scholarly journals 731. Puerperal Sepsis Among Women with In-facility Births in Western Tanzania

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S464-S464
Author(s):  
Rachel Smith ◽  
Alicia Ruiz ◽  
Matthew Westercamp ◽  
Godson Maro ◽  
Florina Serbanescu
Keyword(s):  
Early Recognition ◽  
Descriptive Analysis ◽  
Health Centers ◽  
Mortality Data ◽  
Free Text ◽  
Maternal Complications ◽  
Obstructed Labor ◽  
Puerperal Sepsis ◽  
Neonatal Deaths ◽  
Facility Births

Abstract Background Puerperal sepsis is an important cause of maternal mortality worldwide. As access to emergency obstetric services expands in resource-limited settings, rapid recognition and treatment of sepsis, and prevention of nosocomial infections that might lead to sepsis, is critical. We describe puerperal sepsis cases among women with in-facility births in the Kigoma region of Tanzania. Methods Demographic, obstetric history, pregnancy complication and outcome, as well as mortality data were collected for women who delivered in hospitals, health centers and dispensaries in the Kigoma region, Tanzania 2016 – 2018. Up to 3 maternal complications were recorded as free text. Puerperal sepsis included women where ‘sepsis’ was recorded as a complication during hospitalization. We calculated rates of puerperal sepsis and completed a descriptive analysis of patients. Results 203,604 women delivered infants in 197 participating facilities during the data collection period. Of these, 2228 (1.1%) had sepsis recorded, for an overall rate of 10.9 sepsis cases per 1000 deliveries. Although 48% of births occurred in dispensaries, sepsis complications were reported almost exclusively in hospitals and health centers (37.7 and 10.3 per 1000 deliveries, respectively). Sepsis rates varied across individual facilities, from 15.5 to 45.2 cases per 1000 deliveries in hospitals and 0 to 38.6 cases per 1000 deliveries in health centers. Women who developed sepsis had a median age of 25 (IQR 22 – 30) years and 1113 (56%) were nulliparous. 1763 (90%) of women who had sepsis delivered by caesarian delivery. Obstructed labor (827; 42%) was a common co-complication of sepsis; obstetric hemorrhage and uterine rupture were seen in 93 (5%) and 77 (4%) women with sepsis, respectively. 49 women with sepsis (3%) died prior to hospital discharge. Stillbirths and pre-discharge neonatal deaths complicated 107 (5%) and 74 (4%) deliveries to women with sepsis. Conclusion In the Kigoma region of Tanzania puerperal sepsis frequently occurs in women with obstructed labor and caesarian delivery. Further evaluation of both facility-level and individual factors that contribute to the incidence of sepsis in this population, particularly those related to invasive procedures, is critical for early recognition and prevention. issue Disclosures All Authors: No reported disclosures

scholarly journals The application of WHO ICD-PM: Feasibility for the classification of timing and causes of perinatal deaths in a busy birth centre in a low-income country

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245196
Author(s):  
Natasha Housseine ◽  
Anne Snieder ◽  
Mithle Binsillim ◽  
Tarek Meguid ◽  
Joyce L. Browne ◽  
...  
Keyword(s):  
Perinatal Mortality ◽  
Low Income ◽  
Perinatal Death ◽  
Descriptive Analysis ◽  
Accurate Determination ◽  
Referral Hospital ◽  
Maternal Complications ◽  
Perinatal Deaths ◽  
Neonatal Deaths

