The determinants of staff retention after Emergency Obstetrics and Newborn Care training in Kenya: A cross- sectional study

2021 ◽  
Author(s):  
Duncan N. Shikuku ◽  
Irene Nyaoke ◽  
Martin Eyinda ◽  
Sylvia Gichuru ◽  
Onesmus Maina ◽  
...  
Keyword(s):  
Transfer Rate ◽  
Maternal Mortality Ratio ◽  
Newborn Care ◽  
Staff Retention ◽  
Cross Sectional ◽  
Maternal Deaths ◽  
Study Objective ◽  
Significant Difference ◽  
Trained Staff ◽  
Nurse Midwives

Abstract Introduction Kenya’s maternal mortality ratio is relatively high at 342/100,000 live births. Confidential enquiry into maternal deaths showed that 90% of the maternal deaths received substandard care with health workforce related factors identified in 75% of 2015/2016 maternal deaths. Competent Skilled Health Personnel (SHP) providing emergency obstetric and newborn care (EmOC) in an enabling environment reduces the risk of adverse maternal and newborn outcomes. The study objective was to identify factors that determine the retention of SHP 1 – 5 years after EmOC training in Kenya.Methods A cross-sectional review of EmOC SHP in five counties (Kilifi, Taita Taveta, Garissa, Vihiga and Uasin Gishu) was conducted between January-February 2020. Data was extracted from a training database. Verification of current health facilities where trained SHP were deployed and reasons for non-retention were collected. Descriptive data analysis, transfer rate by county and logistic regression for SHP retention determinants was performed. Results A total of 927 SHP were trained from 2014-2019. Most SHP trained were nurse/midwives (677, 73%) followed by clinical officers (151, 16%) and doctors (99, 11%). Half (500, 54%) of trained SHP were retained in the same facility. Average trained staff transfer rate was 43%, with Uasin Gishu lowest at 24% and Garissa highest at 50%. Considering a subset of trained staff from level 4/5 facilities with distinct hospital departments, only a third (36%) of them are still working in relevant maternity/newborn/gynaecology departments. There was a statistically significant difference in transfer rate by gender in Garissa, Vihiga and the combined 5 counties (p<0.05). Interval from training in years (1 year, AOR=4.2 (2.1-8.4); cadre (nurse/midwives, AOR=2.5 (1.4-4.5); and county (Uasin Gishu AOR=9.5 (4.6- 19.5), Kilifi AOR=4.0 (2.1-7.7) and Taita Taveta AOR=1.9 (1.1-3.5), p<0.05, were significant determinants of staff retention in the maternity departments.Conclusion Retention of EmOC trained SHP in the relevant maternity departments was low at 36 percent. SHP were more likely to be retained by 1-year after training compared to the subsequent years and this varied from county to county. County policies and guidelines on SHP deployment, transfers and retention should be strengthened to optimise the benefits of EmOC training.

scholarly journals Epidemiology of respiratory distress in pregnancy and the newborn in Delta state Nigeria

2020 ◽  
Vol 7 (11) ◽  
pp. 4631
Author(s):  
Omatseye A. Akuirene ◽  
Samuel D. Nwajei ◽  
Josiah O. Adjene ◽  
John E. Moyegbone ◽  
Ezekiel U. Nwose
Keyword(s):  
Risk Factors ◽  
Respiratory Distress ◽  
Maternal Mortality Ratio ◽  
Significant Risk ◽  
Newborn Care ◽  
Developed Countries ◽  
Cross Sectional ◽  
Maternal Deaths ◽  
New Born ◽  
In Pregnancy

