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Vallely LM, Calvert B, De Silva M, Panisi L, Babona D, Bolnga J, Duro-Aina T, Noovao-Hill A, Naidu S, Leisher S, Flenady V, Smith RM, Vogel JP, Homer CS. Improving maternal and newborn health and reducing stillbirths in the Western Pacific Region - current situation and the way forward. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 32:100653. [PMID: 36785855 PMCID: PMC9918777 DOI: 10.1016/j.lanwpc.2022.100653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022]
Abstract
Despite positive trends in many indicators, there remains an unacceptable burden of preventable maternal, newborn deaths and stillbirths every year. This paper provides an overview of the maternal and perinatal outcomes across 22 Pacific Island Countries and Territories, including Papua New Guinea. We highlight some unique challenges and provide examples of initiatives in three of the larger countries to contribute to safer childbirth. There are high maternal and perinatal morbidity and mortality rates in many of the countries, although reliable data are limited. There are currently no data relating to the burden of intrapartum-related maternal and perinatal morbidity or stillbirth or the quality of intrapartum care. Varying definitions across countries for perinatal indicators mean that meaningful comparisons are difficult and unreliable. There is need for midwives and other maternal and newborn health providers to improve maternal and newborn indicators as countries advance towards the 2030 Sustainable Development Goals.
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Affiliation(s)
- Lisa M. Vallely
- Global Health Program, Kirby Institute, University of New South Wales, Sydney, Australia,Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Boe Calvert
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Manarangi De Silva
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia,Mercy Perinatal, Mercy Hospital for Women, and Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital, Heidelberg, Australia
| | - Leeanne Panisi
- Department of Obstetrics and Gynaecology, National Referral Hospital, Honiara, Solomon Islands
| | - Delly Babona
- Burnet Institute and the University of Melbourne, Australia
| | - John Bolnga
- Department of Obstetrics and Gynaecology, Modilon Hospital, Madang Provincial Health Authority, Papua New Guinea,Papua New Guinea Institute of Medical Research, Papua New Guinea
| | | | | | | | - Susannah Leisher
- International Stillbirth Alliance, NJ, USA,University of Utah Stillbirth Research Program, Utah, USA
| | - Vicki Flenady
- NHMRC Stillbirth Centre for Research Excellence, Mater Research Institute–The University of Queensland, Australia
| | - Rachel M. Smith
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Caroline S.E. Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia,Corresponding author. Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
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High Prevalence of Low-Level Parasitemia With Plasmodium vivax in Makira-Ulawa Province Presents a Challenge for the Diagnosis and Eradication of Malaria in Solomon Islands. Ochsner J 2021; 21:76-80. [PMID: 33828428 PMCID: PMC7993419 DOI: 10.31486/toj.20.0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Malaria remains endemic in Solomon Islands, but data on malaria in the provinces of Solomon Islands are limited. This study from Makira-Ulawa Province aimed to identify the most prevalent strain of malaria and assess if the available rapid diagnostic test (RDT) was effective in Kirakira Hospital. Methods: Forty-five patients who presented to Kirakira Hospital with symptoms of fever had a positive malaria parasite smear during a 4-week period in 2017. The parasite count for each smear was calculated. Simultaneous testing using the CareStart Malaria HRP2/pLDH (Pf/pan) Combo RDT was conducted. The data for all malaria parasite smears performed in Makira-Ulawa Province in 2016 were collated for comparison. Results: All 45 patients diagnosed with malaria in a 4-week period in 2017 were positive for Plasmodium vivax. The median parasite load was 280 parasites per μL (range, 160 to 640 parasites per μL). None of the 45 CareStart RDTs performed was positive. In 2016, 5,505 of 17,195 patients (32.0%) screened had malaria parasites detected on a malaria parasite smear. P vivax was detected in 5,212 (94.7%) and Plasmodium falciparum in 285 (5.2%) of patients with malaria. Conclusion:P vivax is the predominant strain of malaria present in Makira-Ulawa Province. RDTs were not helpful in the diagnosis of malaria at Kirakira Hospital. The parasite load detected in the 45 patients diagnosed with malaria in this study was low. A focus on attempting to eradicate P vivax in the community through improved compliance with treatment protocols is suggested as a possible way forward to best manage malaria in Makira-Ulawa Province.
