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Okonofua F, Ekezue BF, Ntoimo LF, Ohenhen V, Agholor K, Imongan W, Ogu R, Galadanci H. Outcomes of a multifaceted intervention to prevent eclampsia and eclampsia-related deaths in Nigerian referral facilities. Int Health 2024; 16:293-301. [PMID: 37386659 PMCID: PMC11062200 DOI: 10.1093/inthealth/ihad044] [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: 03/28/2023] [Revised: 05/01/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Eclampsia causes maternal mortality in Nigeria. This study presents the effectiveness of multifaceted interventions that addressed institutional barriers in reducing the incidence and case fatality rates associated with eclampsia. METHODS The design was quasi-experimental and the activities implemented at intervention hospitals included a new strategic plan, retraining health providers on eclampsia management protocols, clinical reviews of delivery care and educating pregnant women and their partners. Prospective data were collected monthly on eclampsia and related indicators from study sites over 2 y. The results were analysed by univariate, bivariate and multivariable logistic regression. RESULTS The results show a higher eclampsia rate (5.88% vs 2.45%) and a lower use of partograph and antenatal care (ANC; 17.99% vs 23.42%) in control compared with intervention hospitals, but similar case fatality rates of <1%. Overall, adjusted analysis shows a 63% decrease in the odds of eclampsia at intervention compared with control hospitals. Factors associated with eclampsia were ANC, referral for care from other facilities and older maternal age. CONCLUSION We conclude that multifaceted interventions that address challenges associated with managing pre-eclampsia and eclampsia in health facilities can reduce eclampsia occurrence in referral facilities in Nigeria and potential eclampsia death in resource-poor African countries.
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Affiliation(s)
- Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria
- Department of Obstetrics and Gynaecology, University of Benin and University of Benin Teaching Hospital, Benin City, Nigeria
- Women's Health and Action Research Centre, Benin City, Nigeria
| | - Bola F Ekezue
- Broadwell College of Business and Economics, Fayetteville State University, Fayetteville, NC, USA
| | - Lorretta Favour Ntoimo
- Women's Health and Action Research Centre, Benin City, Nigeria
- Department of Demography and Social Statistics, Federal University Oye-Ekiti, Nigeria
| | - Victor Ohenhen
- Department of Obstetrics and Gynaecology, Central Hospital Benin City, Benin City, Nigeria
| | - Kingsley Agholor
- Department of Obstetrics and Gynaecology/Anti-Retroviral Therapy Centre, Central Hospital, Warri, Delta State, Nigeria
| | - Wilson Imongan
- Women's Health and Action Research Centre, Benin City, Nigeria
| | - Rosemary Ogu
- Department of Obstetrics and Gynaecology, University of Port Harcourt, Rivers State, Nigeria
| | - Hadiza Galadanci
- Department of Obstetrics and Gynaecology, Bayero University, Kano, Nigeria
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Irangani L, Prasanna IR, Gunarathne SP, Shanthapriya SH, Wickramasinghe ND, Agampodi SB, Agampodi TC. Social determinants of health pave the path to maternal deaths in rural Sri Lanka: reflections from social autopsies. Reprod Health 2022; 19:221. [PMID: 36471339 PMCID: PMC9724344 DOI: 10.1186/s12978-022-01527-2] [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: 04/22/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ending preventable maternal deaths remains a challenge in low- and middle-income countries (LMICs). Society perceived causes and real-life observations can reveal the intangible causes of maternal deaths irrespective of formal maternal death investigations. This study reports complex patterns in which social determinants act towards paving the path to maternal deaths in a rural Sri Lankan setting. METHODS We conducted social autopsies for 15/18 maternal deaths (in two consecutive years during the past decade) in district A (pseudonymized). In-depth interviews of 43 respondents and observations were recorded in the same field sites. During thematic analysis, identified themes were further classified according to the World Health Organization framework for social determinants of health (SDH). The patterns between themes and clustering of social determinants based on the type of maternal deaths were analyzed using mixed methods. RESULTS Discernable social causes underpinned 12 out of 15 maternal deaths. Extreme poverty, low educational level, gender inequity, and elementary or below-level occupations of the husband were the characteristic structural determinants of most deceased families. Social isolation was the commonest leading cause manifesting as a reason for many other social factors and resulted in poor social support paving the path to most maternal deaths. A core set of poverty, social isolation, and poor social support acted together with alcohol usage, and violence leading to suicides. These core determinants mediating through neglected self-health care led to delay in health-seeking. Deficits in quality of care and neglect were noted at health institutions and the field. CONCLUSION Social autopsies of maternal deaths revealed complex social issues and social determinants of health leading to maternal deaths in Sri Lanka, indicating the need for a socially sensitive health system.
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Affiliation(s)
- Lasandha Irangani
- grid.430357.60000 0004 0433 2651Department of Humanities, Faculty of Social Sciences and Humanities, Rajarata University of Sri Lanka, Mihintale, 50300 Sri Lanka
| | - Indika Ruwan Prasanna
- grid.430357.60000 0004 0433 2651Department of Economics, Faculty of Social Sciences and Humanities, Rajarata University of Sri Lanka, Mihintale, 50300 Sri Lanka
| | - Sajaan Praveena Gunarathne
- grid.430357.60000 0004 0433 2651Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008 Sri Lanka
| | - Sandaru Hasaranga Shanthapriya
- grid.430357.60000 0004 0433 2651Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008 Sri Lanka
| | - Nuwan Darshana Wickramasinghe
- grid.430357.60000 0004 0433 2651Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008 Sri Lanka
| | - Suneth Buddhika Agampodi
- grid.430357.60000 0004 0433 2651Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008 Sri Lanka
| | - Thilini Chanchala Agampodi
- grid.430357.60000 0004 0433 2651Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008 Sri Lanka
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Olamijulo JA, Olorunfemi G, Osman H. Predictors and causes of in-hospital maternal deaths within 120 h of admission at a tertiary hospital in South-Western, Nigeria: A retrospective cohort study. Niger Postgrad Med J 2022; 29:325-333. [PMID: 36308262 DOI: 10.4103/npmj.npmj_180_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND An efficient, comprehensive emergency obstetrics care (CEMOC) can considerably reduce the burden of maternal mortality (MM) in Nigeria. Information about the risk of maternal death within 120 h of admission can reflect the quality of CEMOC offered. AIM This study aims to determine the predictors and causes of maternal death within 120 h of admission at the Lagos University Teaching Hospital, LUTH, Lagos South-Western, Nigeria. METHODS We conducted a retrospective cohort study amongst consecutive maternal deaths at a hospital in South-Western Nigeria, from 1 January 2007 to 31 December 2017, using data from patients' medical records. We compared participants that died within 120 h to participants that survived beyond 120 h. Survival life table analysis, Kaplan-Meier plots and multivariable Cox proportional hazard regression were conducted to evaluate the factors affecting survival within 120 h of admission. Stata version 16 statistical software (StatCorp USA) was used for analysis. RESULTS Of the 430 maternal deaths, 326 had complete records. The mean age of the deceased was 30.7± (5.9) years and median time to death was 24 (5-96) h. Two hundred and sixty-eight (82.2%) women out of 326 died within 120 h of admission. Almost all maternal deaths from uterine rupture (95.2%) and most deaths from obstetric haemorrhage (87.3%), induced miscarriage (88.9%), sepsis (82.9%) and hypertensive disorders of pregnancy (77.9%) occurred within 120 h of admission. Admission to the intensive care unit (P = 0.007), cadre of admitting doctor (P < 0.001), cause of death (P = 0.036) and mode of delivery (P = 0.012) were independent predictors of hazard of death within 120 h. CONCLUSION The majority (82.2%) of maternal deaths occurred within 120 h of admission. Investment in the prevention and acute management of uterine rupture, obstetric haemorrhage, sepsis and hypertensive disorders of pregnancy can help to reduce MM within 120 h in our environment.
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Affiliation(s)
- Joseph Ayodeji Olamijulo
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Gbenga Olorunfemi
- Division of Epidemiology and Biostatistics, University of Witwatersrand, Johannesburg, South Africa
| | - Halimat Osman
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
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Nasir N, Aderoba AK, Ariana P. Scoping review of maternal and newborn health interventions and programmes in Nigeria. BMJ Open 2022; 12:e054784. [PMID: 35168976 PMCID: PMC8852735 DOI: 10.1136/bmjopen-2021-054784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To systematically scope and map research regarding interventions, programmes or strategies to improve maternal and newborn health (MNH) in Nigeria. DESIGN Scoping review. DATA SOURCES AND ELIGIBILITY CRITERIA Systematic searches were conducted from 1 June to 22 July 2020 in PubMed, Embase, Scopus, together with a search of the grey literature. Publications presenting interventions and programmes to improve maternal or newborn health or both in Nigeria were included. DATA EXTRACTION AND ANALYSIS The data extracted included source and year of publication, geographical setting, study design, target population(s), type of intervention/programme, reported outcomes and any reported facilitators or barriers. Data analysis involved descriptive numerical summaries and qualitative content analysis. We summarised the evidence using a framework combining WHO recommendations for MNH, the continuum of care and the social determinants of health frameworks to identify gaps where further research and action may be needed. RESULTS A total of 80 publications were included in this review. Most interventions (71%) were aligned with WHO recommendations, and half (n=40) targeted the pregnancy and childbirth stages of the continuum of care. Most of the programmes (n=74) examined the intermediate social determinants of maternal health related to health system factors within health facilities, with only a few interventions aimed at structural social determinants. An integrated approach to implementation and funding constraints were among factors reported as facilitators and barriers, respectively. CONCLUSION Using an integrated framework, we found most MNH interventions in Nigeria were aligned with the WHO recommendations and focused on the intermediate social determinants of health within health facilities. We determined a paucity of research on interventions targeting the structural social determinants and community-based approaches, and limited attention to pre-pregnancy interventions. To accelerate progress towards the sustainable development goal MNH targets, greater focus on implementing interventions and measuring context-specific challenges beyond the health facility is required.
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Affiliation(s)
- Naima Nasir
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
- APIN Clinic, Infectious Diseases Unit, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Adeniyi Kolade Aderoba
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
- Department of Obstetrics and Gynaecology, Mother and Child Hospital, Akure, Ondo, Nigeria
| | - Proochista Ariana
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
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5
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Muriithi FG, Banke-Thomas A, Gakuo R, Pope K, Coomarasamy A, Gallos ID. Individual, health facility and wider health system factors contributing to maternal deaths in Africa: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000385. [PMID: 36962364 PMCID: PMC10021542 DOI: 10.1371/journal.pgph.0000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/24/2022] [Indexed: 11/18/2022]
Abstract
The number of women dying during pregnancy and after childbirth remains unacceptably high, with African countries showing the slowest decline. The leading causes of maternal deaths in Africa are preventable direct obstetric causes such as haemorrhage, infection, hypertension, unsafe abortion, and obstructed labour. There is an information gap on factors contributing to maternal deaths in Africa. Our objective was to identify these contributing factors and assess the frequency of their reporting in published literature. We followed the Arksey and O'Malley methodological framework for scoping reviews. We searched six electronic bibliographic databases: MEDLINE, SCOPUS, African Index Medicus, African Journals Online (AJOL), French humanities and social sciences databases, and Web of Science. We included articles published between 1987 and 2021 without language restriction. Our conceptual framework was informed by a combination of the socio-ecological model, the three delays conceptual framework for analysing the determinants of maternal mortality and the signal functions of emergency obstetric care. We included 104 articles from 27 African countries. The most frequently reported contributory factors by level were: (1) Individual-level: Delay in deciding to seek help and in recognition of danger signs (37.5% of articles), (2) Health facility-level: Suboptimal service delivery relating to triage, monitoring, and referral (80.8% of articles) and (3) Wider health system-level: Transport to and between health facilities (84.6% of articles). Our findings indicate that health facility-level factors were the most frequently reported contributing factors to maternal deaths in Africa. There is a lack of data from some African countries, especially those countries with armed conflict currently or in the recent past. Information gaps exist in the following areas: Statistical significance of each contributing factor and whether contributing factors alone adequately explain the variations in maternal mortality ratios (MMR) seen between countries and at sub-national levels.
