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Khatun F, Distler R, Rahman M, O'Donnell B, Gachuhi N, Alwani M, Wang Y, Rahman A, Frøen JF, Friberg IK. Comparison of a palm-based biometric solution with a name-based identification system in rural Bangladesh. Glob Health Action 2022; 15:2045769. [PMID: 35343885 PMCID: PMC8967207 DOI: 10.1080/16549716.2022.2045769] [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] [Indexed: 11/25/2022] Open
Abstract
Background Unique identifiers are not universal in low- and middle-income countries. Biometric solutions have the potential to augment existing name-based searches used for identification in these settings. This paper describes a comparison of the searching accuracy of a palm-based biometric solution with a name-based database. Objective To compare the identification of individuals between a palm-based biometric solution to a name-based District Health Information Software 2 (DHIS2) Android application, in a low-resource setting. Methods The study was conducted in Chandpur district, Bangladesh. Trained data collectors enrolled 150 women of reproductive age into two android applications – i) a name-based DHIS2 application, and ii) a palm-based biometric solution – both run on tablets. One week after enrollment, a different research team member attempted to re-identify each enrolled woman using both systems. A single image or text-based name was used for searching at the time of re-identification. We interviewed data collectors at the end of the study. Results Significantly more women were successfully identified on the first attempt with a palm-based biometric application (84%) compared with the name-based DHIS2 application (61%). The proportion of identifications that required three or more attempts was similar between name-based (7%, CI 3.7–12.3) and palm-based biometric system (5%, CI: 1.9–9.4). However, the total number of attempts needed was significantly lower with the palm-based solution (mean 1.2 vs. 1.5, p < 0.001). In a group discussion, data collectors reported that the palm-based biometric identification system was both accurate and easy to use. Conclusion A palm-based biometric identification system on mobile devices was found to be an easy-to-use and accurate technology for the unique identification of individuals compared to an existing name-based application. Our findings imply that palm-based biometrics on mobile devices may be the next step in establishing unique identifiers in remote and rural settings where they are currently absent.
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Affiliation(s)
- Fatema Khatun
- Norwegian Institute of Public Health, Oslo, Norway.,International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Monjur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Noni Gachuhi
- Intellectual Ventures, Global Good Fund, Bellevue, WA, USA
| | | | | | - Anisur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - J Frederik Frøen
- Norwegian Institute of Public Health, Oslo, Norway.,University of Bergen, Bergen, Norway
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Venkateswaran M, Nazzal Z, Ghanem B, Khraiwesh R, Abbas E, Abu Khader K, Awwad T, Hijaz T, Isbeih M, Mørkrid K, Rose CJ, Frøen JF. eRegTime-Time Spent on Health Information Management in Primary Health Care Clinics Using a Digital Health Registry Versus Paper-Based Documentation: Cluster-Randomized Controlled Trial. JMIR Form Res 2022; 6:e34021. [PMID: 35559792 PMCID: PMC9143771 DOI: 10.2196/34021] [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] [Received: 10/18/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background Digital health interventions have been shown to improve data quality and health services in low- and middle-income countries (LMICs). Nonetheless, in LMICs, systematic assessments of time saved with the use of digital tools are rare. We ran a set of cluster-randomized controlled trials as part of the implementation of a digital maternal and child health registry (eRegistry) in the West Bank, Palestine. Objective In the eRegTime study, we compared time spent on health information management in clinics that use the eRegistry versus the existing paper-based documentation system. Methods Intervention (eRegistry) and control (paper documentation) arms were defined by a stratified random subsample of primary health care clinics from the concurrent eRegQual trial. We used time-motion methodology to collect data on antenatal care service provision. Four observers used handheld tablets to record time-use data during one working day per clinic. We estimated relative time spent on health information management for booking and follow-up visits and on client care using mixed-effects linear regression. Results In total, 22 of the 24 included clinics (12 intervention, 10 control) contributed data; no antenatal care visits occurred in the other two clinics during the study period. A total of 123 and 118 consultations of new pregnancy registrations and follow-up antenatal care visits were observed in the intervention and control groups, respectively. Average time spent on health information management for follow-up antenatal care visits in eRegistry clinics was 5.72 minutes versus 8.10 minutes in control clinics (adjusted relative time 0.69, 95% CI 0.60-0.79; P<.001), and 15.26 minutes versus 18.91 minutes (adjusted relative time 0.96, 95% CI 0.61-1.50; P=.85) for booking visits. The average time spent on documentation, a subcategory of health information management, was 5.50 minutes in eRegistry clinics versus 8.48 minutes in control clinics (adjusted relative time 0.68, 95% CI 0.56-0.83; P<.001). While the average time spent on client care was 5.01 minutes in eRegistry clinics versus 4.91 minutes in control clinics, some uncertainty remains, and the CI was consistent with eRegistry clinics using less, the same, or more time on client care compared to those that use paper (adjusted relative time 0.85, 95% CI 0.64-1.13; P=.27). Conclusions The eRegistry captures digital data at point of care during client consultations and generates automated routine reports based on the clinical data entered. Markedly less time (plausibly a saving of at least 18%) was spent on health information management in eRegistry clinics compared to those that use paper-based documentation. This is likely explained by the fact that the eRegistry requires lesser repetitive documentation work than paper-based systems. Adoption of eRegistry-like systems in comparable settings may save valuable and scarce health care resources. Trial Registration ISRCTN registry ISRCTN18008445; https://doi.org/10.1186/ISRCTN18008445 International Registered Report Identifier (IRRID) RR2-10.2196/13653
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Affiliation(s)
- Mahima Venkateswaran
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway.,Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Zaher Nazzal
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Occupied Palestinian Territory
| | - Buthaina Ghanem
- Palestinian National Institute of Public Health, Al-Bireh, Occupied Palestinian Territory
| | - Reham Khraiwesh
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Occupied Palestinian Territory
| | - Eatimad Abbas
- Palestinian National Institute of Public Health, Al-Bireh, Occupied Palestinian Territory
| | - Khadija Abu Khader
- Palestinian National Institute of Public Health, Al-Bireh, Occupied Palestinian Territory
| | - Tamara Awwad
- Palestinian National Institute of Public Health, Al-Bireh, Occupied Palestinian Territory
| | - Taghreed Hijaz
- Palestinian National Institute of Public Health, Al-Bireh, Occupied Palestinian Territory
| | - Mervett Isbeih
- Palestinian National Institute of Public Health, Al-Bireh, Occupied Palestinian Territory
| | - Kjersti Mørkrid
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Christopher James Rose
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - J Frederik Frøen
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway.,Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
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Venkateswaran M, Ghanem B, Abbas E, Khader KA, Ward IA, Awwad T, Baniode M, Frost MJ, Hijaz T, Isbeih M, Mørkrid K, Rose CJ, Frøen JF. A digital health registry with clinical decision support for improving quality of antenatal care in Palestine (eRegQual): a pragmatic, cluster-randomised, controlled, superiority trial. The Lancet Digital Health 2022; 4:e126-e136. [PMID: 35090675 PMCID: PMC8811715 DOI: 10.1016/s2589-7500(21)00269-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 10/15/2021] [Accepted: 11/19/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Mahima Venkateswaran
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health, Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
| | - Buthaina Ghanem
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Eatimad Abbas
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | | | - Itimad Abu Ward
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Tamara Awwad
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Mohammad Baniode
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Michael James Frost
- Health Information Systems Programme, Department of Informatics, University of Oslo, Oslo, Norway
| | - Taghreed Hijaz
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Mervett Isbeih
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Kjersti Mørkrid
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Christopher J Rose
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - J Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health, Department of Global Health and Primary Care, University of Bergen, Bergen, Norway.
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Pervin J, Venkateswaran M, Nu UT, Rahman M, O’Donnell BF, Friberg IK, Rahman A, Frøen JF. Determinants of utilization of antenatal and delivery care at the community level in rural Bangladesh. PLoS One 2021; 16:e0257782. [PMID: 34582490 PMCID: PMC8478219 DOI: 10.1371/journal.pone.0257782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Timely utilization of antenatal care and delivery services supports the health of mothers and babies. Few studies exist on the utilization and determinants of timely ANC and use of different types of health facilities at the community level in Bangladesh. This study aims to assess the utilization, timeliness of, and socio-demographic determinants of antenatal and delivery care services in two sub-districts in Bangladesh. METHODS This cross-sectional study used data collected through a structured questionnaire in the eRegMat cluster-randomized controlled trial, which enrolled pregnant women between October 2018-June 2020. We undertook univariate and multivariate logistic regression analysis to determine the associations of socio-demographic variables with timely first ANC, four timely ANC visits, and facility delivery. We considered the associations in the multivariate logistic regression as statistically significant if the p-value was found to be <0.05. Results are presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI). RESULTS Data were available on 3293 pregnant women. Attendance at a timely first antenatal care visit was 59%. Uptake of four timely antenatal care visits was 4.2%. About three-fourths of the women delivered in a health facility. Women from all socio-economic groups gradually shifted from using public health facilities to private hospitals as the pregnancy advanced. Timely first antenatal care visit was associated with: women over 30 years of age (AOR: 1.52, 95% CI: 1.05-2.19); nulliparity (AOR: 1.30, 95% CI: 1.04-1.62); husbands with >10 years of education (AOR: 1.40, 95% CI: 1.09-1.81) and being in the highest wealth quintile (AOR: 1.49, 95% CI: 1.18-1.89). Facility deliveries were associated with woman's age; parity; education; the husband's education, and wealth index. None of the available socio-demographic factors were associated with four timely antenatal care visits. CONCLUSIONS The study observed socio-demographic inequalities associated with increased utilization of timely first antenatal care visit and facility delivery. The pregnant women, irrespective of wealth shifted from public to private facilities for their antenatal care visits and delivery. To increase the health service utilization and promote good health, maternal health care programs should pay particular attention to young, multiparous women, of low socio-economic status, or with poorly educated husbands. CLINICAL TRIAL REGISTRATION ISRCTN69491836; https://www.isrctn.com/. Registered on December 06, 2018. Retrospectively registered.
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Affiliation(s)
- Jesmin Pervin
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- University of Bergen, Bergen, Norway
| | - Mahima Venkateswaran
- University of Bergen, Bergen, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - U. Tin Nu
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Monjur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Ingrid K. Friberg
- Norwegian Institute of Public Health, Oslo, Norway
- Tacoma-Pierce County Health Department, Tacoma, WA, United States of America
| | - Anisur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - J. Frederik Frøen
- University of Bergen, Bergen, Norway
- Norwegian Institute of Public Health, Oslo, Norway
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Frøen JF, Bianchi A, Moller AB, Jacobsson B. FIGO good practice recommendations on the importance of registry data for monitoring rates and health systems performance in prevention and management of preterm birth. Int J Gynaecol Obstet 2021; 155:5-7. [PMID: 34520059 PMCID: PMC9293020 DOI: 10.1002/ijgo.13847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
FIGO calls for strengthening of health information systems for reproductive, maternal, newborn, and child health services, co‐designed with users, to ensure the timely accessibility of actionable high‐quality data for all stakeholders engaged in preventing and managing preterm birth consequences. FIGO calls for strengthening of investments and capacity for implementing digital registries and the continuity of reproductive, maternal, newborn, and child health services in line with WHO recommendations, and strengthening of the science of implementation and use of registries—from local quality improvement to big data exploration. Effective preterm birth prevention needs strengthened health information systems for maternal and child health services, co‐designed with users, to ensure accountability and actionable high‐quality data for all stakeholders.
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Affiliation(s)
- J Frederik Frøen
- Global Health Cluster, Division for Health Serrvices, Norwegian Institute of Public Health, Oslo, Norway
| | - Ana Bianchi
- Perinatal Department, Pereira Rossell Hospital, and University Hospital, Montevideo, Uruguay
| | - Ann-Beth Moller
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Institute of Public Health, Oslo, Norway
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Rahman A, Friberg IK, Dolphyne A, Fjeldheim I, Khatun F, O'Donnell B, Pervin J, Rahman M, Rahman AMQ, Nu UT, Sarker BK, Venkateswaran M, Frøen JF. An Electronic Registry for Improving the Quality of Antenatal Care in Rural Bangladesh (eRegMat): Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e26918. [PMID: 34255723 PMCID: PMC8292932 DOI: 10.2196/26918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Digital health interventions (DHIs) can alleviate several barriers to achieving better maternal and child health. The World Health Organization's guideline recommendations for DHIs emphasize the need to integrate multiple DHIs for maximizing impact. The complex health system of Bangladesh provides a unique setting for evaluating and understanding the role of an electronic registry (eRegistry) for antenatal care, with multiple integrated DHIs for strengthening the health system as well as improving the quality and utilization of the public health care system. OBJECTIVE The aim of this study is to assess the effect of an eRegistry with DHIs compared with a simple digital data entry tool without DHIs in the community and frontline health facilities. METHODS The eRegMat is a cluster-randomized controlled trial conducted in the Matlab North and Matlab South subdistricts in the Chandpur district, Bangladesh, where health facilities are currently using the eRegistry for digital tracking of the health status of pregnant women longitudinally. The intervention arm received 3 superimposed data-driven DHIs: health worker clinical decision support, health worker feedback dashboards with action items, and targeted client communication to pregnant women. The primary outcomes are appropriate screening as well as management of hypertension during pregnancy and timely antenatal care attendance. The secondary outcomes include morbidity and mortality in the perinatal period as well as timely first antenatal care visit; successful referrals for anemia, diabetes, or hypertension during pregnancy; and facility delivery. RESULTS The eRegistry and DHIs were co-designed with end users between 2016 and 2018. The eRegistry was implemented in the study area in July 2018. Recruitment for the trial started in October 2018 and ended in June 2020, followed by an 8-month follow-up period to capture outcome data until February 2021. Trial results will be available for publication in June 2021. CONCLUSIONS This trial allows the simultaneous assessment of multiple integrated DHIs for strengthening the health system and aims to provide evidence for its implementation. The study design and outcomes are geared toward informing the living review process of the guidelines for implementing DHIs. TRIAL REGISTRATION ISRCTN Registry ISRCTN69491836; https://www.isrctn.com/ISRCTN69491836. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/26918.
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Affiliation(s)
- Anisur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Ingrid K Friberg
- Tacoma-Pierce County Health Department, Tacoma, WA, United States
| | - Akuba Dolphyne
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Ingvild Fjeldheim
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Fatema Khatun
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Brian O'Donnell
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Jesmin Pervin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Monjur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - A M Qaiyum Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - U Tin Nu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Bidhan Krishna Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Mahima Venkateswaran
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - J Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
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Isbeih M, Venkateswaran M, Abbas E, Abu-Khader K, Awwad T, Baniode M, Ghanem B, Hijaz T, Ramlawi A, Salman R, White R, Frøen JF. Gestational age recorded at delivery versus estimations using antenatal care data from the Electronic Maternal and Child Health Registry in the West Bank: a comparative analysis. Lancet 2021; 398 Suppl 1:S31. [PMID: 34227964 DOI: 10.1016/s0140-6736(21)01517-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Estimated dates of delivery have important consequences for clinical decisions during pregnancy and labour. The Electronic Maternal and Child Health Registry (MCH eRegistry) in Palestine includes antenatal care data and birth data from hospitals. Our objective was to compare computed best estimates of gestational age in the MCH eRegistry with the gestational ages recorded by health-care providers in hospital delivery units. METHODS We obtained data for pregnant women in the West Bank registered in the MCH eRegistry from Jan 1, 2017 to March 31, 2017. Best estimates of gestational age in the registry are automated and based on a standard pregnancy duration of 280 days and ultrasound-based pregnancy dating before 20 weeks' gestation or the woman's last menstrual period date. Hospital recorded gestational ages are reported by care providers in delivery units and are rounded to the nearest week. We calculated proportions of gestational ages (with 95% CIs) from both sources that fell into the categories of term, very preterm (24-32 weeks' gestation), preterm (33-37 weeks), or post-term (>42 weeks). FINDINGS 1924 women were included in the study. The median hospital recorded gestational age was 39 weeks (IQR 38-40 weeks) and according to MCH eRegistry estimates was 39 weeks and 5 days (IQR 38 weeks and 1 day to 40 weeks and 5 days). Proportions of very preterm, preterm, and post-term deliveries were higher based on MCH eRegistry estimates than on hospital recorded gestational ages (very preterm 3%, 95% CI 2-4 vs 2%, 1-2; preterm 6%, 5-7 vs 5%, 3-6 ; post-term 6%, 5-7 vs 1%, 1-2). INTERPRETATION In addition to clinical care, the proportions of term, very preterm, preterm, and post-term births can have implications for public health monitoring. The proportion of deliveries within the normal range of term gestation was calculated to be higher by care providers in delivery units than by MCH eRegistry estimates. Extending the access of hospitals to information from antenatal care in the MCH e-Registry could improve continuity of data and better care for pregnant women. FUNDING European Research Council, Research Council of Norway.
