Unskilled Birth Attendants Research Articles

A STUDY OF OBSTETRIC HYSTERECTOMY OVER A PERIOD OF 5 YEARS AT CUSMCH

Objectives: The study aimed (1) to determine the indication of obstetric hysterectomy and (2) to determine the fetomaternal outcome. Methods: This is a hospital-based retrospective study carried out in the Department of Obstetrics and Gynecology, C.U.Shah Medical College and Hospital from January 2018 to December 2020. Results: Out of 8881 deliveries during our study period, there were a total of 20 patients who underwent an obstetric hysterectomy, the incidence being 0.2%. Nine cases out of 6871 vaginal deliveries and 11 cases out of 2510 cesarean deliveries required an obstetric hysterectomy. Maximum patients, seven out of 20 were between 31 and 35 years age group followed by six patients between 36 and 40 years and five patients above 41 years. Only two patients were below 30 years of age. Most of the cases (70%) belonged to the lower middle class and 30% were from the upper middle class. About 60% were registered antenatal care (ANC) cases while 40% never visited any health-care facility. Out of 20 patients who underwent an obstetric hysterectomy, 18 patients (90%) were referred from another center while only 2 patients (10%) were admitted at our center. Eleven patients that are 55% delivered outside the institute among which three patients were home delivered by unskilled birth attendants. Nine patients were delivered at our center and among these sseven patients were referred from adjoining primary health-care centers, community health-care centers, and other private hospitals. Our institute being a tertiary hospital, maximum high-risk and complicated deliveries were referred. Conclusion: Obstetric hysterectomy is an unwanted but necessary emergency in obstetrics. It is a life-saving procedure in many catastrophic conditions, although it curtails the future. Good ANC, identification of risk factors, timely referral, and intervention at a well-equipped hospital can reduce obstetric hysterectomies. With the increasing incidence of cesarean deliveries and morbidly adherent placenta, the need for obstetric hysterectomy is increasing. With the improvement of modern obstetrics and modern modalities for the treatment of postpartum hemorrhage and adherent placenta, there is a reduction in the number of obstetric hysterectomies.

Predictors and Outcome of Surgical Repair of Obstetric Fistula at a Private Hospital of Dhaka City

Background: Obstetric fistula remains a significant public health issue in low-resource settings, with high prevalence in countries like Bangladesh. The condition often results from prolonged, obstructed labor, compounded by socio-cultural factors such as early marriage, financial constraints, and lack of access to skilled birth attendants. This study aimed to explore the socio-demographic characteristics and surgical outcomes of women undergoing fistula repair at a private hospital in Dhaka, Bangladesh. Methods: This observational descriptive study included 62 women who underwent obstetric fistula repair between September 2010 and September 2012. Data were collected on socio-demographic characteristics, fistula details, and surgical outcomes through a structured booklet completed at various stages of patient care. Surgical success, complications, and post-operative outcomes were analyzed to identify factors influencing recovery and success rates. Result: The study found that 100% of participants were married at an early age, with significant financial barriers reported by all. A majority (87.10%) had home deliveries attended by unskilled birth attendants. Surgical repair was successful in 88.71% of cases, with a small proportion (11.29%) of unsuccessful repairs. Residual stress incontinence was noted in 4.84% of participants. The mean hospital stay was 17.52 days, with 95.16% of participants requiring continuous catheterization for 7 to 10 days. Conclusion: The high success rate of surgical repairs is promising, but the persistence of socio-cultural barriers and residual complications highlights the need for improved access to maternal healthcare and enhanced post-operative care. Addressing these issues is critical for reducing the burden of obstetric fistula and improving outcomes for affected women.

Spatial variation of skilled birth attendance and associated factors among reproductive age women in Ethiopia, 2019; a spatial and multilevel analysis.

