino BC, Ryckman KK, Radke S. Labor & delivery unit closures most impact travel times to birth locations for micropolitan residents in Iowa. J Rural Health 2023; 39:113-120. [PMID: 34978349 DOI: 10.1111/jrh.12643] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Continued closure of rural hospitals and labor & delivery units can impact timely access to care. Iowa has lost over a quarter of its labor & delivery units in the previous decade. Calculating how travel times to labor & delivery services have changed, and where in the state the largest travel times take place, are important for understanding access to this critical service. METHODS Using parental address and facility location from birth certificate data in Iowa from 2013 to 2019, travel times to birth facility are assessed for rural, micropolitan, and metropolitan parents, as well as for complicated versus noncomplicated births and Medicaid versus non-Medicaid recipients. FINDINGS Parts of the state have travel times that are consistently greater than 30 minutes over the duration of the study. The largest increases in travel times are found among micropolitan residents, particularly those experiencing complicated births. Travel times are consistently the longest for rural residents but increased only slightly over the study time period. CONCLUSIONS These findings suggest that access to hospital-based obstetric care is most changed for residents of small towns rather than rural or larger city residents.
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Affiliation(s)
- Margaret Carrel
- Department of Geographical & Sustainability Sciences, University of Iowa, Iowa City, Iowa, USA.,Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Barbara C Keino
- Department of Geographical & Sustainability Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Kelli K Ryckman
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Stephanie Radke
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, Iowa, USA
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10
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Association of Driving Distance to Maternity Hospitals and Maternal and Perinatal Outcomes. Obstet Gynecol 2022; 140:812-819. [DOI: 10.1097/aog.0000000000004960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/09/2022] [Indexed: 11/05/2022]
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Kaur A, Hornberger LK, Fruitman D, Ngwezi D, Eckersley LG. Impact of rural residence and low socioeconomic status on rate and timing of prenatal detection of major congenital heart disease in a jurisdiction of universal health coverage. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:359-366. [PMID: 35839119 DOI: 10.1002/uog.26030] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Socioeconomic status (SES) and distance of residence from tertiary care may impact fetal detection of congenital heart disease (CHD), partly through reduced access to and quality of obstetric ultrasound screening. It is unknown whether SES and remoteness of residence (RoR) affect prenatal detection of CHD in jurisdictions with universal health coverage. We examined the impact of SES and RoR on the rate and timing of prenatal diagnosis of major CHD within the province of Alberta in Canada. METHODS In this retrospective study, we identified all fetuses and infants diagnosed with major CHD in Alberta, from 2008 to 2018, that underwent cardiac surgical intervention within the first year after birth, died preoperatively, were stillborn or underwent termination. Using maternal residence postal code and geocoding, Chan SES index quintile, geographic distance from a tertiary-care fetal cardiology center and the Canadian Index of Remoteness (IoR) were calculated. Outcome measures included rates of prenatal diagnosis and diagnosis after 22 weeks' gestation. Risk ratios (RR) were calculated using log-binomial regression and stratified by rural (≥ 100 km from tertiary care) or metropolitan (< 100 km from tertiary care) residence, adjusting for year of birth and the obstetric ultrasound screening view in which CHD would most likely be detected (four-chamber view; outflow-tract view; three-vessel or three-vessels-and-trachea or non-standard view; septal view). RESULTS Of 1405 fetuses/infants with major CHD, prenatal diagnosis occurred in 814 (57.9%). Residence ≥ 100 km from tertiary care (adjusted RR, 1.19; 95% CI, 1.05-1.34) and higher IoR (adjusted RR, 1.9; 95% CI, 1.1-3.3) were associated with missed prenatal diagnosis of major CHD. Similarly, residence ≥ 100 km from tertiary care (adjusted RR, 1.41; 95% CI, 1.22-1.62) and higher IoR (adjusted RR, 3.6; 95% CI, 2.2-8.2) were associated with prenatal diagnosis after 22 weeks. Although adjusted and unadjusted analyses showed no association between Chan SES index quintile and prenatal-diagnosis rate overall nor for residence in rural areas, in metropolitan regions, lower SES quintiles were associated with missed prenatal diagnosis (quintile 1: RR, 1.24; 95% CI, 1.02-1.50) and higher risk of diagnosis after 22 weeks' gestation (quintile 1: RR, 1.46; 95% CI, 1.10-1.93; quintile 2: RR, 1.66; 95% CI, 1.24-2.23). CONCLUSIONS Despite universal healthcare, rural residence in Alberta is associated with lower rate of prenatal diagnosis of major CHD and higher risk of late prenatal diagnosis (≥ 22 weeks). Within metropolitan regions, lower SES impacts negatively prenatal-diagnosis rate and timing. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Kaur
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - L K Hornberger
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - D Fruitman
- Division of Cardiology, Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada
| | - D Ngwezi
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - L G Eckersley
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
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12
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Aheto JMK, Pannell O, Dotse-Gborgbortsi W, Trimner MK, Tatem AJ, Rhoda DA, Cutts FT, Utazi CE. Multilevel analysis of predictors of multiple indicators of childhood vaccination in Nigeria. PLoS One 2022; 17:e0269066. [PMID: 35613138 PMCID: PMC9132327 DOI: 10.1371/journal.pone.0269066] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 05/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Substantial inequalities exist in childhood vaccination coverage levels. To increase vaccine uptake, factors that predict vaccination coverage in children should be identified and addressed. Methods Using data from the 2018 Nigeria Demographic and Health Survey and geospatial data sets, we fitted Bayesian multilevel binomial and multinomial logistic regression models to analyse independent predictors of three vaccination outcomes: receipt of the first dose of Pentavalent vaccine (containing diphtheria-tetanus-pertussis, Hemophilus influenzae type B and Hepatitis B vaccines) (PENTA1) (n = 6059) and receipt of the third dose having received the first (PENTA3/1) (n = 3937) in children aged 12–23 months, and receipt of measles vaccine (MV) (n = 11839) among children aged 12–35 months. Results Factors associated with vaccination were broadly similar for documented versus recall evidence of vaccination. Based on any evidence of vaccination, we found that health card/document ownership, receipt of vitamin A and maternal educational level were significantly associated with each outcome. Although the coverage of each vaccine dose was higher in urban than rural areas, urban residence was not significant in multivariable analyses that included travel time. Indicators relating to socio-economic status, as well as ethnic group, skilled birth attendance, lower travel time to the nearest health facility and problems seeking health care were significantly associated with both PENTA1 and MV. Maternal religion was related to PENTA1 and PENTA3/1 and maternal age related to MV and PENTA3/1; other significant variables were associated with one outcome each. Substantial residual community level variances in different strata were observed in the fitted models for each outcome. Conclusion Our analysis has highlighted socio-demographic and health care access factors that affect not only beginning but completing the vaccination series in Nigeria. Other factors not measured by the DHS such as health service quality and community attitudes should also be investigated and addressed to tackle inequities in coverage.
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Affiliation(s)
- Justice Moses K. Aheto
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- * E-mail: ,
| | - Oliver Pannell
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Winfred Dotse-Gborgbortsi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Mary K. Trimner
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Andrew J. Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Dale A. Rhoda
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Felicity T. Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C. Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
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13
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van den Berg LMM, Gordon BBM, Kleefstra SM, Martijn L, van Dillen J, Verhoeven CJ, de Jonge A. Centralisation of acute obstetric care in the Netherlands: a qualitative study to explore the experiences of stakeholders with adaptations in organisation of care. BMC Health Serv Res 2021; 21:1233. [PMID: 34774037 PMCID: PMC8590329 DOI: 10.1186/s12913-021-07269-4] [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: 08/02/2021] [Accepted: 10/26/2021] [Indexed: 11/27/2022] Open
Abstract
Background In the past decade, acute obstetric care (AOC) has become centralised in many high-income countries. In this qualitative study, we explored how stakeholders in maternity care perceived and experienced adaptations in the organisation of maternity care in areas in the Netherlands where AOC was centralised. Methods A heterogenic group of fifteen maternity care stakeholders, including patients, were purposively selected for semi-structured interviews. An inductive thematic analysis was used. Results Three main themes were identified: (1) lack of involvement. (2) the process of making adaptations in the organisation of maternity care. (3) maintaining quality of care. Stakeholders in this study were highly motivated to maintain a high quality of maternity care and therefore made adaptations at several organisational levels. However, they felt a lack of involvement during the planning of centralisation of AOC and highlighted the importance of a collaborative process when making adaptations after centralisation of AOC. Conclusions Regions with AOC centralisation plans should invest time and money in change management, encourage early involvement of all maternity care stakeholders and acknowledge centralisation of AOC as a professional life event with associated emotions, including a feeling of unsafety. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07269-4.
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Affiliation(s)
- Lauri M M van den Berg
- Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
| | - Bernardus Benjamin Maria Gordon
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6523 GA, Nijmegen, the Netherlands
| | - Sophia M Kleefstra
- Dutch Health and Youth Care Inspectorate, Stadsplateau 1, 3521 AZ, Utrecht, the Netherlands
| | - Lucie Martijn
- Dutch Health and Youth Care Inspectorate, Stadsplateau 1, 3521 AZ, Utrecht, the Netherlands
| | - Jeroen van Dillen
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6523 GA, Nijmegen, the Netherlands
| | - Corine J Verhoeven
- Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,Maxima Medical Centre, Department of Obstetrics and Gynecology, De Run 4600, Veldhoven, Netherlands.,Division of Midwifery, School of Health Sciences, University of Nottingham, Floor 12, Tower Building, University Park, NG7 2RD, Nottingham, UK
| | - Ank de Jonge
- Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
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14
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Caviglia M, Putoto G, Conti A, Tognon F, Jambai A, Vandy MJ, Youkee D, Buson R, Pini S, Rosi P, Hubloue I, Della Corte F, Ragazzoni L, Barone-Adesi F. Association between ambulance prehospital time and maternal and perinatal outcomes in Sierra Leone: a countrywide study. BMJ Glob Health 2021; 6:e007315. [PMID: 34844999 PMCID: PMC8634006 DOI: 10.1136/bmjgh-2021-007315] [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] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Sierra Leone, one of the countries with the highest maternal and perinatal mortality in the world, launched its first National Emergency Medical Service (NEMS) in 2018. We carried out a countrywide assessment to analyse NEMS operational times for obstetric emergencies in respect the access to timely essential surgery within 2 hours. Moreover, we evaluated the relationship between operational times and maternal and perinatal mortality. METHODS We collected prehospital data of 6387 obstetric emergencies referrals from primary health units to hospital facilities between June 2019 and May 2020 and we estimated the proportion of referrals with a prehospital time (PT) within 2 hours. The association between PT and mortality was investigated using Poisson regression models for binary data. RESULTS At the national level, the proportion of emergency obstetric referrals with a PT within 2 hours was 58.5% (95% CI 56.9% to 60.1%) during the rainy season and 61.4% (95% CI 59.5% to 63.2%) during the dry season. Results were substantially different between districts, with the capital city of Freetown reporting more than 90% of referrals within the benchmark and some rural districts less than 40%. Risk of maternal death at 60, 120 and 180 min of PT was 1.8%, 3.8% and 4.3%, respectively. Corresponding figures for perinatal mortality were 16%, 18% and 25%. CONCLUSION NEMS operational times for obstetric emergencies in Sierra Leone vary greatly and referral transports in rural areas struggle to reach essential surgery within 2 hours. Maternal and perinatal risk of death increased concurrently with operational times, even beyond the 2-hour target, therefore, any reduction of the time to reach the hospital, may translate into improved patient outcomes.
