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McCormack LA, Smith DL, Schiltz C, Boadwine D, Ruiter J, Mahagnoul P, Jaton E, McKay K. A Perinatal Extension for the Community Healthcare Outcomes (ECHO) Program to Improve Rural Obstetrics Care. Am J Public Health 2024; 114:S304-S305. [PMID: 38748957 PMCID: PMC11096768 DOI: 10.2105/ajph.2024.307622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Lacey A McCormack
- Lacey A. McCormack, Diane L. Smith, and Paula Mahagnoul are with the Avera Research Institute, Sioux Falls, SD. Catherine Schiltz, Dominique Boadwine, Juanita Ruiter, and Kimberlee McKay are with the Avera Medical Group, Sioux Falls, SD. Eric Jaton is with the University of South Dakota School of Medicine, Sioux Falls, SD
| | - Diane L Smith
- Lacey A. McCormack, Diane L. Smith, and Paula Mahagnoul are with the Avera Research Institute, Sioux Falls, SD. Catherine Schiltz, Dominique Boadwine, Juanita Ruiter, and Kimberlee McKay are with the Avera Medical Group, Sioux Falls, SD. Eric Jaton is with the University of South Dakota School of Medicine, Sioux Falls, SD
| | - Catherine Schiltz
- Lacey A. McCormack, Diane L. Smith, and Paula Mahagnoul are with the Avera Research Institute, Sioux Falls, SD. Catherine Schiltz, Dominique Boadwine, Juanita Ruiter, and Kimberlee McKay are with the Avera Medical Group, Sioux Falls, SD. Eric Jaton is with the University of South Dakota School of Medicine, Sioux Falls, SD
| | - Dominique Boadwine
- Lacey A. McCormack, Diane L. Smith, and Paula Mahagnoul are with the Avera Research Institute, Sioux Falls, SD. Catherine Schiltz, Dominique Boadwine, Juanita Ruiter, and Kimberlee McKay are with the Avera Medical Group, Sioux Falls, SD. Eric Jaton is with the University of South Dakota School of Medicine, Sioux Falls, SD
| | - Juanita Ruiter
- Lacey A. McCormack, Diane L. Smith, and Paula Mahagnoul are with the Avera Research Institute, Sioux Falls, SD. Catherine Schiltz, Dominique Boadwine, Juanita Ruiter, and Kimberlee McKay are with the Avera Medical Group, Sioux Falls, SD. Eric Jaton is with the University of South Dakota School of Medicine, Sioux Falls, SD
| | - Paula Mahagnoul
- Lacey A. McCormack, Diane L. Smith, and Paula Mahagnoul are with the Avera Research Institute, Sioux Falls, SD. Catherine Schiltz, Dominique Boadwine, Juanita Ruiter, and Kimberlee McKay are with the Avera Medical Group, Sioux Falls, SD. Eric Jaton is with the University of South Dakota School of Medicine, Sioux Falls, SD
| | - Eric Jaton
- Lacey A. McCormack, Diane L. Smith, and Paula Mahagnoul are with the Avera Research Institute, Sioux Falls, SD. Catherine Schiltz, Dominique Boadwine, Juanita Ruiter, and Kimberlee McKay are with the Avera Medical Group, Sioux Falls, SD. Eric Jaton is with the University of South Dakota School of Medicine, Sioux Falls, SD
| | - Kimberlee McKay
- Lacey A. McCormack, Diane L. Smith, and Paula Mahagnoul are with the Avera Research Institute, Sioux Falls, SD. Catherine Schiltz, Dominique Boadwine, Juanita Ruiter, and Kimberlee McKay are with the Avera Medical Group, Sioux Falls, SD. Eric Jaton is with the University of South Dakota School of Medicine, Sioux Falls, SD
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Roder N, Bhadra-Heintz N, Cronholm PF, Donze M, DeMarco MP. Integrating Perinatal Addiction Medicine Education Into Family Medicine Residency Programs: The Perinatal Resources for Opiate Use Disorder Program. Am J Public Health 2024; 114:S306-S307. [PMID: 38748953 PMCID: PMC11096756 DOI: 10.2105/ajph.2024.307623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Navid Roder
- Navid Roder and Melissa Donze are with the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia. Nia Bhadra-Heintz is with the Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia. Peter F. Cronholm and Mario P. DeMarco are with the Department of Family Medicine and Community Health and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Nia Bhadra-Heintz
- Navid Roder and Melissa Donze are with the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia. Nia Bhadra-Heintz is with the Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia. Peter F. Cronholm and Mario P. DeMarco are with the Department of Family Medicine and Community Health and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Peter F Cronholm
- Navid Roder and Melissa Donze are with the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia. Nia Bhadra-Heintz is with the Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia. Peter F. Cronholm and Mario P. DeMarco are with the Department of Family Medicine and Community Health and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Melissa Donze
- Navid Roder and Melissa Donze are with the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia. Nia Bhadra-Heintz is with the Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia. Peter F. Cronholm and Mario P. DeMarco are with the Department of Family Medicine and Community Health and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Mario P DeMarco
- Navid Roder and Melissa Donze are with the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia. Nia Bhadra-Heintz is with the Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia. Peter F. Cronholm and Mario P. DeMarco are with the Department of Family Medicine and Community Health and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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de Luis Rosell D, Martín-Ancel A, de Veciana AR, Habimana-Jordana A, Palomo AM. Structured programs in perinatal palliative care improve medical assistance. An Pediatr (Barc) 2024; 100:376-377. [PMID: 38714460 DOI: 10.1016/j.anpede.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/13/2024] [Indexed: 05/09/2024] Open
Affiliation(s)
| | - Ana Martín-Ancel
- Servicio de Neonatología, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Ana Riverola de Veciana
- Servicio de Neonatología, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Anna Habimana-Jordana
- Servicio de Neonatología, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Ana Morillo Palomo
- Servicio de Neonatología, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
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Maaløe N, Housseine N, Sørensen JB, Obel J, Sequeira DMello B, Kujabi ML, Osaki H, John TW, Khamis RS, Muniro ZSS, Nkungu DJ, Pinkowski Tersbøl B, Konradsen F, Mookherji S, Mbekenga C, Meguid T, van Roosmalen J, Bygbjerg IC, van den Akker T, Jensen AK, Skovdal M, L. Kidanto H, Wolf Meyrowitsch D. Scaling up context-tailored clinical guidelines and training to improve childbirth care in urban, low-resource maternity units in Tanzania: A protocol for a stepped-wedged cluster randomized trial with embedded qualitative and economic analyses (The PartoMa Scale-Up Study). Glob Health Action 2022; 15:2034135. [PMID: 35410590 PMCID: PMC9009913 DOI: 10.1080/16549716.2022.2034135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 07/04/2021] [Accepted: 01/21/2022] [Indexed: 11/04/2022] Open
Abstract
While facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore, realistic, context-tailored clinical support is crucially needed to assist birth attendants in resource-constrained realities to provide best possible evidence-based and respectful care. Our pilot study in Zanzibar suggested that co-created clinical practice guidelines (CPGs) and low-dose, high-frequency training (PartoMa intervention) were associated with improved childbirth care and survival. We now aim to modify, implement, and evaluate this multi-faceted intervention in five high-volume, urban maternity units in Dar es Salaam, Tanzania (approximately 60,000 births annually). This PartoMa Scale-up Study will include four main steps: I. Mixed-methods situational analysis exploring factors affecting care; II. Co-created contextual modifications to the pilot CPGs and training, based on step I; III. Implementation and evaluation of the modified intervention; IV. Development of a framework for co-creation of context-specific CPGs and training, of relevance in comparable fields. The implementation and evaluation design is a theory-based, stepped-wedged cluster-randomised trial with embedded qualitative and economic assessments. Women in active labour and their offspring will be followed until discharge to assess provided and experienced care, intra-hospital perinatal deaths, Apgar scores, and caesarean sections that could potentially be avoided. Birth attendants' perceptions, intervention use and possible associated learning will be analysed. Moreover, as further detailed in the accompanying article, a qualitative in-depth investigation will explore behavioural, biomedical, and structural elements that might interact with non-linear and multiplying effects to shape health providers' clinical practices. Finally, the incremental cost-effectiveness of co-creating and implementing the PartoMa intervention is calculated. Such real-world scale-up of context-tailored CPGs and training within an existing health system may enable a comprehensive understanding of how impact is achieved or not, and how it may be translated between contexts and sustained.Trial registration number: NCT04685668.
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Affiliation(s)
- Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Natasha Housseine
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Jane Brandt Sørensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Josephine Obel
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Brenda Sequeira DMello
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
- Comprehensive Community Based Rehabilitation in Tanzania, Dar Es Salaam, Tanzania
| | - Monica Lauridsen Kujabi
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Haika Osaki
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Thomas Wiswa John
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Rashid Saleh Khamis
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | | | | | - Britt Pinkowski Tersbøl
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Konradsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sangeeta Mookherji
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Columba Mbekenga
- School of Nursing and Midwifery East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | | | - Jos van Roosmalen
- Athena Institute, VU University, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas van den Akker
- Athena Institute, VU University, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Andreas Kryger Jensen
- Section for Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Morten Skovdal
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hussein L. Kidanto
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Dan Wolf Meyrowitsch
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Abstract
Despite substantial improvement in reducing maternal mortality during the recent decades, we constantly face tragic fact that maternal mortality (especially preventable deaths) is still unacceptably too high, particularly in the developing countries, where 99% of all maternal deaths worldwide occur. Poverty, lack of proper statistics, gender inequality, beliefs and corruption-associated poor governmental policies are just few of the reasons why decline in maternal mortality has not been as sharp as it was wished and expected. Education has not yet been fully recognized as the way out of poverty, improvement of women's role in the society and consequent better perinatal care and consequent lower maternal mortality. Education should be improved on all levels including girls, women and their partners, medical providers, religious and governmental authorities. Teaching the teachers should be also an essential part of global strategy to lower maternal mortality. This paper is mostly a commentary, not a systematic review nor a meta-analysis with the aim to rise attention (again) to the role of different aspects of education in lowering maternal mortality. The International Academy of Perinatal Medicine should play a crucial role in pushing the efforts on this issue as the influential instance that promotes reflection and dialog in perinatal medicine, especially in aspects such as bioethics, the appropriate use of technological advances, and the sociological and humanistic dimensions of this specific problem of huge magnitude. The five concrete steps to achieve these goals are listed and discussed.
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Affiliation(s)
- Vedran Stefanovic
- IAPM Educational Committee, Department of Obstetrics and Gynecology, Fetomaternal Medical Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Alves AC, Cecatti JG, Souza RT. Resilience and Stress during Pregnancy: A Comprehensive Multidimensional Approach in Maternal and Perinatal Health. ScientificWorldJournal 2021; 2021:9512854. [PMID: 34434079 PMCID: PMC8382548 DOI: 10.1155/2021/9512854] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022] Open
Abstract
This narrative review addresses resilience and stress during pregnancy, which is part of a broader concept of maternal health. Pregnancy and postpartum are opportune periods for health promotion interventions, especially because the close contact of the women with health professionals. In this way, it can be considered a useful window of opportunity to identify women at higher risk for adverse outcomes. Integrated health is a concept that aims at providing comprehensive care related to the promotion of individuals' physical, mental, and social well-being. In this context, stress during pregnancy has been targeted as a remarkable condition to be addressed whether due to individual issues, social issues, or specific pregnancy issues, since it is directly and indirectly associated with pregnancy complications. Stress is associated with preterm birth, postpartum depression, anxiety, child neurodevelopment, and fetal distress. The way that an individual faces a stressful and adverse situation is called resilience; this reaction is individual, dynamic, and contextual, and it can affect maternal and fetal outcomes. Low resilience has been associated with poorer pregnancy outcomes. The social context of pregnancy can act as a protective or contributory (risk) factor, indicating that environments of high social vulnerability play a negative role in resilience and, consequently, in perceived stress. A given stressor can be enhanced or mitigated depending on the social context that was imposed, as well as it can be interpreted as different degrees of perceived stress and faced with a higher or lower degree of resilience. Understanding these complex mechanisms may be valuable for tackling this matter. Therefore, in the pregnancy-puerperal period, the analysis of the stress-resilience relationship is essential, especially in contexts of greater social vulnerability, and is a health-promoting factor for both the mother and baby.
