Increases in diagnosis and management of obstetric and neonatal complications in district hospitals during a high intensity nurse-mentoring program in Bihar, India.
Maternal and neonatal mortality in Bihar, India was far higher than the aspirational levels set out by the Sustainable Development Goals. Provider training programs have been implemented in many low-resource settings to improve obstetric and neonatal outcomes. This longitudinal investigation assesse...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2021-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0247260&type=printable |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850240550562693120 |
|---|---|
| author | Ammar Joudeh Rakesh Ghosh Hilary Spindler Seema Handu Sunil Sonthalia Aritra Das Aboli Gore Tanmay Mahapatra Dilys Walker |
| author_facet | Ammar Joudeh Rakesh Ghosh Hilary Spindler Seema Handu Sunil Sonthalia Aritra Das Aboli Gore Tanmay Mahapatra Dilys Walker |
| author_sort | Ammar Joudeh |
| collection | DOAJ |
| description | Maternal and neonatal mortality in Bihar, India was far higher than the aspirational levels set out by the Sustainable Development Goals. Provider training programs have been implemented in many low-resource settings to improve obstetric and neonatal outcomes. This longitudinal investigation assessed diagnoses and management of postpartum hemorrhage (PPH), hypertensive disorders of pregnancy, birth asphyxia (BA), and low birth weight (LBW), as part of the CARE's AMANAT program in 22 District Hospitals in Bihar, between 2015 and 2017. Physicians and nurse mentors conducted clinical instruction, simulations and teamwork and communication activities, infrastructure and management support, and data collection for 6 consecutive months. Analysis of diagnosis included 11,259 non-referred and management included 11,800 total (non-referred and referred) admissions that were observed. Data were analyzed using the chi-square test for trend. PPH was diagnosed in 3.7% with no significant trend but diagnosis of hypertensive disorders increased from 1.0% to 1.7%, (ptrend = 0.04), over the 6 months. BA was diagnosed in 5.8% with no significant trend but LBW diagnoses increased from 11% to 16% (ptrend<0.01). Among PPH patients, 96% received fluids, 85% received uterotonics and 11% received Tranexamic Acid (TXA). There was a significant positive trend in the number of patients receiving TXA for PPH (6% to 13.8%, ptrend = 0.03). Of all neonates with BA, there were statistically significant increases in the proportion who were initially warmed, dried, and stimulated (78% to 94%, ptrend = 0.02), received airway suction (80% to 93%, ptrend = 0.03), and supplemental oxygen without positive pressure ventilation (73% to 86%, ptrend = 0.05). Diagnoses of hypertensive disorders and LBW as well as initial management of BA increased during the AMANAT program. However, underdiagnoses of PPH and hypertensive disorders relative to population levels remain critical barriers to improving maternal morbidity and mortality. |
| format | Article |
| id | doaj-art-2d2acc99223a4bacbd4502747ca7e15c |
| institution | OA Journals |
| issn | 1932-6203 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-2d2acc99223a4bacbd4502747ca7e15c2025-08-20T02:00:50ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01163e024726010.1371/journal.pone.0247260Increases in diagnosis and management of obstetric and neonatal complications in district hospitals during a high intensity nurse-mentoring program in Bihar, India.Ammar JoudehRakesh GhoshHilary SpindlerSeema HanduSunil SonthaliaAritra DasAboli GoreTanmay MahapatraDilys WalkerMaternal and neonatal mortality in Bihar, India was far higher than the aspirational levels set out by the Sustainable Development Goals. Provider training programs have been implemented in many low-resource settings to improve obstetric and neonatal outcomes. This longitudinal investigation assessed diagnoses and management of postpartum hemorrhage (PPH), hypertensive disorders of pregnancy, birth asphyxia (BA), and low birth weight (LBW), as part of the CARE's AMANAT program in 22 District Hospitals in Bihar, between 2015 and 2017. Physicians and nurse mentors conducted clinical instruction, simulations and teamwork and communication activities, infrastructure and management