ResearchPad - labor-and-delivery https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Predictors of change of health workers’ knowledge and skills after the Helping Mothers Survive Bleeding after Birth (HMS BAB) in-facility training in Tanzania]]> https://www.researchpad.co/article/elastic_article_15768 Our study aimed to assess the effect of Helping Mothers Survive Bleeding after Birth on knowledge and skills of health workers and whether such effect varies by health workers characteristics.MethodsNested in a cluster-randomised trial to assess the effect of the training on health outcomes, we assessed changes in knowledge and simulated skills in 61 facilities. The assessments were done i) before, ii) immediately-after training session and iii) at 10-month follow-up for subset of health-workers of implementation facilities as defined by the trial. We used a self-administered questionnaire and Objective Structures Clinical Examinations to assess three skill sets: Active Management of Third Stage of Labour, removal of retained placenta and management of severe postpartum haemorrhage. We computed summary statistics and used the paired t-test to assess change of knowledge and skills immediately post-training and at 10-month follow-up. Linear regression was done to assess association of scores and health worker characteristics.ResultsOf the 636 health workers included, 606 (96.7%) and 591 (91.4%) completed the knowledge and skills assessments, respectively. Majority of the participants (68%) were nurse-midwives. Knowledge scores increased by 15 percentage-points from 77.5% to 93% (95% CI 14.3, 16.3, p-value <0.000), and skills scores by 47 percentage-points (95% CI 46.5, 49.2, p-value <0.000) from 37.5% to 83%. There was a 4.0% decline of skills at 10-month follow-up. The decline was higher in auxiliary staff (-11.8%) and least in nurse-midwives (-2.1%) p-value <0.001. Health workers who assisted less than 5 deliveries in the last month, those who never attended postpartum haemorrhage in-service training and profession experience >8 years were associated with lower mean skill change immediately post-training.ConclusionOur study supports the potential of the Helping Mothers Survive Bleeding after Birth training to increase knowledge and skills of postpartum haemorrhage among all professional groups. Auxiliary staff benefited most from the training but also showed higher skill decline at 10-month. Our study highlights the importance to disaggregate knowledge and skills by health workers characteristics. ]]> <![CDATA[Spatiotemporal trends and ecological determinants in maternal mortality ratios in 2,205 Chinese counties, 2010–2013: A Bayesian modelling analysis]]> https://www.researchpad.co/article/elastic_article_14689 Information about the spatiotemporal trends of the maternal mortality ratio is helpful in the policymaking response to reducing the maternal mortality ratio (MMR) in developing areas.The study can help the government to preassess the effects of policy if the corresponding magnitudes of influence of the underlying determinants can be quantified.The quantitative statistical results of national and subnational influencing effects and patterns can help the government to create policies with precision.What did the researchers do and find?We employed a Bayesian space–time model to explore the spatiotemporal trends of the MMR in 2,205 Chinese counties from 2010 to 2013 and used Bayesian multivariable regression and GeoDetector models to address 3 main ecological determinants of MMR.The major determinants of the MMR in China are medical intervention factors. The MMR will decrease by 1.787 (95% CI 1.424–2.142, p < 0.001) and 0.623 (95% CI 0.436–0.798, p < 0.001) per 100,000 live births when the proportion of hospital births and the proportion of 5 or more antenatal care visits increase by 1.0%.The major determinants for the MMR in the western and southwestern regions of China are per capita income and antenatal care, while in the eastern and southern coastal regions, it is per capita income.What do these results mean?Many countries, and particularly developing countries, may learn from China’s dramatic improvement in maternal survival rates.This progress has profited from long-term strategies to enhance delivery care in healthcare facilities and the provision of professional maternity care in large hospitals. There are, however, a variety of policy effects that have occurred in different areas due to regional heterogeneity.We have revealed the dominant factors and their corresponding influencing magnitudes at the national and subnational level, and this evidence may help China or other developing countries to preassess policy effects. ]]> <![CDATA[Cytokine signatures of <i>Plasmodium vivax</i> infection during pregnancy and delivery outcomes]]> https://www.researchpad.co/article/elastic_article_14648 Cytokine and growth factor plasma concentrations were evaluated in women from five countries endemic for malaria vivax, at different moments and blood compartments during pregnancy. P. vivax infection during pregnancy was associated with a pro-inflammatory and TH1 response, together with an antiinflammatory response. Nevertheless, at delivery most associations between cytokines and infection were lost. Of note, CCL11/eotaxin, a chemokine not generally analyzed in malaria studies, presented a lower concentration in P. vivax-infected women and a protective association with hemoglobin levels at delivery. Moreover, IL-4 levels had a negative association with birth weight. Data suggest that a compensated inflammatory/antiinflammatory response in P. vivax infection during pregnancy might avoid poor delivery outcomes, while a predominance of TH2 responses may be detrimental for birth weight. Further research is warranted to unravel the role of CCL11 in malaria infection or exposure.

