Maternal health, neonatology and perinatology最新文献

{"title":"What topics should we teach the parents of admitted neonates in the newborn care unit in the resource-limited setting - a Delphi study.","authors":"Jean Aime Musabyemungu, Alice Willson, Sean Batenhorst, James Webbe, Peter Thomas Cartledge","doi":"10.1186/s40748-019-0106-8","DOIUrl":"10.1186/s40748-019-0106-8","url":null,"abstract":"<p><strong>Background: </strong>In resource-limited settings, such as Rwanda, health care profession (HCP) to neonate ratios are low, and therefore caregivers play a significant role in providing care for their admitted neonates. To provide such Family Integrated Care, caregivers need knowledge, skills, and confidence. The objective of this study was to identify consensus from key stakeholders regarding the priority topics for a \"parental neonatal curriculum.\"</p><p><strong>Methods: </strong>A three-round Delphi-study was conducted. During Round-1, face-to-face interviews were undertaken and responses coded and categorized into themes. In Round-2, participants were presented with Round-1 feedback and asked to provide additional topics in respective themes. In Round-3, respondents were asked to rank the importance of these items using a 9-point Likert scale.</p><p><strong>Results: </strong>Ten, 36 and 40 stakeholders participated in Rounds-1, - 2 and - 3 respectively, including parents, midwives, nurses and physicians. Twenty and 37 education topics were identified in Rounds-1 and -2 respectively. In Round-3 47 of the 57 presented outcomes met pre-defined criteria for inclusion in the \"parental neonatal curriculum.\"</p><p><strong>Conclusion: </strong>We describe a \"parental neonatal curriculum,\" formed using robust consensus methods, describing the core topics required to educate parents of neonates admitted to a newborn care unit. The curriculum has been developed in Rwanda and is relevant to other resource-limited settings.</p>","PeriodicalId":74120,"journal":{"name":"Maternal health, neonatology and perinatology","volume":" ","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2019-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6621949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48143055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facility readiness in low and middle-income countries to address care of high risk/ small and sick newborns.","authors":"Indira Narayanan,&nbsp;Jesca Nsungwa-Sabiti,&nbsp;Setyadewi Lusyati,&nbsp;Rinawati Rohsiswatmo,&nbsp;Niranjan Thomas,&nbsp;Chinnathambi N Kamalarathnam,&nbsp;Jane Judith Wembabazi,&nbsp;Victoria Nakibuuka Kirabira,&nbsp;Peter Waiswa,&nbsp;Santorino Data,&nbsp;Darious Kajjo,&nbsp;Paul Mubiri,&nbsp;Emmanuel Ochola,&nbsp;Pradita Shrestha,&nbsp;Ha Young Choi,&nbsp;Jayashree Ramasethu","doi":"10.1186/s40748-019-0105-9","DOIUrl":"https://doi.org/10.1186/s40748-019-0105-9","url":null,"abstract":"<p><strong>Background: </strong>The successful promotion of facility births in low and middle-income countries has not always resulted in improved neonatal outcome. We evaluated key signal functions pertinent to Level II neonatal care to determine facility readiness to care for high risk/ small and sick newborns.</p><p><strong>Method: </strong>Facility readiness for care of high risk/ small and sick babies was determined through self-evaluation using a pre-designed checklist to determine key signal functions pertinent to Level II neonatal care in selected referral hospitals in Uganda (10), Indonesia (4) and India (2) with focus on the Sub-Saharan country with greater challenges.</p><p><strong>Results: </strong>Most facilities reported having continuous water supply, resources for hand hygiene and waste disposal. Delivery rooms had newborn corners for basic neonatal resuscitation, but few practiced proper reprocessing of resuscitation equipment. Birth weight records were not consistently maintained in the Ugandan hospitals. In facilities with records of birth weights, more than half (51.7%) of newborns admitted to the neonatal units weighed 2500 g or more. Neonatal mortality rates ranged from 1.5 to 22.5%. Evaluation of stillbirths and numbers of babies discharged against medical advice gave a more comprehensive idea of outcome. Kangaroo Mother Care was practiced to varying extents. Incubators were more common in Africa while radiant warmers were preferred in Indian hospitals. Tube feeding was practiced in all and cup feeding in most, with use of human milk at all sites. There were proportionately more certified pediatricians and nurses in Indonesia and India. There was considerable shortage of nursing staff, (worst nurse -bed ratio ranging from 1 to 15 in the day shift, and 1 to 30 at night). There was significant variability in facility readiness, as in data maintenance, availability of commodities such as linen, air -oxygen blenders and infusion pumps and of infection prevention practices.