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Biomedical subjects

R C Pattinson

Publications and source records attributed to R C Pattinson.

At least 19 recordsLinked to original sources
PubMed2006

Does kangaroo mother care save lives?

To assess the impact of the introduction of kangaroo mother care (KMC) in hospitals using the Perinatal Problem Identification Programme (PPIP) in South Africa, a survey was conducted of the PPIP sentinel sites in South Africa requesting information on the practice of KMC in the hospital and if practised, when it had been initiated. Data on live births and the neonatal deaths of infants weighing between 1000 and 1999 g for each institution were obtained from the national PPIP database and, where applicable, divided into two periods, before and after the introduction of KMC. The practice of KMC and PPIP data could be combined for 40 of the hospitals that had responded to the survey. Of these, eight hospitals had not initiated KMC by January 2005, 21 had PPIP data for a period after KMC had commenced and 11 had PPIP data for periods before and after the introduction of KMC. The neonatal death rate (NNDR) for all hospitals with no KMC or before the introduction of KMC was 88.14/1000 live births, whereas the NNDR for hospitals with KMC or after the introduction of KMC was 71.43/1000 live births [relative risk (RR) 0.81; 95% confidence interval (CI) 0.72-0.91]. For the 11 hospitals that had reliable PPIP data for periods before and after the initiation of KMC, the NNDR was 87.72/1000 live births before KMC and 60.76/1000 live births after KMC had been introduced (RR 0.62; 95% CI 0.53-0.73). The large and significant reduction in the NNDR of neonates weighing between 1000 and 1999 g was associated with the introduction of KMC.

Female↗
PubMed2006

Babies who die from labour-related intrapartum hypoxia: a confidential enquiry in South African public hospitals.

Seventeen hospitals, from a range of health-care environments, participated in confidential enquiries of perinatal deaths resulting from labour-related intrapartum hypoxia. There were 102 deaths, including 22 stillbirths and 80 neonatal deaths. The mean birthweight was 3021 g. The active phase of the first stage of labour was prolonged beyond 12 h in six cases, and oxytocin was used for induction or augmentation in 10 women. Fetal heart decelerations were detected in 39 (49%) of the babies that went on to die in the neonatal period, and meconium passage was evident in 50 (63%). There were six breech presentations, and seven cases of cord prolapse. The majority of these deaths occurred in low-risk women with apparently uncomplicated labour. There appears to be a failure to detect or respond to evidence of fetal distress. Intrapartum care for all women in labour requires close attention to detail in monitoring fetal health.

Asphyxia Neonatorum↗
PubMed2006

Evaluation of a strict protocol approach in managing women with severe disease due to abortion.

AIM: To evaluate whether the introduction of a strict protocol approach based on the systemic evaluation of critically ill pregnant women with complications of abortion affected outcome. SETTING: Indigent South Africans managed in the regional and tertiary hospitals of the Pretoria Academic Complex. METHOD: Since 1997 a standard definition of severe acute maternal morbidity (SAMM) has been used in the Pretoria Academic Complex. All cases of SAMM and maternal deaths were entered on the Maternal Morbidity and Mortality Audit System programme. A comparison of outcome of severely ill women who had complications of abortion was made between 1997-1998 (original protocol) and 2002-2004 (strict protocol). OUTCOME MEASURES: The mortality index and prevalence of organ system failure or dysfunction. RESULTS: In 1997-1998 there were 43 women with SAMM who survived and a further 10 maternal deaths due to complications of abortion, compared with 107 women with SAMM and 7 maternal deaths during 2002-2004. The mortality index declined from 18.9% in 1997-1998 to 6.1% in 2002-2004 (p = 0.02, odds ratio 0.28, 95% confidence limits 0.10 - 0.79). Significantly more women had hypovolaemic shock in 2002-2004 compared with 1997-1998 (54.4% v. 35.8%, p = 0.04), but fewer women had immune system failure including septic shock (18.4% v. 47.2%, p = 0.0002) and metabolic dysfunction (0 v. 5.7%, p = 0.03) and there was a trend to less renal failure (10.5% v. 22.6%, p = 0.06) and cardiac failure (4.4% v. 13.2%, p = 0.08). CONCLUSION: The strict protocol approach based on systemic evaluation in managing critically ill pregnant women with complications of abortion, coupled with an intensive, regular feedback mechanism, has been associated with a reduction in the mortality index.

Abortion, Induced↗
PubMed2005

Critical incident audit and feedback to improve perinatal and maternal mortality and morbidity.

