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Hwang WJ, Lee TH. Safe delivery kits and newborn infection in rural Ethiopian communities. Front Public Health 2024; 12:1305255. [PMID: 39185109 PMCID: PMC11341469 DOI: 10.3389/fpubh.2024.1305255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 05/14/2024] [Indexed: 08/27/2024] Open
Abstract
Objectives Our goal in this study to investigate the impacts of using safe delivery kits, along with education on their appropriate use, has on preventing newborn and maternal infection. Design A cross-sectional study. Setting Participants, and Interventions: we conducted the study on 23 sites across a rural district in Oromia Region, Ethiopia. Safe delivery kits were distributed by health extension workers. Participants comprised 534 mothers between the ages of 17 and 45 years, who were given a safe delivery kit at 7 months' pregnancy for use during their subsequent delivery. Data collection was performed by the trained interviewers in rural Ethiopian communities. Results Multiple logistic regression analyses showed an independent association between using the cord tie provided in the kits and decreased newborn infection. Specifically, newborns whose mothers used the cord tie were 30 times less likely to develop cord infection than those not using the cord tie in the kits. Further, mothers who received education regarding safe delivery kit use had lower rates of puerperal infection. Conclusion Single-use delivery kits, when combined with education regarding the appropriate means of using the kit, can decrease the likelihood of maternal infection. Implications for nursing Nurses and health extension workers in low and middle-income countries should educate mothers on safe delivery kits by providing information regarding their usefulness and the importance of correct and consistent use. Implications for Health Policy: our findings emphasize the need for further interventions in vulnerable countries designed to increase the rate of hygienic birthing practices for deliveries outside health-care facilities.
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Affiliation(s)
- Won Ju Hwang
- East-West Nursing Research Institute, College of Nursing Science Kyung Hee University, Seoul, Republic of Korea
| | - Tae Hwa Lee
- School of Nursing, Yonsei University, Seoul, Republic of Korea
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Marcus JK, Fawcus S. Clinical algorithms for management of third stage abnormalities. BJOG 2024; 131 Suppl 2:37-48. [PMID: 35411672 DOI: 10.1111/1471-0528.16729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022]
Abstract
AIMS To develop algorithms for identifying, managing and monitoring postpartum haemorrhage (PPH) and other third stage of labour abnormalities after vaginal delivery. POPULATION Women with low-risk singleton term pregnancies who have had a vaginal delivery. SETTING Hospital settings with a particular focus on healthcare facilities in low- and middle-income countries (LMICs). SEARCH STRATEGY Searches for international and national guidance documents, research databases (Cochrane, Medline and CINAHL) and published systematic reviews. Searches were limited to work published in English between 1 January 2008 and 31 December 2018. CASE SCENARIOS Four interlinked case scenarios were identified for algorithm development: (1) an approach to PPH after vaginal delivery, (2) uterine atony, (3) genital tract trauma and (4) retained placenta/placental products. CONCLUSIONS The development of clear approaches to the assessment, resuscitation, treatment and monitoring of the four case scenarios are presented as algorithms, based on available evidence. They need to be field tested and evaluated for effectiveness, and may be adapted for electronic decision support tools using artificial intelligence in different settings. Further research is needed around multimodal sequential packages of care for PPH, conservative surgical measures, resuscitation in LMICs, and how a respectful maternity care focus can be incorporated into the algorithms. TWEETABLE ABSTRACT Algorithm development for standardised approaches to managing PPH in low-resource settings.
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Affiliation(s)
- J K Marcus
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - S Fawcus
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Lokuge K, Wemin F, Joshy G, Dl Mola G. Evaluation of an obstetric and neonatal care upskilling program for community health workers in Papua New Guinea. BMC Pregnancy Childbirth 2024; 24:357. [PMID: 38745135 PMCID: PMC11094975 DOI: 10.1186/s12884-024-06531-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND 60% of women in Papua New Guinea (PNG) give birth unsupervised and outside of a health facility, contributing to high national maternal and perinatal mortality rates. We evaluated a practical, hospital-based on-the-job training program implemented by local health authorities in PNG between 2013 and 2019 aimed at addressing this challenge by upskilling community health workers (CHWs) to provide quality maternal and newborn care in rural health facilities. METHODS Two provinces, the Eastern Highlands and Simbu Provinces, were included in the study. In the Eastern Highlands Province, a baseline and end point skills assessment and post-training interviews 12 months after completion of the 2018 training were used to evaluate impacts on CHW knowledge, skills, and self-reported satisfaction with training. Quality and timeliness of referrals was assessed through data from the Eastern Highlands Province referral hospital registers. In Simbu Province, impacts of training on facility births, stillbirths and referrals were evaluated pre- and post-training retrospectively using routine health facility reporting data from 2012 to 2019, and negative binomial regression analysis adjusted for potential confounders and correlation of outcomes within facilities. RESULTS The average knowledge score increased significantly, from 69.8% (95% CI:66.3-73.2%) at baseline, to 87.8% (95% CI:82.9-92.6%) following training for the 8 CHWs participating in Eastern Highlands Province training. CHWs reported increased confidence in their skills and ability to use referral networks. There were significant increases in referrals to the Eastern Highlands provincial hospital arriving in the second stage of labour but no significant difference in the 5 min Apgar score for children, pre and post training. Data on 11,345 births in participating facilities in Simbu Province showed that the number of births in participating rural health facilities more than doubled compared to prior to training, with the impact increasing over time after training (0-12 months after training: IRR 1.59, 95% CI: 1.04-2.44, p-value 0.033, > 12 months after training: IRR 2.46, 95% CI:1.37-4.41, p-value 0.003). There was no significant change in stillbirth or referral rates. CONCLUSIONS Our findings showed positive impacts of the upskilling program on CHW knowledge and practice of participants, facility births rates, and appropriateness of referrals, demonstrating its promise as a feasible intervention to improve uptake of maternal and newborn care services in rural and remote, low-resource settings within the resourcing available to local authorities. Larger-scale evaluations of a size adequately powered to ascertain impact of the intervention on stillbirth rates are warranted.
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Affiliation(s)
- Kamalini Lokuge
- National Centre for Epidemiology and Population Health, The Australian National University, 62 Mills Road, Canberra, Acton, ACT, 2601, Australia.
| | - Freda Wemin
- Goroka Provincial Hospital, 441, Eastern Highlands Province, PO Box 392, Goroka, Papua New Guinea
| | - Grace Joshy
- National Centre for Epidemiology and Population Health, The Australian National University, 62 Mills Road, Canberra, Acton, ACT, 2601, Australia
| | - Glen Dl Mola
- School of Medicine and Health Sciences, University of Papua New Guinea, Papua New Guinea, NCD, Box 5623, Port Moresby, Boroko, Papua New Guinea
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van Tetering AAC, Ntuyo P, Martens RPJ, Winter N, Byamugisha J, Oei SG, Fransen AF, van der Hout-van der Jagt MB. Simulation-Based Training in Emergency Obstetric Care in Sub-Saharan and Central Africa: A Scoping Review. Ann Glob Health 2023; 89:62. [PMID: 37780839 PMCID: PMC10540704 DOI: 10.5334/aogh.3891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
Background Every day approximately 810 women die from complications related to pregnancy and childbirth worldwide. Around two thirds of these deaths happen in sub-Saharan Africa. One of the strategies to decrease these numbers is improving the quality of care by emergency obstetric simulation-based training. The effectiveness of such training programs depends on the program's instructional design. Objective This review gives an overview of studies about emergency obstetric simulation-based training and examines the applied instructional design of the training programs in sub-Saharan and Central Africa. Methods We searched Medline, Embase and Cochrane Library from inception to May 2021. Peer-reviewed articles on emergency obstetric, postgraduate, simulation-based training in sub-Saharan and Central Africa were included. Outcome measures were categorized based on Kirkpatrick's levels of training evaluation. The instructional design was evaluated by using the ID-SIM questionnaire. Findings In total, 47 studies met the inclusion criteria. Evaluation on Kirkpatrick level 1 showed positive reactions in 18 studies. Challenges and recommendations were considered. Results on knowledge, skills, and predictors for these results (Kirkpatrick level 2) were described in 29 studies. Retention as well as decay of knowledge and skills over time were presented. Results at Kirkpatrick level 3 were measured in 12 studies of which seven studies demonstrated improvements of skills on-the-job. Improvements of maternal and neonatal outcomes were described in fifteen studies and three studies reported on cost-estimations for training rollout (Kirkpatrick level 4). Instructional design items were heterogeneously applied and described. Conclusions Results of 47 studies indicate evidence that simulation-based training in sub-Saharan and Central Africa can have a positive impact across all four levels of Kirkpatrick's training evaluation model. However, results were not consistent across all studies and the effects vary over time. A detailed description of instructional design features in future publications on simulation-based training will contribute to a deeper understanding of the underlying mechanisms that determine why certain training programs are more effective in improving maternal and neonatal healthcare outcomes than other.
