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Wang L, Gao J, Tang P, Hu H, Chen X, Chen Z, Sun Y. Comparing urine point-of-care tests to screen preeclampsia: Congo-red dot paper test versus dipstick urinalysis. J Clin Hypertens (Greenwich) 2024; 26:349-354. [PMID: 38430477 PMCID: PMC11007796 DOI: 10.1111/jch.14783] [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: 12/02/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/03/2024]
Abstract
To compare the urine Congo-red dot paper test (CRD) with dipstick urinalysis to screen preeclampsia (PE). A total of 409 paired spot urine samples were obtained prospectively from women with suspected pre-eclampsia attending for routine hospital visits. Congo-red dot paper test and dipstick urinalysis were examined and compared to screen pre-eclampsia. The agreement between the two urinary test is modest (kappa coefficient = 0.28, 95% CI 0.14-0.42). The specificity of CRD was higher than urinalysis (97.4% vs. 90.4%, p < .001). Urinalysis performed better in sensitivity (77.3% vs. 40.9%, p = .04) and the area under the receiver operating characteristic curves (AUC) (0.84 [95% CI 0.74-0.94] vs. 0.69 [95% CI 0.55-0.83], p = .04) than CRD, respectively. The sensitivity, specificity, AUC of the parallel test of them is 86.4% (64.0%-96.4%), 89.1% (85.5%-92.0%), and 0.88 (95% CI 0.79-0.96). And the serial test is 31.8% (14.7%-54.9%), 98.7% (96.8%-99.5%), 0.65 (95% CI 0.51-0.79), accordingly. The urinalysis is a better diagnosing test for preeclampsia. CRD could aid in the diagnosis of patients with preeclampsia. Combined the two tests in suspected patients may further improve the performance in the diagnosis of preeclampsia. Further study need to be made for its potential clinical practice.
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Affiliation(s)
- Liying Wang
- Department of Obstetrics and GynecologyChinese Academy of Medical SciencesPeking Union Medical CollegeNational Clinical Research Center for Obstetric and Gynecologic DiseasesPeking Union Medical College HospitalBeijingChina
| | - Jinsong Gao
- Department of Obstetrics and GynecologyChinese Academy of Medical SciencesPeking Union Medical CollegeNational Clinical Research Center for Obstetric and Gynecologic DiseasesPeking Union Medical College HospitalBeijingChina
| | - Pingping Tang
- Department of Obstetrics and GynecologyChinese Academy of Medical SciencesPeking Union Medical CollegeNational Clinical Research Center for Obstetric and Gynecologic DiseasesPeking Union Medical College HospitalBeijingChina
| | - Huiying Hu
- Department of Obstetrics and GynecologyChinese Academy of Medical SciencesPeking Union Medical CollegeNational Clinical Research Center for Obstetric and Gynecologic DiseasesPeking Union Medical College HospitalBeijingChina
| | - Xiaoxu Chen
- Department of Obstetrics and GynecologyChinese Academy of Medical SciencesPeking Union Medical CollegeNational Clinical Research Center for Obstetric and Gynecologic DiseasesPeking Union Medical College HospitalBeijingChina
| | - Ziyi Chen
- Department of Obstetrics and GynecologyChinese Academy of Medical SciencesPeking Union Medical CollegeNational Clinical Research Center for Obstetric and Gynecologic DiseasesPeking Union Medical College HospitalBeijingChina
| | - Yin Sun
- Department of Obstetrics and GynecologyChinese Academy of Medical SciencesPeking Union Medical CollegeNational Clinical Research Center for Obstetric and Gynecologic DiseasesPeking Union Medical College HospitalBeijingChina
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Molla A, Mekonnen S, Alemu K, Tigabu Z, Gebeyehu A. Community-based newborn care intervention fidelity and its implementation drivers in South Wollo Zone, North-east Ethiopia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001168. [PMID: 37566575 PMCID: PMC10420373 DOI: 10.1371/journal.pgph.0001168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 07/17/2023] [Indexed: 08/13/2023]
Abstract
Community-based newborn care (CBNC) has been implemented in Ethiopia across the maternal, neonatal, and child health continuum of care with the goal of lowering newborn mortality. However, neonatal mortality rate in Ethiopian is among the highest in the world. Why neonatal mortality remains high in the face of such effective interventions is the issue. As a result, the authors claim that it is unknown whether the planned intervention is carried out effectively or not. The purpose of this study was to investigate the fidelity of community-based newborn care intervention and its implementation drivers. Multicenter community-based mixed method study was employed on 898 postpartum women, 16 health extension workers (HEWs) and 10 health posts to evaluate CBNC intervention fidelity. Structured questionnaire and facility audit checklist was used to collect quantitative data. In-depth interview technique was used to explore lived experiences of HEWs on CBNC implementation. CBNC intervention fidelity was computed as a composite index of the product of program coverage, frequency and contents. Multilevel linear regression model with adjusted β-coefficients at P-value of 0.05 and a 95% confidence interval (CI) were used to declare a significant relation between CBNC intervention fidelity and its implementation drivers. Interpretative phenomenological analysis was employed for qualitative data analysis. CBNC intervention fidelity was found to be 4.5% (95% CI: 3.6-5.4) with only two women received the intervention with full fidelity. The overall CBNC intervention coverage was 38.4% (95% CI: 35.2-41.6). Only 8.1% and 1.5% of women received all CBNC interventions with recommended frequency and content, respectively. HEWs knowledge of danger sign was significant facilitator while lack of: health center's feedback, related short-term training, health development army support, health center staff's technical assistance to HEWs and shortage of medical equipment supply were barriers for CBNC intervention fidelity. In conclusion the CBNC intervention fidelity was too low in this study. This indicates that CBNC intervention package was not implemented as envisioned implying an implementation gap. All implementation drivers were poorly implemented to result in improved fidelity and intervention outcomes.
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Affiliation(s)
- Asressie Molla
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Solomon Mekonnen
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Zemene Tigabu
- Department of Pediatrics and Child Health, University of Gondar, Gondar, Ethiopia
| | - Abebaw Gebeyehu
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Ayawine A, Atinga RA. “We know it is not good, but we are constrained”: A study on quality of emergency obstetric and newborn care in Northern Ghana. Heliyon 2023; 9:e15250. [PMID: 37095927 PMCID: PMC10121449 DOI: 10.1016/j.heliyon.2023.e15250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
Objective To explore the quality of emergency obstetric and newborn care provided to newly delivered women in rural Ghana. Methods A multiple case study design, involving in-depth face to face interviews, was deployed to draw evidence from essential health providers, clients and caretakers. Data were further derived from non-participant observation by means of an observation guide and analysis of physical artifacts using the room-by-room walk-through tool. Data analysis followed Yin's five phase process to case study analysis. Results Quality of care was compromised by non-adherence to standard practices, inadequate monitoring, crude treatment procedures, lack of basic care needs and poor health providers' relational behaviours. Limited supplies of drugs, equipment and essential care providers further weakened the provision of quality emergency obstetric and newborn care. Conclusion Inadequate supply of essential logistics and skill gaps on the part of health providers in some maternal and newborn care components adversely produced poor maternal and neonatal outcomes in rural Ghana. Elements of disrespectful care for women suggest violations of their rights in the maternal and newborn care encounter.
