1
|
Hulman A, Pakai A, Csákvári T, Keczeli V, Varga K. The Impact of Mode of Delivery and Postpartum Conditions on Breastfeeding: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:248. [PMID: 38255135 PMCID: PMC10814997 DOI: 10.3390/healthcare12020248] [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: 12/23/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Breast milk is the optimal and essential source of nutrients for babies. Many women, however, do not breastfeed or stop early after giving birth, often due to lack of support. For newborns delivered by caesarean section, there is often a delay, or no skin-to-skin contact after birth; thus, early breastfeeding is not achieved. Separation, complementary feeding or pacifier use also limits the mother's ability to breastfeed. A quantitative, cross-sectional study was conducted. Sociodemographic data, the mode of delivery and postpartum circumstances, information on breastfeeding, and the method and duration of feeding were collected (n = 2008). Two-thirds of children born by caesarean section did not have skin-to-skin contact after birth (p < 0.001). Lack of rooming-in placement increased the incidence of more frequent complementary feeding (p < 0.001) and shortened the duration of exclusive breastfeeding (p < 0.001). The duration of breastfeeding may also be negatively affected by scheduled feeding (p = 0.007) and pacifier utilization (p < 0.001). The mode of delivery and postpartum circumstances directly affecting the mother and the newborn can affect the feasibility of breastfeeding and the duration of exclusive and partial breastfeeding. For positive breastfeeding outcomes, skin-to-skin contact immediately after birth, rooming-in and unrestricted, demand breastfeeding, as well as the avoidance of the use of pacifiers, are recommended.
Collapse
Affiliation(s)
- Anita Hulman
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 4 Vörösmarty Str., H-7621 Pécs, Hungary
| | - Annamária Pakai
- Institute of Basics of Health Sciences, Midwifery and Health Visiting, Faculty of Health Sciences, University of Pécs, 4 Vörösmarty Str., H-7621 Pécs, Hungary
| | - Tímea Csákvári
- Department of Health Economics and Health Care Management, Institute of Health Insurance, Faculty of Health Sciences, University of Pécs, 33 Landorhegyi Str., H-8900 Zalaegerszeg, Hungary
| | - Viola Keczeli
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 4 Vörösmarty Str., H-7621 Pécs, Hungary
| | - Katalin Varga
- Department of Affective Psychology, Institute of Psychology, ELTE Eötvös Loránd University, 46 Izabella Str., H-1064 Budapest, Hungary
| |
Collapse
|
2
|
Nguyen TTT, Nishino K, Le LTH, Inthaphatha S, Yamamoto E. Strong Negative Association between Cesarean Delivery and Early Initiation of Breastfeeding Practices among Vietnamese Mothers-A Secondary Analysis of the Viet Nam Sustainable Development Goal Indicators on Children and Women Survey. Nutrients 2023; 15:4501. [PMID: 37960155 PMCID: PMC10647442 DOI: 10.3390/nu15214501] [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: 09/13/2023] [Revised: 10/22/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
Early initiation of breastfeeding (EIBF) involves feeding a newborn with the mother's breast milk within the first hour of delivery. The prevalence of EIBF in Vietnam has recently shown a downward trend. The present study aimed to demonstrate the current prevalence of EIBF practices and identify factors associated with EIBF among Vietnamese mothers with children under 24 months of age. This study was a secondary analysis of data from the Viet Nam Sustainable Development Goal Indicators on Children and Women (SDGCW) survey 2020-2021. The study participants included 1495 mothers extracted from the SDGCW dataset. Descriptive statistics and logistic regression analyses were performed. The prevalence of EIBF practice was 25.5% among all mothers, 31.9% among vaginal-delivery mothers groups, and 9.0% among cesarean-section mothers groups. Factors negatively associated with EIBF were younger age (0.18 times), cesarean delivery (0.25 times), and absence of skin-to-skin contact with newborns immediately after birth (0.43 times). The prevalence of EIBF among Vietnamese mothers was found to be substantially low, especially among those who underwent cesarean delivery. EIBF should be promoted among younger mothers and those who underwent cesarean delivery.
Collapse
Affiliation(s)
- Tam Thi Thanh Nguyen
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan; (T.T.T.N.)
- Department of Nutrition and Food Safety, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 250000, Vietnam
- Thai Nguyen General Hospital, Thai Nguyen 250000, Vietnam
| | - Kimihiro Nishino
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan; (T.T.T.N.)
| | | | - Souphalak Inthaphatha
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan; (T.T.T.N.)
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan; (T.T.T.N.)
| |
Collapse
|
3
|
Ball MK, Seabrook RB, Corbitt R, Stiver C, Nardell K, Medoro AK, Beer L, Brown A, Mollica J, Bapat R, Cosgrove T, Texter KT. Safety and Feasibility of Skin-to-Skin Contact in the Delivery Room for High-Risk Cardiac Neonates. Pediatr Cardiol 2023; 44:1023-1031. [PMID: 36971793 PMCID: PMC10040310 DOI: 10.1007/s00246-023-03149-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/12/2023] [Indexed: 03/28/2023]
Abstract
Early skin-to-skin contact (SSC), beginning in the delivery room, provides myriad health benefits for mother and baby. Early SSC in the delivery room is the standard of care for healthy neonates following both vaginal and cesarean delivery. However, there is little published evidence on the safety of this practice in infants with congenital anomalies requiring immediate postnatal evaluation, including critical congenital heart disease (CCHD). Currently, the standard practice following delivery of infants with CCHD in many delivery centers has been immediate separation of mother and baby for neonatal stabilization and transfer to a different hospital unit or a different hospital altogether. However, most neonates with prenatally diagnosed congenital heart disease, even those with ductal-dependent lesions, are clinically stable in the immediate newborn period. Therefore, we sought to increase the percentage of newborns with prenatally diagnosed CCHD who are born in our regional level II-III delivery hospitals who receive mother-baby SSC in the delivery room. Using quality improvement methodology, through a series of Plan-Do-Study-Act cycles we successfully increased mother-baby skin-to-skin contact in the delivery room for eligible cardiac patients born across our city-wide delivery hospitals from a baseline 15% to greater than 50%.
