Browsing by Subject "Maternal mortality"

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    Open Access
    A clinical audit on the quality of care and the outcome of patients with pregnancy induced hypertension within a primary-secondary care pathway: the Wesfleur-New Somerset Hospital Axis, Cape Town, South Africa.
    (2020) Sobamowo, Theophilus Oluwadayo; Ras, Tasleem; Ugoagwu Abiola Abimbola
    Background: Pregnancy Induced Hypertension (PIH) and its complications contribute to a significant burden of disease both in developed and developing countries of the world. Unfortunately, PIH has no cure, the delivery of the baby and the placenta is required. Early detection of pregnancy induced hypertension and close monitoring remains the key to achieving a favourable outcome. This study aimed to determine the quality of care given to women diagnosed with Pregnancy Induced Hypertension (PIH) within a care pathway spanning peri-urban primary and urban secondary level facilities. Methods: This was a retrospective clinical audit of medical records of patients diagnosed with PIH. It was conducted in the Wesfleur -New Somerset Hospital drainage area, using a locally validated data extraction tool, based on the South African Maternal Care Guidelines. The data were analyzed using descriptive methods to report on the frequencies and proportions of the variables, and analyzed to report on statistical significance of correlations. Results: The prevalence rate of pregnancy induced hypertension in this study was 12%. The overall pregnancy induced hypertension complication prevalence in the study for mothers was 7.7%, and that of babies was 30.7%. Facilities generally performed well according to the audit indicators detailing structures and processes that should be followed, as outlined by the standard guidelines used. Two process indicators were correlated with adverse outcomes: 66.1% of patients were appropriately referred, resulting in statistically better foetal outcomes (p = 0.059); and those who booked early in the pregnancy had less PIH-induced complications than those who booked late (p = 0.012) Conclusion: This study followed a standardized audit methodology and found that the quality of care in this peri-urban area is of a good standard and identified areas for quality improvement and further enquiry to ensure continual improvement in maternal and fetal outcomes.
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    The burden of antenatal heart disease in South Africa: a systematic review
    (BioMed Central Ltd, 2012) Watkins, David; Sebitloane, Motshedisi; Engel, Mark E; Mayosi, Bongani
    BACKGROUND: Maternal mortality in South Africa is rising, and heart conditions currently account for 41 per cent of indirect causes of deaths. Little is known about the burden of heart disease in pregnant South Africans. METHODS: We systematically reviewed the contemporary epidemiology and peripartum outcomes of heart disease in South African women attending antenatal care. Searches were performed in PubMed, ISI Web of Science, the EBSCO Africa-Wide database, the South African Union Catalogue, and the Current and Completed Research database (South Africa). References of included articles were also hand-searched. Studies reporting epidemiologic data on antenatal heart disease in South Africa were included. Data on morbidity and mortality were also collected. RESULTS: Seven studies were included in the systematic review. The prevalence of heart disease ranged from 123 to 943 per 100,000 deliveries, with a median prevalence of 616 per 100,000. Rheumatic valvular lesions were the commonest abnormalities, although cardiomyopathies were disproportionately high in comparison with other developing countries. Peripartum case-fatality rates were as high as 9.5 per cent in areas with limited access to care. The most frequent complications were pulmonary oedema, thromboembolism, and major bleeding with warfarin use. Perinatal mortality ranged from 8.9 to 23.8 per cent, whilst mitral lesions were associated with low birth weight. Meta-analysis could not be performed due to clinical and statistical heterogeneity of the included studies. CONCLUSION: Approximately 0.6 per cent of pregnant South Africans have pre-existing cardiac abnormalities, with rheumatic lesions being the commonest. Maternal and perinatal morbidity and mortality continue to be very high. We conclude this review by summarising limitations of the current literature and recommending standard reporting criteria for future reports.
