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Manu A, Pingray V, Billah SM, Williams J, Kilima S, Yeji F, Gohar F, Wobil P, Karim F, Muganyizi P, Mogela D, El Arifeen S, Vandenent M, Matin Z, Janda I, Zaka N, Hailegebriel TD. Implementing maternal and newborn health quality of care standards in healthcare facilities to improve the adoption of respectful maternity care in Bangladesh, Ghana and Tanzania: a controlled before and after study. BMJ Glob Health 2023; 8:e012673. [PMID: 37963610 PMCID: PMC10649771 DOI: 10.1136/bmjgh-2023-012673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/07/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Many women worldwide cannot access respectful maternity care (RMC). We assessed the effect of implementing maternal and newborn health (MNH) quality of care standards on RMC measures. METHODS We used a facility-based controlled before and after design in 43 healthcare facilities in Bangladesh, Ghana and Tanzania. Interviews with women and health workers and observations of labour and childbirth were used for data collection. We estimated difference-in-differences to compare changes in RMC measures over time between groups. RESULTS 1827 women and 818 health workers were interviewed, and 1512 observations were performed. In Bangladesh, MNH quality of care standards reduced physical abuse (DiD -5.2;-9.0 to -1.4). The standards increased RMC training (DiD 59.0; 33.4 to 84.6) and the availability of policies and procedures for both addressing patient concerns (DiD 46.0; 4.7 to 87.4) and identifying/reporting abuse (DiD 45.9; 19.9 to 71.8). The control facilities showed greater improvements in communicating the delivery plan (DiD -33.8; -62.9 to -4.6). Other measures improved in both groups, except for satisfaction with hygiene. In Ghana, the intervention improved women's experiences. Providers allowed women to ask questions and express concerns (DiD 37.5; 5.9 to 69.0), considered concerns (DiD 14.9; 4.9 to 24.9), reduced verbal abuse (DiD -8.0; -12.1 to -3.8) and physical abuse (DiD -5.2; -11.4 to -0.9). More women reported they would choose the facility for another delivery (DiD 17.5; 5.5 to 29.4). In Tanzania, women in the intervention facilities reported improvements in privacy (DiD 24.2; 0.2 to 48.3). No other significant differences were observed due to improvements in both groups. CONCLUSION Institutionalising care standards and creating an enabling environment for quality MNH care is feasible in low and middle-income countries and may facilitate the adoption of RMC.
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Affiliation(s)
- Alexander Manu
- Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | - Veronica Pingray
- Maternal, Newborn and Adolescents Health, UNICEF HQ consultant, New York, New York, USA
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Sk Masum Billah
- Maternal and Child Health Division, ICDDRB, Dhaka, Bangladesh
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John Williams
- Department of Clinical Sciences, Dodowa Health Research Centre, Ghana Health Service, Accra, Ghana
| | - Stella Kilima
- Research Publication and Documentation Section, National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
| | - Francis Yeji
- Planning, Policy, Monitoring, and Evaluation Division (PPMED), Ghana Health Service, HQ, Accra, Ghana
| | - Fatima Gohar
- Health Section, UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | | | - Farhana Karim
- Maternal and Child Health Division, ICDDRB, Dhaka, Bangladesh
| | - Projestine Muganyizi
- Department of Obstetrics & Gynaecology, University of Dar es Salaam Mbeya College of Health and Allied Sciences (UDSM MCHAS), Mbeya, United Republic of Tanzania
| | - Deus Mogela
- National Blood Transfusion Unit, Ministry of Health, Social Development, Gender, Elderly and Children, Dar es Salaam, United Republic of Tanzania
| | | | | | - Ziaul Matin
- Health, UNICEF Bangladesh, Dhaka, Bangladesh
| | - Indeep Janda
- Maternal, Newborn and Adolescents Health, UNICEF, New York, New York, USA
| | - Nabila Zaka
- Health, UNICEF Pakistan, Islamabad, Pakistan
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Bogee GP, Sagoe-Moses I, Adongo EA, Kuma-Aboagye P, Wobil P, Shetye M, Kwarteng PG, Denckla C, Guure C. Situational Analysis on the Impact of Perinatal Deaths Among Bereaved Families in Ghana. Omega (Westport) 2023:302228221138992. [PMID: 36594922 PMCID: PMC10315411 DOI: 10.1177/00302228221138992] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background: Annually, about 5.9 million perinatal deaths occur worldwide, leaving millions bereaved due to stillbirths or early neonatal deaths. The highest burden of stillbirths (97%) and newborn deaths (98%) occurs in lower- and middle-income countries, with the majority occurring in Sub-Saharan African countries. Method: This cross-sectional qualitative study was conducted to identify existing policies and protocols to