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Journal articles on the topic 'Community mobilisation and obstetric emergency'
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Opoku, S. A., S. Kyei-Faried, S. Twum, J. O. Djan, E. N. L. Browne, and J. Bonney. "Community education to improve utilization of emergency obstetric services in Ghana." International Journal of Gynecology & Obstetrics 59 (November 1997): S201—S207. http://dx.doi.org/10.1016/s0020-7292(97)00166-5.
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Bello Gummi, F., M. Hassan, D. Shehu, and L. Audu. "Community education to encourage use of emergency obstetric services, Kebbi State, Nigeria." International Journal of Gynecology & Obstetrics 59 (November 1997): S191—S200. http://dx.doi.org/10.1016/s0020-7292(97)00165-3.
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Kandeh, H. B. S., B. Leigh, M. S. Kanu, M. Kuteh, J. Bangura, and A. L. Seisay. "Community motivators promote use of emergency obstetric services in rural Sierra Leone." International Journal of Gynecology & Obstetrics 59 (November 1997): S209—S218. http://dx.doi.org/10.1016/s0020-7292(97)00167-7.
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Bhandari, TR, and G. Dangal. "Emergency Obstetric Care: Strategy for Reducing Maternal Mortality in Developing Countries." Nepal Journal of Obstetrics and Gynaecology 9, no. 1 (September 28, 2014): 8–16. http://dx.doi.org/10.3126/njog.v9i1.11179.
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Twenty-five years have passed since the global community agreed in Nairobi to address the high maternal mortality by implementing the Safe Motherhood Initiative. However, every year nearly three million women die due to pregnancy related causes. This tragedy is avoidable if women have timely access to required emergency obstetric care. Emergency obstetric care refers to life-saving services for maternal and neonatal complications provided by skilled health workers. Since the beginning of the 1980’s, several efforts have been intensified to improve maternal and child health status and reducing the high morbidity and mortality. There was built on a worldwide consensus to provide improved maternal and child health care for addressing the high morbidity and mortality. All participant countries agreed to integrate emergency obstetric care services in their national health care system. Emergency obstetric care is one of the strategies for reducing the maternal mortality as pregnancy related complications are unpredictable. However, many women in developing countries do not have access to essential health care services including emergency obstetric care. Basic emergency obstetric care by skilled birth attendants or timely referral for further comprehensive emergency obstetric care can reduce maternal deaths and disabilities significantly. This paper is based on the results published in PubMed, Medline, Lancet, WHO and Google Scholar web pages from 1990 to 2013. DOI: http://dx.doi.org/10.3126/njog.v9i1.11179 NJOG 2014 Jan-Jun; 2(1):8-16
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Mutuku, J., and Dr M. Githae. "Delays in Africa Accessing Emergency Obstetric Care in Sub-Saharan; Kenya Situation." International Journal of Contemporary Research and Review 9, no. 07 (July 11, 2018): 20484–96. http://dx.doi.org/10.15520/ijcrr/2018/9/07/549.
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Delay in accessing facility for delivery by a skilled person has huge impact on maternal health outcomes in developing countries. However, women’s deaths at birth in Sub-Saharan countries remain high due to challenges associated with accessing immediate Emergency Obstetric Care (EmOC) at birth.
While the deaths are preventable through availability of EmOC and skilled persons attending to delivery, access to these services remain poor and most women continue to give birth at home without the assistance of a skilled person.
The purpose of the study was to identify barriers to accessing EmOC in order to suggest ways of increasing skilled birth attendance in Kenya, a strategy that is known to reduce maternal mortality and morbidity. Relevant literature from abstracts of scholarly journals from major search engines were scanned and analyzed for results.
Significant factors that were identified to cause delay in accessing EmOC are maternal education, financial status, ignorance, delay in decision making by family, preference for Traditional Birth Attendants (TBA), travel cost, means of transport, distance, and impassable roads. Further barriers are poor quality of care due to supplies and equipment shortage, rude, unwelcoming staff, user fees paid on admission and long waiting hours in the facilities.
Based on the findings, various barriers that hinder women from accessing EmOC exist. To increase the number of births assisted by skilled professionals and reduce maternal deaths, these barriers need to be tackled from family, community, and facility levels.
The recommendations include community sensitization and health education on pregnancy related danger signs, strengthening of health care systems to ensure availability of supplies, equipment, and improving referral systems. Integration of TBAs role to health care system will ensure timely referral and increased facility deliveries.
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Dumont, Alexandre, Alioune Gaye, Patricia Mahé, and Marie-Hélène Bouvier-Colle. "Emergency obstetric care in developing countries: impact of guidelines implementation in a community hospital in Senegal." BJOG: An International Journal of Obstetrics & Gynaecology 112, no. 9 (March 1, 2005): 1264–69. http://dx.doi.org/10.1111/j.1471-0528.2005.00604.x.
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Novita, Winda, Destanul Aulia Aulia, and Juanita Juanita. "The Relationship between Geography Access and Utilization of Basic Emergency Neonatal Obstetric Services (PONED) in Hamparan Perak Health Center, Deli Serdang Regency in 2018." Budapest International Research and Critics Institute (BIRCI-Journal) : Humanities and Social Sciences 3, no. 1 (February 16, 2020): 674–81. http://dx.doi.org/10.33258/birci.v3i1.829.
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Every pregnancy and childbirth is a risky event, therefore every pregnant and childbirth woman must be as close as possible to basic emergency obstetric services. Health service units that are close and affordable to the community Community Health Centreare expected to be able to provide basic emergency neonatal obstetric services. Deli Serdang Regency has a high number of maternal mortality rates (AKI) and there are still cases of maternal deaths due to delays in handling due to geographical factors which is one of the causes of the low utilization of PONED (Pelayanan Obstetri Neonatal Emergency Dasar) Community Health Centre. The study aims to analyze the relationship between geographic access and the use of PONED in Hamparan Perak Health Center, Deli Serdang Regency.This type of research is an explanatory survey with cross sectional approach. The study was conducted in the working area of the Hamparan Perak Health Center with a sample of 100 pregnant, childbirth and postpartum women obtained using the proportional random sampling method. The independent variable in the study is geographic access. The dependent variable in research is the use of PONED. Data obtained using a questionnaire. Data analysis was performed using the chi-square test. The results showed a significant relationship between geographic access and the use of PONED (OR = 9,615; 95% CI = 2,974 to 31,088; p = 0.001). Pregnant, childbirth and childbirth mothers who have an assessment of good geographical access will use the PONED Community Health Centre.
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Ahsan, Ahsan, Ni Luh Diah Ayu Sita Dewi, Ali Haedar, and Ike Nesdia Rahmawati. "Factors Associated to Basic Emergency Obstetric Neonatal Care (BEONC) Nurses' Decision Making Skill." Jurnal Keperawatan Soedirman 13, no. 2 (November 18, 2018): 64. http://dx.doi.org/10.20884/1.jks.2018.13.2.732.
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<em><span lang="EN-US">Neonatal mortality rate (NMR) is an indicator to measure health degree of an area, health problem which involves some institutions to take a decision. The postponement of emergency condition recognition, attaining health facilities, and treatment are three theories of neonatal emergency postponement. The prominent problem of postponement of emergency condition recognition is nurse's ability to think critically to take a decision to determine emergency condition in neonatal. Critical thinking skill is an obligation competence for neonatal emergency nurses. Some theories reveal that characteristic of age, gender, educational background, training and tertiary education, working experience, and employment status influence nurses's decision making skill in treating neonatal emergency case. Different curriculum for introduction to critical thinking in treating neonatal emergency is a basis problem to be a neonatal emergency competent nurse. This research aims to analyze age, gender, education, advance training, experience, and employment status towards decision making skill neonatal emergency implementation at community health care center PONED. This research used cross sectional with purposive sampling. One hundred fifty three (153) nurses were invoked to be the subjects of this research. Besides, this research used Closed Ended Instrument. Based on the results of cross table, p value p>0.05 age, training, working experience and employment status were not related to decision making skill in emergency. Furthermore, male and bachelor of nursing science (p<0.05) is decision making skill of nurses in neonatal emergency. It is concluded that gender and nurse's educational background related to situation awareness. The results of this research are expected to encourage on service quality enhancement of neonatal emergency treatment.</span></em>
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Badu, Franning Deisi, and Fitria Saleh. "The Representation of Neonatal Emergency Obstetric Care Management Base (PONED) In Gorontalo District Tibawa Health Centers." PROMOTIF: Jurnal Kesehatan Masyarakat 6, no. 2 (November 19, 2017): 109. http://dx.doi.org/10.31934/promotif.v6i2.16.
