Health Facilities In Africa Research Articles

Effectiveness of infection prevention and control interventions in health care facilities in Africa: A systematic review

Health care-associated infections (HAIs) are a major threat to patient safety and quality care. However, they are avoidable by implementing evidence-based infection prevention and control (IPC) measures. This review evaluated the evidence of the effectiveness of IPC interventions in reducing rates of HAIs in health care settings in Africa. We searched several databases: CENTRAL, EMBASE, PUBMED, CINAHL, WHO IRIS, and AJOL for primary studies reporting rates of the 4 most frequent HAIs: surgical site infections, central line--associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumoniae, and increase in hand hygiene compliance. Two reviewers appraised the studies and PRISMA guidelines were followed. Out of 4,624 studies identified from databases and additional sources, 15 studies were finally included in the review. Themajority of studies were of pre- and post-test study design. All the studies implemented a combination of interventions and not as stand-alone components. Across all included studies, an improvement was reported in at least 1primary outcome. Our review highlights the potential of IPC interventions in reducing HAIs and improving compliance with hand hygiene in health care facilities in Africa. For future research, we recommend more pragmatic study designs with improved methodological rigor.

Meta-analytic review on the impact of factors that affect performance of malaria rapid diagnostic test in Africa

Timely, accurate diagnosis and treatment has improved malaria case management. Malaria Rapid Diagnostic Test (mRDT) kits are largely used in malaria diagnosis. Their performance is compromised by factors related to gene deletions, parasite density, quality of the kit, poor storage conditions and end-user inefficiencies hence diagnosis gives either positive, negative, false negative (FN) or false positive (FP) which defines consequent management strategies. This review assessed reports on prevalence of the Plasmodium falciparum histidine rich protein 2/3 (Pfhrp2/3) gene deletions in malaria infected populations in Africa and the risk of mRDT failure to identify malaria positive cases. Preferred Reporting Items for Systematic Meta-Analysis (PRISMA) statement was used for data collection. Literature search was done using Google and Mendel search for data published in a malaria journal, Journal of infectious diseases, scientific reports, Annals of Ibadan postgraduate medicine, and BMC journals published between 2019 and 2023. Fifty eight reports were identified were screened and tested for eligibility. 
 Majority of studies described the consistent use of Pfhrp2/3 mRDT for malaria diagnosis in rural health facilities in Africa and nine reports met inclusion criteria for review. Five of them certified the world health organization’s sample criteria of ‘more than 350 sample’ to estimate the prevalence of Pfhrp2/3 gene deletions leading to declaration of false negative results of which one study posted FN outcome resulting from these deletions. Four out of nine studies did not meet this WHO criterion. This review affirmed presence of Pfhrp2/3 gene deletions challenges in Africa though other countries recorded the converse. Data was pooled using random effect models with Odds ratio and 95% confidence limit. The prevalence of the gene deletions was heterogeneous, ranging from 0% to 78.1%. The review found that an average prevalence of Pfhrp2/3 deletion as 26.2%. This was above the WHO standard recommended declaration value of 5%.; a factor that demonstrated setback to the use of mRDT in malaria endemic regions. Therefore alternative methods should be used where aspersions are cast on outcome of mRDT for 
 it will help improve malaria treatment, tracking and management.

Preparing healthcare facilities in sub-Saharan Africa for future outbreaks: insights from a multi-country digital self-assessment of COVID-19 preparedness