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Affiliation(s)
- A. C. Alves
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - J. G. Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - R. T. Souza
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
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Dixon-Shambley K, Gabbe PT. Using Telehealth Approaches to Address Social Determinants of Health and Improve Pregnancy and Postpartum Outcomes. Clin Obstet Gynecol 2021; 64:333-344. [PMID: 33882522 DOI: 10.1097/grf.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Telehealth has expanded its reach significantly since its inception due to the advances in technology over the last few decades. Social determinants of health (SDOH) negatively impact the health of pregnant and postpartum women and need to be considered when deploying telehealth strategies. In this article, we describe telehealth modalities and their application to improve the SDOH that impact pregnancy and postpartum outcomes. Physicians and patients alike report satisfaction with telehealth as it improves access to education, disease monitoring, specialty care, prenatal and postpartum care. Ten years ago, we developed a program, Moms2B, to eliminate disparities in pregnancy outcomes for underserved women. Using a case study, we describe how Moms2B, devoted to improve the SDOH for pregnant women, transitioned from an in-person to a virtual format. Telehealth benefited women before the recent coronavirus disease 2019 pandemic and increasingly after emergency authorizations has allowed telehealth to flourish.
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Affiliation(s)
| | - Patricia T Gabbe
- Departments of Obstetrics and Gynecology
- Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
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Westergren A, Edin K, Christianson M. Reproducing normative femininity: Women's evaluations of their birth experiences analysed by means of word frequency and thematic analysis. BMC Pregnancy Childbirth 2021; 21:300. [PMID: 33853542 PMCID: PMC8045345 DOI: 10.1186/s12884-021-03758-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Given the significance of the birth experience on women's and babies' well-being, assessing and understanding maternal satisfaction is important for providing optimal care. While previous research has thoroughly reviewed women's levels of satisfaction with the childbirth experience from a multitude of different angles, there is a dearth of papers that use a gender lens in this area. The aim of this study is to explore through a gender perspective the circumstances attributed to both women's assessment of a positive birth experience and those which contribute to a lack of satisfaction with their birth experience. METHODS Through the use of a local birth evaluation form at a Swedish labour ward, 190 women gave written evaluations of their birth experiences. The evaluations were divided into groups of positive, ambiguous, and negative evaluations. By means of a latent and constructionist thematic analysis based on word count, women's evaluations are discussed as reflections of the underlying sociocultural ideas, assumptions, and ideologies that shape women's realities. RESULTS Three themes were identified: Grateful women and nurturing midwives doing gender together demonstrates how a gender-normative behaviour may influence a positive birth experience when based on a reciprocal relationship. Managing ambiguous feelings by sympathising with the midwife shows how women's internalised sense of gender can make women belittle their negative experiences and refrain from delivering criticism. The midwifery model of relational care impeded by the labour care organisation describes how the care women receive during labour and birth is regulated by an organisation not always adapted to the benefit of birthing women. CONCLUSIONS Most women were very satisfied, predominantly with emotional support they received from the midwives. The latent constructionist thematic analysis also elicited women's mixed feelings towards the birth experience, with the majority of negative experiences directed towards the labour care organisation. Recognising the impact of institutional and medical discourses on childbirth, women's birth evaluations demonstrate the benefits and challenges of gender-normative behaviour, where women's internalised sense of gender was found to affect their experiences. A gender perspective may provide a useful tool in unveiling gender-normative complexities surrounding the childbirth experience.
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Affiliation(s)
- Agneta Westergren
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden.
- The Graduate School of Gender Studies, Umeå University, Umeå, Sweden.
| | - Kerstin Edin
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Shamba D, Day LT, Zaman SB, Sunny AK, Tarimo MN, Peven K, Khan J, Thakur N, Talha MTUS, K C A, Haider R, Ruysen H, Mazumder T, Rahman MH, Shaikh MZH, Sæbø JI, Hanson C, Singh NS, Schellenberg J, Vaz LME, Requejo J, Lawn JE. Barriers and enablers to routine register data collection for newborns and mothers: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:233. [PMID: 33765963 PMCID: PMC7995573 DOI: 10.1186/s12884-020-03517-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Policymakers need regular high-quality coverage data on care around the time of birth to accelerate progress for ending preventable maternal and newborn deaths and stillbirths. With increasing facility births, routine Health Management Information System (HMIS) data have potential to track coverage. Identifying barriers and enablers faced by frontline health workers recording HMIS source data in registers is important to improve data for use. METHODS The EN-BIRTH study was a mixed-methods observational study in five hospitals in Bangladesh, Nepal and Tanzania to assess measurement validity for selected Every Newborn coverage indicators. We described data elements required in labour ward registers to track these indicators. To evaluate barriers and enablers for correct recording of data in registers, we designed three interview tools: a) semi-structured in-depth interview (IDI) guide b) semi-structured focus group discussion (FGD) guide, and c) checklist assessing care-to-documentation. We interviewed two groups of respondents (January 2018-March 2019): hospital nurse-midwives and doctors who fill ward registers after birth (n = 40 IDI and n = 5 FGD); and data collectors (n = 65). Qualitative data were analysed thematically by categorising pre-identified codes. Common emerging themes of barriers or enablers across all five hospitals were identified relating to three conceptual framework categories. RESULTS Similar themes emerged as both barriers and enablers. First, register design was recognised as crucial, yet perceived as complex, and not always standardised for necessary data elements. Second, register filling was performed by over-stretched nurse-midwives with variable training, limited supervision, and availability of logistical resources. Documentation complexity across parallel documents was time-consuming and delayed because of low staff numbers. Complete data were valued more than correct data. Third, use of register data included clinical handover and monthly reporting, but little feedback was given from data users. CONCLUSION Health workers invest major time recording register data for maternal and newborn core health indicators. Improving data quality requires standardised register designs streamlined to capture only necessary data elements. Consistent implementation processes are also needed. Two-way feedback between HMIS levels is critical to improve performance and accurately track progress towards agreed health goals.
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Affiliation(s)
- Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK.
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Menna Narcis Tarimo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Kimberly Peven
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Jasmin Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Md Taqbir Us Samad Talha
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashish K C
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Rajib Haider
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - Tapas Mazumder
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Hafizur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Ziaul Haque Shaikh
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Claudia Hanson
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
- Global Public Health Karolinska Institutet, Stockholm, Sweden
| | - Neha S Singh
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - Joanna Schellenberg
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - Lara M E Vaz
- International Programs, Population Reference Bureau, Washington DC, USA
| | | | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
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Ameen S, Siddique AB, Peven K, Rahman QSU, Day LT, Shabani J, Kc A, Boggs D, Shamba D, Tahsina T, Rahman AE, Zaman SB, Hossain AT, Ahmed A, Basnet O, Malla H, Ruysen H, Blencowe H, Arnold F, Requejo J, Arifeen SE, Lawn JE. Survey of women's report for 33 maternal and newborn indicators: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:238. [PMID: 33765956 PMCID: PMC7995710 DOI: 10.1186/s12884-020-03425-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Population-based household surveys, notably the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), remain the main source of maternal and newborn health data for many low- and middle-income countries. As part of the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study, this paper focuses on testing validity of measurement of maternal and newborn indicators around the time of birth (intrapartum and postnatal) in survey-report. METHODS EN-BIRTH was an observational study testing the validity of measurement for selected maternal and newborn indicators in five secondary/tertiary hospitals in Bangladesh, Nepal and Tanzania, conducted from July 2017 to July 2018. We compared women's report at exit survey with the gold standard of direct observation or verification from clinical records for women with vaginal births. Population-level validity was assessed by validity ratios (survey-reported coverage: observer-assessed coverage). Individual-level accuracy was assessed by sensitivity, specificity and percent agreement. We tested indicators already in DHS/MICS as well as indicators with potential to be included in population-based surveys, notably the first validation for small and sick newborn care indicators. RESULTS 33 maternal and newborn indicators were evaluated. Amongst nine indicators already present in DHS/MICS, validity ratios for baby dried or wiped, birthweight measured, low birthweight, and sex of baby (female) were between 0.90-1.10. Instrumental birth, skin-to-skin contact, and early initiation of breastfeeding were highly overestimated by survey-report (2.04-4.83) while umbilical cord care indicators were massively underestimated (0.14-0.22). Amongst 24 indicators not currently in DHS/MICS, two newborn contact indicators (kangaroo mother care 1.00, admission to neonatal unit 1.01) had high survey-reported coverage amongst admitted newborns and high sensitivity. The remaining indicators did not perform well and some had very high "don't know" responses. CONCLUSIONS Our study revealed low validity for collecting many maternal and newborn indicators through an exit survey instrument, even with short recall periods among women with vaginal births. Household surveys are already at risk of overload, and some specific clinical care indicators do not perform well and may be under-powered. Given that approximately 80% of births worldwide occur in facilities, routine registers should also be explored to track coverage of key maternal and newborn health interventions, particularly for clinical care.
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Affiliation(s)
- Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
| | - Abu Bakkar Siddique
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Kimberly Peven
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Ashish Kc
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Dorothy Boggs
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Omkar Basnet
- Research Division, Golden Community, Lalitpur, Nepal
| | - Honey Malla
- Research Division, Golden Community, Lalitpur, Nepal
| | - Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Fred Arnold
- Demographic and Health Survey Program, ICF, Rockville, MD, USA
| | - Jennifer Requejo
- Division of Data, Analysis, Planning and Monitoring, United Nations Children's Fund, Headquarters, New York, New York, USA
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
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Tahsina T, Hossain AT, Ruysen H, Rahman AE, Day LT, Peven K, Rahman QSU, Khan J, Shabani J, Kc A, Mazumder T, Zaman SB, Ameen S, Kong S, Amouzou A, Lincetto O, El Arifeen S, Lawn JE. Immediate newborn care and breastfeeding: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:237. [PMID: 33765946 PMCID: PMC7995709 DOI: 10.1186/s12884-020-03421-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Immediate newborn care (INC) practices, notably early initiation of breastfeeding (EIBF), are fundamental for newborn health. However, coverage tracking currently relies on household survey data in many settings. "Every Newborn Birth Indicators Research Tracking in Hospitals" (EN-BIRTH) was an observational study validating selected maternal and newborn health indicators. This paper reports results for EIBF. METHODS The EN-BIRTH study was conducted in five public hospitals in Bangladesh, Nepal, and Tanzania, from July 2017 to July 2018. Clinical observers collected tablet-based, time-stamped data on EIBF and INC practices (skin-to-skin within 1 h of birth, drying, and delayed cord clamping). To assess validity of EIBF measurement, we compared observation as gold standard to register records and women's exit-interview survey reports. Percent agreement was used to assess agreement between EIBF and INC practices. Kaplan Meier survival curves showed timing. Qualitative interviews were conducted to explore barriers/enablers to register recording. RESULTS Coverage of EIBF among 7802 newborns observed for ≥1 h was low (10.9, 95% CI 3.8-21.0). Survey-reported (53.2, 95% CI 39.4-66.8) and register-recorded results (85.9, 95% CI 58.1-99.6) overestimated coverage compared to observed levels across all hospitals. Registers did not capture other INC practices apart from breastfeeding. Agreement of EIBF with other INC practices was high for skin-to-skin (69.5-93.9%) at four sites, but fair/poor for delayed cord-clamping (47.3-73.5%) and drying (7.3-29.0%). EIBF and skin-to-skin were the most delayed and EIBF rarely happened after caesarean section (0.5-3.6%). Qualitative findings suggested that focusing on accuracy, as well as completeness, contributes to higher quality with register reporting. CONCLUSIONS Our study highlights the importance of tracking EIBF despite measurement challenges and found low coverage levels, particularly after caesarean births. Both survey-reported and register-recorded data over-estimated coverage. EIBF had a strong agreement with skin-to-skin but is not a simple tracer for other INC indicators. Other INC practices are challenging to measure in surveys, not included in registers, and are likely to require special studies or audits. Continued focus on EIBF is crucial to inform efforts to improve provider practices and increase coverage. Investment and innovation are required to improve measurement.
