Ali S. Khashan

Background: Sub-Saharan Africa faces challenges with collecting maternal and perinatal data because of poor documentation in paper-based systems and inadequate infrastructure for digital utilization. The electronic health record system-ULTRA (EHRS-ULTRA) was developed and piloted in the Kilimanjaro region from October 2022 to August 2024 to improve data management. Objective: This qualitative study aimed to explore health care providers’ perspectives and experiences of using EHRS-ULTRA in maternal and perinatal health care. Methods: The study used a qualitative, exploratory, descriptive design to examine health care providers’ experiences using the EHRS-ULTRA in Kilimanjaro, Tanzania. Data were collected through key informant interviews and focus group discussions. Participants were purposively selected from 2 districts representing urban (Moshi Municipal) and rural (Moshi District) areas, including reproductive and child health coordinators; facility managers; and health care professionals from the antenatal care, labor and delivery, and postnatal care departments. A total of 35 participants took part, including 29 health care providers and 6 health managers. The data were analyzed through reflexive thematic analysis. Results: The EHRS-ULTRA was perceived by study participants to improve access to patients’ clinical information, continuity of care, quality of clinical decision-making, and quality of documentation for maternal and perinatal health services. Real-time notifications and referral tracking were reported to support timely clinical responses and leadership oversight. Key success factors for future adoption included leadership engagement, supportive supervision, and alignment of their existing Mfumo wa Taarifa za Uendeshaji wa Huduma za Afya (MTUHA) paper records system workflow. However, widespread challenges with unstable electricity, lack of reliable internet service, limited number of digital devices, and variability in digital literacy skills were perceived as the primary barriers to successful implementation and scaling of the system. Conclusions: Based on users’ experiences with the EHRS-ULTRA, health care professionals perceived EHRS-ULTRA as complementing existing paper-based documentation systems by improving information access, continuity of care, referral tracking, and the timeliness of clinical decisions about maternal and perinatal health care. EHRS-ULTRA demonstrated considerable potential to strengthen maternal and perinatal care; however, broader implementation and scale-up will require improvements in infrastructure, workforce readiness, and overall health system preparedness.

Background During a novel public health emergency, pregnant women are a high priority group for research to protect foetal development. We examined the rates of COVID-19 exposures, (infection and vaccination), among pregnant women in the Republic of Ireland (ROI), and assessed the feasibility of investigating their impact on pregnancy outcomes. Methods National aggregate data on COVID-19 exposures, infection (March 2020–December 2021) and vaccination (May–December 2021), were accessed from the Health Service Executive and COVID-19 Data Hub. To analyse exposure rates in women of childbearing age (WCBA) by pregnancy status, a denominator estimate was calculated. Infection data were analysed by pregnancy status and COVID-19 waves. Vaccination data were analysed by pregnancy status and week, not limited to WCBA due data unavailability. Results Infection exposure: During the 22-month study period, 234,803 cases were confirmed in WCBA, of which 55.8% had a recorded pregnancy status with 3.7% of women recorded as pregnant at the time of infection (n = 4,780). This reflects our denominator estimate for the proportion of the population that are pregnant at any given time (3.8–4%). Vaccination exposure: uptake varied over time for pregnant women compared to non-pregnant women; lower at the beginning in May 2021 (0.03% compared to 4.3%), but higher in December 2021 (1.65% compared to 0.2%). It was not feasible to investigate the impact of COVID-19 exposures on pregnancy outcomes in the absence of an individual health identifier (IHI). Conclusions Pregnancy status did not significantly impact infection exposure but did impact vaccination uptake. However, findings should be interpreted with caution due to potential ascertainment bias arising from testing/vaccination strategies which could not be adjusted for due to the absence of reliable denominators for WCBA (aggregate testing/vaccination data stratified by age and sex). An IHI could have enabled linked-data analyses of COVID-19 exposures and pregnancy outcomes using routine administrative datasets.

In this policy brief, we explain why pandemic preparedness must include significantly improving the availability of data on infection and vaccination in pregnant women in the Republic of Ireland (ROI). We base this on an in-depth analysis of data availability during the COVID-19 pandemic in ROI. These improvements include 1) the need to optimise research governance processes, 2) better linkage between different data sources, 3) improving documentation of data sources, 4) timely release of data, 5) prioritisation of pregnancy data collection, and 6) increased supports and funding.