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Affiliation(s)
- Francis G Muriithi
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Aduragbemi Banke-Thomas
- School of Human Sciences, University of Greenwich, Old Royal Naval College, Park Row, Greenwich, London, United Kingdom
| | - Ruth Gakuo
- School of Nursing, University of Derby, Derby, United Kingdom
| | - Kia Pope
- Nottingham Medical School, Queen's Medical Centre, Nottingham, United Kingdom
| | - Arri Coomarasamy
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Ioannis D Gallos
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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Matovelo D, Ndaki P, Yohani V, Laisser R, Bakalemwa R, Ndaboine E, Masatu Z, Mwaikambo M, Brenner JL, Wilson WM. Why don't illiterate women in rural, Northern Tanzania, access maternal healthcare? BMC Pregnancy Childbirth 2021; 21:452. [PMID: 34182949 PMCID: PMC8240192 DOI: 10.1186/s12884-021-03906-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 05/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background In 2017, roughly 540 women in Sub-Saharan Africa died every day from preventable causes related to pregnancy and childbirth. To stem this public-health crisis, the WHO recommends a standard continuity of maternal healthcare, yet most women do not receive this care. Surveys suggest that illiteracy limits the uptake of the recommended care, yet little is understood about why this is so. This gap in understanding why healthcare is not sought by illiterate women compromises the ability of public health experts and healthcare providers to provide culturally relevant policy and practice. This study consequently explores the lived experiences related to care-seeking by illiterate women of reproductive age in rural Tanzania to determine why they may not access maternal healthcare services. Methods An exploratory, qualitative study was conducted in four communities encompassing eight focus group discussions with 81 illiterate women, 13 in-depth interviews with illiterate women and seven key-informant interviews with members of these communities who have first-hand experience with the decisions made by women concerning maternal care. Interviews were conducted in the informant’s native language. The interviews were coded, then triangulated. Results Two themes emerged from the analysis: 1) a communication gap arising from a) the women’s inability to read public-health documents provided by health facilities, and b) healthcare providers speaking a language, Swahili, that these women do not understand, and 2) a dependency by these women on family and neighbors to negotiate these barriers. Notably, these women understood of the potential benefits of maternal healthcare. Conclusions These women knew they should receive maternal healthcare but could neither read the public-health messaging provided by the clinics nor understand the language of the healthcare providers. More health needs of this group could be met by developing a protocol for healthcare providers to determine who is illiterate, providing translation services for those unable to speak Swahili, and graphic public health messaging that does not require literacy. A failure to address the needs of this at-risk group will likely mean that they will continue to experience barriers to obtaining maternal care with detrimental health outcomes for both mothers and newborns. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03906-2.
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Affiliation(s)
- Dismas Matovelo
- Department of Obstetrics & Gynecology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.,Bugando Medical Centre, Mwanza, Tanzania
| | - Pendo Ndaki
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Victoria Yohani
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Rose Laisser
- School of Nursing, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Respicious Bakalemwa
- Bugando Medical Centre, Mwanza, Tanzania.,Department of Pediatrics, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Edgar Ndaboine
- Department of Obstetrics & Gynecology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.,Bugando Medical Centre, Mwanza, Tanzania
| | - Zabron Masatu
- District Medical Officer, Misungwi District, Mwanza, Tanzania
| | | | - Jennifer L Brenner
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Warren M Wilson
- Departments of Anthropology & Archaeology and Community Health Sciences, University of Calgary, Calgary, Canada.
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Ngwenya S, Jones B, Mwembe D, Nare H, Heazell AE. Development and validation of risk prediction models for adverse maternal and neonatal outcomes in severe preeclampsia in a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe. Pregnancy Hypertens 2021; 23:18-26. [DOI: 10.1016/j.preghy.2020.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023]
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Tran PL, Randria JM, Ratsiatosika AT, Winer A, Schweizer C, Omarjee A, Peretti V, Dumont C, Dennis T, Lazaro G, Robillard PY, Boukerrou M. Admission into intensive care unit in preeclampsia: a four-year population-based study in Reunion Island. J Matern Fetal Neonatal Med 2020; 35:4285-4290. [PMID: 33207978 DOI: 10.1080/14767058.2020.1849106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality. The objective of our study was to study risk factors and complications associated with severe preeclampsia requiring intensive care unit (ICU) admission. METHODS Retrospective comparative study over a period from 1st of January 2015 to 1st of January 2019 in the University's maternity unit of South Reunion (Indian Ocean). Our sampling included all preeclamptic patients who delivered in the Southern part of the island. Patients admitted to intensive care unit (ICU) and those who remained in the maternity unit (controls) were reviewed. RESULTS Out of 482 preeclampsia cases, 94 women (19.5%) needed a transfer in ICU, of which only 21 (4.3%) needed invasive intensive care. Mean length of stay was 2.4 ± 2.1 days. ICU admission was associated with HELLP syndrome (OR 8.5 [4.9-14.9], p<.001), severe post-partum hemorrhage (OR 5.86 [1.29-26.70], p=.01) and early onset of preeclampsia (<34 weeks gestation), 2.97 [1.9-4.7], p<.001), leading to higher rate of C-section (OR 2.83 [1.67-4.78], p<.001). There were three patients with a history of eclampsia and no case of maternal death was reported. Fetal prognosis was much poorer in maternal ICU admissions than in controls, with outcomes including lower birth weight (1776 vs. 2304 g, p<.001) and higher perinatal morbidity (infant respiratory distress syndrome 3.70 [1.94-7.05], p<.001) and mortality (<.001). CONCLUSIONS Women needing invasive ICU represented 4.3% of preeclampsia cases. This experience is of interest for lower resource settings such as in countries like Madagascar where very intensive ICU means are very poor, but simpler ICU surveillance is possible. Fetal prognosis was poor though no maternal death was reported. Thus, a multidisciplinary approach of patients with preeclampsia should be encouraged; admission into ICU should be facilitated, as soon as any sign of severity and complications appears.
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Affiliation(s)
- Phuong Lien Tran
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island.,Centre d'Etudes Périnatales Océan Indien Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island
| | - José Mahenina Randria
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island.,Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | | | - Arnaud Winer
- Service de Réanimation Polyvalente, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island
| | - Chloé Schweizer
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island
| | - Asma Omarjee
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island
| | - Véronique Peretti
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island
| | - Coralie Dumont
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island
| | - Thomas Dennis
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island
| | | | - Pierre-Yves Robillard
- Centre d'Etudes Périnatales Océan Indien Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island.,Service de Réanimation néonatale, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island
| | - Malik Boukerrou
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island.,Centre d'Etudes Périnatales Océan Indien Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island.,Faculté de médecine, Unité de formation et de recherche santé de la Réunion, Saint Denis, France
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Okonofua FE, Ntoimo LFC, Ekezue B, Ohenhen V, Agholor K, Gana M, Igboin B, Ekwo C, Imongan W, Galadanci H, Ogu R. Outcome of multifaceted interventions for improving the quality of antenatal care in Nigerian referral hospitals. Reprod Health 2020; 17:170. [PMID: 33148284 PMCID: PMC7641810 DOI: 10.1186/s12978-020-00997-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study was designed as quasi-experimental research to investigate the effectiveness of multifaceted interventions for improving the quality of antenatal care in referral hospitals in Nigeria. Two referral hospitals (the Central Hospital in Benin City, South-South Nigeria, and the General Hospital in Minna) served as intervention sites, while two hospitals in comparable locations, (the Central Hospital Warri and the Suleja Hospital Abuja) were the control hospitals. METHODS Intervention activities consisted of the introduction of a strategic plan with the shared vision of reducing maternal mortality by 50% in 1 year in the hospitals; staff training and re-training; the establishment of an automated appointment system; composite health education involving couples and providers; advocacy with policymakers; and the implementation of maternal death reviews and surveillance. These activities were implemented in the intervention hospitals over 21 months (October 2017 to June 2019). Exit interviews of pregnant women at intervention and control sites by trained interviewers were used to assess the quality of antenatal care after their visit, A total of 777 women were interviewed (427 in the intervention sites and 350 in the control sites). Data were analyzed with univariate and multivariate Poisson and logistic regression to determine the extent to which health providers in the clinics completed the 18 signal functions identified in the WHO assessment tool. RESULTS The regression analyses showed the interventions were effective in improving six quality indicators (QIs) for counseling and information sharing. The difference between intervention and control sites on these QIs was significant at < 0.05. On the contrary, the interventions were less effective for maternal and fetal measurements; and disease testing and management QIs. CONCLUSION The positive effects of the interventions are likely due to the effectiveness of the training and health education components. The lack of intervention impact observed for maternal and fetal measurements may be due to the high workload of care staff and inadequate clinic supplies, which we did not address. We conclude that interventions that address the quality of antenatal care in low-resource settings should focus on improving all elements of care, including adequate staffing and mobilization of material resources. TRIAL REGISTRATION This study was registered in the ISRCTN on August 14th, 2020. TRIAL REGISTRATION NUMBER SRCTN17985403 . Retrospective registration. The reason for the retrospective registration is the current non-recognition of the Nigeria Clinical Trials Registry (NCTR); which is currently not an ICMJE or WHO ICTRP approved registry. (This study was registered in the Nigeria Clinical Trials Registry on April 14th, 2016. Trial Registration Number NCTR No: 91540209 ).
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Affiliation(s)
- Friday Ebhodaghe Okonofua
- Women's Health and Action Research Centre (WHARC), Benin City, Nigeria. .,Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria. .,Department of Obstetrics and Gynaecology, University of Benin and University of Benin Teaching Hospital, Benin City, Nigeria.
| | | | - Bola Ekezue
- Fayetteville State University, Fayetteville, USA
| | | | | | | | - Brian Igboin
- Women's Health and Action Research Centre (WHARC), Benin City, Nigeria
| | - Chioma Ekwo
- Women's Health and Action Research Centre (WHARC), Benin City, Nigeria
| | - Wilson Imongan
- Women's Health and Action Research Centre (WHARC), Benin City, Nigeria
| | | | - Rosemary Ogu
- University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
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"Back to Eden": An explorative qualitative study on traditional medicine use during pregnancy among selected women in Lusaka Province, Zambia. Complement Ther Clin Pract 2020; 40:101225. [PMID: 32798811 DOI: 10.1016/j.ctcp.2020.101225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/15/2020] [Accepted: 07/26/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE No qualitative study on traditional medicine use among Zambian pregnant women has ever been conducted. Accordingly, this study was performed to explore the perceptions, motivations and experiences of Zambian women with regard to traditional medicine use during pregnancy. MATERIALS AND METHODS In-depth, semi-structured interviews were conducted in June/July 2019 with 8 adult women residing in Lusaka, Zambia, who used traditional remedies during their pregnancies, and who were recruited through purposive and snowball sampling. RESULTS Reported reasons behind traditional medicine use during pregnancy included labour induction, prevention of childbirth complications in case of sexual infidelity by either spouse, and prevention and/or treatment of anaemia. In addition, family members and faith leaders played an important role in influencing traditional medicine use. CONCLUSION Multiple, interconnecting factors influence traditional medicine use among pregnant women in Lusaka, Zambia. Traditional medicine use during pregnancy will likely continue to be widespread across Zambia.