</p><p><strong>Conclusions: </strong>Referral neonatal units in LMIC have challenges in meeting even the basic level II requirements, with significant variability in equipment, staffing and selected care practices. Facility readiness has to improve in concert with increased facility births of high risk newborns in order to have an impact on neonatal outcome, and on achieving Sustainable Development Goals 3.2.2.</p>","PeriodicalId":74120,"journal":{"name":"Maternal health, neonatology and perinatology","volume":"5 ","pages":"10"},"PeriodicalIF":0.0,"publicationDate":"2019-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40748-019-0105-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37358798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infectious episodes during pregnancy, at particular mucosal sites, increase specific IgA1 or IgA2 subtype levels in human colostrum.","authors":"Erick Sánchez-Salguero,&nbsp;Geovanni Kaleb Mondragón-Ramírez,&nbsp;Julio C Alcántara-Montiel,&nbsp;Arturo Cérbulo-Vázquez,&nbsp;Xóchitl Villegas-Domínguez,&nbsp;Víctor Manuel Contreras-Vargas,&nbsp;María Del Rocío Thompson-Bonilla,&nbsp;Héctor Romero-Ramírez,&nbsp;Leopoldo Santos-Argumedo","doi":"10.1186/s40748-019-0104-x","DOIUrl":"https://doi.org/10.1186/s40748-019-0104-x","url":null,"abstract":"<p><strong>Background: </strong>Colostrum is the primary source of maternal immunoglobulin A (IgA) for the newborn. IgA participates in protection and regulation mechanisms of the immune response at the neonate's mucosa. Several studies have evaluated infectious diseases and vaccine protocols effects during pregnancy on maternal milk IgA levels, with the aim to understand lactation protecting effect on newborn. However, most of their results demonstrated that there were no differences in the total IgA levels. In humans, IgA has two subclasses (IgA1 and IgA2), they have an anatomical distribution among mucosal compartments, their levels vary after antigen stimulation and are also seen to describe differential affinities in colostrum. Although there are differences between IgA subclasses in several compartments, these studies have excluded specific colostrum IgA1 and IgA2 determination.</p><p><strong>Methods: </strong>We analyzed data from 900 women in Mexico City. With Pearson correlation, we compared the number of infectious episodes during their pregnancy that was associated with mucosal compartments (skin, respiratory and gastrointestinal tracts) and colostrum IgA subclasses.</p><p><strong>Results: </strong>We show a correlation between increased colostrum IgA1 levels and the number of infectious episodes at respiratory tract and the skin. In contrast, infections at the gastrointestinal tract correlated with increased IgA2 amounts.</p><p><strong>Conclusions: </strong><b>I</b>nfections present during pregnancy at certain mucosal site increase specific IgA subclasses levels in human colostrum. These results will help in understanding infections and immunizations effects on maternal IgA at the mammary gland, and their impact on the development and protection of the newborn.</p>","PeriodicalId":74120,"journal":{"name":"Maternal health, neonatology and perinatology","volume":"5 ","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2019-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40748-019-0104-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37340821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of early versus delayed cord clamping in neonate on heart rate, breathing and oxygen saturation during first 10 minutes of birth - randomized clinical trial.","authors":"Ashish Kc,&nbsp;Nalini Singhal,&nbsp;Jageshwor Gautam,&nbsp;Nisha Rana,&nbsp;Ola Andersson","doi":"10.1186/s40748-019-0103-y","DOIUrl":"https://doi.org/10.1186/s40748-019-0103-y","url":null,"abstract":"<p><strong>Background: </strong>Delayed cord clamping (DCC) after 180 s reduces iron deficiency up to 8 months of infancy compared to babies who received Early Cord Clamping (ECC) at less than 60 s. Experimentally DCC has shown to improve cardio-vascular stability. To evaluate the effect of delayed (≥180 s) group versus early (≤60 s) cord clamping group on peripheral blood oxygenation and heart rate up to 10 min after birth on term and late preterm infants.