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Affiliation(s)
- Anne A. C. van Tetering
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, NL
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, NL
| | - Peter Ntuyo
- Department of Obstetrics and Gynaecology, Mulago Specialised Women and Neonatal Hospital, UG
| | | | - Naomi Winter
- Department of Obstetrics and Gynaecology, St. Antonius Hospital, Utrecht, NL
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, UG
| | - S. Guid Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, NL
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, NL
| | | | - M. Beatrijs van der Hout-van der Jagt
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, NL
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, NL
- Department of Biomedical Engineering Eindhoven University of Technology, Eindhoven, NL
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Hulsbergen M, Abera B, Adefris M, Kassahun D, Meulenbeld M, van Nievelt S, Ameh C, Bruinooge M, Rijken MJ, Stekelenburg J. Evaluation of the Emergency Obstetric and Newborn Care training in Gondar, Ethiopia; a mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000889. [PMID: 37751409 PMCID: PMC10522022 DOI: 10.1371/journal.pgph.0000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/31/2023] [Indexed: 09/28/2023]
Abstract
In Ethiopia maternal and perinatal morbidity and mortality remains high. Timely access to quality emergency obstetric and neonatal care is essential for the prevention of adverse outcomes. Training healthcare providers can play an important role in improving quality of care, thereby reducing maternal and perinatal mortality and morbidity. The aim of this study was to evaluate change of knowledge, skills and behaviour in health workers who attended a postgraduate Emergency Obstetric and Newborn Care training in Gondar, Ethiopia. A descriptive study with before-after approach, using a mix of quantitative and qualitative data, based on Kirkpatrick's model for training evaluation was conducted. The evaluation focussed on reaction, knowledge, skills, and change in behaviour in clinical practice of health care providers and facilitator's perspectives on performance. A 'lessons learned approach' was included to summarize facilitators' perspectives. Health care providers reacted positively to the Emergency Obstetric and Newborn Care training with significant improvement in knowledge and skills. Of the 56 participants who attended the training, 44 (79%) were midwives. The main evaluation score for lectures was 4,51 (SD 0,19) and for breakout sessions was 4,52 (SD 0.18) on scale of 1-5. There was a statistically significant difference in the pre and post knowledge (n = 28, mean difference 13.8%, SD 13.5, t = 6.216, p<0.001) and skills assessments (n = 23, mean difference 27.4%, SD 22.1%, t = 5.941, p<0.001). The results were the same for every component of the skills and knowledge assessment. Overall, they felt more confident in performing skills after being trained. Local sustainability, participant commitment and local context were identified as challenging factors after introducing a new training program. In Gondar Ethiopia, the Emergency Obstetric and Newborn Care training has the potential to increase skilled attendance at birth and improve quality of care, both vital to the reduction of maternal and perinatal mortality and morbidity.
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Affiliation(s)
- Myrrith Hulsbergen
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
- Center for Evidence Based Education, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Gynaecology Department, Women’s Healthcare Center, Amsterdam, The Netherlands
| | - Birhanu Abera
- Department of Obstetrics and Gynecology, University of Global Health Equity (UGHE), Kigali, Rwanda
| | - Mulat Adefris
- Department of Obstetrics and Gynaecology, University of Gondar, Gondar, Ethiopia
| | - Dawit Kassahun
- Department of Obstetrics and Gynaecology, University of Gondar, Gondar, Ethiopia
| | - Marieke Meulenbeld
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
| | - Sabine van Nievelt
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
- Department of Obstetrics and Gynaecology, Haaglanden Medical Centre, Hague, The Netherlands
| | - Charles Ameh
- International Public Health Department Liverpool School of Tropical Medicine, Emergency Obstetric Care and Quality of Care Unit, Liverpool, United Kingdom
| | - Mimosa Bruinooge
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
- Department of Obstetrics and Gynaecology, Admiraal de Ruyter Ziekenhuis, Goes, The Netherlands
| | - Marcus J. Rijken
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Jelle Stekelenburg
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
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Emmanuel A, Kain VJ, Forster E. The Impact of an Educational Intervention on Neonatal Care and Survival. J Perinat Neonatal Nurs 2023; 37:138-147. [PMID: 36719649 DOI: 10.1097/jpn.0000000000000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Under-5 mortality has declined globally; however, proportion of under-5 deaths occurring within the first 28 days after birth has increased significantly. This study aims to determine the impact of an educational intervention on neonatal care and survival rates in Nigeria. METHODS This was a sequential exploratory mixed-methods design involving 21 health workers in the preintervention phase, while 15 health workers and 30 mother-baby dyads participated in the postintervention phase. Data were collected using semistructured interviews and nonparticipatory observation. Qualitative data were analyzed using thematic analysis, while quantitative data were analyzed using descriptive and inferential statistics. RESULTS Healthy newborns were routinely separated from their mothers in the preintervention period. During this time, non-evidence-based practices, such as routine nasal and oral suctioning, were performed. Skin-to-skin contact and early initiation of breastfeeding were frequently interrupted. After the intervention, 80.6% were placed in skin-to-skin contact with their mothers, and 20 of these babies maintained contact with the mother until breastfeeding was established. There was decline in neonatal deaths post-intervention. Independent t -test analysis of the day of neonatal death demonstrates a significant difference in mean ( P = .00, 95% confidence interval -5.629; -7.447 to -4.779). CONCLUSION Newborn survival can be improved through regular training of maternity health workers in evidence-based newborn care.
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Affiliation(s)
- Andy Emmanuel
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia (Drs Emmanuel, Kain, and Forster); and Department of Nursing Science, College of Medical Sciences, University of Jos, Jos, Nigeria (Dr Emmanuel)
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Dol J, Hughes B, Bonet M, Dorey R, Dorling J, Grant A, Langlois EV, Monaghan J, Ollivier R, Parker R, Roos N, Scott H, Shin HD, Curran J. Timing of neonatal mortality and severe morbidity during the postnatal period: a systematic review. JBI Evid Synth 2022; 21:98-199. [PMID: 36300916 PMCID: PMC9794155 DOI: 10.11124/jbies-21-00479] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective of this review was to determine the timing of overall and cause-specific neonatal mortality and severe morbidity during the postnatal period (1-28 days). INTRODUCTION Despite significant focus on improving neonatal outcomes, many newborns continue to die or experience adverse health outcomes. While evidence on neonatal mortality and severe morbidity rates and causes are regularly updated, less is known on the specific timing of when they occur in the neonatal period. INCLUSION CRITERIA This review considered studies that reported on neonatal mortality daily in the first week; weekly in the first month; or day 1, days 2-7, and days 8-28. It also considered studies that reported on timing of severe neonatal morbidity. Studies that reported solely on preterm or high-risk infants were excluded, as these infants require specialized care. Due to the available evidence, mixed samples were included (eg, both preterm and full-term infants), reflecting a neonatal population that may include both low-risk and high-risk infants. METHODS MEDLINE, Embase, Web of Science, and CINAHL were searched for published studies on December 20, 2019, and updated on May 10, 2021. Critical appraisal was undertaken by 2 independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by 2 reviewers using a study-specific data extraction form. All conflicts were resolved through consensus or discussion with a third reviewer. Where possible, quantitative data were pooled in statistical meta-analysis. Where statistical pooling was not possible, findings were reported narratively. RESULTS A total of 51 studies from 36 articles reported on relevant outcomes. Of the 48 studies that reported on timing of mortality, there were 6,760,731 live births and 47,551 neonatal deaths with timing known. Of the 34 studies that reported daily deaths in the first week, the highest proportion of deaths occurred on the first day (first 24 hours, 38.8%), followed by day 2 (24-48 hours, 12.3%). Considering weekly mortality within the first month (n = 16 studies), the first week had the highest mortality (71.7%). Based on data from 46 studies, the highest proportion of deaths occurred on day 1 (39.5%), followed closely by days 2-7 (36.8%), with the remainder occurring between days 8 and 28 (23.0%). In terms of causes, birth asphyxia accounted for the highest proportion of deaths on day 1 (68.1%), severe infection between days 2 and 7 (48.1%), and diarrhea between days 8 and 28 (62.7%). Due to heterogeneity, neonatal morbidity data were described narratively. The mean critical appraisal score of all studies was 84% (SD = 16%). CONCLUSION Newborns experience high mortality throughout the entire postnatal period, with the highest mortality rate in the first week, particularly on the first day. Ensuring regular high-quality postnatal visits, particularly within the first week after birth, is paramount to reduce neonatal mortality and severe morbidity.
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, NS, Canada,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - Brianna Hughes
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada,School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rachel Dorey
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Jon Dorling
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| | - Amy Grant
- Maritime SPOR Support Unit, Halifax, NS, Canada
| | - Etienne V. Langlois
- Partnership for Maternal, Newborn and Child Health, World Health Organization, Geneva, Switzerland
| | - Joelle Monaghan
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Rachel Ollivier
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Robin Parker
- W.K. Kellogg Health Sciences Library, Dalhousie Libraries, Dalhousie University, Halifax, NS, Canada
| | - Nathalie Roos
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Heather Scott
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Hwayeon Danielle Shin
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada,School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Janet Curran
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada,School of Nursing, Dalhousie University, Halifax, NS, Canada
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Namazzi G, Hildenwall H, Ndeezi G, Mubiri P, Nalwadda C, Kakooza-Mwesige A, Waiswa P, Tumwine JK. Health facility readiness to care for high risk newborn babies for early childhood development in eastern Uganda. BMC Health Serv Res 2022; 22:306. [PMID: 35248027 PMCID: PMC8898085 DOI: 10.1186/s12913-022-07693-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The neonatal mortality rate in Uganda has barely changed over the past decades, estimated at 28/1000 and 27/1000 live births in 2006 and 2016 respectively. The survivors have a higher risk of developing neurodevelopmental disabilities (NDD) due to brain insults from perinatal complications related to poor quality of health services during pregnancy, around the time of birth, and during the postnatal period. This study aimed to assess health facility readiness to care for high risk newborn babies in order to inform programming that fosters early childhood development in eastern Uganda. METHODS A cross sectional study of 6 hospitals and 10 higher level health centers that offer comprehensive maternal and newborn care was carried out in February 2020 in eastern Uganda. A World Health Organization Service Availability and Readiness Assessment tool (SARA) was adapted and used to assess the health facility readiness to manage maternal and neonatal conditions that are related to NDD. In addition, 201 mothers of high risk newborn babies were interviewed on their satisfaction with health services received. Readiness scores were derived from percentage average facilities with available infrastructure and essential medical commodities to manage neonatal complications. Descriptive statistics were computed for client satisfaction with service provision, and p values used to compare private not for profit to public health facilities. RESULTS There was limited availability in numbers and skilled human resource especially the neonatal nurses. Hospitals and health centers scored least in preterm and hypothermia care, with averages of 38% and 18% respectively. The highest scores were in essential newborn care, with readiness of 78% and 85% for hospitals and health centers, followed by resuscitation at 78% and 77%, respectively. There were no guidelines on positive interaction with newborn babies to foster neurodevelopment. The main cause of admission to neonatal care units was birth asphyxia followed by prematurity, indicative of intrapartum care challenges. The overall client satisfaction with health services was higher in private not for profit facilities at 91% compared to public hospitals at 73%, p = 0.017. CONCLUSION Health facility readiness was inadequate in management of preterm complications. Efforts should, therefore, be geared to improving availability of inputs and quality of emergency obstetric and newborn care in order to manage high risk newborns and reduce the burden of NDD in this setting.
