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2022

Vannevel, V, Vogel JP, Pattinson RC, Adanu R, Charantimath U, Goudar SS, Gwako G, Kavi A, Maya E, Osoti A, Pujar Y, Qureshi ZP, Rulisa S, Botha T, Oladapo OT.  2022.  Antenatal Doppler screening for fetuses at risk of adverse outcomes: a multicountry cohort study of the prevalence of abnormal resistance index in low-risk pregnant women., 2022 Mar 16. BMJ open. 12(3):e053622. Abstract

Few interventions exist to address the high burden of stillbirths in apparently healthy pregnant women in low- and middle-income countries (LMICs). To establish whether a trial on the impact of routine Doppler screening in a low-risk obstetric population is warranted, we determined the prevalence of abnormal fetal umbilical artery resistance indices among low-risk pregnant women using a low-cost Doppler device in five LMICs.

QURESHI, ZAHIDA, Jamner A, Filippi V, Gwako G, Osoti A, Mehrtash H, Baguiya A, Bello FA, Compaoré R, Gadama L, Kim CR, Msusa AT, Tunçalp Ӧ, Calvert C.  2022.  Level and determinants of contraceptive uptake among women attending facilities with abortion-related complications in East and Southern Africa., 2022 Jan. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 156 Suppl 1:27-35. Abstract

To investigate the level and determinants of nonreceipt of contraception among women admitted to facilities with abortion-related complications in East and Southern Africa.

2021

Baguiya, A, Bonet M, Cecatti JG, Brizuela V, Curteanu A, Minkauskiene M, Jayaratne K, Ribeiro-do-Valle CC, Budianu M-A, Souza JP, Kouanda S.  2021.  Perinatal outcomes among births to women with infection during pregnancy., 2021 10. Archives of disease in childhood. 106(10):946-953. Abstract

This study is part of the Global Maternal Sepsis Study (GLOSS). It aimed to estimate neonatal near-miss (NNM) and perinatal death frequency and maternal risk factors among births to women with infection during pregnancy in low-income and middle-income countries (LMIC).

Theunissen, F, Cleps I, Goudar S, QURESHI ZAHIDA, Owa OO, Mugerwa K, Piaggio G, Gülmezoglu MA, Nakalembe M, Byamugisha J, Osoti A, Mandeep S, Poriot T, Gwako G, Vernekar S, Widmer M.  2021.  Cost of hospital care of women with postpartum haemorrhage in India, Kenya, Nigeria and Uganda: a financial case for improved prevention., 2021 Jan 22. Reproductive health. 18(1):18. Abstract

Access to quality, effective lifesaving uterotonics in low and middle-income countries (LMICs) remains a major barrier to reducing maternal deaths from postpartum haemorrhage (PPH). Our objective was to assess the costs of care for women who receive different preventative uterotonics, and with PPH and no-PPH so that the differences, if significant, can inform better resource allocation for maternal health care.

Gwako, GN, Were F, Obimbo MM, John Kinuthia, James N Kiarie, Gachuno OW, Gichangi PB.  2021.  Association between utilization and quality of antenatal care with stillbirths in four tertiary hospitals in a low-income urban setting., 2021 04. Acta obstetricia et gynecologica Scandinavica. 100(4):676-683. Abstract

About 2.6 million stillbirths per year occur globally with 98% occurring in low- and middle-income countries including Kenya, where an estimated 35 000 stillbirths occur annually. Most studies have focused on the direct causes of stillbirth. The aim of this study was to determine the association between antenatal care utilization and quality with stillbirth in a Kenyan set up. This information is key when planning strategies to reduce the stillbirth burden.

Brizuela, V, Cuesta C, Bartolelli G, Abdosh AA, Abou Malham S, Assarag B, Castro Banegas R, Díaz V, El-Kak F, El Sheikh M, Pérez AM, Souza JP, Bonet M, Abalos E.  2021.  Availability of facility resources and services and infection-related maternal outcomes in the WHO Global Maternal Sepsis Study: a cross-sectional study., 2021 09. The Lancet. Global health. 9(9):e1252-e1261. Abstract

Infections are among the leading causes of maternal mortality and morbidity. The Global Maternal Sepsis and Neonatal Initiative, launched in 2016 by WHO and partners, sought to reduce the burden of maternal infections and sepsis and was the basis upon which the Global Maternal Sepsis Study (GLOSS) was implemented in 2017. In this Article, we aimed to describe the availability of facility resources and services and to analyse their association with maternal outcomes.