BackgroundDespite previous experience with epidemics, African healthcare systems were inadequately prepared and substantially impacted by the coronavirus disease 2019 (COVID-19) pandemic. Limited information about the level of COVID-19 preparedness of healthcare facilities in Africa hampers policy decision-making to fight future outbreaks in the region, while maintaining essential healthcare services running.MethodsBetween May–November 2020, we performed a survey study with SafeCare4Covid − a free digital self-assessment application − to evaluate the COVID-19 preparedness of healthcare facilities in Africa following World Health Organization guidelines. The tool assessed (i) COVID-19-related capabilities with 31 questions; and (ii) availability of essential medical supplies with a 23-supplies checklist. Tailored quality improvement plans were provided after assessments. Information about facilities’ location, type, and ownership was also collected.ResultsFour hundred seventy-one facilities in 11 African countries completed the capability assessment; 412 also completed the supplies checklist. The average capability score on a scale of 0–100 (n=471) was 58.0 (interquartile range 40.0–76.0), and the average supplies score (n=412) was 61.6 (39.0–83.0). Both scores were significantly lower in rural (capability score, mean 53.6 [95%CI:50.3–57.0]/supplies score, 59.1 [55.5–62.8]) versus urban facilities (capability score, 65.2 [61.7–68.7]/supplies score, 70.7 [67.2–74.1]) (P<0.0001 for both comparisons). Likewise, lower scores were found for public versus private clinics, and for primary healthcare centres versus hospitals. Guidelines for triage and isolation, clinical management of COVID-19, staff mental support, and contact tracing forms were largely missing. Handwashing stations were partially equipped in 33% of facilities. The most missing medical supply was COVID-19 specimen collection material (71%), while 43% of facilities did not have N95/FFP2 respirators and 19% lacked medical masks.ConclusionsA large proportion of public and private African facilities providing basic healthcare in rural areas, lacked fundamental COVID-19-related capabilities and life-saving personal protective equipment. Decentralization of epidemic preparedness efforts in these settings is warranted to protect healthcare workers and patients alike in future epidemics. Digital tools are of great value to timely measure and improve epidemic preparedness of healthcare facilities, inform decision-making, create a more stakeholder-broad approach and increase health-system resilience for future disease outbreaks.

Determining the Impact of the COVID-19 Pandemic on Availability, Use, and Readiness of Family Planning and Contraceptive Services at Selected Primary Health Care Facilities in Africa and Asia: Protocol for a Mixed Methods Study.

The COVID-19 pandemic and the associated social restrictions may have disrupted the provision of essential services, including family planning (FP) and contraceptive services. This protocol is adapted from a generic study protocol titled "Health systems analysis and evaluations of the barriers to availability and readiness of sexual and reproductive health services in COVID-19 affected areas," conducted by the World Health Organization (WHO) Department of Reproductive Health and Research. This study aims to assess the availability and use of FP and contraceptive services in primary health facilities during and after the COVID-19 pandemic; assess the risk perceptions of COVID-19 stigma, barriers to access, and quality of services from clients' and providers' perspectives in the COVID-19-affected areas; and assess the postpandemic recovery of the facilities in the provision of FP and contraceptive services. In-depth interviews will be conducted with clients-women in the reproductive age group and their male partners who visit the selected health facilities for FP and contraceptive services-and health providers (the most knowledgeable person on FP and contraceptive service provision) at the selected health facilities. Focus group discussions will be conducted with clients at the selected health facilities and in the community. The in-depth interviews and focus group discussions will help to understand clients' and health service providers' perspectives of FP and contraceptive service availability and readiness in COVID-19-affected areas. A cross-sectional health facility assessment will be conducted in all the selected health facilities to determine the health facility infrastructure's ability and readiness to provide FP and contraceptive services and to capture the trends in FP and contraceptive services available during the COVID-19 pandemic. Scientific approval for this study is obtained from the WHO Research Project Review Panel, and the WHO Ethics Review Committee has given ethical approval in the 3 countries. Using a standardized research protocol will ensure that the results from this study can be compared across regions and countries. The study was funded in March 2021. It received ethics approval from the WHO Ethics Review Committee in February 2022. We completed data collection in September 2022. We plan to complete the data analysis by March 2023. We plan to publish the study results by Summer 2023. The findings from this study will provide a better understanding of the impact of the COVID-19 pandemic on FP and contraceptive services at the facility level, which will help policy makers and health managers develop and strengthen FP policies and services in health facilities to be more responsive to community needs. DERR1-10.2196/43329.