BACKGROUND: Audit and feedback of critical incidents is an established part of obstetric practice. However, the effect on perinatal and maternal mortality is unclear. The potential harmful effects and costs are unknown. OBJECTIVES: Is critical incident audit and feedback effective in reducing the perinatal mortality rate, the maternal mortality ratio, and severe neonatal and maternal morbidity? SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (January 2005), the Cochrane Effective Practice and Organisation of Care Group Trials Register (January 2005), MEDLINE (1965 to December 2004), EMBASE (1965 to December 2004), SCIBASE (1965 to December 2004) and the World Health Organization systematic review of maternal mortality and morbidity database (January 1997 to December 2002). SELECTION CRITERIA: Randomized trials of audit (defined as any summary of clinical performance over a specified period of time) and feedback (method of feeding that information back to the clinicians) that reported objectively measured professional practice in a healthcare setting or healthcare outcomes. DATA COLLECTION AND ANALYSIS: No suitable trials were found. MAIN RESULTS: None. AUTHORS' CONCLUSIONS: The necessity of recording the number and cause of deaths is not in question. Mortality rates are essential in identifying problems within the healthcare system. Maternal and perinatal death reviews should continue to be held, until further information is available. The evidence from serial data clearly suggests more benefit than harm. Feedback is essential in any audit system. The most effective mechanisms for this are unknown, but it must be directed at the relevant people.

Cause of Death↗
PubMed2004

Are deaths due to prematurity avoidable in developing countries?

Our aim was to assess the potential for reducing the perinatal mortality rate (PNMR) related to spontaneous preterm delivery. Data from 44 Perinatal Problem Identification Program sentinel sites around South Africa were used. In each perinatal death the primary cause as well as missed opportunities and substandard care were discussed and allocated. 3045 perinatal deaths in 78,343 births of > or = 1000 g were analysed. There were 518 perinatal deaths (17%) whose primary obstetric cause of death was due to spontaneous preterm labour (PNMR 7.48/1000 births). The most common avoidable factors were delay in seeking help during labour (14.7%), lack of neonatal facilities (10.0%), lack of transport (7.3%) and inappropriate response to the presence of premature rupture membranes (4.6%). Few perinatal deaths could be ascribed to poor antenatal or intrapartum management of spontaneous preterm labour. The vast majority of spontaneous preterm births could not be prevented within the health institutions. Prevention of deaths due to prematurity outside of metropolitan areas will rely on the neonatal care being adapted to reduced resources.

Developing Countries↗
PubMed2004

Saving children--an audit system to assess under-5 health care.

OBJECTIVE: To develop and pilot an audit system usable by medical officers in peripheral hospitals for deaths of children under 5 years to: (i) identify and classify all causes of deaths; and (ii) to identify substandard care and missed opportunities for intervention and to classify these as modifiable factors. SETTING: The four public sector hospitals in Mafikeng health region in North West province. METHOD: An action research methodology was used. The system for classifying under-5 deaths was based on the International Classification of Diseases 10 (ICD-10), but modified for practical application in peripheral hospitals. Each death was analysed at a mortality meeting and factors related to the family, administration or actions or omissions by health care workers that could have contributed to the death were recorded. These factors were later grouped and categorised. During the last month of the pilot participating health care workers evaluated the audit system and completed a semi-structured questionnaire. STUDY PERIOD: 1 November 2000-31 October 2001. RESULTS: Two hundred and thirty-nine under-5 deaths occurred and were discussed during 61 mortality meetings. A workable system to identify and classify causes of deaths and modifiable factors occurring within the health system was developed and tested. A simple, user-friendly one-page data sheet encompassing the whole audit was developed. Overall the health care workers were positive about the mortality meetings and were confident that the classification systems developed could be applied in other peripheral hospitals. CONCLUSION: The audit system (called the Under-5 Health Care Problem Identification Programme (U5PIP)), was piloted under normal service conditions and is usable and acceptable for peripheral hospitals.

Child Health Services↗
PubMed2004

Why children die: an under-5 health care survey in Mafikeng region.

OBJECTIVE: To describe causes of under-5 deaths occurring in the health care system in Mafikeng region and modifiable factors related to these deaths. DESIGN: A prospective descriptive study. SETTING: The four public sector hospitals in Mafikeng health region in North West province (Gelukspan, Zeerust-Lehurutshe, Thusong, and Mafikeng Provincial Hospital). METHODS: This study of under-5 deaths used and piloted the Under-5 health care Problem Identification Programme. STUDY PERIOD: 1 November 2000-31 October 2001. RESULTS: Two hundred and thirty-nine under-5 deaths occurred in the health system. The case fatality rate for the total of 4 226 under-5 admissions was 5.7%. Seventy-four per cent of the under-5 deaths occurred during the first year of life; 31% during the first 24 hours in hospital. The main causes of death were lower respiratory tract infections (31.4%), AIDS (21.3%) and sepsis (13.4%). When adding all causes of death and contributing conditions, 61.9% were AIDS- or HIV-related. Eighty-three per cent of cases had administrative modifiable factors, 67% had modifiable factors at primary care level, 47% during admission/emergency care in hospital, and 55% during routine care. CONCLUSIONS: Priority problems identified in this study were case management of lower respiratory tract infections, failure to thrive, and insufficient documentation of patient care. As most under-5 deaths in this study were HIV/AIDS-related, it is an urgent necessity to expand effective programmes to prevent mother-to-child transmission and HIV infection in adults and to advocate comprehensive treatment programmes for HIV/AIDS.