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    Formative research to design an implementation strategy for a postpartum hemorrhage initial response treatment bundle (E-MOTIVE): study protocol
    (2021-07-14) Bohren, Meghan A; Lorencatto, Fabiana; Coomarasamy, Arri; Althabe, Fernando; Devall, Adam J; Evans, Cherrie; Oladapo, Olufemi T; Lissauer, David; Akter, Shahinoor; Forbes, Gillian; Thomas, Eleanor; Galadanci, Hadiza; Qureshi, Zahida; Fawcus, Sue; Hofmeyr, G J; Al-beity, Fadhlun A; Kasturiratne, Anuradhani; Kumarendran, Balachandran; Mammoliti, Kristie-Marie; Vogel, Joshua P; Gallos, Ioannis; Miller, Suellen
    Background: Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide. When PPH occurs, early identification of bleeding and prompt management using evidence-based guidelines, can avert most PPH-related severe morbidities and deaths. However, adherence to the World Health Organization recommended practices remains a critical challenge. A potential solution to inefficient and inconsistent implementation of evidence-based practices is the application of a ‘clinical care bundle’ for PPH management. A clinical care bundle is a set of discrete, evidence-based interventions, administered concurrently, or in rapid succession, to every eligible person, along with teamwork, communication, and cooperation. Once triggered, all bundle components must be delivered. The E-MOTIVE project aims to improve the detection and first response management of PPH through the implementation of the “E-MOTIVE” bundle, which consists of (1) Early PPH detection using a calibrated drape, (2) uterine Massage, (3) Oxytocic drugs, (4) Tranexamic acid, (5) Intra Venous fluids, and (6) genital tract Examination and escalation when necessary. The objective of this paper is to describe the protocol for the formative phase of the E-MOTIVE project, which aims to design an implementation strategy to support the uptake of this bundle into practice. Methods: We will use behaviour change and implementation science frameworks [e.g. capability, opportunity, motivation and behaviour (COM-B) and theoretical domains framework (TDF)] to guide data collection and analysis, in Kenya, Nigeria, South Africa, Sri Lanka, and Tanzania. There are four methodological components: qualitative inter views; surveys; systematic reviews; and design workshops. We will triangulate findings across data sources, participant groups, and countries to explore factors influencing current PPH detection and management, and potentially influencing E-MOTIVE bundle implementation. We will use these findings to develop potential strategies to improve implementation, which will be discussed and agreed with key stakeholders from each country in intervention design workshops. Discussion: This formative protocol outlines our strategy for the systematic development of the E-MOTIVE implementation strategy. This focus on implementation considers what it would take to support roll-out and implementation of the E-MOTIVE bundle. Our approach therefore aims to maximize internal validity in the trial alongside future scalability, and implementation of the E-MOTIVE bundle in routine practice, if proven to be effective. Trial registration: ClinicalTrials.gov: NCT04341662 Plain language summary Excessive bleeding after birth is the leading cause of maternal death globally. The World Health Organization (WHO) has recommended several treatment options for bleeding after birth. However, these treatments are not used regularly, or consistently for all women. A key underlying issue is that it is challenging for health workers to identify when women are bleeding too much, because measuring the amount of blood loss is difficult. Maternal health experts have proposed a new clinical ‘care bundle’ for caring for women with excessive bleeding after birth. A care bundle is a way to group together multiple treatments (e.g. 3–5 treatments). These treatments are then given to the woman at the same time, or one after another in quick succession, and supported by strategies to improve teamwork, communication, and cooperation. This is a research protocol for the preliminary phase of our study (“E-MOTIVE”), which means that it is a description of what we plan to do and how we plan to do it. The aim of our study is to develop a strategy for how we will test whether the E-MOTIVE bundle works through collaborative activities with midwives and doctors in five countries (Kenya, Nigeria, South Africa, Sri Lanka, and Tanzania) to develop a strategy for how we will test whether the E-MOTIVE bundle works. We plan to do this by conducting interviews and surveys with midwives and doctors, and reviewing other research conducted on PPH to understand what works in different settings. We will discuss our research findings in a workshop, with midwives and doctors in the study countries to co-create a strategy that will work for them, based on their needs and preferences.
