The utilization of maternal health services at primary healthcare setting in Southeast Asian Countries: A systematic review of the literature

The reduction of Maternal Mortality Ratio (MMR) remains a global health issue. Although major progress has been achieved in the past 15 years, the ratio is still high, especially in Low Middle-Income Countries. In the Southeast Asian region, most of the countries have not reached the Sustainable Development Goals target yet. Although the countries have several similarities in many aspects, such as community characteristics, cultural context, health systems, and geographical proximity, the MMR in the region presents interesting variations. The scope of this systematic review is to explore published literature on the utilization of maternal health services at the community healthcare centre setting in Southeast Asian countries. The databases PubMed, Web of Science, and Google Scholar were searched systematically to identify quantitative, qualitative and mixed methods studies published in 2000–2020. A total of 1876 records were found, out of which 353 full text were screened. Finally, 27 studies on utilization of maternal health services met the inclusion criteria and were selected for analysis from seven Southeast Asian countries: Cambodia, Indonesia, Lao PDR, Myanmar, The Philippines, Timor Leste and Vietnam. Most of the articles focused on the utilization of maternal health services at primary health care setting. Several themes on maternal health services utilization in the countries emerged, including cultural and socioeconomic factors contributed to the utilization of maternal health services, factors associated with the low utilization of ANC, determinants affected place of delivery and delivery assistance choice. The utilization of maternal health services at primary healthcare setting in seven Southeast Asian countries was identified in a small number of studies. Sociocultural barriers and disparities of health services provision are the major factors associated with low utilization of the services. Further research on strengthening the role of primary healthcare in maternal health services provision is required.     

Women’s negative childbirth experiences and socioeconomic factors: Results from the Babies Born Better survey

ObjectiveTo investigate the association between women's socioeconomic status and overall childbirth experience and to explore how women reporting an overall negative birth experience describe their experiences of intrapartum care.MethodsWe used both quantitative and qualitative data from the Babies Born Better (B3) survey version 2, including a total of 8317 women. First, we performed regression analyses to explore the association between women’s socioeconomic status and labour and birth experience, and then a thematic analysis of three open-ended questions from women reporting a negative childbirth experience (n = 917).ResultsIn total 11.7% reported an overall negative labour and birth experience. The adjusted odds ratio (OR) of a negative childbirth experience was elevated for women with non-tertiary education, for unemployed, students and not married or cohabiting. Women with lower subjective living standard had an adjusted OR of 1.70 (95% CI 1.44–2.00) for a negative birth experience, compared with those with average subjective living standard. The qualitative analysis generated three themes: 1) Uncompassionate care: lack of sensitivity and empathy, 2) Impersonal care: feeling objectified, and 3) Critical situations: feeling unsafe and loss of control.ConclusionImportant socioeconomic disparities in women’s childbirth experiences exist even in the Norwegian setting. Women reporting a negative childbirth experience described disrespect and mistreatment as well as experiences of insufficient attention and lack of awareness of individual and emotional needs during childbirth. The study shows that women with lower socioeconomic status are more exposed to these types of experiences during labour and birth.Tweetable abstractWomen with lower socioeconomic status are more exposed to negative experiences during labour and birth.     

Gestational weight gain in uncomplicated twin pregnancies by pre-pregnancy body mass index

In 2009, the Institute of Medicine provided provisional guidelines for gestational weight gain (GWG) in twin gestations, citing limited research. We examined GWG by pre-pregnancy body mass index in a retrospective cohort of twin births uncomplicated by infant mortality, preterm birth, or low birth weight from Massachusetts in 2006–2017 (N = 273). Median (inter-quartile range [IQR]) GWG was 20.4 kg (IQR: 17.2–25.9 kg) for women who were normal weight pre-pregnancy, 21.3 kg (IQR: 17.2–25.9 kg) for women with overweight pre-pregnancy, and 13.6 kg (IQR: 8.6–20.9 kg) for women with obesity pre-pregnancy. Findings can inform the next generation of GWG recommendations for twin pregnancies.     