Age Distribution↗
PubMed2003

Near misses: a useful adjunct to maternal death enquiries.

In developed countries where maternal death is rare, the factors surrounding the death are often peculiar to the event and are not generalizable, making analysis of maternal deaths less useful. Near misses are defined as pregnant women with severe life-threatening conditions who nearly die but, with good luck or good care, survive. Incorporation of near misses into maternal death enquiries would strengthen these audits by allowing for more rapid reporting, more robust conclusions, comparisons to be made with maternal deaths, reinforcing lessons learnt, establishing requirements for intensive care and calculating comparative indices. The survival of a pregnant woman is dependent on the disease, her basic health, the health care facilities and personnel of the health care system. The criteria currently used to identify a near miss vary greatly. However, areas with similar health care facilities, medical records and personnel should be able to agree on suitable criteria, making their incorporation into maternal death enquiries feasible.

Cause of Death↗
PubMed2003

Aggressive or expectant management of labour: a randomised clinical trial.

OBJECTIVE: To compare labour outcomes using aggressive or expectant management protocols. DESIGN: Randomised trial. SETTING: Pretoria Academic Complex, South Africa. It serves an indigent urban population. POPULATION: Healthy nulliparous women in active labour, at term, with a health singleton pregnancy and cephalic presentation. METHODS: The women were randomised to either aggressive (n = 344) or expectant (n = 350) management protocols. Aggressive management entailed using a single line partogram, a vaginal examination every two hours and use of an oxytocin infusion if the line was crossed. Expectant management entailed using a two line partogram, with the alert line and a parallel action line four hours to the right, with a vaginal examination every four hours. If the action line was reached, oxytocin was started. The women were reassessed every two hours thereafter. Analgesia was prescribed on request. MAIN OUTCOME MEASURES: Mode of birth, use of oxytocin and analgesia and neonatal outcome. RESULTS: The groups were similar with respect to maternal age, cervical dilation at trial entry, number crossing the alert line and birthweight of the infants. Significantly fewer women managed aggressively had caesarean sections (16.0%) than those managed expectantly (23.4%) (relative risk [RR] 0.68, 95% confidence intervals [CI] 0.50, 0.93). Significantly more oxytocin was used in the aggressive management group, but there was no difference with respect to the use of analgesia or episiotomy or in neonatal outcome with respect to the Apgar score at 1 or 10 minutes. There were three perinatal deaths. One woman was found to have an intrauterine death before trial entry and the other two were in the aggressive management group but did not receive oxytocin. Compliance by staff was poor in the aggressive management group. CONCLUSIONS: Aggressive management of labour reduces the caesarean section rate in nulliparous women but requires more intensive nursing.

Adult↗
PubMed2003

Development of a conceptual tool for the implementation of kangaroo mother care.

AIM: To develop a conceptual tool to assist healthcare workers and management in the implementation of a kangaroo mother care programme. METHODS: A qualitative research approach was followed and methods included on-site observations and informal conversational interviews, as well as unstructured, in-depth interviews with senior managers, doctors and nurses at two large training hospitals in the north of South Africa. A consultative process was used to refine the tool. RESULTS: The patterns that emerged from the data were captured in a diagram, entitled: "Main issues in the establishment of kangaroo mother care". In addition, a set of core questions was developed to assist in decision-making at institutional level. CONCLUSION: The diagram and questions contain concepts that could be adapted and used by a healthcare facility's multidisciplinary team in planning the implementation of kangaroo mother care and in reviewing the progress made in the implementation and the quality of the kangaroo mother care provided.

Allied Health Personnel↗
PubMed2003

Why babies die--a perinatal care survey of South Africa, 2000-2002.

