Does Hypertensive Disorder and Obstetric Factors Associate with Still Birth Among Women Who Gave Birth in Selected Hospital of Southwestern, Ethiopia?

2021 ◽  
Author(s):  
Melese ◽  
Sisay
Keyword(s):  
Antenatal Care ◽  
Blood Group ◽  
Multivariable Analysis ◽  
P Value ◽  
Hypertensive Disorder ◽  
Still Birth ◽  
Hypertensive Disorders ◽  
Obstetric Factors ◽  
Clinical Records ◽  
Double Population

Abstract Background: The cause of stillbirth is often unknown, but can be attributable to various causes; hypertensive disorders and obstetric factors supposed to complicate pregnancy and may cost the life of the fetus. It is the series pregnancy problem not precisely known and only available few research findings are inconsistent & not well established.Objectives: The aim of this study is to assess the association between Stillbirth and hypertensive disorder and obstetric factors.Methods: Facility based unmatched case-control study design was employed from January2018 to June2019, (287 cases and 574 controls) was selected using systematic random sampling methods. Double population proportions formula with 1:2 case to control ratio was used to calculate sample size with 95% confidence interval and 80% power. The data was collected from clinical records of mother’s a using data collecting checklist. Epi data version 4.4.2.1 was used for data entry, and analysis was done by SPSS version 21 statistical software. Descriptive analysis such as frequency, percentage and chi-square test were done. For the inferential analysis, a multivariable analysis was done. Statically significant was used at a p-value <0.05 both for the univarible and multivariable analysis.Result: Women who had hypertensive disorder were 1.76 times at risk to have stillbirth than no hypertensive disorder (AOR: 1.76: 95%CI :( 1.06, 2.9). In addition, women who had first antenatal care at third trimester were 4 times at higher risk to have still birth than women, who had first antenatal care at first trimesters (AOR: 4, 95%CI: (1.54, 11). Women who had more than four children were 2.6 times at higher risk of having still birth compared with women one child (AOR: 2.6, 95%CI: (1.2, 5.7). Furthermore, the odds of having still birth was found to be higher in women, who had blood group O than blood group A (AOR: 1.7: 95%CI: (1.057, 2.8).Conclusion: According to the findings of this study, we conclude that a hypertensive disorders and obstetric factors were risk factors for stillbirth. Therefore, it is significant to give special attention to women with hypertensive disorder and multipara women.

scholarly journals Intended Pregnancy as a Predictor of Good Knowledge on Birth Preparedness and Complication Readiness: the Case of Northern Ethiopia Pregnant Mothers

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Haile Zewdu Tsegaw ◽  
Endeshaw Admassu Cherkos ◽  
Marta Berta Badi ◽  
Muhabaw Shumye Mihret
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Multivariable Analysis ◽  
Good Knowledge ◽  
P Value ◽  
Northern Ethiopia ◽  
Birth Preparedness ◽  
Multivariable Logistic Regression Model ◽  
Cross Sectional ◽  
Complication Readiness

Background. Maternal mortality remains unacceptably high in developing countries. One key strategy to reduce such mortality is utilization of birth preparedness and complication readiness (BP/CR) and creating awareness of BP/CR is an important step for pregnant women, their families, and the community. However, there was limited to no evidence regarding the community’s awareness on BP/CR in the study area. Therefore, this study aimed to assess knowledge on BP/CR and associated factors among pregnant women in Debremarkos town, Northwest Ethiopia, 2017. Methods. A Community based cross-sectional study was conducted from July 1 to 30/2017. A total of 441 pregnant women were included in the study. Structured and pretested questionnaire was administered through face to face interview to collect the data. Simple random sampling technique was used to select the study participants. The data were entered in to Epinfo version 7.0 and then exported to SPSS version 20.0 for analysis. Both bivariate and multivariable logistic regression model were fitted. Crude and adjusted odds ratio with 95 % confidence interval have been computed and variables with p-value < 0.05 were considered statistically significance. Results. The proportion of pregnant women having good knowledge on birth preparedness and complication readiness was found to be 45.2 with 95%CI (40.4, 50.0). In the multivariable analysis, having history of childbirth (AOR=2.17;95%CI:1.18,4.00), having intended pregnancy (AOR=2.13;95%CI: 1.16, 3.90), being governmental employee ( AOR=6.50; 95%CI: 2.50, 16.87), and having Antenatal care visits (AOR=5.50; 95%CI:2.2,13.70) were factors which were independently and significantly associated with good knowledge on birth preparedness and complication readiness. Conclusion. Proportion of pregnant women having good knowledge on birth preparedness and complication readiness was low. Putting emphasis on intended pregnancy and antenatal care visit was recommended.

