scholarly journals Predictors of prolonged hospitalization after vaginal birth in Ghana: A comparative study

2022 ◽  
Vol 2 (1) ◽  
pp. e0000100
Author(s):  
Samuel Kwaku Essien ◽  
Batholomew Chireh ◽  
Kidest Getu Melese ◽  
John Kwasi Essien

Early discharge after child delivery although indispensable, but maybe precluded by several factors. The effect of these factors on prolonged length of stay (LOS) after vaginal delivery has been sparsely investigated in Ghana. This limits understanding of potential leading indicators to inform intervention efforts and optimize health care delivery. This study examined factors associated with prolonged LOS after vaginal birth in two time-separated cohorts in Ghana. We analyzed data from Ghana’s demographic and health surveys in 2007 and 2017. Our comparative analysis is based on subsamples in 2007 cohort (n = 2,486) and 2017 cohort (n = 8,065). A generalized estimating equation (GEE) with logistic regression was used to examine predictors of prolonged LOS after vaginal delivery. The cluster effect was accounted for using the exchangeable working correlation. The odds ratios (OR) and 95% confidence interval were reported. We found that 62.4% (1551) of the participants in 2007 had prolonged LOS after vaginal delivery, whereas the prevalence of LOS in the 2017 cohorts was 44.9% (3617). This constitutes a 17.5% decrease over the past decade investigated. Advanced maternal age (AOR = 1.24, 95% Cl 1.01–1.54), place of delivery (AOR = 1.18, 95% Cl 1.02–1.37), child’s size below average (AOR = 1.14; 95% Cl 1.03–1.25), and problems suffered during/after delivery (AOR = 1.60; 95% Cl 1.43–1.80) were significantly associated with prolonged (≥ 24 hours) length of hospitalization after vaginal delivery in 2017. However, among variables that were available in 2007, only those who sought delivery assistance from non-health professionals (AOR = 1.89, 95% CI: 1.00–3.61) were significantly associated with prolonged LOS in the 2007 cohort. Our study provides suggestive evidence of a reduction in prolonged LOS between the two-time points. Despite the reduction observed, more intervention targeting the identified predictors of LOS is urgently needed to further reduce post-vaginal delivery hospital stay. Also, given that LOS is an important indicator of medical services use, an accurate understanding of its prevalence and associated predictors are useful in assessing the efficiency of hospital management practices and the quality of care of patients in Ghana.

Birth ◽  
2021 ◽  
Author(s):  
Gabriel Levin ◽  
Abraham Tsur ◽  
Lee Tenenbaum ◽  
Nizan Mor ◽  
Michal Zamir ◽  
...  

PLoS ONE ◽  
2016 ◽  
Vol 11 (8) ◽  
pp. e0161493 ◽  
Author(s):  
Marie-Eva Laurencet ◽  
François Girardin ◽  
Fabio Rigamonti ◽  
Anne Bevand ◽  
Philippe Meyer ◽  
...  

2014 ◽  
Vol 210 (5) ◽  
pp. 440.e1-440.e6 ◽  
Author(s):  
Erica Wu ◽  
Anjali J. Kaimal ◽  
Kathryn Houston ◽  
Lynn M. Yee ◽  
Sanae Nakagawa ◽  
...  

1970 ◽  
Vol 2 (2) ◽  
pp. 48-52
Author(s):  
Mohammad Taleb Hossain ◽  
Md Mosharaf Hossain Miazi ◽  
Abdul Ghani

This study was conducted to observe the socio-economical status, living standard and health management practices of the people of the Bede community of Bangladesh. Bedes living in the Savar area of Dhaka district was selected for a case study. To conduct the study, data were obtained through a questionnairebased survey of 700 respondents about their social and economical status, professional practices, standard of living and literacy status, health management and treatment methods used. It has been observed that these mostly nomadic people of the Bede community have a weak socio-economic condition, large family size {(9-16 member family (58.22%); 17-24 member family (22.20%)}, intense smoking habit and a low level of literacy (80.00% people are illiterate). They practice ethno-medicine and snake-charming as their main professional business to earn a living. In offering health care services to people, they use medicaments prepared from various plant and animal parts and minerals and apply various ethno-treatment techniques, like spiritual, physical, mystical and psychological techniques to treat various ailments. Although they practice their age-old traditional system of medicine as their profession to treat others, they have been found to depend largely on Allopathic, Homeopathic and modern Traditional medicines for treating their own illness, particularly when they suffer from  diarrhoea, dysentery, small pox, orthopedic problems, and even snake-bite, which is supposed to be their own specialty. Bedes live below the poverty line.  Key words: Bede community; Social life; Health practices; Economic statusDOI: 10.3329/sjps.v2i2.5823Stamford Journal of Pharmaceutical Sciences Vol.2(2) 2009: 42-47


