scholarly journals Does the presence of conflict affect maternal and neonatal mortality during Caesarean sections?

2019 ◽  
Vol 9 (3) ◽  
pp. 107-112
Author(s):  
J. Gil Cuesta ◽  
M. Trelles ◽  
A. Naseer ◽  
A. Momin ◽  
L. Ngabo Mulamira ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Neonatal Mortality ◽  
Health Facility ◽  
High Mortality ◽  
Emergency Care ◽  
Maternity Care ◽  
Health Facilities ◽  
Routinely Collected Data ◽  
Conflict Settings ◽  
War Zones

Introduction: Conflicts frequently occur in countries with high maternal and neonatal mortality and can aggravate difficulties accessing emergency care. No literature is available on whether the presence of conflict influences the outcomes of mothers and neonates during Caesarean sections (C-sections) in high-mortality settings.Objective: To determine whether the presence of conflict was associated with changes in maternal and neonatal mortality during C-sections.Methods: We analysed routinely collected data on C-sections from 17 Médecins Sans Frontières (MSF) health facilities in 12 countries. Exposure variables included presence and intensity of conflict, type of health facility and other types of access to emergency care.Results: During 2008–2015, 30,921 C-sections were performed in MSF facilities; of which 55.4% were in areas of conflict. No differences were observed in maternal mortality in conflict settings (0.1%) vs. non-conflict settings (0.1%) (P = 0.08), nor in neonatal mortality between conflict (12.2%) and non-conflict settings (11.5%) (P = 0.1). Among the C-sections carried out in conflict settings, neonatal mortality was slightly higher in war zones compared to areas of minor conflict (P = 0.02); there was no difference in maternal mortality (P = 0.38).Conclusions: Maternal and neonatal mortality did not appear to be affected by the presence of conflict in a large number of MSF facilities. This finding should encourage humanitarian organisations to support C-sections in conflict settings to ensure access to quality maternity care.

scholarly journals ‘We just look at the well-being of the baby and not the money required’: a qualitative study exploring experiences of quality of maternity care among women in Nairobi’s informal settlements in Kenya

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036966 ◽  
Author(s):  
Jackline Oluoch-Aridi ◽  
Francis Wafula ◽  
Gilbert Kokwaro ◽  
Mary B Adam
Keyword(s):  
Qualitative Study ◽  
Health Facility ◽  
Maternity Care ◽  
Informal Settlement ◽  
Perceived Quality ◽  
Poor Quality ◽  
Health Facilities ◽  
Public Facility ◽  
Clinical Services

ObjectiveTo examine how women living in an informal settlement in Nairobi perceive the quality of maternity care and how it influences their choice of a delivery health facility.DesignQualitative study.SettingsDandora, an informal settlement, Nairobi City in Kenya.ParticipantsSix focus group discussions with 40 purposively selected women aged 18–49 years at six health facilities.ResultsFour broad themes were identified: (1) perceived quality of the delivery services, (2) financial access to delivery service, (3) physical amenities at the health facility, and (4) the 2017 health workers’ strike.The four facilitators that influenced women to choose a private health facility were: (1) interpersonal treatment at health facilities, (2) perceived quality of clinical services, (3) financial access to health services at the facility, and (4) the physical amenities at the health facility. The three barriers to choosing a private facility were: (1) poor quality clinical services at low-cost health facilities, (2) shortage of specialist doctors, and (3) referral to public health facilities during emergencies.The facilitators that influenced women to choose a public facility were: (1) physical amenities for dealing with obstetric emergencies and (2) early referral to public maternity during antenatal care services. Barriers to choosing a public facility were: (1) perception of poor quality clinical services, (2) concerns over security for newborns at tertiary health facilities, (3) fear of mistreatment during delivery, (4) use of unsupervised trainee doctors for deliveries, (5) poor quality of physical amenities, and (6) inadequate staffing.ConclusionThe study provides insights into decision-making processes for women when choosing a delivery facility by identifying critical attributes that they value and how perceptions of quality influence their choices.

scholarly journals A temporal analysis of maternal deaths in some selected health facilities in Zamfara State, Northwest Nigeria: How far were United Nations Millennium Development Goals (MDG) 5 achieved?

