Papers by Adetoro Adegoke
Cochrane Database of Systematic Reviews, Dec 7, 2011
Iron supplementation for sickle cell disease during pregnancy.
Gynecology & Obstetrics, Mar 16, 2015
Maternal and Child Health Journal, May 4, 2014
Although most developing countries monitor the proportion of births attended by skilled birth att... more Although most developing countries monitor the proportion of births attended by skilled birth attendants (SBA), they lack information on the availability and performance of emergency obstetric care (EmOC) signal functions by different cadres of health care providers (HCPs). The World Health Organisation signal functions are set of key interventions that targets direct obstetric causes of maternal deaths. Seven signal functions are required for health facilities providing basic EmOC and nine for facilities providing comprehensive EmOC. Our objectives were to describe cadres of HCPs who are considered SBAs in Tanzania, the EmOC signal functions they perform and challenges associated with performance of EmOC signal functions. We conducted a cross-sectional study of HCPs offering maternity care services at eight health facilities in Moshi Urban District in northern Tanzania. A questionnaire and health facility assessment forms were used to collect information from participants and health facilities. A total of 199 HCPs working at eight health facilities in Moshi Urban District met the inclusion criteria. Out of 199, 158 participated, giving a response rate of 79.4 %. Ten cadres of HCPs were identified as conducting deliveries regardless of the level of health facilities. Most of the participants (81 %) considered themselves SBAs, although some were not considered SBAs by the Ministry of Health and Social Welfare (MOHSW). Only two out of the eight facilities provided all of the required EmOC signal functions. While Assistant Medical Officers are expected to perform all the signal functions, only 38 % and 13 % had performed vacuum extraction or caesarean sections respectively. Very few registered and enrolled nurse-midwives had performed removal of retained products (22 %) or assisted vaginal delivery (24 and 11 %). Inadequate equipment and supplies, and lack of knowledge and skills in performing EmOC were two main challenges identified by health care providers in all the level of care. In the district, gaps existed between performance of EmOC signal functions by SBAs as expected by the MOHSW and the actual performance at health facilities. All basic EmOC facilities were not fully functional. Few health care providers performed all the basic EmOC signal functions. Competency-based in-service training of providers in EmOC and provision of enabling environment could improve performance of EmOC signal functions in the district.
International Health, Dec 19, 2012
Global strategies to target high maternal mortality ratios are focused on providing skilled atten... more Global strategies to target high maternal mortality ratios are focused on providing skilled attendance at delivery as well as access to emergency obstetric care. South Asia has the lowest rates of skilled birth attendance in the world, and Nepal is lagging behind neighbouring countries. This review looks at the demand-side barriers to seeking care as well as strategies to increase facility delivery in rural South Asia. A search was made of key databases, including PubMed and the WHO, for literature relating to utilisation of facility delivery in South Asia. The main factors found to influence facility delivery in South Asia were physical and financial barriers, socioeconomic and educational status, obstetric history and awareness of danger signs, sociocultural factors and perceived quality of care. Strategies to increase facility delivery include maternity waiting homes, demandside financing schemes, education programmes and participatory women's groups. Increasing utilisation of delivery services in South Asia requires a multisectoral approach. Key areas are increasing education for girls as well as empowering women through women's groups and community mobilisation. Removal of user fees appears to be successful but needs to be sustainable and equitable in its delivery.
The Cochrane library, Sep 14, 2015
Iron supplementation for sickle cell disease during pregnancy.
Journal of Health Care for the Poor and Underserved, 2017
Introduction. Nigeria is one of 57 countries with critical shortage of health workers (HWs). Stra... more Introduction. Nigeria is one of 57 countries with critical shortage of health workers (HWs). Strategies to increase and equitably distribute HWs are critical to the achievement of Health Millennium/ Sustainable Development Goals. We describe how three Northern Nigeria states adapted World Health Organisation (WHO)-recommended incentives to attract, recruit, and retain midwives. Methods. Secondary analysis of data from two surveys assessing midwife motivation, retention, and attrition in Northern Nigeria; and expert consultations. Results. Midwives highlighted financial and non-financial incentives as key factors in their decisions to renew their contracts. Their perspectives informed the consensus positions of health managers, policymakers and heads of institutions, and led to the adaptation of the WHO recommendations into appropriate state-specific incentive packages. Conclusions. The feedback from midwives combined with an expert consultation approach allowed stakeholders to consider and use available evidence to select appropriate incentive packages that offer the greatest potential for helping to address inadequate numbers of rural midwives.
