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Maternal predictors of neonatal outcomes after emergency cesarean section: a retrospective study in three rural district hospitals in Rwanda

Overview of attention for article published in Maternal Health, Neonatology and Perinatology, June 2017
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Title
Maternal predictors of neonatal outcomes after emergency cesarean section: a retrospective study in three rural district hospitals in Rwanda
Published in
Maternal Health, Neonatology and Perinatology, June 2017
DOI 10.1186/s40748-017-0050-4
Pubmed ID
Authors

Naome Nyirahabimana, Christine Minani Ufashingabire, Yihan Lin, Bethany Hedt-Gauthier, Robert Riviello, Jackline Odhiambo, Joel Mubiligi, Martin Macharia, Stephen Rulisa, Illuminee Uwicyeza, Patient Ngamije, Fulgence Nkikabahizi, Theoneste Nkurunziza

Abstract

In sub-Saharan Africa, neonatal mortality post-cesarean delivery is higher than the global average. In this region, most emergency cesarean sections are performed at district hospitals. This study assesses maternal predictors for poor neonatal outcomes post-emergency cesarean delivery in three rural district hospitals in Rwanda. This retrospective study includes a random sample of 441 neonates from Butaro, Kirehe and Rwinkwavu District Hospitals, born between 01 January and 31 December 2015. We described the demographic and clinical characteristics of the mothers of these neonates using frequencies and proportions. We assessed the association between maternal characteristics with poor neonatal outcomes, defined as death within 24 h or APGAR < 7 at 5 min after birth, using Fisher's exact test. Factors significant at α = 0.20 significance level were considered for the multivariate logistic regression model, built using a backwards stepwise process. We stopped when all the factors were significant at the α = 0.05 level. For all 441 neonates included in this study, 40 (9.0%) had poor outcomes. In the final model, three factors were significantly associated with poor neonatal outcomes. Neonates born to mothers who had four or more prior pregnancies were more likely to have poor outcomes (OR = 3.01, 95%CI:1.23,7.35, p = 0.015). Neonates whose mothers came from health centers with ambulance travel times of more than 30 min to the district hospital had greater odds of having poor outcomes (for 30-60 min: OR = 3.80, 95%CI:1.07,13.40, p = 0.012; for 60+ minutes: OR = 5.82, 95%CI:1.47,23.05, p = 0.012). Neonates whose mothers presented with very severe indications for cesarean section had twice odds of having a poor outcome (95% CI: 1.11,4.52, p = 0.023). Longer travel time to the district hospital was a leading predictor of poor neonatal outcomes post cesarean delivery. Improving referral systems, ambulance availability, number of equipped hospitals per district, and road networks may lessen travel delays for women in labor. Boosting the diagnostic capacity of labor conditions at the health center level through facilities and staff training can improve early identification of very severe indications for cesarean delivery for early referral and intervention.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 80 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 80 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 17 21%
Student > Bachelor 11 14%
Researcher 6 8%
Student > Postgraduate 5 6%
Student > Doctoral Student 4 5%
Other 12 15%
Unknown 25 31%
Readers by discipline Count As %
Medicine and Dentistry 24 30%
Nursing and Health Professions 11 14%
Social Sciences 4 5%
Unspecified 3 4%
Computer Science 2 3%
Other 5 6%
Unknown 31 39%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 05 July 2017.
All research outputs
#15,467,628
of 22,985,065 outputs
Outputs from Maternal Health, Neonatology and Perinatology
#57
of 83 outputs
Outputs of similar age
#199,351
of 317,534 outputs
Outputs of similar age from Maternal Health, Neonatology and Perinatology
#3
of 3 outputs
Altmetric has tracked 22,985,065 research outputs across all sources so far. This one is in the 22nd percentile – i.e., 22% of other outputs scored the same or lower than it.
So far Altmetric has tracked 83 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 11.0. This one is in the 24th percentile – i.e., 24% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 317,534 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 28th percentile – i.e., 28% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 3 others from the same source and published within six weeks on either side of this one.