The global effect of maternal education on complete childhood vaccination: a systematic review and meta-analysis.

BACKGROUND: There is an established correlation between maternal education and reduction in childhood mortality. One proposed link is that an increase in maternal education will lead to an increase in health care access and vaccine uptake. Vaccinations are a central preventative child health tool, therefore demonstrating the importance of understanding factors that can improve coverage. This review aims to establish if there is a correlation between increasing maternal education and vaccine uptake and if this varies between continents, setting and time. METHODS: An electronic database search was conducted using Medline Ovid, Embase and The Cochrane Library using a combination of keywords and appropriate MeSH terms for maternal education and child vaccination. Bibliographies were also hand searched. Data was extracted and entered onto a Microsoft Excel spreadsheet and analysed using STATA 13.0 software. The primary outcome of effect size of maternal education on completion of childhood vaccinations was analysed at different levels. Secondary outcomes were explored using subgroup analyses of differences between continents, rural or urban settings, and dates. RESULTS: The online search yielded 3430 papers, 37 were included in this study. The analysis showed increasing child vaccination uptake with increasing maternal education. Overall, analysis showed that the odds of full childhood vaccination were 2.3 times greater in children whose mother received secondary or higher education when compared to children whose mother had no education. There was large variability in the effect size between the studies included. CONCLUSIONS: Improving maternal education is important for increasing childhood vaccination uptake and coverage. Further research is needed in higher income countries. TRIAL REGISTRATION: PROSPERO Registration No: CRD42016042409 .

Exploring the third delay: an audit evaluating obstetric triage at Mulago National Referral Hospital.

BACKGROUND: Mulago National Referral Hospital has the largest maternity unit in sub-Saharan Africa. It is situated in Uganda, where the maternal mortality ratio is 310 per 100,000 live births. In 2010 a 'Traffic Light System' was set up to rapidly triage the vast number of patients who present to the hospital every day. The aim of this study was to evaluate the effectiveness of the obstetric department's triage system at Mulago Hospital with regard to time spent in admissions and to identify urgent cases and factors adversely affecting the system. METHODS: A prospective audit of the obstetric admissions department was carried out at the Mulago Hospital. Data were obtained from tagged patient journeys using two data collection tools and compiled using Microsoft Excel. StatsDirect was used to compose graphs to illustrate the results. RESULTS: Informal triage was occurring 46 % of the time at the first checkpoint in a woman's journey, but the 'Traffic Light System' was not being used and many of the patient's vital signs were not being recorded. CONCLUSIONS: It is hypothesised that the 'Traffic Light System' is not being used due to its focus on examination finding and diagnosis, implying that it is not suitable for an early stage in the patient's journey. Replacing it with a simple algorithm to categorise women into the urgency with which they need to be seen could rectify this.