Induction of labor in twin pregnancies – A retrospective cohort study

ObjectiveTo investigate outcomes in spontaneous and induced twin deliveries. Secondary aims were to study impact of delivery interval and breech presentation of the first twin.MethodsThis retrospective cohort study comprised 354 twin deliveries at a tertiary Norwegian hospital. Spontaneous labor onset and induction of labor were compared in women with planned vaginal delivery and gestational age ≥ 34 weeks. The main outcome was intrapartum cesarean section. Secondary outcomes were umbilical arterial pH and five-minute Apgar scores.ResultsAmong the induced labors, 63/229 (27.5%) women underwent intrapartum cesarean section, compared to 45/125 (36%) in spontaneous labors (P = 0.10). Odds ratio for intrapartum cesarean section in induced labors was 0.65 (95% CI 0.40–1.04) after adjusting for maternal age and parity.Median umbilical arterial pH was significantly lower in the second twins in both spontaneous and induced labors, 7.28 (6.94–7.43) vs. 7.32 (7.16–7.42), and 7.27 (6.90–7.48) vs. 7.29 (7.08–7.45), respectively. pH < 7.00 rarely occurred. Second twins born after a delivery interval > 30 min had a significantly higher frequency of pH < 7.10 than those with a shorter interval, P < 0.01. No significant difference was found in frequency of pH < 7.10 between breech-presenting and cephalic-presenting first twins (P = 0.65). One unexpected intrapartum fetal death occurred after labor induction.ConclusionOur results support spontaneous onset and induction of labor as safe. Intrapartum cesarean section rates did not differ significantly between spontaneous and induced labors. Delivery interval > 30 min was associated with a lower pH in the second twin.     

The effect of therapeutic footwear on the recurrence and new formation of foot ulcers in previously affected diabetic patients in Jeddah,Saudi Arabia

AimDiabetic foot ulcers (DFUs), which are a common serious complication of diabetes mellitus, (lifetime occurrence, 19%–34%) account for at least 85% of all lower-limb amputations in diabetic patients. Special footwear (therapeutic footwear) is frequently recommended for such patients to adapt to changes in their foot structure. We aimed to, measure the effect of therapeutic footwear on DFU development and recurrence among previously affected patients in Saudi Arabia.Materials and methodsA cross-sectional study was performed between June and September 2022. The study targeted patients aged ≥18 years previously diagnosed with DFU. Participants were contacted by telephone to complete a questionnaire assessing footwear use and foot care.ResultsThis study included 115 participants with a mean age of 61.9 ± 11.63; overall, 47% of participants used therapeutic footwear and 46% were adherent with wearing it. The DFU recurrence rate among patients who used therapeutic footwear was 27.8% versus 52.5% among patients who did not (p = 0.013). While using therapeutic footwear, patients with foot deformities reported a lower ulcer healing rate than those who did not (50% vs. 81.8%, p = 0.04). Patients who examined their feet had a lower recurrence rate than those who did not (38.5% vs. 50%, p = 0.43).ConclusionTherapeutic footwear use was significantly associated with decreased DFU recurrence. Further investigation to enhance the evidence for the effectiveness of therapeutic footwear in DFUs is warranted.     

Experiences of internet-based treatment for vulvodynia: A qualitative study

ObjectiveThe aim of this study was to describe women's experiences before, under, and after a guided internet-based intervention for vulvodynia.MethodsThe design was qualitative, based on content analysis. Participants were women who had undergone guided internet-based treatment for vulvodynia based on acceptance and commitment therapy principles (n = 13). Data were collected through in-depth interviews approximately-one month after participants completed treatment.ResultsThe analysis revealed the women’s experiences of internet-based treatment for vulvodynia. Three themes emerged: “dealing with pain alone,” which was related to experiences of living with vulvodynia before internet-based treatment; “finding new ways,” which described the experiences of undergoing an internet-based treatment for vulvodynia and “feeling empowered to take control,” referring to the experiences of living with vulvodynia after the internet-based treatment. The women described a long search for a diagnosis, revealing a negative experience of healthcare. The internet-based treatment helped them find new ways to manage vulvodynia, but difficulties with the treatment were also experienced. After the intervention, the women reported improvements in wellbeing and having better strategies to manage pain, but also stated that the treatment was insufficient to perceive changes in vulvar pain.ConclusionsThe guided internet-based treatment program for vulvodynia based on acceptance and commitment therapy principles was perceived as credible, helpful to manage vulvodynia, and could serve as a complement to regular care. Questions regarding the need for more support and optimal length of treatment need to be further evaluated.     

