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Tun KK, Inthaphatha S, Soe MM, Nishino K, Hamajima N, Yamamoto E. Causes of death, three delays, and factors associated with Delay 1 among maternal deaths in Myanmar: The maternal death surveillance in 2019. Midwifery 2023; 121:103657. [PMID: 36989878 DOI: 10.1016/j.midw.2023.103657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE The maternal mortality ratio (MMR) in Myanmar was the highest in Southeast Asia in 2017. The Three Delay Model is used to evaluate delays that contribute to maternal deaths. This study aims to identify MMR, causes of death, the three delays related to maternal deaths, and the factors associated with Delay 1, which is the time of delay in deciding to seek health care (from the start of the woman's illness to the time when the problem is recognized to be requiring care), in Myanmar. STUDY DESIGN A cross-sectional study. PARTICIPANT This study included 934 cases of maternal deaths reported from all states and regions throughout Myanmar in 2019 that were not caused by accidents and injuries. MATERIALS AND METHODS Socio-demographic factors, obstetrical factors, information about deaths, and assessment of delays were obtained from the Maternal Death Surveillance and Response System, the database of maternal deaths. Distribution of maternal deaths by states and regions, causes of maternal death, and types of delay that contributed to maternal deaths were descriptively summarized. Logistic regression analysis was performed to identify factors associated with Delay 1 among 567 maternal deaths without any missing data and unknown information on delays. FINDINGS In 2019, the MMR was 106 (95% confidence interval, 99-112) per 100,000 live births. Of the 934 maternal deaths, 80.5% of deaths had at least one delay, and Delay 1 was the major delay (72.9%). Eclampsia/pre-eclampsia (21.6%), postpartum hemorrhage (18.2%), and abortion-related complications (13.2%) were the major causes of maternal death. The husband's low education, low household income, unplanned pregnancy, and no antenatal care were associated with Delay 1. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE The MMR was lower in 2019 than that in 2017 but remained high. Moreover, we demonstrate that most maternal deaths had at least one delay, mostly Delay 1. To prevent maternal deaths caused by Delay 1, the family planning should be promoted to prevent unplanned pregnancies. Educational training for healthcare providers who deliver antenatal care should be strengthened. Furthermore, education on the danger signs of pregnancy and during childbirth should be provided not only to pregnant women and their husbands in communities at health facilities.
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Endris AA, Tilahun T. Health system readiness to manage maternal death data and avail evidence for decision-making through the Maternal Death Surveillance System in Ethiopia, 2020. BMC Health Serv Res 2023; 23:318. [PMID: 37004028 PMCID: PMC10064677 DOI: 10.1186/s12913-023-09321-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Maternal mortality remains a major health problem in Ethiopia. To generate contextual evidence on the burden and distribution of existing causes and contributing factors for programmatic and individual-level decision-making, the Maternal Death Surveillance and Response System was introduced in 2013. This assessment describes the Ethiopian health system's readiness to avail evidence for decision-making through the MDSR system. METHOD A cross-sectional study designed using the WHO framework for evaluating surveillance systems was used. By employing a multistage sampling, 631 health facilities and 539 health posts were included. ODK collect data entry software was used to collect data from September 2019 to April 2020. Findings are presented in text descriptions, graphs, maps, and tables. FINDINGS Four hundred (77.1%) health facilities (332 (74.6%) health centers and 68 (91.9%) hospitals) and 264 (71.5%) health posts reported implementing the MDSR system. Of the implementing health facilities, 349 (87.3%) had a death review committee, and only 42 (12.4%) were functional. About 89.4% of health centers and 79.4% of hospitals had sub-optimal maternal death identification and notification readiness. Only 23 (6.96%) and 18 (26.47%) MDSR-implementing health centers and hospitals had optimal readiness to investigate and review maternal deaths, respectively. Moreover, only 39 (14.0%) health posts had locally translated case definitions and 28 (10.6%) had verbal autopsy format to investigate maternal deaths. Six (1.5%) facility officers and 24 (9.1%) health extension workers were engaged in data analysis and evidence generation at least once during 2019/20. Regional variation is observed in system implementation. CONCLUSIONS AND RECOMMENDATIONS Sub-optimal MDSR system implementation is recorded. Revitalizing the system by addressing all system components is critical. Having a national-level roadmap for MDSR system implementation and mobilizing all available resources and stakeholders to facilitate this is vital. Establishing a system for routine data quality monitoring and assurance by integrating with the existing PHEM structure, having a system for routine capacity building, advocacy, and monitoring and evaluating the availability and functionality of MDSR committees at health facilities are all critical. Digitalization, designing a system to fit emerging regions' health service delivery, and availing required resources for the system is key.
