• "If we miss this chance, it's futile later on" - late antenatal booking and its determinants in Bhutan: a mixed-methods study.

      Dorji, T; Das, M; Van den Bergh, R; Oo, MM; Gyamtsho, S; Tenzin, K; Tshomo, T; Ugen, S (BioMed Central, 2019-05-07)
      BACKGROUND: To achieve the Sustainable Development Goal related to maternal and neonatal outcomes, the World Health Organization advocates for a first antenatal care (ANC) contact before 12 weeks of gestation. In order to guide interventions to achieve early ANC in the lower middle-income setting of Bhutan, we conducted an assessment of the magnitude and determinants of late ANC in this context. METHODS: This was a mixed-methods study with quantitative (cross-sectional study) and qualitative (in-depth interviews with pregnant women and ANC providers) component in a concurrent triangulation design. The quantitative component retrospectively analysed the socio-demographic and clinical characteristics, and the gestational age at booking of women who were provided care for delivery or miscarriages at the three tertiary hospitals in Bhutan from May-August 2018. The qualitative component involved thematic analysis of in-depth interviews with ten women attending ANC visits and four healthcare workers involved in ANC provision. RESULTS: Among 868 women studied, 67% (n = 584) had a late booking (after 12 weeks), and 1% (n = 13) had no booking. Women with only primary education and those residing in rural areas were more likely to have a late first ANC booking. While many women achieved the recommended eight ANC visits, this did not necessarily reflect early booking. Late booking was common among multigravida women. The interviews illustrated a general understanding and recognition of the importance of early ANC. Support from peers, family and co-workers, and male participation in accessing ANC were seen as enablers. The outreach clinics (ORCs) at the primary healthcare level were an important means of reaching the ANC services to women in rural areas where geographical accessibility was a barrier. Specific barriers to early ANC were gender insensitivity in providing care through male health workers, cost/time in ANC visits, and the inability to produce the documents of the father for booking ANC. CONCLUSION: Late ANC booking was common in Bhutan, and appeared to be associated with educational, geographic, socio-cultural and administrative characteristics. A comprehensive information package on ANC needs to be developed for pregnant mothers, and the quality of ANC coverage needs to be measured in terms of early ANC booking.
    • Improving Men's Participation in Preventing Mother-to-Child Transmission of HIV as a Maternal, Neonatal, and Child Health Priority in South Africa

      van den Berg, W; Brittain, K; Mercer, G; Peacock, D; Stinson, K; Janson, H; Dubula, V (Public Library of Science, 2015-04-07)
      Wessel van den Berg and colleagues outline how increasing male partner involvement in efforts to reduce mother-to-child HIV transmission in South Africa may improve maternal and infant outcomes.
    • Indirect causes of maternal death

      Schulte-Hillen, C; Cabrol, J-C (Elsevier, 2014-10)
    • Keeping it simple: a gender-specific sanitation tool for emergencies

      de Lange, R; Lenglet, A; Francois Fesselet, J; Gartley, M; Altyev, A; Fisher, J; Shanks, L (Practical Action Publishing, 2014-01)
    • Knowledge Translation in Africa for 21(st) Century Integrative Biology: The "Know-Do Gap" in Family Planning with Contraceptive Use among Somali Women