Objective To assess the feasibility of the application of International Classification of Diseases-10—to perinatal mortality (ICD-PM) in a busy low-income referral hospital and determine the timing and causes of perinatal deaths, and associated maternal conditions. Design Prospective application of ICD-PM. Setting Referral hospital of Mnazi Mmoja Hospital, Zanzibar, United Republic of Tanzania. Population Stillbirths and neonatal deaths with a birth weight above 1000 grams born between October 16th 2017 to May 31st 2018. Methods Clinical information and an adapted WHO ICD-PM interactive excel-based system were used to capture and classify the deaths according to timing, causes and associated maternal complications. Descriptive analysis was performed. Main outcome measures Timing and causes of perinatal mortality and their associated maternal conditions. Results There were 661 perinatal deaths of which 248 (37.5%) were neonatal deaths and 413 (62.5%) stillbirths. Of the stillbirths, 128 (31%) occurred antepartum, 129 (31%) intrapartum and for 156 (38%) the timing was unknown. Half (n = 64/128) of the antepartum stillbirths were unexplained. Two-thirds (67%, n = 87/129) of intrapartum stillbirths followed acute intrapartum events, and 30% (39/129) were unexplained. Of the neonatal deaths, 40% died after complications of intrapartum events. Conclusion Problems of documentation, lack of perinatal death audits, capacity for investigations, and guidelines for the unambiguous objective assignment of timing and primary causes of death are major threats for accurate determination of timing and specific primary causes of perinatal deaths.

ANALYSIS OF FETAL AND NEONATAL DEATHS IN 4117 CONSECUTIVE BIRTHS

PEDIATRICS ◽  
1950 ◽  
Vol 5 (2) ◽  
pp. 184-192
Author(s):  
HERBERT C. MILLER
Keyword(s):  
Cause Of Death ◽  
Premature Infants ◽  
Neonatal Death ◽  
Causes Of Death ◽  
Neonatal Period ◽  
Full Term ◽  
Maternal Complications ◽  
Term Infants ◽  
Neonatal Deaths ◽  
Postmortem Examinations

An analysis of the significant causes of death in 4117 consecutive births was made; there were 66 fetal deaths and 85 neonatal deaths. A significant cause of death was determined in 51 fetuses and 56 live-born infants. Eighty-five per cent of the live-born infants who weighed over 1000 gm. at birth and had postmortem examinations had causes of death which were considered to be significant. Almost half of the live-born premature infants with birth weights between 1000 and 2500 gm. were considered to have had more than one significant cause of death. The so-called significant causes of death among live-born infants differed from those determined for fetuses dying before birth. Among the former, pathologic conditions in the infants were determined four times more frequently than in those dying before birth and, in the latter, maternal complications of pregnancy and labor were diagnosed as significant causes of death five times more frequently than in infants dying in the neonatal period. Hyaline-like material in the lung was considered to be the most frequent significant cause of death in live-born premature infants; congenital malformation and anoxia resulting from complications of labor were the most frequently determined significant causes of death in live-born full term infants. No differences were found in the significant causes of death in premature and full term fetuses. Anoxia resulting from accidental and unexpected interruption of the blood flow in the placenta and umbilical cord and from dystocia was the most frequently determined significant cause of death in both groups. A plea has been made for the adoption by obstetricians, pathologists and pediatricians of a formal uniform plan of classifying the causes of fetal and neonatal death which would divest current efforts to determine the cause of death of as much vague terminology and arbitrary opinion as possible.

scholarly journals Parents’ Knowledge of Neonatal Danger Signs and Associated Factors at Health Centers in Kigali, Rwanda

2020 ◽  
Vol 3 (2) ◽  
pp. 128-138
Author(s):  
Patricie Mujawimana ◽  
Fauste Uwingabire ◽  
Felicite Kankindi ◽  
Ruth Dusabe ◽  
Pamela Meharry
Keyword(s):  
Associated Factors ◽  
Neonatal Period ◽  
Healthcare Providers ◽  
Sampling Strategy ◽  
Health Centers ◽  
Cross Sectional ◽  
Neonatal Deaths ◽  
Danger Signs ◽  
Parity Number ◽  
Cross Sectional Design

