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Powell J, Fuentes-Rivera E, Darney B. Comparison of immediate postpartum contraception among women with a high versus low risk pregnancy in Mexico: a retrospective cohort study. BMJ Open 2021; 11:e048048. [PMID: 34341048 PMCID: PMC8330582 DOI: 10.1136/bmjopen-2020-048048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE We tested whether women who reported high-risk pregnancies or deliveries were more likely to receive immediate postpartum contraception prior to discharge compared with normal-risk women in Mexico. METHODS This is a retrospective study using the National Health and Nutrition Survey. We classified women as high-risk based on reported complications in pregnancy and delivery. We used multivariable logistic regression to test the association of high-risk status and receipt of postpartum contraception (any modern method and Tier one methods) prior to discharge. RESULTS Our sample included 5030 deliveries (population N=3 923 657). Overall, 19.1% of the sample were high risk. Over 60% of women in the high-risk and normal-risk group received immediate postpartum contraception, but a greater proportion of high-risk women received a method (67% vs 61% normal risk; p<0.001). However, in multivariable models, there were no significant differences in receipt of any modern method or tier 1 method by risk group. CONCLUSION Women with high-risk pregnancies were not more likely to receive postpartum contraception than the normal-risk group, once accounting for sociodemographic and clinical factors. Prenatal and postpartum contraception counselling should address the health effects of high-risk pregnancies and interpregnancy intervals to improve maternal health outcomes.
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Affiliation(s)
- Jacqueline Powell
- Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Evelyn Fuentes-Rivera
- Center for Health Systems Research, Instituto Nacional de Salud Publica (INSP), Mexico City, Mexico
| | - Blair Darney
- Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
- Center for Population Health Research, Instituto Nacional de Salud Publica (INSP), Mexico City, Mexico
- School of Public Health, Oregon Health & Science University - Portland State University, Portland, OR, USA
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202
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Curtis A, Monet JP, Brun M, Bindaoudou IAK, Daoudou I, Schaaf M, Agbigbi Y, Ray N. National optimisation of accessibility to emergency obstetrical and neonatal care in Togo: a geospatial analysis. BMJ Open 2021; 11:e045891. [PMID: 34330852 PMCID: PMC8327815 DOI: 10.1136/bmjopen-2020-045891] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Improving access to emergency obstetrical and neonatal care (EmONC) is a key strategy for reducing maternal and neonatal mortality. Access is shaped by several factors, including service availability and geographical accessibility. In 2013, the Ministry of Health (MoH) of Togo used service availability and other criteria to designate particular facilities as EmONC facilities, facilitating efficient allocation of limited resources. In 2018, the MoH further revised and rationalised this health facility network by applying an innovative methodology using health facility characteristics and geographical accessibility modelling to optimise timely access to EmONC services. This study compares the geographical accessibility of the network established in 2013 and the smaller network developed in 2018. DESIGN We used data regarding travel modes and speeds, geographical barriers and topographical and urban constraints, to estimate travel times to the nearest EmONC facilities. We compared the EmONC network of 109 facilities established in 2013 with the one composed of 73 facilities established in 2018, using three travel scenarios (walking and motorised, motorcycle-taxi and walking-only). RESULTS When walking and motorised travel is considered, the 2013 EmONC network covers 81% and 96.6% of the population at the 1-hour and 2-hour limit, respectively. These figures are slightly higher when motorcycle-taxis are considered (82.8% and 98%), and decreased to 34.7% and 52.3% for the walking-only scenario. The 2018 prioritised EmONC network covers 78.3% (1-hour) and 95.5% (2-hour) of the population for the walking and motorised scenario. CONCLUSIONS By factoring in geographical accessibility modelling to our iterative EmONC prioritisation process, the MoH was able to decrease the designated number of EmONC facilities in Togo by about 30%, while still ensuring that a high proportion of the population has timely access to these services. However, the physical access to EmONC for women unable to afford motorised transport remains inequitable.
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Affiliation(s)
- Andrew Curtis
- GeoHealth Group, Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | | | - Michel Brun
- Technical Division, UNFPA, New York, New York, USA
| | | | | | | | | | - Nicolas Ray
- GeoHealth Group, Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
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203
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Billah SM, Khan ANS, Rokonuzzaman SM, Huq NL, Khan MA, Priyanka SS, Mannan II, Rahman S, Arifeen SE, George J. Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study. BMJ Open 2021; 11:e046638. [PMID: 34321295 PMCID: PMC8319977 DOI: 10.1136/bmjopen-2020-046638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 07/06/2021] [Indexed: 11/04/2022] Open
Abstract
STUDY OBJECTIVE To evaluate the competency of trained health workers in detecting and managing hypertensive disorders of pregnancy during routine antenatal check-ups (ANCs) at primary care facilities in Bangladesh. STUDY DESIGN AND SETTINGS Cross-sectional study; conducted in 26 primary care facilities. OUTCOME MEASURES Accurate diagnosis of the hypertensive disorders of pregnancy. METHOD In total 1560 ANC consultations provided by primary health workers, known as Family Welfare Visitors (FWVs), were observed using a structured checklist between October 2017 and February 2018. All consultations were reassessed by study physicians for validation. RESULT Of the 'true' cases of gestational hypertension (n=32), pre-eclampsia (n=29) and severe pre-eclampsia (n=16), only 3%, 7% and 25%, respectively, were correctly diagnosed by FWVs. Per cent agreement for the diagnosed cases of any hypertensive disorders of pregnancy was 9% and kappa statistics was 0.50 (p value 0.0125). For identification of any hypertensive disorders by FWVs, sensitivity and positive predictive values were 14% and 50%, respectively. There was a moderate positive correlation between the blood pressure measurements taken by FWVs and study physicians. Only 27% of those who had 'some protein' in urine were correctly identified by FWVs. Women diagnosed with any of the hypertensive disorders of pregnancy by FWVs were more likely to be counselled on at least one danger sign of pre-eclampsia (severe headache, blurring of vision and upper abdominal pain) than those without any such diagnosis (41% vs 19%, p value 0.008). All four cases of severe pre-eclampsia diagnosed by FWVs were given a loading dose of intramuscular magnesium sulphate and three among them were referred to a higher facility. CONCLUSION The FWVs should be appropriately trained on risk assessment of pregnant women with particular emphasis on accurately assessing the diagnostic criteria of hypertensive disorders of pregnancy and its management.
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Affiliation(s)
- Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Abdullah Nurus Salam Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - S M Rokonuzzaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Nafisa Lira Huq
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Sabrina Sharmin Priyanka
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Setara Rahman
- Maternal Health & Family Planning, JHPIEGO, Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Joby George
- MaMoni Health Systems Strengthening, Save the Children Bangladesh, Dhaka, Bangladesh
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Blanchard AK, Colbourn T, Prost A, Ramesh BM, Isac S, Anthony J, Dehury B, Houweling TAJ. Associations between community health workers' home visits and education-based inequalities in institutional delivery and perinatal mortality in rural Uttar Pradesh, India: a cross-sectional study. BMJ Open 2021; 11:e044835. [PMID: 34253660 PMCID: PMC8276308 DOI: 10.1136/bmjopen-2020-044835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 06/20/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION India's National Health Mission has trained community health workers called Accredited Social Health Activists (ASHAs) to visit and counsel women before and after birth. Little is known about the extent to which exposure to ASHAs' home visits has reduced perinatal health inequalities as intended. This study aimed to examine whether ASHAs' third trimester home visits may have contributed to equitable improvements in institutional delivery and reductions in perinatal mortality rates (PMRs) between women with varying education levels in Uttar Pradesh (UP) state, India. METHODS Cross-sectional survey data were collected from a representative sample of 52 615 women who gave birth in the preceding 2 months in rural areas of 25 districts of UP in 2014-2015. We analysed the data using generalised linear modelling to examine the associations between exposure to home visits and education-based inequalities in institutional delivery and PMRs. RESULTS Third trimester home visits were associated with higher institutional delivery rates, in particular public facility delivery rates (adjusted risk ratio (aRR) 1.32, 95% CI 1.30 to 1.34), and to a lesser extent private facility delivery rates (aRR 1.09, 95% CI 1.04 to 1.13), after adjusting for confounders. Associations were stronger among women with lower education levels. Having no compared with any third trimester home visits was associated with higher perinatal mortality (aRR 1.18, 95% CI 1.09 to 1.28). Having any versus no visits was more highly associated with lower perinatal mortality among women with lower education levels than those with the most education, and most notably among public facility births. CONCLUSIONS The results suggest that ASHAs' home visits in the third trimester contributed to equitable improvements in institutional deliveries and lower PMRs, particularly within the public sector. Broader strategies must reinforce the role of ASHAs' home visits in reaching the sustainable development goals of improving maternal and newborn health and leaving no one behind.
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Affiliation(s)
- Andrea Katryn Blanchard
- Institute for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tim Colbourn
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Audrey Prost
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Banadakoppa Manjappa Ramesh
- Institute for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shajy Isac
- Institute for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- India Health Action Trust, Lucknow, India
| | - John Anthony
- Institute for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- India Health Action Trust, Lucknow, India
| | | | - Tanja A J Houweling
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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205
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Nowacka U, Kozlowski S, Januszewski M, Sierdzinski J, Jakimiuk A, Issat T. COVID-19 Pandemic-Related Anxiety in Pregnant Women. Int J Environ Res Public Health 2021; 18:7221. [PMID: 34299673 PMCID: PMC8307177 DOI: 10.3390/ijerph18147221] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 12/29/2022]
Abstract
The COVID-19 pandemic outbreak influenced general and mental health worldwide. The objective of this study was to assess the anxiety level during the COVID-19 pandemic among pregnant women and compare it between COVID-infected and non-infected groups. We prospectively assessed the daily routine and anxiety level using a bespoke questionnaire and GAD-7 scale validated for pregnant women. With logistic regression, we established possible risk factors of generalized anxiety disorder spectrum and main causes of concern. The dataset included 439 responders of our survey. Of which, 21% had COVID-19 infection during pregnancy; 38% were screened for possible generalized anxiety disorder and the proportion was higher in women who suffered from COVID-19 (48% vs. 35%, p = 0.03). Pre-pregnancy anxiety or depression diagnosis and intentional social contact avoidance increased the risk of anxiety (aOR 3.4 and 3.2). Fetal wellbeing was the main concern for 66% of the responders. The COVID-19 pandemic and related restrictions substantially altered daily lives of pregnant women, exaggerating the prevalence of anxiety compared with the pre-COVID-19 studies (38% vs. 15%). COVID-19 infection during pregnancy was associated with increased levels of generalized anxiety scores. Patient-tailored psychological support should be a mainstay of comprehensive antenatal medical care in order to avoid anxiety- and stress-related complications.
