scholarly journals Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra Leone

2020 ◽  
Vol 5 (12) ◽  
pp. e003943
Author(s):  
Alex J van Duinen ◽  
Håvard A Adde ◽  
Ola Fredin ◽  
Hampus Holmer ◽  
Lars Hagander ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Travel Time ◽  
Perinatal Mortality ◽  
Perinatal Death ◽  
Linear Regression Analysis ◽  
Perinatal Outcomes ◽  
Emergency Obstetric Care ◽  
Travel Times ◽  
Time Model ◽  
Patient Reported

IntroductionLonger travel times are associated with increased adverse maternal and perinatal outcomes. Geospatial modelling has been increasingly used to estimate geographic proximity in emergency obstetric care. In this study, we aimed to assess the correlation between modelled and patient-reported travel times and to evaluate its clinical relevance.MethodsWomen who delivered by caesarean section in nine hospitals were followed up with home visits at 1 month and 1 year. Travel times between the location before the delivery and the facility where caesarean section was performed were estimated, based on two models (model I Ouma et al; model II Munoz et al). Patient-reported and modelled travel times were compared applying a univariable linear regression analysis, and the relation between travel time and perinatal mortality was assessed.ResultsThe median reported travel time was 60 min, compared with 13 and 34 min estimated by the two models, respectively. The 2-hour access threshold correlated with a patient-reported travel time of 5.7 hours for model I and 1.8 hours for model II. Longer travel times were associated with transport by boat and ambulance, visiting one or two facilities before reaching the final facility, lower education and poverty. Lower perinatal mortality was found both in the group with a reported travel time of 2 hours or less (193 vs 308 per 1000 births, p<0.001) and a modelled travel time of 2 hours or less (model I: 209 vs 344 per 1000 births, p=0.003; model II: 181 vs 319 per 1000 births, p<0.001).ConclusionThe standard model, used to estimate geographical proximity, consistently underestimated the travel time. However, the conservative travel time model corresponded better to patient-reported travel times. The 2-hour threshold as determined by the Lancet Commission on Global Surgery, is clinically relevant with respect to reducing perinatal death, not a clear cut-off.

scholarly journals Caesarean Section and Perinatal Mortality in South Western Nigeria

1970 ◽  
Vol 4 (1) ◽  
pp. 46-48
Author(s):  
OC Ezechi ◽  
OM Loto ◽  
VI Ndububa ◽  
FO Okogbo ◽  
PM Ezeobi ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Perinatal Mortality ◽  
Caesarean Delivery ◽  
Health Workers ◽  
Perinatal Death ◽  
Fetal Loss ◽  
Birth Asphyxia ◽  
Neonatal Deaths ◽  
Health Delivery ◽  
June July

Aim: Caesarean section carries a substantial hazard to the unborn fetus, especially if done as an emergencyprocedure. In our environment fetal loss following a caesarean delivery is usually attributed to the procedureby patients and relations who do not readily accept caesarean section as a delivery option.Method: A 10 year descriptive study of caesarean section related perinatal mortality in four tertiary hospitalsin South western Nigeria.Results: Nineteen thousand one hundred and seventy nine deliveries were conducted in the hospitalsduring the study period; five thousand one hundred and ninety five (27.1 %) of which were caesareandeliveries. Two hundred and thirty five of the caesarean deliveries were associated with perinatal death (6.9%.). Majority of these deaths were among the unbooked (73.8%), multiparous (69.0 %) patients and emergencycaesarean delivery (83.4%). Prolonged/ obstructed labour (45.4%), preeclampsia/eclampsia (18.8%) andfetal distress (11.5%), were the commonest indication for caesarean deliveries. While majority of the perinataldeath were still born (60.3%), (39.7%) were early neonatal deaths. The common causes of early neonataldeath in these patients were severe birth asphyxia (37.4 %), neonatal sepsis (22.0%) and prematurity (16.4%).Conclusion: The cause of perinatal mortality associated with caesarean delivery in our environment arepreventable with public enlightenment, provision of affordable and accessible prenatal and neonatal care,discipline, behavioural and attitudinal change of health workers, and the political will on the part of policymakers to maternal and child health delivery care more effective.DOI: 10.3126/njog.v4i1.3332Nepal Journal of Obstetrics and Gynaecology June-July 2009; 4(1): 46-48

scholarly journals Measuring the effectiveness of maternal delivery services: A cross-sectional and qualitative study of perinatal mortality in six primary referral hospitals, Kenya

