1
|
Gebremariam BM, Aboye GT, Dessalegn AA, Simegn GL. Rule-based expert system for the diagnosis of maternal complications during pregnancy: For low resource settings. Digit Health 2024; 10:20552076241230073. [PMID: 38313364 PMCID: PMC10836132 DOI: 10.1177/20552076241230073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/06/2024] Open
Abstract
Objectives Maternal complications are health challenges linked to pregnancy, encompassing conditions like gestational diabetes, maternal sepsis, sexually transmitted diseases, obesity, anemia, urinary tract infections, hypertension, and heart disease. The diagnosis of common pregnancy complications is challenging due to the similarity in signs and symptoms with general pregnancy indicators, especially in settings with scarce resources where access to healthcare professionals, diagnostic tools, and patient record management is limited. This paper presents a rule-based expert system tailored for diagnosing three prevalent maternal complications: preeclampsia, gestational diabetes mellitus (GDM), and maternal sepsis. Methods The risk factors associated with each disease were identified from various sources, including local health facilities and literature reviews. Attributes and rules were then formulated for diagnosing the disease, with a Mamdani-style fuzzy inference system serving as the inference engine. To enhance usability and accessibility, a web-based user interface has been also developed for the expert system. This interface allows users to interact with the system seamlessly, making it easy for them to input relevant information and obtain accurate disease diagnose. Results The proposed expert system demonstrated a 94% accuracy rate in identifying the three maternal complications (preeclampsia, GDM, and maternal sepsis) using a set of risk factors. The system was deployed to a custom-designed web-based user interface to improve ease of use. Conclusions With the potential to support health services provided during antenatal care visits and improve pregnant women's health outcomes, this system can be a significant advancement in low-resource setting maternal healthcare.
Collapse
Affiliation(s)
| | - Genet Tadese Aboye
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
| | - Abebaw Aynewa Dessalegn
- Department of Midwifery, Jimma Institute of Health sciences, Jimma University, Jimma, Ethiopia
| | - Gizeaddis Lamesgin Simegn
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
- Artificial Intelligence & Biomedical Imaging Research Lab, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
| |
Collapse
|
2
|
Akter S, Forbes G, Vazquez Corona M, Miller S, Althabe F, Coomarasamy A, Gallos ID, Oladapo OT, Vogel JP, Lorencatto F, Bohren MA. Perceptions and experiences of the prevention, detection, and management of postpartum haemorrhage: a qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 11:CD013795. [PMID: 38009552 PMCID: PMC10680124 DOI: 10.1002/14651858.cd013795.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Postpartum haemorrhage (PPH), defined as blood loss of 500 mL or more after childbirth, is the leading cause of maternal mortality worldwide. It is possible to prevent complications of PPH with timely and appropriate detection and management. However, implementing the best methods of PPH prevention, detection and management can be challenging, particularly in low- and middle-income countries. OBJECTIVES Our overall objective was to explore the perceptions and experiences of women, community members, lay health workers, and skilled healthcare providers who have experience with PPH or with preventing, detecting, and managing PPH, in community or health facility settings. SEARCH METHODS We searched MEDLINE, CINAHL, Scopus, and grey literature on 13 November 2022 with no language restrictions. We then performed reference checking and forward citation searching of the included studies. SELECTION CRITERIA We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that explored perceptions and experiences of PPH prevention, detection, and management among women, community members, traditional birth attendants, healthcare providers, and managers. DATA COLLECTION AND ANALYSIS We used three-stage maximum variation sampling to ensure diversity in terms of relevance of the study to the review objectives, richness of data, and coverage of critical contextual elements: setting (region, country income level), perspective (type of participant), and topic (prevention, detection, management). We extracted data using a data extraction form designed for this review. We used thematic synthesis to analyse and synthesise the evidence, and we used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. To