Midwives' perceptions of disrespect and abuse of women during labour and childbirth in Lusaka, Zambia

Background/Aims Disrespect and abuse is a frequent occurrence in labour wards around the world. Disrespect and abuse during care by health workers can prevent pregnant women from seeking care during labour and childbirth, which can lead to increased maternal and neonatal mortality rates. This study aimed to explore midwives' perceptions of disrespect and abuse of women during labour and childbirth in Lusaka. Methods A concurrent convergent mixed-method approach was used for this study. Data were collected through a self-administered questionnaire given to 217 midwives actively practicing in maternal health services across Lusaka randomly sampled for the quantitative arm of the study. The data were analysed using bivariate and multivariate logistic regression, with P<0.05 used to indicate significance. For the qualitative component of the study, 13 purposively selected key informants were interviewed with an interview guide. Results Most of the respondents (88.5%) perceived disrespect and abuse of women during labour and childbirth as a negative phenomenon. However, almost half (40.1%) had provided care which was disrespectful and abusive during their practice and the majority (68.7%) had observed disrespect and abuse by other midwives. Bivariate and multivariate logistic regression analysis found an association between midwives' perception of disrespect and abuse and witnessing or participating in disrespectful and abusive behaviour during practice. In the qualitative arm of the study, midwives reported that disrespect and abuse occurred in labour wards across Lusaka, demonstrating an urgent need to prevent such practices. Midwives suggested actions such as increased sensitisation and training of midwives on respectful maternity care and improved staffing levels as ways to prevent this practice Conclusions Disrespect and abuse of women during labour and childbirth should be prevented. Increasing health education and training for both the public and midwives on respectful maternity care can help to achieve this goal. Midwives need to be motivated through good working environments, increased wages and increased time to rest while working, as the heavy workload was found to contribute to disrespect and abuse in labour wards.

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“I wouldn’t have hit you, but you would have killed your baby:” Exploring Midwives’ Perspectives on Disrespect and Abusive Care in Ghana.

10.21203/rs.2.12607/v4 ◽

2019 ◽

Author(s):

Millicent Veronica Dzomeku ◽

Boamah Mensah Adwoa Bemah ◽

Emmanuel Kweku Nakua ◽

Pascal Agbadi ◽

Jody R. Lori ◽

...

Keyword(s):

Maternal Health ◽

Professional Practice ◽

Maternity Care ◽

Study Data ◽

Respectful Maternity Care ◽

Disrespect And Abuse ◽

Related Factors ◽

Mortality And Morbidity ◽

Healthcare Facilities ◽

Childbearing Women

Abstract Background Quality maternal health reduces maternal and neonatal mortality and morbidity. Healthcare professionals, including midwives, are significant agents for the promotion of quality maternal health. Frequents reports of disrespect and abuse of childbearing women by midwives during intrapartum care are becoming common, suggesting that many of these agents are engaging in care practices that compromise quality maternal health. Thus, understanding midwives’ descriptions and experiences of the phenomenon is critical to addressing the threat. This paper, therefore, explored the understanding of midwives on D&AC and their occurrence in professional practice in a tertiary health facility in Kumasi, Ghana.Methods An exploratory descriptive qualitative research design using an interpretative approach was employed in the study. Data were generated through individual in-depth interviews. Data saturation was reached with fifteen interviews. The interviews were audio-recorded and transcribed verbatim. Open Code 4.03 was used to manage and analyse the data.Results The midwives understood D&AC. They also confirmed meting out or witnessing colleagues engage in D&AC in their professional practice. The midwives described D&AC as the provision of inadequate care and the overlooking of patient-centred care, and verbal, physical, and psychological abuse. The themes revealed that socio-economic inequalities, provider perception and victim-blaming, and health system-related factors facilitate D&AC. It emerged that the following marginalized groups were at high risk for D&AC: the non-compliant, mentally ill, HIV/AIDs+, teenagers, poor, and childbearing women on admission at the general labour ward.Conclusion The midwives understood D&AC and revealed that it frequently occurred in their professional practice. Frequent in-service training on respectful maternity care and monitoring of care provision in healthcare facilities are needed to eliminate the incidence of D&AC. Keywords Disrespectful maternity care, childbearing women, midwives, Ghana, qualitative

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“I wouldn’t have hit you, but you would have killed your baby:” Exploring Midwives’ Perspectives on Disrespect and Abusive Care in Ghana.