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 732
Author(s):  
Richard Ayah ◽  
Dismas Ongore ◽  
Alfred T.O. Agwanda
Keyword(s):  
Caesarean Section ◽  
Health System ◽  
Perinatal Mortality ◽  
Perinatal Death ◽  
Caesarean Section Rate ◽  
Public Hospitals ◽  
Standards Of Care ◽  
Cross Sectional ◽  
Referral Hospitals ◽  
Delivery Services

Background: The effective performance of hospitals is critical to overall health system goal achievement. Global health system performance frameworks are often used as part of global benchmarking, but not within low and middle-income countries as part of service delivery performance measurement. This study explored the utility of perinatal mortality as a measure of hospital effectiveness. Methods: A cross sectional, mixed methods study of six primary referral hospitals, differentiated by ownership, was conducted from 10th June to 9th October 2015. Monthly summary hospital data of maternal delivery services (MDS) were abstracted to determine the perinatal mortality. Tests of associations were used to correlate bed turnover, skilled staffing, method of delivery and perinatal mortality. Additionally, 40 questionnaire interviews were held with hospital board members and the management team to assess the availability of standard operating procedures (SOP) in MDS. Qualitative data was analysed thematically. Results: All six hospitals reported having SOP in managing MDS. The average perinatal mortality rate for all the hospitals was 24.63 per 1,000 live births. However, a perinatal death was 2.6 times more likely in public hospitals compared to private hospitals (29.8 vs 11.4 per 1,000 births respectively). The average caesarean section rate for all hospitals was 25.9%, but the odds of a caesarean section were 1.67 higher in a private hospital compared to a public hospital (P<0.001 95% CI: 1.58-1.77). Perinatal mortality was associated with bed turnover ratio (R squared 0.260, P=0.001), and skilled staff availability (R squared 0.064,P<0.001). Discussion: The high perinatal mortality reported in public hospitals may be due to high bed turnover and relatively low caesarean section rate. Input measures of performance such as reporting standards of care and staffing levels are not useful performance indicators. Perinatal mortality as a performance indicator may be an ideal measure of the effectiveness of hospitals.

scholarly journals MODELLING TRAVEL TIME DISTRIBUTION AND ITS INFLUENCE OVER STOCHASTIC VEHICLE SCHEDULING

Transport ◽  
2019 ◽  
Vol 34 (3) ◽  
pp. 237-249
Author(s):  
Yindong Shen ◽  
Jia Xu ◽  
Xianyi Wu ◽  
Yudong Ni
Keyword(s):  
Travel Time ◽  
Service Planning ◽  
Vehicle Scheduling ◽  
Travel Times ◽  
Distribution Fitting ◽  
Distribution Models ◽  
Time Model ◽  
Travel Time Distribution ◽  
Compound Model ◽  
Research Findings

Due to the paucity of well-established modelling approaches or well-accepted travel time distributions, the existing travel time models are often assumed to follow certain popular distributions, such as normal or lognormal, which may lead to results deviating from actual ones. This paper proposes a modelling approach for travel times using distribution fitting methods based on the data collected by Automatic Vehicle Location (AVL) systems. By this proposed approach, a compound travel time model can be built, which consists of the best distribution models for the travel times in each period of a day. Applying to stochastic vehicle scheduling, the influence of different travel time models is further studied. Results show that the compound model can fit more precisely to the actual travel times under various traffic situations, whilst the on-time performance of resulting vehicle schedules can be improved. The research findings have also potential benefit for the other research based on travel time models in public transport including timetabling, service planning and reliability measurement.

scholarly journals Prospective study to explore changes in quality of care and perinatal outcomes after implementation of perinatal death audit in Uganda

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e027504
Author(s):  
Victoria Nakibuuka Kirabira ◽  
Mamuda Aminu ◽  
Juan Emmanuel Dewez ◽  
Romano Byaruhanga ◽  
Pius Okong ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Neonatal Mortality ◽  
Perinatal Mortality ◽  
Perinatal Death ◽  
Perinatal Outcomes ◽  
Stillbirth Rate ◽  
Neonatal Mortality Rate ◽  
Neonatal Deaths ◽  
Early Neonatal Mortality ◽  
Early Neonatal Mortality Rate