Healthcare providers’ experiences of comprehensive emergency obstetric care in Somaliland: An explorative study with focus on cesarean deliveries

ObjectiveThis study aimed to explore the experiences of healthcare providers (HCPs) regarding the provision of emergency obstetric care (EmOC) with a focus on cesarean deliveries in a referral hospital and maternal and child health centers in Somaliland.MethodsAn exploratory qualitative approach using focus group discussions was employed at the main referral and teaching hospital and four maternal and child health centers in Hargeisa, Somaliland. Twenty-eight HCPs were divided into groups of 6–8 for discussions lasting 1 to 2 h. All HCPs included in the study had experiences with the provision of EmOC. Data were analyzed using thematic analysis.ResultsCollective family decision making was identified by HCPs as a barrier to the provision of EmOC. This tradition of decision making at a group level was perceived as time-consuming and delayed HCPs from obtaining informed consent for EmOC. Low socioeconomic status and poor knowledge about maternal healthcare among users affected care seeking among women. Suboptimal EmOC at the hospital was reported to be due to miscommunication, inadequate interprofessional collaboration and lack of infrastructure.ConclusionsHCPs encountered difficulties with the provision of EmOC. A broad array of strategies targeting the community and healthcare system is needed, including training of HCPs on intracultural communication competence, interprofessional collaboration and use of alternative birth methods other than CS. Antenatal care can be used to prepare families for potential obstetric emergencies and as an opportunity to obtain written informed consent.     

Knowledge of pressure injury in medical and surgical nurses in a tertiary level hospital: A cross-sectional study

BackgroundNurses play a vital role in pressure injury prevention (PIP) but require foundational knowledge to ensure appropriate PIP strategies are enacted.AimsTo describe and compare medical and surgical nurses’ knowledge of pressure injury (PI) in a tertiary level hospital in China, and to identify predictors of PI knowledge among these groups.DesignA cross-sectional survey was conducted between June and December 2020.MethodsRegistered nurses from nine medical and fifteen surgical wards in a tertiary hospital were invited. The survey was composed of two parts; demographic and professional characteristics; and the Chinese translated version of the Pressure Ulcer Knowledge Assessment Tool 2.0 (PUKAT 2.0) where the total score ranged from 0 to 25; higher scores imply more knowledge. Medical and surgical nurses' knowledge test scores were compared using independent t-test. Multiple linear regression analysis was used to determine factors predictive of nurses’ knowledge.ResultsIn total, 423 nurses from 24 wards participated the study and 404 nurses (95.5%) completed the knowledge test (Surgical n = 236, 58.4%; Medical n = 168, 41.6%). The PUKAT 2.0 mean score was 11.6 ± 3.0 (Surgical 12.2 ± 3.0; Medical 10.7 ± 2.8) with 335 (82.9%) nurses scoring <60%. Multiple linear regression showed working in surgical wards, nurse-in-charge position and previous PI training were significant predictors of knowledge scores.ConclusionKnowledge is a precursor to safe practice. Nurses demonstrated poor knowledge of PIP. Pressure injury related education may help improve nurses' knowledge but the extent to which it is used in place and impacts patients’ outcome requires more investigation.     