10.21203/rs.2.12607/v5 ◽

2019 ◽

Author(s):

Millicent Veronica Dzomeku ◽

Boamah Mensah Adwoa Bemah ◽

Emmanuel Kweku Nakua ◽

Pascal Agbadi ◽

Jody R. Lori ◽

...

Keyword(s):

Maternal Health ◽

Professional Practice ◽

Maternity Care ◽

Study Data ◽

Respectful Maternity Care ◽

Disrespect And Abuse ◽

Related Factors ◽

Mortality And Morbidity ◽

Healthcare Facilities ◽

Childbearing Women

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Exploring midwives’ understanding of respectful and non-abusive maternal care in Kumasi, Ghana: Qualitative Inquiry

10.1101/708776 ◽

2019 ◽

Author(s):

Dzomeku Veronica Millicent ◽

Bonsu Adwoa Bemah ◽

Nakua Kweku Emmanuel ◽

Agbadi Pascal ◽

Lori R. Jody ◽

...

Keyword(s):

Maternity Care ◽

Maternal Care ◽

Study Data ◽

Qualitative Inquiry ◽

Respectful Maternity Care ◽

Disrespect And Abuse ◽

Cross Sectional ◽

Middle Income ◽

Healthcare Facilities ◽

Evidenced Based

AbstractBackgroundVarious aspects of disrespect and abusive maternity care have received scholarly attention because of frequent reports of the phenomenon in most healthcare facilities globally, especially in low- and middle-income countries. However, the perspectives of skilled providers on respectful maternal care have not been extensively studied. Midwives’ knowledge of respectful maternity care is critical in designing any interventive measures to address the menace of disrespect and abuse in maternity care. Therefore, the present study sought to explore the views of midwives on respectful maternity care at a Teaching Hospital in Kumasi, Ghana.MethodsPhenomenological qualitative research design was employed in the study. Data were generated through individual in-depth interviews, which were audio-recorded and transcribed verbatim. Data saturation was reached with fifteen midwives. Open Code 4.03 was used to manage and analyse the data.FindingsThe midwives’ understanding of respectful maternity care was comprised of the following components: non-abusive care, consented care, confidential care, non-violation of childbearing women’s basic human rights, and non-discriminatory care. Probing questions to solicit midwives’ opinions on an evidenced-based component of respectful maternity care generated little information, suggesting that the midwives have a gap in knowledge regarding this component of respectful maternity care.ConclusionMidwives reported an understanding of most components of respectful maternity care, but their gap in knowledge on evidenced-based care requires policy attention and in-service training. To understand the extent to which this gap in knowledge can be generalized for midwives across Ghana to warrant a redesign of the national midwifery curriculum, the authors recommend a nationwide cross-sectional quantitative study.

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“I wouldn’t have hit you, but you would have killed your baby:” Exploring Midwives’ Perspectives on Disrespect and Abusive Care in Ghana.

10.21203/rs.2.12607/v3 ◽

2019 ◽

Author(s):

Millicent Veronica Dzomeku ◽

Boamah Mensah Adwoa Bemah ◽

Emmanuel Kweku Nakua ◽

Pascal Agbadi ◽

Jody R. Lori ◽

...

Keyword(s):

Maternal Health ◽

Professional Practice ◽

Maternity Care ◽

Study Data ◽

Respectful Maternity Care ◽

Disrespect And Abuse ◽

Related Factors ◽

Mortality And Morbidity ◽

Healthcare Facilities ◽

Childbearing Women

Abstract Background: Quality maternal health reduces maternal and neonatal mortality and morbidity. Healthcare professionals, including midwives, are significant agents for the promotion of quality maternal health. Frequents reports of disrespect and abuse of childbearing women by midwives during intrapartum care are becoming common, suggesting that many of these agents are engaging in care practices that compromise quality maternal health. Thus, understanding midwives’ descriptions and experiences of the phenomenon is critical to addressing the threat. This paper, therefore, explored the understanding of midwives on D&AC and their occurrence in professional practice in a tertiary health facility in Kumasi, Ghana. Method: An exploratory descriptive qualitative research design using an interpretative approach was employed in the study. Data were generated through individual in-depth interviews. Data saturation was reached with fifteen interviews. The interviews were audio-recorded and transcribed verbatim. Open Code 4.03 was used to manage and analyse the data. Findings: The midwives understood D&AC. They also confirmed meting out or witnessing colleagues engage in D&AC in their professional practice. The midwives described D&AC as the provision of inadequate care and the overlooking of patient-centred care, and verbal, physical, and psychological abuse. The themes revealed that socio-economic inequalities, provider perception and victim-blaming, and health system-related factors facilitate D&AC. It emerged that the following marginalized groups were at high risk for D&AC: the non-compliant, mentally ill, HIV/AIDs+, teenagers, poor, and childbearing women on admission at the general labour ward. Conclusion: The midwives understood D&AC and revealed that it frequently occurred in their professional practice. Frequent in-service training on respectful maternity care and monitoring of care provision in healthcare facilities are needed to eliminate the incidence of D&AC. Keywords Disrespectful maternity care, childbearing women, midwives, Ghana, qualitative

