Objective To evaluate effect of locally tailored labour management guidelines (PartoMa guidelines) on intrahospital stillbirths and birth asphyxia. Design Quasi‐experimental pre‐post study investigating the causal pathway through changes in clinical practice. Setting Tanzanian low‐resource referral hospital, Mnazi Mmoja Hospital. Population Facility deliveries during baseline (1 October 2014 until 31 January 2015) and the 9th to 12th intervention month (1 October 2014 until 31 January 2015). Methods Birth outcome was extracted from all cases of labouring women during baseline (n = 3690) and intervention months (n = 3087). Background characteristics and quality of care were assessed in quasi‐randomly selected subgroups (n = 283 and n = 264, respectively). Main outcome measures Stillbirths and neonates with 5‐minute Apgar score ≤5. Results Stillbirth rate fell from 59 to 39 per 1000 total births (RR 0.66, 95% CI 0.53–0.82), and subanalyses suggest that this was primarily due to reduction in intrahospital stillbirths. Apgar scores between 1 and 5 fell from 52 to 28 per 1000 live births (RR 0.53, 95% CI 0.41–0.69). Median time from last fetal heart assessment till delivery (or fetal death diagnosis) fell from 120 minutes (IQR 60–240) to 74 minutes (IQR 30‐130) (Mann–Whitney test for difference, P < 0.01). Oxytocin augmentation declined from 22% to 12% (RR 0.54, 95% CI 0.37–0.81) and timely use improved. Conclusion Although low human resources and substandard care remain major challenges, PartoMa guidelines were associated with improvements in care, leading to reductions in stillbirths and birth asphyxia. Findings furthermore emphasise the central role of improved fetal surveillance and restricted intrapartum oxytocin use in safety at birth. Tweetable abstract #PartoMa guidelines aided in reducing stillbirths and birth asphyxia at a Tanzanian low‐resource hospital Plain Language Summary PartoMa guidelines help birth attendants in Tanzania to save livesEvery year, 3 million babies die on the day of birth. The vast majority of these deaths occur in the poorest countries. If their mothers had received better care during birth, most babies would have survived.At Mnazi Mmoja Hospital, an East African referral hospital, the PartoMa study shows that use of locally developed guidelines helps birth attendants to deliver better quality of care, which has led to improved survival at birth.At the hospital studied, resources are scarce. Each birth attendant assists four to six birthing women simultaneously, and many have less than 1 year of professional experience. International guidelines are available, but they are often unachievable and seldom applied.The PartoMa guidelines were developed in close collaboration with the birth attendants and approved by seven international experts. The result is an 8‐page pocket booklet providing locally achievable and simple decision support for care during birth.Use of the PartoMa guidelines began in February 2015. As the staff group frequently changes, quarterly seminars are conducted where b...

IntroductionBreast cancer is the most frequent cancer and the second reason of cancer deaths among woman worldwide, including Malaysia. The objective of this paper is to assess the practice of breast self-examination (BSE) and identify the barriers of BSE practice among undergraduate female students in Malaysia.MethodsA cross-sectional study conducted among 810 female undergraduate students in Klang Valley, Malaysia between April–Jun 2012. Data was collected via self-administered questionnaire which was developed and pre-tested for this study. ResultsThe majority of respondents were Malay 709 (95.6 %) and single 719 (96.9 %) with a mean age of 21.7 (1.1). Only hundred eleven (15 %) of the participants had a family history of breast cancer. 70.5 % of the respondents do not practice breast self-examination, 70.5 % do not know how to do it, 64.7 and 61.5 % reported no symptoms of breast cancer and worries to detect breast cancer, respectively. Univariate analysis showed that age, marital status and personal history of breast disease were statistically associated with the practice of breast self-examination.ConclusionIn this study, a high percentage of respondents were aware of breast cancer but do not perform breast self-examination. Knowledge, socio-cultural and environmental factors were identified as barriers; so it is recommended that knowledge among the public about breast cancer and promotion of public breast health awareness campaigns through the media should be carried out.

BackgroundBreast cancer is the most common cancer and the second principal cause of cancer deaths in women worldwide as well as in Malaysia. Breast self-examination (BSE) has a role in raising breast cancer awareness among women and educational programs play an important role in breast cancer preventive behavior. The aim of this study is to develop, implement and evaluate the effectiveness of Breast Health Awareness program based on health belief model on knowledge of breast cancer and breast-selfexamination and BSE practice among female students in Malaysia.MethodsA single-blind randomized controlled trial was carried out among 370 female undergraduate students from January 2011 to April 2012 in two selected public universities in Malaysia. Participants were randomized to either the intervention group or the control group. The educational program was delivered to the intervention group. The outcome measures were assessed at baseline, 6, and 12 months after implementing the health educational program. Chi-square, independent samples t-test and two-way repeated measures ANOVA (GLM) were conducted in the course of the data analyses.ResultsMean scores of knowledge on breast cancer (p<0.003), knowledge on breast self examination (p<0.001), benefits of BSE (p<0.00), barrier of BSE (0.01) and confidence of BSE practice (p<0.00) in the intervention group had significant differences in comparison with those of the control group 6 and 12 months after the intervention. Also, among those who never practiced BSE at baseline, frequency of BSE practice increased 6 and 12 months after the intervention (p<0.05).ConclusionThe Breast Health Awareness program based on health the belief model had a positive effect on knowledge of breast cancer and breast self-examination and practice of BSE among females in Malaysia.Trial registrationThe ANZCTR clinical trial registry (ACTRN12616000831482), retrospectively registered on Jun 23, 2016 in ANZCTR.org.au.

Background: Breast cancer is the most common cancer and the second principal cause of cancer deaths among women worldwide, including Malaysia. Methods: A cross-sectional study was carried out among 262 female undergraduate students in University Putra Malaysia using a validated questionnaire which was developed for this study. Results: The mean age of respondents was 22±2.3 years. Most of them were single (83.1%), Malay (42.3%) and 20.7% reported having a family history of breast cancer. Eighty-seven (36.7%) claimed they had practiced BSE. Motivation and self-efficacy of the respondents who performed BSE were significantly higher compared with women who did not (p<0.05).There was no association between BSE practice and demographic details (p<0.05). Logistic regression analysis indicated that women who perceived greater motivation (OR=1.089, 95%CI: 1.016-1.168) and had higher confidence of BSE (OR=1.076, 95%CI: 1.028-1.126) were more likely to perform the screening. Conclusions: The findings show that Malaysian young female's perception regarding breast cancer and the practice of BSE is low. Targeted education should be implemented to improve early detection of breast cancer.

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