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Affiliation(s)
- Alice Ayawine
- School of Public Health and Allied Sciences, Catholic University of Ghana, Fiapre-Sunyani, Ghana
- Corresponding author.
| | - Roger A. Atinga
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
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Abstract
Pre-eclampsia is a life-threatening disease of pregnancy unique to humans and a leading cause of maternal and neonatal morbidity and mortality. Women who survive pre-eclampsia have reduced life expectancy, with increased risks of stroke, cardiovascular disease and diabetes, while babies from a pre-eclamptic pregnancy have increased risks of preterm birth, perinatal death and neurodevelopmental disability and cardiovascular and metabolic disease later in life. Pre-eclampsia is a complex multisystem disease, diagnosed by sudden-onset hypertension (>20 weeks of gestation) and at least one other associated complication, including proteinuria, maternal organ dysfunction or uteroplacental dysfunction. Pre-eclampsia is found only when a placenta is or was recently present and is classified as preterm (delivery <37 weeks of gestation), term (delivery ≥37 weeks of gestation) and postpartum pre-eclampsia. The maternal syndrome of pre-eclampsia is driven by a dysfunctional placenta, which releases factors into maternal blood causing systemic inflammation and widespread maternal endothelial dysfunction. Available treatments target maternal hypertension and seizures, but the only 'cure' for pre-eclampsia is delivery of the dysfunctional placenta and baby, often prematurely. Despite decades of research, the aetiology of pre-eclampsia, particularly of term and postpartum pre-eclampsia, remains poorly defined. Significant advances have been made in the prediction and prevention of preterm pre-eclampsia, which is predicted in early pregnancy through combined screening and is prevented with daily low-dose aspirin, starting before 16 weeks of gestation. By contrast, the prediction of term and postpartum pre-eclampsia is limited and there are no preventive treatments. Future research must investigate the pathogenesis of pre-eclampsia, in particular of term and postpartum pre-eclampsia, and evaluate new prognostic tests and treatments in adequately powered clinical trials.
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Thapa DK, Acharya K, Karki A, Cleary M. Health facility readiness to provide antenatal care (ANC) and non-communicable disease (NCD) services in Nepal and Bangladesh: Analysis of facility-based surveys. PLoS One 2023; 18:e0281357. [PMID: 36913361 PMCID: PMC10010536 DOI: 10.1371/journal.pone.0281357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/20/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Antenatal care (ANC) visits provide an important opportunity for diagnostic, preventive, and curative services for non-communicable diseases (NCDs) during pregnancy. There is an identified need for an integrated, system-wide approach to provide both ANC and NCD services to improve maternal and child health outcomes in the short and long term. OBJECTIVE This study assessed the readiness of health facilities to provide ANC and NCD services in Nepal and Bangladesh, identified as low-and middle-income countries. METHOD The study used data from national health facility surveys in Nepal (n = 1565) and Bangladesh (n = 512) assessing recent service provision under the Demographic and Health Survey programs. Using the WHO's service availability and readiness assessment framework, the service readiness index was calculated across four domains: staff and guidelines, equipment, diagnostic, and medicines and commodities. Availability and readiness are presented as frequency and percentages, while factors associated with readiness were examined using binary logistic regression. RESULTS Of the facilities, 71% in Nepal, and 34% in Bangladesh reported offering both ANC and NCD services. The proportion of facilities which showed readiness for providing ANC and NCD services was 24% in Nepal and 16% in Bangladesh. Gaps in readiness were observed in the availability of trained staff, guidelines, basic equipment, diagnostics, and medicines. Facilities managed by the private sector or a Non-Governmental Organization, located in an urban area, with management systems to support the delivery of quality services were positively associated with readiness to provide both ANC and NCD services. CONCLUSION There is a need to strengthen the health workforce by ensuring skilled personnel, having policy, guidelines and standards, and that diagnostics, medicines, and commodities are available/provided in health facilities. Management and administrative systems are also required, including supervision and staff training, to enable health services to provide integrated care at an acceptable level of quality.
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Affiliation(s)
- Deependra K. Thapa
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, Australia
- * E-mail:
| | | | - Anjalina Karki
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
| | - Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, Australia
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Ouédraogo S, Accrombessi M, Ouattara A, Massougbodji A, Dabira ED, Sarigda M, Diallo I, Zida A, Nicolas M, Ouédraogo L, Cot M, Sondo B. Impact of mobile phone intervention on intermittent preventive treatment of malaria during pregnancy in Burkina Faso : A pragmatic randomized trial. Rev Epidemiol Sante Publique 2022; 70:209-214. [PMID: 35989210 DOI: 10.1016/j.respe.2022.07.002] [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: 07/23/2021] [Revised: 07/02/2022] [Accepted: 07/03/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE Intermittent preventive treatment of malaria with sulphadoxine-pyrimethamine for pregnant women (IPTp-SP) coverage remains far below the desirable goal of at least three doses before delivery. This study evaluates an innovative intervention using mobile phones as a means of increasing coverage for the third dose of IPTp-SP. METHODS This study in Burkina Faso was designed as an open-label, pragmatic, two-arm, randomised trial. Pregnant women who attended antenatal clinic (ANC) visits were included at their first ANC visit and followed until delivery. The intervention was built around the use of mobile phones as means ensuring direct tracking of pregnant women. RESULTS Two hundred and forty-eight (248) pregnant women were included in the study. The proportion of women who received at least three doses of IPTp-SP was 54.6 %. In the intervention group, 54.1 % of women received at least three doses of IPTp-SP versus 55.1 % in the control group, a non-significant difference (adjusted odds ratio "aOR", 0.86 ; 95 % confidence interval "95 % CI", 0.49-1.51). Women in the intervention group were more likely to carry out their ANC visits in a timely manner than those in the control group (aOR, 3.21 ; 95 % CI, 1.91-5.39). CONCLUSION While mobile phone intervention did not increase the proportion of women receiving three doses of IPTp-SP, it did help to increase the proportion of timely ANC visits. TRIAL REGISTRATION PACTR202106905150440.
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Affiliation(s)
- Smaïla Ouédraogo
- Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso; Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
| | - Manfred Accrombessi
- Faculty of Infectious and Tropical Diseases, Disease Control Department, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK; Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
| | - Adama Ouattara
- Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso; Centre Hospitalier Universitaire de Bogodogo, Ouagadougou, Burkina Faso
| | | | - Edgard D Dabira
- Medical Research Council at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Maurice Sarigda
- Programme d'appui au développement sanitaire (PADS), Ministère de la santé, Ouagadougou, Burkina Faso
| | - Ismaël Diallo
- Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso; Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Adama Zida
- Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso; Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Méda Nicolas
- Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso
| | | | - Michel Cot
- MERIT- Mère et Enfant Face aux Infections Tropicales, Institut de Recherche pour le Développement, Paris, France, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Blaise Sondo
- Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
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Madaj B, Gopalakrishnan S, Quach A, Filiaci S, Traore A, Bakusa D, Mdegela M, Yousofzai AW, Rahmanzai AJ, Kodindo G, Gami J, Rostand ND, Kessely H, Addo SA, Abbey M, Sapali M, Omar A, Ernest A, Mtandu R, Agossou A, Ketoh GK, Furtado N, Mangiaterra V, van den Broek N. Where is the 'C' in antenatal care and postnatal care: A multi-country survey of availability of antenatal and postnatal care in low- and middle-income settings. BJOG 2022; 129:1546-1557. [PMID: 35106907 PMCID: PMC9541911 DOI: 10.1111/1471-0528.17106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Antenatal (ANC) and postnatal care (PNC) are logical entry points for prevention and treatment of pregnancy-related illness and to reduce perinatal mortality. We developed signal functions and assessed availability of the essential components of care. DESIGN Cross-sectional survey. SETTING Afghanistan, Chad, Ghana, Tanzania, Togo. SAMPLE Three hundred and twenty-one healthcare facilities. METHODS Fifteen essential components or signal functions of ANC and PNC were identified. Healthcare facility assessment for availability of each component, human resources, equipment, drugs and consumables required to provide each component. MAIN OUTCOME MEASURE Availability of ANC PNC components. RESULTS Across all countries, healthcare providers are available (median number per facility: 8; interquartile range [IQR] 3-17) with a ratio of 3:1 for secondary versus primary care. Significantly more women attend for ANC than PNC (1668 versus 300 per facility/year). None of the healthcare facilities was able to provide all 15 essential components of ANC and PNC. The majority (>75%) could provide five components: diagnosis and management of syphilis, vaccination to prevent tetanus, BMI assessment, gestational diabetes screening, monitoring newborn growth. In Sub-Saharan countries, interventions for malaria and HIV (including prevention of mother to child transmission [PMTCT]) were available in 11.7-86.5% of facilities. Prevention and management of TB; assessment of pre- or post-term birth, fetal wellbeing, detection of multiple pregnancy, abnormal lie and presentation; screening and support for mental health and domestic abuse were provided in <25% of facilities. CONCLUSIONS Essential components of ANC and PNC are not in place. Focused attention on content is required if perinatal mortality and maternal morbidity during and after pregnancy are to be reduced. TWEETABLE ABSTRACT ANC and PNC are essential care bundles. We identified 15 core components. These are not in place in the majority of LMIC settings.
