scholarly journals Reliability of maternal recall of delivery and immediate newborn care indicators in Sarlahi, Nepal

2021 ◽  
Author(s):  
Emily D Carter ◽  
Karen Chang ◽  
Luke Mullany ◽  
Subarna Khatry ◽  
Steven LeClerq ◽  
...  
Keyword(s):  
High Reliability ◽  
Newborn Care ◽  
Primary Source ◽  
Household Survey ◽  
Maternal Report ◽  
Maternal Recall ◽  
Immediate Newborn Care ◽  
Peripartum Period ◽  
Facility Births

Abstract Background: The intrapartum period is a time of high mortality risk for newborns and mothers. Numerous interventions exist to minimize risk during this period. Data on intervention coverage are needed for health system improvement. Maternal report of intrapartum interventions through surveys is the primary source of coverage data, but they may be invalid or unreliable. Methods: We assessed the reliability of maternal report of delivery and immediate newborn care for a sample of home and health facility births in Sarlahi, Nepal. Mothers were visited as soon as possible following delivery (<72 hours) and asked to report circumstances of labor and delivery. A subset was revisited 1-24 months after delivery and asked to recall interventions received using standard household survey questions. We assessed the reliability of each indicator by comparing what mothers reported immediately after delivery against what they reported at the follow-up survey. We assessed potential variation in reliability of maternal report by characteristics of the mother, birth event, or intervention prevalence.Results: 1502 mother/child pairs were included in the reliability study, with approximately half of births occurring at home. A higher proportion of women who delivered in facilities reported “don’t know” when asked to recall specific interventions both initially and at follow-up. Most indicators had high observed percent agreement, but kappa values were below 0.4, indicating agreement was primarily due to chance. Only “received any injection during delivery” demonstrated high reliability among all births (kappa: 0.737). The reliability of maternal report was typically lower among women who delivered at a facility. There was no difference in reliability based on time since birth of the follow-up interview. We observed over-reporting of interventions at follow-up that were more common in the population and under-reporting of less common interventions.Conclusions: This study reinforces previous findings that mothers are unable to report reliably on many interventions within the peripartum period effectively. Household surveys which rely on maternal report, therefore, may not be an appropriate method for collecting data on coverage of many interventions during the peripartum period. This is particularly true among facility births, where many interventions may occur without the mother’s full knowledge.

scholarly journals Reliability of maternal recall of delivery and immediate newborn care indicators in Sarlahi, Nepal

2020 ◽  
Author(s):  
Emily D Carter ◽  
Karen Chang ◽  
Luke Mullany ◽  
Subarna Khatry ◽  
Steven LeClerq ◽  
...  
Keyword(s):  
High Reliability ◽  
Newborn Care ◽  
Primary Source ◽  
Household Survey ◽  
Maternal Report ◽  
Maternal Recall ◽  
Immediate Newborn Care ◽  
Peripartum Period ◽  
Facility Births

Abstract Background: The intrapartum period is a time of high mortality risk for newborns and mothers. Numerous interventions exist to minimize risk during this period. Data on intervention coverage are needed for health system improvement. Maternal report of intrapartum interventions through surveys is the primary source of coverage data, but they may be invalid or unreliable. Methods: We assessed the reliability of maternal report of delivery and immediate newborn care for home and health facility births in Sarlahi, Nepal. Mothers were visited as soon as possible following delivery (<72 hours) and asked to report circumstances of labor and delivery. A subset was revisited 1-24 months after delivery and asked to recall interventions received using standard household survey questions. We assessed the reliability of each indicator by comparing what mothers reported immediately after delivery against what they reported at the follow-up survey. We assessed potential variation in the reliability of maternal report by characteristics of the mother, birth event, and intervention prevalence. Results: 1502 mother/child pairs were included in the reliability study, with approximately half of births occurring at home. A higher proportion of women who delivered in facilities reported “don’t know” when asked to recall specific interventions both initially and at follow-up. Most indicators had a high observed percent agreement, but kappa values were below 0.4, indicating agreement was primarily due to chance. Only “received any injection during delivery” demonstrated high reliability among all births (kappa: 0.737). The reliability of maternal report was typically lower among women who delivered at a facility. There was no difference in reliability based on time since birth of the follow-up interview. We observed over-reporting of interventions at follow-up that were more common in the population and under-reporting of less common interventions. Conclusions: This study reinforces previous findings that mothers are unable to report reliably on many interventions within the peripartum period effectively. Household surveys which rely on maternal report, therefore, may not be an appropriate method for collecting data on coverage of many interventions during the peripartum period. This is particularly true among facility births, where many interventions may occur without the mother’s full knowledge.

