Nanna Maaløe1, Camilla B Andersen1,2, Natasha Housseine3,4, Tarek Meguid3,5, Ib C Bygbjerg1, Jos van Roosmalen6. 1. Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 2. Department of Clinical Sciences, Lund University, Malmö, Sweden. 3. Mnazi Mmoja Hospital, Zanzibar City, Tanzania. 4. Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands. 5. O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA. 6. Athena Institute, VU University of Amsterdam, Amsterdam, Netherlands.
Abstract
OBJECTIVE: To estimate the effect of locally tailored clinical guidelines on intrapartum care and perinatal outcomes among women with severe hypertensive disorders in pregnancy (sHDP). METHODS: A pre-post study at Zanzibar's low-resource Mnazi Mmoja Hospital was conducted. All labouring women with sHDP were included at baseline (October 2014 to January 2015) and at 9-12 months after implementation of the ongoing intervention (October 2015 to January 2016). Background characteristics, clinical practice, and delivery outcomes were assessed by criterion-based case file reviews. RESULTS: Overall, 188 of 2761 (6.8%) women had sHDP at baseline, and 196 of 2398 (8.2%) did so during the intervention months. The median time between last blood pressure recording and delivery decreased during the intervention compared with baseline (P=0.015). Among women with severe hypertension, antihypertensive treatment increased during the intervention compared with baseline (relative risk [RR] 1.37, 95% confidence interval [CI] 1.14-1.66). Among the neonates delivered (birthweight ≥1000 g), stillbirths decreased (RR 0.56, 95% CI 0.35-0.90) and Apgar scores of seven or more increased during the intervention compared with baseline (RR 1.17, 95% CI 1.03-1.33). CONCLUSION: Although health system strengthening remains crucial, locally tailored clinical guidelines seemed to help work-overloaded birth attendants at a low-resource hospital to improve care for women with sHDP. CLINICALTRIALS.ORG: NCT02318420.
OBJECTIVE: To estimate the effect of locally tailored clinical guidelines on intrapartum care and perinatal outcomes among women with severe hypertensive disorders in pregnancy (sHDP). METHODS: A pre-post study at Zanzibar's low-resource Mnazi Mmoja Hospital was conducted. All labouring women with sHDP were included at baseline (October 2014 to January 2015) and at 9-12 months after implementation of the ongoing intervention (October 2015 to January 2016). Background characteristics, clinical practice, and delivery outcomes were assessed by criterion-based case file reviews. RESULTS: Overall, 188 of 2761 (6.8%) women had sHDP at baseline, and 196 of 2398 (8.2%) did so during the intervention months. The median time between last blood pressure recording and delivery decreased during the intervention compared with baseline (P=0.015). Among women with severe hypertension, antihypertensive treatment increased during the intervention compared with baseline (relative risk [RR] 1.37, 95% confidence interval [CI] 1.14-1.66). Among the neonates delivered (birthweight ≥1000 g), stillbirths decreased (RR 0.56, 95% CI 0.35-0.90) and Apgar scores of seven or more increased during the intervention compared with baseline (RR 1.17, 95% CI 1.03-1.33). CONCLUSION: Although health system strengthening remains crucial, locally tailored clinical guidelines seemed to help work-overloaded birth attendants at a low-resource hospital to improve care for women with sHDP. CLINICALTRIALS.ORG: NCT02318420.
Authors: Nanna Maaløe; Tarek Meguid; Natasha Housseine; Britt Pinkowski Tersbøl; Karoline Kragelund Nielsen; Ib Christian Bygbjerg; Jos van Roosmalen Journal: Bull World Health Organ Date: 2019-03-26 Impact factor: 9.408
Authors: Jutta M Adelin Jorgensen; Kaya Helene Hedt; Omar Mwalim Omar; Justine I Davies Journal: BMC Public Health Date: 2020-09-04 Impact factor: 3.295
Authors: Jane Brandt Sørensen; Natasha Housseine; Nanna Maaløe; Ib Christian Bygbjerg; Britt Pinkowski Tersbøl; Flemming Konradsen; Brenda Sequeira Dmello; Thomas van Den Akker; Jos van Roosmalen; Sangeeta Mookherji; Eunice Siaity; Haika Osaki; Rashid Saleh Khamis; Monica Lauridsen Kujabi; Thomas Wiswa John; Dan Wolf Meyrowitsch; Columba Mbekenga; Morten Skovdal; Hussein L Kidanto Journal: Glob Health Action Date: 2022-12-31 Impact factor: 2.640
Authors: Nanna Maaløe; Natasha Housseine; Jane Brandt Sørensen; Josephine Obel; Brenda Sequeira DMello; Monica Lauridsen Kujabi; Haika Osaki; Thomas Wiswa John; Rashid Saleh Khamis; Zainab Suleiman Said Muniro; Daniel Joseph Nkungu; Britt Pinkowski Tersbøl; Flemming Konradsen; Sangeeta Mookherji; Columba Mbekenga; Tarek Meguid; Jos van Roosmalen; Ib Christian Bygbjerg; Thomas van den Akker; Andreas Kryger Jensen; Morten Skovdal; Hussein L Kidanto; Dan Wolf Meyrowitsch Journal: Glob Health Action Date: 2022-12-31 Impact factor: 2.996
Authors: Jutta M Adelin Jørgensen; Dirk Lund Christensen; Karoline Kragelund Nielsen; Halima Saleh Sadiq; Muhammad Yusuf Khan; Ahmed M Jusabani; Richard Walker Journal: Front Neurol Date: 2022-07-28 Impact factor: 4.086
Authors: Kim J C Verschueren; Lachmi R Kodan; Tom K Brinkman; Raez R Paidin; Sheran S Henar; Humphrey H H Kanhai; Joyce L Browne; Marcus J Rijken; Kitty W M Bloemenkamp Journal: BMC Health Serv Res Date: 2019-09-09 Impact factor: 2.655