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Adu-Amankwah A, Bellad MB, Benson AM, Beyuo TK, Bhandankar M, Charanthimath U, Chisembele M, Cole SR, Dhaded SM, Enweronu-Laryea C, Freeman BL, Freeman NLB, Goudar SS, Jiang X, Kasaro MP, Kosorok MR, Luckett D, Mbewe FM, Misra S, Mutesu K, Nuamah MA, Oppong SA, Patterson JK, Peterson M, Pokaprakarn T, Price JT, Pujar YV, Rouse DJ, Sebastião YV, Spelke MB, Sperger J, Stringer JSA, Tuuli MG, Valancius M, Vwalika B. Limiting adverse birth outcomes in resource-limited settings (LABOR): protocol of a prospective intrapartum cohort study. Gates Open Res 2022; 6:115. [PMID: 36636742 PMCID: PMC9822935 DOI: 10.12688/gatesopenres.13716.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Each year, nearly 300,000 women and 5 million fetuses or neonates die during childbirth or shortly thereafter, a burden concentrated disproportionately in low- and middle-income countries. Identifying women and their fetuses at risk for intrapartum-related morbidity and death could facilitate early intervention. Methods: The Limiting Adverse Birth Outcomes in Resource-Limited Settings (LABOR) Study is a multi-country, prospective, observational cohort designed to exhaustively document the course and outcomes of labor, delivery, and the immediate postpartum period in settings where adverse outcomes are frequent. The study is conducted at four hospitals across three countries in Ghana, India, and Zambia. We will enroll approximately 12,000 women at presentation to the hospital for delivery and follow them and their fetuses/newborns throughout their labor and delivery course, postpartum hospitalization, and up to 42 days thereafter. The co-primary outcomes are composites of maternal (death, hemorrhage, hypertensive disorders, infection) and fetal/neonatal adverse events (death, encephalopathy, sepsis) that may be attributed to the intrapartum period. The study collects extensive physiologic data through the use of physiologic sensors and employs medical scribes to document examination findings, diagnoses, medications, and other interventions in real time. Discussion: The goal of this research is to produce a large, sharable dataset that can be used to build statistical algorithms to prospectively stratify parturients according to their risk of adverse outcomes. We anticipate this research will inform the development of new tools to reduce peripartum morbidity and mortality in low-resource settings.
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Affiliation(s)
- Amanda Adu-Amankwah
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Mrutunjaya B. Bellad
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Aimee M. Benson
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Titus K. Beyuo
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Manisha Bhandankar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Umesh Charanthimath
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Maureen Chisembele
- Women and Newborn Hospital, University Teaching Hospital of Lusaka, Lusaka, Zambia
| | - Stephen R. Cole
- Department of Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Sangappa M. Dhaded
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Christabel Enweronu-Laryea
- Department of Child Health, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Bethany L. Freeman
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Nikki L. B. Freeman
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Shivaprasad S. Goudar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Xiaotong Jiang
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Margaret P. Kasaro
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA,UNC Global Projects Zambia, LLC, Lusaka, Zambia
| | - Michael R. Kosorok
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Daniel Luckett
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | | | - Sujata Misra
- Fakir Mohan Medical College and Hospital, Balasore, India
| | - Kunda Mutesu
- Women and Newborn Hospital, University Teaching Hospital of Lusaka, Lusaka, Zambia
| | - Mercy A. Nuamah
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Samuel A. Oppong
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Jackie K. Patterson
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Marc Peterson
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Teeranan Pokaprakarn
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Joan T. Price
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA,
| | - Yeshita V. Pujar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
| | - Yuri V. Sebastião
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - M. Bridget Spelke
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - John Sperger
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Jeffrey S. A. Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Methodius G. Tuuli
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
| | - Michael Valancius
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA,Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
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2
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Adu-Amankwah A, Bellad MB, Benson AM, Beyuo TK, Bhandankar M, Charanthimath U, Chisembele M, Cole SR, Dhaded SM, Enweronu-Laryea C, Freeman BL, Freeman NLB, Goudar SS, Jiang X, Kasaro MP, Kosorok MR, Luckett D, Mbewe FM, Misra S, Mutesu K, Nuamah MA, Oppong SA, Patterson JK, Peterson M, Pokaprakarn T, Price JT, Pujar YV, Rouse DJ, Sebastião YV, Spelke MB, Sperger J, Stringer JSA, Tuuli MG, Valancius M, Vwalika B. Limiting adverse birth outcomes in resource-limited settings (LABOR): protocol of a prospective intrapartum cohort study. Gates Open Res 2022; 6:115. [PMID: 36636742 PMCID: PMC9822935 DOI: 10.12688/gatesopenres.13716.1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 01/17/2023] Open
Abstract
Background: Each year, nearly 300,000 women and 5 million fetuses or neonates die during childbirth or shortly thereafter, a burden concentrated disproportionately in low- and middle-income countries. Identifying women and their fetuses at risk for intrapartum-related morbidity and death could facilitate early intervention. Methods: The Limiting Adverse Birth Outcomes in Resource-Limited Settings (LABOR) Study is a multi-country, prospective, observational cohort designed to exhaustively document the course and outcomes of labor, delivery, and the immediate postpartum period in settings where adverse outcomes are frequent. The study is conducted at four hospitals across three countries in Ghana, India, and Zambia. We will enroll approximately 12,000 women at presentation to the hospital for delivery and follow them and their fetuses/newborns throughout their labor and delivery course, postpartum hospitalization, and up to 42 days thereafter. The co-primary outcomes are composites of maternal (death, hemorrhage, hypertensive disorders, infection) and fetal/neonatal adverse events (death, encephalopathy, sepsis) that may be attributed to the intrapartum period. The study collects extensive physiologic data through the use of physiologic sensors and employs medical scribes to document examination findings, diagnoses, medications, and other interventions in real time. Discussion: The goal of this research is to produce a large, sharable dataset that can be used to build statistical algorithms to prospectively stratify parturients according to their risk of adverse outcomes. We anticipate this research will inform the development of new tools to reduce peripartum morbidity and mortality in low-resource settings.
