scholarly journals The growing use of the WHO Safe Childbirth Checklist: Lessons learned at the Yaounde Gyneco-Obstetric and Pediatric Hospital, Cameroon

2019 ◽  
Author(s):  
Julius Sama DOHBIT ◽  
Namanou Ines Emma WOKS ◽  
Carlin Héméry KOUDJINE ◽  
Willy TAFEN ◽  
Pascal FOUMANE ◽  
...  

Abstract Background: Safe childbirth remains a daunting challenge, particularly in low-resource settings where most pregnancy-related deaths occur. Cameroon’s maternal mortality rate, estimated at 782 per 100,000 live births in 2011 is significantly high. Adherence to good practice standards by birth attendants is key to improving pregnancy outcomes. The WHO Safe Childbirth checklist was designed as a tool to improve the quality of care provided to women giving birth. This checklist was implemented at the Yaounde Gyneco-Obsteric and Pediatric Hospital. Quantitative and qualitative assessment of its utilization is essential to secure a change in attitudes and practice and engender improvement in maternal health. Objective: Evaluate the change in attitudes and practice of nurses and compare outcomes in cases where it was and was not used, 6 months after introduction of the safe childbirth checklist in a maternity setting. Methods: A cross sectional and retrospective study was conducted over a 6 month period (January – June 2018). Predesigned questionnaires were used to collect qualitative data from personnel of the Gynecology and Obstetrics unit who used the safe childbirth checklist and quantitative data from patient delivery records. Data analysis was done using SPSS version 23.0. Chi square test was used to compare categorical variables, while the student test was used to compare continuous variables. Results: Of the 1001 files retrieved from the archives, 25 were excluded. The checklist was used in 828/976 (84.8%) files. We observed an increasing trend in the usage rate, with a peak at 93.9% recorded during the last 2 months. Pages 2 and 3 were least completed, in <10% of cases during the first 5 months. A significant reduction in the onset of pre-eclampsia and eclampsia was noted with the use of the checklist (2·1% Vs 5·4%, p = 0·017). Fifty percent of the staff reported that the checklist increased workload while 37.5% mentioned laziness and absence of checklists in some files as a hindrance to its proper use. Conclusion: The use of the safe childbirth checklist improved progressively with a simultaneous reduction in obstetrical and neonatal complications overtime. Keywords: Checklist, childbirth, Obstetrical complications

2019 ◽  
Author(s):  
Julius Sama DOHBIT ◽  
Namanou Ines Emma Woks ◽  
Carlin Héméry KOUDJINE ◽  
Willy TAFEN ◽  
Pascal FOUMANE ◽  
...  

Abstract Background: Safe childbirth remains a daunting challenge, particularly in low-resource settings where most pregnancy-related deaths occur. Cameroon’s maternal mortality rate, estimated at 782 per 100,000 live births in 2011 is significantly high. Adherence to good practice standards by birth attendants is key to improving pregnancy outcomes. The WHO Safe Childbirth checklist was designed as a tool to improve the quality of care provided to women giving birth. This checklist was implemented at the Yaounde Gyneco-Obsteric and Pediatric Hospital. Quantitative and qualitative assessment of its utilization is essential to secure a change in attitudes and practice and determine improvement in maternal health. Objective: Evaluate a change in attitudes and practice and determine improvement in outcomes 6 months after initiation of the safe childbirth checklist use. Methods: A cross sectional and retrospective study was conducted over a 6 month period (January – June 2018). Predesigned questionnaires were used to collect qualitative data from personnel of the Gynecology and Obstetrics unit and quantitative data from patient delivery records. Data analysis was done using SPSS version 23.0. Chi square test was used to compare categorical variables, while the student test was used to compare continuous variables. P -values below 5% were considered statistically significant. Results: Of the 1001 files retrieved from the archives, 25 were excluded. The checklist was used in 828/976 (84.8%) files. We observed an increasing trend in the usage rate, with a peak at 93.9% during the last 2 months. Pages 2 and 3 were least completed, in <10% of cases during the first 5 months. A significant reduction in the onset of pre-eclampsia and eclampsia was noted with the use of the checklist (2·1% Vs 5·4%, p = 0·017). The proportion of neonatal deaths recorded amongst cases with a used checklist was smaller compared to cases without checklists (0·2% Vs 0·7%, p = 0·380). Fifty percent of the staff reported that the checklist increased workload while 37.5% mentioned laziness and absence of checklists in some files as a hindrance to its proper use. Conclusion: The use of the checklist improved progressively with a simultaneous reduction in obstetrical and neonatal complications.