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Affiliation(s)
- Abduilhafiz A Endris
- Ethiopian Public Health Institutes (EPHI), Public Health Emergency Management (PHEM) Center, Maternal Death Surveillance and Response (MDSR), Addis Ababa, Ethiopia.
| | - Tizita Tilahun
- College of Health Science, Family Health and Population Department, Bahirdar University, Bahirdar, Ethiopia
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Millimouno TM, Meessen B, Put WVD, Garcia M, Camara BS, Christou A, Delvaux T, Sidibé S, Beavogui AH, Delamou A. How has Guinea learnt from the response to outbreaks? A learning health system analysis. BMJ Glob Health 2023; 8:bmjgh-2022-010996. [PMID: 36854489 PMCID: PMC9980363 DOI: 10.1136/bmjgh-2022-010996] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/23/2023] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION Learning is a key attribute of a resilient health system and, therefore, is central to health system strengthening. The main objective of this study was to analyse how Guinea's health system has learnt from the response to outbreaks between 2014 and 2021. METHODS We used a retrospective longitudinal single embedded case study design, applying the framework conceptualised by Sheikh and Abimbola for analysing learning health systems. Data were collected employing a mixed methods systematic review carried out in March 2022 and an online survey conducted in April 2022. RESULTS The 70 reports included in the evidence synthesis were about the 2014-2016 Ebola virus disease (EVD), Measles, Lassa Fever, COVID-19, 2021 EVD and Marburg virus disease. The main lessons were from 2014 to 2016 EVD and included: early community engagement in the response, social mobilisation, prioritising investment in health personnel, early involvement of anthropologists, developing health infrastructure and equipment and ensuring crisis communication. They were learnt through information (research and experts' opinions), action/practice and double-loop and were progressively incorporated in the response to future outbreaks through deliberation, single-loop, double-loop and triple-loop learning. However, advanced learning aspects (learning through action, double-loop and triple-loop) were limited within the health system. Nevertheless, the health system successfully controlled COVID-19, the 2021 EVD and Marburg virus disease. Survey respondents' commonly reported that enablers were the creation of the national agency for health security and support from development partners. Barriers included cultural and political issues and lack of funding. Common recommendations included establishing a knowledge management unit within the Ministry of Health with representatives at regional and district levels, investing in human capacities and improving the governance and management system. CONCLUSION Our study highlights the importance of learning. The health system performed well and achieved encouraging and better outbreak response outcomes over time with learning that occurred.
