Applicability and comparison of the sub-Saharan Africa and original WHO maternal near-miss criteria in a rural hospital in Western Tanzania

Objective: Maternal near-miss refers to a woman who nearly died but survived complications in pregnancy, childbirth, or within 42 days of termination of pregnancy. The study of maternal near-miss has become essential for improving the quality of obstetric care. The objective of this study was to identify the determinants of maternal near-miss among women admitted to major private hospitals in eastern Ethiopia. Method: An unmatched nested case–control study was conducted in major private hospitals in eastern Ethiopia from 5 March to 31 March 2020. Cases were women who fulfilled the sub-Saharan African maternal near-miss criteria and those admitted to the same hospitals but discharged without any complications under the sub-Saharan African maternal near-miss tool were controls. For each case, three corresponding women were randomly selected as controls. Factors associated with maternal near-misses were analyzed using binary and multiple logistic regressions with an adjusted odds ratio along with a 95% confidence interval. Finally, p-value < 0.05 was considered as a cut-off point for the significant association. Results: A total of 432 women (108 cases and 324 controls) participated in the study. History of prior cesarean section (AOR = 4.33; 95% CI = 2.36–7.94), anemia in index pregnancy (AOR = 4.38; 95% CI = 2.43–7.91), being ⩾ 35 years of age (AOR = 2.94; 95% CI = 1.37–6.24), not attending antenatal care (AOR = 3.11; 95% CI = 1.43–6.78), and history of chronic medical disorders (AOR = 2.18; 95% CI = 1.03–4.59) were independently associated with maternal near-miss. Conclusion: Maternal age ⩾ 35 years, had no antenatal care, had prior cesarean section, being anemic in index pregnancy, and have history of chronic medical disorders were the determinants of maternal near-miss. Improving maternal near-misses requires strengthening antenatal care (including supplementation of iron and folic acid to reduce anemia) and prioritizing women with a history of chronic medical illnesses. Interventions for preventing primary cesarean sections are crucial in this era of the cesarean epidemic to minimize its effect on maternal near-miss.

Download Full-text

Improving Hand Hygiene Practices in a Rural Hospital in Sub-Saharan Africa

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.71 ◽

2016 ◽

Vol 37 (7) ◽

pp. 834-839 ◽

Cited By ~ 12

Author(s):

Ian C. Holmen ◽

Celestin Seneza ◽

Berthine Nyiranzayisaba ◽

Vincent Nyiringabo ◽

Mugisha Bienfait ◽

...

Keyword(s):

Hand Hygiene ◽

Low Income ◽

Rural Hospital ◽

Sub Saharan Africa ◽

World Health ◽

Post Intervention ◽

Improve Hand Hygiene ◽

Quasi Experimental ◽

Sub Saharan

OBJECTIVETo improve hand hygiene (HH) compliance among physicians and nurses in a rural hospital in sub-Saharan Africa (SSA) using the World Health Organization’s (WHO’s) Guidelines on Hand Hygiene in Health Care.DESIGNThis study was a quasi-experimental design divided into 4 phases: (1) preparation of materials and acquisition of the hospital administration’s support, (2) baseline evaluation, (3) intervention, and (4) follow-up evaluation.SETTINGA 160-bed, non-referral hospital in Gitwe, RwandaPARTICIPANTSA total of 12 physicians and 54 nurses participated in this study.METHODSThe intervention consisted of introducing locally produced alcohol-based hand rub (ABHR); educating healthcare workers (HCWs) on proper HH practice; providing pocket-sized ABHR bottles for HCWs; placing HH reminders in the workplace; and surveying HCWs at surrounding health centers regarding HH compliance barriers. Hand hygiene infrastructure, compliance, and knowledge were assessed among physicians and nurses using baseline observations and a follow-up evaluation survey.RESULTSOverall, HH compliance improved from 34.1% at baseline to 68.9% post intervention (P<.001), and HH knowledge was significantly enhanced (P<.001). The 3 departments included in this study had only 1 sink for 29 patient rooms, and 100% of HH opportunities used ABHR. Hand hygiene compliance was significantly higher among physicians than nurses both before and after the intervention. All measures of HH compliance improved except for “after body fluid exposure,” which was 51.7% before intervention and 52.8% after intervention (P>.05).CONCLUSIONHand hygiene campaigns using WHO methods in SSA have been implemented exclusively in large, referral hospitals. This study shows that an HH program using the WHO tools successfully improved HH in a low-income, rural hospital in SSA.Infect Control Hosp Epidemiol2016;37:834–839

Download Full-text

On an Average: The Rural Hospital in Sub-Saharan Africa

Tropical Doctor ◽

10.1177/004947558801800317 ◽

1988 ◽

Vol 18 (3) ◽

pp. 139-142 ◽

Cited By ~ 4

Author(s):

Jaap L Hamel ◽

Peter W Janssen

Keyword(s):

Rural Hospitals ◽

Rural Hospital ◽

Sub Saharan Africa ◽

Annual Reports ◽

General Impression ◽

Heavy Workload ◽

Sub Saharan

The general impression of a heavy workload for rural hospitals in sub-Saharan Africa is illustrated by a quantification for 16 parameters, based on data in 120 annual reports from 40 hospitals. The figures presented in this study can be looked upon as “figures of reference” which hospitals can use for reflection on their own data. Comparison with other studies is made possible by presenting the figures after conversion to an assumed population of 100 000. Marginal notes are made on the comparability of the data as presented by the hospitals.

Download Full-text