2019 ◽  
Author(s):  
Julius Sama DOHBIT ◽  
Namanou Ines Emma WOKS ◽  
Carlin Héméry KOUDJINE ◽  
Willy TAFEN ◽  
Pascal FOUMANE ◽  
...  

Abstract Background: Safe childbirth remains a daunting challenge, particularly in low-resource settings where most pregnancy-related deaths occur. Cameroon’s maternal mortality rate, estimated at 782 per 100,000 live births in 2011 is significantly high. Adherence to good practice standards by birth attendants is key to improving pregnancy outcomes. The WHO Safe Childbirth checklist was designed as a tool to improve the quality of care provided to women giving birth. This checklist was implemented at the Yaounde Gyneco-Obsteric and Pediatric Hospital. Quantitative and qualitative assessment of its utilization is essential to secure a change in attitudes and practice and engender improvement in maternal health. Objective: Evaluate the change in attitudes and practice of nurses and compare outcomes in cases where it was and was not used, 6 months after introduction of the safe childbirth checklist in a maternity setting. Methods: A cross sectional and retrospective study was conducted over a 6 month period (January – June 2018). Predesigned questionnaires were used to collect qualitative data on the checklist from personnel of the maternity and another data collection form used to extract information from patient records. Data analysis was done using SPSS version 23.0. Chi square test was used to compare categorical variables, while the student test was used to compare continuous variables. Results: Of the 1001 files retrieved from the archives, 25 were excluded. The checklist was used in 828/976 (84.8%) files. We observed an increasing trend in the usage rate, with a peak at 93.9% recorded during the last 2 months. Pages 2 and 3 were least completed, in <10% of cases during the first 5 months. Fewer cases of pre-eclampsia and eclampsia were associated with the use of the checklist, compared to patients in whom the checklist was not used (2·1% Vs 5·4%, p = 0·017). Fifty percent of the staff reported that the checklist increased workload while 37.5% mentioned laziness and absence of checklists in some files as a hindrance to its proper use. Conclusion: The use of the safe childbirth checklist improved progressively with a simultaneous reduction in obstetrical and neonatal complications overtime.


Author(s):  
Ella Nissan ◽  
Abdulla Watad ◽  
Arnon D. Cohen ◽  
Kassem Sharif ◽  
Johnatan Nissan ◽  
...  

Polymyositis (PM) and dermatomyositis (DM) are autoimmune-mediated multisystemic myopathies, characterized mainly by proximal muscle weakness. A connection between epilepsy and PM/DM has not been reported previously. Our study aim is to evaluate this association. A case–control study was conducted, enrolling a total of 12,278 patients with 2085 cases (17.0%) and 10,193 subjects in the control group (83.0%). Student’s t-test was used to evaluate continuous variables, while the chi-square test was applied for the distribution of categorical variables. Log-rank test, Kaplan–Meier curves and multivariate Cox proportional hazards method were performed for the analysis regarding survival. Of the studied 2085 cases, 1475 subjects (70.7%) were diagnosed with DM, and 610 patients (29.3%) with PM. Participants enrolled as cases had a significantly higher rate of epilepsy (n = 48 [2.3%]) as compared to controls (n = 141 [1.4%], p < 0.0005). Using multivariable logistic regression analysis, PM was found only to be significantly associated with epilepsy (OR 2.2 [95%CI 1.36 to 3.55], p = 0.0014), whereas a non-significant positive trend was noted in DM (OR 1.51 [95%CI 0.99 to 2.30], p = 0.0547). Our data suggest that PM is associated with a higher rate of epilepsy compared to controls. Physicians should be aware of this comorbidity in patients with immune-mediated myopathies.


Healthcare ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 939
Author(s):  
Ana Fresan ◽  
Alma Delia Genis-Mendoza ◽  
María Lilia López-Narváez ◽  
Tania Guadalupe Gómez-Peralta ◽  
Daniela Georgina Aguilar-Velázquez ◽  
...  

