Reducing the distance to walk: establishing a remote maternity facility in Runga, Hoima District, Uganda

2020 ◽  
Vol 14 (2) ◽  
pp. 1-8
Author(s):  
Rhiannon Grindle ◽  
Sofia Giannopoulou ◽  
Harriet Jacobs ◽  
Jerome Barongo ◽  
Alexandra Elspeth Cairns
Keyword(s):  
Antenatal Care ◽  
Maternal Mortality ◽  
Health Facility ◽  
Low Income ◽  
Local Level ◽  
Substantial Reduction ◽  
Care Quality ◽  
Low Income Countries ◽  
Health Seeking ◽  
Birth Attendance

Despite a substantial reduction in global maternal mortality, rates in low-income countries remain unacceptably high. Multiple contributing factors exist, grouped into three delays: health-seeking behaviour; accessibility of care; quality of care. In the Hoima District, rates of health facility delivery and skilled birth attendance remain low and maternal mortality exceeds the national average. Establishing the Midwives At Maternity Azur Clinic (February 2017) has addressed these issues at a local level. Health education and antenatal care are provided at the clinic, encouraging women to seek timely, appropriate intrapartum care. Access from surrounding villages is facilitated by a waiting home and weekly transport for antenatal care, alongside transport to a health facility with a staffed operating theatre, when required. It is run by a resident midwife, with regular training updates, and is stocked with the necessary resources for quality healthcare. Since its advent, village leaders report all-cause burials have reduced from one a day to one a week.

scholarly journals Maternal Mortality and Women’s Political Participation

2019 ◽  
Author(s):  
Sonia Bhalotra ◽  
Damian Clarke ◽  
Joseph Gomes ◽  
Atheendar Venkataramani
Keyword(s):  
Political Participation ◽  
Maternal Mortality ◽  
Low Income ◽  
Skilled Birth Attendance ◽  
Low Income Countries ◽  
Care Utilization ◽  
Gender Quotas ◽  
Birth Attendance ◽  
Women In Parliament ◽  
Women's Political Participation

AbstractWe show that large declines in maternal mortality can be achieved by raising women’s political participation. We estimate that the recent wave of quotas for women in parliament in low income countries has resulted in a 9 to 12% decline in maternal mortality. Among mechanisms are that gender quotas lead to an 8 to 10% increase in skilled birth attendance, a 6 to 12% increase in prenatal care utilization and a 4 to 11% decrease in birth rates.JEL codesI14, I15, O15.

scholarly journals Developing obstetric medicine training in Latin America

2017 ◽  
Vol 10 (1) ◽  
pp. 16-20 ◽  
Author(s):  
José Rojas-Suarez ◽  
Niza Suarez ◽  
Oier Ateka-Barrutia
Keyword(s):  
Latin America ◽  
Maternal Mortality ◽  
Latin American ◽  
Low Income ◽  
Morbidity And Mortality ◽  
Low Income Countries ◽  
Important Indicator ◽  
Obstetric Medicine ◽  
The Impact ◽  
In Pregnancy

Maternal mortality is an important indicator of health in populations around the world. The distribution of maternal mortality ratio globally shows that middle- and low-income countries have ∼99% of the mortality burden. Most countries of Latin America are considered to be middle- or low-income countries, as well as areas of major inequities among the different social classes. Medical problems in pregnancy remain an important cause of morbidity and mortality in this region. Previous data indicate the need for a call to action for adequate diagnosis and care of medical diseases in obstetric care. The impact of nonobstetric and medical pathologies on maternal mortality in Latin America is largely unknown. In Latin America, two educational initiatives have been proposed to improve skills in maternity care. The Advanced Life Support in Obstetrics (ALSO®) was first started to address obstetric emergencies, and subsequently adapted for low-middle-income country settings as the Global ALSO®. In parallel, the Latin American obstetric anesthesia community has progressively focused on improvement of several intrapartum/intraoperative issues, which has secondarily taken them to embrace the obstetric medicine area on interest and join the former initiatives. In the present review, we summarize the available data regarding medical morbidity and mortality in pregnancy in Latin America, as well as the challenges, achievements, issues, initiatives, and future directions encouraging maternal health educators, health care trainers, and physicians in middle- and low-income countries, such as many Latin American ones, to improve and/or change attitudes, if needed, on current clinical practice.

scholarly journals Geographical and socioeconomic inequalities in the utilization of maternal healthcare services in Nigeria: 2003–2017

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chijioke Okoli ◽  
Mohammad Hajizadeh ◽  
Mohammad Mafizur Rahman ◽  
Rasheda Khanam
Keyword(s):  
Low Income ◽  
Rural Areas ◽  
Healthcare Services ◽  
Socioeconomic Inequalities ◽  
Low Income Countries ◽  
Theil Index ◽  
Maternal Healthcare ◽  
North East ◽  
Birth Attendance ◽  
Urban And Rural Areas