support bereaved families, explore the needs of bereaved families, and to also assess the impact of perinatal death on families in Ghana. All in-depth interviews were audio-recorded, transcribed verbatim and analyzed thematically. The results were presented in narratives and supported with illustrative quotes from respondents. Results: In all, 42 in-depth interviews were conducted with 10 (23.8%) from the Northern belt (Upper East), 11 (26.2%) from the middle belt (Ashanti) and 21 (50.0%) from the Southern belt (Greater Accra). The study revealed that practicing health professionals and other stakeholders within the health service delivery chain were not aware of protocols, written guidelines or written documents to initiate counseling at the facility in the event of a mother losing a child. Most of the respondents did not know what to do in the event that a mother loses a baby during delivery or immediately after. Respondents were in favor of having a policy or guidelines which will help them to counsel families who go through perinatal bereavement. Respondents were of the view that it is important for families who experience perinatal grief to be supported. Conclusion: All staff who meet the pregnant mother during her pre-and-post-delivery stages should be trained on the use of guidelines or policies. There is the need to have a policy, train and equip health staff to ensure that families experiencing perinatal grief are provided with effective counseling. Ghana Health Service should consider training and recruiting professional counselors who will support the health staff in dealing with perinatal grief.
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Affiliation(s)
- Gillian P. Bogee
- Bolgatanga Regional Hospital, Ghana Health Service, Bolgatange, Ghana
| | | | | | | | | | | | | | - Christy Denckla
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chris Guure
- School of Public Health, University of Ghana, Legon-Accra, Ghana
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Manu A, Billah SM, Williams J, Kilima S, Yeji F, Matin Z, Hussein A, Gohar F, Wobil P, Baffoe P, Karim F, Muganyizi P, Mogela D, El Arifeen S, Vandenent M, Aung K, Shetye M, Dickson KE, Zaka N, Pearson L, Hailegebriel TD. Institutionalising maternal and newborn quality-of-care standards in Bangladesh, Ghana and Tanzania: a quasi-experimental study. BMJ Glob Health 2022; 7:bmjgh-2022-009471. [PMID: 36130773 PMCID: PMC9490604 DOI: 10.1136/bmjgh-2022-009471] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/27/2022] [Accepted: 08/25/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction Facility interventions to improve quality of care around childbirth are known but need to be packaged, tested and institutionalised within health systems to impact on maternal and newborn outcomes. Methods We conducted cross-sectional assessments at baseline (2016) and after 18 months of provider-led implementation of UNICEF/WHO’s Every Mother Every Newborn Quality Improvement (EMEN-QI) standards (preceding the WHO Standards for improving quality of maternal and newborn care in health facilities). 19 hospitals and health centres (2.8M catchment population) in Bangladesh, Ghana and Tanzania were involved and 24 from adjoining districts served for ‘comparison’. We interviewed 43 facility managers and 818 providers, observed 1516 client–provider interactions, reviewed 12 020 records and exit-interviewed 1826 newly delivered women. We computed a 39-criteria institutionalisation score combining clinical, patient rights and cross-cutting domains from EMEN-QI and used routine/District Health Information System V.2 data to assess the impact on perinatal and maternal mortality. Results EMEN-QI standards institutionalisation score increased from 61% to 80% during EMEN-QI implementation, exceeding 75% target. All mortality indicators showed a downward trajectory though not all reached statistical significance. Newborn case-fatality rate fell significantly by 25% in Bangladesh (RR=0·75 (95% CI=0·59 to 0·96), p=0·017) and 85% in Tanzania (RR=0.15 (95% CI=0.08 to 0.29), p<0.001), but not in Ghana. Similarly, stillbirth (RR=0.64 (95% CI=0.45 to 0.92), p<0.01) and perinatal mortality in Tanzania reduced significantly (RR=0.59 (95% CI=0.40 to 0.87), p=0.007). Institutional maternal mortality ratios generally reduced but were only significant in Ghana: 362/100 000 to 207/100 000 livebirths (RR=0.57 (95% CI=0.33 to 0.99), p=0.046). Routine mortality data from comparison facilities were limited and scarce. Systematic death audits and clinical mentorship drove these achievements but challenges still remain around human resource management and equipment maintenance systems. Conclusion Institutionalisation of the UNICEF/WHO EMEN-QI standards as a package is feasible within existing health systems and may reduce mortality around childbirth. Critical gaps around sustainability must be fundamental considerations for scale-up.