Assessment of patient satisfaction with pharmaceutical services in two tertiary health facilities in Rivers State, Nigeria

Patient satisfaction measurements are necessary to evaluate the quality of care given to patients within a healthcare facility. Healthcare facilities in Africa are faced with numerous challenges such as lack of human and financial resources which can lead to inadequate provision of healthcare to patients. This study aims to assess the level of patient satisfaction with hospital pharmaceutical services in the two tertiary health facilities in Rivers State. A descriptive cross-sectional study was conducted at the various pharmacy units at the health facilities between September and December 2020. Qualitative data was collected using structured self-administered questionnaires. A total of 200 patients from each of the two tertiary health facilities participated in the study. The study showed that majority of the participants( 34 and 64%) at the Rivers State University Teaching Hospital (RSUTH) were either very satisfied or satisfied with pharmaceutical services while 36.5 and 43.5% showed varied level of satisfaction with care by pharmacists. At the University of Port Harcourt Teaching Hospital (UPTH), those that reported satisfaction were 37 and 57.5% for the very satisfied and satisfied respectively for pharmaceutical services while it was 38 and 36% respectively for the very satisfied and satisfied with pharmaceutical care rendered by the pharmacists at the facility. However, there was no statistically significant difference in the satisfaction profile at the two facilities (p&lt;0.05). This study concludes that majority of patients assessing the two tertiary health facilities were either very satisfied or satisfied with the pharmaceutical services and care rendered by Pharmacists. The study recommends that similar studies be conducted to assess patient satisfaction at secondary and primary health care facilities.

Development of the FAST-M Maternal Sepsis Bundle for Use in Low-resource Settings: A Modified Delphi Process

(BJOG. 2020;127:416–423) Although maternal sepsis is the third most common cause of global maternal mortality, there are no internationally recognized sepsis care bundles directed toward pregnant women that can be implemented in a low-resource setting. While the Surviving Sepsis Campaign’s (SSC) care bundle has been associated with reduced mortality for the general population, only 1.5% of health care facilities in Africa are able to implement the SSC guidelines in their entirety. The need to develop and implement effective strategies to reduce the global burden of maternal and neonatal sepsis in low-resource settings has become increasingly important, as demonstrated by a recent global directive by the World Health Organization (WHO) and Jhpiego. This study aimed to accomplish this directive by developing a care bundle for the initial management of maternal sepsis in low-resource settings.

Rural Healthcare Delivery in Sub-Saharan Africa

Access to quality healthcare is a major problem in Sub-Saharan Africa with a doctor-to-patient ratio as high as 1:50,000, which is far above the recommended ratio by the World Health Organization (WHO) which is 1:600. This has been aggravated by the lack of access to critical infrastructures such as the health care facilities, roads, electricity, and many other factors. Even if these infrastructures are provided, the number of medical practitioners to cater for the growing population of these countries is not sufficient. In this article, how information and communication technology (ICT) can be used to drive a sustainable health care delivery system through the introduction and promotion of Virtual Clinics and various health information systems such as mobile health and electronic health record systems into the healthcare industry in Sub-Saharan Africa is presented. Furthermore, the article suggests ways of attaining successful implementation of telemedicine applications /services and remote health care facilities in Africa.

Prevalence and dynamics of missed opportunities for vaccination among children in Africa: applying systems thinking in a systematic review and meta-analysis of observational studies

ABSTRACTObjective: To estimate the prevalence of missed opportunities for vaccination (MOV) among children aged 0–23 months attending health-care facilities in Africa and explore the factors responsible for MOV using systems thinking.Research design and methods: We conducted a systematic review and meta-analysis of studies reporting the proportion MOVs. Five electronic databases were searched. A random effects model was fitted to obtain pooled estimates of MOV and a causal loop diagram (CLD) was constructed to explore the dynamics of the causes of MOV. MOV was defined as any contact with health services in Africa, by an unvaccinated or under-vaccinated child, aged 0–23 months, who is eligible for vaccination and free of any contraindication, which does not result in vaccination.Results: Four hundred and twenty-one publications were found, of which 20 studies from 14 countries were included. The pooled prevalence of MOV was estimated to be 27.26% (95%CI: 18.80–36.62). A CLD with seven reinforcing and two balancing loops were constructed.Conclusion: Our findings suggest that about one in every four children under the age of two years who visited health facilities in 14 African countries missed the vaccination they were eligible to receive. To enable continent-wide estimates, more MOV assessments are required.

Perspectives on Developing Healthcare Managers in Africa: The Strathmore Business School's Healthcare Management Programme.

