Medicine and Health Sciences Commons^™

Perinatal Care In Western Uganda: Prevalence And Factors Associated With Appropriate Care Among Women Attending Three District Hospitals, Mercy Muwema, Dan K. Kaye, Grace Edwards, Gorrette Nalwadda, Joanita Nangendo, Jaffer Okiring, Wilson Mwanja, Elizabeth N. Ekong, Joan N. Kalyango, Joaniter I. Nankabirwa

School of Nursing & Midwifery, East Africa

Background: Perinatal mortality remains high globally and remains an important indicator of the quality of a health care system. To reduce this mortality, it is important to provide the recommended care during the perinatal period. We assessed the prevalence and factors associated with appropriate perinatal care (antenatal, intrapartum, and postpartum) in Bunyoro region, Uganda. Results from this study provide valuable information on the perinatal care services and highlight areas of improvement for better perinatal outcomes.

Methods: A cross sectional survey was conducted among postpartum mothers attending care at three district hospitals in Bunyoro. Following consent, a questionnaire was …

Risk Factors And Compliance Of Surviving Sepsis Campaign: A Retrospective Cohort Study At Tertiary Care Hospital, Farheen Yousuf, Ayesha Malik, Ayesha Saba, Sana Sheikh

Department of Obstetrics & Gynaecology

Background and objective: Sepsis is one of the leading causes of direct maternal mortality in Pakistan. It is recommended that the first three hours after the presentation are crucial. During this time implementation of surviving sepsis campaign resuscitation bundles reduces maternal mortality. Our objective was to assess the factors contributing to puerperal sepsis and the compliance of "surviving sepsis campaign resuscitation bundles in puerperal sepsis" for the management of puerperal sepsis.
Methods: This was a retrospective record review for five years from January 2011-December 2015. All women who fulfilled the inclusion criteria of puerperal sepsis were included and data from …

Why Are The Pakistani Maternal, Fetal And Newborn Outcomes So Poor Compared To Other Low And Middle-Income Countries?, Aleha Aziz, Sarah Saleem, Tracy L. Nolen, Nousheen Akber Pradhan, Elizabeth M. Mcclure, Saleem Jessani, Ana L. Garces, Patricia L. Hibberd, Janet L. Moore, Sameen Siddiqi

Community Health Sciences

Background: Pakistan has among the poorest pregnancy outcomes worldwide, significantly worse than many other low-resource countries. The reasons for these differences are not clear. In this study, we compared pregnancy outcomes in Pakistan to other low-resource countries and explored factors that might help explain these differences.
Methods: The Global Network (GN) Maternal Newborn Health Registry (MNHR) is a prospective, population-based observational study that includes all pregnant women and their pregnancy outcomes in defined geographic communities in six low-middle income countries (India, Pakistan, Democratic Republic of Congo, Guatemala, Kenya, Zambia). Study staff enroll women in early pregnancy and follow-up soon after …

Maternal Mortality In Six Low And Lower-Middle Income Countries From 2010 To 2018: Risk Factors And Trends, Melissa Bauserman, Vanessa R. Thorsten, Tracy L. Nolen, Jackie Patterson, Adrien Lokangaka, Antoinette Tshefu, Archana B. Patel, Patricia L. Hibberd, Sarah Saleem, Saleem Jessani

Community Health Sciences

Background: Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time.
Methods: We analyzed data from women enrolled in the NICHD Global Network for Women's and Children's Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative …

Trends And Determinants Of Newborn Mortality In Kyrgyzstan: A Countdown Country Case Study, Mahdis Kamali, James E. Wright, Nadia Akseer, Hana Tasic, Kaitlin Conway, Saman Brar, Cholpon Imanalieva, Gerrit Maritz, Arjumand Rizvi, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: Kyrgyzstan has made considerable progress in reducing child mortality compared with other countries in the region, despite a comparatively low economic standing. However, maternal mortality is still high. Given the availability of an established birth registration system, we aimed to comprehensively assess the trends and determinants of reproductive, maternal, newborn, and child health in Kyrgyzstan.
Methods: For this Countdown to 2030 country case study, we used publicly available data repositories and the national birth registry of Kyrgyzstan to examine trends and inequalities of reproductive, maternal, and newborn health and mortality between 1990 and 2018, at a national and subnational …

