Using Mobile Technology to Address the ‘Three Delays' to Reduce Maternal Mortality in Zanzibar

2016 ◽  
pp. 1140-1154 ◽  
Author(s):  
Rachel Hoy Deussom ◽  
Marc Mitchell ◽  
Julia Dae Ruben
Keyword(s):  
Maternal Mortality ◽  
Mobile Technology ◽  
Low Income ◽  
Low Income Countries ◽  
Danger Signs ◽  
Birth Attendants ◽  
Adequate Care ◽  
Three Delays ◽  
Clinical Algorithms ◽  
Health Facility Staff

The hallmark article by Thaddeus and Maine (1994) presented a framework to reducing maternal mortality by addressing the delays: (1) deciding to seek care; (2) reaching care; and (3) receiving adequate care. This project developed a phone-based system used by traditional birth attendants to address the three delays in two districts in rural Zanzibar. Mobile phones provided: clinical algorithms to screen pregnant mothers for danger signs; phone numbers and mobile banking to arrange and pay for transportation; and contacts for health facility staff to alert them of referrals. 938 mothers participated in the “mHealth for Safer Deliveries” project. The intervention achieved a 71.0% facility delivery rate in the project zone, compared to the regional average of 32.0% (NBS and ICF Macro, 2011). This project demonstrated the effectiveness of mobile technology in addressing childbirth's three delays and its potential to impact maternal mortality in low-income countries.

Using Mobile Technology to Address the ‘Three Delays' to Reduce Maternal Mortality in Zanzibar

2014 ◽  
Vol 4 (1) ◽  
pp. 33-47 ◽  
Author(s):  
Rachel Hoy Deussom ◽  
Marc Mitchell ◽  
Julia Dae Ruben
Keyword(s):  
Maternal Mortality ◽  
Mobile Technology ◽  
Low Income ◽  
Low Income Countries ◽  
Mobile Banking ◽  
Danger Signs ◽  
Birth Attendants ◽  
Adequate Care ◽  
Three Delays ◽  
Health Facility Staff

The hallmark article by Thaddeus and Maine (1994) presented a framework to reducing maternal mortality by addressing the delays: (1) deciding to seek care; (2) reaching care; and (3) receiving adequate care. This project developed a phone-based system used by traditional birth attendants to address the three delays in two districts in rural Zanzibar. Mobile phones provided: clinical algorithms to screen pregnant mothers for danger signs; phone numbers and mobile banking to arrange and pay for transportation; and contacts for health facility staff to alert them of referrals. 938 mothers participated in the “mHealth for Safer Deliveries” project. The intervention achieved a 71.0% facility delivery rate in the project zone, compared to the regional average of 32.0% (NBS and ICF Macro, 2011). This project demonstrated the effectiveness of mobile technology in addressing childbirth's three delays and its potential to impact maternal mortality in low-income countries.

Reducing the distance to walk: establishing a remote maternity facility in Runga, Hoima District, Uganda

2020 ◽  
Vol 14 (2) ◽  
pp. 1-8
Author(s):  
Rhiannon Grindle ◽  
Sofia Giannopoulou ◽  
Harriet Jacobs ◽  
Jerome Barongo ◽  
Alexandra Elspeth Cairns
Keyword(s):  
Antenatal Care ◽  
Maternal Mortality ◽  
Health Facility ◽  
Low Income ◽  
Local Level ◽  
Substantial Reduction ◽  
Care Quality ◽  
Low Income Countries ◽  
Health Seeking ◽  
Birth Attendance

Despite a substantial reduction in global maternal mortality, rates in low-income countries remain unacceptably high. Multiple contributing factors exist, grouped into three delays: health-seeking behaviour; accessibility of care; quality of care. In the Hoima District, rates of health facility delivery and skilled birth attendance remain low and maternal mortality exceeds the national average. Establishing the Midwives At Maternity Azur Clinic (February 2017) has addressed these issues at a local level. Health education and antenatal care are provided at the clinic, encouraging women to seek timely, appropriate intrapartum care. Access from surrounding villages is facilitated by a waiting home and weekly transport for antenatal care, alongside transport to a health facility with a staffed operating theatre, when required. It is run by a resident midwife, with regular training updates, and is stocked with the necessary resources for quality healthcare. Since its advent, village leaders report all-cause burials have reduced from one a day to one a week.