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Epidemiology of pediatric hydrocephalus in Haiti: analysis of a surgical case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.12.peds18568 ◽

2019 ◽

Vol 23 (5) ◽

pp. 568-576

Author(s):

Michael Ragheb ◽

Ashish H. Shah ◽

Sarah Jernigan ◽

Tulay Koru-Sengul ◽

John Ragheb

Keyword(s):

Public Health ◽

Logistic Regression ◽

Head Circumference ◽

Rainy Season ◽

Statistical Tests ◽

Multivariate Logistic Regression Analysis ◽

Case Series ◽

Multivariate Logistic Regression ◽

Surgical Case ◽

Operative Notes

OBJECTIVEHydrocephalus is recognized as a common disabling pediatric disease afflicting infants and children disproportionately in the developing world, where access to neurosurgical care is limited and risk of perinatal infection is high. This surgical case series describes the Project Medishare Hydrocephalus Specialty Surgery (PMHSS) program experience treating hydrocephalus in Haiti between 2008 and 2015.METHODSThe authors conducted a retrospective review of all cases involving children treated for hydrocephalus within the PMHSS program in Port-au-Prince, Haiti, from 2008 through 2015. All relevant epidemiological information of children treated were prospectively collected including relevant demographics, birth history, hydrocephalus etiology, head circumference, and operative notes. All appropriate associations and statistical tests were performed using univariate and multivariate logistic regression analyses.RESULTSAmong the 401 children treated within PMHSS, postinfectious hydrocephalus (PIH) accounted for 39.4% (n = 158) of cases based on clinical, radiographic, and endoscopic findings. The majority of children with hydrocephalus in Haiti were male (54.8%, n = 197), born in the rainy season (59.7%, n = 233), and born in a coastal/inland location (43.3%, n = 61). The most common surgical intervention was endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) (45.7%, n = 175). Multivariate logistic regression analysis yielded coastal birth location (OR 3.76, 95% CI 1.16–12.18) as a statistically significant predictor of PIH. Increasing head circumference (adjusted OR 1.06, 95% CI 0.99–1.13) demonstrated a slight trend toward significance with the incidence of PIH.CONCLUSIONSThis information will provide the foundation for future clinical and public health studies to better understand hydrocephalus in Haiti. The 39.4% prevalence of PIH falls within observed rates in Africa as does the apparently higher prevalence for those born during the rainy season. Although PIH was the most frequent etiology seen in almost all birth locations, the potential relationship with geography noted in this series will be the focus of further research in an effort to understand the link between climate and PIH in Haiti. The ultimate goal will be to develop an appropriate public health strategy to reduce the burden of PIH on the children of Haiti.

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High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke

Current Neurovascular Research ◽

10.2174/1567202616666190618164528 ◽

2019 ◽

Vol 16 (3) ◽

pp. 250-257 ◽

Cited By ~ 1

Author(s):

Jiann-Der Lee ◽

Ya-Han Hu ◽

Meng Lee ◽

Yen-Chu Huang ◽

Ya-Wen Kuo ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Multivariate Logistic Regression Analysis ◽

Stroke Recurrence ◽

Prior History ◽

Multivariate Logistic Regression ◽

Cart Analysis ◽

Younger Age ◽

History Of ◽

One Year

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

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Efficacy of flurbiprofen axetil for preventing postanesthetic shivering in patients undergoing gynecologic laparotomy surgeries

JA Clinical Reports ◽

10.1186/s40981-020-00403-x ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Atsushi Kotera