Epidemiology can be said to be the branch of medicine that deals with the incidence, distribution, and also possible control of diseases and other factors relating to health. Thus, epidemiology includes controlled clinical evaluations of different treatment methods; comparative assessment of lifestyle factors, such as smoking, drugs, and drinking habits; estimations of the risks of occupational factors; and cross-sectional and time-series analyses of factors that may affect health. To identify epidemiology of respiratory distress in pregnancy and new born. 34 international publications on respiratory distress disease in pregnancy and new born were reviewed for the presentation of this article. Respiratory distress syndrome (RDS) is a frequent newborn morbidity worldwide with reported prevalence of 18.5% in France, 4.24% in Pakistan and 20.5% in China. 20% of all global maternal deaths happen in Nigeria. Total number of maternal deaths in 2015 in the 46 most developed countries was 1700, resulting in a maternal mortality ratio of 12 maternal deaths per 100,000 live births. Given the state of the economy in the low and middle-income countries, Nigeria, like most of the other countries lack the resources (material, manpower and financial) require for optimal newborn care services. Newborn respiratory distress affects almost half of newborns. It is a major cause of neonatal admissions and has a high mortality rate. Many of its significant risk factors and etiologies are preventable. Adequate follow-up of pregnant women and during labor are of great necessity for early detection of risk factors and timely intervention in order to prevent the occurrence of neonatal respiratory distress.

scholarly journals Assessment of Healthcare Providers on the Extent of Essential Intrapartum and Newborn Care (EINC) Implementation among Postpartum Mothers in Cavite, Philippines: An Evaluation

2017 ◽  
Vol 28 (1) ◽  
Author(s):  
Mary Grace Prowel
Keyword(s):  
Post Partum ◽  
Healthcare Providers ◽  
Newborn Care ◽  
Considerable Influence ◽  
Maternal Deaths ◽  
Quality Healthcare ◽  
Live Births ◽  
Significant Difference ◽  
The Government ◽  
Postpartum Mothers

Improved medical care and services are some of the strategies that provide quality healthcare to women provided by the government. Such approach in the form of Essential Intrapartum and Neonatal Care (EINC) had reduced infant mortality from 57 every 1,000 live births in 1990 to 14 in 2011. However, maternal deaths have been unacceptably high as it has increased from 162 in 2006 to 211 in 2011 (NCSB, 2011). The study investigated, through a survey, the extent of the implementation of EINC as perceived by the healthcare providers and as assessed by post-partum mothers in Cavite.  It also wanted to know if health vectors such as mother’s education, the number of pregnancies, age, sex, and income influence their assessment of the implementation of EINC. Sixty-five (65) healthcare providers and 72 post-partum mothers participated in the study. Independent sample t-test and analysis of variance (ANOVA) were used to analyze the data. It was revealed that both healthcare providers and post-partum mothers assessed the implementation as well performed (µ=4.52) and highly observed (µ=4.47). There was no significant difference in the evaluation of the two groups. Health vectors had no considerable influence in the assessment of the post-partum mothers on the implementation of the EINC. Findings imply the success of the EINC application and, therefore, it was recommended that the government would continuously monitor and evaluate EINC to maintain its sustainability.  

scholarly journals Title Knowledge, attitude and use of evidence based practice (EBP) among Registered Nurse-Midwives practicing in Central Hospitals in Malawi: A Cross-Sectional Survey

2021 ◽  
Author(s):  
Paul Uchizi Kaseka ◽  
Balwani Chingatichifwe Mbakaya
Keyword(s):  
Evidence Based Practice ◽  
Critical Element ◽  
Evidence Based ◽  
Research Experience ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Educational Qualification ◽  
Significant Difference ◽  
Nurse Midwives ◽  
Knowledge Levels