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Affiliation(s)
- Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Louise T Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Kimberly Peven
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Jasmin Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Ashish Kc
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Tapas Mazumder
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Stefanie Kong
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Agbessi Amouzou
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | | | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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12
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Gladstone ME, Salim N, Ogillo K, Shamba D, Gore-Langton GR, Day LT, Blencowe H, Lawn JE. Birthweight measurement processes and perceived value: qualitative research in one EN-BIRTH study hospital in Tanzania. BMC Pregnancy Childbirth 2021; 21:232. [PMID: 33765959 PMCID: PMC7995566 DOI: 10.1186/s12884-020-03356-2] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Globally an estimated 20.5 million liveborn babies are low birthweight (LBW) each year, weighing less than 2500 g. LBW babies have increased risk of mortality even beyond the neonatal period, with an ongoing risk of stunting and non-communicable diseases. LBW is a priority global health indicator. Now almost 80% of births are in facilities, yet birthweight data are lacking in most high-mortality burden countries and are of poor quality, notably with heaping especially on values ending in 00. We aimed to undertake qualitative research in a regional hospital in Dar es Salaam, Tanzania, observing birthweight weighing scales, exploring barriers and enablers to weighing at birth as well as perceived value of birthweight data to health workers, women and stakeholders. METHODS Observations were undertaken on type of birthweight scale availability in hospital wards. In-depth semi-structured interviews (n = 21) were conducted with three groups: women in postnatal and kangaroo mother care wards, health workers involved in birthweight measurement and recording, and stakeholders involved in data aggregation in Temeke Hospital, Tanzania, a site in the EN-BIRTH study. An inductive thematic analysis was undertaken of translated interview transcripts. RESULTS Of five wards that were expected to have scales, three had functional scales, and only one of the functional scales was digital. The labour ward weighed the most newborns using an analogue scale that was not consistently zeroed. Hospital birthweight data were aggregated monthly for reporting into the health management information system. Birthweight measurement was highly valued by all respondents, notably families and healthcare workers, and local use of data was considered an enabler. Perceived barriers to high quality birthweight data included: gaps in availability of precise weighing devices, adequate health workers and imprecise measurement practices. CONCLUSION Birthweight measurement is valued by families and health workers. There are opportunities to close the gap between the percentage of babies born in facilities and the percentage accurately weighed at birth by providing accurate scales, improving skills training and increasing local use of data. More accurate birthweight data are vitally important for all babies and specifically to track progress in preventing and improving immediate and long-term care for low birthweight children.
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Affiliation(s)
- Miriam E Gladstone
- Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Nahya Salim
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Karama Ogillo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Georgia R Gore-Langton
- Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
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13
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Gurung R, Ruysen H, Sunny AK, Day LT, Penn-Kekana L, Målqvist M, Ghimire B, Singh D, Basnet O, Sharma S, Shaver T, Moran AC, Lawn JE, Kc A. Respectful maternal and newborn care: measurement in one EN-BIRTH study hospital in Nepal. BMC Pregnancy Childbirth 2021; 21:228. [PMID: 33765971 PMCID: PMC7995692 DOI: 10.1186/s12884-020-03516-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respectful maternal and newborn care (RMNC) is an important component of high-quality care but progress is impeded by critical measurement gaps for women and newborns. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study was an observational study with mixed methods assessing measurement validity for coverage and quality of maternal and newborn indicators. This paper reports results regarding the measurement of respectful care for women and newborns. METHODS At one EN-BIRTH study site in Pokhara, Nepal, we included additional questions during exit-survey interviews with women about their experiences (July 2017-July 2018). The questionnaire was based on seven mistreatment typologies: Physical; Sexual; or Verbal abuse; Stigma/discrimination; Failure to meet professional standards of care; Poor rapport between women and providers; and Health care denied due to inability to pay. We calculated associations between these typologies and potential determinants of health - ethnicity, age, sex, mode of birth - as possible predictors for reporting poor care. RESULTS Among 4296 women interviewed, none reported physical, sexual, or verbal abuse. 15.7% of women were dissatisfied with privacy, and 13.0% of women reported their birth experience did not meet their religious and cultural needs. In descriptive analysis, adjusted odds ratios and multivariate analysis showed primiparous women were less likely to report respectful care (β = 0.23, p-value < 0.0001). Women from Madeshi (a disadvantaged ethnic group) were more likely to report poor care (β = - 0.34; p-value 0.037) than women identifying as Chettri/Brahmin. Women who had caesarean section were less likely to report poor care during childbirth (β = - 0.42; p-value < 0.0001) than women with a vaginal birth. However, babies born by caesarean had a 98% decrease in the odds (aOR = 0.02, 95% CI, 0.01-0.05) of receiving skin-to-skin contact than those with vaginal births. CONCLUSIONS Measurement of respectful care at exit interview after hospital birth is challenging, and women generally reported 100% respectful care for themselves and their baby. Specific questions, with stratification by mode of birth, women's age and ethnicity, are important to identify those mistreated during care and to prioritise action. More research is needed to develop evidence-based measures to track experience of care, including zero separation for the mother-newborn pair, and to improve monitoring.
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Affiliation(s)
- Rejina Gurung
- Research Division, Golden Community, Lalitpur, Nepal
| | - Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | | | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Loveday Penn-Kekana
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Mats Målqvist
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, Sweden
| | | | - Dela Singh
- Ministry of Health and Population, Kathmandu, Nepal
| | - Omkar Basnet
- Research Division, Golden Community, Lalitpur, Nepal
| | | | | | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, Sweden.
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Ruysen H, Shabani J, Hanson C, Day LT, Pembe AB, Peven K, Rahman QSU, Thakur N, Shirima K, Tahsina T, Gurung R, Tarimo MN, Moran AC, Lawn JE. Uterotonics for prevention of postpartum haemorrhage: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:230. [PMID: 33765962 PMCID: PMC7995712 DOI: 10.1186/s12884-020-03420-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Postpartum haemorrhage (PPH) is a leading cause of preventable maternal mortality worldwide. The World Health Organization (WHO) recommends uterotonic administration for every woman after birth to prevent PPH. There are no standardised data collected in large-scale measurement platforms. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) is an observational study to assess the validity of measurement of maternal and newborn indicators, and this paper reports findings regarding measurement of coverage and quality for uterotonics. METHODS The EN-BIRTH study took place in five hospitals in Bangladesh, Nepal and Tanzania, from July 2017 to July 2018. Clinical observers collected tablet-based, time-stamped data. We compared observation data for uterotonics to routine hospital register-records and women's report at exit-interview survey. We analysed the coverage and quality gap for timing and dose of administration. The register design was evaluated against gap analyses and qualitative interview data assessing the barriers and enablers to data recording and use. RESULTS Observed uterotonic coverage was high in all five hospitals (> 99%, 95% CI 98.7-99.8%). Survey-report underestimated coverage (79.5 to 91.7%). "Don't know" replies varied (2.1 to 14.4%) and were higher after caesarean (3.7 to 59.3%). Overall, there was low accuracy in survey data for details of uterotonic administration (type and timing). Register-recorded coverage varied in four hospitals capturing uterotonics in a specific column (21.6, 64.5, 97.6, 99.4%). The average coverage measurement gap was 18.1% for register-recorded and 6.0% for survey-reported coverage. Uterotonics were given to 15.9% of women within the "right time" (1 min) and 69.8% within 3 min. Women's report of knowing the purpose of uterotonics after birth ranged from 0.4 to 64.9% between hospitals. Enabling register design and adequate staffing were reported to improve routine recording. CONCLUSIONS Routine registers have potential to track uterotonic coverage - register data were highly accurate in two EN-BIRTH hospitals, compared to consistently underestimated coverage by survey-report. Although uterotonic coverage was high, there were gaps in observed quality for timing and dose. Standardisation of register design and implementation could improve data quality and data flow from registers into health management information reporting systems, and requires further assessment.
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Affiliation(s)
- Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK.
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Claudia Hanson
- Public Health Sciences - Global Health - Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
| | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania
| | - Kimberly Peven
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Kizito Shirima
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rejina Gurung
- Research division, Golden Community, Lalitpur, Nepal
| | - Menna Narcis Tarimo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
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15
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Ruysen H, Rahman AE, Gordeev VS, Hossain T, Basnet O, Shirima K, Rahman QSU, Zaman SB, Rana N, Salim N, Tahsina T, Gore-Langton GR, Ameen S, Boggs D, Kong S, Day LT, El Arifeen S, Lawn JE. Electronic data collection for multi-country, hospital-based, clinical observation of maternal and newborn care: EN-BIRTH study experiences. BMC Pregnancy Childbirth 2021; 21:234. [PMID: 33765951 PMCID: PMC7995708 DOI: 10.1186/s12884-020-03426-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Observation of care at birth is challenging with multiple, rapid and potentially concurrent events occurring for mother, newborn and placenta. Design of electronic data (E-data) collection needs to account for these challenges. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) was an observational study to assess measurement of indicators for priority maternal and newborn interventions and took place in five hospitals in Bangladesh, Nepal and Tanzania (July 2017-July 2018). E-data tools were required to capture individually-linked, timed observation of care, data extraction from hospital register-records or case-notes, and exit-survey data from women. METHODS To evaluate this process for EN-BIRTH, we employed a framework organised around five steps for E-data design, data collection and implementation. Using this framework, a mixed methods evaluation synthesised evidence from study documentation, standard operating procedures, stakeholder meetings and design workshops. We undertook focus group discussions with EN-BIRTH researchers to explore experiences from the three different country teams (November-December 2019). Results were organised according to the five a priori steps. RESULTS In accordance with the five-step framework, we found: 1) Selection of data collection approach and software: user-centred design principles were applied to meet the challenges for observation of rapid, concurrent events around the time of birth with time-stamping. 2) Design of data collection tools and programming: required extensive pilot testing of tools to be user-focused and to include in-built error messages and data quality alerts. 3) Recruitment and training of data collectors: standardised with an interactive training package including pre/post-course assessment. 4) Data collection, quality assurance, and management: real-time quality assessments with a tracking dashboard and double observation/data extraction for a 5% case subset, were incorporated as part of quality assurance. Internet-based synchronisation during data collection posed intermittent challenges. 5) Data management, cleaning and analysis: E-data collection was perceived to improve data quality and reduce time cleaning. CONCLUSIONS The E-Data system, custom-built for EN-BIRTH, was valued by the site teams, particularly for time-stamped clinical observation of complex multiple simultaneous events at birth, without which the study objectives could not have been met. However before selection of a custom-built E-data tool, the development time, higher training and IT support needs, and connectivity challenges need to be considered against the proposed study or programme's purpose, and currently available E-data tool options.
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Affiliation(s)
- Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Vladimir Sergeevich Gordeev
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Omkar Basnet
- Research Division, Golden Community, Lalitpur, Nepal
| | - Kizito Shirima
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nisha Rana
- Research Division, Golden Community, Lalitpur, Nepal
| | - Nahya Salim
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Georgia R Gore-Langton
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dorothy Boggs
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Stefanie Kong
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Louise T Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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Kong S, Day LT, Zaman SB, Peven K, Salim N, Sunny AK, Shamba D, Rahman QSU, K.C. A, Ruysen H, El Arifeen S, Mee P, Gladstone ME, Blencowe H, Lawn JE. Birthweight: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:240. [PMID: 33765936 PMCID: PMC7995711 DOI: 10.1186/s12884-020-03355-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Accurate birthweight is critical to inform clinical care at the individual level and tracking progress towards national/global targets at the population level. Low birthweight (LBW) < 2500 g affects over 20.5 million newborns annually. However, data are lacking and may be affected by heaping. This paper evaluates birthweight measurement within the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study. METHODS The EN-BIRTH study took place in five hospitals in Bangladesh, Nepal and Tanzania (2017-2018). Clinical observers collected time-stamped data (gold standard) for weighing at birth. We compared accuracy for two data sources: routine hospital registers and women's report at exit interview survey. We calculated absolute differences and individual-level validation metrics. We analysed birthweight coverage and quality gaps including timing and heaping. Qualitative data explored barriers and enablers for routine register data recording. RESULTS Among 23,471 observed births, 98.8% were weighed. Exit interview survey-reported weighing coverage was 94.3% (90.2-97.3%), sensitivity 95.0% (91.3-97.8%). Register-reported coverage was 96.6% (93.2-98.9%), sensitivity 97.1% (94.3-99%). Routine registers were complete (> 98% for four hospitals) and legible > 99.9%. Weighing of stillbirths varied by hospital, ranging from 12.5-89.0%. Observed LBW rate was 15.6%; survey-reported rate 14.3% (8.9-20.9%), sensitivity 82.9% (75.1-89.4%), specificity 96.1% (93.5-98.5%); register-recorded rate 14.9%, sensitivity 90.8% (85.9-94.8%), specificity 98.5% (98-99.0%). In surveys, "don't know" responses for birthweight measured were 4.7%, and 2.9% for knowing the actual weight. 95.9% of observed babies were weighed within 1 h of birth, only 14.7% with a digital scale. Weight heaping indices were around two-fold lower using digital scales compared to analogue. Observed heaping was almost 5% higher for births during the night than day. Survey-report further increased observed birthweight heaping, especially for LBW babies. Enablers to register birthweight measurement in qualitative interviews included digital scale availability and adequate staffing. CONCLUSIONS Hospital registers captured birthweight and LBW prevalence more accurately than women's survey report. Even in large hospitals, digital scales were not always available and stillborn babies not always weighed. Birthweight data are being captured in hospitals and investment is required to further improve data quality, researching of data flow in routine systems and use of data at every level.