</p><p><strong>Methods: </strong>We conducted a single centred randomized clinical trial in a low risk delivery unit in tertiary Hospital, Nepal. One thousand five hundred ten women, low risk vaginal delivery with foetal heart rate (FHR) ≥ 100 ≤ 160 beats per minute (bpm) and gestational age (≥33 weeks) were enrolled in the study. Participants were randomly assigned to cord clamped ≤60 s of birth and ≥ 180 s. The main outcome measures were oxygen saturation, heart rate from birth to 10 min and time of spontaneous breathing. The oxygen saturation and heart rate, the time of first breath and establishment of regular breathing was analysed using Student t-test to compare groups. We analysed the range of heart rate distributed by different centiles from the time of birth at 30 s intervals until 10 min.</p><p><strong>Results: </strong>The oxygen saturation was 18% higher at 1 min, 13% higher at 5 min and 10% higher at 10 min in babies who had cord clamping in delayed group compared to early group (<i>p</i> < 0.001). The heart rate was 9 beats lower at 1 min and3 beats lower at 5 min in delayed group compared to early group (p < 0.001). Time of first breath and regular breathing was established earlier in babies who had cord clamping at 180 s or more.</p><p><strong>Conclusion: </strong>Spontaneously breathing babies subjected to DCC have higher oxygen saturation up to 10 min after birth compared to those who have undergone ECC. Spontaneously breathing babies with DCC have lower heart rates compared to ECC until 390 s. Spontaneously breathing babies receiving DCC have early establishment of breathing compared to ECC.</p><p><strong>Trial registration: </strong>ISRCTN, 5 April 2016.</p>","PeriodicalId":74120,"journal":{"name":"Maternal health, neonatology and perinatology","volume":"5 ","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2019-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40748-019-0103-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37300413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Premenstrual dysphoric disorder and associated factors among female health science students in Wollo University, Ethiopia, 2017/18.","authors":"Delelegn Tsegaye,&nbsp;Yemiamrew Getachew","doi":"10.1186/s40748-019-0102-z","DOIUrl":"https://doi.org/10.1186/s40748-019-0102-z","url":null,"abstract":"<p><strong>Background: </strong>Premenstrual dysphoric disorder (PMDD) is also called late luteal phase dysphoric disorder. The syndrome involves mood symptoms, behavior symptoms and physical symptoms. This pattern of symptoms occurs at a specific time during the menstrual cycle, and the symptoms resolve for some period of time between menstrual cycles. It is one of the most common problems in female students of higher education institution that impaired academic performance and professional and interpersonal relationships. The main objective f this study is to assess Premenstrual dysphoric disorder and associated factors among Female health science students in Wollo University, east Amhara, Ethiopia, 2016/17.</p><p><strong>Methods: </strong>The study was conducted from January 1-15, 2017 involving 254 regular health science students were involved from college of medicine & health science, Wollo University. Institution based cross sectional study design was used. Systematic random sampling technique was utilized. Data were collected through interviewer administered standardized and pretested questionnaires. The collected data were presented in tables, graph & chart. Association between dependent and independent variable were tested using logistic regression model of SPSS version 20. Variables that have <i>P</i>-value less than 0.25 at bivarate analysis were entered to multivariate analysis model. Finally those variables which had P-value of < 0.05 were considered as having statistically significant association with the dependent variables.</p><p><strong>Result: </strong>The prevalence of premenstrual dysphoric disorder in this study was 66.9%. Degree of dysmenorhea was found to have statistically significant association with premenstrual dysphoric disorder. Students who had mild grade of dysmenorhea were less likely to have PMDD as compared with those students who had severe dysmenorhea (AOR = 0.13 at 95%CI (0.03-0.58). About 139 (61.8%) of female student reported that frequent class missing and low grade were occurred due to menstrual disorder.</p><p><strong>Conclusion: </strong>The Prevalence of premenstrual dysphoric disorder was highest as compared to other similar studies done in other countries. The factor associated with premenstrual dyphoric disorder was grade of dysmenorhoea. In order to tackle this problem, collaborative efforts should be taken.