scholarly journals Resilience and vulnerability of maternity services in Zimbabwe: a comparative analysis of the effect of Covid-19 and lockdown control measures on maternal and perinatal outcomes, a single-centre cross-sectional study at Mpilo Central Hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Clare Shakespeare ◽  
Handsome Dube ◽  
Sikhangezile Moyo ◽  
Solwayo Ngwenya
Keyword(s):  
Perinatal Outcomes ◽  
Control Measures ◽  
Central Hospital ◽  
Cross Sectional ◽  
Maternity Services ◽  
Before And After ◽  
The Mean ◽  
Significant Change ◽  
The Impact ◽  
Mpilo Central Hospital

Abstract Background On the 27th of March 2020 the Zimbabwean government declared the Covid-19 pandemic a ‘national disaster’. Travel restrictions and emergency regulations have had significant impacts on maternity services, including resource stock-outs, and closure of antenatal clinics during the lockdown period. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality was expected it to be considerable, but little data was yet available. This study aimed to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before, and after the lockdown was implemented. Methods This was a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures were implemented at Mpilo Central Hospital. Results Between January-March and April-June 2020, the mean monthly deliveries reduced from 747.3 (SD ± 61.3) in the first quarter of 2020 to 681.0 (SD ± 17.6) during lockdown, but this was not statistically significant, p = 0.20. The Caesarean section rates fell from a mean of 29.8% (SD ± 1.7) versus 28.0% (SD ± 1.7), which was also not statistically significant, p = 0.18. During lockdown, the percentage of women delivering at Mpilo Central Hospital who were booked at the hospital fell from a mean of 41.6% (SD ± 1.1) to 35.8% (SD ± 4.3) which was statistically significant, p = 0.03. There was no significant change, however, in maternal mortality or severe maternal morbidity (such as post-partum haemorrhage (PPH), uterine rupture, and severe preeclampsia/eclampsia), stillbirth rate or special care baby unit admission. There was an increase in the mean total number of early neonatal deaths (ENND) (mean 18.7 (SD ± 2.9) versus 24.0 (SD ± 4.6), but this was not statistically significant, p = 0.32. Conclusions Overall, maternity services at Mpilo showed resilience during the lockdown period, with no significant change in maternal and perinatal adverse outcomes, with the same number of man-hours worked before and during the lockdown Maternal and perinatal outcomes should continue to be monitored to assess the impact of Covid-19 and the lockdown measures as the pandemic in Zimbabwe unfolds. Further studies would be beneficial to explore women’s experiences and understand how bookings and deliveries at local clinics changed during this time.

scholarly journals Resilience and vulnerability of maternity services in Zimbabwe: a comparative analysis of the effect of Covid-19 and lockdown control measures on maternal and perinatal outcomes at Mpilo Central Hospital.

2020 ◽  
Author(s):  
Clare Shakespeare ◽  
H Dube ◽  
S Moyo ◽  
S Ngwenya
Keyword(s):  
Post Partum ◽  
Perinatal Outcomes ◽  
Control Measures ◽  
Central Hospital ◽  
Cross Sectional ◽  
Maternity Services ◽  
Travel Restrictions ◽  
Before And After ◽  
The Impact ◽  
Mpilo Central Hospital

Abstract Background: On 27th March the Zimbabwean government declared the Covid-19 pandemic a ‘national disaster’. Travel restrictions and emergency regulations have had significant impacts on maternity services, including staff shortages, resource stock-outs, and closure of antenatal clinics. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality expect it to be considerable, but little data is yet available.This study aims to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before and after lockdown was implemented.Methods: This is a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures at Mpilo Central Hospital.Results: Between January-March and April-June 2020, average monthly deliveries fell from 747 to 681 and Caesarean section rates from 29.8% to 26.6%. Women with unbooked pregnancies presenting in labour almost doubled from 4.4% to 8%. There was no substantial change, however, in maternal mortality or severe maternal morbidity (post-partum haemorrhage (PPH), uterine rupture, severe preeclampsia/eclampsia), stillbirth rate or special care baby unit (SCBU) admission. There was a small increase in early neonatal death (ENND) from an average of 18.7 to 24.0 deaths per month.Conclusion: Maternal and perinatal outcomes must continue to be monitored to assess the impact of Covid-19 and lockdown measures as the epidemic in Zimbabwe unfolds. Despite the vulnerability of the healthcare system, the resilience and commitment of maternity units and healthcare workers to providing care in the most difficult circumstances should not be underestimated.

