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2. A cluster randomized controlled trial of an electronic decision-support system to enhance antenatal care services in pregnancy at primary healthcare level in Telangana, India: trial protocol

Author

Mohan, Sailesh, Chaudhry, Monica, McCarthy, Ona, Jarhyan, Prashant, Calvert, Clara, Jindal, Devraj, Shakya, Rajani, Radovich, Emma, Kondal, Dimple, Penn-Kekana, Loveday, Basany, Kalpana, Roy, Ambuj, Tandon, Nikhil, Shrestha, Abha, Shrestha, Abha, Karmacharya, Biraj, Cairns, John, Perel, Pablo, Campbell, Oona M. R., and Prabhakaran, Dorairaj

Published
2023
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15. Where women go to deliver: understanding the changing landscape of childbirth in Africa and Asia.

Author

Montagu, Dominic, Sudhinaraset, May, Diamond-Smith, Nadia, Campbell, Oona, Gabrysch, Sabine, Freedman, Lynn, Kruk, Margaret E, and Donnay, France

Subjects
Birth demographic shift, childbirth, developing countries, facility-based delivery, health care, home-delivery, location, maternal health, quality, safe delivery, Africa, Asia, Delivery, Obstetric, Developing Countries, Female, Health Facilities, Health Policy, Humans, Maternal Health Services, Pregnancy, Rural Population, Delivery, Obstetric, Health Policy & Services, Public Health and Health Services, Policy and Administration, Political Science
Abstract

Growing evidence from a number of countries in Asia and Africa documents a large shift towards facility deliveries in the past decade. These increases have not led to the improvements in health outcomes that were predicted by health policy researchers in the past. In light of this unexpected evidence, we have assessed data from multiple sources, including nationally representative data from 43 countries in Asia and Africa, to understand the size and range of changing delivery location in Asia and Africa. We have reviewed the policies, programs and financing experiences in multiple countries to understand the drivers of changing practices, and the consequences for maternal and neonatal health and the health systems serving women and newborns. And finally, we have considered what implications changes in delivery location will have for maternal and neonatal care strategies as we move forward into the next stage of global action. As a result of our analysis we make four major policy recommendations. (1) An expansion of investment in mid-level facilities for delivery services and a shift away from low-volume rural delivery facilities. (2) Assured access for rural women through funding for transport infrastructure, travel vouchers, targeted subsidies for services and residence support before and after delivery. (3) Increased specialization of maternity facilities and dedicated maternity wards within larger institutions. And (4) a renewed focus on quality improvements at all levels of delivery facilities, in both private and public settings.

Published
2017

32. Associations between cesarean delivery and child mortality: A national record linkage longitudinal study of 17.8 million births in Brazil

Author

Paixao, Enny S., Bottomley, Christian, Pescarini, Julia M., Wong, Kerry L. M., Cardim, Luciana L., Ribeiro Silva, Rita de Cássia, Brickley, Elizabeth B., Rodrigues, Laura C., Oliveira Alves, Flavia Jôse, Leal, Maria do Carmo, Costa, Maria da Conceicao N., Teixeira, Maria Gloria, Ichihara, Maria Yury, Smeeth, Liam, Barreto, Mauricio L., and Campbell, Oona M. R.

Subjects
Infants -- Patient outcomes, Cesarean section -- Patient outcomes -- Statistics, Pediatric research, Biological sciences
Abstract

Background There is an increasing use of cesarean delivery (CD) based on preference rather than on medical indication. However, the extent to which nonmedically indicated CD benefits or harms child survival remains unclear. Our hypothesis was that in groups with a low indication for CD, this procedure would be associated with higher child mortality and in groups with a clear medical indication CD would be associated with improved child survival chances. Methods and findings We conducted a population-based cohort study in Brazil by linking routine data on live births between January 1, 2012 and December 31, 2018 and assessing mortality up to 5 years of age. Women with a live birth who contributed records during this period were classified into one of 10 Robson groups based on their pregnancy and delivery characteristics. We used propensity scores to match CD with vaginal deliveries (1:1) and prelabor CD with unscheduled CD (1:1) and estimated associations with child mortality using Cox regressions. A total of 17,838,115 live births were analyzed. After propensity score matching (PSM), we found that live births to women in groups with low expected frequencies of CD (Robson groups 1 to 4) had a higher death rate up to age 5 years if they were born via CD compared with vaginal deliveries (HR = 1.25, 95% CI: 1.22 to 1.28; p < 0.001). The relative rate was greatest in the neonatal period (HR = 1.39, 95% CI: 1.34 to 1.45; p < 0.001). There was no difference in mortality rate when comparing offspring born by a prelabor CD to those born by unscheduled CD. For the live births to women with a CD in a prior pregnancy (Robson group 5), the relative rates for child mortality were similar for those born by CD compared with vaginal deliveries (HR = 1.05, 95% CI: 1.00 to 1.10; p = 0.024). In contrast, for live births to women in groups with high expected rates of CD (Robson groups 6 to 10), the child mortality rate was lower for CD than for vaginal deliveries (HR = 0.90, 95% CI: 0.89 to 0.91; p < 0.001), particularly in the neonatal period (HR = 0.84, 95% CI: 0.83 to 0.85; p < 0.001). Our results should be interpreted with caution in clinical practice, since relevant clinical data on CD indication were not available. Conclusions In this study, we observed that in Robson groups with low expected frequencies of CD, this procedure was associated with a 25% increase in child mortality. However, in groups with high expected frequencies of CD, the findings suggest that clinically indicated CD is associated with a reduction in child mortality., Author(s): Enny S. Paixao 1,2,*, Christian Bottomley 1, Julia M. Pescarini 1,2, Kerry L. M. Wong 1, Luciana L. Cardim 2, Rita de Cássia Ribeiro Silva 2,3, Elizabeth B. Brickley [...]

