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Liga AD, Jabir YN, Assefa S, Debelew GT, Worku BT. Identifying associated factors in relation to health-related quality of life among postpartum women in Jimma town: A community-based cross-sectional study. Heliyon 2024; 10:e29328. [PMID: 38644852 PMCID: PMC11033102 DOI: 10.1016/j.heliyon.2024.e29328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 04/23/2024] Open
Abstract
Background The quality of life (QoL) of women during the postpartum period is affected by their living circumstances, reproductive history, exposure to and use of antenatal care, etc. The quality of life (QoL) issues associated to postpartum health among Ethiopian women have not been adequately examined in studies. Therefore, this study identified associated factors in relation to the health-related quality of life (QOL) among postpartum women in Jimma Town, Ethiopia. Methods A structured face-to-face interview and a self-administered questionnaire were utilized in a community-based cross-sectional study to obtain data from 397 postpartum women from May 15 to June 14, 2022, using a multistage sampling strategy. The data analysis utilized several descriptive statistics. Multiple logistic models were run on factors that were significant at the 25 % level in univariate analysis. Adjusted odds ratios and 95 % confidence intervals were computed to identify associated factors. Results The majority (51.2 %) of postpartum women had a low health-related quality of life, with a mean score of 50.58. Women poor health-related quality of life (QoL) was associated with age (AOR = 10.09; CI: 3.45-29.51), non-formal education of partners (AOR = 3.67; CI: 1.25-10.72), multiparousness (AOR = 2.21; CI: 1.14-4.29), unplanned pregnancy (AOR = 7.36; CI: 1.98-27.37), giving birth to a dead baby (AOR = 3.15; CI: 1.54-6.42), and not admitted to the hospital while pregnant (AOR = 5.50; CI: 3.86-26.30). Conclusion The finding revealed that the majority of postpartum women reported poorer health-related QoL. Thus, stakeholders should give attention to significant factors to set up measures to prevent and improve women's postpartum health-related QoL, and should be aware of women about the risk associated with poor health-related QoL.
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Affiliation(s)
- Abebe Debu Liga
- Department of Statistics, College of Natural and Computational Sciences,
Wolkite University, Wolkite, Ethiopia
| | - Yasin Negash Jabir
- Department of Statistics, College of Natural Science, Jimma University,
Jimma, Ethiopia
| | - Seble Assefa
- Department of Nursing, Faculty of Health Sciences, Jimma University,
Jimma, Ethiopia
| | - Gurmesa Tura Debelew
- Department of Population and Family Health, Faculty of Public Health,
Jimma University, Jimma, Ethiopia
| | - Bekalu Teka Worku
- Department of Population and Family Health, Faculty of Public Health,
Jimma University, Jimma, Ethiopia
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Pereira ACG, dos Santos TRZ, Machado HDC, Surita FGDC. Factors associated with the absence of postpartum consultations in a high-risk population. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo23. [PMID: 38765517 PMCID: PMC11075390 DOI: 10.61622/rbgo/2024rbgo23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/28/2023] [Indexed: 05/22/2024] Open
Abstract
Objective To assess the rate of missed postpartum appointments at a referral center for high-risk pregnancy and compare puerperal women who did and did not attend these appointments to identify related factors. Methods This was a retrospective cross-sectional study with all women scheduled for postpartum consultations at a high-risk obstetrics service in 2018. The variables selected to compare women were personal, obstetric, and perinatal. The variables of interest were obtained from the hospital's electronic medical records. Statistical analyses were performed using the Chi-square, Fisher's exact, or Mann-Whitney tests. For the variable of the interbirth interval, a receiver operating characteristic curve (ROC) was used to best discriminate whether or not patients attended the postpartum consultation. The significance level for the statistical tests was 5%. Results A total of 1,629 women scheduled for postpartum consultations in 2018 were included. The rate of missing the postpartum consultation was 34.8%. A shorter interbirth interval (p = 0.039), previous use of psychoactive substances (p = 0.027), current or former smoking (p = 0.003), and multiparity (p < 0.001) were associated with non-attendance. Conclusion This study showed a high rate of postpartum appointment non-attendance. This is particularly relevant because it was demonstrated in a high-risk obstetric service linked to clinical severity or social vulnerability cases. This highlights the need for new approaches to puerperal women before hospital discharge and new tools to increase adherence to postpartum consultations, especially for multiparous women.
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Affiliation(s)
- Ana Carolina Gomes Pereira
- Universidade Estadual de CampinasCampinasSPBrazilUniversidade Estadual de Campinas, Campinas, SP, Brazil.
| | | | - Helymar da Costa Machado
- Universidade Estadual de CampinasCampinasSPBrazilUniversidade Estadual de Campinas, Campinas, SP, Brazil.
