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Pepper M, Campbell OMR, Woodd SL. Current Approaches to Following Up Women and Newborns After Discharge From Childbirth Facilities: A Scoping Review. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300377. [PMID: 38599685 PMCID: PMC11057794 DOI: 10.9745/ghsp-d-23-00377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/12/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION The postpartum period is critical for the health and well-being of women and newborns, but there is limited research on the most effective methods of post-childbirth follow-up. This scoping review synthesizes evidence from high-, middle-, and low-income countries on approaches to following up individuals after discharge from childbirth facilities. METHODS Using a systematic search in Ovid MEDLINE, we identified quantitative studies describing post-discharge follow-up methods deployed up to 12 months postpartum. We searched for English-language, peer-reviewed articles published between January 1, 2007 and November 2, 2022, with search terms covering 2 broad areas: "postpartum/postnatal period" and "surveillance." We single-screened titles and abstracts and double-extracted all included articles, recording study design and location, population, health outcome, method, timing and frequency of data collection, and percentage of study participants reached. RESULTS We identified 1,654 records, of which 31 studies were included. Eight studies used in-person visits to follow up participants, 10 used telephone calls, 7 used self-administered questionnaires, and 6 used multiple methods. Across studies, the minimum length of follow-up was 1 week after delivery, and up to 4 contacts were made within the first year after delivery. Follow-up (response) rates ranged from 23% to100%. Postpartum infection was the most common outcome investigated. Other outcomes included maternal (ill-)health, neonatal (ill-)health and growth, maternal mental health and well-being, care-giving/-seeking behaviors, and knowledge and intentions. CONCLUSION Our scoping review identified multiple follow-up methods after discharge, ranging from home visits to self-administered electronic questionnaires, which could be implemented with high response rates. The studies demonstrated that post-discharge follow-up of women and newborns was feasible, well received, and important for identifying postpartum illness or complications that would otherwise be missed. Therefore, the identified methods have the potential to become an important component of fostering a continuum of care and measuring and addressing postpartum morbidity.
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Affiliation(s)
- Maxine Pepper
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Susannah L Woodd
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Baguiya A, Bonet M, Brizuela V, Cuesta C, Knight M, Lumbiganon P, Abalos E, Kouanda S. Infection-related severe maternal outcomes and case fatality rates in 43 low and middle-income countries across the WHO regions: Results from the Global Maternal Sepsis Study (GLOSS). PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003109. [PMID: 38662723 PMCID: PMC11045079 DOI: 10.1371/journal.pgph.0003109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
The highest toll of maternal mortality due to infections is reported in low and middle-income countries (LMICs). However, more evidence is needed to understand the differences in infection-related severe maternal outcomes (SMO) and fatality rates across the WHO regions. This study aimed to compare the burden of infection-related SMO and case fatality rates across the WHO regions using the Global Maternal Sepsis Study (GLOSS) data. GLOSS was a hospital-based one-week inception prospective cohort study of pregnant or recently pregnant women admitted with suspected or confirmed infection in 2017. Four hundred and eight (408) hospitals from 43 LMICs in the six WHO regions were considered in this analysis. We used a logistic regression model to compare the odds of infection-related SMOs by region. We then calculated the fatality rate as the proportion of deaths over the total number of SMOs, defined as maternal deaths and near-misses. The proportion of SMO was 19.6% (n = 141) in Africa, compared to 18%(n = 22), 15.9%(n = 50), 14.7%(n = 48), 12.1%(n = 95), and 10.8%(n = 21) in the Western Pacific, European, Eastern Meditteranean, Americas, and South-Eastern Asian regions, respectively. Women in Africa were more likely to experience SMO than those in the Americas (aOR = 2.41, 95%CI: [1.78 to 2.83]), in South-East Asia (aOR = 2.60, 95%CI: [1.57 to 4.32]), and the Eastern Mediterranean region (aOR = 1.58, 95%CI: [1.08 to 2.32]). The case fatality rate was 14.3%[3.05% to 36.34%] (n/N = 3/21) and 11.4%[6.63% to 17.77%] (n/N = 16/141) in the South-East Asia and Africa, respectively. Infection-related SMOs and case fatality rates were highest in Africa and Southeast Asia. Specific attention and actions are needed to prevent infection-related maternal deaths and severe morbidity in these two regions.