2015 ◽  
Vol 20 (4) ◽  
pp. 191-198 ◽  
Author(s):  
Chris Johnstone ◽  
Rachel Harwood ◽  
Andrew Gilliam ◽  
Andrew Mitchell

Purpose – Early access to senior decision makers and investigations has improved outcomes for many conditions. A surgical clinical decisions unit (CDU) was created to allow rapid assessment and investigation by on-call senior surgical team members to facilitate decision making and, if appropriate, discharge within a set time frame (less than four hours). The purpose of this paper is to compare outcomes for unscheduled general surgery admissions to the hospital before and after commissioning this unit. Design/methodology/approach – Prospectively collected hospital episode statistics data were compared for all general surgical admissions for one year prior to (July 2010-June 2011) and two years after (July 2011-June 2013) the introduction of the CDU. Statistical analysis using the Mann Whitney U-test was performed. Findings – More patients were discharged within 24 hours (12 per cent vs 20 per cent, p < 0.001) and total hospital stay decreased (4.6 days vs 3.2 days, p < 0.001) following introduction of CDU. Admission via A & E (273 vs 212, p < 0.01) was also decreased. Overall there was a 25.3 per cent reduction in emergency surgical admissions. No difference was noted in 30-day readmission rates (47 vs 49, p=0.29). Originality/value – The introduction of a CDU in has increased early discharge rates and facilitated safe early discharge, reducing overall hospital stay for unscheduled general surgical admissions. This has decreased fixed bed costs and improved patient flow by decreasing surgical care episodes routed through the emergency department (ED). In all, 30-day readmission rates have not been influenced by shorter hospital stay. Service redesign involving early senior decision making and patient investigation increases efficiency and patient satisfaction within unscheduled general surgical care. Not original but significant in that the model has not been widely implemented and this is a useful addition to the literature.


2014 ◽  
Vol 63 (5) ◽  
pp. 58-63
Author(s):  
Olga Petrovna Lebedeva ◽  
Olesya Nikolaevna Ivashova ◽  
Sergey Petrovich Pakhomov ◽  
Mikhail Ivanovich Churnosov ◽  
Nataliya Ivanovna Samborskaya ◽  
...  

The Background: Antimicrobial peptides are first line of defense for mucosa against viruses, bacteria, protozoa and fungi. Meanwhile, expression of antimicrobial peptides in postpartum period has not been studied. Objective: To estimate the expression of mRNA of antimicrobial peptides in epithelium of the cervix uteri after caesarean section and vaginal birth 3 or 4 days after delivery. Materials and methods: The data-sample consisted of 17 women after caesarean section and 46 women after vaginal delivery examined on days 3 or 4 of postpartum period. Quantitative reverse transcription PCR method was used to study mRNA expression of antimicrobial peptides. Statistical analysis was performed using Mann-Whitney criteria. Results: It was shown that higher level of expression of SLPI, HNP3, HD6 and HBD4 in the endocervix was present in women who delivered via caesarean section compared with those who had vaginal delivery. Conclusion: Women who underwent caesarean section exhibited increased expression of antimicrobial peptides compared to those who had vaginal birth. This increased expression can be attributed to multiple reasons such as differences in vaginal microflora restoration, different changes in hormone levels and also due to surgical trauma after operative delivery. The use of antimicrobial peptides can give new opportunities for prophylaxis and treatment of septic complications that occur in postpartum period.


