Rethinking the definition of maternal near‐miss in low‐income countries using data from 104 health facilities in Tanzania and Uganda

Abstract Background: The current discrepancies in maternal mortality and near miss cases of high and low income countries are usually due to the differences in timely management of obstetric complications and the differences in time management comes up with idea of delay in receiving obstetric care. For each maternal death there will be 20 others that suffer as maternal near miss cases worldwide. This study aimed to assess delay of maternal near miss (MNM) and associated factors among women in Felege Hiwot Comprehensive Specialized Hospital (FHCSH), Northwest Ethiopia. Methods: Cross sectional facility based study was conducted among 287 women who were managed as MNM from May 2018 to September 30, 2018. A checklist and structured questionnaire was used to retrieve information from the patient and her medical document. The collected data was cleaned, coded and entered for analysis. The results were presented in tables. Binary and multiple logistic regression analysis were calculated at 95 % CI.Results: There were 2694 patients admitted in wards in the study period and proportion of maternal near miss was 10.65% with maternal near miss mortality ratio of 31.9 and mortality index of 3%. From all maternal near misses studied 44.3% had first delay and 35% had second delay with 51.2% had third delay. Seventy four percent of them had at least one delay. Determinant factors identified were rural residence [AOR, 3.2 P = 0.001], distance more than 10 Kms away from hospital [AOR, 2.18, p =0.025], lack of ambulance [AOR, 3.9 P= 0.009] and lack of awareness on obstetric complications [AOR,27.9, p = 0.001] which were statistically associated with any maternal delay. Conclusion: Maternal near miss proportion is still high in study site and majority of them had at least one delay in receiving care which needs an intervention at community and low level health institutions.

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TAX STRUCTURE AND ECONOMIC GROWTH: DO DIFFERENCES IN INCOME LEVEL AND GOVERNMENT EFFECTIVENESS MATTER?

The Singapore Economic Review ◽

10.1142/s0217590818500170 ◽

2018 ◽

Vol 65 (01) ◽

pp. 217-237 ◽

Cited By ~ 1

Author(s):

HALIT YANIKKAYA ◽

TANER TURAN

Keyword(s):

Low Income ◽

Low Income Countries ◽

Estimation Methods ◽

Property Taxes ◽

Tax Rates ◽

Tax Structure ◽

Tax Rate ◽

Using Data ◽

Positive Effect ◽

Effect On Growth

We examine the effects of both overall tax rate and changes in tax structure on growth by using data for more than 100 high, middle, and low income countries by employing the GMM estimation methods. In general, our results do not support the argument that overall tax rates or changes in tax structure have a significant effect on growth. However, we find that a shift from income to consumption and property taxes leads to a positive and significant effect on growth rate while a shift from consumption and property taxes to income taxes has a positive effect for low-income countries.

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Return to Treatment in the Formal Health Care Sector: Evidence from Tanzania

American Economic Journal Economic Policy ◽

10.1257/pol.20120262 ◽

2015 ◽

Vol 7 (3) ◽

pp. 29-57 ◽

Cited By ~ 7

Author(s):

Achyuta Adhvaryu ◽

Anant Nyshadham

Keyword(s):

Public Health ◽

Health Care ◽

Low Income ◽

Health Care Sector ◽

Health Facilities ◽

Low Income Countries ◽

Formal Sector ◽

Health Goal ◽

Public Health Goal ◽

Formal Health Care

Improving access to the formal health care sector is a primary public health goal in many low-income countries. But the returns to this access are unclear, given that the quality of care at public health facilities is often considered inadequate. We exploit temporal and geographic variation in the cost of traveling to formal sector health facilities to show that treatment at these facilities improves short-term health outcomes for acutely ill children in Tanzania. Our results suggest that these improvements are driven in part by more timely receipt of and better adherence to antimalarial treatment. (JEL I11, I12, I15, I18, J13, O15)

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Wholesome Nutrition: an example for a sustainable diet

Proceedings of The Nutrition Society ◽

10.1017/s0029665116000616 ◽

2016 ◽

Vol 76 (1) ◽

pp. 34-41 ◽

Cited By ~ 17

Author(s):

Karl von Koerber ◽

Nadine Bader ◽

Claus Leitzmann

Keyword(s):