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Affiliation(s)
- Adama Baguiya
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
- Doctoral School, Saint Thomas d’Aquin University, Ouagadougou, Burkina Faso
| | - Mercedes Bonet
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Vanessa Brizuela
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Cristina Cuesta
- Faculty of Economics and Statistics, National University of Rosario, Rosario, Argentina
| | - Marian Knight
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Pisake Lumbiganon
- Faculty of Medicine, Department of Obstetrics and Gynaecology, Khon Kaen University, Khon Kaen, Thailand
| | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Séni Kouanda
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
- Doctoral School, Saint Thomas d’Aquin University, Ouagadougou, Burkina Faso
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Peng R, Tong Y, Yang M, Wang J, Yang L, Zhu J, Liu Y, Wang H, Shi Z, Liu Y. Global burden and inequality of maternal and neonatal disorders: based on data from the 2019 Global Burden of Disease study. QJM 2024; 117:24-37. [PMID: 37773990 PMCID: PMC10849872 DOI: 10.1093/qjmed/hcad220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/04/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Maternal and neonatal disorders account for substantial health loss across the lifespan from early childhood. These problems may be related to health inequality. AIM To provide evidence for improvement in health policies regarding maternal and neonatal disorder inequity. DESIGN This was a population-based cross-sectional study based on 2019 Global Burden of Disease data. METHODS Annual cases and age-standardized rates (ASRs) of incidence, prevalence, death, and disability-adjusted life-years (DALYs) in maternal and neonatal disorders between 1990 and 2019 were collected from the 2019 Global Burden of Disease study. Concentration curves and concentration indices were used to summarize the degree of socioeconomic-related inequality. RESULTS For maternal disorders, the global ASRs of incidence, prevalence, death and DALYs were 2889.4 (95% uncertainty interval (UI), 2562.9-3251.9), 502.9 (95% UI 418.7-598.0), 5.0 (95% UI 4.4-5.8) and 324.9 (95% UI 284.0-369.1) per 100 000 women in 2019, respectively. The ASRs of maternal disorders were all obviously reduced and remained pro-poor from 1990 to 2019. In neonatal disorders, the global ASRs of incidence, prevalence, death and DALYs were 363.3 (95% UI 334.6-396.8), 1239.8 (95% UI 1142.1-1356.7), 29.1 (95% UI 24.8-34.5) and 2828.3 (95% UI 2441.6-3329.6) per 100 000 people in 2019, respectively. The global ASRs of incidence, death and DALYs in neonatal disorders have remained pro-poor. However, the socioeconomic-related fairness in the ASR of neonatal disorder prevalence is being levelled. CONCLUSIONS The global burden of maternal and neonatal disorders has remained high, and socioeconomic-related inequality (pro-poor) tended not to change between 1990 and 2019.
