Causes of maternal deaths in Sierra Leone from 2016 to 2019: analysis of districts maternal death surveillance and response data

Introduction

Sierra Leone is among the top countries with the highest maternal mortality rates. Although progress has been made in reducing maternal mortality, challenges remain, including limited access to skilled care and regional disparities in accessing quality care. This paper presents the first comprehensive analysis of the burden of different causes of maternal deaths reported in the Maternal Death Surveillance and Response (MDSR) system at the district level from 2016 to 2019.

Methods

The MDSR data are accessed from the Ministry of Health and Sanitation, and the secondary data analysis was done to determine the causes of maternal death in Sierra Leone. The proportions of each leading cause of maternal deaths were estimated by districts. A subgroup analysis of the selected causes of death was also performed.

Results

Overall, obstetric haemorrhage was the leading cause of maternal death (39.4%), followed by hypertensive disorders (15.8%) and pregnancy-related infections (10.1%). Within obstetric haemorrhage, postpartum haemorrhage was the leading cause in each district. The burden of death due to obstetric haemorrhage slightly increased over the study period, while hypertensive disorders showed a slightly decreasing trend. Disparities were found among districts for all causes of maternal death, but no clear geographical pattern emerged. Non-obstetric complications were reported in 11.5% of cases.

Conclusion

The MDSR database provides an opportunity for shared learning and can be used to improve the quality of maternal health services. To improve the accuracy and availability of data, under-reporting must be addressed, and frontline community staff must be trained to accurately capture and report death events.

Occupational physical activity as a determinant of daytime activity patterns and pregnancy and infant health

by Alexis Thrower, Tyler Quinn, Melissa Jones, Kara M. Whitaker, Bethany Barone Gibbs

Though physical activity (PA) is recommended during pregnancy, it remains unclear how occupational physical activity (OPA) and sedentary behavior (SB) contribute to activity patterns and health during pregnancy. The purpose of this secondary analysis was to determine if OPA pattern is a determinant of all-day PA and evaluate associations with pregnancy/infant health outcomes. Data was from two prospective cohorts with study visits each trimester: MoM Health (Pittsburgh, PA; n = 120) and PRAMS (Iowa City, Iowa; n = 20). Using employment status/job hours (self-reported in demographic questionnaires) and OPA from the Pregnancy Physical Activity Questionnaire, latent class analysis identified three groups: sitting (n = 61), part-time mixed (n = 9), and active (n = 29). A fourth group included non-working participants (n = 32). Device-based PA (ActiGraph GT3X), SB (activPAL3 micro), and blood pressure were measured each trimester. Glucose screening test, gestational age, gestational weight gain, adverse pregnancy outcomes (APOs: gestational hypertension, preeclampsia, eclampsia, gestational diabetes, intrauterine growth restriction, and preterm birth), and infant outcomes (length, weight, and sex) were abstracted from medical records. Associations between groups with APOs and pregnancy/infant health were calculated using linear/logistic regression with adjustment for age, pre-pregnancy BMI, education, and race. Self-reported participant characteristics were similar across groups, except education which was higher in the sitting versus other groups. All-day device-based PA differed across groups; for example, the sitting group had the highest SB across trimester (all p0.09). Compared to the non-working group, the risk of any APO was non-significantly higher in the sitting (OR = 2.27, 95%CI = 0.63–8.18) and active groups (OR = 2.40, 95%CI = 0.66–9.75), though not the part-time mixed (OR = 0.86, 95%CI = 0.08–9.1). OPA pattern is a determinant of all-day PA during pregnancy. Future studies with larger samples should examine associations between pregnancy OPA patterns and pregnancy/infant health.

Blood pressure and heart rate variability responses following an acute bout of vinyasa yoga and a prolonged seated control: A randomized crossover trial

by Alexis Thrower, Bethany Barone Gibbs, Abdullah Alansare, Sally Sherman, Kelliann Davis

Vinyasa yoga is moderate-intensity physical activity, yet physiological responses are poorly characterized. The purpose of this study was to examine the effect of a vinyasa yoga session on autonomic/cardiovascular functioning in healthy adults. A randomized crossover design took place at the Physical Activity and Weight Management laboratory (Pittsburgh, PA; n = 18), and included two experimental conditions: 60 minutes of vinyasa yoga or a seated control, and measurements were taken at baseline, 5-minutes, and 65-minute post-conditions. The primary cardiovascular-related outcomes of this study included blood pressure (BP), heart rate (HR), and HR variability (HRV) measures [natural log transformed (ln) standard deviation of normal-to-normal R-R intervals (SDNN), root mean square of successive differences (RMSSD), high frequency (HF), and low frequency to high frequency ratio (LF/HF ratio)]. Linear mixed effects models were used for data analyses. Systolic BP was 8.14 mmHg lower at 5 minutes post yoga (p

Prevención de infecciones nosocomiales mediante impregnación antimicrobiana del catéter venoso central

Objetivo principal: Evaluar si el uso de catéter venoso central (CVC) impregnado en antimicrobiano es útil para la reducción de la bacteriemia relacionada con el catéter en  pacientes ingresados en la Unidad de Cuidados Intensivos (UCI), e identificar el antimicrobiano más efectivo. Metodología: Se realizó una revisión sistemática en Bases Datos (CINAHL, PUBMED, CUIDEN, EMBASE, LILACS y SCIELO). Incluidos artículos de 2009 a 2017, inglés y español, que fuesen ensayos clínicos aleatorizados e incluyeran pacientes de UCI con CVC impregnado comparado con CVC convencional. Se evaluó la calidad metodológica de los artículos mediante la herramienta CASPE. Resultados principales: De los 8 estudios, 4 mostraron significancia en cuanto al uso de CVC impregnados para la reducción de infecciones relacionadas con el catéter. Dentro de los antimicrobianos usados, la minociclina-rifampicina muestra la mayor efectividad. Conclusión principal: El uso de CVC impregnado, puede ser efectivo en la reducción de infecciones en UCI. Dentro de las limitaciones de este tipo de catéter, a mayor número de luces y tiempo de mantenimiento de CVC, menor efectividad antimicrobiana.