The majority of maternal deaths were associated with a lack of access to skilled birth attendance. Because childbirth accounts for most maternal deaths, skilled birth attendance is crucial for reducing maternal mortality. The use of skilled birth attendance in Ethiopia is low, and it is crucial to identify factors that determine the use of skilled birth attendance. Hence, this study aimed to assess the spatial distribution, wealth-related inequality, and determinants for skilled birth attendance in Ethiopia. Secondary data analysis was done with a total weighted sample of 5,251 reproductive-aged women using the 2019 mini EDHS. The concentration index and graph were used to assess wealth-related inequalities. Spatial analysis was done to identify the spatial distribution and multilevel logistic regression analysis was used to identify predictors of skilled birth attendance in Ethiopia. Analysis was done using STATA version 14, ArcGIS, and SaTscan software. The prevalence of skilled birth attendance was 50.04% (95% CI: 48.69%, 51.40%) in Ethiopia. Old age, being married, being educated, having television and radio, having ANC visits, being multiparous, having large household sizes, having a rich wealth index, living in rural residence, and living in a high level of community poverty and women's education were significant predictors of skilled birth attendance. Skilled birth attendance was disproportionately concentrated in rich households [C = 0.482; 95% CI: 0.436, 0.528]. High prevalence of unskilled birth attendance was found in Somalia, SNNP, Afar, and southern parts of the Amhara regions. Primary clusters of unskilled birth attendance Somalia and some parts of Oromia region of Ethiopia. Half of the women in Ethiopia did not utilize skilled birth attendants with significant spatial clustering. Age, marital status, educational status, ANC Visit, having television and radio, parity, household size, wealth index, residence, community level poverty, and community level of women's education were significant predictors of skilled birth attendance. Skilled birth attendance was unevenly concentrated in rich households. The regions of Somalia, SNNP, Afar, and southern Amhara were identified as having a high prevalence of using unskilled birth attendance. Public health interventions should target those women at high risk of using unskilled birth attendants.

Using verbal and social autopsy approaches to understand why neonates die in rural settings: a case study of a remote rural district in Uganda

IntroductionNeonatal mortality remains a formidable challenge in low-resource settings, such as Uganda, despite global health initiatives. This study employs a social and verbal autopsy approach to identify the causes, settings...

Influence of socio-demographic factors on the use of maternal health care among Muslim women in urban slums of Mumbai, India

Background: Low and middle-income countries such as India face significant challenges in improving maternal health and reducing maternal mortality rate. To combat this problem, it is essential to utilize maternal health-care services. Objective: This study aims to assess the utilization of maternal health-care services (Antenatal care [ANC] and skilled attendance at birth) and the determining factors of maternal health-care utilization. Materials and Methods: This study is cross-sectional. The study is carried out in an urban slum in Mumbai, India. The respondents were selected using a multistage sampling procedure, and 300 Muslim women who delivered in the past 2 years in the reproductive age group (15–49 years) were selected. The data were collected using a structured interview schedule. Data were analyzed using logistic regression analysis. Results: The study shows that maternal health-care utilization among respondents was unsatisfactory. Only 43.8% of the respondents utilized full ANC service and 27.3% still delivered at home with unskilled birth attendance (traditional Dai). A medical emergency, high cost, and lack of quality of services were the most common reasons to deliver at home. Respondents’ age at marriage, education (respondents and partners), monthly income, number of children, and type of family are the most important determining factors for the utilization of maternal health-care services. Conclusion: Better utilization of maternal health-care services can be achieved by improving the overall socioeconomic status of Muslim women. To improve maternal healthcare, special attention is required to be paid to the education of women and spouses. Furthermore, policies may address the women’s subordinate position in socioeconomic parameters. Similarly, close monitoring is required by the government through different agencies on the utilization of maternal health-care services.

Do disempowered childbearing women give birth at home in Sierra Leone? A secondary analysis of the 2019 Sierra Leone demographic health survey

BackgroundA nationwide assessment of the link between women’s empowerment and homebirth has not been fully examined in Sierra Leone. Our study examined the association between women’s empowerment and homebirth among childbearing women in Sierra Leone using the 2019 Sierra Leone Demographic Health Survey (2019 SLDHS) data.MethodWe used the individual file (IR) of the 2019 SLDHS dataset for our analysis. A total of 7377 women aged 15–49 years who gave birth in the five years preceding the survey were included. Outcome variable was “home birth of their last child among women in the five years preceding the 2019 SLDHS. Women’s empowerment parameters include women’s knowledge level, economic participation, decision-making ability and power to refuse the idea of intimate partner violence. We used the complex sample command on SPSS version 28 to conduct descriptive and multivariate logistic regression analyses.ResultsThree in every 20 women had home childbirth (n = 1177; 15.3%). Women with low [aOR 2.04; 95% CI 1.43–2.92] and medium [aOR 1.44; 95%CI 1.05–1.97] levels of knowledge had higher odds of giving birth at home compared to those with high levels of knowledge. Women who did not have power to refuse the idea of intimate partner violence against women were more likely to had given birth at home [aOR 1.38; 95% CI1.09-1.74]. In addition, women with no [aOR 2.71; 95% CI1.34-5.46) and less than four antenatal care visits [aOR 2.08; 95% CI:1.51–2.88] and for whom distance to a health facility was a major problem [aOR 1.95; 95% CI1.49-2.56] were more likely to have had a homebirth. However, no statistically significant association was observed between a women’s decision-making power and home birth [aOR 1.11; 95% CI 0.86–1.41].ConclusionDespite improvements in maternal health indicators, homebirth by unskilled birth attendants is still a public health concern in Sierra Leone. Women with low knowledge levels, who did not have power to refuse the idea of intimate partner violence against women, had less than four ANC visits and considered distance to a health facility as a major problem had higher odds of giving birth at home. Our findings reflect the need to empower women by improving their knowledge level through girl child and adult education, increasing media exposure, changing societal norms and unequal power relations that promote gender-based violence against women, and improving roads and transport infrastructure.