A substantial shortage of qualified healthcare professionals in Africa continues, but it is now apparent that professionally trained healthcare managers are an equally important need. Health facilities in Africa typically promote physicians into the role of general manager, but physicians and their lay counterparts routinely admit to being ill-prepared for roles as leaders of health systems, healthcare facilities and other services. Few, if any, degree programmes for healthcare management—be they master's in hospital administration or specialized MBA programmes— are available in these regions. And while many master's in public health programmes exist, inclusion of healthcare management content is often an afterthought. This article presents a prototype programme that was designed to address this gap. This comprehensive healthcare management MBA programme that was established at the Business School of Strathmore University in Nairobi, Kenya in 2013 was built around the “Leadership Competencies for Health Care Managers” as promulgated by the International Hospital Federation. The article further presents the development, structure and innovations of the programme, thus providing a blueprint for the development of similar programmes throughout the continent, aimed at addressing the substantial shortage of professionally trained healthcare managers.

Integrated management of type 2 diabetes and gestational diabetes within multi-morbidity conditions in Africa: a systematic review protocol

IntroductionMulti-morbidity, defined as the co-existence of more than one chronic condition in one person, has been increasing due to comorbid non-communicable and infectious chronic diseases (CNCICDs). Type 2 diabetes (T2D)...

Pharmaceutical stockouts: problems and remedies for faith-based health facilities in Africa

Background and aims: Faith-based organizations (FBOs) provide a substantial portion of the health care services in many countries but despite this coverage, many health facilities have struggled to maintain adequate stocks of supplies. The purpose of this study was to identify the types of supply chain systems used by African faith-based health facilities to acquire reproductive health commodities, the performance of the different supply chain system types, their associated challenges and possible corrective actions.Methodology: Through email surveys, phone interviews, and on-site visits, supply chains and challenges of faith-based health facilities in 13 African countries for 16 selected reproductive health (RH) commodities, including contraceptives were studied. Results: Of the 46 facilities surveyed, 55% faced stockouts of one or more products in the three months prior to the survey. Stockouts were less common for contraceptives than other RH products. Significant strengths of the FBO supply chain included creativity in finding other sources of commodities in the face of stockouts, staff designated to monitor quality of the commodities, high capacity for storage, low incidence of expired products, few instances of poor quality, and strong financial sustainability mechanisms, often including patient fees. Weaknesses included unreliable commodity sources and power supplies, long distances to depots, and problems maintaining the cold chain. Five supply chain types were identified. As a result of this study, FBOs in Cameroon have already taken steps to strengthen their supply chain systems and reduce stockouts by forming the Alliance of Christian Faith-Based Organizations for Family Planning (ACFBOFP) in Cameroon. This coalition is raising the profile and fortifying the voice of FBOs toward strengthening FBO commodity security in Cameroon. Conclusions: By studying the supply chains of faith-based health facilities, Christian Connections for International Health (CCIH) and its members have created new awareness among FBOs and international agencies of the importance and challenges of these systems and suggested actions toward improvement. This study can serve as a frame of reference as we move forward, anticipating an acceleration in interest to strengthen FBO supply chains to reach as many communities as possible with supplies and services. The alliance formed in Cameroon to strengthen commodity security may be a good model for other FBOs to consider.

Socio-economic Determinants of Women Access to Healthcare Services in Sub-Saharan Africa

The study examined the socio-economic determinants of women access to healthcare services in Sub-Saharan Africa for the period 1995-2015. The study adopted the dynamic panel model and estimated it using the System Generalized Method of Moments in a bid to overcome the endogeneity problem inherent in the model of study. The study harmonized the theoretical strands in literature by describing the measure of access determinants as three main components: i. health service availability, ii. Health service utilization and, iii. Health service decision. The indicators of health service availability such as community health workers, physician, nurses and midwives and hospital beds improve women access to healthcare facilities in Africa. Also, health service utilization indicators such as population density worsen the quality of healthcare services available to women while electricity access and private health expenditure enhances women access to quality healthcare delivery. Health service decision indicators such as female bank account ownership, female labour force participation, attainment of basic education and female household headship were important in enhancing women access to healthcare facilities. Generally, women health outcomes were more responsive to health service utilization; implying that service utilization is an important proof of healthcare access in Africa.

ANTIBIOTIC RESISTANCE PATTERNS OF POTENTIAL PATHOGENS ISOLATED FROM TWO MAJOR HOSPITALS IN LUSAKA AND NDOLA

BackgroundThis study was conducted as part of an assessment of the effectiveness of existing hygiene and sanitation practices in two first-level hospitals in Lusaka and two central clinics in Ndola...