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Postoperative Pain ◽

Logistic Regression Analysis ◽

Pain Control ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

Postoperative Pain Control ◽

Flurbiprofen Axetil ◽

Postanesthetic Shivering

Abstract Background Postanesthetic shivering is an unpleasant adverse event in surgical patients. A nonsteroidal anti-inflammatory drug has been reported to be useful in preventing postanesthetic shivering in several previous studies. The aim of this study was to evaluate the efficacy of flurbiprofen axetil being a prodrug of a nonsteroidal anti-inflammatory drug for preventing postanesthetic shivering in patients undergoing gynecologic laparotomy surgeries. Method This study is a retrospective observational study. I collected data from patients undergoing gynecologic laparotomy surgeries performed between October 1, 2019, and September 30, 2020, at Kumamoto City Hospital. All the patients were managed with general anesthesia with or without epidural analgesia. The administration of intravenous 50 mg flurbiprofen axetil for postoperative pain control at the end of the surgery was left to the individual anesthesiologist. The patients were divided into two groups: those who had received intravenous flurbiprofen axetil (flurbiprofen group) and those who had not received intravenous flurbiprofen axetil (non-flurbiprofen group), and I compared the frequency of postanesthetic shivering between the two groups. Additionally, the factors presumably associated with postanesthetic shivering were collected from the medical charts. Intergroup differences were assessed with the χ2 test with Yates’ correlation for continuity category variables. The Student’s t test was used to test for differences in continuous variables. Furthermore, a multivariate logistic regression analysis was performed to elucidate the relationship between the administration of flurbiprofen axetil and the incidence of PAS. Results I retrospectively examined the cases of 141 patients aged 49 ± 13 (range 21-84) years old. The overall postanesthetic shivering rate was 21.3% (30 of the 141 patients). The frequency of postanesthetic shivering in the flurbiprofen group (n = 31) was 6.5%, which was significantly lower than that in the non-flurbiprofen group (n = 110), 25.5% (p value = 0.022). A multivariate logistic regression analysis showed that administration of flurbiprofen axetil was independently associated with a reduced incidence of postanesthetic shivering (odds ratio 0.12; 95% confidence interval, 0.02-0.66, p value = 0.015). Conclusions My result suggests that intraoperative 50 mg flurbiprofen axetil administration for postoperative pain control is useful to prevent postanesthetic shivering in patients undergoing gynecologic laparotomy surgeries.

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The association between hypoglycemia and glycemic variability in elderly patients with type 2 diabetes: a prospective observational study

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-021-00656-1 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Takahisa Handa ◽

Akinobu Nakamura ◽

Aika Miya ◽

Hiroshi Nomoto ◽

Hiraku Kameda ◽

...

Keyword(s):

Type 2 Diabetes ◽

Logistic Regression ◽

Regression Analysis ◽

Observational Study ◽

Elderly Patients ◽

Prospective Observational Study ◽

Multivariate Logistic Regression Analysis ◽

Glycemic Variability ◽

Multivariate Logistic Regression

Abstract Background This study aimed to explore predictive factors of time below target glucose range (TBR) ≥ 1% among patients’ characteristics and glycemic variability (GV) indices using continuous glucose monitoring data in elderly patients with type 2 diabetes. Methods We conducted a prospective observational study on 179 (71 female) Japanese outpatients with type 2 diabetes aged ≥ 65 years. The characteristics of the participants with TBR ≥ 1% were evaluated by multivariate logistic regression analysis. Receiver-operating characteristic (ROC) curve analyses of GV indices, comprising coefficient of variation (CV), standard deviation, and mean amplitude of glycemic excursions, were performed to identify the optimal index for the identification of patients with TBR ≥ 1%. Results In the multivariate logistic regression analysis, none of the clinical characteristics, including HbA1c and C-peptide index, were independent markers for TBR ≥ 1%, while all three GV indices showed significant associations with TBR ≥ 1%. Among the three GV indices, CV showed the best performance based on the area under the curve in the ROC curve analyses. Conclusions Among elderly patients with type 2 diabetes, CV reflected TBR ≥ 1% most appropriately among the GV indices examined. Trial registration UMIN-CTR: UMIN000029993. Registered 16 November 2017

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Risk factors for tissue expander infection in scar reconstruction: a retrospective cohort study of 2374 consecutive cases

Burns & Trauma ◽

10.1093/burnst/tkaa037 ◽

2020 ◽

Vol 8 ◽

Author(s):

Chen Dong ◽

Minhui Zhu ◽

Luguang Huang ◽

Wei Liu ◽

Hengxin Liu ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Treatment Failure ◽