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Affiliation(s)
- Urszula Nowacka
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland; (S.K.); (T.I.)
| | - Szymon Kozlowski
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland; (S.K.); (T.I.)
| | - Marcin Januszewski
- Department of Obstetrics and Gynecology CSKMSWiA, Woloska 137, 02-507 Warsaw, Poland; (M.J.); (A.J.)
| | - Janusz Sierdzinski
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Litewska 14/16, 00-581 Warsaw, Poland;
| | - Artur Jakimiuk
- Department of Obstetrics and Gynecology CSKMSWiA, Woloska 137, 02-507 Warsaw, Poland; (M.J.); (A.J.)
| | - Tadeusz Issat
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland; (S.K.); (T.I.)
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206
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Stegwee SI, Ben ÂJ, El Alili M, van der Voet LF, de Groot CJM, Bosmans JE, Huirne JAF. Cost-effectiveness of single-layer versus double-layer uterine closure during caesarean section on postmenstrual spotting: economic evaluation alongside a randomised controlled trial. BMJ Open 2021; 11:e044340. [PMID: 34215598 PMCID: PMC8256741 DOI: 10.1136/bmjopen-2020-044340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the cost-effectiveness of double-layer compared with single-layer uterine closure after a first caesarean section (CS) from a societal and healthcare perspective. DESIGN Economic evaluation alongside a multicentre, double-blind, randomised controlled trial. SETTING 32 hospitals in the Netherlands, 2016-2018. PARTICIPANTS 2292 women ≥18 years undergoing a first CS were randomly assigned (1:1). Exclusion criteria were: inability for counselling, previous uterine surgery, known menstrual disorder, placenta increta or percreta, pregnant with three or more fetuses. 1144 women were assigned to single-layer and 1148 to double-layer closure. We included 1620 women with a menstrual cycle in the main analysis. INTERVENTIONS Single-layer unlocked uterine closure and double-layer unlocked uterine closure with the second layer imbricating the first. MAIN OUTCOME MEASURES Spotting days, quality-adjusted life-years (QALYs), and societal costs at 9 months of follow-up. Missing data were imputed using multiple imputation. RESULTS No significant differences were found between single-layer versus double-layer closure in mean spotting days (1.44 and 1.39 days; mean difference (md) -0.056, 95% CI -0.374 to 0.263), QALYs (0.663 and 0.658; md -0.005, 95% CI -0.015 to 0.005), total healthcare costs (€744 and €727; md €-17, 95% CI -273 to 143), and total societal costs (€5689 and €5927; md €238, 95% CI -624 to 1108). The probability of the intervention being cost-effective at willingness-to-pay of €0, €10 000 and €20 000/QALY gained was 0.30, 0.27 and 0.25, respectively, (societal perspective), and 0.55, 0.41 and 0.32, respectively, (healthcare perspective). CONCLUSION Double-layer uterine closure is not cost-effective compared with single-layer uterine closure from both perspectives. If this is confirmed by our long-term reproductive follow-up, we suggest to adjust uterine closure technique guidelines. TRIAL REGISTRATION NUMBER NTR5480/NL5380.
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Affiliation(s)
- Sanne I Stegwee
- Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ângela J Ben
- Health Sciences, Amsterdam Public Health, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mohamed El Alili
- Health Sciences, Amsterdam Public Health, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Christianne J M de Groot
- Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Judith E Bosmans
- Health Sciences, Amsterdam Public Health, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Judith A F Huirne
- Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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207
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Nawabi F, Alayli A, Krebs F, Lorenz L, Shukri A, Bau AM, Stock S. Health literacy among pregnant women in a lifestyle intervention trial: protocol for an explorative study on the role of health literacy in the perinatal health service setting. BMJ Open 2021; 11:e047377. [PMID: 34210730 PMCID: PMC8252873 DOI: 10.1136/bmjopen-2020-047377] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Pregnancy is a vulnerable period that affects long-term health of pregnant women and their unborn infants. Health literacy plays a crucial role in promoting healthy behaviour and thereby maintaining good health. This study explores the role of health literacy in the GeMuKi (acronym for 'Gemeinsam Gesund: Vorsorge plus für Mutter und Kind'-Strengthening health promotion: enhanced check-up visits for mother and child) Project. It will assess the ability of the GeMuKi lifestyle intervention to positively affect health literacy levels through active participation in preventive counselling. The study also explores associations between health literacy, health outcomes, health service use and effectiveness of the intervention. METHODS AND ANALYSIS The GeMuKi trial has a hybrid effectiveness-implementation design and is carried out in routine prenatal health service settings in Germany. Women (n=1860) are recruited by their gynaecologist during routine check-up visits before 12 weeks of gestation. Trained healthcare providers carry out counselling using motivational interviewing techniques to positively affect health literacy and lifestyle-related risk factors. Healthcare providers (gynaecologists and midwives) and women jointly agree on Specific, Measurable, Achievable Reasonable, Time-Bound goals. Women will be invited to fill in questionnaires at two time points (at recruitment and 37th-40th week of gestation) using an app. Health literacy is measured using the German version of the Health Literacy Survey-16 and the Brief Health Literacy Screener. Lifestyle is measured with questions on physical activity, nutrition, alcohol and drug use. Health outcomes of both mother and child, including gestational weight gain (GWG) will be documented at each routine visit. Health service use will be assessed using social health insurance claims data. Data analyses will be conducted using IBM SPSS Statistics, version 26.0. These include descriptive statistics, tests and regression models. A mediation model will be conducted to answer the question whether health behaviour mediates the association between health literacy and GWG. ETHICS AND DISSEMINATION The study was approved by the University Hospital of Cologne Research Ethics Committee (ID: 18-163) and the State Chamber of Physicians in Baden-Wuerttemberg (ID: B-F-2018-100). Study results will be disseminated through (poster) presentations at conferences, publications in peer-reviewed journals and press releases. TRAIL REGISTRATION German Clinical Trials Register (DRKS00013173). Registered pre-results, 3rd of January 2019, https://www.drks.de.
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Affiliation(s)
- Farah Nawabi
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Adrienne Alayli
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Federal Centre for Health Education, Cologne, Germany
| | - Franziska Krebs
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Laura Lorenz
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Arim Shukri
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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208
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Saidi F, Mutale W, Freeborn K, Rosenberg NE, Graybill LA, Maman S, Amico KR, Mollan KR, Phanga T, Milala B, Hill LM, Gottwalt AM, Phiri S, Kalua T, Chi BH. Combination adherence strategy to support HIV antiretroviral therapy and pre-exposure prophylaxis adherence during pregnancy and breastfeeding: protocol for a pair of pilot randomised trials. BMJ Open 2021; 11:e046032. [PMID: 34193491 PMCID: PMC8246367 DOI: 10.1136/bmjopen-2020-046032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION To realise the expected gains from prevention of mother-to-child HIV transmission initiatives, adherence to preventative and therapeutic antiretroviral regimens is critical and interventions deployable in busy programmatic settings with a high HIV burden are needed. Based on formative research, we developed an approach that integrates patient-centred counselling and engagement of an adherence supporter for pregnant and breastfeeding women initiating HIV treatment (ie, antiretroviral therapy (ART)) or biomedical HIV prevention (ie, pre-exposure prophylaxis (PrEP)). METHODS Tonse Pamodzi 2 is a pilot study designed to provide acceptability, fidelity and clinical outcomes data on a set of behavioural interventions for adherence support. The study comprises two parallel randomised trials, enrolling HIV-positive pregnant women initiating ART (Trial 1, n=100) and HIV-negative pregnant women with risk of HIV acquisition and willing to initiate PrEP (Trial 2, n=200). Within each trial, participants are randomised 1:1 to either the intervention or control group. The Tonse Pamodzi adherence intervention comprises patient-centred counselling (adapted Integrated Next Step Counseling(iNSC)) and external adherence support tailored to the clinical context (ie, for ART or PrEP). Participants randomly assigned to the control group receive standard counselling based on local HIV guidelines. Participants are followed for 6 months. To assess intervention acceptability, we will employ a mixed method approach to describe participant engagement, satisfaction, and discussion content. We will audit and score recorded counselling sessions to evaluate the implementation fidelity of iNSC sessions. We will also assess clinical outcomes at 3 and 6 months for both Trial 1 (retention in care and viral suppression of HIV) and Trial 2 (retention in care, and plasma and intracellular tenofovir drug concentrations). ETHICS AND DISSEMINATION The study protocol was approved by the Malawi National Health Science Research Committee (19/05/2334) and the University of North Carolina at Chapel Hill Institutional Review Board (19-1060). TRIAL REGISTRATION NUMBER NCT04330989.