BMC Pregnancy and Childbirth, Sep 29, 2016
Background: Assessing the feasibility of conducting a prospective Reproductive Age Mortality Surv... more Background: Assessing the feasibility of conducting a prospective Reproductive Age Mortality Survey (RAMOS) study in the low-income setting of Mangochi District, Malawi to obtain cotemporaneous estimates of the number, cause of and conditions associated with maternal deaths (MD) in all women of reproductive age (WRA) (n = 207 688). Methods: MD among all deaths of WRA were identified using the ICD-10 definition. Cause of death and contributing conditions identified by a panel of experts using the classification system for deaths during pregnancy, childbirth and puerperium (ICD-MM). Results: Out of 424 deaths of WRA, 151 were MD giving a Maternal Mortality Ratio (MMR) of 363 per 100,000 live births (95 % CI: 307-425). Only 86 MD had been reported via existing reporting mechanisms representing an underreporting of 43 %. The majority of MD (62.3 %) occurred in a health facility and were the result of direct obstetric causes (74.8 %) with obstetric haemorrhage as the leading cause (35.8 %), followed by pregnancy-related infections (19.4 %), hypertensive disorders (16.8 %) and pregnancy with abortive outcome (13.2 %). Malaria was the most frequently identified indirect cause (9.9 %). Contributing conditions were more frequently identified when both verbal autopsy and facility-based death review had taken place and included obstructed labour (28.5 %), anaemia (12.6 %) and positive HIV status (4.0 %). Conclusion: The high number of MD that occur at health facility level, cause of death and contributing conditions reflect deficiencies in the quality of care at health facility level. A RAMOS is feasible in low-and middle-income settings and provides contemporaneous estimates of MMR.
Acta Obstetricia et Gynecologica Scandinavica, Jun 15, 2013
Objective. To identify which cadres of healthcare providers are considered to be skilled birth at... more Objective. To identify which cadres of healthcare providers are considered to be skilled birth attendants in South Asia, which of the signal functions of emergency obstetric care each cadre is reported to provide and whether this is included in their training and legislation. Design. Cross-sectional, descriptive study. Setting. Bangladesh, India, Nepal and Pakistan. Sample. Thirty-three key informants involved in training, regulation, recruitment and deployment of healthcare providers. Methods. Between November 2011 and March 2012, structured questionnaires were sent out to key informants by email followed up by face-to-face or telephone interviews. Main outcome measures. Mapping of definitions and roles of healthcare providers in four South Asian countries to assess which cadres are skilled birth attendants. Results. Cadres of healthcare providers expected to provide skilled birth attendance differ across countries. Although most identified cadres administer parenteral antibiotics, oxytocics and perform newborn resuscitation; administration of anticonvulsants varies by country. Manual removal of the placenta, removal of retained products of conception and assisted vaginal delivery are not provided by all cadres expected to provide skilled birth attendance. Conclusion. Key signal functions of emergency obstetric care are often provided by medical doctors only. Provision of such potentially life-saving interventions by more healthcare provider cadres expected to function as skilled birth attendants can save lives. Ensuring better training and legislation are in place for this is crucial.
International journal of gynaecology and obstetrics, Oct 1, 2012
were studied using a structured questionnaire. Analysis was by SPSS 16.0 computer package. Method... more were studied using a structured questionnaire. Analysis was by SPSS 16.0 computer package. Methods: It was a cross-sectional study conducted at Federal Medical Centre, Birnin-Kebbi, Nigeria. Using a structured questionnaire data were obtained on socio-demographic characteristics and expenditure on various aspects of care for the obstetric emergency from respondents and their husbands. Results: Mean age of respondents was 25.8yrs (range 14-45 yrs). Most of the patients had no antenatal care (86.7%, N = 124) and were multiparous women (65.1%, N = 93). Majority were not engaged in any income generating activity (53.1%, 76). Average monthly family income was about N13'000 (USD81.3). Complications managed were prolonged and/obstructed labour (23.1%, N = 33), obstetric haemorrhages (21%), N = 30), eclampsia (16.1%, N = 23). Reasons for hospital presentation were mainly 'labour too long', heavy bleeding, and fitting in 30.1%, 23.8%, and 11.2% of respondents respectively, average length of hospital stay was about 9 days. A total of 42% (N = 60) had an operative delivery. 62.2% (N = 89) had visited one or more health facility prior to presentation thus adding to the cost of care. Mean total expenditure on care was about N39'000 (243.8USD) (maximum N 98'000, 608.7 USD); many of the patients (46.7% N = 67) had spent more than this average on care, and it was more than the monthly income of 94.4% (N = 135) of families studied. Mean expenditure on care was significantly higher for victims who had had surgery compared to those who had not, (c = 33.2, p < 0.05). Only 32.8% of the respondent said they could comfortably afford any expenditure that was greater than N20'000 (123.5 USD). Conclusions: The expenditure on maternity care in this study was high and it was more than the average monthly income for most families studied. The 'free maternity care' programme should take into consideration these spendings on some aspects of emergency obstetric care and budget appropriately if a reduction in maternal mortality is to be achieved.