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Affiliation(s)
- Gertrude Namazzi
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Mulago Hill Road, P. O. Box 7072, Kampala, Uganda
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Helena Hildenwall
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
- Health Systems & Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Paul Mubiri
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Mulago Hill Road, P. O. Box 7072, Kampala, Uganda
| | - Christine Nalwadda
- Department of Community Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Peter Waiswa
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Mulago Hill Road, P. O. Box 7072, Kampala, Uganda
| | - James K. Tumwine
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- School of Medicine, Kabale University, Kabale, Uganda
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Lags in the provision of obstetric services to indigenous women and their implications for universal access to health care in Mexico. Sex Reprod Health Matters 2021; 28:1778153. [PMID: 32757830 PMCID: PMC7888012 DOI: 10.1080/26410397.2020.1778153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Through quantitative and qualitative methods, in this article the authors describe the perspectives of indigenous women who received antenatal and childbirth medical care within a care model that incorporates a non-governmental organisation (NGO), Partners in Health. They discuss whether the NGO model better resolves the care-seeking process, including access to health care, compared with a standard model of care in government-subsidised health care units (setting of health services networks). Universal health coverage advocates access for the most disadvantaged and vulnerable populations as a priority. However, the issue of access includes problems related to the effect of certain structural social determinants that limit different aspects of the obstetric care process. The findings of this study show the need to modify the structure of organisational values in order to place users at the centre of medical care and ensure respect for their rights. The participation of agents outside the public system, such as NGOs, can be of great value for moving in this direction. Women’s participation is also necessary for learning how they are being cared for and the extent to which they are satisfied with obstetric services. This research experience can be used for other countries with similar conditions.
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van den Broek N, Ameh C, Madaj B, Makin J, White S, Hemming K, Moodley J, Pattinson R. Effects of emergency obstetric care training on maternal and perinatal outcomes: a stepped wedge cluster randomised trial in South Africa. BMJ Glob Health 2019; 4:e001670. [PMID: 31798985 PMCID: PMC6861119 DOI: 10.1136/bmjgh-2019-001670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/02/2019] [Accepted: 08/10/2019] [Indexed: 01/08/2023] Open
Abstract
Introduction Two-thirds of maternal deaths and 40% of intrapartum-related neonatal deaths are thought to be preventable through emergency obstetric and newborn care (EmOC&NC). The effectiveness of ‘skills and drills’ training of maternity staff in EmOC&NC was evaluated. Methods Implementation research using a stepped wedge cluster randomised trial including 127 of 129 healthcare facilities (HCFs) across the 11 districts in South Africa with the highest maternal mortality. The sequence in which all districts received EmOC&NC training was randomised but could not be blinded. The timing of training resulted in 10 districts providing data before and 10 providing data after EmOC&NC training. Primary outcome measures derived for HCFs are as follows: stillbirth rate (SBR), early neonatal death (ENND) rate, institutional maternal mortality ratio (iMMR) and direct obstetric case fatality rate (CFR), number of complications recognised and managed and CFR by complication. Results At baseline, median SBR (per 1000 births) and ENND rate (per 1000 live births) were 9 (IQR 0–28) and 0 (IQR 0–9). No significant changes following training in EmOC&NC were detected for any of the stated outcomes: SBR (adjusted incidence rate ratio (aIRR) 0.97, 95% CI 0.91 to 1.05), iMMR (aIRR 1.23, 95% CI 0.80 to 1.90), ENND rate (aIRR 1.04, 95% CI 0.92 to 1.17) and direct obstetric CFR (aIRR 1.15, 95% CI 0.66 to 2.02). The number of women who were recognised to need and received EmOC was significantly increased overall (aIRR 1.14, 95% CI 1.02 to 1.27), for haemorrhage (aIRR 1.31, 95% CI 1.13 to 1.52) and for postpartum sepsis (aIRR 1.86, 95% CI 1.17 to 2.95) Conclusion Following EmOC&NC training, healthcare providers are more able to recognise and manage complications at time of birth. This trial did not provide evidence that the intervention was effective in reducing adverse clinical outcomes, but demonstrates randomised evaluations are feasible in implementation research. Trial registration number ISRCTN11224105.
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Affiliation(s)
- Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Charles Ameh
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Barbara Madaj
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jennifer Makin
- Department of Obstetrics & Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Sarah White
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - J Moodley
- Womens Health and HIV Reaserch unit, University of KwaZulu Natal, Durban, South Africa
| | - Robert Pattinson
- MRC Maternal and Infant Health Care Strategies Unit, University of Pretoria, Pretoria, South Africa
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Parmar D, Banerjee A. How do supply- and demand-side interventions influence equity in healthcare utilisation? Evidence from maternal healthcare in Senegal. Soc Sci Med 2019; 241:112582. [PMID: 31590103 DOI: 10.1016/j.socscimed.2019.112582] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/16/2019] [Accepted: 09/27/2019] [Indexed: 11/25/2022]
Abstract
The launch of the Millennium Development Goals in 2000, followed by the Sustainable Development Goals in 2015, and the increasing focus on achieving universal health coverage has led to numerous interventions on both supply- and demand-sides of health systems in low- and middle-income countries. While tremendous progress has been achieved, inequities in access to healthcare persist, leading to calls for a closer examination of the equity implications of these interventions. This paper examines the equity implications of two such interventions in the context of maternal healthcare in Senegal. The first intervention on the supply-side focuses on improving the availability of maternal health services while the second intervention, on the demand-side, abolished user fees for facility deliveries. Using three rounds of Demographic Health Surveys covering the period 1992 to 2010 and employing three measures of socioeconomic status (SES) based on household wealth, mothers' education and rural/urban residence - we find that although both interventions increase utilisation of maternal health services, the rich benefit more from the supply-side intervention, thereby increasing inequity, while those living in poverty benefit more from the demand-side intervention i.e. reducing inequity. Both interventions positively influence facility deliveries in rural areas although the increase in facility deliveries after the demand-side intervention is more than the increase after the supply-side intervention. There is no significant difference in utilisation based on mothers' education. Since people from different SES categories are likely to respond differently to interventions on the supply- and demand-side of the health system, policymakers involved in the design of health programmes should pay closer attention to concerns of inequity and elite capture that may unintentionally result from these interventions.
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Affiliation(s)
- Divya Parmar
- School of Health Sciences, City, University of London, UK.
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12
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Yigzaw M, Tebekaw Y, Kim YM, Kols A, Ayalew F, Eyassu G. Comparing the effectiveness of a blended learning approach with a conventional learning approach for basic emergency obstetric and newborn care training in Ethiopia. Midwifery 2019; 78:42-49. [PMID: 31349183 DOI: 10.1016/j.midw.2019.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/10/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Lack of trained personnel is a major obstacle to providing the full package of emergency obstetric and newborn care (EmONC) services in Ethiopia and other low-income countries. The aim of this study was to evaluate whether a blended learning approach to in-service EmONC training could be as effective as a conventional learning approach while reducing costs. METHODS A quasi-experimental study design assigned providers in need of EmONC training to blended learning (12 days of offsite training followed by daily SMS and weekly phone calls) or conventional learning (18 days of offsite training followed by a facility visit to mentor participants). A self-administered questionnaire measured provider knowledge before training and three months afterwards. Provider skills were assessed three months post-training with an Objective Structured Clinical Examination (OSCE). Independent sample t-test and multiple linear regression analysis were used to assess differences in mean percentage knowledge and skills scores between learning groups. The direct costs and cost-effectiveness of each learning approach were calculated. RESULT Knowledge scores were similar for the blended and conventional learning groups before training (58.5% vs 61.5%, p = 0.358) and three months post-training (74.7% vs 75.5% = 0.720), with no significant difference in gains made. Post-training skills scores were significantly higher for conventional than blended learning (85.8% vs 75.3%, p < 0.001). After controlling for other factors in the multiple linear regression analysis, providers with a university degree had significantly higher skills scores than those with a diploma (p < 0.001). Training costs were lower for blended learning than conventional learning (1032 USD vs 1648 USD per trainee). CONCLUSION Blended learning approach using SMS and phone calls was as effective as conventional one to increase providers' knowledge with substantially lower costs. Further study is warranted to examine the effect of blended learning on providers' skills.