Vogel, JP, Vannevel V, Robbers G, Gwako G, Lavin T, Adanikin A, Hlongwane T, Pattinson RC, Qureshi ZP, Oladapo OT.  2021.  Prevalence of abnormal umbilical arterial flow on Doppler ultrasound in low-risk and unselected pregnant women: a systematic review., 2021 Feb 12. Reproductive health. 18(1):38. Abstract

While Doppler ultrasound screening is beneficial for women with high-risk pregnancies, there is insufficient evidence on its benefits and harms in low- and unselected-risk pregnancies. This may be related to fewer events of abnormal Doppler flow, however the prevalence of absent or reversed end diastolic flow (AEDF or REDF) in such women is unknown. In this systematic review, we aimed to synthesise available data on the prevalence of AEDF or REDF.

Theunissen, F, Cleps I, Goudar S, QURESHI ZAHIDA, Owa OO, Mugerwa K, Piaggio G, Gülmezoglu MA, Nakalembe M, Byamugisha J, Osoti A, Mandeep S, Poriot T, Gwako G, Vernekar S, Widmer M.  2021.  Correction to: Cost of hospital care of women with postpartum haemorrhage in India, Kenya, Nigeria and Uganda: a financial case for improved prevention., 2021 Mar 06. Reproductive health. 18(1):57.
Mitchell, EJ, Pallotti P, Qureshi ZP, Daniels JP, Oliver M, Were F, Osoti A, Gwako G, Kimani V, Opira J, Ojha S.  2021.  Parents, healthcare professionals and other stakeholders' experiences of caring for babies born too soon in a low-resource setting: a qualitative study of essential newborn care for preterm infants in Kenya., 2021 06 23. BMJ open. 11(6):e043802. Abstract

Prematurity is the leading cause of global neonatal and infant mortality. Many babies could survive by the provision of essential newborn care. This qualitative study was conducted in order to understand, from a family and professional perspective, the barriers and facilitators to essential newborn care. The study will inform the development of an early warning score for preterm and low birthweight infants in low and middle income countries (LMICs).

Sura, M, Osoti A, Gachuno O, Musoke R, Kagema F, Gwako G, Ondieki D, Ndavi PM, Ogutu O.  2021.  Effect of umbilical cord milking versus delayed cord clamping on preterm neonates in Kenya: A randomized controlled trial., 2021. PloS one. 16(1):e0246109. Abstract

Delayed cord clamping (DCC) is a placental to new-born transfusion strategy recommended by obstetric and gynaecological societies. Though not widely adopted, umbilical cord milking (UCM) may achieve faster transfusion when DCC cannot be performed such as when a neonate requires resuscitation.

Vogel, JP, Comrie-Thomson L, Pingray V, Gadama L, Galadanci H, Goudar S, Rose Laisser, Lavender T, Lissauer D, Misra S, Pujar Y, Qureshi ZP, Amole T, Berrueta M, Dankishiya F, Gwako G, Homer CSE, Jobanputra J, Meja S, Nigri C, Mohaptra V, Osoti A, Roberti J, Solomon D, Suleiman M, Robbers G, Sutherland S, Vernekar S, Althabe F, Bonet M, Oladapo OT.  2021.  Usability, acceptability, and feasibility of the World Health Organization Labour Care Guide: A mixed-methods, multicountry evaluation., 2021 03. Birth (Berkeley, Calif.). 48(1):66-75. Abstract

The World Health Organization's (WHO) Labour Care Guide (LCG) is a "next-generation" partograph based on WHO's latest intrapartum care recommendations. It aims to optimize clinical care provided to women and their experience of care. We evaluated the LCG's usability, feasibility, and acceptability among maternity care practitioners in clinical settings.

Gwako, GN, Obimbo MM, Gichangi PB, John Kinuthia, James N Kiarie, Gachuno OW, Were F.  2021.  Association between obstetric and medical risk factors and stillbirths in a low-income urban setting., 2021 Aug. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 154(2):331-336. Abstract

To evaluate the association between obstetric and medical risk factors and stillbirths in a Kenyan set-up.

Baguiya, A, Bonet M, Cecatti JG, Brizuela V, Curteanu A, Minkauskiene M, Jayaratne K, Ribeiro-do-Valle CC, Budianu M-A, Souza JP, Kouanda S.  2021.  Perinatal outcomes among births to women with infection during pregnancy., 2021 10. Archives of disease in childhood. 106(10):946-953. Abstract

This study is part of the Global Maternal Sepsis Study (GLOSS). It aimed to estimate neonatal near-miss (NNM) and perinatal death frequency and maternal risk factors among births to women with infection during pregnancy in low-income and middle-income countries (LMIC).