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Affiliation(s)
- Marta Caviglia
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Italy
| | - Giovanni Putoto
- Research Section, Doctors with Africa CUAMM, Padova, Veneto, Italy
| | - Andrea Conti
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Italy
| | - Francesca Tognon
- Research Section, Doctors with Africa CUAMM, Padova, Veneto, Italy
| | - Amara Jambai
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Western Area, Sierra Leone
| | - Matthew Jusu Vandy
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Western Area, Sierra Leone
| | - Daniel Youkee
- School of population health and environmental sciences, King's College London, London, UK
| | - Riccardo Buson
- Research Section, Doctors with Africa CUAMM, Padova, Veneto, Italy
- Cuamm Medical Doctors for Africa, Padova, Veneto, Italy
| | - Sara Pini
- Research Section, Doctors with Africa CUAMM, Padova, Veneto, Italy
- Cuamm Medical Doctors for Africa, Padova, Veneto, Italy
| | - Paolo Rosi
- SUEM 118 - Servizio Urgenza Emergenza Medica, Azienda ULSS 3 Serenissima, Venezia, Veneto, Italy
| | - Ives Hubloue
- Research Group on Emergency and Disaster Medicine, VUB, Brussel, Belgium
| | - Francesco Della Corte
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Italy
| | - Luca Ragazzoni
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Italy
| | - Francesco Barone-Adesi
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Italy
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15
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Banke-Thomas A, Wong KLM, Collins L, Olaniran A, Balogun M, Wright O, Babajide O, Ajayi B, Afolabi BB, Abayomi A, Benova L. An assessment of geographical access and factors influencing travel time to emergency obstetric care in the urban state of Lagos, Nigeria. Health Policy Plan 2021; 36:1384-1396. [PMID: 34424314 PMCID: PMC8505861 DOI: 10.1093/heapol/czab099] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/28/2021] [Accepted: 08/12/2021] [Indexed: 12/14/2022] Open
Abstract
Previous efforts to estimate the travel time to comprehensive emergency obstetric care (CEmOC) in low- and middle-income countries (LMICs) have either been based on spatial models or self-reported travel time, both with known inaccuracies. The study objectives were to estimate more realistic travel times for pregnant women in emergency situations using Google Maps, determine system-level factors that influence travel time and use these estimates to assess CEmOC geographical accessibility and coverage in Lagos state, Nigeria. Data on demographics, obstetric history and travel to CEmOC facilities of pregnant women with an obstetric emergency, who presented between 1st November 2018 and 31st December 2019 at a public CEmOC facility were collected from hospital records. Estimated travel times were individually extracted from Google Maps for the period of the day of travel. Bivariate and multivariate analyses were used to test associations between travel and health system-related factors with reaching the facility >60 minutes. Mean travel times were compared and geographical coverage mapped to identify ‘hotspots’ of predominantly >60 minutes travel to facilities. For the 4005 pregnant women with traceable journeys, travel time ranges were 2–240 minutes (without referral) and 7–320 minutes (with referral). Total travel time was within the 60 and 120 minute benchmark for 80 and 96% of women, respectively. The period of the day of travel and having been referred were significantly associated with travelling >60 minutes. Many pregnant women living in the central cities and remote towns typically travelled to CEmOC facilities around them. We identified four hotspots from which pregnant women travelled >60 minutes to facilities. Mean travel time and distance to reach tertiary referral hospitals were significantly higher than the secondary facilities. Our findings suggest that actions taken to address gaps need to be contextualized. Our approach provides a useful guide for stakeholders seeking to comprehensively explore geographical inequities in CEmOC access within urban/peri-urban LMIC settings.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK.,Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Oba Akinjobi Street, Ikeja, P.M.B. 21266, Lagos, Nigeria
| | - Kerry L M Wong
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Lindsey Collins
- School of Geographical Sciences and Urban Planning, Arizona State University, South Myrtle Avenue, Tempe, Arizona 85281, USA
| | - Abimbola Olaniran
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi Araba, PMB 12003, Lagos, Nigeria
| | - Ololade Wright
- Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Oba Akinjobi Street, Ikeja, P.M.B. 21266, Lagos, Nigeria.,Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Oba Akinjobi Street, Ikeja, P.M.B. 21266, Lagos, Nigeria
| | - Opeyemi Babajide
- Department of Epidemiology and Medical Statistics, University of Ibadan, Oduduwa Road, 200132, Ibadan, Nigeria
| | - Babatunde Ajayi
- Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Oba Akinjobi Street, Ikeja, P.M.B. 21266, Lagos, Nigeria.,Office of the Commissioner, Lagos State Ministry of Health, Secretariat, Alausa, Lagos, Nigeria
| | - Bosede Bukola Afolabi
- Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, Idi Araba, P.M.B 12003, Lagos, Nigeria
| | - Akin Abayomi
- Office of the Commissioner, Lagos State Ministry of Health, Secretariat, Alausa, Lagos, Nigeria
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Kronenburgstraat 43, 2000 Antwerpen, Belgium
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16
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Banke-Thomas A, Avoka CKO, Gwacham-Anisiobi U, Benova L. Influence of travel time and distance to the hospital of care on stillbirths: a retrospective facility-based cross-sectional study in Lagos, Nigeria. BMJ Glob Health 2021; 6:e007052. [PMID: 34615663 PMCID: PMC8496383 DOI: 10.1136/bmjgh-2021-007052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Access to emergency obstetric care can lead to a 45%-75% reduction in stillbirths. However, before a pregnant woman can access this care, she needs to travel to a health facility. Our objective in this study was to assess the influence of distance and travel time to the actual hospital of care on stillbirth. METHODS We conducted a retrospective cross-sectional study of pregnant women who presented with obstetric emergencies over a year across all 24 public hospitals in Lagos, Nigeria. Reviewing clinical records, we extracted sociodemographic, travel and obstetric data. Extracted travel data were exported to Google Maps, where typical distance and travel time for period-of-day they travelled were extracted. Multivariable logistic regression was conducted to determine the relative influence of distance and travel time on stillbirth. RESULTS Of 3278 births, there were 408 stillbirths (12.5%). Women with livebirths travelled a median distance of 7.3 km (IQR 3.3-18.0) and over a median time of 24 min (IQR 12-51). Those with stillbirths travelled a median distance of 8.5 km (IQR 4.4-19.7) and over a median time of 30 min (IQR 16-60). Following adjustments, though no significant association with distance was found, odds of stillbirth were significantly higher for travel of 10-29 min (OR 2.25, 95% CI 1.40 to 3.63), 30-59 min (OR 2.30, 95% CI 1.22 to 4.34) and 60-119 min (OR 2.35, 95% CI 1.05 to 5.25). The adjusted OR of stillbirth was significantly lower following booking (OR 0.37, 95% CI 0.28 to 0.49), obstetric complications with mother (obstructed labour (OR 0.11, 95% CI 0.07 to 0.17) and haemorrhage (OR 0.30, 95%CI 0.20 to 0.46)). Odds were significantly higher with multiple gestations (OR 2.40, 95% CI 1.57 to 3.69) and referral (OR 1.55, 95% CI 1.13 to 2.12). CONCLUSION Travel time to a hospital was strongly associated with stillbirth. In addition to birth preparedness, efforts to get quality care quicker to women or women quicker to quality care will be critical for efforts to reduce stillbirths in a principally urban low-income and middle-income setting.
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Affiliation(s)
| | - Cephas Ke-On Avoka
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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17
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Schnell R, Klingwort J, Farrow JM. Locational privacy-preserving distance computations with intersecting sets of randomly labeled grid points. Int J Health Geogr 2021; 20:14. [PMID: 33743719 PMCID: PMC7980628 DOI: 10.1186/s12942-021-00268-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background We introduce and study a recently proposed method for privacy-preserving distance computations which has received little attention in the scientific literature so far. The method, which is based on intersecting sets of randomly labeled grid points, is henceforth denoted as ISGP allows calculating the approximate distances between masked spatial data. Coordinates are replaced by sets of hash values. The method allows the computation of distances between locations L when the locations at different points in time t are not known simultaneously. The distance between \documentclass[12pt]{minimal}
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\begin{document}$$L_1$$\end{document}L1 and \documentclass[12pt]{minimal}
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\begin{document}$$L_2$$\end{document}L2 could be computed even when \documentclass[12pt]{minimal}
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\begin{document}$$t_2$$\end{document}t2. An example would be patients from a medical data set and locations of later hospitalizations. ISGP is a new tool for privacy-preserving data handling of geo-referenced data sets in general. Furthermore, this technique can be used to include geographical identifiers as additional information for privacy-preserving record-linkage. To show that the technique can be implemented in most high-level programming languages with a few lines of code, a complete implementation within the statistical programming language R is given. The properties of the method are explored using simulations based on large-scale real-world data of hospitals (\documentclass[12pt]{minimal}
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\begin{document}$$n=850$$\end{document}n=850) and residential locations (\documentclass[12pt]{minimal}
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\begin{document}$$n=13,000$$\end{document}n=13,000). The method has already been used in a real-world application. Results ISGP yields very accurate results. Our simulation study showed that—with appropriately chosen parameters – 99 % accuracy in the approximated distances is achieved. Conclusion We discussed a new method for privacy-preserving distance computations in microdata. The method is highly accurate, fast, has low computational burden, and does not require excessive storage.
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Affiliation(s)
- Rainer Schnell
- Research Methodology Group, University of Duisburg-Essen, Duisburg, Germany.