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<![CDATA[The Childbirth Experience Questionnaire (CEQ)—Validation of its use in a Danish-speaking population of new mothers stimulated with oxytocin during labour]]> https://www.researchpad.co/article/elastic_article_14579 When determining optimal treatment regimens, patient reported outcomes including satisfaction are increasingly appreciated. It is well established that the birth experience may affect the postnatal attachment to the newborn and the management of subsequent pregnancies and deliveries. As we have no robust validated Danish tool to evaluate the childbirth experience exists, we aimed to perform a transcultural adaptation of the Childbirth Experience Questionnaire (CEQ) to a Danish context.MethodsIn accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), we translated the Swedish-CEQ to Danish. The Danish-CEQ was tested for content validity among 10 new mothers. In a population of women who have had their labour induced, we then assessed the electronic questionnaire for validity and reliability using factor analytical design, hypothesis testing, and internal consistency. Based on these data, we determined criterion and construct responsiveness in addition to floor and ceiling effects.ResultsThe content validation resulted in minor adjustments in two items. This improved the comprehensibility. The electronic questionnaire was completed by 377 of 495 women (76.2%). The original Swedish-CEQ was four-dimensional, however an exploratory factor analysis revealed a three-dimensional structure in our Danish population (Own capacity, Participation, and Professional support). Parous women, women who delivered vaginally, and women with a labour duration <12 hours had a higher score in each domain. The internal consistency (Cronbach’s alpha) ranged between 0.75 and 0.89 and the ICC between 0.68–0.93. We found ceiling effects of 57.6% in the domain Professional support and of 25.5% in the domain Participation.ConclusionThis study offers transcultural adaptation of the Swedish-CEQ to a Danish context. The 3-dimensional Danish-CEQ demonstrates construct validity and reliability. Our results revealed significant ceiling effect especially in the domain Professional support, which needs to be acknowledged when considering implementing the Danish-CEQ into trials and clinical practice. ]]> <![CDATA[Associations between recent intimate partner violence and receipt and quality of perinatal health services in Uttar Pradesh]]> https://www.researchpad.co/article/elastic_article_14572 India suffers some of the highest maternal and neonatal mortality rates in the world. Intimate partner violence (IPV) can be a barrier to utilization of perinatal care, and has been associated with poor maternal and neonatal health outcomes. However, studies that assess the relationship between IPV and perinatal health care often focus solely on receipt of services, and not the quality of the services received.Methods and findingsData were collected in 2016–2017 from a representative sample of women (15-49yrs) in Uttar Pradesh, India who had given birth within the previous 12 months (N = 5020), including use of perinatal health services and past 12 months experiences of physical and sexual IPV. Multivariate logistic regression models assessed whether physical or sexual IPV were associated with perinatal health service utilization and quality.Reports of IPV were not associated with odds of receiving antenatal care or a health worker home visit during the third trimester, but physical IPV was associated with fewer diagnostic tests during antenatal visits (beta = -0.30), and fewer health topics covered during home visits (beta = -0.44). Recent physical and recent sexual IPV were both associated with decreased odds of institutional delivery (physical IPV AOR 0.65; sexual IPV AOR 0.61), and recent sexual IPV was associated with leaving a delivery facility earlier than recommended (AOR = 1.87). Neither form of IPV was associated with receipt of a postnatal home visit, but recent physical IPV was associated with fewer health topics discussed during such visits (beta = -0.26).ConclusionsIn this study, reduced quantity and quality of perinatal health care were associated with recent IPV experiences. In cases where IPV was not related to care receipt, IPV remained associated with diminished care quality. Additional study to understand the mechanisms underlying associations between IPV and care qualities is required to inform health services. ]]> <![CDATA[Left powerless: A qualitative social media content analysis of the Dutch #breakthesilence campaign on negative and traumatic experiences of labour and birth]]> https://www.researchpad.co/article/elastic_article_13813 Disrespect and abuse during labour and birth are increasingly reported all over the world. In 2016, a Dutch client organization initiated an online campaign, #genoeggezwegen (#breakthesilence) which encouraged women to share negative and traumatic maternity care experiences. This study aimed (1) to determine what types of disrespect and abuse were described in #genoeggezwegen and (2) to gain a more detailed understanding of these experiences.MethodsA qualitative social media content analysis was carried out in two phases. (1) A deductive coding procedure was carried out to identify types of disrespect and abuse, using Bohren et al.’s existing typology of mistreatment during childbirth. (2) A separate, inductive coding procedure was performed to gain further understanding of the data.Results438 #genoeggezwegen stories were included. Based on the typology of mistreatment during childbirth, it was found that situations of ineffective communication, loss of autonomy and lack of informed consent and confidentiality were most often described. The inductive analysis revealed five major themes: ‘‘lack of informed consent”; ‘‘not being taken seriously and not being listened to”; ‘‘lack of compassion”; ‘‘use of force”; and ‘‘short and long term consequences”. “Left powerless” was identified as an overarching theme that occurred throughout all five main themes.ConclusionThis study gives insight into the negative and traumatic maternity care experiences of Dutch women participating in the #genoeggezwegen campaign. This may indicate that disrespect and abuse during labour and birth do happen in the Netherlands, although the current study gives no insight into prevalence. The findings of this study may increase awareness amongst maternity care providers and the community of the existence of disrespect and abuse in Dutch maternity care, and encourage joint effort on improving care both individually and systemically/institutionally. ]]> <![CDATA[Variation in plasma 25-hydroxyvitamin D2 and D3 in normal pregnancy with gestational age, sampling season, and complications: A longitudinal cohort study]]> https://www.researchpad.co/article/Ndf1a2733-e0b1-4fc7-90ad-b2bfa4368f5f