      Ahmed, A A; Mohamed, A A; Guled, I A; Elamin, H M; Abou-Zeid, A H (Mary Ann Liebert, Inc., 2014-10-21)
      Abstract An emerging dimension of 21(st) century integrative biology is knowledge translation in global health. The maternal mortality rate in Somalia is amongst the highest in the world. We set out to study the "know-do" gap in family planning measures in Somalia, with a view to inform future interventions for knowledge integration between theory and practice. We interviewed 360 Somali females of reproductive age and compared university-educated females to women with less or no education, using structured interviews, with a validated questionnaire. The mean age of marriage was 18 years, with 4.5 pregnancies per marriage. The mean for the desired family size was 9.3 and 10.5 children for the university-educated group and the less-educated group, respectively. Importantly, nearly 90% of the university-educated group knew about family planning, compared to 45.6% of the less-educated group. All of the less-educated group indicated that they would never use contraceptives, as compared to 43.5% of the university-educated group. Prevalence of contraceptive use among ever-married women was 4.3%. In the less-educated group, 80.6% indicated that they would not recommend contraceptives to other women as compared to 66.0% of the university-educated group. There is a huge gap between knowledge and practice regarding family planning in Somalia. The attendant reasons for this gap, such as level of education, expressed personal religious beliefs and others, are examined here. For primary health care to gain traction in Africa, we need to address the existing "know-do" gaps that are endemic and adversely impacting on global health. This is the first independent research study examining the knowledge gaps for family planning in Somalia in the last 20 years, with a view to understanding knowledge integration in a global world. The results shall guide policy makers, donors, and implementers to develop a sound family planning policy and program to improve maternal and child health in 21(st) century primary healthcare.
    • Knowledge transmission, peer support, behaviour change and satisfaction in post Natal clubs in Khayelitsha, South Africa: a qualitative study

      Duvivier, H; Decroo, T; Nelson, A; Cassidy, T; Mbakaz, Z; Duran, LT; de Azevedo, V; Solomon, S; Venables, E (BMC, 2020-07-08)
      Background The Post Natal Club (PNC) model assures comprehensive care, including HIV and Maternal and Child Health care, for postpartum women living with HIV and their infants during an 18-month postnatal period. The PNC model was launched in 2016 in Town Two Clinic, a primary health care facility in Khayelitsha, South Africa. This qualitative research study aims to understand how participation in PNCs affected knowledge transmission, peer support, behaviour change and satisfaction with the care provided. Methods We conducted ten in-depth interviews; three focus group discussions and participant observation with PNC members, health-care workers and key informants selected through purposive sampling. Seventeen PNC members between 21 and 38 years old, three key informants and seven staff working in PNC participated in the research. All participants were female, except for one of the three key informants who was male. Data was collected until saturation. The data analysis was performed in an inductive way and involved an iterative process, using Nvivo11 software. Results PNC members acquired knowledge on HIV, ART, adherence, infant feeding, healthy eating habits, follow up tests and treatment for exposed infants. Participants believed that PNC created strong relationships among members and offered an environment conducive to sharing experience and advice. Most interviewees stated that participating in PNC facilitated disclosure of their HIV status, enhanced support network and provided role models. PNC members said that they adapted their behaviour based on advice received in PNCs related to infant feeding, ART adherence, monitoring of symptoms and stimulation of early childhood development. The main benefits were believed to be comprehensive care for mother-infant pairs, time-saving and the peer dynamic. The main challenge from the perspective of key informants was the sustainability of dedicating human resources to PNC. Conclusion The PNC model was believed to improve knowledge acquisition, behaviour change and peer support. Participants, staff and the majority of key informants expressed a high level of satisfaction with the PNC model. Sustainability and finding adequate human resources for PNCs remained challenging. Strategies to improve sustainability may include handing over some PNC tasks to members to increase their sense of ownership.
    • Lassa fever in pregnancy with a positive maternal and fetal outcome: A case report.

