scholarly journals Effect of the CRADLE vital signs alert device intervention on referrals for obstetric haemorrhage in low-middle income countries: a secondary analysis of a stepped- wedge cluster-randomised control trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lucie Giblin ◽  
Nicola Vousden ◽  
Hannah Nathan ◽  
Francis Gidiri ◽  
Shivaprasad Goudar ◽  
...  
Keyword(s):  
Maternal Death ◽  
Maternity Care ◽  
Secondary Analysis ◽  
Vital Signs ◽  
Shock Index ◽  
Middle Income ◽  
Middle Income Countries ◽  
Obstetric Haemorrhage ◽  
Care Facilities ◽  
Emergency Hysterectomy

Abstract Background Obstetric haemorrhage is the leading cause of maternal death worldwide, 99% of which occur in low and middle income countries. The majority of deaths and adverse events are associated with delays in identifying compromise and escalating care. Management of severely compromised pregnant women may require transfer to tertiary centres for specialised treatment, therefore early recognition is vital for efficient management. The CRADLE vital signs alert device accurately measures blood pressure and heart rate, calculates the shock index (heart rate divided by systolic blood pressure) and alerts the user to compromise through a traffic light system reflecting previously validated shock index thresholds. Methods This is a planned secondary analysis of data from the CRADLE-3 trial from ten clusters across Africa, India and Haiti where the device and training package were randomly introduced. Referral data were prospectively collected for a 4-week period before, and a 4-week period 3 months after implementation. Referrals from primary or secondary care facilities to higher level care for any cause were recorded. The denominator was the number of women seen for maternity care in these facilities. Results Between April 1 2016 and Nov 30th, 2017 536,223 women attended maternity care facilities. Overall, 3.7% (n = 2784/74,828) of women seen in peripheral maternity facilities were referred to higher level care in the control period compared to 4.4% (n = 3212/73,371) in the intervention period (OR 0.89; 0.39–2.05) (data for nine sites that were able to collect denominator). Of these 0.29% (n = 212) pre-intervention and 0.16% (n = 120) post-intervention were referred to higher-level facilities for maternal haemorrhage. Although overall referrals did not significantly reduce there was a significant reduction in referrals for obstetric haemorrhage (OR 0.56 (0.39–0.65) following introduction of the device with homogeneity (i-squared 26.1) between sites. There was no increase in any bleeding-related morbidity (maternal death or emergency hysterectomy). Conclusions Referrals for obstetric haemorrhage reduced following implementation of the CRADLE Vital Signs Alert Device, occurring without an increase in maternal death or emergency hysterectomy. This demonstrates the potential benefit of shock index in management pathways for obstetric haemorrhage and targeting limited resources in low- middle- income settings. Trial registration This study is registered with the ISRCTN registry, number ISRCTN41244132 (02/02/2016).

scholarly journals Effect of The CRADLE Vital Signs Alert Device Intervention on Referrals for Obstetric Haemorrhage in Low-Middle Income Countries: A Secondary Analysis of A Stepped-Wedge Cluster-Randomised Control Trial

2021 ◽  
Author(s):  
Lucie Giblin ◽  
Nicola Vousden ◽  
Hannah Nathan ◽  
Muchabayiwa Francis Gidiri ◽  
Shivaprasad Goudar ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Maternity Care ◽  
Secondary Analysis ◽  
Vital Signs ◽  
Shock Index ◽  
Middle Income ◽  
Middle Income Countries ◽  
Obstetric Haemorrhage ◽  
Care Facilities