</p>","PeriodicalId":74120,"journal":{"name":"Maternal health, neonatology and perinatology","volume":"5 ","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2019-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40748-019-0102-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37286777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-based design for neonatal units: a systematic review.","authors":"N O'Callaghan,&nbsp;A Dee,&nbsp;R K Philip","doi":"10.1186/s40748-019-0101-0","DOIUrl":"https://doi.org/10.1186/s40748-019-0101-0","url":null,"abstract":"<p><p>Evidence-based design (EBD) of hospitals could significantly improve patient safety and make patient, staff and family environments healthier. This systematic review aims to determine which neonatal intensive care unit design features lead to improved neonatal, parental and staff outcomes. Medline, CINAHL, Web of Science Citation Index and Cochrane Central Register of Controlled Trials Registry, were searched in January 2017. Using combinations of the relevant key words, review was performed following the recommended guidelines for reporting systematic reviews. English language limitation was applied and term limited to 2006-2016. Included studies were assigned a grade based upon their level of evidence and critically appraised using defined tools. Data were not synthesized for meta-analysis due to nature of literature reviewed and heterogeneity. Three thousand five hundred ninety-two titles were screened with 43 full-texts assessed for eligibility. Twenty nine studies were deemed eligible for inclusion. These included 19 cohort studies, two qualitative studies, seven cross-sectional studies, and one randomised control trial. Grey literature search from guidelines, and repositories yielded an additional 10 guidelines. <i>'Single family room'</i> (SFR) design for neonatal units is recommended. An optimally designed neonatal unit has many possible health implications, including improved breastfeeding, infection and noise control, reduced length of stay, hospitalisation rates and potentially improved neonatal morbidity and mortality. High quality, family centred care (FCC) in neonatology could be assisted through well grounded, future proofed and technology enabled design concepts that have the potential to impact upon early life development.</p>","PeriodicalId":74120,"journal":{"name":"Maternal health, neonatology and perinatology","volume":"5 ","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2019-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40748-019-0101-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37215847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transitional fetal hemodynamics and gas exchange in premature postpartum adaptation: immediate vs. delayed cord clamping.","authors":"Berk Yigit,&nbsp;Ece Tutsak,&nbsp;Canberk Yıldırım,&nbsp;David Hutchon,&nbsp;Kerem Pekkan","doi":"10.1186/s40748-019-0100-1","DOIUrl":"https://doi.org/10.1186/s40748-019-0100-1","url":null,"abstract":"<p><strong>Background: </strong>Recent studies suggest that delayed cord clamping (DCC) is advantageous for achieving hemodynamic stability and improving oxygenation compared to the immediate cord clamping (ICC) during fetal-to-neonatal transition yet there is no quantitative information on hemodynamics and respiration, particularly for pre-term babies and fetal disease states. Therefore, the objective of this study is to investigate the effects of ICC and DCC on hemodynamics and respiration of the newborn preterm infants in the presence of common vascular pathologies.</p><p><strong>Methods: </strong>A computational lumped parameter model (LPM) of the placental and respiratory system of a fetus is developed to predict blood pressure, flow rates and oxygen saturation. Cardiovascular system at different gestational ages (GA) are modeled using scaling relations governing fetal growth with the LPM. Intrauterine growth restriction (GR), patent ductus arteriosus (PDA) and respiratory distress syndrome (RDS) were modeled for a newborn at 30 weeks GA. We also formulated a \"severity index (<i>SI</i>)\" which is a weighted measure of ICC vs. DCC based on the functional parameters derived from our model and existing neonatal disease scoring systems.