Background Globally, nearly half of all under-five deaths occur during the neonatal period. About two million dies within the first week, of which 75% come from low-resource countries, such as Rwanda. Many neonatal deaths are preventable or avoidable if parents are knowledgeable of Neonatal Danger Signs (NDS), and do not delay seeking care at a health facility. Objective To assess the parents’ knowledge of NDS and associated factors within the neonatal period at four health centers in Kigali. Method This study was a descriptive cross-sectional design. A proportionate stratified probability sampling strategy was used to select 209 parents who attended selected health centers in Kigali. Data analysis used descriptive and inferential statistics. Results The findings showed that 67% of participants had some information on NDS. Logistic regression showed that educational level, parity, number of antenatal visits, and information from healthcare providers was significantly associated with parents' knowledge of NDS. Conclusion Our findings indicate the need to enhance education of parents’ knowledge of NDS in the study population. Educational efforts also should target NDS in health centers where most Rwandan women attend antenatal care. Rwanda J Med Health Sci 2020;3(2):128-138

scholarly journals Factors Associated with Utilization of Complete Postnatal Care Service in Baglung Municipality, Nepal

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Sita Chhetri ◽  
Rajani Shah ◽  
Laxmi Rajbanshi
Keyword(s):  
Postnatal Care ◽  
Care Service ◽  
Descriptive Analysis ◽  
Cross Sectional Study ◽  
Vital Role ◽  
Postnatal Period ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Neonatal Deaths ◽  
Factors Associated

Background. Postnatal period is six weeks after birth. It is critical but is the most neglected period. A large proportion of maternal and neonatal deaths occur during 48 hours following childbirth. The utilization of the recommended three postnatal checkups within seven days after delivery, which plays a vital role in preventing maternal and neonatal deaths, is low in Nepal. Objective. This study is aimed at identifying the factors associated with the utilization of complete postnatal care (PNC) among mothers. Method. A cross-sectional study was carried out among 318 mothers in wards 1, 2, 3, and 4 of Baglung municipality, Nepal. Data was collected by semi-structured interviews. Descriptive analysis and comparison of characteristics of women/families with complete vs. partial postnatal checkups using multivariable logistic regression were done. Results. Among 314 respondents receiving at least one PNC, 78% had partial and 22% had complete PNC. Relatively advantaged caste/ethnicity- Brahman/Chhetri (aOR=3.18, 95% CI: 1.24-8.12) and Janajati (aOR=2.87, 95% CI: 1.09-7.53) - compared to Dalits, husbands working as a job holder in Nepal (aOR=3.49, 95% CI: 1.50-8.13), and delivery in a private hospital (aOR=11.4, 95% CI: 5.40-24.2) were associated with having complete PNC. Conclusion. Although PNC attendance at least once was high, utilization of complete PNC was low. More focus to mothers from disadvantaged caste/ethnicity, those whose husbands are in foreign employment, and improvement in quality of care in government health facilities may increase the use of complete PNC.

Varying impact of co-morbid conditions on self-harm resulting in mortality in Australia

2016 ◽  
Vol 47 (1) ◽  
pp. 28-37 ◽  
Author(s):  
Kate Churruca ◽  
Brian Draper ◽  
Rebecca Mitchell
Keyword(s):  
Chronic Conditions ◽  
Mortality Data ◽  
Free Text ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
International Statistical Classification ◽  
Self Harm ◽  
Australian Bureau Of Statistics ◽  
The Impact ◽  
Morbid Conditions

Background: Research has associated some chronic conditions with self-harm and suicide. Quantifying such a relationship in mortality data relies on accurate death records and adequate techniques for identifying these conditions. Objective: This study aimed to quantify the impact of identification methods for co-morbid conditions on suicides in individuals aged 30 years and older in Australia and examined differences by gender. Method: A retrospective examination of mortality records in the National Coronial Information System (NCIS) was conducted. Two different methods for identifying co-morbidities were compared: International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) coded data, which are provided to the NCIS by the Australian Bureau of Statistics, and free-text searches of Medical Cause of Death fields. Descriptive statistics and χ2 tests were used to compare the methods for identifying co-morbidities and look at differences by gender. Results: Results showed inconsistencies between ICD-10 coded and coronial reports in the identification of suicide and chronic conditions, particularly by type (physical or mental). There were also significant differences in the proportion of co-morbid conditions by gender. Conclusion: While ICD-10 coded mortality data more comprehensively identified co-morbidities, discrepancies in the identification of suicide and co-morbid conditions in both systems require further investigation to determine their nature (linkage errors, human subjectivity) and address them. Furthermore, due to the prescriptive coding procedures, the extent to which medico-legal databases may be used to explore potential and previously unrecognised associations between chronic conditions and self-harm deaths remains limited.

