scholarly journals Payment mechanism for institutional births in Nepal

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Ashish KC ◽  
Mats Målqvist ◽  
Amit Bhandari ◽  
Rejina Gurung ◽  
Omkar Basnet ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Mode Of Delivery ◽  
Transportation Cost ◽  
Universal Coverage ◽  
Medical Services ◽  
Incentive Scheme ◽  
Duration Of Stay ◽  
Caesarean Birth ◽  
Demand Side Financing ◽  
Mode Of Birth

Abstract Background Since the Millennium Development Goal era, there have been several efforts to increase institutional births using demand side financing. Since 2005, Government of Nepal has implemented Maternity Incentive Scheme (MIS) to reduce out of pocket expenditure (OOPE) for institutional birth. We aim to assess OOPE among women who had institutional births and coverage of MIS in Nepal. Method We conducted a prospective cohort study in 12 hospitals of Nepal for a period of 18 months. All women who were admitted in the hospital for delivery and consented were enrolled into the study. Research nurses conducted pre-discharge interviews with women on costs paid for medical services and non-medical services. We analysed the out of pocket expenditure by mode of delivery, duration of stay and hospitals. We also analysed the coverage of maternal incentive scheme in these hospitals. Results Among the women (n-21,697) reporting OOPE, the average expenditure per birth was 41.5 USD with 36 % attributing to transportation cost. The median OOPE was highest in Bheri hospital (60.3 USD) in comparison with other hospitals. The OOPE increased by 1.5 USD (1.2, 1.8) with each additional day stay in the hospital. There was a difference in the OOPE by mode of delivery, duration of hospital-stay and hospital of birth. The median OOPE was high among the caesarean birth with 43.3 USD in comparison with vaginal birth, 32.6 USD. The median OOPE was 44.7 USD, if the women stayed for 7 days and 33.5 USD if the women stayed for 24 h. The OOPE increased by 1.5 USD with each additional day of hospital stay after 24 h. The coverage of maternal incentive was 96.5 % among the women enrolled in the study. Conclusions Families still make out of pocket expenditure for institutional birth with a large proportion attributed to hospital care. OOPE for institutional births varied by duration of stay and mode of birth. Given the near universal coverage of incentive scheme, there is a need to review the amount of re-imbursement done to women based on duration of stay and mode of birth.

scholarly journals The true relative financial cost of Planned Caesarean Birth (PCB) versus Planned Vaginal Birth (PVB) in England for the year 2018/19 taking into account litigation and compensation for harm: a sensitivity analysis.

2020 ◽  
Author(s):  
Jonathan West ◽  
Myles Taylor ◽  
Michael Magro
Keyword(s):  
Sensitivity Analysis ◽  
Mode Of Delivery ◽  
Design Sensitivity ◽  
Vaginal Birth ◽  
Cost Advantage ◽  
Financial Cost ◽  
Caesarean Birth ◽  
Financial Costs ◽  
Mode Of Birth ◽  
Additional Costs

OBJECTIVE: To determine the true financial costs of Planned Caesarean Section and Planned Vaginal Birth in England for the year 2018/19 after accounting for litigation and compensation for harm (LCFH) DESIGN: Sensitivity analysis BACKGROUND: Average base costs per delivery remitted to NHS maternity providers for Planned Caesarean Birth (PCB) and Planned Vaginal Birth (PVB) in 2018/19 were £3,948 and £3,270 respectively leading to a perception that PCB is more costly than PVB. Indemnity costs potentially related to planned mode of delivery, however, add an average of £1,571/delivery to overall costs. METHOD: Retrospective analysis of costs according to planned mode of birth was performed based on data and previous research published by NHS Resolution and NHS England. Weighting of results according to PCB and PVB rates was performed in a manner similar to the sensitivity analysis of PCB v PVB (without accounting for LCFH) performed by the National Institute for Health and Care Excellence (NICE) in 2011 RESULTS: Additional costs of LCFH resulted in revised costs of £4,245 and £5,030 for PCB and PVB respectively – a cost advantage of £785 per delivery in favour of PCB. CONCLUSION: Providers should not be discouraged from offering or women refused PCB on grounds of cost.