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Affiliation(s)
- R Peng
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - Y Tong
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - M Yang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - J Wang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - L Yang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - J Zhu
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - Yu Liu
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - H Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Sichuan, 610041, China
| | - Z Shi
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - Ya Liu
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
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Mbwele B, Twaha A, Maksym K, Caputo M, Mkenda DD, Halpern H, Berney S, Kaminyoge EA, Kaminyoge MS, Kaler M, Sobhy S, Hillman SL. The impact of a blended multidisciplinary training for the management of obstetric haemorrhage in Mbeya, Tanzania. Front Glob Womens Health 2023; 4:1270261. [PMID: 38145250 PMCID: PMC10748492 DOI: 10.3389/fgwh.2023.1270261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/09/2023] [Indexed: 12/26/2023] Open
Abstract
Background The Maternal Mortality Rate (MMR) in Tanzania is 78 times higher than that of the UK. Obstetric haemorrhage accounts for two-thirds of these deaths in Mbeya, Tanzania. A lack of healthcare providers' (HCPs') competencies has been the key attribute. This study measured the impact on HCP's competencies from a blended training programme on obstetric haemorrhage. Methods A "before and after" cohort study was undertaken with HCPs in 4 hospitals in the Mbeya region of Tanzania between August 2021 and April 2022. A multidisciplinary cohort of 34 HCPs (doctors, nurses, midwives, anaesthetists and radiologists) were enrolled on a blended face-to-face and virtual training course. The training was delivered by a multidisciplinary team (MDT) from London, UK, assisted by local multidisciplinary trainers from Mbeya, Tanzania and covered anaesthetic, obstetrics, haematology and sonographic use. Results There were 33 HCP in the cohort of trainees where 30/33 (90.9%) of HCPs improved their Anaesthesia skills with a mean score improvement of 26% i.e., 0.26 (-0.009 -0.50), 23 HCPs (69.7%) improved obstetric skills 18% i.e., 0.18 (-0.16 to 0.50), 19 (57.6%), (57.6%) improved competences in Haematology 15%.i.e., 0.15 (-0.33 to 0.87), 20 out of 29 HCPs with ultrasound access (68.8%) improved Sonographic skills 13%.i.e., 0.13 (-0.31 to 0.54). All 33 HCPs (100%) presented a combined change with the mean score improvement of difference of 25% i.e., 0.25 (0.05-0.66). The deaths attributed to obstetric haemorrhage, the mortality rate declined from 76/100,000 to 21/100,000 live births. Actual number of deaths due to obstetric haemorrhage declined from 8 before training to 3 after the completion of the training. Conclusion This comprehensive blended training on anaesthetic surgical, haematological, and sonographic management of obstetric haemorrhage delivers a significant positive impact on the detection, management and outcomes of obstetric haemorrhage.
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Affiliation(s)
- Bernard Mbwele
- Department of Epidemiology and Bio-Statistics, University of Dar es Salaam—Mbeya College of Health and Allied Sciences, UDSM-MCHAS, Mbeya, Tanzania
- Programme Development, Vijiji Tanzania, Mbeya, Tanzania
| | - Amani Twaha
- Obstetrics Department, Mbeya Zonal Referral Hospital (MZRH), Mbeya, Tanzania
| | - Kasia Maksym
- Medical School Building, UCL EGA Institute for Women’s Health, London, United Kingdom
| | - Matthew Caputo
- Department of Statistics, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Delfina D. Mkenda
- Obstetrics Department, Mbeya Zonal Referral Hospital (MZRH), Mbeya, Tanzania
| | - Helen Halpern
- Programme Development, Tanzania UK Healthcare Diaspora Association, London, United Kingdom
| | - Sylvia Berney
- Programme Development, Tanzania UK Healthcare Diaspora Association, London, United Kingdom
| | - Elias A. Kaminyoge
- Obstetrics Department, Mbeya Zonal Referral Hospital (MZRH), Mbeya, Tanzania
| | | | - Mandeep Kaler
- Women’s Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Soha Sobhy
- Women’s Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Sara L. Hillman
- Medical School Building, UCL EGA Institute for Women’s Health, London, United Kingdom
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Sharma B, Lahariya C, Majella MG, Upadhyay A, Yadav S, Raina A, Khan T, Aggarwal N. Burden, Differentials and Causes of Stillbirths in India: A Systematic Review and Meta Analysis. Indian J Pediatr 2023; 90:54-62. [PMID: 37556034 DOI: 10.1007/s12098-023-04749-9] [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: 05/01/2023] [Accepted: 06/22/2023] [Indexed: 08/10/2023]
Abstract
India contributes the highest absolute number of stillbirths in the world. This systematic review and meta-analysis was conducted to synthesize the burden, timing and causes of stillbirths in India. Forty-nine reports from 46 studies conducted in 21 Indian states and Union Territories were included. It was found that there was no uniformity/standardization in the definition of stillbirths and in the classification system used to assign the cause. The share of antepartum stillbirths was estimated to be two-third while remaining were intrapartum stillbirths. Maternal conditions and fetal causes were found to be the leading cause of stillbirth in India. The maternal condition was assigned as the commonest cause (25%) followed by fetal (14%), placental cause (13%), congenital malformation (6%) and intrapartum complications (4%). Approximately 20% of the stillbirths were assigned as unknown or unexplained. This review demonstrates that there is a paucity of quality stillbirth data in India. Other than the state level differences in stillbirth rates, no other data is available on inequities in stillbirths in India. There is an urgent need for strengthening availability and quality of stillbirth data in India on both stillbirth rates as well as the causes. There is a need to conduct additional research to know the timing of the stillbirths, causes of death and actual burden. India needs to strengthen stillbirth audits along with registry to find out the modifiable factors and delays for making country specific preventive strategies. The policy makers, academic community and researchers need to work together to ensure accelerated and equitable reduction in stillbirths in India.