Abstract Background: Even though EBP is being considered as a critical element in improving the quality of health services and achieving excellence in patient care, there is currently little knowledge of how EBP relates to nursing and midwifery in Malawi. This paper is a report of a study describing EBP knowledge, attitudes and use of registered nurses-midwives practicing in central hospitals in Malawi. Methods: The descriptive, cross-sectional research design was conducted with a convenient sample of 183 nurse-midwives (response rate of 86%). The study used a questionnaire to collect data. Data were analysed using both descriptive and inferential statistics in the Statistical Product and Service Solutions version 23. Descriptive statistics were calculated to summarize overall knowledge levels, attitudes and use of nurse-midwives as percentages based on their scores from the assessment scale (1 to 7 Likert scale) in the EBP questionnaire. Non-parametric Mann-Whitney and Kruskal-Wallis tests were carried out to compare evidence-based practice scores based on demographics. Pearson’s correlation (r) and stepwise regression analysis were further performed to analyse the relationship between the knowledge, attitude and use of nurse-midwives on the overall EBP of nurse-midwives. Results: The average scores (mean±SD) of evidence-based practice amongst nurse midwives were 78.7±19.6 for attitude, 70.6±15.1 for knowledge levels, 57.8±23.for use, and 68.9±14.2 for the overall EBP. Higher educational qualification was associated with higher scores in knowledge levels (P=0.02). Research experience was associated with higher scores in nursing use (P=0.005), and higher overall evidence based practice were associated with both research experience (P=0.035) and educational qualification (P=0.004). Nurse-midwives attitude was affected by clinical experience (P=0.006) and the hospital where nurse-midwives worked (P=0.016). There was no significant difference in the EBP scores of nurse-midwives based on gender and/or their administrative roles in their respective central hospitals Conclusion: It is important to develop the knowledge/skills of nurse midwives in order to enhance evidence based practice amongst nurse midwives in Malawian hospitals. The results can be used by nurse managers, nurse educators, Ministry of Health policy makers, Nurses and Midwives Council of Malawi and donors to enhance implementation of EBP.

scholarly journals The changing trends and tendencies in maternal mortality: a compare and contrast spanning two decades

2021 ◽  
Vol 10 (7) ◽  
pp. 2704
Author(s):  
Arunadevi G. ◽  
Vijayalakshmi N. ◽  
Sangeetha R.
Keyword(s):  
Maternal Mortality ◽  
Cause Of Death ◽  
Mode Of Delivery ◽  
Maternal Mortality Ratio ◽  
Maternal Deaths ◽  
Significant Difference ◽  
Centre Of Excellence ◽  
Mortality Ratio ◽  
Hypertensive Diseases ◽  
Compare And Contrast

Background: Though the maternal mortality ratio has been on the constant decline over two decades we shall strive forward to prevent all preventable maternal deaths and we have a long way to reach the SDG 3.1 goal. So, it becomes imperative to further reduce the mortality rates by continuously reviewing and upgrading our health policies. The aim of the study was to compare the trends in maternal mortality in 2002-2011 to the current predicament in 2017- 2019 in our hospital.Methods: Data was collected for all maternal deaths in the Institute of obstetrics and gynaecology, Egmore, Chennai- a centre of excellence for maternal care in South India, in terms of age at time of death, parity, period of death, mode of delivery, the cause of death and the admission to delivery interval and compared between the time periods of 2002-2011 and 2017-2019 to identify the changing patterns.Results: The maternal mortality ratio has consistently declined over the years from 220 in 2002 to 110 in 2019. The age group of 20-29 years and primigravidae continue to amount for most mortality. The postpartum period remains the most susceptible period. There is a significant increase in the number of caesarean deaths (64% from 46%). Significant transition in the cause of death from haemorrhage (20% to 7%) to hypertensive disease of pregnancy (23% to 35%) as leading cause of maternal mortality has been witnessed.Conclusions: Significant difference in the trends over two decades in maternal mortality lies in the fact that the leading cause of maternal mortality has changed from haemorrhage to hypertensive diseases and sepsis and they have continued to occupy the top spots for the past decade. Preventive measures are the solution to reduce maternal mortality due to either of the causes.

scholarly journals Maternal Mortality and Associated Factors in a Tertiary Care Center of Western Nepal

2017 ◽  
Vol 5 (2) ◽  
pp. 58-63
Author(s):  
Junu Shrestha ◽  
Sangeeta Gurung ◽  
Ashika Shrestha ◽  
Anjali Subedi
Keyword(s):  
Health Care ◽  
Maternal Mortality ◽  
Rural Areas ◽  
Care Center ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Medical Personnel ◽  
Educational Status ◽  
Cross Sectional ◽  
Maternal Deaths