identify factors that may influence intervention implementation, we mapped each review finding to the Theoretical Domains Framework (TDF) and the Capability, Motivation, and Opportunity model of Behaviour change (COM-B). We used the Behaviour Change Wheel to explore implications for practice. MAIN RESULTS We included 67 studies and sampled 43 studies for our analysis. Most were from low- or middle-income countries (33 studies), and most included the perspectives of women and health workers. We downgraded our confidence in several findings from high confidence to moderate, low, or very-low confidence, mainly due to concerns about how the studies were conducted (methodological limitations) or concerns about missing important perspectives from some types of participants or in some settings (relevance). In many communities, bleeding during and after childbirth is considered "normal" and necessary to expel "impurities" and restore and cleanse the woman's body after pregnancy and birth (moderate confidence). In some communities, people have misconceptions about causes of PPH or believe that PPH is caused by supernatural powers or evil spirits that punish women for ignoring or disobeying social rules or for past mistakes (high confidence). For women who give birth at home or in the community, female family members or traditional birth attendants are the first to recognise excess bleeding after birth (high confidence). Family members typically take the decision of whether and when to seek care if PPH is suspected, and these family members are often influenced by trusted traditional birth attendants or community midwives (high confidence). If PPH is identified for women birthing at home or in the community, decision-making about the subsequent referral and care pathway can be multifaceted and complex (high confidence). First responders to PPH are not always skilled or trained healthcare providers (high confidence). In health facilities, midwives may consider it easy to implement visual estimation of blood loss with a kidney dish or under-pad, but difficult to accurately interpret the amount of blood loss (very low confidence). Quantifying (rather than estimating) blood loss may be a complex and contentious change of practice for health workers (low confidence). Women who gave birth in health facilities and experienced PPH described it as painful, embarrassing, and traumatic. Partners or other family members also found the experience stressful. While some women were dissatisfied with their level of involvement in decision-making for PPH management, others felt health workers were best placed to make decisions (moderate confidence). Inconsistent availability of resources (drugs, medical supplies, blood) causes delays in the timely management of PPH (high confidence). There is limited availability of misoprostol in the community owing to stockouts, poor supply systems, and the difficulty of navigating misoprostol procurement for community health workers (moderate confidence). Health workers described working on the maternity ward as stressful and intense due to short staffing, long shifts, and the unpredictability of emergencies. Exhausted and overwhelmed staff may be unable to appropriately monitor all women, particularly when multiple women are giving birth simultaneously or on the floor of the health facility; this could lead to delays in detecting PPH (moderate confidence). Inadequate staffing, high turnover of skilled health workers, and appointment of lower-level cadres of health workers are key challenges to the provision of quality PPH care (high confidence). Through team-based simulation training, health workers of different cadres (doctors, midwives, lay health workers) can develop a shared mental model to help them work quickly, efficiently, and amicably as a team when managing women with PPH (moderate confidence). AUTHORS' CONCLUSIONS Our findings highlight how improving PPH prevention, detection, and management is underpinned by a complex system of interacting roles and behaviours (community, women, health workers of different types and with different experiences). Multiple individual, sociocultural, and environmental factors influence the decisions and behaviours of women, families, communities, health workers, and managers. It is crucial to consider the broader health and social systems when designing and implementing PPH interventions to change or influence these behaviours. We have developed a set of prompts that may help programme managers, policymakers, researchers, and other key stakeholders to identify and address factors that affect implementation and scale-up of interventions to improve PPH prevention, detection, and management.