</p><p><strong>Results: </strong>Our results show that transitional hemodynamics is smoother in DCC compared to ICC for all GAs. Blood volume of the neonate increases by 10% for moderately preterm and term infants (32-40 wks) and by 15% for very and extremely preterm infants (22-30 wks) with DCC compared to ICC. DCC also improves the cardiac output and the arterial blood pressure by 17% in term (36-40 wks), by 18% in moderately preterm (32-36 wks), by 21% in very preterm (28-32 wks) and by 24% in extremely preterm (20-28 wks) births compared to the ICC. A decline in oxygen saturation is observed in ICC received infants by 20% compared to the DCC received ones. At 30 weeks GA, SI were calculated for healthy newborns (1.18), and newborns with GR (1.38), PDA (1.22) and RDS (1.2) templates.</p><p><strong>Conclusion: </strong>Our results suggest that DCC provides superior hemodynamics and respiration at birth compared to ICC. This information will help preventing the complications associated with poor oxygenation arising in premature births and pre-screening the more critical babies in terms of their cardiovascular severity.</p>","PeriodicalId":74120,"journal":{"name":"Maternal health, neonatology and perinatology","volume":"5 ","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2019-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40748-019-0100-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37351401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal infections during pregnancy and offspring midlife inflammation.","authors":"Jolene Masters Pedersen,&nbsp;Erik Lykke Mortensen,&nbsp;Rikke Hodal Meincke,&nbsp;Gitte Lindved Petersen,&nbsp;Esben Budtz-Jørgensen,&nbsp;Helle Brunnsgaard,&nbsp;Holger Jelling Sørensen,&nbsp;Rikke Lund","doi":"10.1186/s40748-019-0099-3","DOIUrl":"https://doi.org/10.1186/s40748-019-0099-3","url":null,"abstract":"<p><strong>Background: </strong>Microbial exposures early in life have been found to be associated with lower levels of inflammation in adulthood; however, the role of prenatal exposure to infection on offspring inflammatory profiles is unexplored. The aim was to study if maternal infections during pregnancy are associated with inflammation among offspring in later life and to determine if there are sensitive periods of exposure.</p><p><strong>Methods: </strong>The study was comprised of 1719 participants in the Copenhagen Aging and Midlife Biobank (CAMB) who were also members of the Copenhagen Perinatal Cohort (CPC). When the CPC was established, information on maternal infections during pregnancy was prospectively collected by a trained medical doctor. The inflammatory measures collected in late midlife included, C-reactive protein (CRP), Interleukin-6 (IL-6), TNF-alpha (TNF-α) and Interleukin-10 (IL-10). Multivariable ordinary least squared regression models were implemented to explore associations between maternal infection and inflammatory measures in offspring, controlling for maternal smoking, pre-pregnancy body mass index, age, marital status and parity.</p><p><strong>Results: </strong>Maternal infection was associated with a 7% lower CRP level (95% CI, - 17,5%) among offspring compared with offspring born to women without an infection and similarly an 8% lower level of IL-6 (95% CI -15,1%), and a 9% lower level of IL-10 (95% CI, - 23,20%). However, differences did not reach significance. The effects of infection during the first trimester did not differ from infections later in the pregnancy.</p><p><strong>Conclusions: </strong>Our results suggested that prenatal exposure to infection may be associated with lower levels of inflammatory markers among adult offspring. Additional prospective studies are needed to further explore this finding.</p>","PeriodicalId":74120,"journal":{"name":"Maternal health, neonatology and perinatology","volume":"5 ","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2019-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40748-019-0099-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37100445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the safe childbirth checklist (SCC) program save newborn lives? Evidence from a realistic quasi-experimental study, Rajasthan, India.","authors":"Beena Varghese,&nbsp;Andrew Copas,&nbsp;Shwetanjali Kumari,&nbsp;Souvik Bandyopadhyay,&nbsp;Jigyasa Sharma,&nbsp;Somen Saha,&nbsp;Vikas Yadav,&nbsp;Somesh Kumar","doi":"10.1186/s40748-019-0098-4","DOIUrl":"https://doi.org/10.1186/s40748-019-0098-4","url":null,"abstract":"<p><strong>Background: </strong>The WHO Safe Childbirth Checklist (SCC) is a facility-based reminder tool focusing on essential care to improve quality of intrapartum care. We aimed to assess the impact of an intervention package using the SCC tool on facility-based stillbirths (SBs) and very early neonatal deaths (vENDs), in Rajasthan, India.