What Is the Impact of Prior Authorization on the Incidence of Pediatric Tonsillectomy?

2020 ◽  
pp. 019459982096963
Author(s):  
Vanessa F. Torrecillas ◽  
Kaden Neuberger ◽  
Alexander Ramirez ◽  
Paul Krakovitz ◽  
Jeremy D. Meier
Keyword(s):  
Elective Surgery ◽  
Lag Time ◽  
Cross Sectional Study ◽  
Health Claims ◽  
Third Party ◽  
Prior Authorization ◽  
Cross Sectional ◽  
Before And After ◽  
The Mean ◽  
The Impact

Objective Third-party payers advocate for prior authorization (PA) to reduce overutilization of health care resources. The impact of PA in elective surgery is understudied, especially in cases where evidence-based clinical practice guidelines define operative candidacy. The objective of this study is to investigate the impact of PA on the incidence of pediatric tonsillectomy. Study Design Cross-sectional study. Setting Health claims database from a third-party payer. Methods Any pediatric patient who had evaluation for tonsillectomy from 2016 to 2019 was eligible for inclusion. A time series analysis was used to evaluate the change in incidence of tonsillectomy before and after PA. Lag time from consultation to surgery before and after PA was compared with segmented regression. Results A total of 10,047 tonsillectomy claims met inclusion and exclusion criteria. Female patients made up 51% of claims, and the mean age was 7.9 years. Just 1.5% of claims were denied after PA implementation. There was no change in the incidence of tonsillectomy for all plan types ( P = .1). Increased lag time from consultation to surgery was noted immediately after PA implementation by 2.38 days (95% CI, 0.23-4.54; P = .030); otherwise, there was no significant change over time ( P = .98). Conclusion A modest number of tonsillectomy claims were denied approval after implementation of PA. The value of PA for pediatric tonsillectomy is questionable, as it did not result in decreased incidence of tonsillectomy in this cohort.

scholarly journals Impact of pandemic control measures on physical activities and sedentary behaviour of medical students in Kozhikode

2021 ◽  
Vol 8 (8) ◽  
pp. 3946
Author(s):  
Ajith S. K. ◽  
Alan Gangadaran ◽  
Prabin Pradeep ◽  
Pranav K. Purushothaman ◽  
Jayakrishnan Thayyil
Keyword(s):  
Medical Students ◽  
Sedentary Behaviour ◽  
Control Measure ◽  
Psychological Impact ◽  
Physical Activities ◽  
Control Measures ◽  
Cross Sectional ◽  
Medical College ◽  
Before And After ◽  
The Impact

Background: For a highly contagious disease like COVID-19, restriction of movement and public gatherings is an age-old control measure. But these measures can have some physical and psychological impact on people. This study aimed at investigating the impact of such restrictions on the physical activities (PA) and sedentary behaviour (SB) of students at a medical college in Kozhikode. The objective was to find out the changes in PA and SB among the medical students at government medical college, Kozhikode before and after COVID-19 restrictions.Methods: Cross-sectional study was conducted using modified WHO GPAQ questionnaire sent as google form to potential candidates through whatsapp messenger. Collected data were analysed using Microsoft excel software and statistical comparison was done using the paired t test. Quantitative data was expressed as mean and SD and qualitative data as percentage.Results: The average BMI of the candidates was 21.1 kg/m2 and 21.7 kg/m2 pre and post COVID-19 restrictions, respectively. The PA was 1790.2 and 1445.4 MET minutes before and after the period of study. There is significant reduction in PA (p=0.033) and increment in SB (p<0.01). Weight gain was significant in females (p=0.02).Conclusions: There was decline in the total PA and increase in SB significantly post restriction. There was also an increase in the self-reported weight and BMI of medical students. Almost half of the students made effort to change their physical activity pattern indicating their awareness of increasing SB. 

scholarly journals The impact of coronavirus outbreak on breastfeeding guidelines among Brazilian hospitals and maternity services: a cross-sectional study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Walusa Assad Gonçalves-Ferri ◽  
◽  
Fábia Martins Pereira-Cellini ◽  
Kelly Coca ◽  
Davi Casale Aragon ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
World Health ◽  
Breastfeeding Support ◽  
Cross Sectional ◽  
Maternity Services ◽  
Community Needs ◽  
Care Services ◽  
Skin Contact ◽  
Health Organization ◽  
The Impact

