Disposable clean delivery kits and prevention of neonatal tetanus in the presence of skilled birth attendants.

OBJECTIVE: To determine whether the use of disposable clean delivery kits (CDKs) is effective in reducing neonatal tetanus (NNT) infection, regardless of the skills of birth attendants in resource-poor settings. METHODS: A secondary analysis was conducted on data from a matched case-control study in Karachi, Pakistan, involving 140 NNT cases and 280 controls between 1998 and 2001. Conditional logistic regression was performed to assess the independent effect on NNT of CDKs and skilled birth attendants (SBAs). RESULTS: After adjustment for socioeconomic factors, both CDKs (adjusted matched odds ratio [mOR] 2.0; 95% confidence interval [CI], 1.3-3.1) and SBAs (adjusted mOR 1.7; 95% CI, 1.1-2.7) were independently associated with NNT. The association with CDKs remained significant when additionally adjusted for SBAs (mOR 2.0; 95% CI, 1.0-3.9; P=0.05). The population attributable risk for lack of CDK use was 24% in the study setting. CONCLUSION: In the context of resource-poor settings in low-income countries with poor coverage of tetanus toxoid immunization, the use of CDKs seems to be an effective strategy for reducing NNT infection, irrespective of the skill levels of birth attendants. Approximately one-quarter of NNT cases could be prevented in low-income populations with the use of CDKs

Women's experiences of mistreatment during childbirth: A comparative view of home- and facility-based births in Pakistan.

INTRODUCTION: Respectful and dignified healthcare is a fundamental right for every woman. However, many women seeking childbirth services, especially those in low-income countries such as Pakistan, are mistreated by their birth attendants. The aim of this epidemiological study was to estimate the prevalence of mistreatment and types of mistreatment among women giving birth in facility- and home-based settings in Pakistan in order to address the lack of empirical evidence on this topic. The study also examined the association between demographics (socio-demographic, reproductive history and empowerment status) and mistreatment, both in general and according to birth setting (whether home- or facility-based). MATERIAL AND METHODS: In phase one, we identified 24 mistreatment indicators through an extensive literature review. We then pre-tested these indicators and classified them into seven behavioural types. During phase two, the survey was conducted (April-May 2013) in 14 districts across Pakistan. A total of 1,334 women who had given birth at home or in a healthcare facility over the past 12 months were interviewed. Linear regression analysis was employed for the full data set, and for facility- and home-based births separately, using Stata version 14.1. RESULTS: There were no significant differences in manifestations of mistreatment between facility- and home-based childbirths. Approximately 97% of women reported experiencing at least one disrespectful and abusive behaviour. Experiences of mistreatment by type were as follows: non-consented care (81%); right to information (72%); non-confidential care (69%); verbal abuse (35%); abandonment of care (32%); discriminatory care (15%); and physical abuse (15%). In overall analysis, experience of mistreatment was lower among women who were unemployed (β = -1.17, 95% CI -1.81, -0.53); and higher among less empowered women (β = 0.11, 95% CI 0.06, 0.16); and those assisted by a traditional birth attendant as opposed to a general physician (β = 0.94, 95% CI 0.13, 1.75). Sub-group analyses for home-based births identified the same significant associations with mistreatment, with ethnicity included. In facility-based births, there was a significant relationship between women's employment and empowerment status and mistreatment. Women with prior education on birth preparedness were less likely to experience mistreatment compared to those who had received no previous birth preparedness education. CONCLUSION: In order to promote care that is woman-centred and provided in a respectful and culturally appropriate manner, service providers should be cognisant of the current situation and ensure provision of quality antenatal care. At the community level, women should seek antenatal care for improved birth preparedness, while at the interpersonal level strategies should be devised to leverage women's ability to participate in key household decisions