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Affiliation(s)
- Bharti Sharma
- Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India.
| | - Chandrakant Lahariya
- Integrated Department of Health Policy, Epidemiology, Preventive Medicine and Pediatrics, Foundation for People-centric Health Systems, New Delhi, 110029, India
- SD Gupta School of Public Health, The IIHMR University, Jaipur, 302029, India
| | - Marie Gilbert Majella
- Department of Community Medicine, Sri Venkateshwara Medical College Hospital & Research Center, Puducherry, India
| | - Anita Upadhyay
- Director- Projects, Human Capital Lighthouse Consulting Pvt Ltd, New Delhi, 110029, India
| | - Sapna Yadav
- Integrated Department of Health Policy, Epidemiology, Preventive Medicine and Pediatrics, Foundation for People-centric Health Systems, New Delhi, 110029, India
| | - Ankit Raina
- Department of Public Health, Survival for Women & Children (SWACH) Foundation, Panchkula, Haryana, India
| | - Tamkin Khan
- Department of Obstetrics & Gynecology, Aligarh Muslim University, Aligarh, U.P, India
| | - Neelam Aggarwal
- Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India
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Moller AB, Welsh J, Agossou C, Ayebare E, Chipeta E, Dossou JP, Gross MM, Houngbo G, Hounkpatin H, Kandeya B, Mwilike B, Petzold M, Hanson C. Midwifery care providers' childbirth and immediate newborn care competencies: A cross-sectional study in Benin, Malawi, Tanzania and Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001399. [PMID: 37279204 DOI: 10.1371/journal.pgph.0001399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/11/2023] [Indexed: 06/08/2023]
Abstract
Evidence-based quality care is essential for reducing sub-Saharan Africa's high burden of maternal and newborn mortality and morbidity. Provision of quality care results from interaction between several components of the health system including competent midwifery care providers and the working environment. We assessed midwifery care providers' ability to provide quality intrapartum and newborn care and selected aspects of the working environment as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity (ALERT) project in Benin, Malawi, Tanzania, and Uganda. We used a self-administered questionnaire to assess provider knowledge and their working environment and skills drills simulations to assess skills and behaviours. All midwifery care providers including doctors providing midwifery care in the maternity units were invited to take part in the knowledge assessment and one third of the midwifery care providers who took part in the knowledge assessment were randomly selected and invited to take part in the skills and behaviour simulation assessment. Descriptive statistics of interest were calculated. A total of 302 participants took part in the knowledge assessment and 113 skills drills simulations were conducted. The assessments revealed knowledge gaps in frequency of fetal heart rate monitoring and timing of umbilical cord clamping. Over half of the participants scored poorly on aspects related to routine admission tasks, clinical history-taking and rapid and initial assessment of the newborn, while higher scores were achieved in active management of the third stage of labour. The assessment also identified a lack of involvement of women in clinical decision-making. Inadequate competency level of the midwifery care providers may be due to gaps in pre-service training but possibly related to the structural and operational facility characteristics including continuing professional development. Investment and action on these findings are needed when developing and designing pre-service and in-service training. Trial registration: PACTR202006793783148-June 17th, 2020.