The Relationship Between Birth Intervals And Adverse Maternal And Neonatal Outcomes In Six Low And Lower-Middle Income Countries, Melissa Bauserman, Kayla Nowak, Tracy L. Nolen, Jackie Patterson, Adrien Lokangaka, Antoinette Tshefu, Archana B. Patel, Patricia L. Hibberd, Sarah Saleem, Saleem Jessani

Community Health Sciences

Background: Due to high fertility rates in some low and lower-middle income countries, the interval between pregnancies can be short, which may lead to adverse maternal and neonatal outcomes.
Methods: We analyzed data from women enrolled in the NICHD Global Network Maternal Newborn Health Registry (MNHR) from 2013 through 2018. We report maternal characteristics and outcomes in relationship to the inter-delivery interval (IDI, time from previous delivery [live or stillborn] to the delivery of the index birth), by category of 6-17 months (short), 18-36 months (reference), 37-60 months, and 61-180 months (long). We used non-parametric tests for maternal characteristics, and …

The Global Network Maternal Newborn Health Registry: A Multi-Country, Community-Based Registry Of Pregnancy Outcomes, Elizabeth M. Mcclure, Ana L. Garces, Patricia L. Hibberd, Janet L. Moore, Shivaprasad S. Goudar, Sarah Saleem, Fabian Esamai, Archana Patel, Elwyn Chomba, Adrien Lokangaka

Community Health Sciences

Background: The Global Network for Women's and Children's Health Research (Global Network) conducts clinical trials in resource-limited countries through partnerships among U.S. investigators, international investigators based in in low and middle-income countries (LMICs) and a central data coordinating center. The Global Network's objectives include evaluating low-cost, sustainable interventions to improve women's and children's health in LMICs. Accurate reporting of births, stillbirths, neonatal deaths, maternal mortality, and measures of obstetric and neonatal care is critical to determine strategies for improving pregnancy outcomes. In response to this need, the Global Network developed the Maternal Newborn Health Registry (MNHR), a prospective, population-based registry …

Prevalence And Determinants Of Anemia Among Women Of Reproductive Age In Thatta Pakistan: Findings From A Cross-Sectional Study, Sumera Aziz Ali, Zahid Abbasi, Babar Shahid, Ghazal Moin, K Michael Hambidge, Nancy F. Krebs, Jamie E. Westcott, Elizabeth M. Mcclure, Robert L. Goldenberg, Sarah Saleem

Community Health Sciences

Background: Anemia is a major public health concern among women of reproductive age leading to high maternal mortality in low- and middle-income countries. Of the prior studies conducted in Pakistan, most focused on large urban areas and did not explore the determinants of anemia among women of reproductive age (WRA) across socio-demographic, dietary, reproductive, and biological domains. Thus, we aimed to study the prevalence and determinants of anemia among WRA in rural Pakistan.
Methods: We conducted a cross-sectional study in the Thatta district of Pakistan from September 2018 to January 2019 and enrolled 150 non-pregnant, married women. Data collectors administered …

Obstetric Patients Requiring Critical Care: Retrospective Study In A Tertiary Care Institute Of Pakistan, Samina Ismail, Muhammad Sohaib

Department of Anaesthesia

Background: The outcome of obstetric patients admitted to the intensive care unit (ICU) depends on the number of factors. The objective of this study is to review the outcomes of these patients with regard to pregnancy status, source of admission, and their presenting illness at time of admission to ICU.
Materials and Methods: A retrospective study was undertaken for all obstetric patients admitted to the ICU of a private tertiary care hospital of Pakistan from 2014 to 2018. The data were reviewed thorough ICU log sheet, electronic medical records, and online laboratory data. The data included patient demographics, pregnancy status, …

The Politics Of Abortion And Maternal Health: A Discussion Paper, Ihsan Ullah, Ayaz Ayub, Edwin Van Teijlingen