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Affiliation(s)
- Alexander Manu
- Nutrition and Public Health Interventions, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK .,Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | | | - John Williams
- Maternal and Child Health Cluster, Dodowa Health Research Centre, Ghana Health Service, Accra, Ghana
| | - Stella Kilima
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Francis Yeji
- Maternal and Child Health, Navrongo Health Research Centre, Navrongo, Ghana
| | - Ziaul Matin
- Health Section, UNICEF Bangladesh, Dhaka, Bangladesh
| | | | - Fatima Gohar
- Maternal and Child Health, UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | | | | | - Farhana Karim
- MCHD, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Projestine Muganyizi
- Department of Obstetrics & Gynaecology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Deus Mogela
- Blood Transfusion Services, Dar es Salaam, Tanzania
| | | | | | - Kyaw Aung
- Health Section, UNICEF, Dar es Salaam, Tanzania
| | | | | | - Nabila Zaka
- Health Services Academy, Islamabad, Pakistan
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Labi A, Obeng-Nkrumah N, Nuertey BD, Issahaku S, Ndiaye NF, Baffoe P, Duncan D, Wobil P, Enweronu-Laryea C. Hand hygiene practices and perceptions among healthcare workers in Ghana: A WASH intervention study. J Infect Dev Ctries 2019; 13:1076-1085. [PMID: 32088694 DOI: 10.3855/jidc.11045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 08/03/2019] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION We aimed to investigate whether the provision of water, sanitation, and hand hygiene (WASH) interventions were associated with changes in hand hygiene compliance and perceptions of healthcare workers towards infection control. METHODOLOGY The study was conducted from June 2017 through February 2018 among healthcare workers in two Northern districts of Ghana. Using a pretest-posttest design, we performed hand hygiene observations and perception surveys at baseline (before the start of WASH interventions) and post-intervention (midline and endline). We assessed adherence to hand hygiene practice using the WHO direct observation tool. The perception study was conducted using the WHO perception survey for healthcare workers. Study outcomes were compared between baseline, midline and endline assessments. RESULTS The hand hygiene compliance significantly improved from 28.8% at baseline through 51.7% at midline (n = 726/1404; 95% CI: 49.1-54.2%) to 67.9% at endline (n = 1000/1471; 95% CI: 65.6-70.3%). The highest increase in compliance was to the WHO hand hygiene moment 5 after touching patients surrounding (relative increase, 205%; relative rate, 3.05; 95% CI: 2.23-4.04; p < 0.0001). Post-intervention, the top three policies deemed most effective at improving hand hygiene practice were: provision of water source (rated mean score, n = 6.1 ± 1.4), participation in educational activities (rated mean score 6.0 ± 1.5); and hand hygiene promotional campaign (6.0 ± 1.3). CONCLUSION Hand hygiene compliance significantly improved post-intervention. Sustaining good hand hygiene practices in low resource settings should include education, the provision of essential supplies, and regular hand hygiene audits and feedback.
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Affiliation(s)
- Appiah Labi
- Department of Microbiology, Korle-Bu Teaching Hospital, Accra, Ghana.
| | - Noah Obeng-Nkrumah
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana.
| | | | - Sheila Issahaku
- Department of Obstetrics and Gynaecology, Tamale Teaching Hospital, Tamale, Ghana.
| | | | | | | | | | - Christabel Enweronu-Laryea
- Department of Child Health, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana.