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Affiliation(s)
- Friday Saidi
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Wilbroad Mutale
- Department of Health Policy and Systems, University of Zambia School of Medicine, Lusaka, Zambia
| | - Kellie Freeborn
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Nora E Rosenberg
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Lauren Aiko Graybill
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Suzanne Maman
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - K Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Katie R Mollan
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Beteniko Milala
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Lauren M Hill
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Allison M Gottwalt
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Sam Phiri
- Lighthouse Trust, Lilongwe, Malawi
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- School of Public Health and Family Medicine, College of Medicine University of Malawi, Blantyre, Malawi
| | - Thoko Kalua
- Department of HIV and AIDS, Ministry of Health Malawi, Lilongwe, Malawi
- Institute for Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Benjamin H Chi
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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Saha S, Desai B, Fancy M, Puwar T, Saxena D, Shah K, Pandya A. Protocol for the cost-effectiveness of parenteral iron and oral iron therapy for first-line management of anaemia among pregnant women in a natural programme setting in Gujarat. BMJ Open 2021; 11:e044712. [PMID: 34193482 PMCID: PMC8246360 DOI: 10.1136/bmjopen-2020-044712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Maternal anaemia is a major public health issue in India. The government of India recommends parenteral iron to manage moderate and severe grades of anaemia. In contrast to its clinical efficacy, the cost-effectiveness of intravenous iron sucrose and ferric carboxymaltose is not yet established in Indian context. This article illustrates the protocol of health technology assessment to evaluate the cost-effectiveness of intravenous therapy on the improvement of haemoglobin concentration over oral therapy. METHODS AND ANALYSIS The study will be carried out in two districts of Gujarat state. The study participants will be selected by a proportionate sampling method from the rural, tribal, desert and coastal region of the districts. Data will be collected over 1 year on key outcome indicators using a mixed-method approach. Key informant interviews will be conducted, and cost data will be gathered to perform cost-effectiveness analysis. ETHICS AND DISSEMINATION This study is approved by the Technical Appraisal Committee of Health Technology Assessment India, Department of Health Research and Institutional Ethics Committee of the Indian Institute of Public Health, Gandhinagar.
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Affiliation(s)
- Somen Saha
- Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Bharat Desai
- Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Manish Fancy
- District Panchayat, Banaskantha, Health and Family Welfare Department, Government of Gujarat, Gandhinagar, Gujarat, India
| | - Tapasvi Puwar
- Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Deepak Saxena
- Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Komal Shah
- Indian Institute of Public Health, Gandhinagar, Gujarat, India
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Hincker A, Nadler J, Karan S, Carter E, Porat S, Warner B, Ju YES, Ben Abdallah A, Wilson E, Lockhart EM, Ginosar Y. Sleep Apnea and Fetal Growth Restriction (SAFER) study: protocol for a pragmatic randomised clinical trial of positive airway pressure as an antenatal therapy for fetal growth restriction in maternal obstructive sleep apnoea. BMJ Open 2021; 11:e049120. [PMID: 34187829 PMCID: PMC8245445 DOI: 10.1136/bmjopen-2021-049120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Fetal growth restriction (FGR) is a major contributor to fetal and neonatal morbidity and mortality with intrauterine, neonatal and lifelong complications. This study explores maternal obstructive sleep apnoea (OSA) as a potentially modifiable risk factor for FGR. We hypothesise that, in pregnancies complicated by FGR, treating mothers who have OSA using positive airway pressure (PAP) will improve birth weight and neonatal outcomes. METHODS AND ANALYSIS The Sleep Apnea and Fetal Growth Restriction study is a prospective, block-randomised, single-blinded, multicentre, pragmatic controlled trial. We enrol pregnant women aged 18-50, between 22 and 31 weeks of gestation, with established FGR based on second trimester ultrasound, who do not have other prespecified known causes of FGR (such as congenital anomalies or intrauterine infection). In stage 1, participants are screened by questionnaire for OSA risk. If OSA risk is identified, participants proceed to stage 2, where they undergo home sleep apnoea testing. Participants are determined to have OSA if they have an apnoea-hypopnoea index (AHI) ≥5 (if the oxygen desaturation index (ODI) is also ≥5) or if they have an AHI ≥10 (even if the ODI is <5). These participants proceed to stage 3, where they are randomised to nightly treatment with PAP or no PAP (standard care control), which is maintained until delivery. The primary outcome is unadjusted birth weight; secondary outcomes include fetal growth velocity on ultrasound, enrolment-to-delivery interval, gestational age at delivery, birth weight corrected for gestational age, stillbirth, Apgar score, rate of admission to higher levels of care (neonatal intensive care unit or special care nursery) and length of neonatal stay. These outcomes are compared between PAP and control using intention-to-treat analysis. ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Boards at Washington University in St Louis, Missouri; Hadassah Hebrew University Medical Center, Jerusalem; and the University of Rochester, New York. Recruitment began in Washington University in November 2019 but stopped from March to November 2020 due to COVID-19. Recruitment began in Hadassah Hebrew University in March 2021, and in the University of Rochester in May 2021. Dissemination plans include presentations at scientific conferences and scientific publications. TRIAL REGISTRATION NUMBER NCT04084990.
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Affiliation(s)
- Alex Hincker
- Anesthesiology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Jacob Nadler
- Anesthesiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Suzanne Karan
- Anesthesiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Ebony Carter
- Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Shay Porat
- Obstetrics and Gynecology, Hadassah University Hospital, and the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Barbara Warner
- Neonatology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Yo-El S Ju
- Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Arbi Ben Abdallah
- Anesthesiology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Elizabeth Wilson
- Anesthesiology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Ellen M Lockhart
- Anesthesiology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Yehuda Ginosar
- Anesthesiology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
- Anesthesiology, Critical Care and Pain Medicine, and the Wohl Institute of Translational Medicine, Hadassah University Hospital and the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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211
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Radestad I, Pettersson K, Lindgren H, Skokic V, Akselsson A. Country of birth, educational level and other predictors of seeking care due to decreased fetal movements: an observational study in Sweden using data from a cluster-randomised controlled trial. BMJ Open 2021; 11:e050621. [PMID: 34172554 PMCID: PMC8237734 DOI: 10.1136/bmjopen-2021-050621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To identify predictors of seeking care for decreased fetal movements and assess whether care-seeking behaviour is influenced by Mindfetalness. DESIGN Observational study with data from a cluster-randomised controlled trial. SETTING 67 maternity clinics and 6 obstetrical clinics in Sweden. PARTICIPANTS All pregnant women with a singleton pregnancy who contacted the obstetrical clinic due to decreased fetal movements from 32 weeks' gestation of 39 865 women. METHODS Data were collected from a cluster-randomised controlled trial where maternity clinics were randomised to Mindfetalness or routine care. Mindfetalness is a self-assessment method for women to use daily to become familiar with the unborn baby's fetal movement pattern. OUTCOME MEASURES Predictors for contacting healthcare due to decreased fetal movements. RESULTS Overall, 5.2% (n=2059) of women contacted healthcare due to decreased fetal movements, among which 1287 women (62.5%) were registered at a maternity clinic randomised to Mindfetalness and 772 women (37.5%) were randomised to routine care. Predictors for contacting healthcare due to decreased fetal movements were age, country of birth, educational level, parity, prolonged pregnancy and previous psychiatric care (p<0.001). The main differences were seen among women born in Africa as compared with Swedish-born women (2% vs 6%, relative risk (RR) 0.34, 95% CI 0.25 to 0.44) and among women with low educational level compared with women with university-level education (2% vs 5.4%, RR 0.36, 95% CI 0.19 to 0.62). Introducing Mindfetalness in maternity care increased the number of women seeking care due to decreased fetal movements overall. CONCLUSION Women with country of birth outside Sweden and low educational level sought care for decreased fetal movements to a lesser extent compared with women born in Sweden and those with university degrees. Future research could explore whether pregnancy outcomes can be improved by motivating women in these groups to contact healthcare if they feel a decreased strength or frequency of fetal movements. TRIAL REGISTRATION NUMBER NCT02865759.
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Affiliation(s)
- Ingela Radestad
- Reproductive Health, Sophiahemmet University, Stockholm, Sweden
| | - Karin Pettersson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Helena Lindgren
- Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Viktor Skokic
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Anna Akselsson
- Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
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Diacci RC, Issah A, Williams KP, McAuliffe L, Aubin AM, McAuliffe JE, Phung J, Wang CA, Pennell CE. Effectiveness of combined vaginal progesterone and cervical cerclage in preventing preterm birth: a systematic review and meta-analysis protocol. BMJ Open 2021; 11:e050086. [PMID: 34172552 PMCID: PMC8237739 DOI: 10.1136/bmjopen-2021-050086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/24/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Preterm birth (PTB) is the leading cause of death in children under 5 years. Preventive therapies targeted towards women with risk factors such as a prior PTB or a short cervix reduce the rate of PTB. Cervical cerclage, vaginal progesterone and a combination of the two have been used with no consensus as to whether combined treatment is more effective than any single treatment alone. The objective of this review is to determine the efficacy of combined treatment compared with cerclage alone and combined treatment compared with progesterone alone. METHODS AND ANALYSIS Studies will be sourced from the electronic databases Medline (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Scopus, CINAHL (EBSCOhost) and Cochrane Library (Wiley) and reference lists. We will not exclude any papers due to publication date. Randomised control trials (RCTs), non-RCTs and cohort studies assessing single therapy (either progesterone or cerclage) versus combined therapy in women with a singleton pregnancy will be included. Two independent reviewers will conduct study screening (at abstract and full-text level), data extraction and risk of bias assessment with disagreements resolved by an experienced researcher. Random or fixed effects models will be used depending on data heterogeneity and data will be presented as risk ratio for dichotomous data or mean difference for continuous data with a CI of 95% used for all outcomes. ETHICS AND DISSEMINATION Not applicable due to nature of the study type. PROSPERO REGISTRATION NUMBER CRD42020195975.