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Yadav AK, Sahni B, Jena PK, Kumar D, Bala K. Trends, Differentials, and Social Determinants of Maternal Health Care Services Utilization in Rural India: An Analysis from Pooled Data. WOMEN'S HEALTH REPORTS 2020; 1:179-189. [PMID: 35982988 PMCID: PMC9380883 DOI: 10.1089/whr.2019.0022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/20/2020] [Indexed: 11/12/2022]
Abstract
Background: Millennium development goal 5 aimed at reduction of maternal deaths by three-quarters from 1990 to 2015: a target India commendably achieved, but this milestone remains overshadowed by inequalities in utilization of health services that are driven by determinants both at community and at individual level. Materials and Methods: We studied the utilization trends using descriptive statistics and analyzed the relative contribution of various socioeconomic predictors on the use of maternal health care services in rural India using binary logistic regression analysis on pooled data from three rounds of National Family Health Survey. Outcome variables included four or more antenatal care visits, skilled birth attendance, and postnatal care. Results: Although utilization of maternal health care services showed an upward trend from 1998–1999 to 2015–2016, factors such as illiteracy, female age ≥40 years, having five and more children, belonging to scheduled tribes, rural residence, and not possessing a health card were associated with significantly low utilization of maternal health care services. However, partner's education, good economic status, women's autonomy, and infrastructure at village level were associated with better odds of availing these services. Conclusions: The study generates evidence on the role of various socioeconomic determinants in maternal health care utilization and identifies gaps that must be strategically addressed to reach sustainable developmental goal maternal mortality target of 70 deaths per 100,000 live births by 2030. It reemphasizes the need for ensuring convergence among different stakeholders while structuring maternal health policies so that health reforms can be accomplished effectively at all levels of health care.
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Affiliation(s)
- Arvind Kumar Yadav
- Department of Economics, Shri Mata Vaishno Devi University, Katra, J&K, India
| | - Bhavna Sahni
- Department of Community Medicine, Government Medical College, Jammu, India
| | - Pabitra Kumar Jena
- Department of Economics, Shri Mata Vaishno Devi University, Katra, J&K, India
| | - Dinesh Kumar
- Department of Community Medicine, Government Medical College, Jammu, India
| | - Kiran Bala
- Department of Community Medicine, Government Medical College, Jammu, India
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Ugwu GO, Iyoke CA, Ezugwu EC, Ajah LO, Onah HE, Ozumba BC. A Comparison of the Characteristics of Maternal Near-Misses and Maternal Deaths in Enugu, Southeast Nigeria: A 3-Year Prospective Study. Int J Womens Health 2020; 12:207-211. [PMID: 32273776 PMCID: PMC7105884 DOI: 10.2147/ijwh.s237221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/20/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Maternal near-misses, also known as severe acute maternal morbidity, have become globally recognized as an appropriate indicator of obstetric care. Women experiencing maternal near-misses are more in number than maternal deaths, and can provide more specific and detailed evidence, as the patient herself can be a leading source of useful information. OBJECTIVE To determine the frequency of maternal near-misses and maternal deaths in the University of Nigeria Teaching Hospital in Ituku-Ozalla, Enugu, document the primary determinant factor that caused these, and compare cases of maternal near-miss and maternal deaths. METHODS This was a 3-year prospective study of all women admitted for delivery or within 42 days of delivery or termination of pregnancy at the hospital. Data were collected prospectively in consecutive patients in a pro forma manner and entered into SPSS version 17 for Windows. RESULTS There was a total of 2,236 deliveries, of which 88 had severe maternal outcomes. Of the latter, 60 were maternal near-misses, while 28 suffered maternal death. The maternal near-miss:mortality ratio was found to be 2.14. The maternal mortality ratio here was 1,252 per 100,000. All the 88 women that had severe maternal outcomes lived at least 5 km from the hospital. The leading organ-system dysfunction in this study was cardiovascular, manifesting as shock and cardiac arrest, and respiratory, manifesting as gasping and cyanosis. Leading complications were severe hemorrhage, anemia, and hypertensive disorders. The pattern of complications was similar in both near-misses and maternal deaths, but cases of hypertensive disorders and exploratory laparotomy as an intervention for those with organ dysfunction were noted to be higher in near-miss cases, and differences were statistically significant. CONCLUSION It was concluded that despite numerous similarities in the characteristics of patients who had had maternal near-misses or died, our study points out that those who succumb to death are often <40 years of age, poorly educated, unemployed, usually present as unbooked emergencies from a distance >5 km and suffer maternal death within 24 hours of presentation.
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Affiliation(s)
- George O Ugwu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Chukwuemeka A Iyoke
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Euzebus C Ezugwu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Leonard O Ajah
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Hyacinth E Onah
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Benjamin C Ozumba
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Nsukka, Nigeria
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Onoja A, Onuche S, Sanni F, Onoja S, Umogbai T, Abiodun P, Mohammed S. Using the sisterhood method to determine the maternal mortality ratios in six local governments of Ondo State, Nigeria. INTERNATIONAL ARCHIVES OF HEALTH SCIENCES 2020. [DOI: 10.4103/iahs.iahs_74_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Meh C, Thind A, Ryan B, Terry A. Levels and determinants of maternal mortality in northern and southern Nigeria. BMC Pregnancy Childbirth 2019; 19:417. [PMID: 31718572 PMCID: PMC6852989 DOI: 10.1186/s12884-019-2471-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/22/2019] [Indexed: 11/25/2022] Open
Abstract
Background Maternal mortality is still a major risk for women of childbearing age in Nigeria. In 2008, Nigeria bore 14% of the global burden of maternal mortality. The national maternal mortality ratio has remained elevated despite efforts to reduce maternal deaths. Though health disparities exist between the North and South of Nigeria, there is a dearth of evidence on the estimates and determinants of maternal mortality for these regions. Methods This study aimed to assess differences in the levels and determinants of maternal mortality in women of childbearing age (15–49 years) in the North and South of Nigeria. The Nigeria Demographic and Health Surveys (2008 and 2013) were used. The association between maternal mortality (outcome) and relevant sociocultural, economic and health factors was tested using multivariable logistic regression in a sample of 51,492 living or deceased women who had given birth. Results There were variations in the levels of maternal mortality between the two regions. Maternal mortality was more pronounced in the North and increased in 2013 compared to 2008. For the South, the levels slightly decreased. Media exposure and education were associated with maternal mortality in the North while contraceptive method, residence type and wealth index were associated with maternal death in the South. In both regions, age and community wealth were significantly associated with maternal mortality. Conclusions Differences in the levels and determinants of maternal mortality between the North and South of Nigeria stress the need for efforts to cut maternal deaths through new strategies that are relevant for each region. These should improve education of girls in the North and access to health information and services in the South. Overall, new policies to improve women’s socioeconomic status should be adopted.
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Affiliation(s)
- Catherine Meh
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada.
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada.,Department of Family Medicine, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada.,Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada
| | - Bridget Ryan
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada.,Department of Family Medicine, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada
| | - Amanda Terry
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada.,Department of Family Medicine, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada.,Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada
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Nwafor CC, Akhiwu WO. Profile of Medicolegal Deaths in Females: An Autopsy-Based Study. Niger Med J 2019; 60:300-305. [PMID: 32180660 PMCID: PMC7053274 DOI: 10.4103/nmj.nmj_153_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 09/29/2019] [Accepted: 01/05/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The rate of female medicolegal deaths (MLD) due to homicides and road traffic accidents (RTAs) is the highest in Africa, compared to the rest of the world, though there is scanty literature locally on this subject. MATERIALS AND METHODS The major sources of information reviewed in this study were the autopsy registers and autopsy reports of the police clinic, Benin City, Edo State, over 10 years. RESULTS A total of 331 female medicolegal autopsies were performed, accounting for 21.8% of all cases. The mean age of cases was 40.11 ± 20.25. Age group of 30-39 years accounted for 22.1% (n = 73) of cases, closely followed by the age group of 20-29 years, which accounted for 20.5% (n = 68) of cases. Accidental deaths accounted for 36.9% (n = 122) of cases. RTA was the most common cause of accidental deaths (n = 105; 86%). The most common pattern of RTA was a vehicle knocking down a pedestrian as seen in 45 cases (42.9%). The most common age group involved in RTA was 20-29 years (n = 23; 22%). For homicides, shotguns were mainly used (n = 31; 31.6%), distantly followed by those caused by the use of sharp objects (n = 17; 17.3%) and most cases belonged to the age groups of 40-49 years and 30-39 years (21.5% and 19.5%, respectively). In 5 (71.4%) cases, hanging was the method of choice for suicide. A majority of suicide victims (n = 4; 57.1%) were aged between 30 and 39 years, with an average age of 36.3. Diseases of the cardiovascular system accounted for 41.8% (n = 41) of cases, whereas pregnancy-associated deaths (excluding criminal abortions) accounted for 29.6% (n = 29) of cases in the natural causes group. Preeclampsia/eclampsia (n = 9; 31%) followed by postpartum hemorrhage (n = 8; 27.6%) were the leading causes of maternal deaths. CONCLUSION There is a need to provide basic infrastructure, formulate policies, and implement them, to reduce female MLD, which a significant number of them are preventable.