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Affiliation(s)
- Stefanie Kong
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Louise T. Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kimberly Peven
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | | | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Qazi Sadeq-ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashish K.C.
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Paul Mee
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Miriam E. Gladstone
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Joy E. Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine (LSHTM), London, UK
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Kinney MV, Ajayi G, de Graft-Johnson J, Hill K, Khadka N, Om’Iniabohs A, Mukora-Mutseyekwa F, Tayebwa E, Shittu O, Lipingu C, Kerber K, Nyakina JD, Ibekwe PC, Sayinzoga F, Madzima B, George AS, Thapa K. "It might be a statistic to me, but every death matters.": An assessment of facility-level maternal and perinatal death surveillance and response systems in four sub-Saharan African countries. PLoS One 2020; 15:e0243722. [PMID: 33338039 PMCID: PMC7748147 DOI: 10.1371/journal.pone.0243722] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 11/29/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Maternal and perinatal death surveillance and response (MPDSR) systems aim to understand and address key contributors to maternal and perinatal deaths to prevent future deaths. From 2016-2017, the US Agency for International Development's Maternal and Child Survival Program conducted an assessment of MPDSR implementation in Nigeria, Rwanda, Tanzania, and Zimbabwe. METHODS A cross-sectional, mixed-methods research design was used to assess MPDSR implementation. The study included a desk review, policy mapping, semistructured interviews with 41 subnational stakeholders, observations, and interviews with key informants at 55 purposefully selected facilities. Using a standardised tool with progress markers defined for six stages of implementation, each facility was assigned a score from 0-30. Quantitative and qualitative data were analysed from the 47 facilities with a score above 10 ('evidence of MPDSR practice'). RESULTS The mean calculated MPDSR implementation progress score across 47 facilities was 18.98 out of 30 (range: 11.75-27.38). The team observed variation across the national MPDSR guidelines and tools, and inconsistent implementation of MPDSR at subnational and facility levels. Nearly all facilities had a designated MPDSR coordinator, but varied in their availability and use of standardised forms and the frequency of mortality audit meetings. Few facilities (9%) had mechanisms in place to promote a no-blame environment. Some facilities (44%) could demonstrate evidence that a change occurred due to MPDSR. Factors enabling implementation included clear support from leadership, commitment from staff, and regular occurrence of meetings. Barriers included lack of health worker capacity, limited staff time, and limited staff motivation. CONCLUSION This study was the first to apply a standardised scoring methodology to assess subnational- and facility-level MPDSR implementation progress. Structures and processes for implementing MPDSR existed in all four countries. Many implementation gaps were identified that can inform priorities and future research for strengthening MPDSR in low-capacity settings.
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Affiliation(s)
- Mary V. Kinney
- Save the Children US, Washington, DC, United States of America
- University of the Western Cape, Cape Town, South Africa
| | - Gbaike Ajayi
- US Agency for International Development (USAID)’s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America
- Jhpiego, Baltimore, Maryland, United States of America
| | - Joseph de Graft-Johnson
- Save the Children US, Washington, DC, United States of America
- US Agency for International Development (USAID)’s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America
| | - Kathleen Hill
- US Agency for International Development (USAID)’s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America
- Jhpiego, Baltimore, Maryland, United States of America
| | - Neena Khadka
- Save the Children US, Washington, DC, United States of America
- US Agency for International Development (USAID)’s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America
| | - Alyssa Om’Iniabohs
- Save the Children US, Washington, DC, United States of America
- US Agency for International Development (USAID)’s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America
| | | | | | | | | | - Kate Kerber
- Save the Children US, Washington, DC, United States of America
| | | | - Perpetus Chudi Ibekwe
- Maternal and perinatal death surveillance and response, Abakaliki, Ebonyi State, Nigeria
| | - Felix Sayinzoga
- Maternal, Child, and Community Health Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Bernard Madzima
- Family Health Directorate, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Kusum Thapa
- US Agency for International Development (USAID)’s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America
- Jhpiego, Baltimore, Maryland, United States of America
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Coxon K, Turienzo CF, Kweekel L, Goodarzi B, Brigante L, Simon A, Lanau MM. The impact of the coronavirus (COVID-19) pandemic on maternity care in Europe. Midwifery 2020; 88:102779. [PMID: 32600862 PMCID: PMC7286236 DOI: 10.1016/j.midw.2020.102779] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Kirstie Coxon
- Department of Midwifery, Faculty of Health, Social Care and Education, Kingston University and St.George's, University of London, 6th Floor, Hunter Wing, Cranmer Terrace, London, SW17 0RE, UK.
| | - Cristina Fernandez Turienzo
- Department of Women's and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Bahareh Goodarzi
- Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lia Brigante
- Department of Women's and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Stephens AJ, Barton JR, Bentum NAA, Blackwell SC, Sibai BM. General Guidelines in the Management of an Obstetrical Patient on the Labor and Delivery Unit during the COVID-19 Pandemic. Am J Perinatol 2020; 37:829-836. [PMID: 32344441 PMCID: PMC7356067 DOI: 10.1055/s-0040-1710308] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 02/06/2023]
Abstract
Novel coronavirus disease 2019 (COVID-19) is a respiratory tract infection that was first identified in China. Since its emergence in December 2019, the virus has rapidly spread, transcending geographic barriers. The World Health Organization and the Centers for Disease Control and Prevention have declared COVID-19 as a public health crisis. Data regarding COVID-19 in pregnancy is limited, consisting of case reports and small cohort studies. However, obstetric patients are not immune from the current COVID-19 pandemic, and obstetric care will inevitably be impacted by the current epidemic. As such, clinical protocols and practice on labor and delivery units must adapt to optimize the safety of patients and health care workers and to better conserve health care resources. In this commentary, we provide suggestions to meet these goals without impacting maternal or neonatal outcomes. KEY POINTS: • Novel coronavirus disease 2019 (COVID-19) is a pandemic.• COVID-19 impacts care of obstetric patients.• Health care should be adapted for the COVID-19 pandemic.
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Affiliation(s)
- Angela J. Stephens
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - John R. Barton
- Division of Maternal-Fetal Medicine, Baptist Health Lexington, Lexington, Kentucky
| | - Nana-Ama Ankumah Bentum
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Sean C. Blackwell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Baha M. Sibai
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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Mactier H, Bates SE, Johnston T, Lee-Davey C, Marlow N, Mulley K, Smith LK, To M, Wilkinson D. Perinatal management of extreme preterm birth before 27 weeks of gestation: a framework for practice. Arch Dis Child Fetal Neonatal Ed 2020; 105:232-239. [PMID: 31980443 DOI: 10.1136/archdischild-2019-318402] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/16/2019] [Accepted: 11/21/2019] [Indexed: 11/03/2022]
Affiliation(s)
| | | | - Tracey Johnston
- Department of Fetal and Maternal Medicine, Birmingham Women and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Neil Marlow
- Institute for Women's Health, University College London, London, UK
| | | | - Lucy K Smith
- Health Sciences, University of Leicester, Leicester, UK
| | - Meekai To
- King's College Hospital NHS Trust, London, UK
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
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Belay Tolu L, Yigezu E, Urgie T, Feyissa GT. Maternal and perinatal outcome of preeclampsia without severe feature among pregnant women managed at a tertiary referral hospital in urban Ethiopia. PLoS One 2020; 15:e0230638. [PMID: 32271787 PMCID: PMC7144970 DOI: 10.1371/journal.pone.0230638] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/04/2020] [Indexed: 11/23/2022] Open
Abstract
Background Preeclampsia refers to the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. Pregnant women with preeclampsia are at an increased risk of adverse maternal, fetal and neonatal complications. The objective of the study is, therefore, to determine the maternal and perinatal outcome of preeclampsia without severity feature among women managed at a tertiary referral hospital in urban Ethiopia. Methods A hospital-based prospective observational study was conducted to evaluate the maternal and perinatal outcome of pregnant women who were on expectant management with the diagnosis of preeclampsia without severe feature at a referral hospital in urban Ethiopia from August 2018 to January 2019. Results There were a total of 5400 deliveries during the study period, among which 164 (3%) women were diagnosed with preeclampsia without severe features. Fifty-one (31.1%) patients with preeclampsia without severe features presented at a gestational age between 28 to 33 weeks plus six days, while 113 (68.9%) presented at a gestational age between 34 weeks to 36 weeks. Fifty-two (31.7%) women had maternal complication of which, 32 (19.5%) progressed to preeclampsia with severe feature Those patients with early onset of preeclampsia without severe feature were 5.22 and 25.9 times more likely to develop maternal and perinatal complication respectively compared to late-onset after 34 weeks with P-value of <0.0001, (95% CI 2.01–13.6) and <0.0001(95% CI 5.75–115.6) respectively. Conclusion In a setting where home-based self-care is poor expectant outpatient management of preeclampsia without severe features with a once per week visit is not adequate. It’s associated with an increased risk of maternal and perinatal morbidity and mortality. Our findings call for special consideration and close surveillance of those women with early-onset diseases.
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Affiliation(s)
- Lemi Belay Tolu
- Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- * E-mail:
| | - Endale Yigezu
- Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tadesse Urgie
- Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Thapa Pachya A, Pachya U, Giri M, Shakya S, Mahotra A, Choulagai BP. Newborn Service Readiness of Primary Level Health Facilities of Eastern Mountain Region of Nepal. J Nepal Health Res Counc 2020; 17:431-436. [PMID: 32001844 DOI: 10.33314/jnhrc.v17i4.2119] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 01/21/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Newborn service readiness is facility's observed capacity to provide newborn services and a pre-requisite for quality. Newborn services are priority program of government and efforts are focused on infrastructure and supplies at peripheral health facilities. Study describes health facility readiness for newborn services in four domains of general requirements, equipment, medicines and commodities, and staffing and guidelines. METHODS Convergent parallel mixed method using concurrent triangulation was done in public health facilities providing institutional deliveries of two randomly selected districts- Taplejung and Solukhumbu of Eastern Mountain Region of Nepal. Face to face interview and observation of facilities were done using structured questionnaire and checklist; in-depth interviews were done using interview guideline from November 2016 to January 2017. Ethical clearance was taken. Descriptive analysis and deductive thematic analysis were done. RESULTS Mean score of newborn service readiness was 68.7±7.1 with range from 53.3 to 81.4 out of 100. Domains of general requirement, equipment, medicine and commodity, supervision, staffing and guideline were assessed. The gaps identified in general requirements were availability of uninterrupted power supply, means of communication and referral vehicle. Clean wrappers and heater for room temperature maintenance were identified during interviews to be part of the readiness. All health facilities had trained staff while retention of skill was of concern. There was felt need of enforcing adequate training coverage to suffice the need of human resources in remote. CONCLUSIONS Efforts of improving transportation, heater for room temperature maintenance, trainings with skill retention strategy, utilization of guidelines, availability of skilled birth attendance could result increased and improved newborn service readiness.