Collapse
Affiliation(s)
- Shahinoor Akter
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Gillian Forbes
- Centre for Behaviour Change, University College London, London, UK
| | - Martha Vazquez Corona
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, and Safe Motherhood Program, Bixby Center for Global Reproductive Health and Policy, University of California, San Francisco, California, USA
| | - Fernando Althabe
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
- 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
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research (IMSR), WHO Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
| | - Ioannis D Gallos
- 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
| | - Olufemi T Oladapo
- 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
| | - Joshua P Vogel
- Maternal and Child Health, Burnet Institute, Melbourne, Australia
| | | | - Meghan A Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| |
Collapse
|
3
|
Aryeetey GC, Nonvignon J, Malm K, Owusu R, Baabu BS, Peprah NY, Agyemang SA, Novignon J, Amon S, Dwomoh D, Aikins M. Cost of inappropriate prescriptions for uncomplicated malaria in Ghana. Malar J 2023; 22:157. [PMID: 37202807 DOI: 10.1186/s12936-023-04581-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/03/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Malaria remains a common course of morbidity in many sub-Saharan African countries. While treatment options have improved in recent times, inappropriate prescription seems conventional among providers, increasing the burden on patients and society. This study examined the cost of inappropriate prescriptions for uncomplicated malaria treatment in Ghana. METHODS This study used retrospective data collected from January to December 2016 in 27 selected facilities, under different ownership in three regions of the country, mainly Volta, Upper East and Brong Ahafo. Stratified random sampling technique was used to extract 1625 outpatient folders of patients diagnosed and treated for malaria. Two physicians independently reviewed patient folders according to the stated diagnoses. Malaria prescriptions were described as inappropriate when they do not adhere to the standard treatment guidelines. The economic cost was mainly treatment cost which was sourced as medication cost. Total and average costs for country were calculated using sample estimates and the total number of uncomplicated malaria cases that received inappropriate prescriptions. RESULTS The study revealed that patients received an average of two prescriptions per malaria episode. Artemether-lumefantrine (AL) was the major malaria medication (79.5%) prescribed to patients. Other medications usually antibiotics and vitamins and minerals were included in the prescription. More than 50% of prescribers did not follow the guidelines for prescribing medications to clients. By facility type, inappropriate prescription was high in the CHPS compounds (59.1%) and by ownership, government (58.3%), private (57.5%) and mission facilities (50.7%). Thus, about 55% of malaria prescriptions were evaluated as inappropriate during the review period, which translates into economic cost of approximately US$4.52 million for the entire country in 2016. The total cost of inappropriate prescription within the study sample was estimated at US$1,088.42 while the average cost was US$1.20. CONCLUSION Inappropriate prescription for malaria is a major threat to malaria management in Ghana. It presents a huge economic burden to the health system. Training and strict enforcement of prescribers' adherence to the standard treatment guideline is highly recommended.
Collapse
Affiliation(s)
- Genevieve Cecilia Aryeetey
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana.
| | - Keziah Malm
- National Malaria Elimination Programme, Ghana Health Service, Accra, Ghana
| | - Richmond Owusu
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Bright Sasu Baabu
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Nana Yaw Peprah
- National Malaria Elimination Programme, Ghana Health Service, Accra, Ghana
| | - Samuel Agyei Agyemang
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Jacob Novignon
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Samuel Amon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Duah Dwomoh
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Moses Aikins
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| |
Collapse
|
4
|
Boushra M, Natesan SM, Koyfman A, Long B. High risk and low prevalence diseases: Eclampsia. Am J Emerg Med 2022; 58:223-228. [PMID: 35716535 DOI: 10.1016/j.ajem.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Eclampsia is a rare partum and puerperal condition that carries a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of the care of patients with eclampsia, including presentation, evaluation, and evidence-based management in the emergency department (ED). DISCUSSION Eclampsia is a hypertensive disease of pregnancy defined by new onset tonic-clonic, focal, or multifocal seizures or unexplained altered mental status in a pregnant or postpartum patient in the absence of other causative etiologies. However, signs and symptoms of preeclampsia and prodromes of eclampsia are often subtle and non-specific, making the diagnosis difficult. Thus, it should be considered in pregnant and postpartum patients who present to the ED. Laboratory testing including complete blood cell count, renal and liver function panels, electrolytes, glucose, coagulation panel, fibrinogen, lactate dehydrogenase, uric acid, and urinalysis, as well as imaging to include head computed tomography, can assist, but these evaluations should not delay management. Components of treatment include emergent obstetric specialist consultation, magnesium administration, and blood pressure control in patients with hypertension. Definitive treatment of eclampsia requires emergent delivery in pregnant patients. If consultants are not in-house, emergent stabilization and immediate transfer are required. CONCLUSIONS An understanding of eclampsia can assist emergency clinicians in rapid recognition and timely management of this potentially deadly disease.