Introduction

Low levels of vitamin D in pregnancy have been associated with the risk of a variety of pregnancy outcomes. Few studies have investigated vitamin D concentrations throughout pregnancy in healthy women, and most guidelines recommend high vitamin D levels. In the present study, we investigated 25-hydroxyvitamin D concentrations in healthy Caucasian Danish women in relation to season, gestational age and possible vitamin D-linked complications.

Materials and methods

Eight hundred and one healthy Caucasian Danish women with an expected normal pregnancy were recruited among 2147 women attending first trimester screening. Seven blood samplings were planned throughout the pregnancy and delivery period. The 25-hydroxyvitamin D2 (25(OH)D2) and 25-hydroxyvitamin D3 (25(OH)D3) concentrations were measured by LC-MS/MS and total 25-hydroxyvitamin D (25(OH)D) were calculated.

Results

A total of 3304 samples from 694 women were available for 25(OH)D measurements. The mean (25th-75th percentiles) concentrations of 25(OH)D, 25(OH)D3, and 25(OH)D2 were 54.6 (38.8–68.6) nmol/L, 52.2 (36.4–66.4) nmol/L, and 2.4 (2.2–2.2) nmol/L, respectively. Season was the strongest predictor of 25(OH)D concentration, with the lowest values observed in winter and spring, where only 42% and 41% of samples, respectively, were above 50 nmol/L. Nearly all women had values below the suggested optimal level of 75 nmol/L, independent of season. 25(OH)D peaked at gestational weeks 21–34. Plasma 25(OH)D2 levels were low in all seasons. Women with complications during pregnancy had higher 25(OH)D (estimated difference 9.8 nmol/L, standard error 2.7, p<0.001) than did women without complications, and women giving birth vaginally had lower 25(OH)D than did those delivering via elective (10.0 nmol/L, standard error 2.1, p<0.001) or emergency cesarean section (6.8 nmol/L, standard error 2.2, p<0.001).

Conclusion

The 25(OH)D concentrations vary with both season and gestational age. Healthy women had lower 25(OH)D concentrations than recommended, without an association with an increased risk of pregnancy complications. Guidelines for vitamin D in pregnancy may require revision.

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<![CDATA[High prevalence of caesarean birth among mothers delivered at health facilities in Bahir Dar city, Amhara region, Ethiopia. A comparative study]]> https://www.researchpad.co/article/Nc10b7a7b-4e34-4c06-9bc7-b9eb28d75615

Objective

The study aimed to assess and compare the prevalence of caesarean birth and associated factors among women gave birth at public and private health facilities in Bahir Dar city, Amhara region, Ethiopia.

Methods

An institution-based comparative cross-sectional study design was conducted from March1-April 15, 2019 at health facility provide emergency obstetrics service in Bahir Dar city. Study participants 724(362 for each public and private facility) were recruited using a systematic random sampling technique. Structured interview administered questionnaires and chart review checklist were used to collect data. The data were entered into Epi info version 7.2 and analyzed using SPSS version 23.0 software. A binary logistic regression model was fitted and an adjusted odds ration with 95% CI was used to determine the presence and strength of association between independent variables and cesarean birth.