Logistic Regression Analysis ◽

Disease Duration ◽

Multivariate Logistic Regression Analysis ◽

Tissue Expansion ◽

Multivariate Logistic Regression ◽

Hematoma Evacuation

Abstract Background Tissue expansion is used for scar reconstruction owing to its excellent clinical outcomes; however, the complications that emerge from tissue expansion hinder repair. Infection is considered a major complication of tissue expansion. This study aimed to analyze the perioperative risk factors for expander infection. Methods A large, retrospective, single-institution observational study was carried out over a 10-year period. The study enrolled consecutive patients who had undergone tissue expansion for scar reconstruction. Demographics, etiological data, expander-related characteristics and postoperative infection were assessed. Univariate and multivariate logistic regression analysis were performed to identify risk factors for expander infection. In addition, we conducted a sensitivity analysis for treatment failure caused by infection as an outcome. Results A total of 2374 expanders and 148 cases of expander infection were assessed. Treatment failure caused by infection occurred in 14 expanders. Multivariate logistic regression analysis identified that disease duration of ≤1 year (odds ratio (OR), 2.07; p < 0.001), larger volume of expander (200–400 ml vs <200 ml; OR, 1.74; p = 0.032; >400 ml vs <200 ml; OR, 1.76; p = 0.049), limb location (OR, 2.22; p = 0.023) and hematoma evacuation (OR, 2.17; p = 0.049) were associated with a high likelihood of expander infection. Disease duration of ≤1 year (OR, 3.88; p = 0.015) and hematoma evacuation (OR, 10.35; p = 0.001) were so related to high risk of treatment failure. Conclusions The rate of expander infection in patients undergoing scar reconstruction was 6.2%. Disease duration of <1 year, expander volume of >200 ml, limb location and postoperative hematoma evacuation were independent risk factors for expander infection.

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Donepezil Combined with DL-3-n-Butylphthalide Delays Cognitive Decline in Patients with Mild to Moderate Alzheimer’s Disease: A Multicenter, Prospective Cohort Study

Journal of Alzheimer s Disease ◽

10.3233/jad-201381 ◽

2021 ◽

Vol 80 (2) ◽

pp. 673-681

Author(s):

Jin Wang ◽

Xiaojuan Guo ◽

Wenhui Lu ◽

Jie Liu ◽

Hong Zhang ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Logistic Regression ◽

Regression Analysis ◽

Cohort Study ◽

Prospective Cohort ◽

Daily Living ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

Significant Difference

Background: Vascular factors and mitochondria dysfunction contribute to the pathogenesis of Alzheimer’s disease (AD). DL-3-n-butylphthalide (NBP) has an effect in protecting mitochondria and improving microcirculation. Objective: The aim was to investigate the effect of donepezil combined NBP therapy in patients with mild-moderate AD. Methods: It was a prospective cohort study. 92 mild-moderate AD patients were classified into the donepezil alone group (n = 43) or the donepezil combined NBP group (n = 49) for 48 weeks. All patients were evaluated with Alzheimer’s Disease Assessment Scale-Cognitive subscale (ADAS-cog), Clinician’s Interview-Based Impression of Change plus caregiver input (CIBIC-plus), Alzheimer’s Disease Cooperative Study-Activities of Daily Living (ADCS-ADL), and Neuropsychiatric Inventory (NPI) every 12 weeks. All patients were monitored for adverse events (AEs). The efficacy was analyzed using multivariate logistic regression analysis. Results: The multivariate logistic regression analysis showed that the changes of ADAS-cog score (OR = 2.778, 95% CI: [1.087, 7. 100], p = 0.033) and ADCS-ADL score (OR = 2.733, 95% CI: [1.002, 7.459], p = 0.049) had significant difference between donepezil alone group and donepezil combined NBP group, while the changes of NPI (OR = 1.145, 95% CI: [0.463, 2.829], p = 0.769), MMSE (OR = 1.563, 95% CI: [0.615, 3.971], p = 0.348) and CIBIC-plus (OR = 2.593, 95% CI: [0.696, 9.685], p = 0.156) had no significant difference. The occurrence of AEs was similar in the two groups. Conclusion: Over the 48-week treatment period, donepezil combined NBP group had slower cognitive decline and better activities of daily living in patients with mild to moderate AD. These indicated that the multi-target therapeutic effect of NBP may be a new choice for AD treatment.

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