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Affiliation(s)
- Barbara Madaj
- Centre for Maternal and Newborn HealthLiverpool School of Tropical MedicineLiverpoolUK
| | | | - Alexandre Quach
- Centre for Maternal and Newborn HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Simone Filiaci
- Centre for Maternal and Newborn HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Adama Traore
- Centre for Maternal and Newborn HealthLiverpool School of Tropical MedicineLiverpoolUK
| | | | - Mselenge Mdegela
- Centre for Maternal and Newborn HealthLiverpool School of Tropical MedicineLiverpoolUK
| | | | | | | | | | | | - Hamit Kessely
- Centre de Support en Santé Internationale – Centre de Recherche en Anthropologie et Sciences Humaines (CSSI‐CRASH)N'JamenaChad
| | | | - Mercy Abbey
- Research and Development DivisionGhana Health ServicesAccraGhana
| | - Mary Sapali
- Ministry of Health Tanzania MainlandDar‐ es‐ SalaamTanzania
| | - Ali Omar
- Ministry of HealthZanzibarTanzania
| | | | - Rugola Mtandu
- Centre for Maternal and Newborn HealthDar‐es‐SalaamTanzania
| | | | | | - Nicholas Furtado
- The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM)GenevaSwitzerland
| | - Viviana Mangiaterra
- The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM)GenevaSwitzerland
| | - Nynke van den Broek
- Centre for Maternal and Newborn HealthLiverpool School of Tropical MedicineLiverpoolUK
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8
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McCauley H, Lowe K, Furtado N, Mangiaterra V, van den Broek N. What are the essential components of antenatal care? A systematic review of the literature and development of signal functions to guide monitoring and evaluation. BJOG 2022; 129:855-867. [PMID: 34839568 DOI: 10.1111/1471-0528.17029] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/29/2021] [Accepted: 11/22/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Antenatal care (ANC) is one of the key care packages required to reduce global maternal and perinatal mortality and morbidity. OBJECTIVES To identify the essential components of ANC and develop signal functions. SEARCH STRATEGY MESH headings for databases including Cinahl, Cochrane, Global Health, Medline, PubMed and Web of Science. SELECTION CRITERIA Papers and reports on content of ANC published from 2000 to 2020. DATA COLLECTION AND ANALYSIS Narrative synthesis of data and development of signal function through 7 consensus-building workshops with 184 stakeholders. MAIN RESULTS A total of 221 papers and reports are included from which 28 essential components of ANC were extracted and used to develop 15 signal functions with the equipment, medication and consumables required for implementation of each. Signal functions for the prevention and management of infectious diseases (malaria, HIV, tuberculosis, syphilis and tetanus) can be applied depending on population disease burden. Screening and management of pre-eclampsia, gestational diabetes, anaemia, mental and social health (including intimate partner violence) are recommended universally. Three signal functions address monitoring of fetal growth and wellbeing, and identification and management of obstetric complications. Promotion of health and wellbeing via education and support for nutrition, cessation of substance abuse, uptake of family planning, recognition of danger signs and birth preparedness are included as essential components of ANC. CONCLUSIONS New signal functions have been developed which can be used for monitoring and evaluation of content and quality of ANC. Country adaptation and validation is recommended.
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Affiliation(s)
- H McCauley
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Lowe
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - N Furtado
- The Global Fund for Aids Tuberculosis and Malaria, Geneva, Switzerland
| | - V Mangiaterra
- The Global Fund for Aids Tuberculosis and Malaria, Geneva, Switzerland
- Department of Government, Health and Not for Profit, SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - N van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Fonseca SC, de Carvalho ZSB, Kale PL, Boschi-Pinto C, Guimarães JCC. Trends in sociodemographic inequalities in prenatal care in Baixada Litorânea, a region of the state of Rio de Janeiro, Brazil, 2000-2020: an ecological study. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2022074. [PMID: 36351059 PMCID: PMC9887988 DOI: 10.1590/s2237-96222022000300006] [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: 02/26/2022] [Accepted: 07/27/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To analyze trends in sociodemographic inequalities in the access to and use of prenatal care in Baixada Litorânea, a region of the state of Rio de Janeiro, Brazil, 2000-2020. METHODS This was an ecological time-series study of the number of visits and adequacy of access to prenatal care. Absolute (differences) and relative (ratios) inequalities were calculated between extreme categories of variables; trends were estimated using joinpoint regression. RESULTS A total of 185,242 pregnant women were studied. A proportion of ≥ 7 visits increased annually by 2.4% (95%CI 1.1;3.7) between 2013 (54.4%) and 2020 (63.4%), stable for less than eight years of schooling. Adequacy of access increased 2.6% (95%CI 1.2;4.0) between 2014 and 2020, stable for women ≥ 35 years old and schooling ≥ 12 years. Absolute inequalities decreased (between 3.5% and 6.4%) for age and race/skin color, and relative inequalities decreased (between 7.7% and 20.0%) for all variables. CONCLUSION Access and number of prenatal consultations increased, however, remained lower for adolescents, women with low level of schooling and those of Black and mixed race/skin color.
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Affiliation(s)
- Sandra Costa Fonseca
- Universidade Federal Fluminense, Instituto de Saúde Coletiva,
Niterói, RJ, Brazil
| | | | - Pauline Lorena Kale
- Universidade Federal do Rio de Janeiro, Instituto de Estudos em
Saúde Coletiva, Rio de Janeiro, RJ, Brazil
| | - Cynthia Boschi-Pinto
- Universidade Federal Fluminense, Instituto de Saúde Coletiva,
Niterói, RJ, Brazil
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10
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Kabir MR. Adopting Andersen's behavior model to identify factors influencing maternal healthcare service utilization in Bangladesh. PLoS One 2021; 16:e0260502. [PMID: 34843566 PMCID: PMC8629289 DOI: 10.1371/journal.pone.0260502] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/10/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Equitable maternal healthcare service access and it's optimum utilization remains a challenge for many developing countries like Bangladesh, and different predisposing, enabling, and need-based factors affect the level of maternal healthcare use. The evidently poor maternal healthcare service utilization and disparities among groups in Bangladesh are concerning considering its effect on maternal health outcomes. The study aimed to identify the factors that influence maternal healthcare service (MHS) utilization in Bangladesh by adopting Andersen's behavior model of health service use as the theoretical framework. METHODS The 2017-18 Bangladesh Demographic Health Survey (2017-18 BDHS) data were used which is nationally representative. The survey study used two-stage stratified sampling to select study households, and data were collected through face-to-face interviews. The desirable, moderate, and undesirable maternal health service (MHS) package was developed based on antenatal, and delivery care services use during pregnancy and childbirth. Multinomial logistic regression and discriminant analysis were performed to analyze the factors that affect MHS use. RESULTS Out of 5,011 ever-married women, only 31.2% of women utilized the desirable level of MHS. The likelihood of using the desirable level of MHS package, relative to the undesirable category, was 9.38 times (OR: 9.38, 95% CI: 4.30-20.44) higher for women with a higher level of education compared to illiterate women, and the same trend was noticed for husband's education. The wealth index had the highest standardized function coefficients (Beta coefficient: 0.49) in discriminatory function. Women with the richest wealth index were more than 23 times (OR: 23.27, 95% CI: 12.69-42.68) likely to have utilized desirable MHS than their poorest counterparts. The likelihood of service uses also varied according to the child's birth order, administrative regions, and area of residence (rural vs. urban). CONCLUSIONS Policies and interventions directed towards poverty reduction, universal education, and diminishing geographical disparities of healthcare access might influence the desirable use of maternal healthcare services in Bangladesh.
