scholarly journals Accuracy of the Community Maternal Danger Score Algorithm for Predicting Pregnant Women Requiring Skilled Birth Attendants and at High-risk for Mortality

2021 ◽  
Author(s):  
Rajan Bola ◽  
Fanan Ujoh ◽  
Ugochinyere Vivian Ukah ◽  
Ronald Lett
Keyword(s):  
Literature Review ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Low Cost ◽  
Maternal Mortality Ratio ◽  
Multivariate Logistic Regression Analysis ◽  
Receiver Operating Curve ◽  
Skilled Birth Attendants ◽  
Maternal Risk ◽  
Birth Attendants

Abstract BackgroundHigh rates of maternal mortality in low-and-middle-income countries (LMICs) are associated with the lack of skilled birth attendants (SBAs) at delivery. Risk analysis tools may be useful to identify pregnant women who are at risk of mortality in LMICs. We sought to develop a low-cost maternal risk tool, the Community Maternal Danger Score (CMDS), to identify pregnant women who need an SBA at delivery.MethodsTo design the CMDS algorithm, an initial literature review was conducted to identify predictors of the need for an SBA. Medical records of women who delivered at the Federal Medical Centre in Makurdi, Nigeria (2019-2020) were examined for predictors identified from the literature review. Outcomes associated with the need for an SBA were recorded: caesarean section, postpartum hemorrhage, eclampsia, and sepsis. A maternal mortality ratio (MMR) was determined. Multivariate logistic regression analysis and area under the receiver operating curve (AUC) were used to assess the predictive ability of the CMDS algorithm.ResultsSeven factors from the literature predicted the need for an SBA: age (under 20 years of age or 35 and older), parity (nulliparity or grand-multiparity), BMI (underweight or overweight), fetal size (less than 35cm or 40cm and over), adverse obstetrical history, signs of pre-eclampsia, and co-existing medical conditions. These factors were recorded in 589 women of whom 67% required an SBA (n=396) and 1% died (n=7). The MMR was 1,189 per 100,000 (95%CI: 478-2,449). Signs of pre-eclampsia, obstetrical history, and co-existing conditions were highly associated with the need for an SBA. Age was found to interact with parity, suggesting that the CMDS requires adjustment for younger multigravida and older primigravida women. The CMDS algorithm had an AUC of 0.73 (95%CI: 0.69-0.77) for predicting whether women required an SBA, and an AUC of 0.85 (95%CI: 0.67-1.00) for in-hospital mortality.ConclusionsThe CMDS is a low-cost, evidence-based tool that uses 7 risk factors assessed on 589 women from Makurdi. Non-specialist health workers can use the CMDS to standardize patient assessment and encourage pregnant women to seek an SBA in preparation for delivery, thus improving care in countries with high rates of maternal mortality.

scholarly journals How did Nepal Reduce the Maternal Mortality? A Result from Analysing the Determinants of Maternal Mortality

2012 ◽  
Vol 52 (186) ◽  
Author(s):  
R Karkee
Keyword(s):  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Literature Analysis ◽  
Demographic Health Survey ◽  
Skilled Birth Attendants ◽  
Rate Reduction ◽  
Safe Abortion ◽  
Birth Attendants ◽  
Mortality Ratio ◽  
Determinants Of Maternal Mortality

Nepal reportedly reduced the maternal mortality ratio by 48% within one decade between 1996-2005 and received the Millennium development goal award for this. However, there is debate regarding the accuracy of this figure. On the basis of framework of determinants of maternal mortality proposed by McCarthy and Maine in 1992 and successive data from Nepal demographic health survey of 1996, 2001 and 2006, a literature analysis was done to identify the important factors behind this decline. Although facility delivery and skilled birth attendants are acclaimed as best strategy of reducing maternal mortality, a proportionate increase in these factors was not found to account the maternal mortality rate reduction in Nepal. Alternatively, intermediate factors particularly women awareness, family planning and safe abortion might have played a significant role. Hence, Nepal as well as similar other developing countries should pay equal attention to such intermediate factors while concentrating on biomedical care strategy. Keywords: Determinants, maternal mortality, Nepal, reduction.

scholarly journals The BabySaver: Design of a New Device for Neonatal Resuscitation at Birth with Intact Placental Circulation

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 526
Author(s):  
James Ditai ◽  
Aisling Barry ◽  
Kathy Burgoine ◽  
Anthony K. Mbonye ◽  
Julius N. Wandabwa ◽  
...  
Keyword(s):  
Low Cost ◽  
Neonatal Resuscitation ◽  
Sub Saharan Africa ◽  
Skilled Birth Attendants ◽  
New Device ◽  
Birth Attendants ◽  
Premature Babies ◽  
Sub Saharan ◽  
The Uk ◽  
The University