Low Income ◽

Cultural Dimensions ◽

Low Income Countries ◽

Resource Saving ◽

Cultural Aspects ◽

Fifth Dimension ◽

Global Challenges ◽

Sustainable Diet ◽

Definition Of ◽

The University

‘Wholesome Nutrition’ is a concept of sustainable nutrition that was developed at the University of Giessen in the 1980s. In this concept, health and the ecologic, economic, social and cultural dimensions of nutrition are equally important. In 1992 at the UN-Conference on Environment and Development in Rio de Janeiro the definition of ‘Sustainable Development’ comprised the dimensions environment, economy and society. Additionally to these three ‘classical’ dimensions of sustainability, we included ‘health’ as the fourth dimension because nutrition has far reaching effects on human health. The fifth dimension, ‘culture’, became part of the sustainability dialogue since many years; the respective cultural background influences food habits. Presently, mankind has to cope with huge global challenges such as poverty and food insecurity in low-income countries as well as climate change. Therefore the objective is to identify prospects for actions to respond to these global challenges. The concept of ‘Sustainable Nutrition’ analyses the food supply chain at all stages from input-production and primary production to processing, distribution, preparation, consumption and waste disposal. The present analysis leads to the following seven principles: preference of plant-based foods, organic foods, regional and seasonal products, preference of minimally processed foods, Fair Trade products, resource-saving housekeeping and enjoyable eating culture. This concept is based on holistic thinking and has the potential to reduce the global challenges in the field of nutrition. Scientists, stakeholders, multipliers and consumers are asked to consider environmental, economic, social and cultural aspects in addition to the biological (health) aspects.

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Determinant factors of maternal near miss in selected health facilities of Berak Woreda, Oromia national regional state, Ethiopia

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20201268 ◽

2020 ◽

Vol 6 (4) ◽

pp. 131

Author(s):

Bilal Abdulrazaq ◽

Mulusew Getahun ◽

Ahmed Mohammed ◽

Shemsu Kedir ◽

Negash Nurahmed ◽

...

Keyword(s):

Sampling Technique ◽

Simple Random Sampling ◽

Health Facilities ◽

Near Miss ◽

Maternal Near Miss ◽

Outcome Variable ◽

Obstructed Labor ◽

Determinant Factors ◽

Regional State ◽

Maternal Health Policy

Background: Maternal near miss is one of the related concepts to maternal mortality where women survive merely by chance, luck, or by good hospital care. The present study was aimed to fill the prevailing knowledge gap on maternal near miss ratio and events and identify factors associated with near miss in selected health facilities of berak woreda. To determine associated factors of maternal near miss in selected health facilities of Berak woreda, Oromia national regional state, Ethiopia. Methods: Institutional based case control study was conducted in selected health facilities of barek woreda to asses determinant factors of maternal near miss among delivered women. Data of 1272 (344 cases and 928 controls) women were included in the analysis registered from 11 September 2014 to 30 March 2018. Cases were women due to severe acute maternal morbidity while controls were women for normal labor. Simple random sampling technique was used in the delivery unit. The data were collected using WHO standard tool. Data were entered using epi data version 3.1 and exported to SPSSV.20 for data analysis. Results: Majority of cases were due to obstructed labor 270 (78.8%) followed by hemorrhage 33 (9.6%), preeclampsia 29 (8.14%), abortion 6 (1.74%), anemia 3 (0.87%), congenital heart disease 2 (0.58%) and gestational infection 1 (0.29%).Conclusions: Independent variables residence, duration of labor, ANC utilization, past obstetrics complication and number of live births were statistically significant with the outcome variable near miss. Maternal health policy needs to be concerned preventing major cause of near miss.

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Technological Spillover, Growth Convergence And Technical Progress: Does technology flow from rich to poor economies?