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Bakari A, Bell AJ, Oppong SA, Bockarie Y, Wobil P, Plange-Rhule G, Goka BQ, Engmann CM, Adanu RM, Moyer CA. Neonatal near-misses in Ghana: a prospective, observational, multi-center study. BMC Pediatr 2019; 19:509. [PMID: 31870340 PMCID: PMC6927122 DOI: 10.1186/s12887-019-1883-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/11/2019] [Indexed: 01/24/2023] Open
Abstract
Background For every newborn who dies within the first month, as many as eight more suffer life-threatening complications but survive (termed ‘neonatal near-misses’ (NNM)). However, there is no universally agreed-upon definition or assessment tool for NNM. This study sought to describe the development of the Neonatal Near-Miss Assessment Tool (NNMAT) for low-resource settings, as well as findings when implemented in Ghana. Methods This prospective, observational study was conducted at two tertiary care hospitals in southern Ghana from April – July 2015. Newborns with evidence of complications and those admitted to the NICUs were screened for inclusion using the NNMAT. Incidence of suspected NNM at enrollment and confirmed near-miss (surviving to 28 days) was determined and compared against institutional neonatal mortality rates. Suspected NNM cases were compared with newborns not classified as a suspected near-miss, and all were followed to 28 days to determine odds of survival. Confirmed near-misses were those identified as suspected near-misses at enrollment who survived to 28 days. The main outcome measures were incidence of NNM, NNM:mortality ratio, and factors associated with NNM classification. Results Out of 394 newborns with complications, 341 (86.5%) were initially classified as suspected near-misses at enrollment using the NNMAT, with 53 (13.4%) being classified as a non-near-miss. At 28-day follow-up, 68 (17%) had died, 52 (13%) were classified as a non-near-miss, and 274 were considered confirmed near-misses. Those newborns with complications who were classified as suspected near-misses using the NNMAT at enrollment had 12 times the odds of dying before 28 days than those classified as non-near-misses. While most confirmed near-misses qualified as NNM via intervention-based criteria, nearly two-thirds qualified based on two or more of the four NNMAT categories. When disaggregated, the most predictive elements of the NNMAT were gestational age < 33 weeks, neurologic dysfunction, respiratory dysfunction, and hemoglobin < 10 gd/dl. The ratio of near-misses to deaths was 0.55: 1, yet this varied across the study sites. Conclusions This research suggests that the NNMAT is an effective tool for assessing neonatal near-misses in low-resource settings. We believe this approach has significant systems-level, continuous quality improvement, clinical and policy-level implications.
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Affiliation(s)
- Ashura Bakari
- Department of Child Health, Suntreso Government Hospital, Ghana Health Service, Kumasi, Ghana
| | - April J Bell
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, Medical School, University of Ghana, Accra, Ghana
| | - Yemah Bockarie
- Department of Child Health, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Priscilla Wobil
- Department of Child Health, Komfo Anokye Teaching Hospital / Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gyikua Plange-Rhule
- Department of Child Health, Komfo Anokye Teaching Hospital / Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bamenla Q Goka
- Department of Child Health, Medical School, University of Ghana, Accra, Ghana
| | - Cyril M Engmann
- Departments of Pediatrics and Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA.,Maternal, Newborn Childhealth and Nutrition, PATH, Seattle, WA, USA
| | - Richard M Adanu
- Population, Family and Reproductive Health Department, University of Ghana School of Public Health, Accra, Ghana
| | - Cheryl A Moyer
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, USA. .,Departments of Learning Health Sciences and Obstetrics & Gynecology, University of Michigan Medical School, 1111 E. Catherine Street, 231 Victor Vaughan Bldg, Ann Arbor, MI, 48109, USA.
