scholarly journals Assessing Implementation of Maternal and Perinatal Death Surveillance and Response in Rwanda

2020 ◽  
Vol 17 (12) ◽  
pp. 4376
Author(s):  
Edwin Tayebwa ◽  
Felix Sayinzoga ◽  
Jacqueline Umunyana ◽  
Kusum Thapa ◽  
Efugbaike Ajayi ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Maternal Death ◽  
Perinatal Death ◽  
Health Concern ◽  
Middle Income ◽  
Middle Income Countries ◽  
Surveillance And Response ◽  
Modifiable Factors ◽  
Facility Level

Maternal deaths remain a major public health concern in low- and middle-income countries. Implementation of maternal and perinatal deaths surveillance and response (MPDSR) is vital to reduce preventable deaths. The study aimed to assess implementation of MPDSR in Rwanda. We applied mixed methods following the six-step audit cycle for MPDSR to determine the level of implementation at 10 hospitals and three health centers. Results showed various stages of implementation of MPDSR across facilities. Maternal death audits were conducted regularly, and facilities had action plans to address modifiable factors. However, perinatal death audits were not formally done. Implementation was challenged by lack of enough motivated staff, heavy workload, lack of community engagement, no linkages with existing quality improvement efforts, no guidelines for review of stillbirths, incomplete medical records, poor classification of cause of death, and no sharing of feedback among others. Implementation of MPDSR varied from facility to facility indicating varying capacity gaps. There is need to integrate perinatal death audits with maternal death audits and ensure the process is part of other quality improvement initiatives at the facility level. More efforts are needed to support health facilities to improve implementation of MPDSR and contribute to achieving sustainable development goal (SDG) 3.

scholarly journals Maternal Death Surveillance and Response in Tanzania: Comprehensiveness of narrative summaries and action points from maternal death reviews

2020 ◽  
Author(s):  
Ali Said ◽  
Andrea B. Pembe ◽  
Siriel Massawe ◽  
Claudia Hanson ◽  
Mats Malqvist
Keyword(s):  
Maternal Death ◽  
Demographic Characteristics ◽  
Health Facilities ◽  
World Health ◽  
Action Plans ◽  
Maternal Deaths ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sequence Of Events ◽  
Surveillance And Response

Abstract Background Maternal deaths in Tanzania and other low and middle income countries occur both in and outside health facilities. Review of maternal deaths relies on comprehensive documentation of medical records that can reveal sequence of events leading to death. The World Health Organization’s and the Tanzanian Maternal Death and Surveillance (MDSR) system propose the use of narrative summaries during maternal death reviews for discussing the case to categorize causes of death, identify gaps in care and recommend action plans to prevent deaths. Suggested action plans are recommended to be Specific, Measurable, Attainable, Relevant and Time bound (SMART). To identify gaps in documenting information and developing recommendations, comprehensiveness of written narrative summaries and action plans were assessed. Methods A total of 76 facility maternal deaths that occurred in two regions in Southern Tanzania in 2018 were included for analysis. We assessed the comprehensiveness of summaries and action plans using a prepared checklist from Tanzania MDSR guideline of 2015. Presence or absence of items in four domains each with several attributes was recorded. These were socio-demographic characteristics, antenatal care, referral information and events that occurred after admission. Less than 75% completeness of attributes in all domains was considered poor while 95% and above was good/comprehensive. Action plans were assessed by application of SMART criteria and according to place of planned implementation (community, facility or higher level of health system).Results Almost half of narrative summaries (49%) scored poor, and only 1% scored good/comprehensive. Summaries missed key information such as demographic characteristics, time between diagnosis of complication and commencing treatment (65%), investigation results (47%), summary of case evolution (51%) and referral information (47%). A total of 285 action points were analysed. Most action points 242(85%) recommended strategies to be implemented at health facilities and they were mostly 42(42%) on service delivery. Only 42% (32/76) of the action points were deemed to be SMART.Conclusions Abstraction of information to prepare narrative summaries used in MDSR system is inadequately done. Action plans in MDSR system are mostly recommended to sub standard care in health facilities but are not specific on the issues to be addressed.

scholarly journals Maternal Death Surveillance and Response in Tanzania: Comprehensiveness of narrative summaries and action points from maternal death reviews

2020 ◽  
Author(s):  
Ali Said ◽  
Andrea B. Pembe ◽  
Siriel Massawe ◽  
Claudia Hanson ◽  
Mats Malqvist
Keyword(s):  
Maternal Death ◽  
Demographic Characteristics ◽  
Health Facilities ◽  
World Health ◽  
Action Plans ◽  
Maternal Deaths ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sequence Of Events ◽  
Surveillance And Response