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Abdullahi Mohammed Maiwada ◽  
Nor Azlina A Rahman ◽  
Suzanah Abdul Rahman ◽  
Nik Mazlan Mamat ◽  
Tukur A Baba ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Health Facility ◽  
Rural Areas ◽  
Urban Areas ◽  
Maternal Mortality Ratio ◽  
Temporal Analysis ◽  
Health Facilities ◽  
Steady Increase ◽  
Maternal Deaths ◽  
Mortality Ratio

Introduction: The steady increase in maternal deaths in Nigeria is a serious source of concern to policy makers and key stakeholders as one of the major threats to the achievement of the MDGs. Nigeria is reported to have one of the highest maternal mortality ratios in the world. This study was aimed at examining the challenges confronting the achievement of the MDGs Goals 5 in Zamfara State northwest Nigeria in terms of maternal mortality ratio, causes and frequency of antenatal visits. Methods: Health facility based approach and statistics were used in assessing maternal mortality ratio. Data was collected from health facility records and folders of patients who lost their lives due to pregnancy and childbirth related illnesses in some selected health facilities in Zamfara State from 2011- 2015. Results: The results showed the highest maternal deaths are in the rural areas 5120/100,000 as compared to 750/100,000 urban health facilities. Haemorrhage was the leading medical cause of maternal death. Others include sepsis, eclampsia, sickle cell anaemia, obstructed labour and abortion. However, there was a significant increase in the number of antenatal care visits from 7.20% to 30.93% within the last five years. However, the maternal mortality rate has increased, though not stable from 735/100,000 in 2011 to 1248/100,000 in 2013 and 930/100,000 in mid-2015. Conclusions: There was an increase in maternal deaths in rural compared to urban areas health clinics despite increased in the attendance of ante natal care visits thus the 5th Millennium Development Goal in Zamfara State not achieved.

THE IMPORTANCE OF PUBLIC SECTOR HEALTH FACILITY-LEVEL DATA FOR MONITORING CHANGES IN MATERNAL MORTALITY RISKS AMONG COMMUNITIES: THE CASE OF PAKISTAN

2013 ◽  
Vol 45 (5) ◽  
pp. 601-613 ◽  
Author(s):  
ANRUDH K. JAIN ◽  
ZEBA SATHAR ◽  
MOMINA SALIM ◽  
ZAKIR HUSSAIN SHAH
Keyword(s):  
Public Sector ◽  
Maternal Mortality ◽  
Health Facility ◽  
Health Facilities ◽  
Mortality Risks ◽  
Live Births ◽  
Health Facility Level ◽  
Level Data ◽  
Public Sector Health ◽  
Facility Level

SummaryThis paper illustrates the importance of monitoring health facility-level information to monitor changes in maternal mortality risks. The annual facility-level maternal mortality ratios (MMRs), complications to live births ratios and case fatality ratios (CFRs) were computed from data recorded during 2007 and 2009 in 31 upgraded public sector health facilities across Pakistan. The facility-level MMR declined by about 18%; both the number of Caesarean sections and the episodes of complications as a percentage of live births increased; and CFR based on Caesarean sections and episodes of complications declined by 29% and 37%, respectively. The observed increases in the proportion of women with complications among those who come to these facilities point to a reduction in the delay in reaching facilities (first and second delays; Thaddeus & Maine, 1994); the decrease in CFRs points to improvements in treating obstetric complications and a reduction in the delay in receiving treatment once at facilities (the third delay). These findings point to a decline in maternal mortality risks among communities served by these facilities. A system of woman-level data collection instituted at health facilities with comprehensive emergency obstetric care is essential to monitor changes in the effects of any reduction in the three delays and any improvement in quality of care or the effectiveness of treating pregnancy-related complications among women reaching these facilities. Such a system of information gathering at these health facilities would also help policymakers and programme mangers to measure and improve the effectiveness of safe-motherhood initiatives and to monitor progress being made toward achieving the fifth Millennium Development Goal.