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Affiliation(s)
- Ann-Beth Moller
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joanne Welsh
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Christian Agossou
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Elizabeth Ayebare
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Effie Chipeta
- Kamuzu University of Health Sciences, Centre for Reproductive Health, Blantyre, Malawi
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Gisele Houngbo
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Hashim Hounkpatin
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Bianca Kandeya
- Kamuzu University of Health Sciences, Centre for Reproductive Health, Blantyre, Malawi
| | - Beatrice Mwilike
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Claudia Hanson
- Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Oberlin A, Wallace J, Moore JL, Saleem S, Lokangaka A, Tshefu A, Bauserman M, Figueroa L, Krebs NF, Esamai F, Liechty E, Bucher S, Patel AB, Hibberd PL, Chomba E, Carlo WA, Goudar S, Derman RJ, Koso-Thomas M, McClure EM, Goldenberg RL. Examining maternal morbidity across a spectrum of delivery locations: An analysis of the Global Network's Maternal and Neonatal Health Registry. Int J Gynaecol Obstet 2023; 160:797-805. [PMID: 35949060 PMCID: PMC9911556 DOI: 10.1002/ijgo.14391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To better understand maternal morbidity, using quality data from low- and middle-income countries (LMICs), including out-of-hospital deliveries. Additionally, to compare to the WHO estimate that maternal morbidity occurs in 15% of pregnancies, which is based largely on hospital-level data. METHODS The Global Network for Women's and Children's Health Research Maternal Newborn Health Registry collected data on all pregnancies from seven sites in six LMICs between 2015 and 2020. Rates of maternal mortality and morbidity and the differences in morbidity across delivery location and birth attendant type were evaluated. RESULTS Among the 280 584 deliveries included in the present analysis, the overall maternal mortality ratio was 138 per 100 000, while 11.7% of women experienced at least one morbidity. Rates of morbidity were generally higher for deliveries occurring within hospitals (19.8%) and by physicians (23.6%). The lowest rates of morbidity were noted among women delivering in non-hospital healthcare facilities (5.6%) or with non-physician clinicians (e.g. nurses, midwives [5.4%]). CONCLUSION The present study shows important differences in reported maternal morbidity across delivery sites, with a trend towards lower morbidity in non-hospital healthcare facilities and among non-physician clinicians.
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Affiliation(s)
- Austin Oberlin
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Jacqueline Wallace
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD 20892, USA
| | - Janet L. Moore
- Center for Clinical Research Network Coordination, RTI International, Research Triangle Park, NC, 27709, USA
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Adrien Lokangaka
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Antoinette Tshefu
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F. Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | - Edward Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Sheri Bucher
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Archana B. Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Elwyn Chomba
- Department of Pediatrics, University Teaching Hospital, Lusaka, Zambia
| | | | - Shivaprasad Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Karnataka, India
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD 20892, USA
| | - Elizabeth M. McClure
- Center for Clinical Research Network Coordination, RTI International, Research Triangle Park, NC, 27709, USA
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
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Danso SO, Manu A, Fenty J, Amanga-Etego S, Avan BI, Newton S, Soremekun S, Kirkwood B. Population cause of death estimation using verbal autopsy methods in large-scale field trials of maternal and child health: lessons learned from a 20-year research collaboration in Central Ghana. Emerg Themes Epidemiol 2023; 20:1. [PMID: 36797732 PMCID: PMC9936721 DOI: 10.1186/s12982-023-00120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Low and middle-income countries continue to use Verbal autopsies (VAs) as a World Health Organisation-recommended method to ascertain causes of death in settings where coverage of vital registration systems is not yet comprehensive. Whilst the adoption of VA has resulted in major improvements in estimating cause-specific mortality in many settings, well documented limitations have been identified relating to the standardisation of the processes involved. The WHO has invested significant resources into addressing concerns in some of these areas; there however remains enduring challenges particularly in operationalising VA surveys for deaths amongst women and children, challenges which have measurable impacts on the quality of data collected and on the accuracy of determining the final cause of death. In this paper we describe some of our key experiences and recommendations in conducting VAs from over two decades of evaluating seminal trials of maternal and child health interventions in rural Ghana. We focus on challenges along the entire VA pathway that can impact on the success rates of ascertaining the final cause of death, and lessons we have learned to optimise the procedures. We highlight our experiences of the value of the open history narratives in VAs and the training and skills required to optimise the quality of the information collected. We describe key issues in methods for ascertaining cause of death and argue that both automated and physician-based methods can be valid depending on the setting. We further summarise how increasingly popular information technology methods may be used to facilitate the processes described. Verbal autopsy is a vital means of increasing the coverage of accurate mortality statistics in low- and middle-income settings, however operationalisation remains problematic. The lessons we share here in conducting VAs within a long-term surveillance system in Ghana will be applicable to researchers and policymakers in many similar settings.