Introduction: Identifying the cause of maternal death is important. The aim of this study was to determine the causes of maternal deaths and the factors associated with it. Methods: This was an observational, cross-sectional, analytical study conducted at Department of Obstetrics and Gynecology, Manipal Teaching Hospital from July 2013 to June 2017. Women who died during pregnancy, delivery, or puerperium were included in the study. Demographic factors, clinical profile, cause and type of maternal deaths were noted by taking history and by inquiring with the medical personnel involved in managing patients.  Data analysis was done using SPSS version 16. Results: There were 15 maternal deaths and 9923 livebirths. The maternal mortality ratio was 151 per 100,000 live births. Mean age of mothers was 28 years (SD = 7.5). Most of them were from rural areas, had low educational status. The mean gestational age at time of death was 33 weeks (SD = 7.5). Most of deaths (73%, n = 11) occurred in the postnatal period and 60% (n = 9) were critical at presentation. Direct obstetric causes like eclampsia was the most common (26.7%, n = 4) direct obstetric cause and cardiac disease was one of the important indirect cause (13.3%, n = 2). Delay in seeking health care and delay in reaching health center was the major reason for maternal deaths. Conclusion: Maternal mortality were mostly associated with direct obstetric causes, eclampsia being the most common. Most of the deaths were associated with delay in seeking health care and reaching health care centers.

scholarly journals Knowledge of General Practitioner Doctors and Midwives Who Has and Has Not Attended Neonatal Resuscitation Course Has No Significant Difference

2020 ◽  
Vol 1 (2) ◽  
pp. 38
Author(s):  
Vincent Geraldus Enoch Lusida ◽  
Bambang Puijo Semedi ◽  
Bambang Herwanto
Keyword(s):  
General Practitioners ◽  
Life Support ◽  
Health Workers ◽  
Neonatal Resuscitation ◽  
Newborn Care ◽  
Contributing Factors ◽  
Cross Sectional ◽  
Resuscitation Training ◽  
Significant Difference ◽  
Neonatal Resuscitation Program

Introduction: Infant death is most prominent in the neonatal period. The success of neonatal resuscitation practice has many contributing factors. One of which is the health workers’ knowledge of the Neonatal Resuscitation Program (NRP) algorithm. Therefore, it is necessary to conduct studies to evaluate the health workers’ knowledge of the Neonatal Resuscitation Program who are educated in neonatal resuscitation course and has taken part in Neonatal Life Support practice in primary health care (PHC)  Objective: This study aims to analyze the knowledge of general practitioners and midwives who has or has not attended in neonatal resuscitation course in Surabaya PHC Methods and Materials: this research is descriptive, cross-sectional research. All Basic Emergency Obstetric and Newborn Care (BEmONC) PHC in Surabaya which are Jagir PHC, Banyu Urip PHC, Medokan Ayu PHC, Tanah kali Kedinding PHC, Tanjungsari PHC, Balongsari PHC, Sememi PHC, Simomulyo PHC is included in this research from 2018 to 2019. A nine-item questionnaire referenced from The Textbook of Neonatal Resuscitation 7th Edition is given to ten respondents in each BEmONC PHC. Results and Discussion: from the total sample of 78 respondents, 32 (41,0%) receive a high score, 20 (25,7%) receive a middle score, and 26 (33,3%) receive a low score. The data shows that there is no significant score difference between respondents who has or has not participate in the NRP course (p=0,419). Conclusion:  There is no correlation between difference knowledge midwives and general practitioners who had and had not attended neonatal resuscitation training at basic emergency obstetric and newborn care in public health center Surabaya.

scholarly journals Comparing sagittal plane kinematics and kinetics of gait and stair climbing between hypermobile and non-hypermobile people; a cross-sectional study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alexander Vernon Bates ◽  
Alison H. McGregor ◽  
Caroline M. Alexander
Keyword(s):  
Sagittal Plane ◽  
Statistical Parametric Mapping ◽  
Joint Hypermobility ◽  
Stair Climbing ◽  
Stride Time ◽  
Beighton Score ◽  
Cross Sectional ◽  
Lower Velocity ◽  
Study Objective ◽  
Significant Difference