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Affiliation(s)
- Mervett Isbeih
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory.
| | - Mahima Venkateswaran
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Eatimad Abbas
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Khadija Abu-Khader
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Tamara Awwad
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Mohammad Baniode
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Buthaina Ghanem
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Taghreed Hijaz
- Palestinian Ministry of Health, Ramallah, occupied Palestinian territory
| | - Asad Ramlawi
- Palestinian Ministry of Health, Ramallah, occupied Palestinian territory
| | - Rand Salman
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Richard White
- Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - J Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
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Bogale B, Mørkrid K, O'Donnell B, Ghanem B, Abu Ward I, Abu Khader K, Isbeih M, Frost M, Baniode M, Hijaz T, Awwad T, Rabah Y, Frøen JF. Development of a targeted client communication intervention for pregnant and post-partum women: a descriptive study. Lancet 2021; 398 Suppl 1:S18. [PMID: 34227949 DOI: 10.1016/s0140-6736(21)01504-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Targeted client communication using text messages can inform, motivate, and remind pregnant and postpartum women to use care in a timely way. The mixed results of previous studies of the effectiveness of targeted client communication highlight the importance of theory-based co-design with users. We planned, developed, and tested a theory-based intervention tailored to pregnant and postpartum women, to be automatically distributed via an electronic maternal and child health registry in occupied Palestinian territory. METHODS We did 26 in-depth interviews with pregnant women and health-care providers in seven purposively selected public primary health-care clinics in the West Bank and Gaza to include clinics with different profiles. An interview guide was developed using the Health Belief Model to explore women's perceptions of high-risk conditions (anaemia, hypertension, diabetes, and fetal growth restriction) and timely attendance for antenatal care, as predefined by a national expert panel. We did thematic analyses of the interview data. Based on the results, we composed messages for a targeted client communication intervention, applying concepts from the Model of Actionable Feedback, social nudging, and enhanced active choice. We assessed the acceptability and understandability of the messages through unstructured interviews with local health promotion experts, health-care providers, and pregnant women. FINDINGS The recurring themes indicated that most women were aware of the health consequences of anaemia, hypertension, and diabetes, but that they seldom associated these conditions with pregnancy. We identified knowledge gaps and low awareness of susceptibility to and severity of these complications and the benefits of timely antenatal care. The actionable messages were iteratively improved with stakeholder and end-user feedback after presenting the initial draft, and the messages deemed were understandable and acceptable based on reflections during unstructured assessment. INTERPRETATION Following a stepwise iterative process by a theory-based approach and co-designing the intervention with users, we revealed elements critical to an efficacious targeted client communication intervention. A potential limitation of our study is that conducting in-depth interviews on several health conditions simultaneously might have reduced the depth of information we could have obtained. The strength of our study was that we assessed for, developed, and refined the intervention following recommended theoretical frameworks and best practices. The effectiveness of this intervention is under evaluation in a cluster-randomised trial (ISRCTN10520687). FUNDING European Research Council and Research Council of Norway.
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Affiliation(s)
- Binyam Bogale
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Center for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway.
| | - Kjersti Mørkrid
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Brian O'Donnell
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Buthaina Ghanem
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Itimad Abu Ward
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Khadija Abu Khader
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Mervett Isbeih
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Michael Frost
- Health Information Systems Program, Department of Informatics, University of Oslo, Oslo, Norway
| | - Mohammad Baniode
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Taghreed Hijaz
- Palestinian Ministry of Health, Ramallah, occupied Palestinian territory
| | - Tamara Awwad
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - Yousef Rabah
- Palestinian National Institute of Public Health, WHO, Ramallah, occupied Palestinian territory
| | - J Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Center for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
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Bogale B, Mørkrid K, Abbas E, Abu Ward I, Anaya F, Ghanem B, Hijaz T, Isbeih M, Issawi S, A. S. Nazzal Z, E. Qaddomi S, Frøen JF. The effect of a digital targeted client communication intervention on pregnant women's worries and satisfaction with antenatal care in Palestine-A cluster randomized controlled trial. PLoS One 2021; 16:e0249713. [PMID: 33891597 PMCID: PMC8064599 DOI: 10.1371/journal.pone.0249713] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 03/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background The eRegCom cluster randomized controlled trial assesses the effectiveness of targeted client communication (TCC) via short message service (SMS) to pregnant women, from a digital maternal and child health registry (eRegistry) in Palestine, on improving attendance and quality of care. In this paper, we assess whether this TCC intervention could also have unintended consequences on pregnant women’s worries, and their satisfaction with antenatal care (ANC). Methods We interviewed a sub-sample of Arabic-speaking women attending ANC at public primary healthcare clinics, randomized to either the TCC intervention or no TCC (control) in the eRegCom trial, who were in 38 weeks of gestation and had a phone number registered in the eRegistry. Trained female data collectors interviewed women by phone from 67 intervention and 64 control clusters, after securing informed oral consent. The Arabic interview guide, pilot-tested prior to the data collection, included close-ended questions to capture the woman’s socio-demographic status, agreement questions about their satisfaction with ANC services, and the 13-item Cambridge Worry Scale (CWS). We employed a non-inferiority study design and an intention-to-treat analysis approach. Results A total of 454 women, 239 from the TCC intervention and 215 from the control arm participated in this sub-study. The mean and standard deviation of the CWS were 1.8 (1.9) for the intervention and 2.0 (1.9) for the control arm. The difference in mean between the intervention and control arms was -0.16 (95% CI: -0.31 to -0.01) after adjusting for clustering, which was below the predefined non-inferiority margin of 0.3. Women in both groups were equally satisfied with the ANC services they received. Conclusion The TCC intervention via SMS did not increase pregnancy-related worries among recipients. There was no difference in women’s satisfaction with the ANC services between intervention and control arms.
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Affiliation(s)
- Binyam Bogale
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
- Center for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Kjersti Mørkrid
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
| | - Eatimad Abbas
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - Itimad Abu Ward
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - Firas Anaya
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Buthaina Ghanem
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | | | - Mervett Isbeih
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - Sally Issawi
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - Zaher A. S. Nazzal
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Sharif E. Qaddomi
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - J. Frederik Frøen
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
- Center for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
- * E-mail:
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10
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Pervin J, Sarker BK, Nu UT, Khatun F, Rahman AMQ, Venkateswaran M, Rahman A, Frøen JF, Friberg IK. Developing targeted client communication messages to pregnant women in Bangladesh: a qualitative study. BMC Public Health 2021; 21:759. [PMID: 33879108 PMCID: PMC8056650 DOI: 10.1186/s12889-021-10811-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Timely and appropriate evidence-based practices during antenatal care improve maternal and neonatal health. There is a lack of information on how pregnant women and families perceive antenatal care in Bangladesh. The aim of our study was to develop targeted client communication via text messages for increasing antenatal care utilization, as part of an implementation of an electronic registry for maternal and child health. Methods Using a phenomenological approach, we conducted this qualitative study from May to June 2017 in two sub-districts of Chandpur district, Bangladesh. We selected study participants by purposive sampling. A total of 24 in-depth interviews were conducted with pregnant women (n = 10), lactating women (n = 5), husbands (n = 5), and mothers-in-law (n = 4). The Health Belief Model (HBM) was used to guide the data collection. Thematic analysis was carried out manually according to the HBM constructs. We used behavior change techniques to inform the development of targeted client communication based on the thematic results. Results Almost no respondents mentioned antenatal care as a preventive form of care, and only perceived it as necessary if any complications developed during pregnancy. Knowledge of the content of antenatal care (ANC) and pregnancy complications was low. Women reported a variety of reasons for not attending ANC, including the lack of information on the timing of ANC; lack of decision-making power; long-distance to access care; being busy with household chores, and not being satisfied with the treatment by health care providers. Study participants recommended phone calls as their preferred communication strategy when asked to choose between the phone call and text message, but saw text messages as a feasible option. Based on the findings, we developed a library of 43 automatically customizable text messages to increase ANC utilization. Conclusions Pregnant women and family members had limited knowledge about antenatal care and pregnancy complications. Effective health information through text messages could increase awareness of antenatal care among the pregnant women in Bangladesh. This study presents an example of designing targeted client communication to increase antenatal care utilization within formal scientific frameworks, including a taxonomy of behavior change techniques. Trial registration ISRCTN69491836. Registered on December 06, 2018. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10811-y.
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Affiliation(s)
- Jesmin Pervin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. .,University of Bergen, Bergen, Norway.
| | - Bidhan Krishna Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - U Tin Nu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fatema Khatun
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,Norwegian Institute of Public Health, Oslo, Norway
| | - A M Quaiyum Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahima Venkateswaran
- University of Bergen, Bergen, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Anisur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - J Frederik Frøen
- University of Bergen, Bergen, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Ingrid K Friberg
- Norwegian Institute of Public Health, Oslo, Norway.,Tacoma-Pierce County Health Department, Tacoma, WA, USA
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Mørkrid K, Bogale B, Abbas E, Abu Khader K, Abu Ward I, Attalh A, Awwad T, Baniode M, Frost KS, Frost MJ, Ghanem B, Hijaz T, Isbeih M, Issawi S, Nazzal ZAS, O’Donnell B, Qaddomi SE, Rabah Y, Venkateswaran M, Frøen JF. eRegCom-Quality Improvement Dashboard for healthcare providers and Targeted Client Communication to pregnant women using data from an electronic health registry to improve attendance and quality of antenatal care: study protocol for a multi-arm cluster randomized trial. Trials 2021; 22:47. [PMID: 33430935 PMCID: PMC7802344 DOI: 10.1186/s13063-020-04980-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND This trial evaluates interventions that utilize data entered at point-of-care in the Palestinian maternal and child eRegistry to generate Quality Improvement Dashboards (QID) for healthcare providers and Targeted Client Communication (TCC) via short message service (SMS) to clients. The aim is to assess the effectiveness of the automated communication strategies from the eRegistry on improving attendance and quality of care for pregnant women. METHODS This four-arm cluster randomized controlled trial will be conducted in the West Bank and the Gaza Strip, Palestine, and includes 138 clusters (primary healthcare clinics) enrolling from 45 to 3000 pregnancies per year. The intervention tools are the QID and the TCC via SMS, automated from the eRegistry built on the District Health Information Software 2 (DHIS2) Tracker. The primary outcomes are appropriate screening and management of anemia, hypertension, and diabetes during pregnancy and timely attendance to antenatal care. Primary analysis, at the individual level taking the design effect of the clustering into account, will be done as intention-to-treat. DISCUSSION This trial, embedded in the implementation of the eRegistry in Palestine, will inform the use of digital health interventions as a health systems strengthening approach. TRIAL REGISTRATION ISRCTN Registry, ISRCTN10520687 . Registered on 18 October 2018.
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Affiliation(s)
- Kjersti Mørkrid
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, PB 222 Skøyen, 0213 Oslo, Norway
| | - Binyam Bogale
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, PB 222 Skøyen, 0213 Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Eatimad Abbas
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | | | - Itimad Abu Ward
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Amjad Attalh
- The Palestinian Ministry of Health, Ramallah, Palestine
| | - Tamara Awwad
- Institute of Community and Public Health, Birzeit University, Ramallah, Palestine
| | - Mohammad Baniode
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Kimberly Suzanne Frost
- Health Information Systems Programme, Department of Informatics, University of Oslo, Oslo, Norway
| | - Michael James Frost
- Health Information Systems Programme, Department of Informatics, University of Oslo, Oslo, Norway
| | - Buthaina Ghanem
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Taghreed Hijaz
- Palestinian National Institute of Public Health, Ramallah, Palestine
- The Palestinian Ministry of Health, Ramallah, Palestine
| | - Mervett Isbeih
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Sally Issawi
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Zaher A. S. Nazzal
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Brian O’Donnell
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, PB 222 Skøyen, 0213 Oslo, Norway
- The Palestinian Ministry of Health, Ramallah, Palestine
| | - Sharif E. Qaddomi
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Yousef Rabah
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Mahima Venkateswaran
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, PB 222 Skøyen, 0213 Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
| | - J. Frederik Frøen
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, PB 222 Skøyen, 0213 Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
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12
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Bogale B, Mørkrid K, O'Donnell B, Ghanem B, Abu Ward I, Abu Khader K, Isbeih M, Frost M, Baniode M, Hijaz T, Awwad T, Rabah Y, Frøen JF. Development of a targeted client communication intervention to women using an electronic maternal and child health registry: a qualitative study. BMC Med Inform Decis Mak 2020; 20:1. [PMID: 31906929 PMCID: PMC6945530 DOI: 10.1186/s12911-019-1002-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 12/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Targeted client communication (TCC) using text messages can inform, motivate and remind pregnant and postpartum women of timely utilization of care. The mixed results of the effectiveness of TCC interventions points to the importance of theory based interventions that are co-design with users. The aim of this paper is to describe the planning, development, and evaluation of a theory led TCC intervention, tailored to pregnant and postpartum women and automated from the Palestinian electronic maternal and child health registry. METHODS We used the Health Belief Model to develop interview guides to explore women's perceptions of antenatal care (ANC), with a focus on high-risk pregnancy conditions (anemia, hypertensive disorders in pregnancy, gestational diabetes mellitus, and fetal growth restriction), and untimely ANC attendance, issues predefined by a national expert panel as being of high interest. We performed 18 in-depth interviews with women, and eight with healthcare providers in public primary healthcare clinics in the West Bank and Gaza. Grounding on the results of the in-depth interviews, we used concepts from the Model of Actionable Feedback, social nudging and Enhanced Active Choice to compose the TCC content to be sent as text messages. We assessed the acceptability and understandability of the draft text messages through unstructured interviews with local health promotion experts, healthcare providers, and pregnant women. RESULTS We found low awareness of the importance of timely attendance to ANC, and the benefits of ANC for pregnancy outcomes. We identified knowledge gaps and beliefs in the domains of low awareness of susceptibility to, and severity of, anemia, hypertension, and diabetes complications in pregnancy. To increase the utilization of ANC and bridge the identified gaps, we iteratively composed actionable text messages with users, using recommended message framing models. We developed algorithms to trigger tailored text messages with higher intensity for women with a higher risk profile documented in the electronic health registry. CONCLUSIONS We developed an optimized TCC intervention underpinned by behavior change theory and concepts, and co-designed with users following an iterative process. The electronic maternal and child health registry can serve as a unique platform for TCC interventions using text messages.