The Classical rr-Matrix for the Relativistic Ruijsenaars-Schneider System

We compute the classical $r$-matrix for the relativistic generalization of the Calogero-Moser model, or Ruijsenaars-Schneider model, at all values of the speed-of-light parameter $\lambda$. We connect it with the non-relativistic Calogero-Moser $r$-matrix $(\lambda \rightarrow -1)$ and the $\lambda = 1$ sine-Gordon soliton limit.Comment: LaTeX file, no figures, 8 page

Are underprivileged and less empowered women deprived of respectful maternity care: Inequities in childbirth experiences in public health facilities in Pakistan

Background: Attainment of healthcare in respectful and dignified manner is a fundamental right for every woman regardless of the individual status. However, social exclusion, poor psychosocial support, and demeaning care during childbirth at health facilities are common worldwide, particularly in low- and middle-income countries. We concurrently examined how women with varying socio-demographic characteristics are treated during childbirth, the effect of women\u27s empowerment on mistreatment, and health services factors that contribute to mistreatment in secondary-level public health facilities in Pakistan.Methods: A cross-sectional survey was conducted during August-November 2016 among 783 women who gave birth in six secondary-care public health facilities across four contiguous districts of southern Sindh. Women were recruited in health facilities and later interviewed at home within 42 days of postpartum using a WHO\u27s framework-guided 43-item structured questionnaire. Means, standard deviation, and average were used to describe characteristics of the participants. Multivariable linear regression was applied using Stata 15.1.Results: Women experiencing at least one violation of their right to care by hospital staff during intrapartum care included: ineffective communication (100%); lack of supportive care (99.7%); loss of autonomy (97.5%); failure of meeting professional clinical standards (84.4%); lack of resources (76.3%); verbal abuse (15.2%); physical abuse (14.8%); and discrimination (3.2%). Risk factors of all three dimensions showed significant association with mistreatment: socio-demographic: primigravida and poorer were more mistreated; health services: lesser-education on birth preparedness and postnatal care leads to higher mistreatment; and in terms of women\u27s empowerment: women who were emotionally and physically abused by family, and those with lack of social support and lesser involvement in joint household decision making with husbands are more likely to be mistreated as compared to their counterparts. The magnitude of relationship between all significant risk factors and mistreatment, in the form of β coefficients, ranged from 0.2 to 5.5 with p-values less than 0.05.Conclusion: There are glaring inequalities in terms of the way women are treated during childbirth in public health facilities. Measures of socio-demographic, health services, and women\u27s empowerment showed a significant independent association with mistreatment during childbirth. At the health system level, there is a need for urgent solutions for more inclusive care to ensure that all women are treated with compassion and dignity, complemented by psychosocial support for those who are emotionally disturbed and lack social support

Community Base Newborn Care Evaluation, Ethiopia 2013-2017 - Health Centre Survey Data

The IDEAS Community Base Newborn Care (CBNC) evaluation surveys were conducted in Ethiopia in the last quarter of 2013, 2015 and 2017. Across four regions; Amhara, Oromiya, SNNP and Tigray, 206 Primary Healthcare Units (PHCU) were randomly selected from 12 zones and surveyed at all three time points. These datasets contain anonymised data collected via health facility surveys of a health centre and satellite health post in each Primary Healthcare Units (PHCU). This contains data collected from the Health Centre

Community Base Newborn Care Evaluation, Ethiopia 2013-2017 - Health Post and Health Extension Work Survey Data

The IDEAS Community Base Newborn Care (CBNC) evaluation surveys were conducted in Ethiopia in the last quarter of 2013, 2015 and 2017. Across four regions; Amhara, Oromiya, SNNP and Tigray, 206 Primary Healthcare Units (PHCU) were randomly selected from 12 zones and surveyed at all three time points. These datasets contain anonymised data collected via health facility surveys of a health centre and satellite health post in each Primary Healthcare Units (PHCU). This contains data collected from the Health Post and Health Extension Workers

Community Base Newborn Care Evaluation, Ethiopia 2013-2017 - Household Survey Data

