scholarly journals The Impact of Scientific and Technical Training on Improving Routine Collection of Antenatal Care Data for Maternal and Foetal Risk Assessment: A Case Study in the Province of South Kalimantan, Indonesia

2018 ◽  
Vol 2018 ◽  
pp. 1-13 ◽  
Author(s):  
Dewi Anggraini ◽  
Mali Abdollahian ◽  
Kaye Marion ◽  
Supri Nuryani ◽  
Fadly Ramadhan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antenatal Care ◽  
Technical Training ◽  
P Value ◽  
Factors Affecting ◽  
High Workload ◽  
Data Provision ◽  
Data Documentation ◽  
Evidence Based Guideline ◽  
The Impact

Objectives. First, to assess the impact of scientific and technical training on midwives’ abilities in collecting and recording the results of routine antenatal care examinations. Second, to explore midwives’ views with regard to factors affecting their abilities to successfully complete the data documentation tasks. Methods. The study was conducted in South Kalimantan, Indonesia (April 2016-October 2017). Nineteen urban and rural midwives were selected. Access to antenatal care information on 4,946 women (retrospective cohort study) and 381 women (prospective cohort study) was granted. A descriptive and exploratory design was used to describe midwives’ abilities and challenges pertaining to timely collection and recording of results concerning antenatal care examinations. Results. Scientific and technical training has significantly improved the average amount of recorded antenatal care data (from 17.5% to 62.1%, p-value < 0.0005). Lack of awareness, high workload, and insufficient skills and facilities are the main reasons for the database gaps. Conclusions. The training has equipped midwives with scientific knowledge and technical abilities to allow routine collection of antenatal care data. Provision and adequate use of this information during different stages of pregnancy is crucial as an evidence-based guideline to assess maternal and foetal risk factors to ending preventable mortality.

scholarly journals The Impact of Scientific and Technical Training on Improving Databases’ Adequacy for Fetal Growth Chart Development in Limited-Resource Settings: A Case Study in the Province of South Kalimantan, Indonesia

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Dewi Anggraini ◽  
Mali Abdollahian ◽  
Kaye Marion ◽  
Supri Nuryani ◽  
Fadly Ramadhan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antenatal Care ◽  
Fetal Growth ◽  
Performance Indicators ◽  
Limited Resource ◽  
Key Performance Indicators ◽  
Technical Training ◽  
Fetal Weight ◽  
Growth Chart ◽  
The Impact

Objectives. To assess the impact of scientific and technical training on midwives’ abilities in collecting and recording the key performance indicators for fetal growth chart development in limited-resource settings. Methods. A descriptive design was used to describe midwives’ abilities in timely collecting and recording the minimum data required to estimate fetal weight and develop fetal growth chart. The study was conducted among 19 urban and rural midwives in South Kalimantan, Indonesia, between April 2016 and October 2017. The training provided access to antenatal care information on 4,946 women (retrospective cohort study) and 381 women (prospective cohort study). Results. The average amount of recorded antenatal care data on the key performance indicators of fetal growth assessment has been significantly improved (from 33.4% to 89.1%, p-value < 0.0005) through scientific and technical training. Conclusions. Scientific knowledge and technical abilities have enabled midwives to timely record routine data of the key performance indicators for fetal growth surveillance. Access to this information is vital during different stages of pregnancy. The information can be utilised as evidence-based guidelines to assess fetal risks through fetal weight estimation and to develop fetal growth chart that is currently not available in Indonesian primary healthcare systems.

scholarly journals The impact of antenatal care on under‐five mortality in Ethiopia: a difference‐in‐differences analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Samuel Oduse ◽  
Temesgen Zewotir ◽  
Delia North
Keyword(s):  
Antenatal Care ◽  
Child Survival ◽  
First Trimester ◽  
Sub Saharan Africa ◽  
P Value ◽  
Difference In Differences ◽  
Under Five ◽  
Care Services ◽  
Sub Saharan ◽  
The Impact