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Affiliation(s)
- Tamba Mina Millimouno
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea .,Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Conakry, Guinea
| | - Bruno Meessen
- Health Systems Governance and Financing Department, World Health Organization, Geneva, Switzerland
| | - Willem Van De Put
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Marlon Garcia
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Bienvenu Salim Camara
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Aliki Christou
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Therese Delvaux
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Sidikiba Sidibé
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Conakry, Guinea
| | - Abdoul Habib Beavogui
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Alexandre Delamou
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Conakry, Guinea
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Witter S, Sheikh K, Schleiff M. Learning health systems in low-income and middle-income countries: exploring evidence and expert insights. BMJ Glob Health 2022; 7:bmjgh-2021-008115. [PMID: 36130793 PMCID: PMC9490579 DOI: 10.1136/bmjgh-2021-008115] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/16/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Learning health systems (LHS) is a multifaceted subject. This paper reviewed current concepts as well as real-world experiences of LHS, drawing on published and unpublished knowledge in order to identify and describe important principles and practices that characterise LHS in low/middle-income country (LMIC) settings. Methods We adopted an exploratory approach to the literature review, recognising there are limited studies that focus specifically on system-wide learning in LMICs, but a vast set of connected bodies of literature. 116 studies were included, drawn from an electronic literature search of published and grey literature. In addition, 17 interviews were conducted with health policy and research experts to gain experiential knowledge. Results The findings were structured by eight domains on learning enablers. All of these interact with one another and influence actors from community to international levels. We found that learning comes from the connection between information, deliberation, and action. Moreover, these processes occur at different levels. It is therefore important to consider experiential knowledge from multiple levels and experiences. Creating spaces and providing resources for communities, staff and managers to deliberate on their challenges and find solutions has political implications, however, and is challenging, particularly when resources are constrained, funding and accountability are fragmented and the focus is short-term and narrow. Nevertheless, we can learn from countries that have managed to develop institutional mechanisms and human capacities which help health systems respond to changing environments with ‘best fit’ solutions. Conclusion Health systems are knowledge producers, but learning is not automatic. It needs to be valued and facilitated. Everyday governance of health systems can create spaces for reflective practice and learning within routine processes at different levels. This article highlights important enablers, but there remains much work to be done on developing this field of knowledge.
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Affiliation(s)
- Sophie Witter
- Institute for Global Health and Development & ReBUILD Consortium, Queen Margaret University Edinburgh, Edinburgh, UK
| | - Kabir Sheikh
- Alliance For Health Policy and System Research, Geneva, Switzerland
| | - Meike Schleiff
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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Boyi Hounsou C, Agossou MCU, Bello K, Delvaux T, Benova L, Vigan Guézodjè A, Hounkpatin H, Dossou JP. "So hard not to feel blamed!": Assessment of implementation of Benin's Maternal and Perinatal Death Surveillance and Response strategy from 2016-2018. Int J Gynaecol Obstet 2021; 158 Suppl 2:6-14. [PMID: 34961924 DOI: 10.1002/ijgo.14041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess the implementation of the Maternal and Perinatal Death Surveillance and Response (MPDSR) strategy institutionalized in Benin in 2013 to address the alarmingly high maternal and neonatal death rates. METHODS A retrospective, mixed-methods study was performed. We used all maternal and neonatal death notifications and reviews from 2016 to 2018, reviewed the reports of 63 MPDSR working groups, and held two online group discussions. Descriptive quantitative analysis was performed, and content analysis was applied to qualitative data. RESULTS Deaths were under-notified, with estimated notification rates at 46%-48% for maternal and 16%-21% for neonatal deaths over the 3 years. Review completion rates were low, corresponding to 50%-56% of maternal and 8%-17% of neonatal deaths. Causes of undernotification included very low notification of community-based and private health facility deaths, and fear of blame. Low review completion rates were due to heavy workload, staffing shortages, fear of blame, and weak leadership. Moreover, reviews were of poor quality and the response was weak. CONCLUSION Maternal and Perinatal Death Surveillance and Response is operational in Benin. However, this assessment highlights the need to strengthen the notification strategy, continuously build MPDSR committee members' capacities, engage decision-makers for an effective response, and create a better blame-free, accountable, and learning culture.