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Affiliation(s)
- Amanda Adu-Amankwah
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Mrutunjaya B. Bellad
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Aimee M. Benson
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Titus K. Beyuo
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Manisha Bhandankar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Umesh Charanthimath
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Maureen Chisembele
- Women and Newborn Hospital, University Teaching Hospital of Lusaka, Lusaka, Zambia
| | - Stephen R. Cole
- Department of Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Sangappa M. Dhaded
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Christabel Enweronu-Laryea
- Department of Child Health, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Bethany L. Freeman
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Nikki L. B. Freeman
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Shivaprasad S. Goudar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Xiaotong Jiang
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Margaret P. Kasaro
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA,UNC Global Projects Zambia, LLC, Lusaka, Zambia
| | - Michael R. Kosorok
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Daniel Luckett
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | | | - Sujata Misra
- Fakir Mohan Medical College and Hospital, Balasore, India
| | - Kunda Mutesu
- Women and Newborn Hospital, University Teaching Hospital of Lusaka, Lusaka, Zambia
| | - Mercy A. Nuamah
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Samuel A. Oppong
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Jackie K. Patterson
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Marc Peterson
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Teeranan Pokaprakarn
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Joan T. Price
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA,
| | - Yeshita V. Pujar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
| | - Yuri V. Sebastião
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - M. Bridget Spelke
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - John Sperger
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Jeffrey S. A. Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Methodius G. Tuuli
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
| | - Michael Valancius
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA,Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
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Gosavi M, Chavan R, Bellad MB. NESTROFT-A Cost-Effective Mass Screening Tool for the Detection of β-Thalassemia Carrier Status in Anemic Pregnant Women: A Step Toward Reducing the National Disease Burden. J Lab Physicians 2022; 13:368-373. [PMID: 34975258 PMCID: PMC8714408 DOI: 10.1055/s-0041-1732493] [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] [Indexed: 10/31/2022] Open
Abstract
Introduction β-Thalassemias are inherited hemoglobinopathies commonly encountered in practice. With chances of a promising cure being rare, the prevention of births with this disorder should assume priority, especially in low-resource countries. This can be achieved by the implementation of a mass screening program that is reliable and, at the same time, cost-effective. Objectives This study focuses on the utility of Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) as a mass screening tool to detect thalassemia carriers. Hematological parameters that may predict carrier status were also evaluated. Materials and Methods Hemoglobin estimation was performed on all consented pregnant women. If the patient was found to have hemoglobin < 11 g/dL, the blood sample was subjected to other routine hematological tests along with peripheral smear examination. NESTROFT was performed using 0.36% saline solution. Confirmation was done using high-performance liquid chromatography (HPLC). Statistical Analysis Data obtained were tabulated using version 21 of the Statistical Package for Social Sciences. Means, standard deviations, and percentages were used to describe the sample. Chi-square test and Students' t test were used to identify differences between the groups. Results Of 441 pregnant women enrolled, 206 were found to be anemic. Nineteen (9.2%) of the anemic pregnant women were detected to be carriers of hemoglobinopathies. Among the hematological parameters, mean red blood cell count and reticulocyte count were higher, while mean corpuscular hemoglobin concentration was lower in carriers. Also, carriers were more likely to present with microcytic hypochromic anemia. NESTROFT showed a sensitivity of 84.21%, specificity of 96.25%, a positive predictive value of 69.56%, and a negative predictive value of 98.36%. A false-positive result was seen in 3.74% of the tests, while a false negative result was seen in 15.78% of the tests. Conclusions NESTROFT (0.36%) can be used as a simple and cost-effective mass screening tool for the detection of carrier status. This should be followed by confirmation using HPLC or hemoglobin electrophoresis.
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Affiliation(s)
- Manasi Gosavi
- Department of Pathology, KAHER's Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Ramesh Chavan
- Department of Pathology, KAHER's Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - M B Bellad
- Department of Obstetrics and Gynaecology, KAHER's Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
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Magee LA, Bone J, Owasil SB, Singer J, Lee T, Bellad MB, Goudar SS, Logan AG, Macuacua SE, Mallapur AA, Nathan HL, Qureshi RN, Sevene E, Shennan AH, Valá A, Vidler M, Bhutta ZA, von Dadelszen P. Pregnancy Outcomes and Blood Pressure Visit-to-Visit Variability and Level in Three Less-Developed Countries. Hypertension 2021; 77:1714-1722. [PMID: 33775120 PMCID: PMC8284372 DOI: 10.1161/hypertensionaha.120.16851] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine (L.A.M., H.L.N., A.H.S., P.v.D.), King's College London, United Kingdom.,Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute (L.A.M., J.B., M.V., P.v.D.)
| | - Jeffrey Bone
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute (L.A.M., J.B., M.V., P.v.D.)
| | - Salwa Banoo Owasil
- GKT School of Biomedical Sciences (S.B.O.), King's College London, United Kingdom
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (J.S., T.L.), University of British Columbia, Vancouver, Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (J.S., T.L.), University of British Columbia, Vancouver, Canada
| | - Mrutunjaya B Bellad
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, Karnataka, India (M.B.B., S.S.G.)
