scholarly journals Bayesian Additive Modeling of Maternal Mortality In Ghana

2021 ◽  
Author(s):  
Dioggban Jakperik ◽  
Saralees Nadarajah ◽  
Michael Jackson Adjabui
Keyword(s):  
Maternal Mortality ◽  
Health System ◽  
Rural Areas ◽  
Negative Binomial ◽  
Health Workers ◽  
Negative Binomial Regression ◽  
Northern Region ◽  
Maternal Deaths ◽  
Road Map ◽  
Critical Measure

Abstract Maternal mortality is a critical measure for quality of health system in any country and hence many countries have made concerted efforts to check its occurrence. Various stakeholders involved in the management of health system in Ghana have been tasked to ensure women do not die whilst giving birth. This study was conducted on a sample of 1,052 women selected from all the ten administrative regions of Ghana in which 188 maternal deaths occurred. Two main analytical tools, namely the Zero-Inflated Negative Binomial Regression and Bayesian Additive Posterior Modeling using IN LA were used. Age at death, Marital Status, and Place of Death emerged as the most significant determinants of maternal mortality in Ghana. It was realized that high number of maternal deaths were recorded in the least developed regions with Northern Region having the highest number of Maternal Deaths. It is therefore important for stakeholders to devise a road map of getting health workers to accept postings to the rural areas and also provide well resourced health facilities to stem this menace.

scholarly journals ‘Maternal deaths should simply be 0’: politicization of maternal death reporting and review processes in Ethiopia

2019 ◽  
Vol 34 (7) ◽  
pp. 492-498 ◽  
Author(s):  
Andrea Melberg ◽  
Alemnesh Hailemariam Mirkuzie ◽  
Tesfamichael Awoke Sisay ◽  
Mitike Molla Sisay ◽  
Karen Marie Moland
Keyword(s):  
Maternal Mortality ◽  
Health System ◽  
Maternal Death ◽  
Health Workers ◽  
Adverse Outcomes ◽  
Surveillance Systems ◽  
Maternal Deaths ◽  
Reporting Practices ◽  
Conflicting Demands ◽  
Problems And Solutions

Abstract The Maternal Death Surveillance and Response system (MDSR) was implemented in Ethiopia in 2013 to record and review maternal deaths. The overall aim of the system is to identify and address gaps in order to prevent future death but, to date, around 10% of the expected number of deaths are reported. This article examines practices and reasoning involved in maternal death reporting and review practices in Ethiopia, building on the concept of ‘practical norms’. The study is based on multi-sited fieldwork at different levels of the Ethiopian health system including interviews, document analysis and observations, and has documented the politicized nature of MDSR implementation. Death reporting and review are challenged by the fact that maternal mortality is a main indicator of health system performance. Health workers and bureaucrats strive to balance conflicting demands when implementing the MDSR system: to report all deaths; to deliver perceived success in maternal mortality reduction by reporting as few deaths as possible; and to avoid personalized accountability for deaths. Fear of personal and political accountability for maternal deaths strongly influences not only reporting practices but also the care given in the study sites. Health workers report maternal deaths in ways that minimize their number and deflect responsibility for adverse outcomes. They attribute deaths to community and infrastructural factors, which are often beyond their control. The practical norms of how health workers report deaths perpetuate a skewed way of seeing problems and solutions in maternal health. On the basis of our findings, we argue that closer attention to the broader political context is needed to understand the implementation of MDSR and other surveillance systems.

scholarly journals Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India

2018 ◽  
Vol 7 (6) ◽  
pp. 2283
Author(s):  
Darshna M. Patel ◽  
Mahesh M. Patel ◽  
Vandita K. Salat
Keyword(s):  
Mortality Rate ◽  
Maternal Mortality ◽  
Rural Areas ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Maternal Mortality Rate ◽  
Live Births ◽  
Mortality Ratio

