umu.sePublikationer
Ändra sökning
Länk till posten
Permanent länk

Direktlänk
BETA
Godefay Debeb, Hagos
Alternativa namn
Publikationer (3 of 3) Visa alla publikationer
Godefay, H., Kinsman, J., Admasu, K. & Byass, P. (2016). Can innovative ambulance transport avert pregnancy-related deaths?: One-year operational assessment in Ethiopia. Journal of Global Health, 6(1), Article ID 010410.
Öppna denna publikation i ny flik eller fönster >>Can innovative ambulance transport avert pregnancy-related deaths?: One-year operational assessment in Ethiopia
2016 (Engelska)Ingår i: Journal of Global Health, ISSN 2047-2978, E-ISSN 2047-2986, Vol. 6, nr 1, artikel-id 010410Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND:

To maximise the potential benefits of maternity care services, pregnant women need to be able to physically get to health facilities in a timely manner. In most of sub-Saharan Africa, transport represents a major practical barrier. Here we evaluate the extent to which an innovative national ambulance service in Ethiopia, together with mobile phones, may have been successful in averting pregnancy-related deaths.

METHODS:

An operational assessment of pregnancy-related deaths in relation to utilisation of the new national ambulance service was undertaken in six randomly selected Districts in northern Ethiopia. All 183 286 households in the six randomly selected Districts were visited to identify live-births and deaths among women of reproductive age that occurred over a one-year period. The uptake of the new ambulance transport service for women's deliveries in the same six randomly selected Districts over the same period was determined retrospectively from ambulance log books. Pregnancy-related deaths as determined by the World Health Organization (WHO 2012) verbal autopsy tool [13] and the InterVA-4 model [14] were analysed against ambulance utilisation by District, month, local area, distance from health facility and mobile network coverage.

FINDINGS:

A total of 51 pregnancy-related deaths and 19 179 live-births were documented. Pregnancy-related mortality for Districts with above average ambulance utilisation was 149 per 100 000 live-births (95% confidence interval CI 77-260), compared with 350 per 100 000 (95% CI 249-479) for below average utilisation (P = 0.01). Distance to a health facility, mobile network availability and ambulance utilisation were all significantly associated with pregnancy-related mortality on a bivariable basis. On a multivariable basis, ambulance non-utilisation uniquely persisted as a significant determinant of mortality (mortality rate ratio 1.97, 95% CI 1.05-3.69; P = 0.03).

CONCLUSIONS:

The uptake of freely available transport in connection with women's obstetric needs correlated with substantially reduced pregnancy-related mortality in this operational assessment, though the design did not allow cause and effect to be attributed. However, the halving of pregnancy-related mortality associated with ambulance uptake in the sampled Districts suggests that the provision of transport to delivery facilities in Africa may be a key innovation for delivering maternal health care, which requires wider consideration.

Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-127315 (URN)10.7189/jogh.06.010410 (DOI)000396976400018 ()
Tillgänglig från: 2016-11-07 Skapad: 2016-11-07 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
Godefay Debeb, H. (2016). Maternal Mortality Then, Now, and Tomorrow: The Experience of Tigray Region, Northern Ethiopia. (Doctoral dissertation). Umeå: Umeå universitet
Öppna denna publikation i ny flik eller fönster >>Maternal Mortality Then, Now, and Tomorrow: The Experience of Tigray Region, Northern Ethiopia
2016 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Abstract

Background: Maternal mortality is one of the most sensitive indicators of the health disparities between poorer and richer nations. It is also one of the most difficult health outcomes to measure reliably. In many settings, major challenges remain in terms of both measuring and reducing maternal mortality effectively. This thesis aims to quantify overall levels, identify specific causes, and evaluate local interventions in relation to efforts to reduce maternal mortality in Tigray Region, Northern Ethiopia, thereby providing a strong empirical basis for decision making by the Tigray Regional Health Bureau using methods that can be scaled at national level.

 

Methods: This study employed a combination of community-based study designs to investigate the level and determinants of maternal mortality in six randomly selected rural districts of Tigray Region. A census of all households in the six districts was conducted to identify all live births and all deaths to women of reproductive age occurring between May 2012 and September 2013. Pregnancy-related deaths were screened through verbal autopsy with the data processed using the InterVA-4 model, which was used to estimate Maternal Mortality Ratio. To identify independent determinants of maternal mortality, a case-control study using multiple logistic regression analysis was done, taking all pregnancy-related deaths as cases and a random sample of geographical and age matched mothers as controls. Uptake of ambulance services in the six districts was determined retrospectively from ambulance logbooks, and the trends in pregnancy-related death were analyzed against ambulance utilization, distance from nearest health center, and mobile network coverage at local area level. Lastly, implementation of the Family Folder paper health register, and its potential for accurately capturing demographic and health events, were evaluated using a capture-recapture assessment.

 

Results: A total of 181 deaths to women of reproductive age and 19,179 live births were documented from May 2012 to April2013. Of the deaths, 51 were pregnancy-related. The maternal mortality ratio for Tigray region was calculated at 266 deaths per 100,000 live births (95% CI 198-350), which is consistently lower than previous “top down” MMR estimates. District–level MMRs showed strong inverse correlation with population density (r2 = 0.86). Direct obstetric causes accounted for 61% of all pregnancy–related deaths, with hemorrhage accounting for 34%. Non-membership in the voluntary Women’s Development Army (AOR 2.07, 95% CI 1.04-4.11), low husband or partner involvement during pregnancy (AOR 2.19, 95% CI 1.14-4.18), pre-existing history of other illness (AOR 5.58, 95% CI 2.17-14.30), and never having used contraceptives (AOR 2.58, 95% CI 1.37-4.85) were associated with increased risk of maternal death in a multivariable regression model. In addition, utilization of free ambulance transportation service was strongly associated with reduced MMR at district level. Districts with above-average ambulance utilization had an MMR of 149 per 100,000 LB (95% CI: 77-260) compared with 350 per 100,000 (95% CI: 249-479) in districts with below average utilization. The Family Folder implementation assessment revealed some inconsistencies in the way Health Extension Workers utilize the Family Folders to record demographic and health events.

 

Conclusion: This work contributes to understanding the status of and factors affecting maternal mortality in Tigray Region. It introduces a locally feasible approach to MMR estimation and gives important insights in to the effectiveness of various interventions that have been targeted at reducing maternal mortality in recent years.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet, 2016. s. 90
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1819
Nyckelord
Maternal mortality, intervention, ambulance, family folder, case-control, cross-sectional survey, verbal autopsy, Tigray, Ethiopia
Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-128117 (URN)978-91-7601-510-0 (ISBN)
Disputation
2016-12-16, Room 135, Family Medicine, Building 9A, Norrlands University Hospital, Umeå, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2016-11-25 Skapad: 2016-11-23 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
Godefay, H., Abrha, A., Yang, H., Kinsman, J., Myléus, A., Mulugeta, A. & Byass, P. Assessing the performance of the Ethiopian family folder system for collecting community-based health information.
Öppna denna publikation i ny flik eller fönster >>Assessing the performance of the Ethiopian family folder system for collecting community-based health information
Visa övriga...
(Engelska)Artikel i tidskrift (Refereegranskat) Submitted
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-127316 (URN)
Tillgänglig från: 2016-11-07 Skapad: 2016-11-07 Senast uppdaterad: 2018-06-09
Organisationer

Sök vidare i DiVA

Visa alla publikationer