Journal of Asian Midwives (JAM)

Abortion should be legally allowed for women because it can save mothers from childbirth-related complications and death. Legal abortion is one of the safest methods to terminate a pregnancy when there is a risk to the mother’s health by childbirth or severe deformity of the fetus or it is unwanted. Unfortunately, approximately half of all abortions worldwide mostly in nations where abortion is severely restricted and are performed in dangerous settings. These risky abortions are a significant contributor to maternal morbidity and disability. Limiting a woman's access to an abortion does not stop abortion; rather, it just encourages more risky …

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 …

Development And Internal Validation Of The Multivariable Cipher (Collaborative Integrated Pregnancy High-Dependency Estimate Of Risk) Clinical Risk Prediction Model, Beth A. Payne, Helen Ryan, Jeffrey Bone, Laura A. Magee, Alice B. Aarvold, J. Mark Ansermino, Zulfiqar Ahmed Bhutta, Mary Bowen, J. Guilherme Cecatti, Cynthia Chazotte

Department of Paediatrics and Child Health

Background: Intensive care unit (ICU) outcome prediction models, such as Acute Physiology And Chronic Health Evaluation (APACHE), were designed in general critical care populations and their use in obstetric populations is contentious. The aim of the CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) study was to develop and internally validate a multivariable prognostic model calibrated specifically for pregnant or recently delivered women admitted for critical care.
Methods: A retrospective observational cohort was created for this study from 13 tertiary facilities across five high-income and six low- or middle-income countries. Women admitted to an ICU for more than 24 h …

Improving Pregnancy Outcomes In Low- And Middle-Income Countries, Robert L. Goldenberg, Elizabeth M. Mcclure, Sarah Saleem

Community Health Sciences

This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal mortality, stillbirth and neonatal mortality in low-and middle-income countries. Next, we explore the medical interventions that were associated with the very rapid and very large declines in maternal, fetal and neonatal mortality rates in the last eight decades in high-income countries. The medical interventions likely to achieve similar declines in pregnancy-related mortality in low-income countries are considered. Finally, the quality of providers and the data to be collected necessary to achieve these reductions are discussed. It …

A Rare Case: Rupture Of Internal Pudendal And Uterine Artery In A Vaginal Delivery, Novera G. Chughtai, Raheela Mohsin Rizvi

Department of Obstetrics & Gynaecology

The management of puerperal hematomas after normal delivery has always been challenging for obstetricians. Vulvar, vulvovaginal, or paravaginal hematomas are common. On the other hand, retroperitoneal hematomas are uncommon and can be life-threatening. The diagnosis of vascular injury is rarely made preoperatively as atonic or traumatic postpartum hemorrhage (PPH), uterine rupture and amniotic fluid embolism are more common differential diagnoses. Injury to internal pudendal and uterine vessels is extremely rare in cases of vaginal delivery and, therefore, the literature on this topic is very scarce. We present a rare case of both internal pudendal and uterine artery rupture in a …

A Rare Case: Rupture Of Internal Pudendal And Uterine Artery In A Vaginal Delivery, Novera G. Chughtai, Raheela Mohsin Rizvi

Department of Obstetrics & Gynaecology

The management of puerperal hematomas after normal delivery has always been challenging for obstetricians. Vulvar, vulvovaginal, or paravaginal hematomas are common. On the other hand, retroperitoneal hematomas are uncommon and can be life-threatening. The diagnosis of vascular injury is rarely made preoperatively as atonic or traumatic postpartum hemorrhage (PPH), uterine rupture and amniotic fluid embolism are more common differential diagnoses. Injury to internal pudendal and uterine vessels is extremely rare in cases of vaginal delivery and, therefore, the literature on this topic is very scarce. We present a rare case of both internal pudendal and uterine artery rupture in a …

Root-Cause Analysis Of Persistently High Maternal Mortality In A Rural District Of Indonesia: Role Of Clinical Care Quality And Health Services Organizational Factors, Mohammad Afzal Mahmood, Ismi Mufidah, Steven Scroggs, Amna Rehana Siddiqui, Hafsa Raheel, Koentijo Wibdarminto, Bernardus Dirgantoro, Jorien Vercruyssen, Hayfaa A. Wahabi