scholarly journals Prevalence and Factors Associated with Late Antenatal Care Visit in Ethiopia: A population-based study using the 2016 Ethiopia Demographic and Health Survey

2019 ◽  
Author(s):  
Eskeziaw Kassahun Abebe ◽  
Amanuel Addisu Dessie ◽  
Liknaw Bewket Zeleke
Keyword(s):  
Maternal Health ◽  
Antenatal Care ◽  
Health Survey ◽  
Multivariable Analysis ◽  
Demographic And Health Survey ◽  
Maternal Health Service ◽  
P Value ◽  
Factors Associated ◽  
Antenatal Care Visit ◽  
Care Visit

Abstract Objectives Maternal health care services are important for the survival and wellbeing of both mother and infant. In 2015, an estimated 303,000 women died from pregnancy-related complications. The Ethiopian government has implemented strategies to enhance maternal health service utilization, and reduce maternal morbidity and mortality. However, only 20.4% of women initiated the first antenatal care visit before 16 weeks of gestation. Therefore, this study assessed factors associated with late antenatal care visit in Ethiopia. A community based cross-sectional study design was used to examine 4,740 women from the 2016 Ethiopia Demographic and Health Survey data. Odds ratios with corresponding 95% confidence intervals (CI) were computed to examine the strength of an association. In the multivariable analysis, variables with p-value <0.05 were considered as statistically significant. Result The prevalence of late initiation of first antenatal care visit in Ethiopia was 67.3% (65.0%,69.6%). Living in rural areas (AOR= 95% CI:1.19,2.56) and fifth or above birth order (AOR=1.5;95% CI:1.10,2.00) were significantly associated with late antenatal care visit. Consequently, increasing the access and utilization of family planning, and raise an awareness on the benefit of early initiation of first antenatal care visit is recommended.

scholarly journals STUDY ON STILL BIRTH: A CATASTROPH FOR PATIENT AND NIGHTMARE FOR THE OBSTETRICIAN

2020 ◽  
Vol 8 (10) ◽  
pp. 249-253
Author(s):  
Somya Saxena ◽  
◽  
Veena Gupta ◽  
Nidhi Sachan ◽  
◽  
...  
Keyword(s):  
Antenatal Care ◽  
Low Socioeconomic Status ◽  
Birth Rate ◽  
Early Recognition ◽  
P Value ◽  
Vaginal Route ◽  
Skilled Attendant ◽  
Still Birth ◽  
Still Births ◽  
Significant Difference