Collapse
Affiliation(s)
- Molly K Ball
- Division of Neonatology, The Ohio State University Wexner Medical Center, 700 Children's Drive - FOB Suite 6.4A, Columbus, OH, 43205, USA.
| | - R B Seabrook
- Division of Neonatology, The Ohio State University Wexner Medical Center, 700 Children's Drive - FOB Suite 6.4A, Columbus, OH, 43205, USA
- The Fetal Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - R Corbitt
- The Fetal Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - C Stiver
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - K Nardell
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - A K Medoro
- Division of Neonatology, The Ohio State University Wexner Medical Center, 700 Children's Drive - FOB Suite 6.4A, Columbus, OH, 43205, USA
| | - L Beer
- Pediatrix Medical Group, Columbus, OH, USA
| | - A Brown
- Phoenix Children's Medical Group, Neonatology, Phoenix, AZ, USA
| | - J Mollica
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - R Bapat
- Division of Neonatology, The Ohio State University Wexner Medical Center, 700 Children's Drive - FOB Suite 6.4A, Columbus, OH, 43205, USA
| | - T Cosgrove
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - K T Texter
- The Fetal Center at Nationwide Children's Hospital, Columbus, OH, USA
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| |
Collapse
|
4
|
Reinders S, Blas MM, Neuman M, Huicho L, Ronsmans C. Prevalence of essential newborn care in home and facility births in the Peruvian Amazon: analysis of census data from programme evaluation in three remote districts of the Loreto region. LANCET REGIONAL HEALTH. AMERICAS 2022; 18:100404. [PMID: 36844009 PMCID: PMC9950545 DOI: 10.1016/j.lana.2022.100404] [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: 05/09/2022] [Revised: 10/16/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
Background Essential newborn care (ENC) covers optimal breastfeeding, thermal care, and hygienic cord care. These practices are fundamental to save newborn lives. Despite neonatal mortality remaining high in some parts of Peru, no comprehensive data on ENC is available. We sought to estimate the prevalence of ENC and assess differences between facility and home births in the remote Peruvian Amazon. Methods We used baseline data from a household census of rural communities of three districts in Loreto region, collected as part of the evaluation of a maternal-neonatal health (MNH) programme. Women between 15 and 49 years with a live birth in the last 12 months were invited to complete a questionnaire about MNH-related care and ENC. Prevalence of ENC was calculated for all births and disaggregated by place of birth. Adjusted prevalence differences (PD) were post-estimated from logistic regression models on the effect of place of birth on ENC. Findings All 79 rural communities with a population of 14,474 were censused. Among 324 (>99%) women interviewed, 70% gave birth at home, most (93%) without skilled birth assistance. Among all births, prevalence was lowest for immediate skin-to-skin contact (24%), colostrum feeding (47%), and early breastfeeding (64%). ENC was consistently lower in home compared to facility births. After adjusting for confounders, largest PD were found for immediate skin-to-skin contact (50% [95% CI: 38-62]), colostrum feeding (26% [16-36]), and clean cord care (23% [14-32]). ENC prevalence in facilities ranged between 58 and 93%; delayed bathing was lower compared to home births (-19% [-31 to -7]). Interpretation Low prevalence of ENC practices among home births in a setting with high neonatal mortality and difficult access to quality care in facilities suggests potential for a community-based intervention to promote ENC practices at home, along with promotion of healthcare seeking and simultaneous strengthening of routine facility care. Funding Grand Challenges Canada and Peruvian National Council of Science, Technology, and Technology Innovation.
Collapse
Affiliation(s)
- Stefan Reinders
- Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú,Corresponding author. Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Magaly M. Blas
- Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Melissa Neuman
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK,MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Carine Ronsmans
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
5
|
Lundin R, Mariani I, Peven K, Day LT, Lazzerini M. Quality of routine health facility data used for newborn indicators in low- and middle-income countries: A systematic review. J Glob Health 2022. [PMCID: PMC9031513 DOI: 10.7189/jogh.12.04019] [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] [Indexed: 11/26/2022] Open
Abstract
Background High-quality data are fundamental for effective monitoring of newborn morbidity and mortality, particularly in high burden low- and middle-income countries (LMIC). Methods We conducted a systematic review on the quality of routine health facility data used for newborn indicators in LMIC, including measures employed. Five databases were searched from inception to February 2021 for relevant observational studies (excluding case-control studies, case series, and case reports) and baseline or control group data from interventional studies, with no language limits. An adapted version (19-point scale) of the Critical Appraisal Tool to assess the Quality of Cross-Sectional Studies (AXIS) was used to assess methodological quality, and results were synthesized using descriptive analysis. Results From the 19 572 records retrieved, 34 studies in 16 LMIC countries were included. Methodological quality was high (>14/19) in 32 studies and moderate (10-14/19) in two. Studies were mostly from African (n = 30, 88.2%) and South-East Asian (n = 24, 70.6%) World Health Organization (WHO) regions, with very few from Eastern Mediterranean (n = 2, 5.9%) and Western Pacific (n = 1, 2.9%) ones. We found that only data elements used to calculate neonatal indicators had been assessed, not the indicators themselves. 41 data elements were assessed, most frequently birth outcome. 20 measures of data quality were used, most along three dimensions: 1) completeness and timeliness, 2) internal consistency, and 3) external consistency. Data completeness was very heterogeneous across 26 studies, ranging from 0%-100% in routine facility registers, 0%-100% in patient case notes, and 20%-68% in aggregate reports. One study reported on the timeliness of aggregate reports. Internal consistency ranged from 0% to 96.2% in four studies. External consistency (21 studies) varied widely in measurement and findings, with specificity (6.4%-100%), sensitivity (23.6%-97.6%), and percent agreement (24.6%-99.4%) most frequently reported. Conclusions This systematic review highlights a gap in the published literature on the quality of routine LMIC health facility data for newborn indicators. Robust evidence is crucial in driving data quality initiatives at national and international levels. The findings of this review indicate that good quality data collection is achievable even in high-burden LMIC settings, but more efforts are needed to ensure uniformly high data quality for neonatal indicators.