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Manu A, Arifeen S, Williams J, Mwasanya E, Zaka N, Plowman BA, Jackson D, Wobil P, Dickson K. Assessment of facility readiness for implementing the WHO/UNICEF standards for improving quality of maternal and newborn care in health facilities - experiences from UNICEF's implementation in three countries of South Asia and sub-Saharan Africa. BMC Health Serv Res 2018; 18:531. [PMID: 29986692 PMCID: PMC6038273 DOI: 10.1186/s12913-018-3334-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 08/02/2017] [Accepted: 06/27/2018] [Indexed: 11/16/2022] Open
Abstract
Background There is a global drive to promote facility deliveries but unless coupled with concurrent improvement in care quality, it might not translate into mortality reduction for mothers and babies. The World Health Organization published the new “Standards for improving quality of care for mothers and newborns in health facilities” but these have not been tested in low- and middle-income settings. UNICEF and its partners are taking the advantage provided by the Mother and Baby Friendly Hospital Initiative in Bangladesh, Ghana and Tanzania to test these standards to inform country adaptation. This manuscript presents a framework used for assessment of facility quality of care to inform the effect of quality improvement interventions. Methods This assessment employed a quasi-experimental design with pre-post assessments in “implementation” and “comparison” facilities-the latter will have no quality improvement interventions implemented. UNICEF and assessment partners developed an assessment framework, developed uniform data collection tools and manuals for harmonised training and implementation across countries. The framework involves six modules assessing: facility structures, equipment, drugs and supplies; policies and guidelines supporting care-giving, staff recruitment and training; care-providers competencies; previous medical records; provider-client interactions (direct observation); and client perspectives on care quality; using semi-structured questionnaires and data collectors with requisite training. In Bangladesh, the assessment was conducted in 3 districts. In one "intervention" district, the district hospital and five upazilla health complexes were assessed. similar number of facilities were assessed each two adjoining comparison districts. In Ghana it was in three hospitals and five health centres and in Tanzania, two hospitals and four health centres. In the latter countries, same number of facilities were selected in the same number of districts to serve for comparison. Outcomes were structured to examine whether facilities currently provide services commensurate with their designation (basic or comprehensive emergency obstetric and newborn care). These outcomes were stratified so that they inform intervention implementation in the short-, medium- and long-term. Conclusion This strategy and framework provides a very useful model for supporting country implementation of the new WHO standards. It will serve as a template around which countries can build quality of care assessment strategies and metrics to inform their health systems on the effect of QI interventions on care processes and outcomes.
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Affiliation(s)
- Alexander Manu
- London School of Hygiene & Tropical Medicine, London, UK. .,Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Shams Arifeen
- International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | - Edward Mwasanya
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Nabila Zaka
- United Nations Children's Fund/HQ, New York, USA
| | | | | | | | - Kim Dickson
- United Nations Fund for Population, Freetown, Sierra Leone
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Abstract
Background The first 28 days of life- the neonatal period is the most vulnerable time for a child's survival. Globally, neonatal mortality has seen a downward trend in recent years. The main objective of this study was to determine the percentage of neonatal mortality and to provide information on factors associated with neonatal mortality at the neonatal unit of a tertiary health facility or teaching hospital. Methods Data of neonates admitted to the neonatal in-patient unit of the Komfo Anokye Teaching Hospital (KATH) in Ghana from January 2013 to May 2014 were analyzed. Logistic regression model was performed to assess the association between neonatal mortality and predictors. Results A total of 5,195 neonatal admissions were recorded. The overall percentage of neonatal mortality was 20.2%. Infants with very low birth weight, having 5-minute Apgar score lower than 4, newborns with pre-term delivery, being referred from other health facilities, and being diagnosed with respiratory distress and birth asphyxia had a higher percentage of neonatal mortality. Conclusion The mortality at the neonatal in-patient unit at the Komfo Anokye Teaching Hospital in Ghana is very high. There is the need for continuous attention and interventions to help reduce the risk of mortality among neonates admitted to the facility.