scholarly journals Developing obstetric medicine training in Latin America

2017 ◽  
Vol 10 (1) ◽  
pp. 16-20 ◽  
Author(s):  
José Rojas-Suarez ◽  
Niza Suarez ◽  
Oier Ateka-Barrutia
Keyword(s):  
Latin America ◽  
Maternal Mortality ◽  
Latin American ◽  
Low Income ◽  
Morbidity And Mortality ◽  
Low Income Countries ◽  
Important Indicator ◽  
Obstetric Medicine ◽  
The Impact ◽  
In Pregnancy

Maternal mortality is an important indicator of health in populations around the world. The distribution of maternal mortality ratio globally shows that middle- and low-income countries have ∼99% of the mortality burden. Most countries of Latin America are considered to be middle- or low-income countries, as well as areas of major inequities among the different social classes. Medical problems in pregnancy remain an important cause of morbidity and mortality in this region. Previous data indicate the need for a call to action for adequate diagnosis and care of medical diseases in obstetric care. The impact of nonobstetric and medical pathologies on maternal mortality in Latin America is largely unknown. In Latin America, two educational initiatives have been proposed to improve skills in maternity care. The Advanced Life Support in Obstetrics (ALSO®) was first started to address obstetric emergencies, and subsequently adapted for low-middle-income country settings as the Global ALSO®. In parallel, the Latin American obstetric anesthesia community has progressively focused on improvement of several intrapartum/intraoperative issues, which has secondarily taken them to embrace the obstetric medicine area on interest and join the former initiatives. In the present review, we summarize the available data regarding medical morbidity and mortality in pregnancy in Latin America, as well as the challenges, achievements, issues, initiatives, and future directions encouraging maternal health educators, health care trainers, and physicians in middle- and low-income countries, such as many Latin American ones, to improve and/or change attitudes, if needed, on current clinical practice.

scholarly journals Trend and Causes of Maternal Mortality in a Nigerian Tertiary Hospital: A 5-year Retrospective Study (2010-2014) at the University of Calabar Teaching Hospital, Calabar, Nigeria

2018 ◽  
Vol 6 (6) ◽  
pp. 1153-1158 ◽  
Author(s):  
Thomas U. Agan ◽  
Emmanuel Monjok ◽  
Ubong B. Akpan ◽  
Ogban E. Omoronyia ◽  
John E. Ekabua
Keyword(s):  
Maternal Mortality ◽  
Low Income ◽  
Post Partum ◽  
Maternal Mortality Ratio ◽  
Low Income Countries ◽  
Live Births ◽  
Mortality Ratio ◽  
Post Partum Haemorrhage ◽  
The University ◽  
Hypertensive Diseases

BACKGROUND: Maternal mortality ratios (MMR) are still unacceptably high in many low-income countries especially in sub-Saharan Africa. MMR had been reported to have improved from an initial 3,026 per 100,000 live births in 1999 to 941 in 2009, at the University of Calabar Teaching Hospital (UCTH), Calabar, a tertiary health facility in Nigeria. Post-partum haemorrhage and hypertensive diseases of pregnancy have been the common causes of maternal deaths in the facility.AIM: This study was aimed at determining the trend in maternal mortality in the same facility, following institution of some facility-based intervention measures.METHODOLOGY: A retrospective study design was utilised with extraction and review of medical records of pregnancy-related deaths in UCTH, Calabar, from January 2010 to December 2014. The beginning of the review period coincided with the period the “Woman Intervention Trial” was set up to reduce maternal mortality in the facility. This trial consists of the use of Tranexamic acid for prevention of post-partum haemorrhage, as well as more proactive attendance to parturition.RESULTS: There were 13,605 live births and sixty-one (61) pregnancy-related deaths in UCTH during the study period. This yielded a facility Maternal Mortality Ratio of 448 per 100,000 live births. In the previous 11-year period of review, there was sustained the decline in MMR by 72.9% in the initial four years (from 793 in 2010 to 215 in 2013), with the onset of resurgence to 366 in the last year (2014). Mean age at maternal death was 27 ± 6.5 years, with most subjects (45, 73.8%) being within 20-34 years age group. Forty-eight (78.7%) were married, 26 (42.6%) were unemployed, and 33 (55.7%) had at least secondary level of education. Septic abortion (13, 21.3%) and hypertensive diseases of pregnancy (10, 16.4%) were the leading causes of death. Over three quarters (47, 77.0%) had not received care from any health facility. Most deaths (46, 75.5%) occurred between 24 and 97 hours of admission.CONCLUSION: Compared with previous trends, there has been a significant improvement in maternal mortality ratio in the study setting. There is also a significant change in the leading cause of maternal deaths, with septic abortion and hypertensive disease of pregnancy now replacing post-partum haemorrhage and puerperal sepsis that was previously reported. This success may be attributable to the institution of the Woman trial intervention which is still ongoing in other parts of the world. There is, however, need to sustain effort at a further reduction in MMR towards the attainment of set sustainable development goals (SDGs), through improvement in the provision of maternal health services in low-income countries.

