Determinants of maternal mortality in south-western Nigeria: Midwives’ perceptions

Background Maternal mortality remains one of Nigeria's most significant public health challenges. In order to address this issue sustainably, it is necessary to consider the perceptions of all stakeholders involved, including midwives. Objectives To examine the determinants of maternal mortality in south-western Nigeria from the midwife's perspective. Design A cross-sectional study was employed using mixed methods with a semi-structured questionnaire and an in-depth interview guide. Participants Quantitative data were obtained from 215 midwives using a convenience sampling technique. Qualitative data were obtained from 25 midwives from five government health centres, selected using a stratified sampling technique. Methods Quantitative data were analysed using SPSS Version 20 using descriptive and inferential statistics with 95 % confidence intervals, while qualitative data were analysed using thematic analyses. Findings The mean age and work experience of the participants were 35.2 ± 9.3 years and 8.4 ± 7.0 years, respectively. The midwives perceived that the main determinants of maternal mortality were postpartum haemorrhage (86.5 %), hypertensive disorder in pregnancy (80.9 %), mismanagement at mission homes/traditional birth attendant centres (MH/TBAs) (79.1 %) and sepsis (70.1 %). Some of the priority target areas to improve the well-being of pregnant women as identified by the midwives, were increased awareness of pregnancy danger signs (97 %), destigmatising caesarean section (CS) (96 %), regulation of MH/TBAs (92 %), and increased accessibility of hospitals (84 %). Findings from the qualitative data also affirmed that regulating MH/TBAs, destigmatising CS and subsidising healthcare expenses were prerequisites to curbing maternal mortality. Inferential analysis revealed that determinants such as unsafe abortion (p < 0.001), ectopic pregnancy (p = 0.001), domestic violence (p = 0.023), malaria (p = 0.029), short interbirth interval (p = 0.03), and patients’ negative perceptions of CS delivery (p = 0.036) were more commonly perceived to be associated with maternal mortality by younger midwives (age 17–34 years) compared with older midwives

From MDGs to SDGs: implications for maternal newborn health in Africa

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Exchanging ideas and good practice globally: reciprocal learning in the context of a twinning project

Between August and November 2019, I had the pleasure of making two trips to Bangladesh to support the Royal College of Midwives’ (RCM) twinning project with the Bangladesh Midwifery Society (BMS). The partnership between the RCM and the BMS aims to strengthen the BMS to advocate for the midwifery profession and to create demand for midwifery services. The project is part of a wider programme of midwifery strengthening activities, managed by the United Nations Population Fund (UNFPA) Bangladesh, and funded by donors, the Department for International Development (DFID) and the Swedish International Development Cooperation Agency (Sida)

Social determinants and maternal exposure to intimate partner violence of obstetric patients with severe maternal morbidity in the intensive care unit: a systematic review protocol

Introduction: Maternal mortality is a potentially preventable public health issue. Maternal morbidity is increasingly of interest to aid the reduction of maternal mortality. Obstetric patients admitted to the intensive care unit (ICU) are an important part of the global burden of maternal morbidity. Social determinants influence health outcomes of pregnant women. Additionally, intimate partner violence has a great negative impact on women's health and pregnancy outcome. However, little is known about the contextual and social aspects of obstetric patients treated in the ICU. This study aimed to conduct a systematic review of the social determinants and exposure to intimate partner violence of obstetric patients admitted to an ICU. Methods and analysis: A systematic search will be conducted in MEDLINE, CINAHL, ProQuest, LILACS and SciELO from 2000 to 2016. Studies published in English and Spanish will be identified in relation to data reporting on social determinants of health and/or exposure to intimate partner violence of obstetric women, treated in the ICU during pregnancy, childbirth or within 42 days of the end of pregnancy. Two reviewers will independently screen for study eligibility and data extraction. Risk of bias and assessment of the quality of the included studies will be performed by using the Critical Appraisal Skills Programme (CASP) checklist. Data will be analysed and summarised using a narrative description of the available evidence across studies. This systematic review protocol will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. Ethics and dissemination: Since this systematic review will be based on published studies, ethical approval is not required. Findings will be presented at La Trobe University, in Conferences and Congresses, and published in a peer-reviewed journal

Causes of Maternal Mortality in Tehran, Iran

Maternal mortality is a woman’s death during pregnancy or postpartum period due to direct or indirect causes. Its direct causes are related to obstetrical issues. The indirect cause of it refer to an underlying disease, i.e. aggravated during pregnancy and leads to death. A routine data-based study conducted at the Legal Medicine Organization of Tehran City, Iran, the autopsy findings of maternal mortalities during April 2017-2019 were reviewed. During the study period, 53 cases were autopsied of which 29 (54.7%) and 24 (45.3%) died due to direct and indirect causes, respectively. , The prevalent direct causes of death, were bleeding (22.6%), eclampsia/preeclampsia (13.2%), and ectopic pregnancy (5.7%). Frequent indirect causes were cardiac diseases (20.7%) and nervous system and infectious diseases (both: 7.5%). This study revealed the considerable share of indirect causes in maternal mortalities in Tehran. Moreover, we outlined the importance of early detection of non-obstetrical medical conditions during pregnancy care to reduce preventable maternal mortalities