Abstract Background Joint Hypermobility Syndrome (JHS) presents with a range of symptoms including widespread joint hypermobility and chronic arthralgia. The study objective was to investigate whether impairments in JHS are due to hypermobility or another factor of JHS by identifying impairments in gait and stair-climbing tasks; an activity that is demanding and so may better show differences between the cohorts. Methods Sixty-eight adults participated; 23 JHS, 23 Generalised Joint Hypermobility (GJH), and 22 Normal Flexibility (NF). Inclusion criteria for JHS participants were a positive classification using the Brighton Criteria, for GJH a Beighton Score ≥ 4, and for NF a Beighton Score < 4 with no hypermobile knees. Participants were recorded with a 10-camera Vicon system whilst they performed gait and stair-climbing. Temporal-spatial, and sagittal plane kinematic and kinetic outcome measures were calculated and input to statistical analyses by statistical parametric mapping (SPM). Results During the gait activity JHS had significantly greater stride time and significantly lower velocity than NF, and significantly greater stride time, lower velocity, and lower stride length than GJH. SPM analysis showed no significant differences between groups in gait kinematics. There were significant differences between groups for gait moments and powers; people with JHS tended to have lower moments and generate less power at the ankle, and favour power generation at the knee. A similar strategy was present in stair ascent. During stair descent people with JHS showed significantly more hip flexion than people with NF. Conclusions As there was only one significant difference between GJH and NF we conclude that impairments cannot be attributed to hypermobility alone, but rather other factor(s) of JHS. The results show that both gait and stair-climbing is impaired in JHS. Stair-climbing results indicate that JHS are using a knee-strategy and avoiding use of the ankle, which may be a factor for clinicians to consider during treatment.

scholarly journals ROP screening and treatment in four district-level special newborn care units in India: a cross-sectional study of screening and treatment rates

2021 ◽  
Vol 5 (1) ◽  
pp. e000930
Author(s):  
Shalinder Sabherwal ◽  
Clare Gilbert ◽  
Allen Foster ◽  
Praveen Kumar
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Newborn Care ◽  
Cross Sectional Study ◽  
District Level ◽  
Sectional Study ◽  
Cross Sectional ◽  
Significant Difference ◽  
Rop Screening

ObjectiveBlindness from retinopathy of prematurity (ROP) in middle-income countries is generally due to absence of screening or inadequate screening. The objective of this study was to assess uptake of services in an ROP programme in four district-level special newborn care units in India.DesignCross-sectional study.SettingAll four neonatal units of a state in India where model programme for ROP had been introducedPatientsInfants eligible for screening and treatment of ROP between March and May 2017.InterventionData on sex, birth weight and gestational age of eligible infants were collected and medical records reviewed for follow-up.Main outcome measuresProportion of eligible infants screened and for those screened, age at first screening, completion of screening, diagnosis and treatment received if indicated. The characteristics of infants screened and not screened were compared.Results137 (18%) of the 751 infants eligible for screening were screened at least once, with no statistically significant difference by sex. The mean birth weight and gestational age of those screened were significantly lower than those not screened. Among those screened, 43% underwent first screening later than recommended and 44% had incomplete follow-up. Fourteen infants (11% of those screened) were diagnosed with ROP. Five were advised laser treatment and all complied.ConclusionUptake, completion and timing of first screening was suboptimal. Some planned interventions including training of nursing staff, use of integrated data-management software and providing material for parent counselling, which have been initiated, need to be fully implemented to improve uptake of ROP screening services.

Personal Audio System: Hearing Symptoms, Habits, and Sound Pressure Levels Measured in Real Ear and a Manikin

2020 ◽  
Vol 63 (6) ◽  
pp. 2016-2026
Author(s):  
Tamara R. Almeida ◽  
Clayton H. Rocha ◽  
Camila M. Rabelo ◽  
Raquel F. Gomes ◽  
Ivone F. Neves-Lobo ◽  
...  
Keyword(s):  
Sound Pressure ◽  
Daily Basis ◽  
Cross Sectional Study ◽  
Normal Hearing ◽  
Chi Square ◽  
Cross Sectional ◽  
The Real ◽  
Significant Difference ◽  
Sound Pressure Levels ◽  
Audio System