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Affiliation(s)
- Christelle Boyi Hounsou
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Bénin.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Mahugnon C U Agossou
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Bénin
| | - Kéfilath Bello
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Bénin
| | | | - Lenka Benova
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Hashim Hounkpatin
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Bénin
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Bénin
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Keugoung B, Bello KOA, Millimouno TM, Sidibé S, Dossou JP, Delamou A, Legrand A, Massat P, Gutierrez NO, Meessen B. Mobilizing health district management teams through digital tools: Lessons from the District.Team initiative in Benin and Guinea using an action research methodology. Learn Health Syst 2021; 5:e10244. [PMID: 34667871 PMCID: PMC8512739 DOI: 10.1002/lrh2.10244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/07/2020] [Accepted: 08/04/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Improving capacities of health systems to quickly respond to emerging health issues, requires a health information system (HIS) that facilitates evidence-informed decision-making at the operational level. In many sub-Saharan African countries, HIS are mostly designed to feed decision-making purposes at the central level with limited feedback and capabilities to take action from data at the operational level. This article presents the case of an eHealth innovation designed to capacitate health district management teams (HDMTs) through participatory evidence production and peer-to-peer exchange. METHODS We used an action research design to develop the eHealth initiative called "District.Team," a web-based and facilitated platform targeting HDMTs that was tested in Benin and Guinea from January 2016 to September 2017. On District.Team, rounds of knowledge sharing processes were organized into cycles of five steps. Quantitative and qualitative data were collected to assess the participation of HDMTs and identify enablers and barriers of using District.Team. RESULTS Participation of HDMTs in District.Team varied between cycles and steps. In Benin, 79% to 94% of HDMTs filled in the online questionnaire per cycle compared to 61% to 100% in Guinea per cycle. In Benin, 26% to 41% of HDMTs shared a commentary on the results published on the platform while 21% to 47% participated in the online discussion forum. In Guinea, only 3% to 8% of HDMTs shared a commentary on the results published on the platform while 8% to 74% participated in the online discussion forum. Five groups of factors affected the participation: characteristics of the digital tools, the quality of the facilitation, profile of participants, shared content and data, and finally support from health authorities. CONCLUSION District.Team has shown that knowledge management platforms and processes valuing horizontal knowledge sharing among peers at the decentralized level of health systems are feasible in limited resource settings.
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Affiliation(s)
- Basile Keugoung
- Health Service Delivery Community of PracticeYaoundeCameroon
| | | | - Tamba Mina Millimouno
- Centre National de Formation et de Recherche en Santé Rurale de MaferinyahForécariahGuinea
| | - Sidikiba Sidibé
- Centre National de Formation et de Recherche en Santé Rurale de MaferinyahForécariahGuinea
| | - Jean Paul Dossou
- Centre de Recherche en Reproduction Humaine et en DémographieCotonouBenin
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de MaferinyahForécariahGuinea
| | | | | | | | - Bruno Meessen
- Collective HorizonLierBelgium
- Public Health DepartmentInstitute of Tropical MedicineAntwerpBelgium
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Said A, Sirili N, Massawe S, Pembe AB, Hanson C, Malqvist M. Mismatched ambition, execution and outcomes: implementing maternal death surveillance and response system in Mtwara region, Tanzania. BMJ Glob Health 2021; 6:bmjgh-2021-005040. [PMID: 34020994 PMCID: PMC8144036 DOI: 10.1136/bmjgh-2021-005040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/07/2022] Open
Abstract
Background Since 2015, Tanzania has been implementing the Maternal Death Surveillance and Response (MDSR) system. The system employs interactions of health providers and managers to identify, notify and review maternal deaths and recommend strategies for preventing further deaths. We aimed to analyse perceptions and experiences of health providers and managers in implementing the MDSR system. Methods An exploratory qualitative study was carried out with 30 purposively selected health providers and 30 health managers in four councils from the Mtwara region between June and July 2020. Key informant interviews and focus group discussions were used to collect data. Inductive thematic analysis was used to analyse data. Results Two main themes emerged from this study: ‘Accomplishing by ambitions’ and ‘A flawed system’. The themes suggest that health providers and managers have a strong desire to make the MDSR system work by making deliberate efforts to implement it. They reported working hard to timely notify, review death and implement action plans from meetings. Health providers and managers reported that MDSR has produced changes in care provision such as behavioural changes towards maternal care, increased accountability and policy changes. The system was however flawed by lack of training, organisational problems, poor coordination with other reporting and quality improvements systems, assigning blame and lack of motivation. Conclusion The implementation of the MDSR system in Tanzania faces systemic, contextual and individual challenges. However, our results indicate that health providers and managers are willing and committed to improve service delivery to avoid maternal deaths. Empowering health providers and managers by training and addressing the flaws will improve the system and quality of care.