</p><p><strong>Methods: </strong>Within a quasi-experimental framework, districts were selected as intervention or comparison, matched by annual delivery load. The SCC tool was introduced at all district and sub-district level health facilities in the seven intervention districts, followed by monthly supportive supervision visits. In addition, supply of drugs and equipment were facilitated in all facilities (2013-2015). Facilities in the comparison districts provided routine care. Analysis included only the facilities with a specialized newborn care unit and information on all births was collected from facility registers. The primary outcome was the combined facility-based stillbirths and very early neonatal deaths (within 3-days after birth). We used generalized estimating equation with a Poisson regression model, with time as a linear term and adjusted for facility type in our model to estimate the effect of the intervention. [ClinicalTrials.gov: NCT01994304].</p><p><strong>Results: </strong>77,239 births were recorded from 19 intervention facilities and 59,800 births from 15 comparison facilities. The intervention facilities reported 1621 stillbirths and 505 vENDs compared to 1390 stillbirths and 420 vENDs from the comparison facilities (RR 0.89, CI 0.81, 0.97). This translated to 11.16% (<i>p</i> = 0.01) reduction in total mortality (11.39% in stillbirths alone) in the intervention facilities.</p><p><strong>Conclusion: </strong>Our results suggest that the SCC program is an effective intervention that could potentially avert 40,000 intrapartum deaths in India annually, most of reduction coming from prevention of stillbirths.</p>","PeriodicalId":74120,"journal":{"name":"Maternal health, neonatology and perinatology","volume":"5 ","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40748-019-0098-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37052878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of early initiation of breastfeeding among Zimbabwean women: secondary analysis of ZDHS 2015.","authors":"Fadzai Mukora-Mutseyekwa,&nbsp;Hilary Gunguwo,&nbsp;Rugare Gilson Mandigo,&nbsp;Paddington Mundagowa","doi":"10.1186/s40748-018-0097-x","DOIUrl":"https://doi.org/10.1186/s40748-018-0097-x","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization recommends initiation of breastfeeding within the first hour of delivery. Early initiation is beneficial for both mother and baby. Previous Zimbabwe Demographic and Health Surveys (ZDHS) have shown reduction in early initiation of breast feeding from 68% (2005/06) to 58% (2015). This study sought to investigate factors associated with early initiation of breast feeding among women aged 15-49 years in Zimbabwe.</p><p><strong>Methodology: </strong>Secondary analysis of ZDHS 2015 data was done to investigate the association between early initiation of breast feeding and maternal, provider and neonatal factors using multivariate logistic regression (<i>n</i> = 2192).</p><p><strong>Results: </strong>The majority of the study sample (78%) reported having practised early initiation of breastfeeding during their most recent delivery (preceding 24 months).Children who were put on skin to skin contact (AOR = 1.51, 95% CI 1.13-2.02) and those delivered by skilled attendants (AOR = 4.36, 95% CI 1.07-17.77) had greater odds of early initiation compared to those who were not. Other factors associated with early initiation were multiparity (AOR 1.82 95% CI 1.33-2.49) and rural residence (AOR 2.10 95% 1.12-3.93). However, having an abnormal birth weight, i.e. low birth weight (AOR 0.60 95% CI 0.36-0.99) and macrosomia (AOR = 0.42, CI 0.22-0.79) as well as delivery by caesarean section (AOR 0.1195% CI 0.06-0.19) were associated with reduced odds of early initiation.</p><p><strong>Conclusion: </strong>Early initiation of breast feeding in Zimbabwe is mainly associated with residing in the rural areas and multiparity. The 78% rate of early initiation of breastfeeding was contrary to the 58% reported in the ZDHS findings. Interventions targeting an improvement in early initiation of breastfeeding must aim at women who deliver by caesarean section, women with babies of abnormal birth weight, primi-parous women and women residing in rural areas.</p>","PeriodicalId":74120,"journal":{"name":"Maternal health, neonatology and perinatology","volume":"5 ","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2019-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40748-018-0097-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36890403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}