| | - Jonas Klingwort
- Research Methodology Group, University of Duisburg-Essen, Duisburg, Germany.,Methodology R&D, Statistics Netherlands (CBS), Heerlen, The Netherlands
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18
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Wariri O, Onuwabuchi E, Alhassan JAK, Dase E, Jalo I, Laima CH, Farouk HU, El-Nafaty AU, Okomo U, Dotse-Gborgbortsi W. The influence of travel time to health facilities on stillbirths: A geospatial case-control analysis of facility-based data in Gombe, Nigeria. PLoS One 2021; 16:e0245297. [PMID: 33411850 PMCID: PMC7790442 DOI: 10.1371/journal.pone.0245297] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/24/2020] [Indexed: 12/14/2022] Open
Abstract
Access to quality emergency obstetric and newborn care (EmONC); having a skilled attendant at birth (SBA); adequate antenatal care; and efficient referral systems are considered the most effective interventions in preventing stillbirths. We determined the influence of travel time from mother's area of residence to a tertiary health facility where women sought care on the likelihood of delivering a stillbirth. We carried out a prospective matched case-control study between 1st January 2019 and 31st December 2019 at the Federal Teaching Hospital Gombe (FTHG), Nigeria. All women who experienced a stillbirth after hospital admission during the study period were included as cases while controls were consecutive age-matched (ratio 1:1) women who experienced a live birth. We modelled travel time to health facilities. To determine how travel time to the nearest health facility and the FTHG were predictive of the likelihood of stillbirths, we fitted a conditional logistic regression model. A total of 318 women, including 159 who had stillborn babies (cases) and 159 age-matched women who had live births (controls) were included. We did not observe any significant difference in the mean travel time to the nearest government health facility for women who had experienced a stillbirth compared to those who had a live birth [9.3 mins (SD 7.3, 11.2) vs 6.9 mins (SD 5.1, 8.7) respectively, p = 0.077]. However, women who experienced a stillbirth had twice the mean travel time of women who had a live birth (26.3 vs 14.5 mins) when measured from their area of residence to the FTHG where deliveries occurred. Women who lived farther than 60 minutes were 12 times more likely of having a stillborn [OR = 12 (1.8, 24.3), p = 0.011] compared to those who lived within 15 minutes travel time to the FTHG. We have shown for the first time, the influence of travel time to a major tertiary referral health facility on the occurrence of stillbirths in an urban city in, northeast Nigeria.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of
Hygiene and Tropical Medicine, Fajara, The Gambia
- African Population and Health Policy Initiative, Gombe, Gombe State,
Nigeria
| | - Egwu Onuwabuchi
- African Population and Health Policy Initiative, Gombe, Gombe State,
Nigeria
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital
Gombe, Gombe, Nigeria
| | - Jacob Albin Korem Alhassan
- African Population and Health Policy Initiative, Gombe, Gombe State,
Nigeria
- Department of Community Health and Epidemiology, College of Medicine,
University of Saskatchewan, Saskatoon, Canada
| | - Eseoghene Dase
- African Population and Health Policy Initiative, Gombe, Gombe State,
Nigeria
- Department of Obstetrics and Gynaecology, Cedarcrest Hospital, Abuja,
Nigeria
| | - Iliya Jalo
- Department of Paediatrics, Federal Teaching Hospital Gombe, Gombe,
Nigeria
| | | | - Halima Usman Farouk
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital
Gombe, Gombe, Nigeria
| | - Aliyu U. El-Nafaty
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital
Gombe, Gombe, Nigeria
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of
Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Winfred Dotse-Gborgbortsi
- School of Geography and Environmental Science, University of Southampton,
Southampton, United Kingdom
- WorldPop Research Group, School of Geography and Environmental Science,
University of Southampton, Southampton, United Kingdom
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19
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Malouf RS, Tomlinson C, Henderson J, Opondo C, Brocklehurst P, Alderdice F, Phalguni A, Dretzke J. Impact of obstetric unit closures, travel time and distance to obstetric services on maternal and neonatal outcomes in high-income countries: a systematic review. BMJ Open 2020; 10:e036852. [PMID: 33318106 PMCID: PMC7735086 DOI: 10.1136/bmjopen-2020-036852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To systematically review (1) The effect of obstetric unit (OU) closures on maternal and neonatal outcomes and (2) The association between travel distance/time to an OU and maternal and neonatal outcomes. DESIGN Systematic review of any quantitative studies with a comparison group. DATA SOURCES Embase, MEDLINE, PsycINFO, Applied Social Science Index and Abstracts, Cumulative Index to Nursing and Allied Health and grey literature were searched. METHODS Eligible studies explored the impact of closure of an OU or the effect of travel distance/time on prespecified maternal or neonatal outcomes. Only studies of women giving birth in high-income countries with universal health coverage of maternity services comparable to the UK were included. Identification of studies, extraction of data and risk of bias assessment were undertaken by at least two reviewers independently. The risk of bias checklist was based on the Cochrane Effective Practice and Organisation of Care criteria and the Newcastle-Ottawa scale. Heterogeneity across studies precluded meta-analysis and synthesis was narrative, with key findings tabulated. RESULTS 31 studies met the inclusion criteria. There was some evidence to suggest an increase in babies born before arrival following OU closures and/or associated with longer travel distances or time. This may be associated with an increased risk of perinatal or neonatal mortality, but this finding was not consistent across studies. Evidence on other maternal and neonatal outcomes was limited but did not suggest worse outcomes after closures or with longer travel times/distances. Interpretation of findings for some studies was hampered by concerns around how accurately exposures were measured, and/or a lack of adjustment for confounders or temporal changes. CONCLUSION It is not possible to conclude from this review whether OU closure, increased travel distances or times are associated with worse outcomes for the mother or the baby. PROSPERO REGISTRATION NUMBER CRD42017078503.
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Affiliation(s)
- Reem Saleem Malouf
- Nuffield Department of Population Health, Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Claire Tomlinson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jane Henderson
- Nuffield Department of Population Health, Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Charles Opondo
- Nuffield Department of Population Health, Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Peter Brocklehurst
- Nuffield Department of Population Health, Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Fiona Alderdice
- Nuffield Department of Population Health, Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Angaja Phalguni
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Janine Dretzke
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Paynter MJ, Bagg ML, Heggie C. Invisible women: correctional facilities for women across Canada and proximity to maternity services. Int J Prison Health 2020. [DOI: 10.1108/ijph-06-2020-0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to describe the process to create an inventory of the facilities in Canada designated to incarcerate women and girls, health service responsibility by facility, facility proximity to hospitals with maternity services and residential programmes for mothers and children to stay together. This paper creates the inventory to support health researchers, prison rights advocates and policymakers to identify, analyse and respond to sex and gender differences in health and access to health services in prisons.
Design/methodology/approach
In spring 2019, this study conducted an environmental scan to create an inventory of every facility in Canada designated for the incarceration of girls and women, including remand/pretrial custody, immigration detention, youth facilities and for provincial and federal sentences.
Findings
There are 72 facilities in the inventory. In most, women are co-located with men. Responsibility for health varies by jurisdiction. Few sites have mother-child programmes. Distance to maternity services varies from 1 to 132 km.
Research limitations/implications
This paper did not include police lock-up, courthouse cells or involuntary psychiatric units in the inventory. Information is unavailable regarding trans and non-binary persons, a priority for future work. Access to maternity hospital services is but one critical question regarding reproductive care. Maintenance of the database is challenging.
Originality/value
Incarcerated women are an invisible population. The inventory is the first of its kind and is a useful tool to support sex and gender and health research across jurisdictions.
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van Duinen AJ, Adde HA, Fredin O, Holmer H, Hagander L, Koroma AP, Koroma MM, Leather AJ, Wibe A, Bolkan HA. Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra Leone. BMJ Glob Health 2020; 5:e003943. [PMID: 33355267 PMCID: PMC7754652 DOI: 10.1136/bmjgh-2020-003943] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Longer travel times are associated with increased adverse maternal and perinatal outcomes. Geospatial modelling has been increasingly used to estimate geographic proximity in emergency obstetric care. In this study, we aimed to assess the correlation between modelled and patient-reported travel times and to evaluate its clinical relevance. METHODS Women who delivered by caesarean section in nine hospitals were followed up with home visits at 1 month and 1 year. Travel times between the location before the delivery and the facility where caesarean section was performed were estimated, based on two models (model I Ouma et al; model II Munoz et al). Patient-reported and modelled travel times were compared applying a univariable linear regression analysis, and the relation between travel time and perinatal mortality was assessed. RESULTS The median reported travel time was 60 min, compared with 13 and 34 min estimated by the two models, respectively. The 2-hour access threshold correlated with a patient-reported travel time of 5.7 hours for model I and 1.8 hours for model II. Longer travel times were associated with transport by boat and ambulance, visiting one or two facilities before reaching the final facility, lower education and poverty. Lower perinatal mortality was found both in the group with a reported travel time of 2 hours or less (193 vs 308 per 1000 births, p<0.001) and a modelled travel time of 2 hours or less (model I: 209 vs 344 per 1000 births, p=0.003; model II: 181 vs 319 per 1000 births, p<0.001). CONCLUSION The standard model, used to estimate geographical proximity, consistently underestimated the travel time. However, the conservative travel time model corresponded better to patient-reported travel times. The 2-hour threshold as determined by the Lancet Commission on Global Surgery, is clinically relevant with respect to reducing perinatal death, not a clear cut-off.
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Affiliation(s)
- Alex J van Duinen
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Håvard A Adde
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ola Fredin
- Geological Survey of Norway, Trondheim, Norway
- Department of Geography, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hampus Holmer
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Lars Hagander
- Centre for Surgery and Public Health, Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Alimamy P Koroma
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Obstetrics and Gynaecology, Princess Christian Maternity Hospital (PCMH), University Teaching Hospitals Complex, University of Sierra Leone, Freetown, Sierra Leone
| | - Michael M Koroma
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Obstetrics and Gynaecology, Princess Christian Maternity Hospital (PCMH), University Teaching Hospitals Complex, University of Sierra Leone, Freetown, Sierra Leone
| | - Andrew Jm Leather
- King's Centre for Global Health & Health Partnerships, King's College London, London, UK
| | - Arne Wibe
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Håkon A Bolkan
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Disparities in Geographical Access to Hospitals in Portugal. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2020. [DOI: 10.3390/ijgi9100567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Geographical accessibility to health care services is widely accepted as relevant to improve population health. However, measuring it is very complex, mainly when applied at administrative levels that go beyond the small-area level. This is the case in Portugal, where the municipality is the administrative level that is most appropriate for implementing policies to improve the access to those services. The aim of this paper is to assess whether inequalities in terms of access to a hospital in Portugal have improved over the last 20 years. A population-weighted driving time was applied using the census tract population, the roads network, the reference hospitals’ catchment area and the municipality boundaries. The results show that municipalities are 25 min away from the hospital—3 min less than in 1991—and that there is an association with premature mortality, elderly population and population density. However, disparities between municipalities are still huge. Municipalities with higher rates of older populations, isolated communities or those located closer to the border with Spain face harder challenges and require greater attention from local administration. Since municipalities now have responsibilities for health, it is important they implement interventions at the local level to tackle disparities impacting access to healthcare.
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23
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Banke-Thomas A, Balogun M, Wright O, Ajayi B, Abejirinde IOO, Olaniran A, Giwa-Ayedun RO, Odusanya B, Afolabi BB. Reaching health facilities in situations of emergency: qualitative study capturing experiences of pregnant women in Africa's largest megacity. Reprod Health 2020; 17:145. [PMID: 32977812 PMCID: PMC7519554 DOI: 10.1186/s12978-020-00996-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/17/2020] [Indexed: 11/14/2022] Open
Abstract
Background The consequences of delays in travel of pregnant women to reach facilities in emergency situations are well documented in literature. However, their decision-making and actual experiences of travel to health facilities when requiring emergency obstetric care (EmOC) remains a ‘black box’ of many unknowns to the health system, more so in megacities of low- and middle-income countries which are fraught with wide inequalities. Methods This in-depth study on travel of pregnant women in Africa’s largest megacity, Lagos, is based on interviews conducted between September 2019 and January 2020 with 47 women and 11 of their relatives who presented at comprehensive EmOC facilities in situations of emergency, requiring some EmOC services. Following familiarisation, coding, and searching for patterns, the data was analysed for emerging themes. Results Despite recognising danger signs, pregnant women are often faced with conundrums on “when”, “where” and “how” to reach EmOC facilities. While the decision-making process is a shared activity amongst all women, the available choices vary depending on socio-economic status. Women preferred to travel to facilities deemed to have “nicer” health workers, even if these were farther from home. Reported travel time was between 5 and 240 min in daytime and 5–40 min at night. Many women reported facing remarkably similar travel experiences, with varied challenges faced in the daytime (traffic congestion) compared to night-time (security concerns and scarcity of public transportation). This was irrespective of their age, socio-economic background, or obstetric history. However, the extent to which this experience impacted on their ability to reach facilities depended on their agency and support systems. Travel experience was better if they had a personal vehicle for travel at night, support of relatives or direct/indirect connections with senior health workers at comprehensive EmOC facilities. Referral barriers between facilities further prolonged delays and increased cost of travel for many women. Conclusion If the goal, to leave no one behind, remains a priority, in addition to other health systems strengthening interventions, referral systems need to be improved. Advocacy on policies to encourage women to utilise nearby functional facilities when in situations of emergency and private sector partnerships should be explored.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- LSE Health, London School of Economics and Political Science, WC2A 2AE, London, UK. .,Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.
| | - Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Ololade Wright
- Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.,Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Babatunde Ajayi
- Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Ibukun-Oluwa Omolade Abejirinde
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Abimbola Olaniran
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Bilikisu Odusanya
- Department of Obstetrics and Gynaecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria
| | - Bosede Bukola Afolabi
- Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, Idi-Araba, Lagos, Nigeria
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24
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Maldonado LY, Fryer KE, Tucker CM, Stuebe AM. The Association between Travel Time and Prenatal Care Attendance. Am J Perinatol 2020; 37:1146-1154. [PMID: 31189187 DOI: 10.1055/s-0039-1692455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the association between a patient's travel time to clinic and her prenatal care attendance. STUDY DESIGN We conducted a retrospective cohort study of women (≥18 years) who received prenatal care and delivered at North Carolina Women's Hospital between July 1, 2014, and June 30, 2016 (n = 2,808 women, 24,021 appointments). We queried demographic data from the electronic medical record and calculated travel time with ArcGIS. Multinomial logistic regression models estimated the association between travel time and attendance, adjusted for sociodemographic covariates. RESULTS For every 10 minutes of additional travel time, women were 1.05 (95% confidence interval [CI]: 1.02-1.08, p < 0.001) times as likely to arrive late and 1.03 (95% CI: 1.01-1.04, p < 0.001) times as likely to cancel appointments than arrive on time. Travel time did not significantly affect a patient's likelihood of not showing for appointments. Non-Hispanic black patients were 71% more likely to arrive late and 51% more likely to not show for appointments than non-Hispanic white patients (p < 0.05). Publicly insured women were 28% more likely to arrive late to appointments and 82% more likely to not show for appointments than privately insured women (p < 0.05). CONCLUSION Changes to transportation availability alone may only modestly affect outcomes compared with strategically improving access for sociodemographically marginalized women.
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Affiliation(s)
- Lauren Y Maldonado
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Kimberly E Fryer
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christine M Tucker
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Alison M Stuebe
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina.,Divsion of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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25
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Allen M, Villeneuve E, Pitt M, Thornton S. How can consultant-led childbirth care at time of delivery be maximised? A modelling study. BMJ Open 2020; 10:e034830. [PMID: 32641323 PMCID: PMC7348651 DOI: 10.1136/bmjopen-2019-034830] [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: 11/12/2022] Open
Abstract
OBJECTIVE The Royal College of Obstetricians and Gynaecologists has advised that consolidation of birth centres, where reasonable, into birth centres of at least 6000 admissions per year should allow constant consultant presence. Currently, only 17% of mothers attend such birth centres. The objective of this work was to examine the feasibility of consolidation of birth centres, from the perspectives of birth centre size and travel times for mothers. DESIGN Computer-based optimisation. SETTING Hospital-based births. POPULATION OR SAMPLE 1.91 million admissions in 2014-2016. METHODS A multiple-objective genetic algorithm. MAIN OUTCOME MEASURES Travel time for mothers and size of birth centres. RESULTS Currently, with 161 birth centres, 17% of women attend a birth centre with at least 6000 admissions per year. We estimate that 95% of women have a travel time of 30 min or less. An example scenario, with 100 birth centres, could provide 75% of care in birth centres with at least 6000 admissions per year, with 95% of women travelling 35 min or less to their closest birth centre. Planning at local level leads to reduced ability to meet admission and travel time targets. CONCLUSIONS While it seems unrealistic to have all births in birth centres with at least 6000 admissions per year, it appears realistic to increase the percentage of mothers attending this type of birth centre from 17% to about 75% while maintaining reasonable travel times. Planning at a local level leads to suboptimal solutions.
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Affiliation(s)
- Michael Allen
- Medical School, University of Exeter, Exeter, United Kingdom
| | - Emma Villeneuve
- Medical School, University of Exeter, Exeter, United Kingdom
| | - Martin Pitt
- Medical School, University of Exeter, Exeter, United Kingdom
| | - Steve Thornton
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Chambers D, Cantrell A, Baxter SK, Turner J, Booth A. Effects of increased distance to urgent and emergency care facilities resulting from health services reconfiguration: a systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundService reconfigurations sometimes increase travel time and/or distance for patients to reach their nearest hospital or other urgent and emergency care facility. Many communities value their local services and perceive that proposed changes could worsen outcomes for patients.ObjectivesTo identify, appraise and synthesise existing research evidence regarding the outcomes and impacts of service reconfigurations that increase the time and/or distance for patients to reach an urgent and emergency care facility. We also aimed to examine the available evidence regarding associations between distance to a facility and outcomes for patients and health services, together with factors that may influence (moderate or mediate) these associations.Data sourcesWe searched seven bibliographic databases in February 2019. The search was supplemented by citation-tracking and reference list checking. A separate search was conducted to identify the current systematic reviews of telehealth to support urgent and emergency care.MethodsBrief inclusion and exclusion criteria were as follows: (1) population – adults or children with conditions that required emergency treatment; (2) intervention/comparison – studies comparing outcomes before and after a service reconfiguration, which affects the time/distance to urgent and emergency care or comparing outcomes in groups of people travelling different distances to access urgent and emergency care; (3) outcomes – any patient or health system outcome; (4) setting – the UK and other developed countries with relevant health-care systems; and (5) study design – any. The search results were screened against the inclusion criteria by one reviewer, with a 10% sample screened by a second reviewer. A quality (risk-of-bias) assessment was undertaken using The Joanna Briggs Institute Checklist for Quasi-Experimental Studies. We performed a narrative synthesis of the included studies and assessed the overall strength of evidence using a previously published method.ResultsWe included 44 studies in the review, of which eight originated from the UK. For studies of general urgent and emergency care populations, there was no evidence that reconfiguration that resulted in increased travel time/distance affected mortality rates. By contrast, evidence of increased risk was identified from studies restricted to patients with acute myocardial infarction. Increases in mortality risk were most obvious within the first 1–4 years after reconfiguration. Evidence for other conditions was inconsistent or very limited. In the absence of reconfiguration, evidence mainly from cohort studies indicated that increased travel time or distance is associated with increased mortality risk for the acute myocardial infarction and trauma populations, whereas for obstetric emergencies the evidence was inconsistent. We included 12 systematic reviews of telehealth. Meta-analyses suggested that telehealth technologies can reduce time to treatment for people with stroke and ST elevation myocardial infarction.LimitationsMost studies came from non-UK settings and many were at high risk of bias because there was no true control group. Most review processes were carried out by a single reviewer within a constrained time frame.ConclusionsWe found no evidence that increased distance increases mortality risk for the general population of people requiring urgent and emergency care, although this may not be true for people with acute myocardial infarction or trauma. Increases in mortality risk were most likely in the first few years after reconfiguration.Future workResearch is needed to better understand how health systems plan for and adapt to increases in travel time, to quantify impacts on health system outcomes, and to address the uncertainty about how risk increases with distance in circumstances relevant to UK settings.Study registrationThis study is registered as PROSPERO CRD42019123061.FundingThis project was funded by the NIHR Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 8, No. 31. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Susan K Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Janette Turner
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Salih T, Martin P, Poulton T, Oliver CM, Bassett MG, Moonesinghe SR. Distance travelled to hospital for emergency laparotomy and the effect of travel time on mortality: cohort study. BMJ Qual Saf 2020; 30:bmjqs-2019-010747. [PMID: 32576606 PMCID: PMC8070618 DOI: 10.1136/bmjqs-2019-010747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/22/2020] [Accepted: 05/25/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate whether distance and estimated travel time to hospital for patients undergoing emergency laparotomy is associated with postoperative mortality. DESIGN National cohort study using data from the National Emergency Laparotomy Audit. SETTING 171 National Health Service hospitals in England and Wales. PARTICIPANTS 22 772 adult patients undergoing emergency surgery on the gastrointestinal tract between 2013 and 2016. MAIN OUTCOME MEASURES Mortality from any cause and in any place at 30 and 90 days after surgery. RESULTS Median on-road distance between home and hospital was 8.4 km (IQR 4.7-16.7 km) with a median estimated travel time of 16 min. Median time from hospital admission to operating theatre was 12.7 hours. Older patients live on average further from hospital and patients from areas of increased socioeconomic deprivation live on average less far away.We included estimated travel time as a continuous variable in multilevel logistic regression models adjusting for important confounders and found no evidence for an association with 30-day mortality (OR per 10 min of travel time=1.02, 95% CI 0.97 to 1.06, p=0.512) or 90-day mortality (OR 1.02, 95 % CI 0.97 to 1.06, p=0.472).The results were similar when we limited our analysis to the subgroup of 5386 patients undergoing the most urgent surgery. 30-day mortality: OR=1.02 (95% CI 0.95 to 1.10, p=0.574) and 90-day mortality: OR=1.01 (95% CI 0.94 to 1.08, p=0.858). CONCLUSIONS In the UK NHS, estimated travel time between home and hospital was not a primary determinant of short-term mortality following emergency gastrointestinal surgery.
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Affiliation(s)
- Tom Salih
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, Department for Targeted Intervention, Surgical Outcomes Research Centre, Centre for Perioperative Medicine, University College London, London, UK
| | - Peter Martin
- Department of Applied Heath Research, University College London, London, UK
| | - Tom Poulton
- Health Services Research Centre, National Institute for Academic Anaesthesia, London, UK
| | - Charles M Oliver
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, Department for Targeted Intervention, Surgical Outcomes Research Centre, Centre for Perioperative Medicine, University College London, London, UK
| | - Mike G Bassett
- Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Ramani Moonesinghe
- Division of Surgery and Interventional Science, Department for Targeted Intervention, Surgical Outcomes Research Centre, Centre for Perioperative Medicine, University College London, London, UK
- Health Services Research Centre, National Institute for Academic Anaesthesia, London, UK
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Lee HY, Yoon NH, Oh J, Park JS, Lee JK, Moon JR, Subramanian SV. Are "Obstetrically Underserved Areas" really underserved? Role of a government support program in the context of changing landscape of maternal service utilization in South Korea: A sequential mixed method approach. PLoS One 2020; 15:e0232760. [PMID: 32374772 PMCID: PMC7202644 DOI: 10.1371/journal.pone.0232760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 04/21/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The Korean government has been providing financial support to open and operate the maternal hospital in Obstetrically Underserved Areas (OUAs) since 2011. Our study aims to assess the effectiveness of the government-support program for OUAs and to suggest future directions for it. METHODS We performed sequential-mixed method approach. Descriptive analyses and multi-level logistic regression were performed based on the 2015 Korean National Health Insurance claim data. Data for the qualitative analysis were obtained from in-depth interviews with health providers and mothers in OUAs. RESULTS Descriptive analyses indicated that the share of babies born in the hospitals located in the area among total babies ever born from mothers residing in the area (Delivery concentration Index: DCI) was lower in government-supported OUAs than other areas. Qualitative analyses revealed that physical distance is no longer a barrier in current OUAs. Mothers travel to neighboring big cities to seek elective preferences only available at specialized maternal hospitals rather than true medical need. Increasing one-child families changed the mother's perception of pregnancy and childbirth, making them willing to pay for more expensive services. Concern about an emergency for mothers or infants, especially of high-risk mothers was also an important factor to make mothers avoid local government-supported hospitals. Adjusted multi-level logistic regression indicated that DCIs of government-supported OUAs were higher than the ones of their counterpart areas. CONCLUSION Our results suggest that current OUAs do not reflect reality. Identification of true OUAs where physical distance is a real barrier to the use of obstetric service and focused investment on them is necessary. In addition, more sophisticated performance indicator other than DCI needs to be developed.