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Affiliation(s)
- Muluneh Yigzaw
- Jhpiego-Ethiopia, P.O.Box: 201748/1000, Addis Ababa, Ethiopia.
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13
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Adewuyi EO, Auta A, Khanal V, Tapshak SJ, Zhao Y. Cesarean delivery in Nigeria: prevalence and associated factors-a population-based cross-sectional study. BMJ Open 2019; 9:e027273. [PMID: 31213450 PMCID: PMC6596937 DOI: 10.1136/bmjopen-2018-027273] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate the prevalence and factors associated with caesarean delivery in Nigeria. DESIGN This is a secondary analysis of the nationally representative 2013 Nigeria Demographic and Health Survey (NDHS) data. We carried out frequency tabulation, χ2 test, simple logistic regression and multivariable binary logistic regression analyses to achieve the study objective. SETTING Nigeria. PARTICIPANTS A total of 31 171 most recent live deliveries for women aged 15-49 years (mother-child pair) in the 5 years preceding the 2013 NDHS was included in this study. OUTCOME MEASURE Caesarean mode of delivery. RESULTS The prevalence of caesarean section (CS) was 2.1% (95% CI 1.8 to 2.3) in Nigeria. At the region level, the South-West had the highest prevalence of 4.7%. Factors associated with increased odds of CS were urban residence (adjusted OR (AOR): 1.51, 95% CI 1.15 to 1.97), maternal age ≥35 years (AOR: 2.12, 95% CI 1.08 to 4.11), large birth size (AOR: 1.39, 95% CI 1.10 to 1.74) and multiple births (AOR: 4.96, 95% CI 2.84 to 8.62). Greater odds of CS were equally associated with maternal obesity (AOR: 3.16, 95% CI 2.30 to 4.32), Christianity (AOR: 2.06, 95% CI 1.58 to 2.68), birth order of one (AOR: 3.86, 95% CI 2.66 to 5.56), husband's secondary/higher education level (AOR: 2.07, 95% CI 1.29 to 3.33), health insurance coverage (AOR: 2.01, 95% CI 1.37 to 2.95) and ≥4 antenatal visits (AOR: 2.84, 95% CI 1.56 to 5.17). CONCLUSIONS The prevalence of CS was low, indicating unmet needs in the use of caesarean delivery in Nigeria. Rural-urban, regional and socioeconomic differences were observed, suggesting inequitable access to the obstetric surgery. Intervention efforts need to prioritise women living in rural areas, the North-East and the North-West regions, as well as women of the Islamic faith.
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Affiliation(s)
- Emmanuel O Adewuyi
- Statistical and Genomic Epidemiology Laboratory, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Pharmacy Department, 2 Division Hospital, Ibadan, Oyo State, Nigeria
| | - Asa Auta
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, UK
| | | | - Samson J Tapshak
- Department of Obstetrics and Gynaecology, Chivar Specialist Hospital, and Urology Centre Ltd, Abuja, Nigeria
| | - Yun Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Curtin University, Perth, Western Australia, Australia
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Emmanuel A, Kain V, Forster E. The Impact of the World Health Organization Essential Newborn Package on Newborn Care Practices and Survival Rates in Sub-Saharan Africa: A Systematic Literature Review. INTERNATIONAL JOURNAL OF CHILDBIRTH 2019. [DOI: 10.1891/2156-5287.9.1.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sub-Saharan Africa, has the highest child mortality rate in the world (World Health Organization [WHO], 2016). However, there is a paucity of current systematic reviews on the impact of essential newborn care interventions in Africa. Therefore, the aim of this systematic review was to summarize evidence about the impact of essential newborn care interventions in Africa. Numerous databases were searched to retrieve articles that reported interventions in newborn care in Africa. The search was limited to the English language and to articles published between 2007 and 2017. Nine articles were selected for inclusion in this systematic review. Overall, these papers demonstrated an increase in performance of health workers (between 8 and 400%) following a test of knowledge, while health workers practical performance increased by 34%. Moreover, neonatal mortality was reduced by 45%, while perinatal mortality was reduced by 30%. Training healthcare workers is one of the most effective ways of improving newborn care and neonatal survival in Africa. However, there is a need for additional evidence to support this, because none of the reviewed studies assessed the impact of training by examining variables such as trainees' satisfaction with training, the knowledge and skills developed, and the health outcomes achieved.
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Bolan NE, Sthreshley L, Ngoy B, Ledy F, Ntayingi M, Makasy D, Mbuyi MC, Lowa G, Nemeth L, Newman S. mLearning in the Democratic Republic of the Congo: A Mixed-Methods Feasibility and Pilot Cluster Randomized Trial Using the Safe Delivery App. GLOBAL HEALTH: SCIENCE AND PRACTICE 2018; 6:693-710. [PMID: 30591577 PMCID: PMC6370362 DOI: 10.9745/ghsp-d-18-00275] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/06/2018] [Indexed: 11/15/2022]
Abstract
Health worker knowledge and self-confidence in basic emergency obstetric and newborn care (BEmONC) increased significantly 3 months after introduction of the Safe Delivery App in intervention facilities compared with controls. Background: Substandard delivery care has been widely documented as a major cause of maternal mortality in health facilities globally. Health worker learning via mobile devices is increasing rapidly; however, there is little evidence of mLearning effectiveness. This study sought to determine the feasibility, acceptability, and potential effect of the Safe Delivery App (SDA) on health workers' practices in basic emergency obstetric and newborn care (BEmONC) in the Democratic Republic of the Congo (DRC). The Theoretical Domains Framework was used to guide this research. Methods: Eight BEmONC facilities in central DRC were randomized to either an mLearning intervention or to standard practice (control). Maternal and newborn health workers in intervention facilities (n=64) were trained on the use of smartphones and the French version of the SDA. The SDA is an evidence-based BEmONC training resource with visual guidance using animated videos and clinical management instructions developed by the Maternity Foundation and the Universities of Copenhagen and Southern Denmark. Knowledge on postpartum hemorrhage (PPH) and neonatal resuscitation (NR) and self-confidence in performing 12 BEmONC procedures were assessed at baseline and at 3 months post-intervention. Eighteen qualitative interviews were conducted with app users and key stakeholders to assess feasibility and acceptability of mLearning and the use of the SDA. Maternal mortality was compared in intervention and control facilities using a smartphone-based Open Data Kit (ODK) data application. One smartphone with SDA and ODK was entrusted to intervention facilities for the study period, whereas control facilities received smartphones with ODK only. Results: The analysis included 62 heath workers. Knowledge scores on postpartum hemorrhage and neonatal resuscitation increased significantly from baseline among intervention participants compared with controls at 3 months post-intervention (mean difference for PPH knowledge, 17.4 out of 100; 95% confidence interval [CI]=10.7 to 24.0 and 19.4 for NR knowledge; 95% CI=11.4 to 27.4), as did self-confidence scores on 12 essential BEmONC procedures (mean difference, 4.2 out of 48; CI=0.7 to 7.7). Increases were unaffected by health worker cadre and previous smartphone use. Qualitative interviews supported the feasibility and acceptability of the SDA and mLearning, and the potential for it to impact maternal and neonatal mortality in the DRC. Conclusion: Use of the Safe Delivery App supported increased health worker knowledge and self-confidence in the management of obstetric and newborn emergencies after 3 months. SDA and mLearning were found to be feasible and acceptable to health workers and key stakeholders in the DRC.
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Affiliation(s)
- Nancy E Bolan
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA.
| | | | - Bernard Ngoy
- IMA World Health, Kinshasa, Democratic Republic of the Congo
| | - Faustin Ledy
- IMA World Health, Kinshasa, Democratic Republic of the Congo
| | - Mano Ntayingi
- IMA World Health, Kinshasa, Democratic Republic of the Congo
| | - Davis Makasy
- IMA World Health, Kinshasa, Democratic Republic of the Congo
| | | | - Gisele Lowa
- IMA World Health, Kinshasa, Democratic Republic of the Congo
| | - Lynne Nemeth
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Susan Newman
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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Retention of knowledge and skills after Emergency Obstetric Care training: A multi-country longitudinal study. PLoS One 2018; 13:e0203606. [PMID: 30286129 PMCID: PMC6171823 DOI: 10.1371/journal.pone.0203606] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/07/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To determine retention of knowledge and skills after standardised “skills and drills” training in Emergency Obstetric Care. Design Longitudinal cohort study. Setting Ghana, Malawi, Nigeria, Kenya, Tanzania and Sierra Leone. Population 609 maternity care providers, of whom 455 were nurse/midwives (NMWs) Methods Knowledge and skills assessed before and after training, and, at 3, 6, 9 and 12 months. Analysis of variance to explore differences in scores by country and level of healthcare facility for each cadre. Mixed effects regression analysis to account for potential explanatory factors including; facility type, years of experience providing maternity care, months since training and number of repeat assessments. Main outcome measures Change in knowledge and skills. Results Before training the overall mean (SD) score for skills was 48.8% (11.6%) and 65.6% (10.7%). for knowledge. After training the mean (95% CI) relative improvement in knowledge was 30.8% (29.1% - 32.6%) and 59.8% (58.6%– 60.9%) for skills. Mean scores for knowledge and skills at each subsequent assessment remained between those immediately post-training and those at 3 months. NMWs who attended all four assessments demonstrated statistically better retention of skills (14.9%, 95% CI 7.8%, 22.0% p<0.001) but not knowledge (8.6%, 95% CI -0.3%, 17.4%. p = 0.06) compared to those who attended one or two assessments only. Health care facility level or experience were not determinants of retention. Conclusions After training, healthcare providers retain knowledge and skills for up to 12 months. This effect can likely be enhanced by short repeat skills-training sessions, or, ‘fire drills’.