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Affiliation(s)
- Ambika Thapa Pachya
- School of Public Health/ Department of Community Health Science, Patan Academy of Health Science, Lalitpur, Nepal
| | - Uttam Pachya
- Gulmi District Hospital, Government of Nepal, Gulmi, Nepal
| | - Mona Giri
- Family Planning, FHI 360, Lalitpur, Nepal
| | - Sujata Shakya
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Anita Mahotra
- Nutrition Program, Global Health Alliance Nepal, Kathmandu, Nepal
| | - Bishnu Prasad Choulagai
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Affiliation(s)
| | - Stephan D Fihn
- Department of Medicine, University of Washington, Seattle
- Deputy Editor
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24
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Bender TM. Pope Francis and Perinatal Palliative Care: Advancing the Culture of Mercy. Perspect Biol Med 2020; 63:512-525. [PMID: 33416626 DOI: 10.1353/pbm.2020.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
For the last 25 years, the Popes of the Roman Catholic Church have been vocal proponents of palliative care in an effort to promote human dignity, decrease human suffering, and discourage euthanasia and suicide. They have supported efforts to expand the scope and provision of palliative care. Recently, Pope Francis has focused on the need to provide perinatal palliative care. He has emphasized the need to do so as an act of mercy, love, and solidarity. His approach builds on the main pastoral theme of his Papacy, the mercy of God. This article outlines the thought of Pope Francis on the mercy of God and how he wishes to see this mercy motivate and invigorate not only the Church but all people. Perinatal palliative care becomes a further outgrowth of the love and mercy we show one another. It is a pastoral practice encouraged by the Church and consistent with Catholic doctrine and the mission of Catholic health-care facilities.
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Lantos JD. Yes to Life: An Opportunity for Partnership Between Medicine and Religion. Perspect Biol Med 2020; 63:509-511. [PMID: 33416625 DOI: 10.1353/pbm.2020.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Pope Francis recently spoke about perinatal palliative care and the dilemmas that parents of critically ill babies encounter. In his speech, the Pope beautifully captured what many parents feel. They love their baby even if they know that the baby cannot survive. They need compassionate care of the sort that will allow them to express that love, even if it is only for minutes or hours, and even if the expression of love takes the form of comforting the dying baby rather than intervening medically or surgically to try to prolong life. "Many times," the Pope said, "Those few hours in which a mother can cradle her child in her arms leave an unforgettable trace in her heart." For those who work in perinatal palliative care, this affirmation and endorsement of their efforts by the Church is a welcome offer for an important collaboration. Medicine and religion can work hand in hand, here, to help parents and doctors who struggle to do the right thing when all the choices seem bad.
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Munch S, McCoyd JLM, Curran L, Harmon C. Medically high-risk pregnancy: Women's perceptions of their relationships with health care providers. Soc Work Health Care 2020; 59:20-45. [PMID: 31714182 DOI: 10.1080/00981389.2019.1683786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 08/27/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
The purpose of this article is to examine women's perceptions of the patient-provider relationship in the context of medically high-risk pregnancy (MHRP). Sixteen in-depth interviews were conducted with women hospitalized for MHRP on a maternal-fetal medical unit in the US. Tenets of phenomenology guided the data analysis. We found that beyond normative stress related to managing physical aspects of MHRP, women reported added emotional stressors associated with navigating the fragmented health care environment. This study suggests that improved care coordination and systematic integration of psychosocial professionals within the perinatal interdisciplinary health care team are vital to reduce care-related stressors on this vulnerable patient group.
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Affiliation(s)
- Shari Munch
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Judith L M McCoyd
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Laura Curran
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Cara Harmon
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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Kuebelbeck A. "Yes to Life" and the Expansion of Perinatal Hospice. Perspect Biol Med 2020; 63:526-531. [PMID: 33416627 DOI: 10.1353/pbm.2020.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Since the model of perinatal hospice was first proposed more than two decades ago, its growth has been exponential. Perinatal hospice, now also called perinatal palliative care, is a practical and compassionate model of care for those continuing a pregnancy following a prenatal diagnosis indicating that their baby has a life-limiting condition and might die before or shortly after birth. Well over 300 international perinatal hospice and palliative care programs have been created; many articles have been published in major medical journals; several textbooks and guides have now been published; protocols and training have been developed; and growing numbers of parents are choosing to continue their pregnancies when perinatal hospice care is offered. And now the idea has even reached Pope Francis.
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Hardt J. Birth Narratives, Babies, and the Catholic Moral Imagination: Informing Influences on the Pope's Address. Perspect Biol Med 2020; 63:539-543. [PMID: 33416630 DOI: 10.1353/pbm.2020.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This commentary considers two informing influences on Pope Francis's support of perinatal hospice care for families facing diagnoses of serious fetal anomalies. Reflecting on the morally formative scriptural narrative of Mary's pregnancy and Jesus's birth and drawing upon an often-repeated idea of Pope Francis's papacy that "time is greater than space," this commentary suggests that Francis's perspective is deeply shaped by an understanding of life as a gift given by God, destined to return to God, and shaped by the invitation to participate in the fullness of our nature through acts of loving accompaniment in the face of grave suffering and loss.
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Carter BS. The Natal Journey and Perinatal Palliative Care. Perspect Biol Med 2020; 63:549-552. [PMID: 33416632 DOI: 10.1353/pbm.2020.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Doctors often focus on the science of medicine involved in matters of reproductive health and childbirth, at times to the exclusion of the psychosocial and spiritual dimensions of health. Pregnancy and childbirth are clothed in mystery when it comes to the question of why a pregnancy goes well or is fraught with complications. And while explanations may abound in this age of increasing genetic understanding, the meaning attached to these matters is beyond the scope of medicine alone-especially when the newborn's very survival is in question. Perinatal palliative care can bring solace to such troubling realities.
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Kirkham R, Trap-Jensen N, Boyle JA, Barzi F, Barr ELM, Whitbread C, Van Dokkum P, Kirkwood M, Connors C, Moore E, Zimmet P, Corpus S, Hanley AJ, O'Dea K, Oats J, McIntyre HD, Brown A, Shaw JE, Maple-Brown L. Diabetes care in remote Australia: the antenatal, postpartum and inter-pregnancy period. BMC Pregnancy Childbirth 2019; 19:389. [PMID: 31660892 PMCID: PMC6819653 DOI: 10.1186/s12884-019-2562-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 10/17/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander women experience high rates of diabetes in pregnancy (DIP), contributing to health risks for mother and infant, and the intergenerational cycle of diabetes. By enhancing diabetes management during pregnancy, postpartum and the interval between pregnancies, the DIP Partnership aims to improve health outcomes and reduce risks early in the life-course. We describe a mixed methods formative study of health professional's perspectives of antenatal and post-partum diabetes screening and management, including enablers and barriers to care. METHODS Health professionals involved in providing diabetes care in pregnancy, from a range of health services across the Northern Territory, completed the survey (n = 82) and/or took part in interviews and/or focus groups (n = 62). RESULTS Qualitative findings highlighted factors influencing the delivery of care as reported by health professionals, including: whose responsibility it is, access to care, the baby is the focus and pre-conception care. The main challenges were related to: disjointed systems and confusion around whose role it is to provide follow-up care beyond six weeks post-partum. Quantitative findings indicated that the majority of health professionals reported confidence in their own skills to manage women in the antenatal period (62%, 40/79) and slightly lower rates of confidence in the postpartum interval (57%, 33/58). CONCLUSION These findings regarding whose role it is to provide postpartum care, along with opportunities to improve communication pathways and follow up care have informed the design of a complex health intervention to improve health systems and the provision of DIP related care.
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Affiliation(s)
- R Kirkham
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
| | - N Trap-Jensen
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - J A Boyle
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - F Barzi
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - E L M Barr
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Population Health Research, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - C Whitbread
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
| | - P Van Dokkum
- Alice Springs Hospital, Alice Springs, Australia
- Population Health Research, Baker Heart and Diabetes Institute, Alice Springs, Australia
| | - M Kirkwood
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - C Connors
- Northern Territory Department of Health, Darwin, Australia
| | - E Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Australia
| | - P Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - S Corpus
- Danila Dilba Health Service, Darwin, Australia
| | - A J Hanley
- Department of Nutritional Sciences, Faculty of Medicine and the Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - K O'Dea
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - J Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - H D McIntyre
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | - A Brown
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - J E Shaw
- Population Health Research, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - L Maple-Brown
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
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de Jonge HC, Lagendijk J, Saha U, Been JV, Burdorf A. Did an urban perinatal health programme in Rotterdam, the Netherlands, reduce adverse perinatal outcomes? Register-based retrospective cohort study. BMJ Open 2019; 9:e031357. [PMID: 31641003 PMCID: PMC6830581 DOI: 10.1136/bmjopen-2019-031357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To study the effect of an urban perinatal health programme in Rotterdam, the Netherlands, on perinatal outcomes. DESIGN A retrospective cohort study with difference-in-differences analysis using individual-level perinatal outcome data from the Dutch Perinatal Registry 2003-2014 linked to Central Bureau of Statistics data of migration background and individual disposable household income. INTERVENTION The programme consisted of perinatal health promotion, risk selection and risk-guided pregnancy care, and a new primary care child birth centre. The programme was implemented during 2009-2012. PRIMARY OUTCOME MEASURES We compared trends in perinatal mortality, preterm delivery and small-for-gestational-age births between targeted urban neighbourhoods in Rotterdam (n=61 415) and all other urban neighbourhoods in the Netherlands (n=881 202). The effect of the programme was modelled as a change in trend of each perinatal outcome in the treatment group post intervention compared with the control population from January 2010 onwards. All analyses were adjusted for maternal age, parity, ethnicity and individual-level low socioeconomic status (SES). We also conducted a stratified analysis by SES. RESULTS During 2003-2014, downward trends in perinatal mortality (adjusted OR (aOR) 0.9439 per year, 95% CI 0.9362 to 0.9517), preterm birth (aOR 0.9970 per year, 95% CI 0.9944 to 0.9997) and small-for-gestational-age births (aOR 0.9809 per year, 95% CI 0.9787 to 0.9831) in the entire study population were observed. No demonstrable changes in these trends were found in the intervention group after the programme had started. The stratified analyses by SES showed no changes in trends post intervention in both strata either. CONCLUSIONS The programme had no demonstrable effects on perinatal outcomes. The intervention may not have reached a sufficient proportion of the population or has provided too little contrast to the widespread attention for inequalities in pregnancy outcomes occurring simultaneously in the Netherlands.
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Affiliation(s)
| | - Jacqueline Lagendijk
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Unnati Saha
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Jasper V Been
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
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Al-Shammari I, Roa L, Yorlets RR, Akerman C, Dekker A, Kelley T, Koech R, Mutuku J, Nyarango R, Nzorubara D, Spieker N, Vaidya M, Meara JG, Ljungman D. Implementation of an international standardized set of outcome indicators in pregnancy and childbirth in Kenya: Utilizing mobile technology to collect patient-reported outcomes. PLoS One 2019; 14:e0222978. [PMID: 31618249 PMCID: PMC6795527 DOI: 10.1371/journal.pone.0222978] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 09/27/2018] [Accepted: 09/11/2019] [Indexed: 11/29/2022] Open
Abstract
Background Limited data exist on health outcomes during pregnancy and childbirth in low- and middle-income countries. This is a pilot of an innovative data collection tool using mobile technology to collect patient-reported outcome measures (PROMs) selected from the International Consortium of Health Outcomes Measurement (ICHOM) Pregnancy and Childbirth Standard Set in Nairobi, Kenya. Methods Pregnant women in the third trimester were recruited at three primary care facilities in Nairobi and followed prospectively throughout delivery and until six weeks postpartum. PROMs were collected via mobile surveys at three antenatal and two postnatal time points. Outcomes included incontinence, dyspareunia, mental health, breastfeeding and satisfaction with care. Hospitals reported morbidity and mortality. Descriptive statistics on maternal and child outcomes, survey completion and follow-up rates were calculated. Results In six months, 204 women were recruited: 50% of women returned for a second ante-natal care visit, 50% delivered at referral hospitals and 51% completed the postnatal visit. The completion rates for the five PROM surveys were highest at the first antenatal care visit (92%) and lowest in the postnatal care visit (38%). Data on depression, dyspareunia, fecal and urinary incontinence were successfully collected during the antenatal and postnatal period. At six weeks postpartum, 86% of women breastfeed exclusively. Most women that completed the survey were very satisfied with antenatal care (66%), delivery care (51%), and post-natal care (60%). Conclusion We have demonstrated that it is feasible to use mobile technology to follow women throughout pregnancy, track their attendance to pre-natal and post-natal care visits and obtain data on PROM. This study demonstrates the potential of mobile technology to collect PROM in a low-resource setting. The data provide insight into the quality of maternal care services provided and will be used to identify and address gaps in access and provision of high quality care to pregnant women.