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Al Rehaili BO, Al-Raddadi R, ALEnezi NK, ALYami AH. Postpartum quality of life and associated factors: a cross-sectional study. Qual Life Res 2023:10.1007/s11136-023-03384-3. [PMID: 37036641 DOI: 10.1007/s11136-023-03384-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE To determine factors associated with postpartum quality of life (QOL). METHODS An analytic cross-sectional design was used in this study, and data was collected from December 2019 to March 2020. Participants were 252 postpartum women visiting eight governmental primary healthcare centers in Madinah city, Saudi Arabia. Data were collected using a sociodemographic questionnaire, the World Health Organization Quality of Life Assessment-BREF, Multidimensional Scale of Perceived Social Support (MSPSS), and Edinburgh Postnatal Depression Scale. Sleep problems were assessed using an item from the Prime-MD Patient Health Questionnaire. RESULTS Maternal age between 26 and 35 years had a significant independent association with the physical health domain of QOL (p < .01). Postpartum depression was significantly associated with lower QOL in all dimensions (p < .01). In addition, sleep problems were associated with three out of the four QOL domains (p < .05). The significant other subscale of the MSPSS was significantly associated with higher QOL scores in all dimensions (p < .01); additionally, family and friends subscales of the MSPSS were significantly associated with the social domain of QOL (p < .01). CONCLUSIONS Maternal QOL, during the postpartum period, showed negative associations with age, postpartum depression, and sleep disturbances. Ultimately, social support appeared to be an essential factor in mothers' ability to cope with the physical and psychological problems experienced during this period.
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Affiliation(s)
- Bushra O Al Rehaili
- Saudi Board of Preventive Medicine, Al Madinah Residency Program of Preventive Medicine, Ministry of Health, Madinah, Kingdom of Saudi Arabia.
| | - Rajaa Al-Raddadi
- Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nadiyah Karim ALEnezi
- Saudi Board of Preventive Medicine, Ministry of Health, Madinah, Kingdom of Saudi Arabia
| | - Ala H ALYami
- Saudi Board of Preventive Medicine, Ministry of Health, Tabuk, Kingdom of Saudi Arabia
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Manoussi A, Baali A, Amor H, Ouzennou N. Postpartum Depression in a Context of Social Vulnerability in Morocco. Psychiatr Ann 2023. [DOI: 10.3928/00485713-20230207-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Wood SN, Pigott A, Thomas HL, Wood C, Zimmerman LA. A scoping review on women’s sexual health in the postpartum period: opportunities for research and practice within low-and middle-income countries. Reprod Health 2022; 19:112. [PMID: 35527298 PMCID: PMC9079206 DOI: 10.1186/s12978-022-01399-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Women’s sexual health is generally defined and explored solely in relation to reproductive capacity, and often omits elements of sexual function and/or dysfunction. Concerted focus is given to women’s health during pregnancy; however, women’s sexual health is largely neglected after childbirth. This scoping review explored how the sexual health of postpartum women has been defined, measured, and researched in low- and middle-income countries (LMICs). Methods Articles eligible for review were those that investigated women’s sexual health during the first 12 months postpartum and were conducted among women aged 15–49 in LMICs. Eligibility was further restricted to studies that were published within the last 20 years (2001–2021). The initial PubMed search identified 812 articles, but upon further eligibility review, 97 remained. At this time, the decision was made to focus this review only on articles addressing sexual function and/or dysfunction, which yielded 46 articles. Key article characteristics were described and analyzed by outcome. Results Of the final included articles, five studies focused on positive sexual health, 13 on negative sexual health, and the remaining 28 on both positive and negative sexual health or without specified directionality. The most common outcome examined was resumption of sex after childbirth. Most studies occurred within sub-Saharan Africa (n = 27), with geographic spread throughout the Middle East (n = 10), Asia (n = 5), North Africa (n = 3), and cross-geography (n = 1); notably, all five studies on positive sexual health were conducted in Iran. Negative sexual health outcomes included vaginismus, dyspareunia, episiotomy, perineal tears, prolapse, infection, obstetric fistula, female genital cutting, postnatal pain, uterine prolapse, coercion to resume sex, sexual violence, and loss of sexual desire/arousal. Most studies were quantitative, though eight qualitative studies elucidated the difficulties women endured in receiving information specific to sexual health and hesitance in seeking help for sexual morbidities in the postpartum period. Conclusions Overall, the evidence base surrounding women’s sexual health in the postpartum period within LMICs remains limited, with most studies focusing solely on the timing of resumption of sex. Integration of sexual health counseling into postnatal care and nonjudgmental service provision can help women navigate these bodily changes and ultimately improve their sexual health. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01399-6. Women’s sexual health is often studied in relation to reproductive health and childbearing. While reproductive health during pregnancy and immediately after is well documented, it remains unclear how women’s sexual health is addressed, particularly within low- and middle-income countries. The aim of this review is to understand how researchers have measured, defined, and examined postpartum sexual health. In October 2021, we searched PubMed database with the following criteria: published in the last 20 years; conducted in a low- or middle-income context; examined sexual function and/or dysfunction among women aged 15–49 within 1 year after childbirth. From this inclusion criteria, we identified 46 relevant articles. Most studies were conducted in sub-Saharan Africa. Only five studies focused exclusively on positive sexual health, and the majority of studies examined the resumption of sex after childbirth. Multiple qualitative studies described women’s reluctance to seek help for postpartum sexual health issues and highlighted the difficulties they faced in receiving information specific to sexual health. Overall, the evidence base surrounding women’s sexual health after childbirth within low- and middle-income contexts is limited. Future research should examine sexual health beyond resumption of sex after childbirth and explore barriers to help-seeking for women experiencing sexual health issues. Further exploration of positive sexual health is needed across contexts.