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Background: Development of Community Health Centers capable PONED that is part of the MPS which began in 2009, beginning with the training of doctors, nurses and midwives as well as complementary facilities and infrastructure on the terms that have been set were expected to prevent and manage complications of pregnancy and childbirth so be able to reduce MMR and IMR. The purpose og this research is to find out information about the implementation of Emergency Obstetric Care and Neonatal Basic (PONED) in Tibawa Health Centers 2016. Methods: This Research used qualitative research was to obtain in-deph information (in-deph-Interview) on management of the implementation (PONED) in rural community of Tibawa Health Centers 2016 sample size consisted of three people, divided into key informants and common informant. Results: PONED own with good planning, because the planning has been carried out every year. Organizing PONED has made the division of tasks and organizational structures that standard. PONED implementation in the field still had shortcoming, for the reason that a trained midwife PONED not all exposed areas of training MPS (Management Pregnancy Saver). Supervision is good, because the leader oversight had been monitoring on a regular basis at the Community Health Center. Evaluation was good quality, because the health department regularly conducted supervision through the evaluation of SPM (Minimum Service Standards) which is done every three months and every year. Suggestion: The health department would be able to think of the addition of qualified helath professionals such as midwives are sufficient for basic emergency care and trained nurses. Keywords: Planning, Organizing, Implementing, Monitoring and Evaluation
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Joiner, Anjni, Austin Lee, Phindile Chowa, Ramu Kharel, Lekshmi Kumar, Nayara Malheiros Caruzzo, Thais Ramirez, et al. "Access to care solutions in healthcare for obstetric care in Africa: A systematic review." PLOS ONE 16, no. 6 (June 4, 2021): e0252583. http://dx.doi.org/10.1371/journal.pone.0252583.
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Background Emergency Medical Services (EMS) systems exist to reduce death and disability from life-threatening medical emergencies. Less than 9% of the African population is serviced by an emergency medical services transportation system, and nearly two-thirds of African countries do not have any known EMS system in place. One of the leading reasons for EMS utilization in Africa is for obstetric emergencies. The purpose of this systematic review is to provide a qualitative description and summation of previously described interventions to improve access to care for patients with maternal obstetric emergencies in Africa with the intent of identifying interventions that can innovatively be translated to a broader emergency context. Methods The protocol was registered in the PROSPERO database (International Prospective Register of Systematic Reviews) under the number CRD42018105371. We searched the following electronic databases for all abstracts up to 10/19/2020 in accordance to PRISMA guidelines: PubMed/MEDLINE, Embase, CINAHL, Scopus and African Index Medicus. Articles were included if they were focused on a specific mode of transportation or an access-to-care solution for hospital or outpatient clinic care in Africa for maternal or traumatic emergency conditions. Exclusion criteria included in-hospital solutions intended to address a lack of access. Reference and citation analyses were performed, and a data quality assessment was conducted. Data analysis was performed using a qualitative metasynthesis approach. Findings A total of 6,457 references were imported for screening and 1,757 duplicates were removed. Of the 4,700 studies that were screened against title and abstract, 4,485 studies were excluded. Finally, 215 studies were assessed for full-text eligibility and 152 studies were excluded. A final count of 63 studies were included in the systematic review. In the 63 studies that were included, there was representation from 20 countries in Africa. The three most common interventions included specific transportation solutions (n = 39), community engagement (n = 28) and education or training initiatives (n = 27). Over half of the studies included more than one category of intervention. Interpretation Emergency care systems across Africa are understudied and interventions to improve access to care for obstetric emergencies provides important insight into existing solutions for other types of emergency conditions. Physical access to means of transportation, efforts to increase layperson knowledge and recognition of emergent conditions, and community engagement hold the most promise for future efforts at improving emergency access to care.
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McCord, C., R. Premkumar, S. Arole, and R. Arole. "Efficient and effective emergency obstetric care in a rural Indian community where most deliveries are at home." International Journal of Gynecology & Obstetrics 75, no. 3 (November 26, 2001): 297–307. http://dx.doi.org/10.1016/s0020-7292(01)00526-4.
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Fawcus, S., M. Mbizvo, G. Lindmark, and L. Nyström. "A Community-Based Investigation of Maternal Mortality from Obstetric Haemorrhage in Rural Zimbabwe." Tropical Doctor 27, no. 3 (July 1997): 159–63. http://dx.doi.org/10.1177/004947559702700314.
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In the rural province Masvingo in Zimbabwe, 25% of maternal deaths were caused by obstetric haemorrhage, which had a cause specific maternal mortality rate (MMR) of 40 per 100 000 live births. Forty per cent of cases were due to a ruptured uterus, and 30% to an atonic uterus. Forty-two per cent were more than 35 years old and 44% para 5 or more. In spite of antenatal coverage for 85% of the women, 42% died outside any health facility. Fifty per cent of the women had had no intervention whatsoever before death from haemorrhage. The most important factor for prevention at community level is provision of emergency transport, which would have saved 50% of the women. Other non-health service factors contributing to the adverse outcome were found in actions of the patient herself or a traditional birth attendant. In the health services avoidable factors were identified in 58% of women. More effective antenatal attention to high risk factors, especially high age and parity, appropriate use of maternity waiting shelters, action programmes for management and haemorrhage at all levels, basic resources for resuscitation, improved surgical skills with supervision and available transport for referrals are all necessary parts of a programme to prevent maternal deaths from obstetric haemorrhage.
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Sastradinata, Irawan. "Comprehensive Obstetric and Neonatal Emergency Services (PONEK) to Reduce Infant Mortality and Improve Maternal Health." Bioscientia Medicina : Journal of Biomedicine and Translational Research 5, no. 2 (January 19, 2021): 258–65. http://dx.doi.org/10.32539/bsm.v5i2.218.
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A B S T R A C TThe Millennium Development Goals (Millennium Development Goal's) in2015, there are two targets and indicators that are specifically related tothe health of mothers, infants and children. The Millennium DevelopmentGoal's (MDG's) are for the hospital to implement the PONEK program(Comprehensive Obstetric Neonatal Emergency Services) for reduce infantmortality and improve maternal health. Maternal and perinatal servicesmust be organized in a teamwork and integrated between medical, nursing,midwifery and support services. The hospital as a health serviceorganization for the community needs to make continuous qualityimprovement, which continuously improves performance andservice quality in order to meet the demands of consumers and thehospital environment.
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Tasnim, Saria, Aminur Rahman, and A. K. M. Shahabuddin. "Access to Skilled Care at Home during Pregnancy and Childbirth: Dhaka Bangladesh." International Quarterly of Community Health Education 30, no. 1 (March 26, 2010): 81–87. http://dx.doi.org/10.2190/iq.30.1.g.
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In Bangladesh the majority of childbirth takes place at home by unskilled persons. The objective of this study was to strengthen maternity care services through provision of skilled midwives and to explore people's perception of skilled birth attendants. As part of a quasi-experimental community trial conducted among selected urban area of Dhaka city, a group of skilled midwives were posted in selected urban centers between January to December 2002 to provide obstetric care services and some social mobilization activity in the community. Analysis of skilled midwives self-reported case records and monitory reports of the researchers was done on selected themes. The perception of the skilled midwife was not clear to people. They thought traditional birth attendants who conducts delivery over years were skilled midwives. Preparedness for obstetric emergency and birth planning was non-existent in the families. The skilled midwives were well accepted in the community but discouraged by center authority for home birth, apprehending that it will reduce their client flow and earning. Non-cooperation by other health care providers was common.
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Rochjati, Poedji. "Common obstetric emergency (Field experiences on community based antenatal risk screening in village level in East Java, Indonesia)." Medical Journal of Indonesia 5, no. 2 (April 1, 1996): 65. http://dx.doi.org/10.13181/mji.v5i2.849.
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Chaudhary, Shrawan K. "Scaling up safe motherhood program at Dang district: Impact of programmatic intervention." Nepal Journal of Obstetrics and Gynaecology 3, no. 2 (July 29, 2014): 21–25. http://dx.doi.org/10.3126/njog.v3i2.10827.
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Introduction: Safe motherhood has been a national priority programme and this article highlights the impact of a good programmatic approach to improve safe motherhood services in a district of mid west region of Nepal. Method: Interventions included strengthening of program- Emergency Obstetric Care Services (EmOC) at district hospital and Primary Health Care Center level (basic and comprehensive), Skilled Birth Attendance (SBA) at Health Post level and Community Based Safe Motherhood interventions at community level. In addition, improved family/community practices for birth preparedness and referral of mothers through building the capacity of individuals and families to demand and utilize health services were also implemented. Results: Met need of Emergency Obstetric Care increased from 2% in 2000 to 27.58 % in 2005/06. Number of births increased in hospital from 1078 (2003/2004) to 1753 (2005/2006). Number of caesarean sections was 10 in 2003/04 whereas it has risen to 174 in 2005/06. Similar trends were noticed in other obstetric procedures such as instrumental deliveries and manual removal of placenta. There has also been a significant increase in utilization of EmOC services among the poorest castes- Dalits and Janjatis (from 6.3% in 2000/01 to 12.7% in 2003/04). Twenty four hours blood transfusion services are made available at district hospital. EmOC fund has saved the life of 676 women who utilized EmOC fund and watch group has referred total 559 women to health facilities. Conclusion: Data from Dang district suggests that if interventions are delivered simultaneously and effectively at community level and health facility level, there is definite impact on various indicators of safe motherhood program. However, frequent turnover of staff, vacant post, lack of provision of 24 hours SBA services, limited budget for construction, training and equipment supports, lack of transportation and communication in remote Village Development Committees are barriers of effective safe motherhood program. DOI: http://dx.doi.org/10.3126/njog.v3i2.10827 Nepal Journal of Obstetrics and Gynaecology Vol.3(2) 2008; 21-25
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Umoiyoho, Aniefiok J., Aniekan M. Abasiattai, and Okon E. Akaiso. "Review of obstetric fistulas in a rural hospital in South-South Nigeria." Urogynaecologia 25, no. 1 (November 4, 2011): 7. http://dx.doi.org/10.4081/uij.2011.e7.