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Affiliation(s)
- Binyam Bogale
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Center for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Kjersti Mørkrid
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Brian O'Donnell
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Buthaina Ghanem
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Itimad Abu Ward
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Khadija Abu Khader
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Mervett Isbeih
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Michael Frost
- Health Information Systems Program, Department of Informatics, University of Oslo, Oslo, Norway
| | - Mohammad Baniode
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | | | - Tamara Awwad
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Yousef Rabah
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - J Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
- Center for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
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13
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Lindberg MH, Venkateswaran M, Abu Khader K, Awwad T, Ghanem B, Hijaz T, Mørkrid K, Frøen JF. eRegTime, Efficiency of Health Information Management Using an Electronic Registry for Maternal and Child Health: Protocol for a Time-Motion Study in a Cluster Randomized Trial. JMIR Res Protoc 2019; 8:e13653. [PMID: 31392962 PMCID: PMC6702800 DOI: 10.2196/13653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/14/2019] [Accepted: 06/16/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Paper-based routine health information systems often require repetitive data entry. In the West Bank, the primary health care system for maternal and child health was entirely paper-based, with care providers spending considerable amounts of time maintaining multiple files and client registers. As part of the phased national implementation of an electronic health information system, some of the primary health care clinics are now using an electronic registry (eRegistry) for maternal and child health. The eRegistry consists of client-level data entered by care providers at the point-of-care and supports several digital health interventions that are triggered by the documented clinical data, including guideline-based clinical decision support and automated public health reports. OBJECTIVE The aim of the eRegTime study is to investigate whether the use of the eRegistry leads to changes in time-efficiency in health information management by the care providers, compared with the paper-based systems. METHODS This is a substudy in a cluster randomized controlled trial (the eRegQual study) and uses the time-motion observational study design. The primary outcome is the time spent on health information management for antenatal care, informed and defined by workflow mapping in the clinics. We performed sample size estimations to enable the detection of a 25% change in time-efficiency with a 90% power using an intracluster correlation coefficient of 0.1 and an alpha of .05. We observed care providers for full workdays in 24 randomly selected primary health care clinics-12 using the eRegistry and 12 still using paper. Linear mixed effects models will be used to compare the time spent on health information management per client per care provider. RESULTS Although the objective of the eRegQual study is to assess the effectiveness of the eRegistry in improving quality of antenatal care, the results of the eRegTime study will contribute to process evaluation, supplementing the findings of the larger trial. CONCLUSIONS Electronic health tools are expected to reduce workload for the care providers and thus improve efficiency of clinical work. To achieve these benefits, the implementation of such systems requires both integration with existing workflows and the creation of new workflows. Studies assessing the time-efficiency of electronic health information systems can inform policy decisions for implementations in resource-limited low- and middle-income settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13653.
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Affiliation(s)
- Marie Hella Lindberg
- Faculty of Health Sciences, UiT - the Arctic University of Norway, Tromsø, Norway
| | - Mahima Venkateswaran
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Khadija Abu Khader
- Palestinian National Institute of Public Health, World Health Organization, Al-Bireh, Occupied Palestinian Territory
| | - Tamara Awwad
- Palestinian National Institute of Public Health, World Health Organization, Al-Bireh, Occupied Palestinian Territory
| | - Buthaina Ghanem
- Palestinian National Institute of Public Health, World Health Organization, Al-Bireh, Occupied Palestinian Territory
| | - Taghreed Hijaz
- Ministry of Health, Ramallah, Occupied Palestinian Territory
| | - Kjersti Mørkrid
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - J Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
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14
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Venkateswaran M, Bogale B, Abu Khader K, Awwad T, Friberg IK, Ghanem B, Hijaz T, Mørkrid K, Frøen JF. Effective coverage of essential antenatal care interventions: A cross-sectional study of public primary healthcare clinics in the West Bank. PLoS One 2019; 14:e0212635. [PMID: 30794645 PMCID: PMC6386267 DOI: 10.1371/journal.pone.0212635] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/06/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The proportion of women attending four or more antenatal care (ANC) visits is widely used for monitoring, but provides limited information on quality of care. Effective coverage metrics, assessing if ANC interventions are completely delivered, can identify critical gaps in healthcare service delivery. We aimed to measure coverage of at least one screening and effective coverage of ANC interventions in the public health system in the West Bank, Palestine, and to explore associations between infrastructure-related and maternal sociodemographic variables and effective coverage. METHODS We used data from paper-based clinical records of 1369 pregnant women attending ANC in 17 primary healthcare clinics. Infrastructure-related variables were derived from a 2014 national inventory assessment of clinics. Sample size calculations were made to detect effective coverage ranging 40-60% with a 2-3% margin of error, clinics were selected by probability sampling. We calculated inverse probability weighted percentages of: effective coverage of appropriate number and timing of screenings of ANC interventions; and coverage of at least one screening. RESULTS Coverage of one screening and effective coverage of ANC interventions were notably different for screening for: hypertension (98% vs. 10%); fetal growth abnormalities (66% vs. 6%); anemia (93% vs. 14%); gestational diabetes (93% vs. 34%), and antenatal ultrasound (74% vs. 24%). Clinics with a laboratory and ultrasound generally performed better in terms of effective coverage, and maternal sociodemographic factors had no associations with effective coverage estimates. Only 13% of the women attended ANC visits according to the recommended national schedule, driving effective coverage down. CONCLUSION Indicators for ANC monitoring and their definitions can have important consequences for quantifying health system performance and identifying issues with care provision. To achieve more effective coverage in public primary care clinics in the West Bank, efforts should be made to improve care provision according to prescribed guidelines.
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Affiliation(s)
- Mahima Venkateswaran
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Binyam Bogale
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Khadija Abu Khader
- Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Tamara Awwad
- Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Ingrid K. Friberg
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Buthaina Ghanem
- Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | | | - Kjersti Mørkrid
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - J. Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
- * E-mail:
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15
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Friberg IK, Venkateswaran M, Ghanem B, Frøen JF. Antenatal care data sources and their policy and planning implications: a Palestinian example using the Lives Saved Tool. BMC Public Health 2019; 19:124. [PMID: 30700260 PMCID: PMC6354562 DOI: 10.1186/s12889-019-6427-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 10/26/2018] [Accepted: 01/11/2019] [Indexed: 11/24/2022] Open
Abstract
Background Policy making in healthcare requires reliable and local data. Different sources of coverage data for health interventions can be utilized to populate the Lives Saved Tool (LiST), a commonly used policy-planning tool for women and children’s health. We have evaluated four existing sources of antenatal care data in Palestine to discuss the implications of their use in LiST. Methods We identified all intervention coverage and health status indicators around the antenatal period that could be used to populate LiST. These indicators were calculated from 1) routine reported data, 2) a Multiple Indicator Cluster Survey (MICS), 3) paper-based antenatal records and 4) the eRegistry (an electronic health information system) for public clinics in the West Bank, Palestine for the most recent year available. We scaled coverage of each indicator to 90%, in public clinics only, and compared this to a no-change scenario for a seven-year period. Results Eight intervention coverage and health status indicators needed to populate the antenatal section of LiST could be calculated from both paper-based antenatal records and the eRegistry. Only two could be calculated from routine reports and three from a national survey. Maternal lives saved over seven years ranged from 5 to 39, with percent reduction in the maternal mortality ratio (MMR) ranging from 1 to 6%. Pre-eclampsia management accounted for 25 to 100% of these lives saved. Conclusions The choice of data source for antenatal indicators will affect policy-based decisions when used to populate LiST. Although all data sources have their purpose, clinical data collected directly in an electronic registry during antenatal contacts may provide the most reliable and complete data to populate currently unavailable but needed indicators around specific antenatal care interventions. Electronic supplementary material The online version of this article (10.1186/s12889-019-6427-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingrid K Friberg
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, P.O.Box 222 Skøyen, N-0213, Oslo, Norway.
| | - Mahima Venkateswaran
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, P.O.Box 222 Skøyen, N-0213, Oslo, Norway.,Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Buthaina Ghanem
- World Health Organization, Palestinian National Institute of Public Health, Al Bireh P.O.Box 4284, Ramallah, Palestinian Territory
| | - J Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, P.O.Box 222 Skøyen, N-0213, Oslo, Norway.,Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
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16
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Venkateswaran M, Mørkrid K, Abu Khader K, Awwad T, Friberg IK, Ghanem B, Hijaz T, Frøen JF. Comparing individual-level clinical data from antenatal records with routine health information systems indicators for antenatal care in the West Bank: A cross-sectional study. PLoS One 2018; 13:e0207813. [PMID: 30481201 PMCID: PMC6258527 DOI: 10.1371/journal.pone.0207813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/05/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In most low- and middle-income settings, national aggregate health data is the most consistently available source for policy-making and international comparisons. In the West Bank, the paper-based health information system with manual aggregations is transitioning to an individual-level data eRegistry for maternal and child health at the point-of-care. The aim of this study was to explore beforehand how routine health information systems indicators for antenatal care can change with the introduction of the eRegistry. METHODS Data were collected from clinical antenatal paper records of pregnancy enrollments for 2015 from 17 primary healthcare clinics, selected by probability sampling from five districts in the West Bank. We used the individual-level data from clinical records to generate routinely reported health systems indicators. We weighted the data to produce population-level estimates, and compared these indicators with aggregate routine health information systems reports. RESULTS Antenatal anemia screening at 36 weeks was 20% according to the clinical records data, compared to 52% in the routine reports. The clinical records data showed considerably higher incidences of key maternal conditions compared to the routine reports, including fundal height discrepancy (20% vs. 0.01%); Rh-negative blood group (6.8% vs. 1.4%); anemia with hemoglobin<9.5 g/dl (6% vs. 0.6%); and malpresentation at term (1.3% vs. 0.03%). Only about a sixth of cases with these conditions were referred according to guidelines to designated referral clinics. CONCLUSIONS Differences between indicators from the clinical records data and routine health information systems reports can be attributed to human error, inconsistent denominators, and complexities of data processes. Key health systems indicators were prone to underestimations since their registration was dependent on referral of pregnant women. With a transition to individual-level data, as in the eRegistry under implementation, the public health authorities will be able to generate reliable health systems indicators reflective of the population's health status.
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Affiliation(s)
- Mahima Venkateswaran
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Kjersti Mørkrid
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Khadija Abu Khader
- Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Tamara Awwad
- Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Ingrid K. Friberg
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Buthaina Ghanem
- Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | | | - J. Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
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17
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Norman JE, Heazell AEP, Rodriguez A, Weir CJ, Stock SJE, Calderwood CJ, Cunningham Burley S, Frøen JF, Geary M, Breathnach F, Hunter A, McAuliffe FM, Higgins MF, Murdoch E, Ross-Davie M, Scott J, Whyte S. Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a stepped wedge, cluster-randomised trial. Lancet 2018; 392:1629-1638. [PMID: 30269876 PMCID: PMC6215771 DOI: 10.1016/s0140-6736(18)31543-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/12/2018] [Accepted: 06/28/2018] [Indexed: 11/02/2022]
Abstract
BACKGROUND 2·6 million pregnancies were estimated to have ended in stillbirth in 2015. The aim of the AFFIRM study was to test the hypothesis that introduction of a reduced fetal movement (RFM), care package for pregnant women and clinicians that increased women's awareness of the need for prompt reporting of RFM and that standardised management, including timely delivery, would alter the incidence of stillbirth. METHODS This stepped wedge, cluster-randomised trial was done in the UK and Ireland. Participating maternity hospitals were grouped and randomised, using a computer-generated allocation scheme, to one of nine intervention implementation dates (at 3 month intervals). This date was concealed from clusters and the trial team until 3 months before the implementation date. Each participating hospital had three observation periods: a control period from Jan 1, 2014, until randomised date of intervention initiation; a washout period from the implementation date and for 2 months; and the intervention period from the end of the washout period until Dec 31, 2016. Treatment allocation was not concealed from participating women and caregivers. Data were derived from observational maternity data. The primary outcome was incidence of stillbirth. The primary analysis was done according to the intention-to-treat principle, with births analysed according to whether they took place during the control or intervention periods, irrespective of whether the intervention had been implemented as planned. This study is registered with www.ClinicalTrials.gov, number NCT01777022. FINDINGS 37 hospitals were enrolled in the study. Four hospitals declined participation, and 33 hospitals were randomly assigned to an intervention implementation date. Between Jan 1, 2014, and Dec, 31, 2016, data were collected from 409 175 pregnancies (157 692 deliveries during the control period, 23 623 deliveries in the washout period, and 227 860 deliveries in the intervention period). The incidence of stillbirth was 4·40 per 1000 births during the control period and 4·06 per 1000 births in the intervention period (adjusted odds ratio [aOR] 0·90, 95% CI 0·75-1·07; p=0·23). INTERPRETATION The RFM care package did not reduce the risk of stillbirths. The benefits of a policy that promotes awareness of RFM remains unproven. FUNDING Chief Scientist Office, Scottish Government (CZH/4/882), Tommy's Centre for Maternal and Fetal Health, Sands.