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Affiliation(s)
- Samuel O. Danso
- grid.4305.20000 0004 1936 7988Disease Modelling Research Group, Centre for Dementia Prevention & Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alexander Manu
- Centre for Maternal and Newborn Health, Liverpool School of Hygiene and Tropical Medicine, Liverpool, UK
| | - Justin Fenty
- grid.8991.90000 0004 0425 469XFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Liverpool, UK
| | - Seeba Amanga-Etego
- grid.415375.10000 0004 0546 2044Centre for Computing, Kintampo Health Research Centre, Ministry of Health, Kintampo, Ghana
| | - Bilal Iqbal Avan
- grid.8991.90000 0004 0425 469XFaculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Sam Newton
- grid.9829.a0000000109466120School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Seyi Soremekun
- grid.8991.90000 0004 0425 469XFaculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Betty Kirkwood
- grid.8991.90000 0004 0425 469XFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Archary P, Potgieter L, Elgindy E, Adageba RK, Mboloko J, Iketubosin F, Serour G, Dyer S. Assisted reproductive technologies in Africa: The African Network and Registry for ART, 2018 and 2019. Reprod Biomed Online 2023; 46:835-845. [PMID: 36959069 DOI: 10.1016/j.rbmo.2023.01.014] [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: 08/31/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
RESEARCH QUESTION What were the utilization, practices and outcomes of assisted reproductive technology (ART) in Africa in 2018 and 2019? DESIGN Cycle-based data (CBD) and retrospective summary data were collected cross-sectionally from voluntarily participating ART centres. RESULTS During 2018, 43,958 ART procedures were reported by 67 centres in 16 countries, increasing to 45,185 procedures reported by 70 centres in 18 countries in 2019. Autologous fresh procedures predominated at 70%, whereas autologous frozen embryo transfers (FET) increased from 21.2% to 23.1% and oocyte donation cycles remained below 10%. In 2019, the mean age of women undergoing autologous fresh embryo transfer was 33.9 years and received a mean number of 2.4 embryos per transfer. The clinical pregnancy rate (CPR) per fresh embryo transfer was 42.8% in 2018 and 38.4% in 2019, with corresponding rates of 38.3% and 31.8% after FET. In both years, most ART procedures, excluding single embryo transfer (SET), were associated with a multiple delivery rate above 20%, reaching over 30% after elective dual embryo transfer in autologous cycles and after fresh oocyte donation. Multiples were predominantly born preterm with a substantially increased perinatal mortality rate. The CBD for both years showed that elective SET (eSET) achieved a high CPR without compromising safety. CONCLUSION This third report of The African Network and Registry for Assisted Reproductive Technology documents the prevailing practice of multiple embryo transfers in a cohort of relatively young women while highlighting the importance of disaggregating eSET, non-eSET and double embryo transfer. The high CPR after eSET and the increase in cryopreservation cycles are encouraging trends towards decreasing the number of embryos transferred without compromising effectiveness. Improved follow-up of ART pregnancies is required.
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Affiliation(s)
- Paversan Archary
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; African Network and Registry for Assisted Reproductive Technology.
