Browsing by Subject "Perinatal mortality"

Now showing 1 - 5 of 5
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    First look: a cluster-randomized trial of ultrasound to improve pregnancy outcomes in low income country settings
    (Springer Nature, 2014-02-17) McClure, Elizabeth M.; Nathan, Robert O.; Saleem, Sarah; Esamai, Fabian; Garces, Ana; Chomba, Elwyn; Tshefu, Antoinette; Swanson, David; Mabeya, Hillary; Figuero, Lester; Mirza, Waseem; Muyodi, David; Franklin, Holly; Lokangaka, Adrien; Bidashimwa, Dieudonne; Pasha, Omrana; Mwenechanya, Musaku; Bose, Carl L.; Carlo, Waldemar A.; Hambidge, K. Michael; Liechty, Edward A.; Krebs, Nancy; Wallace, Dennis D.; Swanson, Jonathan; Koso-Thomas, Marion; Widmer, Rexford; Goldenberg, Robert L.; Pediatrics, School of Medicine
    Background: In high-resource settings, obstetric ultrasound is a standard component of prenatal care used to identify pregnancy complications and to establish an accurate gestational age in order to improve obstetric care. Whether or not ultrasound use will improve care and ultimately pregnancy outcomes in low-resource settings is unknown. Methods/design: This multi-country cluster randomized trial will assess the impact of antenatal ultrasound screening performed by health care staff on a composite outcome consisting of maternal mortality and maternal near-miss, stillbirth and neonatal mortality in low-resource community settings. The trial will utilize an existing research infrastructure, the Global Network for Women's and Children's Health Research with sites in Pakistan, Kenya, Zambia, Democratic Republic of Congo and Guatemala. A maternal and newborn health registry in defined geographic areas which documents all pregnancies and their outcomes to 6 weeks post-delivery will provide population-based rates of maternal mortality and morbidity, stillbirth, neonatal mortality and morbidity, and health care utilization for study clusters. A total of 58 study clusters each with a health center and about 500 births per year will be randomized (29 intervention and 29 control). The intervention includes training of health workers (e.g., nurses, midwives, clinical officers) to perform ultrasound examinations during antenatal care, generally at 18-22 and at 32-36 weeks for each subject. Women who are identified as having a complication of pregnancy will be referred to a hospital for appropriate care. Finally, the intervention includes community sensitization activities to inform women and their families of the availability of ultrasound at the antenatal care clinic and training in emergency obstetric and neonatal care at referral facilities. Discussion: In summary, our trial will evaluate whether introduction of ultrasound during antenatal care improves pregnancy outcomes in rural, low-resource settings. The intervention includes training for ultrasound-naïve providers in basic obstetric ultrasonography and then enabling these trainees to use ultrasound to screen for pregnancy complications in primary antenatal care clinics and to refer appropriately.
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    Helping Babies Breathe (HBB) training: What happens to knowledge and skills over time?