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Affiliation(s)
- Jane E Norman
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
| | - Alexander E P Heazell
- Tommy's Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Aryelly Rodriguez
- Centre for Population Health Sciences, Usher Institute of Population Health, Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Christopher J Weir
- Centre for Population Health Sciences, Usher Institute of Population Health, Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Sarah J E Stock
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Sarah Cunningham Burley
- Centre for Population Health Sciences, Usher Institute of Population Health, Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - J Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | - Alyson Hunter
- Centre for Fetal Medicine, Royal Maternity Hospital, Belfast, UK
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Mary F Higgins
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Edile Murdoch
- Department of Neonatology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | | | | | - Sonia Whyte
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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18
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Venkateswaran M, Mørkrid K, Ghanem B, Abbas E, Abuward I, Baniode M, Norheim OF, Frøen JF. eRegQual-an electronic health registry with interactive checklists and clinical decision support for improving quality of antenatal care: study protocol for a cluster randomized trial. Trials 2018; 19:54. [PMID: 29357912 PMCID: PMC5778657 DOI: 10.1186/s13063-017-2386-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Received: 05/15/2017] [Accepted: 12/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background Health worker compliance with established best-practice clinical and public health guidelines may be enhanced by customized checklists of care and clinical decision support driven by point-of-care data entry into an electronic health registry. The public health system of Palestine is currently implementing a national electronic registry (eRegistry) for maternal and child health. This trial is embedded in the national implementation and aims to assess the effectiveness of the eRegistry’s interactive checklists and clinical decision support, compared with the existing paper based records, on improving the quality of care for pregnant women. Methods This two-arm cluster randomized controlled trial is conducted in the West Bank, Palestine, and includes 120 clusters (primary healthcare clinics) with an average annual enrollment of 60 pregnancies. The intervention tool is the eRegistry’s interactive checklists and clinical decision support implemented within the District Health Information System 2 (DHIS2) Tracker software, developed and customized for the Palestinian context. The primary outcomes reflect the processes of essential interventions, namely timely and appropriate screening and management of: 1) anemia in pregnancy; 2) hypertension in pregnancy; 3) abnormal fetal growth; 4) and diabetes mellitus in pregnancy. The composite primary health outcome encompasses five conditions representing risk for the mother or baby that could have been detected or prevented by high-quality antenatal care: moderate or severe anemia at admission for labor; severe hypertension at admission for labor; malpresentation at delivery undetected during pregnancy; small for gestational age baby at delivery undetected during pregnancy; and large for gestational age baby at delivery. Primary analysis at the individual level taking the design effect of the clustering into account will be performed as intention-to-treat. Discussion This trial, embedded in the national implementation of the eRegistry in Palestine, allows the assessment of process and health outcomes in a large-scale pragmatic setting. Findings will inform the use of interactive checklists and clinical decision support driven by point-of-care data entry into an eRegistry as a health systems-strengthening approach. Trial registration ISRCTN trial registration number, ISRCTN18008445. Registered on 6 April 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2386-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mahima Venkateswaran
- Division for Health Services, Norwegian Institute of Public Health, PB 4404, Nydalen, N-0403, Oslo, Norway.,Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Kjersti Mørkrid
- Division for Health Services, Norwegian Institute of Public Health, PB 4404, Nydalen, N-0403, Oslo, Norway
| | - Buthaina Ghanem
- Palestinian National Institute of Public Health, World Health Organization, P.O. Box 4284, Al-Bireh, Palestine
| | - Eatimad Abbas
- Palestinian National Institute of Public Health, World Health Organization, P.O. Box 4284, Al-Bireh, Palestine
| | - Itimad Abuward
- Palestinian National Institute of Public Health, World Health Organization, P.O. Box 4284, Al-Bireh, Palestine
| | - Mohammad Baniode
- Palestinian National Institute of Public Health, World Health Organization, P.O. Box 4284, Al-Bireh, Palestine
| | - Ole Frithjof Norheim
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - J Frederik Frøen
- Division for Health Services, Norwegian Institute of Public Health, PB 4404, Nydalen, N-0403, Oslo, Norway. .,Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
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19
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Reinebrant HE, Leisher SH, Coory M, Henry S, Wojcieszek AM, Gardener G, Lourie R, Ellwood D, Teoh Z, Allanson E, Blencowe H, Draper ES, Erwich JJ, Frøen JF, Gardosi J, Gold K, Gordijn S, Gordon A, Heazell A, Khong TY, Korteweg F, Lawn JE, McClure EM, Oats J, Pattinson R, Pettersson K, Siassakos D, Silver RM, Smith G, Tunçalp Ö, Flenady V. Making stillbirths visible: a systematic review of globally reported causes of stillbirth. BJOG 2017; 125:212-224. [PMID: 29193794 DOI: 10.1111/1471-0528.14971] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Stillbirth is a global health problem. The World Health Organization (WHO) application of the International Classification of Diseases for perinatal mortality (ICD-PM) aims to improve data on stillbirth to enable prevention. OBJECTIVES To identify globally reported causes of stillbirth, classification systems, and alignment with the ICD-PM. SEARCH STRATEGY We searched CINAHL, EMBASE, Medline, Global Health, and Pubmed from 2009 to 2016. SELECTION CRITERIA Reports of stillbirth causes in unselective cohorts. DATA COLLECTION AND ANALYSIS Pooled estimates of causes were derived for country representative reports. Systems and causes were assessed for alignment with the ICD-PM. Data are presented by income setting (low, middle, and high income countries; LIC, MIC, HIC). MAIN RESULTS Eighty-five reports from 50 countries (489 089 stillbirths) were included. The most frequent categories were Unexplained, Antepartum haemorrhage, and Other (all settings); Infection and Hypoxic peripartum (LIC), and Placental (MIC, HIC). Overall report quality was low. Only one classification system fully aligned with ICD-PM. All stillbirth causes mapped to ICD-PM. In a subset from HIC, mapping obscured major causes. CONCLUSIONS There is a paucity of quality information on causes of stillbirth globally. Improving investigation of stillbirths and standardisation of audit and classification is urgently needed and should be achievable in all well-resourced settings. Implementation of the WHO Perinatal Mortality Audit and Review guide is needed, particularly across high burden settings. FUNDING HR, SH, SHL, and AW were supported by an NHMRC-CRE grant (APP1116640). VF was funded by an NHMRC-CDF (APP1123611). TWEETABLE ABSTRACT Urgent need to improve data on causes of stillbirths across all settings to meet global targets. PLAIN LANGUAGE SUMMARY Background and methods Nearly three million babies are stillborn every year. These deaths have deep and long-lasting effects on parents, healthcare providers, and the society. One of the major challenges to preventing stillbirths is the lack of information about why they happen. In this study, we collected reports on the causes of stillbirth from high-, middle-, and low-income countries to: (1) Understand the causes of stillbirth, and (2) Understand how to improve reporting of stillbirths. Findings We found 85 reports from 50 different countries. The information available from the reports was inconsistent and often of poor quality, so it was hard to get a clear picture about what are the causes of stillbirth across the world. Many different definitions of stillbirth were used. There was also wide variation in what investigations of the mother and baby were undertaken to identify the cause of stillbirth. Stillbirths in all income settings (low-, middle-, and high-income countries) were most frequently reported as Unexplained, Other, and Haemorrhage (bleeding). Unexplained and Other are not helpful in understanding why a baby was stillborn. In low-income countries, stillbirths were often attributed to Infection and Complications during labour and birth. In middle- and high-income countries, stillbirths were often reported as Placental complications. Limitations We may have missed some reports as searches were carried out in English only. The available reports were of poor quality. Implications Many countries, particularly those where the majority of stillbirths occur, do not report any information about these deaths. Where there are reports, the quality is often poor. It is important to improve the investigation and reporting of stillbirth using a standardised system so that policy makers and healthcare workers can develop effective stillbirth prevention programs. All stillbirths should be investigated and reported in line with the World Health Organization standards.
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Affiliation(s)
- H E Reinebrant
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - S H Leisher
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - M Coory
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - S Henry
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - A M Wojcieszek
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - G Gardener
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - R Lourie
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - D Ellwood
- Griffith University School of Medicine, Gold Coast, QLD, Australia.,Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Z Teoh
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,Department of Medicine-Pediatrics, University of Louisville, Louisville, KY, USA
| | - E Allanson
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.,School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, WA, Australia
| | - H Blencowe
- London School of Hygiene & Tropical Medicine, London, UK
| | - E S Draper
- MBRRACE-UK, Department of Health Sciences, University of Leicester Centre for Medicine, Leicester, UK
| | - J J Erwich
- International Stillbirth Alliance, Bristol, UK.,University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J F Frøen
- Norwegian Institute of Public Health, Oslo, Norway.,Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | | | - K Gold
- International Stillbirth Alliance, Bristol, UK.,Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - S Gordijn
- International Stillbirth Alliance, Bristol, UK.,University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A Gordon
- University of Sydney, Sydney, NSW, Australia
| | - Aep Heazell
- Division of Developmental Biomedicine, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - T Y Khong
- SA Pathology, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - F Korteweg
- Department of Obstetrics and Gynecology, Martini Hospital, Groningen, the Netherlands
| | - J E Lawn
- London School of Hygiene & Tropical Medicine, London, UK
| | - E M McClure
- International Stillbirth Alliance, Bristol, UK.,Department of Social, Statistical and Environmental Health Sciences, Research Triangle Institute, Research Triangle Park, NC, USA
| | - J Oats
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia.,Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM), Melbourne, Vic., Australia
| | - R Pattinson
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - K Pettersson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - D Siassakos
- International Stillbirth Alliance, Bristol, UK.,Obstetrics and Gynaecology, School of Social and Community Medicine, Southmead Hospital, University of Bristol, Bristol, UK
| | - R M Silver
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Gcs Smith
- Department of Obstetrics and Gynaecology, NIHR Cambridge Comprehensive Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Ö Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - V Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
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20
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Abstract
OBJECTIVES We sought to evaluate the impact of later menarche on the risk of operative delivery. POPULATION We studied 38,069 eligible women (first labors at term with a singleton infant in a cephalic presentation) from the Norwegian Mothers and Child Cohort Study. The main exposures were the age at menarche and the duration of the interval between menarche and the first birth. METHODS Poisson's regression with a robust variance estimator. MAIN OUTCOME MEASURES Operative delivery, defined as emergency cesarean or assisted vaginal delivery (ventouse extraction or forceps). RESULTS A 5 year increase in age at menarche was associated with a reduced risk of operative delivery (risk ratio [RR] 0.84, 95%CI 0.78, 0.89; p < .001). Adjustment for the age at first birth slightly strengthened the association (RR 0.79, 95%CI 0.74, 0.84; p < .001). However, the association was lost following adjustment for the menarche to birth interval (RR 0.99, 95%CI 0.93, 1.06; p = .81). A 5 years increase in menarche to birth interval was associated with an increased risk of operative delivery (RR 1.26, 95%CI 1.23, 1.28; p < .001). This was not materially affected by adjustment for an extensive series of maternal characteristics (RR 1.23, 95%CI 1.20, 1.25; p < .001). CONCLUSIONS Later menarche reduces the risk of an operative first birth through shortening the menarche to birth interval. This observation is consistent with the hypothesis that the pattern and/or duration of prepregnancy exposure of the uterus to estrogen and progesterone contributes to uterine aging.
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Affiliation(s)
- Hsu Phern Chong
- a Department of Obstetrics and Gynecology , University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre , Cambridge , UK
| | - J Frederik Frøen
- b Department of International Public Health , Norwegian Institute of Public Health , Nydalen , Norway
| | - Sylvia Richardson
- c MRC Biostatistics Unit , Cambridge Institute of Public Health , Cambridge , UK
| | - Benoit Liquet
- c MRC Biostatistics Unit , Cambridge Institute of Public Health , Cambridge , UK
| | - D Stephen Charnock-Jones
- a Department of Obstetrics and Gynecology , University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre , Cambridge , UK
| | - Gordon C S Smith
- a Department of Obstetrics and Gynecology , University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre , Cambridge , UK
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21
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Flenady V, Wojcieszek AM, Ellwood D, Leisher SH, Erwich JJHM, Draper ES, McClure EM, Reinebrant HE, Oats J, McCowan L, Kent AL, Gardener G, Gordon A, Tudehope D, Siassakos D, Storey C, Zuccollo J, Dahlstrom JE, Gold KJ, Gordijn S, Pettersson K, Masson V, Pattinson R, Gardosi J, Khong TY, Frøen JF, Silver RM. Classification of causes and associated conditions for stillbirths and neonatal deaths. Semin Fetal Neonatal Med 2017; 22:176-185. [PMID: 28285990 DOI: 10.1016/j.siny.2017.02.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 11/15/2022]
Abstract
Accurate and consistent classification of causes and associated conditions for perinatal deaths is essential to inform strategies to reduce the five million which occur globally each year. With the majority of deaths occurring in low- and middle-income countries (LMICs), their needs must be prioritised. The aim of this paper is to review the classification of perinatal death, the contemporary classification systems including the World Health Organization's International Classification of Diseases - Perinatal Mortality (ICD-PM), and next steps. During the period from 2009 to 2014, a total of 81 new or modified classification systems were identified with the majority developed in high-income countries (HICs). Structure, definitions and rules and therefore data on causes vary widely and implementation is suboptimal. Whereas system testing is limited, none appears ideal. Several systems result in a high proportion of unexplained stillbirths, prompting HICs to use more detailed systems that require data unavailable in low-income countries. Some systems appear to perform well across these different settings. ICD-PM addresses some shortcomings of ICD-10 for perinatal deaths, but important limitations remain, especially for stillbirths. A global approach to classification is needed and seems feasible. The new ICD-PM system is an important step forward and improvements will be enhanced by wide-scale use and evaluation. Implementation requires national-level support and dedicated resources. Future research should focus on implementation strategies and evaluation methods, defining placental pathologies, and ways to engage parents in the process.
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Affiliation(s)
| | - Vicki Flenady
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK.
| | - Aleena M Wojcieszek
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK
| | - David Ellwood
- International Stillbirth Alliance, Bristol, UK; School of Medicine, Griffith University & Gold Coast University Hospital, Gold Coast, Australia
| | - Susannah Hopkins Leisher
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK
| | - Jan Jaap H M Erwich
- International Stillbirth Alliance, Bristol, UK; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester Centre for Medicine, Leicester, UK
| | - Elizabeth M McClure
- International Stillbirth Alliance, Bristol, UK; Department of Maternal and Child Health, Research Triangle Institute, Research Triangle Park, NC, USA
| | - Hanna E Reinebrant
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Alison L Kent
- International Stillbirth Alliance, Bristol, UK; Australian National University Medical School, Canberra, Australia; Centenary Hospital for Women and Children, Canberra, Australia
| | - Glenn Gardener
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK; Mater Health Services, Brisbane, Australia
| | | | - David Tudehope
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Dimitrios Siassakos
- International Stillbirth Alliance, Bristol, UK; University of Bristol, School of Social and Community Medicine, Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
| | | | - Jane Zuccollo
- Auckland DHB LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Jane E Dahlstrom
- Australian National University Medical School, Canberra, Australia; Anatomical Pathology, ACT Pathology, The Canberra Hospital, Garran, Australia
| | - Katherine J Gold
- International Stillbirth Alliance, Bristol, UK; Department of Family Medicine and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Sanne Gordijn
- International Stillbirth Alliance, Bristol, UK; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Pettersson
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Robert Pattinson
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | | | - T Yee Khong
- SA Pathology, University of Adelaide, Adelaide, Australia
| | - J Frederik Frøen
- Norwegian Institute of Public Health, Oslo, Norway; Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Robert M Silver
- International Stillbirth Alliance, Bristol, UK; University of Utah Health Sciences Center, Salt Lake City, UT, USA
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Pay ASD, Frøen JF, Staff AC, Jacobsson B, Gjessing HK. Symfyse-fundus-mål – prediktiv verdi av ny referansekurve. Tidsskriftet 2017; 137:717-720. [DOI: 10.4045/tidsskr.16.1022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Frøen JF, Staines A, Vrijheid M, Casas M, Delnord M, Friberg IK, van Gent D, McQuinn S, Zeitlin J. Invisibility: The Health Information gaps affecting women, children and adolescents in Europe. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw168.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Leisher SH, Teoh Z, Reinebrant H, Allanson E, Blencowe H, Erwich JJ, Frøen JF, Gardosi J, Gordijn S, Gülmezoglu AM, Heazell AEP, Korteweg F, Lawn J, McClure EM, Pattinson R, Smith GCS, Tunçalp Ӧ, Wojcieszek AM, Flenady V. Seeking order amidst chaos: a systematic review of classification systems for causes of stillbirth and neonatal death, 2009-2014. BMC Pregnancy Childbirth 2016; 16:295. [PMID: 27716090 PMCID: PMC5053068 DOI: 10.1186/s12884-016-1071-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 09/07/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Each year, about 5.3 million babies die in the perinatal period. Understanding of causes of death is critical for prevention, yet there is no globally acceptable classification system. Instead, many disparate systems have been developed and used. We aimed to identify all systems used or created between 2009 and 2014, with their key features, including extent of alignment with the International Classification of Diseases (ICD) and variation in features by region, to inform the World Health Organization's development of a new global approach to classifying perinatal deaths. METHODS A systematic literature review (CINAHL, EMBASE, Medline, Global Health, and PubMed) identified published and unpublished studies and national reports describing new classification systems or modifications of existing systems for causes of perinatal death, or that used or tested such systems, between 2009 and 2014. Studies reporting ICD use only were excluded. Data were independently double-extracted (except from non-English publications). Subgroup analyses explored variation by extent and region. RESULTS Eighty-one systems were identified as new, modifications of existing systems, or having been used between 2009 and 2014, with an average of ten systems created/modified each year. Systems had widely varying characteristics: (i) comprehensiveness (40 systems classified both stillbirths and neonatal deaths); (ii) extent of use (systems were created in 28 countries and used in 40; 17 were created for national use; 27 were widely used); (iii) accessibility (three systems available in e-format); (iv) underlying cause of death (64 systems required a single cause of death); (v) reliability (10 systems tested for reliability, with overall Kappa scores ranging from .35-.93); and (vi) ICD alignment (17 systems used ICD codes). Regional databases were not searched, so system numbers may be underestimated. Some non-differential misclassification of systems was possible. CONCLUSIONS The plethora of systems in use, and continuing system development, hamper international efforts to improve understanding of causes of death. Recognition of the features of currently used systems, combined with a better understanding of the drivers of continued system creation, may help the development of a truly effective global system.
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Affiliation(s)
- Susannah Hopkins Leisher
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.