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Affiliation(s)
- Rosanna C Diacci
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Ashad Issah
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Kimberley P Williams
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Liam McAuliffe
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Anne-Marie Aubin
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jack E McAuliffe
- Department of Engineering, Computing and Mathematical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Jason Phung
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Carol A Wang
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Craig E Pennell
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
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213
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Abstract
OBJECTIVES To compare the differences in the prevalence of birth defects among offspring conceived by assisted reproductive technology (ART) and conceived spontaneously (non-ART), and assess the contribution of ART to birth defects. DESIGN A population-based retrospective cohort study. SETTING Beijing. PARTICIPANTS Pregnant women whose expected date of childbirth was verified as occurring between October 2014 and September 2015, and were registered on the Beijing Maternal and Child Health Information Network System, were the recorded pregnancy outcomes. 2699 ART offspring and 191 368 non-ART offspring (live births, stillbirths and medical terminations) were included in our study. INTERVENTIONS None. OUTCOME MEASURES Risk ratios (RR) for birth defects were calculated among ART conceptions and non-ART conceptions with confounding factors by using logistic regression models. RESULTS 194 067 offspring were included in the present study, and 2699 (1.4%) were conceived using ART. Among all the births, the prevalence of any birth defect in the ART offspring (5.5%) was significantly higher than in the non-ART offspring (3.8%) (crude RR, 1.49, 95% CI 1.26 to 1.76). After adjusting for confounding factors, ART use was still associated with an increased risk of any birth defect (5.4% vs 3.5% in ART and non-ART group, adjusted RR (aRR), 1.43, 95% CI 1.08 to 1.90), especially for chromosomal abnormalities (0.5% vs 0.2% in ART and non-ART group, aRR, 3.11, 95% CI 1.28 to 7.58), in singleton births to mothers <35 years. Circulatory system malformations and musculoskeletal system malformations were observed to have a non-significant increase in offspring conceived by ART. However, the associations between ART and birth defects were not detected in multiple births or mothers ≥35 years. CONCLUSIONS This study confirmed a small but significant association between ART and birth defects. However, the risk tends to be non-significant under the conditions of advanced maternal age or multiple pregnancies.
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Affiliation(s)
- Lu Zhang
- Department of Perinatal Health Care, Capital Medical University Beijing Obstetrics and Gynecology Hospital, Beijing, China
| | - Wen Zhang
- Department of Perinatal Health Care, Capital Medical University Beijing Obstetrics and Gynecology Hospital, Beijing, China
| | - Hongyan Xu
- Department of Perinatal Health Care, Capital Medical University Beijing Obstetrics and Gynecology Hospital, Beijing, China
| | - Kaibo Liu
- Department of Perinatal Health Care, Capital Medical University Beijing Obstetrics and Gynecology Hospital, Beijing, China
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Mitchell EJ, Pallotti P, Qureshi ZP, Daniels JP, Oliver M, Were F, Osoti A, Gwako G, Kimani V, Opira J, Ojha S. Parents, healthcare professionals and other stakeholders' experiences of caring for babies born too soon in a low-resource setting: a qualitative study of essential newborn care for preterm infants in Kenya. BMJ Open 2021; 11:e043802. [PMID: 34162635 PMCID: PMC8230931 DOI: 10.1136/bmjopen-2020-043802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Prematurity is the leading cause of global neonatal and infant mortality. Many babies could survive by the provision of essential newborn care. This qualitative study was conducted in order to understand, from a family and professional perspective, the barriers and facilitators to essential newborn care. The study will inform the development of an early warning score for preterm and low birthweight infants in low and middle income countries (LMICs). SETTING Single-centre, tertiary referral hospital in Nairobi, Kenya. PARTICIPANTS Nineteen mothers and family members participated in focus group discussions and 20 key-informant interviews with professionals (healthcare professionals and policy-makers) were conducted. Focus group participants were identified via postnatal wards, the newborn unit and Kangaroo Mother Care (KMC) unit. Convenience and purposive sampling was used to identify professionals. OUTCOME MEASURES Understanding facilitators and barriers to provision of essential newborn care in preterm infants. RESULTS From 27 themes, three global themes emerged from the data: mothers' physical and psychological needs, system pillars and KMC. CONCLUSION Meeting mothers' needs in the care of their babies is important to mothers, family members and professionals, and deserves greater attention. Functioning system pillars depended on a standardised approach to care and low cost, universally applicable interventions are needed to support the existing care structure. KMC was effective in both meeting mothers' needs, supporting existing care structures and also provided a space for the resolution of the dialectical relationship between families and hospital procedures. Lessons learnt from the implementation of KMC could be applied to the development of an early warning score in LMICs.
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Affiliation(s)
- Eleanor J Mitchell
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Phoebe Pallotti
- Maternal Health and Wellbeing Research Group, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Zahida P Qureshi
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Jane P Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Mary Oliver
- School of Education, University of Nottingham, Nottingham, UK
| | - Fredrick Were
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Alfred Osoti
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - George Gwako
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Violet Kimani
- Kenya Paediatric Research Consortium, Nairobi, Kenya
| | | | - Shalini Ojha
- Population and Applied Health Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Neonatal Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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215
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Walker JL, Rentsch CT, McDonald HI, Bak J, Minassian C, Amirthalingam G, Edelstein M, Thomas S. Social determinants of pertussis and influenza vaccine uptake in pregnancy: a national cohort study in England using electronic health records. BMJ Open 2021; 11:e046545. [PMID: 34155074 PMCID: PMC8217954 DOI: 10.1136/bmjopen-2020-046545] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine the social determinants of influenza and pertussis vaccine uptake among pregnant women in England. DESIGN Nationwide population-based cohort study. SETTING The study used anonymised primary care data from the Clinical Practice Research Datalink and linked Hospital Episode Statistics secondary care data. PARTICIPANTS Pregnant women eligible for pertussis (2012-2015, n=68 090) or influenza (2010/2011-2015/2016, n=152 132) vaccination in England. MAIN OUTCOME MEASURES Influenza and pertussis vaccine uptake. RESULTS Vaccine uptake was 67.3% for pertussis and 39.1% for influenza. Uptake of both vaccines varied by region, with the lowest uptakes in London and the North East. Lower vaccine uptake was associated with greater deprivation: almost 10% lower in the most deprived quintiles compared with the least deprived for influenza (34.5% vs 44.0%), and almost 20% lower for pertussis (57.7% vs 76.0%). Lower uptake for both vaccines was also associated with non-white ethnicity (lowest among women of black ethnicity), maternal age under 20 years and a greater number of children in the household. The associations between all social factors and vaccine uptake were broadly unchanged in fully adjusted models, suggesting the social determinants of uptake were largely independent of one another. Among 3111 women vaccinated against pertussis in their first eligible pregnancy and pregnant again, 1234 (40%) were not vaccinated in their second eligible pregnancy. CONCLUSIONS Targeting promotional campaigns to pregnant women who are younger, of non-white ethnicity, with more children, living in areas of greater deprivation or the London or North East regions, has potential to reduce vaccine-preventable disease among infants and pregnant women, and to reduce health inequalities. Vaccination promotion needs to be sustained across successive pregnancies. Further research is needed into whether the effectiveness of vaccine promotion strategies may vary according to social factors.
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Affiliation(s)
- Jemma L Walker
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Statistics, Modelling and Economics Department, Public Health England, London, UK
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London, UK
| | - Christopher T Rentsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London, UK
| | - Helen I McDonald
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London, UK
| | - JeongEun Bak
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London, UK
| | - Caroline Minassian
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Gayatri Amirthalingam
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London, UK
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Michael Edelstein
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London, UK
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Sara Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London, UK
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Silwal RC, Shibanuma A, Poudyal AK, Ikeda S, Jimba M. Difference in factors associated with continuum of care completion rate from pregnancy to postpartum period in rural Nepal: a community-based, cross-sectional study. BMJ Open 2021; 11:e044928. [PMID: 34135036 PMCID: PMC8211074 DOI: 10.1136/bmjopen-2020-044928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 06/03/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the continuum of care (CoC) completion rate in maternal, neonatal and child health and its associated factors among mothers in two ecological regions in Nepal. DESIGN This was a community-based, cross-sectional study, for which data were collected through face-to-face interviews using a structured questionnaire. Multiple logistic regression analyses were conducted to determine the associated factors. SETTING This was carried out in two rural districts of Nepal, in different regions: one in the hills (Dhading) and another in the flatlands called Terai (Nawalparasi). The data were collected between July and December 2016. PARTICIPANTS Mothers who gave birth within a year before this study were included as participants. In total, there were 1803 participants. AN OUTCOME MEASURE The outcome of this study was measured by the CoC completion rate when a mother completes four antenatal check-ups, deliver at a health facility and receives postnatal care within 24 hours of delivery. RESULTS The CoC completion rates were 41% in Dhading and 28% in Nawalparasi. In Dhading, shorter travel time to a health facility and higher wealth quintiles were associated with a better CoC completion rate. In Nawalparasi, the CoC completion rate was affected by parity and decision-making for pregnancy care. CONCLUSIONS The CoC completion rate was low in both districts in Nepal. However, factors associated with the CoC completion rate varied by district. Differences in these factors might be reflected by geographical and socioeconomic conditions and the characteristics of household decision making in these districts.
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Affiliation(s)
- Ram Chandra Silwal
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Amod Kumar Poudyal
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Subaru Ikeda
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Sabo S, Wightman P, McCue K, Butler M, Pilling V, Jimenez DJ, Celaya M, Rumann S. Addressing maternal and child health equity through a community health worker home visiting intervention to reduce low birth weight: retrospective quasi-experimental study of the Arizona Health Start Programme. BMJ Open 2021; 11:e045014. [PMID: 34135037 PMCID: PMC8211081 DOI: 10.1136/bmjopen-2020-045014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To test if participation in the Health Start Programme, an Arizona statewide Community Health Worker (CHW) maternal and child health (MCH) home visiting programme, reduced rates of low birth weight (LBW), very LBW (VLBW), extremely LBW (ELBW) and preterm birth (PTB). DESIGN Quasi-experimental retrospective study using propensity score matching of Health Start Programme enrolment data to state birth certificate records for years 2006-2016. SETTING Arizona is uniquely racially and ethnically diverse with comparatively higher proportions of Latino and American Indian residents and a smaller proportion of African Americans. PARTICIPANTS 7212 Health Start Programme mothers matched to non-participants based on demographic, socioeconomic and geographic characteristics, health conditions and previous birth experiences. INTERVENTION A statewide CHW MCH home visiting programme. PRIMARY AND SECONDARY OUTCOME MEASURES LBW, VLBW, ELBW and PTB. RESULTS Using Health Start Programme's administrative data and birth certificate data from 2006 to 2016, we identified 7212 Health Start Programme participants and 53 948 matches. Programme participation is associated with decreases in adverse birth outcomes for most subgroups. Health Start participation is associated with statistically significant lower rates of LBW among American Indian women (38%; average treatment-on-the-treated effect (ATT): 2.30; 95% CI -4.07 to -0.53) and mothers with a pre-existing health risk (25%; ATT: -3.06; 95% CI -5.82 to -0.30). Among Latina mothers, Health Start Programme participation is associated with statistically significant lower rates of VLBW (36%; ATT: 0.35; 95% CI -0.69 to -0.01) and ELBW (62%; ATT: 0.31; 95% CI (-0.52 to -0.10)). Finally, Health Start Programme participation is associated with a statistically significant lower rate of PTB for teen mothers (30%; ATT: 2.81; 95% CI -4.71 to -0.91). Other results were not statistically significant. CONCLUSION A state health department-operated MCH home visiting intervention that employs CHWs as the primary interventionist may contribute to the reduction of LBW, VLBW, ELBW and PTB and could improve birth outcomes statewide, especially among women and children at increased risk for MCH inequity.
