• "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.
    • 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)
    • 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).
    • 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 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)
    • The prevention of mother-to-child HIV transmission programme and infant feeding practices.

      Hilderbrand, K; Goemaere, E; Coetzee, D; Infectious Diseases and HIV/AIDS Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town. (2003-10)
      Since the first cases of HIV transmission through breast-feeding were documented, a fierce debate has raged on appropriate guidelines for infant feeding in resource-poor settings. A major problem is determining when it is safe and feasible to formula-feed, as breast-milk protects against other diseases. A cross-sectional survey of 113 women attending the programme for the prevention of mother-to-child transmission in Khayelitsha, Cape Town, was conducted. Over 95% of women on the programme formula-fed their infants and did not breast-feed at all. Seventy per cent of women said that their infant had never had diarrhoea, and only 3% of children had had two episodes of diarrhoea. Focus groups identified the main reasons for not breast-feeding given by women to their families and those around them. Formula feeding is safe and feasible in an urban environment where sufficient potable water is available.
    • Provision of emergency obstetric care at secondary level in a conflict setting in a rural area of Afghanistan - is the hospital fulfilling its role?

      Lagrou, D; Zachariah, R; Bissell, K; Van Overloop, C; Nasim, M; Wagma, HN; Kakar, S; Caluwaerts, S; De Plecker, E; Fricke, R; et al. (BioMed Central, 2018-01-22)
      Provision of Emergency Obstetric and Neonatal Care (EmONC) reduces maternal mortality and should include three components: Basic Emergency Obstetric and Neonatal Care (BEmONC) offered at primary care level, Comprehensive EmONC (CEmONC) at secondary level and a good referral system in-between. In a conflict-affected province of Afghanistan (Khost), we assessed the performance of an Médecins Sans Frontières (MSF) run CEmONC hospital without a primary care and referral system. Performance was assessed in terms of hospital utilisation for obstetric emergencies and quality of obstetric care.
    • Removal of user fees and system strengthening improves access to maternity care, maternal and neonatal mortality in a district hospital in Lesotho

      Steele, SJ; Sugianto, H; Baglione, Q; Sedlimaier, S; Niyibizi, AA; Duncan, K; Hill, J; Brix, J; Philips, M; Van Cutsem, G; et al. (Blackwell Publishing Ltd, 2018-10-26)
      Lesotho has one of the highest maternal mortality rates in the world. While at primary health care (PHC) level maternity care is free, at hospital level co-payments are required from patients. We describe service utilisation and delivery outcomes before and after removal of user fees and quality of delivery care, and associated costs, at St Joseph's Hospital (SJH) in Roma, Lesotho.
    • Reproductive health in humanitarian settings in Lebanon and Iraq: results from four cross-sectional studies, 2014-2015.

      Balinska, MA; Nesbitt, R; Ghantous, Z; Ciglenecki, I; Staderini, N (BMC, 2019-06-10)
      BACKGROUND: Reproductive health is an important component of humanitarian response. Displaced women need access to family planning, antenatal care, and the presence of a skilled birth attendant at delivery. Since the beginning of the Syrian conflict in 2011, Lebanon and Iraq have been hosting large numbers of refugees, thereby straining local capacities to provide these services. In order to identify salient health needs, Médecins Sans Frontières conducted a survey in several sites hosting refugees and internally displaced persons across the region. Here we describe the reproductive health profile of Syrian refugees, Iraqi displaced persons, and vulnerable Lebanese and their use of services. METHODS: We conducted four cross-sectional surveys in 2014-2015 in two sites in Lebanon and two sites in Iraq. Depending on the site, two-stage cluster sampling or systematic sampling was intended, but non-probability methods were employed at the second stage due to implementation challenges. We collected information on overall health (including reproductive health) and demographic information from heads of households on the basis of a standardized questionnaire. Pearson chi-square tests were used to compare proportions, and generalized linear models were used to calculate odds ratios with regard to risk factors. All analyses were performed using the survey suite of commands in Stata version 14.1. RESULTS: A total of 23,604 individuals were surveyed, including 5925 women of childbearing age. Overall, it was reported that 7.5% of women were currently pregnant and 12.8% had given birth within the previous 12 months. It was reported that pregnancy was unplanned for 57% of currently pregnant women and 66.7% of women who had delivered in the previous year. A slight majority of women from both groups had accessed antenatal care at least once. Amongst women who had delivered in the previous year, 84.5% had done so with a skilled birth attendant and 22.1% had had a cesarean section. Location and head of household education were predictors of unplanned pregnancy in multivariable analysis. Head of household education was also significantly associated with higher uptake of antenatal care. CONCLUSIONS: Considering the large number of pregnant women and women having recently delivered in these settings, addressing their sexual and reproductive health needs emerges as a crucial aspect of humanitarian response. This study identified unmet needs for family planning and high cesarean section rates at all sites, suggesting both lack of access to certain services (contraception, antenatal care), but also over-recourse to cesarean section. These specific challenges can impact directly on maternal and child health and need today to be kept high on the humanitarian agenda.
    • Responding to rape.

      Shanks, L; Ford, N; Schull, M; de Jong, K; Médecins Sans Frontières, Toronto, Canada. msfcan@msf.ca (Elsevier, 2001-01-27)