Background: According to the WHO, 80 of maternal deaths in developing countries are due to direct maternal causes such as haemorrhage, hypertensive disorders and sepsis. These deaths are largely preventable. Maternal mortality ratio (MMR) in India is 167/100,000 live births.Methods: This retrospective observational study was conducted at GMERS, Valsad. Data regarding maternal deaths from January 2016 to December 2017 were collected and analyzed with respect to epidemiological parameters. The number of live births in the same period was obtained from the labour ward ragister. Maternal mortality rate and Mean maternal mortality ratio for the study period was calculated.Results: The mean Maternal mortality rate in the study period was 413.3/100,000 births. The maternal mortality ratio (MMR) in India is 167/100,000 live births. More than half of maternal deaths were reported in multiparous patients. More maternal deaths were observed in women from rural areas (67.3%), unbooked patients (73.3%) and illiterate women (65.3%). Thirty six (69.3%) maternal death occurred during postpartum period. Most common delay was first delay (60.0%) followed by second delay (40.0%). Postpartum haemorrhage (28.8%), preeclampsia (17.3%), sepsis (13.46%) were the major direct causes of maternal deaths. Indirect causes accounted for one third of maternal deaths in our study. Anemia, hepatitis and heart disease were responsible for 13.4%, 5.7%, and 1.9% of maternal deaths, respectively.Conclusions: Majority of maternal deaths are observed in patients from rural areas, unbooked, and illiterate patients. Hemorrhage, eclampsia and sepsis are leading causes of maternal deaths. Most of these maternal deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers.

Safety Evaluation of Destination Lighting Treatment at Stop Controlled Cross-Intersections

2018 ◽  
Vol 2672 (16) ◽  
pp. 113-121 ◽  
Author(s):  
Amrita Goswamy ◽  
Shauna Hallmark ◽  
Theresa Litteral ◽  
Michael Pawlovich
Keyword(s):  
Rural Areas ◽  
Negative Binomial ◽  
Safety Evaluation ◽  
Negative Binomial Regression ◽  
State Agencies ◽  
Crash Frequency ◽  
Binomial Regression ◽  
Manual Selection ◽  
Roadway Lighting ◽  
Selection Of

Intersection crashes during nighttime hours may occur because of poor driver visual cognition of conflicting traffic or intersection presence. In rural areas, the only source of lighting is typically provided by vehicle headlights. Roadway lighting enhances driver recognition of intersection presence and visibility of signs and markings. Destination lighting provides some illumination for the intersection but is not intended to fully illuminate all approaches. Destination lighting has been widely used in Iowa but the effectiveness has not been well documented. This study, therefore, sought to evaluate the effect on safety of destination lighting at rural intersections. As part of an extensive data collection effort, locations with destination/street lighting were gathered with the assistance of several state agencies. After manual selection of a similar number of control intersections, propensity score matching using the caliper width technique was used to match 245 treatments with 245 control sites. Negative binomial regression was used to evaluate crash frequency data. The presence of destination lighting at stop-controlled cross-intersections generally reduced the night-to-day crash ratio by 19%. The presence of treatment or destination lighting was associated with a 33%–39% increase in daytime crashes across all models but was associated with an 18%–33% reduction in nighttime crashes. Injuries in nighttime crashes decreased by 24% and total nighttime crashes reduced by 33%. Property damage crashes were reduced by 18%.

scholarly journals Unmet Social Needs and No-Show Visits in Primary Care in a US Northeastern Urban Health System, 2018–2019

2020 ◽  
Vol 110 (S2) ◽  
pp. S242-S250 ◽  
Author(s):  
Kevin P. Fiori ◽  
Caroline G. Heller ◽  
Colin D. Rehm ◽  
Amanda Parsons ◽  
Anna Flattau ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Health System ◽  
Urban Health ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Social Needs ◽  
Positive Trend ◽  
Missed Appointments ◽  
Primary Care Practices