Abstract Background Maternal mortality has remained a challenge in many low-income countries, especially in Africa and in Nigeria in particular. This study examines the geographical and socioeconomic inequalities in maternal healthcare utilization in Nigeria over the period between 2003 and 2017. Methods The study used four rounds of Nigeria Demographic Health Surveys (DHS, 2003, 2008, 2013, and 2018) for women aged 15–49 years old. The rate ratios and differences (RR and RD) were used to measure differences between urban and rural areas in terms of the utilization of the three maternal healthcare services including antenatal care (ANC), facility-based delivery (FBD), and skilled-birth attendance (SBA). The Theil index (T), between-group variance (BGV) were used to measure relative and absolute inequalities in the utilization of maternal healthcare across the six geopolitical zones in Nigeria. The relative and absolute concentration index (RC and AC) were used to measure education-and wealth-related inequalities in the utilization of maternal healthcare services. Results The RD shows that the gap in the utilization of FBD between urban and rural areas significantly increased by 0.3% per year over the study period. The Theil index suggests a decline in relative inequalities in ANC and FBD across the six geopolitical zones by 7, and 1.8% per year, respectively. The BGV results do not suggest any changes in absolute inequalities in ANC, FBD, and SBA utilization across the geopolitical zones over time. The results of the RC and the AC suggest a persistently higher concentration of maternal healthcare use among well-educated and wealthier mothers in Nigeria over the study period. Conclusion We found that the utilization of maternal healthcare is lower among poorer and less-educated women, as well as those living in rural areas and North West and North East geopolitical zones. Thus, the focus should be on implementing strategies that increase the uptake of maternal healthcare services among these groups.

scholarly journals Trend and Causes of Maternal Mortality in a Nigerian Tertiary Hospital: A 5-year Retrospective Study (2010-2014) at the University of Calabar Teaching Hospital, Calabar, Nigeria

2018 ◽  
Vol 6 (6) ◽  
pp. 1153-1158 ◽  
Author(s):  
Thomas U. Agan ◽  
Emmanuel Monjok ◽  
Ubong B. Akpan ◽  
Ogban E. Omoronyia ◽  
John E. Ekabua
Keyword(s):  
Maternal Mortality ◽  
Low Income ◽  
Post Partum ◽  
Maternal Mortality Ratio ◽  
Low Income Countries ◽  
Live Births ◽  
Mortality Ratio ◽  
Post Partum Haemorrhage ◽  
The University ◽  
Hypertensive Diseases

BACKGROUND: Maternal mortality ratios (MMR) are still unacceptably high in many low-income countries especially in sub-Saharan Africa. MMR had been reported to have improved from an initial 3,026 per 100,000 live births in 1999 to 941 in 2009, at the University of Calabar Teaching Hospital (UCTH), Calabar, a tertiary health facility in Nigeria. Post-partum haemorrhage and hypertensive diseases of pregnancy have been the common causes of maternal deaths in the facility.AIM: This study was aimed at determining the trend in maternal mortality in the same facility, following institution of some facility-based intervention measures.METHODOLOGY: A retrospective study design was utilised with extraction and review of medical records of pregnancy-related deaths in UCTH, Calabar, from January 2010 to December 2014. The beginning of the review period coincided with the period the “Woman Intervention Trial” was set up to reduce maternal mortality in the facility. This trial consists of the use of Tranexamic acid for prevention of post-partum haemorrhage, as well as more proactive attendance to parturition.RESULTS: There were 13,605 live births and sixty-one (61) pregnancy-related deaths in UCTH during the study period. This yielded a facility Maternal Mortality Ratio of 448 per 100,000 live births. In the previous 11-year period of review, there was sustained the decline in MMR by 72.9% in the initial four years (from 793 in 2010 to 215 in 2013), with the onset of resurgence to 366 in the last year (2014). Mean age at maternal death was 27 ± 6.5 years, with most subjects (45, 73.8%) being within 20-34 years age group. Forty-eight (78.7%) were married, 26 (42.6%) were unemployed, and 33 (55.7%) had at least secondary level of education. Septic abortion (13, 21.3%) and hypertensive diseases of pregnancy (10, 16.4%) were the leading causes of death. Over three quarters (47, 77.0%) had not received care from any health facility. Most deaths (46, 75.5%) occurred between 24 and 97 hours of admission.CONCLUSION: Compared with previous trends, there has been a significant improvement in maternal mortality ratio in the study setting. There is also a significant change in the leading cause of maternal deaths, with septic abortion and hypertensive disease of pregnancy now replacing post-partum haemorrhage and puerperal sepsis that was previously reported. This success may be attributable to the institution of the Woman trial intervention which is still ongoing in other parts of the world. There is, however, need to sustain effort at a further reduction in MMR towards the attainment of set sustainable development goals (SDGs), through improvement in the provision of maternal health services in low-income countries.