ObjectiveTo assess the effects of perinatal death (PND) audit on perinatal outcomes in a tertiary hospital in Kampala.DesignInterrupted time series (ITS) analysis.SettingNsambya Hospital, Uganda.ParticipantsLive births and stillbirths.InterventionsPND audit.Primary and secondary outcome measuresPrimary outcomes: perinatal mortality rate, stillbirth rate, early neonatal mortality rate. Secondary outcomes: case fatality rates (CFR) for asphyxia, complications of prematurity and neonatal sepsis.Results526 PNDs were audited: 142 (27.0%) fresh stillbirths, 125 (23.8%) macerated stillbirths and 259 (49.2%) early neonatal deaths. The ITS analysis showed a decrease in perinatal death (PND) rates without the introduction of PND audits (incidence risk ratio (IRR) (95% CI) for time=0.94, p<0.001), but an increase in PND (IRR (95% CI)=1.17 (1.0 to –1.34), p=0.0021) following the intervention. However, when overdispersion was included in the model, there were no statistically significant differences in PND with or without the intervention (p=0.06 and p=0.44, respectively). Stillbirth rates exhibited a similar pattern. By contrast, early neonatal death rates showed an overall upward trend without the intervention (IRR (95% CI)=1.09 (1.01 to 1.17), p=0.01), but a decrease following the introduction of the PND audits (IRR (95% CI)=0.35 (0.22 to 0.56), p<0.001), when overdispersion was included. The CFR for prematurity showed a downward trend over time (IRR (95% CI)=0.94 (0.88 to 0.99), p=0.04) but not for the intervention. With regards CFRs for intrapartum-related hypoxia or infection, no statistically significant effect was detected for either time or the intervention.ConclusionThe introduction of PND audit showed no statistically significant effect on perinatal mortality or stillbirth rate, but a significant decrease in early neonatal mortality rate. No effect was detected on CFRs for prematurity, intrapartum-related hypoxia or infections. These findings should encourage more research to assess the effectiveness of PND reviews on perinatal deaths in general, but also on stillbirths and neonatal deaths in particular, in low-resource settings.

Ultrasonographic severity scoring of non-immune hydrops: a predictor of perinatal mortality

2014 ◽  
Vol 0 (0) ◽  
Author(s):  
Su Ah Kim ◽  
Seung Mi Lee ◽  
Joon-Seok Hong ◽  
JoonHo Lee ◽  
Chan-Wook Park ◽  
...  
Keyword(s):  
Perinatal Mortality ◽  
Perinatal Death ◽  
Fluid Collection ◽  
Perinatal Outcomes ◽  
Predictive Marker ◽  
Severity Scoring ◽  
Survivor Group ◽  
Subcutaneous Edema ◽  
Study Population ◽  
Fluid Collections

AbstractTo develop an ultrasonographic severity scoring of non-immune hydrops in order to predict perinatal outcomes in women with non-immune hydrops.The study population consisted of pregnant women who were admitted and delivered with the diagnosis of fetal non-immune hydrops and singleton gestation. Cases were divided into “perinatal survivor” and “perinatal non-survivor” groups. Perinatal non-survivor cases were defined as those with stillbirth or neonatal death ≤28 completed days after birth. The presence of an abnormal fluid collection in each body compartment, such as subcutaneous edema, pleural effusion, pericardial effusion, or ascites was assigned a score of 1 point per each body compartment, and the absence of abnormal fluid collection was scored as 0 point. The total number of abnormal fluid collections was converted to a numeric score, which was called the ultrasonographic severity scoring of non-immune hydrops (USNIH).Perinatal death occurred in 46.5% (20/43) of the cases of non-immune hydrops. USNIH in patients of the non-survivor group was significantly higher than that in those of the survivor group [non-survivor group 3 (2–4) vs. survivor 2 (2–3); median (range); P<0.05]. Perinatal mortality rates were higher in patients with USNIH ≥3 points than in those with USNIH of 2 points (67% vs. 13%, P<0.005). This difference remained significant after adjustment for confounding variables. When confining analysis to those with idiopathic non-immune hydrops, women in the perinatal non-survivor group had significantly higher USNIH score than those in the perinatal survivor group, and this difference remained significant after adjustment.Our USNIH system may be a reliable predictive marker for perinatal outcomes in cases of non-immune hydrops, especially in idiopathic hydrops during the antenatal period.