scholarly journals Weight Shapes the Intestinal Microbiome in Preterm Infants: Results of a Prospective Observational Study

2021 ◽  
Author(s):  
Fardou H. Heida ◽  
Elisabeth M. W. Kooi ◽  
Josef Wagner ◽  
Thi-Yen Nguyen ◽  
Jan B. F. Hulscher ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Mode Of Delivery ◽  
Intestinal Microbiome ◽  
Skin Microbiome ◽  
Term Infants ◽  
Microbiome Composition ◽  
Mode Of Birth ◽  
Postconceptional Age ◽  
Specific Factors ◽  
Microbiome Development

Abstract Background: The intestinal microbiome in preterm infants differs markedly from term infants. It is unclear whether the microbiome develops over time according to infant specific factors. Methods: We analysed (clinical) metadata - to identify the main factors influencing the microbiome composition development - and the first meconium and feacal samples til the 4th week via 16S rRNA amplican sequencing. Results: We included 41 infants (gestational age 25-30 weeks; birth weight 430-990g. Birth via Caesarean section (CS) was associated with placental insufficiency during pregnancy and lower BW. In meconium and in weeks 2 and 3 an increased combined abundance of Escherichia and Bacteroides (maternal fecal representatives) was associated with vaginal delivery (p=0.021, p=0.0002, p=0.028, respectively) while Staphylococcus (skin microbiome representative) was associated with CS (p=0.0008, p=0.0003 p=0.046, respectively). Secondly, irrespective of the week of sampling or the mode of birth, a transition was observed as children children gradually increased in weight from a microbiome dominated by Staphylococcus (Bacilli) towards a microbiome dominated by Enterobacteriaceae (Gammaproteobacteria). Conclusions: Mode of delivery affects the meconium microbiome composition. It also suggests that the weight of the infant at the time of sampling is a better predictor for the stage of progression of the intestinal microbiome development/maturation than postconceptional age.

scholarly journals Influence of maternal age and hospital characteristics on the mode of delivery

2020 ◽  
Vol 73 (suppl 4) ◽  
Author(s):  
Thales Philipe Rodrigues da Silva ◽  
Bruna Luiza Soares Pinheiro ◽  
Karolina Yukari Kitagawa ◽  
Renato Camargo Couto ◽  
Tânia Moreira Grillo Pedrosa ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Maternal Age ◽  
Diagnosis Related Groups ◽  
Mode Of Delivery ◽  
Length Of Hospital Stay ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Public And Private ◽  
Public Care ◽  
Vaginal Deliveries

ABSTRACT Objectives: to analyze the relationship between maternal age and the source of healthcare payment with mode of delivery in public and private national hospitals between the years 2012 to 2017, and the length of hospital stay. Methods: cross-sectional study of 91,894 women who had children in public and private hospitals between 2012 and 2017. Data were collected from the Diagnosis-Related Groups Brazil system and a comparative analysis was performed between patients in public care and those in supplementary healthcare. Results: in public care, the majority were vaginal deliveries and the reverse occurred in supplementary health. The proportion of cesarean sections was higher in the age group 31 to 40 years old in both services. The hospital stay was longer among women who underwent a cesarean section. Conclusions: high maternal age and the source of healthcare payment influence the mode of delivery, which interfere with the length of hospital stay.

scholarly journals The observed effect of adverse drug reactions on the length of hospital stay among medical inpatients in a Nigerian University Teaching Hospital

2019 ◽  
Vol 3 ◽  
pp. 239784731985045
Author(s):  
Olumuyiwa John Fasipe ◽  
Peter Ehizokhale Akhideno ◽  
Omagbemi Sampson Owhin
Keyword(s):  
Hospital Stay ◽  
Teaching Hospital ◽  
Median Duration ◽  
Length Of Hospital Stay ◽  
University Teaching ◽  
Duration Of Stay ◽  
Prolonged Length ◽  
Medical Inpatients ◽  
The Mean ◽  
Nigerian University