The birthing experiences of mothers with clinical healthcare professionals and community birth attendants in rural northern Ghana

BackgroundThe use of non-professional birth attendants, such as untrained family members and traditional birth attendants, contributes to birth-related complications such as neonatal and maternal mortality. Strategies such as professionally conducted home births and placement of community health professionals close to homes to ensure easy access to skilled birth attendants aim to reduce complications. However, women in labour continue to access the services of unskilled birth attendants in developing settings. AimTo explore the experiences of women in labour who received care from professional birth attendants and community birth attendants to understand the reasons for continued use of non-professional community birth attendants. MethodsA qualitative approach was used to explore the birthing experiences of nine mothers, aged 20–45 years. In-depth face-to-face interviews were conducted to generate data with the help of an interview guide. A content analysis approach was used to organise and interpret the data. FindingsThe participants reported hostile interactions with professional birth attendants, imposition of birthing positions by professional birth attendants, high cost of birthing services by professional birth attendants, and safety risks with non-professional community birth attendants. ConclusionThere is a need for explicit health financing systems that ensure mothers are aware and adequately prepared for labour-related costs. Mothers wish to receive care from professional birth attendants, but feel compelled by negative experiences to choose family members and non-professional birth attendants instead. The adherence of health professionals to the fundamental principles of ‘Respectful Maternity Care’ could reduce their negative attitudes towards women in labour.

Epidemiological Profile and Outcome of Pregnancy Associated Acute Kidney Injury

Background: In developing countries, pregnancy-associated acute kidney injury (PAAKI) is a significant cause of maternal and neonatal mortality and morbidity. A systematic evaluation is essential to understand its frequency and severity in our setting. Objectives: Primary aim of our study was to evaluate the epidemiological profile and outcome of patients with pregnancy-associated acute kidney injury. Patients and Methods: The study was conducted in the Department of Nephrology, Rajshahi medical college hospital, from January 2019 to March 2020. A total of 83 patients with pregnancy-associated acute kidney injury were evaluated. Patients who had a history of chronic kidney disease or were diagnosed as a case of chronic kidney disease were excluded from the study.
 Result: The mean age±SD was 25.39±5.90 years. The majority were <30 years of age (56.6%). Only 24.1% had completed regular antenatal checkups. Preeclamsic toxaemia was present in 10.8% of patients. 85.5% of delivery was performed at hospitals/ clinics, and 75.9% of delivery was done by cesarean section. Unskilled birth attendants did 9.7% of delivery. Anaemia was present in 41.0% of patients at presentation, and 67.5% received a blood transfusion. Maternal mortality was 32.5%, and neonatal mortality was 21.7%. Renal replacement therapy was given in 56 (67.5%) patients. Among them, 47 (83.9%) received hemodialysis. Common causes of pregnancy-associated acute kidney injury were found to be sepsis (77.1%), postpartum hemorrhage (41.0%), disseminated intravascular coagulation (21.7%), severe preeclampsia (16.9%), HELLP syndrome (2.4%) and transfusion reaction (7.2%). 31.4% of patients recovered completely, and 10.8% of patients developed chronic kidney disease.
 Conclusion: Providing good quality perinatal care is essential to reduce the frequency of pregnancy-associated acute kidney injury and maternal and neonatal mortality related to this.
 TAJ 2022; 36: No-1: 127-134