Published
2021
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33. Effects of size at birth on health, growth and developmental outcomes in children up to age 18: an umbrella review.

Author

Jamaluddine, Zeina, Sharara, Eman, Helou, Vanessa, El Rashidi, Nadine, Safadi, Gloria, El-Helou, Nehmat, Ghattas, Hala, Miho Sato, Blencowe, Hannah, and Campbell, Oona M. R.

Subjects
BIRTH size, FETAL macrosomia, LOW birth weight, SKIN cancer, PREMATURE infants, VERY low birth weight, SMALL for gestational age, JUNK food, BABY foods
Published
2023
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41. Additional file 1 of Readiness of health facilities to provide safe childbirth in Liberia: a cross-sectional analysis of population surveys, facility censuses and facility birth records

Author

King, Jessica, Tarway-Twalla, Alfred K., Dennis, Mardieh, Twalla, Musu Pusah, Konwloh, Patrick K., Wesseh, Chea Sanford, Tehoungue, Bentoe Zoogley, Saydee, Geetor S., Campbell, Oona, and Ronsmans, Carine

Abstract

Additional file 1: Fig. S1. Yearly volume of births in health facilities in Liberia (SARA 2018 and HMIS 2019). Table S1. Location of delivery indicators definitions. Table S2. EmONC signal functions definitions. Table S3. Place of delivery by midpoint of DHS recall period and location type. Table S4. Facilities in SARA 2018 offering delivery services. Table S5. Individual EmONC signal functions and EmONC classification by facility level and sector. Table S6. Individual EmONC signal functions and EmONC classification by facility volume. Table S7. Skilled birth attendants by cadre, SARA 2018.

Published
2023
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42. Assessing the potential of two electronic decision support systems to improve the quality of antenatal care in primary care facilities in Nepal: study protocol

Author

Radovich, Emma, Penn-Kekana, Loveday, Karki, Sulata, Das, Seema, Shakya, Rajani, Campbell, Oona M. R., McCarthy, Ona, Jarhyan, Prashant, Mishra, Aparajita, Karmacharya, Biraj, and Shrestha, Abha

Abstract

Introduction Good quality antenatal care plays an important role in reducing maternal and perinatal mortality, including in high-burden settings like Nepal. Electronic decision support systems (EDSS) aim to promote adherence to evidence-based guidelines. This protocol outlines the outcome and process evaluation of two tablet-based EDSS, the Mobile health Integrated Rural Antenatal care (mIRA) EDSS and the World Health Organization’s ANC Reference Application EDSS, on improving antenatal care quality in primary-level healthcare facilities in Nepal. The outcome evaluation aims to assess the effectiveness of the intervention on quality of antenatal care. The process evaluation aims to inform interpretation of outcome results and to improve understanding of the implementation process and intervention effects, addressing the research question: why or how does an EDSS influence quality of antenatal care and in what circumstances? Methods and analysis The pre-post outcome and theory-driven, mixed-methods process evaluation will assess implementation fidelity and improvements in the performance of selected antenatal care components, explore the implementation process and contextual factors, and examine causal mechanisms leading to change in antenatal care quality. Data for quantitative and qualitative analyses will be collected at multiple time points, and initial analyses of quantitative and qualitative data completed separately. Results will be integrated using convergent parallel-databases triangulation to develop explanations about the implementation process—over time and across settings—and the effects observed. Ethics and dissemination Ethical approval for this study was obtained from ethics committees at Kathmandu University School of Medical Sciences, Nepal Health Research Council and the London School of Hygiene & Tropical Medicine. Results will be disseminated through academic publications, stakeholder workshops, conference presentations and reports.

Published
2023
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