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Affiliation(s)
- Hwa-Young Lee
- Department of Global Health and Population, Takemi program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Nan-Hee Yoon
- Department of Health Administration, Hanyang Cyber University, Seoul, Republic of Korea
| | - Juhwan Oh
- Department of Medicine of Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong-Koo Lee
- Center for Healthy Society and Education, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - J. Robin Moon
- Bronx Partners for Health Communities New York City, Bronx, NY, United States of America
| | - S. V. Subramanian
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Abstract
The American Academy of Pediatrics (AAP) believes that current data show that hospitals and accredited birth centers are the safest settings for birth in the United States. The AAP does not recommend planned home birth, which has been reported to be associated with a twofold to threefold increase in infant mortality in the United States. The AAP recognizes that women may choose to plan a home birth. This statement is intended to help pediatricians provide constructive, informed counsel to women considering home birth while retaining their role as child advocates and to summarize appropriate care for newborn infants born at home that is consistent with care provided for infants born in a medical care facility. Regardless of the circumstances of his or her birth, including location, every newborn infant deserves health care consistent with that highlighted in this statement, which is more completely described in other publications from the AAP, including Guidelines for Perinatal Care and the Textbook of Neonatal Resuscitation All health care clinicians and institutions should promote communications and understanding on the basis of professional interaction and mutual respect.
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Affiliation(s)
- Kristi Watterberg
- Department of Pediatrics, The University of New Mexico, Albuquerque, New Mexico
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Huotari T, Rusanen J, Keistinen T, Lähderanta T, Ruha L, Sillanpää MJ, Antikainen H. Effect of centralization on geographic accessibility of maternity hospitals in Finland. BMC Health Serv Res 2020; 20:337. [PMID: 32316970 PMCID: PMC7171856 DOI: 10.1186/s12913-020-05222-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background In the past two decades, the number of maternity hospitals in Finland has been reduced from 42 to 22. Notwithstanding the benefits of centralization for larger units in terms of increased safety, the closures will inevitably impair geographical accessibility of services. Methods This study aimed to employ a set of location-allocation methods to assess the potential impact on accessibility, should the number of maternity hospitals be reduced from 22 to 16. Accurate population grid data combined with road network and hospital facilities data is analyzed with three different location-allocation methods: straight, sequential and capacitated p-median. Results Depending on the method used to assess the impact of further reduction in the number of maternity hospitals, 0.6 to 2.7% of mothers would have more than a two-hour travel time to the nearest maternity hospital, while the corresponding figure is 0.5 in the current situation. The analyses highlight the areas where the number of births is low, but a maternity hospital is still important in terms of accessibility, and the areas where even one unit would be enough to take care of a considerable volume of births. Conclusions Even if the reduction in the number of hospitals might not drastically harm accessibility at the level of the entire population, considerable changes in accessibility can occur for clients living close to a maternity hospital facing closure. As different location-allocation analyses can result in different configurations of hospitals, decision-makers should be aware of their differences to ensure adequate accessibility for clients, especially in remote, sparsely populated areas.
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Affiliation(s)
- Tiina Huotari
- Geography Research Unit, University of Oulu, PO Box 3000, FI-90014 University of Oulu, Oulu, Finland.
| | - Jarmo Rusanen
- Geography Research Unit, University of Oulu, PO Box 3000, FI-90014 University of Oulu, Oulu, Finland
| | - Timo Keistinen
- Ministry of Social Affairs and Health, Finland, PO Box 33, FI-00023 Government, Helsinki, Finland
| | - Tero Lähderanta
- Research Unit of Mathematical Sciences, University of Oulu, PO Box 3000, FI-90014 University of Oulu, Oulu, Finland
| | - Leena Ruha
- Research Unit of Mathematical Sciences, University of Oulu, PO Box 3000, FI-90014 University of Oulu, Oulu, Finland
| | - Mikko J Sillanpää
- Research Unit of Mathematical Sciences, University of Oulu, PO Box 3000, FI-90014 University of Oulu, Oulu, Finland
| | - Harri Antikainen
- Geography Research Unit, University of Oulu, PO Box 3000, FI-90014 University of Oulu, Oulu, Finland
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Kwak MY, Lee SM, Kim HJ, Eun SJ, Jang WM, Jung H, Kim Y, Lee JY. How far is too far? A nationwide cross-sectional study for establishing optimal hospital access time for Korean pregnant women. BMJ Open 2019; 9:e031882. [PMID: 31542767 PMCID: PMC6756354 DOI: 10.1136/bmjopen-2019-031882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Access to a delivery unit is a major factor in determining maternal morbidity and mortality. However, there is little information about the optimal access time to a delivery unit. This study aimed to establish the optimal hospital access time (OHAT) for pregnant women in South Korea. DESIGN Nationwide cross-sectional study. SETTING We used the National Health Insurance System database of South Korea. PARTICIPANTS We analysed the data of 371 341 women who had experienced pregnancy in 2013. PRIMARY AND SECONDARY OUTCOME MEASURES Access time to hospital was defined as the time required to travel from the patient's home to the delivery unit. The incidence of obstetric complications was plotted against the access time to hospital. Change-point analysis was performed to identify the OHAT by determining a point wherein the incidence of obstetric complications changed significantly. As a final step, the risk of obstetric complications was compared by type among pregnant women who lived within the OHAT against those who lived outside the OHAT. RESULTS The OHAT associated with each adverse pregnancy outcomes were as follows: inadequate prenatal care, 41-50 min; preeclampsia, 51-60 min; placental abruption, 51-60 min; preterm delivery, 31-40 min; postpartum transfusion, 31-40 min; uterine artery embolisation, 31-40 min; admission to intensive care unit, 31-40 min; and caesarean hysterectomy, 31-40 min. Pregnant women who lived outside the OHAT had significantly higher risk for obstetric complications than those who lived within the OHAT. CONCLUSIONS Our results showed that the OHAT for each obstetric complication ranged between 31 and 60 min. The Korean government should take the OHAT under consideration when establishing interventions for pregnant women who live outside OHAT to reduce maternal morbidity and mortality.
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Affiliation(s)
- Mi Young Kwak
- Center for Public Health, National Medical Center, Seoul, South Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Joo Kim
- Department of Nursing Science, Shinsung University, Dangjin, South Korea
| | - Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Won Mo Jang
- Health Review and Assessment Committee, Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Hyemin Jung
- Deaprtment of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
| | - Yoon Kim
- Deaprtment of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Yong Lee
- Deaprtment of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
- Department of Public Health and Community Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, South Korea
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Ahmed S, Adams AM, Islam R, Hasan SM, Panciera R. Impact of traffic variability on geographic accessibility to 24/7 emergency healthcare for the urban poor: A GIS study in Dhaka, Bangladesh. PLoS One 2019; 14:e0222488. [PMID: 31525226 PMCID: PMC6746363 DOI: 10.1371/journal.pone.0222488] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/30/2019] [Indexed: 11/18/2022] Open
Abstract
Ensuring access to healthcare in emergency health situations is a persistent concern for health system planners. Emergency services, including critical care units for severe burns and coronary events, are amongst those for which travel time is the most crucial, potentially making a difference between life and death. Although it is generally assumed that access to healthcare is not an issue in densely populated urban areas due to short distances, we prove otherwise by applying improved methods of assessing accessibility to emergency services by the urban poor that take traffic variability into account. Combining unique data on emergency health service locations, traffic flow variability and informal settlements boundaries, we generated time-cost based service areas to assess the extent to which emergency health services are reachable by urban slum dwellers when realistic traffic conditions and their variability in time are considered. Variability in traffic congestion is found to have significant impact on the measurement of timely access to, and availability of, healthcare services for slum populations. While under moderate traffic conditions all slums in Dhaka City are within 60-minutes travel time from an emergency service, in congested traffic conditions only 63% of the city's slum population is within 60-minutes reach of most emergency services, and only 32% are within 60-minutes reach of a Burn Unit. Moreover, under congested traffic conditions only 12% of slums in Dhaka City Corporation comply with Bangladesh's policy guidelines that call for access to 1 health service per 50,000 population for most emergency service types, and not a single slum achieved this target for Burn Units. Emergency Obstetric Care (EmOC) and First Aid & Casualty services provide the best coverage, with nearly 100% of the slum population having timely access within 60-minutes in any traffic condition. Ignoring variability in traffic conditions results in a 3-fold overestimation of geographic coverage and masks intra-urban inequities in accessibility to emergency care, by overestimating geographic accessibility in peripheral areas and underestimating the same for central city areas. The evidence provided can help policy makers and urban planners improve health service delivery for the urban poor. We recommend that taking traffic conditions be taken into account in future GIS-based analysis and planning for healthcare service accessibility in urban areas.
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Affiliation(s)
- Shakil Ahmed
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Alayne M. Adams
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Rubana Islam
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Shaikh Mehdi Hasan
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Rocco Panciera
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
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Bergh EP, Donepudi R, Bell CS, Moise KJ, Johnson A, Papanna R. Distance Traveled to a Fetal Center and Pregnancy Outcomes in Twin-Twin Transfusion Syndrome. Fetal Diagn Ther 2019; 47:451-456. [PMID: 31487738 DOI: 10.1159/000501774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/26/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fetoscopic laser photocoagulation (FLP) is the definitive treatment for twin-twin transfusion syndrome (TTTS). Due to variability in geographic proximity to high-volume fetal centers, many patients travel great distances to receive experienced care. We sought to determine whether distance traveled (DT) is associated with gestational age (GA) at delivery and neonatal survival. METHODS A prospective cohort study of patients within the continental United States referred to our center between September 23, 2011 and July 25, 2018 undergoing planned FLP for TTTS (n = 393; GA 20.6 ± 2.5 weeks; stage I: n = 50; stage II: n = 118; stage III: n = 208; stage IV: n = 17) was performed. The great-circle distance to our center was calculated using patients' home zip codes. DT was stratified into groups containing equal patient numbers and pregnancy outcomes assessed. RESULTS A total of 393 patients met the inclusion criteria. The threshold distance from our center was <250 miles (n = 181), 250-499 miles (n= 119), and ≥500 miles (n = 93). There was no significant difference between any of the preoperative variables among the three groups, with the exception of race and rural status. Furthermore, there was no significant association between DT and GA at delivery (p = 0.34), time interval from procedure to delivery (p = 0.37), and the number of neonatal survivors (p= 0.21). Preterm premature rupture of membranes (PPROM) at <34 weeks was highest (47.9%, p = 0.04) in the group traveling 250-499 miles. CONCLUSION To our knowledge, this is the largest study to show that in TTTS, DT is not associated with GA at delivery, time interval from procedure to delivery, or neonatal survival. Although PPROM at <34 weeks was higher in the group traveling 250-499 miles, there was no significant difference in GA at delivery. While patients with advanced disease may choose to seek treatment based on proximity, traveling long distances does not adversely affect pregnancy outcomes.
