Perinatal outcomes in women with lower-range elevated blood pressure and stage 1 hypertension: insights from the Kaya health and demographic surveillance system, Burkina Faso.

BACKGROUND: The impact of lower thresholds for elevated blood pressure (BP) on adverse perinatal outcomes has been poorly explored in sub-Saharan African populations. We aimed to explore the association between lower BP cutoffs (according to the 2017 American College of Cardiology/American Heart Association [ACC/AHA] criteria) and adverse perinatal outcomes in Kaya, Burkina Faso. METHODS: This retrospective cohort study included 2,232 women with singleton pregnancies between February and September 2021. BP was categorized according to the ACC/AHA criteria and applied throughout pregnancy. A multivariable Poisson regression model based on Generalized Estimating Equation with robust standard errors was used to evaluate the association between elevated BP, stage 1 hypertension, and adverse perinatal outcomes, controlling for maternal sociodemographic characteristics, parity, and the number of antenatal consultations, and the results were presented as adjusted risk ratios (aRRs) with corresponding 95% confidence intervals (CIs). RESULTS: Of the 2,232 women, 1000 (44.8%) were normotensive, 334 (14.9%) had elevated BP, 759 (34.0%) had stage 1 hypertension, and 139 (6.2%) had stage 2 hypertension. There was no significant association between elevated BP and adverse pregnancy outcomes. Compared to normotensive women, women with elevated BP had a 2.05-fold increased risk of delivery via caesarean section (aRR;2.05, 95%CI; 1.08-3.92), while those with stage 1 hypertension had a 1.41-fold increased risk of having low birth weight babies (aRR; 1.41, 95%CI; 1.06-1.86), and a 1.32-fold increased risk of having any maternal or neonatal adverse outcome (aRR; 1.32, 95%CI; 1.02-1.69). CONCLUSIONS: Our results suggest that the risk of adverse pregnancy outcomes is not increased with elevated BP. Proactive identification of pregnant women with stage 1 hypertension in Burkina Faso can improve hypertension management through enhanced clinical surveillance.

Quality of maternal and newborn care in limited-resource settings: a facility-based cross-sectional study in Burkina Faso and Côte d'Ivoire.

OBJECTIVE: To assess and compare the quality of intrapartum and immediate postpartum care across levels of healthcare in Burkina Faso and Côte d'Ivoire using validated process indicators. DESIGN: Health facility-based cross-sectional study with direct observation of healthcare workers' practices while caring for mother-newborn pairs during intrapartum and immediate postpartum periods. SETTING: Primary healthcare facilities and their corresponding referral hospitals in the Central-North region in Burkina Faso and the Agneby-Tiassa-Mé region in Côte d'Ivoire. PARTICIPANTS: Healthcare providers who care for mother-newborn pairs during intrapartum and immediate postpartum periods, the labouring women and their newborns after childbirth. MAIN OUTCOME MEASURES: Adherence to essential best practices (EBPs) at four pause points in each birth event and the overall quality score based on the level of adherence to the set of EBPs observed for a selected pause point. RESULTS: A total of 532 and 627 labouring women were included in Burkina Faso and Côte d'Ivoire, respectively. Overall, the compliance with EBPs was insufficient at all the four pause points, even though it varied widely from one EBP to another. The adherence was very low with respect to hand hygiene practices: the care provider wore sterile gloves for vaginal examination in only 7.96% cases (95% CI 5.66% to 11.06%) in Burkina Faso and the care provider washed hands before examination in 6.71% cases (95% CI 3.94% to 11.20%) in Côte d'Ivoire. The adherence was very high with respect to thermal management of newborns in both countries (>90%). The overall mean quality scores were consistently higher in referral hospitals in Burkina Faso at all pause points excluding immediate post partum. CONCLUSIONS: Women delivering in healthcare facilities do not always receive proven EBPs needed to prevent poor childbirth outcomes. There is a need for quality improvement interventions.

Post-partum family planning in Burkina Faso (Yam Daabo): a two group, multi-intervention, single-blinded, cluster-randomised controlled trial.

BACKGROUND: Post-partum family planning services can prevent maternal and child morbidity and mortality in low-resource settings. We assessed the effect of a family planning intervention package on modern contraceptive use at 12 months post partum in predominantly rural Burkina Faso. METHODS: Yam Daabo was a two group, multi-intervention, single-blinded, cluster randomised controlled trial. Primary health-care centres were randomly allocated to intervention or control clusters in a 1:1 ratio with only data analysts masked to the allocation assignment. Interventions comprised refresher training for the provider, a counselling tool, supportive supervision, availability of contraceptive services 7 days a week, client appointment cards, and invitation letters for partners. The primary outcome was modern contraceptive prevalence at 12 months, and secondary outcomes were modern contraceptive prevalence at 6 weeks and 6 months post partum. Analysis was by modified intention to treat. Prevalence ratios were adjusted for cluster effects and baseline characteristics. This study was registered with the Pan-African Clinical Trials Registry (PACTR201609001784334). FINDINGS: From July 27-Oct 17, 2016, eight clinics were randomised and 571 women were enrolled and allocated: 286 to four intervention clusters and 285 to four control clusters. Of these, 523 completed the 12-month study exit interview (260 in the intervention group, 263 in the control group) and 523 were included in the intention-to-treat analysis. At 12 months, modern contraceptive prevalence was 55% among women who received the package and 29% among those who received routine care in control clusters (adjusted prevalence ratio 1·79, 95% CI 1·30-2·47). Significant differences in modern contraceptive prevalence were also seen between intervention and control groups at 6 weeks (42% and 10%, respectively; adjusted prevalence ratio 3·88, 95% CI 1·46-10·35) and 6 months (59% and 24%, respectively; 2·31, 1·44-3·71). INTERPRETATION: A package of six low-technology interventions, aimed at strengthening existing primary health-care services and enhancing demand for these services, can effectively increase modern contraceptive use for up to a year post partum in rural settings in Burkina Faso and has the potential to be suitable in similar settings in this country and others. FUNDING: Government of France.