Collapse
Affiliation(s)
- Rebecca Lundin
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” – WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” – WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
| | - Kimberly Peven
- London School of Hygiene & Tropical Medicine, London, UK
| | - Louise T Day
- London School of Hygiene & Tropical Medicine, London, UK
| | - Marzia Lazzerini
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” – WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
| |
Collapse
|
6
|
Philemon RN, Mmbaga BT, Bartlett J, Renju J, Mtuy TB, Mboya IB, Msuya SE. Adherence to Optimal Breastfeeding Practices Among HIV-Positive Mothers in Kilimanjaro, Tanzania. Patient Prefer Adherence 2022; 16:841-852. [PMID: 35387257 PMCID: PMC8977531 DOI: 10.2147/ppa.s343213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/04/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose We sought to assess how HIV-positive mothers enrolled in the PMTCT program adhere to breastfeeding recommendations concerning early initiation of breastfeeding (EIBF), ie, within one hour of birth, pre-lacteal feeds, exclusive breastfeeding until six months (EBF), and continued breastfeeding to one year of age. This study was designed to assess the practices in response to changing recommendations for breastfeeding in HIV, which have differed drastically over the years. Patients and Methods We recruited 524 mother-child pairs from 37 PMTCT clinics across Kilimanjaro, Tanzania. The 5 clinics with the highest patient load in each of the 7 districts of Kilimanjaro were chosen, plus the zonal and municipal referral hospitals. The children were below two years of age and currently in the PMTCT program. We administered a questionnaire to assess the mother's practices in feeding the child. We used multiple logistic regression models to determine factors associated with EIBF, EBF, and continued breastfeeding. Results EIBF was achieved for 73.1% of babies. Cesarean delivery, low birth weight, and partner disclosure of HIV status were significant risk factors for not achieving EIBF. About 19% of children did not breastfeed exclusively. Of the 247 children ≥12 months old, 43.3% had stopped breastfeeding before 12 months. Counseling on ARV, having had >2 pregnancies while HIV-positive and EBF were associated with breastfeeding until 12 months old. Using ART for more than two years decreased the odds of EBF and continued breastfeeding to 12 months of age. Conclusion Adherence to breastfeeding recommendations for HIV-positive women is suboptimal, particularly in aspects of recent changes in recommendations such as continuing breastfeeding for one year. There is a missed opportunity for interventions such as counseling, which has shown to favor adherence. Health education and counseling are needed for providers and mothers to keep them abreast with the frequently changing recommendations.
Collapse
Affiliation(s)
- Rune Nathaniel Philemon
- Department of Pediatrics and Child Health, Kilimanjaro Christian Medical University College (KCMUCo) & Kilimanjaro Christian Medical Centre (KCMC), Moshi, Kilimanjaro, Tanzania
| | - Blandina T Mmbaga
- Department of Pediatrics and Child Health, Kilimanjaro Christian Medical University College (KCMUCo) & Kilimanjaro Christian Medical Centre (KCMC), Moshi, Kilimanjaro, Tanzania
- Department of Research, Kilimanjaro Clinical Research Institute (KCRI), Moshi, Kilimanjaro, Tanzania
| | - John Bartlett
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jenny Renju
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Department of Population Studies, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Tara B Mtuy
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Faculty of Public Health and Policy and the Department of Global Health and Development, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Innocent B Mboya
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- School of Mathematics, Statistics & Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Sia E Msuya
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Department of Community Health, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Kilimanjaro, Tanzania
| |
Collapse
|
7
|
Mhajabin S, Hossain AT, Nusrat N, Jabeen S, Ameen S, Banik G, Tahsina T, Ahmed A, Sadeq-Ur Rahman Q, Gurley ES, Bari S, Chowdhury AI, Arifeen SE, Mehta R, Rahman AE. Indirect effects of the early phase of the COVID-19 pandemic on the coverage of essential maternal and newborn health services in a rural subdistrict in Bangladesh: results from a cross-sectional household survey. BMJ Open 2022; 12:e056951. [PMID: 35115357 PMCID: PMC8814430 DOI: 10.1136/bmjopen-2021-056951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE This paper presents the effect of the early phase of COVID-19 on the coverage of essential maternal and newborn health (MNH) services in a rural subdistrict of Bangladesh. DESIGN Cross-sectional household survey with random sampling. SETTING Baliakandi subdistrict, Rajbari district, Bangladesh. PARTICIPANTS Data were collected from women who were on the third trimester of pregnancy during the early phase of the pandemic (111) and pre-pandemic periods (115) to measure antenatal care (ANC) service coverage. To measure birth, postnatal care (PNC) and essential newborn care (ENC), data were collected from women who had a history of delivery during the early phase of the pandemic (163) and pre-pandemic periods (166). EXPOSURE Early phase of the pandemic included a strict national lockdown between April and June 2020, and pre-pandemic was defined as August-October 2019. OUTCOME OF INTEREST Changes in the coverage of selected MNH services (ANC, birth, PNC, ENC) during the early phase of COVID-19 pandemic compared with the pre-pandemic period, estimated by two-sample proportion tests. FINDINGS Among women who were on the third trimester of pregnancy during the early phase of the pandemic period, 77% (95% CI: 70% to 85%) received at least one ANC from a medically trained provider (MTP) during the third trimester, compared with 83% (95% CI: 76% to 90%) during the pre-pandemic period (p=0.33). Among women who gave birth during the early phase of the pandemic period, 72% (95% CI: 66% to 79%) were attended by an MTP, compared with 63% (95% CI: 56% to 71%) during the pre-pandemic period (p=0.08). Early initiation of breast feeding was practised among 38% (95% CI: 31% to 46%) of the babies born during the early phase of the pandemic period. It was 37% (95% CI: 29% to 44%) during the pre-pandemic period (p=0.81). The coverage of ANC, birth, PNC and ENC did not differ by months of pandemic and pre-pandemic periods; only the coverage of at least one ANC from an MTP significantly differed among the women who were 7 months pregnant during the early phase of the pandemic (35%, 95% CI: 26% to 44%) and pre-pandemic (49%, 95% CI: 39% to 58%) (p=0.04). CONCLUSION The effect of the early phase of the pandemic including lockdown on the selected MNH service coverage was null in the study area. The nature of the lockdown, the availability and accessibility of private sector health services in that area, and the combating strategies at the rural level made it possible for the women to avail the required MNH services.
Collapse
Affiliation(s)
- Shema Mhajabin
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Nowrin Nusrat
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Sabrina Jabeen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Shafiqul Ameen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Goutom Banik
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Tazeen Tahsina
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | | | - Sanwarul Bari
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Atique Iqbal Chowdhury
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Rajesh Mehta
- WHO Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
8
|
Peven K, Day LT, Bick D, Purssell E, Taylor C, Akuze J, Mallick L. Household Survey Measurement of Newborn Postnatal Care: Coverage, Quality Gaps, and Internal Inconsistencies in Responses. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:737-751. [PMID: 34933972 PMCID: PMC8691891 DOI: 10.9745/ghsp-d-21-00209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
Reliable measurement of postnatal content of care is currently lacking despite the critical importance of care in this vulnerable period. We found that there is a large quality-coverage gap with missed opportunities for quality care as well as internal inconsistencies in responses to newborn questions. Background: Reliable measurement of newborn postnatal care is essential to understand gaps in coverage and quality and thereby improve outcomes. This study examined gaps in coverage and measurement of newborn postnatal care in the first 2 days of life. Methods: We analyzed Demographic and Health Survey data from 15 countries for 71,366 births to measure the gap between postnatal contact coverage and content coverage within 2 days of birth. Coverage was a contact with the health system in the first 2 days (postnatal check or newborn care intervention), and quality was defined as reported receipt of 5 health worker-provided interventions. We examined internal consistency between interrelated questions regarding examination of the umbilical cord. Results: Reported coverage of postnatal check ranged from 13% in Ethiopia to 78% in Senegal. Report of specific newborn care interventions varied widely by intervention within and between countries. Quality-coverage gaps were high, ranging from 26% in Malawi to 89% in Burundi. We found some internally inconsistent reporting of newborn care. The percentage of women who reported that a health care provider checked their newborn's umbilical cord but responded “no” to the postnatal check question was as high as 16% in Malawi. Conclusion: Reliable measurement of coverage and content of early postnatal newborn care is essential to track progress in improving quality of care. Postnatal contact coverage is challenging to measure because it may be difficult for women to distinguish postnatal care from intrapartum care and it is a less recognizable concept than antenatal care. Co-coverage measures may provide a useful summary of contact and content, reflecting both coverage and an aspect of quality.