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Affiliation(s)
- Ali Said
- Department of Women and Children's Health, Uppsala University, Uppsala, Sweden .,Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Nathanael Sirili
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Siriel Massawe
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Andrea B Pembe
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Mats Malqvist
- Department of Women and Children's Health, Uppsala University, Uppsala, Sweden
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Musarandega R, Machekano R, Munjanja SP, Pattinson R. Methods used to measure maternal mortality in Sub-Saharan Africa from 1980 to 2020: A systematic literature review. Int J Gynaecol Obstet 2021; 156:206-215. [PMID: 33811639 DOI: 10.1002/ijgo.13695] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Gobally, Sub-Saharan Africa (SSA) has the largest maternal mortality burden, but the region lacks accurate data. OBJECTIVE To review methods historically used to measure maternal mortality in SSA to inform future study methods. SEARCH STRATEGY We searched databases: PubMed, Medline, WorldCat and CINHAL, using keywords "maternal mortality," "pregnancy-related death," "reproductive age mortality," "ratio," "rate," and "risk," using Boolean operators "OR" and "AND" to combine the search terms. SELECTION CRITERIA We searched for empirical and analytical studies that: (1) measured maternal mortality levels, (2) were in SSA, (3) reported original results, and (4) were not duplicate studies. We included studies published in English since 1980. DATA COLLECTION AND ANALYSIS We screened the studies using titles and abstracts, reading the full text of selected studies. We analyzed the estimates and strengths, and limitations of the methods. MAIN RESULTS We identified 96 studies that used nine methods: demographic surveillance (n = 4), health record reviews (n = 18), confidential enquiries and maternal death surveillance and response (n = 7), prospective cohort (n = 9), reproductive age mortality survey (RAMOS) (n = 6), sisterhood method (n = 35), mixed methods (n = 4), and mathematical modeling (n = 13). CONCLUSION Sisterhood method studies and RAMOS studies that combined institutional records and community data produced maternal mortality ratios more comparable with WHO estimates.
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Affiliation(s)
- Reuben Musarandega
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Rhoderick Machekano
- Biostatistics and Epidemiology Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephen Peter Munjanja
- Obstetrics and Gynaecology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Robert Pattinson
- Maternal, Fetal, Newborn & Child Health Care Strategies Research Centre, University of Pretoria, Pretoria, South Africa
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Ahinkorah BO, Seidu AA, Agbaglo E, Adu C, Budu E, Hagan JE, Schack T, Yaya S. Determinants of antenatal care and skilled birth attendance services utilization among childbearing women in Guinea: evidence from the 2018 Guinea Demographic and Health Survey data. BMC Pregnancy Childbirth 2021; 21:2. [PMID: 33390164 PMCID: PMC7778812 DOI: 10.1186/s12884-020-03489-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, maternal health remains a major priority. Most of maternal deaths globally occur in sub-Saharan Africa, with most of these deaths linked to lack of access to antenatal care and skilled assistance during delivery. This study assessed the determinants of antenatal care and skilled birth attendance services utilization among childbearing women in Guinea. METHODS Data for this study were obtained from the 2018 Guinea Demographic and Health Survey (GDHS). Data of 4,917 childbearing women were considered as our analytical sample. The outcome variables for the study were utilization of antenatal care and skilled birth attendance. Analysis was carried out using chi-square tests and multivariable logistic regression. RESULTS The results showed that women aged 15-24 (AOR=1.29, CI=1.03-1.62), women who had secondary/higher level of education (AOR=1.70, CI=1.33-2.19), and those whose partners had secondary/higher level of education (AOR=1.46, CI=1.22-1.75), women in the richest wealth quintile (AOR=5.09, CI=3.70-7.00), those with planned pregnancies (AOR=1.50, CI=1.23-1.81), Muslim women (AOR=1.65, CI=1.38-2.12), those who take healthcare decisions alone (AOR=1.53, CI=1.24-1.89), and those who listened to radio less than once a week (AOR= 1.30, CI=1.10-1.53) had higher odds of antenatal care uptake. Also, women with secondary/higher level of education (AOR=1.83, CI=1.25-2.68), those whose partners had secondary/higher level of education (AOR=1.40, CI=1.11-1.76), those in the richest wealth quintile (AOR=10.79, CI=6.64-17.51), those with planned pregnancies (AOR=1.25, CI=1.03-1.52), Christian women (AOR=4.13, CI=3.17-5.39), those living in urban areas (AOR=3.00, CI=2.29-3.94), women with one birth (AOR= 1.58, CI=1.20-2.06), those who take healthcare decisions alone (AOR=1.87, CI=1.46-2.39), those who read newspaper at least once a week (AOR= 1.19, CI=1.01-1.40), those who watched television at least once week (AOR=1.69, CI=1.30-2.19), and those in female-headed households (AOR=1.52, CI=1.20-1.92) were more likely to utilize the services of skilled birth attendants. CONCLUSION The study proved that various socio-economic and contextual factors influence antenatal care and skilled birth attendance in Guinea. These findings suggest the need to design community-based interventions (e.g., miniature local ANC clinics, early screening services) that prioritize women's education and vocational training, media accessibility, especially among the poor, and those residing in rural settings. Such interventions should not ignore the influence of other socio-cultural norms that hinder the utilization of antenatal care and skilled birth attendance services in Guinea.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Collins Adu
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Thomas Schack
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, The University of Oxford, Oxford, United Kingdom
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Beigi M, Jahanian Sadatmahaleh S, Changizi N, Mohammadi E, Kazemi A. Analysis of the Iranian maternal mortality surveillance system and providing system improvement strategies: study protocol for strategy formulation. Reprod Health 2020; 17:111. [PMID: 32703296 PMCID: PMC7376841 DOI: 10.1186/s12978-020-00963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/13/2020] [Indexed: 11/18/2022] Open
Abstract
Background The implementation of the maternal mortality surveillance system in Iran has significantly reduced the incidence of maternal mortality. However, the pattern of the causes of the mortalities, which has remained constant over the years, are still concerning. This study aimed to explain the experiences of the actors of the Iranian maternal mortality surveillance and provide strategies for improving this system. Methods This research is a qualitative study to develop strategies, that will be conducted in two phases. In the first phase, purposive sampling will be performed, and the data will be collected based on the experiences of the Iranian maternal mortality surveillance system actors in Iran’s Ministry of Health and the selected universities (Shiraz, Isfahan, Tehran, Zahedan, Alborz, Shahrekord) through semi-structured interviews. Moreover, during this phase, some part of the data will be collected through random participation of the researcher in some maternal mortality committees of the selected universities. In order to carry out the second phase, a panel of experts will be set up to discuss the best strategies for improving the Iranian maternal mortality surveillance by considering the above results. Discussion The analysis of maternal mortality surveillance system needs to evaluate the experiences of the actors who are the policymakers of this system and can be effective in identifying its challenges. This analysis and formulation of the subsequent strategies can lead to maternal health indicators remaining within the range of international standards or even beyond those standards in Iranian universities and countries with similar surveillance system.
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Affiliation(s)
- Marjan Beigi
- Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | | | | | - Eesa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ashraf Kazemi
- Nursing and Midwifery Care Research Center, Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Aikpitanyi J, Ohenhen V, Ugbodaga P, Ojemhen B, Omo-Omorodion BI, Ntoimo LFC, Imongan W, Balogun JA, Okonofua FE. Maternal death review and surveillance: The case of Central Hospital, Benin City, Nigeria. PLoS One 2019; 14:e0226075. [PMID: 31856173 PMCID: PMC6922332 DOI: 10.1371/journal.pone.0226075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/18/2019] [Indexed: 12/03/2022] Open
Abstract