Abstract Background Sub-Saharan Africa, as opposed to other regions, has the highest under-five mortality rates yet makes the least improvement in reducing under-five mortality. Despite the decline, Ethiopia is among the top ten countries contributing the most to global under-five mortalities. This article examines the impact of the number of antenatal care and the timing of first antenatal care on child health outcomes. We specifically investigated if the utilization of antenatal care services positively affects the reduction of under-five mortality. Methods We employ a difference-in-differences design with propensity score matching to identify direct causal effects of antenatal care on under-five mortality based on the Ethiopian Demographic Health Survey data of 2011 and 2016. Our sample includes 22 295 women between the ages of 14–49 who had antenatal care visits at different times before delivery. Results The study revealed 1 481 cases of reported under-five mortality. 99.0% of that under-five mortality cases are women who had less than eight antenatal care visits, while only 1% of that is by women who had eight or more antenatal care visits. Antenatal care visit decreases the likelihood of under-five mortality in Ethiopia by 45.2% (CI = 19.2–71.3%, P-value < 0.001) while the timing of first antenatal care within the first trimester decreases the likelihood of under-five mortality by 10% (CI = 5.7–15.6%, P-value < 0.001). Conclusions To achieve a significant reduction in the under-five mortality rate, Intervention programs that encourages more antenatal care visits should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets.

scholarly journals The Risk of Stroke after Acute Myocardial Infarction in Patients with and without Atrial fibrillation: A Nationwide Cohort Study in Taiwan

2021 ◽  
Author(s):  
Cheng-Hung Chiang ◽  
Wan-Ting Hung ◽  
Wei-Chun Huang ◽  
Kun-Chang Lin ◽  
Chin-Chang Cheng ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Cohort Study ◽  
Primary Diagnosis ◽  
P Value ◽  
Kaplan Meier ◽  
Cox Proportional Hazard Regression ◽  
The Impact ◽  
New Onset

Abstract Background Both acute myocardial infarction (AMI) and atrial fibrillation (AF) are risks for stroke. The risk of stroke after AMI may be different in patients with or without AF. The aim of this study was to evaluate the impact of AF on stroke in patients after first AMI. Methods This is a retrospective nationwide cohort study. A total of 170,472 patients who had the primary diagnosis of first AMI between 2000 and 2012 were enrolled. Among them, 8,530 patients with AF were identified. Propensity score matching technique was used to match 8,530 patients without AF with similar ages and genders. All patients were followed until stroke or 31 December 2012, whichever occurred first. Kaplan–Meier cumulative survival curves were constructed to compare stroke between AMI patients with and without AF. Results Overall, 12-year stroke rate was higher in patients with AF than without AF (log rank P-value < 0.001), including in different genders, ages, or intervention subgroups. In patients with AF, those with preexisted AF had higher stroke rates in male gender, age below 65 years, and with intervention subgroups than those with new-onset AF. In Cox proportional-hazard regression analysis, AF was an independent risk factor for stroke after first AMI (hazard ratio, 1.67; 95% confidence interval, 1.5–1.87). Conclusions AF significantly increased stroke risks after first AMI. In patients with AF, those with preexisting AF have higher stroke risks in male genders, ages below 65 years, and with interventions than those with new-onset AF.

scholarly journals DOP42 Impact of discontinuing thiopurines at anti-TNF initiation in inflammatory bowel disease: A nationwide Danish cohort study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S079-S080
Author(s):  
S Bohn Thomsen ◽  
R Ungaro ◽  
K Allin ◽  
G Poulsen ◽  
A Mikael ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Cohort Study ◽  
Bowel Disease ◽  
Cox Regression ◽  
Clinical Event ◽  
P Value ◽  
The Past ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background The impact of discontinuing vs. continuing thiopurines at anti-TNF initiation in thiopurine experienced patients with inflammatory bowel disease (IBD) is unclear. Methods We used the nationwide Danish registers to establish a national cohort of patients with IBD who received thiopurines prior to initiating anti-TNF during 2003–2014. We compared patients who discontinued vs. continued thiopurine within 90 days of anti-TNF initiation. Our primary outcome was a composite of any clinical event: corticosteroids, hospitalisation, surgery, or death. We used Cox regression models to calculate adjusted hazard ratios (aHR) with 95% confidence intervals (CI). Analyses were adjusted for sex, diagnosis-age, IBD-subtype, disease duration, calendar year, pre-anti-TNF thiopurine duration, and past disease severity including hospitalisations the past year, surgery past 5 years, and corticosteroid use the past year. Results Of 6998 anti-TNF exposed, 1602 patients (Crohn’s disease, n = 1000, ulcerative colitis, n = 602) received thiopurines prior to anti-TNF. Of these, 489 (44%) received thiopurines for more than 180 days. At anti-TNF initiation, 503 patients discontinued thiopurines and were followed for a median 3.54 years and 1099 continued thiopurines with a median follow-up of 3.92 years. Discontinuing thiopurines at anti-TNF initiation statistically significantly increased the risk of the composite outcome (aHR 1.25; 95% CI 1.09 to 1.45). Analyses of the individual outcomes revealed a statistically significantly increased risk of later corticosteroid use in thiopurine discontinuers (aHR 1.31; 95% CI 1.11 to 1.56), but no increased risk of the remaining outcomes. IR; incidence rate, HR; hazard ratio, CI; confidence interval, IBD; inflammatory bowel disease. P-value is the test of interaction between the variable and the treatment groups. Conclusion In our nationwide cohort study of patients with IBD, we found that continuing thiopurines after anti-TNF initiation impacted the outcome favourably, especially regarding corticosteroid use. Further studies are warranted to investigate this central clinical question.