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Banke-Thomas A, Wilson-Jones M, Madaj B, van den Broek N. Economic evaluation of emergency obstetric care training: a systematic review. BMC Pregnancy Childbirth 2017; 17:403. [PMID: 29202731 PMCID: PMC5716021 DOI: 10.1186/s12884-017-1586-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/20/2017] [Indexed: 12/20/2022] Open
Abstract
Background Training healthcare providers in Emergency Obstetric Care (EmOC) has been shown to be effective in improving their capacity to provide this critical care package for mothers and babies. However, little is known about the costs and cost-effectiveness of such training. Understanding costs and cost-effectiveness is essential in guaranteeing value-for-money in healthcare spending. This study systematically reviewed the available literature on cost and cost-effectiveness of EmOC trainings. Methods Peer-reviewed and grey literature was searched for relevant papers published after 1990. Studies were included if they described an economic evaluation of EmOC training and the training cost data were available. Two reviewers independently searched, screened, and selected studies that met the inclusion criteria, with disagreements resolved by a third reviewer. Quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards statement. For comparability, all costs in local currency were converted to International dollar (I$) equivalents using purchasing power parity conversion factors. The cost per training per participant was calculated. Narrative synthesis was used to summarise the available evidence on cost effectiveness. Results Fourteen studies (five full and nine partial economic evaluations) met the inclusion criteria. All five and two of the nine partial economic evaluations were of high quality. The majority of studies (13/14) were from low- and middle-income countries. Training equipment, per diems and resource person allowance were the most expensive components. Cost of training per person per day ranged from I$33 to I$90 when accommodation was required and from I$5 to I$21 when training was facility-based. Cost-effectiveness of training was assessed in 5 studies with differing measures of effectiveness (knowledge, skills, procedure cost and lives saved) making comparison difficult. Conclusions Economic evaluations of EmOC training are limited. There is a need to scale-up and standardise processes that capture both cost and effectiveness of training and to agree on suitable economic evaluation models that allow for comparability across settings. Trial registration PROSPERO_CRD42016041911. Electronic supplementary material The online version of this article (10.1186/s12884-017-1586-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Megan Wilson-Jones
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Barbara Madaj
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK.
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Mgawadere F, Unkels R, Kazembe A, van den Broek N. Factors associated with maternal mortality in Malawi: application of the three delays model. BMC Pregnancy Childbirth 2017; 17:219. [PMID: 28697794 PMCID: PMC5506640 DOI: 10.1186/s12884-017-1406-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 07/03/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The three delays model proposes that maternal mortality is associated with delays in: 1) deciding to seek care; 2) reaching the healthcare facility; and 3) receiving care. Previously, the majority of women who died were reported to have experienced type 1 and 2 delays. With increased coverage of healthcare services, we sought to explore the relative contribution of each type of delay. METHOD 151 maternal deaths were identified during a 12-month reproductive age mortality survey (RAMOS) conducted in Malawi; verbal autopsy and facility-based medical record reviews were conducted to obtain details about the circumstances surrounding each death. Using the three delays framework, data were analysed for women who had; 1) died at a healthcare facility, 2) died at home but had previously accessed care and 3) died at home and had not accessed care. RESULTS 62.2% (94/151) of maternal deaths occurred in a healthcare facility and a further 21.2% (32/151) of mothers died at home after they had accessed care at a healthcare facility. More than half of all women who died at a healthcare facility (52.1%) had experienced more than one type of delay. Type 3 delays were the most significant delay for women who died at a healthcare facility or women who died at home after they had accessed care, and was identified in 96.8% of cases. Type 2 delays were experienced by 59.6% and type 1 delays by 39.7% of all women. Long waiting hours before receiving treatment at a healthcare facility, multiple delays at the time of admission, shortage of drugs, non-availability and incompetence of skilled staff were some of the major causes of type 3 delays. Distance to a healthcare facility was the main problem resulting in type 2 delays. CONCLUSION The majority of women do try to reach health services when an emergency occurs, but type 3 delays present a major problem. Improving quality of care at healthcare facility level will help reduce maternal mortality.
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Affiliation(s)
- Florence Mgawadere
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - Regine Unkels
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - Abigail Kazembe
- Kamuzu College of Nursing, University of Malawi, Zomba, Malawi
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
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Niles P, Ojemeni MT, Kaplogwe NA, Voeten SMJ, Stafford R, Kibwana M, Deng L, Theonestina S, Budin W, Chhun N, Squires A. Mentoring to build midwifery and nursing capacity in the Africa region: An integrative review. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2017. [DOI: 10.1016/j.ijans.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ameh CA, Kerr R, Madaj B, Mdegela M, Kana T, Jones S, Lambert J, Dickinson F, White S, van den Broek N. Knowledge and Skills of Healthcare Providers in Sub-Saharan Africa and Asia before and after Competency-Based Training in Emergency Obstetric and Early Newborn Care. PLoS One 2016; 11:e0167270. [PMID: 28005984 PMCID: PMC5179026 DOI: 10.1371/journal.pone.0167270] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 11/13/2016] [Indexed: 11/22/2022] Open
Abstract
Background Healthcare provider training in Emergency Obstetric and Newborn Care (EmOC&NC) is a component of 65% of intervention programs aimed at reducing maternal and newborn mortality and morbidity. It is important to evaluate the effectiveness of this. Methods We evaluated knowledge and skills among 5,939 healthcare providers before and after 3–5 days ‘skills and drills’ training in emergency obstetric and newborn care (EmOC&NC) conducted in 7 sub-Saharan Africa countries (Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Zimbabwe) and 2 Asian countries (Bangladesh, Pakistan). Standardised assessments using multiple choice questions and objective structured clinical examination (OSCE) were used to measure change in knowledge and skills and the Improvement Ratio (IR) by cadre and by country. Linear regression was performed to identify variables associated with pre-training score and IR. Results 99.7% of healthcare providers improved their overall score with a median (IQR) increase of 10.0% (5.0% - 15.0%) for knowledge and 28.8% (23.1% - 35.1%) for skill. There were significant improvements in knowledge and skills for each cadre of healthcare provider and for each country (p<0.05). The mean IR was 56% for doctors, 50% for mid-level staff and nurse-midwives and 38% for nursing-aides. A teaching job, previous in-service training, and higher percentage of work-time spent providing maternity care were each associated with a higher pre-training score. Those with more than 11 years of experience in obstetrics had the lowest scores prior to training, with mean IRs 1.4% lower than for those with no more than 2 years of experience. The largest IR was for recognition and management of obstetric haemorrhage (49–70%) and the smallest for recognition and management of obstructed labour and use of the partograph (6–15%). Conclusions Short in-service EmOC&NC training was associated with improved knowledge and skills for all cadres of healthcare providers working in maternity wards in both sub-Saharan Africa and Asia. Additional support and training is needed for use of the partograph as a tool to monitor progress in labour. Further research is needed to assess if this is translated into improved service delivery.
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Affiliation(s)
- Charles A. Ameh
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Robert Kerr
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Barbara Madaj
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Mselenge Mdegela
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Terry Kana
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Susan Jones
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jaki Lambert
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Fiona Dickinson
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sarah White
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Iravani M, Janghorbani M, Zarean E, Bahrami M. Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e21471. [PMID: 27175303 PMCID: PMC4863155 DOI: 10.5812/ircmj.21471] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/26/2014] [Accepted: 09/03/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women. OBJECTIVES The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran. MATERIALS AND METHODS This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis. RESULTS Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system. CONCLUSIONS The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality.
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Affiliation(s)
- Mina Iravani
- Department of Midwifery, Reproductive Health Promotion Research Center, Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Mohsen Janghorbani
- Department of Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Ellahe Zarean
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Masod Bahrami
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, IR Iran
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Making It Happen: Training health-care providers in emergency obstetric and newborn care. Best Pract Res Clin Obstet Gynaecol 2015; 29:1077-91. [DOI: 10.1016/j.bpobgyn.2015.03.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/23/2015] [Indexed: 11/22/2022]
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Ueno E, Adegoke AA, Masenga G, Fimbo J, Msuya SE. Skilled birth attendants in Tanzania: a descriptive study of cadres and emergency obstetric care signal functions performed. Matern Child Health J 2015; 19:155-69. [PMID: 24791974 DOI: 10.1007/s10995-014-1506-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although most developing countries monitor the proportion of births attended by skilled birth attendants (SBA), they lack information on the availability and performance of emergency obstetric care (EmOC) signal functions by different cadres of health care providers (HCPs). The World Health Organisation signal functions are set of key interventions that targets direct obstetric causes of maternal deaths. Seven signal functions are required for health facilities providing basic EmOC and nine for facilities providing comprehensive EmOC. Our objectives were to describe cadres of HCPs who are considered SBAs in Tanzania, the EmOC signal functions they perform and challenges associated with performance of EmOC signal functions. We conducted a cross-sectional study of HCPs offering maternity care services at eight health facilities in Moshi Urban District in northern Tanzania. A questionnaire and health facility assessment forms were used to collect information from participants and health facilities. A total of 199 HCPs working at eight health facilities in Moshi Urban District met the inclusion criteria. Out of 199, 158 participated, giving a response rate of 79.4 %. Ten cadres of HCPs were identified as conducting deliveries regardless of the level of health facilities. Most of the participants (81 %) considered themselves SBAs, although some were not considered SBAs by the Ministry of Health and Social Welfare (MOHSW). Only two out of the eight facilities provided all of the required EmOC signal functions. While Assistant Medical Officers are expected to perform all the signal functions, only 38 % and 13 % had performed vacuum extraction or caesarean sections respectively. Very few registered and enrolled nurse-midwives had performed removal of retained products (22 %) or assisted vaginal delivery (24 and 11 %). Inadequate equipment and supplies, and lack of knowledge and skills in performing EmOC were two main challenges identified by health care providers in all the level of care. In the district, gaps existed between performance of EmOC signal functions by SBAs as expected by the MOHSW and the actual performance at health facilities. All basic EmOC facilities were not fully functional. Few health care providers performed all the basic EmOC signal functions. Competency-based in-service training of providers in EmOC and provision of enabling environment could improve performance of EmOC signal functions in the district.