The initial bedside care of premature babies with an intact cord has been shown to reduce mortality; there is evidence that resuscitation of term babies with an intact cord may also improve outcomes. This process has been facilitated by the development of bedside resuscitation surfaces. These new devices are unaffordable, however, in most of sub-Saharan Africa, where 42% of the world’s 2.4 million annual newborn deaths occur. This paper describes the rationale and design of BabySaver, an innovative low-cost mobile resuscitation unit, which was developed iteratively over five years in a collaboration between the Sanyu Africa Research Institute (SAfRI) in Uganda and the University of Liverpool in the UK. The final BabySaver design comprises two compartments; a tray to provide a firm resuscitation surface, and a base to store resuscitation equipment. The design was formed while considering contextual factors, using the views of individual women from the community served by the local hospitals, medical staff, and skilled birth attendants in both Uganda and the UK.

scholarly journals Maternal mortality during the COVID-19 pandemic in Mexico: a preliminary analysis during the first year

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nina Mendez-Dominguez ◽  
Karen Santos-Zaldívar ◽  
Salvador Gomez-Carro ◽  
Sudip Datta-Banik ◽  
Genny Carrillo
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Maternal Mortality ◽  
Respiratory Distress ◽  
Pregnant Women ◽  
Distress Syndrome ◽  
Maternal Mortality Ratio ◽  
Maternal Deaths ◽  
Immune Impairment ◽  
Mortality Ratio

Abstract Background In Mexico, the COVID-19 pandemic led to preventative measures such as confinement and social interaction limitations that paradoxically may have aggravated healthcare access disparities for pregnant women and accentuated health system weaknesses addressing high-risk patients’ pregnancies. Our objective is to estimate the maternal mortality ratio in 1 year and analyze the clinical course of pregnant women hospitalized due to acute respiratory distress syndrome and COVID-19. Methods A retrospective surveillance study of the national maternal mortality was performed from February 2020–February 2021 in Mexico related to COVID-19 cases in pregnant women, including their outcomes. Comparisons were made between patients who died and those who survived to identify prognostic factors and underlying health conditions distribution. Results Maternal Mortality Ratio increased by 56.8% in the studied period, confirmed COVID-19 was the cause of 22.93% of cases. Additionally, unconfirmed cases represented 4.5% of all maternal deaths. Among hospitalized pregnant women with Acute Respiratory Distress Syndrome consistent with COVID-19, smoking and cardiovascular diseases were more common among patients who faced a fatal outcome. They were also more common in the age group of < 19 or > 38. In addition, pneumonia was associated with asthma and immune impairment, while diabetes and increased BMI increased the odds for death (Odds Ratio 2.30 and 1.70, respectively). Conclusions Maternal Mortality Ratio in Mexico increased over 60% in 1 year during the pandemic; COVID-19 was linked to 25.4% of maternal deaths in the studied period. Lethality among pregnant women with a diagnosis of COVID-19 was 2.8%, and while asthma and immune impairment increased propensity for developing pneumonia, obesity and diabetes increased the odds for in-hospital death. Measures are needed to improve access to coordinated well-organized healthcare to reduce maternal deaths related to COVID-19 and pandemic collateral effects.

scholarly journals Temporal evolution and spatial distribution of maternal death

2014 ◽  
Vol 48 (4) ◽  
pp. 662-670 ◽  
Author(s):  
Ioná Carreno ◽  
Ana Lúcia de Lourenzi Bonilha ◽  
Juvenal Soares Dias da Costa
Keyword(s):  
Spatial Distribution ◽  
Maternal Mortality ◽  
Maternal Death ◽  
Temporal Evolution ◽  
Maternal Mortality Ratio ◽  
Rio Grande ◽  
The State ◽  
Rio Grande Do Sul ◽  
Maternal Risk ◽  
Mortality Ratio

OBJECTIVE To analyze the temporal evolution of maternal mortality and its spatial distribution.METHODS Ecological study with a sample made up of 845 maternal deaths in women between 10 and 49 years, registered from 1999 to 2008 in the state of Rio Grande do Sul, Southern Brazil. Data were obtained from Information System on Mortality of Ministry of Health. The maternal mortality ratio and the specific maternal mortality ratio were calculated from records, and analyzed by the Poisson regression model. In the spatial distribution, three maps of the state were built with the rates in the geographical macro-regions, in 1999, 2003, and 2008.RESULTS There was an increase of 2.0% in the period of ten years (95%CI 1.00;1.04; p = 0.01), with no significant change in the magnitude of the maternal mortality ratio. The Serra macro-region presented the highest maternal mortality ratio (1.15, 95%CI 1.08;1.21; p < 0.001). Most deaths in Rio Grande do Sul were of white women over 40 years, with a lower level of education. The time of delivery/abortion and postpartum are times of increased maternal risk, with a greater negative impact of direct causes such as hypertension and bleeding.CONCLUSIONS The lack of improvement in maternal mortality ratio indicates that public policies had no impact on women’s reproductive and maternal health. It is needed to qualify the attention to women’s health, especially in the prenatal period, seeking to identify and prevent risk factors, as a strategy of reducing maternal death.