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<em>Background</em>. Obstetric fistula is a devastating medical condition associated with adverse social, psychological and reproductive health consequences. This study was carried out to review the pattern of presentation and outcome of patients with obstetric fistulas in a rural health facility in South-South Nigeria. <em>Design and Method</em>. A retrospective review of case notes of 51 patients with obstetric fistula that were managed at the Family Life Center, Mbribit Itam, in Itu, Local Government Area of Akwa Ibom State. <em>Results</em>. During the study period, 51 obstetric fistulas were repaired in the hospital. The ages of the patients ranged from 15 to 50 years with median age of 25.8 years and modal age group of 21-30 years (45.1%). The majority of the patients were of low parity (72.5%), 56.9% had no formal education and 27.5% were traders. Thirty four patients (66.7%) had their fistulas for between 1 and 6 years, 19.6% of the patients had juxta-cervical fistulas, while eight (15.7%) had circumferential loss of the urethra. Thirty-seven (72.5%) of them where unbooked and thus had no antenatal care, while 4 (7.8%) booked and had antenatal care in conventional health facilities. Thirty-four patients (66.7%) remained dry twenty-one days after surgery, thirteen (23.5%) were still wet, while 4 patients (7.8%) had stress incontinence despite repair. <em>Conclusion</em>. Obstetric fistulas are found most commonly among young, poorly educated women of low parity who do not avail themselves of orthodox ANC in our environment. Government, community and religious leaders must make concerted efforts to ensure women obtain formal education and when pregnant, have access to emergency obstetric care even if resident in the rural areas. Government, relevant non-Governmental organisations, community leaders and health workers should through relevant health messages enlighten women in the community about obstetric fistulas and the dangers of delivering in unorthodox health facilities. More medical personnel should be trained as the first attempt at repair is the one that is most likely to succeed.
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Olowokere, Adekemi Eunice, Aanuoluwapo Omobolanle Olajubu, Ifeoluwa Eunice Ayeni, and Olayinka Olaitan Aremu. "Healthcare workers’ knowledge and attitude towards prompt referral of women with postpartum haemorrhage in Nigeria: a community-based study." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 1 (December 26, 2019): 335. http://dx.doi.org/10.18203/2320-1770.ijrcog20196044.
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Background: Postpartum Haemorrhage (PPH) is a major contributor to maternal mortality in developing countries most especially in the rural areas where Emergency Obstetric Care (EmOC) are not available. Delay in referring women from rural health facilities to settings where EmOC services are available have been reported. This study assessed community-based healthcare workers’ (CHWs) knowledge and attitude towards the prevention, early recognition and prompt referral of women with Post-Partum Haemorrhage (PPH) for Emergency Obstetric Care (EmOC).Methods: Descriptive cross-sectional design was used. Structured questionnaire was used to collect data from 200 CHWs recruited from community-based healthcare. Data analysis was done in SPSS version 20 at significance level of 0.05.Results: Findings show that 86.5% (n=173) of the respondents had good knowledge while 12% (n=24) and 1.5% (n=3) had moderate and poor knowledge respectively. Negative attitude towards prompt referral of women affected with PPH was found among 51% (n=102) of the respondents. Unavailability of blood drapes to estimate blood loss [χ2 (1, n=200) = 4.51, p=0.03], lack of ambulance [χ2 (1, n=200) = 4.46, p=0.03], and poor state of the roads [χ2 (1, n=200) = 4.44, p=0.03] were factors linked to poor attitude of CHWs towards prompt referral of affected women.Conclusions: The study concluded that there is a need for intervention that can help improve community healthcare workers’ attitude towards prompt referral of women affected with postpartum haemorrhage. There is also a need for general overhaul of community-based facilities to effectively support prompt referral.
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de Ramirez, Sarah Stewart, Jacob Doll, Sarah Carle, Trisha Anest, Maya Arii, Yu-Hsiang Hsieh, Martins Okongo, Rachel Moresky, Sonia Ehrlich Sachs, and Michael Millin. "Emergency Response in Resource-poor Settings: A Review of a Newly-implemented EMS System in Rural Uganda." Prehospital and Disaster Medicine 29, no. 3 (April 16, 2014): 311–16. http://dx.doi.org/10.1017/s1049023x14000363.
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AbstractIntroductionThe goal of an Emergency Medical Services (EMS) system is to prevent needless death or disability from time-sensitive disease processes. Despite growing evidence that these processes contribute significantly to mortality in low- and middle- income countries (LMICs), there has been little focus on the development of EMS systems in poor countries.ProblemThe objective of this study was to understand the utilization pattern of a newly-implemented EMS system in Ruhiira, Uganda.MethodsAn EMS system based on community priorities was implemented in rural Uganda in 2009. Six months of ambulance logs were reviewed. Patient, transfer, and clinical data were extracted and analyzed.ResultsIn total, 207 cases were reviewed. Out of all transfers, 66% were for chief complaints that were obstetric related, while 12% were related to malaria. Out of all activations, 77.8% were for female patients. Among men, 34% and 28% were related to malaria and trauma, respectively. The majority of emergency transfers were from district to regional hospitals, including 52% of all obstetric transfers, 65% of malaria transfers, and 62% of all trauma transfers. There was no significant difference in the call to arrival on scene time, the time to scene or the scene to treatment time during the day and night (P > .05). Cost-benefit analysis revealed a cost of $89.95 per life saved with an estimated $0.93/capita to establish the system and $0.09/capita/year to maintain the system.ConclusionContrary to current belief, EMS systems in rural Africa can be affordable and highly utilized, particularly for life-threatening, nontrauma complaints. Construction of a simple but effective EMS system is feasible, acceptable, and an essential component to the primary health care system of LMICs.Stewart De RamirezS, DollJ, CarleS, AnestT, AriiM, HsiehYH, OkongoM, MoreskyR, SachsSE, MillinM. Emergency response in resource poor-settings: a review of a newly-implemented EMS system in rural Uganda. Prehosp Disaster Med. 2014;29(3):1-6.
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Brückmann, Peter, Ashfa Hashmi, Marina Kuch, Jana Kuhnt, Ida Monfared, and Sebastian Vollmer. "Public provision of emergency obstetric care: a case study in two districts of Pakistan." BMJ Open 9, no. 5 (May 2019): e027187. http://dx.doi.org/10.1136/bmjopen-2018-027187.
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ObjectivesPakistan is one out of five countries where together half of the global neonatal deaths occur. As the provision of services and facilities is one of the key elements vital to reducing this rate as well as the maternal mortality rate, this study investigates the status of the delivery of essential obstetric care provided by the public health sector in two districts in Khyber Pakhtunkhwa in 2015 aiming to highlight areas where critical improvements are needed.SettingWe analysed data from a survey of 22 primary and secondary healthcare facilities as well as 85 community midwives (CMWs) in Haripur and Nowshera districts.ParticipantsUsing a structured questionnaire we evaluated the performance of emergency obstetric care (EmOC) signal functions and patient statistics in public health facilities. Also, 102 CMWs were interviewed about working hours, basic and specialised delivery service provision, referral system and patient statistics.Primary outcome measuresWe investigate the public provision of emergency obstetric care using seven key medical services identified by the United Nations (UN).ResultsDeliveries by public health cadres account for about 30% of the total number of births in these districts. According to the UN benchmark, only a small fraction of basic EmOC (2/18) and half of the comprehensive EmOC (2/4) facilities of the recommended minimum number were available to the population in both districts. Only a minority of health facilities and CMWs carry out several signal functions. Only 8% of the total births in one of the study districts are performed in public EmOC health facilities.ConclusionsBoth districts show a significant shortage of available public EmOC service provisions. Development priorities need to be realigned to improve the availability, accessibility and quality of EmOC service provisions by the public health sector alongside with existing activities to increase institutional births.
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Shahi, Prakash. "Female Community Health Volunteers’ (FCHVs) Involvement in Improving Maternal Health, Nepal." Journal of Karnali Academy of Health Sciences 2, no. 3 (December 10, 2019): 250–52. http://dx.doi.org/10.3126/jkahs.v2i3.26664.
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Improving maternal health was one of the eight millennium development goals (MDGs) in 2000 and later included in SDG as a major agenda in 2015 which was adopted by the international community. In Nepal, the first elected democratic government developed Health Policy in 1991 and revised in 2014 which has identified safe motherhood as a priority program and institutionalized safe motherhood as a primary health care. In order to effectively address maternal and neonatal morbidity and mortality, the Family Health Division, Department of Health Services (DoHS) developed National Safe Motherhood Long Term Plan 2002- 2017 (revised in 2006) which aimed to establish basic and comprehensive emergency obstetric care services in all districts. To complement this plan, the National Policy on SBA (2006) was developed with the aim of increasing the percentage of births assisted by a skilled birth attendant (as internationally defined) to 60 percent by 2015. Table 1 explains some historical shifts in maternal health policies and programs in Nepal.