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Affiliation(s)
- Eric P Bergh
- The Fetal Center, Department of Obstetrics, Children's Memorial Hermann Hospital, Gynecology and Reproductive Sciences, UTHealth, McGovern Medical School, University of Texas, Houston, Texas, USA
| | - Roopali Donepudi
- Texas Children's Fetal Center, Departments of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Cynthia S Bell
- McGovern Medical School at UTHealth, Center for Clinical Research and Evidence-Based Medicine, Houston, Texas, USA
| | - Kenneth J Moise
- The Fetal Center, Department of Obstetrics, Children's Memorial Hermann Hospital, Gynecology and Reproductive Sciences, UTHealth, McGovern Medical School, University of Texas, Houston, Texas, USA
| | - Anthony Johnson
- The Fetal Center, Department of Obstetrics, Children's Memorial Hermann Hospital, Gynecology and Reproductive Sciences, UTHealth, McGovern Medical School, University of Texas, Houston, Texas, USA
| | - Ramesha Papanna
- The Fetal Center, Department of Obstetrics, Children's Memorial Hermann Hospital, Gynecology and Reproductive Sciences, UTHealth, McGovern Medical School, University of Texas, Houston, Texas, USA,
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Takač I, Belak U, Gorjup D, Kavšek G, Macun E, Medved R, Mihevc Ponikvar B, Mole H, Mujezinović F, Najdenov P, Prelec A, Premru Sršen T, Mikluš M, Serdinšek T, Sobočan M, Steblovnik L, Tičar Z, Horvat M, Jamšek T, Arko D. Planned home birth in Slovenia-Are we ready? Int J Health Plann Manage 2019; 34:e1961-e1967. [PMID: 31436355 DOI: 10.1002/hpm.2893] [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: 07/21/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 11/07/2022] Open
Abstract
Nowadays, women want a more intimate and familiar atmosphere during labour, which results in increased planned home birth rates. Every woman has the autonomy to decide where she will give birth; however, it is important that she is informed of risks and advantages beforehand. Home births can be distinguished between planned and unplanned home births. Planned home births can be conducted by professional birth attendants (licensed midwives) or birth assistants (doulas, etc). The rates of Slovenian women who decided to deliver at home are increasing year by year. Researches on home births still present discordant data about home birth safety. Their findings have shown that the main advantage of home birth is a spontaneous birth without medical interventions, especially in multiparous low-risk women. The main disadvantage, however, is a higher risk for neonatal death, in particular on occurrence of complications requiring a transfer to hospital and surgical intervention. Global guidelines emphasize careful selection of candidates suitable for home birth, well-informed pregnant women, education of birth attendants, and strict formation of transfer indications.
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Affiliation(s)
- Iztok Takač
- Division of Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Urška Belak
- Division of Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Denis Gorjup
- Rescue Station, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gorazd Kavšek
- Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Eva Macun
- Department of Gynaecology and Obstetrics, General Hospital Jesenice, Jesenice, Slovenia
| | - Robert Medved
- Ministry of Health of the Republic of Slovenia, Ljubljana, Slovenia
| | | | - Helena Mole
- Paediatrician, office-based doctor participating in the publicly-funded health care network, Ljubljana, Slovenia
| | - Faris Mujezinović
- Division of Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Peter Najdenov
- Department of Paediatrics, General Hospital Jesenice, Jesenice, Slovenia
| | - Anita Prelec
- Nurses and Midwives Association of Slovenia, Ljubljana, Slovenia
| | - Tanja Premru Sršen
- Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Milena Mikluš
- Division of Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Tamara Serdinšek
- Division of Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Monika Sobočan
- Division of Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Lili Steblovnik
- Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Zdenka Tičar
- Ministry of Health of the Republic of Slovenia, Ljubljana, Slovenia
| | - Martina Horvat
- National Institute of Public Health, Ljubljana, Slovenia
| | - Tina Jamšek
- Ministry of Health of the Republic of Slovenia, Ljubljana, Slovenia
| | - Darja Arko
- Division of Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Pařízková A, Clausen JA. Women on the move: A search for preferred birth services. Women Birth 2019; 32:e483-e491. [DOI: 10.1016/j.wombi.2018.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 01/26/2023]
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Aubrey-Bassler FK, Cullen RM, Simms A, Asghari S, Crane J, Wang PP, Godwin M. Population-based cohort study of hospital delivery volume, geographic accessibility, and obstetric outcomes. Int J Gynaecol Obstet 2019; 146:95-102. [PMID: 31032903 DOI: 10.1002/ijgo.12832] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/11/2019] [Accepted: 04/26/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine associations between geographic accessibility, delivery volume, and obstetric outcomes. METHODS Population-based cohort study of linked hospital administrative, census, and geospatial data (2006-2009) from all Canadian jurisdictions except Quebec. Perinatal mortality and major maternal morbidity/mortality were compared across categories of road distance and hospital delivery volume. RESULTS Among 820 761 mothers delivering 827 504 neonates, travel distance had minimal effect on perinatal mortality. Compared with mothers travelling 0-9 km, the odds of adverse maternal outcomes was decreased for women travelling modest distances (20-49 km, odds ratio, 0.80 [95% confidence interval, 0.75-0.86]), and increased thereafter (50-99 km, 0.99 [0.89-1.10]; 200-299 km, 1.44 [1.10-1.87]; >400 km, 2.22 [1.06-4.63]). Relative to high-volume hospitals (>2500 deliveries/year), adverse maternal outcomes were less likely for hospitals with 1000-2499 (0.90 [0.86-0.95]), and roughly equivalent for hospitals with 200-499 (1.34 [1.22-1.48]) and 500-999 (1.27 [1.17-1.39]) deliveries/year. Odds of perinatal mortality ranged from 1.04 (0.73-1.49; 100-199 deliveries/year) to 1.50 (1.04-2.16; 50-99 deliveries/year); the pattern did not suggest causality. CONCLUSION Maternal outcomes worsen when travel distance is greater than 200 km, and improve when delivery volume exceeds 1000 deliveries per year.
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Affiliation(s)
- F Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Richard M Cullen
- Primary Healthcare Research Unit, Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Alvin Simms
- Department of Geography, Faculty of Humanities and Social Sciences, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Shabnam Asghari
- Primary Healthcare Research Unit, Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Joan Crane
- Discipline of Obstetrics and Gynecology, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Peizhong P Wang
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Marshall Godwin
- Primary Healthcare Research Unit, Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Maternal Area of Residence, Socioeconomic Status, and Risk of Adverse Maternal and Birth Outcomes in Adolescent Mothers. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1752-1759. [PMID: 31047831 DOI: 10.1016/j.jogc.2019.02.126] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Adolescent pregnancy is a significant public health issue in Canada. Current evidence highlights the individual role of social determinants of health such as maternal residence and socioeconomic status (SES) on teen pregnancy outcomes. This study evaluated the joint association between residence/SES and adverse adolescent pregnancy outcomes. METHODS This was a population-based retrospective cohort study of all singleton, live deliveries (2010-2015) from women aged 15 to 19 who were registered in the Alberta Perinatal Health Program. Information on maternal residence and SES was extracted from the Pampalon Material Deprivation Index data set. The study categorized mothers into four risk dyads: rural/high SES, rural/low SES, urban/high SES, and urban/low SES. Adjusted odds ratios (ORs) of adverse pregnancy outcomes were calculated in logistic regression models (Canadian Task Force Classification II-2). RESULTS A total of 9606 births from adolescent mothers were evaluated. Thirty percent of adolescent mothers were classified as urban/high SES; 27% were urban/low SES; 7% were rural/high SES; and 36% were placed in the rural/low SES category. Compared with urban/high SES mothers, rural/low SES mothers had increased odds of postpartum hemorrhage (OR 1.57; 95% confidence interval [CI] 1.41-1.74), operative vaginal delivery (OR 1.37; 95% CI 1.18-1.60), Caesarean section (OR 1.39; 95% CI 1.19-1.62), large for gestational age infants (OR 1.39; 95% CI 1.16-1.66), low birth weight (OR 1.11; 95% CI 1.07-1.65), and preterm birth (OR 1.48; 95% CI 1.17-1.87). CONCLUSION Rural pregnant adolescents of low SES have the highest odds for adverse pregnancy outcomes. Social determinants of health that affect adolescent pregnancies need further examination to identify high-risk subgroups and understand pathways to health disparities in this vulnerable population.
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Pilkington H, Prunet C, Blondel B, Charreire H, Combier E, Le Vaillant M, Amat-Roze JM, Zeitlin J. Travel Time to Hospital for Childbirth: Comparing Calculated Versus Reported Travel Times in France. Matern Child Health J 2018; 22:101-110. [PMID: 28780684 DOI: 10.1007/s10995-017-2359-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives Timely access to health care is critical in obstetrics. Yet obtaining reliable estimates of travel times to hospital for childbirth poses methodological challenges. We compared two measures of travel time, self-reported and calculated, to assess concordance and to identify determinants of long travel time to hospital for childbirth. Methods Data came from the 2010 French National Perinatal Survey, a national representative sample of births (N = 14 681). We compared both travel time measures by maternal, maternity unit and geographic characteristics in rural, peri-urban and urban areas. Logistic regression models were used to study factors associated with reported and calculated times ≥30 min. Cohen's kappa coefficients were also calculated to estimate the agreement between reported and calculated times according to women's characteristics. Results In urban areas, the proportion of women with travel times ≥30 min was higher when reported rather than calculated times were used (11.0 vs. 3.6%). Longer reported times were associated with non-French nationality [adjusted odds ratio (aOR) 1.3 (95% CI 1.0-1.7)] and inadequate prenatal care [aOR 1.5 (95% CI 1.2-2.0)], but not for calculated times. Concordance between the two measures was higher in peri-urban and rural areas (52.4 vs. 52.3% for rural areas). Delivery in a specialised level 2 or 3 maternity unit was a principal determinant of long reported and measured times in peri-urban and rural areas. Conclusions for Practice The level of agreement between reported and calculated times varies according to geographic context. Poor measurement of travel time in urban areas may mask problems in accessibility.
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Affiliation(s)
- Hugo Pilkington
- Département de Géographie, Université Paris 8 Vincennes-Saint-Denis, UMR7533 Ladyss, 2 rue de la Liberté, 93526, Saint-Denis, France.
| | - Caroline Prunet
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | - Béatrice Blondel
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | - Hélène Charreire
- Université Paris-Est, LabUrba, Ecole d'urbanisme de Paris, Créteil, France
| | - Evelyne Combier
- Centre d'épidémiologie des populations (CEP), University of Burgundy, EA4184 CHU, Hôpital du Bocage, Dijon, France
| | - Marc Le Vaillant
- Centre de Recherche, médecine, sciences, santé, santé mentale, société (CERMES3) INSERM U988 - CNRS UMR 8211, Villejuif Cedex, France
| | | | - Jennifer Zeitlin
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
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Jepsen I, Juul S, Foureur MJ, Sørensen EE, Nohr EA. Labour outcomes in caseload midwifery and standard care: a register-based cohort study. BMC Pregnancy Childbirth 2018; 18:481. [PMID: 30522453 DOI: 10.1186/s12884-018-2090-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 11/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on caseload midwifery in a Danish setting is missing. This cohort study aimed to compare labour outcomes in caseload midwifery and standard midwifery care. METHODS A historical register-based cohort study was carried out using routinely collected data about all singleton births 2013-2016 in two maternity units in the North Denmark Region. In this region, women are geographically allocated to caseload midwifery or standard care, as caseload midwifery is only available in some towns in the peripheral part of the uptake areas of the maternity units, and it is the only model of care offered here. Labour outcomes of 2679 all-risk women in caseload midwifery were compared with those of 10,436 all-risk women in standard midwifery care using multivariate linear and logistic regression analyses. RESULTS Compared to women in standard care, augmentation was more frequent in caseload women (adjusted odds ratio (aOR) 1.20; 95% CI 1.06-1.35) as was labour duration of less than 10 h (aOR 1.26; 95% CI 1.13-1.42). More emergency caesarean sections were observed in caseload women (aOR 1.17; 95% CI 1.03-1.34), but this might partly be explained by longer distance to the maternity unit in caseload women. When caseload women were compared to women in standard care with a similar long distance to the hospital, no difference in emergency caesarean sections was observed (aOR 1.04; 95% CI 0.84-1.28). Compared to standard care, infants of caseload women more often had Apgar ≤7 after 5 min. (aOR 1.57; 95% CI 1.11-2.23) and this difference remained when caseload women were compared to women with similar distance to the hospital. For elective caesarean sections, preterm birth, induction of labour, dilatation of cervix on admission, amniotomy, epidural analgesia, and instrumental deliveries, we did not obseve any differences between the two groups. After birth, caseload women more often experienced no laceration (aOR 1.17; 95% CI 1.06-1.29). CONCLUSIONS For most labour outcomes, there were no differences across the two models of midwifery-led care but unexpectedly, we observed slightly more augmentation and adverse neonatal outcomes in caseload midwifery. These findings should be interpreted in the context of the overall low intervention and complication rates in this Danish setting and in the context of research that supports the benefits of caseload midwifery. Although the observational design of the study allows only cautious conclusions, this study highlights the importance of monitoring and evaluating new practices contextually.