      Agboeze, J; Nwali, MI; Nwakpakpa, E; Ogah, OE; Onoh, R; Eze, J; Ukaegbe, C; Ajayi, N; Nnadozie, UU; Orji, ML; et al. (Elsevier, 2019-08-26)
      BACKGROUND: The signs and symptoms of Lassa fever are initially indistinguishable from other febrile illnesses common in the tropics and complications of pregnancy. Surviving Lassa fever during pregnancy is rare. Only few cases have been documented. The antiviral drug of choice is ribavirin. CASE DESCRIPTION: A 25-year-old multigravida farmer with fever who was initially thought to have malaria in pregnancy at 29 weeks gestation. Further changes in her clinical state and laboratory tests led to a confirmation of Lassa fever. The Liver enzymes were markedly deranged and the packed cell volume was 27%. She commenced on ribavirin and subsequently was delivered of a live male neonate who was RT PCR negative for Lassa fever virus. Her clinical state improved, repeat RT PCR on day 15 was negative and she made full recovery. DISCUSSION: The case reported had similar clinical features of fever and abdominal pain and resulted in the initial diagnoses of Malaria in pregnancy. When she failed to respond to antimalarial and antibiotics treatments, a strong suspicion of viral hemorrhagic fever was made. At this time the patient was in advanced stage of the disease with bleeding from vagina and puncture sites. On the third day of admission she was delivered of a live male neonate who remained negative after 2 consecutive RT PCR tests for Lassa fever virus. Lassa fever carries a high risk of death to the fetus throughout pregnancy and to the mother in the third trimester. Mothers with Lassa fever improved rapidly after evacuation of the uterus by spontaneous abortion, or normal delivery. She was clinically stable following delivery. Her laboratory investigations were essentially normal. Throughout her management transmission based precautions were observed. None of the six close contacts developed symptoms after been followed up for 21 days. CONCLUSION: This report adds to the body of literature that individuals can survive Lassa fever during pregnancy with good maternal and fetal outcome.
    • A Live Term Intra-Abdominal Pregnancy in a Field Hospital: a Case Report

      Abdelrahman, S; Deeter, M; Muthusami, A; Peterson, TG; Wackenier, L (Oxford University Press, 2017-03-22)
      Abdominal pregnancy is a rare form of ectopic pregnancy with high morbidity and mortality for both the mother and the fetus. Diagnosis can be challenging, especially in a resource-limited setting. We report a case of abdominal pregnancy that presented to Médecins Sans Frontières field hospital in Agok, South Sudan, with abdominal pain. Examination revealed a term pregnancy and a live fetus in transverse lie. The diagnosis of abdominal pregnancy was made intraoperatively, with successful management and delivery of a healthy baby.
    • Local health workers' perceptions of Substandard Care in the Management of Obstetric Hemorrhage in rural Malawi

      Beltman, J J; van den Akker, T; Bwirire, D; Korevaar, A; Chidakwani, R; van Lonkhuijzen, L; van Roosmalen, J; Thyolo District Health Office, Ministry of Health, Thyolo, Malawi. j.j.beltman@lumc.nl. (2013-02-15)
      ABSTRACT:
    • Management of pregnant women infected with Ebola virus in a treatment centre in Guinea, June 2014

      Baggi, F M; Taybi, A; Kurth, A; Van Herp, M; Di Caro, A; Wolfel, R; Gunther, S; Decroo, T; Declerck, H; Jonckheere, S (European Centre for Disease Prevention and Control, 2014-12-11)
    • Maternal health after Ebola: unmet needs and barriers to healthcare in rural Sierra Leone

      Elston, JWT; Danis, K; Gray, N; West, K; Lokuge, K; Black, B; Stringer, B; Jimmisa, AS; Biankoe, A; Sanko, MO; et al. (Oxford University Press, 2019-11-07)
      Sierra Leone has the world’s highest estimated maternal mortality. Following the 2014–16 Ebola outbreak, we described health outcomes and health-seeking behaviour amongst pregnant women to inform health policy. In October 2016–January 2017, we conducted a sequential mixed-methods study in urban and rural areas of Tonkolili District comprising: household survey targeting women who had given birth since onset of the Ebola outbreak; structured interviews at rural sites investigating maternal deaths and reporting; and in-depth interviews (IDIs) targeting mothers, community leaders and health workers. We selected 30 clusters in each area: by random GPS points (urban) and by random village selection stratified by population size (rural). We collected data on health-seeking behaviours, barriers to healthcare, childbirth and outcomes using structured questionnaires. IDIs exploring topics identified through the survey were conducted with a purposive sample and analysed thematically. We surveyed 608 women and conducted 29 structured and 72 IDIs. Barriers, including costs of healthcare and physical inaccessibility of healthcare facilities, delayed or prevented 90% [95% confidence interval (CI): 80–95] (rural) vs 59% (95% CI: 48–68) (urban) pregnant women from receiving healthcare. Despite a general preference for biomedical care, 48% of rural and 31% of urban women gave birth outside of a health facility; of those, just 4% and 34%, respectively received skilled assistance. Women expressed mistrust of healthcare workers (HCWs) primarily due to payment demanded for ‘free’ healthcare. HCWs described lack of pay and poor conditions precluding provision of quality care. Twenty percent of women reported labour complications. Twenty-eight percent of villages had materials to record maternal deaths. Pregnant women faced important barriers to care, particularly in rural areas, leading to high preventable mortality and morbidity. Women wanted to access healthcare, but services available were often costly, unreachable and poor quality. We recommend urgent interventions, including health promotion, free healthcare access and strengthening rural services to address barriers to maternal healthcare.
    • Obstetric Fistula in Burundi: a comprehensive approach to managing women with this neglected disease