scholarly journals Reliability of maternal recall of delivery and immediate newborn care indicators in Sarlahi, Nepal

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emily D. Carter ◽  
Karen T. Chang ◽  
Luke C. Mullany ◽  
Subarna K. Khatry ◽  
Steven C. LeClerq ◽  
...  
Keyword(s):  
High Reliability ◽  
Newborn Care ◽  
Primary Source ◽  
Household Survey ◽  
Maternal Report ◽  
Maternal Recall ◽  
Immediate Newborn Care ◽  
Peripartum Period ◽  
Facility Births

Abstract Background The intrapartum period is a time of high mortality risk for newborns and mothers. Numerous interventions exist to minimize risk during this period. Data on intervention coverage are needed for health system improvement. Maternal report of intrapartum interventions through surveys is the primary source of coverage data, but they may be invalid or unreliable. Methods We assessed the reliability of maternal report of delivery and immediate newborn care for a sample of home and health facility births in Sarlahi, Nepal. Mothers were visited as soon as possible following delivery (< 72 h) and asked to report circumstances of labor and delivery. A subset was revisited 1–24 months after delivery and asked to recall interventions received using standard household survey questions. We assessed the reliability of each indicator by comparing what mothers reported immediately after delivery against what they reported at the follow-up survey. We assessed potential variation in reliability of maternal report by characteristics of the mother, birth event, or intervention prevalence. Results One thousand five hundred two mother/child pairs were included in the reliability study, with approximately half of births occurring at home. A higher proportion of women who delivered in facilities reported “don’t know” when asked to recall specific interventions both initially and at follow-up. Most indicators had high observed percent agreement, but kappa values were below 0.4, indicating agreement was primarily due to chance. Only “received any injection during delivery” demonstrated high reliability among all births (kappa: 0.737). The reliability of maternal report was typically lower among women who delivered at a facility. There was no difference in reliability based on time since birth of the follow-up interview. We observed over-reporting of interventions at follow-up that were more common in the population and under-reporting of less common interventions. Conclusions This study reinforces previous findings that mothers are unable to report reliably on many interventions within the peripartum period. Household surveys which rely on maternal report, therefore, may not be an appropriate method for collecting data on coverage of many interventions during the peripartum period. This is particularly true among facility births, where many interventions may occur without the mother’s full knowledge.

scholarly journals Immediate newborn care and breastfeeding: EN-BIRTH multi-country validation study

2021 ◽  
Vol 21 (S1) ◽  
Author(s):  
Tazeen Tahsina ◽  
◽  
Aniqa Tasnim Hossain ◽  
Harriet Ruysen ◽  
Ahmed Ehsanur Rahman ◽  
...  
Keyword(s):  
Newborn Care ◽  
Health Indicators ◽  
Newborn Health ◽  
Public Hospitals ◽  
Maternal And Newborn Health ◽  
Delayed Cord Clamping ◽  
Cord Clamping ◽  
Improve Measurement ◽  
Immediate Newborn Care ◽  
Skin To Skin