Association of Maternal Height with Delivery Outcome

Background: Height is easy to measure and may serve as a triaging and referral tool in the rural communities of the West African subregion where a significant proportion of deliveries are undertaken by unskilled birth attendants with devastating maternal and perinatal outcomes. Objective: The objective of this study was to determine the association between maternal height and the route of delivery. Materials and Methods: This was a cross-sectional study undertaken at the Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria. A total of 180 consenting randomly selected pregnant participants who met the inclusion criteria and had presented in spontaneous labor at the maternity unit were selected for the study. Each participant's sociodemographic data, height, mode of delivery, and neonatal birth weight were obtained using a semistructured proforma. Data analysis was done using the Statistical Package for Social Sciences (IBM-SPSS) version 22, Atlanta, Georgia. Results: The mean age of the study participants was 30.4 ± 4.2 years and the mean height was 164.5 ± 6.1 cm. Approximately 82% of the women had vaginal delivery. Majority (96.6%) of the participants were booked and more than 75% have had previous vaginal delivery. There was no significant association between the maternal height and mode of delivery (P = 0.95). However, there was a significant association between neonatal birthweight and route of delivery (P < 0.001). Conclusion: There is no significant association between maternal height and route of delivery in Abakiliki, Nigeria. Although height has traditionally been used in participant counseling regarding potential route of delivery, this study shows that height may not serve as an evidence-based tool in screening or predicting the route of delivery in the Abakaliki metropolis. Further larger studies are advocated to corroborate or refute this observation

Systematic review and meta-analysis of maternal mortality ratio and related factors in the Islamic Republic of Iran.

Maternal mortality is an indication of the health status of women in the society. To investigate the maternal mortality ratio, causes of maternal mortality, and related risk factors among Iranian women. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the Peer Review of Electronic Search Strategies (PRESS) guideline, we systematically searched electronic databases, and the grey literature, for publications in Farsi and English from 1970 to January 2022 for studies that reported the number of maternal deaths and/or maternal mortality ratio and their related factors. Data analysis was conducted using Stata 16 and 2-sided P ≤ 0.05 was considered statistically significant, if not otherwise specified. A subgroup meta-analysis of studies conducted since 2000 estimated the maternal mortality ratio as 45.03 per 100 000 births during 2000-2004, 36.05 during 2005-2009, and 23.71 after 2010. The most frequent risk factors for maternal mortality were caesarean section, poor antenatal and delivery care, unskilled birth attendance, age, low maternal education level, lower human development index, and residence in rural or remote areas. There has been a significant decrease in maternal mortality in the Islamic Republic of Iran during the last few decades. Mothers in the country need to be monitored more carefully by trained healthcare workers during the pregnancy, delivery and postpartum periods so they can effectively handle postpartum complications, such as haemorrhage and infection, thereby further reducing maternal mortality.

Exploring the Factors Influencing Home Delivery: A Cross Sectional Study among Rural Residents in Tamale Metropolis

Introduction: Maternal and child mortality continues as a disturbing public health problem facing Ghana and other low and middle-income countries. As such there are advocacy for skilled birth delivery. Despite the advocacy, in most rural communities, unskilled delivery still persists. It is against this background that this study aims to explore the factors influencing home delivery among women in rural areas of Tamale Metropolis.
 Methods: The study employed the descriptive cross-sectional design with the mixed method approach. The study recruited 200 women within reproductive age of 18-49 who had delivered at least once in the selected rural communities in the Tamale Metropolis. Questionnaire and interview guide were used to collect data for this study. The data was analyzed using SPSS version 26 and manual thematic content analysis for quantitative and qualitative data respectively.
 Results: The prevalence of home delivery was reported as (36.5%) among the respondents. More than quarter (35.5%) of the respondents rate their satisfaction of home delivery as good whereas more than half of the respondents rated TBAs’ attitude as good. Three (3) qualitative respondents indicated that most women chose to deliver at home in neglect of hospital because of better satisfaction gained from delivering at home. The qualitative data showed that the factors identified to influence home delivery were as followed: negative attitude of health workers, lack of trust in health workers competence, unnecessary expenses from hospitals, distance, and poor quality of services. Nearly 90.0% of the respondents were enrolled on the NHIS with a proof of active NHIS card. Majority of the respondents were aware of the free maternal health services and all respondents agreed that they had a CHPs compound in their communities, however, only 36.5% responded in the affirmative that these CHPs compound are resourced adequately.
 Conclusion: The study showed a substantive percentage of the respondents to be practicing home delivery with the support of unskilled birth attendants. Poor attitudes from health workers, better previous experience in delivering at home, unreliable means of transport to the hospital and additional informal delivery expenses were some of the factors found to be significant determinants of home delivery. It is recommended for the government and other stakeholders to provide rural ambulance services to aid in the transport of pregnant women in labor to the nearest health facility.