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Roberts, Rosalyn M., Kate L. Dalton, Jane V. Evans, and Catherine L. Wilson. "A service model of short-term case management for elderly people at risk of hospital admission." Australian Health Review 31, no. 2 (2007): 173. http://dx.doi.org/10.1071/ah070173.
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This article presents the model of a short-term case management program focused on reducing emergency department presentations and unplanned hospital admissions for a targeted group of older people with complex care needs. As a semi-integrated health care program, Treatment Response and Assessment for Aged Care (TRAAC) is implemented by short-term case managers located in a variety of community agencies as well as acute and sub-acute hospital settings. The article discusses the features of the model including case finding, early intervention and risk screening, combined with the rapid mobilisation of specialised geriatric assessment services. The model has the potential to contribute to positive results in managing the complex health needs of this group. Evaluation outcomes including reductions in hospital use for the target group, and positive client and staff perceptions of the service model are discussed in relation to the unique features of the intervention program.
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Griffiths, Karolina, Megha Raj Banjara, T. O'Dempsey, B. Munslow, and Axel Kroeger. "Public Health Responses to a Dengue Outbreak in a Fragile State: A Case Study of Nepal." Journal of Tropical Medicine 2013 (2013): 1–8. http://dx.doi.org/10.1155/2013/158462.
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Objectives. The number of countries reporting dengue cases is increasing worldwide. Nepal saw its first dengue outbreak in 2010, with 96% of cases reported in three districts. There are numerous policy challenges to providing an effective public health response system in a fragile state. This paper evaluates the dengue case notification, surveillance, laboratory facilities, intersectoral collaboration, and how government and community services responded to the outbreak.Methods. Qualitative data were collected through 20 in-depth interviews, with key stakeholders, and two focus-group discussions, with seven participants.Results. Limitations of case recognition included weak diagnostic facilities and private hospitals not incorporated into the case reporting system. Research on vectors was weak, with no virological surveillance. Limitations of outbreak response included poor coordination and an inadequate budget. There was good community mobilization and emergency response but no routine vector control.Conclusions. A weak state has limited response capabilities. Disease surveillance and response plans need to be country-specific and consider state response capacity and the level of endemicity. Two feasible solutions for Nepal are (1) go upwards to regional collaboration for disease and vector surveillance, laboratory assistance, and staff training; (2) go downwards to expand upon community mobilisation, ensuring that vector control is anticipatory to outbreaks.
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Ruducha, Jenny, Divya Hariharan, James Potter, Danish Ahmad, Sampath Kumar, P. S. Mohanan, Laili Irani, and Katelyn N. G. Long. "Measuring coordination between women’s self-help groups and local health systems in rural India: a social network analysis." BMJ Open 9, no. 8 (August 2019): e028943. http://dx.doi.org/10.1136/bmjopen-2019-028943.
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ObjectivesTo assess how the health coordination and emergency referral networks between women’s self-help groups (SHGs) and local health systems have changed over the course of a 2-year learning phase of the Uttar Pradesh Community Mobilization Project, India.DesignA pretest, post-test programme evaluation using social network survey to analyse changes in network structure and connectivity between key individuals and groups.SettingThe study was conducted in 18 villages located in three districts in Uttar Pradesh, India.InterventionTo improve linkages and coordination between SHGs and government health providers by building capacity in leadership, management and community mobilisation skills of the SHG federation.ParticipantsA purposeful sampling that met inclusion criteria. 316 respondents at baseline and 280 respondents at endline, including SHG members, village-level and block-level government health workers, and other key members of the community (traditional birth attendants, drug sellers, unqualified rural medical providers, pradhans or elected village heads, and religious leaders).Main outcome measuresSocial network analysis measured degree centrality, density and centralisation to assess changes in health services coordination networks at the village and block levels.ResultsThe health services coordination and emergency referral networks increased in density and the number of connections between respondents as measured by average degree centrality have increased, along with more diversity of interaction between groups. The network expanded relationships at the village and block levels, reflecting the rise of bridging social capital. The accredited social health activist, a village health worker, occupied the central position in the network, and her role expanded to sharing information and coordinating services with the SHG members.ConclusionsThe creation of new partnerships between traditionally under-represented communities and local government can serve as vehicle for building social capital that can lead to a more accountable and accessible community health delivery system.
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Waniala, Isaac, Sandra Nakiseka, Winnie Nambi, Isaac Naminya, Margret Osuban Ajeni, Jacob Iramiot, Rebecca Nekaka, and Julius Nteziyaremye. "Prevalence, Indications, and Community Perceptions of Caesarean Section Delivery in Ngora District, Eastern Uganda: Mixed Method Study." Obstetrics and Gynecology International 2020 (July 20, 2020): 1–11. http://dx.doi.org/10.1155/2020/5036260.
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Background. Uganda has a high maternal mortality ratio (MMR) of 336/100,000 live births. Caesarean section is fundamental in achieving equity and equality in emergency obstetric care services. Despite it being a lifesaving intervention, it is associated with risks. There has been a surge in caesarean section rates in some areas, yet others remain underserved. Studies have shown that rates exceeding 15% do not improve maternal and neonatal morbidity and mortality. Our study aimed at determining the prevalence, indications, and community perceptions of caesarean section delivery in Eastern Uganda. Methods and Materials. It was both health facility and commuity based cross-sectional descriptive study in Ngora district, Eastern Uganda. Mixed methods of data collection were employed in which quantitative data were collected by retrospectively reviewing all charts of all the mothers that had delivered at the two comprehensive emergency obstetric care service facilities between April 2018 and March 2019. Qualitative data were collected by focus group discussions till point of saturation. Data were entered into EpiData (version 3.1) and analyzed using SPSS software (version 24). Qualitative data analysis was done by transcribing and translating into English verbatim and then analyzed into themes and subthemes with the help of NVIVO 12. Results. Of the total 2573 deliveries, 14% (357/2573) were by CS. The major single indications were obstructed labour 17.9%, fetal distress 15.3%, big baby 11.6%, and cephalopelvic disproportion (CPD) 11%. Although appreciated as lifesaving for young mothers, those with diseases and recurrent intrauterine fetal demise, others considered CS a curse, marriage-breaker, misfortune, money-maker and a sign of incompetent health workers, and being for the lazy women and the rich civil servants. The rise was also attributed to intramuscular injections and contraceptive use. Overall, vaginal delivery was the preferred route. Conclusion. Several misconceptions that could hinder access to CS were found which calls for more counseling and male involvement. Although facility based, the rate is higher than the desired 5–15%. It is higher than the projected increase of 36% by 2021. It highlights the need for male involvement during counseling and consent for CS and concerted efforts to demystify community misconceptions about women that undergo CS. These misconceptions may be a hindrance to access to CS.
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B.C., Durga, Ganesh Prasad Neupane, Maya Rai, and Aseem Sharma. "Etiology of Maternal Mortality at Nepalgunj Medical College." Journal of Nepalgunj Medical College 16, no. 2 (December 31, 2018): 27–30. http://dx.doi.org/10.3126/jngmc.v16i2.24870.
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Introduction: Maternal mortality is an indicator of the quality of obstetric care in a community directly reflecting the utilization of health care services available. Maternal mortality has been recognised as a public health problem in the developing countries.
Aim and Objective: To analyse the etiology of maternal deaths.
Material and Methods: This descriptive study was conducted in the gynaecology and obstetrics department of the Nepalgunj Medical College Teaching Hospital Banke Nepal for a period of two years from august 2016-august 2018. All cases of maternal deaths in line with the definition of World Health Organization have been
included. Data were collected and analyzed.
Results: Twenty three (23) maternal deaths were identified during the study period. 69.56% of deaths occurred due to direct obstetric causes. Uncontrollable postpartum haemorrhage with 37.5 % was the leading cause of maternal death followed by eclampsia (18.75%) and sepsis (18.75%). Indirect causes were dominated by heart disease. Maximum 56.5% of deaths had occurred after 48 hours of admission.
Conclusions: Haemorrhage, eclampsia and infections are the main causes of maternal deaths in our study. access to emergency medication, transfusion and anaesthetic and surgical teams in hospitals but also through the involvement of religious leaders, traditional and any community to better understand the population obstacles to reducing maternal mortality.
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Sarala Kumari, Balmur, and Guthi Visweswara Rao. "Study on factors influencing caesarean section delivery in urban field practice area of Kamineni Institute of Medical Sciences, Narketpally, Nalgonda, India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 7 (June 24, 2017): 3129. http://dx.doi.org/10.18203/2320-1770.ijrcog20172947.