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Affiliation(s)
- Md. Ruhul Kabir
- School of Communication, Hong Kong Baptist University, Kowloon Tong, Hong Kong
- Department of Food Technology & Nutrition Science, Noakhali Science & Technology University, Noakhali, Bangladesh
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11
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Chappell LC, Cluver CA, Kingdom J, Tong S. Pre-eclampsia. Lancet 2021; 398:341-354. [PMID: 34051884 DOI: 10.1016/s0140-6736(20)32335-7] [Citation(s) in RCA: 390] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/20/2020] [Accepted: 10/25/2020] [Indexed: 12/13/2022]
Abstract
Pre-eclampsia is a multisystem pregnancy disorder characterised by variable degrees of placental malperfusion, with release of soluble factors into the circulation. These factors cause maternal vascular endothelial injury, which leads to hypertension and multi-organ injury. The placental disease can cause fetal growth restriction and stillbirth. Pre-eclampsia is a major cause of maternal and perinatal mortality and morbidity, especially in low-income and middle-income countries. Prophylactic low-dose aspirin can reduce the risk of preterm pre-eclampsia, but once pre-eclampsia has been diagnosed there are no curative treatments except for delivery, and no drugs have been shown to influence disease progression. Timing of delivery is planned to optimise fetal and maternal outcomes. Clinical trials have reported diagnostic and prognostic strategies that could improve fetal and maternal outcomes and have evaluated the optimal timing of birth in women with late preterm pre-eclampsia. Ongoing studies are evaluating the efficacy, dose, and timing of aspirin and calcium to prevent pre-eclampsia and are evaluating other drugs to control hypertension or ameliorate disease progression.
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Affiliation(s)
- Lucy C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, Kings' College London, London, UK.
| | - Catherine A Cluver
- Department of Obstetrics and Gynaecology, Stellenbosch University, Stellenbosch, South Africa; Tygerberg Hospital, Cape Town, South Africa
| | - John Kingdom
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Stephen Tong
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia; Mercy Hospital for Women, Heidelberg, VIC, Australia
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Babughirana G, Gerards S, Mokori A, Baigereza IC, Mukembo A, Rukanda G, Kremers SPJ, Gubbels J. Can the Timed and Targeted Counseling Model Improve the Quality of Maternal and Newborn Health Care? A Process Analysis in the Rural Hoima District in Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094410. [PMID: 33919191 PMCID: PMC8122283 DOI: 10.3390/ijerph18094410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 11/27/2022]
Abstract
Each year, more than half a million women die worldwide from causes related to pregnancy and childbirth, and nearly 4 million newborns die within 28 days of birth. In Uganda, 15 women die every single day from pregnancy and childbirth-related causes, 94 babies are stillborn, and 81 newborn babies die. Cost-effective solutions for the continuum of care can be achieved through Village Health Teams to improve home care practices and health care-seeking behavior. This study aims at examining the implementation of the timed and targeted counseling (ttC) model, as well as improving maternal and newborn health care practices. We conducted a quantitative longitudinal study on pregnant mothers who were recruited on suspicion of the pregnancy and followed-up until six weeks post-delivery. The household register was the primary data source, which was collected through a secondary review of the ttC registers. All outcome and process variables were analyzed using descriptive statistics. The study enrolled 616 households from 64 villages across seven sub-counties in Hoima district with a 98.5% successful follow-up rate. Over the course of the implementation period of ttC, there was an increase of 29.6% in timely 1st antenatal care, 28.7% in essential newborn care, 25.5% in exclusive breastfeeding, and 17.5% in quality of antenatal care. All these improvements were statistically significant. The findings from this study show that the application of the ttC model through Village Health Teams has great potential to improve the quality of antenatal and newborn care and the health-seeking practices of pregnant and breastfeeding mothers in rural communities.
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Affiliation(s)
- Geoffrey Babughirana
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 GT Maastricht, The Netherlands; (S.G.); (S.P.J.K.); (J.G.)
- Correspondence:
| | - Sanne Gerards
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 GT Maastricht, The Netherlands; (S.G.); (S.P.J.K.); (J.G.)
| | - Alex Mokori
- Independent Researcher, 627 Ntinda, Kampala 10302, Uganda;
| | - Isaac Charles Baigereza
- World Vision International, Hoima Plot 15B, Nakasero Road, Kampala 5319, Uganda; (I.C.B.); (A.M.)
| | - Alex Mukembo
- World Vision International, Hoima Plot 15B, Nakasero Road, Kampala 5319, Uganda; (I.C.B.); (A.M.)
| | - Grace Rukanda
- Lutheran World Federation, Kyangwali Plot 1401 Gaba Road, Kampala 5827, Uganda;
| | - Stef P. J. Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 GT Maastricht, The Netherlands; (S.G.); (S.P.J.K.); (J.G.)
| | - Jessica Gubbels
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 GT Maastricht, The Netherlands; (S.G.); (S.P.J.K.); (J.G.)
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Kale PL, Fonseca SC, Oliveira PWMD, Brito ADS. Fetal and infant mortality trends according to the avoidability of causes of death and maternal education. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210008. [PMID: 33886881 DOI: 10.1590/1980-549720210008.supl.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate trends of fetal (FMR) and neonatal (NMR) mortality rates due to avoidable causes and maternal education in the city of Rio de Janeiro (2000-2018). METHODS Ecological time series study. Mortality and Live Birth Information System Data. The List of Avoidable Causes of Death Due to Interventions of the Brazilian Health System was used for neonatal deaths and an adaptation for fetal deaths, according to maternal education indicators (low <4 and high ≥12, years of study). Joinpoint regression models were used to estimate trends in FMR, based on one thousand births, and NMR, based on one thousand live births. RESULTS FMR decreased from 11.0 to 9.3% and NMR from 11.3 to 7.8% (2000/2018). In 2006, FMR (10.5%) exceeded NMR (9.0%), remaining higher. From 2000 to 2018, the annual decrease of FMR was 0.8% (2000 to 2018) and of NMR, 3.8% until 2007, decreasing to 1.1% by 2011; from then on, it remained stable. Avoidable causes, especially those reducible by adequate prenatal care, showed higher rates. Both FMR and NMR for low-education women were higher than those for the high-education level, the difference being much more pronounced for FMR, and at the end of the period: low- and high-education FMR were respectively 16.4 and 4.5% (2000) and 48.5 and 3.9% (2018), and for NMR, 18.2 and 6.7% (2000) and 28.4 and 5.0% (2018). CONCLUSION The favorable trend of decreasing mortality was not observed for children of mothers with low education, revealing inequalities. The causes were mostly avoidable, being related to prenatal care and childbirth.
