Factors associated with neonatal deaths in Chitwan district of Nepal

Background: Neonatal mortality has remained unchanged since 2006 in Nepal. Reducing neonatal mortality is indispensable to reduce child mortality. The objective of this study was to investigate the factors associated with neonatal mortality. This study assesses socio-demographic factors, maternal health care and newborn care practices contributing to neonatal deaths in Chitwan district of Central Nepal. Methods: A case–control study was conducted during April–July 2012. The study used a mixed-method approach, in which records of neonatal deaths were obtained from the District Public Health Office and a comparison group, survivors, was obtained from the same community. A total of 198 mothers (of 99 neonatal deaths and 99 survivor neonates) were included in the survey. Focus group discussions, in-depth interviews and case studies were also conducted. Maternal characteristics were analyzed using descriptive statistics, Mc Nemar’s Chi square test and multivariable backward conditional logistic regression analysis. Qualitative data were analyzed by narrative analysis method.Results: More than four-fifth of mothers (86 %) had antenatal check-up (ANC) and the proportion of four or more ANC was 64 %. Similarly, the percentage of mothers having institutional delivery was 62 %, and postnatal check-up was received by 65 % of mothers. In multivariable analysis, low birth weight [adjusted odds ratio: 8.49, 95 % CI (3.21–22.47)], applying nothing on cord [adjusted odds ratio: 5.72, 95 % CI (1.01-32.30)], not wrapping of newborn [adjusted odds ratio: 9.54, 95 % CI (2.03–44.73)], and no schooling of mother [adjusted odds ratio: 2.09, 95 % CI (1.07–4.11)] were significantly associated with an increased likelihood of neonatal mortality after adjusting for other confounding variables. Qualitative findings suggested that bathing newborns after 24 h and wrapping in clean clothes were common newborn care practices. The mothers only attended postnatal care services if health problems appeared either in the mother or in the child. Conclusion:L Results of this study suggest that the current community based newborn survival intervention should provide an even greater focus to essential newborn care practices, low birth weight newborns, and female education

Complications of childbirth and maternal deaths in Kinshasa hospitals: testimonies from women and their families

<p>Abstract</p> <p>Background</p> <p>Maternal mortality in Kinshasa is high despite near universal availability of antenatal care and hospital delivery. Possible explanations are poor-quality care and by delays in the uptake of care. There is, however, little information on the circumstances surrounding maternal deaths. This study describes and compares the circumstances of survivors and non survivors of severe obstetric complications.</p> <p>Method</p> <p>Semi structured interviews with 208 women who survived their obstetric complication and with the families of 110 women who died were conducted at home by three experienced nurses under the supervision of EK. All the cases were identified from twelve referral hospitals in Kinshasa after admission for a serious acute obstetric complication. Transcriptions of interviews were analysed with N-Vivo 2.0 and some categories were exported to SPSS 14.0 for further quantitative analysis.</p> <p>Results</p> <p>Testimonies showed that despite attendance at antenatal care, some women were not aware of or minimized danger signs and did not seek appropriate care. Cost was a problem; 5 deceased and 4 surviving women tried to avoid an expensive caesarean section by delivering in a health centre, although they knew the risk. The majority of surviving mothers (for whom the length of stay was known) had the caesarean section on the day of admission while only about a third of those who died did so. Ten women died before the required caesarean section or blood transfusion could take place because they did not bring the money in time. Negligence and lack of staff competence contributed to the poor quality of care. Interviews revealed that patients and their families were aware of the problem, but often powerless to do anything about it.</p> <p>Conclusion</p> <p>Our findings suggest that women with serious obstetric complications have a greater chance of survival in Kinshasa if they have cash, go directly to a functioning referral hospital and have some leverage when dealing with health care staff</p

National Mass Drug Administration Costs for Lymphatic Filariasis Elimination

Lymphatic filariasis (LF), commonly known as elephantiasis, is a profoundly disfiguring parasitic disease caused by thread-like nematode worms. This disease can often be disabling, thus reducing the potential productivity of the affected individuals. The WHO places the number of people at risk in 83 countries at 1.307 billion. This study was undertaken in seven countries—Burkina Faso, Ghana, Egypt, Tanzania, the Philippines, the Dominican Republic, and Haiti—using a common protocol to determine the costs of mass drug administration (MDA) programs to interrupt transmission of infection with LF, because there is lack of sufficient information about the costs of these programs. The results demonstrate that LF MDA is affordable and relatively inexpensive when compared to other public health programs. In the context of initiatives for integrating programs for the control and elimination of neglected tropical diseases, this study adds specifically to the relatively scarce body of information about the costs of MDA programs for LF. It also adds to the general knowledge about the application of methods that can be used to estimate the costs and cost-effectiveness of an integrated approach

Towards a bottom-up understanding of antimicrobial use and resistance on the farm: A knowledge, attitudes, and practices survey across livestock systems in five African countries.

The nutritional and economic potentials of livestock systems are compromised by the emergence and spread of antimicrobial resistance. A major driver of resistance is the misuse and abuse of antimicrobial drugs. The likelihood of misuse may be elevated in low- and middle-income countries where limited professional veterinary services and inadequately controlled access to drugs are assumed to promote non-prudent practices (e.g., self-administration of drugs). The extent of these practices, as well as the knowledge and attitudes motivating them, are largely unknown within most agricultural communities in low- and middle-income countries. The main objective of this study was to document dimensions of knowledge, attitudes and practices related to antimicrobial use and antimicrobial resistance in livestock systems and identify the livelihood factors associated with these dimensions. A mixed-methods ethnographic approach was used to survey households keeping layers in Ghana (N = 110) and Kenya (N = 76), pastoralists keeping cattle, sheep, and goats in Tanzania (N = 195), and broiler farmers in Zambia (N = 198), and Zimbabwe (N = 298). Across countries, we find that it is individuals who live or work at the farm who draw upon their knowledge and experiences to make decisions regarding antimicrobial use and related practices. Input from animal health professionals is rare and antimicrobials are sourced at local, privately owned agrovet drug shops. We also find that knowledge, attitudes, and particularly practices significantly varied across countries, with poultry farmers holding more knowledge, desirable attitudes, and prudent practices compared to pastoralist households. Multivariate models showed that variation in knowledge, attitudes and practices is related to several factors, including gender, disease dynamics on the farm, and source of animal health information. Study results emphasize that interventions to limit antimicrobial resistance should be founded upon a bottom-up understanding of antimicrobial use at the farm-level given limited input from animal health professionals and under-resourced regulatory capacities within most low- and middle-income countries. Establishing this bottom-up understanding across cultures and production systems will inform the development and implementation of the behavioral change interventions to combat antimicrobial resistance globally