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    Increasing utilisation of perinatal services: estimating the impact of community health worker program in Neno, Malawi
    (2020-01-06) Kachimanga, Chiyembekezo; Dunbar, Elizabeth L; Watson, Samuel; Cundale, Katie; Makungwa, Henry; Wroe, Emily B; Malindi, Charles; Nazimera, Lawrence; Palazuelos, Daniel; Drake, Jeanel; Gates, Thomas; van den Akker, Thomas; Shea, Jawaya
    Abstract Background By 2015, Malawi had not achieved Millennium Development Goal 4, reducing maternal mortality by about 35% from 675 to 439 deaths per 100,000 livebirths. Hypothesised reasons included low uptake of antenatal care (ANC), intrapartum care, and postnatal care. Involving community health workers (CHWs) in identification of pregnant women and linking them to perinatal services is a key strategy to reinforce uptake of perinatal care in Neno, Malawi. We evaluated changes in uptake after deployment of CHWs between March 2014 and June 2016. Methods A CHW intervention was implemented in Neno District, Malawi in a designated catchment area of about 3100 women of childbearing age. The pre-intervention period was March 2014 to February 2015, and the post-intervention period was March 2015 to June 2016. A 5-day maternal health training package was delivered to 211 paid and supervised CHWs. CHWs were deployed to identify pregnant women and escort them to perinatal care visits. A synthetic control method, in which a “counterfactual site” was created from six available control facilities in Neno District, was used to evaluate the intervention. Outcomes of interest included uptake of first-time ANC, ANC within the first trimester, four or more ANC visits, intrapartum care, and postnatal care follow-up. Results Women enrolled in ANC increased by 18% (95% Credible Interval (CrI): 8, 29%) from an average of 83 to 98 per month, the proportion of pregnant women starting ANC in the first trimester increased by 200% (95% CrI: 162, 234%) from 10 to 29% per month, the proportion of women completing four or more ANC visits increased by 37% (95% CrI: 31, 43%) from 28 to 39%, and monthly utilisation of intrapartum care increased by 20% (95% CrI: 13, 28%) from 85 to 102 women per month. There was little evidence that the CHW intervention changed utilisation of postnatal care (− 37, 95% CrI: − 224, 170%). Conclusions In a rural district in Malawi, uptake of ANC and intrapartum care increased considerably following an intervention using CHWs to identify pregnant women and link them to care.
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    Trends in maternal and neonatal mortality in South Africa: a systematic review protocol
    (BioMed Central, 2017-08-17) Damian, Damian J; Njau, Bernard; Lisasi, Ester; Msuya, Sia E; Boulle, Andrew
    Background: Measuring and monitoring progress towards Millennium Development Goals (MDG) 4 and 5 requires valid and reliable estimates of maternal and neonatal mortality. In South Africa, there are conflicting reports on the estimates of maternal and neonatal mortality, derived from both direct and indirect estimation techniques. This study aims to systematically review the estimates made of maternal and neonatal mortality in the period from 1990 to 2015 in South Africa and determine trends over this period. Methods: For the purpose of this review, searches for eligible studies will be conducted in MEDLINE, Africa-Wide Information, African Index Medicus, African Journals Online, Scopus, Web of Science and CINAHL databases. Searches will be restricted to articles written in English and presenting data covering the period between 1990 and 2015. Reference lists of retrieved articles will also be screened for additional publications. Three independent reviewers will be involved in the study selection, data extractions and achieving consensus. Study quality and risk of bias will thereafter be assessed by two authors. The results will be presented as rates/ratio with their corresponding 95% confidence/uncertainty intervals. Discussion: Identifying trends in maternal and neonatal mortality will help to track progress in MDGs 4 and 5 and will serve in evaluating interventions focusing on reducing maternal and child mortality in the country. This study will, in particular, provide the context for understanding inconsistencies in reported estimates of maternal and neonatal mortality by considering estimation methods, data sources and definitions used. Systematic review registration: PROSPERO CRD42016042769.