Results

The response rate was 98.3% and 97.2% for public and private health facilities respectively. The prevalence of caesarean birth in private health facilities was 198 (56.3%) (95%CI: 50.9, 61.4) and in public health facilities was 98 (27.5%) (95%CI: 22.8, 32.2). Overall prevalence of caesarean birth was 296 (41.8%) (95%CI: 38.4, 45.5). Breech presentation (AOR = 3.64; 95%CI:1.49, 8.89), urban residence (AOR = 6.54; 95%CI:2.59, 16.48) and being referred (AOR = 2.44; 95%CI:1.46, 4.08) were variables significantly associated with caesarean birth among public facilities whereas age between 15–24 (AOR = 0.20, 95% CI; 0.07, 0.52), government employe (AOR = 2.28; 95%CI: 1.39,3.75), self-employed (AOR = 3.73; 95%CI:1.15,8.59), para one (AOR = 6.79; 95%CI:2.02, 22.79), para two (AOR = 3.88; 95% CI:1.15,13.08), and wealth index being highest level of wealth asset AOR = 5.39; 95%CI:1.08, 26.8) in private health facility associated with caesarean birth.

Conclusions

We concluded that there is high prevalence of caesarean birth both in private and public facility. There is a statistically significant difference in the prevalence of caesarean birth in public and private health facilities.

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<![CDATA[Would you like to participate in this trial? The practice of informed consent in intrapartum research in the last 30 years]]> https://www.researchpad.co/article/Na45ec8a9-d35b-4ecd-a654-0f10371697fd

Background

Informed consent is the cornerstone of the ethical conduct and protection of the rights and wellbeing of participants in clinical research. Therefore, it is important to identify the most appropriate moments for the participants to be informed and to give consent, so that they are able to make a responsible and autonomous decision. However, the optimal timing of consent in clinical research during the intrapartum period remains controversial, and currently, there is no clear guidance.

Objective

We aimed to describe practices of informed consent in intrapartum care clinical research in the last three decades, as reported in uterotonics for postpartum haemorrhage prevention trials.

Methods

This is a secondary analysis of the studies included in the Cochrane review entitled “Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis” published in 2018. All the reports included in the Cochrane network meta-analysis were eligible for inclusion in this analysis, except for those reported in languages other than English, French or Spanish. We extracted and synthesized data on the time each of the components of the informed consent process occurred.

Results

We assessed data from 192 studies, out of 196 studies included in the Cochrane review. The majority of studies (59.9%, 115 studies) reported that women were informed about the study, without specifying the timing. When reported, most studies informed women at admission to the facility for childbirth. Most of the studies reported that consent was sought, but only 59.9% reported the timing, which in most of the cases, was at admission for childbirth. Among these, 32 studies obtained consent in the active phase of labour, 17 in the latent phase and in 10 studies the labour status was unknown. Women were consented antenatally in 6 studies and in 8 studies the consent was obtained indistinctly during antenatal care or at admission. Most of the studies did not specified who was the person who sought the informed consent.

Conclusion

Practices of informed consent in trials on use of uterotonics for prevention of postpartum haemorrhage showed variability and substandard reporting. Informed consent sought at admission for childbirth was the most frequent approach implemented in these trials.

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<![CDATA[Dynamics of leukocyte telomere length in pregnant women living with HIV, and HIV-negative pregnant women: A longitudinal observational study]]> https://www.researchpad.co/article/5c897779d5eed0c4847d2db4

Background

HIV-mediated inflammation and immune activation can accelerate telomere attrition. In addition, antiretrovirals can inhibit telomerase, possibly shortening telomeres. We examined the longitudinal dynamics of leukocyte telomere length (LTL) during pregnancy in a unique cohort of women living with HIV (WLWH) treated with combination antiretroviral therapy (cART), and HIV-negative control women.

Methods

Blood was collected at three visits during pregnancy, at 13–23, >23–30, and >30–40 weeks of gestation, and for WLWH only, at 6 weeks post-partum. LTL was measured by qPCR and both cross-sectional and longitudinal (MANOVA) models were used to examine possible predictors of LTL among participants who attended all three visits during pregnancy.