scholarly journals A Ten Years Retrospective Study of Hysterectomy in Goba Referral Hospital, Bale Zone, South East Ethiopia, Magnitude Indications and Outcomes

2020 ◽  
Author(s):  
Aklilu Getachew ◽  
Takele Mengistu ◽  
Yaregal Asres
Keyword(s):  
Retrospective Study ◽  
Antenatal Care ◽  
Low Income ◽  
Uterine Rupture ◽  
Female Genital Tract ◽  
Referral Hospital ◽  
Low Income Countries ◽  
Categorical Variables ◽  
P Value

Abstract Background: Hysterectomy is one of the major surgeries performed in clinical practice for commonly encountered diseases of the female genital tract worldwide. Even if Hysterectomy is widely performed surgery in both developed and low income countries little is known about is epidemiology in rural part of develop countries. Especially in developing countries like Ethiopia representative reliable statistics are rarely available on this important aspect of women’s health mainly on its prevalence, indication and outcome. So the aim of this study was to assess the magnitude indication and outcome of hysterectomy in Goba Referral Hospital from January 1, 2008 to January1, 2018. Methods: institutional based retrospective study was conducted in Goba Referral Hospital. Self-administered structured checklists were used to collect the data. The data were entered into Epi data version 3.1 and analyzed by SPSS version 20. Continuous and categorical variables were summarized by tables, graph and descriptive statistics. Logistic regression was used to determine association between predictors and Hysterectomy prevalence. P-value <0.05 was -considered as statistically significant. Results: a total of 200 hysterectomies were done for obstetrics and gynecology indications, of which the commonest, 47% (n=94), indication was uterine rupture. From the total of 116 women, who had no antenatal care follow up, 40% (n=47) had uterine rupture. This study also indicated that, most of uterine rupture cases 80% (n=76) were living far away from the hospital (> 50km from the hospital) 94.6% (n-89) were multiparous. This study has also indicated that from the total of 20 discharged dead, 90% (n=18)) were came from a distance of >100km far from the hospital and 95% (n=19) were those who didn’t attend antenatal care. Conclusions: the higher rate of uterine rupture was seen in those who were multi Para, far from Hospitals and those who have no ANC follow up. Large scale study for the identification of determinant factors for evidence based intervention will be very important.

scholarly journals Factors Affecting Home Delivery among Women Living in Remote Areas of Rural Zambia: A Cross-Sectional, Mixed-Methods Analysis

2021 ◽  
pp. 1-13
Author(s):  
Ireen Chola Mwape Musonda
Keyword(s):  
Maternal Mortality ◽  
Health Facility ◽  
Low Income ◽  
Rural Areas ◽  
Home Delivery ◽  
Childbearing Age ◽  
Long Distance ◽  
Cross Sectional ◽  
Home Deliveries ◽  
At Home

Luapula Province has the highest maternal mortality and one of the lowest facility-based births in Zambia. The distance to facilities limits facility-based births for women in rural areas. In 2013, the government incorporated maternity homes into the health system at the community level to increase facility-based births and reduce maternal mortality. Despite the policy to stopping traditional birth attendants from conducting deliveries at home and encouraging all women to give birth at the health facility under skilled care, many women still give birth at home. An exploratory cross section survey was used to gather data by conducting structured interviews with 50 women of childbearing age who had a recent or previous home delivery. The following factors were found to be associated with home deliveries in surrounding villages in kashikishi; abrupt onset/precipitate labor, long distance/transport difficulties to reach the nearest health facility, having had successful HD, poverty/low income and gender though having a small percentage. Parity in which the majority were multiparas’ women, attitude was also associated with home deliveries and other unforeseen circumstances such as a funeral and being alone at home at the onset of labour.

scholarly journals Factors associated with the preference of institutional delivery after antenatal care attendance in Northwest Ethiopia

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Araya Mesfin Nigatu ◽  
Kassahun Alemu Gelaye
Keyword(s):  
Health Education ◽  
Antenatal Care ◽  
Low Income ◽  
Institutional Delivery ◽  
Statistical Significance ◽  
Health Facilities ◽  
Low Income Countries ◽  
Contributing Factors ◽  
Place Of Delivery ◽  
Factors Associated