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, Karnataka, India (M.B.B., S.S.G.)
| | | | - Salésio E Macuacua
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique (S.E.M., E.S., A.V.)
| | - Ashalata A Mallapur
- S Nijalingappa Medical College, Hanagal Shree Kumareshwar Hospital and Research Centre, Bagalkote, Karnataka, India (A.A.M.)
| | - Hannah L Nathan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine (L.A.M., H.L.N., A.H.S., P.v.D.), King's College London, United Kingdom
| | - Rahat N Qureshi
- Centre of Excellence, Division of Woman and Child Health, Aga Khan University, Karachi, Pakistan (R.N.Q., Z.A.B.)
| | - Esperança Sevene
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique (S.E.M., E.S., A.V.).,Department of Physiological Sciences, Clinical Pharmacology, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique (E.S.)
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine (L.A.M., H.L.N., A.H.S., P.v.D.), King's College London, United Kingdom
| | - Anifa Valá
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique (S.E.M., E.S., A.V.)
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute (L.A.M., J.B., M.V., P.v.D.)
| | - Zulfiqar A Bhutta
- Centre of Excellence, Division of Woman and Child Health, Aga Khan University, Karachi, Pakistan (R.N.Q., Z.A.B.).,Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada (Z.A.B.)
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine (L.A.M., H.L.N., A.H.S., P.v.D.), King's College London, United Kingdom.,Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute (L.A.M., J.B., M.V., P.v.D.)
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Magee LA, Sharma S, Sevene E, Qureshi RN, Mallapur A, Macuácua SE, Goudar S, Bellad MB, Adetoro OO, Payne BA, Sotunsa J, Valá A, Bone J, Shennan AH, Vidler M, Bhutta ZA, von Dadelszen P. Population-level data on antenatal screening for proteinuria; India, Mozambique, Nigeria, Pakistan. Bull World Health Organ 2020; 98:661-670. [PMID: 33177756 PMCID: PMC7652559 DOI: 10.2471/blt.19.248898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/18/2019] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 02/02/2023] Open
Abstract
Objective To estimate the prevalence and prognosis of proteinuria at enrolment in the 27 intervention clusters of the Community-Level Interventions for Pre-eclampsia cluster randomized trials. Methods We identified pregnant women eligible for inclusion in the trials in their communities in four countries (2013–2017). We included women who delivered by trial end and received an intervention antenatal care visit. The intervention was a community health worker providing supplementary hypertension-oriented care, including proteinuria assessment by visual assessment of urinary dipstick at the first visit and all subsequent visits when hypertension was detected. In a multilevel regression model, we compared baseline prevalence of proteinuria (≥ 1+ or ≥ 2+) across countries. We compared the incidence of subsequent complications by baseline proteinuria. Findings Baseline proteinuria was detected in less than 5% of eligible pregnancies in each country (India: 234/6120; Mozambique: 94/4234; Nigeria: 286/7004; Pakistan: 315/10 885), almost always with normotension (India: 225/234; Mozambique: 93/94; Nigeria: 241/286; Pakistan: 264/315). There was no consistent relationship between baseline proteinuria (either ≥ 1+ or ≥ 2+) and progression to hypertension, maternal mortality or morbidity, birth at < 37 weeks, caesarean section delivery or perinatal mortality or morbidity. If proteinuria testing were restricted to women with hypertension, we projected annual cost savings of 153 223 981 United States dollars (US$) in India, US$ 9 055 286 in Mozambique, US$ 53 181 933 in Nigeria and US$ 38 828 746 in Pakistan. Conclusion Our findings question the recommendations to routinely evaluate proteinuria at first assessment in pregnancy. Restricting proteinuria testing to pregnant women with hypertension has the potential to save resources.