2020

Oladapo, OT, Vogel JP, Piaggio G, Nguyen M-H, Althabe F, Gülmezoglu MA, Bahl R, Rao SPN, De Costa A, Gupta S et al..  2020.  Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries., 2020 12 24. The New England journal of medicine. 383(26):2514-2525. Abstract

The safety and efficacy of antenatal glucocorticoids in women in low-resource countries who are at risk for preterm birth are uncertain.

Brizuela, V, Bonet M, Romero CLT, Abalos E, Baguiya A, Fawole B, Knight M, Lumbiganon P, Minkauskienė M, Nabhan A, Osman NB, Qureshi ZP, Souza JP.  2020.  Early evaluation of the 'STOP SEPSIS!' WHO Global Maternal Sepsis Awareness Campaign implemented for healthcare providers in 46 low, middle and high-income countries., 2020 05 21. BMJ open. 10(5):e036338. Abstract

To evaluate changes in awareness of maternal sepsis among healthcare providers resulting from the WHO Global Maternal Sepsis Study (GLOSS) awareness campaign.

Mitchell, EJ, Qureshi ZP, Were F, Daniels J, Gwako G, Osoti A, Opira J, Bradshaw L, Oliver M, Pallotti P, Ojha S.  2020.  Feasibility of using an Early Warning Score for preterm or low birthweight infants in a low-resource setting: results of a mixed-methods study at a national referral hospital in Kenya., 2020 10 28. BMJ open. 10(10):e039061. Abstract

Fifteen million babies are born prematurely, before 37 weeks gestational age, globally. More than 80% of these are in sub-Saharan Africa and Asia. 35% of all deaths in the first month of life are due to prematurity and the neonatal mortality rate is eight times higher in low-income and middle-income countries (LMICs) than in Europe. Early Warning Scores (EWS) are a way of recording vital signs using standardised charts to easily identify adverse clinical signs and escalate care appropriately. A range of EWS have been developed for neonates, though none in LMICs. This paper reports the findings of early work to examine if the use of EWS is feasible in LMICs.

WHO Global Maternal Sepsis Study (GLOSS) Research Group.  2020.  Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study., 2020 05. The Lancet. Global health. 8(5):e661-e671. Abstract

Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management.

Oladapo, OT, Vogel JP, Piaggio G, Nguyen M-H, Althabe F, Gülmezoglu MA, Bahl R, Rao SPN, De Costa A, Gupta S et al..  2020.  Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries., 2020 12 24. The New England journal of medicine. 383(26):2514-2525. Abstract

The safety and efficacy of antenatal glucocorticoids in women in low-resource countries who are at risk for preterm birth are uncertain.

2019

WHO ACTION Trials Collaborators.  2019.  The World Health Organization ACTION-I Trial:multi-country, multi-centre, double-blind, placebo-controlled, randomized trial of antenatal corticosteroids for women at risk of imminent early preterm birth in hospitals in LMICs, 2019 Aug 16. Trials. 20(1):507. Abstract

Antenatal corticosteroids (ACS) have long been regarded as a cornerstone intervention in mitigating the adverse effects of a preterm birth. However, the safety and efficacy of ACS in hospitals in low-resource countries has not been established in an efficacy trial despite their widespread use. Findings of a large cluster-randomized trial in six low- and middle-income countries showed that efforts to scale up ACS use in low-resource settings can lead to harm. There is equipoise regarding the benefits and harms of ACS use in hospitals in low-resource countries. This randomized controlled trial aims to determine whether ACS are safe and efficacious when given to women at risk of imminent birth in the early preterm period, in hospitals in low-resource countries.

2018

Widmer, M, Piaggio G, Nguyen TMH, Osoti A, Owa OO, Misra S, Coomarasamy A, Abdel-Aleem H, Mallapur AA, QURESHI ZAHIDA, Lumbiganon P, Patel AB, Carroli G, Fawole B, Goudar SS, Pujar YV, Neilson J, Hofmeyr JG, Su LL, Ferreira de Carvalho J, Pandey U, Mugerwa K, Shiragur SS, Byamugisha J, Giordano D, Gülmezoglu MA.  2018.  Heat-Stable Carbetocin versus Oxytocin to Prevent Hemorrhage after Vaginal Birth., 2018 Aug 23. The New England journal of medicine. 379(8):743-752. Abstract

Postpartum hemorrhage is the most common cause of maternal death. Oxytocin is the standard therapy for the prevention of postpartum hemorrhage, but it requires cold storage, which is not available in many countries. In a large trial, we compared a novel formulation of heat-stable carbetocin with oxytocin.