Abstract Background Even though maternal mortality during the time of delivery can be prevented with proper medical care in the health facilities with skilled healthcare professionals, unexpectedly death is still high and is a persistent challenge for low-income countries. Therefore identifying factors affecting the preference of institutional delivery after antenatal care service attendance is a key intervention to reduce maternal morbidity and mortality. Method A community-based cross-sectional study was conducted using face to face using interviewer-administered questionnaire from a total of 528 women who gave their last birth within 12 months prior to the study period who attended antenatal care (ANC) services. Descriptive statistics, bivariable and multivariable logistic regressions analysis were performed. Statistical significance was considered at p < 0.05 and odds ratio with 95% CI were calculated to examine factors associated with institutional delivery. Results Of the 528 pregnant women attending ANC services, 250 (47.3%) gave birth in health facilities (95% CI: 43.2, 51.7%). Urban residence [AOR = 7.8, 95% CI: 4.1, 15.6], four or more ANC visits [AOR = 4.5, 95% CI: 1.6, 12.3], those who got health education on ANC [AOR = 2.9, 95% CI: 1.5, 5.6] and decision on place of delivery with her partner agreement [AOR = 3.3, 95% CI: 1.3, 8.7] were found to be contributing factors for the preference of institutional delivery. Conclusion Institutional delivery was not adequate. Residence, number of antenatal care visits, health education, decisions making on a place of delivery and having awareness of the difference of place of delivery were contributing factors for the preference of institutional delivery.

Using Mobile Technology to Address the ‘Three Delays' to Reduce Maternal Mortality in Zanzibar

2016 ◽  
pp. 1140-1154 ◽  
Author(s):  
Rachel Hoy Deussom ◽  
Marc Mitchell ◽  
Julia Dae Ruben
Keyword(s):  
Maternal Mortality ◽  
Mobile Technology ◽  
Low Income ◽  
Low Income Countries ◽  
Danger Signs ◽  
Birth Attendants ◽  
Adequate Care ◽  
Three Delays ◽  
Clinical Algorithms ◽  
Health Facility Staff

The hallmark article by Thaddeus and Maine (1994) presented a framework to reducing maternal mortality by addressing the delays: (1) deciding to seek care; (2) reaching care; and (3) receiving adequate care. This project developed a phone-based system used by traditional birth attendants to address the three delays in two districts in rural Zanzibar. Mobile phones provided: clinical algorithms to screen pregnant mothers for danger signs; phone numbers and mobile banking to arrange and pay for transportation; and contacts for health facility staff to alert them of referrals. 938 mothers participated in the “mHealth for Safer Deliveries” project. The intervention achieved a 71.0% facility delivery rate in the project zone, compared to the regional average of 32.0% (NBS and ICF Macro, 2011). This project demonstrated the effectiveness of mobile technology in addressing childbirth's three delays and its potential to impact maternal mortality in low-income countries.

scholarly journals Integrated and simplified approaches to community management of acute malnutrition in rural Kenya: a cluster randomized trial protocol

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Elizabeth Wambui Kimani-Murage ◽  
Hermann Pythagore ◽  
Elizabeth Mwaniki ◽  
Tewoldeberha Daniel ◽  
Betty Samburu ◽  
...  
Keyword(s):  
Health Facility ◽  
Low Income ◽  
Severe Acute Malnutrition ◽  
Intervention Group ◽  
Acute Malnutrition ◽  
Low Income Countries ◽  
Control Group ◽  
Community Case Management ◽  
Integrated Community Case Management ◽  
Cluster Randomized

Abstract Background In many low income countries, the majority of acutely malnourished children are either brought to the health facility late or never at all due to reasons related to distance and associated costs. Integrated community case management (iCCM) is an integrated approach addressing disease and malnutrition through use of community health volunteers (CHVs) in children under-5 years. Evidence on the potential impact and practical experiences on integrating community-based management of acute malnutrition as part of an iCCM package is not well documented. In this study, we aim to investigate the effectiveness and cost effectiveness of integrating management of acute malnutrition into iCCM. Methods This is a two arm parallel groups, non-inferiority cluster randomized community trial (CRT) employing mixed methods approach (both qualitative and quantitative approaches). Baseline and end line data will be collected from eligible (malnourished) mother/caregiver-child dyads. Ten community units (CUs) with a cluster size of 24 study subjects will be randomized to either an intervention (5 CUs) and a control arm (5 CUs). CHV in the control arm, will only screening and refer MAM/SAM cases to the nearby health facility for treatment by healthcare professionals. In the intervention arm, however; CHVs will be trained both to screen/diagnose and also treat moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) without complication. A paired-matching design where each control group will be matched with intervention group with similar characteristics will be matched to ensure balance between the two groups with respect to baseline characteristics. Qualitative data will be collected using key informant and in-depth interviews (KIIs) and focused group discussions (FGDs) to capture the views and experiences of stakeholders. Discussion Our proposed intervention is based on an innovative approach of integrating and simplifying SAM and MAM management through CHWs bring the services closer to the community. The trial has received ethical approval from the Ethics Committee of AMREF Health Africa - Ethical and Scientific Review Committee (AMREF- ESRC), Nairobi, Kenya. The results will be disseminated through workshops, policy briefs, peer-reviewed publications, and presented to local and international conferences. Trial registration PACTR201811870943127; Pre-results. 26 November 2018.

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