Browsing by Author "IMAgiNE EURO study group"
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- Quality of facility-based maternal and newborn care around the time of childbirth during the COVID-19 pandemic: online survey investigating maternal perspectives in 12 countries of the WHO European RegionPublication . IMAgiNE EURO study groupBackground: Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic, as defined by WHO Standards, are lacking. Methods: Women who gave birth in 12 countries of the WHO European Region from March 1, 2020 - March 15, 2021 answered an online questionnaire, including 40 WHO Standard-based Quality Measures. Findings: 21,027 mothers were included in the analysis. Among those who experienced labour (N=18,063), 41·8% (26·1%- 63·5%) experienced difficulties in accessing antenatal care, 62% (12·6%-99·0%) were not allowed a companion of choice, 31·1% (16·5%-56·9%) received inadequate breastfeeding support, 34·4% (5·2%-64·8%) reported that health workers were not always using protective personal equipment, and 31·8% (17·8%-53·1%) rated the health workers’ number as “insufficient”. Episiotomy was performed in 20·1% (6·1%-66·0%) of spontaneous vaginal births and fundal pressure applied in 41·2% (11·5% -100%) of instrumental vaginal births. In addition, 23·9% women felt they were not treated with dignity (12·8%-59·8%), 12·5% (7·0%-23·4%) suffered abuse, and 2·4% (0·1%-26·2%) made informal payments. Most findings were significantly worse among women with prelabour caesarean birth (N=2,964). Multivariate analyses confirmed significant differences among countries, with Croatia, Romania, Serbia showing significant lower QMNC Indexes and Luxemburg showing a significantly higher QMNC Index than the total sample. Younger women and those with operative births also reported significantly lower QMNC Indexes. Interpretation: Mothers reports revealed large inequities in QMNC across countries of the WHO European Region. Quality improvement initiatives to reduce these inequities and promote evidence-based, patient-centred respectful care for all mothers and newborns during the COVID-19 pandemic and beyond are urgently needed. Funding: The study was financially supported by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy. Study registration: ClinicalTrials.gov Identifier: NCT04847336
- Rates of instrumental vaginal birth and cesarean and quality of maternal and newborn health care in private versus public facilities: results of the IMAgiNE EURO study in 16 countriesPublication . IMAgiNE EURO study group; Lazzerini, Marzia; Valente, Emanuelle Pessa; Covi, Benedetta; Rozée, Virginie; Costa, Raquel; Otelea, Marina Ruxandra; Abderhalden-Zellweger, Alessia; Węgrzynowska, Maria; Linden, Karolina; Arendt, Maryse; Brigidi, Serena; Miani, Céline; Pumpure, Elizabete; Radetic, Jelena; Drandic, Daniela; Cerimagic, Amira; Nedberg, Ingvild Hersoug; Liepinaitienė, Alina; Rodrigues, Carina; de Labrusse, Claire; Baranowska, Barbara; Zaigham, Mehreen; Castañeda, Lara Martín; Batram-Zantvoort, Stephanie; Jakovicka, Dārta; Ruzicic, Jovana; Juciūtė, Simona; Santos, Teresa; Gemperle, Michael; Tataj-Puzyna, Urszula; Elden, Helen; Mizgaitienė, Marija; Lincetto, Ornella; Sacks, Emma; Mariani, IlariaObjective: To explore the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic by facility type among 16 European countries, comparing rates of instrumental vaginal birth and cesarean. Methods: Women who gave birth in the WHO European Region from March 1, 2020, to February 7, 2022, answered a validated online questionnaire. Rates of instrumental birth, instrumental vaginal birth, and cesarean, and a QMNC index were calculated for births in public versus private facilities. Results: Responses from 25 206 participants were analyzed. Women giving birth in private compared with public facilities reported significantly more frequent total cesarean (32.5% vs 19.0%; aOR 1.70; 95% CI 1.52–1.90), elective cesarean (17.3% vs 7.8%; aOR 1.90; 95% CI 1.65–2.19), and emergency cesarean before labor (7.4% vs 3.9%; aOR 1.39; 95% CI 1.14–1.70) (P < 0.001 for all comparisons), with analyses by country confirming these results. QMNC index results were heterogeneous across countries and regions in the same country and were largely affected by geographical distribution of regions rather than by type of facility alone. Conclusion: The study confirms that births in private facilities have higher odds of cesarean. It also suggests that QMNC should be closely monitored in all facilities to achieve high-quality care, independent of facility type or geographical distribution. ClinicalTrials.gov Identifier: NCT04847336.
- Regional differences in the quality of maternal and neonatal care during the COVID-19 pandemic in Portugal: results from the IMAgiNE EURO studyPublication . IMAgiNE EURO study group; Costa, Raquel; Barata, Catarina; Dias, Heloísa; Rodrigues, Carina; Santos, Teresa; Mariani, Ilaria; Covi, Benedetta; Valente, Emanuelle Pessa; Lazzerini, Marzia; Ćerimagić, Amira; Drandić, Daniela; Kurbanović, Magdalena; Virginie, Rozée; de La Rochebrochard, Elise; Löfgren, Kristina; Miani, Céline; Batram-Zantvoort, Stephanie; Wandschneider, Lisa; Morano, Sandra; Chertok, Ilana; Hefer, Emek; Artzi-Medvedik, Rada; Pumpure, Elizabete; Rezeberga, Dace; Jansone-Šantare, Gita; Jakovicka, Dārta; Knoka, Anna Regīna; Vilcāne, Katrīna Paula; Liepinaitienė, Alina; Kondrakova, Andželika; Mizgaitienė, Marija; Juciūtė, Simona; Arendt, Maryse; Tasch, Barbara; Nedberg, Ingvild Hersoug; Kongslien, Sigrun; Vik, Eline Skirnisdottir; Baranowska, Barbara; Tataj-Puzyna, Urszula; Węgrzynowska, Maria; Otelea, Marina RuxandraObjective: To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal during the COVID-19 pandemic. Methods: Women participating in the cross-sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured questionnaire with 40 key WHO standards-based quality measures. Four domains of QMNC were assessed: (1) provision of care; (2) experience of care; (3) availability of human and physical resources; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region. Results: Out of 1845 participants, one-third (33.7%) had a cesarean. Examples of high-quality care included: low frequencies of lack of early breastfeeding and rooming-in (8.0% and 7.7%, respectively) and informal payment (0.7%); adequate staff professionalism (94.6%); adequate room comfort and equipment (95.2%). However, substandard practices with large heterogeneity across regions were also reported. Among women who experienced labor, the percentage of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in Center; among these, fundal pressure ranged from 34.8% in Lisbon to 66.7% in Center. Episiotomy was performed in 39.3% of noninstrumental vaginal births with variations between 31.8% in the North to 59.8% in Center. One in four women reported inadequate breastfeeding support (26.1%, ranging from 19.4% in Algarve to 31.5% in Lisbon). One in five reported no exclusive breastfeeding at discharge (22.1%; 19.5% in Lisbon to 28.2% in Algarve). Conclusion: Urgent actions are needed to harmonize QMNC and reduce inequities across regions in Portugal.