A clustered randomized control trial to assess feasibility, acceptability, and impact of implementing the birth companion intervention package in Ethiopia, Kenya, and Nigeria: study protocol

BACKGROUND

A birth companion is a simple and low-cost intervention that can improve both maternal and newborn health outcomes. The evidence that birth companionship improves labor outcomes and experiences of care has been available for many years. Global and national policies exist in support of birth companions. Many countries including Ethiopia, Kenya, and Nigeria have not yet incorporated birth companions into routine practice in health facilities. This paper presents the protocol for a trial that aims to assess if a package of interventions that addresses known barriers can increase the coverage of birth companions.

METHODS

This two parallel arm cluster randomized controlled trial will evaluate the impact of a targeted intervention package on scale-up of birth companionship at public sector health facilities in Ethiopia (five study sites encompassing 12 facilities), Kenya (two sites encompassing 12 facilities in Murang'a and 12 facilities in Machakos counties), and Nigeria (two sites encompassing 12 facilities in Kano and 12 facilities in Nasarawa states). Baseline and endline assessments at each site will include 744 women who have recently given birth in the quantitative component. We will interview a maximum of 16 birth companions, 48 health care providers, and eight unit managers quarterly for the qualitative component in each country.

DISCUSSION

Ample evidence supports the contribution of birth companions to positive health outcomes for mothers and newborns. However, limited data are available on effective strategies to improve birth companion coverage and inform scale-up efforts. This trial tests a birth companion intervention package in diverse clinical settings and cultures to identify possible barriers and considerations to increasing uptake of birth companions. Findings from this study may provide valuable evidence for scaling up birth companionship in similar settings.

TRIAL REGISTRATION

Trial is registered with ClinicalTrials.gov with identifier: NCT05565196, first posted 04/10/ 2022.

Eclampsia a preventable tragedy: an African overview

Eclampsia is a multisystemic disease associated with various complications which individually or in combination can lead to maternal/fetal morbidity and mortality. Developed countries and some developing countries were largely successful in reducing the incidence of eclampsia. Developing countries especially those in Sub-Saharan Africa (SSA) are still dealing with high incidence of eclampsia. The question is why have the incidence and mortality of eclampsia remained high in SSA? The risk factors for this disease are globally the same but a critical assessment showed that there are certain risk factors that are common in Sub-Saharan Africa (multiple pregnancy, sickle cell disease, pregnancies at the extremes of reproductive age, pre-existing vasculitis). In addition, there are compounding factors (illiteracy, poverty, superstitious beliefs, poor prenatal care services, poorly trained manpower and lack of facilities to cater for patients). Addressing the menace of this disease require a holistic approach which among others, includes education to address beliefs and reduce harmful practices, poverty alleviation which will improve the ability for communities to afford health care services. Improving transport services to convey patients quickly to facilities on time when there is need. Improving the health infrastructure, building more facilities, providing trained and motivated manpower and regular supply of quality essential drugs for the management of the disease. This review is meant to analyze factors prevalent in Sub-Saharan that hinder reducing incidence of the disease and provide comprehensive and cost-effective solutions.

Impediments to maternal mortality reduction in Africa: a systemic and socioeconomic overview

Maternal mortality is nowadays more of a problem of developing countries especially those in Sub-Saharan Africa (SSA). Maternal mortality has to large extent been eliminated in developed countries and has drastically been reduced in many other regions of the world. The maternal mortality rate (MMR) available in the literature from Africa is not a true reflection of the actual MMR as it is derived from institutional studies. The causes of maternal mortality in SSA are the same as those in developed countries. The means of addressing maternal mortality used in developed countries are the same as those used in developing countries, however, the success levels are not the same. There are various impediments to reducing maternal mortality with roots in cultural, social, economic and systemic factors prevalent in SSA. An in-depth study of these factors will give an insight as to why maternal mortality reduction has remained an enigma in SSA. Analyzing these factors will guide us to design and implement measures that will in the long run lead to significant maternal mortality reduction in SSA. The aim of this review is to identify impediments to maternal mortality reduction in SSA and highlight measures that can lead to maternal mortality reduction.

Care-seeking behavior for neonatal jaundice in rural northern Nigeria

Objective

This study determined the predictors of maternal knowledge and health-seeking behavior for neonatal jaundice in rural Kumbotso, northern Nigeria.

