scholarly journals Abortion-related near-miss morbidity and mortality in 43 health facilities with differences in readiness to provide abortion care in Uganda

2021 ◽  
Vol 6 (2) ◽  
pp. e003274
Author(s):  
Susan Atuhairwe ◽  
Kristina Gemzell-Danielsson ◽  
Josaphat Byamugisha ◽  
Frank Kaharuza ◽  
Nazarius Mbona Tumwesigye ◽  
...  
Keyword(s):  
Health Facilities ◽  
Near Miss ◽  
Morbidity And Mortality ◽  
Eastern Region ◽  
Care Provision ◽  
Second Trimester ◽  
Management Options ◽  
Live Births ◽  
Postabortion Care ◽  
Facility Readiness

IntroductionWith a view to inform policy for improved postabortion care, we describe abortion-related near-miss and mortality by sociodemographic risk factors and management options by pregnancy trimester in Uganda.MethodsThis secondary data analysis used an adapted WHO near-miss methodology to collect cross-sectional maternal near-miss and abortion complications data at 43 health facilities in Central and Eastern Uganda in 2016–2017. We computed abortion severe morbidity, near-miss and mortality ratios per 100 000 live births, and described the proportion of cases that worsened to an abortion near-miss or death, stratified by geographical region and trimester. We tested for association between independent variables and abortion near-miss, and obtained prevalence ratios for association between second trimester near-miss and independent demographic and management indicators. We assessed health facility readiness for postabortion care provision in Central and Eastern regions.ResultsOf 3315 recorded severe abortion morbidity cases, 1507 were near-misses. Severe abortion morbidity, near-miss and mortality ratios were 2063, 938 and 23 per 100 000 live births, respectively. Abortion-related mortality ratios were 11 and 57 per 100 000 in Central and Eastern regions, respectively. Abortion near-miss cases were significantly associated with referral (p<0.001). Second trimester had greater abortion mortality than first trimester. Eastern region had greater abortion-related morbidity and mortality than Central region with facilities in the former characterised by inferior readiness to provide postabortion care.ConclusionsUganda has a major abortion near-miss morbidity and mortality; with mortality higher in the second trimester. Life-saving commodities are lacking especially in Eastern region compromising facility readiness for postabortion care provision.

scholarly journals Health facility capacity to provide postabortion care in Afghanistan: a cross-sectional study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Farzana Maruf ◽  
Hannah Tappis ◽  
Enriquito Lu ◽  
Ghutai Sadeq Yaqubi ◽  
Jelle Stekelenburg ◽  
...  
Keyword(s):  
Public Health ◽  
Family Planning ◽  
High Volume ◽  
Health Facilities ◽  
Public Health Facilities ◽  
Care Services ◽  
Vacuum Aspiration ◽  
Postabortion Care ◽  
Products Of Conception ◽  
Family Planning Counseling

Abstract Background Afghanistan has one of the highest burdens of maternal mortality in the world, estimated at 638 deaths per 100,000 live births in 2017. Infections, obstetric hemorrhage, and unsafe abortion are the three leading causes of maternal death. Contraceptive prevalence rate has fluctuated between 10 and 20% since 2006. The 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment evaluated facility readiness to provide quality routine and emergency obstetric and newborn care, including postabortion care services. Methods Accessible public health facilities with at least five births per day (n = 77), a nationally representative sample of public health facilities with fewer than five births per day (n = 149), and 20 purposively selected private health facilities were assessed. Assessment components examining postabortion care included a facility inventory and record review tool to verify drug, supply, equipment, and facility record availability, and an interview tool to collect information on skilled birth attendants’ knowledge and perceptions. Results Most facilities had supplies, equipment, and drugs to manage postabortion care, including family planning counseling and services provision. At public facilities, 36% of skilled birth attendants asked to name essential actions to address abortion complications mentioned manual vacuum aspiration (23% at private facilities); fewer than one-quarter mentioned counseling. When asked what information should be given to postabortion clients, 73% described family planning counseling need (70% at private facilities). Nearly all high-volume public health facilities with an average of five or more births per day and less than 5% of low volume public health facilities with an average of 0–4 deliveries per day reported removal of retained products of conception in the past 3 months. Among the 77 high volume facilities assessed, 58 (75%) reported using misoprostol for removal of retained products of conception, 59 (77%) reported using manual vacuum aspiration, and 67 (87%) reported using dilation and curettage. Conclusions This study provides evidence that there is room for improvement in postabortion care services provision in Afghanistan health facilities including post abortion family planning. Access to high-quality postabortion care needs additional investments to improve providers’ knowledge and practice, availability of supplies and equipment.