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McCauley M, White S, Bar-Zeev S, Godia P, Mittal P, Zafar S, van den Broek N. Physical morbidity and psychological and social comorbidities at five stages during pregnancy and after childbirth: a multicountry cross-sectional survey. BMJ Open 2022; 12:e050287. [PMID: 35470180 PMCID: PMC9039410 DOI: 10.1136/bmjopen-2021-050287] [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: 11/03/2022] Open
Abstract
OBJECTIVE Maternal morbidity affects millions of women, the burden of which is highest in low resource settings. We sought to explore when this ill-health occurs and is most significant. SETTINGS A descriptive observational cross-sectional study at primary and secondary-level healthcare facilities in India, Pakistan, Kenya and Malawi. PARTICIPANTS Women attending for routine antenatal care, childbirth or postnatal care at the study healthcare facilities. PRIMARY AND SECONDARY OUTCOMES Physical morbidity (infectious, medical, obstetrical), psychological and social comorbidity were assessed at five stages: first half of pregnancy (≤20 weeks), second half of pregnancy (>20 weeks), at birth (within 24 hours of childbirth), early postnatal (day 1-7) and late postnatal (week 2-12). RESULTS 11 454 women were assessed: India (2099), Malawi (2923), Kenya (3145) and Pakistan (3287) with similar numbers assessed at each of the five assessment stages in each country. Infectious morbidity and anaemia are highest in the early postnatal stage (26.1% and 53.6%, respectively). For HIV, malaria and syphilis combined, prevalence was highest in the first half of pregnancy (10.0%). Hypertension, pre-eclampsia and urinary incontinence are most common in the second half of pregnancy (4.6%, 2.1% and 6.6%). Psychological (depression, thoughts of self-harm) and social morbidity (domestic violence, substance misuse) are significant at each stage but most commonly reported in the second half of pregnancy (26.4%, 17.6%, 40.3% and 5.9% respectively). Of all women assessed, maternal morbidity was highest in the second half of pregnancy (81.7%), then the early postnatal stage (80.5%). Across the four countries, maternal morbidity was highest in the second half of pregnancy in Kenya (73.8%) and Malawi (73.8%), and in the early postnatal stage in Pakistan (92.2%) and India (87.5%). CONCLUSIONS Women have significant maternal morbidity across all stages of the continuum of pregnancy and childbirth, and especially in the second half of pregnancy and after childbirth.
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Affiliation(s)
- Mary McCauley
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Obstetrics, Liverpool Women's NHS Foundation Trust,Crown street, Liverpool, UK
| | - Sarah White
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sarah Bar-Zeev
- Department of Obstetrics, Centre for Maternal and Newborn Health, Lilongwe Office, Lilongwe, Malawi
| | - Pamela Godia
- Centre for Maternal and Newborn Health, Nairobi Office, Nairobi, Kenya
| | - Pratima Mittal
- Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Shamsa Zafar
- Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Semaan A, Dey T, Kikula A, Asefa A, Delvaux T, Langlois EV, van den Akker T, Benova L. "Separated during the first hours"-Postnatal care for women and newborns during the COVID-19 pandemic: A mixed-methods cross-sectional study from a global online survey of maternal and newborn healthcare providers. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000214. [PMID: 36962168 PMCID: PMC10022345 DOI: 10.1371/journal.pgph.0000214] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/23/2022] [Indexed: 01/22/2023]
Abstract
Routine postnatal care (PNC) allows monitoring, early detection and management of complications, and counselling to ensure immediate and long-term wellbeing of mothers and newborns; yet effective coverage is sub-optimal globally. The COVID-19 pandemic disrupted availability and quality of maternal and newborn care despite established guidelines promoting continuity of essential services. We conducted a cross-sectional global online survey of 424 maternal and newborn healthcare providers from 61 countries, to explore PNC provision, availability, content and quality following the early phase of the COVID-19 pandemic. The questionnaire (11 languages), included four multiple-choice and four open-text questions on changes to PNC during the pandemic. Quantitative and qualitative responses received between July and December 2020 were analysed separately and integrated during reporting. Tightened rules for visiting postpartum women were reported in health facilities, ranging from shorter visiting hours to banning supportive companions and visitors. A quarter (26%) of respondents reported that mothers suspected/confirmed with COVID-19 were routinely separated from their newborns. Early initiation of breastfeeding was delayed due to waiting for maternal SARS-CoV-2 test results. Reduced provision of breastfeeding support was reported by 40% of respondents in high-income countries and 7% in low-income countries. Almost 60% reported that women were discharged earlier than usual and 27% perceived a reduction in attendance to outpatient PNC. Telemedicine and home visits were mostly reported in high-income countries to ensure safe care provision. Beyond the early phase of the COVID-19 pandemic, severe disruptions to content and quality of PNC continued to exist, whereas disruptions in availability and use were less commonly reported. Depriving women of support, reducing availability of PNC services, and mother-newborn separation could lead to negative long-term outcomes for women, newborns and families, and deny their rights to respectful care. Protecting these essential services is imperative to promoting quality woman-centred PNC during and beyond the pandemic.
