Perinatal health care in a conflict-affected setting: evaluation of health-care services and newborn outcomes at a regional medical centre in Iraq

Abstract

A field-based assessment was conducted to assess maternal and newborn health-care services, perinatal and newborn outcomes and associated risk factors at Bint Al-Huda Maternal and Newborn Teaching Hospital, a large referral hospital in southern Iraq. The multi-method approach used interviews, discussions, observation and review of perinatal and newborn outcome data. There is limited assessment of maternal vital signs, labour pattern, fetal response, and complications during pregnancy and labour. Perinatal and neonatal mortality rates are 27.4/1000 births and 30.9/1000 live births respectively. Associated neonatal mortality factors were gestational age < 37 weeks, male sex, birth weight < 2.5 kg, maternal age > 35 years, rural maternal residence and vaginal delivery. Improving birth outcomes in southern Iraq requires evidence-based clinical guidelines, additional supplies and equipment, quality improvement initiatives and in-service training.

Quality in crisis: a systematic review of the quality of health systems in humanitarian settings

“…A common theme that emerged was an emphasis on the workforce and tools quality sub-domains. The evidence identified on workforce constraints focused on human resource shortages [ 34 , 39 , 57 , 63 , 80 , 81 , 84 ], low workforce moral [ 47 , 75 ], and inadequate provider training [ 48 , 51 , 56 , 58 , 61 , 71 , 74 ] as the most cited causes of poor quality. A qualitative study in Afghanistan articulated the intense physical and mental pressures that medical staff face in the field and assured that sub-optimal care was unlikely deliberate but rather the result of “conflicting priorities, the workload, poor clinical skills and the struggle for survival” [ 56 ].…”

“…A qualitative study in Afghanistan articulated the intense physical and mental pressures that medical staff face in the field and assured that sub-optimal care was unlikely deliberate but rather the result of “conflicting priorities, the workload, poor clinical skills and the struggle for survival” [ 56 ]. The physical resources needed for a functioning health system was often used in the studies as a quality measure, specifically limited access to medicines [ 32 , 34 , 38 , 57 , 60 , 61 , 79 , 81 , 84 ] and supplies [ 42 , 48 , 57 – 60 , 63 , 64 , 70 , 72 , 79 ]. Mowafi and colleagues highlighted the severe material and human resource constraints that Syrian trauma hospitals operate under including the large amount of nonfunctioning diagnostic equipment (e.g., 23% broken X-ray machines) [ 63 ].…”

Adverse effects of exposure to armed conflict on pregnancy: a systematic review

“…Health services, for instance, are often severely interrupted by the destruction of infrastructure and management systems. 10 The many challenges for rebuilding these services mean that health provision can be disrupted for years after the cease of conflict. 11 12 …”

Data Collection Tools for Maternal and Child Health in Humanitarian Emergencies: An Updated Systematic Review

“…[62][63][64][65] Four of the 5 new tools were identified through a search of organization websites; the fifth tool was used in 1 of the studies included in the review. One of the tools, which aimed to collect data on children's well-being, 13 Number of deliveries at health facilities, caesarean section rate, induction of labor, obstetric complications managed, place of delivery, maternal deaths, and prehospital childbirths No description of specific tools used Newborn health [13][14][15][16][17][18][19][20][21] Apgar score, birthweight, birth length, mean gestational age at birth, preterm labor, congenital malformations, maternal mortality, thoracic circumference, and head circumference at birth No description of specific tools used General maternal and newborn health 49,[13][14][15][16][17][18][19][20] Hypertensive disorders of pregnancy, reception of ANC and TT vaccination, use of postnatal care, perinatal maternal depression and well-being, miscarriage, transport of pregnant women, antenatal services, antenatal care quality, prevalence of gestational diabetes mellitus, malaria, anemia and screening for hepatitis B in pregnant women, delivery characteristics, indications for referral of pregnant, spontaneous vaginal deliveries, postpartum hemorrhage, hemoglobin, iron status, zinc, retinol, β-carotene, tryptophan, delivery history, maternal vital signs, labor pattern, fetal response, complications during pregnancy and labor, perinatal and neonatal mortality, intestinal parasitic infection in pregnant women…”