High mortality and prevalence of HIV and tuberculosis in adults with chronic cough in Malawi: a cohort study.

SUMMARYBACKGROUND: Adults with suspected tuberculosis (TB) in health facilities in Africa have a high risk of death. The risk of death for adults with suspected TB at community-level is not known but may also be high.METHODS: Adults reporting cough of ⩾ 2 weeks (coughers) during a household census of 19 936 adults in a poor urban setting in Malawi were randomly sampled and age-frequency matched with adults without cough ⩾ 2 weeks (controls). At 12 months, participants were traced to establish vital status, offered human immunodeficiency virus (HIV) testing and investigated for TB if symptomatic (sputum for Xpert® MTB/RIF, smear microscopy and culture).RESULTS: Of 345 individuals with cough, 245 (71%) were traced, as were 243/345 (70.4%) controls. TB was diagnosed in 8.9% (16/178) of the coughers and 3.7% (7/187) of the controls (P = 0.039). HIV prevalence among coughers was 34.6% (56/162) and 18.8% (32/170) in controls (P = 0.005); of those who were HIV-positive, respectively 26.8% and 18.8% were newly diagnosed. The 12-month risk of death was 4.1% (10/245) in coughers and 2.5% (6/243) in controls (P = 0.317).CONCLUSION: Undiagnosed HIV and TB are common among adults with chronic cough, and mortality is high in this urban setting. Interventions that promote timely seeking of HIV and TB care are needed.

Treatment of infections in young infants in low- and middle-income countries: a systematic review and meta-analysis of frontline health worker diagnosis and antibiotic access.

Inadequate illness recognition and access to antibiotics contribute to high case fatality from infections in young infants (<2 months) in low- and middle-income countries (LMICs). We aimed to address three questions regarding access to treatment for young infant infections in LMICs: (1) Can frontline health workers accurately diagnose possible bacterial infection (pBI)?; (2) How available and affordable are antibiotics?; (3) How often are antibiotics procured without a prescription? We searched PubMed, Embase, WHO/Health Action International (HAI), databases, service provision assessments (SPAs), Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and grey literature with no date restriction until May 2014. Data were identified from 37 published studies, 46 HAI national surveys, and eight SPAs. For study question 1, meta-analysis showed that clinical sign-based algorithms predicted bacterial infection in young infants with high sensitivity (87%, 95% CI 82%-91%) and lower specificity (62%, 95% CI 48%-75%) (six studies, n = 14,254). Frontline health workers diagnosed pBI in young infants with an average sensitivity of 82% (95% CI 76%-88%) and specificity of 69% (95% CI 54%-83%) (eight studies, n = 11,857) compared to physicians. For question 2, first-line injectable agents (ampicillin, gentamicin, and penicillin) had low variable availability in first-level health facilities in Africa and South Asia. Oral amoxicillin and cotrimoxazole were widely available at low cost in most regions. For question 3, no studies on young infants were identified, however 25% of pediatric antibiotic purchases in LMICs were obtained without a prescription (11 studies, 95% CI 18%-34%), with lower rates among infants <1 year. Study limitations included potential selection bias and lack of neonatal-specific data. Trained frontline health workers may screen for pBI in young infants with relatively high sensitivity and lower specificity. Availability of first-line injectable antibiotics appears low in many health facilities in Africa and Asia. Improved data and advocacy are needed to increase the availability and appropriate utilization of antibiotics for young infant infections in LMICs. PROSPERO International prospective register of systematic reviews (CRD42013004586). Please see later in the article for the Editors' Summary.