Background Despite the adoption of Maternal and Perinatal Death Surveillance and Response (MPDSR) by Nigeria’s Federal Ministry of Health to track and rectify the causes of maternal mortality, very limited documentation exists on experiences with the method and its outcomes at institutional and policy levels. Objective The objective of this study was to identify through the MPDSR process, the medical causes and contributory factors of maternal mortality, and to elucidate the policy response that took place after the dissemination of the results. Methods The study was conducted at the Central Hospital, Benin between October 1, 2017, and May 31, 2019. We first developed a strategic plan with the objective to reduce maternal mortality by 50% in the hospital in two years. An MPDSR committee was established and the members and all staff of the Maternity Department of the hospital were trained to use the nationally approved protocol. All consecutive cases of maternal deaths in the hospital were then reviewed using the MPDSR protocol. The results were submitted to the hospital Management and its supporting agencies for administrative action to correct the identified deficiencies. Results There were 18 maternal deaths in the hospital during the period, and 4,557 deliveries giving a maternal mortality ratio (MMR) of 395/100,000 deliveries. This amounted to a seven-fold reduction in MMR in the hospital at the onset of the project. The main medical causes identified were obstetric hemorrhage (n = 10), pulmonary embolism (n = 2), ruptured uterus (n = 2), eclampsia (n = 1), anemic heart failure (n = 1) and post-partum sepsis (n = 2). Several facility-based and patient contributory factors were identified such as lack of blood in the hospital and late reporting with severe obstetric complication among others. Response to the recommendations from the committee include increased commitment of hospital managers to immediately rectify the attributable causes of deaths, the establishment of a couples health education program, mobilization and sensitization of staff to handle pregnant women with great sensitivity, promptness and care, the refurbishing of an intensive care unit, and the increased availability of blood for transfusion through the intensification of blood donation drive in the hospital. Conclusion We conclude that the results of MPDSR, when acted upon by hospital managers and policymakers can lead to an improvement in quality of care and a consequent decline in maternal mortality ratio in referral hospitals.
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Affiliation(s)
- Josephine Aikpitanyi
- The Women’s Health and Action Research Centre (WHARC), Benin City, Nigeria
- The Centre of Excellence in Reproductive Health Innovation (CERHI), University of Benin, Benin City, Nigeria
| | - Victor Ohenhen
- The Centre of Excellence in Reproductive Health Innovation (CERHI), University of Benin, Benin City, Nigeria
- The Central Hospital, Benin City, Nigeria
| | | | - Best Ojemhen
- The Women’s Health and Action Research Centre (WHARC), Benin City, Nigeria
- The Centre of Excellence in Reproductive Health Innovation (CERHI), University of Benin, Benin City, Nigeria
| | | | - Lorretta FC Ntoimo
- The Women’s Health and Action Research Centre (WHARC), Benin City, Nigeria
- The Federal University, Oye-Ekiti, Nigeria
| | - Wilson Imongan
- The Women’s Health and Action Research Centre (WHARC), Benin City, Nigeria
| | - Joseph A. Balogun
- The University of Medical Sciences, Ondo City, Ondo State, Nigeria
- Chicago State University, Chicago, United States of America
| | - Friday E. Okonofua
- The Women’s Health and Action Research Centre (WHARC), Benin City, Nigeria
- The Centre of Excellence in Reproductive Health Innovation (CERHI), University of Benin, Benin City, Nigeria
- The University of Medical Sciences, Ondo City, Ondo State, Nigeria
- * E-mail:
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Meessen B, Akhnif ELH, Kiendrébéogo JA, Belghiti Alaoui A, Bello K, Bhattacharyya S, Faich Dini HS, Dkhimi F, Dossou JP, Gamble Kelley A, Keugoung B, Millimouno TM, Pfaffmann Zambruni J, Rouve M, Sieleunou I, van Heteren G. Learning for Universal Health Coverage. BMJ Glob Health 2019; 4:e002059. [PMID: 31908875 PMCID: PMC6936401 DOI: 10.1136/bmjgh-2019-002059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/15/2019] [Accepted: 11/17/2019] [Indexed: 12/04/2022] Open
Abstract
The journey to universal health coverage (UHC) is full of challenges, which to a great extent are specific to each country. 'Learning for UHC' is a central component of countries' health system strengthening agendas. Our group has been engaged for a decade in facilitating collective learning for UHC through a range of modalities at global, regional and national levels. We present some of our experience and draw lessons for countries and international actors interested in strengthening national systemic learning capacities for UHC. The main lesson is that with appropriate collective intelligence processes, digital tools and facilitation capacities, countries and international agencies can mobilise the many actors with knowledge relevant to the design, implementation and evaluation of UHC policies. However, really building learning health systems will take more time and commitment. Each country will have to invest substantively in developing its specific learning systemic capacities, with an active programme of work addressing supportive leadership, organisational culture and knowledge management processes.