Introduction: Still Birth is a catastrophic event for both treating doctor and the patient.World wide in 2015, for every 1000 total births, 18.4 babies were stillborn, mostly in low and middle income countries. India has the highest number of stillbirths, with an estimated 592 100 deaths per year Aim : To evaluate the still birth rate of our institution and to assess the sociodemographic factors contributing to it, and to predict the maximum risk period for still birth. Material and Methods: All patients who gave consent and delivered a baby either vaginally or by caeserian section after 28 weeks of gestation during the study period(july 2019-June 2020) were included in the study.Still Birth was defined as a baby born after 28 completed weeks of gestation or weighing more than 1 kg,with no signs of life .Total no of patients during the study period were 2629, with 5 sets of twins. So total no of birth during the study period was 2634. Epidemiological data were compared between still birth and total births.Causes of still births were analysed and period of maximum risk for still birth was predicted. Statistical Analysis :Descriptiveanalytes were expressed in proportion. Chi square test was used to assess the significance level and p value of <.05 was taken as significant. Result: Total no. of births by either vaginal route or caesarean section during june 2019 to july 2020 were 2634 foetuses. among which,137 fetus were still born. So still birth rate was 52/1000 live births.Maximum no of still births were in the age group of 20-25 years 69(50.3%), were primigravida 46(33.5%), belonged to low socioeconomic status 95(69.3%), came from rural areas79(57.6%) and were unbooked 94(68.6%).There was statistically significant difference(p=.0012) in unbooked cases when still births and total births were compared. No cause could be attributable to still birth in 15(10.9%) of cases, whereas 81(59.1%) had maternal causes,17(12.4%) had fetal causes, 19(13.8%) had placental causes while 5(3.6%) had other reasons like acute infections or thermal burns. Major reason of StillBirth amongst the maternal causes, was labour complications 38(37.7%), whereas intra uterine growth restriction was the leading cause 8(5.8%) amongst the fetal factors.36-40 week was the gestational age during which maximum still births occured.95(69.31%) of still birth cases were delivered by vaginal route Conclusion:Majority of still births were in unbooked cases and labourcomplications were the leading cause of still births overall. Hence antenatal care and delivery by skilled attendant is of paramount importance. Routine antenatal care would also lead to early recognition of maternal and fetal high risk factors and their management.

scholarly journals PREVALENCE OF HYPERTENSIVE DISORDERS AMONG PREGNANT WOMEN ATTENDING ANTENATAL CARE IN SELECTED PUBLIC HOSPITALS IN ADDIS ABABA, ETHIOPIA

2021 ◽  
Vol 7 (2) ◽  
pp. 19-44
Author(s):  
Weynshet Firisa ◽  
Lister Onsongo ◽  
Judy Mugo
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Quantitative Data ◽  
Qualitative Data ◽  
Addis Ababa ◽  
Public Hospitals ◽  
Hypertensive Disorder ◽  
Hypertension In Pregnancy ◽  
Hypertensive Disorders ◽  
In Pregnancy

Purpose: This study sought to assess the prevalence of hypertension in pregnancy and associated risk factors among women attending antenatal care clinics in selected Pubic Hospitals in Addis Ababa, Ethiopia. Materials and Methods: The research employed a cross-sectional descriptive study design. Study population was pregnant women who attended ANC care in selected hospital.  The respondents were randomly selected from Tikur Anbesa specialized, Zewuditu Memorial and St. Paul’s Millennium medical college hospitals. Respondents for interview were selected using systematic random sampling at an interval of nine until a sample size of 297 was reached. The study used an adopting both quantitative and qualitative data collection methods. Quantitative data was collected using structured questionnaires from pregnant women attending antenatal care clinics while qualitative data was collected using key informant interview schedules and Focused Group Discussion guides with Nurses in charge of antenatal care clinics and primary respondents respectively. Key informants and focused group discussants were purposively selected. Descriptive data was analysed using Statistical Package for Social Sciences version 20.0 with the aid of Microsoft Excel program to generate frequency tables, graphs and pie-charts. Qualitative data was analysed using thematic analysis and results triangulated with quantitative data as direct quotes or narrations. Inferential statistics were calculated using Chi-Square tests done at 95% confidence interval and a margin of error of 0.05 to establish the association between variables. Information generated were presented in the text in the form of tables, bar graphs and pie charts. Results: The study results revealed that the prevalence of pregnancy induced hypertension in Addis Ababa was 21.9%. Socio-demographic factors such as age (p=0.030), occupation (p=0.031), income (p=0.0014), highest level of education (p=0.001) and health insurance (p=0.001) were significantly associated with occurrence of hypertension in pregnancy. Rreproductive and obstetric factors such as age at first pregnancy (p=0.001), gravidity (p=0.046), parity (p=0.001), history of obesity (p=0.001) and occurrence of gestational diabetes (p=0.002) were significantly associated with hypertension in pregnancy. More than a half (51.9%) of respondents had negative attitude towards hypertensive disorder in pregnancy. The level of attitude (p=0.040) was significantly associated with occurrence of hypertension in pregnancy. Unique contribution to theory, practice and policy: The study recommends that the management of the 3 health facilities together with other stakeholders in health empower women to start income generating projects to increase their financial access to antenatal care services consequently reduces hindrances that may lead to pregnancy complications such as hypertensive disorders in pregnancy.

