Skilled birth attendance (SBA) has been shown to reduce maternal mortality and improve birth outc... more Skilled birth attendance (SBA) has been shown to reduce maternal mortality and improve birth outcomes. Because skilled professionals are supposed to be present in health facilities, increasing facility deliveries is expected to increase SBA. However, in a country with a critical shortage of skilled health personnel, is this always the case? We present data from three studies conducted in Zambia to understand SBA and delivery practices in health facilities.
In each of the studies, women were asked where and with whom they delivered their youngest child. We calculated the proportion of all deliveries that occurred at health facilities, and proportion of SBAs at health facilities.
Across all three studies, 62.5% of 39,419 were facility deliveries. Of 39,078 deliveries where data were available for the person assisting, SBA was 54.1%; non-SBA was 45.9%. TBAs assisted 18.5% of all deliveries, but of all non-SBAs, TBAs delivered 40.3%.
Among 24,254 health facility deliveries where data were available for person assisting, SBA was 86.3%; non-SBA was 13.7%; TBAs assisted 10% of all facility deliveries. Of all non-SBA deliveries within health facilities, 70.9% were assisted by TBAs.
Our studies revealed that unskilled personnel attended 14% of deliveries occurring within health facilities and TBAs assisted 71% of these. In a country with a critical shortage of skilled health personnel, facility deliveries may not directly translate into SBA. We recommend equipping TBAs with stronger skills to conduct deliveries and manage delivery-associated complications in addition to emphasizing the need to refer to health facilities.
International Journal of Gynecology & Obstetrics, 2015
To evaluate the impact of rapid syphilis tests (RSTs) on syphilis testing and treatment in pregna... more To evaluate the impact of rapid syphilis tests (RSTs) on syphilis testing and treatment in pregnant women in Kalomo District, Zambia. In March 2012, health workers at all 35 health facilities in Kalomo Distract were trained in RST use and penicillin treatment. In March 2013, data were retrospectively abstracted from 18 randomly selected health facilities and stratified into three time intervals: baseline (6months prior to RST introduction), midline (0-6 months after RST introduction), and endline (7-12 months after RST introduction). Data collected on 4154 pregnant women showed a syphilis-reactive seroprevalence of 2.7%. The proportion of women screened improved from baseline (140/1365, 10.6%) to midline (976/1446, 67.5%), finally decreasing at endline (752/1337, 56.3%) (P<0.001). There was no significant difference in the proportion of syphilis-seroreactive pregnant women who received 1 dose of penicillin before (1/2, 50%) or after (5/48, 10.4%; P=0.199) RST introduction with low treatment rates throughout. With RST scale-up in Zambia and other resource-limited settings, same-day test and treatment with penicillin should be prioritized to achieve the goal of eliminating congenital syphilis.
Epidemiology of injuries, outcomes, and hospital resource utilisation at a tertiary teaching hosp... more Epidemiology of injuries, outcomes, and hospital resource utilisation at a tertiary teaching hospital in Lusaka, Zambia
In March 2012, The Elizabeth Glaser Pediatric AIDS Foundation trained maternal and child health w... more In March 2012, The Elizabeth Glaser Pediatric AIDS Foundation trained maternal and child health workers in Southern Province of Zambia to use a new rapid syphilis test (RST) during routine antenatal care. A recent study by Bonawitz et al. (2014) evaluated the impact of this roll out in Kalomo District. This paper estimates the costs and cost-effectiveness from the provider's perspective under the actual conditions observed during the first year of the RST roll out. Information on materials used and costs were extracted from program records. A decision-analytic model was used to evaluate the costs (2012 USD) and cost-effectiveness. Basic parameters needed for the model were based on the results from the evaluation study. During the evaluation study, 62% of patients received a RST, and 2.8% of patients tested were positive (and 10.4% of these were treated). Even with very high RST sensitivity and specificity (98%), true prevalence of active syphilis would be substantially less (es...
Skilled birth attendance (SBA) has been shown to reduce maternal mortality and improve birth outc... more Skilled birth attendance (SBA) has been shown to reduce maternal mortality and improve birth outcomes. Because skilled professionals are supposed to be present in health facilities, increasing facility deliveries is expected to increase SBA. However, in a country with a critical shortage of skilled health personnel, is this always the case? We present data from three studies conducted in Zambia to understand SBA and delivery practices in health facilities.
In each of the studies, women were asked where and with whom they delivered their youngest child. We calculated the proportion of all deliveries that occurred at health facilities, and proportion of SBAs at health facilities.
Across all three studies, 62.5% of 39,419 were facility deliveries. Of 39,078 deliveries where data were available for the person assisting, SBA was 54.1%; non-SBA was 45.9%. TBAs assisted 18.5% of all deliveries, but of all non-SBAs, TBAs delivered 40.3%.
Among 24,254 health facility deliveries where data were available for person assisting, SBA was 86.3%; non-SBA was 13.7%; TBAs assisted 10% of all facility deliveries. Of all non-SBA deliveries within health facilities, 70.9% were assisted by TBAs.