Quality of Antenatal, Labour and Delivery Services in Selected Districts in Malawi, Zambia and Zimbabwe: A Descriptive Cross-Sectional Study

2021 ◽  
pp. 1-9
Author(s):  
Clara Opha Haruzivishe
Keyword(s):  
Perinatal Care ◽  
Neonatal Morbidity ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Morbidity And Mortality ◽  
World Health ◽  
Performance Standard ◽  
Cross Sectional ◽  
Care Services

Background: High Maternal and Neonatal Mortality Ratios persist in Sub-Saharan Africa despite increasing perinatal care coverage. This suggests that coverage alone is not adequate to reduce maternal and neonatal morbidity and mortality. Quality of care should be the emphasis of maternal and child care services. Materials and Methods: A descriptive cross-sectional multicentre study was conducted in selected health facilities in Zambia, Malawi and Zimbabwe using purposive sampling. A World Health Organization-WHO 2016 Quality of Maternal and New-born assessment Framework and the WHO (2015) Service Availability and Readiness Assessment tool were used for data collection. Data was analyzed using Statistical Package for Social Scientist (SPSS) version 24.0. Results: Less than 43% of the health facilities satisfied at least three of the five Performance Standards of availability and adequacy of Antenatal infrastructure and supplies. Regarding Antenatal processes/care, an observation was the most common performance standard satisfied by 70.6% of all health facilities assessed while less than 30% fulfilled all other standards. Only 57.1% of the health facilities satisfied 5 of the 11 standards for labour and delivery infrastructure, while only 55.6% of the Health facilities satisfied only two of the 13 standards of Labour and delivery care. Conclusion: To achieve a significant and sustainable reduction in maternal and neonatal morbidity and mortality, there is a need for investment and improvement in maternity care services infrastructure and processes as opposed to focusing on mere attendance of Antenatal, and deliveries by trained birth attendants.

Cross-sectional study of the quality of neonatal care services in Armenia

2019 ◽  
Vol 32 (8) ◽  
pp. 1145-1161
Author(s):  
Suren H. Galstyan ◽  
Hrant Z. Kalenteryan ◽  
Arshak S. Djerdjerian ◽  
Hovhannes S. Ghazaryan ◽  
Naira T. Gharakhanyan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Quality Assessment ◽  
Neonatal Care ◽  
Health Facilities ◽  
Cross Sectional ◽  
Content Type ◽  
Neonatal Deaths ◽  
Live Births ◽  
Care Services

Purpose The purpose of this paper is to report the assessment results of the quality of neonatal care services in Armenia and to describe the identified obstacles to improving the quality of care for newborn infants. Design/methodology/approach The study carried out a cross-sectional descriptive design. The data were collected in health facilities with different levels of neonatal care that were selected employing a multi-stage, stratified purposeful sampling design. The quality of neonatal services was assessed using the generic WHO tool. Data collection was performed using face-to-face semi-structured interviews, hospital statistics, medical records and direct observations. Findings In 31 study hospitals, 31,976 deliveries were performed resulting in 31,701 live births and 734 stillbirths. About 85 percent of all neonatal deaths was attributable to early neonatal deaths with over 48 percent occurring during the first 24 h of life. The proportion of neonatal deaths was highest in infants with low birth weight constituting 92.8 percent of all neonatal deaths. The total neonatal mortality rate was 3.50 per 1,000 live births, whereas stillbirth rate and perinatal mortality rate were 22.60 and 25.26 per 1,000 total births in 2015. Specific indicators with relatively lower mean scores included neonatal resuscitation, early breastfeeding, monitoring of newborn conditions, neonatal sepsis, feeding standards, total parenteral nutrition, and infection treatment. Originality/value Given the limited scope of research on quality assessment, this paper provides valuable information on the status of quality of neonatal care services in Armenian health facilities. This work also extends the existing studies focused on quality assessment through applying the model of Avedis Donabedian with the structure–process–outcomes approach as a theoretical basis.