Objectives. To characterize the association between social needs prevalence and no-show proportion and variation in these associations among specific social needs. Methods. In this study, we used results from a 10-item social needs screener conducted across 19 primary care practices in a large urban health system in Bronx County, New York, between April 2018 and July 2019. We estimated the association between unmet needs and 2-year history of missed appointments from 41 637 patients by using negative binomial regression models. Results. The overall no-show appointment proportion was 26.6%. Adjusted models suggest that patients with 1 or more social needs had a significantly higher no-show proportion (31.5%) than those without any social needs (26.3%), representing an 19.8% increase (P < .001). We observed a positive trend (P < .001) between the number of reported social needs and the no-show proportion—26.3% for those with no needs, 30.0% for 1 need, 32.1% for 2 needs, and 33.8% for 3 or more needs. The strongest association was for those with health care transportation need as compared with those without (36.0% vs 26.9%). Conclusions. We found unmet social needs to have a significant association with missed primary care appointments with potential implications on cost, quality, and access for health systems.

scholarly journals Community Empowerment in Health: An Exploratory Study in Rural Community of a District of West Bengal

2020 ◽  
pp. 11-19
Author(s):  
Dipta Kanti Mukhopadhyay ◽  
Sujishnu Mukhopadhyay ◽  
Nivedita Das ◽  
Tarun Kumar Sarkar ◽  
Fasihul Akbar ◽  
...  
Keyword(s):  
Health Services ◽  
Health System ◽  
National Health ◽  
Rural Areas ◽  
West Bengal ◽  
Health Workers ◽  
Community Empowerment ◽  
Current Status ◽  
Health Staff ◽  
Key Informants

Background: Community empowerment is the process and outcome where community itself is able to identify, prioritize health problems and address them. It has been considered as the key strategy for scalability and sustainability of health services. Objectives: To explore the status of community empowerment in health in rural areas in West Bengal, India and the interplay of different stakeholders. Methods: A cross-sectional, qualitative study was conducted in 2017 – 2018 among the people residing in rural areas of Birbhum district in West Bengal, India who utilized the public health system (lay informants), formal and informal leaders of the community, community level health workers and peripheral health staff (key informants). Three community blocks, two sub-centers from each block and one village from each sub-center were selected randomly. In-depth interviews were conducted among 36 lay and 36 key informants using Laverack’s nine dimension model of community empowerment. Framework analysis was done to summarize data. Results: Participation of people was restricted to awareness and utilization of existing health services. Unmet aspiration for greater participation was noted among a small section of the community. They were mostly fitted to the role of beneficiaries. Functioning of village level organization to promote communitization as envisaged in national health programmes was largely deficient. The community health workers acted as the most peripheral appendages of formal health system rather than the health activists to empower community regarding community’s health. Conclusion: Although, every national health programme advocated community empowerment, the current status and the process of empowerment in health is in nascent stage.

scholarly journals Evaluation of maternal mortality and their factors in GMCH, Aurangabad, India

2018 ◽  
Vol 7 (3) ◽  
pp. 879
Author(s):  
Ganesh Balasaheb Bharaswadkar ◽  
Murlidhar L. Kurtadikar
Keyword(s):  
Health Care ◽  
Maternal Mortality ◽  
Rural Areas ◽  
Community Education ◽  
Tertiary Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Maternal Deaths ◽  
Infective Hepatitis

Background: Analysing the factors related to maternal mortality is very important as they reflect the socioeconomic status and health care facility availabilities of the country. This study is aimed to analyse the epidemiological aspects and different causes of maternal death and evaluation of preventable factors and unavoidable factors if any causing maternal death.Methods: The retrospective study was carried out at GMCH, Aurangabad during the period from February 2002 to January 2004. All the data related to epidemiological factors and causes of maternal mortality was recorded and analyzed.Results: There were 33 maternal deaths during the study period. The mean maternal mortality rate was 211 per 1,00,000 total births. Maximum maternal deaths were reported at the age group of 26-30 years (36.1%), in primiparous women (46.8%) and from rural areas (78.38%). Most of the deaths (37.5%) were reported within first 24 hours of hospital admission at postpartum stage (87.5%). 84.37% of maternal deaths were due to direct causes. And toxemia of pregnancy (39.5%) was major direct cause. Anaemia and infective hepatitis constitutes for 9.3% each for the indirect causes maternal death.Conclusion: Most maternal deaths can be preventable by multidisciplinary approaches involving mass community education, improving sanitation, early referrals to tertiary care centres and by providing health care facilities in rural areas.