Background/Aim: Obesity in adolescents is increasing; as such, the aim of this study was to determine the prevalence of obesity in Mexican adolescents and examine its possible association with hours of sleep. Methods: A school-based cross-sectional study was carried out. This study included 863 adolescents aged between 11 and 16 years. The prevalence of obesity was estimated using the body mass index (BMI). The duration of sleep (and other information) was assessed by a self-reported questionnaire. The Cochran–Mantel–Hansel test for categorical variables and a general linear model for continuous variables were used to evaluate the interaction effect of BMI and sex with respect to sleeping and assessed activity conditions. Results: It was found that 47.6% of the adolescents were overweight/obese. Men were more frequently overweight/obese than women (52.6% vs. 41.8%, p = 0.002). Moreover, overweight/obese adolescents were younger and spent fewer daily hours watching television (p < 0.05). Men practiced sports more hours per week than women (p = 0.04). However, women spent more daily time on the internet (p = 0.05), and overweight/obese adolescent women slept fewer hours than overweight/obese men and adolescents with normal weight (p = 0.008). Conclusions: The development of strategies for the prevention of overweight/obesity and the improvement of sleep duration should include a gender perspective to improve health habits in Mexican adolescents.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Julius Sama Dohbit ◽  
Namanou Ines Emma Woks ◽  
Carlin Héméry Koudjine ◽  
Willy Tafen ◽  
Pascal Foumane ◽  
...  

Abstract Background Safe childbirth remains a daunting challenge, particularly in low-middle income countries, where most pregnancy-related deaths occur. Cameroon’s maternal mortality rate, estimated at 529 per 100,000 live births in 2017, is significantly high. The WHO Safe Childbirth Checklist (SCC) was designed to improve the quality of care provided to pregnant women during childbirth. The SCC was implemented at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital to improve the quality of care during childbirth. Methods This study was a retrospective study to determine the adoption rate of the SCC and its association with maternal (eclampsia, perineal tears, and postpartum haemorrhage) and neonatal (stillbirth, neonatal asphyxia and neonatal death) complications. Data were collected 6 months after the introduction of the SCC. Multivariate binary logistic regression was used to analyse the association between the use of the SCC and maternofoetal complications. Results Out of 1611 deliveries conducted, 1001 records were found, giving a retrieval rate of 62%. Twenty-five records were excluded. During the study period, the checklists were used in 828 of 976 clinical notes, with an adoption rate of 84.8% and a utilization rate of 93.9% at 6 months. Severe preeclampsia/eclampsia was associated with the non-use of the SCC (2.1 vs 5.4%, p = 0.041). Stillbirth, neonatal asphyxia, and neonatal death rates were not significantly different between the checklist and non-checklist groups. However, for all neonatal outcomes, the proportion of complications was lower when the checklist was used. Conclusion The use of the SCC was associated with significantly reduced pregnancy complications, especially for reducing the rates of severe pre-eclampsia/eclampsia. The use of the SCC increased to 93.9% of all deliveries within 6 months. We advocate for the use of the WHO Safe Childbirth Checklist in maternity units.


Author(s):  
Kalaiselvy Arikrishnan ◽  
Gokul Sarveswaran ◽  
Yuvaraj Krishnamoorthy ◽  
Manikandanesan Sakthivel ◽  
Marie Gilbert Majella ◽  
...  

AbstractObjectivesTo determine the prevalence of Second Hand Smoking (SHS) and assess the factors related to exposure, knowledge and response to SHS among adolescents in rural Puducherry, South India.MethodsA community based cross-sectional study was conducted among adolescents during March and April 2018. Two out of four villages were selected randomly and all the adolescents were contacted through household visit and questionnaire was administered. Semi structured questionnaire contained three sections: sociodemographic details, environmental assessment and third section contained knowledge about SHS, COTPA and response towards being exposed to SHS, as well as exposure history. Continuous variables like age were summarized as mean (SD). Categorical variables such as awareness, attitude and practise towards SHS were summarized as proportions with 95% confidence interval.ResultsTotal number of adolescents interviewed was 789. The mean age of the study participants were 14.1 (2.4) years and majority, 440 (55.8%) were boys and 684 (86.7%) belonged to nuclear family. More than one fourth, 210 (26.6%) belonged to middle class of socio-economic status. Environmental assessment of household showed more than half, 456 (57.8%) were staying in pucca house and majority 642 (81.4%) had adequate cross ventilation. It was found that about 70.1% had adequate knowledge about SHS and its harmful effects. Prevalence of exposure to SHS was 49%. Majority (40.5%) told that they will scold or advice the family member to stop smoking if they are exposed to SHS in the living place. However, almost 80% of adolescents mentioned that they will no’t react if they see someone smoking in a public place.ConclusionsCurrent study found that almost half of the adolescents were exposed to SHS. Even though, almost three fourth had adequate knowledge, attitude towards preventing SHS in public place was found to be poor. Hence, adolescents need to be motivated enough to address the problem in the public place through motivational counselling in adolescent clinics by health care workers.