Collapse
Affiliation(s)
- Kimberly Peven
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom. .,Maternal and Newborn Health Group, Department of Infectious Disease Epidemiology and Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Louise Tina Day
- Maternal and Newborn Health Group, Department of Infectious Disease Epidemiology and Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | | | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Joseph Akuze
- Maternal and Newborn Health Group, Department of Infectious Disease Epidemiology and Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom.,Department of Health Policy, Planning and Management and Centre of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
| | - Lindsay Mallick
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA.,Avenir Health, Glastonbury, CT, USA
| |
Collapse
|
9
|
Gurung R, Sunny AK, Paudel P, Bhattarai P, Basnet O, Sharma S, Shrestha D, Sharma S, Malla H, Singh D, Mishra S, Kc A. Predictors for timely initiation of breastfeeding after birth in the hospitals of Nepal- a prospective observational study. Int Breastfeed J 2021; 16:85. [PMID: 34715883 PMCID: PMC8555201 DOI: 10.1186/s13006-021-00431-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/12/2021] [Indexed: 11/11/2022] Open
Abstract
Background Timely initiation of breastfeeding can reduce neonatal morbidities and mortality. We aimed to study predictors for timely initiation of breastfeeding (within 1 h of birth) among neonates born in hospitals of Nepal. Method A prospective observational study was conducted in four public hospitals between July and October 2018. All women admitted in the hospital for childbirth and who consented were included in the study. An independent researchers observed whether the neonates were placed in skin-to-skin contact, delay cord clamping and timely initiation of breastfeeding. Sociodemographic variables, obstetric and neonate information were extracted from the maternity register. We analysed predictors for timely initiation of breastfeeding with Pearson chi-square test and multivariate logistic regression. Results Among the 6488 woman-infant pair observed, breastfeeding was timely initiated in 49.5% neonates. The timely initiation of breastfeeding was found to be higher among neonates who were placed skin-to-skin contact (34.9% vs 19.9%, p - value < 0.001). The timely initiation of breastfeeding was higher if the cord clamping was delayed than early cord clamped neonates (44.5% vs 35.3%, p - value < 0.001). In multivariate analysis, a mother with no obstetric complication during admission had 57% higher odds of timely initiation of breastfeeding (aOR 1.57; 95% CI 1.33, 1.86). Multiparity was associated with less timely initiation of breastfeeding (aOR 1.56; 95% CI 1.35, 1.82). Similarly, there was more common practice of timely initiation of breastfeeding among low birthweight neonates (aOR 1.46; 95% CI 1.21, 1.76). Neonates who were placed skin-to-skin contact with mother had more than two-fold higher odds of timely breastfeeding (aOR 2.52; 95% CI 2.19, 2.89). Likewise, neonates who had their cord intact for 3 min had 37% higher odds of timely breastfeeding (aOR 1.37; 95% CI 1.21, 1.55). Conclusions The rate of timely initiation of breastfeeding practice is low in the health facilities of Nepal. Multiparity, no obstetric complication at admission, neonates placed in skin-to-skin contact and delay cord clamping were strong predictors for timely initiation of breastfeeding. Quality improvement intervention can improve skin-to-skin contact, delayed cord clamping and timely initiation of breastfeeding.
Collapse
Affiliation(s)
- Rejina Gurung
- Golden Community, Lalitpur, Nepal.,Department of Women's and Children's Health, Uppsala University, Dag Hammarskjöldsväg 14B, Uppsala, Sweden
| | | | - Prajwal Paudel
- Paropakar Maternity and Women's Hospital, Kathmandu, Nepal
| | | | | | | | | | | | | | - Dela Singh
- Pokhara Academy of Health Sciences, Pokhara, Nepal
| | | | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjöldsväg 14B, Uppsala, Sweden. .,Paropakar Maternity and Women's Hospital, Kathmandu, Nepal.
| |
Collapse
|
10
|
Mallick L, Wang W, Farid S, Pullum T. Initiation of Breastfeeding in Low- and Middle-Income Countries: A Time-to-Event Analysis. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:308-317. [PMID: 34019481 PMCID: PMC8324198 DOI: 10.9745/ghsp-d-20-00361] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 03/23/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Early breastfeeding has numerous benefits for both the mother and her baby. Previous research typically analyzes breastfeeding initiation in binary terms (within the first hour or day). Although delays are associated with cesarean delivery and skin-to-skin contact may facilitate early breastfeeding, a more nuanced understanding of these relationships is needed. METHODS With data from 31 countries that had a Demographic and Health Survey since 2015, we described breastfeeding initiation among babies most recently born in the last 2 years to women aged 15-49 years. In a subset of 21 countries, we conducted survival analysis with multivariable log-logistic accelerated failure time (AFT) regressions to examine factors associated with time to initiation of breastfeeding, specifically the mode of delivery and skin-to-skin contact, controlling for receipt of health care as well as socioeconomic and demographic characteristics of mothers and babies. FINDINGS Babies in most countries began breastfeeding within a few hours after birth. The mean time to initiation of breastfeeding ranged from 1.7 hours in Burundi to 32 hours in Pakistan and 40 hours in Chad. In most countries (24 of 31), the median time was 0.5 hours. Median time to initiation was greater for births by cesarean delivery compared with vaginal births at health facilities. After controlling for covariates, AFT models showed significant delays in breastfeeding among cesarean deliveries in most countries, with as much as a 9-fold delay in Senegal. Immediate skin-to-skin contact was significantly associated with a shorter time to initiation. CONCLUSION Efforts to promote early breastfeeding should encourage skin-to-skin and target cesarean deliveries.
Collapse
Affiliation(s)
- Lindsay Mallick
- University of Maryland School of Public Health, College Park, MD, USA. .,Avenir Health, Glastonbury, CT, USA
| | - Wenjuan Wang
- ICF, Rockville, MD, USA.,The Demographic and Health Surveys Program, Rockville, MD, USA
| | | | - Thomas Pullum
- ICF, Rockville, MD, USA.,The Demographic and Health Surveys Program, Rockville, MD, USA
| |
Collapse
|
11
|
Peven K, Mallick L, Taylor C, Bick D, Day LT, Kadzem L, Purssell E. Equity in newborn care, evidence from national surveys in low- and middle-income countries. Int J Equity Health 2021; 20:132. [PMID: 34090427 PMCID: PMC8178885 DOI: 10.1186/s12939-021-01452-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND High coverage of care is essential to improving newborn survival; however, gaps exist in access to timely and appropriate newborn care between and within countries. In high mortality burden settings, health inequities due to social and economic factors may also impact on newborn outcomes. This study aimed to examine equity in co-coverage of newborn care interventions in low- and low middle-income countries in sub-Saharan Africa and South Asia. METHODS We analysed secondary data from recent Demographic and Health Surveys in 16 countries. We created a co-coverage index of five newborn care interventions. We examined differences in coverage and co-coverage of newborn care interventions by country, place of birth, and wealth quintile. Using multilevel logistic regression, we examined the association between high co-coverage of newborn care (4 or 5 interventions) and social determinants of health. RESULTS Coverage and co-coverage of newborn care showed large between- and within-country gaps for home and facility births, with important inequities based on individual, family, contextual, and structural factors. Wealth-based inequities were smaller amongst facility births compared to non-facility births. CONCLUSION This analysis underlines the importance of facility birth for improved and more equitable newborn care. Shifting births to facilities, improving facility-based care, and community-based or pro-poor interventions are important to mitigate wealth-based inequities in newborn care, particularly in countries with large differences between the poorest and richest families and in countries with very low coverage of care.