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Affiliation(s)
- Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Teesta Dey
- Department of Women's and Children's Health, University of Liverpool, Liverpool, United Kingdom
| | - Amani Kikula
- Muhimbili University of Health and Allied Sciences, Upanga-West, Dar es salaam, Tanzania
| | - Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), World Health Organization (WHO), Geneva, Switzerland
| | - Thomas van den Akker
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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McCauley M, Zafar S, van den Broek N. Maternal multimorbidity during pregnancy and after childbirth in women in low- and middle-income countries: a systematic literature review. BMC Pregnancy Childbirth 2020; 20:637. [PMID: 33081734 PMCID: PMC7574312 DOI: 10.1186/s12884-020-03303-1] [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: 02/23/2020] [Accepted: 09/30/2020] [Indexed: 01/21/2023] Open
Abstract
Background For every maternal death, 20 to 30 women are estimated to have morbidities related to pregnancy or childbirth. Much of this burden of disease is in women in low- and middle-income countries. Maternal multimorbidity can include physical, psychological and social ill-health. Limited data exist about the associations between these morbidities. In order to address all health needs that women may have when attending for maternity care, it is important to be able to identify all types of morbidities and understand how each morbidity influences other aspects of women’s health and wellbeing during pregnancy and after childbirth. Methods We systematically reviewed published literature in English, describing measurement of two or more types of maternal morbidity and/or associations between morbidities during pregnancy or after childbirth for women in low- and middle-income countries. CINAHL plus, Global Health, Medline and Web of Science databases were searched from 2007 to 2018. Outcomes were descriptions, occurrence of all maternal morbidities and associations between these morbidities. Narrative analysis was conducted. Results Included were 38 papers reporting about 36 studies (71,229 women; 60,911 during pregnancy and 10,318 after childbirth in 17 countries). Most studies (26/36) were cross-sectional surveys. Self-reported physical ill-health was documented in 26 studies, but no standardised data collection tools were used. In total, physical morbidities were included in 28 studies, psychological morbidities in 32 studies and social morbidities in 27 studies with three studies assessing associations between all three types of morbidity and 30 studies assessing associations between two types of morbidity. In four studies, clinical examination and/or basic laboratory investigations were also conducted. Associations between physical and psychological morbidities were reported in four studies and between psychological and social morbidities in six. Domestic violence increased risks of physical ill-health in two studies. Conclusions There is a lack of standardised, comprehensive and routine measurements and tools to assess the burden of maternal multimorbidity in women during pregnancy and after childbirth. Emerging data suggest significant associations between the different types of morbidity. Systematic review registration number PROSPERO CRD42018079526.
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Affiliation(s)
- Mary McCauley
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Shamsa Zafar
- Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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Creanga AA, Woo M, Seifu Estifanos A, Feleke H, Woldesenbet D, Kebede E, Oguntade H, Liu L, Gebremariam MY. Qualitative assessment of patient-provider communication and provider reporting on misclassification of stillbirths and early neonatal deaths in Ethiopia. MINERVA GINECOLOGICA 2020; 72:138-148. [PMID: 33000614 DOI: 10.23736/s0026-4784.20.04549-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Poor communication between patients and providers can lead to misunderstanding and misclassification of clinical information, including pregnancy outcomes by women. This qualitative study with maternity care providers explores patient-provider communications regarding stillbirths (SB) and early neonatal deaths (END) and potential SB-END misclassification in Ethiopia. METHODS Qualitative data were collected through 8 in-depth interviews and 3 focus group discussions with maternity care providers at Tikur Anbessa and Gandhi Memorial hospitals in Addis-Ababa. RESULTS Twenty-six maternity care providers (10 physicians;16 nurses/midwives) were interviewed. Providers noted that high patient loads negatively influence their provision of quality care to patients. Yet, despite patients generally not asking many questions during their delivery hospitalization, maternity care providers reported offering information about pregnancy outcomes at hospital discharge. The level of education was the most cited factor influencing patients' understanding of the information communicated to them, especially with regard to adverse pregnancy outcomes. Respondents reported that women do not have significant misconceptions about either SB or END. Nevertheless, they also revealed that both purposeful and accidental SB-END misclassification occurs. Reports of the direction of such misclassification differed by type of provider - physicians noted that misclassification of SB as END is most common, while nurses and midwives identified the opposite direction for this type of misclassification. CONCLUSIONS Maternity care providers' reporting practices and the quality of their communication with patients contribute to the SB-END misclassification in Ethiopia. There is need to increase providers' awareness of the importance of capturing and reporting reliable and valid information on pregnancy outcomes.