Factors associated with maternal near-miss morbidity and mortality in Kowloon Hospital, Suzhou, China

2013 ◽  
Vol 123 (1) ◽  
pp. 64-67 ◽  
Author(s):  
Fang-Rong Shen ◽  
Ming Liu ◽  
Xia Zhang ◽  
Weiwen Yang ◽  
You-Guo Chen
Keyword(s):  
Near Miss ◽  
Morbidity And Mortality ◽  
Maternal Near Miss ◽  
Factors Associated

scholarly journals Availability of Safe Second-Trimester Abortion Services in Health Facilities in Accra, Ghana

2021 ◽  
Author(s):  
Fred Yao Gbagbo ◽  
Renee Aku Sitsofe Morhe ◽  
Emmanuel Komla Senanu Morhe
Keyword(s):  
Service Providers ◽  
Social Stigma ◽  
Clinical Care ◽  
Internal Validity ◽  
Health Facilities ◽  
Accurate Information ◽  
Second Trimester ◽  
Care Providers ◽  
Trimester Abortion ◽  
Second Trimester Abortion

Abstract Background Despite a liberal abortion law, access to safe second trimester abortion services in Ghana are challenging for many women. This study sought to examine providers, methods employed, cost, and other determinants of availability of second-trimester abortion services in health facilities in Accra, Ghana in 2019 to inform policy and program decisions. Methods A two-stage mixed quantitative and qualitative study designs were employed in the conduct of this study. The first stage was a short interaction of the mystery client with a clinical care provider to identify health facilities that provide second trimester induced abortion, the cost, and referral practices, where the facility did not have the service. The second stage was in-depth interviews of second-trimester abortion care providers and non-providers in various health facilities. For internal validity, it also explored the procedure cost, referral, and other practices at the health facilities included in the study, independent of what was captured in the mystery client survey. Results Second-trimester abortion services in Accra, Ghana are widely unavailable even in most facilities that provided abortion services. Referral policies and practices indicated by the service providers at various facility levels were inadequate. Criminalization of the procedure, social stigma, and fear of complications are the main factors that adversely influence the availability of second-trimester abortion in health facilities in Accra. Conclusions Albeit increasing demand for second-trimester abortion in health facilities in Accra, services are not readily available due to the ambiguity of the law, its interpretation, and limited flow of accurate information on providers. Policies and programs that limit access to Second-trimester abortions in Ghana are amendable to ensure safe services.

scholarly journals Determinants of Anemia Among Pregnant Women Attending Antenatal Care in Bale-Robe Town Health Facilities, Bale zone, Southeast Ethiopia: A Case-Control Study

2021 ◽  
Author(s):  
Mohammed Hasen Badeso ◽  
Falaho Sani Kalili ◽  
Mohammed Seid Abdulle
Keyword(s):  
Antenatal Care ◽  
Dietary Intake ◽  
Pregnant Women ◽  
Case Control Study ◽  
Case Control ◽  
Health Facilities ◽  
Menstrual Bleeding ◽  
Second Trimester ◽  
Southeast Ethiopia ◽  
Control Study

