Medicine and Health Sciences Commons^™

Adverse Maternal, Fetal, And Newborn Outcomes Among Pregnant Women With Sars-Cov-2 Infection: An Individual Participant Data Meta-Analysis, Emily R. Smith, Erin Oakley, Gargi Wable Grandner, Kacey Ferguson, Fouzia Farooq, Yalda Afshar, Mia Ahlberg, Homa Ahmadzia, Victor Akelo, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Introduction: Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies.

Methods: We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale.

Results: We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.

Pregnant women with …

Understanding Maternity Care Providers’ Use Of Data In Southern Tanzania, Regine Unkels, Fadhlun Alwy Al-Beity, Zamoyoni Julius, Elibariki Mkumbo, Andrea B. Pembe, Claudia Hanson, Helle Molsted-Alvesson

Obstetrics and Gynaecology, East Africa

Introduction: Health information management system data is collected for national planning and evaluation but is rarely used for healthcare improvements at subnational or facility-level in low-and-middle-income countries. Research suggests that perceived data quality and lack of feedback are contributing factors. We aimed to understand maternity care providers’ perceptions of data and how they use it, with a view to co-design interventions to improve data quality and use.

Methods: We based our research on constructivist grounded theory. We conducted 14 in-depth interviews, two focus group discussions with maternity care providers and 48 hours of observations in maternity wards to understand …

Exploring The Impact Of Health Worker Strikes On Maternal And Child Health In A Kenyan County, Abdu Mohiddin, Eva Langat, James Orwa, Violet Naanyu, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Studies of the impact of health care workers’ strikes tend to look at facility-level activity rather than populations, with evidence from low and middle-income countries relatively sparse. This study explored the effect of national strikes on maternal and child health. It looked at the impact on health system activity in both public and non-public sectors (e.g. private, faith-based), on health promotion investments like immunisation, and on disease detection like post-partum haemorrhage (PPH). A 100 day doctors’ strike started in December 2016, a 150 day nurses strike from June 2017 and then the clinical officers for 21 days that …

Cesarean Section: More Than A Maternal Health Issue, Marleen Temmerman, Abdu Mohiddin

Obstetrics and Gynaecology, East Africa

A cesarean section (CS) can be a lifesaving intervention when medically indicated, but it may also lead to adverse short- and long-term health effects for women and children

Maternal Sociodemographic Factors And Antenatal Stress, Maheshwari Andhavarapu, James Orwa, Marleen Temmerman, Wangira Musana

Obstetrics and Gynaecology, East Africa

Antenatal stress has been associated with adverse birth outcomes such as fetal growth restriction, low birth weight, and preterm birth. Understanding key determinants of stress in a vulnerable pregnant population has the potential of informing development of targeted cost-effective interventions to mitigate against these adverse birth outcomes. We conducted a secondary analysis of data from 150 pregnant women attending antenatal care services at a rural referral hospital in Kenya. The participants completed a sociodemographic and clinical questionnaire, the Cohen’s Perceived Stress Scale (PSS) and gave a hair sample for cortisol and cortisone analysis. The association between selected sociodemographic predictors (age, …

Health Care Workers’ Perspectives Of The Influences Of Disrespectful Maternity Care In Rural Kenya, Adelaide Lusambili, Stefania Wisofschi, Constance Shumba, Jerim Obure, Kennedy Mulama, Lucy Nyaga, Terrance J. Wade, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

While disrespectful treatment of pregnant women attending health care facilities occurs globally, it is more prevalent in low-resource countries. In Kenya, a large body of research studied disrespectful maternity care (DMC) from the perspective of the service users. This paper examines the perspective of health care workers (HCWs) on factors that influence DMC experienced by pregnant women at health care facilities in rural Kisii and Kilifi counties in Kenya. We conducted 24 in-depth interviews with health care workers (HCWs) in these two sites. Data were analyzed deductively and inductively using NVIVO 12. Findings from HCWs reflective narratives identified four areas …

Mapping Maternal Mortality Rate Via Spatial Zero-Inflated Models For Count Data: A Case Study Of Facility-Based Maternal Deaths From Mozambique, Osvaldo Loquiha, Niel Hens, Leonardo Chavane, Marleen Temmerman, Nafissa Osman, Christel Faes, Marc Aerts

Obstetrics and Gynaecology, East Africa

Maternal mortality remains very high in Mozambique, with estimates from 2015 showing a maternal mortality ratio of 489 deaths per 100,000 live births, even though the rates tend to decrease since 1990. Pregnancy related hemorrhage, gestational hypertension and diseases such as malaria and HIV/AIDS are amongst the leading causes of maternal death in Mozambique, and a significant number of these deaths occur within health facilities. Often, the analysis of data on maternal mortality involves the use of counts of maternal deaths as outcome variable. Previously we showed that a class of hierarchical zero-inflated models were very successful in dealing with …

Use Of The Robson Classification To Assess Caesarean Section Trends In 21 Countries: A Secondary Analysis Of Two Who Multicountry Surveys, Joshua P. Vogel, Ana Pilar Betrán, Nadia Vindevoghel, João Paulo Souza, Maria Regina Torloni, Jun Zhang, Özge Tunçalp, Rintaro Mori, Naho Morisaki, Eduardo Ortiz-Panozo, Bernardo Hernandez, Ricardo Pérez-Cuevas, Zahida Qureshi, A Metin Gülmezoglu, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Rates of caesarean section surgery are rising worldwide, but the determinants of this increase, especially in low-income and middle-income countries, are controversial. In this study, we aimed to analyse the contribution of specific obstetric populations to changes in caesarean section rates, by using the Robson classification in two WHO multicountry surveys of deliveries in health-care facilities. The Robson system classifies all deliveries into one of ten groups on the basis of five parameters: obstetric history, onset of labour, fetal lie, number of neonates, and gestational age.