scholarly journals Mengenal Tanda-Tanda Bahaya Kehamilan di Puskesmas Pakuan Baru Kota Jambi

2021 ◽  
Vol 3 (1) ◽  
pp. 52
Author(s):  
Ria Febrina
Keyword(s):  
Mortality Rate ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Community Service ◽  
Health Workers ◽  
Obstetric Complications ◽  
Maternal Deaths ◽  
Maternal Mortality Rate ◽  
Live Births ◽  
Danger Signs

Maternal Mortality Rate (MMR) in Indonesia is still high compared to other ASEAN countries. MMR in Indonesia according to the 2017 Indonesian Demographic and Health Survey (IDHS) is 305 per 100,000 live births. The global target of SDGs (Suitainable Development Goals) is to reduce the Maternal Mortality Rate (MMR) to 70 per 100,000 live births. While in Jambi Province in 2017 recorded maternal deaths were 29 cases. Maternal deaths that occur during 90% of pregnancy are caused by obstetric complications. Direct obstetric complications are bleeding, infection and eclampsia. Indirectly maternal mortality is also influenced by delays at the family level in recognizing danger signs of pregnancy and making decisions to immediately seek help. Delay in reaching health facilities and assistance in health service facilities. Pregnancy danger signs must be recognized and detected early so that they can be handled properly because any danger signs of pregnancy can lead to pregnancy complications. Therefore it is necessary to provide counseling to improve the knowledge of pregnant women about the danger signs of pregnancy. This community service activity was carried out by Pakuan Baru Kota Jambi Public Health Center. The time of implementation in April 2020. The target is pregnant women. Community service methods include a survey and lecture approach. The results obtained are pregnant women able to understand the danger signs of pregnancy. It is recommended for health workers to continue to provide education related to pregnancy to pregnant women

scholarly journals Strengthening Routine Immunization Services in an Angolan Comuna: The Fight against the Burden of Unvaccinated Children in the Sustainable Development Goals Era

2019 ◽  
Vol 16 (22) ◽  
pp. 4572
Author(s):  
Mattia Fattorini ◽  
Calistus Wilunda ◽  
Gloria Raguzzoni ◽  
Cecilia Quercioli ◽  
Gabriele Messina ◽  
...  
Keyword(s):  
Sustainable Development Goals ◽  
Negative Binomial ◽  
Health Workers ◽  
Negative Binomial Regression ◽  
Intervention Period ◽  
The Sustainable Development ◽  
Governmental Organization ◽  
Binomial Regression ◽  
Immunization Services ◽  
Development Goals

In May 2018, the non-governmental organization (NGO) Doctors with Africa CUAMM began to implement an intervention to strengthen Chiulo Hospital’s public health section to deliver immunization services in Mucope Comuna, Ombadja District. We aimed to evaluate the effect of this intervention. During the intervention period, actions such as staff training, improvement in the monitoring of vaccine stockpile, and the involvement of Community Health Workers were performed. The effects of the intervention on the number of vaccine doses administered were examined using negative binomial regression. Doses administered were 14,221 during the intervention period and 11,276 in the pre-intervention one. The number of administered doses was 26% higher (95% CI 9%–45%) in the intervention period than in the pre-intervention period. This was driven by vaccine doses administered during outreach sessions, where a statistically significant increase of 62% (95% CI 28%–107%) was observed. Regarding individual vaccines, statistically significant increases in the number of doses were observed for OPV2 (76%), OPV3 (100%), Penta3 (53%), PCV3 (53%), and Rota2 (43%). The NGO interventions led to improved delivery of immunization services in the study area. Greater increases were observed for vaccine doses that are more likely to be missed by children.