2015

Osoti, A, Gwako GN, Liyayi B, Qureshi ZP.  2015.  Distinguishing Intrauterine Fetal Demise Versus Abdominal Pregnancy in Low Resource Settings, A Case Report. East African Medical Journal. 92(1) Abstractfull_article.pdf

Diagnosis of abdominal pregnancy always poses a clinical dilemma. Transvaginal ultrasound is the ideal radiological procedure in locating these pregnancies. However in resource limited setting, abdominal and pelvic ultrasounds can be the only available yet unreliable modalities for distinguishing intrauterine versus abdominal pregnancies. We present a case of a 36 year old para 4+0 gravida 5 who presented with fetal demise at 16 weeks of gestation. Multiple abdominal and pelvic ultrasounds showed intra uterine fetal demise for which she underwent induction. The definitive diagnosis of abdominal pregnancy was established using transcervical Foleys catheter aided abdominal-pelvic ultrasound which showed an empty uterus and a gestational sac, placenta and a 16-week fetus with no cardiac activity in the right adnexa/iliac region.

2013

G, G, ZN Q, W K, F W.  2013.  Antenatal corticosteroid use in preterm birth at Kenyatta National Hospital. Journal of Obstetrics and Gynaecology of Eastern and Central Africa. 25(1):15-21. Abstractfull_article.pdf

AbstractBackground: Preterm birth causes about 75% of neonatal deaths that are not attributable to congenital malfor-mations. Antenatal corticosteroids (ACS) given to mothers at risk of preterm birth reduce the incidence/severity of RDS, intraventricular haemmorhage, necrotizing enterocolitis and neonatal deaths. The WHO recommends use of antenatal steroids for all pregnant women 26-34 weeks gestation at risk of preterm delivery and after 34 weeks gestation only if there is evidence of fetal pulmonary immaturity. Despite this, ACS are widely used locally across all gestational periods.Objective: To determine the frequency of administration and impact of ACS in reducing the morbidity and mor-tality in preterm neonates born 28- 37 weeks gestation at Kenyatta National Hospital.Design: This was a hospital-based retrospective cohort study.Setting: Kenyattah National Hospital labour ward, antenatal wards, NBU, NICU.Methods: The study compared the neonatal outcomes of mothers with preterm birth who received antenatal steroids and those who did not receive. The study populations were mothers with preterm birth due to preterm labor, PPROM and severe pre eclampsia and their neonates. Mothers who met the inclusion criteria were recruit-ed immediately after delivery, interviewed, medical records scrutinized and information obtained entered into a questionnaire. Neonates were followed until discharge/death/ 7th day whichever came earlier. The outcome measures considered were the occurrence and severity of RDS, NBU admissions and neonatal deaths.Results: Two hundred and six mother/neonate pairs were recruited. Overall 35% of mothers/neonates were exposed to ACS. Forty six percent of those who delivered <34 weeks received ACS compared to 26% of those who delivered >34 weeks. Only 3% of mothers received a complete course of ACS. ACS significantly reduced the occurrence and severity of RDS in preterm neonates up to 34 weeks gestation. Sixty eight percent of neonates delivered before 34 weeks and not exposed to ACS developed RDS compared to 38% of those exposed (RR 0.6, 95% CI 0.4-0.9, P= 0.005). Exposure to ACS >34 weeks gestation did not reduce occurrence and severity of RDS. Forty percent of those exposed to ACS developed RDS compared to 37% of those not exposed (RR 1.2 95% CI 0.7-1.8, P =0.755). ACS reduced neonatal mortality across all gestational ages. The neonatal mortality within 7 days of life was 26% among those exposed to ACS <34 weeks compared to 38% among those not exposed (RR1.2, 95% CI 0.9-1.6, p=0.224). for those delivered after 34 weeks mortality was 3.3% in the exposed group compared to 9.2% in the non exposed group (RR 1.1 95%CI 1.0-1.2 p=0.443). ACS did not reduce NBU/NICU admissions across all gestational ages. Eighty five percent of neonates exposed to ACS before 34 weeks were admitted to NBU compared to 71% of those not exposed (RR1.2, 95% CI 1-2.1, p=0.113). Fifty percent of neonates exposed to ACS after 34 weeks were admitted to NBU compared to 32.2% of those not exposed (RR 1.3 95% CI 0.9-2.1, p=0.225). Conclusions: ACS are underutilized. ACS significantly reduce the incidence/severity of neonatal RDS and mortality <34 weeks gestation.Recommendations: There is need to upscale the utilization of ACS. The study provides local evidence to discourage routine use of ACS >34 weeks.

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