Community Health Sciences

Background: Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants.
Method: Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays.
Findings: The root causes were found in poor quality of care, which caused …

Determinants Of Quality Of Care And Access To Basic Emergency Obstetric And Neonatal Care Facilities And Midwife-Led Facilities In Low And Middle-Income Countries: A Systematic Review, Preeti K. Mahato, Edwin Van Teijlingen, Padam P. Simkhada, Catherine Angell

Journal of Asian Midwives (JAM)

Background: Maternal mortality is a major challenge to health systems in Low and Middle-Income Countries (LMICs) where almost 99% of maternal deaths occurred in 2015. Primary-care facilities providing Basic Emergency Obstetric and Neonatal Care (BEmONC) facilities, and facilities that are midwife-led are appropriate for normal birth in LMICs and have been proposed as the best approach to reduce maternal deaths. However, the poor quality of maternal services that leads to decreased utilisation of these facilities is among the major causes of maternal deaths worldwide. This systematic review studied factors affecting the quality of care in BEmONC and midwife-led facilities in …

Comparison Of Foeto-Maternal Outcome In Pregnant Women With Hepatitis E - A Review Of 12 Years., Tahira Naru, Farheen Yousuf, Ayesha Malik, Sumaira Naz, Humera Ismail

Department of Obstetrics & Gynaecology

Objective: To compare adverse maternal and foetal outcome in pregnant women with hepatitis E immunoglobulin M reactive versus non-reactive.
Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of pregnant patients at any gestational age with clinical and biochemical evidence of hepatitis E from January 2002 and December 2014. . Maternal and perinatal outcome of the subjects were analysed. SPSS 20 was used for data analysis.
Results: Out of the 200 subjects, 168(84 %) were hepatitis E immunoglobulin M reactive and 32(16%) were non-reactive. The overall mean age was 26.7±4.5 years. Also, 12(7%) …

Can Right To Health Help Policy Makers To Address Maternal Mortality?: A Short Communication, Sumera Aziz Ali, Nadir Suhail, Savera Aziz Ali

Community Health Sciences

No abstract provided.

Mapping Of Research On Maternal Health Interventions In Low- And Middle-Income Countries: A Review Of 2292 Publications Between 2000 And 2012, Matthew Chersich, Duane Blaauw, Mari Dumbaugh, Loveday Penn-Kekana, Siphiwe Thwala, Leon Bijlmakers, Emily Vargas, Elinor Kern, Josephine Kavanagh, Stanley Luchters

Population Health, East Africa

Background: Progress in achieving maternal health goals and the rates of reductions in deaths from individual conditions have varied over time and across countries. Assessing whether research priorities in maternal health align with the main causes of mortality, and those factors responsible for inequitable health outcomes, such as health system performance, may help direct future research. The study thus investigated whether the research done in low- and middle-income countries (LMICs) matched the principal causes of maternal deaths in these settings.

Methods: Systematic mapping was done of maternal health interventional research in LMICs from 2000 to 2012. Articles were included on …

Systematic Review On Human Resources For Health Interventions To Improve Maternal Health Outcomes: Evidence From Low- And Middle-Income Countries, Zohra S. Lassi, Nabiha B. Musavi, Blerta Maliqi, Nadia Mansoor, Andres De Francisco, Kadidiatou Toure, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

There is a broad consensus and evidence that shows qualified, accessible, and responsive human resources for health (HRH) can make a major impact on the health of the populations. At the same time, there is widespread recognition that HRH crises particularly in low- and middle-income countries (LMICs) impede the achievement of better health outcomes/targets. In order to achieve the Sustainable Development Goals (SDGs), equitable access to a skilled and motivated health worker within a performing health system is need to be ensured. This review contributes to the vast pool of literature towards the assessment of HRH for maternal health and …