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Affiliation(s)
- Ishtar Al-Shammari
- International Consortium for Health Outcomes Measurement (ICHOM), Boston, Massachusetts, United States of America
| | - Lina Roa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Canada
- * E-mail:
| | - Rachel R. Yorlets
- Department of Plastic & Oral Surgery, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Christina Akerman
- International Consortium for Health Outcomes Measurement (ICHOM), Boston, Massachusetts, United States of America
| | | | - Thomas Kelley
- International Consortium for Health Outcomes Measurement (ICHOM), Boston, Massachusetts, United States of America
| | | | - Judy Mutuku
- Gertrude’s Children’s Hospital, Nairobi, Kenya
| | | | | | | | | | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Plastic & Oral Surgery, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - David Ljungman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Surgery, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Ley D, Abrahamsson T, Domellöf M, Jonsson B, Hagberg H, Hellström A. [Extremely preterm birth in Sweden - clear progress but remaining challenges]. Lakartidningen 2019; 116:FR6I. [PMID: 31593285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The recently documented high survival of extremely preterm infants in Sweden is related to a high degree of centralization of pre- and postnatal care and to recently issued national consensus guidelines providing recommendations for perinatal care at 22-24 gestational weeks. The prevalence of major neonatal morbidity remains high and exceeded 60 % in a recent study of extremely preterm infants born at < 27 gestational weeks delivered in Sweden in 2014-2016 and surviving to 1 year of age. Damage to immature organ systems inflicted during the neonatal period causes varying degrees of functional impairment with lasting effects in the growing child. There is an urgent need for evidence-based novel interventions aiming to prevent neonatal morbidity with a subsequent improvement of long-term outcome.
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MESH Headings
- Bronchopulmonary Dysplasia/epidemiology
- Bronchopulmonary Dysplasia/physiopathology
- Bronchopulmonary Dysplasia/prevention & control
- Centralized Hospital Services
- Cerebral Hemorrhage/diagnostic imaging
- Cerebral Hemorrhage/epidemiology
- Cerebral Hemorrhage/physiopathology
- Cerebral Hemorrhage/prevention & control
- Cerebral Ventricles/blood supply
- Cerebral Ventricles/diagnostic imaging
- Enterocolitis, Necrotizing/epidemiology
- Enterocolitis, Necrotizing/physiopathology
- Enterocolitis, Necrotizing/prevention & control
- Female
- Humans
- Infant Nutritional Physiological Phenomena
- Infant, Extremely Premature
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/physiopathology
- Infant, Premature, Diseases/prevention & control
- Perinatal Care/organization & administration
- Pregnancy
- Premature Birth/mortality
- Retinopathy of Prematurity/blood
- Retinopathy of Prematurity/epidemiology
- Retinopathy of Prematurity/physiopathology
- Retinopathy of Prematurity/prevention & control
- Survival Rate
- Sweden/epidemiology
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Affiliation(s)
- David Ley
- Lunds University Faculty of Medicine - Pediatrics Lund, Sweden Lunds University Faculty of Medicine - Pediatrics Lund, Sweden
| | - Thomas Abrahamsson
- Linköpings universitet - Avdelningen för pediatrik Linköping, Sweden Linköpings universitet - Avdelningen för pediatrik Linköping, Sweden
| | - Magnus Domellöf
- Umeå universitet, Institutionen för klinisk vetenskap - Pediatrik Umeå, Sweden Umea universitet Institutionen for Klinisk vetenskap - Pediatrics Umea, Sweden
| | - Baldvin Jonsson
- Karolinska Institute - Stockholm, Sweden Karolinska Institute - Stockholm, Sweden
| | - Henrik Hagberg
- Univ of Gothenburg - Obstetrics&Gynecology Göteborg, Sweden Univ of Gothenburg - Obstetrics&Gynecology Göteborg, Sweden
| | - Ann Hellström
- Sahlgrenska Akademin, Institutionen för neurovetenskap och fysiologi - Pediatrisk Oftalmologi Göteborg, Sweden Goteborgs universitet Institutionen for neurovetenskap och fysiologi - Pediatric Ophthalmology Goteborg, Sweden
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Carlson NS, Neal JL, Tilden EL, Smith DC, Breman RB, Lowe NK, Dietrich MS, Phillippi JC. Influence of midwifery presence in United States centers on labor care and outcomes of low-risk parous women: A Consortium on Safe Labor study. Birth 2019; 46:487-499. [PMID: 30414200 PMCID: PMC6509022 DOI: 10.1111/birt.12405] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Sixty percent of United States births are to multiparous women. Hospital-level policies and culture may influence intrapartum care and birth outcomes for this large population, yet have been poorly explored using a large, diverse sample. We sought to use national United States data to analyze the association between midwifery presence in maternity care teams and the birth processes and outcomes of low-risk parous women. METHODS We conducted a retrospective cohort study using Consortium on Safe Labor data from low-risk parous women in either interprofessional care (n = 12 125) or noninterprofessional care centers (n = 8996). Unadjusted, adjusted (age, race, health insurance type), propensity-adjusted, and propensity-matched logistic regression models were used to assess processes and outcomes. RESULTS There was concordance in outcome differences across regression models. With propensity score matching, women at interprofessional centers, compared with women at noninterprofessional centers, were 85% less likely to have labor induced (risk ratio [RR] 0.15; 95% CI 0.14-0.17). The risk for primary cesarean birth among low-risk parous women was 36% lower at interprofessional centers (RR 0.64; 95% CI 00.52-0.79), whereas the likelihood of vaginal birth after cesarean for this population was 31% higher (RR 1.31; 95% CI 1.10-1.56). There were no significant differences in neonatal outcomes. CONCLUSIONS Parous women have significantly higher rates of vaginal birth, including vaginal birth after cesarean, and lower likelihood of labor induction when cared for in centers with midwives. Our findings are consistent with smaller analyses of midwifery practice and support integrated, team-based models of perinatal care to improve maternal outcomes.
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Affiliation(s)
- Nicole S Carlson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Jeremy L Neal
- School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Ellen L Tilden
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Denise C Smith
- College of Nursing, University of Colorado, Aurora, Colorado
| | | | - Nancy K Lowe
- College of Nursing, University of Colorado, Aurora, Colorado
| | - Mary S Dietrich
- School of Nursing, Vanderbilt University, Nashville, Tennessee
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Hmiel L, Collins C, Brown P, Cherney E, Farmer C. "We have this awesome organization where it was built by women for women like us": Supporting African American women through their pregnancies and beyond. Soc Work Health Care 2019; 58:579-595. [PMID: 30933655 DOI: 10.1080/00981389.2019.1597007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 02/20/2019] [Accepted: 03/15/2019] [Indexed: 06/09/2023]
Abstract
Infant mortality is a problem that disproportionately affects infants of African American women, particularly residents in underserved neighborhoods. Chronic stress due to racism has been identified as an important factor in infant mortality. This study examined a novel community-based perinatal support professional (PSP) program, Birthing Beautiful Communities (BBC), in Cleveland, Ohio. BBC provides services for pregnant African American women in underserved neighborhoods with the goal of decreasing infant mortality and low birthweight rates by addressing chronic stress. Focus groups and one individual interview were conducted with the program's 14 PSPs, and 25 clients were interviewed individually. Interviews were analyzed inductively using qualitative thematic analysis to identify pervasive themes. Coders identified major themes of stress, resilience, community, cultural matching, advocacy, self-care, transformation, and self-actualization. BBC PSPs and clients alike reported the program is transforming the lives of clients by helping them address stressors. Findings suggest the community-based PSP model is an important but underused intervention in addressing infant mortality.
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Affiliation(s)
- Laura Hmiel
- a Department of Medicine , Case Western Reserve University , Cleveland , OH , USA
| | - Cyleste Collins
- b Department of Social Work , Cleveland State University , Cleveland , OH , USA
| | | | - Emily Cherney
- b Department of Social Work , Cleveland State University , Cleveland , OH , USA
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Bezerra FD, Menezes MADS, Mendes RB, Santos JMDJ, Leite DCF, Kassar SB, Gurgel RQ. PERINATAL CARE IN A NORTHEASTERN BRAZILIAN STATE: STRUCTURE, WORK PROCESSES, AND EVALUATION OF THE COMPONENTS OF ESSENTIAL NEWBORN CARE. Rev Paul Pediatr 2019; 37:140-148. [PMID: 30810691 PMCID: PMC6651313 DOI: 10.1590/1984-0462/;2019;37;2;00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 01/28/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe the structure and the processes of care for pregnant women/newborn infants, including the Essential Newborn Care (ENC), in maternity hospitals in Sergipe State, Brazil. METHODS A cross-sectional study carried out between June 2015 and April 2016 in all maternity hospitals of Sergipe with more than 500 deliveries/year (n=11). A questionnaire on the existing structure and work processes was administered to the managers. Subsequently, a representative number of postpartum women from these hospitals were interviewed (n=768). Their medical records, as well as newborn infants' records, were also analyzed. RESULTS Sergipe has 78 beds of Neonatal Intensive Care Unit (NICU) and 90 beds of Intermediate Care Unit (IMCU) to meet spontaneous and programmed demand. Only six maternity hospitals (54.5%) performed the risk classification, and four (36.3%) had protocols for high-risk parturient care. Regarding the ENC components, only 41% (n=315) of the women had early skin-to-skin contact with their babies, 33.1% (n=254) breastfed in the first hour of life, and 18% (n=138) had a companion always during birth. CONCLUSIONS The distribution of NICU beds between capital city and other cities of the State is adequate, considering Brazilian guidelines. However, there was a low adherence to the protocols for hypertensive and hemorrhagic emergencies, and a low coverage of humanization policies, pregnancy risk classification and ENC practices, especially breastfeeding in the first hour of life, and companion always during birth.
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Paudel M, Javanparast S, Dasvarma G, Newman L. A critical account of the policy context shaping perinatal survival in Nepal: policy tension of socio-cultural versus a medical approach. BMC Health Serv Res 2019; 19:166. [PMID: 30871523 PMCID: PMC6417211 DOI: 10.1186/s12913-019-3979-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nepal formulated a range of policies related to maternal and neonatal survival, especially after the year 2000. Nevertheless, Nepal's perinatal mortality remains high, particularly in disadvantaged regions. Policy analysis can uncover the underlying values, strategies and policy formulation processes that shape the potential to reduce in-country health inequities. This paper provides a critical account of the main policy documents relevant to perinatal survival in Nepal. METHODS Six key policy documents covering the period 2000-2015 were reviewed using an adapted framework and were analyzed through qualitative content analysis. RESULTS The analysis shows that the policies focused mainly on the system: improvement in provision of birthing facilities; targeting staff (Skilled Birth Attendants) and health service users by providing cash incentives to staff for bringing patients to services, and to users (pregnant women) to attend health institutions. Despite a growing focus on saving women and newborn babies, there is a poor policy focus and direction on preventing stillbirth. The policy documents were found to emphasize tensions between birthing at home and at health institutions on the one hand, and between strategies to provide culturally appropriate, woman-centered care in communities and medically orientated services on the other. Policies acknowledge the need to provide and address woman-centered care, equity, social inclusion, and a rights-based approach, and identify the community based approach as the mode of service delivery. Over and above this, all policy documents are aimed at the national level, and there is no specific policy direction for the separate ecological, cultural or geographic regions such as the mountainous region, which continues to exhibit higher mortality rates and has different cultural and demographic characteristics to the rest of Nepal. CONCLUSIONS To better address the continuing high perinatal mortality rates, particularly in disadvantaged areas, national health policies should pay more attention to the inequity in healthcare access and in perinatal outcomes by integrating both stillbirth prevention and neonatal survival as policy agenda items. To ensure effective translation of policy into practice, it is imperative to tailor the strategies according to acknowledged policy values such as rights, inclusion and socio-cultural identity.