Results

Among WLWH (n = 64) and HIV-negative women (n = 41), within participant LTL were correlated throughout pregnancy (p<0.001). LTL was shorter among WLWH at first visit, but this difference waned by the second visit. WLWH who discontinued cART post-partum experienced a decrease in LTL. Longitudinally, LTL was similar in both groups and increased as gestation progressed, a change that was more pronounced among women under 35 years. Among WLWH, both smoking throughout pregnancy (p = 0.04) and receiving a ritonavir-boosted protease inhibitor-based regimen (p = 0.03) were independently associated with shorter LTL.

Conclusions

LTL increases as pregnancy progresses; the reasons for this are unknown but may relate to changes in blood volume, hormones, and/or cell subset distribution. While our observations need confirmation in an independent cohort, our data suggest that although some cART regimens may influence LTL, being on cART appears overall protective and that stopping cART post-partum may negatively impact LTL. The effect of smoking on LTL is clearly negative, stressing the importance of smoking cessation.

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<![CDATA[Implementing the INTERGROWTH-21st gestational dating and fetal and newborn growth standards in peri-urban Nairobi, Kenya: Provider experiences, uptake and clinical decision-making]]> https://www.researchpad.co/article/5c8c1980d5eed0c484b4d7dd

Background

Perinatal and newborn complications are major risk factors for unfavorable fetal and neonatal outcomes. Gestational dating and growth monitoring can be instrumental in the identification and management of high-risk pregnancies and births. The INTERGROWTH-21st Project developed the first global standards for gestational dating and fetal and newborn growth monitoring, supplying a toolkit for clinicians. This study aimed to assess the feasibility and acceptability of the first known implementation study of these standards in a low resource setting.

Methods

The study was performed in two 12-month phases from March 2016 to March 2018 at Jacaranda Health, a private maternity hospital in peri-urban Nairobi, Kenya. In-depth interviews, focus group discussions and a provider survey were utilized to evaluate providers’ experiences during implementation. Client chart data, for pregnant women attending antenatal care and/or delivering at Jacaranda Health along with their newborns, were captured to assess uptake and effect of the standards on clinical decision-making.

Results

Facility-level support and provider buy-in proved to be critical factors driving the success of implementing the standards. However, additional support was needed to strengthen capacity to conduct and interpret ultrasounds and maintain motivation among providers. We observed a significant increase in the uptake of obstetric ultrasounds, particularly gestational dating, during the implementation of the standards. Although no significant changes were detected in the identification of high-risk pregnancies, referrals and deliveries by Cesarean section during implementation, we did observe a significant reduction in inductions for post-date. No significant barriers were reported regarding the use of the newborn standards. Over 80% of providers advocated for the standards to remain in place with some enhancements related mainly to training, advocacy and procurement.

Conclusions

The findings are timely with increasing global adoption of the standards and the challenging and multi-faceted nature of translating new, evidence-based guidelines into routine clinical practice.

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<![CDATA[How is women’s demand for caesarean section measured? A systematic literature review]]> https://www.researchpad.co/article/5c89779cd5eed0c4847d317e

Background

Caesarean section rates are increasing worldwide, and since the 2000s, several researchers have investigated women’s demand for caesarean sections.

Question

The aim of this article was to review and summarise published studies investigating caesarean section demand and to describe the methodologies, outcomes, country characteristics and country income levels in these studies.

Methods

This is a systematic review of studies published between 2000 and 2017 in French and English that quantitatively measured women’s demand for caesarean sections. We carried out a systematic search using the Medline database in PubMed.

Findings

The search strategy identified 390 studies, 41 of which met the final inclusion criteria, representing a total sample of 3 774 458 women. We identified two different study designs, i.e., cross-sectional studies and prospective cohort studies, that are commonly used to measure social demand for caesarean sections. Two different types of outcomes were reported, i.e., the preferences of pregnant or non-pregnant women regarding the method of childbirth in the future and caesarean delivery following maternal request. No study measured demand for caesarean section during the childbirth process. All included studies were conducted in middle- (n = 24) and high-income countries (n = 17), and no study performed in a low-income country was found.

Discussion

Measuring caesarean section demand is challenging, and the structural violence leading to demand for caesarean section during childbirth while in the labour ward remains invisible. In addition, the caesarean section demand in low-income countries remains unclear due to the lack of studies conducted in these countries.

Conclusion

We recommend conducting prospective cohort studies to describe the social construction of caesarean section demand. We also recommend conducting studies in low-income countries because demand for caesarean sections in these countries is rarely investigated.