scholarly journals Factors Affecting Visual Outcome in Post-Operative Cases of Lens Induced Glaucoma - A Prospective Study

2021 ◽  
Vol 8 (13) ◽  
pp. 784-789
Author(s):  
Disilva Davis ◽  
Remadevi S ◽  
Accamma Mamman
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Vision Loss ◽  
Visual Outcome ◽  
P Value ◽  
Delayed Presentation ◽  
Elderly Age ◽  
Factors Affecting ◽  
Postoperative Visual Acuity ◽  
The Impact

BACKGROUND Lens induced glaucoma is common in India. By early identification and removal of cataract, vision loss due to lens induced glaucoma can be prevented. Of the 12.5 million blind people in India, 50 - 80 % is due to cataract. In developing countries like India financial, cultural, and psychosocial constraints still exist to access excellent surgical services. This study was undertaken to determine factors affecting postoperative visual acuity in patients with lens induced glaucoma and to estimate the proportion of cases attaining good visual acuity. METHODS This prospective cohort study was conducted in 85 cases of lens induced glaucoma admitted in Regional Institute of Ophthalmology during a period of 1 year from May 2018 - April 2019. All patients underwent a complete ophthalmic examination preoperatively as well as postoperatively. All patients underwent cataract surgery and postoperatively patients were followed up regularly at 1 day, 1 week and 4 week and were evaluated. RESULTS Majority of patients were in the age group of 70 - 79 years (35.3 %). Females outnumbered males by 13 %. Most of the patients had a preoperative intraocular pressure between 21 – 30 mmHg (37.6 %). On analysis of the impact of duration of symptom on postoperative visual acuity, 70.4 % patients attained visual acuity > 6 / 24 when presented within 3 days. This was statistically significant with a P value of 0.011. When preoperative visual acuity was hand movements vision or better, 79.2 % patients attained visual acuity > 6 / 24 and it was significant with a P-value of < 0.01. CONCLUSIONS Delayed presentation, elderly age and sustained rise in preoperative intraocular pressure are the factors leading to poor visual prognosis. As majority of the patients were pseudophakic in the fellow eye, it is necessary to council all patients regarding timely surgery in the second eye at the time of discharge. KEYWORDS Cataract, Secondary Glaucoma, Visual Outcome

scholarly journals Awareness of gestational diabetes mellitus foetal-maternal risks: an Italian cohort study on pregnant women

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Paola Quaresima ◽  
Federica Visconti ◽  
Fabiana Interlandi ◽  
Luigi Puccio ◽  
Patrizia Caroleo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cohort Study ◽  
Treatment Group ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Control Group ◽  
P Value ◽  
Oral Glucose ◽  
Level Of Education ◽  
The Impact