Quality of Maternal Death Documentation in Afghanistan:A Retrospective Health Facility Record Review

Objectives: To assess the quality of health facility documentation related to maternal deaths at health facilities in Afghanistan. Methods: Analysis of a subset of findings from the 2016 National Maternal and Newborn Health Quality of Care Assessment in Afghanistan. At each facility, maternity registers were reviewed to obtain data related to maternity caseload, and number and causes of maternal deaths in the year preceding the survey. Detailed chart reviews were conducted for up to three maternal deaths per facility. Analyses included completeness of charts, quality of documentation, and cause of death using WHO application of International Statistical Classification of Disease to deaths during pregnancy, childbirth and the puerperium. Key findings: Only 129/226 (57%) of facilities had mortality registers available for review on the day of assessment and 41/226 (18%) had charts documenting maternal deaths during the previous year. We reviewed 68 maternal death cases from the 41 facilities. Cause of death was not recorded in nearly half of maternal death cases reviewed. Information regarding mode of birth was missing in over half of the charts, and one third did not capture gestational age at time of death. Hypertensive disorders of pregnancy and obstetric hemorrhage were the most common direct causes of death, followed by maternal sepsis and unanticipated complications of clinical management including anesthesia-related complications. Documented indirect causes of maternal deaths were anemia, cardiac arrest, kidney and hepatic failure. Charts revealed at least eight maternal deaths from indirect causes that were not captured in register books, indicating omission or misclassification of registered deaths. Conclusion: Considerable gaps in quality of recordkeeping exist in Afghanistan, including underreporting, misclassification and incompleteness. This hampers efforts to improve quality of maternal and newborn health data and priority setting

A study of different contraceptive methods: need of the hour during COVID 19 pandemic

Background: COVID-19 disease is the pandemic caused by a single-stranded RNA virus that belongs to the coronavirus family known as 2019-nCoV (SARS-Co V). The disease is highly contagious and transmitted mainly by droplets or close contact. In this time of pandemic it is need of the hour to prevent more and more unwanted pregnancies. This study was to evaluate the contraceptive methods of choice which are easily available, cost effective and suitable to most of the patients during this terrible period of pandemic.Methods: This was a prospective observational study done from April 2020 to December 2020. Women coming to the OPD for contraceptive advice after medical termination of pregnancy and patients desiring postpartum contraception were included in the study. All data were collected from the OPD and IPD of our hospital. Different contraceptive methods available, their costs, hospital visits, complications, failure rate and reason for its discontinuation was analysed.Results: In this study 76.5% patients (n-459) accepted Inj. DMPA as compared to 10 % used Cu T and 13% used OC pills as a method of contraception. Inj DMPA is easily available, cost effective, has lesser side effects and need less hospital visits.Conclusions: DMPA should be made available as a first line method to all those who wishes to opt for reversible method of contraception. This study concludes, during the period of pandemic Inj DMPA was most preferred method of contraception

Knowledge, Atitude and Perception regarding National Health Programmes among villagers of Chauras, Tehri-Garhwal, Uttarakhand

Background and Objective: Since India became independent, several measures have been undertaken by the national government to improve the health of the people. Prominent among these measures are the national health programmes. The main objective of these National Health programmes are protection and promotion of national and individual health. The main objective of this study was to assess the knowledge, attitude and perception regarding various national health programmes among the villagers. Methods: It is a descriptive and observational study. The study subjects comprised 273 respondents belonging to 15 to 64 years age group. The collection tool used was a pre designed questionnaire, which was pre-tested. Results: 60% of respondents were adults, about 16 percent were educated up to primary level and more than 40% belonged to scheduled castes. Nearly 20% were aware about National AIDS Control Programme and 6.59% had clear knowledge about HIV/AIDS. Only 4.02% knew about the national vector borne disease control programme and 24% women clearly knew about exclusive breast feeding. Peripheral health workers were the most common source of information regarding these programmes. 64% of respondents opined that these national health programmes are good. Conclusion: Low level of knowledge was observed among the respondents regarding National Health Programmes

Twenty five years fighting for women's health and rights : some progress but still a long way to go

The aim of this paper is to provide an overview of 25 years women’s health and rights, a difficult journey with steps forward and backwards since the landmark conference in 1994 when reproductive rights were for the first time on the menu. However, although great strides have been made in reducing maternal and child mortality since then, among others by the United Nations with the establishment of the Millennium Development Goals for 2015, showing that change is possible, many countries are still lagging behind in reaching the goals. While the new global architecture, in particular with the Sustainable Development Goals and the Global Strategy for Women’s, Children’s and Adolescents’ Health, ensures that these issues remain high on the political agenda, this paper argues that we must move from political commitment to action, via the creation and dissemination of research evidence. As the Founding President of the Ghent Africa Platform (GAP) at Ghent University, I still believe GAP has an important role to play regarding this international collaboration and dissemination of scientific knowledge