Collapse
Affiliation(s)
- Kimberly Peven
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.
- Maternal and Newborn Health Group, London School of Hygiene & Tropical Medicine, London, UK.
| | - Lindsay Mallick
- University of Maryland, College Park, MD, USA
- Avenir Health, Glastonbury, CT, USA
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Louise T Day
- Maternal and Newborn Health Group, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Edward Purssell
- School of Health Sciences, City, University of London, London, UK
| |
Collapse
|
12
|
Shamba D, Day LT, Zaman SB, Sunny AK, Tarimo MN, Peven K, Khan J, Thakur N, Talha MTUS, K C A, Haider R, Ruysen H, Mazumder T, Rahman MH, Shaikh MZH, Sæbø JI, Hanson C, Singh NS, Schellenberg J, Vaz LME, Requejo J, Lawn JE. Barriers and enablers to routine register data collection for newborns and mothers: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:233. [PMID: 33765963 PMCID: PMC7995573 DOI: 10.1186/s12884-020-03517-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Policymakers need regular high-quality coverage data on care around the time of birth to accelerate progress for ending preventable maternal and newborn deaths and stillbirths. With increasing facility births, routine Health Management Information System (HMIS) data have potential to track coverage. Identifying barriers and enablers faced by frontline health workers recording HMIS source data in registers is important to improve data for use. METHODS The EN-BIRTH study was a mixed-methods observational study in five hospitals in Bangladesh, Nepal and Tanzania to assess measurement validity for selected Every Newborn coverage indicators. We described data elements required in labour ward registers to track these indicators. To evaluate barriers and enablers for correct recording of data in registers, we designed three interview tools: a) semi-structured in-depth interview (IDI) guide b) semi-structured focus group discussion (FGD) guide, and c) checklist assessing care-to-documentation. We interviewed two groups of respondents (January 2018-March 2019): hospital nurse-midwives and doctors who fill ward registers after birth (n = 40 IDI and n = 5 FGD); and data collectors (n = 65). Qualitative data were analysed thematically by categorising pre-identified codes. Common emerging themes of barriers or enablers across all five hospitals were identified relating to three conceptual framework categories. RESULTS Similar themes emerged as both barriers and enablers. First, register design was recognised as crucial, yet perceived as complex, and not always standardised for necessary data elements. Second, register filling was performed by over-stretched nurse-midwives with variable training, limited supervision, and availability of logistical resources. Documentation complexity across parallel documents was time-consuming and delayed because of low staff numbers. Complete data were valued more than correct data. Third, use of register data included clinical handover and monthly reporting, but little feedback was given from data users. CONCLUSION Health workers invest major time recording register data for maternal and newborn core health indicators. Improving data quality requires standardised register designs streamlined to capture only necessary data elements. Consistent implementation processes are also needed. Two-way feedback between HMIS levels is critical to improve performance and accurately track progress towards agreed health goals.
Collapse
Affiliation(s)
- Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK.
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Menna Narcis Tarimo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Kimberly Peven
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Jasmin Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Md Taqbir Us Samad Talha
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashish K C
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Rajib Haider
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - Tapas Mazumder
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Hafizur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Ziaul Haque Shaikh
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Claudia Hanson
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
- Global Public Health Karolinska Institutet, Stockholm, Sweden
| | - Neha S Singh
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - Joanna Schellenberg
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - Lara M E Vaz
- International Programs, Population Reference Bureau, Washington DC, USA
| | | | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| |
Collapse
|
13
|
Ameen S, Siddique AB, Peven K, Rahman QSU, Day LT, Shabani J, Kc A, Boggs D, Shamba D, Tahsina T, Rahman AE, Zaman SB, Hossain AT, Ahmed A, Basnet O, Malla H, Ruysen H, Blencowe H, Arnold F, Requejo J, Arifeen SE, Lawn JE. Survey of women's report for 33 maternal and newborn indicators: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:238. [PMID: 33765956 PMCID: PMC7995710 DOI: 10.1186/s12884-020-03425-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Population-based household surveys, notably the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), remain the main source of maternal and newborn health data for many low- and middle-income countries. As part of the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study, this paper focuses on testing validity of measurement of maternal and newborn indicators around the time of birth (intrapartum and postnatal) in survey-report. METHODS EN-BIRTH was an observational study testing the validity of measurement for selected maternal and newborn indicators in five secondary/tertiary hospitals in Bangladesh, Nepal and Tanzania, conducted from July 2017 to July 2018. We compared women's report at exit survey with the gold standard of direct observation or verification from clinical records for women with vaginal births. Population-level validity was assessed by validity ratios (survey-reported coverage: observer-assessed coverage). Individual-level accuracy was assessed by sensitivity, specificity and percent agreement. We tested indicators already in DHS/MICS as well as indicators with potential to be included in population-based surveys, notably the first validation for small and sick newborn care indicators. RESULTS 33 maternal and newborn indicators were evaluated. Amongst nine indicators already present in DHS/MICS, validity ratios for baby dried or wiped, birthweight measured, low birthweight, and sex of baby (female) were between 0.90-1.10. Instrumental birth, skin-to-skin contact, and early initiation of breastfeeding were highly overestimated by survey-report (2.04-4.83) while umbilical cord care indicators were massively underestimated (0.14-0.22). Amongst 24 indicators not currently in DHS/MICS, two newborn contact indicators (kangaroo mother care 1.00, admission to neonatal unit 1.01) had high survey-reported coverage amongst admitted newborns and high sensitivity. The remaining indicators did not perform well and some had very high "don't know" responses. CONCLUSIONS Our study revealed low validity for collecting many maternal and newborn indicators through an exit survey instrument, even with short recall periods among women with vaginal births. Household surveys are already at risk of overload, and some specific clinical care indicators do not perform well and may be under-powered. Given that approximately 80% of births worldwide occur in facilities, routine registers should also be explored to track coverage of key maternal and newborn health interventions, particularly for clinical care.