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Affiliation(s)
- Laura A Magee
- Department of Women and Children's Health, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, England
| | - Sumedha Sharma
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Esperança Sevene
- Centro de Investigação em Saúde da Manhiça, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Rahat N Qureshi
- Centre of Excellence, Aga Khan University, Karachi, Pakistan
| | - Ashalata Mallapur
- S Nijalingappa Medical College and HSK (Hanagal Shree Kumareshwar) Hospital and Research Centre, Bagalkote, India
| | - Salésio E Macuácua
- Centro de Investigação em Saúde da Manhiça, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Shivaprasad Goudar
- KLE Academy of Higher Education and Research's J N Medical College Belagavi, Karnataka, India
| | - Mrutunjaya B Bellad
- KLE Academy of Higher Education and Research's J N Medical College Belagavi, Karnataka, India
| | - Olalekan O Adetoro
- Department of Obstetrics and Gynaecology, Olabisi Onabanjo University, Ago Iwoye, Nigeria
| | - Beth A Payne
- Centre for International Child Health, University of British Columbia, Vancouver, Canada
| | - John Sotunsa
- Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | - Anifa Valá
- Centro de Investigação em Saúde da Manhiça, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Jeffrey Bone
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Andrew H Shennan
- Department of Women and Children's Health, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, England
| | - Marianne Vidler
- Centre for International Child Health, University of British Columbia, Vancouver, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Peter von Dadelszen
- Department of Women and Children's Health, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, England
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6
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Bellad MB, Goudar SS, Mallapur AA, Sharma S, Bone J, Charantimath US, Katageri GM, Ramadurg UY, Mark Ansermino J, Derman RJ, Dunsmuir DT, Honnungar NV, Karadiguddi C, Kavi AJ, Kodkany BS, Lee T, Li J, Nathan HL, Payne BA, Revankar AP, Shennan AH, Singer J, Tu DK, Vidler M, Wong H, Bhutta ZA, Magee LA, von Dadelszen P. Community level interventions for pre-eclampsia (CLIP) in India: A cluster randomised controlled trial. Pregnancy Hypertens 2020; 21:166-175. [PMID: 32554291 PMCID: PMC7471838 DOI: 10.1016/j.preghy.2020.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 02/21/2020] [Revised: 04/27/2020] [Accepted: 05/09/2020] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Pregnancy hypertension is associated with 7.1% of maternal deaths in India. The objective of this trial was to assess whether task-sharing care might reduce adverse pregnancy outcomes related to delays in triage, transport, and treatment. STUDY DESIGN The Indian Community-Level Interventions for Pre-eclampsia (CLIP) open-label cluster randomised controlled trial (NCT01911494) recruited pregnant women in 12 clusters (initial four-cluster internal pilot) in Belagavi and Bagalkote, Karnataka. The CLIP intervention (6 clusters) consisted of community engagement, community health workers (CHW) provided mobile health (mHeath)-guided clinical assessment, initial treatment, and referral to facility either urgently (<4 h) or non-urgently (<24 h), dependent on algorithm-defined risk. Treatment effect was estimated by multi-level logistic regression modelling, adjusted for prognostically-significant baseline variables. Predefined secondary analyses included safety and evaluation of the intensity of mHealth-guided CHW-provided contacts. MAIN OUTCOME MEASURES 20% reduction in composite of maternal, fetal, and newborn mortality and major morbidity. RESULTS All 14,783 recruited pregnancies (7839 intervention, 6944 control) were followed-up. The primary outcome did not differ between intervention and control arms (adjusted odds ratio (aOR) 0.92 [95% confidence interval 0.74, 1.15]; p = 0.47; intraclass correlation coefficient 0.013). There were no intervention-related safety concerns following administration of either methyldopa or MgSO4, and 401 facility referrals. Compared with intervention arm women without CLIP contacts, those with ≥8 contacts suffered fewer stillbirths (aOR 0.19 [0.10, 0.35]; p < 0.001), at the probable expense of survivable neonatal morbidity (aOR 1.39 [0.97, 1.99]; p = 0.072). CONCLUSIONS As implemented, solely community-level interventions focussed on pre-eclampsia did not improve outcomes in northwest Karnataka.
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Affiliation(s)
- Mrutunjaya B Bellad
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India.
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Ashalata A Mallapur
- S Nijalingappa Medical College, HSK (Hanagal Shree Kumareshwar) Hospital and Research Centre, Navanagar, Bagalkot, 587102 Karnataka, India
| | - Sumedha Sharma
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
| | - Jeffrey Bone
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
| | - Umesh S Charantimath
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Geetanjali M Katageri
- S Nijalingappa Medical College, HSK (Hanagal Shree Kumareshwar) Hospital and Research Centre, Navanagar, Bagalkot, 587102 Karnataka, India
| | - Umesh Y Ramadurg
- S Nijalingappa Medical College, HSK (Hanagal Shree Kumareshwar) Hospital and Research Centre, Navanagar, Bagalkot, 587102 Karnataka, India
| | - J Mark Ansermino
- Centre for International Child Health, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Richard J Derman
- Global Affairs, 1020 Walnut Street, Thomas Jefferson University, Philadelphia 19107, USA
| | - Dustin T Dunsmuir
- Centre for International Child Health, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Narayan V Honnungar
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Chandrashekhar Karadiguddi
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Avinash J Kavi
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Bhalachandra S Kodkany
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Tang Lee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
| | - Jing Li
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
| | - Hannah L Nathan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Beth A Payne
- Centre for International Child Health, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Amit P Revankar
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver V6Z 1Y6, Canada
| | - Domena K Tu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada; Centre for International Child Health, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Hubert Wong