- International Stillbirth Alliance, Millburn, USA.
| | - Zheyi Teoh
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Hanna Reinebrant
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
- International Stillbirth Alliance, Millburn, USA
| | - Emma Allanson
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia
| | | | - Jan Jaap Erwich
- International Stillbirth Alliance, Millburn, USA
- The University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
- Center for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway
| | | | - Sanne Gordijn
- International Stillbirth Alliance, Millburn, USA
- The University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Metin Gülmezoglu
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Alexander E P Heazell
- International Stillbirth Alliance, Millburn, USA
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK
- St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Fleurisca Korteweg
- International Stillbirth Alliance, Millburn, USA
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, The Netherlands
| | - Joy Lawn
- London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth M McClure
- International Stillbirth Alliance, Millburn, USA
- Research Triangle Institute, North Carolina, USA
| | - Robert Pattinson
- South Africa Medical Research Council Maternal and Infant Health Care Strategies Unit, University of Pretoria, Pretoria, South Africa
| | - Gordon C S Smith
- NIHR Biomedical Research Centre & Department of Obstetrics & Gynaecology, Cambridge University, Cambridge, UK
| | - Ӧzge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Aleena M Wojcieszek
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
- International Stillbirth Alliance, Millburn, USA
| | - Vicki Flenady
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
- International Stillbirth Alliance, Millburn, USA
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Flenady V, Wojcieszek AM, Fjeldheim I, Friberg IK, Nankabirwa V, Jani JV, Myhre S, Middleton P, Crowther C, Ellwood D, Tudehope D, Pattinson R, Ho J, Matthews J, Bermudez Ortega A, Venkateswaran M, Chou D, Say L, Mehl G, Frøen JF. eRegistries: indicators for the WHO Essential Interventions for reproductive, maternal, newborn and child health. BMC Pregnancy Childbirth 2016; 16:293. [PMID: 27716088 PMCID: PMC5045645 DOI: 10.1186/s12884-016-1049-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 08/25/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Electronic health registries - eRegistries - can systematically collect relevant information at the point of care for reproductive, maternal, newborn and child health (RMNCH). However, a suite of process and outcome indicators is needed for RMNCH to monitor care and to ensure comparability between settings. Here we report on the assessment of current global indicators and the development of a suite of indicators for the WHO Essential Interventions for use at various levels of health care systems nationally and globally. METHODS Currently available indicators from both household and facility surveys were collated through publicly available global databases and respective survey instruments. We then developed a suite of potential indicators and associated data points for the 45 WHO Essential Interventions spanning preconception to newborn care. Four types of performance indicators were identified (where applicable): process (i.e. coverage) and outcome (i.e. impact) indicators for both screening and treatment/prevention. Indicators were evaluated by an international expert panel against the eRegistries indicator evaluation criteria and further refined based on feedback by the eRegistries technical team. RESULTS Of the 45 WHO Essential Interventions, only 16 were addressed in any of the household survey data available. A set of 216 potential indicators was developed. These indicators were generally evaluated favourably by the panel, but difficulties in data ascertainment, including for outcome measures of cause-specific morbidity and mortality, were frequently reported as barriers to the feasibility of indicators. Indicators were refined based on feedback, culminating in the final list of 193 total unique indicators: 93 for preconception and antenatal care; 53 for childbirth and postpartum care; and 47 for newborn and small and ill baby care. CONCLUSIONS Large gaps exist in the availability of information currently collected to support the implementation of the WHO Essential Interventions. The development of this suite of indicators can be used to support the implementation of eRegistries and other data platforms, to ensure that data are utilised to support evidence-based practice, facilitate measurement and accountability, and improve maternal and child health outcomes.
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Affiliation(s)
- Vicki Flenady
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.
- International Stillbirth Alliance, Bristol, UK.
| | - Aleena M Wojcieszek
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
- International Stillbirth Alliance, Bristol, UK
| | - Ingvild Fjeldheim
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ingrid K Friberg
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Victoria Nankabirwa
- Department of Epidemiology and Biostatics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International health, University of Bergen, Bergen, Norway
| | - Jagrati V Jani
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International health, University of Bergen, Bergen, Norway
| | - Sonja Myhre
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Philippa Middleton
- International Stillbirth Alliance, Bristol, UK
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Caroline Crowther
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - David Ellwood
- International Stillbirth Alliance, Bristol, UK
- Griffith University & Gold Coast University Hospital, Gold Coast, Australia
| | - David Tudehope
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Robert Pattinson
- Medical Research Council, University of Pretoria, Pretoria, South Africa
| | - Jacqueline Ho
- Penang Medical College and Penang Hospital, Penang, Malaysia
| | - Jiji Matthews
- Christian Medical College, Vellore, Tamil Nadu, India
| | - Aurora Bermudez Ortega
- The Australian Nurse Family Partnership Program National Program Centre, Abt Australia, Brisbane, Australia
| | - Mahima Venkateswaran
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International health, University of Bergen, Bergen, Norway
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Lale Say
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Garret Mehl
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - J Frederik Frøen
- International Stillbirth Alliance, Bristol, UK
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International health, University of Bergen, Bergen, Norway
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26
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Myhre SL, Kaye J, Bygrave LA, Aanestad M, Ghanem B, Mechael P, Frøen JF. eRegistries: governance for electronic maternal and child health registries. BMC Pregnancy Childbirth 2016; 16:279. [PMID: 27663979 PMCID: PMC5035445 DOI: 10.1186/s12884-016-1063-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 09/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The limited availability of maternal and child health data has limited progress in reducing mortality and morbidity among pregnant women and children. Global health agencies, leaders, and funders are prioritizing strategies that focus on acquiring high quality health data. Electronic maternal and child health registries (eRegistries) offer a systematic data collection and management approach that can serve as an entry point for preventive, curative and promotive health services. Due to the highly sensitive nature of reproductive health information, careful consideration must be accorded to privacy, access, and data security. In the third paper of the eRegistries Series, we report on the current landscape of ethical and legal governance for maternal and child health registries in developing countries. METHODS This research utilizes findings from two web-based surveys, completed in 2015 that targeted public health officials and health care providers in 76 countries with high global maternal and child mortality burden. A sample of 298 public health officials from 64 countries and 490 health care providers from 59 countries completed the online survey. Based on formative research in the development of the eRegistries Governance Guidance Toolkit, the surveys were designed to investigate topics related to maternal and child health registries including ethical and legal issues. RESULTS According to survey respondents, the prevailing legal landscape is characterized by inadequate data security safeguards and weak support for core privacy principles. Respondents from the majority of countries indicated that health information from medical records is typically protected by legislation although legislation dealing specifically or comprehensively with data privacy may not be in place. Health care provider trust in the privacy of health data at their own facilities is associated with the presence of security safeguards. CONCLUSION Addressing legal requirements and ensuring that privacy and data security of women's and children's health information is protected is an ethical responsibility that must not be ignored or postponed, particularly where the need is greatest. Not only are the potential harm and unintended consequences of inaction serious for individuals, but they could impact public trust in health registries leading to decreased participation and compromised data integrity.
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Affiliation(s)
- Sonja L. Myhre
- Department of International Public Health, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, N-0403 Oslo Norway
| | - Jane Kaye
- Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Rosemary Rue Building, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Lee A. Bygrave
- Department of Private Law, Faculty of Law, University of Oslo, Postboks 6706, St Olavs plass, 0130 Oslo, Norway
| | - Margunn Aanestad
- Department of Informatics, University of Oslo, Gaustadalléen 23 B, N-0373 Oslo, Norway
| | - Buthaina Ghanem
- Palestinian National Institute of Public Health, Qaddoura Street, Ministry of Health Building, 1st Floor, Postbox 54812, Ramallah, Palestine
| | - Patricia Mechael
- School of Advanced International Studies, Johns Hopkins University, 1717 Massachusetts Ave, NW, Washington, DC 20036 USA
- HealthEnabled, Unit D11, Westlake Square, Westlake Drive, Westlake, Cape Town, South Africa 7945
| | - J. Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, N-0403 Oslo Norway
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Postbox 78000, 5020 Bergen, Norway
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27
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Leisher SH, Teoh Z, Reinebrant H, Allanson E, Blencowe H, Erwich JJ, Frøen JF, Gardosi J, Gordijn S, Gülmezoglu AM, Heazell AEP, Korteweg F, Lawn J, McClure EM, Pattinson R, Smith GCS, Tunçalp Ӧ, Wojcieszek AM, Flenady V. Classification systems for causes of stillbirth and neonatal death, 2009-2014: an assessment of alignment with characteristics for an effective global system. BMC Pregnancy Childbirth 2016; 16:269. [PMID: 27634615 PMCID: PMC5025539 DOI: 10.1186/s12884-016-1040-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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] [Received: 10/02/2015] [Accepted: 08/11/2016] [Indexed: 11/10/2022] Open
Abstract
Background To reduce the burden of 5.3 million stillbirths and neonatal deaths annually, an understanding of causes of deaths is critical. A systematic review identified 81 systems for classification of causes of stillbirth (SB) and neonatal death (NND) between 2009 and 2014. The large number of systems hampers efforts to understand and prevent these deaths. This study aimed to assess the alignment of current classification systems with expert-identified characteristics for a globally effective classification system. Methods Eighty-one classification systems were assessed for alignment with 17 characteristics previously identified through expert consensus as necessary for an effective global system. Data were extracted independently by two authors. Systems were assessed against each characteristic and weighted and unweighted scores assigned to each. Subgroup analyses were undertaken by system use, setting, type of death included and type of characteristic. Results None of the 81 systems were aligned with more than 9 of the 17 characteristics; most (82 %) were aligned with four or fewer. On average, systems were aligned with 19 % of characteristics. The most aligned system (Frøen 2009-Codac) still had an unweighted score of only 9/17. Alignment with individual characteristics ranged from 0 to 49 %. Alignment was somewhat higher for widely used as compared to less used systems (22 % v 17 %), systems used only in high income countries as compared to only in low and middle income countries (20 % vs 16 %), and systems including both SB and NND (23 %) as compared to NND-only (15 %) and SB-only systems (13 %). Alignment was higher with characteristics assessing structure (23 %) than function (15 %). Conclusions There is an unmet need for a system exhibiting all the characteristics of a globally effective system as defined by experts in the use of systems, as none of the 81 contemporary classification systems assessed was highly aligned with these characteristics. A particular concern in terms of global effectiveness is the lack of alignment with “ease of use” among all systems, including even the most-aligned. A system which meets the needs of users would have the potential to become the first truly globally effective classification system. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1040-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susannah Hopkins Leisher
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia. .,International Stillbirth Alliance, Millburn, USA.
| | - Zheyi Teoh
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Hanna Reinebrant
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.,International Stillbirth Alliance, Millburn, USA
| | - Emma Allanson
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.,School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia
| | | | - Jan Jaap Erwich
- International Stillbirth Alliance, Millburn, USA.,University Medical Center Groningen, The University of Groningen, Groningen, The Netherlands
| | - J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.,Center for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway
| | | | - Sanne Gordijn
- International Stillbirth Alliance, Millburn, USA.,University Medical Center Groningen, The University of Groningen, Groningen, The Netherlands
| | - A Metin Gülmezoglu
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Alexander E P Heazell
- International Stillbirth Alliance, Millburn, USA.,Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK.,St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Fleurisca Korteweg
- International Stillbirth Alliance, Millburn, USA.,Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, The Netherlands
| | - Joy Lawn
- London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth M McClure
- International Stillbirth Alliance, Millburn, USA.,Research Triangle Institute, North Carolina, USA
| | - Robert Pattinson
- South Africa Medical Research Council Maternal and Infant Health Care Strategies Unit, University of Pretoria, Pretoria, South Africa
| | - Gordon C S Smith
- NIHR Biomedical Research Centre & Department of Obstetrics & Gynaecology, Cambridge University, Cambridge, UK
| | - Ӧzge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Aleena M Wojcieszek
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.,International Stillbirth Alliance, Millburn, USA
| | - Vicki Flenady
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.,International Stillbirth Alliance, Millburn, USA
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28
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Allanson ER, Tunçalp Ӧ, Gardosi J, Pattinson RC, Vogel JP, Erwich JJHM, Flenady VJ, Frøen JF, Neilson J, Quach A, Francis A, Chou D, Mathai M, Say L, Gülmezoglu AM. Giving a voice to millions: developing the WHO application of ICD-10 to deaths during the perinatal period: ICD-PM. BJOG 2016; 123:1896-1899. [DOI: 10.1111/1471-0528.14243] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 11/28/2022]
Affiliation(s)
- ER Allanson
- Faculty of Medicine, Dentistry and Health Sciences; School of Women's and Infants' Health; University of Western Australia; Crawley WA Australia
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research; Development and Research Training in Human Reproduction (HRP); World Health Organization; Geneva Switzerland
| | - Ӧ Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research; Development and Research Training in Human Reproduction (HRP); World Health Organization; Geneva Switzerland
| | | | - RC Pattinson
- Department of Obstetrics and Gynaecology; SAMRC Maternal and Infant Health Care Strategies unit; University of Pretoria; Pretoria South Africa
| | - JP Vogel
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research; Development and Research Training in Human Reproduction (HRP); World Health Organization; Geneva Switzerland
| | - JJHM Erwich
- Department of Obstetrics; University of Groningen; University Medical Centre Groningen; Groningen the Netherlands
| | - VJ Flenady
- Mater Research Institute; The University of Queensland (MRI-UQ); Brisbane Qld Australia
- International Stillbirth Alliance; Bristol UK
| | - JF Frøen
- Department of International Public Health; Norwegian Institute of Public Health; Oslo Norway
- Centre for Intervention Science for Maternal and Child Health; University of Bergen; Bergen Norway
| | - J Neilson
- Centre for Women's Health Research; University of Liverpool; Liverpool UK
| | - A Quach
- Pacific Northwest University of Health Sciences; Yakima WA USA
| | | | - D Chou
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research; Development and Research Training in Human Reproduction (HRP); World Health Organization; Geneva Switzerland
| | - M Mathai
- Maternal & Perinatal Health; Department of Maternal, Newborn Child & Adolescent Health; World Health Organization; Geneva Switzerland
| | - L Say
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research; Development and Research Training in Human Reproduction (HRP); World Health Organization; Geneva Switzerland
| | - AM Gülmezoglu
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research; Development and Research Training in Human Reproduction (HRP); World Health Organization; Geneva Switzerland
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29
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Allanson ER, Vogel JP, Tunçalp Ӧ, Gardosi J, Pattinson RC, Francis A, Erwich J, Flenady VJ, Frøen JF, Neilson J, Quach A, Chou D, Mathai M, Say L, Gülmezoglu AM. Application of ICD-PM to preterm-related neonatal deaths in South Africa and United Kingdom. BJOG 2016; 123:2029-2036. [PMID: 27527390 DOI: 10.1111/1471-0528.14245] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We explore preterm-related neonatal deaths using the WHO application of the International Classification of Disease (ICD-10) to deaths during the perinatal period: ICD-PM as an informative case study, where ICD-PM can improve data use to guide clinical practice and programmatic decision-making. DESIGN Retrospective application of ICD-PM. SETTING South Africa, and the UK. POPULATION Perinatal death databases. METHODS Descriptive analysis of neonatal deaths and maternal conditions present. MAIN OUTCOME MEASURES Causes of preterm neonatal mortality and associated maternal conditions. RESULTS We included 98 term and 173 preterm early neonatal deaths from South Africa, and 956 term and 3248 preterm neonatal deaths from the UK. In the South African data set, the main causes of death were respiratory/cardiovascular disorders (34.7%), low birthweight/prematurity (29.2%), and disorders of cerebral status (25.5%). Amongst preterm deaths, low birthweight/prematurity (43.9%) and respiratory/cardiovascular disorders (32.4%) were the leading causes. In the data set from the UK, the leading causes of death were low birthweight/prematurity (31.6%), congenital abnormalities (27.4%), and deaths of unspecified cause (26.1%). In the preterm deaths, the leading causes were low birthweight/prematurity (40.9%) and deaths of unspecified cause (29.6%). In South Africa, 61% of preterm deaths resulted from the maternal condition of preterm spontaneous labour. Among the preterm deaths in the data set from the UK, no maternal condition was present in 36%, followed by complications of placenta, cord, and membranes (23%), and other complications of labour and delivery (22%). CONCLUSIONS ICD-PM can be used to appraise the maternal and newborn conditions contributing to preterm deaths, and can inform practice. TWEETABLE ABSTRACT ICD-PM can be used to appraise maternal and newborn contributors to preterm deaths to improve quality of care.