Abstract IntroductionIn Ethiopia, the prevalence of anemia in pregnant women differs geographically and ranged from 15.8–56.8%. The objective of this study is to identify the determinants of anemia among pregnant women attending antenatal care in health facilities of Bale-Robe Town, Southeast Ethiopia.MethodsA facility-based case-control study was conducted in Bale-Robe hospital and Baha-biftu health center in Bale-Robe, Southeast Ethiopia. A total of 282 pregnant women participated in the study (141 cases and 141 controls). Cases were pregnant women with altitude-adjusted hemoglobin value < 11.0 g/dl at the first and third trimesters, and < 10.5 g/dl at the second trimester. Controls were pregnant women with hemoglobin value ≥ 11.0 g/dl at first and third trimesters and ≥ 10.5 g/dl at the second trimester. A structured and pretested questionnaire was used to collect data. A multivariable logistic regression analysis was applied to assess the determinants of anemia. Determinants were categorized as sociodemographic and economic, obstetric and medical, and dietary intake and behavioral.ResultsHousewife occupation (AOR=2.1, 95% CI=1.12-3.92), prolonged menstrual bleeding (AOR=2.33, 95% CI=1.38-3.92) and undernutrition (AOR=4.03, 95% CI=1.38-11.83) were factors significantly associated with anemia in pregnant women.ConclusionHousewife occupation, prolonged menstrual bleeding, and malnutrition were the determinants of anemia in pregnant women. Hence, anemia prevention and control strategy in pregnant women should include adequate dietary intake, and strengthening nutritional counseling for pregnant women during antenatal care is also required by the health care provider.

Effects of Human Factors in Process Safety

2022 ◽  
pp. 1477-1507
Author(s):  
Gargi Bhattacharjee ◽  
Sudip Kumar Das
Keyword(s):  
Human Factors ◽  
Human Error ◽  
Organizational Factors ◽  
Near Miss ◽  
Accident Analysis ◽  
Eastern Region ◽  
Process Safety ◽  
Process Industries ◽  
Human And Organizational Factors

Accidents and near-miss accidents in chemical industries are widespread. Most of the incidents occurred due to combinations of organizational and human factors. To identify the causes for an incident of an accident analysis is needed, because it reveals the possible causes behind the accidents. Accident analysis shows the human and organizational factors that support learning from the events. Literature review shows that human error plays an important role of accidents in process industries. The chapter discusses some case studies which are received very little media publicity and also no proper assessment. At first reports on the incidents were collected from newspapers and then the place was visited to conduct an interview with local people and present and past workers with the help of the PESO (M/S Petroleum and Explosive Safety Organization, Eastern Region, Govt. of India).

scholarly journals Infection prevention preparedness and practices for female sterilization services within primary care facilities in Northern India

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Abhishek Kumar ◽  
Abhishek Gautam ◽  
Arnab Dey ◽  
Ruhi Saith ◽  
Uttamacharya ◽  
...  
Keyword(s):  
Public Health ◽  
Infection Prevention ◽  
Uttar Pradesh ◽  
Health Facilities ◽  
Female Sterilization ◽  
Provider Attitudes ◽  
Public Health Facilities ◽  
Northern India ◽  
Provider Adherence ◽  
Facility Readiness

Abstract Background In 2014, 16 women died following female sterilization operations in Bilaspur, a district in central India. In addition to those 16 deaths, 70 women were hospitalized for critical conditions (Sharma, Lancet 384,2014). Although the government of India’s guidelines for female sterilization mandate infection prevention practices, little is known about the extent of infection prevention preparedness and practice during sterilization procedures that are part of the country’s primary health care services. This study assesses facility readiness for infection prevention and adherence to infection prevention practices during female sterilization procedures in rural northern India. Method The data for this study were collected in 2016–2017 as part of a family planning quality of care survey in selected public health facilities in Bihar (n = 100), and public (n = 120) and private health facilities (n = 97) in Uttar Pradesh. Descriptive analysis examined the extent of facility readiness for infection prevention (availability of handwashing facilities, new or sterilized gloves, antiseptic lotion, and equipment for sterilization). Correlation and multivariate statistical methods were used to examine the role of facility readiness and provider behaviors on infection prevention practices during female sterilization. Result Across the three health sectors, 62% of facilities featured all four infection prevention components. Sterilized equipment was lacking in all three health sectors. In facilities with all four components, provider adherence to infection prevention practices occurred in only 68% of female sterilization procedures. In Bihar, 76% of public health facilities evinced all four components of infection prevention, and in those facilities provider’s adherence to infection prevention practices was almost universal. In Uttar Pradesh, where only 55% of public health facilities had all four components, provider adherence to infection prevention practices occurred in only 43% of female sterilization procedures. Conclusion The findings suggest that facility preparedness for infection prevention does play an important role in provider adherence to infection prevention practices. This phenomenon is not universal, however. Not all doctors from facilities prepared for infection prevention adhere to the practices, highlighting the need to change provider attitudes. Unprepared facilities need to procure required equipment and supplies to ensure the universal practice of infection prevention.