2020 ◽  
Vol 10 (4) ◽  
pp. 296-300
Author(s):  
Ameet Jesrani ◽  
Pari Gul ◽  
Nida Khan ◽  
Seema Nayab ◽  
Fahmida Naheed

Objective: To assess different pathological breast lesions in ultra sound in a subgroup of population. Study design and setting: It was a cross sectional study conducted at Bolan Medical Complex Hospital Quetta, Pakistan from June 2018 to January 2019. Methodology: Total 103 patients with breast swelling, pain and discharge were targeted. Gray scale and Doppler Ultrasound of breast followed by FNAC/biopsy of breast lesion was performed. Data presented as mean ± standard deviation for continuous variables and frequency with percentages for categorical variables. Results: Out of 48 clinically palpable lumps US detected all of 48 lumps and additionally 12 clinically non palpable masses were detected on US examination. Thus, overall sensitivity of ultrasound in detecting breast lumps was 100%. Fibroadenoma of the breast was diagnosed accurately in 80.3% of women. Ultrasound reliably differentiated cystic from solid breast masses (100%). The sensitivity of ultrasound for detecting breast carcinoma was 63.4% with a positive predictive value of 87.5%, a negative predictive value of 99.5% and accuracy of 58.33%. US findings most suggestive of benign lesions were oval or round shape in 88.3%, well defined margin in 84%, absent lobulation in 86.04% and wider than taller ratio in 90.69% of the cases.US findings of most predictive for malignancy were of irregular shape in 81.8%, ill-defined margin in 90.9% and length to height ratio in 63.6% of cases. Conclusion: Ultrasound is simple, cheap, safe and relatively accessible imaging modality for evaluation of breast pathologies. Due to its high sensitivity in diagnosing benign breast lesions particularly cystic lesions and fibroadenoma unnecessary interventions can be avoided


2020 ◽  
Author(s):  
Arithi Mutembei ◽  
Festus K. Mutai ◽  
Damaris Mwololo ◽  
John Muriuki ◽  
Mark Obonyo ◽  
...  

AbstractIntroductionLeptospirosis is a neglected bacterial zoonotic infection caused by spirochetes of Leptospira genus. Humans get infected through direct or indirect contact with urine of infected animals or environment. It accounts for more than 300,000 severe cases annually worldwide with case fatality rates of over 30%. Costs of diagnosis and treatment for human and animals, disruption of international trade of animals and products, reduced productivity and reproductivity in animals constitute economic importance. In Kenya, leptospirosis burden is significant but under-diagnosis and under-reporting affects the awareness of the disease. This study aimed to determine and compare the sero-prevalence and factors associated with Leptospira spp. in the two counties.MethodsWe conducted a cross-sectional study that involved apparently healthy people of at least 5 years of age in randomly selected households in Garissa and Tana River Counties. Blood samples were collected and tested for Leptospira spp antibodies using IgM ELISA. Standardized structured questionnaires were administered to collect socio-demographic and exposure information. We calculated frequencies and proportions for categorical variables and odds ratios (OR) and 95% confidence interval (CI) to evaluate association between sero-positivity and exposure factors. We used Wilcoxon test to evaluate statistical difference in sero-positivity for continuous variables and calculated test statistic (H) and p-value.ResultsA total of 952 subjects were recruited into the study – these included 482 persons from Garissa and 470 from Tana River. The overall sero-prevalence was 26% [(244/952); (CI: 23% to 29%)]. Garissa County had significantly higher Leptospira spp. seroprevalence (31%, n = 147; CI: 27% to 35%) compared to Tana River County (21 %, n = 97; CI: 17% to 25%). Being a female (OR=1.6, CI: 1.2-2.2) and engaging in pastoralism (OR=2.7, CI: 1.8-3.9) were significantly associated with higher odds of Leptospira spp. seropositivity compared to being a male or working in irrigated areas. The mean altitude of residence of sero-positive patients was 73m ± 21 SD (standard deviation) above sea level and that for sero-negative was 80m ± 22 SD (H=35, p-value = 0.00).ConclusionThis study determined the seroprevalence and risk factors for Leptospira spp. exposure in Garissa and Tana River Counties, Kenya. Females in pastoral communities experience high burden of the disease. Enhanced surveillance in humans and animals and further research is required to understand the complex and multifactorial drivers of leptospirosis transmission in the two Counties.