Background: The potential impact of an adverse drug reaction (ADR) is multidimensional, and includes prolonged length of hospitalization which significantly increased morbidity, mortality, and economic burden with additional intense medical care. Aim: This study was designed to characterize and evaluate the potential effect of ADRs on the length of hospital stay among adult medical inpatients in an academic teaching hospital in a large West African nation. The overarching goal of the study is to highlight approaches toward mitigating the sequelae of ADRs in this setting, and improving their recognition and timely optimal management. Methods: The patients admitted into the adult medical wards of a Nigerian University Teaching Hospital over a 9-month period from December 2013 to August 2014 were prospectively recruited for the study and followed up till discharge. Results: A total of 507 patients were evaluated during the study, out of which 269 (53.1%) of them were males and 238 (46.9%) were females. The mean age of the study population was 48.9 ± 17.8 years (median of 46 years). In this study, the mean duration of hospital stay for all patients was 11.9 ± 11.3 days (median of 9 days). Females had a mean duration stay of 12.9 ± 12.3 days (median of 10 days) and stayed significantly longer than males who stayed a mean duration of 10.9 ± 10.2 days with a median of 7 days ( t = −1.985, df = 505, p = 0.048). Furthermore, patients admitted solely because of ADRs (ADR-out) had a significantly shorter duration of stay with a mean duration stay of 6.1 ± 3.7 days (median duration stay of 7 days) when compared to those without ADRs whose mean duration of stay was 11.6 ± 11.0 days (median duration stay of 8 days), and this was found to be statistically significant ( t = 2.110, df = 472, p = 0.035). Those patients who developed ADRs during admission (ADR-in) had a mean duration of stay of 18.3 ± 14.8 (median of 15 days). This was significantly longer than the duration of stay for patients without ADRs ( t = −3.398, df = 487, p = 0.001) and also significantly longer than the duration for those who were admitted solely because of ADRs ( t =3.432, df = 49, p = 0.001). Conclusion: In this study, ADRs were associated with a significantly prolonged length of hospital stay for adult medical inpatients in this Nigerian University Teaching Hospital.

ASSOCIATION OF HEMATOCRIT-PLATELET INDEX AND HEMATOCRIT SHIFT WITH WARNING SIGNS AND HOSPITAL STAY IN DENGUE PATIENTS AT A TERTIARY CARE HOSPITAL

2021 ◽  
Vol 71 (Suppl-1) ◽  
pp. S277-82
Author(s):  
Muhammad Fahd Bin Haider ◽  
Humaira Zafar ◽  
Syed Zubair Hussain Shah ◽  
Mobaila Akram ◽  
Kamran Malik ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Warning Signs ◽  
Care Hospital ◽  
Cross Sectional ◽  
Duration Of Stay ◽  
Platelet Indices ◽  
Significant Difference ◽  
Duration Of Hospitalization

Objective: To determine the relationship between hematocrit, platelet count, warning signs and duration ofhospitalization in indoor dengue patients. Study Design: Analytical, cross sectional study. Place and Duration of Study: Department of Medicine, Pakistan Air Force Hospital Islamabad and Departmentof Biochemistry and Molecular Biology, AM College, Rawalpindi, from Sep 2019 to Jun 2020. Methodology: A total of 100 indoor patients were recruited using convenience sampling. Their platelets, hema-tocrit and warning signs were recorded on arrival in the hospital. First two parameters were checked every day for the whole duration of stay in the hospital. The WHO standard treatment of dengue was given to the patients. Patient were divided into two groups based upon duration of hospitalization using cut-off of 3 days. Linear regression was used to analyze association of hematocrit-platelet index and hematocrit shift with presence of one or more warning signs and duration of hospital stay. Results: There was statistically significant difference in 3rd day Hematocrit Platelet Indices of patients with short and long hospital stay (p=0.003). 3rd day Hematocrit-platelet indices of patients with and without warning signs also showed statistically significant difference when compared with eachother (p=0.0001). It was stronger than Hematocrit Shift (p=0.82) and platelets considered alone. Conclusion: Day 3 Hematocrit Platelet Indexis more strongly associated with warning signs and duration of stay rather than hematocrit alone. It means both need to be taken into account while monitoring dengue patients. Hematocrit platelet index for severity and duration of hospitalization while Hematocrit shift for fluid therapy.