Minors are the most affected by Chlamydia trachomatis in Reunion Island: A cross-sectional study, 2017–2018

ObjectivesTo determine the prevalence of Chlamydia trachomatis (CT) in the population screened at sexually transmitted infection (STI) clinics on Reunion Island and to identify risk factors for CT infection.Patients and methodsThis cross-sectional multicenter study was conducted in 2017–2018. Data were obtained from self-administered questionnaires and multiplex PCR tests.ResultsThe overall prevalence of CT in the screened population was 8.6% (95% CI 7.7–9.5%). The prevalence of urogenital CT was highest in women under 18 (13.2%, 95% CI 9.3–18.1%) and in men who have sex with men under 18 (13.3%, 95% CI 1.6–48.2%). Risk factors associated with CT infection in multivariate analysis were: female gender, being born in Reunion Island, having had a large number of sexual partners in the past year, and being co-infected with another STI.ConclusionsThe prevalence of CT in the screened population is higher in Reunion Island than in mainland France, especially in minors. Prevention campaigns targeting minors should be strengthened.     

The Cisnormative Blindspot Explained: Healthcare Experiences of Trans Men and Non-Binary Persons and the accessibility to inclusive sexual & reproductive Healthcare,an integrative review

Trans men and non-binary persons assigned female at birth (AFAB) often encounter resistance and reluctance pertaining to their healthcare needs. As a result of patriarchal-based decision-making and cis-heteronormative ideologies, the trans and gender diverse (TGD) population is routinely left out of representation in research, education, and healthcare. The aim of this integrative literature review is to describe the experiences of trans men and non-binary persons AFAB in healthcare interactions and their sexual and reproductive healthcare needs. A total of 32 articles were analyzed, synthesized, and reconceptualized through joint inductive and deductive analysis with a transfeminist and intersectional lens. From these papers, two broader concepts emerged with five sub-concepts that portrayed underlying barriers to care (primed with fear, onus of self-advocacy, and call for competence) and internalized ideologies (pregnancy incompatibility and presumptive care). A multidisciplinary approach is essential to employ in implementation efforts involving improved standards of care and in achieving desired family planning. As this is not as linear as addressing a knowledge gap, but one of deeper set intrinsic ideologies, instruction on the necessary impact of continued education and peer learning within the context of in-group dynamics can help the efficiency of designated change agents within the healthcare systems themselves.     

Relationship between healing status and microbial dissimilarity in wound and peri-wound skin in pressure injuries

AimWound infection is the most serious cause of delayed healing for patients with pressure injuries. The wound microbiota, which plays a crucial role in delayed healing, forms by bacterial dissemination from the peri-wound skin. To manage the bioburden, wound and peri-wound skin care has been implemented; however, how the microbiota at these sites contribute to delayed healing is unclear. Therefore, we investigated the relationship between healing status and microbial dissimilarity in wound and peri-wound skin.MethodsA prospective cohort study was conducted at a long-term care hospital. The outcome was healing status assessed using the DESIGN-R® tool, a wound assessment tool to monitor the wound healing process. Bacterial DNA was extracted from the wound and peri-wound swabs, and microbiota composition was analyzed using 16S rRNA gene analysis. To evaluate microbial similarity, the weighted UniFrac dissimilarity index between wound and peri-wound microbiota was calculated.ResultsTwenty-two pressure injuries (7 deep and 15 superficial wounds) were included in the study. For deep wounds, the predominant bacteria in wound and peri-wound skin were the same in the healing wounds, whereas they were different in all cases of hard-to-heal wounds. Analysis based on the weighted UniFrac dissimilarity index, there was no significant difference for healing wounds (p = 0.639), while a significant difference was found for hard-to-heal wounds (p = 0.047).ConclusionsDelayed healing is possibly associated with formation of wound microbiota that is different in composition from that of the skin commensal microbiota. This study provides a new perspective for assessing wound bioburden.     

Twin birth: The maternal experience

ObjectiveTwin birth is a special setting for women giving birth, and the experience of childbirth can be different from singleton birth. The objective of this study was to evaluate and compare the childbirth experiences of twin mothers and singleton mothers. We also aimed to identify the risk factors of a negative childbirth experience in the whole study population.MethodsAll live diamniotic twin deliveries in the study hospital of at least 35⁺⁰ weeks of gestation with a plan of vaginal birth were included in this matched groups study from August 2015 to August 2019. For every twin birth, two singleton birth controls were selected and matched with parity, the actual mode of birth, and gestational weeks at birth. Six weeks after birth, a Childbirth Experience Questionnaire (CEQ) was sent to mothers, and 72 twin mothers and 126 singleton mothers returned the questionnaire.ResultsThe twin mothers’ overall childbirth experience was positive. They reported a significantly lower opportunity to choose the birthing position (p < 0.001). Otherwise, there were no differences in the CEQ mean total scores between the study groups. Intrapartum cesarean section raised the risk of a negative childbirth experience and there was a high level of satisfaction with midwifery care among the whole study population.ConclusionThe overall maternal experience in planned vaginal twin birth was positive. Twin mothers felt less often able to choose their birthing position, otherwise the childbirth experience did not differ from that of singleton mothers.     