scholarly journals “In cities, it’s not far, but it takes long”: comparing estimated and replicated travel times to reach life-saving obstetric care in Lagos, Nigeria

2021 ◽  
Vol 6 (1) ◽  
pp. e004318
Author(s):  
Aduragbemi Banke-Thomas ◽  
Kerry L M Wong ◽  
Francis Ifeanyi Ayomoh ◽  
Rokibat Olabisi Giwa-Ayedun ◽  
Lenka Benova
Keyword(s):  
Travel Time ◽  
Friction Surface ◽  
Obstetric Care ◽  
Travel Times ◽  
Night Time ◽  
Google Maps ◽  
Surface Approach ◽  
Low Resource ◽  
Life Saving ◽  
The Cost

BackgroundTravel time to comprehensive emergency obstetric care (CEmOC) facilities in low-resource settings is commonly estimated using modelling approaches. Our objective was to derive and compare estimates of travel time to reach CEmOC in an African megacity using models and web-based platforms against actual replication of travel.MethodsWe extracted data from patient files of all 732 pregnant women who presented in emergency in the four publicly owned tertiary CEmOC facilities in Lagos, Nigeria, between August 2018 and August 2019. For a systematically selected subsample of 385, we estimated travel time from their homes to the facility using the cost-friction surface approach, Open Source Routing Machine (OSRM) and Google Maps, and compared them to travel time by two independent drivers replicating women’s journeys. We estimated the percentage of women who reached the facilities within 60 and 120 min.ResultsThe median travel time for 385 women from the cost-friction surface approach, OSRM and Google Maps was 5, 11 and 40 min, respectively. The median actual drive time was 50–52 min. The mean errors were >45 min for the cost-friction surface approach and OSRM, and 14 min for Google Maps. The smallest differences between replicated and estimated travel times were seen for night-time journeys at weekends; largest errors were found for night-time journeys at weekdays and journeys above 120 min. Modelled estimates indicated that all participants were within 60 min of the destination CEmOC facility, yet journey replication showed that only 57% were, and 92% were within 120 min.ConclusionsExisting modelling methods underestimate actual travel time in low-resource megacities. Significant gaps in geographical access to life-saving health services like CEmOC must be urgently addressed, including in urban areas. Leveraging tools that generate ‘closer-to-reality’ estimates will be vital for service planning if universal health coverage targets are to be realised by 2030.

scholarly journals Maternal and perinatal outcomes in women with eclampsia by mode of delivery at Riley mother baby hospital: a longitudinal case-series study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Koech Irene ◽  
Poli Philippe Amubuomombe ◽  
Richard Mogeni ◽  
Cheruiyot Andrew ◽  
Ann Mwangi ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Perinatal Mortality ◽  
Mode Of Delivery ◽  
Case Series ◽  
Perinatal Outcomes ◽  
Induction Of Labour ◽  
Chi Square ◽  
Case Series Study ◽  
Chi Square Test ◽  
Series Study

Abstract Background Eclampsia, considered as serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16–31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital. Methods This was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as age, parity, medications, initiation of labour, mode of delivery, admission to the intensive care unit, admission to the newborn care unit, organ injuries, and mortality, were analysed using the Statistical Package for the Social Sciences software version 20.0. Quantitative data were described using frequencies and percentages. The significance of the obtained results was judged at the 5% level. The chi-square test was used for categorical variables, and Fisher’s exact test or the Monte Carlo correction was used for correction of the chi-square test when more than 20% of the cells had an expected count of less than 5. Results During the study period, 53 patients diagnosed with eclampsia were treated and followed up to 6 weeks postpartum. There was zero maternal mortality; however, perinatal mortality was reported in 9.4%. Parity was statistically associated with an increased odds of adverse perinatal outcomes (p = 0.004, OR = 9.1, 95% CI = 2.0–40.8) and caesarean delivery (p = 0.020, OR = 4.7, 95% CI = 1.3–17.1). In addition, the induction of labour decreased the risk of adverse outcomes (p = 0.232, OR = 0.3, 95% CI = 0.1–2.0). Conclusion There is no benefit of emergency caesarean section for women with eclampsia. This study showed that induction of labour and vaginal delivery can be successfully achieved in pregnant women with eclampsia. Maternal and perinatal mortality from eclampsia can be prevented through prompt and effective care.