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Affiliation(s)
- Andreea A Creanga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA -
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA -
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA -
| | - Madeline Woo
- Department of Health Policy and Management, Tulane University, New Orleans, LA, USA
| | - Abiy Seifu Estifanos
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis-Ababa, Ethiopia
| | - Hanna Feleke
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis-Ababa, Ethiopia
| | - Dorka Woldesenbet
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis-Ababa, Ethiopia
| | - Eskinder Kebede
- Department of Obstetrics and Gynecology, School of Medicine, Addis Ababa University, Addis-Ababa, Ethiopia
| | - Habibat Oguntade
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Li Liu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mahlet Y Gebremariam
- Department of Obstetrics and Gynecology, School of Medicine, Addis Ababa University, Addis-Ababa, Ethiopia
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Ilo I, Ojukwu C, Okeke C, Okemuo A, Anekwu E, Ede S, Akinola T. Is mode of delivery a determinant of postpartum health-related quality of life in Nigerian Women? NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_119_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Aguiar M, Farley A, Hope L, Amin A, Shah P, Manaseki-Holland S. Birth-Related Perineal Trauma in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. Matern Child Health J 2019; 23:1048-1070. [PMID: 30915627 PMCID: PMC6606670 DOI: 10.1007/s10995-019-02732-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction Birth-related perineal trauma (BPT) is a common consequence of vaginal births. When poorly managed, BPT can result in increased morbidity and mortality due to infections, haemorrhage, and incontinence. This review aims to collect data on rates of BPT in low- and middle-income countries (LMICs), through a systematic review and meta-analysis. Methods The following databases were searched: Medline, Embase, Latin American and Caribbean Health Sciences Literature (LILACs), and the World Health Organization (WHO) regional databases, from 2004 to 2016. Cross-sectional data on the proportion of vaginal births that resulted in episiotomy, second degree tears or obstetric anal sphincter injuries (OASI) were extracted from studies carried out in LMICs by two independent reviewers. Estimates were meta-analysed using a random effects model; results were presented by type of BPT, parity, and mode of birth. Results Of the 1182 citations reviewed, 74 studies providing data on 334,054 births in 41 countries were included. Five studies reported outcomes of births in the community. In LMICs, the overall rates of BPT were 46% (95% CI 36–55%), 24% (95% CI 17–32%), and 1.4% (95% CI 1.2–1.7%) for episiotomies, second degree tears, and OASI, respectively. Studies were highly heterogeneous with respect to study design and population. The overall reporting quality was inadequate. Discussion Compared to high-income settings, episiotomy rates are high in LMIC medical facilities. There is an urgent need to improve reporting of BPT in LMICs particularly with regards to births taking in community settings.
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Affiliation(s)
- Magda Aguiar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lucy Hope
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Nursing and Midwifery, Institute of Health & Society, University of Worcester, Worcester, UK
| | - Adeela Amin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Pooja Shah
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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12
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Mokhtari F, Bahadoran P, Baghersad Z. Effectiveness of Postpartum Homecare Program as a New Method on Mothers' Knowledge about the Health of the Mother and the Infant. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:316-321. [PMID: 30034494 PMCID: PMC6034528 DOI: 10.4103/ijnmr.ijnmr_48_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: Reduced maternal mortality due to pregnancy and delivery is one of the priorities of reproductive health programs of World Health Organization. Benefiting from appropriate social support, such as receiving homecare, has an important role in mothers’ adaptation and health. Lack of access to comprehensive and desirable health services is the most important barrier to improvement of maternal health. In this study, the effect of postpartum homecare on mother's knowledge about maternal and child health is evaluated. Materials and Methods: This study was two-group field trial which was conducted in 2015 on 62 postpartum mothers who were selected randomly in Shahid Beheshti Hospital of Isfahan. Mothers and infants of the intervention (experimental) groups were first visited at the hospital and then received two visits at home. The control group received routine postpartum care. A researcher-designed questionnaire was used for data collection. Data analysis was conducted using SPSS18 and independent, paired t-test, and Chi-square tests. Results: Comparing the demographic characteristics between both groups revealed no significant difference. After the intervention mothers’ knowledge about maternal (t = 4.26; p < 0.001) and child (t = 3.19; p = 0.003) health showed a significant difference between the intervention (experimental) and control groups. Conclusions: Performance of postpartum homecare as a new and useful method in the health system of Iran can increase mothers’ knowledge about their own health and their children, enhance their ability to adapt with the postpartum period, and improve the health level of vulnerable populations.
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Affiliation(s)
- Fatemeh Mokhtari
- Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran
| | - Parvin Bahadoran
- Department of Reproductive Health, Nursing and Midwifery Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Baghersad
- Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran
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Hitimana R, Lindholm L, Krantz G, Nzayirambaho M, Condo J, Sengoma JPS, Pulkki-Brännström AM. Health-related quality of life determinants among Rwandan women after delivery: does antenatal care utilization matter? A cross-sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:12. [PMID: 29703248 PMCID: PMC5921437 DOI: 10.1186/s41043-018-0142-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 04/17/2018] [Indexed: 06/02/2023]
Abstract
BACKGROUND Despite the widespread use of antenatal care (ANC), its effectiveness in low-resource settings remains unclear. In this study, self-reported health-related quality of life (HRQoL) was used as an alternative to other maternal health measures previously used to measure the effectiveness of antenatal care. The main objective of this study was to determine whether adequate antenatal care utilization is positively associated with women's HRQoL. Furthermore, the associations between the HRQoL during the first year (1-13 months) after delivery and socio-economic and demographic factors were explored in Rwanda. METHODS In 2014, we performed a cross-sectional population-based survey involving 922 women who gave birth 1-13 months prior to the data collection. The study population was randomly selected from two provinces in Rwanda, and a structured questionnaire was used. HRQoL was measured using the EQ-5D-3L and a visual analogue scale (VAS). The average HRQoL scores were computed by demographic and socio-economic characteristics. The effect of adequate antenatal care utilization on HRQoL was tested by performing two multivariable linear regression models with the EQ-5D and EQ-VAS scores as the outcomes and ANC utilization and socio-economic and demographic variables as the predictors. RESULTS Adequate ANC utilization affected women's HRQoL when the outcome was measured using the EQ-VAS. Social support and living in a wealthy household were associated with a better HRQoL using both the EQ-VAS and EQ-5D. Cohabitating, and single/unmarried women exhibited significantly lower HRQoL scores than did married women in the EQ-VAS model, and women living in urban areas exhibited lower HRQoL scores than women living in rural areas in the ED-5D model. The effect of education on HRQoL was statistically significant using the EQ-VAS but was inconsistent across the educational categories. The women's age and the age of their last child were not associated with their HRQoL. CONCLUSIONS ANC attendance of at least four visits should be further promoted and used in low-income settings. Strategies to improve families' socio-economic conditions and promote social networks among women, particularly women at the reproductive age, are needed.
