Background and Objectives

  Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide; 99% of maternal deaths due to PPH occur in developing countries. The aim of this study was to analyze the current status and trend of PPH at a district hospital in Zambia.

Methods

  All women who delivered at Zimba Mission Hospital, a district hospital covering a population of 98,000, in 2017 were included in this retrospective survey. The incidence, risk factors, treatment, and outcomes of PPH were analyzed. PPH was defined as blood loss ≥ 500 ml within 24 h after vaginal delivery or ≥1,000 ml within 24 h after cesarean section. Data were extracted from admission, delivery, and operation registers. Risk factors were identified by multivariable logistic regression analysis.

Results

  Among the 1,704 women who delivered at the hospital, PPH developed in 107 (6.3%) women. Risk factors for PPH after vaginal delivery were assisted vaginal delivery (adjusted odds ratio [aOR], 14.40; 95% confidence interval [CI], 6.72-30.80), macrosomia (aOR, 5.19; 95% CI, 1.69-15.90), and multiple pregnancy (aOR, 4.04; 95% CI, 1.37-11.90). Risk factors for PPH after cesarean section were placenta previa (aOR, 13.20; 95% CI, 2.37-73.10) and parity ≥ 3 (aOR, 9.85; 95% CI, 3.50-27.70). Sufficient oxytocin was administered in all cases. Advanced treatment was required in 19 (17.8%) cases. Balloon tamponade was performed successfully in 7 (6.5%) cases. B-Lynch uterine compression suturing was performed successfully in 2 (1.9%) cases. Hysterectomy was performed in 10 (9.3%) cases, and 2 (1.9%) women died after the operation.

Conclusions

  The incidence of PPH was slightly higher than estimated global incidence. Different risk factors for PPH were identified between vaginal deliveries and cesarean sections. Most of the patients survived after advanced treatment.

Objective

  Thailand is experiencing demographic changes owing to an increase of the older population. Family members feel responsible for providing care and are required to offer a broad range of assistance despite insufficiency of the necessary skills, knowledge, and resources. Therefore, family caregivers go through a considerable amount of distress in their efforts to provide long-term care for older people. The aim of this study was to identify the factors which lead to perceivings of burden for family caregivers caring for varied dependent older people in Thailand, and to determine the magnitude of Caregiver Burden Inventory (CBI) they experienced in order to develop appropriate strategies for burden alleviation.

Methods

  A cross-sectional descriptive study was conducted in August 2017. A total of 314 subjects were recruited from ten randomly selected sub-districts in Nakhon Ratchasima Province. The CBI was employed to assess family caregiver burden. Chi-square tests and multiple logistic regression were utilized to examine the association between independent variables and family caregiver burden. One-way Analysis of Variance (ANOVA) was performed to test differences among the five factors of the Caregiver Burden Inventory (CBI).

Results

  The prevalence of high caregiving burden was moderate (41.7%). Among CBI factors, time constraint was a significant and major cause of burden. Increased caregiver burden was significantly related to the caregiver’s own health problems (adjusted odds ratio (AOR) = 3.60, 95% confidence interval (CI) = 2.06-6.27), caregiver’s poor sleep quality (AOR = 2.71, 95% CI = 1.43-5.11), daily hours providing care ≥ eight hours (AOR = 2.81, 95% CI = 1.61-4.91), care-recipient’s low ADL level (AOR = 3.98, 95% CI = 2.29-6.92), and care-recipient’s low cognition level (AOR = 2.12, 95% CI = 1.23-3.67), even after adjusting for other factors.

Conclusion

  The research finding showed that the prevalence high caregiver burden was moderate. Among the five CBI variables, time constraint was the major cause of burden. Further, caregiver’s own health problems, caregiver’s poor sleep quality, daily hours of providing care ≥ eight hours, care-recipient’s low ADL level, and care-recipient’s low cognition level, were regarded as factors affecting caregiver’s major burden. Thus, both caregivers’ and care-recipients’ factors adversely influenced caregivers’ burden.

  One of the characteristics of nursing in Southeast Asia is the ASEAN Mutual Recognition Arrangements on Nursing Services, which strengthens professional capabilities through four objectives include facilitating mobility of nursing professionals within ASEAN.

  The Japanese government supports human resources for health in the ASEAN region, as a member country of ASEAN+3. A meeting was held at the Annual Meeting of the Japan Association for International Health 2017. The meeting objectives were as follows: (1) to share three nursing research findings regarding nursing migration, regulatory framework, and in-service training that may affect quality of nursing and (2) to discuss Japan’s role in improving the quality of nursing in the ASEAN region. This report aims to summarize the presentations and points of that meeting.

  The academic level of nursing education and nursing regulations have improved in ASEAN member countries. All member countries have university nursing education, and some have master’s and doctoral degree nursing programs. In lower middle income ASEAN countries, such as Cambodia, Laos, and Vietnam, the nursing education system is in the process of transition, from the technical to professional level of nursing. The next step for these countries is to strengthen the capabilities of nursing teachers who are responsible for professional nursing education at universities. The ASEAN University Network and universities in neighboring Thailand could also contribute to this end. In-service training is also needed because the guidance of more experienced nurses is crucial in nursing service as well as nursing practicums. Japan’s experience of developing an in-service training system could be useful for some ASEAN countries.

  The objective of mobility among nursing professionals within the ASEAN has yet to be accomplished. However, there are pull and push factors of nurse migration due to economic conditions within the ASEAN. It is predicted that nurse migration will occur with mixed-skill caregivers to high income countries out of the ASEAN countries, because of the lack of caregivers for the aging population. In order to ensure quality nursing in the ASEAN region, it is not only necessary to share country-level experiences to improve nursing education and regulations but also crucial to develop systems that promote the circulation of nursing professionals through wide regional cooperation.