Abstract Background Immediate newborn care (INC) practices, notably early initiation of breastfeeding (EIBF), are fundamental for newborn health. However, coverage tracking currently relies on household survey data in many settings. “Every Newborn Birth Indicators Research Tracking in Hospitals” (EN-BIRTH) was an observational study validating selected maternal and newborn health indicators. This paper reports results for EIBF. Methods The EN-BIRTH study was conducted in five public hospitals in Bangladesh, Nepal, and Tanzania, from July 2017 to July 2018. Clinical observers collected tablet-based, time-stamped data on EIBF and INC practices (skin-to-skin within 1 h of birth, drying, and delayed cord clamping). To assess validity of EIBF measurement, we compared observation as gold standard to register records and women’s exit-interview survey reports. Percent agreement was used to assess agreement between EIBF and INC practices. Kaplan Meier survival curves showed timing. Qualitative interviews were conducted to explore barriers/enablers to register recording. Results Coverage of EIBF among 7802 newborns observed for ≥1 h was low (10.9, 95% CI 3.8–21.0). Survey-reported (53.2, 95% CI 39.4–66.8) and register-recorded results (85.9, 95% CI 58.1–99.6) overestimated coverage compared to observed levels across all hospitals. Registers did not capture other INC practices apart from breastfeeding. Agreement of EIBF with other INC practices was high for skin-to-skin (69.5–93.9%) at four sites, but fair/poor for delayed cord-clamping (47.3–73.5%) and drying (7.3–29.0%). EIBF and skin-to-skin were the most delayed and EIBF rarely happened after caesarean section (0.5–3.6%). Qualitative findings suggested that focusing on accuracy, as well as completeness, contributes to higher quality with register reporting. Conclusions Our study highlights the importance of tracking EIBF despite measurement challenges and found low coverage levels, particularly after caesarean births. Both survey-reported and register-recorded data over-estimated coverage. EIBF had a strong agreement with skin-to-skin but is not a simple tracer for other INC indicators. Other INC practices are challenging to measure in surveys, not included in registers, and are likely to require special studies or audits. Continued focus on EIBF is crucial to inform efforts to improve provider practices and increase coverage. Investment and innovation are required to improve measurement.

scholarly journals The effects of ANC follow up on essential newborn care practices in east Africa: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Erkihun Tadesse Amsalu ◽  
Bereket Kefale ◽  
Amare Muche ◽  
Zinabu Fentaw ◽  
Reta Dewau ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
East Africa ◽  
Meta Analysis ◽  
Newborn Care ◽  
Cochrane Library ◽  
Care Practice ◽  
Essential Newborn Care ◽  
Newborn Care Practice

AbstractIn the situation of high maternal morbidity and mortality in Sub-Saharan Africa, less than 80% of pregnant women receive antenatal care services. To date, the overall effect of antenatal care (ANC) follow up on essential newborn practice have not been estimated in East Africa. Therefore, this study aims to identify the effect of ANC follow up on essential newborn care practice in East Africa. We reported this review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We searched articles using PubMed, Cochrane library, African journal online (AJOL), and HINARI electronic databases as well as Google/Google scholar search engines. Heterogeneity and publication bias between studies were assessed using I2 test statistics and Egger’s significance test. Forest plots were used to present the findings. In this review, 27 studies containing 34,440 study participants were included. The pooled estimate of essential newborn care practice was 38% (95% CI 30.10–45.89) in the study area. Women who had one or more antenatal care follow up were about 3.71 times more likely practiced essential newborn care compared to women who had no ANC follow up [OR 3.71, 95% CI 2.35, 5.88]. Similarly, women who had four or more ANC follow up were 2.11 times more likely practiced essential newborn care compared to women who had less than four ANC follow up (OR 2.11, 95% CI 1.33, 3.35). Our study showed that the practice of ENBC was low in East Africa. Accordingly, those women who had more antenatal follow up were more likely practiced Essential newborn care. Thus, to improve the practice of essential newborn care more emphasis should be given on increasing antenatal care follow up of pregnant women in East Africa.

scholarly journals Immediate newborn care practices delay thermoregulation and breastfeeding initiation

2011 ◽  
Vol 100 (8) ◽  
pp. 1127-1133 ◽  
Author(s):  
Howard L Sobel ◽  
Maria Asuncion A Silvestre ◽  
Jacinto Blas V Mantaring III ◽  
Yolanda E Oliveros ◽  
Soe Nyunt-U
Keyword(s):  
Newborn Care ◽  
Breastfeeding Initiation ◽  
Immediate Newborn Care ◽  
Care Practices

scholarly journals 49. Effects of Maternal SARS-CoV-2 Infection on Neonatal Discharge Planning and Care: Exacerbation of Racial and Ethnic Healthcare Disparities