Newborn Mortality And Its Associated Factors Among Neonates Admitted At Public Hospitals In Afar Region; A Health Facility Based Study

2019 ◽  
Author(s):  
abay woday ◽  
Yohannes Mekuria ◽  
Christine St Denis
Keyword(s):  
Logistic Regression ◽  
Antenatal Care ◽  
Neonatal Mortality ◽  
Health Facility ◽  
Medical Records ◽  
Associated Factors ◽  
Health Facilities ◽  
Public Hospitals ◽  
Afar Region ◽  
Assisted Delivery

Abstract Background: Neonatal mortality is a public health issue in developing countries, such as Ethiopia. Unfortunately, the issue is noticeably under-reported and underestimated, so the true gravity of the situation cannot be acknowledged. Subsequently, Afar in Ethiopia contributes the largest burden of under-five mortality when compared to other regions in the country. Regrettably, there is no current information to the rates and predictors of neonatal mortality for the region even for the health facilities. Thus, this study aims to assess neonatal mortality and associated factors in pastoral region, Afar region. Methods: A health facility-based retrospective cross-sectional study was conducted on 403 neonates admitted to the neonatal intensive care unit (NICU) from May 1st 2015 - May 2nd 2019. Medical records were reviewed and audited for both mothers and neonates to collect data using a standardized data extraction checklist. The medical records were selected using a systematic sampling technique. Binary logistic regression with odds ratio and 95% Confidence interval was calculated to assess the association between neonatal mortality and associated factors. Finally, the statistical significance level was declared at a p-value <0.05. Results: In this study, 391 medical records of neonates were included with the data complete rate of 97.02%. The prevalence of neonatal mortality was 14.6% (95% CI 11.0%-18.4%) with mortality rate of 35.5 per 1000 live births. A multivariable logistic regression showed that the lack of antenatal care (ANC) follow up (AOR = 5.92; 95%CI 2.34, 14.97: P<0.001), giving birth through cesarean section (AOR=3.52; 95%CI 1.22, 10.12: P<0.05), giving birth through assisted delivery (AOR=3.28 (1.14, 9.46): P<0.05), having a temperature less than 36.5oC within the first hour of admission (AOR= 5.89; 95%CI 2.32, 14.94: P<0.001), and perinatal asphyxia (AOR= 6.67; 95%CI 2.35, 18.89: P<0.001) were significantly associated with neonatal mortality. Conclusion: This study revealed that the rate of neonatal mortality is still too high compared to the studies conducted in non-pastoral regions of the nation. Thus, the health facilities should give due attention to improve antenatal care, neonatal resuscitation and follow the standard of care protocol for admitted neonates. Additional community based studies supported with qualitative methods are recommended.

scholarly journals Promoting Respectful Maternity Care for Adolescents In Ghana: a Quasi-Experimental Research Study Protocol

2020 ◽  
Author(s):  
Helen H Habib ◽  
Kwasi Torpey ◽  
Ernest Tei Maya ◽  
Augustine Ankomah
Keyword(s):  
Maternal Mortality ◽  
Maternity Care ◽  
Health Facilities ◽  
The Body ◽  
Human Reproduction ◽  
World Health ◽  
Respectful Maternity Care ◽  
Birth Attendance ◽  
Post Test ◽  
Quasi Experimental