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Affiliation(s)
- Pauline Lorena Kale
- Institute of Collective Health Studies, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
| | - Sandra Costa Fonseca
- Institute of Collective Health, Universidade Federal Fluminense, Niterói (RJ), Brazil
| | | | - Alexandre Dos Santos Brito
- Institute of Collective Health Studies, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
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Tessema AM, Gebeyehu A, Mekonnen S, Alemu K, Tigabu Z. Intervention fidelity and its determinants of focused antenatal care package implementation, in south Wollo zone, Northeast Ethiopia. BMC Pregnancy Childbirth 2021; 21:150. [PMID: 33607962 PMCID: PMC7893970 DOI: 10.1186/s12884-021-03637-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 02/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Focused antenatal care is directed at sustaining maternal health and improving fetal wellbeing to ensure birth of a healthy neonate. Failure to implement focused antenatal care can result in inability to reduce maternal and perinatal morbidity and mortality in low income countries. Due to evidence-practice gaps, however, thousands of maternal, fetal and neonatal lives are still lost every day, mostly from preventable causes. This study aimed to assess focused antenatal care package’s intervention fidelity and its determinant factors in South Wollo Zone, Northeast Ethiopia. Methods A cross-sectional study design was employed and a total of 898 women who gave birth in the last 6 months prior to data collection were included. Also 16 health extension workers, working in ten selected health posts, were included. Interviews and self-administered questionnaires were used to collect data from mothers and health extension workers. Ten [10] health posts were audited to assess availability and functionality of drugs and supplies to provide focused antenatal care. Mothers were asked whether or not the required level of care was provided. Health extension workers were provided with self-administered questionnaires to assess socio-demographic characteristics, reception of training, facilitation strategies for the implementation of focused antenatal care and ability to classify danger signs. Multilevel linear regression analysis was performed to identify individual and organizational level’s factors influencing focused antenatal care package intervention fidelity. Results Overall weighted average focused antenatal care package intervention fidelity (implemented as intended/planned) was 49.8% (95% CI: 47.7–51.8), which means the average number of focused antenatal care package interventions women received is 49.8%. Health extension workers implemented 55.1% and skilled providers (nurses, midwives, health officers or medical doctors) 44.9% of focused antenatal care package interventions. Overall antenatal care coverage, irrespective of frequency (at least one visit), was 752/898 women (83.7%; 95% CI: 81.3–86.1); 263/752 women (35.0%; 95% CI: 31.6–38.4) received at least four antenatal visits and only 46/752 women (6.1%; 95% CI: 4.4–7.8) received all recommended components of focused antenatal care. Previous pregnancy-related problems, paternal education and implementation of facilitation strategies were found to be significant factors enhancing focused antenatal care package intervention fidelity. Conclusion Focused antenatal care package intervention fidelity in the study area was low; this may imply that the current level of maternal, perinatal and neonatal mortality might be partly due to the low level of focused antenatal care intervention fidelity. Improving implementation of facilitation strategies is highly required to contribute to the reduction of those mortalities.
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Affiliation(s)
| | - Abebaw Gebeyehu
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Solomon Mekonnen
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Zemene Tigabu
- Department of Pediatrics and Child Health, University of Gondar, Gondar, Ethiopia
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15
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Saran A, White H, Albright K, Adona J. Mega-map of systematic reviews and evidence and gap maps on the interventions to improve child well-being in low- and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2020; 16:e1116. [PMID: 37018457 PMCID: PMC8356294 DOI: 10.1002/cl2.1116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Despite a considerable reduction in child mortality, nearly six million children under the age of five die each year. Millions more are poorly nourished and in many parts of the world, the quality of education remains poor. Children are at risk from multiple violations of their rights, including child labour, early marriage, and sexual exploitation. Research plays a crucial role in helping to close the remaining gaps in child well-being, yet the global evidence base for interventions to meet these challenges is mostly weak, scattered and often unusable by policymakers and practitioners. This mega-map encourages the generation and use of rigorous evidence on effective ways to improve child well-being for policy and programming. Objectives The aim of this mega-map is to identify, map and provide an overview of the existing evidence synthesis on the interventions aimed at improving child well-being in low- and middle-income countries (LMICs). Methods Campbell evidence and gap maps (EGMs) are based on a review of existing mapping standards (Saran & White, 2018) which drew in particular of the approach developed by 3ie (Snilstveit, Vojtkova, Bhavsar, & Gaarder, 2013). As defined in the Campbell EGM guidance paper; "Mega-map is a map of evidence synthesis, that is, systematic reviews, and does not include primary studies" (Campbell Collaboration, 2020). The mega-map on child well-being includes studies with participants aged 0-18 years, conducted in LMICs, and published from year 2000 onwards. The search followed strict inclusion criteria for interventions and outcomes in the domains of health, education, social work and welfare, social protection, environmental health, water supply and sanitation (WASH) and governance. Critical appraisal of included systematic reviews was conducted using "A Measurement Tool to Assess Systematic Reviews"-AMSTAR-2 rating scale (Shea, et al., 2017). Results We identified 333 systematic reviews and 23 EGMs. The number of studies being published has increased year-on-year since 2000. However, the distribution of studies across World Bank regions, intervention and outcome categories are uneven. Most systematic reviews examine interventions pertaining to traditional areas of health and education. Systematic reviews in these traditional areas are also the most funded. There is limited evidence in social work and social protection. About 69% (231) of the reviews are assessed to be of low and medium quality. There are evidence gaps with respect to key vulnerable populations, including children with disabilities and those who belong to minority groups. Conclusion Although an increasing number of systematic reviews addressing child well-being topics are being published, some clear gaps in the evidence remain in terms of quality of reviews and some interventions and outcome areas. The clear gap is the small number of reviews focusing explicitly on either equity or programmes for disadvantaged groups and those who are discriminated against.
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Affiliation(s)
| | | | | | - Jill Adona
- Philippines Institute of Development StudiesManilaPhilippines
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16
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Morón-Duarte LS, Ramirez Varela A, Segura O, Freitas da Silveira M. Quality assessment indicators in antenatal care worldwide: a systematic review. Int J Qual Health Care 2020; 31:497-505. [PMID: 30295805 DOI: 10.1093/intqhc/mzy206] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 08/15/2018] [Accepted: 09/14/2018] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To describe indicators used for the assessment of antenatal care (ANC) quality worldwide under the World Health Organization (WHO) framework and based on a systematic review of the literature. DATA SOURCES Searches were performed in MEDLINE, SciELO, BIREME and Web of Science for eligible studies published between January 2002 and September 2016. STUDY SELECTION Original articles describing women who had received ANC, any ANC model and, any ANC quality indicators were included. DATA EXTRACTION Publication date, study design and ANC process indicators were extracted. RESULTS OF DATA SYNTHESIS Of the total studies included, 69 evaluated at least one type of ANC process indicator. According to WHO ANC guidelines, 8.7% of the articles reported healthy eating counseling and 52.2% iron and folic acid supplementation. The evaluation indicators on maternal and fetal interventions were: syphilis testing (55.1%), HIV testing (47.8%), gestational diabetes mellitus screening (40.6%) and ultrasound (27.5%). Essential ANC activities assessment ranged from 26.1% report of fetal heart sound, 50.7% of maternal weight and 63.8% of blood pressure. Regarding preventive measures recommended by WHO, tetanus vaccine was reported in 60.9% of the articles. Interventions performed by health services to improve use and quality of ANC care, promotion of maternal and fetal health, and the number of visits to the ANC were evaluated in 65.2% of the studies. CONCLUSION Numerous ANC content indicators are being used to assess ANC quality. However, there is a need to use standardized indicators across countries and efforts to improve quality evaluation.
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Affiliation(s)
- Lina Sofia Morón-Duarte
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Andrea Ramirez Varela
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Omar Segura
- SMC-AS Research Unit - Segura, Moron & Castañeda Health Consultants Ltd., Bogotá, D.C., Colombia
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17
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Chirwa E, Kapito E, Jere DL, Kafulafula U, Chodzaza E, Chorwe-Sungani G, Gresh A, Liu L, Abrams ET, Klima CS, McCreary LL, Norr KF, Patil CL. An effectiveness-implementation hybrid type 1 trial assessing the impact of group versus individual antenatal care on maternal and infant outcomes in Malawi. BMC Public Health 2020; 20:205. [PMID: 32039721 PMCID: PMC7008527 DOI: 10.1186/s12889-020-8276-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa has the world's highest rates of maternal and perinatal mortality and accounts for two-thirds of new HIV infections and 25% of preterm births. Antenatal care, as the entry point into the health system for many women, offers an opportunity to provide life-saving monitoring, health promotion, and health system linkages. Change is urgently needed, because potential benefits of antenatal care are not realized when pregnant women experience long wait times and short visits with inconsistent provisioning of essential services and minimal health promotion, especially for HIV prevention. This study answers WHO's call for the rigorous study of group antenatal care as a transformative model that provides a positive pregnancy experience and improves outcomes. METHODS Using a hybrid type 1 effectiveness-implementation design, we test the effectiveness of group antenatal care by comparing it to individual care across 6 clinics in Blantyre District, Malawi. Our first aim is to evaluate the effectiveness of group antenatal care through 6 months postpartum. We hypothesize that women in group care and their infants will have less morbidity and mortality and more positive HIV prevention outcomes. We will test hypotheses using multi-level hierarchical models using data from repeated surveys (four time points) and health records. Guided by the consolidated framework for implementation research, our second aim is to identify contextual factors related to clinic-level degree of implementation success. Analyses use within and across-case matrices. DISCUSSION This high-impact study addresses three global health priorities, including maternal and infant mortality, HIV prevention, and improved quality of antenatal care. Results will provide rigorous evidence documenting the effectiveness and scalability of group antenatal care. If results are negative, governments will avoid spending on less effective care. If our study shows positive health impacts in Malawi, the results will provide strong evidence and valuable lessons learned for widespread scale-up in other low-resource settings. Positive maternal, neonatal, and HIV-related outcomes will save lives, impact the quality of antenatal care, and influence health policy as governments make decisions about whether to adopt this innovative healthcare model. TRIAL REGISTRATION ClinicalTrials.gov registration number NCT03673709. Registered on September 17, 2018.
