5 results on '"Makonyola, Grace"'
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2. Exploring the effect of implementation and context on a stepped-wedge randomised controlled trial of a vital sign triage device in routine maternity care in low-resource settings
- Author
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Vousden, Nicola, Lawley, Elodie, Seed, Paul T., Gidiri, Muchabayiwa Francis, Charantimath, Umesh, Makonyola, Grace, Brown, Adrian, Yadeta, Lomi, Best, Rebecca, Chinkoyo, Sebastian, Vwalika, Bellington, Nakimuli, Annettee, Ditai, James, Greene, Grace, Chappell, Lucy C., Sandall, Jane, Shennan, Andrew H., and on behalf of the CRADLE Trial Collaborative Group
- Published
- 2019
- Full Text
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3. Effect of a novel vital sign device on maternal mortality and morbidity in low-resource settings:a pragmatic, stepped-wedge, cluster-randomised controlled trial
- Author
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Vousden, Nicola, Lawley, Elodie, Nathan, Hannah L., Seed, Paul T., Gidiri, Muchabayiwa Francis, Goudar, Shivaprasad, Sandall, Jane, Chappell, Lucy C., Shennan, Andrew H., Kachinjika, Monice, Bukani, Doreen, Makwakwa, Jane, Makonyola, Grace, Brown, Adrian, Toussaint, Paul, Vixama, Adeline, Greene, Grace, Hill, Carwyn, Nakiriija, Emily, Birungi, Doreen, Kalyowa, Noela, Namakula, Dorothy, Byamugisha, Josaphat, Nakimuli, Annettee, Mackayi Odeke, Nathan, Ditai, James, Wandabwa, Julius, Momodou, Fatmata, Sesay, Margaret, Sandi, Patricia, Conteh, Jeneba, Kamara, Jesse, Clarke, Matthew, Best, Rebecca, Miti, Josephine, Kopeka, Mercy, Vwalika, Bellington, Chima, Martina, Musonda, Thokozile, Jere, Christine, Chinkoyo, Sebastian, Mambo, Violet, Guchale, Yonas, Yadeta, Lomi, Surur, Feiruz, Mungarwadi, Geetanjali M., Mastiholi, Sphoorthi S., Karadiguddi, Chandrappa C., Hezelgrave, Natasha, and Duhig, Kate E.
- Subjects
Medicine(all) - Abstract
BACKGROUND: In 2015, an estimated 303 000 women died in pregnancy and childbirth. Obstetric haemorrhage, sepsis, and hypertensive disorders of pregnancy account for more than 50% of maternal deaths worldwide. There are effective treatments for these pregnancy complications, but they require early detection by measurement of vital signs and timely administration to save lives. The primary aim of this trial was to determine whether implementation of the CRADLE Vital Sign Alert and an education package into community and facility maternity care in low-resource settings could reduce a composite of all-cause maternal mortality or major morbidity (eclampsia and hysterectomy).METHODS: We did a pragmatic, stepped-wedge, cluster-randomised controlled trial in ten clusters across Africa, India, and Haiti, introducing the device into routine maternity care. Each cluster contained at least one secondary or tertiary hospital and their main referral facilities. Clusters crossed over from existing routine care to the CRADLE intervention in one of nine steps at 2-monthly intervals, with CRADLE devices replacing existing equipment at the randomly allocated timepoint. A computer-generated randomly allocated sequence determined the order in which the clusters received the intervention. Because of the nature of the intervention, this trial was not masked. Data were gathered monthly, with 20 time periods of 1 month. The primary composite outcome was at least one of eclampsia, emergency hysterectomy, and maternal death. This study is registered with the ISRCTN registry, number ISRCTN41244132.FINDINGS: Between April 1, 2016, and Nov 30, 2017, among 536 223 deliveries, the primary outcome occurred in 4067 women, with 998 maternal deaths, 2692 eclampsia cases, and 681 hysterectomies. There was an 8% decrease in the primary outcome from 79·4 per 10 000 deliveries pre-intervention to 72·8 per 10 000 deliveries post-intervention (odds ratio [OR] 0·92, 95% CI 0·86-0·97; p=0·0056). After planned adjustments for variation in event rates between and within clusters over time, the unexpected degree of variability meant we were unable to judge the benefit or harms of the intervention (OR 1·22, 95% CI 0·73-2·06; p=0·45).INTERPRETATION: There was an absolute 8% reduction in primary outcome during the trial, with no change in resources or staffing, but this reduction could not be directly attributed to the intervention due to variability. We encountered unanticipated methodological challenges with this trial design, which can provide valuable learning for future research and inform the trial design of future international stepped-wedge trials.FUNDING: Newton Fund Global Research Programme: UK Medical Research Council; Department of Biotechnology, Ministry of Science & Technology, Government of India; and UK Department of International Development.