scholarly journals Review Article on Emergency Obstetric Care

2018 ◽  
Vol 1 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Silas Ochejele
Keyword(s):  
Maternal Mortality ◽  
Low Income ◽  
Newborn Care ◽  
Emergency Obstetric Care ◽  
Skilled Birth Attendant ◽  
Obstetric Care ◽  
Functional Health ◽  
Low Income Countries ◽  
Mortality Reduction ◽  
Maternal Deaths

Maternal death was once a common occurrence worldwide but today, 99% of maternal deaths occur in low income countries. Most of the maternal deaths are due to direct obstetric complications. Emergency obstetric care is the intervention required to save the lives of these women. It is based on a tripod of signal functions, skilled birth attendants and a functional health system. The objective of this article was to discuss the role of Emergency obstetric care in maternal mortality reduction. A systematic review of available articles on Emergency obstetric care; and Emergency obstetric care training materials, experience and observations used/made between 2003 and 2017 in Nigeria was used for this work. Emergency obstetric care is the nucleus on which all other maternal mortality reduction activities are hinged. The paradigm evolvement of Emergency obstetric care offers the last hope for a woman with direct obstetric complication. However, the skilled birth attendant must have the right attitude in addition to her/his professional skills for effective implementation of these interventions. Women need access to and availability of Emergency obstetric care as well as a continuum of care that includes antenatal, intra-partum and postnatal care, newborn care and family planning services to reduce maternal mortality.

scholarly journals Refining clinical algorithms for a neonatal digital platform for low-income countries: a modified Delphi technique

2020 ◽  
Author(s):  
Mari Evans ◽  
Mark H. Corden ◽  
Caroline Crehan ◽  
Felicity Fitzgerald ◽  
Michelle Heys
Keyword(s):  
Expert Opinion ◽  
Low Income ◽  
Delphi Technique ◽  
High Income ◽  
Low Income Countries ◽  
Current Evidence ◽  
Digital Platform ◽  
Modified Delphi ◽  
Modified Delphi Technique ◽  
Clinical Algorithms

ABSTRACTObjectivesTo determine whether a panel of neonatal experts could address evidence gaps in neonatal guidelines by reaching a consensus on four clinical decision algorithms for a neonatal digital platform (NeoTree).DesignTwo-round, modified Delphi technique.Setting and participantsParticipants were neonatal experts from high-income and low-income countries (LICs).MethodsThis was a consensus-generating study. In round one, experts rated items for four clinical algorithms (neonatal sepsis, hypoxic ischaemic encephalopathy, respiratory distress of the newborn, hypothermia) and justified their responses. Items meeting consensus (≥80% agreement) were included. Items not meeting consensus were either excluded, included following revisions or included if they contained core elements of evidence-based guidelines. In round two, experts rated items from round one that did not reach consensus.ResultsFourteen experts participated in round one, ten in round two. Nine were from high-income countries, five from LICs. Experts included physicians and nurse practitioners with an average neonatal experience of 20 years, 12 in LICs. After two rounds, a consensus was reached on 43 of 84 items (52%). Experts consistently stated that items must be in line with local and WHO guidelines (irrespective of the level of supporting evidence or expert opinion). As a result, the final algorithms included 53 items (62%).ConclusionFour algorithms in a neonatal digital platform were reviewed and refined by consensus expert opinion. Revisions to the NeoTree application were made in response to these findings and will be clinically validated in an imminent study.STRENGTHS AND LIMITATIONS OF THIS STUDY➢In this study, a large number of algorithm items were reviewed and evaluated, and half met consensus for inclusion in the management pathways.➢The review was conducted with experts from a broad range of countries and neonatal experience who simultaneously refined the algorithms and highlighted gaps in current evidence, emphasising the need for future research to support international neonatal guidelines.➢Our study method meant that experts were not able to meet in person, which might have promoted dialogue that would have allowed greater clarity in their collective opinion.➢The representation of neonatal experts from LICs was not as robust as from high-income countries, which may have led to an uneven evaluation of the algorithms.

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