Factors associated with unskilled birth attendance among women in sub-Saharan Africa: A multivariate-geospatial analysis of demographic and health surveys.

Several studies have shown that unskilled birth attendance is associated with maternal and neonatal morbidity, disability, and death in sub-Saharan Africa (SSA). However, little evidence exists on prevailing geospatial variations and the factors underscoring the patterns of unskilled birth attendance in the region. This study analysed the geospatial disparities and factors associated with unskilled birth attendance in SSA. The study is based on data from thirty (30) SSA countries captured in the latest (2010-2019) demographic and health surveys (DHS). A total of 200,736 women aged between 15-49 years were included in the study. Geospatial methods including spatial autocorrelation and hot spot analysis as well as logistic regression models were used to analyse the data. There were random spatial variations in unskilled birth attendance in SSA, with the main hotspot located in Chad, whereas South Africa and the Democratic Republic of Congo showed coldspots. Residence (urban or rural), wealth status, education, maternal age at the time of the survey and age at birth, desire for birth, occupation, media exposure, distance to a health facility, antenatal care visits, and deaths of under-five children showed significant associations with unskilled birth attendance. Random geospatial disparities in unskilled birth attendance exist in SSA, coupled with various associated socio-demographic determinants. Specific geospatial hotspots of unskilled birth attendance in SSA can be targeted for specialised interventions to alleviate the prevailing disparities.

Maternal Mortality in a Rural District of Pakistan and Contributing Factors.

Pakistan is among the ten countries that account for 60% of global maternal mortality. Lack of accurate data on maternal mortality and a complex interrelation of access and quality of healthcare services, healthcare delivery system, and socio-economic and demographic factors contribute significantly to inadequate progress in reducing maternal mortality. A population-based prospective cohort study was conducted in a rural district of Pakistan using data obtained from an enhanced surveillance system. A total of 7572 pregnancies and their outcomes were recorded by 273 Lady Health Workers and 73 Community Health Workers over 2016-2017. Logistic regression was used to calculate the unadjusted and adjusted odds ratios (OR) for maternal mortality for each risk factor. Population Attributable Fraction (PAF) was derived from the ORs and risk factor prevalence. The study recorded 18 maternal deaths. The maternal mortality rate was estimated at 238/100,000 pregnancies (95% CI 141-376), and the maternal mortality ratio was 247/100,000 live births (95% CI 147-391). Half of the maternal deaths (9) were from obstetric hemorrhage, and 28% (5) from puerperal sepsis. Postpartum hemorrhage was associated with a 17-fold higher risk of maternal mortality (PAF = 40%) and puerperal sepsis with a 12-fold higher mortality risk (PAF = 29%) compared to women without these conditions. Women delivered by unskilled birth attendants had a three-fold (PAF = 21%), and women having prolonged labour had a fourfold risk of maternal mortality compared to those with these conditions. Women with leg swelling (47%) and pre-eclampsia (26%) are at seven times the risk of maternal mortality compared to those without these conditions. Mortality in women delivered by unskilled birth attendants was three times higher than with skilled attendants. The study, among a few large-scale prospective cohort studies conducted at the community level in a rural district of Pakistan, provides a better understanding of the risk factors determining maternal mortality in Pakistan. Poverty emerged as a significant risk factor for maternal mortality in the study area and contributes to the underutilization of health facilities and skilled birth attendants. Incorporating poverty reduction strategies across all sectors, including health, is urgently required to address higher maternal mortality in Pakistan. A paradigm shift is required in Maternal and Child health related programs and interventions to include poverty estimation and measuring mortality through linking mortality surveillance with the Civil Registration and Vital Statistics system. Accelerated efforts to expand the coverage and completeness of mortality data with risk factors to address inequalities in access and utilization of health services.

Preference of homebirth and associated factors among pregnant women in Arba Minch health and demographic surveillance site, Southern Ethiopia.