Collapse
Affiliation(s)
- Marina Boushra
- East Carolina University, Brody School of Medicine, Department of Emergency Medicine, 600 Moye Blvd., Mailstop 625, Greenville, NC, USA
| | - Sreeja M Natesan
- Duke University School of Medicine, Department of Surgery, Division of Emergency Medicine, 2301 Erwin Rd., Durham, NC, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| |
Collapse
|
5
|
Escobar MF, Valencia P, Jaimes LM, Hincapié LC, Pulgarín EE, Nasner D, Carvajal J, Echavarría MP, Burke T, Prada S. Resource use decrease after implementation of care bundles for treatment of postpartum hemorrhage. J Matern Fetal Neonatal Med 2021; 35:7874-7881. [PMID: 34112062 DOI: 10.1080/14767058.2021.1937989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate whether the implementation of care bundles has an impact on resource utilization in the care of patients with postpartum hemorrhage (PPH). METHODS Retrospective, cross-sectional, observational study of 404 patients with stage II or greater PPH. Periods 2011-2014 and 2015-2017, before and after the introduction of care bundles, were compared. Billing reports were analyzed, and all services provided to treat these events were extracted. Use of resources within the two periods was computed. RESULTS The amount billed per episode decreased 18.66% from the first to the second period. Most PPH cases used fewer resources after introduction of care bundles. The greatest reduction was in the use of medications, with a decrease of charges by 56.3%. Diagnostic procedure charges decreased by 47.6% and consultation charges decreased by (37.7%). CONCLUSIONS The use of PPH care bundles may be associated with lower resource use and fewer interventions.
Collapse
Affiliation(s)
- María Fernanda Escobar
- Department of Obstetrics and Gynecology, High Complexity Obstetric Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Paola Valencia
- Department of Obstetrics and Gynecology, High Complexity Obstetric Unit, Fundación Valle del Lili, Cali, Colombia
| | | | | | | | - Daniela Nasner
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Javier Carvajal
- Department of Obstetrics and Gynecology, High Complexity Obstetric Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - María Paula Echavarría
- Department of Obstetrics and Gynecology, High Complexity Obstetric Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Thomas Burke
- Department of Emergency Medicine Global Health Innovation Laboratory, Massachusetts General Hospital, Boston, MA, USA.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Sergio Prada
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia.,Centro PROESA, Universidad Icesi, Cali, Colombia
| |
Collapse
|
6
|
Powell-Dunford N, Deuster P, McPherson M, Gaydos SJ. Aviation-Modeled Investigation of Significant Obstetric Events. Mil Med 2020; 185:e616-e624. [PMID: 32175558 DOI: 10.1093/milmed/usaa018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION In this research, the authors attempted to ascertain whether or not the Root Cause Analysis Event Support and Engagement Team (RESET) investigates the use of U.S. Army aviation-based techniques by staff members or organizations in which serious obstetrical events have occurred. Root cause analysis (RCA), originating in the manufacturing and engineering sectors, attempts to elucidate an underlying cause of a problem. Most recently, this process has been applied to the investigation of medical error. RESET was established in order to perform centralized investigation of significant medical error within U.S. Army medical and dental treatment facilities based on request from a hospital commander or general officer. Significant obstetric events are high profile, discussed in multiple safety forums, and an area of close RESET focus. Yet it is unclear if RESET investigates the use of aviation-based techniques by staff and/or organizations involved in serious obstetrical events. Therefore the present survey study was conducted. MATERIALS AND METHODS A structured, anonymous, voluntary survey was fielded to RESET staff in order to assess whether or not the RESET investigates the use of aviation-based techniques by staff members or organizations in which serious obstetrical events have occurred. RESULTS Five of six members of this small team completed the survey. Prebriefs, debriefs, and checklist use were consistently investigated. The employment of a sterile cockpit, first-name introductions, annual check ride, and emergency procedure rehearsal were infrequently investigated. CONCLUSION Obstetric RESET investigations inconsistently ascertain whether or not some of the aviation-based techniques are utilized by staff members or organizations in which serious obstetrical events have occurred. Standardization of investigative procedures and education directed at under-investigated practices may optimize medical investigation using proven tenets of an aviation-based approach.
Collapse
Affiliation(s)
- Nicole Powell-Dunford
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda MD 20814.,U.S. Army School of Aviation Medicine, Fort Rucker AL 36362
| | - Patricia Deuster
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda MD 20814
| | - Mark McPherson
- U.S. Army Aeromedical Research Laboratory, Fort Rucker AL 36362
| | | |
Collapse
|