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<![CDATA[An mHealth pilot designed to increase the reach of prevention of mother-to-child transmission of HIV (PMTCT) across the treatment cascade in a resource-constrained setting in Tanzania]]> https://www.researchpad.co/article/5c70673ed5eed0c4847c6c88

Background

Data collection and integrated reporting between the multiple health facilities for supporting more efficient care linkages is an indispensable element for prevention of mother-to-child transmission of HIV (PMTCT) by fostering continuity of patient care and improving the treatment cascade for HIV-infected pregnant women. mHealth potentially presents timely solutions to the data challenges related to efficient and effective care delivery in resource-constrained settings, particularly in low- and middle-income countries.

Methods

This randomized controlled pilot study used stratified random sampling for the selection of seven intervention and seven control sites in Misungwi, Tanzania, a rural district in the northwestern region. Twenty-eight health workers at seven intervention health facilities used the Tanzania Health Information Technology (T-HIT) system during a 3-month period from February 23, 2015, through May 23, 2015, to capture antenatal, delivery, and postnatal patient visits.

Results

T-HIT was designed for use on tablets with the goal to improve reporting, surveillance and monitoring of HIV rates and care delivery in the remote and rural settings. Health workers successfully recorded 2,453 visits. Of these, 1,594 were antenatal visits, 484 deliveries were recorded, and 375 were postnatal visits. Within the antenatal visits, 96% of women had a single visit (1474). Healthcare workers were unable to test 6.7% of women antenatally for HIV.

Conclusion

The T-HIT pilot demonstrated the feasibility for implementing an mHealth integrated solution in a rural, low-resource setting that links tablet-based surveillance, health worker capacity-building and patient reminders into a single robust and responsive system. Although the implementation phase was only three months, the pilot generated evidence that T-HIT has potential for improving patient outcomes by providing more comprehensive, linked, and timely PMTCT care data at the individual and clinic levels.

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<![CDATA[Individual and community level factors associated with health facility delivery: A cross sectional multilevel analysis in Bangladesh]]> https://www.researchpad.co/article/5c6dca09d5eed0c48452a6ef

Introduction

Improving maternal health remains one of the targets of sustainable development goals. A maternal death can occur at any time during pregnancy, but delivery is by far the most dangerous time for both the woman and her baby. Delivery at a health facility can avoid most maternal deaths occurring from preventable obstetric complications. The influence of both individual and community factors is critical to the use of health facility delivery services. In this study, we aim to examine the role of individual and community factors associated with health facility-based delivery in Bangladesh.

Methods

This cross-sectional study used data from the Bangladesh Maternal Mortality Survey. The sample size constitutes of 28,032 women who had delivered within five years preceding the survey. We fitted logistic random effects regression models with the community as a random effect to assess the influence of individual and community level factors on use of health facility delivery services.

Results

Our study observed substantial amount of variation at the community level. About 28.6% of the total variance in health facility delivery could be attributed to the differences across the community. At community level, place of residence (AOR 1.48; 95% CI 1.35–1.64), concentration of poverty (AOR 1.15; 95% CI 1.03–1.28), concentration of use of antenatal care services (AOR 1.11, 95% CI 1.00–1.23), concentration of media exposure (AOR 1.20, 95% CI 1.07–1.34) and concentration of educated women (AOR 1.12, 95% CI 1.02–1.23) were found to be significantly associated with health facility delivery. At individual level, maternal age, educational status of the mother, religion, parity, delivery complications, individual exposure to media, individual access to antenatal care and household socioeconomic status showed strong association with health facility-based delivery.

Conclusion

Our results strongly suggest factors at both Individual, and community level influenced the use of health facility delivery services in Bangladesh. Thus, any future strategy to improve maternal health in Bangladesh must consider community contexts and undertake multi-sectorial approach to address barriers at different levels. At the individual level the programs should also focus on the need of the young mother, the multiparous the less educated and women in the poorest households.

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<![CDATA[Investigating pathways linking women’s status and empowerment to skilled attendance at birth in Tanzania: A structural equation modeling approach]]> https://www.researchpad.co/article/5c6dc9cbd5eed0c48452a1e8

Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa where use of a skilled birth attendant (SBA) at delivery has remained low. Despite the recognized importance of women’s empowerment as a key determinant of maternal and newborn health, evidence from sub-Saharan Africa is more limited. Using data from the 2010 Tanzania Demographic and Health Survey (n = 4,340), this study employs a robust method–structural equation modeling (SEM)–to investigate the complex and multidimensional pathways through which women’s empowerment affects SBA use. The results show that women’s education and household decision-making are positively associated with SBA use. However, not all empowerment dimensions have similar effects. Attitudes towards sex negotiation and violence as well as early marriage are not significant factors in Tanzania. Mediation analysis also confirms the indirect effect of education on SBA use only through household decision-making. The findings underscore the utility of structural equation modeling when examining complex and multidimensional constructs, such as empowerment, and demonstrate potential causal inference to better inform policy and programmatic recommendations.

