Drivers and deterrents of facility delivery in sub-Saharan Africa: a systematic review

Abstract While the most important factors associated with facility-based delivery (FBD) have been explored within individual countries in Africa, no systematic review has explored the factors associated with FBD across sub-Saharan Africa. A systematic search of the peer-reviewed literature was conducted to identify articles published in English from 1/1995-12/2011 that reported on original research conducted entirely or in part in sub-Saharan Africa and included a primary outcome variable of FBD, delivery location, or skilled birth attendance (SBA). Out of 1,168 citations identified, 65 met inclusion criteria. 62 of 65 were cross-sectional, and 58 of 65 relied upon household survey data. Fewer than two-thirds (43) included multivariate analyses. The factors associated with facility delivery were categorized as maternal, social, antenatal-related, facility-related, and macro-level factors. Maternal factors were the most commonly studied. This may be a result of the overwhelming reliance on household survey data – where maternal sociodemographic factors are likely to be well-represented and non-maternal factors may be less consistently and accurately represented. Multivariate analysis suggests that maternal education, parity / birth order, rural / urban residence, household wealth / socioeconomic status, distance to the nearest facility, and number of antenatal care visits were the factors most consistently associated with FBD. In conclusion, FBD is a complex issue that is influenced by characteristics of the pregnant woman herself, her immediate social circle, the community in which she lives, the facility that is closest to her, and context of the country in which she lives. Research to date has been dominated by analysis of cross-sectional household survey data. More research is needed that explores regional variability, examines longitudinal trends, and studies the impact of interventions to boost rates of facility delivery in sub-Saharan Africa.http://deepblue.lib.umich.edu/bitstream/2027.42/112697/1/12978_2013_Article_214.pd

Prevalence of maternal near miss and community‐based risk factors in Central Uganda

ObjectiveTo examine the prevalence of maternal near‐miss (MNM) and its associated risk factors in a community setting in Central Uganda.MethodsA cross‐sectional research design employing multi‐stage sampling collected data from women aged 15–49 years in Rakai, Uganda, who had been pregnant in the 3 years preceding the survey, conducted between August 10 and December 31, 2013. Additionally, in‐depth interviews were conducted. WHO‐based disease and management criteria were used to identify MNM. Binary logistic regression was used to predict MNM risk factors. Content analysis was performed for qualitative data.ResultsSurvey data were collected from 1557 women and 40 in‐depth interviews were conducted. The MNM prevalence was 287.7 per 1000 pregnancies; the majority of MNMs resulted from hemorrhage. Unwanted pregnancies, a history of MNM, primipara, pregnancy danger signs, Banyakore ethnicity, and a partner who had completed primary education only were associated with increased odds of MNM (all P < 0.05).ConclusionsMNM morbidity is a significant burden in Central Uganda. The present study demonstrated higher MNM rates compared with studies employing organ‐failure MNM‐diagnostic criteria. These findings illustrate the need to look beyond mortality statistics when assessing maternal health outcomes. Concerted efforts to increase supervised deliveries, access to emergency obstetric care, and access to contraceptives are warranted.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135484/1/ijgo214.pd

Three years of data on the impact of obstetrician/gynecologist coverage in rural Uganda

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135481/1/ijgo284.pd

Preeclampsia knowledge among postpartum women treated for preeclampsia and eclampsia at Korle Bu Teaching Hospital in Accra, Ghana

BACKGROUND: Preeclampsia/eclampsia is a major cause of maternal morbidity and mortality worldwide, yet patients\u27 perspectives about their diagnosis are not well understood. Our study examines patient knowledge among women with preeclampsia/eclampsia in a large urban hospital in Ghana. METHODS: Postpartum women diagnosed with preeclampsia or eclampsia were asked to complete a survey 2-5 days after delivery that assessed demographic information, key obstetric factors, and questions regarding provider counseling. Provider counseling on diagnosis, causes, complications, and future health effects of preeclampsia/eclampsia was quantified on a 4-point scale (\u27Counseling Composite Score\u27). Participants also completed an objective knowledge assessment regarding preeclampsia/eclampsia, scored from 0 to 22 points (\u27Preeclampsia/Eclampsia Knowledge Score\u27 (PEKS)). Linear regression was used to identify predictors of knowledge score. RESULTS: A total of 150 participants were recruited, 88.7% (133) with preeclampsia and 11.3% (17) with eclampsia. Participants had a median age of 32 years, median parity of 2, and mean number of 5.4 antenatal visits. Approximately half of participants reported primary education as their highest level of education. While 74% of women reported having a complication during pregnancy, only 32% of participants with preeclampsia were able to correctly identify their diagnosis, and no participants diagnosed with eclampsia could correctly identify their diagnosis. Thirty-one percent of participants reported receiving no counseling from providers, and only 11% received counseling in all four categories. Even when counseled, 40-50% of participants reported incomplete understanding. Out of 22 possible points on a cumulative knowledge assessment scale, participants had a mean score of 12.9 +/- 0.38. Adjusting for age, parity, and the number of antenatal visits, higher scores on the knowledge assessment are associated with more provider counseling (beta 1.4, SE 0.3, p \u3c 0.001) and higher level of education (beta 1.3, SE 0.48, p = 0.008). CONCLUSIONS: Counseling by healthcare providers is associated with higher performance on a knowledge assessment about preeclampsia/eclampsia. Patient knowledge about preeclampsia/eclampsia is important for efforts to encourage informed healthcare decisions, promote early antenatal care, and improve self-recognition of warning signs-ultimately improving morbidity and reducing mortality