Purpose The aims of this study were to characterize hearing symptoms, habits, and sound pressure levels (SPLs) of personal audio system (PAS) used by young adults; estimate the risk of developing hearing loss and assess whether instructions given to users led to behavioral changes; and propose recommendations for PAS users. Method A cross-sectional study was performed in 50 subjects with normal hearing. Procedures included questionnaire and measurement of PAS SPLs (real ear and manikin) through the users' own headphones and devices while they listened to four songs. After 1 year, 30 subjects answered questions about their usage habits. For the statistical analysis, one-way analysis of variance, Tukey's post hoc test, Lin and Spearman coefficients, the chi-square test, and logistic regression were used. Results Most subjects listened to music every day, usually in noisy environments. Sixty percent of the subjects reported hearing symptoms after using a PAS. Substantial variability in the equivalent music listening level (Leq) was noted ( M = 84.7 dBA; min = 65.1 dBA, max = 97.5 dBA). A significant difference was found only in the 4-kHz band when comparing the real-ear and manikin techniques. Based on the Leq, 38% of the individuals exceeded the maximum daily time allowance. Comparison of the subjects according to the maximum allowed daily exposure time revealed a higher number of hearing complaints from people with greater exposure. After 1 year, 43% of the subjects reduced their usage time, and 70% reduced the volume. A volume not exceeding 80% was recommended, and at this volume, the maximum usage time should be 160 min. Conclusions The habit of listening to music at high intensities on a daily basis seems to cause hearing symptoms, even in individuals with normal hearing. The real-ear and manikin techniques produced similar results. Providing instructions on this topic combined with measuring PAS SPLs may be an appropriate strategy for raising the awareness of people who are at risk. Supplemental Material https://doi.org/10.23641/asha.12431435

Parent’s Experiences from the Treatment of their Children at the Physic Children’s Surgery Clinic in Skopje.

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
M. Trajchevska ◽  
A. Lleshi ◽  
S. Gjoshev ◽  
A. Trajchevski
Keyword(s):  
Health Care ◽  
Health Status ◽  
Independent Predictor ◽  
Demographic Data ◽  
Parental Satisfaction ◽  
Pediatric Care ◽  
Simple Random Sample ◽  
Significant Independent Predictor ◽  
Cross Sectional ◽  
Significant Difference

Background: The respect of the needs and wishes of the patients is in the focus of the human health system. The experience of the parents in terms of child’s health care may be used as an indicator of quality of the health care. Material and methods: The research is a quantitative analytical cross-sectional study. In accordance with the inclusion and exclusion criteria, simple random sample of 207 parents / guardians is covered, whose children in the period of three months, had been hospitalized in the hospital department JZUU Pediatric Surgery Clinic in Skopje.It was used a two parted questionnaire. The first part is a standardized questionnaire (Parent Experience of Pediatric Care - PECP), and the second part concerns the general socio-demographic data of the parent/guardian. Statistical evaluation was performed using appropriate statistical programs (Statistics for Windows 7,0 and SPSS 17.0). Results: In accordance with the age of the parents, the survey respondents were divided into two groups: a) age ≤ 33 years - 107 (51.69%) and b) age> 33 years - 100 (48.31%).Significant independent predictor of parental satisfaction from the receipt of their child to the clinic research confirms the age of the parent under / over 33 years due to 4.1% of the change in satisfaction (R2 = 0,041). Parents generally believe that their children's room of the clinic is "good", without significant difference between parental satisfaction from both age groups (Mann-Whitney U Test Z = -0,9613 p = 0,3364). Significant independent predictor of parental satisfaction from the room of their child improves the health status after treatment due to 6% of the change in satisfaction (R2 = 0,060). Parents generally believe that testing and treatment of their children in the clinic was "very good" and an independent significant predictor is to improve the health status after the treatment - 7,8% (R2 = 0,078). Conclusions: Regardless of the generally good parental satisfaction about health care for their children, it is necessary to continuously monitor the status of the clinic in order to consider the possible deficiencies and needs of intervention.

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