Introduction : Electronic health record systems (EHRSs) can promote maternal and perinatal healthcare through timely data capture, data accuracy, continuity of care, and service efficiency. It is unclear how clients to whom the data are collected perceive the process or understand its use. This study investigated the perception of the use of EHRSs during the perinatal period among mothers and male partners attending reproductive and child health (RCH) clinics in the Kilimanjaro Region. Methods : A qualitative study was conducted between April and June 2024 via focus group discussions and in-depth interviews within reproductive and child health clinics around the communities of the Moshi District Council (rural) and the Moshi Municipal Council (urban). The research involved mothers who gave birth in the past 12 months before this study and male escorting partners attending RCH clinics.The data were collected via Sem-structured interview guides and analyzed thematically via NVivo 15 software. Data triangulation, reflexivity, and adherence to qualitative research standards were observed, ensuring that the study met ethical and methodological rigor. To address these components, our study established a trustworthy and robust system. Results : A total of 39 participants were recruited for the study, i.e., 29 mothers who gave birth between March 2023 and March 2024 and 10 male partners attending RCH clinics. The findings revealed that most participants had positive opinions of EHRS due to its efficacy and safety, ability to reduce access time, ensure continuity of care, increase trust through confidentiality, increase data storage, and simplify work. However, limited client awareness, privacy concerns, infrastructure problems, and financial limitations are some of the obstacles that might affect its adoption. Systems integrating healthcare facilities with training for clients and healthcare providers and creating policy documents to ensure sustainability and efficacy were proposed. Conclusion : Our study reflects a representative range in the transition of EHRSs. Although some concerns around understanding, privacy issues, infrastructure, and technical capabilities were revealed, the positive outcomes indicate significant opportunities in improving quality-of-care delivery through the EHRS. Resolving these challenges is crucial for smoother transitions and building trust in EHRSs over time.

Background Monitoring coronavirus disease (COVID-19) infection and vaccination during pregnancy is vital because of the increased susceptibility to severe disease. This article outlines the available data sources on COVID-19 infection and vaccination rates during pregnancy in Northern Ireland (NI) and the Republic of Ireland (ROI) and describes the processes, strengths, and weaknesses of available data. Methods Three data sources on COVID-19 vaccination and infection were identified in the ROI: the national computerized infectious disease reporting (CIDR) system used for reporting notifiable infectious diseases, the national dataset of all COVID-19 vaccinations for all residents (COVAX), and a regional Maternal and Newborn Clinical Management System (MN-CMS), which includes data on COVID-19 vaccination and infection. Four data sources were identified in NI: the NI maternity system (NIMATS) records maternity data, including COVID-19 infection and vaccination during pregnancy; datasets of COVID-19 antigen testing performed in hospitals (Pillar 1) and in the community (Pillar 2); and the NI Vaccine Management System dataset of COVID-19 Vaccinations. Results In the ROI, the CIDR database allows for the calculation of COVID-19 infection rates in women of reproductive age; however, pregnancy status remains largely unreported. The COVAX dataset includes pregnancy status, although the accuracy depends on whether the pregnancy is known at the time of vaccination. The MN-CMS tracks COVID-19 infection and vaccination during pregnancy. However, there are uncertainties regarding its reliability. In NI, COVID-19 data are available for all pregnant women using Health and Care numbers to link the NIMATS data to testing and vaccination databases. Conclusions Both countries track COVID-19 infection and vaccination rates, but the strength of the NI system is the use of unique identification numbers that allow linkage of maternal records to infection and vaccination databases. Both countries face delays in data access, underscoring the need for real-time systems to support future pandemic preparedness.

Background Psychotic disorders are mental illnesses whose treatment often includes antipsychotic medication, a treatment option associated with metabolic side effects including weight gain. However, the influence of sex on antipsychotic-associated weight gain remains inadequately explored. We aim to synthesise the evidence on the sex-specific differences in weight gain among patients with psychotic disorders receiving antipsychotic treatment. Methods We will include cohort, cross-sectional, and case-control studies, randomized, and non-randomized controlled trials, which examine the association between a treated psychotic disorder and weight gain in male and female patients. PubMed, EMBASE, and PsycINFO databases will be systematically searched in accordance with a detailed search strategy. Other inclusion criteria are; only articles which mention gender or sex in the title or abstract, only data from original studies, studies where diagnosis of a psychotic disorder must be made by a medical practitioner using diagnostic guidelines, studies published in English only, and only peer-reviewed literature. Two review authors will independently review the titles and abstracts of all studies and perform data extraction and quality assessment using standardized tools. We will perform meta-analyses to estimate the overall pooled associations using the generic inverse variance method. We will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Ethics and Dissemination This systematic review and meta-analysis, relying solely on already published data, does not necessitate ethics approval. The results will be shared at scientific gatherings and disseminated via publication in a peer-reviewed journal. Registration CRD42023495785