Abstract BackgroundIntra-partum mistreatment by healthcare providers remains a global public health and human rights challenge. Adolescents, who are typically younger, poorer and less educated have been found to be disproportionately exposed to intra-partum mistreatment. In Ghana, maternal mortality remains a leading cause of death among adolescent females, despite increasing patronage of skilled birth attendance in health facilities. In response to the the World Health Organisation Human Reproduction Programme (WHO-HRP) recommendations to address mistreatment with Respectful Maternity Care (RMC), this study aims to generate evidence on promoting respectful treatment of adolescents using an intervention that trains health providers on the concept of mistreatment, their professional roles in RMC and the rights of adolescents to RMC.MethodsThis study will employ a pre-test post-test quasi-experimental design. At pre-test and post-test, quantitative surveys will be conducted among adolescents who deliver at health facilities about their labour experience with mistreatment and RMC. A total target of 392 participants will be recruited across intervention and control facilities. Qualitative interviews will also be conducted with selected adolescents and health professionals for an in-depth understanding of the phenomenon. Following the pre-test, a facility-based training module will be implemented at intervention facilities for the facility midwives. The modules will be co-facilitated by the principal investigator and key resource persons from the district health directorate Quality of Care teams. Training will cover the rights of adolescents to quality healthcare, classifications of mistreatment, RMC as a concept and the role of professionals in providing RMC. No intervention will occur in the control facilities. Descriptive statistics, logistic regressions and difference in differences analyses will be computed. Qualitative data will be transcribed and thematically analysed.DiscussionThis study is designed to test the success of an intervention in promoting RMC and reducing intra-partum mistreatment towards adolescents. It is expected that the findings of this study will be beneficial in adding to the body of knowledge in improving maternal healthcare and reducing maternal mortality, especially for adolescents.Trial Registry DetailsName of the registry: Pan African Clinical Trials RegistryDate of registration: 9th March, 2020URL of trial registry record: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9837

scholarly journals Development of a Study tool to Assess Gaps in Respectful Maternity Care in Health Facilities of India

2021 ◽  
Author(s):  
Shalini Singh ◽  
Aparajita Gogoi ◽  
Leila Caleb-Varkey ◽  
Mercy Manoranjini ◽  
Tina Ravi ◽  
...  
Keyword(s):  
Health Care ◽  
Maternal Mortality ◽  
Maternity Care ◽  
Development Process ◽  
Health Care Facilities ◽  
Health Facilities ◽  
Respectful Maternity Care ◽  
Advisory Group ◽  
Care Providers ◽  
Technical Advisory Group

Abstract Background: Maternal mortality perdures to be a major challenge for India like in other developing countries. Though the efforts to increase the institutional deliveries have resulted in appreciable results, it has not translated to the corresponding decline in maternal mortality rates. Dearth in quality of care especially concerning respectful maternity care in health facilities is considered as a major reason for this phenomenon. This work describes the development process of the study tool to assess respectful maternity care in the health facilities of India. Methods: A collaborative approach was employed for the development of a comprehensive tool to be used to assess respectful maternity care in the Indian setting. The tool development process comprised of four steps: 1) literature review and meeting with Technical Advisory Group; 2) the National Stakeholders workshop and development of the initial tool; 3) feedback on the tool from twenty tertiary care public health facilities from various regions of India; 4) the final tool and its validity approval by Technical Advisory Group. Results: A comprehensive tool was made comprising of indicators for assessing deficits in respectful maternity care, and for assessing contextual data of the health care facility. The initial tool was tested at twenty facilities. The changes suggested and observed were adapted, and the final tool was prepared. The Technical Advisory Group approved the content validity of the tool.Conclusions: A comprehensive tool was made to assess various aspects of respectful maternity care provided in tertiary Indian institutional settings aiding in in a deeper understanding of the phenomenon. This tool is recommended, especially to health care providers of India, for assessing the status of maternity care in health facilities and bringing the required interventions in the health care facilities.

scholarly journals Neonatal Mortality And Associated Factors Among Neonates Admitted In Public Hospitals, Afar Pastoral Region: A Health Facility Based Study