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Affiliation(s)
- Mohan Paudel
- Initiative for Research, Education and Community Health-Nepal, Kathmandu, Nepal
| | - Sara Javanparast
- Southgate Institute of Health, Society & Equity, Flinders University, Adelaide, Australia
| | - Gouranga Dasvarma
- College of Humanities, Arts and Social Sciences, Flinders University, Adelaide, Australia
| | - Lareen Newman
- Education Arts and Social Sciences Divisional Office, University of South Australia , Adelaide, Australia
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Marshall J, Ramakrishnan R, Slotnick AL, Tanner JP, Salemi JL, Kirby RS. Family-Centered Perinatal Services for Children With Down Syndrome and Their Families in Florida. J Obstet Gynecol Neonatal Nurs 2018; 48:78-89. [PMID: 30529051 DOI: 10.1016/j.jogn.2018.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine the experiences of parents or caregivers of children with Down syndrome related to prenatal care, the birth setting, primary and specialty care, and care coordination. DESIGN Cross-sectional, mixed-methods study. SETTING Florida. PARTICIPANTS English- or Spanish-speaking parents/primary caregivers (N = 101) of children who were 0 to 18 years old, had a diagnosis of Down syndrome, and were born in Florida. METHODS Participants were identified through snowball sampling and completed an online version of the Family Experiences Survey. Analyses included descriptive statistics, Fisher exact tests, and content analysis of the open-ended questions. RESULTS Fewer than half of the 101 respondents reported receipt of adequate information after diagnosis of Down syndrome during the prenatal period (n = 18, 19.3%) or in the birth setting (n = 35, 41.2%). Most participants (52.9%-95.4%) reported that they received adequate time and specific information needed and that providers were sensitive to their feelings, values, and family customs during the prenatal period, in the birth setting, and during primary and specialty care. However, fewer than 60% of participants (19.3%-59.1%) recalled that they received information about Down syndrome or helpful programs such as Children's Medical Services, Early Steps, or Healthy Start either from prenatal care providers or in the birth settings. CONCLUSION Our findings highlight the critical role that perinatal care providers play in the establishment of access to and use of specialty care services for neonates with Down syndrome and emphasize the need for family-centered care in prenatal and birth settings.
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Kominiarek MA, O’Dwyer LC, Simon MA, Plunkett BA. Targeting obstetric providers in interventions for obesity and gestational weight gain: A systematic review. PLoS One 2018; 13:e0205268. [PMID: 30289912 PMCID: PMC6173456 DOI: 10.1371/journal.pone.0205268] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 09/22/2018] [Indexed: 11/19/2022] Open
Abstract
Background Providers need to be comfortable addressing obesity and gestational weight gain so they may give appropriate care; however, health care providers lack guidelines for the most effective educational strategies to assist in providing optimal care. Objective To identify studies that involved the obstetric provider in interventions for either the perinatal management of obesity and/or gestational weight gain in a systematic review. Search strategy A keyword search of databases was performed up to April 2017. Selection criteria Obstetric providers who participated in an intervention with the aim to change a provider’s clinical practice, knowledge, and/or satisfaction with the intervention in relation to the perinatal management of obesity or gestational weight gain were included. Provider intervention could include training or education, changes in systems or organization of care, or resources to support practice. PROSPERO database #42016038921. Data collection and analysis Bias was assessed according to the validated Mixed Methods Appraisal Tool. The following variables were synthesized: study location and setting, provider and patient characteristics, intervention features, outcomes and efficacy, and strengths and weakness. Main results Of the 6,821 abstracts screened, seven studies (4 quantitative, 3 mixed-methods) with a total of 335 providers met the inclusion criteria; two of which focused on the management of obesity, three focused on gestational weight gain, and two focused on both topics. Interventions that incorporated motivational interviewing skills (n = 2), required additional training for the research study and addressed specific knowledge deficits such as nutrition and exercise (n = 3), and interfaced with the electronic medical record (n = 1) demonstrated the greatest impact on provider outcomes. Provider reported satisfaction scores were generally favorable, but none addressed provider-level efficacy in practice change. Conclusions Given the limited number of studies, varying range of provider participation, and lack of provider-level efficacy, further evaluation of provider training and involvement in interventions for perinatal obesity or gestational weight gain is indicated to determine best practices for provider and patient outcomes.
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Affiliation(s)
- Michelle A. Kominiarek
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University, Chicago, Illinois, United States of America
- * E-mail:
| | - Linda C. O’Dwyer
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Melissa A. Simon
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, United States of America
| | - Beth A. Plunkett
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States of America
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Tussey C, Olson C. Creating a Multidisciplinary Placenta Accreta Program. Nurs Womens Health 2018; 22:372-386. [PMID: 30176230 DOI: 10.1016/j.nwh.2018.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/27/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To develop a formalized comprehensive placenta accreta (PA) program to improve maternal and neonatal outcomes associated with a PA birth. DESIGN To develop a clinically innovative PA program, goals were identified and teams were created to collaboratively address best practices in each phase of clinical patient care, along with the financial and marketing aspects necessary for a sustainable program. SETTING/LOCAL PROBLEM A Level 3 perinatal center in the Southwestern United States. IMPLEMENTATION A diverse multidisciplinary team addressed each aspect of care associated with a PA birth, including team members from the main operating room; trauma surgery; blood bank; interventional radiology unit; NICU; and gynecology-oncology, anesthesia, and urology departments. MEASUREMENTS Pre- and postprogram clinical outcome measures were examined including estimated blood loss at birth, postbirth ICU transfers and length of stay, and postpartum length of stay. RESULTS Clinical outcomes after program implementation showed decreased blood loss at birth (from an estimated 6,350 ml to 1,300-1,400 ml), reduced postbirth ICU length of stay (from approximately 3 days to less than 1 day, with many women bypassing ICU transfer altogether), and shortened postpartum length of stay (from 8 days to 4 days). CONCLUSION With implementation of this PA program, women receive a proactive approach to care that includes education, holistic care, and an organized team approach to birth made possible by the innovative care delivery model, structures, and processes. Standardized checklists and workflows help each clinician understand his or her role in the process, and resources are directed effectively and efficiently. Multidisciplinary, multispecialty collaboration results in decreased variation in care with associated improved patient outcomes.
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Blomdahl Wetterholm M, Bendix M, Pettersson K, Lindefors N. [A Swedish example of integrated perinatal mental health care]. Lakartidningen 2018; 115:E9ES. [PMID: 30226630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Mental disorders are common during the perinatal period and expose mother and child to major risks. Almost all women in Sweden attend maternal and child health care centers regularly before and after birth. This constitutes a unique opportunity to detect women with early signs of mental disorder or at risk of recurrence of prior illness. Identified women need fast access to diagnostic and treatment providers with specialized knowledge on perinatal mental disorders. As perinatal mental disorders can have severe consequences for mothers and their children a tight cooperation between caregivers is often needed.
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Affiliation(s)
- Margareta Blomdahl Wetterholm
- Stockholms läns sjukvårdsområde - Konsultenheten Psykiatri Sydväst Huddinge, Sweden Stockholms läns sjukvårdsområde - Konsultenheten Psykiatri Sydväst Huddinge, Sweden
| | - Marie Bendix
- SLSO - Psykiatri Sydväst Konsultenheten Stockholm, Sweden SLSO - Psykiatri Sydväst Konsultenheten Stockholm, Sweden
| | - Karin Pettersson
- Patientområde graviditet och förlossning, Karolinska Universitetssjukhuset K57 - Stockholm, SE 14186, Sweden Patientområde graviditet och förlossning, Karolinska Universitetssjukhuset K57 - Stockholm, SE 14186, Sweden
| | - Nils Lindefors
- Karolinska Institutet - Klinisk Neurovetenskap, Centrum för psykiatriforskning Stockholm, Huddinge, Sweden Karolinska Institutet - Clinical Neuroscience Stockholm, Sweden
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Carroll C, Chernew M, Fendrick AM, Thompson J, Rose S. Effects of episode-based payment on health care spending and utilization: Evidence from perinatal care in Arkansas. J Health Econ 2018; 61:47-62. [PMID: 30059822 DOI: 10.1016/j.jhealeco.2018.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 04/10/2018] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Abstract
We study how physicians respond to financial incentives imposed by episode-based payment (EBP), which encourages lower spending and improved quality for an entire episode of care. Specifically, we study the impact of the Arkansas Health Care Payment Improvement Initiative, a multi-payer program that requires providers to enter into EBP arrangements for perinatal care, covering the majority of births in the state. Unlike fee-for-service reimbursement, EBP holds physicians responsible for all care within a discrete episode, rewarding physicians for efficient use of their own services and for efficient management of other health care inputs. In a difference-in-differences analysis of commercial claims, we find that perinatal spending in Arkansas decreased by 3.8% overall under EBP, compared to surrounding states. The decrease was driven by reduced spending on non-physician health care inputs, specifically the prices paid for inpatient facility care. We additionally find a limited improvement in quality of care under EBP.
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Affiliation(s)
- Caitlin Carroll
- Department of Health Care Policy, Harvard University, 180 Longwood Ave, Boston, MA 02115, United States.
| | - Michael Chernew
- Department of Health Care Policy, Harvard University, 180 Longwood Ave, Boston, MA 02115, United States
| | - A Mark Fendrick
- University of Michigan, 2800 Plymouth Road, Building 16/Floor 4, Ann Arbor, MI 48109, United States
| | - Joe Thompson
- Arkansas Center for Health Improvement, 1401 W Capitol Ave, Victory Building, Suite 300, Little Rock, AR 72201, United States
| | - Sherri Rose
- Department of Health Care Policy, Harvard University, 180 Longwood Ave, Boston, MA 02115, United States
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Gathara D, Serem G, Murphy GAV, Abuya N, Kuria R, Tallam E, English M. Quantifying nursing care delivered in Kenyan newborn units: protocol for a cross-sectional direct observational study. BMJ Open 2018; 8:e022020. [PMID: 30037876 PMCID: PMC6059345 DOI: 10.1136/bmjopen-2018-022020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION In many African countries, including Kenya, a major barrier to achieving child survival goals is the slow decline in neonatal mortality that now represents 45% of the under-5 mortality. In newborn care, nurses are the primary caregivers in newborn settings and are essential in the delivery of safe and effective care. However, due to high patient workloads and limited resources, nurses may often consciously or unconsciously prioritise the care they provide resulting in some tasks being left undone or partially done (missed care). Missed care has been associated with poor patient outcomes in high-income countries. However, missed care, examined by direct observation, has not previously been the subject of research in low/middle-income countries. METHODS AND ANALYSIS The aim of this study is to quantify essential neonatal nursing care provided to newborns within newborn units. We will undertake a cross-sectional study using direct observational methods within newborn units in six health facilities in Nairobi City County across the public, private-for-profit and private-not-for-profit sectors. A total of 216 newborns will be observed between 1 September 2017 and 30 May 2018. Stratified random sampling will be used to select random 12-hour observation periods while purposive sampling will be used to identify newborns for direct observation. We will report the overall prevalence of care left undone, the common tasks that are left undone and describe any sharing of tasks with people not formally qualified to provide care. ETHICS AND DISSEMINATION Ethical approval for this study has been granted by the Kenya Medical Research Institute Scientific and Ethics Review Unit. Written informed consent will be sought from mothers and nurses. Findings from this work will be shared with the participating hospitals, an expert advisory group that comprises members involved in policy-making and more widely to the international community through conferences and peer-reviewed journals.
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Affiliation(s)
- David Gathara
- Department of Public Health Research, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - George Serem
- Department of Public Health Research, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Georgina A V Murphy
- Department of Public Health Research, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine and Department of Paediatrics, University of Oxford, Oxford, UK
| | - Nancy Abuya
- Department of Public Health Research, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Curative and Preventative Services, Nairobi City County, Nairobi, Kenya
| | - Rose Kuria
- Department of Nursing, Kenya Medical Training College, Nairobi, Kenya
| | - Edna Tallam
- Department of Registration and Licensing, Nursing Council of Kenya, Nairobi, Kenya
| | - Mike English
- Department of Public Health Research, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine and Department of Paediatrics, University of Oxford, Oxford, UK
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Alexander DC, Geisinger ML, Shenoy S, Dragan IF. Collaborating With the Perinatal Team for Optimal Oral Health Before, During, and After a Healthy Pregnancy. Compend Contin Educ Dent 2018; 39:678-685. [PMID: 30421937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Collaboration with other health professionals can be challenging when attempting to coordinate healthcare before, during, and after pregnancy. However, advantages of interdisciplinary and interprofessional collaborative approaches include facilitation of accurate and timely diagnosis and optimally sequenced treatment for improved health outcomes. This article reviews the current guidelines fostering collaboration between dental professionals and members of the perinatal team and identifies the roles of healthcare providers to support the care of women around the time of pregnancy. Recognizing the maternal oral changes that occur during pregnancy will enable providers to effectively offer diagnosis and referral and organize and deliver comprehensive care. The article discusses how complementing medical care with early professional dental care can help reduce unplanned, expensive "emergency" treatment and describes the concepts of medical and dental homes.