Background Previous studies have established an association between hypertensive disorders of pregnancy (HDP) (e.g. preeclampsia, gestational hypertension) and maternal cardiovascular disease, renal disease, and cerebrovascular disease. There is relatively little known about the association between HDP and maternal retinal disease, despite many retinal disorders having an underlying vascular aetiology. Existing research which has focused on HDP and future maternal ophthalmic outcomes is scarce, and findings are inconsistent. Objective This systematic review will examine the available evidence on the association between HDP and long-term maternal retinal disease and other forms of ophthalmic disease. Methods and analysis We will include cohort, cross-sectional, and case-control studies in which women had a known diagnosis of HDP (including preeclampsia, gestational hypertension) and where measures of association with maternal retinal disease or other ophthalmic disease were reported after at least 6 months postpartum. A systematic search of PubMed, Embase, Web of Science, and Cochrane Library will be conducted following a detailed search strategy until end of September 2024. Two authors will independently review titles and abstracts of all eligible studies, extract data using pre-defined, standardised data extraction tools, and assess the quality of each study using the Newcastle-Ottawa Scale. We will use random-effects meta-analysis for each exposure-outcome association where possible, and we will calculate overall pooled estimates using the generic inverse variance method. PROSPERO registration CRD42024589508

Background Monitoring coronavirus disease (COVID-19) infection and vaccination during pregnancy is vital because of the increased susceptibility to severe disease. This article outlines the available data sources on COVID-19 infection and vaccination rates during pregnancy in Northern Ireland (NI) and the Republic of Ireland (ROI) and describes the processes, strengths, and weaknesses of available data. Methods Three data sources on COVID-19 vaccination and infection were identified in the ROI: the national computerized infectious disease reporting (CIDR) system used for reporting notifiable infectious diseases, the national dataset of all COVID-19 vaccinations for all residents (COVAX), and a regional Maternal and Newborn Clinical Management System (MN-CMS), which includes data on COVID-19 vaccination and infection. Four data sources were identified in NI: the NI maternity system (NIMATS) records maternity data, including COVID-19 infection and vaccination during pregnancy; datasets of COVID-19 antigen testing performed in hospitals (Pillar 1) and in the community (Pillar 2); and the NI Vaccine Management System dataset of COVID-19 Vaccinations. Results In the ROI, the CIDR database allows for the calculation of COVID-19 infection rates in women of reproductive age; however, pregnancy status remains largely unreported. The COVAX dataset includes pregnancy status, although the accuracy depends on whether the pregnancy is known at the time of vaccination. The MN-CMS tracks COVID-19 infection and vaccination during pregnancy. However, there are uncertainties regarding its reliability. In NI, COVID-19 data are available for all pregnant women using Health and Care numbers to link the NIMATS data to testing and vaccination databases. Conclusions Both countries track COVID-19 infection and vaccination rates, but the strength of the NI system is the use of unique identification numbers that allow linkage of maternal records to infection and vaccination databases. Both countries face delays in data access, underscoring the need for real-time systems to support future pandemic preparedness.

Background The World Health Organization (WHO) advocates the use of digital health interventions to strengthen health systems globally. This landscape review evaluated how data related to maternal and neonatal health is recorded and utilized for clinical and policy decision-making in the Kilimanjaro Region of Tanzania. Method This landscape review employed a dual method approach, initially quantifying data recording practices of each clinic and then using qualitative interviews to explore how data is currently captured and utilized. We conducted interviewed with seven Nurse-Midwives, eight Lead Obstetricians at district hospitals, seven District Medical Officers, and seven District Reproductive and Child Health Coordinators. Qualitative data analysis was performed using NVivo software. Results In the region's seven districts, there are 489 healthcare facilities offering Reproductive and Child Health Services, delivery, infant and child care. The facilities comprise 22 hospitals, 62 health centers, 353 dispensaries, and 52 clinics. In 2021, there were 45,343 births with a maternal mortality rate of 146 per 100,000 live births, a neonatal mortality rate of 10.1 per 1,000 live births, and a stillbirth rate of 4 per 1,000 births. Additionally, 20.3% of births were delivered via C-section. Although there was a notable decline in maternal and neonatal mortality rates (from 112 to 51 vs 9.5 to 3.7 deaths per 100,000 live births) from 2020 to 2023, the 2021 data revealed unexpectedly high maternal mortality rates. The qualitative study highlighted issues with the data recording system, which is complex and time-consuming, involving multiple paper-based and digital records. Challenges include data volume, loss, and retrieval issues, affecting clinical decision-making. This data is crucial for identifying resource needs, monitoring health trends like low antenatal care uptake, and advocating for changes in resources, guidelines, and policies at regional and national levels. Conclusion Quantitative data indicates a significant rise in maternal and neonatal mortality rates in the Kilimanjaro region during 2020-2021, followed by a decrease in 2022-2023. Additionally, early antenatal care (ANC) uptake remains below 50%. The qualitative study suggests that paper records are time-consuming and prone to incomplete data making it difficult to use due to their storage approach and the risk of damage to the physical books.