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Background: Caesarean section is one of the most commonly performed major surgeries in obstetric practice intended to save the mother and child in turn reducing maternal and perinatal mortality. The steadily increasing global rate of caesarean section has become one of the most debated topics in maternity care. The objective of this study is to identify the factors influencing caesarean section delivery in the study area.Methods: This is a community based cross sectional study conducted among 66 women who underwent caesarean section in urban slum of field practice area of KIMS Nalgonda from January 2017 to February 2017. Information regarding socio demographic factors, indication of caesarean section, maternal and neonatal outcome was recorded in pre-designed pretested questionnaire.Results: The rate of caesarean section (CS) in this study was 55.9%. The commonest indication for elective caesarean was previous caesarean section (59.5%) and for emergence caesarean section the commonest indication was fetal distress (50%). 47.6% in elective group and 62.5% in emergency underwent caesarean section in government hospitals, 52.38% in elective group and 37.5% in emergency underwent caesarean section in private nursing homes.Conclusions: Elective caesarean sections are more common than emergency sections. Most of the caesarian sections were in the age group of 18-25 years, Hindus, BC community, house wives, who have studied up to intermediate and above, below poverty line group and in multigravida women. Common indication for elective CS was previous CS and for emergency CS was fetal distress.
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Hasegawa, Junichi, Tatsuya Arakaki, Akihiko Sekizawa, Tomoaki Ikeda, Isamu Ishiwata, and Katsuyuki Kinoshita. "Current status of community-acquired infection of COVID-19 in delivery facilities in Japan." PLOS ONE 16, no. 5 (May 20, 2021): e0251434. http://dx.doi.org/10.1371/journal.pone.0251434.
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A nationwide questionnaire survey about community-acquired infection of coronavirus disease 2019 (COVID-19) was conducted in July 2020 to identify the characteristics of and measures taken by Japanese medical facilities providing maternity services. A case-control study was conducted by including medical facilities with (Cases) and without (Control) community-acquired infection of COVID-19. Responses from 711 hospitals and 707 private clinics were assessed (72% of all hospital and 59% all private clinics provided maternity service in Japan). Seventy-five COVID-19-positive pregnant women were treated in 52 facilities. Community-acquired infection was reported in 4.1% of the facilities. Of these, 95% occurred in the hospital. Nine patients developed a community-acquired infection in the maternity ward or obstetric department. Variables that associated with community-acquired infection of COVID-19 (adjusted odds ratio [95% confidence interval]) were found to be state of emergency prefecture (4.93 [2.17–11.16]), PCR test for SARS-CoV-2 on admission (2.88 [1.59–5.24]), and facility that cannot treat COVID-19 positive patients (0.34 [0.14–0.82]). In conclusion, community-acquired infection is likely to occur in large hospitals that treat a higher number of patients than private clinics do, regardless of the preventive measures used.
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Heffernan, Eithne, Jenny Mc Sharry, Andrew Murphy, Tomás Barry, Conor Deasy, David Menzies, and Siobhan Masterson. "Community first response and out-of-hospital cardiac arrest: a qualitative study of the views and experiences of international experts." BMJ Open 11, no. 3 (March 2021): e042307. http://dx.doi.org/10.1136/bmjopen-2020-042307.
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ObjectivesThis research aimed to examine the perspectives, experiences and practices of international experts in community first response: an intervention that entails the mobilisation of volunteers by the emergency medical services to respond to prehospital medical emergencies, particularly cardiac arrests, in their locality.DesignThis was a qualitative study in which semistructured interviews were conducted via teleconferencing. The data were analysed in accordance with an established thematic analysis procedure.SettingThere were participants from 11 countries: UK, USA, Canada, Australia, New Zealand, Singapore, Ireland, Norway, Sweden, Denmark and the Netherlands.ParticipantsSixteen individuals who held academic, clinical or managerial roles in the field of community first response were recruited. Maximum variation sampling targeted individuals who varied in terms of gender, occupation and country of employment. There were eight men and eight women. They included ambulance service chief executives, community first response programme managers and cardiac arrest registry managers.ResultsThe findings provided insights on motivating and supporting community first response volunteers, as well as the impact of this intervention. First, volunteers can be motivated by ‘bottom-up factors’, particularly their characteristics or past experiences, as well as ‘top-down factors’, including culture and legislation. Second, providing ongoing support, especially feedback and psychological services, is considered important for maintaining volunteer well-being and engagement. Third, community first response can have a beneficial impact that extends not only to patients but also to their family, their community and to the volunteers themselves.ConclusionsThe findings can inform the future development of community first response programmes, especially in terms of volunteer recruitment, training and support. The results also have implications for future research by highlighting that this intervention has important outcomes, beyond response times and patient survival, which should be measured, including the benefits for families, communities and volunteers.
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Ezekiel, Aaron, C. Okafor Kingsley, J. M. Ijairi, Ayobami A. Mufutau, Steve T. Olaniyan, and Idoko Lucy. "Social Features and Morbidity Patterns of Women with Obstetric Fistulae at an Obstetric Fistula Centre in a University Teaching Hospital in Jos, Nigeria." European Journal of Medical and Health Sciences 3, no. 4 (July 11, 2021): 44–52. http://dx.doi.org/10.24018/ejmed.2021.3.4.844.
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Obstetric fistulae are largely preventable surgical conditions. Literature has shown that it is common among the low income, less privileged and marginalized members of the community. It affects mainly the poor, young, illiterate girls, and women in the remote rural areas of the world, where access to emergency obstetric care, family planning services and skilled birth attendants are unavailable. And when available are poorly utilized due to cost, distance, and other challenges. This study seeks to identify the social features and morbidity characteristics of obstetric fistulae in women at the fistula center in Bingham University Teaching Hospital, Jos, Plateau State, Nigeria. This was a descriptive study done in 2019 among all the patients who attended the obstetric fistula Centre at Bingham University Teaching Hospital. An Interviewer-administered structured questionnaire was used, and it looked at social and health aspects of obstetric fistulae in all 49 patients at the center. Data was analyzed using a computer software; Statistical Package for the Social Science (SPSS) version 20.0. Most of patients had some form of financial support especially from family members, husbands, parents, and friends. Most of the women had their relationships affected. Majority were separated, and relationships strained and had lost financial support from their spouses. Sexual Intercourse was adversely affected. On surgical outcome, 16% became completely dry and leaking had ceased, a third (36.7%) was still leaking urine after the surgery. Almost all the women have had no childbirth after the repair. Women had mental health issues like depression, anxiety, tension headache, fatigue, and suicidal ideation. Participants also had gynaecological morbidities like vulval dermatitis, irregular menstrual flow, abnormal vaginal discharge, and dysuria. These women also had lower abdominal pains, loss of weight, backache, and foot drop. Majority of the children did not survive after the pregnancy that led to the obstetric fistula. Women should seek financial support from family members to avoid delays in seeking help during pregnancy. Communities are encouraged to continue to give moral, emotional, financial, and social support to fistula patients. Healthcare workers should take advantage of the fact that most women attended ANC to educate and enlighten pregnant women on causes, risk factors, social and health consequences of obstetric fistulae. Government should initiate poverty alleviation activities and help reduce out of pocket expenses for healthcare via health insurance.
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Frogel, Michael, George Foltin, and Arthur Cooper. "Pediatric Outpatient/Urgent-Care Emergency and Disaster Planning." Prehospital and Disaster Medicine 34, s1 (May 2019): s155—s156. http://dx.doi.org/10.1017/s1049023x19003510.
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Introduction:Children are frequently victims of disasters, however important gaps remain in pediatric disaster planning. This includes a lack of resources for pediatric preparedness planning for patients in outpatient/urgent-care facilities. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to improve NYC’s pediatric disaster preparedness and response.Aim:After creating planning resources in Pediatric Long-Term Care Facilities, Hospital Pediatric Departments, Pediatric and Neonatal Intensive Care Units and Obstetric/Newborn Services within NYC hospitals, the NYCPDC partnered with leaders and experts from outpatient/urgent-care facilities caring for pediatric patients and created the Pediatric Outpatient Disaster Planning Committee (PODPC). PODPC’s goal was to create guidelines and templates for use in disaster planning for pediatric patients at outpatient/urgent-care facilities.Methods:The PODPC includes physicians, nurses, administrators, and emergency planning experts who have experience working with outpatient facilities. There were 21 committee members from eight organizations (the NYCPDC, DOHMH, Community Healthcare Association of NY State, NY State DOH, NYC Health and Hospitals, Maimonides Medical Center and Presbyterian/Columbia University Medical Center). The committee met six times over a four-month period and shared information to create disaster planning tools that meet the specific pediatric challenges in the outpatient setting.Results:Utilizing an iterative process including literature review, participant presentations, discussions review, and improvement of working documents, the final guidelines and templates for surge and evacuation of pediatric patients in outpatient/urgent care facilities were created in February 2018. Subsequently, model plans were completed and implemented at five NYC outpatient/urgent-care facilities.Discussion:An expert committee utilizing an iterative process successfully created disaster guidelines and templates for pediatric outpatient/urgent care facilities. They addressed the importance of matching the special needs of children to available space, staff, and equipment needs and created model plans for site-specific use.