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<![CDATA[Monitoring quality of obstetric care from hospital discharge databases: A Delphi survey to propose a new set of indicators based on maternal health outcomes]]> https://www.researchpad.co/article/5c6c7589d5eed0c4843cfe6b

Objectives

Most indicators proposed for assessing quality of care in obstetrics are process indicators and do not directly measure health effects, and cannot always be identified from routinely available databases. Our objective was to propose a set of indicators to assess the quality of hospital obstetric care from maternal morbidity outcomes identifiable in permanent hospital discharge databases.

Methods

Various maternal morbidity outcomes potentially reflecting quality of obstetric care were first selected from a systematic literature review. Then a three-round Delphi consensus survey was conducted online from 11/2016 through 02/2017 among a French panel of 37 expert obstetricians, anesthetists-critical-care specialists, midwives, quality-of-care researchers, and user representatives. For a given maternal outcome, several definitions could be proposed and the indicator (i.e. corresponding rate) could be applied to all women or restricted to specific subgroup(s).

Results

Of the 49 experts invited to participate, 37 agreed. The response rate was 92% in the second round and 97% in the third. Finally, a set of 13 indicators was selected to assess the quality of hospital obstetric care: rates of uterine rupture, postpartum hemorrhage, transfusion incident, severe perineal lacerations, episiotomy, cesarean, cesarean under general anesthesia, post-cesarean site infection, anesthesia-related complications, postpartum pulmonary embolism, maternal readmission and maternal mortality. Six were considered in specific subgroups, with, for example, the postpartum hemorrhage rate assessed among all women and also among women at low risk of PPH.

Implications

This Delphi process enabled us to define consensually a set of indicators to assess the quality of hospital obstetrics care from routine hospital data, based on maternal morbidity outcomes. Considering 6 of them in specific subgroups of women is especially interesting. These indicators, identifiable through codes used in international classifications, will be useful to monitor quality of care over time and across settings.

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<![CDATA[Impact of different stages of intrauterine inflammation on outcome of preterm neonates: Gestational age-dependent and -independent effect]]> https://www.researchpad.co/article/5c6730e6d5eed0c484f382c7

Objective

To investigate the impact of different stages of intrauterine inflammation (IUI) on neonatal outcomes, before and after adjusting for gestational age (GA) and other perinatal confounders.

Methods

This was an observational, prospective, single-center cohort study including all eligible neonates with GA < 35 weeks and/or birth weight ≤ 1500 g born at a 3rd level Neonatal Intensive Care Unit between 2011 and 2014. Pathological patterns of placenta, membranes and cord were classified according to Redline’s criteria. Multivariable linear and logistic regression models were applied, either including or not GA among the covariates.

Results

Of the 807 enrolled neonates, 134 (16.6%) had signs of IUI: among these, 54.5% showed just histological chorioamnionitis (HCA), 25.4% had HCA + funisitis (FUN) stage 1, and 20.1% had HCA + FUN stage 2–3. At univariate analysis, HCA increased the risk for retinopathy of prematurity (ROP) and bronchopulmonary dysplasia, while FUN (any stage) had a deleterious impact on all outcomes investigated. After adjustment for covariates not including GA, HCA was a risk factor only for ROP (OR = 2.8, CI: 1–7.8), while FUN (any stage) was still associated with increased ORs for all outcomes (p <0.01). Upon inclusion of GA in the regression model, the results differed remarkably. HCA was associated with lower risk for mechanical ventilation (OR = 0.3, CI: 0.1–0.7) and need for surfactant (OR = 0.5, CI: 0.2–0.9), while FUN (any stage) worsened clinical conditions at birth (p <0.05), increased the risk for early-onset sepsis (p <0.01), and increased the length of mechanical ventilation (FUN stage 2–3 only, RC = 6.5 days, CI: 2–11). No other outcome was affected.

Conclusions

IUI, especially FUN, negatively impact most neonatal morbidities, but its effect is partially reverted adjusting for GA. Considered that GA is an intermediate variable interposed between prenatal causes of prematurity and outcomes, the appropriateness of adjusting for GA may be questionable.

