Browsing by Author "Fawcus, Sue"

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    Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions
    (BioMed Central Ltd, 2015) Sharma, Gaurav; Mathai, Matthews; Dickson, Kim; Weeks, Andrew; Hofmeyr, G; Lavender, Tina; Day, Louise; Mathews, Jiji; Fawcus, Sue; Simen-Kapeu, Aline; de Bernis, Luc
    BACKGROUND: Good outcomes during pregnancy and childbirth are related to availability, utilisation and effective implementation of essential interventions for labour and childbirth. The majority of the estimated 289,000 maternal deaths, 2.8 million neonatal deaths and 2.6 million stillbirths every year could be prevented by improving access to and scaling up quality care during labour and birth. METHODS: The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for skilled birth attendance and basic and comprehensive emergency obstetric care. RESULTS: Across 12 countries the most critical bottlenecks identified by workshop participants for skilled birth attendance were health financing (10 out of 12 countries) and health workforce (9 out of 12 countries). Health service delivery bottlenecks were found to be the most critical for both basic and comprehensive emergency obstetric care (9 out of 12 countries); health financing was identified as having critical bottlenecks for comprehensive emergency obstetric care (9 out of 12 countries). Solutions to address health financing bottlenecks included strengthening national financing mechanisms and removing financial barriers to care seeking. For addressing health workforce bottlenecks, improved human resource planning is needed, including task shifting and improving training quality. For health service delivery, proposed solutions included improving quality of care and establishing public private partnerships. CONCLUSIONS: Progress towards the 2030 targets for ending preventable maternal and newborn deaths is dependent on improving quality of care during birth and the immediate postnatal period. Strengthening national health systems to improve maternal and newborn health, as a cornerstone of universal health coverage, will only be possible by addressing specific health system bottlenecks during labour and birth, including those within health workforce, health financing and health service delivery.
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    The effect of maternal HIV status on perinatal outcome at Mowbray Maternity Hospital and referring midwife obstetric units Cape Town
    (2012) Kennedy, Deon; Fawcus, Sue; Kroon, Max
    Objectives. To study the effect of maternal HIV status on perinatal outcome at Mowbray Maternity Hospital (a secondary-level hospital in Cape Town) and its satellite community midwife obstetric units. Design. A retrospective descriptive and comparative study.Setting. Public sector maternity facilities serving historically disadvantaged populations. Subjects. All deliveries at Mowbray Maternity Hospital and its referral midwife obstetric units from January to December 2008. Outcome measures. Stillbirth, early neonatal death, perinatal mortality and neonatal encephalopathy rates in HIV-positive and HIVnegative subjects. Results. There was a total of 18 870 deliveries at the units studied, 3 259 (17.2%) of them to HIV-positive mothers. The stillbirth rate in the HIV-positive population was 17.1/1 000 births, compared with 8.3/1 000 in the HIV-negative population (odds ratio (OR), 2.07, 95% confidence interval (CI) 1.5 - 2.8). The early neonatal death rate in the HIV-positive population was 4.6/1 000 live births, compared with 3.1/1 000 in the HIV-negative population (OR 1.46, 95% CI 0.8 - 2.6). The perinatal mortality rate in the HIV-positive population was 21.7/1 000 births, compared with 11.7 in the HIV-negative population (OR 1.91, 95% CI 1.4 - 2.5). A comparison of the pattern of primary obstetric causes of perinatal mortality showed that infection, intra-uterine growth restriction (IUGR) and antepartum haemorrhage (APH) were significantly more common as causes for perinatal death in the HIV-positive population. The risk of neonatal encephalopathy in the HIV-exposed population was 4.9/1 000 live births compared with 2.07 in the HIV-negative group (OR 2.36, 95% CI 1.28 - 4.35). The 1 643 women (8.7% of total deliveries) who were not tested for HIV were at particularly high risk of adverse perinatal outcome. This group included women who had either declined testing or not attended for antenatal care. Conclusion. The perinatal mortality rate in the group of HIV-exposed mothers was significantly higher than that in the HIV-negative group due to a higher stillbirth rate. Infection, IUGR and APH were significantly more common obstetric causes for mortality in the HIV-infected population. The risk of neonatal encephalopathy was also significantly higher in the HIV-positive population.