2017 ◽  
Vol 31 (2) ◽  
pp. 96-106
Author(s):  
Ching-Hsing Hsieh ◽  
Chien-Lan Chen ◽  
Feng-Fang Chung ◽  
Su-Ying Lin

Background and Purpose: Postpartum fatigue is one of the most common complaints among women following childbirth. As a postpartum ritual practice, Taiwanese women refrain from taking showers while “doing the month.” However, warm showers are the systemic application of moist heat, and they maintain physical hygiene, stimulate blood circulation, mitigate discomfort, and provide relaxation. As Taiwanese society becomes increasingly receptive to scientific and contemporary health care practice, more and more women choose to take warm showers after childbirth. The purpose of this study was to evaluate the efficacy of warm showers on postpartum fatigue among vaginal-birth women in Taiwan. Methods: This was a two-group quasi-experimental design. Women took showers in warm water with temperatures ranging between 40 °C and 43 °C for approximately 20 minutes. Postpartum women’s fatigue is measured using the 10-item Postpartum Fatigue Scale (PFS). The intervention effect was analyzed using a generalized estimating equation (GEE) model. Results: The study population consisted of 358 vaginal-birth postpartum Taiwanese women aged 20–43 years. Postpartum women who took warm showers showed improvements from their pretest to posttest mean scores of postpartum fatigue compared to postpartum women who did not take warm showers. Warm showers helped to reduce postpartum fatigue among vaginal-birth women during the study period. Implications for Practice: Nurses have the unique opportunity to provide the intervention to Taiwanese women who have vaginal birth to help them relieve postpartum fatigue with warm showers while “doing the month” without the taboo of no-showering customary practices in the early postpartum period.


2016 ◽  
Vol 29 (2) ◽  
pp. 177-191 ◽  
Author(s):  
Antti Peltokorpi ◽  
Miika Linna ◽  
Tomi Malmström ◽  
Paulus Torkki ◽  
Paul Martin Lillrank

Purpose – The focused factory is one of the concepts that decision-makers have adopted for improving health care delivery. However, disorganized definitions of focus have led to findings that cannot be utilized systematically. The purpose of this paper is to discuss strategic options to focus health care operations. Design/methodology/approach – First the literature on focus in health care is reviewed revealing conceptual challenges. Second, a definition of focus in terms of demand and requisite variety is defined, and the mechanisms of focus are explicated. A classification of five focus strategies that follow the original idea to reduce variety in products and markets is presented. Finally, the paper examines managerial possibilities linked to the focus strategies. Findings – The paper proposes a framework of five customer-oriented focus strategies which aim at reducing variety in different characteristics of care pathways: population; urgency and severity; illnesses and symptoms; care practices and processes; and care outcomes. Research limitations/implications – Empirical research is needed to evaluate the costs and benefits of the five strategies and about system-level effects of focused units on competition and coordination. Practical implications – Focus is an enabling condition that needs to be exploited using specific demand and supply management practices. It is essential to understand how focus mechanisms differ between strategies, and to select focus that fits with organization’s strategy and key performance indicators. Originality/value – Compared to previous more resource-oriented approaches, this study provides theoretically solid and practically relevant customer-oriented framework for focusing in health care.


2017 ◽  
Vol 41 (3) ◽  
pp. 336 ◽  
Author(s):  
Leila Karimi ◽  
Ann Dadich ◽  
Liz Fulop ◽  
Sandra G. Leggat ◽  
Jiri Rada ◽  
...  

Objective The aim of the present study was to develop a positive organisational scholarship in health care approach to health management, informed by health managers and health professionals’ experiences of brilliance in health care delivery. Methods A sample of postgraduate students with professional and/or management experience within a health service was invited to share their experiences of brilliant health services via online discussions and a survey running on the SurveyMonkey platform. A lexical analysis of student contributions was conducted using the individual as the unit of analysis. Results Using lexical analysis, the examination of themes in the concept map, the relationships between themes and the relationships between concepts identified ‘care’ as the most important concept in recognising brilliance in health care, followed by the concepts of ‘staff’ and ‘patient’. Conclusions The research presents empirical material to support the emergence of an evidence-based health professional perspective of brilliance in health management. The findings support other studies that have drawn on both quantitative and qualitative materials to explore brilliance in health care. Pockets of brilliance have been previously identified as catalysts for changing health care systems. Both quality, seen as driven from the outside, and excellence, driven from within individuals, are necessary to produce brilliance. What is known about the topic? The quest for brilliance in health care is not easy but essential to reinvigorating and energising health professionals to pursue the highest possible standards of health care delivery. What does this paper add? Using an innovative methodology, the present study identified the key drivers that health care professionals believe are vital to moving in the direction of identifying brilliant performance. What are the implications for practitioners? This work presents evidence on the perceptions of leadership and management practices associated with brilliant health management. Lessons learned from exceptionally well-delivered services contain different templates for change than those dealing with failures, errors, misconduct and the resulting negativity.


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