      Tayler-Smith, K; Zachariah, R; Manzi, M; van den Boogaard, W; Vandeborne, A; Bishinga, A; De Plecker, E; Lambert, V; Christiaens, B; Sinabajije, G; et al. (BioMed Central Ltd, 2013-08-21)
      In Burundi, the annual incidence of obstetric fistula is estimated to be 0.2-0.5% of all deliveries, with 1000--2000 new cases per year. Despite this relatively high incidence, national capacity for identifying and managing obstetric fistula is very limited. Thus, in July 2010, Medecins Sans Frontieres (MSF) set up a specialised Obstetric Fistula Centre in Gitega (Gitega Fistula Centre, GFC), the only permanent referral centre for obstetric fistula in Burundi. A comprehensive model of care is offered including psychosocial support, conservative and surgical management, post-operative care and follow-up. We describe this model of care, patient outcomes and the operational challenges.
    • An obstetrician reborn

      Garry, R; Médecins Sans Frontières, Sydney, NSW, Australia. raygarry@btinternet.com (2013-07)
    • One Size Fits All? Standardised Provision of Care for Survivors of Sexual Violence in Conflict and Post-Conflict Areas in the Democratic Republic of Congo

      Loko Roka, J; Van den Bergh, R; Au, S; De Plecker, E; Zachariah, R; Manzi, M; Lambert, V; Abi-Aad, E; Nanan-N'Zeth, K; Nzuya, S; et al. (Public Library of Science, 2014-10-20)
      Outcomes of sexual violence care programmes may vary according to the profile of survivors, type of violence suffered, and local context. Analysis of existing sexual violence care services could lead to their better adaptation to the local contexts. We therefore set out to compare the Médecins Sans Frontières sexual violence programmes in the Democratic Republic of Congo (DRC) in a zone of conflict (Masisi, North Kivu) and post-conflict (Niangara, Haut-Uélé).
    • Perinatal outcomes of babies delivered by second-stage Caesarean section versus vacuum extraction in a resource-poor setting, Nigeria - a retrospective analysis

      Eze, P; Lawani, LO; Chikezie, RU; Ukaegbe, CI; Iyoke, CA (BMC, 2020-05-14)
      Background To evaluate the perinatal status of neonates delivered by assisted vaginal delivery (AVD) versus second-stage caesarean birth (CS). Methods A 5-year retrospective study was conducted in a tertiary hospital. Data was analyzed with IBM SPSS® version 25.0 statistical software using descriptive/inferential statistics. Results A total of 559 births met the inclusion criteria; AVD (211; 37.7%) and second-stage CS (348; 62.3%). Over 80% of the women were aged 20–34 years: 185 (87.7%) for the AVD group, and 301 (86.5%) for the second-stage CS group. More than half of the women were parous: 106 (50.2%) for the AVD group, and 184 (52.9%) for the second-stage CS group. The commonest indication for intervention in both groups is delayed second stage: 178 (84.4%) in the AVD group, and 239 (68.9%) in the second-stage CS group. There was a statistically significant difference in decision to delivery interval (DDI) between both groups: 197 (93.4%) women in the AVD group had DDI of less than 30 min and 21 women (6.0%) in the CS group had a DDI of less than 30 min (p <  0.001). During the DDI, there were 3 (1.4%) intra-uterine foetal deaths (IUFD) in the AVD and 19 (5.5%) in the CS group (p = 0.023). After adjusting for co-variates, there were statistically significant differences between the AVD and CS groups in the foetal death during DDI (p = 0.029) and perinatal deaths (p = 0.040); but no statistically significant differences in severe perinatal outcomes (p = 0.811), APGAR scores at 5th minutes (p = 0.355), and admission into the NICU (p = 0.946). After adjusting for co-variates, use of AVD was significantly associated with the level of experience of the care provider, with resident (junior) doctors less likely to opt for AVD than CS (aOR = 0.45, 95% CI: 0.29–0.70). Conclusion Second-stage CS when compared with AVD was not associated with improved perinatal outcomes. AVD is a practical option for reducing the rising Caesarean delivery rates without compromising the clinical status of the newborn.
    • Peripartum infections and associated maternal mortality in rural Malawi