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Affiliation(s)
- Etsuko Ueno
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK,
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Marzolf S, Zekarias B, Tedla K, Woldeyesus DE, Sereke D, Yohannes A, Asrat K, Weaver MR. Continuing professional education in Eritrea taught by local obstetrics and gynaecology residents: Effects on work environment and patient outcomes. Glob Public Health 2015; 10:980-94. [DOI: 10.1080/17441692.2015.1050437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Crowe S, Prost A, Hossen M, Azad K, Kuddus A, Roy S, Nair N, Tripathy P, Saville N, Sen A, Sikorski C, Manandhar D, Costello A, Pagel C. Generating Insights from Trends in Newborn Care Practices from Prospective Population-Based Studies: Examples from India, Bangladesh and Nepal. PLoS One 2015; 10:e0127893. [PMID: 26176535 PMCID: PMC4503724 DOI: 10.1371/journal.pone.0127893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 04/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Delivery of essential newborn care is key to reducing neonatal mortality rates, yet coverage of protective birth practices remains incomplete and variable, with or without skilled attendance. Evidence of changes over time in newborn care provision, disaggregated by care practice and delivery type, can be used by policymakers to review efforts to reduce mortality. We examine such trends in four areas using control arm trial data. METHODS AND FINDINGS We analysed data from the control arms of cluster randomised controlled trials in Bangladesh (27 553 births), eastern India (8 939), Dhanusha, Nepal (15 344) and Makwanpur, Nepal (6 765) over the period 2001-2011. For each trial, we calculated the observed proportion of attended births and the coverage of WHO essential newborn care practices by year, adjusted for clustering and stratification. To explore factors contributing to the observed trends, we then analysed expected trends due only to observed shifts in birth attendance, accounted for stratification, delivery type and statistically significant interaction terms, and examined disaggregated trends in care practice coverage by delivery type. Attended births increased over the study periods in all areas from very low rates, reaching a maximum of only 30% of deliveries. Newborn care practice trends showed marked heterogeneity within and between areas. Adjustment for stratification, birth attendance and interaction revealed that care practices could change in opposite directions over time and/or between delivery types - e.g. in Bangladesh hygienic cord-cutting and skin-to-skin contact fell in attended deliveries but not home deliveries, whereas in India birth attendant hand-washing rose for institutional deliveries but fell for home deliveries. CONCLUSIONS Coverage of many essential newborn care practices is improving, albeit slowly and unevenly across sites and delivery type. Time trend analyses of birth patterns and essential newborn care practices can inform policy-makers about effective intervention strategies.
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Affiliation(s)
- Sonya Crowe
- Clinical Operational Research Unit, University College London, 4 Taviton Street, London, WC1H 0BT, United Kingdom
- * E-mail:
| | - Audrey Prost
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Munir Hossen
- Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka 1000, Bangladesh, India
| | - Kishwar Azad
- Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka 1000, Bangladesh, India
| | - Abdul Kuddus
- Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka 1000, Bangladesh, India
| | - Swati Roy
- Ekjut, Plot 556B, Potka, Chakradharpur, West Singhbhum, Jharkhand, India
| | - Nirmala Nair
- Ekjut, Plot 556B, Potka, Chakradharpur, West Singhbhum, Jharkhand, India
| | - Prasanta Tripathy
- Ekjut, Plot 556B, Potka, Chakradharpur, West Singhbhum, Jharkhand, India
| | - Naomi Saville
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
- Mother Infant Research Activities (MIRA), YB Bhavan, Thapathali, GPO Box 921, Kathmandu, Nepal
| | - Aman Sen
- Mother Infant Research Activities (MIRA), YB Bhavan, Thapathali, GPO Box 921, Kathmandu, Nepal
| | - Catherine Sikorski
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
- Mother Infant Research Activities (MIRA), YB Bhavan, Thapathali, GPO Box 921, Kathmandu, Nepal
| | - Dharma Manandhar
- Mother Infant Research Activities (MIRA), YB Bhavan, Thapathali, GPO Box 921, Kathmandu, Nepal
| | - Anthony Costello
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, 4 Taviton Street, London, WC1H 0BT, United Kingdom
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Bergh AM, Baloyi S, Pattinson RC. What is the impact of multi-professional emergency obstetric and neonatal care training? Best Pract Res Clin Obstet Gynaecol 2015; 29:1028-43. [PMID: 25937554 DOI: 10.1016/j.bpobgyn.2015.03.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 03/16/2015] [Indexed: 11/30/2022]
Abstract
This paper reviews evidence regarding change in health-care provider behaviour and maternal and neonatal outcomes as a result of emergency obstetric and neonatal care (EmONC) training. A refined version of the Kirkpatrick classification for programme evaluation was used to focus on change in efficiency and impact of training (levels 3 and 4). Twenty-three studies were reviewed - five randomised controlled trials, two quasi-experimental studies and 16 before-and-after observational studies. Training programmes had all been developed in high-income countries and adapted for use in low- and middle-income countries. Nine studies reported on behaviour change and 13 on process and patient outcomes. Most showed positive results. Every maternity unit should provide EmONC teamwork training, mandatory for all health-care providers. The challenges are as follows: scaling up such training to all institutions, sustaining regular in-service training, integrating training into institutional and health-system patient safety initiatives and 'thinking out of the box' in evaluation research.
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Affiliation(s)
- Anne-Marie Bergh
- MRC Maternal and Infant Health Care Strategies Unit, Obstetrics and Gynaecology Department, University of Pretoria, Pretoria, South Africa.
| | - Shisana Baloyi
- MRC Maternal and Infant Health Care Strategies Unit, Obstetrics and Gynaecology Department, University of Pretoria, Pretoria, South Africa.
| | - Robert C Pattinson
- MRC Maternal and Infant Health Care Strategies Unit, Obstetrics and Gynaecology Department, University of Pretoria, Pretoria, South Africa.
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Utz B, Kana T, van den Broek N. Practical aspects of setting up obstetric skills laboratories – A literature review and proposed model. Midwifery 2015; 31:400-8. [DOI: 10.1016/j.midw.2014.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 10/09/2014] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
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Browning A, Menber B. Reducing maternal morbidity and mortality in the developing world: a simple, cost-effective example. Int J Womens Health 2015; 7:155-9. [PMID: 25678820 PMCID: PMC4324538 DOI: 10.2147/ijwh.s75097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives To determine the impact of volunteer obstetricians and midwife teams on obstetric services in a rural hospital in Ethiopia. Methods The intervention was undertaken in Mota district hospital, a rural hospital in the Amhara region of Ethiopia, which is the only hospital for 1.2 million people. Before the placement of volunteer teams it had a rudimentary basic obstetric service, no blood transfusion service, and no operative delivery. The study prospectively analyzed delivery data before, during, and after the placement of volunteer obstetrician and midwife teams. The volunteers established emergency obstetric care, and trained and supervised local staff over a 3-year period. Measurable outcomes consisted of the number of women delivering, the number of referrals of pregnant women, the number of maternal deaths, and the number of referrals of obstetric fistula patients. Results With the establishment of the service the number of women attending hospital for delivery increased by 40%. In the hospital maternal mortality decreased from 7.1% to <0.5%, and morbidity, as measured by number of obstetric fistulae, decreased from 1.5% deliveries to 0.5% over the 3-year intervention period. The improvements were sustained after handing the project back to the government. Conclusion The placement of volunteer teams was an effective method of decreasing maternal mortality and morbidity.
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Affiliation(s)
- Andrew Browning
- Maternity Africa, Arusha, Tanzania ; Vision Maternity Care, Barhirdar, Ethiopia
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Ni Bhuinneain GM, McCarthy FP. A systematic review of essential obstetric and newborn care capacity building in rural sub-Saharan Africa. BJOG 2014; 122:174-82. [DOI: 10.1111/1471-0528.13218] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2014] [Indexed: 11/30/2022]
Affiliation(s)
- GM Ni Bhuinneain
- Department of Obstetrics and Gynaecology; Mayo Medical Academy; National University of Ireland Galway at Mayo General Hospital; Castlebar Ireland
- Friends of Londiani; Londiani Kenya
| | - FP McCarthy
- Women's Health Academic Centre; King's Health Partners; St Thomas’ Hospital; London UK
- Department of Obstetrics and Gynaecology; Irish Centre for Fetal and Neonatal Translational Research; Cork University Maternity Hospital; University College Cork; Cork Ireland
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Halim A, Utz B, Biswas A, Rahman F, van den Broek N. Cause of and contributing factors to maternal deaths; a cross-sectional study using verbal autopsy in four districts in Bangladesh. BJOG 2014; 121 Suppl 4:86-94. [PMID: 25236640 DOI: 10.1111/1471-0528.13010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2014] [Indexed: 10/24/2022]
Abstract
Verbal autopsy used at community level is an accepted method to identify cause of death and factors contributing to death. Maternal deaths occurring in four districts in Bangladesh over a period of 24 months were identified and community health workers were trained to conduct a verbal autopsy. Of 571 maternal deaths identified almost half (273, 47.8%) occurred at facility level, 97 (17.0%) died en route to a healthcare facility and 201 (35.2%) maternal deaths occurred at home. The majority of maternal deaths occurred in the postpartum period (78.8%) in the first 6 hours after giving birth (41.6% of all postpartum deaths). Women who had accessed care at a healthcare facility were less likely to die in the first 6 hours when compared with women who died at home (relative risk 0.70; 95% confidence interval 0.56-0.88) 70.4% (402) of deaths were classified as direct maternal deaths, 12.4% (71) as indirect and 13.8% (79) as unspecified. The most common cause of death was haemorrhage (38%), followed by eclampsia (20%) and sepsis (8.1%). Almost three out of four women who died had sought care for complications during the index pregnancy. Most mothers who died in Bangladesh had accessed care. It is now crucial that the quality of care received at health facility level is improved. This includes a refocus on strengthening healthcare providers' knowledge and skills to recognise and manage complications and provide emergency obstetric care. The enabling environment must be in place as well as ensuring a fully functional referral pathway between healthcare facilities.