Association of Progressive Supranuclear Palsy Rating Scale with Progressive Supranuclear Palsy Quality of Life Scale

2021 ◽  
pp. 1-8
Author(s):  
Alexander Pantelyat ◽  
Lenora Higginbotham ◽  
Liana Rosenthal ◽  
Diane Lanham ◽  
Vanessa Nesspor ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Trials ◽  
Progressive Supranuclear Palsy ◽  
Rating Scale ◽  
Linear Regression Analysis ◽  
Disease Evolution ◽  
Quality Of Life Scale ◽  
Patient Reported ◽  
Scale Scores

<b><i>Introduction:</i></b> There is growing interest in using patient-reported outcomes as end points in clinical trials, such as the progressive supranuclear palsy quality of life (PSP-QoL) scale. However, this tool has not been widely validated and its correlation with validated motor scales has not been explored. To evaluate the potential utility of using PSP-QoL as an outcome, it is important to examine its relationship with a standard scale used to evaluate neurologic parameters, such as the PSP Rating Scale. <b><i>Methods:</i></b> PSP-QoL and PSP Rating Scale scores were gathered from 60 clinically diagnosed PSP patients, including patients with Richardson syndrome PSP (PSP-RS, <i>n</i> = 43) and those with non-RS PSP variants (<i>n</i> = 17). Linear regression analysis adjusted for age, sex, and disease duration was used to evaluate the cross-sectional relationship between the total and subscale scores of the 2 instruments. <b><i>Results:</i></b> Among 60 PSP patients, there was a significant correlation between total PSP-QoL and PSP Rating Scale scores. The physical and mentation subscales of each instrument also demonstrated significant correlations. Comparisons among PSP subtypes indicated that worsening PSP-QoL Total and Physical subscale scores correlated with worsening PSP Rating Scale gait subscale scores more strongly for the non-RS PSP variants than for PSP-RS. <b><i>Discussion:</i></b> There is a significant association between the total scores and many of the subscale scores of the PSP-QoL and the PSP Rating Scale. Additionally, the relationship between these measures may differ for PSP-RS and non-RS variants. These findings suggest that the PSP-QoL may be useful in clinical trials as a patient-reported outcome measure. Large prospective multicenter studies utilizing the PSP-QoL are necessary to examine its relationship to disease evolution and changes in the PSP Rating Scale.

Estimation of Path Travel Time Distributions in Stochastic Time-Varying Networks with Correlations

2021 ◽  
pp. 036119812110184
Author(s):  
Monika Filipovska ◽  
Hani S. Mahmassani ◽  
Archak Mittal
Keyword(s):  
Time Dependence ◽  
Travel Time ◽  
Correlation Structure ◽  
Time Varying ◽  
Travel Times ◽  
Trajectory Data ◽  
Time Varying Networks ◽  
Transportation Research ◽  
Search Approach ◽  
Stochastic Time

Transportation research has increasingly focused on the modeling of travel time uncertainty in transportation networks. From a user’s perspective, the performance of the network is experienced at the level of a path, and, as such, knowledge of variability of travel times along paths contemplated by the user is necessary. This paper focuses on developing approaches for the estimation of path travel time distributions in stochastic time-varying networks so as to capture generalized correlations between link travel times. Specifically, the goal is to develop methods to estimate path travel time distributions for any path in the networks by synthesizing available trajectory data from various portions of the path, and this paper addresses that problem in a two-fold manner. Firstly, a Monte Carlo simulation (MCS)-based approach is presented for the convolution of time-varying random variables with general correlation structures and distribution shapes. Secondly, a combinatorial data-mining approach is developed, which aims to utilize sparse trajectory data for the estimation of path travel time distributions by implicitly capturing the complex correlation structure in the network travel times. Numerical results indicate that the MCS approach allowing for time-dependence and a time-varying correlation structure outperforms other approaches, and that its performance is robust with respect to different path travel time distributions. Additionally, using the path segmentations from the segment search approach with a MCS approach with time-dependence also produces accurate and robust estimates of the path travel time distributions with the added benefit of shorter computation times.

Sign in / Sign up

Export Citation Format

Share Document