support, and data collection for 6 consecutive months. Analysis of diagnosis included 11,259 non-referred and management included 11,800 total (non-referred and referred) admissions that were observed. Data were analyzed using the chi-square test for trend. PPH was diagnosed in 3.7% with no significant trend but diagnosis of hypertensive disorders increased from 1.0% to 1.7%, (ptrend = 0.04), over the 6 months. BA was diagnosed in 5.8% with no significant trend but LBW diagnoses increased from 11% to 16% (ptrend<0.01). Among PPH patients, 96% received fluids, 85% received uterotonics and 11% received Tranexamic Acid (TXA). There was a significant positive trend in the number of patients receiving TXA for PPH (6% to 13.8%, ptrend = 0.03). Of all neonates with BA, there were statistically significant increases in the proportion who were initially warmed, dried, and stimulated (78% to 94%, ptrend = 0.02), received airway suction (80% to 93%, ptrend = 0.03), and supplemental oxygen without positive pressure ventilation (73% to 86%, ptrend = 0.05). Diagnoses of hypertensive disorders and LBW as well as initial management of BA increased during the AMANAT program. However, underdiagnoses of PPH and hypertensive disorders relative to population levels remain critical barriers to improving maternal morbidity and mortality.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0247260&type=printable |
| spellingShingle | Ammar Joudeh Rakesh Ghosh Hilary Spindler Seema Handu Sunil Sonthalia Aritra Das Aboli Gore Tanmay Mahapatra Dilys Walker Increases in diagnosis and management of obstetric and neonatal complications in district hospitals during a high intensity nurse-mentoring program in Bihar, India. PLoS ONE |
| title | Increases in diagnosis and management of obstetric and neonatal complications in district hospitals during a high intensity nurse-mentoring program in Bihar, India. |
| title_full | Increases in diagnosis and management of obstetric and neonatal complications in district hospitals during a high intensity nurse-mentoring program in Bihar, India. |
| title_fullStr | Increases in diagnosis and management of obstetric and neonatal complications in district hospitals during a high intensity nurse-mentoring program in Bihar, India. |
| title_full_unstemmed | Increases in diagnosis and management of obstetric and neonatal complications in district hospitals during a high intensity nurse-mentoring program in Bihar, India. |
| title_short | Increases in diagnosis and management of obstetric and neonatal complications in district hospitals during a high intensity nurse-mentoring program in Bihar, India. |
| title_sort | increases in diagnosis and management of obstetric and neonatal complications in district hospitals during a high intensity nurse mentoring program in bihar india |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0247260&type=printable |
| work_keys_str_mv | AT ammarjoudeh increasesindiagnosisandmanagementofobstetricandneonatalcomplicationsindistricthospitalsduringahighintensitynursementoringprograminbiharindia AT rakeshghosh increasesindiagnosisandmanagementofobstetricandneonatalcomplicationsindistricthospitalsduringahighintensitynursementoringprograminbiharindia AT hilaryspindler increasesindiagnosisandmanagementofobstetricandneonatalcomplicationsindistricthospitalsduringahighintensitynursementoringprograminbiharindia AT seemahandu increasesindiagnosisandmanagementofobstetricandneonatalcomplicationsindistricthospitalsduringahighintensitynursementoringprograminbiharindia AT sunilsonthalia increasesindiagnosisandmanagementofobstetricandneonatalcomplicationsindistricthospitalsduringahighintensitynursementoringprograminbiharindia AT aritradas increasesindiagnosisandmanagementofobstetricandneonatalcomplicationsindistricthospitalsduringahighintensitynursementoringprograminbiharindia AT aboligore increasesindiagnosisandmanagementofobstetricandneonatalcomplicationsindistricthospitalsduringahighintensitynursementoringprograminbiharindia AT tanmaymahapatra increasesindiagnosisandmanagementofobstetricandneonatalcomplicationsindistricthospitalsduringahighintensitynursementoringprograminbiharindia AT dilyswalker increasesindiagnosisandmanagementofobstetricandneonatalcomplicationsindistricthospitalsduringahighintensitynursementoringprograminbiharindia |