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Affiliation(s)
- A Halim
- Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh
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Ellard DR, Chimwaza W, Davies D, O'Hare JP, Kamwendo F, Quenby S, Griffiths F. Can training in advanced clinical skills in obstetrics, neonatal care and leadership, of non-physician clinicians in Malawi impact on clinical services improvements (the ETATMBA project): a process evaluation. BMJ Open 2014; 4:e005751. [PMID: 25116455 PMCID: PMC4139632 DOI: 10.1136/bmjopen-2014-005751] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The 'enhancing human resources and the use of appropriate technologies for maternal and perinatal survival in sub-Saharan Africa' (ETATMBA) project is training emergency obstetric and new-born care (EmONC) non-physician clinicians (NPCs) as advanced clinical leaders. Our objectives were to evaluate the implementation and changes to practice. DESIGN A mixed methods process evaluation with the predominate methodology being qualitative. SETTING Rural and urban hospitals in 8 of the 14 districts of northern and central Malawi. PARTICIPANTS 54 EmONC NPCs with 3 years' plus experience. INTERVENTION Training designed and delivered by clinicians from the UK and Malawi; it is a 2-year plus package of training (classroom, mentorship and assignments). RESULTS We conducted 79 trainee interviews over three time points during the training, as well as a convenience sample of 10 colleagues, 7 district officers and 2 UK obstetricians. Trainees worked in a context of substantial variation in the rates of maternal and neonatal deaths between districts. Training reached trainees working across the target regions. For 46 trainees (8 dropped out of the course), dose delivered in terms of attendance was high and all 46 spent time working alongside an obstetrician. In early interviews trainees recalled course content unprompted indicating training had been received. Colleagues and district officers reported cascading of knowledge and initial changes in practice indicating early implementation. By asking trainees to describe actual cases we found they had implemented new knowledge and skills. These included life-saving interventions for postpartum haemorrhage and eclampsia. Trainees identified the leadership training as enabling them to confidently change their own practice and initiate change in their health facility. CONCLUSIONS This process evaluation suggests that trainees have made positive changes in their practice. Clear impacts on maternal and perinatal mortality are yet to be elucidated.
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Affiliation(s)
- David R Ellard
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
| | | | - David Davies
- Educational Development & Research Team, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Joseph Paul O'Hare
- Division of Metabolic & Vascular Health, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Francis Kamwendo
- Obstetrics and Gynaecology Department, Malawi University, College of Medicine, Blantyre, Malawi
| | - Siobhan Quenby
- Division of Reproductive Health, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
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Pagel C, Prost A, Hossen M, Azad K, Kuddus A, Roy SS, Nair N, Tripathy P, Saville N, Sen A, Sikorski C, Manandhar DS, Costello A, Crowe S. Is essential newborn care provided by institutions and after home births? Analysis of prospective data from community trials in rural South Asia. BMC Pregnancy Childbirth 2014; 14:99. [PMID: 24606612 PMCID: PMC4016384 DOI: 10.1186/1471-2393-14-99] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/24/2014] [Indexed: 11/10/2022] Open
Abstract
Background Provision of essential newborn care (ENC) can save many newborn lives in poor resource settings but coverage is far from universal and varies by country and place of delivery. Understanding gaps in current coverage and where coverage is good, in different contexts and places of delivery, could make a valuable contribution to the future design of interventions to reduce neonatal mortality. We sought to describe the coverage of essential newborn care practices for births in institutions, at home with a skilled birth attendant, and at home without a skilled birth attendant (SBA) in rural areas of Bangladesh, Nepal, and India. Methods We used data from the control arms of four cluster randomised controlled trials in Bangladesh, Eastern India and from Makwanpur and Dhanusha districts in Nepal, covering periods from 2001 to 2011. We used these data to identify essential newborn care practices as defined by the World Health Organization. Each birth was allocated to one of three delivery types: home birth without an SBA, home birth with an SBA, or institutional delivery. For each study, we calculated the observed proportion of births that received each care practice by delivery type with 95% confidence intervals, adjusted for clustering and, where appropriate, stratification. Results After exclusions, we analysed data for 8939 births from Eastern India, 27 553 births from Bangladesh, 6765 births from Makwanpur and 15 344 births from Dhanusha. Across all study areas, coverage of essential newborn care practices was highest in institutional deliveries, and lowest in home non-SBA deliveries. However, institutional deliveries did not provide universal coverage of the recommended practices, with relatively low coverage (20%-70%) across all study areas for immediate breastfeeding and thermal care. Institutions in Bangladesh had the highest coverage for almost all care practices except thermal care. Across all areas, fewer than 20% of home non-SBA deliveries used a clean delivery kit, the use of plastic gloves was very low and coverage of recommended thermal care was relatively poor. There were large differences between study areas in handwashing, immediate breastfeeding and delayed bathing. Conclusions There remains substantial scope for health facilities to improve thermal care for the newborn and to encourage immediate and exclusive breastfeeding. For unattended home deliveries, increased handwashing, use of clean delivery kits and basic thermal care offer great scope for improvement.
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Affiliation(s)
- Christina Pagel
- Clinical Operational Research Unit, University College London, 4 Taviton Street, London WC1H 0BT, UK.
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Nelissen E, Ersdal H, Ostergaard D, Mduma E, Broerse J, Evjen-Olsen B, van Roosmalen J, Stekelenburg J. Helping mothers survive bleeding after birth: an evaluation of simulation-based training in a low-resource setting. Acta Obstet Gynecol Scand 2014; 93:287-95. [PMID: 24344822 DOI: 10.1111/aogs.12321] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 12/11/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. DESIGN Educational intervention study. SETTING Rural referral hospital in Northern Tanzania. POPULATION Clinicians, nurse-midwives, medical attendants, and ambulance drivers involved in maternity care. METHODS In March 2012, health care workers were trained in HMS BAB, a half-day simulation-based training, using a train-the-trainer model. The training focused on basic delivery care, active management of third stage of labor, and treatment of postpartum hemorrhage, including bimanual uterine compression. MAIN OUTCOME MEASURES Evaluation questionnaires provided information on course perception. Knowledge, skills, and confidence of facilitators and learners were tested before and after training. RESULTS Four master trainers trained eight local facilitators, who subsequently trained 89 learners. After training, all facilitators passed the knowledge test, but pass rates for the skills test were low (29% pass rate for basic delivery and 0% pass rate for management of postpartum hemorrhage). Evaluation revealed that HMS BAB training was considered acceptable and feasible, although more time should be allocated for training, and teaching materials should be translated into the local language. Knowledge, skills, and confidence of learners increased significantly immediately after training. However, overall pass rates for skills tests of learners after training were low (3% pass rate for basic delivery and management of postpartum hemorrhage). CONCLUSIONS The HMS BAB simulation-based training has potential to contribute to education of health care providers. We recommend a full day of training and validation of the facilitators to improve the training.