Abstract Background The World Health Organization recognizes exclusive breastfeeding a safe source of nutrition available for children in most humanitarian emergencies, as in the current pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Despite the Brazilian national guideline protecting breastfeeding practices, there are many concerns about protecting infants from their infected mothers. This study aimed to analyze how the Brazilian hospitals and maternity services promote and support mothers suspected or diagnosed with coronavirus disease (COVID-19). Methods This is a descriptive cross-sectional and multicenter study which collected data from 24 Brazilian hospitals and maternity services between March and July 2020. Representatives of the institutions completed a questionnaire based on acts to promote and support breastfeeding, the Baby-Friendly Hospital Initiative, and Brazil’s federal law recommendations. Results The results showed that in delivery rooms, 98.5% of the services prohibited immediate and uninterrupted skin-to-skin contact between mothers and their infants and did not support mothers to initiate breastfeeding in the first hour. On the postnatal ward, 98.5% of the services allowed breastfeeding while implementing respiratory hygiene practices to prevent transmission of COVID-19. Companions for mothers were forbidden in 83.3% of the hospitals. Hospital discharge was mostly between 24 and 28 h (79.1%); discharge guidelines were not individualized. Additionally, a lack of support was noticed from the home environment’s health community network (83.3%). Hospital and home breast pumping were allowed (87.5%), but breast milk donation was not accepted (95.8%). There was a lack of guidance regarding the use of infant comforting strategies. Guidelines specific for vulnerable populations were not covered in the material evaluated. Conclusions In Brazil, hospitals have not followed recommendations to protect, promote, and support breastfeeding during the COVID-19 outbreak. The disagreement between international guidelines has been a major issue. The absence of recommendations on breastfeeding support during the pandemic led to difficulties in developing standards among hospitals in different regions of Brazil and other countries worldwide. The scientific community needs to discuss how to improve maternal and infant care services to protect breastfeeding in the current pandemic.

scholarly journals The Impact of Bariatric Surgery on Menstrual Abnormalities—a Cross-Sectional Study

2020 ◽  
Vol 30 (11) ◽  
pp. 4505-4509
Author(s):  
Anna Różańska-Walędziak ◽  
Paweł Bartnik ◽  
Joanna Kacperczyk-Bartnik ◽  
Krzysztof Czajkowski ◽  
Maciej Walędziak
Keyword(s):  
Bariatric Surgery ◽  
Menstrual Cycle ◽  
Cross Sectional Study ◽  
Reproductive Age ◽  
Obese Women ◽  
Sectional Study ◽  
Cross Sectional ◽  
Contraception Use ◽  
Before And After ◽  
The Impact

Abstract Introduction Obesity is associated with hyperestrogenism along with other hormonal abnormalities affecting the menstrual cycle. The most effective and decisive method of obesity treatment is bariatric surgery. The aim of this study was to analyze the impact of bariatric surgery on menstrual cycle, the incidence of menstrual abnormalities, hyperandrogenism manifestation, and contraception use. Materials and Methods It was a cross-sectional study of 515 pre-menopausal women who had undergone bariatric surgery between 1999 and 2017 in a bariatric center. Data was collected via anonymous questionnaire, and the questions covered a 1-year period before the surgery and the last year before questionnaire completion. Results Before the surgery, 38.6% of the patients reported irregular menstruations in comparison with 25.0% after bariatric surgery (RR = 0.65; 95%CI 0.53–0.79). The mean number of menstruations per year did not differ before and after surgery (10.2 ± 3.9 vs 10.4 ± 3.3; p < .45). There were no statistically significant differences in terms of prolonged menstruations, acne, and hirsutism prevalence. A total of 14.4% of patients before surgery reported estrogen-based contraception use in comparison with 15.0% after the surgery (p < .95). There were no significant differences in the frequency of OC use (11.0% before surgery vs 13.6% 12 months after the surgery vs 11.5% at the moment of survey administration; p < 0.46). Conclusion Bariatric surgery improves the regularity of the menstrual cycle in obese women in reproductive age. The lack of any changes in the combined hormonal contraception (CHC) use, especially OC, before and after bariatric surgery may be a result of a possibly low level of contraception counseling.