scholarly journals Perspectives of skilled birth attendants and pregnant women regarding episiotomy: a quantitative approach

2021 ◽  
Vol 21 (3) ◽  
pp. 1355-1361
Author(s):  
Dokuba Tex-Jack ◽  
Chinemerem Eleke
Keyword(s):  
Pregnant Women ◽  
Data Extraction ◽  
Sampling Technique ◽  
Vaginal Birth ◽  
World Health ◽  
Skilled Birth Attendants ◽  
Cross Sectional ◽  
Birth Attendants ◽  
First Time Mothers ◽  
First Time

Background: The World Health Organization recommended less than 10% episiotomy rate for Skilled Birth Attendants (SBAs) and hospitals in 1996. More than two decades afterwards, some health facilities are still grappling with meeting the set target. Objectives: This study assessed the perspectives of SBAs and pregnant women regarding episiotomy in a Nigerian univer- sity teaching hospital. Methods: A cross-sectional design was employed. Census sampling was used to select 19 SBAS and 973 vaginal birth re- cords from 2019, while consecutive sampling technique was used to enrol 134 consenting pregnant women obtaining ante- natal services in the facility. Data was collected using a three part instrument involving a data extraction sheet, episiotomy practice questionnaire for SBAs, and feelings about episiotomy questionnaire for pregnant women. Assembled data were summarised with descriptive statistics. Results: The episiotomy rate was 345(35.5%). About 266 (77.1%) of first time mothers (primips) and 79(22.9%) of non- first time mothers (multips) received episiotomy. Ten (52.6%) of the SBAs were unsure of any evidence supporting routine episiotomy. All the 19(100%) SBAs reported that there was no existing facility-based policy regarding routine episiotomy. Seventy five (56%) of the pregnant women reported feeling generally bad about episiotomy. One hundred and one (82.3%) of them hinted that they will not feel satisfied if they were given episiotomy with the reason that it ensures quick vaginal birth. Conclusion: The rate of episiotomy was higher than global recommended standards and primips are disproportionately af- fected. If organised by professional societies, more scientific conferences on limiting episiotomy might remedy this situation. Keywords: Episiotomy; birth; pregnant women; vagina; Nigeria.

scholarly journals Primary health care among rural pregnant women in China: achievements and challenges in maternal mortality ratio

2019 ◽  
Vol 20 ◽  
Author(s):  
Le Yang ◽  
Hongman Wang
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Rural Areas ◽  
Maternal Mortality Ratio ◽  
Chinese Government ◽  
Primary Health ◽  
Mortality Ratio ◽  
The Government

Abstract Background: The maternal mortality ratio (MMR) is not only an important indicator of maternal and infant safety, but also a sign of the development of economy, education, and medical care in a country. In the last 60 years, the Chinese government has implemented various strategies and policies to reduce the MMR, especially in the rural areas. Aim: This study aimed to discuss the strategies developed by the Chinese government, showing the successful experience of Chinese intervention programs and highlighting the challenges to the government in the context of current economic and social status. Method: This study probed into the Chinese government’s efforts and achievements in the MMR reducing by reviewing the relevant health policies, extracting the data from China Health Statistics Yearbook of 2015, analyzing the reduction of maternal death in rural areas and the major causes from 1991 to 2015, comparing the MMR trend in urban and rural areas, and discussing the changes of the situation in China. Finding: Although it seems that Chinese government’s efforts have brought evangel to the rural pregnant women and significantly reduced rural maternal mortality, the government still needs to develop more equitable and flexible primary health care policies to narrow the imbalance in health resource allocation and pay more attention to the health care for the rural-to-urban migration in China.

scholarly journals Impact of Covid-19 Pandemic on Anc Clinic Visits and Deliveries by Skill Birth Attendant: A Retrospective Analysis in Kaduna State

2021 ◽  
pp. 1-5
Author(s):  
Abiola Clementina Ajibola ◽  
◽  
Saude Sagir ◽  
Keyword(s):  
Pregnant Women ◽  
Infection Prevention ◽  
Clinic Visit ◽  
Skilled Birth Attendants ◽  
Birth Attendants ◽  
Birth Attendance ◽  
Significant Difference ◽  
Antenatal Attendance ◽  
The Impact ◽  
One Way Anova