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Affiliation(s)
- Samantha Sabo
- Center for Health Equity Research, College of Health and Human Services, Northern Arizona University, Flagstaff, Arizona, USA
| | - Patrick Wightman
- Center for Population Science and Discovery, University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Kelly McCue
- Center for Health Equity Research, College of Health and Human Services, Northern Arizona University, Flagstaff, Arizona, USA
| | - Matthew Butler
- Department of Economics, Brigham Young University, Provo, Utah, USA
| | - Vern Pilling
- Center for Biomedical Informatics and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Dulce J Jimenez
- Center for Health Equity Research, College of Health and Human Services, Northern Arizona University, Flagstaff, Arizona, USA
| | - Martín Celaya
- Arizona Department of Health Services, Bureau of Women's and Children's Health, Phoenix, Arizona, USA
| | - Sara Rumann
- Arizona Department of Health Services, Bureau of Women's and Children's Health, Phoenix, Arizona, USA
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de Ruigh AA, Simons NE, Van 't Hooft J, van Wassenaer-Leemhuis AG, Aarnoudse-Moens CSH, van Wely M, van Baaren GJ, Vlemmix F, van der Ham DP, van Teeffelen ASP, Mol BW, Roseboom TJ, Pajkrt E. Child outcomes after induction of labour or expectant management in women with preterm prelabour rupture of membranes between 34 and 37 weeks of gestation: study protocol of the PPROMEXIL Follow-up trial. A long-term follow-up study of the randomised controlled trials PPROMEXIL and PPROMEXIL-2. BMJ Open 2021; 11:e046046. [PMID: 34130959 PMCID: PMC8208011 DOI: 10.1136/bmjopen-2020-046046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Late preterm prelabour rupture of membranes (PROM between 34+0 and 36+6 weeks gestational age) is an important clinical dilemma. Previously, two large Dutch randomised controlled trials (RCTs) compared induction of labour (IoL) to expectant management (EM). Both trials showed that early delivery does not reduce the risk of neonatal sepsis as compared with EM, although prematurity-related risks might increase. An extensive, structured long-term follow-up of these children has never been performed. METHODS AND ANALYSIS The PPROMEXIL Follow-up trial (NL6623 (NTR6953)) aims to assess long-term childhood outcomes of the PPROMEXIL (ISRCTN29313500) and PPROMEXIL-2 trial (ISRCTN05689407), two multicentre RCTs using the same protocol, conducted between 2007 and 2010 evaluating IoL versus EM in women with late preterm PROM. The PPROMEXIL Follow-up will analyse children of mothers with a singleton pregnancy (PPROMEXIL trial n=520, PPROMEXIL-2 trial n=191, total IoL n=359; total EM n=352). At 10-12 years of age all surviving children will be invited for a neurodevelopmental assessment using the Wechsler Intelligence Scale for Children-V, Color-Word Interference Test and the Movement Assessment Battery for Children-2. Parents will be asked to fill out questionnaires assessing behaviour, motor function, sensory processing, respiratory problems, general health and need for healthcare services. Teachers will fill out the Teacher Report Form and answer questions regarding school attainment. For all tests means with SDs will be compared, as well as predefined cut-off scores for abnormal outcome. Sensitivity analyses consisting of different imputation techniques will be used to deal with lost to follow-up. ETHICS AND DISSEMINATION The study has been granted approval by the Medical Centre Amsterdam (MEC) of the AmsterdamUMC (MEC2016_217). Results will be disseminated through peer-reviewed journals and summaries shared with stakeholders. This protocol is published before analysis of the results. TRIAL REGISTRATION NUMBER NL6623 (NTR6953).
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Affiliation(s)
- Annemijn A de Ruigh
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Noor E Simons
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Janneke Van 't Hooft
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Aleid G van Wassenaer-Leemhuis
- Department of Neonatology and Paediatrics, Emma Children's Hospital, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Cornelieke S H Aarnoudse-Moens
- Department of Neonatology and Paediatrics, Emma Children's Hospital, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Madelon van Wely
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Gert-Jan van Baaren
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Floortje Vlemmix
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - D P van der Ham
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, The Netherlands
| | | | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Tessa J Roseboom
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
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Michelsen TM, Tronstad C, Rosseland LA. Blood pressure and cardiac output during caesarean delivery under spinal anaesthesia: a prospective cohort study. BMJ Open 2021; 11:e046102. [PMID: 34127491 PMCID: PMC8204191 DOI: 10.1136/bmjopen-2020-046102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES We have previously established a method to measure transfer of nutrients between mother, placenta and fetus in vivo. The method includes measurements of maternal and fetal blood flow by Doppler ultrasound prior to spinal anaesthesia. Spinal anaesthesia affects maternal blood pressure and cardiac output. We aimed to determine the effect of spinal anaesthesia in mothers undergoing an elective caesarean section on blood pressure, heart rate and cardiac output, and whether cardiac output levels were comparable before induction of spinal anaesthesia and before delivery. DESIGN Prospective cohort study. SETTING Tertiary hospital in Norway. PARTICIPANTS 76 healthy women with uneventful pregnancies undergoing an elective caesarean section. INTERVENTIONS We induced spinal anaesthesia with a standard prevention of hypotension including intravenous fluid coloading and phenylephrine infusion. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measure was maternal cardiac output, and secondary outcome measures were invasive systolic blood pressure and heart rate. We measured heart rate and blood pressure by continuous invasive monitoring with a cannula in the radial artery. Cardiac output was estimated based on continuous arterial waveform. We compared maternal parameters 30 s before induction of spinal anaesthesia to 30 s before delivery. RESULTS Median age at delivery was 34.5 (range 21-43) years and 17 of 76 women were nulliparous. The most prevalent indications were previous caesarean section and maternal request. Among 76 included women, 71 had sufficient data for analysis of endpoints. Median cardiac output was 6.51 (IQR (5.56-7.54) L/min before spinal anaesthesia and 6.40 (5.83-7.56) L/min before delivery (p=0.40)). Median invasive systolic blood pressure increased from 128.5 (120.1-142.7) mm Hg to 134.1 (124.0-146.6) mm Hg (p=0.014), and mean heart rate decreased from 86.0 (SD 13.9) to 75.2 (14.2) (p<0.001). CONCLUSIONS Maternal cardiac output at the time of caesarean delivery is comparable to levels before induction of spinal anaesthesia. TRIAL REGISTRATION NUMBER NCT00977769.
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Affiliation(s)
- Trond Melbye Michelsen
- Department of Obstetrics, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christian Tronstad
- Department of Clinical and Biomedical Engineering, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway
| | - Leiv Arne Rosseland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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220
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Stafford IA, Hummel K, Dunn JJ, Muldrew K, Berra A, Kravitz ES, Gogia S, Martin I, Munson E. Retrospective analysis of infection and antimicrobial resistance patterns of Mycoplasma genitalium among pregnant women in the southwestern USA. BMJ Open 2021; 11:e050475. [PMID: 34127494 PMCID: PMC8204150 DOI: 10.1136/bmjopen-2021-050475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium is a sexually transmitted infection (STI) pathogen. There have been no published studies concerning symptomatology, prevalence data, antibiotic resistance profiling or reports of co-infection with other STI in pregnant women. OBJECTIVE To describe these characteristics among pregnant women attending prenatal clinics in a large tertiary care centre. DESIGN Remnant genital samples collected from pregnant women between August 2018 and November 2019 were tested for M. genitalium and Trichomonas vaginalis by the transcription-mediated amplification technique. Specimens with detectable M. genitalium RNA were sequenced for 23S rRNA mutations associated with azithromycin resistance and parC and gyrA mutations associated with resistance to moxifloxacin. Demographic, obstetric and STI co-infection data were recorded. RESULTS Of the 719 samples, 41 (5.7 %) were positive for M. genitalium. M. genitalium infection was associated with black race, Hispanic ethnicity and young age (p=0.003, p=0.008 and p=0.004, respectively). M. genitalium infection was also associated with T. vaginalis co-infection and Streptococcus agalactiae (group B Streptococcus) colonisation (p≤0.001 and p=0.002, respectively). Of the 41 positive samples, 26 (63.4%) underwent successful sequencing. Eight (30.8%) had 23S rRNA mutations related to azithromycin resistance. One of 26 (3.8%) positive samples with sequencing results had the gyrA gene mutation and 1 of 18 sequenced samples (5.6%) had the parC gene mutation associated with moxifloxacin resistance. CONCLUSIONS Prevalence rates of M. genitalium in pregnant women was 5.7%. M. genitalium infection disproportionately affects young black women co-infected with T. vaginalis. Pregnant women remain at risk for persistent infection with M. genitalium due to decreased azithromycin susceptibility.