Root causes and social consequences of birth injuries in Western Uganda

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138287/1/ijgo12257.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138287/2/ijgo12257_am.pd

Can an integrated obstetric emergency simulation training improve respectful maternity care? Results from a pilot study in Ghana

BackgroundFew evidence‐based interventions exist on how to improve respectful maternity care (RMC) in low‐resource settings. We sought to evaluate the effect of an integrated simulation‐based training on provision of RMC.MethodsThe pilot project was in East Mamprusi District in northern Ghana. We integrated specific components of RMC, emphasizing dignity and respect, communication and autonomy, and supportive care, into a simulation training to improve identification and management of obstetric and neonatal emergencies. Forty‐three providers were trained. For evaluation, we conducted surveys at baseline (N = 215) and endline (N = 318) 6 months later, with recently delivered women to assess their experiences of care using the person‐centered maternity care scale. Higher scores on the scale represent more respectful care.ResultsCompared to the baseline, women in the endline reported more respectful care. The average person‐centered maternity care score increased from 50 at baseline to 72 at endline, a relative increase of 43%. Scores on the subscales also increased between baseline and endline: 15% increase for dignity and respect, 87% increase for communication and autonomy, and 55% increase for supportive care. These differences remained significant in multivariate analysis controlling for several potential confounders.ConclusionsThe findings suggest that integrated provider trainings that give providers the opportunity to learn, practice, and reflect on their provision of RMC in the context of stressful emergency obstetric simulations have the potential to improve women’s childbirth experiences in low‐resource settings. Incorporating such trainings into preservice and in‐service training of providers will help advance global efforts to promote RMC.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151352/1/birt12418.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151352/2/birt12418_am.pd

Contraceptive practices of women visiting a gynecology clinic in Beijing, China

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135321/1/ijgo64.pd

The relationship between facility‐based delivery and maternal and neonatal mortality in Sub‐Saharan Africa

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135613/1/ijgo263.pd

Is Generalized Maternal Optimism or Pessimism During Pregnancy Associated with Unplanned Cesarean Section Deliveries in China?

This research examines whether maternal optimism/pessimism is associated with unplanned Cesarean section deliveries in China. If so, does the association remain after controlling for clinical factors associated with C-sections? A sample of 227 mostly primiparous women in the third trimester of pregnancy was surveyed in a large tertiary care hospital in Beijing, China. Post-delivery data were collected from medical records. In bivariate analysis, both optimism and pessimism were related to unplanned c-section. However, when optimism and pessimism were entered into a regression model together, optimism was no longer statistically significant. Pessimism remained significant, even when adjusting for clinical factors such as previous abortion, previous miscarriage, pregnancy complications, infant gestational age, infant birthweight, labor duration, birth complications, and self-rated difficulty of the pregnancy. This research suggests that maternal mindset during pregnancy has a role in mode of delivery. However, more research is needed to elucidate potential causal pathways and test potential interventions

PREventing Maternal And Neonatal Deaths (PREMAND): a study protocol for examining social and cultural factors contributing to infant and maternal deaths and near-misses in rural northern Ghana

Plain English Summary The Preventing Maternal And Neonatal Deaths (PREMAND) project works to understand the social and cultural factors that may contribute to the deaths and near-misses (people who almost die but end up surviving) of mothers and babies in four districts in Northern Ghana. Examples of these factors include such thing as treating a sick baby at home with traditional medicine instead of going to a hospital or health center, or pregnant women needing permission from several people before they can go to a hospital to deliver. These social and cultural factors will be placed on a map to understand where patterns and clusters of deaths and near-misses are present in these four communities. The final phase of the project will include support and small grants for community members and local leaders to use these maps and this information to create their own solutions that address the specific needs of each community. Abstract Background While Ghana is a leader in some health indicators among West African nations, it still struggles with high maternal and neonatal morbidity and mortality rates, especially in the northern areas. The clinical causes of mortality and morbidity are relatively well understood in Ghana, but little is known about the impact of social and cultural factors on maternal and neonatal outcomes. Less still is understood about how such factors may vary by geographic location, and how such variability may inform locally-tailored solutions. Methods/Design Preventing Maternal And Neonatal Deaths (PREMAND) is a three-year, three-phase project that takes place in four districts in the Upper East, Upper West, and Northern Regions of Ghana. PREMAND will prospectively identify all maternal and neonatal deaths and ‘near-misses’, or those mothers and babies who survive a life threatening complication, in the project districts. Each event will be followed by either a social autopsy (in the case of deaths) or a sociocultural audit (in the case of near-misses). Geospatial technology will be used to visualize the variability in outcomes as well as the social, cultural, and clinical predictors of those outcomes. Data from PREMAND will be used to generate maps for local leaders, community members and Government of Ghana to identify priority areas for intervention. PREMAND is an effort of the Navrongo Health Research Centre and the University of Michigan Medical School. Discussion PREMAND uses an innovative, multifaceted approach to better understand and address neonatal and maternal morbidity and mortality in northern Ghana. It will provide unprecedented access to information on the social and cultural factors that contribute to deaths and near-misses in the project regions, and will allow such causal factors to be situated geographically. PREMAND will create the opportunity for local, regional, and national stakeholders to see how these events cluster, and place them relative to traditional healer compounds, health facilities, and other important geographic markers. Finally, PREMAND will enable local communities to generate their own solutions to maternal and neonatal morbidity and mortality, an effort that has great potential for long-term impact.http://deepblue.lib.umich.edu/bitstream/2027.42/134530/1/12978_2016_Article_142.pd