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Objective To assess the quality of facility-based active management of the third stage of labour in Ethiopia, Kenya, Madagascar, Mozambique, Rwanda and the United Republic of Tanzania. Methods Between 2009 and 2012, using a cross-sectional design, 2317 women in 390 health facilities were directly observed during the third stage of labour. Observers recorded the use of uterotonic medicines, controlled cord traction and uterine massage. Facility infrastructure and supplies needed for active management were audited and relevant guidelines reviewed. Findings Most (94%; 2173) of the women observed were given oxytocin (2043) or another uterotonic (130).The frequencies of controlled cord traction and uterine massage and the timing of uterotonic administration showed considerable between-country variation. Of the women given a uterotonic, 1640 (76%) received it within three minutes of the birth. Uterotonics and related supplies were generally available onsite. Although all of the study countries had national policies and/or guidelines that supported the active management of the third stage of labour, the presence of guidelines in facilities varied across countries and only 377 (36%) of 1037 investigated providers had received relevant training in the previous three years. Conclusion In the study countries, quality and coverage of the active management of the third stage of labour were high. However, to improve active management, there needs to be more research on optimizing the timing of uterotonic administration. Training on the use of new clinical guidelines and implementation research on the best methods to update such training are also needed. [TEXT NOT REPRODUCIBLE IN ASCII] Objectif Evaluer la qualite de la prise en charge active du troisieme stade du travail dans les etablissements medicaux en Ethiopie, au Kenya, a Madagascar, au Mozambique, en Republique-Unie deianzanie et au Rwanda. Methodes Entre 2009 et 2012, 2317 femmes hospitalisees dans 390 etablissements de sante ont ete directement observees, a l'aide d'une analyse transversale, lors du troisieme stade du travail. Les observateurs ont constate l'utilisation de medicaments uterotoniques, de la traction controlee du cordon et de massages uterins. Les infrastructures et le materiel necessaires a une prise en charge active ont ete controles et les directives applicables ont ete examinees. Resultats La plupart des femmes observees (94%; 2173) ont ete traitees par ocytocine (2043) ou a l'aide d'un autre uterotonique (130). La frequence de la traction controlee du cordon et des massages uterins ainsi que le moment choisi pour administrer l'uterotonique variaient considerablement d'un pays a l'autre. Parmi les femmes traitees a l'aide d'un medicament uterotonique, 1640 (76%) l'ont recu dans les trois minutes qui suivent la naissance. Les uterotoniques et le materiel associe etaient generalement disponibles sur place. Si tous les pays etudies disposaient de politiques et/ou de directives nationales soutenant la prise en charge active du troisieme stade du travail, la presence de directives dans les etablissements variait selon les pays et seuls 377 (36%) des 1037 prestataires sondes avaient beneficie d'une formation appropriee au cours des trois annees precedentes. Conclusion La qualite et le nombre des beneficiaires de la prise en charge active du troisieme stade du travail etaient eleves dans les pays etudies. Il est cependant necessaire pour ameliorer la prise en charge active de mener davantage de recherches afin d'optimiser le moment d'administration de l'uterotonique. Une formation a l'utilisation de nouvelles directives cliniques et une recherche sur la mise en oevre des meilleures methodes pour mettre a jour cette formation sont egalement necessaires. [TEXT NOT REPRODUCIBLE IN ASCII] Objetivo Evaluar la calidad de la gestion activa de la tercera etapa del parto en establecimientos sanitarios de Etiopia, Kenya, Madagascar, Mozambique, Rwanda y la Republica Unida de Tanzania. Metodos Entre 2009 y 2012, se observaron 2.317 mujeres en 390 establecimientos sanitarios durante la tercera etapa del parto utilizando un diseno transversal. Los observadores registraron el uso de medicamentos uterotonicos, la traccion controlada del cordon y el masaje uterino. Se verificaron las infraestructuras del establecimiento y los suministros necesarios para la gestion activa y se revisaron las directrices relevantes. Resultados La mayoria (94%; 2173) de las mujeres observadas recibieron oxitocina (2.043) u otros medicamentos uterotonicos (130). Las frecuencias de la traccion controlada del cordon y el masaje uterino y el momento de la administracion uterotonica mostraron considerables diferencias entre paises. De las mujeres que recibieron un medicamento uterotonico, 1.640 (76%) lo recibieron dentro de los tres minutos posteriores al nacimiento. Los medicamentos uterotonicos y los suministros relacionados estaban generalmente disponibles en el lugar. A pesar de que los paises estudiados tenian politicas nacionales y directrices que apoyaban una gestion activa de la tercera etapa del parto, la presencia de dichas directrices en los establecimientos sanitarios variaba dependiendo del pais, y solo 377 (36%) de los 1.037 proveedores investigados habian recibido una formacion relevante durante los tres anos previos. Conclusion En los paises estudiados, la calidad y cobertura de la gestion activa durante la tercera etapa del parto eran elevadas. Sin embargo, se necesitan mas investigaciones sobre como optimizarel momento de la administracion uterotonica de cara a mejorar la gestion activa. Tambien hace falta formacion en el uso de las nuevas directrices medicas e investigacion sobre la aplicacion de los mejores metodos para actualizar dichas formaciones., Introduction Haemorrhage is estimated to cause 27.1% of the 287 000 maternal deaths that occur annually. (1) Postpartum haemorrhage can be prevented by the active management of the third stage [...]