      van den Akker, T; de Vroome, S; Mwagomba, B; Ford, N; van Roosmalen, J; Thyolo District Health Office, Ministry of Health, Thyolo, Malawi; Medecins Sans Frontieres Operational Center Brussels, Brussels, Belgium; The Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; The Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands; Center for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa (Lippincott Williams & Wilkins, 2011-08)
      To assess associations between maternal mortality and severe morbidity and human immunodeficiency virus (HIV) infection, uptake of antiretroviral therapy, obstetric infections, and nonobstetric infections in a rural Malawian district, where the estimated HIV prevalence is 21%.
    • Pregnant Women in War Zones

      Akol, AD; Caluwaerts, S; Weeks, AD (BMJ Publishing Group We regret that this article is behind a paywall., 2016-04-20)
    • Prevalence and correlates of low serum calcium in late pregnancy: A cross sectional study in the Nkongsamba Regional Hospital; Littoral Region of Cameroon

      Ajong, AB; Kenfack, B; Ali, IM; Yakum, MN; Telefo, PB (Public Library of Science, 2019-11-07)
      Introduction Women from low and middle income countries are generally more likely to have sub-optimal calcium intake. The objective of this study was to assess serum calcium disorders and correlates in late pregnancy. Methods We conducted from December 2018 to April 2019, a cross-sectional hospital-based study targeting pregnant women in late pregnancy in the Nkongsamba Regional Hospital. Data were collected by measurement of parameters (weight, height, blood pressure and foetal birthweight), administration of a semi-structured questionnaire and analysis of blood samples collected from each participant. Absorption spectrophotometry was used to measure serum calcium and albumin concentrations and corrected serum calcium calculated from the Payne’s equation. With a statistical significant threshold set at p-value = 0.05, the odds ratio was used as a measure of the strength of association between hypocalcaemia and maternofoetal variables. Results We enrolled a total of 354 consenting participants with a mean age of 27.41±5.84 years. The prevalence of hypocalcaemia in late pregnancy was 58.76 [53.42–63.90]%. The rate of calcium supplementation in pregnancy was 57.63[52.28–62.80]% with a mean duration of supplementation of 3.69±1.47 months. When controlled for marital status, age, level of education, and gestational age at delivery, pregnant women with systolic blood pressures below 130 mmHg were significantly less likely to have hypocalcaemia than their counterparts with higher systolic blood pressures (Adjusted Odds Ratio = 0.41[0.18–0.89], p-value = 0.020). No statistically significant associations were found between diastolic blood pressure, body mass index, foetal birth weight and hypocalcaemia. Conclusion Hypocalcaemia in late pregnancy is highly prevalent (59%) among women accessing reproductive services at the Nkongsamba Regional Hospital. There is also a wide gap in calcium supplementation compared to World Health Organization recommendations. Hypocalcaemia is significantly associated to higher systolic blood pressure in pregnancy. Systematic calcium supplementation and consumption of high calcium containing locally available meals should be encouraged.
    • Prevalence of anaemia, syphilis and hepatitis B in pregnant women in Nausori, Fiji

      Tuinakelo, L R; Tayler-Smith, K; Khogali, M; Marks, G B (Public Health Action, 2013-03)