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Affiliation(s)
- Ingrid Jepsen
- University College of Northern Denmark, Selma Lagerløfs Vej 2, 9220, Aalborg Øst, Denmark. .,Clinical Nursing Research, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark.
| | - Svend Juul
- Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus C, Denmark
| | - Maralyn Jean Foureur
- Research unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Sdr Boulevard 29, 5000, Odense C, Denmark.,Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Erik Elgaard Sørensen
- Clinical Nursing Research, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Ellen Aagaard Nohr
- Research unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Sdr Boulevard 29, 5000, Odense C, Denmark.,Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.,Centre of Women's, Family and Child Health, University of South-Eastern Norway, Kongsberg, Norway
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Darling EK, Lawford KMO, Wilson K, Kryzanauskas M, Bourgeault IL. Distance from Home Birth to Emergency Obstetric Services and Neonatal Outcomes: A Cohort Study. J Midwifery Womens Health 2018; 64:170-178. [PMID: 30325580 DOI: 10.1111/jmwh.12896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 07/11/2018] [Accepted: 07/13/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Little is known about the relationship between distance from hospital services and the outcomes of planned home births. We examined whether greater driving distance from a hospital with continuous cesarean capability was associated with a higher risk of adverse neonatal outcome among individuals who were planning to give birth at home. METHODS Using an intention-to-treat analysis, we conducted a population-based cohort study of 11,869 individuals who planned to give birth at home in Ontario, Canada, between April 1, 2012, and March 31, 2015. We used postal codes to determine the driving time from maternal residence to the closest hospital offering level 2 or higher maternity care services (ie, hospital with continuous cesarean birth capability). We used log binomial regression analysis to compare the outcomes of individuals who planned a birth more than a 30-minute drive from a level 2 hospital with those of individuals whose births were planned to occur within 30 minutes. We adjusted for maternal age, parity, gestational age, season, and maternal material deprivation quintile. RESULTS We found no statistically significant difference in the rates of 5-minute Apgar scores less than 7 (adjusted relative risk [aRR], 1.02; 95% CI, 0.95-1.10; P = .58), perinatal mortality, meconium aspiration syndrome, and emergency medical service usage. Neonates born to individuals who planned to give birth at a greater distance from a hospital had a lower rate of neonatal intensive care unit admission (aRR, 0.6; 95% CI, 0.44-0.81; P = .001). DISCUSSION We found no increased risk of adverse neonatal outcomes for births that were planned to occur more than 30 minutes from a hospital. Our findings can be considered, along with individual risk factors and contextual factors, in decision making about the choice of home birth for individuals who live more than half an hour from a hospital with cesarean capacity.
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Villeneuve E, Landa P, Allen M, Spencer A, Prosser S, Gibson A, Kelsey K, Mujica-Mota R, Manktelow B, Modi N, Thornton S, Pitt M. A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BackgroundThere is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale.Objectives(1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives.Main outcome measuresThe ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents.DesignDescriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study.SettingNHS neonatal services across England.DataNeonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey.ResultsLocation analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling > 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families.LimitationsThe following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface.ConclusionsAn evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents.Future workTo extend the modelling to encompass the interface between maternity and neonatal services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Emma Villeneuve
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Paolo Landa
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Michael Allen
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Anne Spencer
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Sue Prosser
- Neonatal Unit, Royal Devon and Exeter Hospital, Exeter, UK
| | - Andrew Gibson
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Katie Kelsey
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ruben Mujica-Mota
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Brad Manktelow
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neena Modi
- Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, UK
| | - Steve Thornton
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin Pitt
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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Boesveld IC, Hermus MAA, van der Velden-Bollemaat EC, Hitzert M, de Graaf HJ, Franx A, Wiegers TA. An approach to assessing the quality of birth centres results of the Dutch birth centre study. Midwifery 2018; 66:36-48. [PMID: 30121477 DOI: 10.1016/j.midw.2018.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/10/2018] [Accepted: 07/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE to determine the usability of a recently developed set of 30 structure and process birth centre quality indicators. DESIGN an explorative study using mixed-methods including literature, a survey, interviews and observations. The study is part of the Dutch Birth Centre Study. We first determined the measurability of birth centre quality indicators by describing them in detail. Next, we assessed the birth centres in the Netherlands according to these indicators using data derived from the Dutch Birth Centre General Questionnaire, the Dutch Birth Centre Integration Questionnaire, interviews, and policy documents. SETTING AND PARTICIPANTS representatives of 23 birth centres in the Netherlands. MEASUREMENTS AND FINDINGS 28 of the 30 quality indicators could be used to assess birth centres in the Netherlands, one had no optimal value defined, another could not be scored because the information was not available. Each quality indicator could be scored 0 or 1. Differences between birth centres were shown: the scores ranged from 7 to 22. Some of the quality indicators can be combined or made more specific so that they are easier to assess. Some quality indicators need adaptation because they are only applicable for some birth centres (e.g. only for freestanding or alongside birth centres). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE 28 of the 30 quality indicators are usable to assess structure and process quality of birth centres. With the findings of this study the set of structure and process quality indicators for birth centres in the Netherlands can be reduced to 22 indicators. This set of quality indicators can contribute to the development of a quality system for birth centres. Further research is necessary to formulate standards or minimum quality requirements for birth centres and to improve the set of birth centre quality indicators.
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Affiliation(s)
- Inge C Boesveld
- Jan van Es Institute (Netherlands Expert Centre Integrated Primary Care), Wisselweg 33, 1314 CB Almere, The Netherlands.
| | - Marieke A A Hermus
- Department of Child Health, TNO, PO Box 2215, 2301 CE Leiden, The Netherlands; Department of Obstetrics, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands; Midwifery Practice Trivia, Werkmansbeemd 2, 4907 EW Oosterhout, The Netherlands
| | | | - Marit Hitzert
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2014, 3000 CA Rotterdam, The Netherlands
| | - Hanneke J de Graaf
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2014, 3000 CA Rotterdam, The Netherlands
| | - Arie Franx
- Division Woman and Baby, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, the The Netherlands
| | - Therese A Wiegers
- NIVEL (Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands
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Guglielminotti J, Landau R, Wong CA, Li G. Patient-, Hospital-, and Neighborhood-Level Factors Associated with Severe Maternal Morbidity During Childbirth: A Cross-Sectional Study in New York State 2013–2014. Matern Child Health J 2018; 23:82-91. [DOI: 10.1007/s10995-018-2596-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Santos PCD, Silva ZPD, Chiaravalloti Neto F, Alencar GP, Almeida MFD. [Differences in live birth clusters in the city of São Paulo, Brazil, 2010]. CAD SAUDE PUBLICA 2018; 34:e00156416. [PMID: 29947661 DOI: 10.1590/0102-311x00156416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/04/2017] [Indexed: 11/22/2022] Open
Abstract
This study aimed to identify birth clusters according to type of hospital (SUS vs. non-SUS) and the existence of differences in socioeconomic, maternal, neonatal, and healthcare access characteristics, measured by the distance between the mothers' homes and the hospitals where they gave birth. Births to mothers residing in the city of São Paulo, Brazil, in 2010 were georeferenced and allocated in 310 weighting areas from the population census, in addition to classifying them according to hospital of birth (SUS vs. non-SUS). Spatial clusters were identified through the spatial sweep technique for spatial dependence of SUS and non-SUS births, leading to the formation of ten SUS clusters and seven non-SUS clusters. Births in non-SUS hospitals formed clusters in the city's central area, with a lower proportion of low-income households. The SUS birth clusters were located on the outskirts of the city, where there are more households in subnormal clusters. Both SUS and non-SUS clusters were not internally homogeneous, showing differences in maternal age, schooling, and number of prenatal visits and very premature newborns. The theoretical mean distance traveled by mothers to the hospital was 51.8% lower in the SUS clusters (5.1km) than in the non-SUS clusters (9.8km). The formation of birth clusters showed differences in maternal, pregnancy, childbirth, and neonatal characteristics, in addition to displaying a radial-concentric spatial distribution, reflecting the city's prevailing socioeconomic differences. The shorter distance in SUS births indicates regionalization of childbirth care in the city of São Paulo.
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Hitzert M, Boesveld IC, Hermus MAA, de Graaf JP, Wiegers TA, Steegers EAP, Meijboom BR, Akkermans HA. Quality improvement opportunities for handover practices in birth centres: A case study from a process perspective. J Eval Clin Pract 2018; 24:590-597. [PMID: 29878610 DOI: 10.1111/jep.12939] [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: 06/30/2017] [Revised: 03/30/2018] [Accepted: 04/02/2018] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Handovers within and between health care settings are known to affect quality of care. Health care organizations, struggle how to guarantee best care during handovers. The aim of this paper is to evaluate handover practices in Dutch birth centres from a process perspective, to identify obstacles and opportunities for quality improvements. METHODS This case study in 7 Dutch birth centres was undertaken from a process perspective by conducting observations and using process mapping. This study is part of the Dutch Birth Centre Study. RESULTS Solutions to obstacles during handovers from a birth centre to a hospital were identified in at least 1 of the 7 birth centres. Four of the centres had agreements with a hospital for client support when a caregiver in a birth centre was absent. Face-to-face communication during handover was observed in 6 of the 7 centres. An electronic health record was noted in 1 centre; joint training of acute situations was available in 2 centres with 3 centres indicating that this was not compulsory. Continuity of caregiver was present in 4 birth centres with postpartum care available in 3 centres. CONCLUSIONS Ensuring quality during handovers requires a case-specific process approach. This study reveals distinctive aspects during handovers, concrete obstacles, and potential solutions for quality improvements in inter-organizational networks, transferrable to birth centres in other countries as well.