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- 2019
4. Effect of a novel vital sign device on maternal mortality and morbidity in low-resource settings: a pragmatic, stepped-wedge, cluster-randomised controlled trial
- Author
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Vousden, Nicola, primary, Lawley, Elodie, additional, Nathan, Hannah L, additional, Seed, Paul T, additional, Gidiri, Muchabayiwa Francis, additional, Goudar, Shivaprasad, additional, Sandall, Jane, additional, Chappell, Lucy C, additional, Shennan, Andrew H, additional, Kachinjika, Monice, additional, Bukani, Doreen, additional, Makwakwa, Jane, additional, Makonyola, Grace, additional, Brown, Adrian, additional, Toussaint, Paul, additional, Vixama, Adeline, additional, Greene, Grace, additional, Hill, Carwyn, additional, Nakiriija, Emily, additional, Birungi, Doreen, additional, Kalyowa, Noela, additional, Namakula, Dorothy, additional, Byamugisha, Josaphat, additional, Nakimuli, Annettee, additional, Mackayi Odeke, Nathan, additional, Ditai, James, additional, Wandabwa, Julius, additional, Momodou, Fatmata, additional, Sesay, Margaret, additional, Sandi, Patricia, additional, Conteh, Jeneba, additional, Kamara, Jesse, additional, Clarke, Matthew, additional, Best, Rebecca, additional, Miti, Josephine, additional, Kopeka, Mercy, additional, Vwalika, Bellington, additional, Chima, Martina, additional, Musonda, Thokozile, additional, Jere, Christine, additional, Chinkoyo, Sebastian, additional, Mambo, Violet, additional, Guchale, Yonas, additional, Yadeta, Lomi, additional, Surur, Feiruz, additional, Mungarwadi, Geetanjali M, additional, Mastiholi, Sphoorthi S, additional, Karadiguddi, Chandrappa C, additional, Charantimath, Umesh, additional, Bellad, Mrutyunjaya, additional, Hezelgrave, Natasha, additional, and Duhig, Kate E, additional
- Published
- 2019
- Full Text
- View/download PDF
5. Incidence and characteristics of pregnancy-related death across ten low- and middle-income geographical regions: secondary analysis of a cluster randomised controlled trial.
- Author
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Vousden, N, Holmes, E, Seed, PT, Gidiri, MF, Goudar, S, Sandall, J, Chinkoyo, S, Kumsa, LY, Brown, A, Charantimath, U, Bellad, M, Nakimuli, A, Vwalika, B, Chappell, LC, Shennan, AH, Bukani, Doreen, Makonyola, Grace, Toussaint, Paul, Vixama, Adeline, and Greene, Grace
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CLUSTER analysis (Statistics) ,SECONDARY analysis ,MATERNAL age ,MIDDLE-income countries ,MATERNAL health services ,UTERINE hemorrhage ,HYPERTENSION in pregnancy ,BLOOD pressure ,INTENSIVE care units ,RESEARCH ,HEALTH services accessibility ,BLOOD transfusion ,TIME ,RESEARCH methodology ,HEALTH status indicators ,DISEASE incidence ,EVALUATION research ,MEDICAL cooperation ,SEPSIS ,COMPARATIVE studies ,RANDOMIZED controlled trials ,PUERPERIUM ,HEART beat ,RESEARCH funding ,DEVELOPING countries ,DEMOGRAPHY ,MATERNAL mortality ,STATISTICAL sampling - Abstract
Objective: The aim of this article is to describe the incidence and characteristics of pregnancy-related death in low- and middle-resource settings, in relation to the availability of key obstetric resources.Design: This is a secondary analysis of a stepped-wedge cluster randomised controlled trial.Setting: This trial was undertaken at ten sites across eight low- and middle-income countries in sub-Saharan Africa, India and Haiti.Population: Institutional-level consent was obtained and all women presenting for maternity care were eligible for inclusion.Methods: Pregnancy-related deaths were collected prospectively from routine data sources and active case searching.Main Outcome Measures: Pregnancy-related death, place, timing and age of maternal death, and neonatal outcomes in women with this outcome.Results: Over 20 months, in 536 233 deliveries there were 998 maternal deaths (18.6/10 000, range 28/10 000-630/10 000). The leading causes of death were obstetric haemorrhage (36.0%, n = 359), hypertensive disorders of pregnancy (20.6%, n = 206), sepsis (14.1%, n = 141) and other (26.5%, n = 264). Approximately a quarter of deaths occurred prior to delivery (28.4%, n = 283), 35.7% (n = 356) occurred on the day of delivery and 35.9% (n = 359) occurred after delivery. Half of maternal deaths (50.6%; n = 505) occurred in women aged 20-29 years, 10.3% (n = 103) occurred in women aged under 20 years, 34.5% (n = 344) occurred in women aged 30-39 years and 4.6% (n = 46) occurred in women aged ≥40 years. There was no measured association between the availability of key obstetric resources and the rate of pregnancy-related death.Conclusions: The large variation in the rate of pregnancy-related death, irrespective of resource availability, emphasises that inequality and inequity in health care persists.Tweetable Abstract: Inequality and inequity in pregnancy-related death persists globally, irrespective of resource availability. [ABSTRACT FROM AUTHOR]- Published
- 2020
- Full Text
- View/download PDF
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