OBJECTIVE: To identify the major causes of perinatal mortality in South Africa. SETTING: Seventy-three state hospitals throughout South Africa representing metropolitan areas, cities and towns and rural areas. METHOD: Users of the Perinatal Problem Identification Programme (PPIP) amalgamated their data to provide descriptive information on the causes of perinatal death and the avoidable factors, missed opportunities and substandard care in South Africa. RESULTS: A total of 8,085 perinatal deaths among babies weighing 1,000 g or more were reported from 232,718 births at the PPIP user sites. The perinatal mortality rates for the metropolitan, city and town, and rural groupings were 36.2, 38.6 and 26.7/1,000 births, respectively. The neonatal death rate was highest in the city and town group (14.5/1,000 live births) followed by the rural and metropolitan groups (11.3 and 10.0/1,000 live births respectively). The low birth weight rate was highest in the metropolitan group (19.6%), followed by the city and town group (16.5%) and the rural group (13.0%). The most common primary cause of perinatal death in the rural group was intrapartum asphyxia and birth trauma (rate 6.92/1,000 births) followed by spontaneous preterm delivery (5.37/1,000 births). The most common primary cause of death in the city and town group was spontaneous preterm delivery (6.79/1,000 births) followed by intrapartum asphyxia and birth trauma (6.21/1,000 births) and antepartum haemorrhage (5.7/1,000 births). The metropolitan group's most common primary causes were antepartum haemorrhage (7.14/1,000 births), complications of hypertension in pregnancy (5.09/1000 births) and spontaneous preterm labour (4.01/1,000 births). Unexplained intrauterine deaths were the most common recorded primary obstetric cause of death in all areas. Complications of prematurity and hypoxia were the most common final causes of neonatal death in all groups. CONCLUSION: Intrapartum asphyxia, birth trauma, antepartum haemorrhage, complications of hypertension in pregnancy and spontaneous preterm labour account for more than 80% of the primary obstetric causes of death.

Asphyxia Neonatorum↗
PubMed2003

Challenges in saving babies--avoidable factors, missed opportunities and substandard care in perinatal deaths in South Africa.

OBJECTIVE: To identify the most common avoidable factors, missed opportunities and substandard care in perinatal care in South Africa. SETTING: Seventy-three state hospitals throughout South Africa representing metropolitan areas, cities and towns, and rural areas. METHOD: Users of the Perinatal Problem Identification Programme (PPIP) amalgamated their data to provide descriptive information on the causes of perinatal death and the avoidable factors, missed opportunities and substandard care in South Africa. RESULTS: A total of 8,085 perinatal deaths among babies weighing 1,000 g or more were reported from 232,718 births at the PPIP sentinel sites. Avoidable factors, missed opportunities and substandard care were reported to be patient-related (between 31.5% and 47.5% of deaths), due to administrative problems (between 10.1% and 31.1% of deaths), and due to health worker-related problems (between 28.4% and 36.0% of deaths) in the metropolitan and rural areas respectively. Figures for cities and towns lay between these ranges. Deaths due to intrapartum asphyxia and birth trauma were thought to be clearly preventable within the health system in 63.1%, 34.4% and 35.7% of cases in the metropolitan areas, cities and towns, and rural areas respectively. Deaths due to hypertension and antepartum haemorrhage were thought to be clearly preventable within the health system in 18.7%, 15.4% and 20.0% of cases in the metropolitan areas, cities and towns, and rural areas respectively. Far fewer preventable deaths were recorded in the spontaneous preterm labour category. CONCLUSION: Concentration on the remediable priority problems identified (namely labour management, resuscitation of the asphyxiated neonate, and care of the premature neonate) makes the reduction of perinatal mortality in South Africa feasible and inexpensive.

Asphyxia Neonatorum↗
PubMed2003

Can enquiries into severe acute maternal morbidity act as a surrogate for maternal death enquiries?

OBJECTIVE: To assess whether severe acute maternal morbidity (SAMM, 'near misses') can be used as a surrogate of an analysis of maternal deaths to describe the pattern of severe maternal disease and avoidable factors related to it. DESIGN: Prospective, descriptive study. SETTING: A SAMM and maternal mortality audit was conducted in three clearly defined geographical areas, consisting of rural and urban settings in South Africa. POPULATION: Indigent black African pregnant women. METHOD: Cases of SAMM and maternal deaths were collected in the areas and a comparison was made of the disease profiles and avoidable factors, missed opportunities and substandard care. MAIN OUTCOME MEASURES: The proportion of primary obstetric causes and avoidable factors in women with SAMM and maternal deaths, and the mortality indices of the primary obstetric causes of death and organ system dysfunction. RESULTS: A total of 423 women with SAMM and 128 maternal deaths were collected over two years. Demographic factors were similar between the groups except that significantly more maternal deaths had not attended any antenatal care. The primary obstetric causes of SAMM and maternal death did not correlate. The four most common causes of SAMM were complications of hypertension (27.2%), postpartum haemorrhage (18.0%), antepartum haemorrhage (12.8%) and abortion (11.3%), whereas the four most common causes of maternal death were non-pregnancy related sepsis (26.6%), complications of hypertension (23.4%), pre-existing medical disease (14.1%) and abortion (10.9%). The types of avoidable factors were similar between both groups although administrative factors occurred significantly more frequently in the maternal death group as did poor problem identification and monitoring. CONCLUSION: Review of SAMM gives a different disease pattern to that obtained from maternal death audits. However, in diagnosing inadequacies in the health system, similar information was obtained.

Adult↗