Home birth preference is the need of pregnant women to give birth at their home with the help of traditional (unskilled) birth attendants. Homebirth with unskilled birth attendants during childbirth is the main leading indicator for maternal and newborn death. In Ethiopia, numbers of women prefer homebirth which is assisted by unskilled personal. However, there is no information regarding the problem in the Arba Minch zuria woreda. Therefore, it is important to identify prevalence of preference of homebirth and associated factors. This study aimed to assess the preference of home birth and associated factors among pregnant women in Arba Minch health and demographic surveillance site. A community-based cross-sectional study was conducted among pregnant women in Arba Minch health and demographic surveillance site, from May 1 to June 1, 2021. Using simple random sampling technique, 416 study samples were selected. Data were collected by interviewer-administered questionnaire. Data were coded and entered into Epi-Data version 4.4.2.1 computer software and exported to Statistical Package for Social Sciences software version 25 for analysis. Bi-variable binary logistic regression for the selection of potential candidate variables at p-value < 0.25 for multivariable analysis and multivariable binary logistic regression to identify the association between homebirth preference and independent variables were carried out. The level of statistical significance was declared at a p-value < 0.05. In this study, in Arba Minch demographic health surveillance site, the prevalence of preference of pregnant women to give birth at their home was 24% [95%CI: (19.9%-28.2%)] The factors significantly associated with the preference of home birth were husband involvement in decision making [AOR: 0.14 (0.05-0.38)], no access of road for transportation [AOR: 2.4 (1.2-5.18)], not heard about the benefit of institutional birth [AOR: 5.3 (2.3-12.2)], poor knowledge about danger signs [AOR: 3 (1.16-7.6)], negative attitude toward services [AOR: 3.1 (1.19-8.02)], and high fear to give birth at institution [AOR: 5.12 (2.4-10.91)]. In Arba Minch demographic health surveillance site, the prevalence of preference of pregnant women to give birth at their home was 24%. Husband involvement in decision making, no access of road for transportation, not heard about the benefit of institutional birth, poor knowledge about danger signs, negative attitude toward services, and high fear to give birth at health institutions were factors significantly associated with the preference of home birth.

Epidemiology of cerebral palsy among children in the remote Gorkha district of Nepal: findings from the Nepal cerebral palsy register

Purpose To describe the epidemiology of cerebral palsy (CP) among children in Gorkha, Nepal. Methods We established the first population-based register of children with CP aged <18 y in Gorkha, Nepal (i.e., Nepal CP Register). Children with suspected CP underwent detailed neurodevelopmental assessment by a multidisciplinary assessment team. Socio-demographic, etiology, motor severity, rehabilitation, and educational status were documented. Results Between January and October 2018, 182 children with confirmed CP were registered (mean (standard deviation (SD)) age: 10 years 1 months (4 years 10 months), 37.4% females). The majority (88.3%) had CP acquired pre- or perinatally. Mean (SD) age of CP diagnosis was four years five months. Mothers who did not receive any formal schooling had 4.5, 3.1, and 6.3 times higher odds of having inadequate antenatal care, homebirth, and unskilled birth attendants, respectively, when adjusted for other factors. Most children had spastic CP (77.5%) and Gross Motor Function Classification System level III-V (54.9%). Overall, 45.8% had never received rehabilitation services, 58.0% of school-aged children were not attending schools. The median age of receiving rehabilitation services was three years zero months. Conclusions The delayed diagnosis and clinical severity indicate the overall poor health status of children with CP in Nepal which could be improved by ensuring early diagnosis and intervention. Implications for rehabilitation The first population-based cerebral palsy register in Nepal suggests diagnosis of CP is considerably delayed among children. The high burden of severe motor impairment and poor communication skill with limited access to timely rehabilitation among children with CP in Nepal is concerning. Capacity development of community-based health workers and mothers of children with CP could help implementing community-based programs for prevention and early diagnosis of CP, and to promote early intervention for children with CP in remote Gorkha, Nepal.

Spatial and multilevel analysis of unskilled birth attendance in Chad

BackgroundUnskilled birth attendance is a major public health concern in Sub-Saharan Africa (SSA). Existing studies are hardly focused on the socio-demographic correlates and geospatial distribution of unskilled birth attendance in Chad (a country in SSA), although the country has consistently been identified as having one of the highest prevalence of maternal and neonatal deaths in the world. This study aimed to analyse the socio-demographic correlates and geospatial distribution of unskilled birth attendance in Chad.MethodsThe study is based on the latest Demographic and Health Survey (DHS) data for Chad. A total of 10,745 women aged between 15 and 49 years were included in this study. A multilevel analysis based on logistic regression was conducted to estimate associations of respondents’ socio-demographic characteristics with unskilled birth attendance. Geographic Information System (GIS) mapping tools, including Getis-Ord Gi hotspot analysis tool and geographically weighted regression (GWR) tool, were used to explore areas in Chad with a high prevalence of unskilled birth attendance.ResultsThe findings show that unskilled birth attendance was spatially clustered in four Chad departments: Mourtcha, Dar-Tama, Assoungha, and Kimiti, with educational level, occupation, birth desire, birth order, antenatal care, and community literacy identified as the spatial predictors of unskilled birth attendance. Higher educational attainment, higher wealth status, cohabitation, lowest birth order, access to media, not desiring more births, and higher antenatal care visits were associated with lower odds of unskilled birth attendance at the individual level. On the other hand, low community literacy level was associated with higher odds of unskilled birth attendance in Chad whereas the opposite was true for urban residency.ConclusionsUnskilled birth attendance is spatially clustered in some parts of Chad, and it is associated with various disadvantaged individual and community level factors. When developing interventions for unskilled birth attendance in Chad, concerned international bodies, the Chad government, maternal health advocates, and private stakeholders should consider targeting the high-risk local areas identified in this study.