Archives of Business Research ◽

10.14738/abr.84.8097 ◽

2020 ◽

Vol 8 (4) ◽

pp. 132-145

Author(s):

Oladele O Aluko ◽

B. Sabiu Sani

Keyword(s):

Economic Growth ◽

Technical Progress ◽

Low Income ◽

Generalized Method Of Moments ◽

Low Income Countries ◽

Dynamic Panel Model ◽

Poor Countries ◽

Growth Convergence ◽

Using Data ◽

The One

This study examines Technology spillover from rich to poor countries, the study used a model that, at the aggregate level, is similar to the one sector neoclassical growth model. The model was estimated using data on technical progress, Average Product Per-Worker, Capital Stock and Technology Intensive Goods in 25 countries which consist of rich and poor countries over the last decade. A dynamic panel model is formulated and estimated Using Generalized method of moments by Arelano and Bond; and the implications of the estimates were evaluated for aggregate total factor productivity and economic growth. The results reveal that, on average, technology have contributed more to economic growth in high income economies and on the contrary technology have made little or no contribution in low income countries. Consequently, there is substantial variation across technologies and economies

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Evaluation of Health Facilities Capacity for the Management of Severe Preeclampsia and Eclampsia in Bayelsa State, Nigeria

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i930902 ◽

2021 ◽

pp. 78-86

Author(s):

O. M. Alabintei ◽

P. W. Alabrah ◽

I. J. Abasi

Keyword(s):

Health Care ◽

Low Income ◽

Care Delivery ◽

Data Entry ◽

Sampling Technique ◽

Health Care Facilities ◽

Health Facilities ◽

Low Income Countries ◽

Multi Stage ◽

Interview Guide

Background: The lack of properly-stocked facilities with basic and essential equipment and supplies as well as clinical guidelines required to successfully manage Pre-eclampsia/eclampsia (PE/E) has been reported in developing, low-income countries. It is necessary to ensure properly stocked health facilities for effective health care delivery. This study set out to assess the capacity of the health facilities in Bayelsa, Nigeria for the management of cases of eclampsia. Methods: A descriptive design was used in the conduct of this research in which 155 workers were recruited. A multi-stage sampling technique was employed to select health facilities for the study. The study instruments included a self-administered structured questionnaire, an interview guide, and an inventory checklist. Data entry, cleaning and analysis were done using the Statistical Package for Social Sciences (SPSS) version 22. Descriptive and inferential statistics were generated using the data. Results: It was found in this study that though MgSO4 was present in one (8.33%) primary and two (66.6%) secondary health facilities visited, no guide on how to administer and monitor the patients was available. The majority of the workforce in the primary health facility were the CHEW/CHO (48%), followed by midwives (16.9%) and then nurses (12.3%).Doctors constituted 7.7% while pharmacists and pharmacist technicians constituted 6.2% and 9.2% respectively. Conclusion: In conclusion, this study revealed that facilities assessed lacked most of the basic and essential equipment, supplies and drugs, required for the successful management of PE/E. For effective management of cases of eclampsia, it is very essential that there should be a continuous supply of necessary tools, drugs and functioning equipment needed for the management of PE/E in all health care facilities.

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Factors associated with the preference of institutional delivery after antenatal care attendance in Northwest Ethiopia

BMC Health Services Research ◽

10.1186/s12913-019-4636-6 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Araya Mesfin Nigatu ◽

Kassahun Alemu Gelaye

Keyword(s):

Health Education ◽

Antenatal Care ◽

Low Income ◽

Institutional Delivery ◽

Statistical Significance ◽

Health Facilities ◽

Low Income Countries ◽

Contributing Factors ◽

Place Of Delivery ◽

Factors Associated

Abstract Background Even though maternal mortality during the time of delivery can be prevented with proper medical care in the health facilities with skilled healthcare professionals, unexpectedly death is still high and is a persistent challenge for low-income countries. Therefore identifying factors affecting the preference of institutional delivery after antenatal care service attendance is a key intervention to reduce maternal morbidity and mortality. Method A community-based cross-sectional study was conducted using face to face using interviewer-administered questionnaire from a total of 528 women who gave their last birth within 12 months prior to the study period who attended antenatal care (ANC) services. Descriptive statistics, bivariable and multivariable logistic regressions analysis were performed. Statistical significance was considered at p < 0.05 and odds ratio with 95% CI were calculated to examine factors associated with institutional delivery. Results Of the 528 pregnant women attending ANC services, 250 (47.3%) gave birth in health facilities (95% CI: 43.2, 51.7%). Urban residence [AOR = 7.8, 95% CI: 4.1, 15.6], four or more ANC visits [AOR = 4.5, 95% CI: 1.6, 12.3], those who got health education on ANC [AOR = 2.9, 95% CI: 1.5, 5.6] and decision on place of delivery with her partner agreement [AOR = 3.3, 95% CI: 1.3, 8.7] were found to be contributing factors for the preference of institutional delivery. Conclusion Institutional delivery was not adequate. Residence, number of antenatal care visits, health education, decisions making on a place of delivery and having awareness of the difference of place of delivery were contributing factors for the preference of institutional delivery.