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Affiliation(s)
- Benjamin Atta Owusu
- Department of Mathematics and Computer Science, Faculty of Science and Technology, Prince of Songkla University, Pattani, Thailand
| | - Apiradee Lim
- Department of Mathematics and Computer Science, Faculty of Science and Technology, Prince of Songkla University, Pattani, Thailand
| | - Nifatamah Makaje
- Department of Mathematics and Computer Science, Faculty of Science and Technology, Prince of Songkla University, Pattani, Thailand
| | - Priscilla Wobil
- Child Health Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Areeyuth SameAe
- Department of Mathematics and Computer Science, Faculty of Science and Technology, Prince of Songkla University, Pattani, Thailand
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Bell AJ, Wynn LV, Bakari A, Oppong SA, Youngblood J, Arku Z, Bockarie Y, Adu J, Wobil P, Plange-Rhule G, Goka B, Adanu RM, Moyer CA. "We call them miracle babies": How health care providers understand neonatal near-misses at three teaching hospitals in Ghana. PLoS One 2018; 13:e0198169. [PMID: 29847603 PMCID: PMC5976150 DOI: 10.1371/journal.pone.0198169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 04/14/2017] [Accepted: 05/15/2018] [Indexed: 11/19/2022] Open
Abstract
Neonatal mortality is a significant problem in many low-resource countries, yet for every death there are many more newborns who suffer a life-threatening complication but survive. These "near-misses" are not well defined, nor are they well understood. This study sought to explore how health care providers at three tertiary care centers in Ghana (each with neonatal intensive care units (NICUs)) understand the term "near-miss." Eighteen providers from the NICUs at three teaching hospitals in Ghana (Korle Bu Teaching Hospital in Accra, Komfo Anokye Teaching Hospital in Kumasi, and Cape Coast Teaching Hospital in Cape Coast) were interviewed in depth regarding their perceptions of neonatal morbidity, mortality, and survival. Near the end of the interview, they were specifically asked what they understood the term "near-miss" to mean. Participants included nurses and physicians at various levels and with varying years of practice (mean years of practice = 9.33, mean years in NICU = 3.66). Results indicate that the concept of "near-misses" is not universally understood, and providers differ on whether a baby is a near-miss or not. Providers disagreed on the utility of a near-miss classification for clinical practice, with some suggesting it would be helpful to draw their attention to those at highest risk of dying, with others suggesting that the acuity of illness in a NICU means any baby could become a 'near-miss' at any moment. Further efforts are needed to standardize the definitions of neonatal near-misses, including developing criteria that are able to be assessed in a low-resource setting. In addition, further research is warranted to determine the practical implications of using a near miss tool in the process of providing care in a resource-limited setting and whether it might be best reserved as a retrospective indicator of overall quality of care provided.
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Affiliation(s)
- April J. Bell
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Lynette V. Wynn
- Medical School, University of Michigan, Ann Arbor, MI, United States of America
| | - Ashura Bakari
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Child Health Department, Suntresu Hospital, Ghana Health Service, Kumasi, Ghana
| | - Samuel A. Oppong
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Jessica Youngblood
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Zelda Arku
- Neonatal Intensive Care Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Yemah Bockarie
- Neonatal Intensive Care Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Joseph Adu
- Department of Obstetrics and Gynaecology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Priscilla Wobil
- Child Health Department, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Bamenla Goka
- Department of Child Health, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | | | - Cheryl A. Moyer
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Medical School, University of Michigan, Ann Arbor, MI, United States of America
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
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Abstract
Intimate partner violence (IPV) is a major public health problem estimated to affect 15%-71% of women worldwide. We sought to elicit IPV risks among mothers of sick newborns in Ghana. As part of a broader study on postpartum depression, we conducted semistructured surveys of 153 women in a mother-baby unit, assessing demographics, depression, social support, and IPV with the present partner. Forty-six percent of mothers reported some form of violence, mostly emotional (34%), followed by physical (17%), and sexual (15%). The study highlights the frequency of perinatal IPV and the associated risk factors of depression and poor social support.
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Affiliation(s)
- Kathryn Spangenberg
- a Family Medicine, Polyclinic Directorate , Komfo Anokye Teaching Hospital , Kumasi , Ghana
| | - Priscilla Wobil
- b Department of Child Health , Komfo Anokye Teaching Hospital , Kumasi , Ghana
| | - Cassandra L Betts
- c Department of Internal Medicine , Oregon Health & Science University , Portland , Oregon , USA
| | - Theodore F Wiesner
- d Department of Emergency Medicine , Denver Health Medical Center , Denver , Colorado , USA
| | - Katherine J Gold
- e Department of Family Medicine; and Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , Michigan , USA
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Otupiri E, Wobil P, Nguah SB, Hindin MJ. Anthropometric measurements: options for identifying low birth weight newborns in Kumasi, Ghana. PLoS One 2014; 9:e106712. [PMID: 25226505 PMCID: PMC4165589 DOI: 10.1371/journal.pone.0106712] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 11/07/2013] [Accepted: 08/09/2014] [Indexed: 01/15/2023] Open
Abstract
Background In Ghana, 32% of deliveries take place outside a health facility, and birth weight is not measured. Low birth weight (LBW) newborns who are at increased risk of death and disability, are not identified; 13%–14% of newborns in Ghana are LBW. We aimed at determining whether alternative anthropometrics could be used to identify LBW newborns when weighing scales are not available to measure birth weight. Methods We studied 973 mother and newborn pairs at the Komfo Anokye Teaching and the Suntreso Government hospitals between November 2011 and October 2012. We used standard techniques to record anthropometric measurements of newborns within 24 hours of birth; low birth weight was defined as birth weight <2.5kg. Pearson's correlation coefficient and the area under the curve were used to determine the best predictors of low birth weight. The sensitivity, specificity and predictive values were reported with 95% confidence intervals at generated cut-off values. Results One-fifth (21.7%) of newborns weighed less than 2.5 kg. Among LBW newborns, the following measurements had the highest correlations with birth weight: chest circumference (r = 0.69), mid-upper arm circumference (r = 0.68) and calf circumference (r = 0.66); the areas under the curves of these three measurements demonstrated the highest accuracy in determining LBW newborns. Chest, mid-upper arm and calf circumferences at cut-off values of ≤29.8 cm, ≤9.4 cm and ≤9.5 cm respectively, had the best combination of maximum sensitivity, specificity and predictive values for identifying newborns with LBW. Conclusions Anthropometric measurements, such as the chest circumference, mid-upper arm circumference and calf circumference, offer an opportunity for the identification of and subsequent support for LBW newborns in settings in Ghana, where birth weights are not measured by standardized weighing scales.