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Affiliation(s)
| | - Wilson Oberifo Akhiwu
- Department of Medicolegal Unit, Medico-Legal Unit, Police Clinic, Benin City, Edo State, Nigeria
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Gebretsadik A, Tarekegne Z, Teshome M. Retrospective review of maternal deaths in Hawassa Comprehensive Specialised Hospital, in Southern Ethiopia. J OBSTET GYNAECOL 2019; 40:659-665. [PMID: 31512545 DOI: 10.1080/01443615.2019.1648398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to evaluate the causes of and contributors to maternal death at Hawassa Referral Comprehensive Specialised Hospital (HRCSH). A health facility-based, maternal death review was used. All maternal deaths that occurred between January 2016 and August 2017 in HRCSH were included. Data were collected using a structured data collection sheet and analysed. Eighty-two maternal deaths that occurred over a 20-month period were reviewed, of which 77 met the inclusion criteria. A total of 8466 births occurred in HRCSH during the study period. The overall facility-based maternal mortality rate (MMR) was 910 deaths per 100,000 live births. The majority of maternal deaths (69 deaths; 89.6%) were due to direct causes, with pregnancy-induced hypertension as the leading direct cause of 33 deaths (42.8%). Eight avoidable factors were identified in this review. Twenty-six patients (33.9%) died as a result of a combination of three or more factors. Patient-oriented and transport/referral factors were the most common avoidable factors, with each contributing to 62 deaths (80.5%). Prenatal patients would benefit from receiving information regarding danger signs that could assist in the early detection of health problems and increase the likelihood that they seek health care.Impact StatementWhat is already known on this subject? Most maternal deaths are preventable. However, maternal mortality rates remain high despite the presence of multiple measures in the southern part of Ethiopia. There is no adequate information about the maternal death rate in the study setting.What do the results of this study add? Hawassa Referral Comprehensive Specialised Hospital is a regional health centre. This study found that combinations of several factors may be contributing to a high maternal death rate. Most notably, transport, delay management initiation after admission and referral factors account for the majority of maternal deaths.What is the implication of these findings for clinical practice/or further research? Identification of potential problems could assist context-based management of problems. It helps in improving the level of practical skills for the management of pregnancy-related complications like hypertension. It also solves problems in the health services system like access to interventions. It insists on intersectoral collaboration to solve the transportation problems.
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Affiliation(s)
| | - Zerai Tarekegne
- School of Medicine, Department of Obstetrics and Gynecology, Hawassa University, Hawassa, Ethiopia
| | - Million Teshome
- School of Medicine, Department of Obstetrics and Gynecology, Hawassa University, Hawassa, Ethiopia
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Amoo TB, Ajayi OS. Maternal mortality and factors affecting it, among pregnant women in Abeokuta South, Nigeria. ACTA ACUST UNITED AC 2019. [DOI: 10.29328/journal.cjog.1001025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Recurrent or first preeclampsia in multiparae: A case-control study of singleton pregnancies in Reunion Island. Eur J Obstet Gynecol Reprod Biol 2019; 240:80-86. [PMID: 31234061 DOI: 10.1016/j.ejogrb.2019.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/08/2019] [Accepted: 06/11/2019] [Indexed: 11/21/2022]
Abstract
Recurrent or first preeclampsia in multiparae : a case-control study of singleton pregnancies in Reunion Island Phuong Lien Tran, Pierre-Yves Robillard, Coralie Dumont, Chloé Schweizer, Asma Omarjee, Glorianne Lazaro, Silvia Iacobelli, Malik Boukerrou OBJECTIVE: To compare multiparous women with a first occurrence of preeclampsia and those with recurrent preeclampsia in singleton pregnancies. STUDY DESIGN a 17.5-year (2001-2018) case-control study conducted in the University's maternity of South Reunion (Indian Ocean), comparing 125 patients with recurrent preeclampsia and 742 patients with a first episode of the disease (controls). Statistical analyses were performed with use of the Student t-test for comparison of continuous data and the Chi-square or Fisher exact test for comparison of categorical variables. RESULTS There was no difference between the two groups concerning socio-demographic characteristics, post-partum haemorrhage, perinatal mortality rates. Nevertheless, recurrent preeclamptic women had a higher risk to present with prior chronic hypertension (OR 2.05 [1.30-3.23], p = 0.002), and to experience an early onset preeclampsia (< 34 weeks) compared to controls (OR 1.69 [1.15-2.48], p = 0.007). Women with recurrent preeclampsia were more prone to have C-sections (OR 1.63 [1.06-2.51], p = 0.024) mainly because of maternal indications (89.2% vs 76.4%, p = 0.008). Newborns from recurrent preeclampsia were more likely to have very low birthweight < 1500 g (OR 1.79 [1.16-2.77], p = 0.001), while there was no significant difference for gestational ages (34.1 vs 34.7 weeks). CONCLUSION Recurrent multiparous preeclamptic women presented more severe maternal disease (with a higher rate of early onset preeclampsia). Persistent hypertension in women with a history of preeclampsia is a risk factor for developing recurrent preeclampsia, and these patients should be monitored more closely.
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Bwana VM, Rumisha SF, Mremi IR, Lyimo EP, Mboera LEG. Patterns and causes of hospital maternal mortality in Tanzania: A 10-year retrospective analysis. PLoS One 2019; 14:e0214807. [PMID: 30964909 PMCID: PMC6456219 DOI: 10.1371/journal.pone.0214807] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 03/20/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Maternal mortality is among the most important public health concerns in Sub-Saharan Africa. There is limited data on hospital-based maternal mortality in Tanzania. The objective of this study was to determine the causes and maternal mortality trends in public hospitals of Tanzania from 2006-2015. METHODS AND FINDINGS This retrospective study was conducted between July and December 2016 and involved 34 public hospitals in Tanzania. Information on causes of deaths due to pregnancy and delivery complications among women of child-bearing age (15-49 years old) recorded for the period of 2006-2015 was extracted. Data sources included inpatient and death registers and International Classification of Disease (ICD)-10 report forms. Maternal deaths were classified based on case definition by ICD 10 and categorized as direct and indirect causes. A total of 40,052 deaths of women of child-bearing age were recorded. There were 1,987 maternal deaths representing 5·0% of deaths of all women aged 15-49 years. The median age-at-death was 27 years (interquartile range: 22, 33). The average age-at-death increased from 25 years in 2006 to 29 years in 2015. Two thirds (67.1%) of the deaths affected women aged 20-34 years old. The number of deaths associated with teenage pregnancy (15-19 years) declined significantly (p-value<0·001) from 17.8% in 2006-2010 to 11.1% in 2011-2015. The proportion of deaths among 30-34 and 35-39 years old (all together) increased from 13% in 2006-2010 to 15·3% in 2011-2015 (p-value = 0.081). Hospital-based maternal mortality ratio increased from 40.24 (2006) to 57.94/100000 births in 2015. Of the 1,987 deaths, 83.8% were due to direct causes and 16.2% were due to indirect causes. Major direct causes were eclampsia (34.0%), obstetric haemorrhage (24.6%) and maternal sepsis (16.7%). Anaemia (14.9%) and cardiovascular disorders (14.0%) were the main indirect causes. Causes of maternal deaths were highly related; being attributed to up to three direct causes (0.12%). Cardiovascular disorders and anaemia had strong linkage with haemorrhage. While there was a decline in the number of deaths due to eclampsia and abortion, those due to haemorrhage and cardiovascular disoders increased during the period. CONCLUSIONS During the ten year period (2006-2015) there was an increase in the number of hospital maternal deaths in public hospitals in Tanzania. Maternal deaths accounted for 5% of all women of child-bearing age in-hospital mortalities. Most maternal deaths were due to direct causes including eclampsia, haemorrhage and sepsis. The findings of this study provide evidence for better planning and policy formulation for reproductive health programmes to reduce maternal deaths in Tanzania.
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Affiliation(s)
- Veneranda M. Bwana
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanzania
| | - Susan F. Rumisha
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Irene R. Mremi
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
- SACIDS Foundation for One Health, Chuo Kikuu, Morogoro, Tanzania
| | - Emanuel P. Lyimo
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Leonard E. G. Mboera
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
- SACIDS Foundation for One Health, Chuo Kikuu, Morogoro, Tanzania
- * E-mail:
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Adeniran AS, Ocheke AN, Nwachukwu D, Adewole N, Ageda B, Onile T, Umezulike AC, Aboyeji AP, Oladapo OT. Non-obstetric causes of severe maternal complications: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey. BJOG 2019; 126 Suppl 3:41-48. [PMID: 30897278 DOI: 10.1111/1471-0528.15623] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the burden, causes and outcomes of severe non-obstetric maternal complications in Nigerian public tertiary hospitals. DESIGN Secondary analysis of a nationwide cross-sectional study. SETTING Forty-two tertiary health facilities. POPULATION Women admitted with complications during pregnancy, childbirth or puerperium. METHODS All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) due to non-obstetric causes were prospectively identified over a 1-year period. Maternal near-miss was defined using organ-system dysfunction (WHO), clinical, or management-based criteria. MAIN OUTCOME MEASURES Causes and contributions of non-obstetric complications to SMO; fetal and neonatal outcomes; health service events associated with non-obstetric complications; and mortality index (% of maternal death/SMO). RESULTS Of 100 107 women admitted with complications, 9401 (9.4%) were for non-obstetric causes; and 4.0% (375/9401) suffered severe non-obstetric complications. Of the 375 cases of severe non-obstetric complications, 48.8% (183/375) were near-misses and 51.2% (192/375) were maternal deaths. Severe anaemia unrelated to haemorrhage contributed 61.2% of near-misses and 32.8% of maternal deaths. The highest mortality indices were observed for cancer (91.7%), hepatic diseases (81.8%) and HIV/AIDS/HIV wasting syndrome (80.4%). Fatality was significantly high with extremes of age and no formal education. Regarding organ dysfunctions, neurological (77.1%) and cardiovascular (75.0%) dysfunctions had the highest mortality indices. Perinatal mortality was 65.9%. Time from diagnosis of severe non-obstetric complications to review by senior medical personnel, and to definitive intervention was <30 minutes in 30.2% and 29.8% of women with SMO, respectively. However, over 240 minutes elapsed between diagnosis and definitive intervention in more than one-third of women with SMO. CONCLUSION Non-obstetric complications are associated with poorer pregnancy outcomes and deserve attention similar to that accorded obstetric complications. FUNDING The original research that generated the data for this secondary analysis and the publication of this secondary analysis were funded by the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO). TWEETABLE ABSTRACT Non-obstetric causes are important contributors to maternal deaths and life-threatening morbidities in Nigerian hospitals.
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Affiliation(s)
- A S Adeniran
- Department of Obstetrics & Gynaecology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - A N Ocheke
- Department of Obstetrics & Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - D Nwachukwu
- Department of Obstetrics & Gynaecology, Federal Medical Centre, Bida, Nigeria
| | - N Adewole
- Department of Obstetrics & Gynaecology, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - B Ageda
- Department of Obstetrics & Gynaecology, Federal Medical Centre, Makurdi, Nigeria
| | - T Onile
- Department of Obstetrics & Gynaecology, Federal Medical Centre, Lokoja, Nigeria
| | - A C Umezulike
- Department of Obstetrics & Gynaecology, National Hospital, Abuja, Nigeria
| | - A P Aboyeji
- Department of Obstetrics & Gynaecology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - O T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Sageer R, Kongnyuy E, Adebimpe WO, Omosehin O, Ogunsola EA, Sanni B. Causes and contributory factors of maternal mortality: evidence from maternal and perinatal death surveillance and response in Ogun state, Southwest Nigeria. BMC Pregnancy Childbirth 2019; 19:63. [PMID: 30744576 PMCID: PMC6371466 DOI: 10.1186/s12884-019-2202-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/23/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Nigeria still ranks second globally in the number of maternal deaths. Most maternal death reviews in Nigeria are isolated research based reports from a single health facility. This study determined causes and contributory factors of maternal mortality in Ogun statefollowing a periodic State-widematernal and perinatal deaths surveillance and response (MPDSR) review. METHODS We carried out a retrospective analysis of cases of maternal deaths notified (n = 77) and reviewed (n = 45) in health facilities in Ogun State from 2015 to 2016selected using total sampling method. Using the national MPDSR structured and validated data collection tools or questionnaire, collected data was extracted from existing MPDSR data base, andanalyzed using the Statistical Package for Social Sciences (SPSS) software 20.0. We obtained approval from the State Ministry of Health for this study. RESULTS Average age at maternal death was 30.8 ± 5.7 years. Haemorrhageand pre-eclampsia or eclampsia account for 43.4 and 36.9% of causes respectively. Leading contributory factors ofmaternal deaths include inadequate human resource for health, delay in seeking care, inadequate equipment, lack of ambulance transportation, and delay in referrals services. 51.1%of the women had antenatal care while a significant proportion of the women were referred from Traditional Births Attendants (TBAs) and mission houses. CONCLUSION We concluded that many of the contributory factors of maternal mortality could be avoided if preventive measures were taken and adequate care available. MPDSR provides a platform for critical evidence of where the main problems lie, and can provide valuable information on strategies which maternal mortality prevention programs should focus on. The implementation and institutionalization of MPDSR programme is on course in Ogun State. MPDSR is feasible and should be institutionalized in all states of Nigeria. A commitment to act upon the findings of MPDSR is a key prerequisite for success.