Our studies revealed that unskilled personnel attended 14% of deliveries occurring within health facilities and TBAs assisted 71% of these. In a country with a critical shortage of skilled health personnel, facility deliveries may not directly translate into SBA. We recommend equipping TBAs with stronger skills to conduct deliveries and manage delivery-associated complications in addition to emphasizing the need to refer to health facilities.
International Journal of Gynecology & Obstetrics, 2015
To evaluate the impact of rapid syphilis tests (RSTs) on syphilis testing and treatment in pregna... more To evaluate the impact of rapid syphilis tests (RSTs) on syphilis testing and treatment in pregnant women in Kalomo District, Zambia. In March 2012, health workers at all 35 health facilities in Kalomo Distract were trained in RST use and penicillin treatment. In March 2013, data were retrospectively abstracted from 18 randomly selected health facilities and stratified into three time intervals: baseline (6months prior to RST introduction), midline (0-6 months after RST introduction), and endline (7-12 months after RST introduction). Data collected on 4154 pregnant women showed a syphilis-reactive seroprevalence of 2.7%. The proportion of women screened improved from baseline (140/1365, 10.6%) to midline (976/1446, 67.5%), finally decreasing at endline (752/1337, 56.3%) (P<0.001). There was no significant difference in the proportion of syphilis-seroreactive pregnant women who received 1 dose of penicillin before (1/2, 50%) or after (5/48, 10.4%; P=0.199) RST introduction with low treatment rates throughout. With RST scale-up in Zambia and other resource-limited settings, same-day test and treatment with penicillin should be prioritized to achieve the goal of eliminating congenital syphilis.
Epidemiology of injuries, outcomes, and hospital resource utilisation at a tertiary teaching hosp... more Epidemiology of injuries, outcomes, and hospital resource utilisation at a tertiary teaching hospital in Lusaka, Zambia
In March 2012, The Elizabeth Glaser Pediatric AIDS Foundation trained maternal and child health w... more In March 2012, The Elizabeth Glaser Pediatric AIDS Foundation trained maternal and child health workers in Southern Province of Zambia to use a new rapid syphilis test (RST) during routine antenatal care. A recent study by Bonawitz et al. (2014) evaluated the impact of this roll out in Kalomo District. This paper estimates the costs and cost-effectiveness from the provider's perspective under the actual conditions observed during the first year of the RST roll out. Information on materials used and costs were extracted from program records. A decision-analytic model was used to evaluate the costs (2012 USD) and cost-effectiveness. Basic parameters needed for the model were based on the results from the evaluation study. During the evaluation study, 62% of patients received a RST, and 2.8% of patients tested were positive (and 10.4% of these were treated). Even with very high RST sensitivity and specificity (98%), true prevalence of active syphilis would be substantially less (es...
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Papers by Emily Hammond
SBA. However, in a country with a critical shortage of skilled health personnel, is this always the case? We present data from three studies conducted in Zambia to understand SBA and delivery practices in health facilities.
In each of the studies, women were asked where and with whom they delivered their youngest child. We calculated the proportion of all deliveries that occurred at health facilities, and proportion of SBAs at health facilities.
Across all three studies, 62.5% of 39,419 were facility deliveries. Of 39,078 deliveries where data were available for the person assisting, SBA was 54.1%; non-SBA was 45.9%. TBAs assisted 18.5% of all deliveries, but of all non-SBAs, TBAs delivered 40.3%.
Among 24,254 health facility deliveries where data were available for person assisting, SBA was 86.3%; non-SBA was 13.7%; TBAs assisted 10% of all facility deliveries. Of all non-SBA deliveries within health facilities, 70.9% were assisted by TBAs.
Our studies revealed that unskilled personnel attended 14% of deliveries occurring within health facilities and TBAs assisted 71% of these. In a country with a critical shortage of skilled health personnel, facility deliveries may not directly translate into SBA. We recommend equipping TBAs with stronger skills
to conduct deliveries and manage delivery-associated complications in addition to emphasizing the need to refer to health facilities.
SBA. However, in a country with a critical shortage of skilled health personnel, is this always the case? We present data from three studies conducted in Zambia to understand SBA and delivery practices in health facilities.
In each of the studies, women were asked where and with whom they delivered their youngest child. We calculated the proportion of all deliveries that occurred at health facilities, and proportion of SBAs at health facilities.
Across all three studies, 62.5% of 39,419 were facility deliveries. Of 39,078 deliveries where data were available for the person assisting, SBA was 54.1%; non-SBA was 45.9%. TBAs assisted 18.5% of all deliveries, but of all non-SBAs, TBAs delivered 40.3%.
Among 24,254 health facility deliveries where data were available for person assisting, SBA was 86.3%; non-SBA was 13.7%; TBAs assisted 10% of all facility deliveries. Of all non-SBA deliveries within health facilities, 70.9% were assisted by TBAs.
Our studies revealed that unskilled personnel attended 14% of deliveries occurring within health facilities and TBAs assisted 71% of these. In a country with a critical shortage of skilled health personnel, facility deliveries may not directly translate into SBA. We recommend equipping TBAs with stronger skills
to conduct deliveries and manage delivery-associated complications in addition to emphasizing the need to refer to health facilities.