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<![CDATA[Regional disparities in maternal and child health indicators: Cluster analysis of districts in Bangladesh]]> https://www.researchpad.co/article/5c648d13d5eed0c484c81eed

Efforts to mitigate public health concerns are showing encouraging results over the time but disparities across the geographic regions still exist within countries. Inadequate researches on the regional disparities of health indicators based on representative and comparable data create challenges to develop evidence-based health policies, planning and future studies in developing countries like Bangladesh. This study examined the disparities among districts on various maternal and child health indicators in Bangladesh. Cluster analysis–an unsupervised learning technique was used based on nationally representative dataset originated from Multiple Indicator Cluster Survey (MICS), 2012–13. According to our results, Bangladesh is classified into two clusters based on different health indicators with substantial variations in districts per clusters for different sets of indicators suggesting regional variation across the indicators. There is a need to differentially focus on community-level interventions aimed at increasing maternal and child health care utilization and improving the socioeconomic position of mothers, especially in disadvantaged regions. The cluster analysis approach is unique in terms of the use of health care metrics in a multivariate setup to study regional similarity and dissimilarity in the context of Bangladesh.

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<![CDATA[Client satisfaction with existing labor and delivery care and associated factors among mothers who gave birth in university of Gondar teaching hospital; Northwest Ethiopia: Institution based cross-sectional study]]> https://www.researchpad.co/article/5c648d12d5eed0c484c81ecb

Background

There are many reasons for mothers not receiving modern obstetric care, being dissatisfied by health care deliveries is one of the major factors. There are limited studies about maternal satisfaction with labor and delivery care services in Ethiopia and particularly in the study area. Therefore, the aim of this study was to better understand client satisfaction on existing labor and delivery care service and associated factors among mothers who gave birth in the University of Gondar Teaching Hospital, Ethiopia.

Methods

This institution based cross-sectional study was conducted at the University of Gondar Referral Hospital. 593 mothers who gave birth between July and September 2016 were enrolled. Study participants were selected by systematic random sampling. A standardized, interviewer-administered questionnaire was used to collect data. Descriptive and summary statistics were performed. A linear regression model was fitted and variables having a P value of ≤0.05 in the multivariable model were considered statistically significant.

Result

Overall, 31.3% of mothers were satisfied by the existing labor and delivery care. Living in rural areas (-2.9%; 95% CI: -5.75,-0.12) and the presence of a co-morbidity (-3.2%; 95%CI:-5.70, -0.72) were the factor which have a negative influence on maternal satisfaction. On the other hand, travel time to reach to the hospital (hours) (0.79%; 95% CI: 0.07, 1.52), birth by episiotomy or assisted vaginal delivery (6.3%; 95%CI: 1.56, 11.04), and receiving cost-free maternal health services (6.66%; 95%CI: 3.31, 10.01) were the factors that had positive influence.

Conclusion

The level of satisfaction of laboring mothers with the labor and delivery care services was poor. Rural residency and chronic medical co-morbidity were negatively associated with level of satisfaction while travel time, mode of delivery, and payment free delivery service had a statistically significant positive influence on satisfaction.

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<![CDATA[Maternal and perinatal outcomes in pregnant women with BMI >50: An international collaborative study]]> https://www.researchpad.co/article/5c61e935d5eed0c48496f9bb

Objective

To examine the association between maternal BMI>50kg/m2 during pregnancy and maternal and perinatal outcomes.

Materials and methods

An international cohort study was conducted using data from separate national studies in the UK and Australia. Outcomes of pregnant women with BMI>50 were compared to those of pregnant women with BMI<50. Multivariable logistic regression estimated the association between BMI>50 and perinatal and maternal outcomes.

Results

932 pregnant women with BMI>50 were compared with 1232 pregnant women with BMI<50. Pregnant women with BMI>50 were slightly older, more likely to be multiparous, and have pre-existing comorbidities. There were no maternal deaths, however, extremely obese women had a nine-fold increase in the odds of thrombotic events compared to those with a BMI<50 (uOR: 9.39 (95%CI:1.15–76.43)). After adjustment, a BMI>50 during pregnancy had significantly raised odds of preeclampsia/eclampsia (aOR:4.88(95%CI: 3.11–7.65)), caesarean delivery (aOR: 2.77 (95%CI: 2.31–3.32)), induction of labour (aOR: 2.45(95% CI:2.00–2.99)) post caesarean wound infection (aOR:7.25(95%CI: 3.28–16.07)), macrosomia (aOR: 8.05(95%CI: 4.70–13.78)) compared a BMI<50. Twelve of the infants born to women in the extremely obese cohort died in the early neonatal period or were stillborn.

Conclusions

Pregnant women with BMI>50 have a high risk of inferior maternal and perinatal outcomes.

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