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Affiliation(s)
| | | | | | | | | | - Bola Sanni
- Ogun State Primary Health Care Board, Abeokuta, Nigeria
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Grønvik T, Fossgard Sandøy I. Complications associated with adolescent childbearing in Sub-Saharan Africa: A systematic literature review and meta-analysis. PLoS One 2018; 13:e0204327. [PMID: 30256821 PMCID: PMC6157872 DOI: 10.1371/journal.pone.0204327] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 09/06/2018] [Indexed: 11/18/2022] Open
Abstract
Objective To examine whether childbearing before age 18 in Sub-Saharan Africa is associated with increased risk of maternal and child complications through a systematic literature review and meta-analysis. Methods The literature on adolescent pregnancy and associated complications in Sub-Saharan Africa was reviewed. A systematic electronic database search in Medline and Embase identified relevant papers. Studies were eligible for inclusion if they had numeric data on maternal mortality, pre-eclampsia, eclampsia, preterm birth, low birth weight, small for gestational age, stillbirth, neonatal death or perinatal death. We included studies on adolescents aged 17 years or younger, and with a comparison group of adult women aged between 20 and 35 years. The quality of the articles was assessed. Meta-analyses were conducted when there were at least three included studies with minor clinical heterogeneity in population and outcome measures. Results Eighteen studies met our inclusion criteria. There were many studies from Sub-Saharan Africa with data on the age group 15–19 years old, but few studies had separate data on adolescents <18 years old. All included studies were of either moderate or low quality. Adolescents had an increased risk of low birth weight, pre-eclampsia/eclampsia, preterm birth and maternal and perinatal mortality. We found a lower, nonsignificant risk of stillbirth and for small for gestational age babies among the young mothers. Conclusion In this systematic review, the findings indicate that young maternal age is associated with some unfavorable outcomes in Sub-Saharan Africa. High quality observational studies that adjust for sociodemographic factors are lacking.
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Affiliation(s)
- Taran Grønvik
- Centre for International Health, University of Bergen, Bergen, Norway
- * E-mail:
| | - Ingvild Fossgard Sandøy
- Centre for International Health, University of Bergen, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health, University of Bergen, Bergen, Norway
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23
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Yakubu Y, Mohamed Nor N, Abidin EZ. A systematic review of micro correlates of maternal mortality. REVIEWS ON ENVIRONMENTAL HEALTH 2018; 33:147-161. [PMID: 29729149 DOI: 10.1515/reveh-2017-0050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/12/2018] [Indexed: 06/08/2023]
Abstract
In the year 2000, the World Health Organization launched the Millennium Development Goals (MDGs) which were to be achieved in 2015. Though most of the goals were not achieved, a follow-up post 2015 development agenda, the Sustainable Development Goals (SDGs) was launched in 2015, which are to be achieved by 2030. Maternal mortality reduction is a focal goal in both the MDGs and SDGs. Achieving the maternal mortality target in the SDGs requires multiple approaches, particularly in developing countries with high maternal mortality. Low-income developing countries rely to a great extent on macro determinants such as public health expenditure, which are spent mostly on curative health and health facilities, to improve population health. To complement the macro determinants, this study employs the systematic review technique to reveal significant micro correlates of maternal mortality. The study searched MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Science Direct, and Global Index Medicus of the World Health Organization. Our search was time framed from the 1st January, 2000 to the 30th September, 2016. In the overall search result, 6758 articles were identified, out of which 33 were found to be eligible for the review. The outcome of the systematic search for relevant literature revealed a concentration of literature on the micro factors and maternal mortality in developing countries. This shows that maternal mortality and micro factors are a major issue in developing countries. The studies reviewed support the significant relationship between the micro factors and maternal mortality. This study therefore suggests that more effort should be channelled to improving the micro factors in developing countries to pave the way for the timely achievement of the SDGs' maternal mortality ratio (MMR) target.
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Affiliation(s)
- Yahaya Yakubu
- Department of Economics, Faculty of Economics and Management, University Putra Malaysia, Selangor, Malaysia
- Department of Economics, Faculty of Social and Management Sciences, Bauchi State University Gadau, Bauchi State, Nigeria
| | - Norashidah Mohamed Nor
- Department of Economics, Faculty of Economics and Management, University Putra Malaysia, Selangor, Malaysia
| | - Emilia Zainal Abidin
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
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Valdes V, Adongo PB, Nwameme AU, Tabong PTN, Fernandes M. Risk factors for self-reported postpartum hemorrhage in Ga East, Ghana. Int J Gynaecol Obstet 2018; 142:201-206. [PMID: 29742294 DOI: 10.1002/ijgo.12523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/20/2018] [Accepted: 05/03/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To document the prevalence of self-reported postpartum hemorrhage (PPH) in Ga East, Accra, Ghana, and examine the demographic, biological, and social risk factors for PPH. METHODS The present study was a cross-sectional secondary analysis of data collected during 2010-2012 from the Ghana Essential Health Interventions Program, a quasi-experimental interventional study surveying households in the urban Ga East Municipal District. The analysis included data from randomly selected parous women of childbearing age (15-49 years), excluding those with a history of abortion (spontaneous or induced) or stillbirth. The χ2 test and logistic regression were used to identify significant risk factors for self-reported PPH. RESULTS The current analysis included 2136 women. Self-reported PPH was recorded for 95 (4.4%) participants. The maternal age at delivery, the duration of labor, and the number of skilled delivery providers were significantly associated with self-reported PPH. Prolonged labor (odds ratio 3.70, 95% confidence interval 2.27-5.94; P<0.001) and maternal age (odds ratio 0.96, 95% confidence interval 0.94-0.99; P=0.020) were predictors of self-reported PPH. CONCLUSION Prolonged labor and younger maternal age were related to a higher burden of reported PPH. These findings were congruent with global and regional data on the prevalence and risk factors for objectively measured PPH and could help focus intervention strategies to high-risk groups, particularly in resource-limited settings.
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Affiliation(s)
- Viviane Valdes
- Boston Children's Hospital, Harvard Medical School, Laboratories of Cognitive Neuroscience, Boston, MA, USA
| | - Philip B Adongo
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Adanna U Nwameme
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Philip T N Tabong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Michelle Fernandes
- Department of Paediatrics, Southampton General Hospital, University of Southampton, Southampton, UK.,Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford, UK
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25
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Aarnio P, Kulmala T, Olsson P. Husband's role in handling pregnancy complications in Mangochi District, Malawi: A call for increased focus on community level male involvement. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:61-66. [PMID: 29804778 DOI: 10.1016/j.srhc.2018.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 02/04/2018] [Accepted: 02/12/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of the current study is to provide information about husbands' role in decision-making and healthcare seeking in cases of pregnancy complications in Mangochi district, Malawi with an analysis of qualitative interviews using the concepts of "capital" and "field" from Bourdieu's social field theory. STUDY DESIGN Twelve husbands and wives who had experienced pregnancy complications and six key informants from a semi-rural area of Mangochi district were interviewed individually. Thematic analysis was conducted based on the concepts of capital and field in Bourdieu's social field theory. RESULTS Husbands have significant economic and symbolic capital in decisions about healthcare seeking during instances of pregnancy complications as a result of their roles as father, head of the household and main income earner. Lack of money is the only acceptable reason for husbands to deny their wives healthcare. Husbands have limited access to knowledge of maternal health, which can compromise their decisions about seeking healthcare. Joint decision-making within families can be bypassed to allow for prompt healthcare seeking in emergencies. CONCLUSIONS Husbands are important decision makers regarding seeking healthcare for pregnancy complications because of their economic and symbolic power and despite their limited access to knowledge of maternal health. Maternal healthcare seeking practices would benefit from wives gaining an empowered role as well as improved knowledge of maternal health among husbands.
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Affiliation(s)
- Pauliina Aarnio
- University of Tampere, Medical School, Department of International Health, Tampere, Finland.
| | - Teija Kulmala
- University of Tampere, Medical School, Department of International Health, Tampere, Finland.
| | - Pia Olsson
- Uppsala University, Department of Women's and Children's Health, International Maternal and Child Health, Uppsala, Sweden.
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26
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Yousif D, Topping A, Osman M, Raimann J, Osman E, Kotanko P, Abboud O. Acute Kidney Injury in Sub-Sahara Africa: A Single-Center Experience from Khartoum, Sudan. Blood Purif 2018; 45:201-207. [DOI: 10.1159/000485214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: The burden of acute kidney injury (AKI) is high in Africa. While there are no reliable statistics about AKI in Africa, the Global Snapshot Study of the 0by25 initiative of the International Society of Nephrology has determined dehydration, infections, animal envenomation, and complications during pregnancy as the main causes. Methods: This study was conducted at the Soba University Hospital (SUH), Khartoum, Sudan, a tertiary referral center. We included all hemodialysis patients treated for AKI at SUH between January 1, 2013 and December 31, 2014 in the study. We reviewed patients’ hospital records and characterized pathogenesis, treatment, and patient outcomes. In addition, we investigated survival by Kaplan-Meier and Cox regression analysis. Results: Out of 520 patients who received emergency HD, 71 patients (14%) had AKI (age 40.6 ± 17.3 years, 56.5% were males). Glomerular and tubular-interstitial diseases were the leading cause of AKI, followed by envenomation and intoxication by hair dye. Patients received a median of 5 dialysis sessions for a median of 8 days. In 32 patients (45%) renal function recovered, 10 patients (14%) died, and 29 patients (41%) remained dialysis-dependent. Mortality was significantly higher in females compared to men (hazard ratio 4.1 [95% CI 1.02–16.67]). Outcomes were worse in patients with pre-renal AKI and intoxications. Conclusion: Our results indicate a higher mortality in females and in patients with pre-renal AKI and intoxications. Awareness of factors associating with poor outcomes is central to diagnostic and therapeutic efforts, and must be considered in the design of initiatives to reduce risk factors and improve outcomes of AKI in developing countries.