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Affiliation(s)
- Irene A Stafford
- Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kelsey Hummel
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - James J Dunn
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - Kenneth Muldrew
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - Alexandra Berra
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Irene Martin
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Erik Munson
- Clinical Laboratory Science, Marquette University, Milwaukee, Wisconsin, USA
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Coomar D, Hazlehurst JM, Austin F, Foster C, Hitman GA, Heslehurst N, Iliodromiti S, Betran AP, Moss N, Poston L, Nirantharakumar K, Roberts T, Simpson SA, Teede HJ, Riley R, Allotey J, Thangaratinam S. Diet and physical activity in pregnancy to prevent gestational diabetes: a protocol for an individual participant data (IPD) meta-analysis on the differential effects of interventions with economic evaluation. BMJ Open 2021; 11:e048119. [PMID: 34117047 PMCID: PMC8202105 DOI: 10.1136/bmjopen-2020-048119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Mothers with gestational diabetes mellitus (GDM) are at increased risk of pregnancy-related complications and developing type 2 diabetes after delivery. Diet and physical activity-based interventions may prevent GDM, but variations in populations, interventions and outcomes in primary trials have limited the translation of available evidence into practice. We plan to undertake an individual participant data (IPD) meta-analysis of randomised trials to assess the differential effects and cost-effectiveness of diet and physical activity-based interventions in preventing GDM and its complications. METHODS The International Weight Management in Pregnancy Collaborative Network database is a living repository of IPD from randomised trials on diet and physical activity in pregnancy identified through a systematic literature search. We shall update our existing search on MEDLINE, Embase, BIOSIS, LILACS, Pascal, Science Citation Index, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment Database without language restriction to identify relevant trials until March 2021. Primary researchers will be invited to join the Network and share their IPD. Trials including women with GDM at baseline will be excluded. We shall perform a one and two stage random-effect meta-analysis for each intervention type (all interventions, diet-based, physical activity-based and mixed approach) to obtain summary intervention effects on GDM with 95% CIs and summary treatment-covariate interactions. Heterogeneity will be summarised using I2 and tau2 statistics with 95% prediction intervals. Publication and availability bias will be assessed by examining small study effects. Study quality of included trials will be assessed by the Cochrane Risk of Bias tool, and the Grading of Recommendations, Assessment, Development and Evaluations approach will be used to grade the evidence in the results. A model-based economic analysis will be carried out to assess the cost-effectiveness of interventions to prevent GDM and its complications compared with usual care. ETHICS AND DISSEMINATION Ethics approval is not required. The study is registered on the International Prospective Register of Systematic Reviews (CRD42020212884). Results will be submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Dyuti Coomar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan M Hazlehurst
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Frances Austin
- Maternity Dietetic Service, Women's Health Division, Barts Health NHS Trust, Antenatal Clinic, Royal London Hospital and Newham University Hospital, London, UK
| | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Graham A Hitman
- Centre for Genomic Medicine and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stamatina Iliodromiti
- Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Ngawai Moss
- Katie's Team Patient and Public Involvement Advisory Group, Queen Mary University of London, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | | | - Tracy Roberts
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Sharon A Simpson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, Victoria, Australia
| | - Richard Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - John Allotey
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Pragmatic Clinical Trials Unit, Institute of Population Health Sciences, Barts and the London, School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Affiliation(s)
- Carl Heneghan
- Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
| | - Jeffrey Aronson
- Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
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Garriga M, Van't Hooft J. When is the right time to induce labour? BMJ Evid Based Med 2021; 26:135-136. [PMID: 32184227 DOI: 10.1136/bmjebm-2019-111330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Meera Garriga
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
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Dahlen HG, Thornton C, Downe S, de Jonge A, Seijmonsbergen-Schermers A, Tracy S, Tracy M, Bisits A, Peters L. Intrapartum interventions and outcomes for women and children following induction of labour at term in uncomplicated pregnancies: a 16-year population-based linked data study. BMJ Open 2021; 11:e047040. [PMID: 34059509 PMCID: PMC8169493 DOI: 10.1136/bmjopen-2020-047040] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES We compared intrapartum interventions and outcomes for mothers, neonates and children up to 16 years, for induction of labour (IOL) versus spontaneous labour onset in uncomplicated term pregnancies with live births. DESIGN We used population linked data from New South Wales, Australia (2001-2016) for healthy women giving birth at 37+0 to 41+6 weeks. Descriptive statistics and logistic regression were performed for intrapartum interventions, postnatal maternal and neonatal outcomes, and long-term child outcomes adjusted for maternal age, country of birth, socioeconomic status, parity and gestational age. RESULTS Of 474 652 included births, 69 397 (15%) had an IOL for non-medical reasons. Primiparous women with IOL versus spontaneous onset differed significantly for: spontaneous vaginal birth (42.7% vs 62.3%), instrumental birth (28.0% vs 23.9%%), intrapartum caesarean section (29.3% vs 13.8%), epidural (71.0% vs 41.3%), episiotomy (41.2% vs 30.5%) and postpartum haemorrhage (2.4% vs 1.5%). There was a similar trend in outcomes for multiparous women, except for caesarean section which was lower (5.3% vs 6.2%). For both groups, third and fourth degree perineal tears were lower overall in the IOL group: primiparous women (4.2% vs 4.9%), multiparous women (0.7% vs 1.2%), though overall vaginal repair was higher (89.3% vs 84.3%). Following induction, incidences of neonatal birth trauma, resuscitation and respiratory disorders were higher, as were admissions to hospital for infections (ear, nose, throat, respiratory and sepsis) up to 16 years. There was no difference in hospitalisation for asthma or eczema, or for neonatal death (0.06% vs 0.08%), or in total deaths up to 16 years. CONCLUSION IOL for non-medical reasons was associated with higher birth interventions, particularly in primiparous women, and more adverse maternal, neonatal and child outcomes for most variables assessed. The size of effect varied by parity and gestational age, making these important considerations when informing women about the risks and benefits of IOL.
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Affiliation(s)
- Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
| | - Charlene Thornton
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
- College of Nursing and Health Sciences, Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Soo Downe
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
- Research in Childbirth and Health (ReaCH) Unit, University of Central Lancashire, Preston, Lancashire, UK
| | - Ank de Jonge
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
- Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anna Seijmonsbergen-Schermers
- Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sally Tracy
- School of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mark Tracy
- Westmead Newborn Intensive Care Unit, The University of Sydney Paediatrics and ChildHealth and WSLHD, Westmead, New South Wales, Australia
| | - Andrew Bisits
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lilian Peters
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
- Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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225
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Muldoon KA, Denize KM, Talarico R, Boisvert C, Frank O, Harvey ALJ, Rennicks White R, Fell DB, O'Hare-Gordon MA, Guo Y, Murphy MSQ, Corsi DJ, Sampsel K, Wen SW, Walker MC, El-Chaar D. COVID-19 and perinatal intimate partner violence: a cross-sectional survey of pregnant and postpartum individuals in the early stages of the COVID-19 pandemic. BMJ Open 2021; 11:e049295. [PMID: 34045216 PMCID: PMC8728372 DOI: 10.1136/bmjopen-2021-049295] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/13/2021] [Accepted: 04/08/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The objectives of this study were to: (1) document violent and controlling behaviours within intimate partnerships during the perinatal period; and (2) determine individual, interpersonal and household-level factors influencing the risk of perinatal intimate partner violence (IPV). DESIGN Cross-sectional survey. SETTING The Ottawa Hospital, Department of Obstetrics and Gynecology, Ottawa, Ontario, Canada. PARTICIPANTS Patients who gave birth at The Ottawa Hospital and were >20 days post partum between 17 March and 16 June 2020. MAIN OUTCOMES AND MEASURES Perinatal IPV was defined as regular controlling behaviours or act-based forms of emotional/physical/sexual abuse in the 12 months before pregnancy, during pregnancy and/or post partum. Log-binomial multivariable regression models were used to compute adjusted risk ratios (aRRs) and 95% CIs to identify potential risk factors for IPV: maternal age, postpartum depression, parity, increase in partner substance use and household income. RESULTS Among 216 participants, the median maternal age was 33 years (IQR: 30-36). In total, 52 (24.07%) reported some form of perinatal IPV, 37 (17.13%) reported regular controlling behaviour and 9 (4.17%) reported both. Household income below the municipal median was the strongest risk factor for perinatal IPV (aRR: 3.24, 95% CI: 1.87 to 5.59). There was no apparent association between maternal age (aRR: 0.99, 95% CI: 0.94 to 1.04), postpartum depression (aRR: 1.03, 95% CI: 1.00 to 1.07), nulliparity (aRR: 1.18, 95% CI: 0.71 to 1.97) or increases in partner substance use (aRR: 0.73, 95% CI: 0.42 to 1.25) with IPV. CONCLUSION One in four individuals in this study experienced perinatal IPV. Household income was the strongest risk factor, and surprisingly, many hypothesised risk factors (eg, mental health, partner substance use, etc) were not significantly associated with perinatal IPV in this sample. This highlights the challenges in both measuring IPV and identifying individuals exposed to perinatal IPV during the high stress of the COVID-19 pandemic.