Background: Umbilical cord hygiene prevents sepsis, a leading cause of neonatal mortality. The World Health Organization recommends 7.1% chlorhexidine digluconate (CHX) application to the umbilicus after home birth in high mortality contexts. In Bangladesh and Nepal, national policies recommend CHX use for all facility births. Population-based household surveys include optional questions on CHX use, but indicator validation studies are lacking. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) was an observational study assessing measurement validity for maternal and newborn indicators. This paper reports results regarding CHX.Methods: The EN-BIRTH study (July 2017-July 2018) included three public hospitals in Bangladesh and Nepal where CHX cord application is routine. Clinical-observers collected tablet-based, time-stamped data regarding cord care during admission to labour and delivery wards as the gold standard to assess accuracy of women's report at exit survey, and of routine-register data. We calculated validity ratios and individual-level validation metrics; analysed coverage, quality and measurement gaps. We conducted qualitative interviews to assess barriers and enablers to routine register-recording.Results: Umbilical cord care was observed for 12,379 live births. Observer-assessed CHX coverage was very high at 89.3-99.4% in all 3 hospitals, although slightly lower after caesarean births in Azimpur (86.8%), Bangladesh. Exit survey-reported coverage (0.4-45.9%) underestimated the observed coverage with substantial "don't know" responses (55.5-79.4%). Survey-reported validity ratios were all poor (0.01 to 0.38). Register-recorded coverage in the specific column in Bangladesh was underestimated by 0.2% in Kushtia but overestimated by 9.0% in Azimpur. Register-recorded validity ratios were good (0.9 to 1.1) in Bangladesh, and poor (0.8) in Nepal. The non-specific register column in Pokhara, Nepal substantially underestimated coverage (20.7%).Conclusions: Exit survey-report highly underestimated observed CHX coverage in all three hospitals. Routine register-recorded coverage was closer to observer-assessed coverage than survey reports in all hospitals, including for caesarean births, and was more accurately captured in hospitals with a specific register column. Inclusion of CHX cord care into registers, and tallied into health management information system platforms, is justified in countries with national policies for facility-based use, but requires implementation research to assess register design and data flow within health information systems. [ABSTRACT FROM AUTHOR]

Abstract Background Despite massive anti-malaria campaigns across the subcontinent, effective access to intermittent preventive treatment (IPTp) and insecticide-treated nets (ITNs) among pregnant women remain low in large parts of sub-Saharan Africa. The slow uptake of malaria prevention products appears to reflect lack of knowledge and resistance to behavioural change, as well as poor access to resources, and limited support of programmes by local communities and authorities. Methods A recent community-based programme in Akwa Ibom State, Nigeria, is analysed to determine the degree to which community-directed interventions can improve access to malaria prevention in pregnancy. Six local government areas in Southern Nigeria were selected for a malaria in pregnancy prevention intervention. Three of these local government areas were selected for a complementary community-directed intervention (CDI) programme. Under the CDI programme, volunteer community-directed distributors (CDDs) were appointed by each village and kindred in the treatment areas and trained to deliver ITNs and IPTp drugs as well as basic counseling services to pregnant women. Findings Relative to women in the control area, an additional 7.4 percent of women slept under a net during pregnancy in the treatment areas (95% CI [0.035, 0.115], p-value < 0.01), and an additional 8.5 percent of women slept under an ITN after delivery and prior to the interview (95% CI [0.045, 0.122], p-value < 0.001). The effects of the CDI programme were largest for IPTp adherence, increasing the fraction of pregnant women taking at least two SP doses during pregnancy by 35.3 percentage points [95% CI: 0.280, 0.425], p-value < 0.001) relative to the control group. No effects on antenatal care attendance were found. Conclusion The presented results suggest that the inclusion of community-based programmes can substantially increase effective access to malaria prevention, and also increase access to formal health care access in general, and antenatal care attendance in particular in combination with supply side interventions. Given the relatively modest financial commitments they require, community-directed programmes appear to be a cost-effective way to improve malaria prevention; the participatory approach underlying CDI programmes also promises to strengthen ties between the formal health sector and local communities.