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1. Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study

Author

Mercedes Bonet, Vanessa Brizuela, Edgardo Abalos, Cristina Cuesta, Adama Baguiya, Mónica Chamillard, Bukola Fawole, Marian Knight, Seni Kouanda, Pisake Lumbiganon, Ashraf Nabhan, Ruta J Nadisauskiene, Abdulfetah Abdulkadir, Richard MK Adanu, Mohammad Iqbal Aman, William E. Arriaga Romero, Bouchra Assarag, Kitty W.M. Bloemenkamp, Aigul Boobekova, Mihaela A. Budianu, Vicenç Cararach, Rigoberto Castro, Sylvia Cebekhulu, José Guilherme Cecatti, Lotte Berdiin Colmorn, Ala Curteanu, Serena Donati, Hla Mya Thway Einda, Yasser Salah El Deen, Faysal El Kak, Mohamed Elsheikh, Maria F Escobar-Vidarte, Marisa Mabel Espinoza, María Ester Estrada, Luis Aaron Gadama, Sourou B Goufodji, Saima Hamid, Rosalinda Hernandez Munoz, Nazarea Herrera Maldonado, Kapila Jayaratne, Saule Kabylova, Alexandra Kristufkova, Vijay Kumar, David Lissauer, Wilson Mereci, Meile Minkauskiene, Philippe Moreira, Stephen Munjanja, Nafissa B. Osman, Henri Gautier Ouedraogo, Aquilino M. Perez, Julia Pasquale, Lucian Puscasiu, Zahida Qureshi, Zenaida Recidoro, Carolina C. Ribeiro-do-Valle, Dhammica Rowel, Hamadoun Sangho, Amir Babu Shrestha, Thitiporn Siriwachirachai, Pierre Marie Tebeu, Khaing Nwe Tin, Dinh Anh Tuan, Rathavy Tung, Griet Vandenberghe, Buyanjargal Yadamsuren, Dilrabo Yunusova, Nelly Zavaleta Pimentel, Bashir Noormal, Virginia Díaz, Charlotte Leroy, Kristien Roelens, M. Christian Urlyss Agossou, Christiane Tshabu Aguemon, Patricia Soledad Apaza Peralta, Víctor Conde Altamirano, Vincent Batiene, Kadari Cisse, Kannitha Cheang, Phirun Lam, Elie Simo, Emah Irene Yakana, Javier Carvajal, Paula Fernández, Jens Langhoff-Roos, Paola Vélez, Alaa Sultan, Alula M. Teklu, Dawit Worku, Philip Govule, Charles Noora Lwanga, María Guadalupe Flores Aceituno, Carolina Bustillo, Bredy Lara, Vanita Suri, Sonia Trikha, Irene Cetin, Carlo Personeni, Guldana Baimussanova, Balgyn Sagyndykova, George Gwako, Alfred Osoti, Raisa Asylbasheva, Damira Seksenbaeva, Saad Eddine Itani, Sabina Abou Malham, Diana Ramašauskaitė, Owen Chikhwaza, Eddie Malunga, Haoua Dembele, Fanta Eliane Zerbo, Filiberto Dávila Serapio, Juan I. Islas Castañeda, Tatiana Cauaus, Victor Petrov, Seded Khishgee, Bat-Erdene Lkhagvasuren, Amina Essolbi, Rachid Moulki, Zara Jaze, Arlete Mariano, Thae Maung Maung, Tara Gurung, Sangeeta Shrestha, Marcus J. Rijken, Thomas Van Den Akker, María Esther Estrada, Néstor J. Pavón Gómez, Olubukola Adesina, Chris Aimakhu, Rizwana Chaudhri, M. Adnan Khan, María del Pilar Huatuco Hernández, Maria Lu Andal, Carolina Paula Martin, Léopold Diouf, Dembo Guirassy, Miroslav Borovsky, Ladislav Kovac, Laura Cornelissen, Priya Soma-Pillay, Marta López, María José Vidal Benedé, Hemali Jayakody, Wisal Nabag, Sara Omer, Victoria Tsoy, Urunbish Uzakova, Thumwadee Tangsiriwatthana, Catherine Dunlop, Jhon Roman, Gerardo Vitureira, Luong Ngoc Truong, Nghiem Thi Xuan Hanh, Mugove Madziyire, Thulani Magwali, Linda Bartlett, Fernando Bellissimo-Rodrigues, Shevin T. Jacob, Sadia Shakoor, Khalid Yunis, Liana Campodónico, Hugo Gamerro, Daniel Giordano, Fernando Althabe, A. Metin Gülmezoglu, and João Paulo Souza