Moving Beyond Essential Interventions for Reduction of Maternal Mortality (the WHO Multicountry Survey on Maternal and Newborn Health)

Summary Background We report the main findings of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), which aimed to assess the burden of complications related to pregnancy, the coverage of key maternal health interventions, and use of the maternal severity index (MSI) in a global network of health facilities. Methods In our cross-sectional study, we included women attending health facilities in Africa, Asia, Latin America, and the Middle East that dealt with at least 1000 childbirths per year and had the capacity to provide caesarean section. We obtained data from analysis of hospital records for all women giving birth and all women who had a severe maternal outcome (SMO; ie, maternal death or maternal near miss). We regarded coverage of key maternal health interventions as the proportion of the target population who received an indicated intervention (eg, the proportion of women with eclampsia who received magnesium sulphate). We used areas under the receiver operator characteristic curves (AUROC) with 95% CI to externally validate a previously reported MSI as an indicator of severity. We assessed the overall performance of care (ie, the ability to produce a positive effect on health outcomes) through standardised mortality ratios. Results From May 1, 2010, to Dec 31, 2011, we included 314 623 women attending 357 health facilities in 29 countries (2538 had a maternal near miss and 486 maternal deaths occurred). The mean period of data collection in each health facility was 89 days (SD 21). 23 015 (7·3%) women had potentially life-threatening disorders and 3024 (1·0%) developed an SMO. 808 (26·7%) women with an SMO had post-partum haemorrhage and 784 (25·9%) had pre-eclampsia or eclampsia. Cardiovascular, respiratory, and coagulation dysfunctions were the most frequent organ dysfunctions in women who had an SMO. Reported mortality in countries with a high or very high maternal mortality ratio was two-to-three-times higher than that expected for the assessed severity despite a high coverage of essential interventions. The MSI had good accuracy for maternal death prediction in women with markers of organ dysfunction (AUROC 0·826 [95% CI 0·802–0·851]). Interpretation High coverage of essential interventions did not imply reduced maternal mortality in the health-care facilities we studied. If substantial reductions in maternal mortality are to be achieved, universal coverage of life-saving interventions need to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care. The MSI could be used to assess the performance of health facilities providing care to women with complications related to pregnancy. Funding UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP); WHO; USAID; Ministry of Health, Labour and Welfare of Japan; Gynuity Health Projects.

The Tanzania Connect Project: a cluster-randomized trial of the child survival impact of adding paid community health workers to an existing facility-focused health system

BackgroundTanzania has been a pioneer in establishing community-level services, yet challenges remain in sustaining these systems and ensuring adequate human resource strategies. In particular, the added value of a cadre of professional community health workers is under debate. While Tanzania has the highest density of primary health care facilities in Africa, equitable access and quality of care remain a challenge. Utilization for many services proven to reduce child and maternal mortality is unacceptably low. Tanzanian policy initiatives have sought to address these problems by proposing expansion of community-based providers, but the Ministry of Health and Social Welfare (MoHSW ) lacks evidence that this merits national implementation. The Tanzania Connect Project is a randomized cluster trial located in three rural districts with a population of roughly 360,000 ( Kilombero, Rufiji, and Ulanga).Description of interventionConnect aims to test whether introducing a community health worker into a general program of health systems strengthening and referral improvement will reduce child mortality, improve access to services, expand utilization, and alter reproductive, maternal, newborn and child health seeking behavior; thereby accelerating progress towards Millennium Development Goals 4 and 5. Connect has introduced a new cadre — Community Health Agents (CHA) — who were recruited from and work in their communities. To support the CHA, Connect developed supervisory systems, launched information and monitoring operations, and implemented logistics support for integration with existing district and village operations. In addition, Connect’s district-wide emergency referral strengthening intervention includes clinical and operational improvements.Evaluation designDesigned as a community-based cluster-randomized trial, CHA were randomly assigned to 50 of the 101 villages within the Health and Demographic Surveillance System (HDSS) in the three study districts. To garner detailed information on household characteristics, behaviors, and service exposure, a random sub-sample survey of 3,300 women of reproductive age will be conducted at the baseline and endline. The referral system intervention will use baseline, midline, and endline facility-based data to assess systemic changes. Implementation and impact research of Connect will assess whether and how the presence of the CHA at village level provides added life-saving value to the health system.DiscussionGlobal commitment to launching community-based primary health care has accelerated in recent years, with much of the implementation focused on Africa. Despite extensive investment, no program has been guided by a truly experimental study. Connect will not only address Tanzania’s need for policy and operational research, it will bridge a critical international knowledge gap concerning the added value of salaried professional community health workers in the context of a high density of fixed facilities.Trial registration: ISRCTN96819844

Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study

We report the main findings of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), which aimed to assess the burden of complications related to pregnancy, the coverage of key maternal health interventions, and use of the maternal severity index (MSI) in a global network of health facilities. In our cross-sectional study, we included women attending health facilities in Africa, Asia, Latin America, and the Middle East that dealt with at least 1000 childbirths per year and had the capacity to provide caesarean section. We obtained data from analysis of hospital records for all women giving birth and all women who had a severe maternal outcome (SMO; ie, maternal death or maternal near miss). We regarded coverage of key maternal health interventions as the proportion of the target population who received an indicated intervention (eg, the proportion of women with eclampsia who received magnesium sulphate). We used areas under the receiver operator characteristic curves (AUROC) with 95% CI to externally validate a previously reported MSI as an indicator of severity. We assessed the overall performance of care (ie, the ability to produce a positive effect on health outcomes) through standardised mortality ratios. From May 1, 2010, to Dec 31, 2011, we included 314,623 women attending 357 health facilities in 29 countries (2538 had a maternal near miss and 486 maternal deaths occurred). The mean period of data collection in each health facility was 89 days (SD 21). 23,015 (7.3%) women had potentially life-threatening disorders and 3024 (1.0%) developed an SMO. 808 (26.7%) women with an SMO had post-partum haemorrhage and 784 (25.9%) had pre-eclampsia or eclampsia. Cardiovascular, respiratory, and coagulation dysfunctions were the most frequent organ dysfunctions in women who had an SMO. Reported mortality in countries with a high or very high maternal mortality ratio was two-to-three-times higher than that expected for the assessed severity despite a high coverage of essential interventions. The MSI had good accuracy for maternal death prediction in women with markers of organ dysfunction (AUROC 0.826 [95% CI 0.802-0.851]). High coverage of essential interventions did not imply reduced maternal mortality in the health-care facilities we studied. If substantial reductions in maternal mortality are to be achieved, universal coverage of life-saving interventions need to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care. The MSI could be used to assess the performance of health facilities providing care to women with complications related to pregnancy. UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP); WHO; USAID; Ministry of Health, Labour and Welfare of Japan; Gynuity Health Projects.

Mesenteric lipoma causing recurrent intestinal obstruction

Although lipoma is a common tumor found in almost all parts of the body, that occurring in the mesentery of the gut is a rarity. A 29-year-old man presented in our center with a 10-year history of recurrent central colicky abdominal pain, vomiting, constipation, and central abdominal mass. Exploratory laparotomy revealed a huge smooth yellow mass in the mesentery of the mid ileum. Resection of the affected segment of the ileum and end to end ileal anastomosis were carried out. Histology report confirmed lipoma. He had uneventful post-operative recovery. Mesenteric lipoma should be considered as a possible differential diagnosis in a patient with recurrent features of intestinal obstruction and a mobile abdominal mass. A high index of suspicion and improvement on the pre-operative diagnosis and treatment are needed in secondary health facilities in Africa.

Unmet need for induction of labor in Africa: secondary analysis from the 2004 - 2005 WHO Global Maternal and Perinatal Health Survey (A cross-sectional survey)

BackgroundInduction of labor is being increasingly used to prevent adverse outcomes in the mother and the newborn.This study assessed the prevalence of induction of labor and determinants of its use in Africa.MethodsWe performed secondary analysis of the WHO Global Survey of Maternal and Newborn Health of 2004 and 2005. The African database was analyzed to determine the use of induction of labor at the country level and indications for induction of labor. The un-met needs for specific obstetric indications and at country level were assessed. Determinants of use of induction of labor were explored with multivariate regression analysis.ResultsA total of 83,437 deliveries were recorded in the 7 participating countries. Average rate of induction was 4.4% with a range of 1.4 – 6.8%. Pre-labor rupture of membranes was the commonest indication for induction of labor. Two groups of women were identified: 2,776 women with indications had induction of labor while 7,996 women although had indications but labor was not induced.Induction of labor was associated with reduction of stillbirths and perinatal deaths [OR – 0.34; 95% CI (0.27 – 0.43)].Unmet need for induction of labor ranged between 66.0% and 80.2% across countries. Determinants of having an induction of labor were place of residence, duration of schooling, type of health facility and level of antenatal care.ConclusionUtilization of induction of labor in health facilities in Africa is very low. Improvements in social and health infrastructure are required to reverse the high unmet need for induction of labor.