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CM, KM, CS and MM designed the study; CM, SKF, KM and MM created the data acquisition log. CM and KM analyzed qualitative data and CM and MM performed statistical analyses. CM, CS and MM wrote the manuscript. All authors have read and approved the final version of the manuscript. Our cross-sectional design means that data is snapshots of specific points in time. Results may have changed over time due to a number of unmeasured factors, such as staffing trends or workload. The design of the pre-post intervention is likely to be confused by secular trends. No other immediate interventions in neonatal care occurred during the period. Moreover, the huge increase in deliveries to facilities that took place in the Philippines between 2008 and 2015 was not offset by an increase in hospital staff . Given that the INAC protocol was the DOH`s main effort and was supported by national policies, it most likely appears to be the main influence on health workforce practices. The guidelines for post-emergency and post-disaster maternal and newborn care in the Philippines have been widely applied throughout the health sector and will continue to guide maternal and child care in all future emergencies in the Philippines.
The four EINC interventions were implemented in Regions 6, 7 and 8, and KMC was successfully implemented in 15 health facilities. This short report focused on the training program for the EINC and KMC protocol. One limitation of this report is that formal program evaluations have not been included. However, anecdotal evidence, as well as the high number of health workers trained, suggests that the guidelines have been helpful in this disaster situation. The guidelines could also be adapted for application by other countries, particularly resource-limited and disaster-prone countries. These relatively simple, low-cost, low-tech interventions enabled a successful response to maternal and newborn health after Haiyan. The four time-limited interventions of the INAC Protocol (section 1 of the new guidelines) are evidence-based interventions that focus on a fundamental sequence of time-limited actions: (1) immediate and complete drying of the newborn, (2) early skin-to-skin contact between mother and newborn, (3) clamping and excision of the cord at the right time, and (4) non-separation of the newborn from the mother for early initiation of breastfeeding. Our study found that potentially unsafe practices are still ongoing that contribute to the emergence of OASIS. The perception of these practices differs from current evidence, and empirical knowledge has more influence. In order to improve practices, the scientific evidence and its basis should be understood by providers. Risk factors for OASIS include primaparity, gestational diabetes, macrosomia, fetal misrepresentation or misalignment, assisted vaginal delivery, and episiotomy.
A sub-analysis of primiparous and non-instrumental births in a systematic review of randomized controlled trials found that the prevalence of OASIS in a restrictive episiotomy group ranged from 0% to 16% (3% on average); and between 0 and 14% (5% on average) in a liberal episiotomy group . Aggregated national data from twenty European countries showed that OASIS rates ranged from 0.1% in Romania to 5% in Iceland . It is difficult to determine the standard prevalence of OASIS at the facility level because reproductive characteristics are different for each health facility. However, our study showed that the prevalence of OASIS among primiparous people was 28%, which is much higher than previous results. This study confirmed that birth weights greater than 3.5 kg, episiotomy, fundic pressure and instrumental delivery were significantly associated with the occurrence of OASIS, which is consistent with the literature [34-36]. OASIS has serious short- and long-term consequences such as pain, infection, dyspareunia, sexual dysfunction and analine incontinence [37, 38]. Therefore, it is important to minimize risk factors to avoid AVSIS. The rate of instrumental deliveries in the cases we observed was 9% (16/170). However, in 13 cases (81%), it was applied within an hour in the second phase of delivery. Since RFH has not been adequately monitored, careful monitoring of maternal and fetal conditions can help reduce the need for instrumental births.
The use of episiotomy should be improved and not systematically performed on primiparous. It has been suggested that the mediolateral episiotomy is safer than the median incision . Median episiotomy is a known risk factor for OASIS, particularly during surgical deliveries, while mediolateral or lateral episiotomy has a protective effect [39–41]. The pressure of the fund must be avoided because of its harmfulness. Another important topic would be to carefully communicate risk factors and midwifery care during pregnancy and childbirth carefully to pregnant women. The rate of OASIS under primiparae has been reported at 0.2% in midwife-led birth centers in Japan [42, 43]. Midwives in Japan are not allowed to perform invasive medical procedures, including episiotomy. Therefore, they only work in low-risk cases. They are committed to humanized and evidence-based care during pregnancy and childbirth [44, 45].
These factors can help reduce the risk of OASIS. Unang Yakap is a simple, evidence-based intervention that can help ensure survival for all newborns and infants. This includes interventions such as warmth, breastfeeding, love and safety, and infection control. This protocol is now practiced in birth centers and hospitals. Clear instructions that the INAC protocol is performed immediately after birth should be given by the mother prior to birth. Prioritizing a newborn`s health is critical to a newborn`s growth and development. It is important for a mother to include INAC protocols or the Unang Yakap campaign in her birth plans, as this would benefit both the mother and her baby. Newborns should also undergo and listen to newborn screening to treat and prevent complications that may occur in the future. A baby must receive essential health services for newborns, including vaccination in the health facility. Newborns should be adequately cared for and supported to ensure their survival.###VVF This study protocol was submitted and approved to the Ethics Committee of the School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan (approval number NU_TMGH-048) and the Ethics Review Committee of the Sector Group of the Department of Health XI in the Philippines (approved protocol number P18032601).