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Affiliation(s)
- Ellen Chirwa
- University of Malawi, Kamuzu College of Nursing, PO Box 415, Blantyre, Malawi
| | - Esnath Kapito
- University of Malawi, Kamuzu College of Nursing, PO Box 415, Blantyre, Malawi
| | - Diana L Jere
- University of Malawi, Kamuzu College of Nursing, PO Box 415, Blantyre, Malawi
| | - Ursula Kafulafula
- University of Malawi, Kamuzu College of Nursing, PO Box 415, Blantyre, Malawi
| | - Elizabeth Chodzaza
- University of Malawi, Kamuzu College of Nursing, PO Box 415, Blantyre, Malawi
| | | | - Ashley Gresh
- Johns Hopkins University, School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Li Liu
- University of Illinois at Chicago, School of Public Health, 1603 W. Taylor Street (M/C 932), Chicago, IL, 60612, USA
| | - Elizabeth T Abrams
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
| | - Carrie S Klima
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
| | - Linda L McCreary
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
| | - Kathleen F Norr
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
| | - Crystal L Patil
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA.
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18
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Doctor HV, Radovich E, Benova L. Time trends in facility-based and private-sector childbirth care: analysis of Demographic and Health Surveys from 25 sub-Saharan African countries from 2000 to 2016. J Glob Health 2019; 9:020406. [PMID: 31360446 PMCID: PMC6644920 DOI: 10.7189/jogh.09.020406] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Africa, and sub-Saharan Africa in particular, remains one of the regions with modest improvements to maternal and newborn survival and morbidity. Good quality intrapartum and early postpartum care in a health facility as well as delivery under the supervision of trained personnel is associated with improved maternal and newborn health outcomes and decreased mortality. We describe and contrast recent time trends in the scale and socio-economic inequalities in facility-based and private facility-based childbirth in sub-Saharan Africa. Methods We used Demographic and Health Surveys in two time periods (2000-2007 and 2008-2016) to analyse levels and time trends in facility-based and private facility-based deliveries for all live births in the five-year survey recall period to women aged 15-49. Household wealth quintiles were used for equity analysis. Absolute numbers of births by facility sector were calculated applying UN Population Division crude birth rates to the total country population. Results The percentage of all live births occurring in health facilities varied across countries (5%-85%) in 2000-2007. In 2008-2016, this ranged from 22% to 92%. The lowest percentage of all births occurring in private facilities in 2000-2007 period was in Ethiopia (0.3%) and the highest in the Democratic Republic of Congo at 20.5%. By 2008-2016, this ranged from 0.6% in Niger to 22.3% in Gabon. Overall, the growth in the absolute numbers of births in facilities outpaced the growth in the percentage of births in facilities. The largest increases in absolute numbers of births occurred in public sector facilities in all countries. Overall, the percentage of births occurring in facilities was significantly lower for poorest compared to wealthiest women. As the percentage of facility births increased in all countries over time, the extent of wealth-based differences had reduced between the two time periods in most countries (median risk ratio in 2008-2016 was 2.02). The majority of countries saw a narrowing in both the absolute and relative difference in facility-based deliveries between poorest and wealthiest. Conclusions The growth in facility-based deliveries, which was largely driven by the public sector, calls for increased investments in effective interventions to improve service delivery and quality of life for the mother and newborn. The goal of universal health coverage to provide better quality services can be achieved by deploying interventions that are holistic in managing and regulating the private sector to enhance performance of the health care system in its entirety rather than interventions that only target service delivery in one sector.
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Affiliation(s)
- Henry Victor Doctor
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Emma Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Abstract
Pre-eclampsia is a common disorder that particularly affects first pregnancies. The clinical presentation is highly variable but hypertension and proteinuria are usually seen. These systemic signs arise from soluble factors released from the placenta as a result of a response to stress of syncytiotrophoblast. There are two sub-types: early and late onset pre-eclampsia, with others almost certainly yet to be identified. Early onset pre-eclampsia arises owing to defective placentation, whilst late onset pre-eclampsia may center around interactions between normal senescence of the placenta and a maternal genetic predisposition to cardiovascular and metabolic disease. The causes, placental and maternal, vary among individuals. Recent research has focused on placental-uterine interactions in early pregnancy. The aim now is to translate these findings into new ways to predict, prevent, and treat pre-eclampsia.
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Affiliation(s)
- Graham J Burton
- Department of Physiology, Development & Neuroscience, University of Cambridge, UK
- Centre for Trophoblast Research, University of Cambridge, UK
| | | | - James M Roberts
- Magee-Womens Research Institute, Depts. Obstetric Gynecology and Reproductive Sciences, Epidemiology, and Clinical and Translational Research, University of Pittsburgh, USA
| | - Ashley Moffett
- Centre for Trophoblast Research, University of Cambridge, UK
- Dept of Pathology, University of Cambridge, UK
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Kochhar S, Edwards KM, Ropero Alvarez AM, Moro PL, Ortiz JR. Introduction of new vaccines for immunization in pregnancy - Programmatic, regulatory, safety and ethical considerations. Vaccine 2019; 37:3267-3277. [PMID: 31072733 PMCID: PMC6771279 DOI: 10.1016/j.vaccine.2019.04.075] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 12/11/2022]
Abstract
Immunizing pregnant women is a promising strategy to reduce infectious disease-related morbidity and mortality in pregnant women and their infants. Important pre-requisites for the successful introduction of new vaccines for immunization in pregnancy include political commitment and adequate financial resources: trained, committed and sufficient numbers of healthcare workers to deliver the vaccines; close integration of immunization programs with antenatal care and Maternal and Child Health services; adequate access to antenatal care by pregnant women in the country (especially in low and middle-income countries (LMIC)); and a high proportion of births occurring in health facilities (to ensure maternal and neonatal follow-up can be done). The framework needed to advance a vaccine program from product licensure to successful country-level implementation includes establishing and organizing evidence for anticipated vaccine program impact, developing supportive policies, and translating policies into local action. International and national coordination efforts, proactive planning from conception to implementation of the programs (including country-level policy making, planning, and implementation, regulatory guidance, pharmacovigilance) and country-specific and cultural factors must be taken into account during the vaccines introduction.