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver V6Z 1Y6, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, 525 University Avenue, Suite 702, Toronto M5G 2L3, Canada; Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
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Bellad MB, Hoffman MK, Mallapur AA, Charantimath US, Katageri GM, Ganachari MS, Kavi A, Ramdurg UY, Bannale SG, Revankar AP, Sloan NL, Kodkany BS, Goudar SS, Derman RJ. Clindamycin to reduce preterm birth in a low resource setting: a randomised placebo-controlled clinical trial. BJOG 2018; 125:1601-1609. [PMID: 29790266 DOI: 10.1111/1471-0528.15290] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 04/22/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine whether oral clindamycin reduces the risk of preterm birth (PTB) in women with abnormal vaginal microflora as evidenced by a vaginal pH ≥5.0. DESIGN Randomised double-blind placebo-controlled trial. SETTING Rural southern India. POPULATION Pregnant women with a singleton fetus between 13+0/7 weeks and 20+6/7 weeks. METHODS Pregnant women were recruited during prenatal visits in Karnataka, India, from October 2013 to July 2015. Women were required to have a singleton fetus between 13+0/7 weeks and 20+6/7 weeks and an elevated vaginal pH (≥5.0) by colorimetric assessment. Participants were randomised to either oral clindamycin 300 mg twice daily for 5 days or an identical-appearing placebo. MAIN OUTCOME MEASURES The primary outcome was the incidence of PTB, defined as delivery before 37+0/7 weeks. RESULTS Of the 6476 screened women, 1727 women were randomised (block randomised in groups of six; clindamycin n = 866, placebo n = 861). The demographic, reproductive, and anthropomorphometric characteristics of the study groups were similar. Compliance was high, with over 94% of capsules being taken. The rate of PTB before 37 weeks was comparable between the two groups [clindamycin 115/826 (13.9%) versus placebo 111/806 (13.8%), between-group difference 0.2% (95% CI -3.2 to 3.5%, P = 0.93)], as was PTB at less than 34 weeks [clindamycin 40/826 (4.8%) versus placebo group 37/806 (4.6%), between-group difference 0.3% (95% CI -1.8 to 2.3%, P = 0.81)]. No differences were detected in the incidence of birthweight of<2500 g, <1500 g, miscarriage, stillbirth or neonatal death. CONCLUSION In this setting, oral clindamycin did not decrease PTB among women with vaginal pH ≥5.0. TWEETABLE ABSTRACT Oral clindamycin between 13+0/7 and 20+6/7 weeks does not prevent preterm birth in women with a vaginal pH ≥5.0.
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Affiliation(s)
- M B Bellad
- KLE Academy of Higher Education and Research's J N Medical College, Belgaum, Karnataka, India
| | - M K Hoffman
- Department of Obstetrics & Gynecology, Christiana Care Health System, Newark, DE, USA
| | - A A Mallapur
- S Nijalingappa Medical College and HSK Hospital and Research Centre, Bagalkot, Karnataka, India
| | - U S Charantimath
- KLE Academy of Higher Education and Research's J N Medical College, Belgaum, Karnataka, India
| | - G M Katageri
- S Nijalingappa Medical College and HSK Hospital and Research Centre, Bagalkot, Karnataka, India
| | - M S Ganachari
- KLE Academy of Higher Education and Research's College of Pharmacy, JNMC University Campus, Belgaum, Karnataka, India
| | - A Kavi
- KLE Academy of Higher Education and Research's J N Medical College, Belgaum, Karnataka, India
| | - U Y Ramdurg
- S Nijalingappa Medical College and HSK Hospital and Research Centre, Bagalkot, Karnataka, India
| | - S G Bannale
- S Nijalingappa Medical College and HSK Hospital and Research Centre, Bagalkot, Karnataka, India
| | - A P Revankar
- KLE Academy of Higher Education and Research's J N Medical College, Belgaum, Karnataka, India
| | - N L Sloan
- Department of Obstetrics & Gynecology, Christiana Care Health System, Newark, DE, USA
| | - B S Kodkany
- KLE Academy of Higher Education and Research's J N Medical College, Belgaum, Karnataka, India
| | - S S Goudar
- KLE Academy of Higher Education and Research's J N Medical College, Belgaum, Karnataka, India
| | - R J Derman
- Thomas Jefferson University, Philadelphia, PA, USA
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Raghavan S, Geller S, Miller S, Goudar SS, Anger H, Yadavannavar MC, Dabash R, Bidri SR, Gudadinni MR, Udgiri R, Koch AR, Bellad MB, Winikoff B. Misoprostol for primary versus secondary prevention of postpartum haemorrhage: a cluster-randomised non-inferiority community trial. BJOG 2016; 123:120-7. [PMID: 26333044 PMCID: PMC5014137 DOI: 10.1111/1471-0528.13540] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess whether secondary prevention, which preemptively treats women with above-average postpartum bleeding, is non-inferior to universal prophylaxis. DESIGN A cluster-randomised non-inferiority community trial. SETTING Health sub-centres and home deliveries in the Bijapur district of Karnataka, India. POPULATION Women with low-risk pregnancies who were eligible for delivery with an Auxiliary Nurse Midwife at home or sub-centre and who consented to be part of the study. METHODS Auxiliary Nurse Midwifes were randomised to secondary prevention using 800 mcg sublingual misoprostol administered to women with postpartum blood loss ≥350 ml or to universal prophylaxis using 600 mcg oral misoprostol administered to all women during the third stage of labour. MAIN OUTCOME MEASURES Postpartum haemoglobin ≤7.8 g/dl, mean postpartum blood loss and postpartum haemoglobin, postpartum haemorrhage rate, transfer to higher-level facilities, acceptability and feasibility of the intervention. RESULTS Misoprostol was administered to 99.7% of women as primary prevention. In secondary prevention, 92 (4.7%) women had postpartum bleeding ≥350 ml, of which 90 (97.8%) received misoprostol. The proportion of women with postpartum haemoglobin ≤7.8 g/dl was 5.9 and 8.8% in secondary and primary prevention clusters, respectively [difference -2.9%, one-sided 95% confidence interval (CI) <1.3%]. Postpartum transfer and haemorrhage rates were low (<1%) in both groups. Shivering was more common in primary prevention clusters (P = 0.013). CONCLUSION Secondary prevention of postpartum haemorrhage with misoprostol is non-inferior to universal prophylaxis based on the primary outcome of postpartum haemoglobin. Secondary prevention could be a good alternative to universal prophylaxis as it medicates fewer women and is an acceptable and feasible strategy at the community level. TWEETABLE ABSTRACT Secondary prevention of postpartum haemorrhage with misoprostol is non-inferior to universal prophylaxis.