Abstract Background Obstetric haemorrhage is the leading cause of maternal death worldwide, 99% of which occur in low and middle income countries. The majority of deaths and adverse events are associated with delays in identifying compromise and escalating care. Management of severely compromised pregnant women may require transfer to tertiary centres for specialised treatment, therefore early recognition is vital for efficient management. The CRADLE vital signs alert device accurately measures blood pressure and heart rate, calculates the shock index (heart rate divided by systolic blood pressure) and alerts the user to compromise through a traffic light system reflecting previously validated shock index thresholds. Methods This is a planned secondary analysis of data from the CRADLE-3 trial from ten clusters across Africa, India and Haiti where the device and training package were randomly introduced. Referral data were prospectively collected for a 4-week period before, and a 4-week period 3 months after implementation. Referrals from primary or secondary care facilities to higher level care for any cause were recorded. The denominator was the number of women seen for maternity care in these facilities. Results Between April 1 2016 and Nov 30th, 2017 536 223 women attended maternity care facilities. We reviewed a total of 144 cases that were referred, 119 cases 3.84% pre-implementation and 4.48% post-implementation were referred to higher-level facilities. Overall referrals did not significantly reduce (OR 0.89 (0.39- 2.05)) but there was a significant reduction in referrals for bleeding (OR 0.5 (0.39-0.65) following introduction of the device, with homogeneity (I-squared 10.4) between sites. There was no increase in any bleeding-related morbidity.Conclusions Referrals for obstetric haemorrhage reduced following implementation of the CRADLE Vital Signs Alert Device, occurring without an increase in maternal death or emergency hysterectomy. This demonstrates the potential benefit of Shock Index in management pathways for obstetric haemorrhage and targeting limited resources in low- middle- income settings. Trial Registration This study is registered with the ISRCTN registry, number ISRCTN41244132 (02/02/2016)

Midwifery leadership, advocacy and action to improve maternal health in PNG

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
H Hall ◽  
J Kep ◽  
J Brown ◽  
J Pyakalyia ◽  
R King ◽  
...  
Keyword(s):  
Maternal Health ◽  
Peer Support ◽  
Leadership Training ◽  
Maternity Care ◽  
Universal Access ◽  
Middle Income ◽  
Improvement Project ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Innovative Model

Abstract Background The SDG target for maternal mortality is less than 70 per 100,000 live births; in Papua New Guinea, it is estimated to be 145. PNG will require significant resources and strong leadership to meet the 2030 target. The PNG Midwifery Leadership Buddy Program (Buddy Program), funded and coordinated by Rotary, offers an innovative model to improve maternal health, which may be transferable to other low-middle-income countries. Objectives The Buddy Program aims to build midwifery leadership resulting in improved outcomes in PNG. As partners, midwives from PNG and Australia undertake leadership training in Port Moresby and enter a reciprocal peer support relationship. Over 12 months, they support each other in their professional roles and progress a quality improvement project. Results Three cohorts of midwives (18 from each country), have participated in the leadership training and the first group has completed 12 months of peer support. Participants have reported increased confidence for leadership, action and advocacy. There has been some communication challenges and variation in expectations, predominately due to cultural differences. The Buddy Program has resulted in a number of tangible projects including the introduction of family planning education at a local school and University, introduction of respectful care in pregnancy charter and increased surveillance and treatment of pregnant women with anaemia. Interestingly, a number of participants have continued to support each other beyond the initial 12-month commitment. Conclusions Supportive partnerships that grow midwifery leadership hold significant potential to increase the quality of maternity care and reduce preventable maternal deaths in low-middle-income countries. Key messages Midwifery leadership plays a vital role in addressing the SDG targets for maternal health. The Buddy Program offers an innovative model to progress the agenda for universal access to quality maternity care.

scholarly journals Co-morbid anaemia and stunting among children of pre-school age in low- and middle-income countries: a syndemic

2018 ◽  
Vol 22 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Thach Duc Tran ◽  
Beverley-Ann Biggs ◽  
Sara Holton ◽  
Hau Thi Minh Nguyen ◽  
Sarah Hanieh ◽  
...  
Keyword(s):  
Rural Areas ◽  
Secondary Analysis ◽  
Logistic Models ◽  
Demographic And Health Surveys ◽  
Healthy Children ◽  
Middle Income ◽  
Disadvantaged Children ◽  
Middle Income Countries ◽  
Co Morbidity ◽  
Low And Middle Income