scholarly journals Determinants of births protected against neonatal tetanus in Ethiopia: A multilevel analysis using EDHS 2016 data

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243071
Author(s):  
Achamyeleh Birhanu Teshale ◽  
Getayeneh Antehunegn Tesema
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Multilevel Analysis ◽  
Multivariable Analysis ◽  
Media Exposure ◽  
Maternal Health Services ◽  
Reproductive Age ◽  
Neonatal Tetanus ◽  
P Value

Background Even though there is low coverage of maternal health services such as antenatal care and skilled birth attendant delivery as well as poor sanitary practice during delivery in Ethiopia, the proportion of births protected by the tetanus vaccine is low. Thus, this study aimed to investigate the determinants of births protected against neonatal tetanus in Ethiopia. Objective To assess the determinants of births protected against neonatal tetanus in Ethiopia. Method The study was based on secondary data analysis of the Ethiopian Demographic and Health Survey 2016 data. A weighted sample of 7590 women who gave birth within five years preceding the survey was used for analysis. We conducted a multilevel analysis, due to the hierarchical nature of the data. Variables with p-value <0.05 in the multivariable analysis were declared to be significantly associated with having births protected against neonatal tetanus. Result In this study, mothers with primary education [adjusted odds ratio (AOR) = 1.23; 95%CI: 1.04, 1.44] and secondary and above education [AOR = 1.36; 95%CI: 1.06, 1.73], media exposure [AOR = 1.35; 95%CI: 1.15, 1.58], not perceiving distance from the health facility as a big problem [AOR = 1.24; 95%CI: 1.08,1.42], one antenatal care (ANC) visit [AOR = 1.56; 95%CI: 2.71, 4.68], two to three ANC visit [AOR = 11.82; 95%CI: 9.94,14.06], and four and more ANC visit [AOR = 15.25; 95%CI: 12.74, 18.26], being in Amhara [AOR = 0.59; 95%CI: 0.38,0.92], Afar [AO = 0.41; 95%CI: 0.25,0.66], and Harari [AOR = 1.88; 95%CI: 1.15,3.07] regions, being in communities with higher level of women education [AOR = 1.25; 95%CI: 1.03,1.52], and higher level of media exposure [AOR = 1.22; 95%CI: 1.01,1.48] were significant predictors of having a protected birth against neonatal tetanus. Conclusion In this study, both individual level and community level factors were associated with having protected birth against neonatal tetanus. Therefore, strengthening maternal health services such as ANC visits and interventions related to increasing media campaigns regarding tetanus could increase the immunization against tetanus among reproductive-age women. In addition, it is also better to give attention to those reproductive age group women from remote areas and also better to distribute maternal services fairly and equally between regions.

HUBUNGAN ANTARA USIA DAN PENDIDIKAN IBU DENGAN PEMERIKSAAN KEHAMILAN DI KLINIK BUDI MULIA PALEMBANG TAHUN 2014

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Rubiyati Rubiyati
Keyword(s):  
Prenatal Care ◽  
Antenatal Care ◽  
Gestational Age ◽  
Significant Relationship ◽  
Univariate Analysis ◽  
Survey Method ◽  
Bivariate Analysis ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional

ABSTRACT Antenatal Care is the care given to pregnant woman to monitor, support maternal health and maternal detect, whether normal or troubled pregnant women. Aki in Indonesia amounted to 359 in 100.000 live births. The purpose of the study was to determine the relationship between age and education in the clinic Budi Mulia Medika 2014. This study used a survey method whit cross sectional analytic. This is the overall study population of women with gestational age ≥36 weeks who come to visit the clinic Budi Mulia Medika Palembang on February 10 to 18. The study sample was taken in non-random with the technique of “accidental smapling “ with respondents who happens to be there or variable. The obtained using univariate and bivariate analysis using Chi-Square test statistic. The results of the univariate analysis showed that 83,3% of respondents did according to the standard prenatal care, high risk age 40,0 %, 60,0% lower risk of age, higher education 70,0%, 30,0% low education. Bivariate analysis showed that there was no significant relationship betwee age and pregnancy tests wit p value= 0,622, and significant relationship between education and prenatal care with p value= 0,019. From the results of this study are expected to need to increase outreach activities to the community about the importance of examination of pregnancy according to gestational age in an effort to reduse maternal mortality.   ABSTRAK Antenatal Care merupakan pelayanan  yang di berikan pada ibu hamil untuk memonitor, mendukung kesehatan ibu dan mendeteksi ibu, apakah ibu hamil normal atau bermasalah. Di Indonesia AKI berjumlah 359 per 100.000 kelahiran hidup. Tujuan penelitian adalah untuk mengetahui hubungan antara usia dan pendidikan dengan pemeriksaan kehamilan di klinik budi mulia medika tahun 2014. Penelitian ini menggunakan metode survey analitik dengan pendekatan cross sectional. Populasi penelitian ini adalahseluruh ibu dengan usia kehamilan ≥ 36 minggu yang dating berkunjung ke Klinik Budi Mulia Medika pada tanggal 10-18 Februari. Sampel penelitian ini di ambil secara non random dengan tekhnik ‘’ Accidental Sampling’’ dengan responden yang kebetulan ada atau tersedia. Data yang di peroleh menggunakan analisis univariat dan bivariat menggunakan uji statistik Chi-Square. Hasil analisis univariat ini menunjukan bahwa 83,8% responden melakukan pemeriksaan kehamilan sesuai standar, 16,7% tidak melakukan pemeriksaan kehamilan sesuai standar, usia resiko tinggi 40,0%, usia resiko rendah 60,0%, pendidikan tinggi 70,0 %, pendidikan rendah 30,0 %. Analisis bivariat menunjukan bahwa tidak ada hubungan bermakna antara usia dengan pemeriksaan kehamilan dengan p value =0,622, ada hubunngan bermakana antara pendidikan dengan pemeriksaan kehamilan dengan p value = 0,019. Dari hasil penelitian ini di harapkan perlu meningkatkan kegiatan penyuluhan kepada masyarakat tentang pentingnya dilakukan pemeriksaan kehamilan sesuai dengan umur kehamilan sebagai upaya menurunkan angka kematian ibu.    

The impact of SPY angiography on intraoperative decision making and outcomes for post-mastectomy reconstruction

2019 ◽  
pp. 1-5
Keyword(s):  
Decision Making ◽  
Logistic Regression ◽  
Skin Necrosis ◽  
Regression Models ◽  
Multivariable Analysis ◽  
P Value ◽  
Flap Necrosis ◽  
Single Institution ◽  
Logistic Regression Models ◽  
The Impact