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Affiliation(s)
- Marit Hitzert
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | | | - Johanna P de Graaf
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Henk A Akkermans
- Tilburg School of Economics and Management, Tilburg, The Netherlands
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Skaftun EK, Verguet S, Norheim OF, Johansson KA. Geographic health inequalities in Norway: a Gini analysis of cross-county differences in mortality from 1980 to 2014. Int J Equity Health 2018; 17:64. [PMID: 29793490 PMCID: PMC5968669 DOI: 10.1186/s12939-018-0771-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 05/03/2018] [Indexed: 01/30/2023] Open
Abstract
Background This study aims at quantifying the level and changes over time of inequality in age-specific mortality and life expectancy between the 19 Norwegian counties from 1980 to 2014. Methods Data on population and mortality by county was obtained from Statistics Norway for 1980–2014. Life expectancy and age-specific mortality rates (0–4, 5–49 and 50–69 age groups) were estimated by year and county. Geographic inequality was described by the absolute Gini index annually. Results Life expectancy in Norway has increased from 75.6 to 82.0 years, and the risk of death before the age of 70 has decreased from 26 to 14% from 1980 to 2014. The absolute Gini index decreased over the period 1980 to 2014 from 0.43 to 0.32 for life expectancy, from 0.012 to 0.0057 for the age group 50–69 years, from 0.0038 to 0.0022 for the age group 5–49 years, and from 0.0009 to 0.0006 for the age group 0–4 years. It will take between 2 and 32 years (national average 7 years) until the counties catch up with the life expectancy in the best performing county if their annual rates of increase remain unchanged. Conclusion Using the absolute Gini index as a metric for monitoring changes in geographic inequality over time may be a valuable tool for informing public health policies. The absolute inequality in mortality and life expectancy between Norwegian counties has decreased from 1980 to 2014. Electronic supplementary material The online version of this article (10.1186/s12939-018-0771-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eirin K Skaftun
- Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, N-5018, Bergen, Norway.
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, N-5018, Bergen, Norway.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kjell A Johansson
- Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, N-5018, Bergen, Norway.,Department of Drug and Addiction Medicine, Haukeland University Hospital, Bergen, Norway
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Geographic Accessibility to Health Services and Neonatal Mortality Among Very-Low Birthweight Infants in South Carolina. Matern Child Health J 2017; 20:2382-2391. [PMID: 27406152 DOI: 10.1007/s10995-016-2065-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction Mortality for infants born with very-low birthweight (VLBW, 500-1499 grams) is markedly higher than for babies born with normal birthweight (2500-4000 grams). Although these high-risk infants show better outcomes in advanced care settings, only 80 % of VLBW infants born in South Carolina (SC) are delivered in hospitals with a level-III neonatal intensive care unit (NICU). The purpose of this research project was to assess geographic access to delivery hospitals and risk of neonatal death among singleton VLBW infants born in SC. Methods The linked birth and death records of a cross-sectional, population-based study of singleton VLBW infants born in SC between 2010 and 2012 were used (n = 2030). We assessed the impact of travel time from maternal residence to delivery hospital. Logistic regression modeling was performed with adjustments for maternal, newborn, and hospital characteristics. Results The neonatal mortality rate among singleton VLBW infants was 11.03 deaths per 100 live births in 2010-2012. We did not find a significant association between travel time to delivery hospital and neonatal mortality after adjusting for confounders. However, we found that a 1-week increase in gestational age (odds ratio (OR): 0.61) and non-Hispanic black mothers (versus non-Hispanic white mothers) (OR: 0.68) were associated with lower odds of neonatal death, whereas non-NICU admission at birth (OR: 5.90) was associated with increased odds of death. The results of the sensitivity analyses including both singleton and multiple births did not yield significant results for travel time and neonatal mortality in VLBW infants. Discussion Although we found no significant association between travel time and neonatal mortality in singleton VLBW births in SC, we identified significant factors consistent with those found in previous studies that may affect neonatal mortality.
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Smirnova A, Ravelli ACJ, Stalmeijer RE, Arah OA, Heineman MJ, van der Vleuten CPM, van der Post JAM, Lombarts KMJMH. The Association Between Learning Climate and Adverse Obstetrical Outcomes in 16 Nontertiary Obstetrics-Gynecology Departments in the Netherlands. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1740-1748. [PMID: 28953570 DOI: 10.1097/acm.0000000000001964] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To investigate the association between learning climate and adverse perinatal and maternal outcomes in obstetrics-gynecology departments. METHOD The authors analyzed 23,629 births and 103 learning climate evaluations from 16 nontertiary obstetrics-gynecology departments in the Netherlands in 2013. Multilevel logistic regressions were used to calculate the odds of adverse perinatal and maternal outcomes, by learning climate score tertile, adjusting for maternal and department characteristics. Adverse perinatal outcomes included fetal or early neonatal mortality, five-minute Apgar score < 7, or neonatal intensive care unit admission for ≥ 24 hours. Adverse maternal outcomes included postpartum hemorrhage and/or transfusion, death, uterine rupture, or third- or fourth-degree perineal laceration. Bias analyses were conducted to quantify the sensitivity of the results to uncontrolled confounding and selection bias. RESULTS Learning climate scores were significantly associated with increased odds of adverse perinatal outcomes (aOR 2.06, 95% CI 1.14-3.72). Compared with the lowest tertile, departments in the middle tertile had 46% greater odds of adverse perinatal outcomes (aOR 1.46, 95% CI 1.09-1.94); departments in the highest tertile had 69% greater odds (aOR 1.69, 95% CI 1.24-2.30). Learning climate was not associated with adverse maternal outcomes (middle vs. lowest tertile: OR 1.04, 95% CI 0.93-1.16; highest vs. lowest tertile: OR 0.98, 95% CI 0.88-1.10). CONCLUSIONS Learning climate was associated with significantly increased odds of adverse perinatal, but not maternal, outcomes. Research in similar clinical contexts is needed to replicate these findings and explore potential mechanisms behind these associations.
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Affiliation(s)
- Alina Smirnova
- A. Smirnova is a PhD candidate, School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands, and researcher, Professional Performance Research Group, Institute for Education and Training, Academic Medical Center, Amsterdam, The Netherlands. A.C.J. Ravelli is epidemiologist and assistant professor, Departments of Medical Informatics and Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands. R.E. Stalmeijer is assistant professor, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands. O.A. Arah is professor, Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California. M.J. Heineman is professor, Board of Directors, Academic Medical Center, Amsterdam, The Netherlands. C.P.M. van der Vleuten is professor and scientific director, School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands. J.A.M. van der Post is professor, Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands. K.M.J.M.H. Lombarts is professor, Professional Performance Research Group, Institute for Education and Training, Academic Medical Center, Amsterdam, The Netherlands
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Bauer J, Groneberg DA, Maier W, Manek R, Louwen F, Brüggmann D. Accessibility of general and specialized obstetric care providers in Germany and England: an analysis of location and neonatal outcome. Int J Health Geogr 2017; 16:44. [PMID: 29191184 PMCID: PMC5709855 DOI: 10.1186/s12942-017-0116-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/20/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Health care accessibility is known to differ geographically. With this study we focused on analysing accessibility of general and specialized obstetric units in England and Germany with regard to urbanity, area deprivation and neonatal outcome using routine data. METHODS We used a floating catchment area method to measure obstetric care accessibility, the degree of urbanization (DEGURBA) to measure urbanity and the index of multiple deprivation to measure area deprivation. RESULTS Accessibility of general obstetric units was significantly higher in Germany compared to England (accessibility index of 16.2 vs. 11.6; p < 0.001), whereas accessibility of specialized obstetric units was higher in England (accessibility index for highest level of care of 0.235 vs. 0.002; p < 0.001). We further demonstrated higher obstetric accessibility for people living in less deprived areas in Germany (r = - 0.31; p < 0.001) whereas no correlation was present in England. There were also urban-rural disparities present, with higher accessibility in urban areas in both countries (r = 0.37-0.39; p < 0.001). The analysis did not show that accessibility affected neonatal outcomes. Finally, our computer generated model for obstetric care provider demand in terms of birth counts showed a very strong correlation with actual birth counts at obstetric units (r = 0.91-0.95; p < 0.001). CONCLUSION In Germany the focus of obstetric care seemed to be put on general obstetric units leading to higher accessibility compared to England. Regarding specialized obstetric care the focus in Germany was put on high level units whereas in England obstetric care seems to be more balanced between the different levels of care with larger units on average leading to higher accessibility.
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Affiliation(s)
- Jan Bauer
- Division of Epidemiology and Health Services Research, The Institute of Occupational, Social and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany
| | - David A. Groneberg
- Division of Epidemiology and Health Services Research, The Institute of Occupational, Social and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany
| | - Werner Maier
- Institute for Health Economics and Management of Health Care, Helmholtz Centre Munich, German Science Centre for Health and Environment (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Roxanne Manek
- Touro College, 500 Seventh Ave, New York, NY 10018 USA
| | - Frank Louwen
- Division of Obstetrics and Fetomaternal Medicine, University Hospital of Frankfurt, Theodor-Stern-Kai, 7, 60590 Frankfurt, Germany
| | - Dörthe Brüggmann
- Division of Epidemiology and Health Services Research, The Institute of Occupational, Social and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany
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Waelput AJM, Sijpkens MK, Lagendijk J, van Minde MRC, Raat H, Ernst-Smelt HE, de Kroon MLA, Rosman AN, Been JV, Bertens LCM, Steegers EAP. Geographical differences in perinatal health and child welfare in the Netherlands: rationale for the healthy pregnancy 4 all-2 program. BMC Pregnancy Childbirth 2017; 17:254. [PMID: 28764640 PMCID: PMC5540512 DOI: 10.1186/s12884-017-1425-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 07/18/2017] [Indexed: 03/01/2023] Open
Abstract
Background Geographical inequalities in perinatal health and child welfare require attention. To improve the identification, and care, of mothers and young children at risk of adverse health outcomes, the HP4All-2 program was developed. The program consists of three studies, focusing on creating a continuum for risk selection and tailored care pathways from preconception and antenatal care towards 1) postpartum care, 2) early childhood care, as well as 3) interconception care. The program has been implemented in ten municipalities in the Netherlands, aiming to target communities with a relatively disadvantageous position with regard to perinatal and child health outcomes. To delineate the position of the ten participating municipalities, we present municipal and regional differences in the prevalence of perinatal mortality, perinatal morbidity, children living in deprived neighbourhoods, and children living in families on welfare. Methods Data on all singleton births in the Netherlands between 2009 and 2014 were analysed for the prevalence of perinatal mortality and morbidity. In addition, national data on children living in deprived neighbourhoods and children living in families on welfare between 2009 and 2012 were analysed. The prevalence of these outcomes were calculated and ranked for 62 geographical areas, the 50 largest municipalities and the 12 provinces, to determine the position of the municipalities that participate in HP4All-2. Results Considerable geographical differences were present for all four outcomes. The municipalities that participate in HP4All-2 are among the 25 municipalities with the highest prevalence of perinatal mortality, perinatal morbidity, children living in deprived neighbourhoods, or children in families on welfare. Conclusion This study illustrates geographical differences in perinatal health and/or child welfare outcomes and demonstrates that the HP4All-2 program targets municipalities with a relative unfavourable position. By targeting these municipalities, the program is expected to contribute most to improving the care for young children and their mothers at risk, and hence to reducing their risks and health inequalities. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1425-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adja J M Waelput
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Meertien K Sijpkens
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Jacqueline Lagendijk
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Minke R C van Minde
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Public Health, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Hiske E Ernst-Smelt
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Marlou L A de Kroon
- Department of Public Health, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Ageeth N Rosman
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Jasper V Been
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Paediatrics, Division of Neonatology, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Loes C M Bertens
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
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