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Affiliation(s)
- Katherine A Muldoon
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathryn M Denize
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Carlie Boisvert
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Olivia Frank
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Alysha L J Harvey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ruth Rennicks White
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | | | - Yanfang Guo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- BORN Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Malia S Q Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Daniel J Corsi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Kari Sampsel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark C Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Darine El-Chaar
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Miele MJ, Souza RT, Calderon I, Feitosa F, Leite DF, Rocha Filho E, Vettorazzi J, Mayrink J, Fernandes KG, Vieira MC, Pacagnella RC, Cecatti JG. Proposal of MUAC as a fast tool to monitor pregnancy nutritional status: results from a cohort study in Brazil. BMJ Open 2021; 11:e047463. [PMID: 34031116 PMCID: PMC8149442 DOI: 10.1136/bmjopen-2020-047463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE In Brazil, although the assessment of maternal nutritional status is recommended using body mass index (BMI), this is only possible in settings adequately prepared. Midupper arm circumference (MUAC) is another biological variable identified as a tool for rapid assessment of nutritional status that is correlated with BMI. Therefore, we aim to surrogate BMI by MUAC cut-offs for rapid screening of maternal nutritional status starting at midpregnancy. DESIGN Analysis of the multicentre cohort study entitled 'Preterm SAMBA' using an approach of validation of diagnostic test. SETTING Outpatient prenatal care clinics from five tertiary maternity hospitals from three different Brazilian regions. PARTICIPANTS 1165 pregnant women attending prenatal care services from 2015 to 2018 and with diverse ethnic characteristics who were enrolled at midpregnancy and followed in three visits at different gestational weeks. PRIMARY AND SECONDARY OUTCOME MEASURES Sensitivity, specificity, positive and negative predictive values, likelihood ratio and accuracy of MUAC being used instead of BMI for the assessment of nutritional status of women during pregnancy. RESULTS We found a strong correlation between MUAC and BMI, in the three set points analysed (r=0.872, 0.870 and 0.831, respectively). Based on BMI categories of nutritional status, we estimated the best MUAC cut-off points, finding measures according to each category: underweight <25.75 cm (19-39 weeks); overweight 28.11-30.15 cm (19-21 weeks), 28.71-30.60 cm (27-29 weeks) and 29.46-30.25 cm (37-39 weeks); and obese >30.15 cm (19-21 weeks), >30.60 cm (27-29 weeks) and >30.25 cm (37-39 weeks) per gestational week. Therefore, we defined as adequate between 25.75-28.10 cm (19-21 weeks), 25.75-28.70 cm (27-29 weeks) and 25.75-29.45 cm (37-39 weeks) of MUAC. CONCLUSION We conclude that MUAC can be useful as a surrogate for BMI as a faster screening of nutritional status in pregnant women.
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Affiliation(s)
- Maria J Miele
- Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Renato T Souza
- Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Imp Calderon
- Department of Gynecology and Obstetrics, UNESP Campus de Botucatu, Botucatu, Brazil
| | - Francisco Feitosa
- Obstetric Department of MEAC, Federal University of Ceara, Fortaleza, Brazil
| | - Debora F Leite
- Obstetrics and Gynecology, Federal University of Pernambuco, Recife, Brazil
| | | | - Janete Vettorazzi
- Obstetrics and Gynecology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jussara Mayrink
- Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | | | - Matias C Vieira
- Division of Women's Health, King's College London School of Life Course Sciences, London, UK
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227
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Tan GN, Tan PC, Hong JGS, Kartik B, Omar SZ. Rating of four different foods in women with hyperemesis gravidarum: a randomised controlled trial. BMJ Open 2021; 11:e046528. [PMID: 33986063 PMCID: PMC8126296 DOI: 10.1136/bmjopen-2020-046528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate four foods in women with hyperemesis gravidarum (HG) on their agreeability and tolerability. DESIGN Prospective, randomised, within-subject cross-over trial. SETTING Single-centre, tertiary, university hospital in Malaysia. PARTICIPANTS 72 women within 24-hour of first admission for HG who were 18 years or above, with confirmed clinical pregnancy of less than 16 weeks' gestation were recruited and analysed. Women unable to consume food due to extreme symptoms, known taste or swallowing disorder were excluded. INTERVENTIONS Each participant chewed and swallowed a small piece of apple, watermelon, cream cracker and white bread in random order and was observed for 10 min after each tasting followed by a 2 min washout for mouth rinsing and data collection. OUTCOME MEASURES Primary outcome was food agreeability scored after 10 min using an 11-point 0-10 Visual Numerical Rating Scale (VNRS). Nausea was scored at baseline (prior to tasting) and 2 and 10 min using an 11-point VNRS. Intolerant responses of gagging, heaving and vomiting were recorded. RESULTS On agreeability scoring, apple (mean±SD 7.2±2.4) ranked highest followed by watermelon (7.0±2.7) and crackers (6.5±2.6), with white bread ranked lowest (6.0±2.7); Kruskal-Wallis H test, p=0.019. Apple had the lowest mean nausea score and mean rank score, while white bread had the highest at both 2 and 10 min; the Kruskal-Wallis H test showed a significant difference only at 10 min (p=0.019) but not at 2 min (p=0.29) in the ranking analyses. The intolerant (gagged, heaved or vomited) response rates within the 10 min study period were apple 3/72 (4%), watermelon 7/72 (10%), crackers 8/72 (11%) and white bread 12/72 (17%): χ2 test for trend p=0.02. CONCLUSION Sweet apple had the highest agreeability score, the lowest nausea severity and intolerance-emesis response rate when tasted by women with HG. White bread consistently performed worst.
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Affiliation(s)
- Gi Ni Tan
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | - Peng Chiong Tan
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Balaraman Kartik
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Zawiah Omar
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
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228
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Ikeda S, Shibanuma A, Silwal R, Jimba M. Factors associated with the length of stay at health facilities after childbirth among mothers and newborns in Dhading, Nepal: a cross-sectional study. BMJ Open 2021; 11:e042058. [PMID: 33947724 PMCID: PMC8098919 DOI: 10.1136/bmjopen-2020-042058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To measure the length of stay at a health facility after childbirth, identify factors associated with the length of stay and measure the gap between the timings of the last check-up and discharge. DESIGN A cross-sectional study. SETTING Five public health facilities in Dhading, Nepal. PARTICIPANTS 351 randomly selected mothers who gave birth at selected health facilities within 1 year of data collection between 10 and 31 August 2018. OUTCOME MEASURE Length of stay (hours) at a health facility after childbirth. Adequate length was defined as 24 hours or longer based on the WHO guidelines. RESULTS Among 350 mothers (99.7%) out of 351 recruited, 61.7% were discharged within 24 hours after childbirth. Factors associated with shorter length of stay were as follows: travel time less than 30 min to a health facility (incidence rate ratio (IRR)=0.69, 95% CI 0.61 to 0.78); delivery attended by auxiliary staff (IRR=0.86, 95% CI 0.75 to 0.98); and delivery in a primary healthcare centre (IRR=0.67, 95% CI 0.58 to 0.79). Factors associated with longer length of stay were as follows: aged 22 years or above at the first pregnancy (IRR=1.25, 95% CI 1.13 to 1.40); having maternal complications (IRR=2.41, 95% CI 2.16 to 2.70); accompanied by her own family (IRR=1.17, 95% CI 1.03 to 1.34), accompanied by her husband (IRR=1.16, 95% CI 1.04 to 1.29); and delivered at a facility with a physical space where mother and newborn could stay overnight (IRR=1.20, 95% CI 1.07 to 1.34). Among mothers without complications, 32% received the last check-up 3 hours or less before discharge. CONCLUSIONS Multiple factors, such as mothers' conditions, health facility characteristics and external support, were associated with the length of stay after childbirth. However, even if mothers stayed long, they might have not necessarily received timely and proper assessment before discharge.
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Affiliation(s)
- Subaru Ikeda
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ram Silwal
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Green Tara Nepal, Kathmandu, Nepal
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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229
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Stock SJ, Bhide A, Richardson H, Black M, Yuill C, Harkness M, Reid M, Wee F, Cheyne H, McCourt C, Rana D, Boyd KA, Sanders J, Heera N, Huddleston J, Denison F, Pasupathy D, Modi N, Smith G, Norrie J. Cervical ripening at home or in-hospital-prospective cohort study and process evaluation (CHOICE) study: a protocol. BMJ Open 2021; 11:e050452. [PMID: 33947741 PMCID: PMC8098973 DOI: 10.1136/bmjopen-2021-050452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The aim of the cervical ripening at home or in-hospital-prospective cohort study and process evaluation (CHOICE) study is to compare home versus in-hospital cervical ripening to determine whether home cervical ripening is safe (for the primary outcome of neonatal unit (NNU) admission), acceptable to women and cost-effective from the perspective of both women and the National Health Service (NHS). METHODS AND ANALYSIS We will perform a prospective multicentre observational cohort study with an internal pilot phase. We will obtain data from electronic health records from at least 14 maternity units offering only in-hospital cervical ripening and 12 offering dinoprostone home cervical ripening. We will also conduct a cost-effectiveness analysis and a mixed methods study to evaluate processes and women/partner experiences. Our primary sample size is 8533 women with singleton pregnancies undergoing induction of labour (IOL) at 39+0 weeks' gestation or more. To achieve this and contextualise our findings, we will collect data relating to a cohort of approximately 41 000 women undergoing IOL after 37 weeks. We will use mixed effects logistic regression for the non-inferiority comparison of NNU admission and propensity score matched adjustment to control for treatment indication bias. The economic analysis will be undertaken from the perspective of the NHS and Personal Social Services (PSS) and the pregnant woman. It will include a within-study cost-effectiveness analysis and a lifetime cost-utility analysis to account for any long-term impacts of the cervical ripening strategies. Outcomes will be reported as incremental cost per NNU admission avoided and incremental cost per quality adjusted life year gained. RESEARCH ETHICS APPROVAL AND DISSEMINATION CHOICE has been funded and approved by the National Institute of Healthcare Research Health Technology and Assessment, and the results will be disseminated via publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN32652461.