scholarly journals Association between maternity waiting home stay and obstetric outcomes in Yetebon, Ethiopia: a mixed-methods observational cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anne K. Erickson ◽  
Safa Abdalla ◽  
Alice Serenska ◽  
Bete Demeke ◽  
Gary L. Darmstadt
Keyword(s):  
Lower Risk ◽  
Placenta Previa ◽  
Randomized Study ◽  
Obstetric Outcomes ◽  
Maternal Complications ◽  
Obstructed Labor ◽  
Convenience Sample ◽  
Maternity Waiting Homes ◽  
Adverse Pregnancy ◽  
Newborn Complications

Abstract Background A strategy for reducing adverse pregnancy outcomes is the expanded implementation of maternity waiting homes (MWHs). We assessed factors influencing MWH use, as well as the association between MWH stay and obstetric outcomes in a hospital in rural Ethiopia. Methods Data from medical records of the Glenn C. Olson Memorial Primary Hospital obstetric ward were cross matched with records from the affiliated MWH between 1 and 2011 to 31 March 2014. Poisson regression with robust variance was conducted to estimate the relative risk (RR) of childbirth complications associated with MWH use vs. non-use. Five key informant interviews of a convenience sample of three MWH staff and two users were conducted and a thematic analysis performed of social, cultural, and economic factors underlying MWH use. Results During the study period, 489 women gave birth at the hospital, 93 of whom were MWH users. Common reasons for using the MWH were post-term status, previous caesarean section/myomectomy, malposition/malpresentation, and low-lying placenta, placenta previa, or antepartum hemorrhage, and hypertension or preeclampsia. MWH users were more likely than non-users to have had a previous caesarean Sec. (15.1 % vs. 5.3 %, p < 0.001) and to be post-term (21.5 % vs. 3.8 %, p < 0.001). MWH users were also more likely to undergo a caesarean Sec. (51.0 % vs. 35.4 %, p < 0.05) and less likely (p < 0.05) to have a spontaneous vaginal delivery (49.0 % vs. 63.6 %), obstructed labor (6.5 % vs. 14.4 %) or stillbirth (1.1 % vs. 8.6 %). MWH use (N = 93) was associated with a 77 % (adjusted RR = 0.23, 95 % Confidence Interval (CI) 0.12–0.46, p < 0.001) lower risk of childbirth complications, a 94 % (adjusted RR = 0.06, 95 % CI 0.01–0.43, p = 0.005) lower risk of fetal and newborn complications, and a 73 % (adjusted RR = 0.27, 95 % CI 0.13–0.56, p < 0.001) lower risk of maternal complications compared to MWH non-users (N = 396). Birth weight [median 3.5 kg (interquartile range 3.0-3.8) vs. 3.2 kg (2.8–3.5), p < 0.001] and 5-min Apgar scores (adjusted difference = 0.25, 95 % CI 0.06–0.44, p < 0.001) were also higher in offspring of MWH users. Opportunity costs due to missed work and need to arrange for care of children at home, long travel times, and lack of entertainment were suggested as key barriers to MWH utilization. Conclusions This observational, non-randomized study suggests that MWH usage was associated with significantly improved childbirth outcomes. Increasing facility quality, expanding services, and providing educational opportunities should be considered to increase MWH use.

scholarly journals Assessment of Facility based newborn care at various health care facilities in Rajkot district

2017 ◽  
Vol 4 (4) ◽  
pp. 1125
Author(s):  
Jasmin R. Oza ◽  
Ashutosh D. Jogia ◽  
Bhavesh R. Kanabar ◽  
Dhara V. Thakrar
Keyword(s):  
Health Care ◽  
Health Personnel ◽  
Newborn Care ◽  
Health Care Facilities ◽  
Health Facilities ◽  
Health Centers ◽  
Care Providers ◽  
Digital Thermometer ◽  
Neonatal Deaths ◽  
District Hospitals