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27
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Ariyo O, Ozodiegwu ID, Doctor HV. The influence of the social and cultural environment on maternal mortality in Nigeria: Evidence from the 2013 demographic and health survey. PLoS One 2017; 12:e0190285. [PMID: 29287102 PMCID: PMC5747485 DOI: 10.1371/journal.pone.0190285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 12/09/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Reducing maternal mortality remains a priority for global health. One in five maternal deaths, globally, are from Nigeria. Objective This study aimed to assess the sociocultural correlates of maternal mortality in Nigeria. Methods We conducted a retrospective analysis of nationally representative data from the 2013 Nigeria Demographic and Health Survey. The analysis was based on responses from the core women’s questionnaire. Maternal mortality was categorized as ‘yes’ for any death while pregnant, during delivery or two months after delivery (as reported by the sibling), and ‘no’ for deaths of other or unknown causes. Multilevel logistic regression analysis was conducted to test for association between maternal mortality and predictor variables of sociocultural status (educational attainment, community women’s education, region, type of residence, religion, and women’s empowerment). Results Region, Religion, and the level of community women’s education were independently associated with maternal mortality. Women in the North West were more than twice as likely to report maternal mortality (OR: 2.14; 95% CI: 1.42–3.23) compared to those in the North Central region. Muslim women were 52% more likely to report maternal deaths (OR: 1.52; 95% CI: 1.10–2.11) compared to Christian women. Respondents living in communities where a significant proportion of women have at least secondary schooling were 33% less likely to report that their sisters died of pregnancy-related causes (OR: 0.67; 95% CI: 0.48–0.95). Conclusion Efforts to reduce maternal mortality should implement tailored programs that address barriers to health-seeking behavior influenced by cultural beliefs and attitudes, and low educational attainment. Strategies to improve women’s agency should be at the core of these programs; they are essential for reducing maternal mortality and achieving sustainable development goals towards gender equality. Future studies should develop empirically evaluated measures which assess, and further investigate the association between women’s empowerment and maternal health status and outcomes.
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Affiliation(s)
- Oluwatosin Ariyo
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, Tennessee, United States of America
| | - Ifeoma D Ozodiegwu
- Department of Epidemiology and Biostatistics, East Tennessee State University, Johnson City, Tennessee, United States of America
| | - Henry V Doctor
- Department of Information, Evidence and Research, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
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29
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Ashraf N, Field E, Rusconi G, Voena A, Ziparo R. Traditional Beliefs and Learning about Maternal Risk in Zambia. THE AMERICAN ECONOMIC REVIEW 2017; 107:511-515. [PMID: 29553631 DOI: 10.1257/aer.p20171106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Maternal mortality remains very high in many parts of the developing world, especially in sub-Saharan Africa. While maternal deaths are observable, it may not be straightforward for individuals to learn about risk factors. This paper utilizes novel data on male and female perceptions of maternal risk in Zambia to document that superstitions about causes of maternal mortality are pervasive and to uncover evidence that such beliefs impede learning about maternal health risk levels and correlates. In our data, people who hold traditional beliefs disregard past birth complications completely in assessing future risk, unlike those who hold modern beliefs.
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Affiliation(s)
- Nava Ashraf
- Department of Economics, London School of Economics and Political Science, London, UK
| | - Erica Field
- Department of Economics, Duke University, Durham, NC
| | | | | | - Roberta Ziparo
- Aix-Marseille School of Economics, Aix-Marseille University, Centrale Marseille, Chemin du Château Lafarge, 13290 Les Milles FR, CNRS
and EHESS
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30
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Ouédraogo AM, Ouédraogo HG, Baguiya A, Millogo T, Somé A, Kouanda S. A case-control study of risk factors for maternal mortality in Burkina Faso in 2014. Int J Gynaecol Obstet 2016; 135 Suppl 1:S79-S83. [PMID: 27836090 DOI: 10.1016/j.ijgo.2016.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze the factors associated with maternal mortality in hospitals in Burkina Faso in the context of emergency obstetric neonatal care. METHODS A case-control study was conducted in 812 health facilities in the public and private sectors, involving all categories of health facility in the 13 regions of Burkina Faso. The study population included all women with obstetric complications from May 2013 to April 2014. For any identified case of maternal death, a control counterpart (living woman) was matched according to the obstetric complication. Conditional logistic regression was used to assess factors associated with maternal mortality. RESULTS The analysis focused on a total of 1128 women (564 cases and 564 controls). Place of residence (P=0.011), the referral for care (P<0.001), maternal age (P<0.001), state of consciousness of the mother (P<0.001), and the presence of a fever (P<0.001) were significantly associated with the occurrence of maternal death. In multivariate analysis, maternal age (OR 1.45; 95% CI, 0.95-2.20; P<0.001), coma (OR 1.44; 95% CI, 0.16-0.2; P=0.010), and presence of fever (OR 1.67; 95% CI, 1.21-2.28; P<0.001) were risk factors related to maternal death. CONCLUSION The determined factors demonstrate that the survival of women is closely linked to their health.
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Affiliation(s)
- Adja M Ouédraogo
- Kaya Health and Demographic Surveillance System, Kaya, Burkina Faso; Research Institute of Health Sciences, Ouagadougou, Burkina Faso; African Institute of Public Health, Ouagadougou, Burkina Faso.
| | - Henri G Ouédraogo
- Kaya Health and Demographic Surveillance System, Kaya, Burkina Faso; Research Institute of Health Sciences, Ouagadougou, Burkina Faso; African Institute of Public Health, Ouagadougou, Burkina Faso
| | - Adama Baguiya
- Kaya Health and Demographic Surveillance System, Kaya, Burkina Faso; Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Tieba Millogo
- African Institute of Public Health, Ouagadougou, Burkina Faso
| | - Anthony Somé
- Kaya Health and Demographic Surveillance System, Kaya, Burkina Faso; Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Seni Kouanda
- Kaya Health and Demographic Surveillance System, Kaya, Burkina Faso; Research Institute of Health Sciences, Ouagadougou, Burkina Faso; African Institute of Public Health, Ouagadougou, Burkina Faso
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31
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Ansari U, Cobham B, Etim EM, Ahamad HM, Owan NO, Tijani Y, Cockcroft A, Andersson N. Insights Into Intimate Partner Violence in Pregnancy: Findings From a Cross-Sectional Study in Two States in Nigeria. Violence Against Women 2016; 23:469-481. [PMID: 27121216 DOI: 10.1177/1077801216644072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A household survey and focus group discussions examined the frequency and risk factors for physical intimate partner violence (IPV) during pregnancy in two Nigerian states. Some 22% of women in Cross River and 9% in Bauchi reported IPV in their last pregnancy. The risk was higher in communities where more women reported IPV in the past year and lower among less poor women with more educated partners. Women were more likely to experience IPV in pregnancy if they had an income and decided how to spend it. Efforts to reduce IPV in pregnancy should involve communities as well as individuals.
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Affiliation(s)
| | | | | | | | | | - Yaya Tijani
- 4 Primary Health Care Development Agency, Bauchi, Nigeria
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Jordan K, Butrick E, Yamey G, Miller S. Barriers and Facilitators to Scaling Up the Non-Pneumatic Anti-Shock Garment for Treating Obstetric Hemorrhage: A Qualitative Study. PLoS One 2016; 11:e0150739. [PMID: 26938211 PMCID: PMC4777561 DOI: 10.1371/journal.pone.0150739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/18/2016] [Indexed: 11/19/2022] Open
Abstract
Background Obstetric hemorrhage (OH), which includes hemorrhage from multiple etiologies during pregnancy, childbirth, or postpartum, is the leading cause of maternal mortality and accounts for one-quarter of global maternal deaths. The Non-pneumatic Anti-Shock Garment (NASG) is a first-aid device for obstetric hemorrhage that can be applied for post-partum/post miscarriage and for ectopic pregnancies to buy time for a woman to reach a health care facility for definitive treatment. Despite successful field trials, and endorsement by safe motherhood organizations and the World Health Organization (WHO), scale-up has been slow in some countries. This qualitative study explores contextual factors affecting uptake. Methods From March 2013 to April 2013, we conducted 13 key informant interviews across four countries with a large burden of maternal mortality that had achieved varying success in scaling up the NASG: Ethiopia, India, Nigeria, and Zimbabwe. These key informants were health providers or program specialists working with the NASG. We applied a health policy analysis framework to organize the results. The framework has five domains: attributes of the intervention, attributes of the implementers, delivery strategy, attributes of the adopting community, the socio-political context, and the research context. Results The interviews from our study found that relevant facilitators for scale-up are the simplicity of the device, local and international champions, well-developed training sessions, recommendations by WHO and the International Federation of Gynecology and Obstetrics, and dissemination of NASG clinical trial results. Barriers to scaling up the NASG included limited health infrastructure, relatively high upfront cost of the NASG, initial resistance by providers and policy makers, lack of in-country champions or policy makers advocating for NASG implementation, inadequate return and exchange programs, and lack of political will. Conclusions There was a continuum of uptake ranging in both speed and scale. Ethiopia while not the first country to use the NASG has the most rapid scale-up, followed by Nigeria, then India, and finally Zimbabwe. Increasing the coverage of the NASG will require collaboration with local NASG champions, greater NASG awareness among clinicians and policymakers, as well as stronger political will and advocacy.
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Affiliation(s)
- Keely Jordan
- College of Global Public Health, New York University, New York, New York, United States of America
- * E-mail:
| | - Elizabeth Butrick
- Private Sector Healthcare Initiative, Global Health Group, University of California, San Francisco, United States of America
| | - Gavin Yamey
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Suellen Miller
- Safe Motherhood Program, Bixby Center for Global Reproductive Health, University of California, San Francisco, United States of America
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Ugwu IA, Oluwasola TA, Enabor OO, Anayochukwu-Ugwu NN, Adeyemi AB, Olayemi OO. Randomized controlled trial comparing 200μg and 400μg sublingual misoprostol for prevention of primary postpartum hemorrhage. Int J Gynaecol Obstet 2016; 133:173-7. [PMID: 26892695 DOI: 10.1016/j.ijgo.2015.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/14/2015] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare efficacy and adverse effects of 200μg and 400μg misoprostol for prevention of postpartum hemorrhage (PPH). METHODS In a randomized control trial, women with term singleton pregnancies in active labor attending University College Hospital, Ibadan, Nigeria, were enrolled between July 2011 and February 2012. Participants were randomly assigned using random numbers (block size four) to receive 200μg or 400μg sublingual misoprostol after delivery of the anterior shoulder, alongside intravenous oxytocin. Investigators were masked to group assignment, but participants were not. The primary outcomes were blood loss up to 1h after delivery, PPH (blood loss ≥500mL), and adverse effects. RESULTS Overall, 62 patients were assigned to each group. No significant differences between the 200-μg and 400-μg groups were recorded in mean peripartum blood loss (307±145mL vs 296±151mL; P=0.679) and PPH occurrence (5 [8.1%] vs 6 [9.7%] women; P=0.752). Noticeable adverse effects were reported by 16 (25.8%) women in the 200-μg group and 42 (67.7%) in the 400-μg group (P<0.001). Risk of shivering was significantly lower with 200μg than 400μg (relative risk 0.33, 95% confidence interval 0.19-0.58). CONCLUSION Blood loss and PPH occurrence did not differ by misoprostol dose, but a 200-μg dose was associated with a reduction in adverse effects. Pan Africa Clinical Trials Registry: PACTR201505001107182.