Characterisation of superficial corneocytes in skin areas of the face exposed to prolonged usage of respirators by healthcare professionals during COVID-19 pandemic

IntroductionDuring the COVID-19 pandemic healthcare workers (HCWs) have used respiratory protective equipment for prolonged periods, which has been associated with detrimental effects on the underlying skin. The present study aims to evaluate changes in the main cells (corneocytes) of the stratum corneum (SC) following prolonged and consecutive use of respirators.Methods17 HCWs who wore respirators daily during routine hospital practice were recruited to a longitudinal cohort study. Corneocytes were collected via tape stripping from a negative control site (area outside the respirator) and from the cheek which was in contact with the device. Corneocytes were sampled on three occasions and analysed for the level of positive-involucrin cornified envelopes (CEs) and the amount of desmoglein-1 (Dsg1), as indirect measurements of immature CEs and corneodesmosomes (CDs), respectively. These were compared to biophysical measurements (Transepidermal water loss, TEWL, and SC hydration) at the same investigation sites.ResultsA large degree of inter-subject variability was observed, with maximum coefficients of variation of 43% and 30% for the level of immature CEs and Dsg1, respectively. Although it was observed that there was not an effect of prolonged respirator usage on the properties of corneocytes, the level of CDs was greater at the cheek than the negative control site (p < 0.05). Furthermore, low levels of immature CEs correlated with greater TEWL values after prolonged respirator application (p < 0.01). It was also noted that a smaller proportion of immature CEs and CDs was associated with a reduced incidence of self-reported skin adverse reactions (p < 0.001).ConclusionsThis is the first study that investigated changes in corneocyte properties in the context of prolonged mechanical loading following respirator application. Although differences were not recorded over time, the levels of CDs and immature CEs were consistently higher in the loaded cheek compared to the negative control site and were positively correlated with a greater number of self-reported skin adverse reactions. Further studies are required to evaluate the role of corneocyte characteristics in the evaluation of both healthy and damaged skin sites.     

Methotrexate reduces keratinocyte proliferation,migration and induces apoptosis in HaCaT keratinocytes in vitro and reduces wound closure in Skh1 mice in vivo

The aim of the present work was to evaluate MTX treatment (0.1, 1 and 10 μg mL^?1) in vitro in order to characterize its effects on cell proliferation alterations in cell cycle of HaCaT keratinocytes and wound healing in a Skh1 mice treated with MTX (low doses 30 mg kg^?1, high doses 200 mg kg^?1 and repeated doses at 1.5 mg kg^?1). We analyzed the cytotoxic effect of methotrexate by a resazurin assay. The effects in the proliferation, cell cycle and apoptosis of HaCaT cells were analyzed by flow cytometry. The effects of MTX on wound healing in vivo were also analyzed. A trend toward reduction in the resazurin assay was found (p > 0.05). Reduced proliferation was also identified in a clonogenic assay and a CFSE assay (p < 0.05) due to the MTX treatment. A reduction in the G₂/M and S phases was observed accompanied by apoptosis induction with increased sub G₀ phase and annexin V FITC staining. Effect of MTX was evidenced in vivo on the wound closure process after day 10 (p < 0.05) with alterations in tissue architecture and remodeling. There is a marked effect of MTX on wound healing in vivo in Skh1 mice with implications for long-term therapy and surgical interventions.     