    (Springer Nature, 2016-11-22) Bang, Akash; Patel, Archana; Bellad, Roopa; Gisore, Peter; Goudar, Shivaprasad S.; Esamai, Fabian; Liechty, Edward A.; Meleth, Sreelatha; Goco, Norman; Niermeyer, Susan; Keenan, William; Kamath-Rayne, Beena D.; Little, George A.; Clarke, Susan B.; Flanagan, Victoria A.; Bucher, Sherri; Jain, Manish; Mujawar, Nilofer; Jain, Vinita; Rukunga, Janet; Mahantshetti, Niranjana; Dhaded, Sangappa; Bhandankar, Manisha; McClure, Elizabeth M.; Carlo, Waldemar A.; Wright, Linda L.; Hibberd, Patricia L.; Pediatrics, School of Medicine
    Background: The first minutes after birth are critical to reducing neonatal mortality. Helping Babies Breathe (HBB) is a simulation-based neonatal resuscitation program for low resource settings. We studied the impact of initial HBB training followed by refresher training on the knowledge and skills of the birth attendants in facilities. Methods: We conducted HBB trainings in 71 facilities in the NICHD Global Network research sites (Nagpur and Belgaum, India and Eldoret, Kenya), with a 6:1 ratio of facility trainees to Master Trainers (MT). Because of staff turnover, some birth attendants (BA) were trained as they joined the delivery room staff, after the initial training was completed (catch-up initial training). We compared pass rates for skills and knowledge pre- and post- initial HBB training and following refresher training among active BAs. An Objective Structured Clinical Examination (OSCE) B tested resuscitation skill retention by comparing post-initial training performance with pre-refresher training performance. We identified factors associated with loss of skills in pre-refresher training performance using multivariable logistic regression analysis. Daily bag and mask ventilation practice, equipment checks and supportive supervision were stressed as part of training. Results: One hundred five MT (1.6 MT per facility) conducted initial and refresher HBB trainings for 835 BAs; 76% had no prior resuscitation training. Initial training improved knowledge and skills: the pass percentage for knowledge tests improved from 74 to 99% (p < 0.001). Only 5% could ventilate a newborn mannequin correctly before initial training but 97% passed the post-initial ventilation training test (p < 0.0001) and 99% passed the OSCE B resuscitation evaluation. During pre-refresher training evaluation, a mean of 6.7 (SD 2.49) months after the initial training, 99% passed the knowledge test, but the successful completion rate fell to 81% for the OSCE B resuscitation skills test. Characteristics associated with deterioration of resuscitation skills were BAs from tertiary care facilities, no prior resuscitation training, and the timing of training (initial vs. catch-up training). Conclusions: HBB training significantly improved neonatal resuscitation knowledge and skills. However, skills declined more than knowledge over time. Ongoing skills practice and monitoring, more frequent retesting, and refresher trainings are needed to maintain neonatal resuscitation skills.
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    Home birth attendants in low income countries: who are they and what do they do?
    (Springer Nature, 2012-05-14) Garces, Ana; McClure, Elizabeth M.; Chomba, Elwyn; Patel, Archana; Pasha, Omrana; Tshefu, Antoinette; Esamai, Fabian; Goudar, Shivaprasad; Lokangaka, Adrien; Hambidge, K. Michael; Wright, Linda L.; Koso-Thomas, Marion; Bose, Carl; Carlo, Waldemar A.; Liechty, Edward A.; Hibberd, Patricia L.; Bucher, Sherri; Whitworth, Ryan; Goldenberg, Robert L.; Pediatrics, School of Medicine
    Background: Nearly half the world's babies are born at home. We sought to evaluate the training, knowledge, skills, and access to medical equipment and testing for home birth attendants across 7 international sites. Methods: Face-to-face interviews were done by trained interviewers to assess level of training, knowledge and practices regarding care during the antenatal, intrapartum and postpartum periods. The survey was administered to a sample of birth attendants conducting home or out-of-facility deliveries in 7 sites in 6 countries (India, Pakistan, Guatemala, Democratic Republic of the Congo, Kenya and Zambia). Results: A total of 1226 home birth attendants were surveyed. Less than half the birth attendants were literate. Eighty percent had one month or less of formal training. Most home birth attendants did not have basic equipment (e.g., blood pressure apparatus, stethoscope, infant bag and mask manual resuscitator). Reporting of births and maternal and neonatal deaths to government agencies was low. Indian auxilliary nurse midwives, who perform some home but mainly clinic births, were far better trained and differed in many characteristics from the birth attendants who only performed deliveries at home. Conclusions: Home birth attendants in low-income countries were often illiterate, could not read numbers and had little formal training. Most had few of the skills or access to tests, medications and equipment that are necessary to reduce maternal, fetal or neonatal mortality.