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Affiliation(s)
- Sonali Kochhar
- Global Healthcare Consulting, New Delhi, India; Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Global Health, University of Washington, Seattle, USA.
| | - Kathryn M Edwards
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, TN, USA
| | - Alba Maria Ropero Alvarez
- Comprehensive Family Immunization Unit, Department of Family, Health Promotion and Life Course (FPL). Pan American Health Organization (PAHO/WHO), Washington DC, USA
| | - Pedro L Moro
- Immunization Safety Office, Division Of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, USA
| | - Justin R Ortiz
- Department of Global Health, University of Washington, Seattle, USA; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
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21
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Olivia Kim U, Barnekow K, Ahamed SI, Dreier S, Jones C, Taylor M, Hasan MK, Basir MA. Smartphone-based prenatal education for parents with preterm birth risk factors. PATIENT EDUCATION AND COUNSELING 2019; 102:701-708. [PMID: 30396713 PMCID: PMC6440855 DOI: 10.1016/j.pec.2018.10.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/20/2018] [Accepted: 10/26/2018] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To develop an educational mobile application (app) for expectant parents diagnosed with risk factors for premature birth. METHODS Parent and medical advisory panels delineated the vision for the app. The app helps prepare for preterm birth. For pilot testing, obstetricians offered the app between 18-22 weeks gestational age to English speaking parents with risk factors for preterm birth. After 4 weeks of use, each participant completed a questionnaire. The software tracked topics accessed and duration of use. RESULTS For pilot testing, 31 participants were recruited and 28 completed the questionnaire. After app utilization, participants reported heightened awareness of preterm birth (93%), more discussion of pregnancy or prematurity issues with partner (86%), increased questions at clinic visits (43%), and increased anxiety (21%). Participants reported receiving more prematurity information from the app than from their healthcare providers. The 15 participants for whom tracking data was available accessed the app for an average of 8 h. CONCLUSION Parents with increased risk for preterm birth may benefit from this mobile app educational program. PRACTICE IMPLICATIONS If the pregnancy results in preterm birth hospitalization, parents would have built a foundation of knowledge to make informed medical care choices.
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Affiliation(s)
| | - K Barnekow
- University of Wisconsin Milwaukee, Milwaukee, USA
| | | | - S Dreier
- Parent Advocate, Milwaukee, WI, USA
| | - C Jones
- Medical College of Wisconsin, Milwaukee, USA
| | - M Taylor
- Moreland Obstetrics and Gynecology, Waukesha, USA
| | | | - M A Basir
- Medical College of Wisconsin, Milwaukee, USA.
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Gandhi K, Montoya‐Uribe V, Martinez S, David S, Jain B, Shim G, Li C, Jenkins S, Nathanielsz P, Schlabritz‐Loutsevitch N. Ontogeny and programming of the fetal temporal cortical endocannabinoid system by moderate maternal nutrient reduction in baboons (Papio spp.). Physiol Rep 2019; 7:e14024. [PMID: 30912236 PMCID: PMC6434170 DOI: 10.14814/phy2.14024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 12/24/2022] Open
Abstract
Poor nutrition during pregnancy is a worldwide public health problem. Maternal nutrient reduction (MNR) is associated with maternal and fetal stress and a sex-dependent decrease in nonhuman primate (NHP) cognitive performance. Early life stress potentiates epileptogenesis in a sex-specific manner, and temporal lobe (TL) epilepsy is associated with neurocognitive disorders. The endogenous cannabinoid system (ECS) demonstrates remarkable developmental changes and plays a key role in aging-related diseases (e.g., dementia). Baboons have been studied as a natural model of epilepsy and express all ECS system components. We therefore evaluated baboon fetal temporal cortex ECS ontogenic and MNR-dependent changes. At 120 days gestational age (dGA) (term 185 days), maternal, fetal, and placental morphometry were similar between control and MNR pregnancies. MNR maternal weight gain was decreased compared with controls at 165 dGA independent of fetal sex. In male fetuses, expression of ECS synthesizing and degrading enzymes was gestational age-dependent, with the exception of fatty acid amide hydrolase (FAAH). MNR had a sex-specific effect on the protein expression of CB1R during development: CB1R protein expression was decreased in fetal temporal cortex of male fetuses at 120 and 140 dGA. Our data reveal that the MNR has sex-specific effects on temporal cortical expression of the ECS in baboon offspring and shows vulnerability of ECS in male fetuses during gestation.
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MESH Headings
- Amidohydrolases/genetics
- Amidohydrolases/metabolism
- Animal Nutritional Physiological Phenomena
- Animals
- Caloric Restriction
- Endocannabinoids/genetics
- Endocannabinoids/metabolism
- Female
- Fetal Development
- Gene Expression Regulation, Developmental
- Gene Expression Regulation, Enzymologic
- Gestational Age
- Male
- Maternal Nutritional Physiological Phenomena
- Papio
- Pregnancy
- Receptor, Cannabinoid, CB1/genetics
- Receptor, Cannabinoid, CB1/metabolism
- Receptor, Cannabinoid, CB2/genetics
- Receptor, Cannabinoid, CB2/metabolism
- Sex Factors
- Signal Transduction
- Temporal Lobe/growth & development
- Temporal Lobe/metabolism
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Affiliation(s)
- Kushal Gandhi
- Department of Obstetrics and GynecologyTexas Tech University Health sciences Center at the Permian BasinOdessaTexas
| | | | - Stacy Martinez
- Department of Obstetrics and GynecologyTexas Tech University Health sciences Center at the Permian BasinOdessaTexas
| | - Samuel David
- Department of ChemistryUniversity of Texas at the Permian BasinOdessaTexas
| | - Bobby Jain
- Department of PsychiatryTexas Tech University Health Sciences Center at the Permian BasinOdessaTexas
| | - Grace Shim
- Department of Obstetrics and GynecologyTexas Tech University Health sciences Center at the Permian BasinOdessaTexas
| | - Cun Li
- University of WyomingLaramieWyoming
- Texas Biomedical Research InstituteSan AntonioTexas
| | - Susan Jenkins
- University of WyomingLaramieWyoming
- Texas Biomedical Research InstituteSan AntonioTexas
| | - Peter Nathanielsz
- University of WyomingLaramieWyoming
- Texas Biomedical Research InstituteSan AntonioTexas
| | - Natalia Schlabritz‐Loutsevitch
- Department of Obstetrics and GynecologyTexas Tech University Health sciences Center at the Permian BasinOdessaTexas
- Department of BiologyUniversity of Texas at the Permian BasinOdessaTexas
- Department of Neurobiology and PharmacologyTexas Tech University Health Sciences CenterLubbockTexas
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Abstract
Universal health care (UHC) is garnering growing support throughout the world, a reflection of social and economic progress and of the recognition that population health is both an indicator and an instrument of national development. Substantial human and financial resources will be required to achieve UHC in any of the various ways it has been conceived and defined. Progress toward achieving UHC will be aided by new technologies, a willingness to shift medical tasks from highly trained to appropriately well-trained personnel, a judicious balance between the quantity and quality of health care services, and resource allocation decisions that acknowledge the important role of public health interventions and nonmedical influences on population health.
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Affiliation(s)
- David E Bloom
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Alexander Khoury
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Ramnath Subbaraman
- Center for Global Public Health and the Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA
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24
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Fekadu GA, Kassa GM, Berhe AK, Muche AA, Katiso NA. The effect of antenatal care on use of institutional delivery service and postnatal care in Ethiopia: a systematic review and meta-analysis. BMC Health Serv Res 2018; 18:577. [PMID: 30041655 PMCID: PMC6056996 DOI: 10.1186/s12913-018-3370-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 07/09/2018] [Indexed: 11/24/2022] Open
Abstract
Background Although there are many initiatives to improve maternal health services use, utilization of health facility delivery and postnatal care services is low in Ethiopia. Current evidence at global level showed that antenatal care increases delivery and postnatal care services use. But previous studies in Ethiopia indicate contrasting results. Therefore, this meta-analysis was done to identify the effect of antenatal care on institutional delivery and postnatal care services use in Ethiopia. Methods Studies were searched from databases using keywords like place of birth, institutional delivery, and delivery by a skilled attendant, health facility delivery, delivery care, antenatal care, prenatal care and postnatal care and Ethiopia as search terms. The Joanna Briggs Critical Appraisal Tools and the Preferred Reporting Items for Systematic Review and Meta-Analyses were used for quality assessment and data extraction. Data analysis was done using STATA 14. Heterogeneity and publication bias were assessed using I2 test statistic and Egger’s test of significance. Forest plots were used to present the odds ratio (OR) with 95% confidence interval (CI). Result A total of 40 articles with a total sample size of 26,350 were included for this review and meta-analysis. Mothers who had attended one or more antenatal care visits were more likely (OR = 4.07: 95% CI 2.75, 6.02) to deliver at health institutions compared to mothers who did not attend antenatal care. Similarly, mothers who reported antenatal care use were about four times more likely to attend postnatal care service (OR 4.11, 95% CI: 3.32, 5.09). Conclusion Women who attended antenatal care are more likely to deliver in health institutions and attend postnatal care. Therefore, the Ethiopian government and other stakeholders should design interventions that can increase antenatal care uptake since it has a multiplicative effect on health facility delivery and postnatal care services use. Further qualitative research is recommended to identify why the huge gap exists between antenatal care and institutional delivery and postnatal care services use in Ethiopia.