Abstract Background Gestational diabetes mellitus (GDM) incidence is increasing worldwide. It represents a major risk factor for adverse foetal-maternal outcomes. Awareness among women in regard to GDM-related risks (in particular foetus ones) has been proven to have an impact on compliance with recommendations. Therefore we aimed to evaluate the efficacy of our post-diagnosis counselling, that informs affected women of the GDM related risks for complications, in determining an adequate level of understanding. Method This is a cohort study involving 400 women undergoing the 24-28 weeks 75 g oral glucose tolerance test. Two hundred women diagnosed with GDM received the post-diagnosis counselling (treatment group) and two hundred women diagnosed without did not receive any counselling (control group). Both populations were surveyed with a 5 question questionnaire regarding their awareness about GDM foetal-maternal related risks. Their level of education about GDM foetal-maternal related risks, estimated according to the number of correct answers, was scored as: primary (score 0-1), secondary (score 2-3) or tertiary (score 4-5). Results Most of the women in the treatment group after receiving the post-diagnosis counselling have demonstrated a secondary level of education 132/200 (66%). Their mean level of awareness was higher in comparison to the control group 2.6 ± 1.8 (SD) versus 2.14 ± 1.8 (SD) p value = 0.012. In particular, they’ve demonstrated to be more aware of the risks for the foetus to become macrosomic (p = 0.004) or to die in utero (p = 0.0001). A high level of education and to have had previous pregnancies positively affected correct answers. Conclusions Our post-diagnosis counselling has played a role in improving women awareness about GDM foetal-maternal related risks. Future study will explore the impact of women’s level of awareness on glycaemic control.

scholarly journals Impact of COVID-19 on Antenatal, Natal, and Postnatal Care of pregnant females at Akbar Niazi Teaching Hospital

2021 ◽  
Vol 25 (1) ◽  
pp. 60-65
Author(s):  
Nadia Jabeen ◽  
Fareeha Zaheer ◽  
Kinza Ali ◽  
Amna Faruqi ◽  
Irfan Afzal Mughal ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Postnatal Care ◽  
Preventive Measures ◽  
Care Delivery ◽  
P Value ◽  
Pregnant Females ◽  
Number Of Patients ◽  
The Impact ◽  
Middle Class Families ◽  
Source Of Information

Objective: To determine the perception of pregnant patients regarding the COVID pandemic, preventive measures taken by the patients during the pandemic, and the impact of COVID on their Natal, Intrapartum, and Postpartum Care.Materials and Methods: This study included 850 patients presenting in the Obstetrics and Gynaecology department for antenatal care, inpatient care (delivery and caesarean section), and postpartum complications. Percentages were calculated for descriptive variables like demographic factors, source of information, and opinion of patients about COVID-19, preventive measures are taken by the patients, their Antenatal, Natal, and Postnatal fears. An independent t-test was applied and a p-value of ˂0.05 was taken as statistically significant.Results: We enrolled 850 patients in this study with a mean age of +28 years,mean gravidity of +3, 50% were matriculated and 75% of our patients belonged to middle-class families.. Among our patients, 96% were in fear of getting infected along with their fetus, if they visited the hospital for antenatal care, which is why a majority of them did not visit the hospital for antenatal care and a statistically significant percentage (80%) of them missed antenatal care for 5 months. While the same number of patients (96%, p-value ˂0.05) shared their fear regarding contracting the infection from the hospital during delivery and postnatal care in the hospital, and the same percentage were of the opinion that the baby would get infected during and after delivery in a hospital.Conclusion: Antenatal care is a basic right of every pregnant female. During emergencies like pandemics ways and means should be devised, not only to provide care but, also, to address the fears of pregnant females to prevent complications during this important phase of life.

scholarly journals Adverse maternal outcomes of adolescent pregnancy in Northwest Ethiopia: A prospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257485
Author(s):  
Getachew Mullu Kassa ◽  
Ayodele O. Arowojolu ◽  
Akin Tunde A. Odukogbe ◽  
Alemayehu Worku Yalew
Keyword(s):  
Cohort Study ◽  
Postpartum Depression ◽  
Cesarean Section ◽  
Antenatal Care ◽  
Adolescent Pregnancy ◽  
Postnatal Depression ◽  
Northwest Ethiopia ◽  
P Value ◽  
Maternal Outcomes ◽  
Adult Women

