Abstract:The establishment of interventions to maximize maternal health requires the identification of modifiable risk factors. Toward the identification of modifiable hospital-based factors, we analyze over 2 million births from 2005 to 2010 in Texas, employing a series of quasiexperimental tests involving hourly, daily, and monthly circumstances where medical service quality (or clinical capital) is known to vary exogenously. Motivated by a clinician's choice model, we investigate whether maternal delivery complicati… Show more
“…Staff shortages may also explain the lower levels of quality found in evening and night deliveries. Studies in the United States have shown that delivery complications tend to be higher during night shifts and on weekends and holidays, when hospitals are understaffed, and less experienced doctors are more likely to work . In low‐income countries, studies found that disrespectful and abusive experiences are more common, and women are more likely to be left alone during night shifts while there are fewer providers .…”
objective Although substantial progress has been made in increasing access to care during childbirth, reductions in maternal and neonatal mortality have been slower. Poor-quality care may be to blame. In this study, we measure the quality of labour and delivery services in Kenya and Malawi using data from observations of deliveries and explore factors associated with levels of competent and respectful care.methods We used data from nationally representative health facility assessment surveys. A total of 1100 deliveries in 392 facilities across Kenya and Malawi were observed and quality was assessed using two indices: the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) index and a previously validated index of respectful maternity care. Data from standardised observations of care were analysed using descriptive statistics and multivariable randomintercept regression models to examine factors associated with variation in quality of care. We also quantified the variance in quality explained by each domain of covariates (patient-, provider-and facility-level and subnational divisions).results Only 61-66% of basic elements of competent and respectful care were performed. In adjusted models, better-staffed facilities, private hospitals and morning deliveries were associated with higher levels of competent and respectful care. In Malawi, younger, primipara and HIV-positive women received higher-quality care. Quality also differed substantially across regions in Kenya, with a 25 percentage-point gap between Nairobi and the Coast region. Quality was also higher in highervolume facilities and those with caesarean section capacity. Most of the explained variance in quality was due to regions in Kenya and to facility, and patient-level characteristics in Malawi.conclusions Our findings suggest considerable scope for improvement in quality. Increasing staffing and shifting births to higher-volume facilitiesalong with promotion of respectful care in these facilities should be considered in sub-Saharan Africa to improve outcomes for mothers and newborns.keywords quality, labour, childbirth, health systems research, sub-Saharan Africa Sustainable Development Goals (SDGs): SDG 3 (good health and well-being), SDG 5 (gender equity), SDG 9 (industry, innovation and infrastructure), SDG 10 (reduced inequalities), SDG 17 (partnerships for the goals)
“…Staff shortages may also explain the lower levels of quality found in evening and night deliveries. Studies in the United States have shown that delivery complications tend to be higher during night shifts and on weekends and holidays, when hospitals are understaffed, and less experienced doctors are more likely to work . In low‐income countries, studies found that disrespectful and abusive experiences are more common, and women are more likely to be left alone during night shifts while there are fewer providers .…”
objective Although substantial progress has been made in increasing access to care during childbirth, reductions in maternal and neonatal mortality have been slower. Poor-quality care may be to blame. In this study, we measure the quality of labour and delivery services in Kenya and Malawi using data from observations of deliveries and explore factors associated with levels of competent and respectful care.methods We used data from nationally representative health facility assessment surveys. A total of 1100 deliveries in 392 facilities across Kenya and Malawi were observed and quality was assessed using two indices: the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) index and a previously validated index of respectful maternity care. Data from standardised observations of care were analysed using descriptive statistics and multivariable randomintercept regression models to examine factors associated with variation in quality of care. We also quantified the variance in quality explained by each domain of covariates (patient-, provider-and facility-level and subnational divisions).results Only 61-66% of basic elements of competent and respectful care were performed. In adjusted models, better-staffed facilities, private hospitals and morning deliveries were associated with higher levels of competent and respectful care. In Malawi, younger, primipara and HIV-positive women received higher-quality care. Quality also differed substantially across regions in Kenya, with a 25 percentage-point gap between Nairobi and the Coast region. Quality was also higher in highervolume facilities and those with caesarean section capacity. Most of the explained variance in quality was due to regions in Kenya and to facility, and patient-level characteristics in Malawi.conclusions Our findings suggest considerable scope for improvement in quality. Increasing staffing and shifting births to higher-volume facilitiesalong with promotion of respectful care in these facilities should be considered in sub-Saharan Africa to improve outcomes for mothers and newborns.keywords quality, labour, childbirth, health systems research, sub-Saharan Africa Sustainable Development Goals (SDGs): SDG 3 (good health and well-being), SDG 5 (gender equity), SDG 9 (industry, innovation and infrastructure), SDG 10 (reduced inequalities), SDG 17 (partnerships for the goals)
“…These are important findings. According to a recent study that included over 2 million births, delivery complications are higher during night shifts when hospitals are understaffed (18). Also, in developed countries, i.e.…”
<p><strong>Objective. </strong>The aim of this study was to assess and compare morning vs. midnight initiation of induction of labor (IOL) on time of birth and perinatal outcome.</p><p><strong>Study Design. </strong>A retrospective study performed at University Hospital Merkur, Zagreb, Croatia; in period between 2006 to 2017. The participants were low-risk nulliparous women with gestational age over 41 weeks who had labor induced by a prostaglandin E2 analogue dinoprostone applied intracervically. Two groups were compared; the first one had IOL initiated in the morning and the second one at midnight.</p><p><strong>Results. </strong>A total of 206 pregnant women were included in the study. Women with IOL starting at midnight (n=103) gave birth more often during daytime (7am-6.59pm) compared to women with IOL starting in the morning (n=103) (p<0.01). The midnight group also gave birth more often during regular hospital working hours (7.30am-3.30pm), but this result was not statistically significant (p=0.091). The rate of epidural analgesia was higher among women in the midnight group, while no other differences were observed in predefined perinatal outcome between the two groups.</p><strong>Conclusions. </strong>Initiation of IOL at midnight compared to morning results in giving birth more often during daytime. This presents a favourable option for reducing out of hours and night work.
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