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Affiliation(s)
| | - S Geller
- University of Illinois at ChicagoChicagoILUSA
| | - S Miller
- University of CaliforniaSan FranciscoCAUSA
| | - SS Goudar
- KLE University's Jawaharlal Nehru Medical CollegeBelgaumIndia
| | - H Anger
- Gynuity Health ProjectsNew YorkNYUSA
| | - MC Yadavannavar
- BLDE University's Sri B. M. Patil Medical CollegeBijapurIndia
| | - R Dabash
- Gynuity Health ProjectsNew YorkNYUSA
| | - SR Bidri
- BLDE University's Sri B. M. Patil Medical CollegeBijapurIndia
| | - MR Gudadinni
- BLDE University's Sri B. M. Patil Medical CollegeBijapurIndia
| | - R Udgiri
- BLDE University's Sri B. M. Patil Medical CollegeBijapurIndia
| | - AR Koch
- University of Illinois at ChicagoChicagoILUSA
| | - MB Bellad
- KLE University's Jawaharlal Nehru Medical CollegeBelgaumIndia
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9
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Althabe F, Berrueta M, Hemingway-Foday J, Mazzoni A, Bonorino CA, Gowdak A, Gibbons L, Bellad MB, Metgud MC, Goudar S, Kodkany BS, Derman RJ, Saleem S, Iqbal S, Ala SH, Goldenberg RL, Chomba E, Manasyan A, Chiwila M, Imenda E, Mbewe F, Tshefu A, Lokomba V, Bose CL, Moore J, Meleth S, McClure EM, Koso-Thomas M, Buekens P, Belizán JM. A color-coded tape for uterine height measurement: a tool to identify preterm pregnancies in low resource settings. PLoS One 2015; 10:e0117134. [PMID: 25822529 PMCID: PMC4379082 DOI: 10.1371/journal.pone.0117134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 05/06/2014] [Accepted: 10/28/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction Neonatal mortality associated with preterm birth can be reduced with antenatal corticosteroids (ACS), yet <10% of eligible pregnant women in low-middle income countries. The inability to accurately determine gestational age (GA) leads to under-identification of high-risk women who could receive ACS or other interventions. To facilitate better identification in low-resource settings, we developed a color-coded tape for uterine height (UH) measurement and estimated its accuracy identifying preterm pregnancies. Methods We designed a series of colored-coded tapes with segments corresponding to UH measurements for 20–23.6 weeks, 24.0–35.6 weeks, and >36.0 weeks GA. In phase 1, UH measurements were collected prospectively in the Democratic Republic of Congo, India and Pakistan, using distinct tapes to address variation across regions and ethnicities. In phase 2, we tested accuracy in 250 pregnant women with known GA from early ultrasound enrolled at prenatal clinics in Argentina, India, Pakistan and Zambia. Providers masked to the ultrasound GA measured UH. Receiver operating characteristics (ROC) analysis was conducted. Results 1,029 pregnant women were enrolled. In all countries the tapes were most effective identifying pregnancies between 20.0–35.6 weeks, compared to the other GAs. The ROC areas under the curves and 95% confidence intervals were: Argentina 0.69 (0.63, 0.74); Zambia 0.72 (0.66, 0.78), India 0.84 (0.80, 0.89), and Pakistan 0.83 (0.78, 0.87). The sensitivity and specificity (and 95% confidence intervals) for identifying pregnancies between 20.0–35.6 weeks, respectively, were: Argentina 87% (82%–92%) and 51% (42%–61%); Zambia 91% (86%–95%) and 50% (40%–60%); India 78% (71%–85%) and 89% (83%–94%); Pakistan 63% (55%–70%) and 94% (89%–99%). Conclusions We observed moderate-good accuracy identifying pregnancies ≤35.6 weeks gestation, with potential usefulness at the community level in low-middle income countries to facilitate the preterm identification and interventions to reduce preterm neonatal mortality. Further research is needed to validate these findings on a population basis.