Abstract Background Maternal deaths reviews are proposed as one strategy to address high maternal mortality in low and middle-income countries, including Tanzania. Review of maternal deaths relies on comprehensive documentation of medical records that can reveal the sequence of events leading to death. The World Health Organization’s and the Tanzanian Maternal Death and Surveillance (MDSR) system propose the use of narrative summaries during maternal death reviews for discussing the case to categorize causes of death, identify gaps in care and recommend action plans to prevent deaths. Suggested action plans are recommended to be Specific, Measurable, Attainable, Relevant and Time bound (SMART). To identify gaps in documenting information and developing recommendations, comprehensiveness of written narrative summaries and action plans were assessed. Methods A total of 76 facility maternal deaths that occurred in two regions in Southern Tanzania in 2018 were included for analysis. Using a prepared checklist from Tanzania 2015 MDSR guideline, we assessed comprehensiveness by presence or absence of items in four domains, each with several attributes. These were socio-demographic characteristics, antenatal care, referral information and events that occurred after admission. Less than 75% completeness of attributes in all domains was considered poor while 95% and above were good/comprehensive. Action plans were assessed by application of SMART criteria and according to the place of planned implementation (community, facility or higher level of health system).Results Almost half of narrative summaries (49%) scored poor, and only1% scored good/comprehensive. Summaries missed key information such as demographic characteristics, time between diagnosis of complication and commencing treatment (65%), investigation results (47%), summary of case evolution (51%) and referral information (47%). A total of 285 action points were analysed. Most action points, 242(85%), recommended strategies to be implemented at health facilities and were mostly about service delivery, 120(42%). Only 42% (32/76) of the action points were deemed to be SMART.Conclusions Abstraction of information to prepare narrative summaries used in the MDSR system is inadequately done. Most recommendations were unspecific with a focus on improving quality of care in health facilities

scholarly journals Maternal Death Surveillance and Response in Tanzania: Comprehensiveness of narrative summaries and action points from maternal death reviews

2021 ◽  
Author(s):  
Ali Said ◽  
Andrea B. Pembe ◽  
Siriel Massawe ◽  
Claudia Hanson ◽  
Mats Malqvist
Keyword(s):  
Maternal Death ◽  
Demographic Characteristics ◽  
Health Facilities ◽  
World Health ◽  
Action Plans ◽  
Maternal Deaths ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sequence Of Events ◽  
Surveillance And Response

Abstract Background Maternal deaths reviews are proposed as one strategy to address high maternal mortality in low and middle-income countries, including Tanzania. Review of maternal deaths relies on comprehensive documentation of medical records that can reveal the sequence of events leading to death. The World Health Organization’s and the Tanzanian Maternal Death and Surveillance (MDSR) system propose the use of narrative summaries during maternal death reviews for discussing the case to categorize causes of death, identify gaps in care and recommend action plans to prevent deaths. Suggested action plans are recommended to be Specific, Measurable, Attainable, Relevant and Time bound (SMART). To identify gaps in documenting information and developing recommendations, comprehensiveness of written narrative summaries and action plans were assessed. Methods A total of 76 facility maternal deaths that occurred in two regions in Southern Tanzania in 2018 were included for analysis. Using a prepared checklist from Tanzania 2015 MDSR guideline, we assessed comprehensiveness by presence or absence of items in four domains, each with several attributes. These were socio-demographic characteristics, antenatal care, referral information and events that occurred after admission. Less than 75% completeness of attributes in all domains was considered poor while 95% and above were good/comprehensive. Action plans were assessed by application of SMART criteria and according to the place of planned implementation (community, facility or higher level of health system).Results Almost half of narrative summaries (49%) scored poor, and only1% scored good/comprehensive. Summaries missed key information such as demographic characteristics, time between diagnosis of complication and commencing treatment (65%), investigation results (47%), summary of case evolution (51%) and referral information (47%). A total of 285 action points were analysed. Most action points, 242(85%), recommended strategies to be implemented at health facilities and were mostly about service delivery, 120(42%). Only 42% (32/76) of the action points were deemed to be SMART.Conclusions Abstraction of information to prepare narrative summaries used in the MDSR system is inadequately done. Most recommendations were unspecific with a focus on improving quality of care in health facilities

Migraine and Stress – An Explorative Cross-Country Study of External Stress Factors

2020 ◽  
Author(s):  
Irene van Staveren
Keyword(s):  
Low Income ◽  
Developed Countries ◽  
Ordinary Least Squares ◽  
External Stress ◽  
Stress Factors ◽  
Middle Income ◽  
Middle Income Countries ◽  
Proxy Variables ◽  
Modifiable Factors ◽  
Cross Country