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Oguntunde, Olugbenga, Farouk Musa Yusuf, Jabulani Nyenwa, Dauda Sulaiman Dauda, Abdulsamad Salihu, and Irit Sinai. "Emergency transport for obstetric emergencies: integrating community-level demand creation activities for improved access to maternal, newborn, and child health services in northern Nigeria." International Journal of Women's Health Volume 10 (November 2018): 773–82. http://dx.doi.org/10.2147/ijwh.s180415.
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Subedi, Sabitra. "Knowledge and Practice on Birth Preparedness and Complication Readiness among Pregnant Women in Selected Ward of Biratnager Municipality, Nepal." Tribhuvan University Journal 33, no. 1 (June 30, 2019): 53–66. http://dx.doi.org/10.3126/tuj.v33i1.28682.
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Birth preparedness and complication readiness is the process planning for normal birth and anticipating the action needed in case of an emergency. Promoting birth and emergency planning helps to improve preventive behavior, increase awareness of mothers about danger signs and improvement in care seeking behavior in the case of obstetric complication. A cross sectional descriptive quantitative community-based study was conducted to assess knowledge and practice on birth preparedness and complication readiness among 150 pregnant women of 24 weeks gestation and above in selected wards of Biratnagar with non- probability purposive sampling.
The findings of the study showed that 22.7% of the respondents had adequate knowledge on the birth preparedness and complication readiness and 19.8% of respondents had adequate practice. However, the only 9.3% of respondents were prepared for birth complications. Analysis using chi square test identified statistically significant association between knowledge and practice. The study found significant association of knowledge with gravida and weeks of gestation. It seemed there is significant association of practice level with occupation and weeks of gestation and weeks of gestation. The study identified inadequate knowledge and practices on birth preparedness and complication readiness. Thus, the government office, policy makers and partner that are working in maternal health should give due emphasis to preparation for birth and its complication and provide information and education to all pregnant women at community level.
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Nimbulkar, Gargi C., Kumar G. Chhabra, Shravani Deolia, and B. Unnikrishnan. "Public Health Dentist: An Untapped Potential during COVID-19 Pandemic." Open Dentistry Journal 15, no. 1 (July 12, 2021): 296–99. http://dx.doi.org/10.2174/1874210602115010296.
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To date, the 21st century has encountered various outbreaks, causing global disruption and highlighting our vulnerability to epidemics. Coronavirus disease (COVID-19) is a highly infectious respiratory illness. Approximately 15% of the affected individuals show severe symptoms requiring oxygen, and of these, 5% require ventilation. This pandemic has affected more than 216 countries or territories (by 20th September 2020), infecting more than 30.6 million people; hitherto, 950000 deaths have been reported. This public health emergency has created a disproportionate burden on the health care system worldwide. Therefore, the management and resolution of this critical situations require the mobilisation of excessive human resources for rapid response, and time is essential in the management of this crisis. Together, these factors contribute to the rapid capacity development with the minimal investment of time and resources, which requires the deployment of an existing skilled workforce, such as public health dentists. These dentists have administrative capabilities and can work in coherence with the community and other health professionals. The present review aims to highlight the areas in which the untapped potential of Public Health Dentists can be explored to tackle the COVID-19 pandemic.
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Mufti, Asma Hassan, Samiya Mufti, and Nasir Jeelani Wani. "Intrauterine fetal death associated socio-demographic factors and obstetric causes: a retrospective study." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 10 (September 25, 2020): 4027. http://dx.doi.org/10.18203/2320-1770.ijrcog20204281.
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Background: The death of a fetus is emotionally traumatic for the parents. It is also distressing for the treating obstetrician. Besides being emotionally challenging, fetal demise raises a lot of questions and increases an obstetrician’s medicolegal risk. The aim of this study was to identify various maternal conditions and socio-demographic factors associated with fetal death and to find the preventable causes of fetal death.Methods: A retrospective observational study was undertaken at Lalla Ded Hospital, Srinagar, Kashmir - a tertiary care centre. The cases of singleton intrauterine fetal deaths (IUFD) with either ultrasound reports proving IUFD or diagnosed on clinical examination by absence of fetal heart sound with gestational age >28 weeks were included. Exclusion criteria includes molar pregnancy and multiple pregnancy.Results: Still birth rate in our study was 19.6 per 1000. Most of the patients with stillbirth belonged to age group of 21-30 years accounting for 67.1% of all cases. Unbooked cases comprised of 58.9%. Most of the study patients i.e. 74.7% belonged to lower middle class. In our study 39% of stillbirth cases were in the range of 28-32 gestational weeks followed by 33.6% cases in 33-37 gestational weeks. Maternal hypertensive disorders had a strong association with IUFD 33.6% (pre-eclampsia 27.4%, eclampsia 6.2%). This was followed by placental abruption comprising 11.7%. Gestational diabetes and severe anaemia accounted for 6.2% and 3.4% respectively. Gross congenital anomalies and fetal infections contributed 2.7% and 2% respectively.Conclusions: Routine antenatal checkups with identification of high risk pregnancies, better access to emergency obstetric care especially during labor, emphasis on institutional deliveries community birth attendant training should help in reducing stillbirth rates in developing countries. Optimal evaluation for future pregnancy is necessary. Counseling and support group should be involved.
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Nkhwalume, Ludo, and Yohana Mashalla. "Health care workers experiences in emergency obstetric care following implementation of an in-service training program: case of 2 Referral Hospitals in Botswana." African Health Sciences 21 (May 23, 2021): 51–58. http://dx.doi.org/10.4314/ahs.v21i.9s.
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Background: Maternal mortality rate remains a challenge in many developing countries.
Objectives: This study explored experiences of Health Care Workers on Emergency Obstetrics Care (EMOC) in-service training and its effect on maternal mortality.
Methods: Descriptive qualitative study design was conducted using in-depth interviews and focus group discussions. Par- ticipants were EMOC trained midwives and doctors purposively selected from the 2 referral hospitals in the country. Data were transcribed verbatim, coded, and analysed using Grounded Theory approach.
Results: Four themes emerged including training, EMOC implementation, maternal death factors and EMOC prioritisation. The duration of training was viewed inadequate but responsiveness to and confidence in managing obstetric emergencies improved post EMOC training. Staff shortage, HCWs non-adherence and negative attitude to EMOC guidelines; delays in instituting interventions, inadequate community involvement, minimal or no health talk to women and their partners and communities on sexual reproductive matters and non-prioritisation of EMOC by authorities were concerns raised.
Conclusion: Strengthening health education at health facility levels, stakeholders’ involvement; and prioritising EMOC in-service training are necessary in reducing the national maternal mortality.
Keywords: Maternal mortality; health care workers; EMOC, in-service training.
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Nkhwalume, Ludo, and Yohana Mashalla. "Health care workers experiences in emergency obstetric care following implementation of an in-service training program: case of 2 Referral Hospitals in Botswana." African Health Sciences 21, no. 1 (May 23, 2021): 51–58. http://dx.doi.org/10.4314/ahs.v21i1.9s.
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Background: Maternal mortality rate remains a challenge in many developing countries.
Objectives: This study explored experiences of Health Care Workers on Emergency Obstetrics Care (EMOC) in-service training and its effect on maternal mortality.
Methods: Descriptive qualitative study design was conducted using in-depth interviews and focus group discussions. Par- ticipants were EMOC trained midwives and doctors purposively selected from the 2 referral hospitals in the country. Data were transcribed verbatim, coded, and analysed using Grounded Theory approach.
Results: Four themes emerged including training, EMOC implementation, maternal death factors and EMOC prioritisation. The duration of training was viewed inadequate but responsiveness to and confidence in managing obstetric emergencies improved post EMOC training. Staff shortage, HCWs non-adherence and negative attitude to EMOC guidelines; delays in instituting interventions, inadequate community involvement, minimal or no health talk to women and their partners and communities on sexual reproductive matters and non-prioritisation of EMOC by authorities were concerns raised.
Conclusion: Strengthening health education at health facility levels, stakeholders’ involvement; and prioritising EMOC in-service training are necessary in reducing the national maternal mortality.
Keywords: Maternal mortality; health care workers; EMOC, in-service training.
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Nyandieka, Lilian Nyamusi, Mercy Karimi Njeru, Zipporah Ng’ang’a, Elizabeth Echoka, and Yeri Kombe. "Male Involvement in Maternal Health Planning Key to Utilization of Skilled Birth Services in Malindi Subcounty, Kenya." Advances in Public Health 2016 (2016): 1–8. http://dx.doi.org/10.1155/2016/5608198.
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Background.In Malindi, rural populations face challenges in accessing skilled birth services. Consequently, the majority of women deliver at home and only seek help when they have complications. This paper reports part findings from a study conducted to assess health priority setting process and its implication on availability, access, and use of emergency obstetric care services in Malindi.Methods. The study utilized qualitative methods to collect data from health personnel and maternal health stakeholders including community members. Source and method triangulation was used to strengthen the credibility of study findings. Data was categorized manually into themes around issues relating to utilization of skilled birth services discussed in this paper.Findings. Various barriers to utilization of skilled birth services were cited. However, most were linked tomwenye(the husband) who decides on the place of birth for the wife.Conclusion.Husbands are very influential in regard to decisions on skilled birth service utilization in this community. Their lack of involvement in maternal health planning may contribute as a barrier to utilization of skilled care by pregnant women. There is need to address themwenyefactor in an attempt to mitigate some of the barriers cited for nonutilization of skilled birth services.