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Affiliation(s)
- Easmon Otupiri
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- * E-mail:
| | | | | | - Michelle J. Hindin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Abstract
BACKGROUND Maternal knowledge about serious infant illnesses has significant implications for care after discharge, particularly in countries with high infant mortality rates. No existing studies on this topic in low-income countries were identified. The study sought to identify the level of maternal understanding about why a newborn was hospitalized and how mothers in Ghana attributed blame for the illness. METHODS The project team conducted semi-structured interviews with mothers aged 18 and older who had infants hospitalized in a tertiary care facility in Kumasi, Ghana, and collected data on demographics, pregnancy and delivery, and beliefs about their infant's illness. Infant charts were abstracted to identify medical reasons for hospitalization for comparison with the mother's understanding, and levels of understanding were coded as 'none', 'partial' or 'full'. RESULTS 153 mothers were interviewed and their average age was 28. For 27%, this was their first pregnancy. Forty per cent of mothers had no understanding of why their infant was in the hospital and 28% had only partial understanding. One-third of the women reported blaming themselves for the child's illness. In multivariable analysis, demographic factors including maternal age, education, primiparous status, and urban vs rural residence did not predict maternal understanding or self-blame. CONCLUSIONS Sick newborns in low-income countries are at very high risk of adverse outcomes. Mothers who lack a clear understanding of why their infant is in the hospital might have difficulty communicating preferences about care, understanding the type of care that is being given, and recognizing future warning signs of illness. Such gaps in understanding could put the discharged infant at significant risk.
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Gold KJ, Spangenberg K, Wobil P, Schwenk TL. Depression and risk factors for depression among mothers of sick infants in Kumasi, Ghana. Int J Gynaecol Obstet 2012; 120:228-31. [PMID: 23228821 DOI: 10.1016/j.ijgo.2012.09.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 09/11/2012] [Accepted: 11/13/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the prevalence of and risk factors for depression in a high-risk population of mothers of ill newborns in Ghana. METHODS Semi-structured interviews were conducted with women who had a hospitalized newborn at a tertiary teaching hospital in Kumasi, Ghana. Surveys included information on maternal demographics, pregnancy and delivery, interpersonal violence, and social support. Postpartum depression was measured with the Patient Health Questionnaire (PHQ)-9. Bivariable analysis was conducted using analysis of variance, χ(2), and Fisher exact tests; multivariable analysis was performed using multinomial logistic regression. RESULTS In total, 153 women completed the survey. Fifty (32.7%) had PHQ-9 scores of 5-9, indicating mild depression; 42 (27.4%) had PHQ-9 scores of 10-14, indicating moderate depression; and 15 (9.8%) had scores of 15 or higher, indicative of moderate/severe depression. History of interpersonal violence with current partner predicted depression. CONCLUSION Mothers of sick infants in Ghana are at high risk for symptoms of clinical depression. This is of critical importance because maternal depression affects infant health outcomes and may be particularly important for mothers of sick infants.
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Affiliation(s)
- Katherine J Gold
- Department of Family Medicine, University of Michigan, Ann Arbor, MI 48104-1213, USA.
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