clinics in Mother and Child Health, 2007
Reduction of maternal mortality is one of the major goals of several recent international confere... more Reduction of maternal mortality is one of the major goals of several recent international conferences and has been included in the Millennium Development Goals (MDGs). However, because measuring maternal mortality is difficult and complex, reliable estimates of the dimensions of the problem are not generally available. In most parts of sub-Saharan Africa in spite of the large number of maternal deaths, national statistics are either not available or unreliable. This has resulted in one of the principal obstacles to appropriate distribution of resources targeted towards improving maternal health care. A pilot study of maternal mortality was conducted between 11th April and 22nd April 2005 in a state in Nigeria, as a preliminary to a full community-based study to estimate the maternal mortality rate in Oyo State, Nigeria, using the Indirect Sisterhood method. Data were analysed descriptively using the statistical package SPSS. Four hundred and twenty respondents participated in the study (100% response rate). The total number of maternal deaths identified was 87.The major cause of death of the sisters as reported by the respondents was haemorrhage. The results suggest that maternal deaths remain a major public health issue in Ibadan, North East Local Government Area of Nigeria and that the proposed main study is important and urgently needed as the findings would be of relevance to the study of maternal mortality in Nigeria, and perhaps in countries with similar socio-economic situations. La reduction de mortalite maternelle est l\'un des objectifs majeurs de plusieurs conferences internationales recentes, et a ete incluse dans les objectifs du Millenaire pour le developpement (OMD). Cependant, puisque la mesure de la mortalite maternelle est difficile et complexe, les estimations fiables des dimensions de ce probleme ne sont pas generalement disponibles. Dans la plupart des regions d\'Afrique sub-Saharienne, et malgre le grand nombre de deces maternels, les statistiques nationales ne sont ni disponibles ni fiables. La consequence de ceci est la difficulte de distribuer des ressources qui visent l\'amelioration des soins de sante maternelle. Cette etude pilote de la mortalite maternelle a ete conduite du 11 au 22 Avril 2005 dans un etat au Nigeria, comme preliminaire a une etude plus globale pour estimer le taux maternel de mortalite dans l\'etat d\'Oyo, Nigeria en utilisant la Methode des Soeurs. Les donnees ont ete analysees d\'une maniere descriptive en utilisant le logiciel SPSS. Quatre cents et vingt repondants ont participe a cette etude (taux de reponse de 100%). Quatre vingt sept (87) deces maternels ont ete identifies. La principale cause de deces des soeurs rapportee par ces femmes etait l\'hemorragie. Ces resultats suggerent que les deces maternels restent un probleme majeur de sante publique dans la region de l\'Ibadan dans le « North West Local Gouvernement Area » du Nigeria. Nous proposons qu\'une etude plus vaste soit faite urgemment et les resultats pourraient etre utiles pour etudier la mortalite maternelle au Nigeria, et peut-etre dans d\'autres pays avec les situations socio-economiques semblables. Keywords : Maternal death - Maternal mortality- Avoidable factors - Community study - Pilot study. Clinics in Mother and Child Health Vol. 4 (2) 2007 pp. 763-770
Midwifery, Nov 1, 2013
to describe the incidence of maternal death by age, marital status, timing and place of death in ... more to describe the incidence of maternal death by age, marital status, timing and place of death in Ibadan North and Ido Local Government Areas of Oyo State, Nigeria. a retrospective study using multistage sampling with stratification and clustering to select local government areas, political wards and households. We included one eligible subject by household in the sample. Data on maternal mortality were collected using the principles of the indirect sisterhood method. Ibadan city of Oyo state, Nigeria. We included eight randomly selected political wards from Ibadan North LGA (urban) and Ido LGA (rural). 3028 participants were interviewed using the four questions of the indirect sisterhood method: How many sisters have you ever had who are ever married (or who survived until age 15)? How many are dead? How many are alive? How many died while they were pregnant, during childbirth, or within six weeks after childbirth (that is, died of maternal causes)? We also included other questions such as place and timing of death, age of women at death and number of pregnancies. 