Study design

Cross-sectional survey.

Method

A total of 361 mothers were interviewed using structured questionnaires. Knowledge scores and care-seeking practices were determined. Adjusted odds ratios were generated from logistic regression models.

Results

The proportion of respondents with good, fair and poor knowledge of neonatal jaundice were (46.0%, n ​= ​166), (24.1%, n ​= ​87) and (30.0%, n ​= ​108), respectively. Of the 117 mothers with a jaundiced child, (67.5%, n ​= ​79) and (20.5%, n ​= ​24) received treatment from health facilities and traditional healers, respectively, whereas (12.0%, n ​= ​14) resorted to home remedies. Maternal education Adjusted Odds Ratio (AOR) ​= ​2.39; 95% Confidence Interval (CI): 1.16–4.91) (secondary school versus no formal), source of information on neonatal jaundice (AOR ​= ​11.3; 95%CI: 5.84–21.93) (health worker versus ‘others’), recent delivery in a health facility (AOR ​= ​1.83; 95%CI: 1.06–3.14) and having a previously jaundiced child (AOR ​= ​5.06; 95%CI: 2.76–9.27) predicted knowledge. Preference for health facility treatment was predicted by a previously jaundiced child (AOR ​= ​10.04; 95%CI: 5.73–17.60), antenatal care (AOR ​= ​2.97; 95%CI: 1.43–6.15) (≥4 versus 0 visits), source of information on neonatal jaundice (AOR ​= ​2.33; 95%CI: 1.30–4.17) (health worker versus ‘others’), and maternal ethnicity (AOR ​= ​0.36; 95%CI: 0.14–0.96) (Hausa-Fulani versus ‘others’).

Conclusion

Maternal knowledge of neonatal jaundice was sub-optimal. Being educated, health facility delivery, having had a jaundiced child, and receiving information from health workers predicted good knowledge. Having a previously jaundiced child, antenatal care, obtaining information from health workers and maternal ethnicity predicted preference for health facility treatment. Policies and programs should be strengthened to focus on prevention, early detection and prompt management of neonatal jaundice.

Molecular characterization of invasive Enterobacteriaceae from pediatric patients in Central and Northwestern Nigeria

Background

Bacteremia is a leading cause of mortality in developing countries, however, etiologic evaluation is infrequent and empiric antibiotic use not evidence-based. Here, we evaluated the patterns of ESBL resistance in children enrolled into a surveillance study for community acquired bacteremic syndromes across health facilities in Central and Northwestern Nigeria.

Method

Blood culture was performed for children aged less than 5 years suspected of having sepsis from Sept 2008-Dec 2016. Blood was incubated using the BACTEC^00AE system and Enterobacteriacea identified to the species level using Analytical Profile Index (API20E^®). Antibiotic susceptibility profile was determined by the disc diffusion method. Real time PCR was used to characterize genes responsible for ESBL production.

Result

Of 21,000 children screened from Sept 2008-Dec 2016, 2,625(12.5%) were culture-positive. A total of 413 Enterobacteriaceae available for analysis were screened for ESBL. ESBL production was detected in 160 Enterobacteriaceae, high resistance rates were observed among ESBL-positive isolates for Ceftriaxone (92.3%), Aztreonam (96.8%), Cefpodoxime (96.3%), Cefotaxime (98.8%) and Trimethoprim/sulfamethoxazole (90%), while 87.5%, 90.7%, and 91.9% of the isolates were susceptible to Imipenem, Amikacin and Meropenem respectively. Frequently detected resistance genes were blaTEM—83.8% (134/160), and, blaCTX-M 83.1% (133/160) followed by blaSHVgenes 66.3% (106/160). Co-existence of blaCTX-M, blaTEM and blaSHV was seen in 94/160 (58.8%), blaCTX-M and blaTEM in 118/160 (73.8%), blaTEM and blaSHV in 97/160 (60.6%) and blaCTX-M and blaSHV in 100/160 (62.5%) of isolates tested.

Conclusion

Our results indicate a high prevalence of bacteremia from ESBL Enterobacteriaceae in this population of children. These are resistant to commonly used antibiotics and careful choice of antibiotic treatment options is critical. Further studies to evaluate transmission dynamics of resistance genes could help in the reduction of ESBL resistance in these settings.