Global Collaboration Between Tanzania And Japan To Advance Midwifery Profession: A Case Report Of A Partnership Model, Yoko Shimpuku, Shigeko Horiuchi, Sebalda C. Leshabari, Dickson Mkoka, Yasuko Nagamatsu, Miwako Matsutani, Hiromi Eto, Michiko Oguro, Yukari Yaju, Mariko Iida, Columba Mbekenga, Lilian Mselle, Agnes Mtawa

School of Nursing & Midwifery, East Africa

The global health agenda to reduce maternal mortality is delayed in Sub-Saharan Africa. The shortage of skilled birth attendants in Tanzania hinders the improvement of midwifery care to prevent maternal mortality and morbidity. It is urgently neccesary to develop midwifery leaders capable of working as educators, researchers, administrators, and advanced practitioners, contributing to the improvement of midwifery care and maternal child health in their own country. This report describes the process of establishing the first midwifery master’s program in Tanzania through the efforts of two academic institutions, one in Tanzania and one in Japan. The collaboration developed a sustainable partnership …

National Skills Training Centre In India, Manju Chhugani, Ashin Merlin

Journal of Asian Midwives (JAM)

A key determinant which can ensure the quality of healthcare in public health institutions is the skill set of the individuals providing service delivery. Health professionals possess the skills and the expertise in this respect; however, they fail to utilize these optimally. This is because there is a disconnect between their knowledge and practice, it is now imperative tobridge the gap between basic education and clinical practice. The creation of skill labs is one way in which this gap can be addressed. Though India has seen a decline inboth the Maternal and Infant Mortality Rates, significant changes are yet to …

Opportunities To Improve Postpartum Care For Mothers And Infants: Design Of Context-Specific Packages Of Postpartum Interventions In Rural Districts In Four Sub-Saharan African Countries, Els Duysburgh, Birgit Kerstens, Seni Kouanda, Charles Paulin Kaboré, Danielle Belemsaga Yugbare, Peter Gichangi, Gibson Masache, Beatrice Crahay, Gilda Gondola Sitefane, Nafissa Bique Osman, Severiano Foia, Henrique Barros, Sofia Castro Lopes, Susan Mann, Bejoy Nambiar, Tim Colbourn, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Postpartum maternal and infant mortality is high in sub-Saharan Africa and improving postpartum care as a strategy to enhance maternal and infant health has been neglected. We describe the design and selection of suitable, context-specific interventions that have the potential to improve postpartum care.

Methods: The study is implemented in rural districts in Burkina Faso, Kenya, Malawi and Mozambique. We used the four steps ‘systems thinking’ approach to design and select interventions: 1) we conducted a stakeholder analysis to identify and convene stakeholders; 2) we organised stakeholders causal analysis workshops in which the local postpartum situation and challenges and …

A Review Of Critical Care Management Of Maternal Sepsis, Madiha Hashmi, Fazal Hameed Khan

Department of Anaesthesia

Sepsis is a leading cause of preventable maternal mortality in developing countries due to poverty, home deliveries by untrained persons in unhygienic conditions, limited access to healthcare facilities and lack of availability of antibiotics. Recent confidential enquiries into maternal deaths from the developed nations have revealed an increase in maternal mortality secondary to genital tract sepsis and provision of suboptimal critical care. Early recognition of critical illness in obstetric patients, involvement of intensive care teams earlier and provision of same standard of critical care to pregnant women as non-pregnant patients while being mindful of the altered maternal physiology and fetal …

Community-Based Intervention Packages For Reducing Maternal And Neonatal Morbidity And Mortality And Improving Neonatal Outcomes, Zohra S. Lassi, Batool A. Haider, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: While maternal, infant and under-five child mortality rates in developing countries have declined significantly in the past two to three decades, newborn mortality rates have reduced much more slowly. While it is recognised that almost half of the newborn deaths can be prevented by scaling up evidence-based available interventions such as tetanus toxoid immunisation to mothers, clean and skilled care at delivery, newborn resuscitation, exclusive breastfeeding, clean umbilical cord care, management of infections in newborns, many require facility based and outreach services. It has also been stated that a significant proportion of these mortalities and morbidities could also be …