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S35-S35
Author(s):  
Jennifer Jubulis ◽  
Amanda Goddard ◽  
Sarah Dibrigida ◽  
Carol A McCarthy
Keyword(s):  
Healthcare Disparities ◽  
Discharge Planning ◽  
Medical Center ◽  
Newborn Care ◽  
Well Being ◽  
Racial Minorities ◽  
Foreign Born ◽  
Factors Affecting ◽  
Exposed Infant

Abstract Background SARS-CoV-2 has exacerbated healthcare disparities. Maine’s population of 1.3 million is comprised of only 6% Black, Indigenous, People of Color (BIPOC); however, statewide 18% of SARS-CoV-2 infections have occurred in this group. This study examines newborn care inequities for infants born to mothers with SARS-CoV-2. Methods This study was conducted at Maine Medical Center in Portland, the largest hospital in Maine. Maternal SARS-CoV-2 infections from March 15, 2020 through April 1, 2021 were identified by PCR near time of delivery. Cases were matched to uninfected women by date of delivery. Chart review was conducted assessing demographic and clinical characteristics, comparing SARS-CoV-2 exposed and unexposed infants. The subset of SARS-CoV-2 exposed infants was further analyzed for trends in care by race. Protocol was exempt by MaineHealth IRB. Results Twenty four women and their infants were identified with maternal positive SARS-CoV-2 PCR just prior to delivery. An additional 24 unexposed infants were enrolled. When compared to unexposed infants, SARS-CoV-2 exposed were more likely to be racial minorities (63% vs 21%, p = 0.003), to have foreign-born mothers (58% vs 0.4%, p&lt; 0.05) or to receive health care in a language other than English (29% vs 0.4%, p =0.02). For infants born to SARS-CoV-2 infected mothers, only 29% had initial follow up visit in person with their primary care provider (13% of BIPOC infants vs 56% of non-BIPOC infants, p = 0.03). Time to in-person follow up for exposed infants varied by race, with median time of 21 days (range 2-53 days) for racial minorities and 7.5 days (range 2-30 days) for non minorities. All families were discharged with a thermometer and scale for home management. No infants required re-admission during the month after discharge. One exposed infant tested positive for SARS-CoV-2. Conclusion The American Academy of Pediatrics recommends evaluation of newborns 3-5 days after discharge to identify maternal and child health factors affecting newborn well-being. The SARS-CoV-2 pandemic has made this challenging for patients, particularly for racial minorities. BIPOC pediatric patients were disproportionately affected by the pandemic in Maine, and were disproportionately affected by care discrepancies even when the infant was uninfected. Disclosures All Authors: No reported disclosures

Abstract TP52: Comparison of Two Methods of the Alberta Stroke Program Early CT Score

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Alex J Linn ◽  
Steve O’Donnell ◽  
Adam de Havenon
Keyword(s):  
Ct Perfusion ◽  
High Reliability ◽  
Scoring Systems ◽  
Weighted Kappa ◽  
Medical Decision ◽  
Rater Agreement ◽  
Clinical Tool ◽  
Ct Angiogram ◽  
The Mean

Introduction: Alberta Stroke Program Early CT Score (ASPECTS) is a validated clinical tool to predict early ischemic changes in acute ischemic stroke (AIS). In addition to scoring of non-contrast brain CT images (CT), head CT angiogram source images (CTA) have also been demonstrated as useful for scoring. We hypothesized that CTA ASPECTS would show superior inter-rater reliability as compared to CT ASPECTS, and that both would perform better in the setting of the favorable target mismatch (TM) profile on CT perfusion imaging (CTP). Methods: We reviewed AIS patients from 2010-2014 with an acute M1 middle cerebral artery occlusion that underwent CT, CTA, and CTP imaging at hospital admission. CT and CTA were independently scored by two experienced physician raters using the standard ASPECTS methodology. Inter-rater agreement was calculated with a weighted kappa. The cohort was then further stratified into either favorable or non-favorable TM profiles using volumetric measurements from the Olea Sphere software and the DEFUSE-3 definition of TM. Results: We included 68 patients. The mean±SD age was 62±18 years. 60% were men. The mean NIH stroke scale was 14.5±7.9. The median (IQR) follow-up modified Rankin Scale (mRS) was 3 (1,6). 37 of 68 (54%) patients had the TM profile and were significantly more likely to have lower follow-up mRS scores (z=3.5, p<0.001). Inter-rater agreement of CTA ASPECTS (kappa=0.82) was superior to CT ASPECTS (kappa=0.76). Patients with the TM profile demonstrated more reliable agreement on both CTA and CT ASPECTS scoring systems (kappa=0.79, 0.78), compared to those without the TM profile (kappa=0.71, 0.75). Discussion: We found that inter-rater agreement was higher for CTA ASPECTS as compared to CT ASPECTS and that both performed better in patents with the TM profile. Clinically this is important because it reaffirms the utility of CTA ASPECTS in this population of patients in which high reliability is paramount, as ASPECTS is often used in medical decision making when determining eligibility for medical and/or endovascular thrombolytic therapies.