AbstractObjectiveTo determine the prevalence of co-morbidity of two important global health challenges, anaemia and stunting, among children aged 6–59 months in low- and middle-income countries.DesignSecondary analysis of data from Demographic and Health Surveys (DHS) conducted 2005–2015. Child stunting and anaemia were defined using current WHO classifications. Sociodemographic characteristics of children with anaemia, stunting and co-morbidity of these conditions were compared with those of ‘healthy’ children in the sample (children who were not stunted and not anaemic) using multiple logistic models.SettingLow- and middle-income countries.SubjectsChildren aged 6–59 months.ResultsData from 193 065 children from forty-three countries were included. The pooled proportion of co-morbid anaemia and stunting was 21·5 (95 % CI 21·2, 21·9) %, ranging from the lowest in Albania (2·6 %; 95 % CI 1·8, 3·7 %) to the highest in Yemen (43·3; 95 % CI 40·6, 46·1 %). Compared with the healthy group, children with co-morbidity were more likely to be living in rural areas, have mothers or main carers with lower educational levels and to live in poorer households. Inequality in children who had both anaemia and stunting was apparent in all countries.ConclusionsCo-morbid anaemia and stunting among young children is highly prevalent in low- and middle-income countries, especially among more disadvantaged children. It is suggested that they be considered under a syndemic framework, the Childhood Anaemia and Stunting (CHAS) Syndemic, which acknowledges the interacting nature of these diseases and the social and environmental factors that promote their negative interaction.

Video Relay Interpreting and Overcoming Barriers in Health Care for Deaf Users: A Scoping Review (Preprint)

2021 ◽  
Author(s):  
Minerva Rivas Velarde ◽  
Caroline Jagoe ◽  
Jess Cuculick
Keyword(s):  
Health Care ◽  
Sign Language ◽  
Scoping Review ◽  
Secondary Analysis ◽  
Healthcare Services ◽  
Eligibility Criteria ◽  
Middle Income ◽  
Middle Income Countries ◽  
Healthcare Settings ◽  
Study Selection

UNSTRUCTURED Abstract Objectives To identify existing evidence regarding the use of Video Remote Interpretation (VRI) in healthcare settings. To assess if VRI technology can enable deaf-users to overcome interpretation barriers and improve communication outcomes between them and health care personnel. Design Scoping review. Data sources Seven medical research databases (Medline, Web of Science, Embase, Google Scholar) from 2006 and bibliographies and citations of relevant papers. Searches included articles in English, Spanish and French. Eligibility criteria for study selection Original articles about the use of VRI for Deaf or Hard of Hearing sign language users (DHH) for, or within, healthcare. Results From the original 176 articles identified, 120 were eliminated after reading the article title and abstract, and 41 articles were excluded after they were fully read. Fifteen articles were selected for inclusion. Four were literature reviews; four were surveys, three qualitative studies; and one mixed-methods study that combined qualitative and quantitative data, one brief communication, one quality improvement report and one secondary analysis. This scoping review identified a knowledge gap regarding the quality of interpretation and training of sign language interpretation for healthcare. It also shows that this area is under researched and evidence is scant. All evidence was from high-income countries which is particularly problematic given that the majority of DHH persons live in low- and middle-income countries. Conclusions Furthering our understanding on the use of VRI technology is pertinent and relevant. Available literature shows that VRI may enable deaf-users to overcome interpretation barriers and can potentially improve communication outcomes between them and health personnel within healthcare services. For VRI to be acceptable, sign language users require a VRI system supported by devices with large screen and a reliable internet connection, as well as qualified interpreters trained on medical interpretation.

scholarly journals Outcomes associated with anaesthetic techniques for caesarean section in low- and middle-income countries: a secondary analysis of WHO surveys

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Pisake Lumbiganon ◽  
Hla Moe ◽  
Siriporn Kamsa-ard ◽  
Siwanon Rattanakanokchai ◽  
Malinee Laopaiboon ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Secondary Analysis ◽  
Anaesthetic Techniques ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Impact of water fortification with calcium on calcium intake in different countries: a simulation study

2020 ◽  
pp. 1-14 ◽  
Author(s):  
Gabriela Cormick ◽  
Luz Gibbons ◽  
Jose M Belizán
Keyword(s):  
Simulation Study ◽  
Democratic Republic ◽  
Age Groups ◽  
Lao Pdr ◽  
Secondary Analysis ◽  
Planning Program ◽  
Middle Income ◽  
Middle Income Countries ◽  
Upper Limit ◽  
The Impact