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Affiliation(s)
- E R Allanson
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, WA, Australia. .,Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
| | - J P Vogel
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Ӧ Tunçalp
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - J Gardosi
- Perinatal Institute, Edgbaston, Birmingham, UK
| | - R C Pattinson
- SAMRC Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - A Francis
- Perinatal Institute, Edgbaston, Birmingham, UK
| | - Jjhm Erwich
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - V J Flenady
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - J F Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.,Centre for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway
| | - J Neilson
- Centre for Women's Health Research, University of Liverpool, Liverpool, UK
| | - A Quach
- Pacific Northwest University of Health Sciences, Yakima, WA, USA
| | - D Chou
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - M Mathai
- Maternal & Perinatal Health, Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
| | - L Say
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - A M Gülmezoglu
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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30
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Allanson ER, Tunçalp Ö, Gardosi J, Pattinson RC, Francis A, Vogel JP, Erwich J, Flenady VJ, Frøen JF, Neilson J, Quach A, Chou D, Mathai M, Say L, Gülmezoglu AM. The WHO application of ICD-10 to deaths during the perinatal period (ICD-PM): results from pilot database testing in South Africa and United Kingdom. BJOG 2016; 123:2019-2028. [PMID: 27527122 DOI: 10.1111/1471-0528.14244] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To apply the World Health Organization (WHO) Application of the International Classification of Diseases, tenth revision (ICD-10) to deaths during the perinatal period: ICD-Perinatal Mortality (ICD-PM) to existing perinatal death databases. DESIGN Retrospective application of ICD-PM. SETTING South Africa, UK. POPULATION Perinatal death databases. METHODS Deaths were grouped according to timing of death and then by the ICD-PM cause of death. The main maternal condition at the time of perinatal death was assigned to each case. MAIN OUTCOME MEASURES Causes of perinatal mortality, associated maternal conditions. RESULTS In South Africa 344/689 (50%) deaths occurred antepartum, 11% (n = 74) intrapartum and 39% (n = 271) in the early neonatal period. In the UK 4377/9067 (48.3%) deaths occurred antepartum, with 457 (5%) intrapartum and 4233 (46.7%) in the neonatal period. Antepartum deaths were due to unspecified causes (59%), chromosomal abnormalities (21%) or problems related to fetal growth (14%). Intrapartum deaths followed acute intrapartum events (69%); neonatal deaths followed consequences of low birthweight/ prematurity (31%), chromosomal abnormalities (26%), or unspecified causes in healthy mothers (25%). Mothers were often healthy; 53%, 38% and 45% in the antepartum, intrapartum and neonatal death groups, respectively. Where there was a maternal condition, it was most often maternal medical conditions, and complications of placenta, cord and membranes. CONCLUSIONS The ICD-PM can be a globally applicable perinatal death classification system that emphasises the need for a focus on the mother-baby dyad as we move beyond 2015. TWEETABLE ABSTRACT ICD-PM is a global system that classifies perinatal deaths and links them to maternal conditions.
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Affiliation(s)
- E R Allanson
- Faculty of Medicine, Dentistry and Health Sciences, School of Women's and Infants' Health, University of Western Australia, Crawley, Western Australia, Australia. , .,Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland. ,
| | - Ö Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | | | - R C Pattinson
- SAMRC Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | | | - J P Vogel
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Jjhm Erwich
- Department of Obstetrics, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - V J Flenady
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Queensland, Australia.,International Stillbirth Alliance, Bristol, UK
| | - J F Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - J Neilson
- Centre for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway.,Centre for Women's Health Research, University of Liverpool, Liverpool, UK
| | - A Quach
- Pacific Northwest University of Health Sciences, Yakima, Washington, USA
| | - D Chou
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - M Mathai
- Maternal & Perinatal Health, Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
| | - L Say
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - A M Gülmezoglu
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Allanson ER, Tunçalp Ӧ, Gardosi J, Pattinson RC, Francis A, Vogel JP, Erwich J, Flenady VJ, Frøen JF, Neilson J, Quach A, Chou D, Mathai M, Say L, Gülmezoglu AM. Optimising the International Classification of Diseases to identify the maternal condition in the case of perinatal death. BJOG 2016; 123:2037-2046. [PMID: 27527550 DOI: 10.1111/1471-0528.14246] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The WHO application of the tenth edition of the International Classification of Diseases (ICD-10) to deaths during the perinatal period (ICD Perinatal Mortality, ICD-PM) captures the essential characteristics of the mother-baby dyad that contribute to perinatal deaths. We compare the capture of maternal conditions in the existing ICD-PM with the maternal codes from the WHO application of ICD-10 to deaths during pregnancy, childbirth, and the puerperium (ICD Maternal Mortality, ICD-MM) to explore potential benefits in the quality of data received. DESIGN Retrospective application of ICD-PM. SETTING South Africa and the UK. POPULATION Perinatal death databases. METHODS The maternal conditions were classified using the ICD-PM groupings for maternal condition in perinatal death, and then mapped to the ICD-MM groupings of maternal conditions. MAIN OUTCOME MEASURES Main maternal conditions in perinatal deaths. RESULTS We reviewed 9661 perinatal deaths. The largest group (4766 cases, 49.3%) in both classifications captures deaths where there was no contributing maternal condition. Each of the other ICD-PM groups map to between three and six ICD-MM groups. If the cases in each ICD-PM group are re-coded using ICD-MM, each group becomes multiple, more specific groups. For example, the 712 cases in group M4 in ICD-PM become 14 different and more specific main disease categories when the ICD-MM is applied instead. CONCLUSIONS As we move towards ICD-11, the use of the more specific, applicable, and relevant codes outlined in ICD-MM for both maternal deaths and the maternal condition at the time of a perinatal death would be preferable, and would provide important additional information about perinatal deaths. TWEETABLE ABSTRACT Improving the capture of maternal conditions in perinatal deaths provides important actionable information.
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Affiliation(s)
- E R Allanson
- Faculty of Medicine, Dentistry, and Health Sciences, School of Women's and Infants' Health, University of Western Australia, Crawley, WA, Australia. .,Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
| | - Ӧ Tunçalp
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - J Gardosi
- Perinatal Institute, Edgbaston, Birmingham, UK
| | - R C Pattinson
- SAMRC Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - A Francis
- Perinatal Institute, Edgbaston, Birmingham, UK
| | - J P Vogel
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Jjhm Erwich
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - V J Flenady
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, QLD, Australia.,International Stillbirth Alliance, Bristol, UK
| | - J F Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.,Centre for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway
| | - J Neilson
- Centre for Women's Health Research, University of Liverpool, Liverpool, UK
| | - A Quach
- Pacific Northwest University of Health Sciences, Yakima, WA, USA
| | - D Chou
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - M Mathai
- Maternal & Perinatal Health, Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
| | - L Say
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - A M Gülmezoglu
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Wojcieszek AM, Reinebrant HE, Leisher SH, Allanson E, Coory M, Erwich JJ, Frøen JF, Gardosi J, Gordijn S, Gulmezoglu M, Heazell AEP, Korteweg FJ, McClure E, Pattinson R, Silver RM, Smith G, Teoh Z, Tunçalp Ö, Flenady V. Characteristics of a global classification system for perinatal deaths: a Delphi consensus study. BMC Pregnancy Childbirth 2016; 16:223. [PMID: 27527704 PMCID: PMC4986199 DOI: 10.1186/s12884-016-0993-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 06/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the global burden of perinatal deaths, there is currently no single, globally-acceptable classification system for perinatal deaths. Instead, multiple, disparate systems are in use world-wide. This inconsistency hinders accurate estimates of causes of death and impedes effective prevention strategies. The World Health Organisation (WHO) is developing a globally-acceptable classification approach for perinatal deaths. To inform this work, we sought to establish a consensus on the important characteristics of such a system. METHODS A group of international experts in the classification of perinatal deaths were identified and invited to join an expert panel to develop a list of important characteristics of a quality global classification system for perinatal death. A Delphi consensus methodology was used to reach agreement. Three rounds of consultation were undertaken using a purpose built on-line survey. Round one sought suggested characteristics for subsequent scoring and selection in rounds two and three. RESULTS The panel of experts agreed on a total of 17 important characteristics for a globally-acceptable perinatal death classification system. Of these, 10 relate to the structural design of the system and 7 relate to the functional aspects and use of the system. CONCLUSION This study serves as formative work towards the development of a globally-acceptable approach for the classification of the causes of perinatal deaths. The list of functional and structural characteristics identified should be taken into consideration when designing and developing such a system.
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Affiliation(s)
- Aleena M Wojcieszek
- Mater Research Institute - The University of Queensland (MRI-UQ), Brisbane, Australia
- International Stillbirth Alliance, Bristol, UK
| | - Hanna E Reinebrant
- Mater Research Institute - The University of Queensland (MRI-UQ), Brisbane, Australia
- International Stillbirth Alliance, Bristol, UK
| | - Susannah Hopkins Leisher
- Mater Research Institute - The University of Queensland (MRI-UQ), Brisbane, Australia
- International Stillbirth Alliance, Bristol, UK
| | - Emma Allanson
- School of Women and Infants Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Michael Coory
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Jan Jaap Erwich
- International Stillbirth Alliance, Bristol, UK
- The University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Sanne Gordijn
- International Stillbirth Alliance, Bristol, UK
- The University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Metin Gulmezoglu
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Alexander E P Heazell
- International Stillbirth Alliance, Bristol, UK
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK & St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Fleurisca J Korteweg
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, The Netherlands
| | - Elizabeth McClure
- International Stillbirth Alliance, Bristol, UK
- Research Triangle Institute, Research Triangle Park, NC, USA
| | - Robert Pattinson
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Robert M Silver
- International Stillbirth Alliance, Bristol, UK
- University of Utah Health Sciences Center, Salt Lake City, USA
| | - Gordon Smith
- National Institute for Health Research, Biomedical Research Centre & Department of Obstetrics & Gynaecology, Cambridge University, Cambridge, UK
| | - Zheyi Teoh
- Mater Research Institute - The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Özge Tunçalp
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Vicki Flenady
- Mater Research Institute - The University of Queensland (MRI-UQ), Brisbane, Australia.
- International Stillbirth Alliance, Bristol, UK.
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Flenady V, Wojcieszek AM, Middleton P, Ellwood D, Erwich JJ, Coory M, Khong TY, Silver RM, Smith GCS, Boyle FM, Lawn JE, Blencowe H, Leisher SH, Gross MM, Horey D, Farrales L, Bloomfield F, McCowan L, Brown SJ, Joseph KS, Zeitlin J, Reinebrant HE, Cacciatore J, Ravaldi C, Vannacci A, Cassidy J, Cassidy P, Farquhar C, Wallace E, Siassakos D, Heazell AEP, Storey C, Sadler L, Petersen S, Frøen JF, Goldenberg RL. Stillbirths: recall to action in high-income countries. Lancet 2016; 387:691-702. [PMID: 26794070 DOI: 10.1016/s0140-6736(15)01020-x] [Citation(s) in RCA: 378] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Variation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19,439 late gestation (28 weeks or more) stillbirths could have been avoided in 2015. The proportion of unexplained stillbirths is high and can be addressed through improvements in data collection, investigation, and classification, and with a better understanding of causal pathways. Substandard care contributes to 20-30% of all stillbirths and the contribution is even higher for late gestation intrapartum stillbirths. National perinatal mortality audit programmes need to be implemented in all high-income countries. The need to reduce stigma and fatalism related to stillbirth and to improve bereavement care are also clear, persisting priorities for action. In high-income countries, a woman living under adverse socioeconomic circumstances has twice the risk of having a stillborn child when compared to her more advantaged counterparts. Programmes at community and country level need to improve health in disadvantaged families to address these inequities.
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Affiliation(s)
- Vicki Flenady
- Mater Research Institute, University of Queensland, Brisbane, QLD Australia; International Stillbirth Alliance, NJ, USA.
| | - Aleena M Wojcieszek
- Mater Research Institute, University of Queensland, Brisbane, QLD Australia; International Stillbirth Alliance, NJ, USA
| | - Philippa Middleton
- International Stillbirth Alliance, NJ, USA; Women's & Children's Health Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - David Ellwood
- International Stillbirth Alliance, NJ, USA; Griffith University and Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Jan Jaap Erwich
- International Stillbirth Alliance, NJ, USA; University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Michael Coory
- International Stillbirth Alliance, NJ, USA; Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - T Yee Khong
- International Stillbirth Alliance, NJ, USA; SA Pathology, University of Adelaide, Adelaide, SA, Australia
| | - Robert M Silver
- International Stillbirth Alliance, NJ, USA; University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Gordon C S Smith
- National Institute for Health Research, Biomedical Research Centre and Cambridge University, Cambridge, UK
| | - Frances M Boyle
- School of Public Health, University of Queensland, Brisbane, QLD Australia; International Stillbirth Alliance, NJ, USA
| | - Joy E Lawn
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Susannah Hopkins Leisher
- Mater Research Institute, University of Queensland, Brisbane, QLD Australia; International Stillbirth Alliance, NJ, USA
| | - Mechthild M Gross
- Hannover Medical School, Hannover, Germany; Zurich University of Applied Sciences, Institute for Midwifery, Winterthur, Switzerland
| | - Dell Horey
- Mater Research Institute, University of Queensland, Brisbane, QLD Australia; La Trobe University, Melbourne, VIC, Australia
| | - Lynn Farrales
- International Stillbirth Alliance, NJ, USA; Still Life Canada: Stillbirth and Neonatal Death Education, Research and Support Society, Vancouver, Canada; University of British Columbia, Vancouver, Canada
| | | | - Lesley McCowan
- International Stillbirth Alliance, NJ, USA; Liggins Institute, Auckland, New Zealand
| | - Stephanie J Brown
- Murdoch Childrens Research Institute and General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, VIC, Australia
| | - K S Joseph
- University of British Columbia, Vancouver, Canada
| | - Jennifer Zeitlin
- Institut National de la Santé et de la Recherche Médicale, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France
| | - Hanna E Reinebrant
- Mater Research Institute, University of Queensland, Brisbane, QLD Australia; International Stillbirth Alliance, NJ, USA
| | | | - Claudia Ravaldi
- International Stillbirth Alliance, NJ, USA; CiaoLapo Onlus, Charity for High-Risk Pregnancies and Perinatal Grief Support, Prato, Italy
| | - Alfredo Vannacci
- International Stillbirth Alliance, NJ, USA; CiaoLapo Onlus, Charity for High-Risk Pregnancies and Perinatal Grief Support, Prato, Italy; Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Jillian Cassidy
- International Stillbirth Alliance, NJ, USA; Umamanita, Girona, Spain
| | - Paul Cassidy
- International Stillbirth Alliance, NJ, USA; Umamanita, Girona, Spain
| | | | - Euan Wallace
- International Stillbirth Alliance, NJ, USA; Monash University, Melbourne, VIC, Australia
| | - Dimitrios Siassakos
- International Stillbirth Alliance, NJ, USA; University of Bristol, Bristol, UK; Southmead Hospital, Bristol, UK
| | - Alexander E P Heazell
- International Stillbirth Alliance, NJ, USA; Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; St Mary's Hospital, Central Manchester University Hospitals, NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Lynn Sadler
- University of Auckland, Auckland, New Zealand
| | - Scott Petersen
- Mater Research Institute, University of Queensland, Brisbane, QLD Australia; Mater Health Services, Brisbane, QLD, Australia
| | - J Frederik Frøen
- Mater Research Institute, University of Queensland, Brisbane, QLD Australia; Griffith University and Gold Coast University Hospital, Gold Coast, QLD, Australia; Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway; Center for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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Frøen JF, Friberg IK, Lawn JE, Bhutta ZA, Pattinson RC, Allanson ER, Flenady V, McClure EM, Franco L, Goldenberg RL, Kinney MV, Leisher SH, Pitt C, Islam M, Khera A, Dhaliwal L, Aggarwal N, Raina N, Temmerman M. Stillbirths: progress and unfinished business. Lancet 2016; 387:574-586. [PMID: 26794077 DOI: 10.1016/s0140-6736(15)00818-1] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This first paper of the Lancet Series on ending preventable stillbirths reviews progress in essential areas, identified in the 2011 call to action for stillbirth prevention, to inform the integrated post-2015 agenda for maternal and newborn health. Worldwide attention to babies who die in stillbirth is rapidly increasing, from integration within the new Global Strategy for Women's, Children's and Adolescents' Health, to country policies inspired by the Every Newborn Action Plan. Supportive new guidance and metrics including stillbirth as a core health indicator and measure of quality of care are emerging. Prenatal health is a crucial biological foundation to life-long health. A key priority is to integrate action for prenatal health within the continuum of care for maternal and newborn health. Still, specific actions for stillbirths are needed for advocacy, policy formulation, monitoring, and research, including improvement in the dearth of data for effective coverage of proven interventions for prenatal survival. Strong leadership is needed worldwide and in countries. Institutions with a mandate to lead global efforts for mothers and their babies must assert their leadership to reduce stillbirths by promoting healthy and safe pregnancies.
