Suchergebnisse

Background: Pre-eclampsia is a leading cause of maternal and fetal morbidity and mortality worldwide. Early detection and treatment have been instrumental in reducing case fatality in high-income countries. To achieve this in a low-income country, like Nigeria, community health workers who man primary health centres must have adequate knowledge and skills to identify and provide emergency care for women with pre-eclampsia. This study aimed to determine community health workers' knowledge and practice in the identification and treatment of pre-eclampsia, as they are essential providers of maternal care services in Nigeria. Methods: This study was part of a multi-country evaluation of community treatment of pre-eclampsia. Qualitative data were obtained from four Local Government Areas of Ogun State, in south western Nigeria by focus group discussions (N = 15) and in-depth interviews (N = 19). Participants included a variety of community-based health care providers - traditional birth attendants, community health extension workers, nurses and midwives, chief nursing officers, medical officers – and health administrators. Data were transcribed and validated with field notes and analysed with NVivo 10.0. Results: Community-based health care providers proved to be aware that pre-eclampsia was due to the development of hypertension and proteinuria in pregnant women. They had a good understanding of the features of the condition and were capable of identifying women at risk, initiating care, and referring women with this condition. However, some were not comfortable managing the condition because of the limitation in their 'Standing Order'; these guidelines do not explicitly authorize community health extension workers to treat pre-eclampsia in the community. Conclusion: Community-based health care providers were capable of identifying and initiating appropriate care for women with pre-eclampsia. These competencies combined with training and equipment availability could improve maternal health in the rural areas. There is a need for regular training and retraining to enable successful task-sharing with these cadres. Trial registration NCT01911494 . ; Medicine, Faculty of ; Other UBC ; Non UBC ; Obstetrics and Gynaecology, Department of ; Reviewed ; Faculty

ObjectiveTo generate a global reference for caesarean section (CS) rates at health facilities. DesignCross-sectional study. SettingHealth facilities from 43 countries. Population/SampleThirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10045875 women giving birth from 43 countries for model testing. MethodsWe hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. Main outcome measuresArea under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. ResultsAccording to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (). ConclusionsThis article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. Tweetable abstractThe C-Model provides a customized benchmark for caesarean section rates in health facilities and systems. Tweetable abstract The C-Model provides a customized benchmark for caesarean section rates in health facilities and systems. ; NICHD NIH HHS ; World Health Organization ; Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Social Med, Av Bandeirantes, BR-3900 Ribeirao Preto, Brazil ; WHO, World Bank Special Programme Res Dev & Res Traini, UNDP UNFPA UNICEF WHO, Dept Reprod Hlth & Res, CH-1211 Geneva, Switzerland ; Univ Paris 05, Sorbonne Paris Cite, UMR 216, Inst Dev Res, Paris, France ; WHO Reg Off Amer, Women & Reprod Hlth CLAP WR, Latin Amer Ctr Perinatol, Montevideo, Uruguay ; Emory Univ, Rollins Sch Publ Hlth, Dept Epidemiol, Atlanta, GA 30322 USA ; Paris Descartes Univ, Ctr Epidemiol & Biostat, Obstetr Perinatal & Pediat Epidemiol Res Team, Inserm U1153, Paris, France ; Natl Inst Publ Hlth, Ctr Populat Hlth Res, Cuernavaca, Morelos, Mexico ; Univ Technol, Fac Hlth, Sydney, NSW, Australia ; Natl Ctr Child Hlth & Dev, Dept Hlth Policy, Tokyo, Japan ; Ctr Rosarino Estudios Perinat, Rosario, Argentina ; Lindsay Stewart R&D Ctr, Off Res & Clin Audit, Royal Coll Obstetricians & Gynaecologists, London, England ; London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy, London WC1, England ; Shanghai Jiao Tong Univ, Sch Med, Xinhua Hosp, Shanghai Key Lab Childrens Environ Hlth,Minist Ed, Shanghai 200030, Peoples R China ; Univ Estadual Campinas, Sch Med Sci, Dept Obstet & Gynaecol, Campinas, SP, Brazil ; Family Hlth Bur, Minist Hlth, Colombo, Sri Lanka ; Fiocruz MS, ENSP, BR-21045900 Rio De Janeiro, Brazil ; Natl Inst Hlth & Welf, Helsinki, Finland ; Univ Tokyo, Grad Sch Med, Dept Paediat, Tokyo, Japan ; Bayer Krankenhausgesellschaft, Bayer Arbeitsgemeinschaft Qualitatssicherun Stati, Munich, Germany ; Khon Kaen Univ, Fac Med, Dept Obstet & Gynecol, Khon, Kaen, Thailand ; Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Obstet & Gynaecol, BR-14049 Ribeirao Preto, Brazil ; Minist Sante, Direct Sante Famille, Ouagadougou, Burkina Faso ; Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA ; Univ Mongolia, Hlth Sci, Sch Publ Hlth, Ulaanbaatar, Mongol Peo Rep ; GLIDE Tech Cooperat & Res, Ribeirao Preto, SP, Brazil ; Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Paediat, BR-14049 Ribeirao Preto, SP, Brazil ; Univ Calif San Francisco, Dept Obstet & Gynaecol & Global Hlth Sci, San Francisco, CA 94143 USA ; Khon Kaen Univ, Fac Publ Hlth, Dept Biostat & Demog, Khon Kaen, Thailand ; Univ Fed Sao Paulo, Sch Med Sao Paulo, Dept Obstet, Sao Paulo, Brazil ; Inter Amer Dev Bank, Social Protect & Hlth Div, Mexico City, DF, Mexico ; Fortis Mem Res Inst, Gurgaon, Haryana, India ; Hosp Nacl Itaugua, Itaugua, Paraguay ; Univ Fed Sao Paulo, Sch Med Sao Paulo, Dept Obstet, Sao Paulo, Brazil ; NICHD NIH HHS: T32 HD052460 ; World Health Organization: 001 ; Web of Science