Background: India carries the single largest share (around 25-30%) of neonatal deaths in the world. It has been estimated that about 70% of neonatal deaths could be prevented if proven interventions are implemented effectively with high coverage.Methods: A cross-sectional observational study was conducted at various health facilities of Rajkot district where facility based newborn care are created as per the guidelines under NRHM. It was conducted during August 2013 to October, 2013. The data entry was done in Microsoft Office Excel 2007 and analyzed in Epi info software from CDC Atlanta. Results: This study included total 32 health facilities including 10 Primary Health Centers (PHC) (24X7), 15 Community Health Centers (CHC), 5 Sub District Hospitals (SDH), one District Hospital (DH) and one Medical College (MC). There are a total of 36 facilities of different level available in government set up for newborn care starting from NBCC to SNCU. All (100%) of the health centers visited were equipped with NBCC for newborn care, while NBSU and SNCU for newborn care were created at only 2 (6.2%) centers respectively. Only 2 out of 10 PHC had all required equipments for NBCC. All the required equipments were available at 3 CHCs out of total 15 CHCs. All the SDH were having adequate equipment for NBCC except resuscitator & separate Digital Thermometer were not available at 2 SDH. At DH, except for Digital thermometer, all equipments were adequate. Only 1 SDH has been established for NBSU and it did not have adequate no. of radiant warmer and resuscitator. DH is lacking in all the required equipment for SNCU except for resuscitator (250 ml) and refrigerator. Out of total 101 health personnel, 68 (67.3%) have been trained for NSSK.  From total 68 trained health personnel, 12 (17.7%) got the score above the cut off for resuscitation skill. Out of the trained respondents, 29 (42.7%) acquired score above cut off for routine care.Conclusion: All the PHCs, CHCs, SDHs and DH were deficient in equipments. NBSU was created in only one SDH. SNBU was created at DH and MC, but equipments were not sufficient at both centers. Health care providers involved in facility based newborn care units had poor knowledge regarding routine newborn care and also not properly trained in resuscitation.

scholarly journals Trends, patterns and cause-specific neonatal mortality in Tanzania: a hospital-based retrospective survey

2020 ◽  
Author(s):  
Chacha D Mangu ◽  
Susan F Rumisha ◽  
Emanuel P Lyimo ◽  
Irene R Mremi ◽  
Isolide S Massawe ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Neonatal Mortality ◽  
Neonatal Death ◽  
Birth Asphyxia ◽  
International Classification Of Diseases ◽  
Mortality Rates ◽  
Data Availability ◽  
Mortality Data ◽  
Neonatal Deaths ◽  
Over Time

Abstract Background Globally, large numbers of children die shortly after birth and many of them within the first 4 wk of life. This study aimed to determine the trends, patterns and causes of neonatal mortality in hospitals in Tanzania during 2006–2015. Methods This retrospective study involved 35 hospitals. Mortality data were extracted from inpatient registers, death registers and International Classification of Diseases-10 report forms. Annual specific hospital-based neonatal mortality rates were calculated and discussed. Two periods of 2006–2010 and 2011–2015 were assessed separately to account for data availability and interventions. Results A total of 235 689 deaths were recorded and neonatal deaths accounted for 11.3% (n=26 630) of the deaths. The majority of neonatal deaths (87.5%) occurred in the first week of life. Overall hospital-based neonatal mortality rates increased from 2.6 in 2006 to 10.4 deaths per 1000 live births in 2015, with the early neonates contributing 90% to this rate constantly over time. The neonatal mortality rate was 3.7/1000 during 2006–2010 and 10.4/1000 during 2011–2015, both periods indicating a stagnant trend in the years between. The leading causes of early neonatal death were birth asphyxia (22.3%) and respiratory distress (20.8%), while those of late neonatal death were sepsis (29.1%) and respiratory distress (20.0%). Conclusion The majority of neonatal deaths in Tanzania occur among the early newborns and the trend over time indicates a slow improvement. Most neonatal deaths are preventable, hence there are opportunities to reduce mortality rates with improvements in service delivery during the first 7 d and maternal care.

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