2019 ◽  
Author(s):  
abay woday ◽  
Yohannes Mekuria ◽  
Christine St Denis
Keyword(s):  
Logistic Regression ◽  
Antenatal Care ◽  
Neonatal Mortality ◽  
Health Facility ◽  
Medical Records ◽  
Associated Factors ◽  
Neonatal Resuscitation ◽  
Health Facilities ◽  
Public Hospitals ◽  
Assisted Delivery

Abstract Background: Neonatal mortality is a public health issue in developing countries, such as Ethiopia. Unfortunately, the issue is noticeably under-reported and underestimated, so the true gravity of the situation cannot be acknowledged. Subsequently, Afar in Ethiopia contributes the largest burden of under-five mortality when compared to other regions in the country. Regrettably, there is no current information to the rates and predictors of neonatal mortality for the region even for the health facilities. Thus, this study aims to assess neonatal mortality and associated factors in pastoral region, Afar region. Methods: A health facility-based retrospective cross-sectional study was conducted on 403 neonates admitted to the neonatal intensive care unit (NICU) from May 1st 2015 - May 2nd 2019. Medical records were reviewed and audited for both mothers and neonates to collect data using a standardized data extraction checklist. The medical records were selected using a systematic sampling technique. Binary logistic regression with odds ratio and 95% Confidence interval was calculated to assess the association between neonatal mortality and associated factors. Finally, the statistical significance level was declared at a p-value <0.05. Results: In this study, 391 medical records of neonates were included with the data complete rate of 97.02%. The prevalence of neonatal mortality was 14.6% (95% CI 11.0%-18.4%) with mortality rate of 35.5 per 1000 live births. A multivariable logistic regression showed that the lack of antenatal care (ANC) follow up (AOR = 5.92; 95%CI 2.34, 14.97: P<0.001), giving birth through cesarean section (AOR=3.52; 95%CI 1.22, 10.12: P<0.05), giving birth through assisted delivery (AOR=3.28 (1.14, 9.46): P<0.05), having a temperature less than 36.5oC within the first hour of admission (AOR= 5.89; 95%CI 2.32, 14.94: P<0.001), and perinatal asphyxia (AOR= 6.67; 95%CI 2.35, 18.89: P<0.001) were significantly associated with neonatal mortality. Conclusion: This study revealed that the rate of neonatal mortality is still too high compared to the studies conducted in non-pastoral regions of the nation. Thus, the health facilities should give due attention to improve antenatal care, neonatal resuscitation and follow the standard of care protocol for admitted neonates. Additional community based studies supported with qualitative methods are recommended.

scholarly journals Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative

2021 ◽  
Vol 6 (6) ◽  
pp. e005833
Author(s):  
Leena N Patel ◽  
Samantha Kozikott ◽  
Rodrigue Ilboudo ◽  
Moreen Kamateeka ◽  
Mohammed Lamorde ◽  
...  
Keyword(s):  
Health Facility ◽  
Healthcare Workers ◽  
National Level ◽  
Lessons Learned ◽  
Health Facilities ◽  
Infection Prevention And Control ◽  
Health Facility Level ◽  
Ensure Patient Safety ◽  
Increased Risk ◽  
Facility Level

Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve.

scholarly journals Improving Tanzanian childbirth service quality

2018 ◽  
Vol 31 (3) ◽  
pp. 190-202 ◽  
Author(s):  
Jennie Jaribu ◽  
Suzanne Penfold ◽  
Cathy Green ◽  
Fatuma Manzi ◽  
Joanna Schellenberg
Keyword(s):  
Health Facility ◽  
Low Income ◽  
Healthcare Providers ◽  
Health Facilities ◽  
Rural District ◽  
Local Data ◽  
Content Type ◽  
Primary Health ◽  
Primary Health Facilities ◽  
Childbirth Care

Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

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