Methods: We studied deliveries in 287 facilities in 21 countries that …

Maternal And Perinatal Health Research Priorities Beyond 2015: An International Survey And Prioritization Exercise, Joao Paulo Souza, Mariana Widmer, Ahmet Metin Gülmezoglu, Theresa Anne Lawrie, Ebunoluwa Aderonke Adejuyigbe, Guillermo Carroli, Caroline Crowther, Sheena M. Currie, Therese Dowswell, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Maternal mortality has declined by nearly half since 1990, but over a quarter million women still die every year of causes related to pregnancy and childbirth. Maternal-health related targets are falling short of the2015 Millennium Development Goals and a post-2015 Development Agenda is emerging. In connection with this, setting global research priorities for the next decade is now required.

Methods: We adapted the methods of the Child Health and Nutrition Research Initiative (CHNRI) to identify and set global research priorities for maternal and perinatal health for the period 2015 to 2025. Priority research questions were received from various international …

Implementation Of Evidence-Based Antenatal Care In Mozambique: A Cluster Randomized Controlled Trial: Study Protocol, Leonardo Chavane, Mario Merialdi, Ana Pilar Betrán, Jennifer Requejo-Harris, Eduardo Bergel, Alicia Aleman, Mercedes Colomar, Maria Luisa Cafferata, Alicia Carbonell, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Antenatal care (ANC) reduces maternal and perinatal morbidity and mortality directly through the detection and treatment of pregnancy-related illnesses, and indirectly through the detection of women at increased risk of delivery complications. The potential benefits of quality antenatal care services are most significant in low-resource countries where morbidity and mortality levels among women of reproductive age and neonates are higher. WHO developed an ANC model that recommended the delivery of services scientifically proven to improve maternal, perinatal and neonatal outcomes. The aim of this study is to determine the effect of an intervention designed to increase the use of …

Use Of Antenatal Corticosteroids And Tocolytic Drugs In Preterm Births In 29 Countries: An Analysis Of The Who Multicountry Survey On Maternal And Newborn Health, Joshua P. Vogel, João Paulo Souza, A Metin Gülmezoglu, Rintaro Mori, Pisake Lumbiganon, Zahida Qureshi, Guillermo Carroli, Malinee Laopaiboon, Bukola Fawole, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Despite the global burden of morbidity and mortality associated with preterm birth, little evidence is available for use of antenatal corticosteroids and tocolytic drugs in preterm births in low-income and middle-income countries. We analysed data from the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS) to assess coverage for these interventions in preterm deliveries.

Methods: WHOMCS is a facility-based, cross-sectional survey database of birth outcomes in 359 facilities in 29 countries, with data collected prospectively from May 1, 2010, to Dec 31, 2011. For this analysis, we included deliveries after 22 weeks’ gestation and we excluded births that …

Pregnancy And Childbirth Outcomes Among Adolescent Mothers: A World Health Organization Multicountry Study, Togoobaatar Ganchimeg, E Ota, N Morisaki, M Laopaiboon, P Lumbiganon, J Zhang, B Yamdamsuren, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objective: To investigate the risk of adverse pregnancy outcomes among adolescents in 29 countries. Design: Secondary analysis using facility-based cross-sectional data of the World Health Organization Multicountry Survey on Maternal and Newborn Health.

Setting: Twenty-nine countries in Africa, Latin America, Asia and the Middle East.

Population: Women admitted for delivery in 359 health facilities during 2–4 months between 2010 and 2011.

Methods: Multilevel logistic regression models were used to estimate the association between young maternal age and adverse pregnancy outcomes.

Main outcome measures: Risk of adverse pregnancy outcomes among adolescent mothers.

Results: A …

Ending Preventable Maternal Deaths: The Time Is Now, Flavia Bustreo, Lale Say, Marge Koblinsky, Thomas W. Pullum, Marleen Temmerman, Ariel Pablos-Méndez

Obstetrics and Gynaecology, East Africa

Between 1990 and 2010, maternal mortality decreased globally by nearly 50%, from 543 000 maternal deaths per year to 287 000, with the greatest reductions in the second half of this period. A major catalyst for this progress was the target set by Millennium Development Goal 5: reduction of the maternal mortality ratio by 75% between 1990 and 2015. Later, a second target on reproductive health was added, which has undoubtedly contributed to accelerated progress. In tandem, countries and the international community enhanced their commitment to support, develop, and implement effective interventions to improve the health of women, especially during …