Background Adolescent pregnancy is considered a major contributor to maternal and child morbidity and mortality, the greatest concern of developing countries and an important public health issue globally. Adolescents are responsible for eleven percent of births worldwide and they face several pregnancy and childbirth related complications. However, in low-income countries like Ethiopia, there are limited researches conducted to investigate outcomes of adolescent pregnancy. Therefore, this study was conducted to assess the adverse maternal outcomes of adolescent pregnancy in Northwest Ethiopia. Methods A prospective cohort study was conducted in 12 health facilities from seven districts in East Gojjam zone, Northwest Ethiopia. A total of 418 adolescents (15–19 years old) and 836 adult women (20–34 years old) who attended randomly selected health facilities in East Gojjam zone were included. Data were collected starting from admission to the maternity ward for labor and delivery, and postnatal depression was measured at six weeks’ postpartum period using the Edinburgh Postnatal Depression Scale. Generalized estimating equations (GEE) was used to account for the within subject correlation and assess the effect of different known factors that could influence the outcome of this study. Results A lower percentage of adolescent (58.4%) than adult (71.2%) women had their first antenatal care booking before 16 weeks of gestation. After adjusting for different confounding factors, the adverse outcome that was significantly associated with adolescent pregnancy was postpartum depression (AOR: 2.29; 95% CI, 1.42, 3.7, p-value = 0.001). Assisted vaginal delivery (AOR: 0.44; 95% CI, 0.23, 0.86, p-value 0.016) and cesarean section (AOR: 0.43; 95% CI, 0.19, 0.97, p-value = 0.042) were significantly lower among adolescent women. Conclusions Adolescent pregnancy is associated with higher odds of postpartum depression, and lower odds to undergo cesarean section and assisted vaginal delivery than adult women. Perinatal care services should be more adolescent-friendly to ensure early diagnosis and treatment of postpartum depression. School and community-based awareness programs regarding use of contraception to prevent unwanted adolescent pregnancy, early antenatal care booking and adverse pregnancy outcomes of adolescent pregnancy and provision of psychosocial support are recommended.

scholarly journals The Incidence and Outcomes of Healthcare-associated Respiratory Tract Infections in Non-ventilated Neurocritical Care Patients: Results of a 10-year Prospective Cohort Study

2021 ◽  
Author(s):  
Ksenia Ershova ◽  
Ivan Savin ◽  
Oleg Khomenko ◽  
Darren Wong ◽  
Gleb Danilov ◽  
...  
Keyword(s):  
Cohort Study ◽  
Respiratory Tract ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Respiratory Tract Infections ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Tract Infections ◽  
Healthcare Associated ◽  
The Impact

Abstract Background. The incidence of healthcare-associated respiratory tract infections in non-ventilated patients (NVA-HARTI) in neurosurgical intensive care units (ICU) is unknown. The impact of NVA-HARTI on patient outcomes and differences between NVA-HARTI and ventilator-associated healthcare-associated respiratory tract infections (VA-HARTI) are poorly understood. Our objectives were to report the incidence, hospital length of stay (LOS), ICU LOS, and mortality in neurosurgical ICU and compare these characteristics between NVA- and VA-HARTI.Methods. This prospective cohort study was conducted in a neurosurgical ICU in Moscow from 2011 to 2020. All patients with ICU LOS >48h were included. Time trends were analyzed for all outcomes. A competing risk model was used for survival and risk analysis.Results. A total of 3,937 ICU admissions were analyzed. NVA-HARTI vs VA-HARTI results were: cumulative incidence 7.2 (6.4-8.0) vs 15.4 (14.2-16.5) per 100 ICU admissions, incidence rate 4.2±2.0 vs 9.5±3.0 per 1000 patient-days in the ICU, median LOS 32 [21; 48.5] vs 46 [28; 76.5] days, median ICU LOS 15 [10; 28.75] vs 26 [17; 43] days, and mortality rates 12.3% (7.9-16.8) vs 16.7% (13.6-19.7). The incidence of VA-HARTI decreased in ten years while NVA-HARTI incidence did not change. VA-HARTI was found to be an independent risk factor of death, odds ratio 1.54 (1.11-2.14), p-value=0.009 while NVA-HARTI was not.Conclusion. Our findings suggest that NVA-HARTI in neurosurgical ICU patients represents a significant healthcare burden with relatively high incidence and associated poor outcomes. NVA-HARTI appeared to be different from VA-HARTI and persisted despite preventive measures; therefore, extrapolating VA-HARTI research findings to NVA-HARTI should be avoided.

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