Association Between Mode of Birth and Posttraumatic Stress Disorder Following Childbirth: A Prospective Cohort Study of Chinese Women

2020 ◽  
Author(s):  
YanFang Chen ◽  
Ri-hua Xie ◽  
Meng Li ◽  
Wenxing Hu ◽  
Innie Chen ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Cohort Study ◽  
Cesarean Section ◽  
Posttraumatic Stress ◽  
Vaginal Delivery ◽  
Prospective Cohort ◽  
Stress Disorder ◽  
Chinese Women ◽  
Mode Of Delivery ◽  
Mode Of Birth

Abstract Background Previous studies on the association between mode of delivery and posttraumatic stress disorder have yielded inconsistent results. This study aimed to further investigate the association between mode of delivery and posttraumatic stress disorder in a cohort of Chinese women with a high rate of cesarean delivery.Methods We conducted a prospective cohort study in Guangdong, China between October 2019 and August 2020. Women aged 20-45 years who visited Nanhai Hospital of Southern Medical University for prenatal care and planned to give birth at the same hospital during the study period were approached and were enrolled after a written consent was obtained. Posttraumatic stress disorder was assessed by the Posttraumatic Stress Disorder Checklist-Civilian Version. We first compared the sociodemographic and obstetric characteristics between cesarean delivery group and vaginal delivery group. We then examined the independent association between mode of birth and posttraumatic stress disorder by log binomial regression analysis.Results A total of 630 women were included in the final analysis, with 385 (61%) who delivered vaginally and 245 (39%) who delivered by cesarean section. Fifty-six (8.9%) women developed posttraumatic stress disorder. Of them, 31 (12.7%) occurred in women with cesarean section, and 25 (6.5%) occurred in women with vaginal delivery. The risk of developing posttraumatic stress disorder in women with cesarean section was more than twice of that in women with vaginal delivery after adjusting for confounding variables (adjusted RR 1.91, 95% CI 1.08 to 3.36).Conclusion Cesarean section is an independent risk factor of posttraumatic stress disorder in a cohort of Chinese women with a high cesarean section rate.

Interventions for supporting women with decisions about mode of birth in a pregnancy after caesarean birth

2012 ◽  
Author(s):  
Dell Horey ◽  
Mary-Ann Davey ◽  
Rhonda Small ◽  
Michelle Kealy ◽  
Caroline A Crowther
Keyword(s):  
Caesarean Birth ◽  
Mode Of Birth

scholarly journals Acute kidney injury in obstetrics: a five-year study in a tertiary centre

2019 ◽  
Vol 9 (1) ◽  
pp. 113
Author(s):  
Sushma H. Papegowda ◽  
Pratima K. Devi ◽  
Ranjit L. Singh ◽  
Agalya Muruganadam ◽  
Zikpuii L. Tochhawng
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Stay ◽  
Maternal Morbidity ◽  
Mode Of Delivery ◽  
Kidney Injury ◽  
Renal Perfusion ◽  
Exclusion Criteria ◽  
Tubular Necrosis ◽  
Tertiary Centre ◽  
Foetal Outcome