Subjects
Public aspects of medicine, RA1-1270
Abstract

Summary: Background: Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management. Methods: We did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups. Findings: Between Nov 28, 2017, and Dec 4, 2017, of 2965 women assessed for eligibility, 2850 pregnant or recently pregnant women with suspected or confirmed infection were included. 70·4 (95% CI 67·7–73·1) hospitalised women per 1000 livebirths had a maternal infection, and 10·9 (9·8–12·0) women per 1000 livebirths presented with infection-related (underlying or contributing cause) severe maternal outcomes. Highest ratios were observed in LMICs and the lowest in HICs. The proportion of intrahospital fatalities was 6·8% among women with severe maternal outcomes, with the highest proportion in low-income countries. Infection-related maternal deaths represented more than half of the intrahospital deaths. Around two-thirds (63·9%, n=1821) of the women had a complete set of vital signs recorded, or received antimicrobials the day of suspicion or diagnosis of the infection (70·2%, n=1875), without marked differences across severity groups. Interpretation: The frequency of maternal infections requiring management in health facilities is high. Our results suggest that contribution of direct (obstetric) and indirect (non-obstetric) infections to overall maternal deaths is greater than previously thought. Improvement of early identification is urgently needed, as well as prompt management of women with infections in health facilities by implementing effective evidence-based practices. Funding: UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Merck for Mothers, and United States Agency for International Development.

Published
2020
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2. PW 2909 Impact assessment of the rural response system to reduce violence against women in the central region of ghana: results from a cluster randomized controlled trial

Author

Esnat Chirwa, Adolphina Addo-Lartey, Richard Mk Adanu, Yandisa Sikweyiya, Dorcas Coker-Appiah, Rachel Jewkes, and Deda Ogum Alangea

Subjects
medicine.medical_specialty, Impact assessment, business.industry, Public health, Developing country, Disease cluster, Mental health, law.invention, Randomized controlled trial, law, Intervention (counseling), Environmental health, medicine, Domestic violence, business
Abstract

Background Violence against women by their intimate partners, remains a global public health concern due to its adverse health consequences to the victims. Strong empirical evidence show that intimate partner violence (IPV) constitutes the largest form of violence experience by women. IPV impacts women’s physical, reproductive and mental health. The trial assessed the community level impact of the Rural Response System for preventing/reducing intimate partner violence perpetration against women in Ghana. Method The trial is a two-arm unmatched cluster randomised controlled that was done in rural and urban communities in 4 districts located in the Central Region of Ghana. The intervention arm received the rural response system package for preventing VAW while the control arm received no intervention. The trial was conducted over a period of 36 months with prevalence of IPV perpetration by men and experience among women assessed at baseline in the 4 districts. The baseline assessment was followed by 18 months of intervention conducted in 2 districts. Results The presentation will show if the intervention has been effective in reducing intimate partner violence against women. We anticipate significant reduction in men’s reported perpetration and/or women’s reported experience of IPV in the intervention districts. It is also anticipated that there will be positive change in men’s and women’s gender equitable attitudes, and a positive shift in community attitudes towards violence against women. Conclusion The results will provide evidence on the effectiveness of a targeted VAW intervention in the Ghanaian society that is needed to inform the development of national policies for preventing VAW which may also be replicated in other developing countries.

Published
2018

3. Hysterectomy for uterine fibroids in Nullipara at Korle Bu Teaching Hospital, Ghana

Author

Richard Mk Adanu and Joseph D. Seffah

Subjects
Ghanaian, nulliparous, fibroids, hysterectomy, litigation, medicine.medical_specialty, Hysterectomy, Obstetrics and gynaecology, Obstetrics, business.industry, Uterine fibroids, medicine.medical_treatment, medicine, business, medicine.disease, Teaching hospital
Abstract

Introduction: Uterine fibroids are common in Ghana and they constitute about 40%of the major gynaecological operations in Accra. Objective: To determine the factors predisposing nullipara to hysterectomy Design: A retrospective case-control study Setting: The Korle Bu Teaching Hospital, Accra, Ghana between January 2002 and September 2003. Method: A study of nullipara who had surgery for uterine fibroids. Data were extracted from operation records, patient clinical notes and histopathology reports. Comparisons were made using chi squared and t tests. Results: Thirty eight hysterectomy cases and 52 myomectomy controls were studied. Only 3 (7.9%) of the hysterectomies were planned before surgery. The commonest reason for unsuccessful myomectomy was big uterine size and poor architecture. Hysterectomy cases were older (p Conclusion: A large proportion of nullipara scheduled for myomectomy could end up with a hysterectomy. Careful and detailed counseling before planned myomectomy is needed to prevent regret, litigation and major psychological trauma. Keywords: Ghanaian, nulliparous, fibroids, hysterectomy, litigation Tropical Journal of Obstetrics and Gynaecology Vol. 22(2) 2005: 125-128

Published
2006

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