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Affiliation(s)
- Gedefaw Abeje Fekadu
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia.
| | | | | | - Achenef Asmamaw Muche
- Department of Epidemiology and Biostatistics, Institute of public health, University of Gondar, Gondar, Ethiopia
| | - Nuradin Abusha Katiso
- Department of Nursing, College of Health Sciences and Medicine, Woliata Sodo University, Woliata Sodo, Ethiopia
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25
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Benova L, Tunçalp Ö, Moran AC, Campbell OMR. Not just a number: examining coverage and content of antenatal care in low-income and middle-income countries. BMJ Glob Health 2018; 3:e000779. [PMID: 29662698 PMCID: PMC5898334 DOI: 10.1136/bmjgh-2018-000779] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Antenatal care (ANC) provides a critical opportunity for women and babies to benefit from good-quality maternal care. Using 10 countries as an illustrative analysis, we described ANC coverage (number of visits and timing of first visit) and operationalised indicators for content of care as available in population surveys, and examined how these two approaches are related. METHODS We used the most recent Demographic and Health Survey to analyse ANC related to women's most recent live birth up to 3 years preceding the survey. Content of care was assessed using six components routinely measured across all countries, and a further one to eight additional country-specific components. We estimated the percentage of women in need of ANC, and using ANC, who received each component, the six routine components and all components. RESULTS In all 10 countries, the majority of women in need of ANC reported 1+ ANC visits and over two-fifths reported 4+ visits. Receipt of the six routine components varied widely; blood pressure measurement was the most commonly reported component, and urine test and information on complications the least. Among the subset of women starting ANC in the first trimester and receiving 4+ visits, the percentage receiving all six routinely measured ANC components was low, ranging from 10% (Jordan) to around 50% in Nigeria, Nepal, Colombia and Haiti. CONCLUSION Our findings suggest that even among women with patterns of care that complied with global recommendations, the content of care was poor. Efficient and effective action to improve care quality relies on development of suitable content of care indicators.
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Affiliation(s)
- Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Özge Tunçalp
- Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland
| | - Oona Maeve Renee Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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26
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Luyckx VA, Tuttle KR, Garcia-Garcia G, Gharbi MB, Heerspink HJL, Johnson DW, Liu ZH, Massy ZA, Moe O, Nelson RG, Sola L, Wheeler DC, White SL. Reducing major risk factors for chronic kidney disease. Kidney Int Suppl (2011) 2017; 7:71-87. [PMID: 30675422 DOI: 10.1016/j.kisu.2017.07.003] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Chronic kidney disease (CKD) is a global public health concern and a key determinant of poor health outcomes. While the burden of CKD is reasonably well defined in developed countries, increasing evidence indicates that the CKD burden may be even greater in developing countries. Diabetes, hypertension, and obesity are major contributors to the global burden of the disease and are important traditional CKD risk factors; however, nontraditional CKD risk factors such as nephrotoxin exposure, kidney stones, fetal and maternal factors, infections, environmental factors, and acute kidney injury are also increasingly being recognized as major threats to global kidney health. A broad approach to CKD prevention begins with the identification of CKD risk factors in the population, followed by the development of appropriate mitigation strategies. Effective prevention policies rely on an accurate understanding of the incidence and prevalence of CKD in a given setting, as well as the distribution and burden of risk factors. Populations or individuals at CKD risk must be screened and treated early to prevent the onset of and delay the progression of the kidney disease. Systematically collected data should be analyzed at country, province, and district levels to identify regional disparities and CKD hotspots and develop targeted prevention strategies. Race-ethnicity, genetics, sex, socioeconomic status, and geography are likely modifiers of CKD risk. A comprehensive, informed approach to prevention that takes into account all of these factors is therefore required to successfully tackle the global CKD epidemic.
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Affiliation(s)
- Valerie A Luyckx
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.,Klinik für Nephrologie, Universitätsspital, Zurich, Switzerland
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Health Care Kidney Research Institute, Nephrology Division and Institute for Translational Health Sciences, University of Washington, Spokane, Washington, USA
| | - Guillermo Garcia-Garcia
- Servicio de Nefrologia, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital 278, Guadalajara, Jalisco, Mexico
| | - Mohammed Benghanem Gharbi
- Urinary Tract Diseases Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - David W Johnson
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré Hospital, APHP, Boulogne Billancourt/Paris, France.,French National Institute of Health and Medical Research (INSERM) U1018, Team5, Centre for Research in Epidemiology and Population Health (CESP), Paris-Ile-de-France-West, Versailles-Saint-Quentin-en-Yvelines University, Villejuif, France
| | - Orson Moe
- Department of Internal Medicine and Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
| | - Laura Sola
- Division Epidemiologia, Direccion General de Salud (DIGESA)-Ministerio Salud Publica, Montevideo, Uruguay
| | - David C Wheeler
- Centre for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Sarah L White
- Charles Perkins Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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27
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Lori JR, Ofosu-Darkwah H, Boyd CJ, Banerjee T, Adanu RMK. Improving health literacy through group antenatal care: a prospective cohort study. BMC Pregnancy Childbirth 2017; 17:228. [PMID: 28705179 PMCID: PMC5513199 DOI: 10.1186/s12884-017-1414-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 07/05/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To examine whether exposure to group antenatal care increased women's health literacy by improving their ability to interpret and utilize health messages compared to women who received standard, individual antenatal care in Ghana. METHODS We used a prospective cohort design. The setting was a busy urban district hospital in Kumasi, the second most populous city in Ghana. Pregnant women (N = 240) presenting for their first antenatal visit between 11 and 14 weeks gestation were offered participation in the study. A 27% drop-out rate was experienced due to miscarriage, transfer or failure to return for follow-up visits, leaving 184 women in the final sample. Data were collected using an individual structured survey and medical record review. Summary statistics as well as two sample t-tests or chi-square were performed to evaluate the group effect. RESULTS Significant group differences were found. Women participating in group care demonstrated improved health literacy by exhibiting a greater understanding of how to operationalize health education messages. There was a significant difference between women enrolled in group antenatal care verses individual antenatal care for preventing problems before delivery, understanding when to access care, birth preparedness and complication readiness, intent to use a modern method of family planning postpartum, greater understanding of the components of breastfeeding and lactational amenorrhea for birth spacing, and intent for postpartum follow-up. CONCLUSION Group antenatal care as compared to individual care offers an opportunity to increase quality of care and improve maternal and newborn outcomes. Group antenatal care holds the potential to increase healthy behaviors, promote respectful maternity care, and generate demand for services. Group ANC improves women's health literacy on how to prevent and recognize problems, prepare for delivery, and care for their newborn.
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Affiliation(s)
- Jody R. Lori
- Department of Health Behavior and Biological Sciences, University of Michigan, School of Nursing, 400 N. Ingalls Bldg, Ann Arbor, MI 48109 USA
| | | | - Carol J. Boyd
- Department of Health Behavior and Biological Sciences, University of Michigan, School of Nursing, 400 N. Ingalls Bldg, Ann Arbor, MI 48109 USA
| | - Tanima Banerjee
- Institute for Health Care Policy & Innovation, University of Michigan, NCAC Bldg 16, SPC 2800, Ann Arbor, MI 48109 USA
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