Abstract Objective: To simulate the impact – effectiveness and safety – of water fortification with different concentrations of Ca using the Intake Modelling, Assessment and Planning Program. Design: This is a secondary analysis of national or sub-national dietary intake databases. Setting and Participants: Uganda, Lao People’s Democratic Republic (PDR), Bangladesh, Zambia, Argentina, USA and Italy. Results: We found that for dietary databases assessed from low- and middle-income countries (LMIC), the strategy of fortifying water with 500 mg of Ca/l would decrease the prevalence of low Ca intake in all age groups. We also found that this strategy would be safe as no group would present a percentage of individuals exceeding the upper limit in >2 %, except women aged 19–31 years in Lao PDR, where 6·6 % of women in this group would exceed the upper limit of Ca intake. The same strategy would lead to some groups exceeding the upper limit in USA and Italy. Conclusions: We found that for most LMIC countries, water fortified with Ca could decrease the prevalence of Ca intake inadequacy without exceeding the upper levels of Ca intake.

scholarly journals Maternal Death Surveillance and Response in Tanzania: Comprehensiveness of narrative summaries and action points from maternal death reviews

2020 ◽  
Author(s):  
Ali Said ◽  
Andrea B. Pembe ◽  
Siriel Massawe ◽  
Claudia Hanson ◽  
Mats Malqvist
Keyword(s):  
Maternal Death ◽  
Demographic Characteristics ◽  
Health Facilities ◽  
World Health ◽  
Action Plans ◽  
Maternal Deaths ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sequence Of Events ◽  
Surveillance And Response

Abstract Background Maternal deaths in Tanzania and other low and middle income countries occur both in and outside health facilities. Review of maternal deaths relies on comprehensive documentation of medical records that can reveal sequence of events leading to death. The World Health Organization’s and the Tanzanian Maternal Death and Surveillance (MDSR) system propose the use of narrative summaries during maternal death reviews for discussing the case to categorize causes of death, identify gaps in care and recommend action plans to prevent deaths. Suggested action plans are recommended to be Specific, Measurable, Attainable, Relevant and Time bound (SMART). To identify gaps in documenting information and developing recommendations, comprehensiveness of written narrative summaries and action plans were assessed. Methods A total of 76 facility maternal deaths that occurred in two regions in Southern Tanzania in 2018 were included for analysis. We assessed the comprehensiveness of summaries and action plans using a prepared checklist from Tanzania MDSR guideline of 2015. Presence or absence of items in four domains each with several attributes was recorded. These were socio-demographic characteristics, antenatal care, referral information and events that occurred after admission. Less than 75% completeness of attributes in all domains was considered poor while 95% and above was good/comprehensive. Action plans were assessed by application of SMART criteria and according to place of planned implementation (community, facility or higher level of health system).Results Almost half of narrative summaries (49%) scored poor, and only 1% scored good/comprehensive. Summaries missed key information such as demographic characteristics, time between diagnosis of complication and commencing treatment (65%), investigation results (47%), summary of case evolution (51%) and referral information (47%). A total of 285 action points were analysed. Most action points 242(85%) recommended strategies to be implemented at health facilities and they were mostly 42(42%) on service delivery. Only 42% (32/76) of the action points were deemed to be SMART.Conclusions Abstraction of information to prepare narrative summaries used in MDSR system is inadequately done. Action plans in MDSR system are mostly recommended to sub standard care in health facilities but are not specific on the issues to be addressed.

scholarly journals An emergency strategy framework for managing COVID-19 in long-term care facilities in Brazil

2021 ◽  
Vol 15 ◽  
Author(s):  
Peter Lloyd-Sherlock ◽  
João Bastos Freire ◽  
Meirelayne Duarte ◽  
Monica Frank ◽  
Karla Giacomin ◽  
...  
Keyword(s):  
Long Term Care ◽  
Policy Framework ◽  
Intersectoral Collaboration ◽  
Term Care ◽  
Middle Income ◽  
Local Implementation ◽  
Middle Income Countries ◽  
Care Facilities ◽  
The Impact

This paper presents a novel policy framework to support government responses to COVID-19 in long-term care facilities (LTCFs) in low and middle-income countries. It focuses on issues that are of specific relevance to Brazilian policy-settings, including examples of its local implementation. The CIAT Framework combines and summarizes broad elements for an emergency strategy to address the potential effects of COVID-19. The 4 steps of the Framework entail policies to coordinate, identify, assess, and target support. Those policies can be applied immediately to mitigate the impact of the COVID-19 pandemic in LTCFs. It is, however, essential to situate these responses within a more comprehensive and permanent strategy. Intersectoral collaboration must evolve into a fully institutionalized system.

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