scholarly journals Going home with baby: innovative and comprehensive support for new mothers

2018 ◽  
Vol 20 ◽  
Author(s):  
Tonia Olson ◽  
Angela Bowen ◽  
Julie Smith-Fehr ◽  
Swagata Ghosh
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Newborn Care ◽  
Community Services ◽  
Screening Tests ◽  
Physical And Mental Health ◽  
New Mothers ◽  
Care Clinic ◽  
Primary Health

AbstractShorter length of stay for postpartum mothers and their newborns necessitates careful community follow-up after hospital discharge. The vast amount of information given during the initial postpartum period can be overwhelming. New parents often need considerable support to understand the nuances of newborn care including newborn feeding. Primary health care and community services need to ensure there is a seamless continuum of care to support, empower, and educate new mothers and their families to prevent unnecessary hospital readmission and other negative health outcomes. The Healthy & Home postpartum community nursing program provides clinical communication and supports to bridge the gap between acute hospital and community follow-up care through home visits, a primary health care clinic, a breastfeeding center, a breastfeeding café, a postpartum anxiety and depression support group, bereavement support, and involvement in a Baby-Friendly Initiative™ coalition. Nurses working in the program have the acute care skills and resources to complete required health care assessments and screening tests. They are also international board-certified lactation consultants able to provide expert breastfeeding and lactation care. This paper describes how the Healthy & Home program has evolved over the past 25 years and offers suggestions to other organizations wanting to develop a postpartum program to meet the physical and mental health needs of postpartum families to promote maternal and infant wellbeing.

Obstetric and Perinatal Events

1992 ◽  
Vol 31 (4) ◽  
pp. 200-204 ◽  
Author(s):  
Rosemary Casey ◽  
Monica Rieckhoff ◽  
Susan A. Beebe ◽  
Jennifer Pinto-Martin
Keyword(s):  
Birth Weight ◽  
Perinatal Period ◽  
Discharge Summary ◽  
Maternal Knowledge ◽  
Maternal Report ◽  
Maternal Recall ◽  
Pregnancy And Delivery ◽  
Sensitivity Specificity ◽  
Infant Birth ◽  
Type Of Delivery

Physicians commonly rely on maternal recall of events during pregnancy, delivery, and the perinatal period. Investigators who are doing research in the reproductive and perinatal areas also rely on maternal recall. However, there is little information regarding its accuracy. This study evaluates the accuracy of maternal knowledge of events during pregnancy, delivery, and the perinatal period by comparing maternal report with information recorded on the medical records of the mother-infant pair. Results are presented as sensitivity, specificity, and chance-corrected agreement. Mothers demonstrated poor knowledge of pregnancy and delivery-room events. Agreement between maternal reports and hospital records was excellent for infant birth weight and type of delivery, and good for infant jaundice. However, other important areas of the infant's history, such as an evaluation for sepsis, were poorly recalled. The implications of these results are both medical- and research-specific. Physicians must be aware of possible inaccuracies in the mother's history and make every attempt to obtain the nursery discharge summary. In addition, researchers must verify the results of their data when relying on maternal recall, with the exception of infant birth weight and method of delivery.

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