‘Of course,women will adopt it!’: A qualitative study on the acceptability of medical menstrual regulation in Senegal

ObjectiveMedical menstrual regulation (MMR) may offer a promising way to reach Senegalese women and girls in need of fertility management, especially in rural contexts. To assess the feasibility of introducing a MMR service in Senegal, the study aimed to (1) understand how women and girls manage their menses and fertility, and (2) document acceptability of MMR among women, youth, and health providers.MethodsSix focus group discussions and 34 in-depth interviews were conducted with women, youth, and health providers in Kaolack, Mbour, and Thiès, Senegal.ResultsAll participants characterized the pubescent period by a lack of sexual education, familial support, and access to reproductive health services. Reproductive health service utilization in Senegal was portrayed as highly stigmatized, creating barriers to contraception and reliable information on family planning. Unwanted pregnancy and clandestine abortion were depicted as common occurrences among many participants. Senegalese women and youth perceived MMR services as an acceptable method to manage a missed period with discretion, rid of moral and legal ramifications – and framed MMR as a needed mechanism to prevent abortion and avoid undesired pregnancies. The majority of health providers, with the exception of female health volunteers, were reluctant to endorse the service, comparing MMR to abortion.ConclusionsIn a context fraught with restrictive abortion laws and limited uptake of modern contraception, MMR is an acceptable among potential service users. Nonetheless, introduction and implementation of MMR will be feasible in Senegal only if policymakers approve and support the service and health provider buy-in is achieved.     

Prevalence and predictive factors for fear of childbirth in pregnant Portuguese women: A cross-sectional study

ObjectiveTo measure the prevalence of the fear of childbirth (FOC) and determine which factors predict severe FOC among pregnant Portuguese women.MethodsAn online cross-sectional study among pregnant Portuguese women aged ≥ 20 years who were recorded using a convenience sampling. Self-administered questionnaires were used for data collection: socio-demographic and obstetric questionnaire and European Portuguese version of Wijma Delivery Expectancy Questionnaire-version A (WDEQ-A). Data of 669 participants were collected successfully from June 9 to October 30, 2019. Predictive factors for severe FOC were investigated using a multivariate logistic regression analysis. Odds ratios (OR) and 95% confidence intervals were calculated.ResultsThe prevalence of severe FOC (WDEQ-A ≥ 85) among pregnant Portuguese women was 10%. Severe FOC was significantly associated with lower educational level, single/divorced marital status, and negative previous childbirth experience. Multivariate logistic regression analysis indicated that being single or divorced and having a negative previous childbirth experience were predictive variables for severe FOC.ConclusionPregnant Portuguese women have FOC, although with varying severity. The data suggest that marital status and women's perceptions of previous childbirth experience may be useful variables to predict severe FOC. Further research for extending the predictive factors of FOC should be refined. The results are clinically relevant for midwifery care, as they should be used in the sense of early identification of fearful pregnant women to provide adequate support strategies to reduce FOC.     

Preventing recurrence after surgical repair of pressure injuries in patients with spinal cord injury: Effects of a presurgical and postsurgical wheelchair seating intervention by experts

ObjectivePressure injuries in people with spinal cord injury or dysfunction (SCI/D) are known to have a high recurrence rate. As a countermeasure, we perform surgery after adjusting the wheelchair and cushion with the intervention of a seating expert. The effectiveness of seating interventions in postsurgical recurrence prevention was examined.Materials and methodsIn this retrospective analysis, the participants were 19 patients with SCI/D who underwent pressure injury surgical treatment in the gluteal region from 2005 to 2018. The patients with conventional rehabilitation were assigned to Group 1 (n = 8), and those with seating intervention by experts in addition to conventional rehabilitation were assigned to Group 2 (n = 11). The main outcome measure was the presence or absence of recurrence 3 years after the surgery. The recurrence rate was compared between the two groups.ResultsThe recurrence rates were 18% with seating intervention and 75% without; there was a significant difference (p = 0.025). The recurrence odds ratio was 13.5.ConclusionThis study suggests that presurgical seating evaluation and assessment by experts, postsurgical rehabilitation based on presurgical evaluation and assessment, and routine follow-up and seating adjustment according to changes are efficacious for preventing postsurgical pressure injury recurrence in patients with SCI/D.