| | - Liezel Potgieter
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; African Network and Registry for Assisted Reproductive Technology
| | - Eman Elgindy
- Egypt IVF Registry; Department of Obstetrics and Gynecology, Zagazig University School of Medicine, Zagazig Sharkia 44511, Egypt
| | | | - Justin Mboloko
- Groupe Interafricain d'Etude, de Recherche et d'Application sur la Fertilité
| | | | - Gamal Serour
- African Federation of Fertility Societies; Department of Obstetrics and Gynaecology, Al Azhar University, The Egyptian IVF-ET Center, 3 Street 161, Hadayek El-Maadi, Cairo 11431, Egypt
| | - Silke Dyer
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; African Network and Registry for Assisted Reproductive Technology
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Dol J, Hughes B, Bonet M, Dorey R, Dorling J, Grant A, Langlois EV, Monaghan J, Ollivier R, Parker R, Roos N, Scott H, Shin HD, Curran J. Timing of maternal mortality and severe morbidity during the postpartum period. JBI Evid Synth 2022; 20:2119-2194. [PMID: 35916004 PMCID: PMC9594153 DOI: 10.11124/jbies-20-00578] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: The objective of this review was to determine the timing of overall and cause-specific maternal mortality and severe morbidity during the postpartum period. Introduction: Many women continue to die or experience adverse health outcomes in the postpartum period; however, limited work has explored the timing of when women die or present complications during this period globally. Inclusion criteria: This review considered studies that reported on women after birth up to 6 weeks postpartum and included data on mortality and/or morbidity on the first day, days 2–7, and days 8–42. Studies that reported solely on high-risk women (eg, those with antenatal or intrapartum complications) were excluded, but mixed population samples were included (eg, low-risk and high-risk women). Methods: MEDLINE, Embase, Web of Science, and CINAHL were searched for published studies on December 20, 2019, and searches were updated on May 11, 2021. Critical appraisal was undertaken by 2 independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by at least 2 reviewers using a study-specific data extraction form. Quantitative data were pooled, where possible. Identified studies were used to obtain the summary estimate (proportion) for each time point. Maternal mortality was calculated as the maternal deaths during a given period over the total number of maternal deaths known during the postpartum period. For cause-specific analysis, number of deaths due to a specific cause was the numerator, while the total number of women who died due to the same cause in that period was the denominator. Random effects models were run to pool incidence proportion for relative risk of overall maternal deaths. Subgroup analysis was conducted according to country income classification and by date (ie, data collection before or after 2010). Where statistical pooling was not possible, the findings were reported narratively. Results: A total of 32 studies reported on maternal outcomes from 17 reports, all reporting on mixed populations. Most maternal deaths occurred on the first day (48.9%), with 24.5% of deaths occurring between days 2 and 7, and 24.9% occurring between days 8 and 42. Maternal mortality due to postpartum hemorrhage and embolism occurred predominantly on the first day (79.1% and 58.2%, respectively). Most deaths due to postpartum eclampsia and hypertensive disorders occurred within the first week (44.3% on day 1 and 37.1% on days 2–7). Most deaths due to infection occurred between days 8 and 42 (61.3%). Due to heterogeneity, maternal morbidity data are described narratively, with morbidity predominantly occurring within the first 2 weeks. The mean critical appraisal score across all included studies was 85.9% (standard deviation = 13.6%). Conclusion: Women experience mortality throughout the entire postpartum period, with the highest mortality rate on the first day. Access to high-quality care during the postpartum period, including enhanced frequency and quality of postpartum assessments during the first 42 days after birth, is essential to improving maternal outcomes and to continue reducing maternal mortality and morbidity worldwide. Systematic review registration number: PROSPERO CRD42020187341
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change (AH_NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - Brianna Hughes
- Aligning Health Needs and Evidence for Transformative Change (AH_NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Mercedes Bonet
- UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rachel Dorey
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Jon Dorling
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| | - Amy Grant
- Maritime SPOR Support Unit, Halifax, NS, Canada
| | - Etienne V. Langlois
- Partnership for Maternal, Newborn and Child Health, World Health Organization, Geneva, Switzerland
| | - Joelle Monaghan
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Rachel Ollivier
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Robin Parker
- W.K. Kellogg Health Sciences Library, Dalhousie Libraries, Dalhousie University, Halifax, NS, Canada
| | - Nathalie Roos
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Heather Scott
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Hwayeon Danielle Shin
- Aligning Health Needs and Evidence for Transformative Change (AH_NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Janet Curran
- Aligning Health Needs and Evidence for Transformative Change (AH_NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- School of Nursing, Dalhousie University, Halifax, NS, Canada
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