Author(s):  
NV Roopesh Gopal ◽  
SV Sathish Kumar ◽  
Kiran S Bhat

Introduction: An intimate relationship is an interpersonal relationship that involves physical or emotional intimacy. Those who are in such a relationship may experience violence from partners which may affect their day-to-day quality of life and thus cause a burden on the family. Aim: To assess the relationship between Intimate Partner Violence (IPV) with Quality of life and to provide early interventions. Materials and Methods: Hospital-based, cross-sectional study was conducted at the Department of Psychiatry, Kodagu Institute of Medical Sciences (KoIMS) teaching hospital Madikeri, Karnataka. The subjects were recruited by purposive sampling method. A total of 5810 consecutive subjects who visited the psychiatry OPD from March 2017 to June 2019 were assessed and among them, 82 subjects both men and women in the age group of 18 to 60 years were recruited. All of them reported IPV on the Hurt, Insulted, Threatened, and Screamed (HITS) scale and were further assessed for Quality of life using the World Health Organisation Quality of Life BREF (WHOQOL-BREF) scale. Descriptive statistics were used for continuous variables. A Nonparametric Chi-square test was applied for categorical variables and Mann-Whitney U scores were used for quality of life variables. The correlation was done using Pearson’s correlation. Results: Mean age was 36.04 in years (SD±11.28) having a mean of 7.5 years of schooling (SD±4.5). The majority belonged to the rural background and lower socioeconomic status. Out of 82 subjects, 21 subjects reported IPV score less than 10 (25.60%) and among the rest of the 61 (74.39%) subjects, 80.32% were females and 19.67% were males who had IPV scores of more than 10. The study subjects reported poor and very poor scores in their overall quality of life and very dissatisfied and dissatisfied in their health domain. IPV also correlated with reduced quality of life, which was statistically significant. Conclusion: People that experience IPV has an overall reduced quality of life. Routine clinical assessment needs to be done to provide early interventions.


2021 ◽  
Vol 5 (1) ◽  
pp. 62-70
Author(s):  
Rodrigo Fernandes Weyll Pimentel ◽  
Leonardo Castro Dantas Macêdo ◽  
Sérgio Diniz Gonçalves Queiroz Filho ◽  
Pedro Carlos Muniz de Figueiredo ◽  
Magno Conceição das Merces

OBJECTIVE: Evaluate the medical students’ knowledge about perioperative nutritional care. These students are from public and private academic institutions in the state of Bahia, Brazil. METHODS: This is a cross-sectional study to analyze medical students based on an online instrument regarding topics related to perioperative care. For data analysis, absolute and relative frequencies were calculated for categorical variables, and mean and standard deviation were calculated for continuous variables. Fisher's Exact Test and G Test were used to analyze the association. Results: 209 responses were obtained. Regarding the learning on nutritional preparation of the patient submitted to a surgery, 25 (64.9%) students of public institutions and 90 (52.3%) students of private ones reported not knowing or not having been exposed to such knowledge. Regarding the importance of addressing topics related to nutritional therapy (NT), 37 (100%) students from public institutions and 168 (97.7%) from private ones recognize the importance of spreading this knowledge. Unnecessary absolute preoperative fasting, shortening techniques of fasting and bronchoaspiration prevention and reintroduction time of a diet in the postoperative period are unknown to most of the population studied. CONCLUSION: Most students included in this study do not have satisfactory knowledge in NT and for preparing the surgical patient.


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