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Affiliation(s)
| | | | - Joël Arthur Kiendrébéogo
- Department of Public Health, University Joseph Ki-Zerbo,Health Sciences Training and Research Unit, Ouagadougou, Burkina Faso
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Kefilath Bello
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Public Health, Centre de recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Sanghita Bhattacharyya
- Collective Horizon, New Delhi, India
- Community Health Community of Practice, New Delhi, India
| | | | | | - Jean-Paul Dossou
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Public Health, Centre de recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | | | | | - Tamba Mina Millimouno
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | | | - Maxime Rouve
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Isidore Sieleunou
- Médecine Sociale et Préventive, Université de Montréal, Ecole de Sante Publique, Montreal, Quebec, Canada
- Collective Horizon, Montreal, Québec, Canada
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Ayele B, Gebretnsae H, Hadgu T, Negash D, G/silassie F, Alemu T, Haregot E, Wubayehu T, Godefay H. Maternal and perinatal death surveillance and response in Ethiopia: Achievements, challenges and prospects. PLoS One 2019; 14:e0223540. [PMID: 31603937 PMCID: PMC6788713 DOI: 10.1371/journal.pone.0223540] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/22/2019] [Indexed: 11/18/2022] Open
Abstract
Background Maternal and Perinatal Death Surveillance and Response (MPDSR) was a pilot program introduced in Tigray, Ethiopia to monitor maternal and perinatal death. However; its implementation and operation is not evaluated yet. Therefore, this study aimed to assess the implementation and operational status and determinants of MPDSR using a programmatic data and stakeholders involved in the program. Methods Institutional based cross-sectional study was applied in public health facilities (75 health posts, 50 health centers and 16 hospitals) using both qualitative and quantitative methods. Data were entered in to Epi-info and then transferred to SPSS version 21 for analysis. All variables with a p-value of ≤ 0.25 in the bivariate analysis were included in to multivariable logistic regression model to identify the independent predictors. For the qualitative part, manual thematic content analysis was done following data familiarization (reading and re-reading of the transcripts). Results In this study, only 34 (45.3%) of health posts were practicing early identification and notification of maternal/perinatal death. Furthermore, only 36 (54.5%) and 35(53%) of health facilities were practiced good quality of death review and took proper action respectively following maternal/perinatal deaths. Availability of three to four number of Health Extension Workers (HEWs) (Adjusted Odds Ratio (AOR) = 6.09, 95%CI (Confidence Interval): 1.51–24.49), availability of timely Public Health Emergency Management (PHEM) reports (AOR = 4.39, 95%CI: 1.08–17.80) and participation of steering committee’s in death response (AOR = 9.19, 95%CI: 1.31–64.34) were the predictors of early identification and notification of maternal and perinatal death among health posts. Availability of trained nurse (AOR = 3.75, 95%CI: 1.08–12.99) and health facility’s head work experience (AOR = 3.70, 95%CI: 1.04–13.22) were also the predictors of quality of death review among health facilities. Furthermore; availability of at least one cluster review meeting (AOR = 4.87, 95%CI: 1.30–18.26) and uninterrupted pregnant mothers registration (AOR = 6.85, 95%CI: 1.22–38.54) were associated with proper response implementation to maternal and perinatal death. Qualitative findings highlighted that perinatal death report was so neglected. Community participation and intersectoral collaboration were among the facilitators for MPDSR implementation while limited human work force capacity and lack of maternity waiting homes were identified as some of the challenges for proper response implementation. Conclusion This study showed that the magnitude of: early death identification and notification, review and response implementation were low. Strengthening active surveillance with active community participation alongside with strengthening capacity building and recruitment of additional HEWs with special focus to improve the quality of health service could enhance the implementation of MPDSR in the region.
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Affiliation(s)
- Brhane Ayele
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
- * E-mail:
| | | | - Tsegay Hadgu
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | - Degnesh Negash
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | | | - Esayas Haregot
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | - Hagos Godefay
- Tigray Regional Health Bureau, Mekelle, Tigray, Ethiopia
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