A comprehensive and integrated project to improve reproductive health at Oyam district, northern Uganda: insights from maternal death review at the district hospital

Somigliana, Edgardo; Sabino, Alice; Schrettenbrunner, Christa; Nkurunziza, Richard; Okello, Emmy; Manenti, Fabio

doi:10.1007/s00404-010-1780-y

Cited by 9 publications

(4 citation statements)

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“…From the screening and assessment of the grey literature and of the reference lists of relevant systematic reviews, a further 24 eligible publications were identified. From the total of 194 eligible publications18–211 included in our review (table 1; online supplementary appendix B), we captured 392 reported instances of infectious disease intervention delivery. Publication frequency varied since the beginning of the review study period in 1990, with peaks in 1996 and again in 2013 (n=26), and remaining high since then (figure 2).…”

Section: Resultsmentioning

confidence: 99%

Delivering infectious disease interventions to women and children in conflict settings: a systematic review

et al. 2020

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BackgroundConflict has played a role in the large-scale deterioration of health systems in low-income and middle-income countries (LMICs) and increased risk of infections and outbreaks. This systematic review aimed to synthesise the literature on mechanisms of delivery for a range of infectious disease-related interventions provided to conflict-affected women, children and adolescents.MethodsWe searched Medline, Embase, CINAHL and PsychINFO databases for literature published in English from January 1990 to March 2018. Eligible publications reported on conflict-affected neonates, children, adolescents or women in LMICs who received an infectious disease intervention. We extracted and synthesised information on delivery characteristics, including delivery site and personnel involved, as well as barriers and facilitators, and we tabulated reported intervention coverage and effectiveness data.ResultsA majority of the 194 eligible publications reported on intervention delivery in sub-Saharan Africa. Vaccines for measles and polio were the most commonly reported interventions, followed by malaria treatment. Over two-thirds of reported interventions were delivered in camp settings for displaced families. The use of clinics as a delivery site was reported across all intervention types, but outreach and community-based delivery were also reported for many interventions. Key barriers to service delivery included restricted access to target populations; conversely, adopting social mobilisation strategies and collaborating with community figures were reported as facilitating intervention delivery. Few publications reported on intervention coverage, mostly reporting variable coverage for vaccines, and fewer reported on intervention effectiveness, mostly for malaria treatment regimens.ConclusionsDespite an increased focus on health outcomes in humanitarian crises, our review highlights important gaps in the literature on intervention delivery among specific subpopulations and geographies. This indicates a need for more rigorous research and reporting on effective strategies for delivering infectious disease interventions in different conflict contexts.PROSPERO registration numberCRD42019125221.

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Section: Resultsmentioning

confidence: 99%

Delivering infectious disease interventions to women and children in conflict settings: a systematic review

et al. 2020

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“…A study of 17 maternal deaths in Uganda showed that 2 were due to meningitis. Both patients were HIV positive [16]. Menéndez et al [17] performed autopsies following 139 maternal deaths in Mozambique and found pyogenic meningitis in 7% of cases.…”

Section: Discussionmentioning

confidence: 97%

Maternal death reviews at a rural hospital in Malawi

Vink

Jonge

Haar

et al. 2012

Intl J Gynecology & Obste

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“…Malaria was an important cause of maternal death in some studies,43–45 while in others it was not as frequent 46. The substantial reduction in maternal mortality observed in Thailand after the implementation of early detection and treatment of malaria suggests that malaria is an important contributor to maternal mortality 47.…”

Section: Introductionmentioning

confidence: 99%

Malaria in Pregnancy

Takem¹,

D’Alessandro

2013

Mediterr J Hematol Infect Dis

133

102

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Pregnant women have a higher risk of malaria compared to non-pregnant women. This review provides an update on knowledge acquired since 2000 on P. falciparum and P.vivax infections in pregnancy. Maternal risk factors for malaria in pregnancy (MiP) include low maternal age, low parity, and low gestational age. The main effects of MIP include maternal anaemia, low birth weight (LBW), preterm delivery and increased infant and maternal mortality.P. falciparum infected erythrocytes sequester in the placenta by expressing surface antigens, mainly variant surface antigen (VAR2CSA), that bind to specific receptors, mainly chondroitin sulphate A. In stable transmission settings, the higher malaria risk in primigravidae can be explained by the non-recognition of these surface antigens by the immune system. Recently, placental sequestration has been described also for P.vivax infections. The mechanism of preterm delivery and intrauterine growth retardation is not completely understood, but fever (preterm delivery), anaemia, and high cytokines levels have been implicated.Clinical suspicion of MiP should be confirmed by parasitological diagnosis. The sensitivity of microscopy, with placenta histology as the gold standard, is 60% and 45% for peripheral and placental falciparum infections in African women, respectively. Compared to microscopy, RDTs have a lower sensitivity though when the quality of microscopy is low RDTs may be more reliable. Insecticide treated nets (ITN) and intermittent preventive treatment in pregnancy (IPTp) are recommended for the prevention of MiP in stable transmission settings. ITNs have been shown to reduce malaria infection and adverse pregnancy outcomes by 28–47%. Although resistance is a concern, SP has been shown to be equivalent to MQ and AQ for IPTp. For the treatment of uncomplicated malaria during the first trimester, quinine plus clindamycin for 7 days is the first line treatment and artesunate plus clindamycin for 7 days is indicated if this treatment fails; in the 2nd and 3rd trimester first line treatment is an artemisinin-based combination therapy (ACT) known to be effective in the region or artesunate and clindamycin for 7 days or quinine and clindamycin. For severe malaria, in the second and third trimester parenteral artesunate is preferred over quinine. In the first trimester, both artesunate and quinine (parenteral) may be considered as options. Nevertheless, treatment should not be delayed and should be started immediately with the most readily available drug.

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A comprehensive and integrated project to improve reproductive health at Oyam district, northern Uganda: insights from maternal death review at the district hospital

Abstract: Three main targets for future interventions were identified: improving the quality of assistance in the health centers, implementing an emergency room service in the hospital and counteract unsafe abortion.

Cited by 9 publications

References 14 publications

Delivering infectious disease interventions to women and children in conflict settings: a systematic review

Delivering infectious disease interventions to women and children in conflict settings: a systematic review

Maternal death reviews at a rural hospital in Malawi

Malaria in Pregnancy

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