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Affiliation(s)
- Innocent A Ugwu
- Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
| | - Timothy A Oluwasola
- Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria; Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Obehi O Enabor
- Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
| | | | - Abolaji B Adeyemi
- Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
| | - Oladapo O Olayemi
- Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria; Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Sayinzoga F, Bijlmakers L, van Dillen J, Mivumbi V, Ngabo F, van der Velden K. Maternal death audit in Rwanda 2009-2013: a nationwide facility-based retrospective cohort study. BMJ Open 2016; 6:e009734. [PMID: 26801466 PMCID: PMC4735162 DOI: 10.1136/bmjopen-2015-009734] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Presenting the results of 5 years of implementing health facility-based maternal death audits in Rwanda, showing maternal death classification, identification of substandard (care) factors that have contributed to death, and conclusive recommendations for quality improvements in maternal and obstetric care. DESIGN Nationwide facility-based retrospective cohort study. SETTINGS All cases of maternal death audited by district hospital-based audit teams between January 2009 and December 2013 were reviewed. Maternal deaths that were not subjected to a local audit are not part of the cohort. POPULATION 987 audited cases of maternal death. MAIN OUTCOME MEASURES Characteristics of deceased women, timing of onset of complications, place of death, parity, gravida, antenatal clinic attendance, reported cause of death, service factors and individual factors identified by committees as having contributed to death, and recommendations made by audit teams. RESULTS 987 cases were audited, representing 93.1% of all maternal deaths reported through the national health management information system over the 5-year period. Almost 3 quarters of the deaths (71.6%) occurred at district hospitals. In 44.9% of these cases, death occurred in the post-partum period. Seventy per cent were due to direct causes, with post-partum haemorrhage as the leading cause (22.7%), followed by obstructed labour (12.3%). Indirect causes accounted for 25.7% of maternal deaths, with malaria as the leading cause (7.5%). Health system failures were identified as the main responsible factor for the majority of cases (61.0%); in 30.3% of the cases, the main factor was patient or community related. CONCLUSIONS The facility-based maternal death audit approach has helped hospital teams to identify direct and indirect causes of death, and their contributing factors, and to make recommendations for actions that would reduce the risk of reoccurrence. Rwanda can complement maternal death audits with other strategies, in particular confidential enquiries and near-miss audits, so as to inform corrective measures.
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Affiliation(s)
- Felix Sayinzoga
- Maternal, Child and Community Health Division, Rwanda Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda
| | - Leon Bijlmakers
- Department for Health Evidence, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Jeroen van Dillen
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Victor Mivumbi
- Maternal, Child and Community Health Division, Rwanda Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda
| | - Fidèle Ngabo
- Maternal, Child and Community Health Division, Rwanda Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda
| | - Koos van der Velden
- Department of Primary and Community Care, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
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Mehta RL, Cerdá J, Burdmann EA, Tonelli M, García-García G, Jha V, Susantitaphong P, Rocco M, Vanholder R, Sever MS, Cruz D, Jaber B, Lameire NH, Lombardi R, Lewington A, Feehally J, Finkelstein F, Levin N, Pannu N, Thomas B, Aronoff-Spencer E, Remuzzi G. International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet 2015; 385:2616-43. [PMID: 25777661 DOI: 10.1016/s0140-6736(15)60126-x] [Citation(s) in RCA: 653] [Impact Index Per Article: 72.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ravindra L Mehta
- Department of Medicine, University of California San Diego, San Diego, CA, USA.
| | - Jorge Cerdá
- Division of Nephrology, Department of Medicine, Albany Medical College, Albany, NY, USA
| | - Emmanuel A Burdmann
- LIM 12, Division of Nephrology, University of Sao Paulo Medical School, São Paulo, Brazil
| | | | - Guillermo García-García
- Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
| | - Vivekanand Jha
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Tufts University School of Medicine, Boston, MA, USA
| | - Michael Rocco
- Department of Internal Medicine, Section of Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium
| | - Mehmet Sukru Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Mehmet, Turkey
| | - Dinna Cruz
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Bertrand Jaber
- Tufts University School of Medicine, Boston, MA, USA; St Elizabeth's Medical Center, Boston, MA, USA
| | - Norbert H Lameire
- Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium
| | - Raúl Lombardi
- Department of Critical Care Medicine, SMI, Montevideo, Uruguay
| | | | | | | | | | | | - Bernadette Thomas
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Giuseppe Remuzzi
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy; Department of Medicine, Unit of Nephrology, Dialysis and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
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Badawy AM, Elnashar AM. Treatment with misoprostol by midwives is safe and effective. Lancet 2015; 385:2335-7. [PMID: 25817471 DOI: 10.1016/s0140-6736(14)62287-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ahmed M Badawy
- Department of Obstetrics and Gynecology, Mansura University, Mansoura 35111, Egypt.
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Schieppati A, Perico N, Remuzzi G. Eliminating treatable deaths due to acute kidney injury in resource-poor settings. Semin Dial 2014; 28:193-7. [PMID: 25441104 DOI: 10.1111/sdi.12328] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Acute kidney injury (AKI) is imposing a severe burden of morbidity and mortality both in developed and developing countries. Also AKI has a major economic impact on healthcare expenditure. This is particularly so in poor countries where AKI especially impacts young productive people, imposing severe penury upon their families. The mission is to lessen the high burden in terms of death consequent to this disorder in low-resource regions, which in many cases is preventable and treatable with simple measures. The International Society of Nephrology has launched a long-term program, called "0 by 25", which advocates that zero people should die of untreated AKI in the poorest part of Africa, Asia, and Latin America by 2025. This paper illustrates how the project will be developed.
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Affiliation(s)
- Arrigo Schieppati
- Unit of Nephrology, Dialysis and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", IRCCS - Istituto di Ricerche Famacologiche Mario Negri, Ranica, Bergamo, Italy
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Okokon IB, Oku AO, Agan TU, Asibong UE, Essien EJ, Monjok E. An evaluation of the knowledge and utilization of the partogragh in primary, secondary, and tertiary care settings in calabar, South-South Nigeria. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2014; 2014:105853. [PMID: 25298892 PMCID: PMC4179950 DOI: 10.1155/2014/105853] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/27/2014] [Accepted: 07/28/2014] [Indexed: 06/04/2023]
Abstract
The challenge to maternal well-being with associated maternal wastages especially in labor has remained unsurmountable across the three tiers of health care delivery in Nigeria. This study aimed to determine and compare the factors that influence utilization of the partograph in primary, secondary, and tertiary health care delivery levels in Calabar, Nigeria. This was a descriptive study, using a self-administered semistructured questionnaire on 290 consenting nonphysician obstetric care workers, purposively recruited. The mean age of the respondents was 40.25 ± 8.68 with a preponderance of females (92.4%). Knowledge of the partograph and previous partograph training had statistically significant relationship with its utilization among respondents from the tertiary and general hospitals. The level of knowledge was higher among workers in the general hospital than those working in the university teaching hospital. Nurses/midwives in the three levels of care were significantly more knowledgeable in partograph use than other nonphysician obstetric care workers. Lack of detailed knowledge of the partograph, its nonavailability and poor staff strength in the study centers were factors militating against its ease of utilization. The authors recommend periodic in-service training and provision of partograph in labor rooms in all maternity wards in our environment.
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Affiliation(s)
- Ita B. Okokon
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Medical Sciences, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Afiong O. Oku
- Department of Community Medicine, Faculty of Medicine and Dentistry, College of Medical Sciences, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Thomas U. Agan
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, College of Medical Sciences, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Udeme E. Asibong
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Medical Sciences, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ekere J. Essien
- Institute of Community Health, University of Houston, Texas Medical Center, Houston, TX, USA
| | - Emmanuel Monjok
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Medical Sciences, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Community Medicine, Faculty of Medicine and Dentistry, College of Medical Sciences, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
- Institute of Community Health, University of Houston, Texas Medical Center, Houston, TX, USA
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Pembe AB, Paulo C, D’mello BS, van Roosmalen J. Maternal mortality at Muhimbili National Hospital in Dar-es-Salaam, Tanzania in the year 2011. BMC Pregnancy Childbirth 2014; 14:320. [PMID: 25217326 PMCID: PMC4174678 DOI: 10.1186/1471-2393-14-320] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/09/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Improving maternal health is one of the eight millennium development goals adopted at the millennium summit in the year 2000. Within this frame work, the international community is committed to reduce the maternal mortality ratio by 75% between 1990 and 2015. The objective of this study was to determine the maternal mortality ratio, classify causes of maternal deaths and assess substandard care factors at Muhimbili National Hospital (MNH), Dar-es-Salaam in Tanzania. METHODS A retrospective review of all maternal death records of cases that occurred from 1st January to 31st December 2011 was done. RESULTS There were 10,057 live births, 155 maternal deaths and hence MMR of 1,541 per 100,000 live births. Direct causes of maternal deaths were classified in 69.5% of the maternal deaths. Of the direct causes, preeclampsia/eclampsia was the major cause (19.9% of all deaths), followed by post partum haemorrhage (14.9%), abortion complications (9.9%) and sepsis (9.2%). Among the indirect causes anaemia was the leading cause (11.3%) of all deaths, followed by HIV/AIDS (9.9%). Substandard care factors contributing to deaths were identified in 116 (82.3%) of all cases. Among these 28 had patient factors only, 71 medical service factors while 17 had both patient and medical service substandard care factors. The common factors from the woman's side included delay in seeking care (73.3%) and complete lack of antenatal care (11.1%). Of the medical service factors, inadequate (26.1%) or no blood for transfusion (19.3%), delay in receiving treatment (18.3%) and mismanagement (17%) were the common factors. CONCLUSION There is a high maternal mortality ratio at MNH. Hypertensive disorders of pregnancy, post partum haemorrhage and anaemia are the leading causes of maternal deaths in this institution. Multiple substandard care factors identified both at individual and health care service levels that contributed to maternal deaths. There is a need for increasing efforts in the fight to reduce maternal deaths at the institution. A more pro-active role from the referring facilities in the region is needed.
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Affiliation(s)
- Andrea B Pembe
- />Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Chetto Paulo
- />Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- />Dodoma Regional Referral Hospital, Dodoma, Tanzania
| | - Brenda S D’mello
- />Maternal and Newborn Health Care, Comprehensive Community Based Rehabilitation in Tanzania, Dar es Salaam, Tanzania
| | - Jos van Roosmalen
- />Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- />Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands
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Buchmann EJ, Mnyani CN, Frank KA, Chersich MF, McIntyre JA. Declining maternal mortality in the face of persistently high HIV prevalence in a middle-income country. BJOG 2014; 122:220-7. [PMID: 25213804 DOI: 10.1111/1471-0528.13064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To estimate maternal mortality ratio (MMR) and determine maternal death causes and trends in Greater Soweto, Johannesburg, South Africa. DESIGN Cross-sectional study. SETTING Chris Hani Baragwanath Maternity Hospital (CHBMH) in Greater Soweto. POPULATION Maternal deaths at CHBMH. METHODS Record review of maternal deaths from 1997 to 2012, using hospital death records, with denominator data from the district health information system and the hospital. MAIN OUTCOME MEASURES Maternal mortality ratio per 100,000 live births, and causes of death classified as in the South African confidential enquiries. RESULTS There were 479 deaths, with a peak MMR of 139 in 2004 and a decline to 86 in 2012. Of 332 women tested, 245 (74%) were HIV-infected. Nonpregnancy-related infection (40%) was the most frequent cause of death, followed by hypertension (16%) and obstetric haemorrhage (13%). HIV infection rates in these groups were 92%, 30% and 61%, respectively. Previous caesarean section was associated with obstetric haemorrhage death (odds ratio [OR] 3.2, 95% confidence interval [95% CI] 1.7-6.0), maternal age ≥35 years with hypertension death (OR 2.2, 95% CI 1.2-3.7) and antenatal anaemia with nonpregnancy-related infection death (OR 4.0, 95% CI 2.3-6.9), compared with other causes of death. CONCLUSION There is evidence of a decline in MMR since HIV treatment for pregnant women was introduced in 2004. Previous caesarean section, advanced maternal age, and anaemia were associated with death from obstetric haemorrhage, hypertensive disorders of pregnancy and nonpregnancy-related infections, respectively. MMR may be further reduced with accelerated initiation of HIV treatment during pregnancy.