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Affiliation(s)
- Regis Hitimana
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Lindholm
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Gunilla Krantz
- Section of Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Manasse Nzayirambaho
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Jean Paul Semasaka Sengoma
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Anni-Maria Pulkki-Brännström
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Kaboré S, Méda CZ, Sombié I, Savadogo LB, Karama R, Bakouan K, Ouédraogo DS, Coulibaly N, Kargougou RL, Lankoandé E, Sawadogo RW, Gosch K. [Fight against maternal mortality in rural areas: decentralization of emergency obstetric cares in Burkina Faso]. Pan Afr Med J 2017; 27:236. [PMID: 28979638 PMCID: PMC5622841 DOI: 10.11604/pamj.2017.27.236.12952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 07/16/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Pour combler la pénurie en sages-femmes (SF) dans le district sanitaire de Tougan au Burkina Faso, il a été conçu une stratégie de décentralisation de l'offre des soins obstétricaux d'urgence basée sur des interventions ponctuelles de prise en charge des complications obstétricales au niveau des centres de santé (CS) en milieu rural par des SF. La présente étude a eu pour objectif de décrire cette expérience et d'analyser ses résultats. Méthodes Il s'agit d'une étude intervention de type transversal analytique basée sur une revue des données routinières de l'ensemble des parturientes prises en charge de 2013 à 2015. La collecte des données s'est déroulée du 5 au 20 janvier 2016. Un test Chi2, des rapports de cotes (OR) et leurs intervalles de confiance à 95% ont été calculés. Résultats Au total 416 parturientes présentant des complications obstétricales ont été prises en charge par les SF de zone. L'âge moyen des parturientes était de 26.4 ans. La distance médiane parcourue pour prendre en charge les parturientes était de quinze km pour un délai moyen d'intervention de 21.1 minutes (déviation standard = 7.13 minutes). Les dystocies représentaient la moitié (50.7%, IC95% = 45.8-55.6) des complications prises en charge suivies des hémorragies (26.4%, IC95% = 22.3%-31.0%). Plus de 77% des interventions avaient abouti à la résolution locale des complications obstétricales. Enfin, le résultat de l'intervention était fonction de la pathologie prise en charge (OR = 5.88; p < 0.001). Conclusion Cette stratégie a permis d'apporter une réplique à l'absence de SF dans les CS périphériques du district sanitaire de Tougan. Dans ce contexte particulier, cette intervention pourrait apporter une solution alternative au manque de ressources humaines en santé en milieu rural.
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Affiliation(s)
- Souleymane Kaboré
- Institut Supérieur des Sciences de la Santé, Université de Bobo-Dioulasso/Burkina Faso.,Direction Régionale de la Santé de la Boucle du Mouhoun/Burkina Faso
| | - Clément Ziemlé Méda
- Institut Supérieur des Sciences de la Santé, Université de Bobo-Dioulasso/Burkina Faso
| | - Issiaka Sombié
- Institut Supérieur des Sciences de la Santé, Université de Bobo-Dioulasso/Burkina Faso.,Organisation Ouest Africaine de la Santé
| | - Léon Blaise Savadogo
- Institut Supérieur des Sciences de la Santé, Université de Bobo-Dioulasso/Burkina Faso
| | - Robert Karama
- Direction Régionale de la Santé de la Boucle du Mouhoun/Burkina Faso
| | - Koabié Bakouan
- Direction Régionale de la Santé de la Boucle du Mouhoun/Burkina Faso
| | | | | | | | - Emanuel Lankoandé
- Direction Régionale de la Santé de la Boucle du Mouhoun/Burkina Faso
| | | | - Karen Gosch
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ)
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Kale PL, Mello-Jorge MHPD, Silva KSD, Fonseca SC. Neonatal near miss and mortality: factors associated with life-threatening conditions in newborns at six public maternity hospitals in Southeast Brazil. CAD SAUDE PUBLICA 2017; 33:e00179115. [PMID: 28538795 DOI: 10.1590/0102-311x00179115] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 06/16/2016] [Indexed: 11/21/2022] Open
Abstract
We aimed to evaluate factors associated with cases of neonatal near miss and neonatal deaths at six public maternity hospitals in São Paulo and Rio de Janeiro States, Brazil, in 2011. A prospective hospital-based birth cohort investigated these outcomes among live births with life-threatening conditions. Associations were tested using multinomial logistic regression models with hierarchical levels. High rates of near miss were observed for maternal syphilis (52.2‰ live births) and lack of prenatal care (80.8‰ live births). Maternal black skin color (OR = 1.9; 95%CI: 1.2-3.2), hemorrhage (OR = 2.2; 95%CI: 1.3-3.9), hypertension (OR = 3.0; 95%CI: 2.0-4.4), syphilis (OR = 3.3; 95%CI: 1.5-7.2), lack of prenatal care (OR = 5.6; 95%CI: 2.6-11.7), cesarean section and hospital, were associated with near miss; while hemorrhage (OR = 4.6; 95%CI: 1,8-11.3), lack of prenatal care (OR = 17.4; 95%CI: 6.5-46.8) and hospital, with death. Improvements in access to qualified care for pregnant women and newborns are necessary to reduce neonatal life-threatening conditions.