scholarly journals Maternal mortality in tertiary care hospital: a 2-year review

2018 ◽  
Vol 8 (1) ◽  
pp. 184
Author(s):  
Juhi Ankit Patel ◽  
Kanaklata D. Nakum ◽  
Aditi Vithal ◽  
Mayank R. Lunagariya
Keyword(s):  
Maternal Mortality ◽  
Low Socioeconomic Status ◽  
Rural Areas ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Epidemiological Data ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Mortality Ratio ◽  
Set Up

Background: Epidemiological data pertaining to maternal mortality is valuable in each set up to design interventional programs to favourably reduce the ratio. This study was done to evaluate the maternal mortality rate in our hospital, to assess the epidemiological aspects and causes of maternal mortality, and to suggest recommendations for improvement.Methods: This was a 2-year retrospective study. Epidemiological data was collected from the Last 2 years of Facility Based Maternal Death Review Form. Maternal mortality ratio, epidemiological factors and causes affecting maternal mortality were assessed.Results: A total of 72 maternal deaths occurred. Most maternal deaths occurred in the age group of 20–24 years (40.27%), multiparous women (70.83%), women from rural areas (65.27%), illiterate women, unbooked patients (83.33%), and patients of low socioeconomic status. Direct causes accounted for 62.4% of maternal deaths where as 37.4% of maternal deaths were due to indirect causes.Conclusions: There is a wide scope for improvement as a large proportion of the observed deaths could be preventable.

scholarly journals Determinants of Antenatal Care Visit Utilization of Child-Bearing Mothers in Kaffa, Sheka, and Bench Maji Zones of SNNPR, Southwestern Ethiopia

2019 ◽  
Vol 6 ◽  
pp. 233339281986662 ◽  
Author(s):  
Abiyot Negash Terefe ◽  
Assaye Belay Gelaw
Keyword(s):  
Health Care ◽  
Antenatal Care ◽  
Rural Areas ◽  
Goodness Of Fit ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Care Program ◽  
Normal Pregnancy ◽  
World Health ◽  
Child Bearing

Background: Antenatal care (ANC) is a preventive obstetric health-care program aimed at optimizing maternal fetal outcome through regular monitoring of pregnancy. Even if World Health Organization recommends a minimum of 4 ANC visits for normal pregnancy, existing evidence from developing countries including Ethiopia indicates there are few women who utilize it due to different reasons. The purpose of this article is to identify determinants significantly influencing the ANC visit utilization of child-bearing mothers in the Kaffa, Sheka, and Bench-Maji zones of Southern Nation Nationalities and Peoples Region, Ethiopia. Methods: A total of 1715 child-bearing mothers were selected. Several count models such as Poisson, negative binomial, zero-inflated Poisson, zero-inflated negative binomial, hurdle Poisson, and hurdle negative binomial regression models were fitted to select the model which best fits the data. The parameters were estimated by maximum likelihood. Measures of goodness of fit were based on the Rootogram. Results: The data were found zeros (8.1%); the variance (3.794), which is less than its mean (3.91). Hurdle Poisson regression model was found to be better fitted with the data given. Variables are selected by backward selection method, through the analysis, zones, residence, age at first pregnancy, source of information, knowledge during danger sin, willingness, time of visit, and satisfaction, which were major predictors of ANC service utilization. The estimated odds that the number of ANC visits those child-bearing mothers made (mothers who lived in urban) are 3.52 times more likely than mothers who lived in rural keeping others variables constant and the like. Conclusion: Based on our findings, a lot of effort needs to be made by health offices to create awareness, maternal health-care programs should be expanded and intensified in rural areas, improve women’s knowledge and awareness about the risk factor of late visit, the necessary investigations and follow-up throughout the antenatal period to promote regular attendance for ANC, and fulfill the client’s satisfaction.

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