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Tosif S, Jatobatu A, Maepioh A, Subhi R, Francis KL, Duke T. Cause-specific neonatal morbidity and mortality in the Solomon Islands: An assessment of data from four hospitals over a three-year period. J Paediatr Child Health 2020; 56:607-614. [PMID: 31820849 DOI: 10.1111/jpc.14699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/26/2019] [Accepted: 11/03/2019] [Indexed: 11/27/2022]
Abstract
AIM Data on stillbirths and neonatal morbidity and mortality in low-middle income Pacific Island Nations such as Solomon Islands is limited, partly due to weak health information systems. We describe the perinatal mortality and clinical factors associated with poor newborn outcomes at four hospitals in Solomon Islands. METHODS This was a registry based retrospective cohort study at three provincial hospitals and the National Referral Hospital (NRH) from 2014-2016 inclusive. RESULTS 23 966 labour ward births and 3148 special care nursery (SCN) admissions were reviewed. Overall still birth rate was 29.2/1000 births and the perinatal mortality rate was 35.9/1000 births. PNMR were higher in provincial hospitals (46.2, 44.0 and 34.3/1000) than at NRH (33.3/1000). The commonest reasons for admission to SCN across the hospitals were sepsis, complications of prematurity and birth asphyxia. SCN mortality rates were higher in the 3 provincial hospitals than at NRH (15.9% (95/598) vs. 7.9% (202/2550), P value <0.01). At NRH, the conditions with the highest case fatality rates were birth asphyxia (21.3%), congenital abnormalities (17.7%), and prematurity (15.1%). Up to 11% of neonates did not have a diagnosis recorded. CONCLUSIONS The perinatal mortality rates are high and intrapartum complications, prematurity and sepsis are the main causes of morbidity and mortality for neonates at hospitals in Solomon Islands. Stillbirths account for 81% of perinatal deaths. These results are useful for planning for quality improvement at provincial level. Improved vital registration systems are required to better capture stillbirths and neonatal outcomes.
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Affiliation(s)
- Shidan Tosif
- Centre for International Child Health, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, University of Melbourne, Melbourne, Victoria, Australia
| | - Annie Jatobatu
- Reproductive and Child Health Department, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Anita Maepioh
- Department of Obstetrics and Gynaecology, National Referral Hospital, Honiara, Solomon Islands
| | - Rami Subhi
- Centre for International Child Health, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate L Francis
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Trevor Duke
- Centre for International Child Health, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, University of Melbourne, Melbourne, Victoria, Australia
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Tosif S, Jatobatu A, Maepioh A, Gray A, Gilbert K, Hodgson J, Duke T. Implementation Lessons from a Multifaceted National Newborn Program in Solomon Islands: A Mixed-Methods Study. Am J Trop Med Hyg 2020; 102:667-675. [PMID: 31971147 PMCID: PMC7056423 DOI: 10.4269/ajtmh.19-0631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/24/2019] [Indexed: 11/07/2022] Open
Abstract
Multifaceted interventions are important in improving neonatal quality of care and health outcomes. This study describes the implementation of an intervention to improve the quality of newborn care in Solomon Islands, a small island developing state and lower middle-income country in the Western Pacific. Inputs included training, equipment provision, and healthcare system organizational changes. For evaluation, we used a mixed-methods design, using quantitative (audits of health facility equipment, structure, and organization) and qualitative (semi-structured interviews and focused group discussions with healthcare workers) methods. Participants highlighted the practical, interactive, coaching style of training and its short duration as positive features in establishing skills. Training had indirect impacts through improving culture of the workplace, and the evaluation provided a valuable opportunity for reflection of the implementation process for healthcare workers. Facility limitations from equipment deficits and poor condition of clinical areas had implications by limiting the provision of quality care, as well as contributing to healthcare workers feeling undervalued. Resuscitation of a nonbreathing baby was a stressful experience for many health workers, compounded by geographic isolation and feeling unsupported. Our findings highlight the importance of training methodology, impact from structural limitations, and experience of resuscitation for the healthcare worker. Attention to these factors may help the design and implementation of newborn care programs in similar contexts.
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Affiliation(s)
- Shidan Tosif
- Centre for International Child Health, Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, University of Melbourne, Parkville VIC, Australia
| | - Anna Jatobatu
- Reproductive and Child Health Department, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Anita Maepioh
- Department of Obstetrics and Gynaecology, National Referral Hospital, Honiara, Solomon Islands
| | - Amy Gray
- Centre for International Child Health, Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, University of Melbourne, Parkville VIC, Australia
| | - Katherine Gilbert
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Parkville VIC, Australia
| | - Jan Hodgson
- Department of Paediatrics, University of Melbourne, Parkville VIC, Australia
| | - Trevor Duke
- Centre for International Child Health, Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, University of Melbourne, Parkville VIC, Australia
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