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Affiliation(s)
- Pauline Lorena Kale
- Instituto de Estudos de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Kátia Silveira da Silva
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Vyas N, Kamath R, Pattanshetty S, Binu VS. Postpartum related morbidities among women visiting government health facilities in Udupi Taluk, Karnataka, India. J Family Med Prim Care 2016; 5:320-325. [PMID: 27843835 PMCID: PMC5084555 DOI: 10.4103/2249-4863.192319] [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] [Indexed: 11/20/2022] Open
Abstract
Background: Maternal morbidities are considered a leading contributor to the burden of disease among women. Especially, if postpartum morbidities are left untreated, this can cause a negative impact on the quality of life. The study was conducted to determine the proportion and types of postpartum morbidities among women visiting government health facilities in Udupi Taluk, Karnataka and to find out the association between the morbidities and various factors. Subjects and Methods: A cross-sectional study was conducted in various government hospitals in Udupi Taluk, consisted of 229 postpartum women. These subjects were selected from mothers who accompanied their children for immunization from February 2013 to July 2013 using purposive sampling technique. Multiple logistic regression analysis was used to find out the association between the morbidities and various factors using SPSS version 15. Results: Among 112 (48.9%) women who experienced postpartum morbidities, back pain (23.6%), and perineal pain (15.7%) were most commonly reported physical morbidities. Similarly, anxiety (10%) and irritability (7.9%) were the most common psychological problems. Demographic factors such as religion 2.4 (95% confidence interval [CI] 1.1, 5.4) and occupation 2.5 (95% CI 1.1, 5.9) were associated with the morbidities. Likewise, obstetric factors such as place of delivery 1.5 (95% CI 0.8, 2.9) and type of delivery 1.9 (95% CI 1.0, 3.6) were also associated with various morbidities. Conclusions: The findings showed a high proportion of postpartum morbidities being reported in our study settings. These observation priorities a need of health program for early recognition, treatment and improving awareness of postpartum morbidities among near mothers.
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Affiliation(s)
- Navya Vyas
- Department of Public Health, Manipal University, Manipal, Karnataka, India
| | - Ramachandra Kamath
- Department of Public Health, Manipal University, Manipal, Karnataka, India
| | | | - V S Binu
- Department of Statistics, Manipal University, Manipal, Karnataka, India
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A glance into the hidden burden of maternal morbidity and patterns of management in a Palestinian governmental referral hospital. Women Birth 2015; 28:e148-56. [PMID: 26340885 DOI: 10.1016/j.wombi.2015.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/29/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known about the burden and patterns of maternal morbidity during childbirth, particularly in the Middle East Region. Investigating the patterns of maternal morbidity can be useful in guiding improvement in the quality of maternal services, and informing policy debates on women's health. OBJECTIVE To examine the incidence, types and patterns of management of severe and non-severe maternal morbidities of Palestinian women during pregnancy, labour, delivery and up to seven days postpartum in one Palestinian hospital. METHODS A prospective hospital-based study was conducted for a 3-month period in 2011-2012, reviewing hospital records for all pregnant women (1.583) admitted to the governmental hospital in Ramallah, Palestine. FINDINGS Of all pregnant women included in this analysis (1.558), 419 (26.9%) women experienced one or more maternal morbidities and 15 (0.96%) women survived a life-threatening complication (near miss). Of all women who suffered morbidities, 69 (16.5%) had vaginal deliveries, 61 (14.6%) had cesarean sections, 179 (42.7%) had abortions/miscarriage, and 110 (26.3%) experienced complications during pregnancy or the post-partum. Hemorrhage during pregnancy, birth or postpartum was the most common morbidity. Of those who gave birth, women who gave birth by cesarean sections were three times more likely to suffer from morbidities than those who had vaginal delivery. CONCLUSIONS The burden of maternal morbidity for Palestinian women between the ages of 16 and 48 is high. In Palestine, maternal morbidity can be prevented by promoting a rational use of cesarean section, avoiding unnecessary medicalization, reducing unwanted pregnancies and updating practices of providers related to abortion/miscarriage care.