COVID-19 pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) was first discovered in December 2019 in Wuhan, China and later declared a pandemic on March 11, 2020 by the WHO. This study was conducted to assess the impact of COVID -19 pandemic and its attendant infection prevention of lockdown on ANC utilization and deliveries by skilled birth attendants in Kaduna State. It is a retrospective data review of 18 months data on ANC clinic visit and skill birth delivery from 1,722 health facilities. October 2019 to March 2021 data was extracted from the DHIS 2. The analysis was carried out on SPSS using One Way ANOVA. A decline of 13.5% antenatal attendance for first booking compared to pre-COVID-19 was recorded. There was a slight increase of 3.5% Post-COVID-19. There was also a reduction of 4.1% in the number of pregnant women who had the four recommended ANC visits during the COVID-19 compared to pre-COVID-19 period. However, there was a reduction of 10.2% of pregnant women returning post COVID-19 lockdown. The study revealed increased number of pregnant women that delivered during and post COVID-19. There was an increase of 2, 753 and 1,699 during and post-COVID-19, respectively. At 95% confidence interval using significance value is 0.610 (i.e., p = .610), the significance is more than 0.05. Therefore, there is no statistically significant difference in the ANC utilization and skill birth attendance before, during and after the Covid-19 pandemic. Therefore Covid-19 did not affect ANC and skill birth deliveries.

scholarly journals Reducing maternal mortality in China in the era of the two-child policy

2020 ◽  
Vol 5 (2) ◽  
pp. e002157
Author(s):  
Jue Liu ◽  
Li Song ◽  
Jie Qiu ◽  
Wenzhan Jing ◽  
Liang Wang ◽  
...  
Keyword(s):  
High Risk ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Maternal Mortality Ratio ◽  
Pregnancy Risk ◽  
Risk Screening ◽  
Live Births ◽  
Child Policy ◽  
Mortality Ratio ◽  
Maternal And Newborn

Reducing maternal mortality ratio (MMR) is of great concern worldwide. After the implementation of the two-child policy in 2013, the number of live births and the proportion of high-risk pregnancies both increased, and these bring new challenges to the reduction of MMR. China implemented a package of nationwide strategies in April 2016, the Five Strategies for Maternal and Newborn Safety (FSMNS). The FSMNS consists of five components: (1) pregnancy risk screening and assessment strategy, (2) case-by-case management strategy for high-risk pregnancies, (3) referral and treatment strategy for critically ill pregnant women and newborns, (4) reporting strategy for maternal deaths (and 5) accountability strategy. To better implement the FSMNS, China formulated a unified pregnancy risk screening form. After risk assessment and classification, medical records of all the pregnant women are labelled with green (low risk), yellow (moderate risk), orange (high risk), red (highest risk) or purple (infectious disease) for tailored management. By the implementation of FSMNS, China has already kept the MMR stable and cause it to enter a controlled decline. MMR in China has declined by 21.1%, from 23.2 per 100 000 live births in 2013 to 18.3 per 100 000 live births in 2018. The country’s challenges and experience in reducing the MMR could provide useful lessons for other countries.

scholarly journals LITERATURE REVIEW OF PERCEPTION, MATERNAL, PREGNANCY, AND LABOR IN 2015-2021

2021 ◽  
Vol 1 (3) ◽  
pp. 159-170
Author(s):  
Eddy Siswanto ◽  
Junardi Harahap
Keyword(s):  
Mortality Rate ◽  
Health Services ◽  
Literature Review ◽  
Antenatal Care ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Basic Assumption ◽  
Risk Groups ◽  
African Countries ◽  
Vos Viewer

The aim of this literature review was to find out any topics which had discussed and researched scientifically according to behavior, perception, maternal, pregnancy, and labor, especially in 2015 - 2021. The method of literature review was descriptive quantitative. Literatures were tracked by using Mendeley, then selected and processed by using VOS Viewer. They were also manually processed according to completeness of each literature. Of the 4 main discussion clusters had been found, i.e.  target clusters, mothers, risk groups, and health services, there were determined several main topics and keywords i.e: examination (care), mothers, factors, experiences, childbirth, and antenatal care. Meanwhile, topics those rarely discussed or researched were perceptions and adolescents. The most collected literatures were published in 2019 (29%), followed by 2020 (22%), and 2015 (15%). Most of the research or studies of the collected literatures were conducted descriptively and took research locations in Indonesia and African countries. Of the selected literatures rose basic assumption that the high maternal mortality rate, especially in Indonesia, is closely related to the lack of utilization of health facilitaties, as a result of the improper behavior of pregnant women in maintaining pregnancy and labor. This behavior is based on mindsets and perceptions related to pregnancy and labor, which have been formed since the pregnant women were teenagers. (9 pt).

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