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Banu, M., M. Akter, K. Begum, R. H. Choudhury, and H. E. Nasreen. "‘The clock keeps ticking’ – the role of a community-based intervention in reducing delays in seeking emergency obstetric care in rural Bangladesh: a quasi-experimental study." Public Health 128, no. 4 (April 2014): 332–40. http://dx.doi.org/10.1016/j.puhe.2014.01.009.
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DesLauriers, Nicholas R., Evance Ogola, Gor Ouma, Marcus Salmen, Lily Muldoon, Ben L. Pederson, Kelsi Hines, et al. "The MOMENTUM study: Putting the ‘Three Delays’ to work to evaluate access to emergency obstetric and neonatal care in a remote island community in Western Kenya." Global Public Health 15, no. 7 (March 17, 2020): 1016–29. http://dx.doi.org/10.1080/17441692.2020.1741662.
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Dey, Ajit Kumar, and Debojit Chutia. "A study on obstetric care in a primary health center of South Assam district, India." International Journal Of Community Medicine And Public Health 5, no. 8 (July 23, 2018): 3629. http://dx.doi.org/10.18203/2394-6040.ijcmph20183110.
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Background: Maternal and child health are critically important in a country that is experiencing high infant mortality and maternal mortality. Research all over the world has suggested that one of the major solutions to this problem is availability of Emergency Obstetric Care services within the reach of people. Objectives of the study were to examine profile of mothers who have delivered in health facility during a year and the interplay of various factors in child birth and newborn outcome.Methods: Retrospective cross sectional study conducted by collecting information in predesigned format from medical records. Appropriate statistical methods and test of significance performed for qualitative and quantitative variables.Results: Out of 539 women, the majority of 42.9% were in the age group 20-25 years, the mean age (SD) of mother was 24.1 years (±4.09). Out of total 539 vaginal deliveries, 56.6% cases episiotomy was performed. 41.6% deliveries occurred from 8 AM to 4 PM. The mean birth weight was 2.830 kg SD 0.439 and low birth prevalence 16.0%. Parity with time to delivery after admission in different age groups revealed significant association (X2=66.456, p=0.000). Women aged less than 20 years are 12 times more at risk of episiotomy performed. The multivariate logistic regression analysis shows 60.67% specificity and 85.59% sensitivity in predicting episiotomy.Conclusions: From study it is evident that women report to hospital late in labor hence there is urgent need to provide quality antenatal care services at village and PHC level and augment awareness among the community for promotion of safe motherhood.
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Citron, Isabelle, Desmond Jumbam, James Dahm, Swagoto Mukhopadhyay, Karolina Nyberger, Katherine Iverson, Larry Akoko, et al. "Towards equitable surgical systems: development and outcomes of a national surgical, obstetric and anaesthesia plan in Tanzania." BMJ Global Health 4, no. 2 (April 2019): e001282. http://dx.doi.org/10.1136/bmjgh-2018-001282.
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AbstractDespite emergency and essential surgery and anaesthesia care being recognised as a part of Universal Health Coverage, 5 billion people worldwide lack access to safe, timely and affordable surgery and anaesthesia care. In Tanzania, 19% of all deaths and 17 % of disability-adjusted life years are attributable to conditions amenable to surgery. It is recommended that countries develop and implement National Surgical, Obstetric and Anesthesia Plans (NSOAPs) to systematically improve quality and access to surgical, obstetric and anaesthesia (SOA) care across six domains of the health system including (1) service delivery, (2) infrastructure, including equipment and supplies, (3) workforce, (4) information management, (5) finance and (6) Governance. This paper describes the NSOAP development, recommendations and lessons learnt from undertaking NSOAP development in Tanzania.The NSOAP development driven by the Ministry of Health Community Development Gender Elderly and Children involved broad consultation with over 200 stakeholders from across government, professional associations, clinicians, ancillary staff, civil society and patient organisations. The NSOAP describes time-bound, costed strategic objectives, outputs, activities and targets to improve each domain of the SOA system. The final NSOAP is ambitious but attainable, reflects on-the-ground priorities, aligns with existing health policy and costs an additional 3% of current healthcare expenditure.Tanzania is the third country to complete such a plan and the first to report on the NSOAP development in such detail. The NSOAP development in Tanzania provides a roadmap for other countries wishing to undertake a similar NSOAP development to strengthen their SOA system.
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Anggraini Nursal, D. G., R. Machmud, E. Darwin, N. Mulyana, and R. Yolanda. "The Development of Malcolm Baldrige-Based Patient Safety Model in Basic Emergency Obstetric Care Community Health Center (BEOC-CHC). Preliminary Study: Implementation of Patient Safety in Padang." KnE Life Sciences 4, no. 10 (March 7, 2019): 295. http://dx.doi.org/10.18502/kls.v4i10.3799.
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Heffernan, Eithne, Iris Oving, Tomás Barry, Viet-Hai Phung, Aloysius Niroshan Siriwardena, and Siobhán Masterson. "Factors that motivate individuals to volunteer to be dispatched as first responders in the event of a medical emergency: A systematic review protocol." HRB Open Research 2 (December 3, 2019): 34. http://dx.doi.org/10.12688/hrbopenres.12969.1.
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Background: Voluntary First Response is an important component of prehospital care for medical emergencies, particularly cardiac arrest, in many countries. This intervention entails the mobilisation of volunteers, known as Community First Responders (CFRs), by the Emergency Medical Services to respond to medical emergencies in their locality. They include lay responders and/or professional responders (e.g. police officers, fire fighters, and general practitioners). A wide variety of factors are thought to motivate CFRs to join and remain engaged in Voluntary First Response schemes, such as the availability of learning opportunities, recognition, counselling, and leadership. The aim of this review is to develop an in-depth understanding of CFR motivation, including the factors that influence the initial decision to volunteer as a CFR and the factors that sustain involvement in Voluntary First Response over time. Any factors relevant to CFR de-motivation and turnover will also be examined. Methods: This is a protocol for a qualitative systematic review of the factors that influence the motivation of individuals to participate in Voluntary First Response. A systematic search will be carried out on seven electronic databases. Qualitative studies, mixed-methods studies, and any other studies producing data relating to the review question will be eligible for inclusion. Title and abstract screening, as well as full text screening, will be completed independently by two authors. A narrative synthesis, which is an established qualitative synthesis methodology, will be performed. The quality of each of the included studies will be critically appraised. Discussion: The findings of this review will be used to optimise the intervention of Voluntary First Response. Specifically, the results will inform the design and organisation of Voluntary First Response schemes, including their recruitment, training, and psychological support processes. This could benefit a range of stakeholders, including CFRs, paramedics, emergency physicians, patients, and the public.
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Heffernan, Eithne, Iris Oving, Tomás Barry, Viet-Hai Phung, Aloysius Niroshan Siriwardena, and Siobhán Masterson. "Factors that motivate individuals to volunteer to be dispatched as first responders in the event of a medical emergency: A systematic review protocol." HRB Open Research 2 (September 14, 2020): 34. http://dx.doi.org/10.12688/hrbopenres.12969.2.
Full textAbstract:
Background: Voluntary First Response is an important component of prehospital care for medical emergencies, particularly cardiac arrest, in many countries. This intervention entails the mobilisation of volunteers, known as Community First Responders (CFRs), by the Emergency Medical Services to respond to medical emergencies in their locality. They include lay responders and/or professional responders (e.g. police officers, fire fighters, and general practitioners). A wide variety of factors are thought to motivate CFRs to join and remain engaged in Voluntary First Response schemes, such as the availability of learning opportunities, recognition, counselling, and leadership. The aim of this review is to develop an in-depth understanding of CFR motivation, including the factors that influence the initial decision to volunteer as a CFR and the factors that sustain involvement in Voluntary First Response over time. Any factors relevant to CFR de-motivation and turnover will also be examined. Methods: This is a protocol for a qualitative systematic review of the factors that influence the motivation of individuals to participate in Voluntary First Response. A systematic search will be carried out on seven electronic databases. Qualitative studies, mixed-methods studies, and any other studies producing data relating to the review question will be eligible for inclusion. Title and abstract screening, as well as full text screening, will be completed independently by two authors. A narrative synthesis, which is an established qualitative synthesis methodology, will be performed. The quality of each of the included studies will be critically appraised. Discussion: The findings of this review will be used to optimise the intervention of Voluntary First Response. Specifically, the results will inform the design and organisation of Voluntary First Response schemes, including their recruitment, training, and psychological support processes. This could benefit a range of stakeholders, including CFRs, paramedics, emergency physicians, patients, and the public.
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Tasleem, Huma, and Haider Ghazanfar. "Trial of labor after previous cesarean delivery (TOLAC) and association of BMI and previous vaginal delivery with frequency of VBAC." Bangladesh Journal of Medical Science 15, no. 4 (December 18, 2016): 546–50. http://dx.doi.org/10.3329/bjms.v15i4.21687.