The IDEAS Community Base Newborn Care (CBNC) evaluation surveys were conducted in Ethiopia in the last quarter of 2013, 2015 and 2017. Across four regions; Amhara, Oromiya, SNNP and Tigray, 206 Primary Healthcare Units (PHCU) were randomly selected from 12 zones and surveyed at all three time points. Household surveys of women who delivered in the previous 3-15 months collected demographic and healthcare data during the antenatal, delivery and postnatal period. Health facility surveys of the health centre and health post collected data on facility staff, supportive supervision services and availability of supplies as well as a register review of the target population. Health worker surveys of health extension workers and woman’s development army volunteers collected data on demographics, care provision, MNH knowledge, training and supervisions. This contains data collected from Household survey data

Community Base Newborn Care Evaluation, Ethiopia 2013-2017 - Contextual

The IDEAS Community Base Newborn Care (CBNC) evaluation surveys were conducted in Ethiopia in the last quarter of 2013, 2015 and 2017. Across four regions; Amhara, Oromiya, SNNP and Tigray, 206 Primary Healthcare Units (PHCU) were randomly selected from 12 zones and surveyed at all three time points. Household surveys of women who delivered in the previous 3-15 months collected demographic and healthcare data during the antenatal, delivery and postnatal period. The selection of zones was based on the phasic implementation plan on the CBNC programme and therefore not random. This dataset covers health worker surveys of woman’s development army volunteers. Collected data covers demographics, care provision, MNH knowledge, training and supervisions. This contains contextual data

Factors influencing women’s preference for health facility deliveries in Jharkhand state, India: a cross sectional analysis

BACKGROUND: Expanding institutional deliveries is a policy priority to achieve MDG5. India adopted a policy to encourage facility births through a conditional cash incentive scheme, yet 28% of deliveries still occur at home. In this context, it is important to understand the care experience of women who have delivered at home, and also at health facilities, analyzing any differences, so that services can be improved to promote facility births. This study aims to understand women's experience of delivery care during home and facility births, and the factors that influence women's decisions regarding their next place of delivery. METHOD: A community-based cross-sectional survey was undertaken in a district of Jharkhand state in India. Interviews with 500 recently delivered women (210 delivered at facility and 290 delivered at home) included socio-demographic characteristics, experience of their recent delivery, and preference of future delivery site. Data analysis included frequencies, binary and multiple logistic regressions. RESULTS: There is no major difference in the experience of care between home and facility births, the only difference in care being with regard to pain relief through massage, injection and low cost of delivery for those having home births. 75% women wanted to deliver their next child at a facility, main reasons being availability of medicine (29.4%) and perceived health benefits for mother and baby (15%). Women with higher education (AOR = 1.67, 95% CI = 1.04-3.07), women who were above 25 years (AOR = 2.14, 95% CI = 1.26-3.64), who currently delivered at facility (AOR = 5.19, 95% CI = 2.97-9.08) and had health problem post-delivery (AOR = 1.85, 95% CI = 1.08-3.19) were significant predictors of future facility-based delivery. CONCLUSION: The predictors for facility deliveries include, availability of medicines and supplies, potential health benefits for the mother and newborn and the perception of good care from the providers. There is a growing preference for facility delivery particularly among women with higher age group, education, income and those who had antennal checkup. In order to uptake facility births, the quality improvement initiatives should regularly assess and address women's experiences of care

How Do Frontline Workers Provide the Four Cs of CBNC? Contact with newborns, Case identification, Care and Completion of treatment

Community Based Newborn Care (CBNC) Qualitative Research conducted by Della Berhanu and supervised by Bilal Avan. In partnership with JaRco: -Qualitative lead Nolawi Tadesse -Social science specialist: Ayalew Gebre -Research advisor: Tsegahun Tessema This research was conducted by IDEAS, for the FMOH Ethiopia, funded by BMFG under the IDEAS project. Joanna Schellenberg is the PI of IDEAS