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Affiliation(s)
- Fernando Althabe
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Mabel Berrueta
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Agustina Mazzoni
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Andrea Gowdak
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Luz Gibbons
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - M B Bellad
- KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - M C Metgud
- KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Shivaprasad Goudar
- KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | | | | | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi Pakistan
| | - Samina Iqbal
- Department of Obstetrics, Sobhraj Maternity Hospital, Karachi, Pakistan
| | - Syed Hasan Ala
- Department of Obstetrics, Sindh Government Qatar Hospital, Karachi Pakistan
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, United States of America
| | | | - Albert Manasyan
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; University of North Carolina, Chapel Hill, North Carolina, United States of America
| | | | - Edna Imenda
- University Teaching Hospital, Lusaka, Zambia
| | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Victor Lokomba
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Carl L Bose
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Janet Moore
- RTI International; Durham, North Carolina, United States of America
| | - Sreelatha Meleth
- RTI International; Durham, North Carolina, United States of America
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver NICHD, Bethesda, Maryland, United States of America
| | - Pierre Buekens
- School of Public Health and Tropical Medicine, Tulane University, Louisiana, United States of America
| | - José M Belizán
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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Bellad MB, Chalasani P, Ganachari MS, Goudar SS, Sloan NL, Hoffman MK, Derman RJ. Oral Clindamycin to prevent Preterm Birth: A Randomized Placebo Controlled Trial in South India. ACTA ACUST UNITED AC 2015. [DOI: 10.5005/jp-journals-10006-1354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Objectives
Clindamycin is the only antibiotic shown effective, in a single study conducted in the United Kingdom, to prevent preterm birth, the leading cause of neonatal mortality. The study objective was to confirm whether oral clindamycin reduces preterm birth by two-thirds in women with vaginal pH > five in a developing country.
Materials and Methods
All women presenting to antenatal care were screened for study eligibility. Two hundred and ten consenting women were randomized at 13 to 17 weeks gestation in this double-blind randomized trial to 300 mg oral clindamycin twice daily for 5 days or an identical placebo at Jawaharlal Nehru Medical College, Belgaum, India. Outcomes were assessed using Chi-square and Student's t-tests.
Results
Twelve women lost to follow-up and three women with unexpected multiple gestation were excluded from analysis. The study group characteristics (n = 100 clindamycin, n = 95 placebo) were similar. The incidence of birth <37 and <34 weeks were 12.0 and 6.0% in the clindamycin compared with 24.2 and 14.7% in the placebo groups (p = 0.026 and p = 0.044, respectively).
Conclusion
Gestational infection accounts for ~40% of preterm births. This is the first confirmation of the only published trial demonstrating that oral clindamycin provided to women with vaginal pH > 5.0 early in gestation substantially reduces preterm birth.
How to cite this article
Bellad MB, Chalasani P, Ganachari MS, Goudar SS, Sloan NL, Hoffman MK, Derman RJ. Oral Clindamycin to prevent Preterm Birth: A Randomized Placebo Controlled Trial in South India. J South Asian Feder Obst Gynae 2015;7(3):191-196.
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Bellad MB, Tara D, Ganachari MS, Mallapur MD, Goudar SS, Kodkany BS, Sloan NL, Derman R. Prevention of postpartum haemorrhage with sublingual misoprostol or oxytocin: a double-blind randomised controlled trial. BJOG 2012; 119:975-82; discussion 982-6. [PMID: 22703421 DOI: 10.1111/j.1471-0528.2012.03341.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sublingual misoprostol produces a rapid peak concentration, and is more effective than oral administration. We compared the postpartum measured blood loss with 400 μg powdered sublingual misoprostol and after standard care using 10 iu intramuscular (IM) oxytocin. DESIGN Double-blind randomised controlled trial. SETTING A teaching hospital: J N Medical College, Belgaum, India. SAMPLE A cohort of 652 consenting eligible pregnant women admitted to the labour room. METHODS Subjects were assigned to receive the study medications and placebos within 1 minute of clamping and cutting the cord by computer-generated randomisation. Chi-square and bootstrapped Student's t-tests were used to test categorical and continuous outcomes, respectively. MAIN OUTCOME MEASURES Measured mean postpartum blood loss and haemorrhage (PPH, loss ≥ 500 ml), >10% pre- to post-partum decline in haemoglobin, and reported side effects. RESULTS The mean blood loss with sublingual misoprostol was 192 ± 124 ml (n=321) and 366 ± 136 ml with oxytocin IM (n=331, P ≤ 0.001). The incidence of PPH was 3.1% with misoprostol and 9.1% with oxytocin (P=0.002). No woman lost ≥ 1000 ml of blood. We observed that 9.7% and 45.6% of women experienced a haemoglobin decline of >10% after receiving misoprostol and oxytocin, respectively (P ≤ 0.001). Side effects were significantly greater in the misoprostol group than in the oxytocin group. CONCLUSION Unlike other studies, this trial found sublingual misoprostol more effective than intramuscular oxytocin in reducing PPH, with only transient side effects being greater in the misoprostol group. The sublingual mode and/or powdered formulation may increase the effectiveness of misoprostol, and render it superior to injectable oxytocin for the prevention of PPH. Further research is needed to confirm these results.