1139 deaths were reported to be related to pregnancy, childbirth or the puerperium. Almost half were aged between aged 25-34 years. More deaths occurred to women who were pregnant for the first time (33.4%, n=380) than for any other number of pregnancies, with 49.9% (n=521) dying within 24 hours after childbirth or abortion and 30.9% (n=322) dying after 24 hours but within 72 hours after childbirth or abortion. Only 71.5% (n=809) were reported to have been admitted to health-care facilities before their death, the percentage being higher in the urban LGA (72.4%, n=720) than the rural LGA (65.4%, n=89). The percentage being admitted varied from one political ward to another (from 42.9% to 80.4%), the difference being statistically significant (χ(2)=17.55, df=7, p=0.014). The majority of the deaths occurred after childbirth (63.5%, n=723). Most deaths were said to have occurred in the hospital (38.6%) or private clinic (28.2%), with 16.0% dying at home and 6.5% on the way to hospital. maternal mortality in Nigeria is still unacceptably high. ensure adequate training, recruitment and deployment of midwives and others with midwifery skills. Ensure midwives and other skilled birth attendants are backed up with functioning and well equipped health-care facilities. Provide health education and information to the public with regard to reproductive health and ensure the development and dissemination of a policy regarding attendance at birth by only health workers who have midwifery skills.
PubMed, Sep 1, 2007
Background: Reduction of maternal mortality is one of the major goals of several recent internati... more Background: Reduction of maternal mortality is one of the major goals of several recent international conferences and has been included within the Millennium Development Goals. However, because measuring maternal mortality is difficult and complex, reliable estimates of the dimensions of the problem are not generally available and assessing progress towards the goal is difficult in some countries. Reliable baseline data are crucial to effectively track progress and measure that targets or goals of reducing maternal mortality have been met. Objectives: The objectives of this pilot study were: to test adequacy of research instruments; to improve research techniques; to determine an appropriate workload; to determine the time required for interviews; and to assess the feasibility of a (full-scale) study/survey. Methods: This pilot study was conducted between 11(th) April and 22(nd) April 2005. 420 houses were visited and interviews of 420 respondents between the ages of 15-49 were conducted in a randomly pre-selected Local Government Area of Oyo state using a structured instrument developed using the principles of the Sisterhood Method. Results: There was willingness of the public to participate in the study. The response rate was 100%. There was no issue raised as regards the structure, wording and translation of the questionnaire. This pilot study uncovered local political problems and other issues that may be encountered during the main study. Conclusions: The pilot raised a number of fundamental issues related to the process of designing the research instrument, identifying and recruiting Data Collectors, training and supervision of Data Collectors and the research project, gaining access to respondents and obtaining support and approval from "gatekeepers". This paper highlights the lessons learned and reports practical issues that occurred during pilot study.
Maternal and Child Health Journal, Mar 13, 2012
A significant reduction in maternal mortality was witnessed globally in the year 2010, yet, no si... more A significant reduction in maternal mortality was witnessed globally in the year 2010, yet, no significant reduction in the maternal mortality ratio (MMR) in Nigeria was recorded. The absence of accurate data on the numbers, causes and local factors influencing adverse maternal outcomes has been identified as a major obstacle hindering appropriate distribution of resources targeted towards improving maternal healthcare. This paper reports the first community based study that measures the incidence of maternal mortality in Ibadan, Nigeria using the indirect sisterhood method and explores the applicability of this method in a community where maternal mortality is not a rare event. A community-based study was conducted in Ibadan using the principles of the sisterhood method developed by Graham et al. for developing countries. Using a multi-stage sampling design with stratification and clustering, 3,028 households were selected. All persons approached agreed to take part in the study (a participation rate of 100%), with 2,877 respondents eligible for analysis. There was a high incidence of maternal mortality in the study setting: 1,324/6,519 (20.3%) sisters of the respondents had died, with 1,139 deaths reportedly related to pregnancy, childbirth or the puerperium. The MMR was 7,778 per 100,000 live births (95% CI 7,326-8,229). Adjusted for a published Total Fertility Rate of 6.0, the MMR was 6,525 per 100,000 live births (95% CI 6,144-6,909). Women in Ibadan were dying more from pregnancy related complications than from other causes. Findings of this study have implications for midwifery education, training and practice and for the first time provide policy makers and planners with information on maternal mortality in the community of Ibadan city and shed light on the causes of maternal mortality in the area.