Magnitude, trends and determinants of skilled delivery from Kilite-Awlaelo Health Demographic Surveillance System, Northern Ethiopia, 2009- 2017.

The fundamental approach to improve maternal and neonatal health is increasing skilled delivery rate. Women giving birth at health institutions can prevent maternal and neonatal deaths by getting skilled birth attendance. In Ethiopia, despite a significant decrease in maternal mortality over the past decade, still a significant number of women give birth at home. Moreover, evidence from population-based longitudinal studies on skilled delivery is limited. Therefore, this study aims to investigate the magnitude, trend, and determinants of skilled delivery in Kilite-Awlaelo Health Demographic Surveillance System (KA-HDSS), Northern Ethiopia. Population-based longitudinal study design was conducted by extracting data for nine consecutive years (2009-2017) from KA-HDSS database. In order to measure the trends of skilled delivery, KA-HDSS data sets were analyzed (2009-2017). Bivariate and multivariate analyses were performed using STATA version 16. A multivariable binary logistic regression model was fitted to assess determinants of skilled delivery and odds ratio with 95% CI was used to assess presence of associations at a 0.05 level of significance. The skilled delivery rate have continuously increased among reproductive age women from 15.12% (95% CI: 13.30% - 17.09%) in 2010 to 95.85% (95% CI: 94.58% - 96.895%) in 2017. The skilled delivery rate becomes high (> = 82) in the period of 2014-2017. Education, residence, marital status, occupation and antenatal care (ANC) visits were the most important determinants for skilled delivery among reproductive age women during the period of high skilled delivery rate (2014-2017). Women urban dwellers had about 28 times (AOR = 27.66; 95% CI: 3.86-196.97) higher odds to deliver by skilled birth attendants than rural dwellers. Unmarried women who gave birth were 2.18 (AOR: 2.18; 95% CI: 1.30-3.64) times more likely to have skilled delivery service compared to those married. Likewise, women with four or more ANC visits were 3.2 times more likely to undergo skilled delivery service than those having no ANC visits (AOR: 3.16; 95% CI: 2.33-4.28). Moreover, women having at least a secondary education were 2 times more likely to have skilled delivery service compared to those women with no formal education (AOR = 2.10, 95% CI: 1.18-3.74). Regardless of the importance of health facility delivery, a significant number of women still deliver at home attended by unskilled birth attendants. There has been a substantial increase in use of health facilities for delivery among women in the reproductive age. The factors affecting skilled delivery among reproductive age women were educational level, residence, marital status, occupation and use of ANC service. Maternal health related interventions are needed to change women's attitudes towards skilled delivery. Moreover, ANC coverage should be increased to improve skilled delivery service.

Prevalence, Risk Factors and Outcome of Perinatal Asphyxia in Newborns at Benue State University Teaching Hospital Makurdi

Perinatal asphyxia is a global neonatal problem, which significantly contributes to both neonatal morbidity and mortality. This study was therefore undertaken to determine the prevalence, risk factors and outcomes of perinatal asphyxia in Makurdi, Nigeria. A retrospective review of clinical data of all newborns managed at the Special Care Baby Unit of the Benue State University Teaching Hospital over a 5 year period (January 2015-December 2019) was carried out using the research clinical data form. Maternal information including biodata, obstetric history, perinatal events as well as neonates' presentation and outcomes were reviewed. All inborn neonates with Apgar scores &lt;7 at 5 min or out-born neonates with no recorded Apgar scores but with history of poor cry/inability to cry at birth were classified as asphyxiated. Out of the 1142 neonates admitted during the study period, 127 neonates had perinatal asphyxia with prevalence of 11.1%. Eighty-four (66.1%) of the newborns were males, while 43(33.9%) were females with male to female ratio of 1.95:1 Majority of the newborns(89.1%) were managed and discharged without early neurologic complications; eight survived with early neurologic complications, eight were discharged against medical advice, while 7 newborns died, giving a case fatality rate of 5.5%.Risk factors significantly associated were Meconium-stained amniotic fluid(P=0.002) ,fetal presentation (P=0.030),and birth attendants (P=0.001). The burden of perinatal asphyxia still persists in our environment. Associated factors in this study were meconium-stained liquor and unskilled birth attendants. Hence pregnant women should be encouraged to attend antenatal care and should ensure skilled birth attendants attend delivery with capacity to conduct safe delivery and institute neonatal resuscitation when necessary.