Tracheobronchial Foreign Bodies: The Impact of a Postgraduate Educational Program on Diagnosis, Morbidity, and Treatment

PEDIATRICS ◽  
1982 ◽  
Vol 70 (1) ◽  
pp. 96-98
Author(s):  
Marc Puterman ◽  
Rafael Gorodischer ◽  
Alberto Leiberman
Keyword(s):  
Educational Program ◽  
Foreign Bodies ◽  
Final Diagnosis ◽  
Physician Performance ◽  
Postgraduate Educational ◽  
Before And After ◽  
History Of ◽  
The Mean ◽  
Hospital Days ◽  
The Impact

Aspirated foreign bodies (FBs) may remain undetected and cause serious complications. As part of a postgraduate educational program, results of a local survey were presented to the local medical staff in order to increase its awareness of this diagnostic possibility. The present study was carried out in order to evaluate the management of children with tracheobronchial FBs during two 2-year periods, before and after teaching sessions held in December 1976. In comparison with the previous two years during the 1977-1978 period, the percentage of cases in which a positive history of aspiration was obtained increased from 47.6% to 84.0%; the mean number of hospitalizations due to tracheobronchial FBs decreased from 1.9 to 1.04 per infant, and the mean number of hospital days required for final diagnosis decreased from 17.6 to 5.3. The postgraduate educational program had a positive effect on physician performance and patient care.

IMPACT OF JOINT COMMISSION INTERNATIONALACCREDITATION (JCIA) ON HEALTH CARE PROCESSES AND THE CHALLENGES FACED BY PHYSICIANS AND NURSES.

2021 ◽  
pp. 34-35
Author(s):  
Binu Thomas ◽  
Ankur Joshi
Keyword(s):  
Health Care ◽  
Employee Engagement ◽  
Interdisciplinary Collaboration ◽  
Joint Commission ◽  
Health Centers ◽  
Cross Sectional ◽  
Care Processes ◽  
Before And After ◽  
Collaboration And Communication ◽  
The Impact

Purpose: To evaluate the impact of joint commission international accreditation on health care processes as well as to assess the challenges faced by the physicians and nurses . Method: Conducted a cross sectional study in 11 health centers belong to Dubai health authority. Prepared a checklist and questionnaire to assess the changes in the processes brought by accreditation as well as the challenges faced by employees respectively. Studied perceived challenges by recruiting physician (n=106) and nurses (n=194) using convenience sampling technique. Done content validity of the tools with clinical quality experts. Conducted pilot study for the questionnaire and checked the reliability using Cronbach alpha (0.924). After obtaining ethical clearance and consent from subjects, the researcher visited health centers and administered questionnaire to the participants. To evaluate the process improvements, the researcher audited documents for the availability of processes before and after accreditation using the validated checklist, which consisted of 25 processes reecting various domains of quality, employee engagement, interdisciplinary collaboration and communication. Results: Observed tremendous improvements in the availability of processes. The proportion of processes before and after the accreditation was statistically signicantly different (p <.001) for quality of health care. However for employee engagement (p=.250) and interdisciplinary collaboration and communication (p=1.000) no statistical signicance were noted even though there were signicant improvements. Majority (57.5%) of doctors and nurses perceived that the accreditation processes were challenging. Discussion: Observed processes improvements ensuring quality, employee engagement, interdisciplinary collaboration and communication after accreditation.However,majority ofthe employees perceived that, the accreditationwas challenging in terms ofworkload, communication and documentation.

scholarly journals Awareness of COVID-19 Before and After Quarantine Based on Crowdsourced Data From Rabigh City, Saudi Arabia: A Cross-Sectional and Comparative Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Mai Aldhahri ◽  
Rana Alghamdi
Keyword(s):  
Saudi Arabia ◽  
Online Survey ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Cross Sectional ◽  
Second Stage ◽  
Before And After ◽  
Prevention And Control Measures ◽  
Two Stages ◽  
And Control

Background: Infection prevention and control measures are critical for the prevention of the spread of COVID-19.Aim: In this study, we aimed to measure and evaluate the level of awareness and knowledge of the prevention, symptoms, and transmission control of COVID-19 before and after quarantine among the residents of Rabigh city and adjacent villages in Saudi Arabia.Methods: A cross-sectional online survey was conducted in two stages: the first stage took place before quarantine and the second stage took place after quarantine. The survey was filled out electronically.Results: A total of 448 participants responded and filled out the questionnaires. Females (73.70%) formed the largest number of participants for both stages. The majority of the participants were &lt;30 years old (50.90%) and had a high education level in various sectors and levels (97.1%). It was noticeable that during the first stage, the participants' awareness of COVID-19 symptoms was not very high: 13.62% did not know about the symptoms. However, by the second stage, awareness about symptoms had increased (9.6%).Conclusion: The residents of Rabigh city and the surrounding villages had good levels of knowledge about COVID-19.

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