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Affiliation(s)
- J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway; Center for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway.
| | - Ingrid K Friberg
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Zulfiqar A Bhutta
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Robert C Pattinson
- South African Medical Research Council, Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Emma R Allanson
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, Australia; UNDP/UN Population fund/UNICEF/WHO/World Bank Special Programme of Research, WHO, Geneva, Switzerland
| | - Vicki Flenady
- Mater Research Institute, University of Queensland, Brisbane, Australia; International Stillbirth Alliance, Millburn, NJ, USA
| | | | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Mary V Kinney
- Save the Children, Saving Newborn Lives, Edgemead, South Africa
| | - Susannah Hopkins Leisher
- Mater Research Institute, University of Queensland, Brisbane, Australia; International Stillbirth Alliance, Millburn, NJ, USA
| | - Catherine Pitt
- Department of Global Healthand Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ajay Khera
- Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Lakhbir Dhaliwal
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Aggarwal
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neena Raina
- Department of Child and Adolescent Health, WHO Regional Office for South-East Asia, Delhi, India
| | - Marleen Temmerman
- Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
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Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, Flenady V, Frøen JF, Qureshi ZU, Calderwood C, Shiekh S, Jassir FB, You D, McClure EM, Mathai M, Cousens S. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet 2016; 387:587-603. [PMID: 26794078 DOI: 10.1016/s0140-6736(15)00837-5] [Citation(s) in RCA: 945] [Impact Index Per Article: 118.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An estimated 2.6 million third trimester stillbirths occurred in 2015 (uncertainty range 2.4-3.0 million). The number of stillbirths has reduced more slowly than has maternal mortality or mortality in children younger than 5 years, which were explicitly targeted in the Millennium Development Goals. The Every Newborn Action Plan has the target of 12 or fewer stillbirths per 1000 births in every country by 2030. 94 mainly high-income countries and upper middle-income countries have already met this target, although with noticeable disparities. At least 56 countries, particularly in Africa and in areas affected by conflict, will have to more than double present progress to reach this target. Most (98%) stillbirths are in low-income and middle-income countries. Improved care at birth is essential to prevent 1.3 million (uncertainty range 1.2-1.6 million) intrapartum stillbirths, end preventable maternal and neonatal deaths, and improve child development. Estimates for stillbirth causation are impeded by various classification systems, but for 18 countries with reliable data, congenital abnormalities account for a median of only 7.4% of stillbirths. Many disorders associated with stillbirths are potentially modifiable and often coexist, such as maternal infections (population attributable fraction: malaria 8.0% and syphilis 7.7%), non-communicable diseases, nutrition and lifestyle factors (each about 10%), and maternal age older than 35 years (6.7%). Prolonged pregnancies contribute to 14.0% of stillbirths. Causal pathways for stillbirth frequently involve impaired placental function, either with fetal growth restriction or preterm labour, or both. Two-thirds of newborns have their births registered. However, less than 5% of neonatal deaths and even fewer stillbirths have death registration. Records and registrations of all births, stillbirths, neonatal, and maternal deaths in a health facility would substantially increase data availability. Improved data alone will not save lives but provide a way to target interventions to reach more than 7000 women every day worldwide who experience the reality of stillbirth.
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Affiliation(s)
- Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK; Saving Newborn Lives, Save the Children, Washington, DC, USA.
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK; Saving Newborn Lives, Save the Children, Washington, DC, USA
| | - Peter Waiswa
- Maternal and Newborn Centre of Excellence, Makerere University and INDEPTH Maternal Newborn Working Group, School of Public Health, Kampala, Uganda
| | - Agbessi Amouzou
- Division of Data, Research, and Policy, United Nations Children's Fund, New York, NY, USA
| | - Colin Mathers
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Dan Hogan
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | | | - J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway; Center for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Zeshan U Qureshi
- Institute of Global Health, University College London, London, UK
| | - Claire Calderwood
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Suhail Shiekh
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiorella Bianchi Jassir
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Danzhen You
- Division of Data, Research, and Policy, United Nations Children's Fund, New York, NY, USA
| | | | - Matthews Mathai
- Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Simon Cousens
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK
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Allanson E, Tunçalp Ö, Gardosi J, Pattinson RC, Erwich JJHM, Flenady VJ, Frøen JF, Neilson J, Chou D, Mathai M, Say L, Gülmezoglu M. Classifying the causes of perinatal death. Bull World Health Organ 2016; 94:79-79A. [PMID: 26908954 PMCID: PMC4750440 DOI: 10.2471/blt.15.168047] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Emma Allanson
- Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, Geneva 27, Switzerland
| | - Özge Tunçalp
- Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, Geneva 27, Switzerland
| | | | - Robert C Pattinson
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Jan Jaap HM Erwich
- Department of Obstetrics, University Medical Center Groningen, Groningen, Netherlands
| | - Vicki J Flenady
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - James Neilson
- Centre for Women’s Health Research, University of Liverpool, Liverpool, England
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, Geneva 27, Switzerland
| | - Matthews Mathai
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Lale Say
- Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, Geneva 27, Switzerland
| | - Metin Gülmezoglu
- Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, Geneva 27, Switzerland
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Frøen JF, Myhre SL, Frost MJ, Chou D, Mehl G, Say L, Cheng S, Fjeldheim I, Friberg IK, French S, Jani JV, Kaye J, Lewis J, Lunde A, Mørkrid K, Nankabirwa V, Nyanchoka L, Stone H, Venkateswaran M, Wojcieszek AM, Temmerman M, Flenady VJ. eRegistries: Electronic registries for maternal and child health. BMC Pregnancy Childbirth 2016; 16:11. [PMID: 26791790 PMCID: PMC4721069 DOI: 10.1186/s12884-016-0801-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/07/2016] [Indexed: 02/07/2023] Open
Abstract
Background The Global Roadmap for Health Measurement and Accountability sees integrated systems for health information as key to obtaining seamless, sustainable, and secure information exchanges at all levels of health systems. The Global Strategy for Women’s, Children’s and Adolescent’s Health aims to achieve a continuum of quality of care with effective coverage of interventions. The WHO and World Bank recommend that countries focus on intervention coverage to monitor programs and progress for universal health coverage. Electronic health registries - eRegistries - represent integrated systems that secure a triple return on investments: First, effective single data collection for health workers to seamlessly follow individuals along the continuum of care and across disconnected cadres of care providers. Second, real-time public health surveillance and monitoring of intervention coverage, and third, feedback of information to individuals, care providers and the public for transparent accountability. This series on eRegistries presents frameworks and tools to facilitate the development and secure operation of eRegistries for maternal and child health. Methods In this first paper of the eRegistries Series we have used WHO frameworks and taxonomy to map how eRegistries can support commonly used electronic and mobile applications to alleviate health systems constraints in maternal and child health. A web-based survey of public health officials in 64 low- and middle-income countries, and a systematic search of literature from 2005–2015, aimed to assess country capacities by the current status, quality and use of data in reproductive health registries. Results eRegistries can offer support for the 12 most commonly used electronic and mobile applications for health. Countries are implementing health registries in various forms, the majority in transition from paper-based data collection to electronic systems, but very few have eRegistries that can act as an integrating backbone for health information. More mature country capacity reflected by published health registry based research is emerging in settings reaching regional or national scale, increasingly with electronic solutions. 66 scientific publications were identified based on 32 registry systems in 23 countries over a period of 10 years; this reflects a challenging experience and capacity gap for delivering sustainable high quality registries. Conclusions Registries are being developed and used in many high burden countries, but their potential benefits are far from realized as few countries have fully transitioned from paper-based health information to integrated electronic backbone systems. Free tools and frameworks exist to facilitate progress in health information for women and children. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0801-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway. .,Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
| | - Sonja L Myhre
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Michael J Frost
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway. .,John Snow, Inc., Boston, MA, USA.
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Garrett Mehl
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Lale Say
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Socheat Cheng
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Ingvild Fjeldheim
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Ingrid K Friberg
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Steve French
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Jagrati V Jani
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway. .,Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
| | - Jane Kaye
- HeLEX - Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - John Lewis
- Health Information System Programme (HISP) Vietnam, Ho Chí Minh, Vietnam. .,Department of Informatics, University of Oslo, Oslo, Norway.
| | - Ane Lunde
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Kjersti Mørkrid
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Victoria Nankabirwa
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway. .,Department of Epidemiology and Biostatics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Linda Nyanchoka
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Hollie Stone
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Mahima Venkateswaran
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway. .,Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
| | - Aleena M Wojcieszek
- Mater Research Institute, The University of Queensland, Brisbane, Australia. .,International Stillbirth Alliance, Millburn, NJ, USA.
| | | | - Vicki J Flenady
- Mater Research Institute, The University of Queensland, Brisbane, Australia. .,International Stillbirth Alliance, Millburn, NJ, USA.
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Pay A, Frøen JF, Staff AC, Jacobsson B, Gjessing HK. Prediction of small-for-gestational-age status by symphysis-fundus height: a registry-based population cohort study. BJOG 2015; 123:1167-73. [PMID: 26644370 DOI: 10.1111/1471-0528.13727] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop a chart for risk of small-for-gestational-age (SGA) at birth depending on deviations in symphysis-fundus (SF) height values for gestational age during pregnancy weeks 24-42. DESIGN Registry-based population cohort study. SETTING Antenatal clinics, Västra Götaland County, Sweden, 2005-2010. POPULATION The study included 42 018 women with ultrasound-dated singleton pregnancies who delivered at Sahlgrenska University Hospital. Data (including 282 713 SF height measurements) were extracted from the hospital's computerised obstetric database. METHODS Linear and binary regression analyses were used to derive prediction models with deviations in birthweight (BW) and SF height by gestational age as dependent and independent variables, respectively. Receiver operating characteristic curves were generated to evaluate the predictive value of the model in detecting SGA. MAIN OUTCOME MEASURES Birthweight and small-for-gestational-age. RESULTS Symphysis-fundus height accounted for 3% of individual BW variance at 24 weeks, increasing gradually to 20% at 40 weeks. Maternal factors explained an additional 10 percentage points of BW variance. Receiver operating characteristic curves confirmed that SF height was a stronger SGA predictor in late than in early pregnancy. Using an SGA relative risk cut-off limit of ≥2-fold, the overall sensitivity was 50% and the overall specificity 80%. Only the most recent SF measurement was useful in predicting BW deviation; previous measurements added nothing to the predictive value. CONCLUSIONS The ability of SF measurements to detect SGA status at birth increases with gestational age. Only the most recent SF measurement has predictive value; a static or falling pattern of SF values did not increase SGA likelihood. TWEETABLE ABSTRACT New SF curves predict SGA best in late pregnancy; only the most recent SF measurement has predictive value.
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Affiliation(s)
- Asd Pay
- Departments of Obstetrics and Gynaecology, Women's and Children's Division, Oslo University Hospital, Oslo, Norway.,Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - J F Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - A C Staff
- Departments of Obstetrics and Gynaecology, Women's and Children's Division, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - B Jacobsson
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway
| | - H K Gjessing
- Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Winje BA, Wojcieszek AM, Gonzalez-Angulo LY, Teoh Z, Norman J, Frøen JF, Flenady V. Interventions to enhance maternal awareness of decreased fetal movement: a systematic review. BJOG 2015; 123:886-98. [DOI: 10.1111/1471-0528.13802] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2015] [Indexed: 11/28/2022]
Affiliation(s)
- BA Winje
- Division of Infectious Disease Control; Norwegian Institute of Public Health; Oslo Norway
| | - AM Wojcieszek
- Mater Research Institute; The University of Queensland; Brisbane Qld Australia
| | - LY Gonzalez-Angulo
- Division of Infectious Disease Control; Norwegian Institute of Public Health; Oslo Norway
| | - Z Teoh
- Mater Research Institute; The University of Queensland; Brisbane Qld Australia
| | - J Norman
- Tommy's Centre for Maternal and Fetal Health; Queen's Medical Research Institute; University of Edinburgh MRC Centre for Reproductive Health; Edinburgh Scotland
| | - JF Frøen
- Department of International Public Health; Norwegian Institute of Public Health; Oslo Norway
| | - V Flenady
- Mater Research Institute; The University of Queensland; Brisbane Qld Australia
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40
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Affiliation(s)
- J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, N-0403 Oslo, Norway.
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Winje BA, Røislien J, Saastad E, Eide J, Riley CF, Stray-Pedersen B, Frøen JF. Wavelet principal component analysis of fetal movement counting data preceding hospital examinations due to decreased fetal movement: a prospective cohort study. BMC Pregnancy Childbirth 2013; 13:172. [PMID: 24007565 PMCID: PMC3844562 DOI: 10.1186/1471-2393-13-172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 08/29/2013] [Indexed: 11/23/2022] Open
Abstract
Background Fetal movement (FM) counting is a simple and widely used method of assessing fetal well-being. However, little is known about what women perceive as decreased fetal movement (DFM) and how maternally perceived DFM is reflected in FM charts. Methods We analyzed FM counting data from 148 DFM events occurring in 137 pregnancies. The women counted FM daily from pregnancy week 24 until birth using a modified count-to-ten procedure. Common temporal patterns for the two weeks preceding hospital examination due to DFM were extracted from the FM charts using wavelet principal component analysis; a statistical methodology particularly developed for modeling temporal data with sudden changes, i.e. spikes that are frequently found in FM data. The association of the extracted temporal patterns with fetal complications was assessed by including the individuals’ scores on the wavelet principal components as explanatory variables in multivariable logistic regression analyses for two outcome measures: (i) complications identified during DFM-related consultations (n = 148) and (ii) fetal compromise at the time of consultation (including relevant information about birth outcome and placental pathology). The latter outcome variable was restricted to the DFM events occurring within 21 days before birth (n = 76). Results Analyzing the 148 and 76 DFM events, the first three main temporal FM counting patterns explained 87.2% and 87.4%, respectively, of all temporal variation in the FM charts. These three temporal patterns represented overall counting times, sudden spikes around the time of DFM events, and an inverted U-shaped pattern, explaining 75.3%, 8.6%, and 3.3% and 72.5%, 9.6%, and 5.3% of variation in the total cohort and subsample, respectively. Neither of the temporal patterns was significantly associated with the two outcome measures. Conclusions Acknowledging that sudden, large changes in fetal activity may be underreported in FM charts, our study showed that the temporal FM counting patterns in the two weeks preceding DFM-related consultation contributed little to identify clinically important changes in perceived FM. It thus provides insufficient information for giving detailed advice to women on when to contact health care providers. The importance of qualitative features of maternally perceived DFM should be further explored.
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Affiliation(s)
- Brita Askeland Winje
- Division of Epidemiology, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway.