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Affiliation(s)
- David C Alexander
- Adjunct Professor, Epidemiology and Health Promotion, New York University, New York, New York; Principal, Appolonia Global Health Sciences LLC, Green Brook, New Jersey
| | - Maria L Geisinger
- Associate Professor, Director, Advanced Education Program in Periodontology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sachin Shenoy
- Fellow, Obstetrics and Gynecology, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Irina F Dragan
- Assistant Professor, Department of Periodontology, and Faculty Practice Provider, Tufts University School of Dental Medicine, Boston, Massachusetts
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Catalano A, Bennett A, Busacker A, Carr A, Goodman D, Kroelinger C, Okoroh E, Brantley M, Barfield W. Implementing CDC's Level of Care Assessment Tool (LOCATe): A National Collaboration to Improve Maternal and Child Health. J Womens Health (Larchmt) 2017; 26:1265-1269. [PMID: 29240547 PMCID: PMC6020827 DOI: 10.1089/jwh.2017.6771] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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] [Indexed: 10/18/2022] Open
Abstract
Perinatal regionalization, or risk-appropriate care, is an approach that classifies facilities based on capabilities to ensure women and infants receive care at a facility that aligns with their risk. The CDC designed the Levels of Care Assessment Tool (LOCATe) to assist jurisdictions working in risk-appropriate care in assessing a facility's level of maternal and neonatal care aligned with the most current American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) and American Academy of Pediatrics (AAP) guidelines. LOCATe produces standardized assessments for each hospital that participates and facilitates conversations among stakeholders in risk-appropriate care. This article describes how public health departments implement and use LOCATe in their jurisdictions.
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Affiliation(s)
- Andrea Catalano
- Division of Reproductive Health, Centers for Disease Prevention and Control, Atlanta, Georgia
| | - Amanda Bennett
- Division of Reproductive Health, Centers for Disease Prevention and Control, Atlanta, Georgia
- Illinois Department of Public Health, Chicago, Illinois
| | - Ashley Busacker
- Division of Reproductive Health, Centers for Disease Prevention and Control, Atlanta, Georgia
- Wyoming Department of Health, Public Health Division, Cheyenne, Wyoming
| | - Alethia Carr
- Southeast Michigan Perinatal Quality Improvement Coalition, Detroit, Michigan
| | - David Goodman
- Division of Reproductive Health, Centers for Disease Prevention and Control, Atlanta, Georgia
| | - Charlan Kroelinger
- Division of Reproductive Health, Centers for Disease Prevention and Control, Atlanta, Georgia
| | - Ekwutosi Okoroh
- Division of Reproductive Health, Centers for Disease Prevention and Control, Atlanta, Georgia
| | - Mary Brantley
- Division of Reproductive Health, Centers for Disease Prevention and Control, Atlanta, Georgia
| | - Wanda Barfield
- Division of Reproductive Health, Centers for Disease Prevention and Control, Atlanta, Georgia
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Winn A, Hetherington E, Tough S. Systematic Review of Immigrant Women's Experiences With Perinatal Care in North America. J Obstet Gynecol Neonatal Nurs 2017; 46:764-775. [PMID: 28667831 DOI: 10.1016/j.jogn.2017.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To understand the perinatal care experiences of pregnant immigrant women in North America. DATA SOURCES We searched five electronic databases: MEDLINE, PsycINFO, SocINDEX, CINAHL, and Social Work Abstracts. Two categories of search terms, pregnancy and immigrant, were used to conduct a title/abstract and subject heading search. We manually searched the reference lists of all relevant articles to identify additional articles. STUDY SELECTION Inclusion criteria were qualitative or mixed methods study design, focus on immigrant women's experiences of accessing perinatal care, and data collection in North America. Two reviewers were involved in a three-stage selection process: title/abstract screen, full text review, and data extraction and quality appraisal. DATA EXTRACTION Data on authors, date, location, methodology, sample characteristics, data collection, and themes or topics were extracted from 19 articles. DATA SYNTHESIS We followed the Thomas and Harden (2008) thematic synthesis methodology, which involved a three-stage data analysis approach: free line-by-line coding, organization of free codes into descriptive themes, and construction of analytical themes. We developed three meta-themes from the 19 articles included in our review: Expectations of Pregnancy as Derived From Home, Reality of Pregnancy in the Host Health Care System, and Support. CONCLUSION Immigration is a relevant issue in North America, and pregnancy can be an entry point into the health care system for immigrant women. We provide relevant information for health care providers, policy makers, program planners, and researchers about opportunities to explain models of health care delivery, improve communication, and facilitate social support to improve the experiences of immigrant women who interact with the health care system during pregnancy.
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Grigg CP, Tracy SK, Tracy M, Daellenbach R, Kensington M, Monk A, Schmied V. Evaluating Maternity Units: a prospective cohort study of freestanding midwife-led primary maternity units in New Zealand-clinical outcomes. BMJ Open 2017; 7:e016288. [PMID: 28851782 PMCID: PMC5634452 DOI: 10.1136/bmjopen-2017-016288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To compare maternal and neonatal birth outcomes and morbidities associated with the intention to give birth in a freestanding primary level midwife-led maternity unit (PMU) or tertiary level obstetric-led maternity hospital (TMH) in Canterbury, Aotearoa/New Zealand. DESIGN Prospective cohort study. PARTICIPANTS 407 women who intended to give birth in a PMU and 285 women who intended to give birth at the TMH in 2010-2011. All of the women planning a TMH birth were 'low risk', and 29 of the PMU cohort had identified risk factors. PRIMARY OUTCOMES Mode of birth, Apgar score of less than 7 at 5 min and neonatal unit admission. SECONDARY OUTCOMES labour onset, analgesia, blood loss, third stage of labour management, perineal trauma, non-pharmacological pain relief, neonatal resuscitation, breastfeeding, gestational age at birth, birth weight, severe morbidity and mortality. RESULTS Women who planned a PMU birth were significantly more likely to have a spontaneous vaginal birth (77.9%vs62.3%, adjusted OR (AOR) 1.61, 95% CI 1.08 to 2.39), and significantly less likely to have an instrumental assisted vaginal birth (10.3%vs20.4%, AOR 0.59, 95% CI 0.37 to 0.93). The emergency and elective caesarean section rates were not significantly different (emergency: PMU 11.6% vs TMH 17.5%, AOR 0.88, 95% CI 0.55 to 1.40; elective: PMU 0.7% vs TMH 2.1%, AOR 0.34, 95% CI 0.08 to 1.41). There were no significant differences between the cohorts in rates of 5 min Apgar score of <7 (2.0%vs2.1%, AOR 0.82, 95% CI 0.27 to 2.52) and neonatal unit admission (5.9%vs4.9%, AOR 1.44, 95% CI 0.70 to 2.96). Planning to give birth in a primary unit was associated with similar or reduced odds of intrapartum interventions and similar odds of all measured neonatal well-being indicators. CONCLUSIONS The results of this study support freestanding midwife-led primary-level maternity units as physically safe places for well women to plan to give birth, with these women having higher rates of spontaneous vaginal births and lower rates of interventions and their associated morbidities than those who planned a tertiary hospital birth, with no differences in neonatal outcomes.
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Affiliation(s)
- Celia P Grigg
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | | | | | | | - Amy Monk
- University of Technology Sydney, Sydney, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery and the Family and Community Health, University of Western Sydney, Sydney, Australia
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Simioni AT, Llanos O, Romero M, Ramos S, Brizuela V, Abalos E. [Regionalization of perinatal health care in the province of Santa Fe, Argentina]. Rev Panam Salud Publica 2017; 41:e38. [PMID: 28591333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/20/2016] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE Improve the performance of the regionalization policy in the province of Santa Fe, Argentina, as a strategy to improve perinatal health care by analyzing implementation processes and building consensus among decision makers and stakeholders around an action plan. METHODS Implementation research was conducted using mixed methodology. A needs assessment established tracer indicators to measure adherence to the components of the policy. Actors were studied to identify the barriers and facilitators of implementation. Training was provided on the development of consensus- and evidence-based policies, through workshops in which policy briefs were prepared and through a deliberative dialogue. RESULTS There were improvements in the number of births in appropriate hospitals and in the number of births in maternity hospitals with Essential Obstetric and Neonatal Care (CONE). Barriers were identified in the referral systems and in communication on policy, which resulted in an initial agreement on the need for guidelines and specific technical training on the transfer of babies and mothers. CONCLUSIONS The participation of health workers in identifying barriers and strategies to overcome them, and the use of tools to report this to management, permit the adoption of consensus- and evidence-based strategies to improve policy implementation.
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Affiliation(s)
- Alberto Tomás Simioni
- Dirección Provincial por la Salud en la Niñez, Adolescencia, Sexual y Reproductiva (DPSNASyR), Ministerio de Salud de la Provincia de Santa Fe, Argentina
| | - Oraldo Llanos
- Dirección Provincial por la Salud en la Niñez, Adolescencia, Sexual y Reproductiva (DPSNASyR), Ministerio de Salud de la Provincia de Santa Fe, Argentina
| | - Mariana Romero
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvina Ramos
- Centro de Estudios de Estado y Sociedad (CEDES), Ciudad Autónoma de Buenos Aires, Argentina
| | - Vanessa Brizuela
- Centro de Estudios de Estado y Sociedad (CEDES), Ciudad Autónoma de Buenos Aires, Argentina
| | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
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de Graft-Johnson J, Vesel L, Rosen HE, Rawlins B, Abwao S, Mazia G, Bozsa R, Mwebesa W, Khadka N, Kamunya R, Getachew A, Tibaijuka G, Rakotovao JP, Tekleberhan A. Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries. BMJ Open 2017; 7:e014680. [PMID: 28348194 PMCID: PMC5372100 DOI: 10.1136/bmjopen-2016-014680] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To present information on the quality of newborn care services and health facility readiness to provide newborn care in 6 African countries, and to advocate for the improvement of providers' essential newborn care knowledge and skills. DESIGN Cross-sectional observational health facility assessment. SETTING Ethiopia, Kenya, Madagascar, Mozambique, Rwanda and Tanzania. PARTICIPANTS Health workers in 643 facilities. 1016 health workers were interviewed, and 2377 babies were observed in the facilities surveyed. MAIN OUTCOME MEASURES Indicators of quality of newborn care included (1) provision of immediate essential newborn care: thermal care, hygienic cord care, and early and exclusive initiation of breast feeding; (2) actual and simulated resuscitation of asphyxiated newborn infants; and (3) knowledge of health workers on essential newborn care, including resuscitation. RESULTS Sterile or clean cord cutting instruments, suction devices, and tables or firm surfaces for resuscitation were commonly available. 80% of newborns were immediately dried after birth and received clean cord care in most of the studied facilities. In all countries assessed, major deficiencies exist for essential newborn care supplies and equipment, as well as for health worker knowledge and performance of key routine newborn care practices, particularly for immediate skin-to-skin contact and breastfeeding initiation. Of newborns who did not cry at birth, 89% either recovered on their own or through active steps taken by the provider through resuscitation with initial stimulation and/or ventilation. 11% of newborns died. Assessment of simulated resuscitation using a NeoNatalie anatomic model showed that less than a third of providers were able to demonstrate ventilation skills correctly. CONCLUSIONS The findings shared in this paper call attention to the critical need to improve health facility readiness to provide quality newborn care services and to ensure that service providers have the necessary equipment, supplies, knowledge and skills that are critical to save newborn lives.
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Affiliation(s)
| | - Linda Vesel
- Innovations for Maternal, Newborn and Child Health, Concern Worldwide, New York, New York, USA
| | - Heather E Rosen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Stella Abwao
- Maternal and Child Survival Program, Washington, DC, USA
| | - Goldy Mazia
- Maternal and Child Survival Program, Washington, DC, USA
| | | | | | - Neena Khadka
- Maternal and Child Survival Program, Washington, DC, USA
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Butcher L. BUNDLE OF JOY: Expanding bundled payments into maternity care. Hosp Health Netw 2017; 91:11. [PMID: 30085442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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