Collapse
Affiliation(s)
- Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
| | - Abu Bakkar Siddique
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Kimberly Peven
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Ashish Kc
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Dorothy Boggs
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Omkar Basnet
- Research Division, Golden Community, Lalitpur, Nepal
| | - Honey Malla
- Research Division, Golden Community, Lalitpur, Nepal
| | - Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Fred Arnold
- Demographic and Health Survey Program, ICF, Rockville, MD, USA
| | - Jennifer Requejo
- Division of Data, Analysis, Planning and Monitoring, United Nations Children's Fund, Headquarters, New York, New York, USA
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
14
|
Gurung R, Ruysen H, Sunny AK, Day LT, Penn-Kekana L, Målqvist M, Ghimire B, Singh D, Basnet O, Sharma S, Shaver T, Moran AC, Lawn JE, Kc A. Respectful maternal and newborn care: measurement in one EN-BIRTH study hospital in Nepal. BMC Pregnancy Childbirth 2021; 21:228. [PMID: 33765971 PMCID: PMC7995692 DOI: 10.1186/s12884-020-03516-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respectful maternal and newborn care (RMNC) is an important component of high-quality care but progress is impeded by critical measurement gaps for women and newborns. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study was an observational study with mixed methods assessing measurement validity for coverage and quality of maternal and newborn indicators. This paper reports results regarding the measurement of respectful care for women and newborns. METHODS At one EN-BIRTH study site in Pokhara, Nepal, we included additional questions during exit-survey interviews with women about their experiences (July 2017-July 2018). The questionnaire was based on seven mistreatment typologies: Physical; Sexual; or Verbal abuse; Stigma/discrimination; Failure to meet professional standards of care; Poor rapport between women and providers; and Health care denied due to inability to pay. We calculated associations between these typologies and potential determinants of health - ethnicity, age, sex, mode of birth - as possible predictors for reporting poor care. RESULTS Among 4296 women interviewed, none reported physical, sexual, or verbal abuse. 15.7% of women were dissatisfied with privacy, and 13.0% of women reported their birth experience did not meet their religious and cultural needs. In descriptive analysis, adjusted odds ratios and multivariate analysis showed primiparous women were less likely to report respectful care (β = 0.23, p-value < 0.0001). Women from Madeshi (a disadvantaged ethnic group) were more likely to report poor care (β = - 0.34; p-value 0.037) than women identifying as Chettri/Brahmin. Women who had caesarean section were less likely to report poor care during childbirth (β = - 0.42; p-value < 0.0001) than women with a vaginal birth. However, babies born by caesarean had a 98% decrease in the odds (aOR = 0.02, 95% CI, 0.01-0.05) of receiving skin-to-skin contact than those with vaginal births. CONCLUSIONS Measurement of respectful care at exit interview after hospital birth is challenging, and women generally reported 100% respectful care for themselves and their baby. Specific questions, with stratification by mode of birth, women's age and ethnicity, are important to identify those mistreated during care and to prioritise action. More research is needed to develop evidence-based measures to track experience of care, including zero separation for the mother-newborn pair, and to improve monitoring.
Collapse
Affiliation(s)
- Rejina Gurung
- Research Division, Golden Community, Lalitpur, Nepal
| | - Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | | | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Loveday Penn-Kekana
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Mats Målqvist
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, Sweden
| | | | - Dela Singh
- Ministry of Health and Population, Kathmandu, Nepal
| | - Omkar Basnet
- Research Division, Golden Community, Lalitpur, Nepal
| | | | | | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, Sweden.