Objective: While the use of intraoperative laser angiography (SPY) is increasing in mastectomy patients, its impact in the operating room to change the type of reconstruction performed has not been well described. The purpose of this study is to investigate whether SPY angiography influences post-mastectomy reconstruction decisions and outcomes. Methods and materials: A retrospective analysis of mastectomy patients with reconstruction at a single institution was performed from 2015-2017.All patients underwent intraoperative SPY after mastectomy but prior to reconstruction. SPY results were defined as ‘good’, ‘questionable’, ‘bad’, or ‘had skin excised’. Complications within 60 days of surgery were compared between those whose SPY results did not change the type of reconstruction done versus those who did. Preoperative and intraoperative variables were entered into multivariable logistic regression models if significant at the univariate level. A p-value <0.05 was considered significant. Results: 267 mastectomies were identified, 42 underwent a change in the type of planned reconstruction due to intraoperative SPY results. Of the 42 breasts that underwent a change in reconstruction, 6 had a ‘good’ SPY result, 10 ‘questionable’, 25 ‘bad’, and 2 ‘had areas excised’ (p<0.01). After multivariable analysis, predictors of skin necrosis included patients with ‘questionable’ SPY results (p<0.01, OR: 8.1, 95%CI: 2.06 – 32.2) and smokers (p<0.01, OR:5.7, 95%CI: 1.5 – 21.2). Predictors of any complication included a change in reconstruction (p<0.05, OR:4.5, 95%CI: 1.4-14.9) and ‘questionable’ SPY result (p<0.01, OR: 4.4, 95%CI: 1.6-14.9). Conclusion: SPY angiography results strongly influence intraoperative surgical decisions regarding the type of reconstruction performed. Patients most at risk for flap necrosis and complication post-mastectomy are those with questionable SPY results.

Association Between Awareness of Informal Caregivers and Falls in Elderly Patients with Uncontrolled Diabetes Mellitus

2020 ◽  
Vol 13 (1) ◽  
pp. 658-666
Author(s):  
Tossapon Chamnankit ◽  
Parichat Ong-artborirak ◽  
Jukkrit Wangrath
Keyword(s):  
Diabetes Mellitus ◽  
Elderly Patients ◽  
Elderly People ◽  
Informal Caregivers ◽  
Multivariable Analysis ◽  
P Value ◽  
Uncontrolled Diabetes ◽  
Risk Of Falls ◽  
The Mean ◽  
Falls In Elderly

Background: Elderly people with uncontrolled diabetes mellitus (DM) are at risk of falls, which can lead to injury and disability. Not much is known of informal caregivers’ awareness of falls in elderly patients with DM. Objective: This study aims to identify an association between caregiver’s awareness and falls in elderly patients with DM. Methods: A total of 136 pairs of DM patients and their respective family caregivers were recruited from a clinical service center at Chiang Mai University, Thailand. The questionnaire regarding the caregiver’s awareness of the risk of falls in elderly patients was given via a face-to-face interview. Each elderly patient was asked about their history of falls in the prior year, and the risk of falls was assessed by Time Up & Go (TUG) test. Logistic regression analysis was performed to determine association. Results: The mean age of the DM patients was 65.7 years. Sixty-two patients (45.6%) had fallen at least once in the prior year. The mean TUG test result was 12.67±1.83 second. Most caregivers demonstrated a high level of awareness regarding the risk of falls in elderly patients. The results of the multivariable analysis showed that three variables – balance problems, risk of falls assessed by TUG test, and scores of caregiver’s awareness of risk of falls – were significantly related to falls in the previous year among elderly patients with DM (p-value<0.05). Conclusion: The caregivers’ awareness of fall risk may influence fall occurrence among older adults with DM. An intervention program to improve awareness among informal caregivers should be considered for fall prevention in elderly people.

scholarly journals Orthodontic Treatment and Craniocervical Posture in Patients with Temporomandibular Disorders: An Observational Study

2021 ◽  
Vol 18 (6) ◽  
pp. 3295
Author(s):  
Maria Paço ◽  
José Alberto Duarte ◽  
Teresa Pinho
Keyword(s):  
Temporomandibular Disorders ◽  
Orthodontic Treatment ◽  
Hyoid Bone ◽  
Craniofacial Morphology ◽  
P Value ◽  
Skeletal Class ◽  
Treatment Data ◽  
Phase Data ◽  
Condylar Displacement ◽  
Clinical Records