Midwifery, Oct 1, 2015
ABSTRACT Nigeria is one of the 57 countries with a critical shortage of human resources for healt... more ABSTRACT Nigeria is one of the 57 countries with a critical shortage of human resources for health, especially in remote rural areas and in northern states. The National Midwifery Service Scheme (MSS) is one approach introduced by the Government of Nigeria to address the health workforce shortage in rural areas. Since 2009, unemployed, retired and newly graduated midwives are deployed to primary health care (PHC) facilities in rural areas of Nigeria. These midwives form the mainstay of the health system at the primary health care level especially as it relates to the provision of skilled attendance at birth. This study followed up and explored the job satisfaction and retention of the MSS midwives in three Northern states of Nigeria.
International journal of gynaecology and obstetrics, Mar 24, 2012
Objective: To provide and evaluate in-service training in "Life Saving Skills-Emergency Obstetric... more Objective: To provide and evaluate in-service training in "Life Saving Skills-Emergency Obstetric and Newborn Care" in order to improve the availability of emergency obstetric care (EmOC) in Somaliland. Methods: In total, 222 healthcare providers (HCPs) were trained between January 2007 and December 2009. A beforeafter study was conducted using quantitative and qualitative methods to evaluate trainee reaction and change in knowledge, skills, and behavior, in addition to functionality of healthcare facilities, during and immediately after training, and at 3 and 6 months post-training. Results: The HCPs reacted positively to the training, with a significant improvement in 50% of knowledge and 100% of skills modules assessed. The HCPs reported improved confidence in providing EmOC. Basic and comprehensive EmOC healthcare facilities provided 100% of expected signal functions-compared with 43% and 56%, respectively, at baseline-with trained midwives performing skills usually performed by medical doctors. Lack of drugs, supplies, medical equipment, and supportive policy were identified as barriers that could contribute to nonuse of new skills and knowledge acquired. Conclusion: The training impacted positively on the availability and quality of EmOC and resulted in "up-skilling" of midwives.
International journal of gynaecology and obstetrics, May 29, 2011
To gain an overview of approaches, methodologies, and tools used in quality improvement of matern... more To gain an overview of approaches, methodologies, and tools used in quality improvement of maternal and newborn health in low-income countries. Methods: Electronic search of MEDLINE and organizational databases for literature describing approaches, methodologies, and tools used to improve the quality of maternal and newborn health care in low-income countries. Relevant papers and reports were reviewed and summarized. Results: Developing a culture of quality is an important requisite for successful quality improvement. Methodologies to improve quality include the development of standards and guidelines and the performance of mortality, near-miss, and criterion-based audits. Tools for data collection and process description were identified, and examples of work to improve quality of care are provided. Conclusion: The documented experience with the identified approaches, methodologies, and tools indicates that none is sufficient by itself to achieve a desirable improvement in quality of care. The choice of methodologies and tools depends on the healthcare system and its available resources. There is a lack of studies that describe the process of quality improvement and a need for research to provide evidence of the effectiveness of the identified methods and tools.
Journal of Obstetrics and Gynaecology, 2011
Skilled birth attendance (SBA) and essential obstetric care (EOC) are key strategies for reducing... more Skilled birth attendance (SBA) and essential obstetric care (EOC) are key strategies for reducing maternal and newborn mortality and morbidity globally. Lack of adequately trained competent staff is a key barrier to achieving this. We assessed the effectiveness of a new package of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Life Saving Skills - Essential Obstetric and Newborn Care Training&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (LSS-EOC and NC) designed specifically around the UN signal functions in seven countries in sub-Saharan Africa. Among 600 healthcare providers (nurse-midwives, doctors, clinical officers and specialists), knowledge about the diagnosis and management of complications of pregnancy and childbirth as well as newborn care significantly increased (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). There was measurable improvement in skills (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and participants expressed a high level of satisfaction with the training. The training package was found to meet the needs of healthcare providers, increased awareness of the need for evidence-based care and encouraged teamwork.
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Papers by Adetoro Adegoke