Pillay Yashodani, Ngonzi Joseph, Nguyen Vuong, Payne Beth A, Komugisha Clare, Twinomujuni Annet Happy, Vidler Marianne, Lavoie Pascal M, Bebell Lisa M, Christoffersen-Deb Astrid, Kenya-Mugisha Nathan, Kissoon Niranjan, Ansermino J Mark, Wiens Matthew O
Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.
Institute for Global Health, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
PLOS Glob Public Health. 2024 Aug 7;4(8):e0003458. doi: 10.1371/journal.pgph.0003458. eCollection 2024.
Sub-Saharan Africa accounts for two-thirds of the global burden of maternal and newborn deaths. Adverse outcomes among postpartum women and newborns occurring in the first six weeks of life are often related, though data co-examining patients are limited. This study is an exploratory analysis describing the epidemiology of postnatal complications among postpartum women and newborns following facility birth and discharge in Mbarara, Uganda. This single-site prospective cohort observational study enrolled postpartum women following facility-based delivery. To capture health information about both the postpartum women and newborns, data was collected and categorized according to domains within the continuum of care including (1) social and demographic, (2) pregnancy history and antenatal care, (3) delivery, (4) maternal discharge, and (5) newborn discharge. The primary outcomes were readmission and mortality within the six-week postnatal period as defined by the WHO. Multivariable logistic regression was used to identify risk factors. Among 2930 discharged dyads, 2.8% and 9.0% of women and newborns received three or more postnatal visits respectively. Readmission and deaths occurred among 108(3.6%) and 25(0.8%) newborns and in 80(2.7%) and 0(0%) women, respectively. Readmissions were related to sepsis/infection in 70(88%) women and 68(63%) newborns. Adjusted analysis found that caesarean delivery (OR:2.91; 95%CI:1.5-6.04), longer travel time to the facility (OR:1.54; 95%CI:1.24-1.91) and higher maternal heart rate at discharge (OR:1.02; 95%CI:1.00-1.01) were significantly associated with maternal readmission. Discharge taken on all patients including maternal haemoglobin (per g/dL) (OR:0.90; 95%CI:0.82-0.99), maternal symptoms (OR:1.76; 95%CI:1.02-2.91), newborn temperature (OR:1.66; 95%CI:1.28-2.13) and newborn heart rate at (OR:1.94; 95%CI:1.19-3.09) were risk factors among newborns. Readmission and death following delivery and discharge from healthcare facilities is still a problem in settings with low rates of postnatal care visits for both women and newborns. Strategies to identify vulnerable dyads and provide better access to follow-up care, are urgently required.
撒哈拉以南非洲地区承担了全球三分之二的孕产妇和新生儿死亡负担。产后六周内出现的产后妇女和新生儿不良结局往往相互关联，不过同时检查患者的相关数据有限。本研究是一项探索性分析，描述了乌干达姆巴拉拉地区医疗机构分娩及出院后产后妇女和新生儿产后并发症的流行病学情况。这项单中心前瞻性队列观察研究纳入了在医疗机构分娩后的产后妇女。为获取产后妇女和新生儿的健康信息，数据按照连续护理范围内的领域进行收集和分类，包括（1）社会和人口统计学信息，（2）妊娠史和产前护理，（3）分娩情况，（4）产妇出院情况，以及（5）新生儿出院情况。主要结局是世界卫生组织定义的产后六周内再次入院和死亡情况。采用多变量逻辑回归来确定风险因素。在2930对出院的母婴中，分别有2.8%的妇女和9.0%的新生儿接受了三次或更多次产后访视。新生儿和产妇再次入院和死亡的发生率分别为108例（3.6%）和25例（0.8%），以及80例（2.7%）和0例（0%）。70例（88%）妇女和68例（63%）新生儿的再次入院与败血症/感染有关。校正分析发现，剖宫产（比值比：2.91；95%置信区间：1.5 - 6.04）、到医疗机构的较长行程时间（比值比：1.54；95%置信区间：1.24 - 1.91）以及出院时较高的产妇心率（比值比：1.02；95%置信区间：1.00 - 1.01）与产妇再次入院显著相关。包括产妇血红蛋白（每克/分升）（比值比：0.90；95%置信区间：0.82 - 0.99）、产妇症状（比值比：1.76；95%置信区间：1.02 - 2.91）、新生儿体温（比值比：1.66；95%置信区间：1.28 - 2.13）和新生儿心率（比值比：1.94；95%置信区间：1.19 - 3.09）在内的所有患者出院时的情况都是新生儿的风险因素。对于妇女和新生儿产后护理访视率较低的地区，分娩和医疗机构出院后的再次入院和死亡仍然是一个问题。迫切需要制定策略来识别脆弱的母婴对，并提供更好的后续护理服务。