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Solar-powered oxygen, quality improvement and child pneumonia deaths: a large-scale effectiveness study

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-320107 ◽

2020 ◽

pp. archdischild-2020-320107

Author(s):

Trevor Duke ◽

Francis Pulsan ◽

Doreen Panauwe ◽

Ilomo Hwaihwanje ◽

Martin Sa'avu ◽

...

Keyword(s):

Quality Improvement ◽

Low Income ◽

Large Scale ◽

Incidence Rates ◽

Health Care Facilities ◽

Health Facilities ◽

Low Income Countries ◽

Continuous Quality ◽

Child Deaths ◽

Solar Powered

BackgroundPneumonia is the largest cause of child deaths in low-income countries. Lack of availability of oxygen in small rural hospitals results in avoidable deaths and unnecessary and unsafe referrals.MethodWe evaluated a programme for improving reliable oxygen therapy using oxygen concentrators, pulse oximeters and sustainable solar power in 38 remote health facilities in nine provinces in Papua New Guinea. The programme included a quality improvement approach with training, identification of gaps, problem solving and corrective measures. Admissions and deaths from pneumonia and overall paediatric admissions, deaths and referrals were recorded using routine health information data for 2–4 years prior to the intervention and 2–4 years after. Using Poisson regression we calculated incidence rates (IRs) preintervention and postintervention, and incidence rate ratios (IRR).ResultsThere were 18 933 pneumonia admissions and 530 pneumonia deaths. Pneumonia admission numbers were significantly lower in the postintervention era than in the preintervention era. The IRs for pneumonia deaths preintervention and postintervention were 2.83 (1.98–4.06) and 1.17 (0.48–1.86) per 100 pneumonia admissions: the IRR for pneumonia deaths was 0.41 (0.24–0.71, p<0.005). There were 58 324 paediatric admissions and 2259 paediatric deaths. The IR for child deaths preintervention and postintervention were 3.22 (2.42–4.28) and 1.94 (1.23–2.65) per 100 paediatric admissions: IRR 0.60 (0.45–0.81, p<0.005). In the years postintervention period, an estimated 348 lives were saved, at a cost of US$6435 per life saved and over 1500 referrals were avoided.ConclusionsSolar-powered oxygen systems supported by continuous quality improvement can be achieved at large scale in rural and remote hospitals and health care facilities, and was associated with reduced child deaths and reduced referrals. Variability of effectiveness in different contexts calls for strengthening of quality improvement in rural health facilities.Trial registration numberACTRN12616001469404.

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Trading Equality for Health? Evaluating the Trade-off and Institutional Hypotheses on Health Inequalities in the Global South

Journal of Health and Social Behavior ◽

10.1177/0022146517721950 ◽

2017 ◽

Vol 58 (3) ◽

pp. 340-356 ◽

Cited By ~ 4

Author(s):

Benjamin Sosnaud ◽

Jason Beckfield

Keyword(s):

Low Income ◽

Global South ◽

Low Income Countries ◽

Educational Systems ◽

Demographic And Health Surveys ◽

Trade Off ◽

Under Five ◽

Inequality In Health ◽

Small Increments ◽

Using Data

It has been suggested that as medicine advances and mortality declines, socioeconomic disparities in health outcomes will grow. Yet, most research on this topic uses data from affluent Western democracies, where mortality is declining in small increments. We argue that the Global South represents the ideal setting to study this issue in a context of rapid mortality decline. We evaluate two competing hypotheses: (1) there is a trade-off between population health and health inequality such that reductions in under-five mortality are linked to higher levels of social inequality in health; and (2) institutional interventions that improve under-five mortality, like the expansion of educational systems and public health expenditure, are associated with reductions in inequalities. We test these hypotheses using data on 1,369,050 births in 34 low-income countries in the Demographic and Health Surveys from 1995 to 2012. The results show little evidence of a health-for-equality trade-off and instead support the institutional hypothesis.

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