| |
Collapse
|
15
|
Zaman SB, Siddique AB, Ruysen H, Kc A, Peven K, Ameen S, Thakur N, Rahman QSU, Salim N, Gurung R, Tahsina T, Rahman AE, Coffey PS, Rawlins B, Day LT, Lawn JE, Arifeen SE. Chlorhexidine for facility-based umbilical cord care: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:239. [PMID: 33765947 PMCID: PMC7995704 DOI: 10.1186/s12884-020-03338-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Umbilical cord hygiene prevents sepsis, a leading cause of neonatal mortality. The World Health Organization recommends 7.1% chlorhexidine digluconate (CHX) application to the umbilicus after home birth in high mortality contexts. In Bangladesh and Nepal, national policies recommend CHX use for all facility births. Population-based household surveys include optional questions on CHX use, but indicator validation studies are lacking. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) was an observational study assessing measurement validity for maternal and newborn indicators. This paper reports results regarding CHX. METHODS The EN-BIRTH study (July 2017-July 2018) included three public hospitals in Bangladesh and Nepal where CHX cord application is routine. Clinical-observers collected tablet-based, time-stamped data regarding cord care during admission to labour and delivery wards as the gold standard to assess accuracy of women's report at exit survey, and of routine-register data. We calculated validity ratios and individual-level validation metrics; analysed coverage, quality and measurement gaps. We conducted qualitative interviews to assess barriers and enablers to routine register-recording. RESULTS Umbilical cord care was observed for 12,379 live births. Observer-assessed CHX coverage was very high at 89.3-99.4% in all 3 hospitals, although slightly lower after caesarean births in Azimpur (86.8%), Bangladesh. Exit survey-reported coverage (0.4-45.9%) underestimated the observed coverage with substantial "don't know" responses (55.5-79.4%). Survey-reported validity ratios were all poor (0.01 to 0.38). Register-recorded coverage in the specific column in Bangladesh was underestimated by 0.2% in Kushtia but overestimated by 9.0% in Azimpur. Register-recorded validity ratios were good (0.9 to 1.1) in Bangladesh, and poor (0.8) in Nepal. The non-specific register column in Pokhara, Nepal substantially underestimated coverage (20.7%). CONCLUSIONS Exit survey-report highly underestimated observed CHX coverage in all three hospitals. Routine register-recorded coverage was closer to observer-assessed coverage than survey reports in all hospitals, including for caesarean births, and was more accurately captured in hospitals with a specific register column. Inclusion of CHX cord care into registers, and tallied into health management information system platforms, is justified in countries with national policies for facility-based use, but requires implementation research to assess register design and data flow within health information systems.
Collapse
Affiliation(s)
- Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
| | - Abu Bakkar Siddique
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Harriet Ruysen
- The Maternal, Adolescent, Reproductive, & Child, Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Kimberly Peven
- The Maternal, Adolescent, Reproductive, & Child, Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | | | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Rejina Gurung
- Research Division, Golden Community, Lalitpur, Nepal
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | | | - Barbara Rawlins
- Maternal and Child Survival Program, jhpiego, Baltimore, MD, USA
| | - Louise T Day
- The Maternal, Adolescent, Reproductive, & Child, Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Joy E Lawn
- The Maternal, Adolescent, Reproductive, & Child, Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| |
Collapse
|
16
|
Ruysen H, Rahman AE, Gordeev VS, Hossain T, Basnet O, Shirima K, Rahman QSU, Zaman SB, Rana N, Salim N, Tahsina T, Gore-Langton GR, Ameen S, Boggs D, Kong S, Day LT, El Arifeen S, Lawn JE. Electronic data collection for multi-country, hospital-based, clinical observation of maternal and newborn care: EN-BIRTH study experiences. BMC Pregnancy Childbirth 2021; 21:234. [PMID: 33765951 PMCID: PMC7995708 DOI: 10.1186/s12884-020-03426-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Observation of care at birth is challenging with multiple, rapid and potentially concurrent events occurring for mother, newborn and placenta. Design of electronic data (E-data) collection needs to account for these challenges. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) was an observational study to assess measurement of indicators for priority maternal and newborn interventions and took place in five hospitals in Bangladesh, Nepal and Tanzania (July 2017-July 2018). E-data tools were required to capture individually-linked, timed observation of care, data extraction from hospital register-records or case-notes, and exit-survey data from women. METHODS To evaluate this process for EN-BIRTH, we employed a framework organised around five steps for E-data design, data collection and implementation. Using this framework, a mixed methods evaluation synthesised evidence from study documentation, standard operating procedures, stakeholder meetings and design workshops. We undertook focus group discussions with EN-BIRTH researchers to explore experiences from the three different country teams (November-December 2019). Results were organised according to the five a priori steps. RESULTS In accordance with the five-step framework, we found: 1) Selection of data collection approach and software: user-centred design principles were applied to meet the challenges for observation of rapid, concurrent events around the time of birth with time-stamping. 2) Design of data collection tools and programming: required extensive pilot testing of tools to be user-focused and to include in-built error messages and data quality alerts. 3) Recruitment and training of data collectors: standardised with an interactive training package including pre/post-course assessment. 4) Data collection, quality assurance, and management: real-time quality assessments with a tracking dashboard and double observation/data extraction for a 5% case subset, were incorporated as part of quality assurance. Internet-based synchronisation during data collection posed intermittent challenges. 5) Data management, cleaning and analysis: E-data collection was perceived to improve data quality and reduce time cleaning. CONCLUSIONS The E-Data system, custom-built for EN-BIRTH, was valued by the site teams, particularly for time-stamped clinical observation of complex multiple simultaneous events at birth, without which the study objectives could not have been met. However before selection of a custom-built E-data tool, the development time, higher training and IT support needs, and connectivity challenges need to be considered against the proposed study or programme's purpose, and currently available E-data tool options.
Collapse
Affiliation(s)
- Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Vladimir Sergeevich Gordeev
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Omkar Basnet
- Research Division, Golden Community, Lalitpur, Nepal
| | - Kizito Shirima
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nisha Rana
- Research Division, Golden Community, Lalitpur, Nepal
| | - Nahya Salim
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Georgia R Gore-Langton
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dorothy Boggs
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Stefanie Kong
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Louise T Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
17
|
Moran AC, Requejo J. Count every newborn: EN-BIRTH study improving facility-based coverage and quality measurement in routine information systems. BMC Pregnancy Childbirth 2021; 21:227. [PMID: 33765953 PMCID: PMC7995686 DOI: 10.1186/s12884-020-03427-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Jennifer Requejo
- Division of Data, Analysis, Planning and Monitoring, United Nations Children's Fund, Headquarters, New York, NY, USA.
| |
Collapse
|