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    Maternal Opioid Drug Use during Pregnancy and Its Impact on Perinatal Morbidity, Mortality, and the Costs of Medical Care in the United States
    (Hindawi, 2014) Whiteman, Valerie E.; Salemi, Jason L.; Mogos, Mulubrhan F.; Cain, Mary Ashley; Aliyu, Muktar H.; Salihu, Hamisu M.; School of Nursing
    Objective: To identify factors associated with opioid use during pregnancy and to compare perinatal morbidity, mortality, and healthcare costs between opioid users and nonusers. Methods: We conducted a cross-sectional analysis of pregnancy-related discharges from 1998 to 2009 using the largest publicly available all-payer inpatient database in the United States. We scanned ICD-9-CM codes for opioid use and perinatal outcomes. Costs of care were estimated from hospital charges. Survey logistic regression was used to assess the association between maternal opioid use and each outcome; generalized linear modeling was used to compare hospitalization costs by opioid use status. Results: Women who used opioids during pregnancy experienced higher rates of depression, anxiety, and chronic medical conditions. After adjusting for confounders, opioid use was associated with increased odds of threatened preterm labor, early onset delivery, poor fetal growth, and stillbirth. Users were four times as likely to have a prolonged hospital stay and were almost four times more likely to die before discharge. The mean per-hospitalization cost of a woman who used opioids during pregnancy was $5,616 (95% CI: $5,166-$6,067), compared to $4,084 (95% CI: $4,002-$4,166) for nonusers. Conclusion: Opioid use during pregnancy is associated with adverse perinatal outcomes and increased healthcare costs.
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    The efficacy of low-dose aspirin in pregnancy among women in malaria-endemic countries
    (Springer, 2022-04-10) Bauserman, Melissa; Leuba, Sequoia I.; Hemingway-Foday, Jennifer; Nolen, Tracy L.; Moore, Janet; McClure, Elizabeth M.; Lokangaka, Adrien; Tsehfu, Antoinette; Patterson, Jackie; Liechty, Edward A.; Esamai, Fabian; Carlo, Waldemar A.; Chomba, Elwyn; Goldenberg, Robert L.; Saleem, Sarah; Jessani, Saleem; Koso-Thomas, Marion; Hoffman, Matthew; Derman, Richard J.; Meshnick, Steven R.; Bose, Carl L.; Pediatrics, School of Medicine
    Background Low dose aspirin (LDA) is an effective strategy to reduce preterm birth. However, LDA might have differential effects globally, based on the etiology of preterm birth. In some regions, malaria in pregnancy could be an important modifier of LDA on birth outcomes and anemia. Methods This is a sub-study of the ASPIRIN trial, a multi-national, randomized, placebo controlled trial evaluating LDA effect on preterm birth. We enrolled a convenience sample of women in the ASPIRIN trial from the Democratic Republic of Congo (DRC), Kenya and Zambia. We used quantitative polymerase chain reaction to detect malaria. We calculated crude prevalence proportion ratios (PRs) for LDA by malaria for outcomes, and regression modelling to evaluate effect measure modification. We evaluated hemoglobin in late pregnancy based on malaria infection in early pregnancy. Results One thousand four hundred forty-six women were analyzed, with a malaria prevalence of 63% in the DRC site, 38% in the Kenya site, and 6% in the Zambia site. Preterm birth occurred in 83 (LDA) and 90 (placebo) women, (PR 0.92, 95% CI 0.70, 1.22), without interaction between LDA and malaria (p = 0.75). Perinatal mortality occurred in 41 (LDA) and 43 (placebo) pregnancies, (PR 0.95, 95% CI 0.63, 1.44), with an interaction between malaria and LDA (p = 0.014). Hemoglobin was similar by malaria and LDA status. Conclusions Malaria in early pregnancy did not modify the effects of LDA on preterm birth, but modified the effect of LDA on perinatal mortality. This effect measure modification deserves continued study as LDA is used in malaria endemic regions.