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- Mgaya, Andrew, et al.
(författare)
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Optimizing the use of cesarean section in a low resource setting: Criteria-Based Audit at a tertiary referral hospital in Tanzania.
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Introduction. Substandard intrapartum care contributes to maternal and perinatal morbidity in low-resource settings. The aim was to estimate the impact of a criteria-based audit (CBA) of obstructed labour (OL) and fetal distress (FD), at a tertiary referral hospital in Tanzania. Material and Methods. The CBA included a baseline audit (December 2013-June 2014) followed by implementation of audit recommendations (March-June 2015). A before-and-after survey of maternal and perinatal outcomes included 499 patients with FD (baseline audit n=248; re-audit n=251) and 510 with OL (baseline n=260; re-audit n=250). Patients with OL and FD were grouped as OL (baseline audit n=82; re-audit n=76). The maternal and perinatal outcomes of 27,960 deliveries were analysed in 10 Robson groups, which are mutually exclusive and reproducible, unlike CS indications, FD and OL. Bivariate and multivariate logistic regression estimated the likelihood of CS, neonatal distress rate and perinatal mortality rate (PMR) after the CBA. Results. Perinatal morbidity and mortality decreased (16% vs. 8.8%; p=0.01) for the OL group. The likelihood of CS increased for nulliparous, singleton, breech, term pregnancies (Robson group 6) (adjusted odds ratio (aOR) 5.2, 95% confidence interval (CI); 1.4-19) and singleton, preterm pregnancies (Robson group 10) (aOR 1.6, 95%CI; 1.4-2.0). Similarly, the overall likelihood of CS increased (aOR 1.1, 95%CI; 1.1-1.2). The neonatal distress rate decreased for multiparas (excluding previous CS), singleton, term pregnancies (Robson group 3) (aOR 0.76, 0.62-0.95) and singleton, preterm pregnancies (aOR 0.30, 95%CI; 0.25-0.36). The singleton, preterm pregnancies also had a decreased PMR (aOR 0.58, 95%CI; 0.46-0.78). The overall neonatal distress and PMR were comparable before and after the CBA process. Conclusion: With the use of Robson classification we could demonstrate that CBA is a feasible and reliable tool that improved perinatal outcome of OL and optimized benefits of CS in relatively high- and low-risk pregnancies.
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- Numan Hellquist, Barbro, et al.
(författare)
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Effectiveness of population-based service screening with mammography for women ages 40 to 49 years with high and low risk of breast cancer : socioeconomic status, parity and age at birth of first child
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background Whether women in age 40-49 years should be invited to mammography screening or not is debated in many countries and a cost-effective alternative in countries with no screening in age 40-49 years could be selective screening i.e. inviting women at higher risk. In the current study relative effectiveness of mammography screening was estimated for subgroups based on the breast cancer risk factors parity, age at birth of first child and socioeconomic status (SES).Methods The SCReening of Young women (SCRY) database consist of all women in age 40-49 years in Sweden in 1986-2005 and is split into a study and control group. The study group consists of women in areas where women age 40-49 years were invited to screening and the control group of women in areas where women 40-49 years were not. Rate ratio (RR) estimates were calculated for risk groups. Two exposures were considered; invitation to mammography screening and attendance.Results There were striking similarities in the RR pattern for women invited to and attending in screening for all three risk factors and there was no statistically significant difference or trend in the RR by risk group. The RR estimates increased by increasing parity for parity 0 to 2 and ranged from 0.55 (95% CI 0.38-0.79) to 0.79 (95% CI 0.65-0.95) for women attending screening. The RR for white collar workers (low SES) was lower than for blue collar workers (high SES), 0.72 (95% CI 0.60-0.86) and 0.79 (95% CI 0.63-0.99) respectively for attending. For women 20-24 years at birth of first child RR was estimated at 0.73 (95% CI 0.58-0.91) for attending and estimates for other ages were similar.Conclusion There was no statistically significant difference in relative effectiveness of mammography screening by parity, age at birth of first child or socio-economic status.
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- Pembe, Andrea Barnabas, 1966-, et al.
(författare)
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Maternal referral system in Rufiji rural district in Tanzania
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Annan publikation (populärvet., debatt m.m.)abstract
- Objective: To evaluate the effectiveness of the maternal referral system through determining proportion of women reaching the hospitals after referral advice, appropriateness of the referral indications, reasons for non-compliance and to find out if compliance to referrals makes a difference in the perinatal outcome. Design: A prospective cohort study. Setting: Rufiji rural district, Tanzania. Study participants: One thousand five hundred and thirty eight women referred from 18 primary level of care facilities during the 13 months. Data collection: Referred women were identified at hospitals. Those not reaching the hospitals were traced and interviewed. Main outcome measures: Compliance to referral advice, reasons for non-compliance, appropriateness of referral indication, and perinatal outcome. Results: Out of 1538 women referred 70% were referred for demographic risks, 12% for historical obstetric risks, 12% for prenatal complications and 5.5% for natal and immediate postnatal complications. Five or more pregnancies as well as age <20 years were the most common referral indications. The compliance rate was 37% for women referred due to demographic risks and more than 50% among women referred in the other groups. Among women who did not comply with referral advice, almost half of them mentioned financial constraints as the major factor. Lack of compliance with the referral did not significantly increase the risk for a perinatal death. Conclusion: Majority of the maternal referrals were due to demographic risks, where few women complied. To improve compliance to maternal referrals there is need to review referral indications and strengthen counselling on birth preparedness and complication readiness.
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