Multilevel geospatial analysis of factors associated with unskilled birth attendance in Ghana.

Globally, about 810 women die every day due to pregnancy and its related complications. Although the death of women during pregnancy or childbirth has declined from 342 deaths to 211 deaths per 100,000 live births between 2000 and 2017, maternal mortality is still higher, particularly in sub-Saharan Africa and South Asia, where 86% of all deaths occur. A secondary analysis was carried out using the 2014 Ghana Demographic and Health Survey. A sample total of 4,290 women who had a live birth in the 5 years preceding the survey was included in the analysis. GIS software was used to explore the spatial distribution of unskilled birth attendance in Ghana. The Geographic Weighted Regression (GWR) was employed to model the spatial relationship of some predictor of unskilled birth attendance. Moreover, a multilevel binary logistic regression model was fitted to identify factors associated with unskilled birth attendance. In this study, unskilled birth attendance had spatial variations across the country. The hotspot, cluster and outlier analysis identified the concerned districts in the north-eastern part of Ghana. The GWR analysis identified different predictors of unskilled birth attendance across districts of Ghana. In the multilevel analysis, mothers with no education, no health insurance coverage, and mothers from households with lower wealth status had higher odds of unskilled birth attendance. Being multi and grand multiparous, perception of distance from the health facility as not a big problem, urban residence, women residing in communities with medium and higher poverty level had lower odds of unskilled birth attendance. Unskilled birth attendance had spatial variations across the country. Areas with high levels of unskilled birth attendance had mothers who had no formal education, not health insured, mothers from poor households and communities, primiparous women, mothers from remote and border districts could get special attention in terms of allocation of resources including skilled human power, and improved access to health facilities.

Mapping Evidence of Neonatal Resuscitation Training on the Practices of Unskilled Birth Attendants in Low-Resource Countries: Protocol for a Scoping Review.

BackgroundCompetence in neonatal resuscitation of the newborn is very critical to ensure the safety and well-being of newborn infants. The acquisition of neonatal resuscitation skills by birth attendants improves self-efficacy, thereby reducing neonatal mortality as a result of asphyxia. Approximately one-quarter of all neonatal deaths globally are caused by birth asphyxia. The need for neonatal resuscitation is most imperative in resource-constrained settings, where access to intrapartum obstetric care is inadequate.ObjectiveThis protocol describes the methodology of a scoping review on evidence of training in neonatal resuscitation and its association with practice in low-resource countries. The aim of the review is to map the available evidence of neonatal resuscitation training on the practices of unskilled birth attendants.MethodsThe scoping review will use the Population, Concept, and Context (PCC) framework proposed by Arksey and O’Malley, refined by Levac et al, and published by Joanna Briggs Institute, while following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The search strategy was developed with the assistance of the college librarian. A number of databases of peer-reviewed research (PsycINFO and Wiley Online Library [via EBSCOhost], PubMed, MEDLINE with full text, Google Scholar [via ScienceDirect], and CINAHL Plus with full text [via EBSCOhost]) and databases committed to grey literature sources will be searched, and reference extraction will be performed. Two independent reviewers will screen and extract data, and discrepancies will be resolved by a third reviewer. The extracted data will undergo a descriptive analysis of contextual data and a quantitative analysis using appropriate statistical methods.ResultsData relating to neonatal resuscitation training and practices in low-resource settings will be extracted and included for analysis. We expect that the review will be completed 12 months from the publication of this protocol.ConclusionsThis scoping review will focus on the review of evidence and provide an insight into the existing literature to guide further research and identify implementation strategies to improve the practices of unskilled birth attendants through the acquisition of skills and self-efficacy in neonatal resuscitation. The results of this review will be presented at relevant conferences related to newborn and child health and neonatal nursing studies and published in a peer-reviewed journal.International Registered Report Identifier (IRRID)DERR1-10.2196/18935