ObjectiveTo generate a global reference for caesarean section (CS) rates at health facilities. DesignCross-sectional study. SettingHealth facilities from 43 countries. Population/SampleThirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10045875 women giving birth from 43 countries for model testing. MethodsWe hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. Main outcome measuresArea under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. ResultsAccording to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (). ConclusionsThis article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. Tweetable abstractThe C-Model provides a customized benchmark for caesarean section rates in health facilities and systems. Tweetable abstract The C-Model provides a customized benchmark for caesarean section rates in health facilities and systems. ; NICHD NIH HHS ; World Health Organization ; Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Social Med, Av Bandeirantes, BR-3900 Ribeirao Preto, Brazil ; WHO, World Bank Special Programme Res Dev & Res Traini, UNDP UNFPA UNICEF WHO, Dept Reprod Hlth & Res, CH-1211 Geneva, Switzerland ; Univ Paris 05, Sorbonne Paris Cite, UMR 216, Inst Dev Res, Paris, France ; WHO Reg Off Amer, Women & Reprod Hlth CLAP WR, Latin Amer Ctr Perinatol, Montevideo, Uruguay ; Emory Univ, Rollins Sch Publ Hlth, Dept Epidemiol, Atlanta, GA 30322 USA ; Paris Descartes Univ, Ctr Epidemiol & Biostat, Obstetr Perinatal & Pediat Epidemiol Res Team, Inserm U1153, Paris, France ; Natl Inst Publ Hlth, Ctr Populat Hlth Res, Cuernavaca, Morelos, Mexico ; Univ Technol, Fac Hlth, Sydney, NSW, Australia ; Natl Ctr Child Hlth & Dev, Dept Hlth Policy, Tokyo, Japan ; Ctr Rosarino Estudios Perinat, Rosario, Argentina ; Lindsay Stewart R&D Ctr, Off Res & Clin Audit, Royal Coll Obstetricians & Gynaecologists, London, England ; London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy, London WC1, England ; Shanghai Jiao Tong Univ, Sch Med, Xinhua Hosp, Shanghai Key Lab Childrens Environ Hlth,Minist Ed, Shanghai 200030, Peoples R China ; Univ Estadual Campinas, Sch Med Sci, Dept Obstet & Gynaecol, Campinas, SP, Brazil ; Family Hlth Bur, Minist Hlth, Colombo, Sri Lanka ; Fiocruz MS, ENSP, BR-21045900 Rio De Janeiro, Brazil ; Natl Inst Hlth & Welf, Helsinki, Finland ; Univ Tokyo, Grad Sch Med, Dept Paediat, Tokyo, Japan ; Bayer Krankenhausgesellschaft, Bayer Arbeitsgemeinschaft Qualitatssicherun Stati, Munich, Germany ; Khon Kaen Univ, Fac Med, Dept Obstet & Gynecol, Khon, Kaen, Thailand ; Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Obstet & Gynaecol, BR-14049 Ribeirao Preto, Brazil ; Minist Sante, Direct Sante Famille, Ouagadougou, Burkina Faso ; Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA ; Univ Mongolia, Hlth Sci, Sch Publ Hlth, Ulaanbaatar, Mongol Peo Rep ; GLIDE Tech Cooperat & Res, Ribeirao Preto, SP, Brazil ; Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Paediat, BR-14049 Ribeirao Preto, SP, Brazil ; Univ Calif San Francisco, Dept Obstet & Gynaecol & Global Hlth Sci, San Francisco, CA 94143 USA ; Khon Kaen Univ, Fac Publ Hlth, Dept Biostat & Demog, Khon Kaen, Thailand ; Univ Fed Sao Paulo, Sch Med Sao Paulo, Dept Obstet, Sao Paulo, Brazil ; Inter Amer Dev Bank, Social Protect & Hlth Div, Mexico City, DF, Mexico ; Fortis Mem Res Inst, Gurgaon, Haryana, India ; Hosp Nacl Itaugua, Itaugua, Paraguay ; Univ Fed Sao Paulo, Sch Med Sao Paulo, Dept Obstet, Sao Paulo, Brazil ; NICHD NIH HHS: T32 HD052460 ; World Health Organization: 001 ; Web of Science