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Affiliation(s)
- Ellen Nelissen
- Haydom Lutheran Hospital, Mbulu, Manyara, Tanzania; Athena Institute, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, the Netherlands
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Bang KS, Lee I, Chae SM, Yu J, Park J, Kim H. Effects of Maternal-Child Health Education Program for Nurses in Tigray, Ethiopia on Their Knowledge and Confidence. CHILD HEALTH NURSING RESEARCH 2014. [DOI: 10.4094/chnr.2014.20.4.275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kyung-Sook Bang
- College of Nursing · The Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| | - Insook Lee
- College of Nursing · The Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| | - Sun-Mi Chae
- College of Nursing · The Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| | - Juyoun Yu
- Graduate student, College of Nursing, Seoul National University, Seoul, Korea
| | - Jisun Park
- Graduate student, College of Nursing, Seoul National University, Seoul, Korea
| | - Hyungkyung Kim
- Graduate student, College of Nursing, Seoul National University, Seoul, Korea
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Johnson P, Fogarty L, Fullerton J, Bluestone J, Drake M. An integrative review and evidence-based conceptual model of the essential components of pre-service education. HUMAN RESOURCES FOR HEALTH 2013; 11:42. [PMID: 23984867 PMCID: PMC3847625 DOI: 10.1186/1478-4491-11-42] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 08/08/2013] [Indexed: 05/04/2023]
Abstract
BACKGROUND With decreasing global resources, a pervasive critical shortage of skilled health workers, and a growing disease burden in many countries, the need to maximize the effectiveness and efficiency of pre-service education in low-and middle-income countries has never been greater. METHODS We performed an integrative review of the literature to analyse factors contributing to quality pre-service education and created a conceptual model that shows the links between essential elements of quality pre-service education and desired outcomes. RESULTS The literature contains a rich discussion of factors that contribute to quality pre-service education, including the following: (1) targeted recruitment of qualified students from rural and low-resource settings appears to be a particularly effective strategy for retaining students in vulnerable communities after graduation; (2) evidence supports a competency-based curriculum, but there is no clear evidence supporting specific curricular models such as problem-based learning; (3) the health workforce must be well prepared to address national health priorities; (4) the role of the preceptor and preceptors' skills in clinical teaching, identifying student learning needs, assessing student learning, and prioritizing and time management are particularly important; (5) modern, Internet-enabled medical libraries, skills and simulation laboratories, and computer laboratories to support computer-aided instruction are elements of infrastructure meriting strong consideration; and (6) all students must receive sufficient clinical practice opportunities in high-quality clinical learning environments in order to graduate with the competencies required for effective practice. Few studies make a link between PSE and impact on the health system. Nevertheless, it is logical that the production of a trained and competent staff through high-quality pre-service education and continuing professional development activities is the foundation required to achieve the desired health outcomes. Professional regulation, deployment practices, workplace environment upon graduation and other service delivery contextual factors were analysed as influencing factors that affect educational outcomes and health impact. CONCLUSIONS Our model for pre-service education reflects the investments that must be made by countries into programmes capable of leading to graduates who are competent for the health occupations and professions at the time of their entry into the workforce.
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Affiliation(s)
- Peter Johnson
- Jhpiego, 1615 Thames Street, Baltimore, MD 21231-3492, USA
| | - Linda Fogarty
- Jhpiego, 1615 Thames Street, Baltimore, MD 21231-3492, USA
| | - Judith Fullerton
- Independent consultant- 7717 Canyon Point Lane, San Diego, CA 92126-2049, USA
| | | | - Mary Drake
- Jhpiego, 1615 Thames Street, Baltimore, MD 21231-3492, USA
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Utz B, Siddiqui G, Adegoke A, van den Broek N. Definitions and roles of a skilled birth attendant: a mapping exercise from four South-Asian countries. Acta Obstet Gynecol Scand 2013; 92:1063-9. [PMID: 23656549 PMCID: PMC3902985 DOI: 10.1111/aogs.12166] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 05/02/2013] [Indexed: 11/30/2022]
Abstract
Objective. To identify which cadres of healthcare providers are considered to be skilled birth attendants in South Asia, which of the signal functions of emergency obstetric care each cadre is reported to provide and whether this is included in their training and legislation. Design. Cross-sectional, descriptive study. Setting. Bangladesh, India, Nepal and Pakistan. Sample. Thirty-three key informants involved in training, regulation, recruitment and deployment of healthcare providers. Methods. Between November 2011 and March 2012, structured questionnaires were sent out to key informants by email followed up by face-to-face or telephone interviews. Main outcome measures. Mapping of definitions and roles of healthcare providers in four South Asian countries to assess which cadres are skilled birth attendants. Results. Cadres of healthcare providers expected to provide skilled birth attendance differ across countries. Although most identified cadres administer parenteral antibiotics, oxytocics and perform newborn resuscitation; administration of anticonvulsants varies by country. Manual removal of the placenta, removal of retained products of conception and assisted vaginal delivery are not provided by all cadres expected to provide skilled birth attendance. Conclusion. Key signal functions of emergency obstetric care are often provided by medical doctors only. Provision of such potentially life-saving interventions by more healthcare provider cadres expected to function as skilled birth attendants can save lives. Ensuring better training and legislation are in place for this is crucial.
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Affiliation(s)
- Bettina Utz
- Maternal and Newborn Health Unit, Liverpool School of Tropical Medicine, Liverpool, UK.
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Ameh C, Msuya S, Hofman J, Raven J, Mathai M, van den Broek N. Status of emergency obstetric care in six developing countries five years before the MDG targets for maternal and newborn health. PLoS One 2012; 7:e49938. [PMID: 23236357 PMCID: PMC3516515 DOI: 10.1371/journal.pone.0049938] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 10/18/2012] [Indexed: 11/25/2022] Open
Abstract
Background Ensuring women have access to good quality Emergency Obstetric Care (EOC) is a key strategy to reducing maternal and newborn deaths. Minimum coverage rates are expected to be 1 Comprehensive (CEOC) and 4 Basic EOC (BEOC) facilities per 500,000 population. Methods and Findings A cross-sectional survey of 378 health facilities was conducted in Kenya, Malawi, Sierra Leone, Nigeria, Bangladesh and India between 2009 and 2011. This included 160 facilities designated to provide CEOC and 218 designated to provide BEOC. Fewer than 1 in 4 facilities aiming to provide CEOC were able to offer the nine required signal functions of CEOC (23.1%) and only 2.3% of health facilities expected to provide BEOC provided all seven signal functions. The two signal functions least likely to be provided included assisted delivery (17.5%) and manual vacuum aspiration (42.3%). Population indicators were assessed for 31 districts (total population = 15.7 million). The total number of available facilities (283) designated to provide EOC for this population exceeded the number required (158) a ratio of 1.8. However, none of the districts assessed met minimum UN coverage rates for EOC. The population based Caesarean Section rate was estimated to be <2%, the maternal Case Fatality Rate (CFR) for obstetric complications ranged from 2.0–9.3% and still birth (SB) rates ranged from 1.9–6.8%. Conclusions Availability of EOC is well below minimum UN target coverage levels. Health facilities in the surveyed countries do not currently have the capacity to adequately respond to and manage women with obstetric complications. To achieve MDG 5 by 2015, there is a need to ensure that the full range of signal functions are available in health facilities designated to provide CEOC or BEOC and improve the quality of services provided so that CFR and SB rates decline.
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Affiliation(s)
- Charles Ameh
- Maternal and Newborn Health Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sia Msuya
- Maternal and Newborn Health Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Jan Hofman
- Maternal and Newborn Health Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Joanna Raven
- Maternal and Newborn Health Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Matthews Mathai
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | - Nynke van den Broek
- Maternal and Newborn Health Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Ameh CA, Ekechi CI, Tukur J. Monitoring severe pre-eclampsia and eclampsia treatment in resource poor countries: skilled birth attendant perception of a new treatment and monitoring chart (LIVKAN chart). Matern Child Health J 2012; 16:941-6. [PMID: 21656055 DOI: 10.1007/s10995-011-0832-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The lack of easy to use protocols and monitoring charts in the management of pre-eclampsia/eclampsia contribute to substandard care of women in resource poor settings. A treatment monitoring tool (LIVKAN chart) has been developed to improve the quality of care for these women. Based on feedback from skilled birth attendants (SBAs), a two page document which provides a visual record of the treatment and monitoring of women with severe pre-eclampsia/eclampsia over a 24 h period was developed. It also contains detailed treatment guidelines as well as a summary of the woman's treatment. A two page document on instructions for use of the chart was also developed. The chart design was evaluated by different level SBAs via a semi structured questionnaire. There was a 92% (109) response rate. About 30% (33) and 58% (63) of the respondents provided care to women in Primary Health Care and referral health care facilities respectively. Ninety eight percentage of respondents indicated that the chart would be of additional benefit in their care of women with pre-eclamptic/eclampsia. Seventy three percentage of respondents indicated that the chart would also be useful to lower health care facility SBAs. The design of the chart ensures that guidelines for managing/monitoring of patients are instantly available on a concise easy-to-use chart which confers added advantage over other chart designs. Having been evaluated by SBAs, acceptability and utilization in poor resource settings should be high. A study has been designed to evaluate the acceptability and effectiveness of this new monitoring chart in both BEOCs and CEOCs in two sub-Saharan African countries.
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Affiliation(s)
- Charles A Ameh
- Maternal and Newborn Health Unit, Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, L3 5QA, UK.
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Ameh C, Adegoke A, Hofman J, Ismail FM, Ahmed FM, van den Broek N. The impact of emergency obstetric care training in Somaliland, Somalia. Int J Gynaecol Obstet 2012; 117:283-7. [DOI: 10.1016/j.ijgo.2012.01.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 01/03/2012] [Accepted: 02/23/2012] [Indexed: 11/29/2022]
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Siddiqui GK, Hussein R, Dornan JC. Dying to give birth: the Pakistan Liaison Committee's strategies to improve maternal health in Pakistan. BJOG 2011; 118 Suppl 2:96-9. [PMID: 21951508 DOI: 10.1111/j.1471-0528.2011.03118.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pakistan has one of the worst maternal mortality ratios worldwide: 260-490 women die for every 100,000 live births in Pakistan. The Pakistan Liaison Group (PLG) was formed to work with and through the international office of the Royal College of Obstetricians and Gynaecologists (RCOG). It works with the RCOG representative committee in Pakistan to improve the health of women. It aims to contribute to improving maternal morbidity and mortality through strategies directed at improving the education and training of health professionals. In addition, the PLG aims to promote changes in the legislature to allow for the notification of maternal deaths so that accurate figures can be obtained, and so that health parameters can be accurately assessed and, in the long term, a confidential enquiry into maternal deaths can be initiated.
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Affiliation(s)
- G K Siddiqui
- Royal Free & University College Medical Schools, London, UK.
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Raven J, Utz B, Roberts D, van den Broek N. The ‘Making it Happen’ programme in India and Bangladesh. BJOG 2011; 118 Suppl 2:100-3. [DOI: 10.1111/j.1471-0528.2011.03119.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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