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42
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Heazell AEP, Leisher S, Cregan M, Flenady V, Frøen JF, Gravensteen IK, de Groot-Noordenbos M, de Groot P, Hale S, Jennings B, McNamara K, Millard C, Erwich JJHM. Sharing experiences to improve bereavement support and clinical care after stillbirth: report of the 7th annual meeting of the International Stillbirth Alliance. Acta Obstet Gynecol Scand 2012; 92:352-61. [PMID: 23157497 DOI: 10.1111/aogs.12042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 10/19/2012] [Indexed: 11/30/2022]
Abstract
Stillbirth remains a global health challenge which is greatly affected by social and economic inequality, particularly the availability and quality of maternity care. The International Stillbirth Alliance (ISA) exists to raise awareness of stillbirth and to promote global collaboration in the prevention of stillbirth and provision of appropriate care for parents whose baby is stillborn. The focus of this ISA conference was to share experiences to improve bereavement support and clinical care. These issues, relevant throughout the globe, are not discrete but closely interrelated, with both similarities and differences depending on the specific country and cultural context. Counting stillbirths and understanding the causes of stillbirth are essential not only for providing optimal care and support to parents whose babies die, but also for reducing the future burden of stillbirth. This summary highlights novel work from obstetricians, midwives, psychologists, parents and peer support organizations that was presented at the ISA meeting. It covers topics including the bereavement process, peer support for parents, support and training for staff, evidence for clinical care, and the need for accurate data on stillbirths and perinatal audits. Representatives from the maternity services of the region presented their outcome data and shared their experiences of clinical and bereavement care. Data and developments in practice within stillbirth and bereavement care must be widely disseminated and acted upon by those responsible for maternity care provision, both to prevent stillbirths and to provide high-quality care when they do occur.
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Affiliation(s)
- Alexander E P Heazell
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
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Winje BA, Røislien J, Frøen JF. Temporal patterns in count-to-ten fetal movement charts and their associations with pregnancy characteristics: a prospective cohort study. BMC Pregnancy Childbirth 2012; 12:124. [PMID: 23126608 PMCID: PMC3542088 DOI: 10.1186/1471-2393-12-124] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 10/29/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fetal movement counting has long been suggested as a screening tool to identify impaired placental function. However, quantitative limits for decreased fetal movement perform poorly for screening purposes, indicating the need for methodological refinement. We aimed to identify the main individual temporal patterns in fetal movement counting charts, and explore their associations with pregnancy characteristics. METHODS In a population-based prospective cohort in Norway, 2009-2011, women with singleton pregnancies counted fetal movements daily from pregnancy week 24 until delivery using a modified "count-to-ten" procedure. To account for intra-woman correlation of observations, we used functional data analysis and corresponding functional principal component analysis to identify the main individual temporal patterns in fetal movement count data. The temporal patterns are described by continuous functional principal component (FPC) curves, with an individual score on each FPC for each woman. These scores were later used as outcome variables in multivariable linear regression analyses, with pregnancy characteristics as explanatory variables. RESULTS Fetal movement charts from 1086 pregnancies were included. Three FPC curves explained almost 99% of the variation in the temporal data, with the first FPC, representing the individual overall counting time, accounting for 91% alone. There were several statistically significant associations between the FPCs and various pregnancy characteristics. However, the effects were small and of limited clinical value. CONCLUSIONS This statistical approach for analyzing fetal movement counting data successfully captured clinically meaningful individual temporal patterns and how these patterns vary between women. Maternal body mass index, gestational age and placental site explained little of the variation in the temporal fetal movement counting patterns. Thus, a perceived decrease in fetal movement should not be attributed to a woman's basic pregnancy characteristics, but assessed as a potential marker of risk.
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Affiliation(s)
- Brita Askeland Winje
- Division of Epidemiology, Norwegian Institute of Public Health, Nydalen, 0403, Oslo, Norway.
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Dutton PJ, Warrander LK, Roberts SA, Bernatavicius G, Byrd LM, Gaze D, Kroll J, Jones RL, Sibley CP, Frøen JF, Heazell AEP. Predictors of poor perinatal outcome following maternal perception of reduced fetal movements--a prospective cohort study. PLoS One 2012; 7:e39784. [PMID: 22808059 PMCID: PMC3394759 DOI: 10.1371/journal.pone.0039784] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/30/2012] [Indexed: 11/24/2022] Open
Abstract
Background Maternal perception of reduced fetal movement (RFM) is associated with increased risk of stillbirth and fetal growth restriction (FGR). RFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen and nutrient transfer resulting from placental insufficiency. Objective To identify predictors of poor perinatal outcome after maternal perception of reduced fetal movements (RFM). Design Prospective cohort study. Methods 305 women presenting with RFM after 28 weeks of gestation were recruited. Demographic factors and clinical history were recorded and ultrasound performed to assess fetal biometry, liquor volume and umbilical artery Doppler. A maternal serum sample was obtained for measurement of placentally-derived or modified proteins including: alpha fetoprotein (AFP), human chorionic gonadotrophin (hCG), human placental lactogen (hPL), ischaemia-modified albumin (IMA), pregnancy associated plasma protein A (PAPP-A) and progesterone. Factors related to poor perinatal outcome were determined by logistic regression. Results 22.1% of pregnancies ended in a poor perinatal outcome after RFM. The most common complication was small-for-gestational age infants. Pregnancy outcome after maternal perception of RFM was related to amount of fetal activity while being monitored, abnormal fetal heart rate trace, diastolic blood pressure, estimated fetal weight, liquor volume, serum hCG and hPL. Following multiple logistic regression abnormal fetal heart rate trace (Odds ratio 7.08, 95% Confidence Interval 1.31–38.18), (OR) diastolic blood pressure (OR 1.04 (95% CI 1.01–1.09), estimated fetal weight centile (OR 0.95, 95% CI 0.94–0.97) and log maternal serum hPL (OR 0.13, 95% CI 0.02–0.99) were independently related to pregnancy outcome. hPL was related to placental mass. Conclusion Poor perinatal outcome after maternal perception of RFM is closely related to factors which are connected to placental dysfunction. Novel tests of placental function and associated fetal response may provide improved means to detect fetuses at greatest risk of poor perinatal outcome after RFM.
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Affiliation(s)
- Philip J. Dutton
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Lynne K. Warrander
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Stephen A. Roberts
- Health Sciences – Methodology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Giovanna Bernatavicius
- Department of Obstetrics, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Louise M. Byrd
- Department of Obstetrics, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - David Gaze
- Department of Chemical Pathology, St George's Hospital Medical School, London, United Kingdom
| | - Josh Kroll
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Rebecca L. Jones
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Colin P. Sibley
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - J. Frederik Frøen
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Alexander E. P. Heazell
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Department of Obstetrics, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
- * E-mail:
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Abstract
BACKGROUND Fetal movement counting may improve timely identification of decreased fetal activity and thereby contribute to prevent adverse pregnancy outcomes, but it may also contribute to maternal concern. This study aimed to test whether fetal movement counting increased maternal concern. METHODS In a multicenter, controlled trial 1,013 women with a singleton pregnancy were randomly assigned either to perform daily fetal movement counting from pregnancy week 28 or to follow standard Norwegian antenatal care where fetal movement counting is not encouraged. The primary outcome was maternal concern, measured by the Cambridge Worry Scale. Analysis was by intention-to-treat. RESULTS The means and SDs on Cambridge Worry Scale scores were 0.77 (0.55) and 0.90 (0.62) for the intervention and the control groups, respectively, a mean difference between the groups of 0.14 (95% CI: 0.06-0.21, p<0.001). Decreased fetal activity was of concern to 433 women once or more during pregnancy, 45 and 42 percent in the intervention and control groups, respectively (relative risk=1.1, 95% CI: 0.9-1.2). Seventy-nine percent of the women responded favorably to the use of counting charts. CONCLUSIONS Women who performed fetal movement counting in the third trimester reported less concern than those in the control group. The frequency of maternal report of concern about decreased fetal activity was similar between the groups. Most women considered the use of a counting chart to be positive.
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Affiliation(s)
- Eli Saastad
- AkershusUniversity College, PB 423, N-2001 Lillestrøm, Norway
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46
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Saastad E, Winje BA, Stray Pedersen B, Frøen JF. Fetal movement counting improved identification of fetal growth restriction and perinatal outcomes--a multi-centre, randomized, controlled trial. PLoS One 2011; 6:e28482. [PMID: 22205952 PMCID: PMC3244397 DOI: 10.1371/journal.pone.0028482] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 11/09/2011] [Indexed: 12/02/2022] Open
Abstract
Background Fetal movement counting is a method used by the mother to quantify her baby's movements, and may prevent adverse pregnancy outcome by a timely evaluation of fetal health when the woman reports decreased fetal movements. We aimed to assess effects of fetal movement counting on identification of fetal pathology and pregnancy outcome. Methodology In a multicentre, randomized, controlled trial, 1076 pregnant women with singleton pregnancies from an unselected population were assigned to either perform fetal movement counting from gestational week 28, or to receive standard antenatal care not including fetal movement counting (controls). Women were recruited from nine Norwegian hospitals during September 2007 through November 2009. Main outcome was a compound measure of fetal pathology and adverse pregnancy outcomes. Analysis was performed by intention-to-treat. Principal Findings The frequency of the main outcome was equal in the groups; 63 of 433 (11.6%) in the intervention group, versus 53 of 532 (10.7%) in the control group [RR: 1.1 95% CI 0.7–1.5)]. The growth-restricted fetuses were more often identified prior to birth in the intervention group than in the control group; 20 of 23 fetuses (87.0%) versus 12 of 20 fetuses (60.0%), respectively, [RR: 1.5 (95% CI 1.0–2.1)]. In the intervention group two babies (0.4%) had Apgar scores <4 at 1 minute, versus 12 (2.3%) in the control group [RR: 0.2 (95% CI 0.04–0.7)]. The frequency of consultations for decreased fetal movement was 71 (13.1%) and 57 (10.7%) in the intervention and control groups, respectively [RR: 1.2 (95% CI 0.9–1.7)]. The frequency of interventions was similar in the groups. Conclusions Maternal ability to detect clinically important changes in fetal activity seemed to be improved by fetal movement counting; there was an increased identification of fetal growth restriction and improved perinatal outcome, without inducing more consultations or obstetric interventions. Trial Registration ClinicalTrials.govNCT00513942
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Affiliation(s)
- Eli Saastad
- Faculty of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
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47
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Abstract
BACKGROUND Women presenting with decreased fetal movement have an increased risk of adverse pregnancy outcomes. Fetal movement counting may be associated with improvement in maternal-fetal attachment, which in turn, improves pregnancy outcome and postnatal mother-infant attachment. The study aim was to test whether maternal-fetal attachment differed between groups of mothers who systematically performed fetal movement counting and mothers who followed standard antenatal care where routine fetal movement counting was discouraged. METHODS In a multicenter, randomized trial, 1,123 women were assigned to either systematic fetal movement counting from pregnancy week 28 or to standard antenatal care. This study sample included primarily white, cohabiting, nonsmoking, and relatively well-educated women. The outcome measure was maternal-fetal attachment, measured by using the Prenatal Attachment Inventory. Analysis was by intention-to-treat. RESULTS No difference was found between the groups in the scores on prenatal attachment; the means and standard deviations were 59.54 (9.39) and 59.34 (9.75) [corrected] for the intervention and the control groups, respectively (p = 0.747). The mean difference between the groups was 0.20 (95% CI: -1.02-1.42) [corrected]. CONCLUSIONS Fetal movement counting in the third trimester does not stimulate antenatal maternal-fetal attachment. This result differs from a previous study where fetal movement counting improved maternal-fetal attachment. Further research with a focus on possible mediating factors such as levels of stress, concern, and other psychological factors is required.
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Affiliation(s)
- Eli Saastad
- Akershus University College, Lillestrøm, Norway
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Winje BA, Saastad E, Gunnes N, Tveit JVH, Stray-Pedersen B, Flenady V, Frøen JF. Analysis of ‘count-to-ten’ fetal movement charts: a prospective cohort study. BJOG 2011; 118:1229-38. [DOI: 10.1111/j.1471-0528.2011.02993.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Flenady V, Middleton P, Smith GC, Duke W, Erwich JJ, Khong TY, Neilson J, Ezzati M, Koopmans L, Ellwood D, Fretts R, Frøen JF. Stillbirths: the way forward in high-income countries. Lancet 2011; 377:1703-17. [PMID: 21496907 DOI: 10.1016/s0140-6736(11)60064-0] [Citation(s) in RCA: 316] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Stillbirth rates in high-income countries declined dramatically from about 1940, but this decline has slowed or stalled over recent times. The present variation in stillbirth rates across and within high-income countries indicates that further reduction in stillbirth is possible. Large disparities (linked to disadvantage such as poverty) in stillbirth rates need to be addressed by providing more educational opportunities and improving living conditions for women. Placental pathologies and infection associated with preterm birth are linked to a substantial proportion of stillbirths. The proportion of unexplained stillbirths associated with under investigation continues to impede efforts in stillbirth prevention. Overweight, obesity, and smoking are important modifiable risk factors for stillbirth, and advanced maternal age is also an increasingly prevalent risk factor. Intensified efforts are needed to ameliorate the effects of these factors on stillbirth rates. Culturally appropriate preconception care and quality antenatal care that is accessible to all women has the potential to reduce stillbirth rates in high-income countries. Implementation of national perinatal mortality audit programmes aimed at improving the quality of care could substantially reduce stillbirths. Better data on numbers and causes of stillbirth are needed, and international consensus on definition and classification related to stillbirth is a priority. All parents should be offered a thorough investigation including a high-quality autopsy and placental histopathology. Parent organisations are powerful change agents and could have an important role in raising awareness to prevent stillbirth. Future research must focus on screening and interventions to reduce antepartum stillbirth as a result of placental dysfunction. Identification of ways to reduce maternal overweight and obesity is a high priority for high-income countries.
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Affiliation(s)
- Vicki Flenady
- Mater Medical Research Institute, South Brisbane, QLD, Australia.
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Flenady V, Koopmans L, Middleton P, Frøen JF, Smith GC, Gibbons K, Coory M, Gordon A, Ellwood D, McIntyre HD, Fretts R, Ezzati M. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 2011; 377:1331-40. [PMID: 21496916 DOI: 10.1016/s0140-6736(10)62233-7] [Citation(s) in RCA: 817] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Stillbirth rates in high-income countries have shown little or no improvement over the past two decades. Prevention strategies that target risk factors could be important in rate reduction. This systematic review and meta-analysis was done to identify priority areas for stillbirth prevention relevant to those countries. METHODS Population-based studies addressing risk factors for stillbirth were identified through database searches. The factors most frequently reported were identified and selected according to whether they could potentially be reduced through lifestyle or medical intervention. The numbers attributable to modifiable risk factors were calculated from data relating to the five high-income countries with the highest numbers of stillbirths and where all the data required for analysis were available. Odds ratios were calculated for selected risk factors, from which population-attributable risk (PAR) values were calculated. FINDINGS Of 6963 studies initially identified, 96 population-based studies were included. Maternal overweight and obesity (body-mass index >25 kg/m(2)) was the highest ranking modifiable risk factor, with PARs of 8-18% across the five countries and contributing to around 8000 stillbirths (≥22 weeks' gestation) annually across all high-income countries. Advanced maternal age (>35 years) and maternal smoking yielded PARs of 7-11% and 4-7%, respectively, and each year contribute to more than 4200 and 2800 stillbirths, respectively, across all high-income countries. In disadvantaged populations maternal smoking could contribute to 20% of stillbirths. Primiparity contributes to around 15% of stillbirths. Of the pregnancy disorders, small size for gestational age and abruption are the highest PARs (23% and 15%, respectively), which highlights the notable role of placental pathology in stillbirth. Pre-existing diabetes and hypertension remain important contributors to stillbirth in such countries. INTERPRETATION The raising of awareness and implementation of effective interventions for modifiable risk factors, such as overweight, obesity, maternal age, and smoking, are priorities for stillbirth prevention in high-income countries. FUNDING The Stillbirth Foundation Australia, the Department of Health and Ageing, Canberra, Australia, and the Mater Foundation, Brisbane, Australia.
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Affiliation(s)
- Vicki Flenady
- Mater Medical Research Institute, South Brisbane, QLD, Australia.
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