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Assarag B, Dujardin B, Essolbi A, Cherkaoui I, De Brouwere V. Consequences of severe obstetric complications on women's health in Morocco: please, listen to me! Trop Med Int Health 2015; 20:1406-1414. [DOI: 10.1111/tmi.12586] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Bouchra Assarag
- Ministry of Health National School of Public Health Rabat Morocco
- Woman & Child Health Research Centre Department of Public Health Institute of Tropical Medicine Antwerp Belgium
- School of Public Health Université Libre de Bruxelles Brussels Belgium
| | - Bruno Dujardin
- School of Public Health Université Libre de Bruxelles Brussels Belgium
| | - Amina Essolbi
- Ministry of Health National School of Public Health Rabat Morocco
| | - Imad Cherkaoui
- Ministry of Health Directorate of Epidemiology and Disease Control Rabat Morocco
| | - Vincent De Brouwere
- Woman & Child Health Research Centre Department of Public Health Institute of Tropical Medicine Antwerp Belgium
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Elkhoudri N, Amor H, Baali A. Self-reported postpartum morbidity: prevalence and determinants among women in Marrakesh, Morocco. Reprod Health 2015; 12:75. [PMID: 26303890 PMCID: PMC4548450 DOI: 10.1186/s12978-015-0066-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 08/10/2015] [Indexed: 11/13/2022] Open
Abstract
Background Maternal mortality is a public health problem particularly in developing countries. This is mainly related to maternal morbidity, especially during the post-partum period (Haemorrhage, infections…). In Morocco, little is known about maternal morbidity within the population. The aim of this study is to determine the prevalence of self-reported postpartum morbidity and grasp its determinants. Methods This descriptive and analytic cross-sectional survey was carried out in six health centers drawn randomly in Marrakesh, Morocco. A total of 1,029 women of reproductive age (15–49) giving birth in the year preceding the survey were enrolled. Women were examined in these health centers during the study period. A questionnaire gathered information about socio-demographic, health and reported postpartum morbidity. Bivariate and multiple analyses were used to identify associated factors with the self-reported postpartum morbidity. Statistical significance was set at p < 0.05. Results The self-reported postpartum morbidity prevalence was 13.1 % while haemorrhage, pregnancy-induced hypertension and fever were the main complications: 71.92 %; 12.18 % and 10.64 % respectively. According to the multiple logistic regression model, the illiteracy among women and the number of pregnancies greater than 3 determine independently this morbidity (OR = 1.24; CI 95 %: 1.09–1.54; and OR = 1.69; CI 95 %:1.04–2.70 respectively). Conclusion Reducing female illiteracy and fertility will help the fight against postpartum maternal morbidity, which is critical to the wellbeing of women and their infants.
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Affiliation(s)
- Noureddine Elkhoudri
- Laboratory of Human Ecology, Faculty of Science Semlalia, Cadi Ayyad Marrakesh University, Avenue Prince Moulay Abdellah, BP 2390, Marrakech, Morocco.
| | - Hakima Amor
- Laboratory of Human Ecology, Faculty of Science Semlalia, Cadi Ayyad Marrakesh University, Avenue Prince Moulay Abdellah, BP 2390, Marrakech, Morocco.
| | - Abdellatif Baali
- Laboratory of Human Ecology, Faculty of Science Semlalia, Cadi Ayyad Marrakesh University, Avenue Prince Moulay Abdellah, BP 2390, Marrakech, Morocco.
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Cost-effectiveness of clinical decision support system in improving maternal health care in Ghana. PLoS One 2015; 10:e0125920. [PMID: 25974093 PMCID: PMC4431831 DOI: 10.1371/journal.pone.0125920] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/26/2015] [Indexed: 11/19/2022] Open
Abstract
Objective This paper investigated the cost-effectiveness of a computer-assisted Clinical Decision Support System (CDSS) in the identification of maternal complications in Ghana. Methods A cost-effectiveness analysis was performed in a before- and after-intervention study. Analysis was conducted from the provider’s perspective. The intervention area was the Kassena- Nankana district where computer-assisted CDSS was used by midwives in maternal care in six selected health centres. Six selected health centers in the Builsa district served as the non-intervention group, where the normal Ghana Health Service activities were being carried out. Results Computer-assisted CDSS increased the detection of pregnancy complications during antenatal care (ANC) in the intervention health centres (before-intervention= 9 /1,000 ANC attendance; after-intervention= 12/1,000 ANC attendance; P-value=0.010). In the intervention health centres, there was a decrease in the number of complications during labour by 1.1%, though the difference was not statistically significant (before-intervention =107/1,000 labour clients; after-intervention= 96/1,000 labour clients; P-value=0.305). Also, at the intervention health centres, the average cost per pregnancy complication detected during ANC (cost –effectiveness ratio) decreased from US$17,017.58 (before-intervention) to US$15,207.5 (after-intervention). Incremental cost –effectiveness ratio (ICER) was estimated at US$1,142. Considering only additional costs (cost of computer-assisted CDSS), cost per pregnancy complication detected was US$285. Conclusions Computer –assisted CDSS has the potential to identify complications during pregnancy and marginal reduction in labour complications. Implementing computer-assisted CDSS is more costly but more effective in the detection of pregnancy complications compared to routine maternal care, hence making the decision to implement CDSS very complex. Policy makers should however be guided by whether the additional benefit is worth the additional cost.
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Nkwabong E, Ilue EE, Bisong CE. Factors associated with poor attendance at the postpartum clinic six weeks after delivery in Cameroon. Int J Gynaecol Obstet 2015; 129:248-50. [DOI: 10.1016/j.ijgo.2014.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/02/2014] [Accepted: 02/03/2015] [Indexed: 11/16/2022]
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