Orthodontic treatment acts through the application of forces and/or by stimulating and redirecting the functional forces within the craniofacial complex. Considering the interrelationship between craniomandibular and craniocervical systems, this intervention may alter craniocervical posture. Thus, our aim is to (a) compare craniocervical posture, hyoid bone position, and craniofacial morphology before, after, and also in the contention phase at least one year after the orthodontic treatment, in patients with temporomandibular disorders and (b) to verify whether the presence of condylar displacement, the skeletal class, or the facial biotype interferes with the abovementioned outcomes. To do so an observational, analytical, longitudinal, and retrospective design study was carried out. A non-probabilistic convenience sampling method was applied. The sample consisted of clinical records of patients diagnosed with temporomandibular disorders in order to compare pre-orthodontic treatment with post-orthodontic treatment (n = 42) and contention phase data (n = 26). A cephalometric analysis of several variables was performed. The p-value was set as 0.05. When the pre- and post-orthodontic treatment data were analyzed, there were statistically significant changes in variables concerning craniocervical posture (CV angle, C0-C1, and AA-PNS) and also concerning hyoid bone position (C3-Rgn). When pre- and post-orthodontic treatment and contention phase data were analyzed the variables concerning craniocervical posture (C0-C1, CVT/Ver, NSL/OPT, NSL/CVT, NSL/Ver; OPT/CVT, OPT/Ver) and facial biotype had statistically significant changes. This allowed us to conclude that in the sample studied, there were significant differences regarding hyoid bone position (pre- versus post-orthodontic treatment) and craniocervical posture (pre- versus post-orthodontic versus contention), with the craniocervical posture being prone to return to basal values. The presence of condylar displacement was found to significantly increase the H-H1 distance in the three moments of evaluation. Facial biotype was found to significantly increase the NSL/Ver angle on hypodivergent compared to hyperdivergent in the contention phase.

scholarly journals Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046638
Author(s):  
Sk Masum Billah ◽  
Abdullah Nurus Salam Khan ◽  
S M Rokonuzzaman ◽  
Nafisa Lira Huq ◽  
Marufa Aziz Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Workers ◽  
Gestational Hypertension ◽  
Cross Sectional Study ◽  
P Value ◽  
Sectional Study ◽  
Hypertensive Disorders Of Pregnancy ◽  
Cross Sectional ◽  
Hypertensive Disorders ◽  
Care Facilities

Study objectiveTo evaluate the competency of trained health workers in detecting and managing hypertensive disorders of pregnancy during routine antenatal check-ups (ANCs) at primary care facilities in Bangladesh.Study design and settingsCross-sectional study; conducted in 26 primary care facilities.Outcome measuresAccurate diagnosis of the hypertensive disorders of pregnancy.MethodIn total 1560 ANC consultations provided by primary health workers, known as Family Welfare Visitors (FWVs), were observed using a structured checklist between October 2017 and February 2018. All consultations were reassessed by study physicians for validation.ResultOf the ‘true’ cases of gestational hypertension (n=32), pre-eclampsia (n=29) and severe pre-eclampsia (n=16), only 3%, 7% and 25%, respectively, were correctly diagnosed by FWVs. Per cent agreement for the diagnosed cases of any hypertensive disorders of pregnancy was 9% and kappa statistics was 0.50 (p value 0.0125). For identification of any hypertensive disorders by FWVs, sensitivity and positive predictive values were 14% and 50%, respectively. There was a moderate positive correlation between the blood pressure measurements taken by FWVs and study physicians. Only 27% of those who had ‘some protein’ in urine were correctly identified by FWVs. Women diagnosed with any of the hypertensive disorders of pregnancy by FWVs were more likely to be counselled on at least one danger sign of pre-eclampsia (severe headache, blurring of vision and upper abdominal pain) than those without any such diagnosis (41% vs 19%, p value 0.008). All four cases of severe pre-eclampsia diagnosed by FWVs were given a loading dose of intramuscular magnesium sulphate and three among them were referred to a higher facility.ConclusionThe FWVs should be appropriately trained on risk assessment of pregnant women with particular emphasis on accurately assessing the diagnostic criteria of hypertensive disorders of pregnancy and its management.

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