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Affiliation(s)
- M B Bellad
- KLE University, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
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Bellad MB, Goudar SS, Edlavitch SA, Mahantshetti NS, Naik V, Hemingway-Foday JJ, Gupta M, Nalina HR, Derman R, Moss N, Kodkany BS. Consanguinity, prematurity, birth weight and pregnancy loss: a prospective cohort study at four primary health center areas of Karnataka, India. J Perinatol 2012; 32:431-7. [PMID: 21852769 DOI: 10.1038/jp.2011.115] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [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: 11/09/2022]
Abstract
OBJECTIVE To determine whether consanguinity adversely influences pregnancy outcome in South India, where consanguinity is a common means of family property retention. STUDY DESIGN Data were collected from a prospective cohort of 647 consenting women, consecutively registered for antenatal care between 14 and 18 weeks gestation, in Belgaum district, Karnataka in 2005. Three-generation pedigree charts were drawn for consanguineous participants. χ (2)-Test and Student's t-test were used to assess categorical and continuous data, respectively, using SPSS version 14. Multivariate logistic regression adjusted for confounding variables. RESULT Overall, 24.1% of 601 women with singleton births and outcome data were consanguineous. Demographic characteristics between study groups were similar. Non-consanguineous couples had fewer stillbirths (2.6 vs 6.9% P=0.017; adjusted P=0.050), miscarriages (1.8 vs 4.1%, P=0.097; adjusted P=0.052) and lower incidence of birth weight <2500 g (21.8 vs 29.5%, P=0.071, adjusted P=0.044). Gestation <37 weeks was 6.2% in both the groups. Adjusted for consanguinity and other potential confounders, age <20 years was protective of stillbirth (P=0.01), pregnancy loss (P=0.023) and preterm birth (P=0.013), whereas smoking (P=0.015) and poverty (P=0.003) were associated with higher rates of low birth weight. CONCLUSION Consanguinity significantly increases pregnancy loss and birth weight <2500 g.
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Affiliation(s)
- M B Bellad
- Department of Medical Education, Jawaharlal Nehru Medical College, Belgaum, India
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Bellad MB, Laxmi BV, Goudar SS, Kumar A. Standardized Visual Estimation of Blood Loss during Vaginal Delivery with its Correlation Hematocrit Changes—A Descriptive Study. ACTA ACUST UNITED AC 2009. [DOI: 10.5005/jp-journals-10006-1040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Introduction
Postpartum hemorrhage is a leading cause of maternal morbidity and mortality. Traditionally, visual method with variations in accuracy is followed, because it is quick, simple and noninvasive. To rely on this method accuracy is of vital importance. This study was aimed to improve accuracy of visual estimation of blood loss during vaginal delivery by standardizing (using similar sized mops and a fixed container) and correlating with hematocrit changes.
Methods design
A descriptive study.
Sample size
250 women. Single fixed collecting container and similar sized mops were used in the third stage of labor. Blood was drained into the container and was visually calibrated by a single trained observer. The soaking characteristics of the mops were used to estimate total blood loss. Blood spillage on delivery table, garments and floor were approximately assessed. Total blood loss was calculated from the above three sources. Hemoglobin and hematocrit measurements were done at the time of admission and, at 24 and 72 hours postpartum and its correlation was done with blood loss.
Analysis
By paired and unpaired ‘t’ test.
Results
250 out of 269 women completed the study. Incidence of PPH (> 500 ml) was 11.2%. The estimated blood loss correlated well with the hemoglobin and hematocrit changes postpartum.
Conclusion
Standardized visual method (fixed container and mops) with trained observer improves the accuracy of estimation. This may assist clinicians to accurately estimate blood loss thus preventing hemorrhage related complications.
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Derman RJ, Kodkany BS, Goudar SS, Geller SE, Naik VA, Bellad MB, Patted SS, Patel A, Edlavitch SA, Hartwell T, Chakraborty H, Moss N. Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial. Lancet 2006; 368:1248-53. [PMID: 17027730 DOI: 10.1016/s0140-6736(06)69522-6] [Citation(s) in RCA: 217] [Impact Index Per Article: 12.1] [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: 11/19/2022]
Abstract
BACKGROUND Postpartum haemorrhage is a major cause of maternal mortality in the developing world. Although effective methods for prevention and treatment of such haemorrhage exist--such as the uterotonic drug oxytocin--most are not feasible in resource-poor settings where many births occur at home. We aimed to investigate whether oral misoprostol, a potential alternative to oxytocin, could prevent postpartum haemorrhage in a community home-birth setting. METHODS In a placebo-controlled trial undertaken between September, 2002, and December, 2005, 1620 women in rural India were randomised to receive oral misoprostol (n=812) or placebo (n=808) after delivery. 25 auxiliary nurse midwives undertook the deliveries, administered the study drug, and measured blood loss. The primary outcome was the incidence of acute postpartum haemorrhage (defined as > or =500 mL bleeding) within 2 h of delivery. Analysis was by intention-to-treat. The trial was registered with the US clinical trials database (http://www. clinicaltrials.gov) as number NCT00097123. FINDINGS Oral misoprostol was associated with a significant reduction in the rate of acute postpartum haemorrhage (12.0% to 6.4%, p<0.0001; relative risk 0.53 [95% CI 0.39-0.74]) and acute severe postpartum haemorrhage (1.2% to 0.2%, p<0.0001; 0.20 [0.04-0.91]. One case of postpartum haemorrhage was prevented for every 18 women treated. Misoprostol was also associated with a decrease in mean postpartum blood loss (262.3 mL to 214.3 mL, p<0.0001). Postpartum haemorrhage rates fell over time in both groups but remained significantly higher in the placebo group. Women taking misoprostol had a higher rate of transitory symptoms of chills and fever than the control. INTERPRETATION Oral misoprostol was associated with significant decreases in the rate of acute postpartum haemorrhage and mean blood loss. The drug's low cost, ease of administration, stability, and a positive safety profile make it a good option in resource-poor settings.
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