Background: Pregnancy Related Acute Kidney Injury (PRAKI) is a major cause of maternal and foetal morbidity and mortality in developing countries. The incidence has declined due to improvements in reproductive health but it is still associated with significant perinatal mortality and maternal morbidity. It may be due to decrease in renal perfusion or ischemic tubular necrosis from a variety of conditions encountered during pregnancy. Our study aims at determining the predisposing factors and causes of AKI during pregnancy and its impact on maternal and foetal outcome.Methods: A retrospective cohort study over a period of 5 years was conducted on pregnant women with AKI as per inclusion and exclusion criteria. The detailed history, events, mode of delivery, cause leading to AKI, management, hospital stay, maternal and foetal outcome were studied in detail and evaluated. These patients were classified according to RIFLE criteria and were followed up for hospital stay and residual morbidities.Results: The incidence of PRAKI in the study was 0.07% (36 out of 50,735 deliveries) and among obstetric ICU patients, it was 6.8%. Most of the majority of the cases were unbooked (66.7%) and multipara (61.1%). Maternal morbidity was seen in 66.7% and mortality was 27.8%. Poor foetal outcome was seen in 44.4%.Conclusions: Haemorrhage is the most common cause of PRAKI, followed by toxaemia of pregnancy and sepsis. Early detection and meticulous management of haemorrhage, hypertension and sepsis reduce the incidence of PRAKI and associated maternal mortality.

Choosing mode of delivery after previous caesarean birth

2007 ◽  
Vol 15 (4) ◽  
pp. 188-194 ◽  
Author(s):  
Allison Farnworth ◽  
Pauline H Pearson
Keyword(s):  
Mode Of Delivery ◽  
Caesarean Birth

scholarly journals Women's Views on Mode of Birth in Public Hospitals in Argentina: Inputs From a Formative Research to Optimize the Use of Caesarean Section

2021 ◽  
Author(s):  
Carla Perrotta ◽  
Mariana Romero ◽  
Yanina Sguassero ◽  
Natalia Righetti ◽  
Celia Gialdini ◽  
...  
Keyword(s):  
Pain Management ◽  
Caesarean Section ◽  
Quantitative Methods ◽  
Mode Of Delivery ◽  
Formative Research ◽  
Vaginal Birth ◽  
Public Hospitals ◽  
Postpartum Women ◽  
Maternity Hospitals ◽  
Mode Of Birth

Abstract BackgroundThis paper reports on women's perspectives on the birth mode in five public maternity hospitals in Argentina. The study is a formative research study component aimed at tailoring interventions to reduce unnecessary caesarean section (CS) use. MethodsParticipants were postpartum women aged ≥15 years old in five hospitals in the provinces of Salta, Corrientes, Tucuman, Santa Fe and Buenos Aires City. Hospitals completed an institutional survey indicating the availability of obstetric services. The fieldwork was carried out from November 2018 to June 2019. Trained interviewers gathered data on obstetric history, companionship, mode of delivery preferences, and general opinion on vaginal and caesarean section births through semi-structured interviews. The interviews were coded and analysed with standard quantitative methods. ResultsThe five hospitals had a CS rate between 29.2 and 45.5. Four institutions indicated limited access to epidural and other pain management strategies and a restricted antenatal education schedule. The sample included 621 postpartum women with a mean age of 26 years (± SD 6). 60% of them had a vaginal birth (VB). More than 90% of women in three hospitals favoured VB, and in two, 67% (p<0001). CS preference was associated with giving birth in those two hospitals and the numbers of miscarriages adjusting by maternal age and previous pregnancies. The reasons for preferring a VB included faster recovery, feeling ready, and considering it more natural. Most women chose CS as the best mode of birth to avoid birth pain. CS disadvantages included post-procedure pain, dependence on others to take care of her or the baby afterwards, and prolonged time in the hospital. Six out of ten women would have liked to be asked by their providers about the MOB of choice. ConclusionsWomen giving birth in public maternity hospitals of Argentina preferred a vaginal delivery to a caesarean section. There is an ongoing need to improve access to pain management during labour and vaginal birth and include women's opinions along the decision-making process for selecting the mode of childbirth. Hospitals with a lower preference for VB will require additional efforts to understand women's needs and values. Trial registration: IS002316

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