Abstract BackgroundAccording to the Global Burden of Disease 2016 project, migraine ranks first for 15-49 years and second for all ages. The project has reported no significant relation with socio-economic status of a country. To the contrary, migraine ranks first for all ages in low- and middle-income countries suffering from civic unrest and conflict. This raises the question whether external stress factors may be correlated with migraine years lived with disability (YLD).MethodsIn the absence of cross-country studies on migraine and stress, this is a unique exploratory study. The analysis uses two country groups: developed countries (including some middle-income countries) and developing (middle- and low-income) countries. For the first group, proxy variables for stress are included that relate to flexible and highly competitive labour markets (productivity and unemployment), whereas for the second group, proxy variables are used that relate to conflict and migration. The data were analysed with multiple ordinary least squares cross-section regressions.ResultsThe results show a positive relationship between the stress variables on the one hand and migraine YLD on the other hand for both country groups. Almost all results are statistically significant at p<0.01.ConclusionsThe findings from the exploratory cross-country analysis suggest that societal stress factors may be potential candidates for modifiable factors for the prevalence and severity of migraine at the country level.

scholarly journals Quality improvement initiatives for hospitalised small and sick newborns in low- and middle-income countries: a systematic review

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Nabila Zaka ◽  
Emma C. Alexander ◽  
Logan Manikam ◽  
Irena C. F. Norman ◽  
Melika Akhbari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Improvement ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Prognostic models for adverse pregnancy outcomes in low-income and middle-income countries: a systematic review

2019 ◽  
Vol 4 (5) ◽  
pp. e001759 ◽  
Author(s):  
Tessa Heestermans ◽  
Beth Payne ◽  
Gbenga Ayodele Kayode ◽  
Mary Amoakoh-Coleman ◽  
Ewoud Schuit ◽  
...  
Keyword(s):  
Low Income ◽  
Perinatal Death ◽  
External Validation ◽  
Perinatal Outcomes ◽  
Risk Of Bias ◽  
Prognostic Models ◽  
Cochrane Library ◽  
Middle Income ◽  
Middle Income Countries ◽  
Adverse Pregnancy

IntroductionNinety-nine per cent of all maternal and neonatal deaths occur in low-income and middle-income countries (LMIC). Prognostic models can provide standardised risk assessment to guide clinical management and can be vital to reduce and prevent maternal and perinatal mortality and morbidity. This review provides a comprehensive summary of prognostic models for adverse maternal and perinatal outcomes developed and/or validated in LMIC.MethodsA systematic search in four databases (PubMed/Medline, EMBASE, Global Health Library and The Cochrane Library) was conducted from inception (1970) up to 2 May 2018. Risk of bias was assessed with the PROBAST tool and narratively summarised.Results1741 articles were screened and 21 prognostic models identified. Seventeen models focused on maternal outcomes and four on perinatal outcomes, of which hypertensive disorders of pregnancy (n=9) and perinatal death including stillbirth (n=4) was most reported. Only one model was externally validated. Thirty different predictors were used to develop the models. Risk of bias varied across studies, with the item ‘quality of analysis’ performing the least.ConclusionPrognostic models can be easy to use, informative and low cost with great potential to improve maternal and neonatal health in LMIC settings. However, the number of prognostic models developed or validated in LMIC settings is low and mirrors the 10/90 gap in which only 10% of resources are dedicated to 90% of the global disease burden. External validation of existing models developed in both LMIC and high-income countries instead of developing new models should be encouraged.PROSPERO registration numberCRD42017058044.

Childhood Obesity: Nutritional Transition of Bangladesh

2019 ◽  
Vol 31 (1) ◽  
pp. 37-38
Author(s):  
SM Tajdit Rahman ◽  
Md Daharul Islam ◽  
Ranajit Sen Chowdhury ◽  
Abida Tarannum
Keyword(s):  
Public Health ◽  
Childhood Obesity ◽  
Review Article ◽  
Health Concern ◽  
Public Health Concern ◽  
Middle Income ◽  
Childhood Nutrition ◽  
Middle Income Countries ◽  
Obesity Status ◽  
Nutritional Transition

Childhood obesity has been a major public health concern in many high income countries. In middle income countries, like Bangladesh, the coexistence of obesity and underweight makes the situation more grievous. It creates a transitional status in the childhood nutrition in Bangladesh. The priority is to identify the overall picture of obesity status in our country. In this review article we try to identify the transitional situation of childhood nutrition and the importance of finding out the overall picture of childhood obesity throughout the country. Bangladesh J Medicine Jan 2020; 31(1) : 37-38

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