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Affiliation(s)
- E J Buchmann
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
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Ugwu IA, Enabor OO, Adeyemi AB, Lawal OO, Oladokun A, Olayemi O. Sublingual misoprostol to decrease blood loss after caesarean delivery: A randomised controlled trial. J OBSTET GYNAECOL 2014; 34:407-11. [DOI: 10.3109/01443615.2014.899329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Landi B, Bezzeccheri V, Guerra B, Piemontese M, Cervi F, Cecchi L, Margarito E, Giannubilo SR, Ciavattini A, Tranquilli AL. HIV Infection in Pregnancy and the Risk of Gestational Hypertension and Preeclampsia. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/wjcd.2014.45034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Adegoke AA, Campbell M, Ogundeji MO, Lawoyin T, Thomson AM. Place of birth or place of death: An evaluation of 1139 maternal deaths in Nigeria. Midwifery 2013; 29:e115-21. [DOI: 10.1016/j.midw.2012.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 11/07/2012] [Accepted: 11/27/2012] [Indexed: 10/27/2022]
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Lewington AJP, Cerdá J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int 2013; 84:457-67. [PMID: 23636171 PMCID: PMC3758780 DOI: 10.1038/ki.2013.153] [Citation(s) in RCA: 451] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 02/05/2013] [Accepted: 02/07/2013] [Indexed: 12/15/2022]
Abstract
Worldwide, acute kidney injury (AKI) is associated with poor patient outcomes. Over the last few years, collaborative efforts, enabled by a common definition of AKI, have provided a description of the epidemiology, natural history, and outcomes of this disease and improved our understanding of the pathophysiology. There is increased recognition that AKI is encountered in multiple settings and in all age groups, and that its course and outcomes are influenced by the severity and duration of the event. The effect of AKI on an individual patient and the resulting societal burden that ensues from the long-term effects of the disease, including development of chronic kidney disease (CKD) and end-stage renal disease (ESRD), is attracting increasing scrutiny. There is evidence of marked variation in the management of AKI, which is, to a large extent, due to a lack of awareness and an absence of standards for prevention, early recognition, and intervention. These emerging data point to an urgent need for a global effort to highlight that AKI is preventable, its course is modifiable, and its treatment can improve outcomes. In this article, we provide a framework of reference and propose specific strategies to raise awareness of AKI globally, with the goal to ultimately improve outcomes from this devastating disease.
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Affiliation(s)
| | - Jorge Cerdá
- Department of Medicine, Albany Medical College, Albany, New York, USA
| | - Ravindra L Mehta
- Department of Medicine, University of California San Diego, San Diego CA, USA
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Adegoke AA, Campbell M, Ogundeji MO, Lawoyin TO, Thomson AM. Community Study of maternal mortality in South West Nigeria: how applicable is the sisterhood method. Matern Child Health J 2013; 17:319-29. [PMID: 22411705 DOI: 10.1007/s10995-012-0977-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A significant reduction in maternal mortality was witnessed globally in the year 2010, yet, no significant reduction in the maternal mortality ratio (MMR) in Nigeria was recorded. The absence of accurate data on the numbers, causes and local factors influencing adverse maternal outcomes has been identified as a major obstacle hindering appropriate distribution of resources targeted towards improving maternal healthcare. This paper reports the first community based study that measures the incidence of maternal mortality in Ibadan, Nigeria using the indirect sisterhood method and explores the applicability of this method in a community where maternal mortality is not a rare event. A community-based study was conducted in Ibadan using the principles of the sisterhood method developed by Graham et al. for developing countries. Using a multi-stage sampling design with stratification and clustering, 3,028 households were selected. All persons approached agreed to take part in the study (a participation rate of 100%), with 2,877 respondents eligible for analysis. There was a high incidence of maternal mortality in the study setting: 1,324/6,519 (20.3%) sisters of the respondents had died, with 1,139 deaths reportedly related to pregnancy, childbirth or the puerperium. The MMR was 7,778 per 100,000 live births (95% CI 7,326-8,229). Adjusted for a published Total Fertility Rate of 6.0, the MMR was 6,525 per 100,000 live births (95% CI 6,144-6,909). Women in Ibadan were dying more from pregnancy related complications than from other causes. Findings of this study have implications for midwifery education, training and practice and for the first time provide policy makers and planners with information on maternal mortality in the community of Ibadan city and shed light on the causes of maternal mortality in the area.
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Affiliation(s)
- Adetoro A Adegoke
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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A retrospective analysis of maternal and neonatal mortality at a teaching and referral hospital in Kenya. Reprod Health 2013; 10:13. [PMID: 23421605 PMCID: PMC3599365 DOI: 10.1186/1742-4755-10-13] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 02/14/2013] [Indexed: 11/28/2022] Open
Abstract
Objective To measure the incidence of maternal and early neonatal mortality in women who gave birth at Moi Teaching and Referral Hospital (MTRH) in Kenya and describe clinical and other characteristics and circumstances associated with maternal and neonatal deaths following deliveries at MTRH. Methods A retrospective audit of maternal and neonatal records was conducted with detailed analysis of the most recent 150 maternal deaths and 200 neonatal deaths. Maternal mortality ratios and early neonatal mortality rates were calculated for each year from January 2004 to December 2011. Results Between 2004 and 2011, the overall maternal mortality ratio was 426 per 100,000 live births and the early neonatal mortality rate (<7 days) was 68 per 1000 live births. The Hospital record audit showed that half (51%) of the neonatal mortalities were for young mothers (15–24 years) and 64% of maternal deaths were in women between 25 and 45 years. Most maternal and early neonatal deaths occurred in multiparous women, in referred admissions, when the gestational age was under 37 weeks and in latent stage of labour. Indirect complications accounted for the majority of deaths. Where there were direct obstetric complications associated with the delivery, the leading cause of maternal death was eclampsia and the leading cause of early neonatal death was pre-mature rupture of membranes. Pre-term birth and asphyxia were leading causes of early neonatal deaths. In both sets of records the majority of deliveries were vaginal and performed by midwives. Conclusion This study provides important information about maternal and early neonatal mortality in Kenya’s second largest tertiary hospital. A range of socio demographic, clinical and health system factors are identified as possible contributors to Kenya’s poor progress towards reducing maternal and early neonatal mortality.
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Gerdts C, Vohra D, Ahern J. Measuring unsafe abortion-related mortality: a systematic review of the existing methods. PLoS One 2013; 8:e53346. [PMID: 23341939 PMCID: PMC3544771 DOI: 10.1371/journal.pone.0053346] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 11/27/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The WHO estimates that 13% of maternal mortality is due to unsafe abortion, but challenges with measurement and data quality persist. To our knowledge, no systematic assessment of the validity of studies reporting estimates of abortion-related mortality exists. STUDY DESIGN To be included in this study, articles had to meet the following criteria: (1) published between September 1(st), 2000-December 1(st), 2011; (2) utilized data from a country where abortion is "considered unsafe"; (3) specified and enumerated causes of maternal death including "abortion"; (4) enumerated ≥100 maternal deaths; (5) a quantitative research study; (6) published in a peer-reviewed journal. RESULTS 7,438 articles were initially identified. Thirty-six studies were ultimately included. Overall, studies rated "Very Good" found the highest estimates of abortion related mortality (median 16%, range 1-27.4%). Studies rated "Very Poor" found the lowest overall proportion of abortion related deaths (median: 2%, range 1.3-9.4%). CONCLUSIONS Improvements in the quality of data collection would facilitate better understanding global abortion-related mortality. Until improved data exist, better reporting of study procedures and standardization of the definition of abortion and abortion-related mortality should be encouraged.
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Affiliation(s)
- Caitlin Gerdts
- Advancing New Standards in Reproductive Health, University of California San Francisco, San Francisco, CA, USA.
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Mboho M, Furber C, Waterman H. Social-cultural practices and beliefs influencing maternal mortality. ACTA ACUST UNITED AC 2013. [DOI: 10.12968/ajmw.2013.7.1.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Margaret Mboho
- in Health Education Dept. of Physical and Health Education, University of Uyo Nigeria
| | - Christine Furber
- School of Nursing, Midwifery and Social Work, University of Manchester, UK
| | - Heather Waterman
- School of Nursing, Midwifery and Social Work, University of Manchester, UK
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Girard AW, Dzingina C, Akogun O, Mason JB, McFarland DA. Public health interventions, barriers, and opportunities for improving maternal nutrition in Northeast Nigeria. Food Nutr Bull 2012; 33:S51-70. [PMID: 22913107 DOI: 10.1177/15648265120332s104] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Efficacious strategies to improve maternal nutrition and subsequent maternal, neonatal, and child health exist, but their utilization and application at scale is limited. OBJECTIVE This study explored the gaps, barriers, and opportunities for maternal nutrition policy and programming in Nigeria, a country with a disproportionate share of the global burden of maternal and child mortality METHODS Research was conducted in three phases in four Local Government Authorities in Taraba State. Phase 1 consisted of a desk review of policies, programs, and sociodemographic and health indicators pertinent to maternal nutrition. In-depth interviews were conducted with key informants in state and local ministries of health as well as international nongovernmental organizations and community- and faith-based organizations. Phase 2 utilized in-depth interviews and focus group discussions with community leaders, health promoters, and mothers. Phase 3 consisted of key informant interviews with federal policy and program leaders in government ministries and nongovernmental organizations. RESULTS Nutrition, especially maternal nutrition, is not prioritized and is poorly funded in both the governmental and the nongovernmental systems. Perceived weak advocacy for nutrition and its role in economic development and the lack of coordination among governmental and nongovernmental actors were said to contribute to low prioritization. Dependence on health facilities as the primary platform for delivering maternal nutrition is problematic, given severe resource constraints and perceived community barriers, including cost, distance, and poor quality of care. CONCLUSIONS Advocacy for maternal nutrition that improves understanding of its consequences for health and economic development could hasten prioritization, coordination, and investment in maternal nutrition at the national, state, and local levels. Innovative, multisectoral strategies that move beyond facility-based platforms are needed to reduce the burden of maternal undernutrition in Northeast Nigeria.
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Affiliation(s)
- Amy Webb Girard
- Rollins School of Public Health, Emory University, Atlanta, Georgia 30317, USA.
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