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Objectives: To determine the frequency of successful Vaginal Birth after One Cesarean Section in our tertiary care institution and to determine the causes of its failure.Material and Methods: This study was conducted in department of Obstetrics and Gynecology of Shifa International Hospital and Shifa Foundation Community Health Centre Islamabad Pakistan from Feb 2011 to Dec 2014. This study included 592 patients who presented in labor room emergency reception of Obs/Gynae department at term with previous one scar having fulfilled the laid down inclusion criteria for VBAC during ante-natal care. The patients were admitted in hospital and were allowed to proceed for spontaneous labor under vigilant monitoring on complications of trial of scar. Immediate emergency cesarean sections were performed, where indicated.Results: Out of 592 patients 70.7% were delivered vaginally after previous one cesarean section and 29.3% had emergency cesarean section. Leading indications for repeat cesarean section was fetal distress, failure to progress and scar tenderness. No maternal and fetal complication occurred in our study. The success rate of Trial of labor after one previous cesarean delivery was lower in obese (64.38%) as compared to non-obese women (82.06%) (p<0.001). Women with previous successful vaginal delivery had a success rate of 88.2% compared with 62.25% in women without such a history (OR 4.4; 95% CI 2.7-7.2 p <0.001).Conclusion: Vaginal birth after one lower segment cesarean section should be encouraged with vigilant monitoring provided no obstetric contra-indication to vaginal birth exists.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.546-550
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Fouogue, Jovanny Tsuala, Gerard Tama Fetse, Bruno Kenfack, Jeanne Hortence Fouedjio, Florent Ymele Foueifack, and Jean Dupont Ngowa Kemfang. "A freaky motorbike accident causing vulvar hematoma: a case report at the Bafoussam Regional Hospital, West-Cameroon." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 3 (February 27, 2020): 1321. http://dx.doi.org/10.18203/2320-1770.ijrcog20200927.
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Non-obstetric vulvar hematomas are rare and have never been reported in West Cameroon. No guidelines are available to inform the management of cases. Authors herein report the successful management of a post-traumatic vulvar hematoma in a 17 years old gravida 1 para 1001 patient. She was referred to our emergency department ten hours after a fall in a squatting position during a road traffic accident. Prior to the referral she had been managed conservatively by analgesics and a compressive dressing of the vulva in a community clinic. Clinical assessment on admission revealed a good general condition, normal vital signs and a tense and painful hematoma of the right labia. Surgery was done under general anesthesia to drain the hematoma, ligate the bleeding vessels and repair the vulva. Post-operative course was uneventful and the patient was discharge six days later. This case reminds practitioners in remote health facilities that early referral of this rare pathology contributes to its successful surgical management in our semi-urban region.
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Turner, H., G. Bennett, and S. Hurst. "60 Front Door Specialist Frailty MDT Working at MFT NHS Trust—The Therapy Team Poster Presentation." Age and Ageing 50, Supplement_1 (March 2021): i12—i42. http://dx.doi.org/10.1093/ageing/afab030.21.
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Abstract Introduction The therapy team consists of physiotherapists, Occupational therapists and therapy technicians working generically to deliver a comprehensive therapy assessment to patients presenting in our Emergency Department, Clinical Decisions Unit and Medical Admissions Unit between the hours of 08:00–18:00 7 days a week. The therapists provide the hospitals frailty service in ED and MAU with early therapy assessment and intervention, supporting the provision of a Comprehensive Geriatric Assessment. The aims of our service are to provide early therapy assessment of our most vulnerable patients to avoid unnecessary hospital admissions and reduce readmission rates, and for those requiring hospital care to provide early mobilisation and discharge planning to reduce length of stay and complications associated with hospital admission. We provide the therapy component of the CGA as part of the specialist frailty MDT service and act as an interface with local community health and social services. Method A full review of our frailty MDT service was undertaken and a re-allocation of our resources and staff was piloted in July 2019. During this pilot our therapy staff presence was re-distributed allowing greater patient numbers to be assessed promptly on their arrival to ED. This adjustment supported the Frailty MDT actions of: Results Data collection showed total referrals to therapy increased from 67 (June 2019) to 160 (July 2019). In July same day discharges were at 43%; discharges ≥72 hours 24%; 7 day readmission at 9%; 28 day readmissions at 11% and 38% were referred to community services. Conclusion These changes enabled us to provide a full MDT frailty service to frail older people presenting at our ED in a timely manner and to a larger number of suitable patients.
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Chien, Bonnie Y., Khumukcham I. Singh, Laksmi S. Hashimoto-Govindasamy, Meena N. Cherian, Manish Mehrotra, Paul P. Francis, and Natela Menabde. "Emergency and Essential Surgical Care Capacity across Primary, Secondary, and Tertiary Institutions in Meghalaya, India: A Cross-sectional Study." International Journal of Research Foundation of Hospital and Healthcare Administration 4, no. 1 (2016): 35–44. http://dx.doi.org/10.5005/jp-journals-10035-1058.
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ABSTRACT Aim This study aims to evaluate surgical care systems across tertiary, secondary, and primary health institutions in the state of Meghalaya, India. Materials and methods The government of Meghalaya conducted the first comprehensive assessment of surgical capacity at three levels of care: Tertiary hospitals, community health centers (CHCs), and primary health centers (PHCs). This cross-sectional survey utilized World Health Organization (WHO) tool for situational analysis to assess emergency and essential surgical care (EESC) to capture health facilities’ capacity to perform life-saving and disabilitypreventing surgical interventions, such as resuscitation, surgical, trauma, obstetric, and anesthetic care. Data were collected across four categories Infrastructure, human resources, surgical procedures, and equipment. Results The 55 facilities surveyed comprised 8 tertiary hospitals, 26 CHCs, and 21 PHCs. A total of 107,962 surgical presentations were reported across all facilities per year, with the greatest number presenting to PHC. No specialist doctors worked at PHC level; there were 1 anesthesiologist and 2 obstetricians at the CHC level. All of the PHCs or CHCs referred do not provide key emergency and essential surgical procedures, including resuscitation, cesarean section, general anesthesia, laparotomy, and closed and open treatment of fractures. At the tertiary level, only 50% provide cesarean section and laparotomy procedures. Conclusion The results of this WHO state survey demonstrate significant gaps, notably in resuscitation, at all lower level health facilities and the absence of obstetric procedures at some tertiary hospitals, in essential and emergency surgical capacity, including human resources, equipment, and infrastructure, across all levels of health institutions in Meghalaya. Clinical significance This study is an effort to identify the strengths and limitations of surgical capacity in the state of Meghalaya. The method of the study are simple and results can be extrapolated to other states of the country or any third world state which can translate into enhancement and redirection of resources for an optimum outcome. Strengths of the study • This study is driven by the motivation of the government of Meghalaya to address the issue of surgical care capacity. • The study identifies concrete areas of need in surgical care capacity in a collaborative effort with the government of Meghalaya. • Given the wealth of information on different levels of care centers provided by the government, specific recommendations for improvement can be made. Limitations of the study • Although detailed, the situation analysis survey tool is not fully comprehensive and cannot be used exclusively for program planning. • Not all care centers were able to be surveyed; thus, the results may be representative of only those surveyed. How to cite this article Chien BY, Singh KI, Hashimoto- Govindasamy LS, Cherian MN, Mehrotra M, Francis PP, Menabde N. Emergency and Essential Surgical Care Capacity across Primary, Secondary, and Tertiary Institutions in Meghalaya, India: A Cross-sectional Study. Int J Res Foundation Hospc Health Adm 2016;4(1):35-44.
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Roy, N., K. Nahar, UK Sarker, A. Beg, S. Dhar, J. Roy, and R. Chakrabarty. "A Clinical Study on socio-demographic background in Ruptured Uterus Cases." Community Based Medical Journal 2, no. 2 (October 28, 2013): 9–14. http://dx.doi.org/10.3329/cbmj.v2i2.16692.
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A study of 72 cases of uterine rupture out of total 5984 deliveries(including 3619 caesarean sections) over 1 year (from Sep. 2006 to Aug 2007) in the dept. of Obstetrics and Gynaecology, Mymensingh Medical College Hospital was reported. This gives an incidence of uterine rupture 1: 83. The results showed that, this was a common obstetric emergency & was a major cause of maternal & foetal deaths. Study showed that, 87.5% came from rural areas where facility was not available, 79% were of poor socio-economic condition .All rupture uterus cases (100%)was house wife. Peak age was between 20-30 years (68%). Among all rupture cases, 72.22% cases were between gravida 2nd to 4th,and 19.44% cases were gravida 5th or above & only 8.33% cases were Primigravida, Most of the patients(56%) were illiterate. 46% of cases had no antenatal checkup during their pregnancies. 51.38% cases labour pain lasting>16 hours. Most of the mishandled cases (66.67%) were exposed to injudicious use of uterotonic drugs before admission. Most of the cases (38.9%) handled by untrained birth attendants. DOI: http://dx.doi.org/10.3329/cbmj.v2i2.16692 Community Based Medical Journal 2013 July: Vol.02 No 02: 9-14