scholarly journals Accuracy of serum markers, progesterone and vitamins measurements for early screening of abortions in the eastern region of Algeria (Batna)

2018 ◽  
Vol 90 (2) ◽  
Author(s):  
Sara Mouffouk ◽  
Mouloud Yahia ◽  
Chaima Mouffouk ◽  
Hanane Boukrous ◽  
Aicha Saaidia ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
First Trimester ◽  
Serum Markers ◽  
Average Concentration ◽  
Serum Folate ◽  
Control Group ◽  
Eastern Region ◽  
Second Trimester ◽  
Early Screening ◽  
Β Hcg

Spontaneous abortion is an involuntary interruption of pregnancy before 22 weeks of gestation. According to the Algerian National Institute of Public Health the percentage of women suffering from permanent complications during pregnancy is approximately 15%. The aim of this study is the determination of some biochemical analytes, including folic acid, vitamin B12, alphafoetoproteine, beta human chorionic gonadotropin (β-hCG), progesterone and oestradiol (uE3), which are involved in the detection of pregnancy failures. This case-control study was carried out on women in the process of abortion and a control group with viable pregnancies in the East region of Algeria (Batna) during the year 2015. In the present investigation, 69 pregnant women during the first and second trimester were recruited during the first and second trimesters as cases (with miscarriages) and the control group (n=69) was constituted of women who had normal ultrasound. The average concentration of alpha-fetoprotein is significantly low during the first trimester, but it is very high during the second trimester between cases and controls. The median values of β- hCG, uE3 and progesterone decrease very significantly. The mean concentration of serum folate and vitamin B12 did not change significantly between cases and controls in the first and second trimesters. The results of this study revealed that, spontaneous abortions are associated with changes in serum markers and progesterone, which could form an important part in the early diagnosis of non-viable pregnancies. However, vitamins levels have no significant effects on these pregnancies.

scholarly journals Emergency cervical cerclage and pregnancy outcomes

2017 ◽  
Vol 6 (5) ◽  
pp. 1993
Author(s):  
N. Nagendra Prasad ◽  
Sherin Annamma Thampan ◽  
R. Nagarathnamma
Keyword(s):  
Retrospective Study ◽  
Spontaneous Abortion ◽  
Pregnancy Outcomes ◽  
Cervical Dilatation ◽  
Second Trimester ◽  
Cervical Cerclage ◽  
Live Births ◽  
Term Delivery

Background: To evaluate the effectiveness and safety of emergency cervical cerclage in women who presented with advanced cervical changes such as cervical dilatation and bulging foetal membranes.Methods: This is a retrospective study on all women treated with cervical cerclage presented in the late second trimester with advanced cervical dilatation (2 to 4cms) for whom emergency cervical cerclage by McDonald technique.Results: Out of the 24 patients for whom emergency cervical cerclage was performed, three patients had spontaneous abortion after cervical cerclage, two had PROM and eight of these patients had term delivery. Twenty-one fetus were live born after the period of viability. Nine of these babies were admitted to NICU and 50 percent of the neonates required only regular perinatal care.Conclusions: Post emergency cervical cerclage, the outcome in terms of prolongation of pregnancy, live births and neonatal survival is better.

Sign in / Sign up

Export Citation Format

Share Document