AMMAN — Over three-quarters of neonatal deaths
and stillbirths in Jordan are caused not by disease, but by delays related to
appropriate healthcare, according to a new study from professors at the Jordan
University of Science and Technology, supported by UNICEF and the International
Development Research Center of Canada.
اضافة اعلان
A total of 10,726 births were included in the
sample for the study, of which 156 were neonatal deaths and 108 were
stillbirths. Three kinds of delays were identified: A delay in recognizing the
need for care and in the decision to seek care was believed to be responsible
for 118 (44.6 percent) deaths. The two other delays, which included a delay in
seeking or reaching appropriate care due to transportation issues and a delay in
receiving appropriate care at a suitable healthcare facility, were responsible
for 3.5 percent and 30.7 percent of deaths respectively.
A total of 78.8 percent of stillbirths and
neonatal deaths were attributed to some kind of delay — making them most likely
preventable, “if optimal care is provided”.
The idea for the study originated when researchers
noticed that there was no reliable system for tracking stillbirths and neonatal
deaths, according to lead investigator Yousef Khader. Khader explained that in
2012, when his team began studying these deaths, only 14 percent were
registered. Stillbirths and newborn deaths “go unnoticed without any
registration”, he told Jordan News. “If you don’t register deaths (and) you
don’t know the causes, how can you prevent them?”
The research team implemented a new electronic
stillbirths and neonatal deaths surveillance system called J-SANDS, an
electronic stillbirths and neonatal deaths surveillance system in five large
hospitals in three of Jordan’s largest cities in August 2019. The system automatically
collects and reports data to the Ministry of Health, providing basic functions
such as counts of all births and deaths in the participating hospitals and
information about the causes of the deaths, including social determinants
related to equity.
Additionally, they established a “death
auditing system” through which committees of medical staff meet monthly to
discuss each stillbirth or neonatal death and identify future interventions.
The project produced “plenty of data that can
be used by decision-makers to prevent and minimize” the deaths, said Khader.
“So we expect with suitable interventions we can prevent almost three quarters
of neonatal deaths and the stillbirths.”
“The major cause of death is related to those
who are low birth weight babies, or those who are pre-term babies,” explained
Khader. He pointed out that premature babies in particular need advanced care
from trained staff — which is not always available in Jordan.
“The quality of antenatal care in other
studies has been found in Jordan to be very poor,” added Khader. According to
the researcher, women often visit health centers for their prenatal care but
then deliver the baby in a hospital — with a medical team that knows nothing
about them or their possible health problems. “They’re not informed about the
situation,” he said.
Delayed care is a “major cause” of stillbirths
and neonatal deaths, according to Raghad Al-Hadidi, a neonatal and child health
(NCH) expert and consultant at the World Health Organization (WHO). She
explained in an interview with Jordan News that though clinics are
well-distributed across the country, the level of services varies dramatically,
and that obtaining “ultrasounds and early detection for stillbirths and
complications is very difficult.” Particularly for women in rural areas, she
said, reaching high-quality care in the case of emergencies can be very
difficult.
Additionally, she described the “poor” state
of health education in Jordan. She explained that midwives and doctors —
overworked in health centers — “cannot have enough time to educate mothers
about the dangers, how to prepare, how to detect stillbirths from an early
time.” Accordingly, women don’t know when they should seek out medical care or
when the pregnancy is in danger.
While the number of stillbirths and neonatal
deaths in Jordan is relatively low, Hadidi emphasized the fact that many of
these deaths are preventable. “Especially if the cause is infection, the cause
is hypertension during pregnancy, diseases of the mother, this must be
controlled and detected early and managed early,” she said.
For Hadidi, the solution to preventing
stillbirths and neonatal deaths is straightforward: Jordan should establish
more prenatal clinics to provide preconception health services and screenings
for women before they even become pregnant.
“This is an important issue, because we lack
this type of service,” she said. When a woman gets married “immediately she
becomes pregnant; she doesn't know anything about her health situation, if she
has any disease” or risk factors that may increase the chance of a stillbirth
or miscarriage.
“Even taking folic acid before getting
pregnant, this is not implemented in Jordan,” she said, referencing the common
prenatal vitamin women are recommended to take before and during pregnancy.
Khader explained that as a solution to this
lack of awareness, his team is developing a mobile app to help pregnant women
identify signs that they should seek medical attention.
A
previous study by Khader found that 9.9 per 1000 total births in
Jordan, or
approximately 1 percent, were stillbirths between August 2019 and January 2020.
This rate was described as lower than that in other countries in the region.
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