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Affiliation(s)
- Sarah Jane Stock
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Amarnath Bhide
- Obstetrics and Gynaecology, St George's University Hospitals Trust, London, UK
| | - Heather Richardson
- Women and Children's Health, NHS Lothian University Hospitals Division, Edinburgh, UK
| | - Mairead Black
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Cassandra Yuill
- Centre for Maternal & Child Health Research, School of Health Sciences, City University of London, London, UK
| | - Mairi Harkness
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP), University of Stirling, Stirling, UK
| | - Maggie Reid
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Fiona Wee
- Edinburgh Clinical Trials Unit (ECTU) Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP), University of Stirling, Stirling, UK
| | - Christine McCourt
- Centre for Maternal & Child Health Research, School of Health Sciences, City University of London, London, UK
| | - Dikshyanta Rana
- Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | | | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Neelam Heera
- Patient and Public Involvement Representative, Edinburgh, UK
| | - Jane Huddleston
- Patient and Public Involvement Representative, Edinburgh, UK
| | - Fiona Denison
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Dharmintra Pasupathy
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Neena Modi
- Department of Medicine, Imperial College London, London, UK
| | - Gordon Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit (ECTU) Usher Institute, University of Edinburgh, Edinburgh, UK
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230
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Bintabara D, Basinda N. Twelve-year persistence of inequalities in antenatal care utilisation among women in Tanzania: a decomposition analysis of population-based cross-sectional surveys. BMJ Open 2021; 11:e040450. [PMID: 33879479 PMCID: PMC8061846 DOI: 10.1136/bmjopen-2020-040450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study was undertaken to assess the trend and contributors of socioeconomic inequalities in antenatal care (ANC) utilisation among women of reproductive age in Tanzania from 2004 to 2016. DESIGN Population-based cross-sectional surveys. SETTING This study analysed nationally representative data for women of reproductive age obtained from the 2004-2016 Tanzania Demographic Health Surveys. PRIMARY OUTCOME MEASURE The outcome variables analysed in this study are: (1) attendance of ANC and (2) accessing adequate antenatal care. ANALYTICAL METHODS The concentration curve and the concentration index were used to measure socioeconomic inequality in attending and accessing adequate ANC. The concentration index was decomposed to identify the factors explaining the observed socioeconomic inequality of these two outcomes. RESULTS The concentration index for attending at least four ANC visits increased from 0.169 in 2004 to 0.243 in 2016 (p<0.01). Similarly, for accessing adequate care, the index increased from 0.147 in 2004 to 0.355 in 2016 (p<0.01). This indicates the significant increase in socioeconomic inequalities (favouring wealthier women) for these two outcomes over time. Furthermore, the results show that wealth status was the largest contributor to inequality in both attending at least four visits (71%, 50% and 70%) and accessing adequate ANC (50%, 42% and 51%) in 2004, 2010 and 2016, respectively, in favour of wealthier women (p<0.05). The other contributors to socioeconomic inequalities in ANC utilisation were maternal education and type of residence. CONCLUSION Over the 12 years of surveys, there was no reduction in socioeconomic inequalities in ANC utilisation in Tanzania. Therefore, the efforts of achieving universal health coverage should focus on reducing wealth-related inequality and improving women's education from poor households.
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Affiliation(s)
| | - Namanya Basinda
- Department of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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231
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Abstract
OBJECTIVE Episiotomy is still performed widely by obstetricians and midwives in some Chinese maternity units, but the reasons are unknown. This study aims to determine the knowledge, attitude and experience towards the practice of episiotomy among obstetricians and midwives in China's public hospitals and consider strategies to reduce its practice. METHODS A cross-sectional web survey using a self-administered questionnaire was conducted among obstetricians and midwives in 90 public hospitals in Henan Province, China. RESULTS 900 (82.21%) participants completed the questionnaire. Average knowledge level (4.15, SD=1.10) on complications and overuse was identified among participants. Episiotomy was performed more frequently in secondary hospitals than in tertiary hospitals (p<0.05). Senior clinicians were more likely to perform episiotomy than younger ones (p<0.05). Almost half of the clinicians (42.11%) considered the current rate of episiotomy (45%) to be right or too low. The most common reason for performing episiotomy identified by obstetricians (83.94%) and midwives (79.69%) was to reduce third-degree or fourth-degree perineal laceration. Both obstetricians (80.29%) and midwives (82.57%) agreed that the most significant obstacle to reducing the rate of episiotomy was lack of training on reducing perineal tears. CONCLUSION In sum, episiotomy was driven by previous training, practitioners' experience and local norms rather than the latest medical evidence. Clinicians in secondary hospitals and senior clinicians are key training targets. It is urgent to improve current clinical policies and surgical procedure guidelines for obstetricians and midwives regarding episiotomy.
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Affiliation(s)
- Jingxuan Yang
- The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Hua Bai
- The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
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232
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Nilvér H, Wessberg A, Dencker A, Hagberg H, Wennerholm UB, Fadl H, Wesström J, Sengpiel V, Lundgren I, Bergh C, Wikström AK, Saltvedt S, Elden H. Women's childbirth experiences in the Swedish Post-term Induction Study (SWEPIS): a multicentre, randomised, controlled trial. BMJ Open 2021; 11:e042340. [PMID: 33827832 PMCID: PMC8031013 DOI: 10.1136/bmjopen-2020-042340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare childbirth experiences in women randomly assigned to either induction of labour at 41 weeks or to expectant management until 42 weeks, in the Swedish Post-term Induction Study. DESIGN A register-based, multicentre, randomised, controlled, superiority trial. SETTING Women were recruited at 14 hospitals in Sweden, 2016-2018. PARTICIPANTS Women with an uncomplicated singleton pregnancy were recruited at 41 gestational weeks. INTERVENTIONS The women were randomly assigned to induction of labour at 41 weeks (induction group, n=1381) or expectant management until 42 weeks (expectant management group, n=1379). OUTCOME MEASURES As main outcome, women's childbirth experiences were measured using the Childbirth Experience Questionnaire version 2 (CEQ2), in 656 women, 3 months after the birth at three hospitals. As exploratory outcome, overall childbirth experience was measured in 1457 women using a Visual Analogue Scale (VAS 1-10) within 3 days after delivery at the remaining eleven hospitals. RESULTS The total response rate was 77% (2113/2760). There were no significant differences in childbirth experience measured with CEQ2 between the groups (induction group, n=354; expectant management group, n=302) in the subscales: own capacity (2.8 vs 2.7, p=0.09), perceived safety (3.3 vs 3.2, p=0.06) and professional support (3.6 vs 3.5, p=0.38) or in the total CEQ2 score (3.3 vs 3.2, p=0.07), respectively. Women in the induction group scored higher in the subscale participation (3.6 vs 3.4, p=0.02), although with a small effect size (0.19). No significant difference was observed in overall childbirth experience according to VAS (8.0 (n=735) vs 8.1 (n=735), p=0.22). CONCLUSIONS There were no differences in childbirth experience, according to CEQ2 or overall childbirth experience assessed with VAS, between women randomly assigned to induction of labour at 41 weeks or expectant management until 42 weeks. Overall, women rated their childbirth experiences high. TRIAL REGISTRATION NUMBER ISRCTN26113652.
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Affiliation(s)
- Helena Nilvér
- Institute of Health and Care Sciences, Sahlgrenska Akademy, University of Gothenbourg, Gothenbourg, Sweden
| | - Anna Wessberg
- Institute of Health and Care Sciences, Sahlgrenska Akademy, University of Gothenbourg, Gothenbourg, Sweden
- Department of Obstetrics, Sahlgrenska University Hospital, Gothenbourg, Sweden
| | - Anna Dencker
- Institute of Health and Care Sciences, Sahlgrenska Akademy, University of Gothenbourg, Gothenbourg, Sweden
| | - Henrik Hagberg
- Department of Obstetrics, Sahlgrenska University Hospital, Gothenbourg, Sweden
- Centre of Perinatal Medicine & Health, Institute of Clinical Sciences, Salgrenska Akademy, Göteborgs Universitet, Gothenbourg, Sweden
| | - Ulla-Britt Wennerholm
- Department of Obstetrics, Sahlgrenska University Hospital, Gothenbourg, Sweden
- Centre of Perinatal Medicine & Health, Institute of Clinical Sciences, Salgrenska Akademy, Göteborgs Universitet, Gothenbourg, Sweden
| | - Helena Fadl
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jan Wesström
- Centre for Clinical Research, Department of Women's Health, Dalarna County Council, Falun, Sweden
| | - Verena Sengpiel
- Department of Obstetrics, Sahlgrenska University Hospital, Gothenbourg, Sweden
- Centre of Perinatal Medicine & Health, Institute of Clinical Sciences, Salgrenska Akademy, Göteborgs Universitet, Gothenbourg, Sweden
| | - Ingela Lundgren
- Institute of Health and Care Sciences, Sahlgrenska Akademy, University of Gothenbourg, Gothenbourg, Sweden
- Department of Obstetrics, Sahlgrenska University Hospital, Gothenbourg, Sweden
| | - Christina Bergh
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Gothenbourg, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sissel Saltvedt
- Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska Akademy, University of Gothenbourg, Gothenbourg, Sweden
- Department of Obstetrics, Sahlgrenska University Hospital, Gothenbourg, Sweden
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233
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Affiliation(s)
- Liz Bailey
- Elizabeth Bryan Cenre for Multiple Births, Birmingham City University, Birmingham, UK
| | - Kerry Gaskin
- Midwifery and CPD, University of Worcester, Worcester, UK
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Muriithi FG. Does ursodeoxycholic acid have a role in the treatment of women with intrahepatic (obstetric) cholestasis of pregnancy anymore? BMJ Evid Based Med 2021; 26:69-70. [PMID: 32047066 DOI: 10.1136/bmjebm-2019-111292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Francis Githae Muriithi
- Obstetrics and Gynaecology, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
- Obstetrics and Gynaecology, Health Education England East Midlands, Nottingham, UK
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235
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Wu Y, Marc I, Bouchard L, Ouyang F, Luo ZC, Fan J, Dubois L, Mâsse B, Zhang J, Leung PCK, Liao XP, Herba CM, Booij L, Shen J, Lewin A, Jiang H, Wang L, Xu J, Wu W, Sun W, Wu J, Li H, Lei C, Kozyrskyj A, Semenic S, Chaillet N, Fortier I, Masse L, Zhan J, Allard C, Knoppers B, Zawati M, Baillargeon JP, Velez MP, Zhang H, Yu Y, Yu W, Ding Y, Vaillancourt C, Liu H, Tetu A, Fang W, Zhang R, Zhao X, Jin Y, Liu XM, Zhang H, Chen Z, Yang X, Hao YH, Abdelouahab N, Fraser W, Huang HF. Study protocol for the Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI): a multicentre, cluster-randomised, parallel-group, superiority trial of a multifaceted community-family-mother-child intervention to prevent childhood overweight and obesity. BMJ Open 2021; 11:e045192. [PMID: 33795307 PMCID: PMC8021741 DOI: 10.1136/bmjopen-2020-045192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Childhood overweight and obesity (OWO) is a primary global health challenge. Childhood OWO prevention is now a public health priority in China. The Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI), one of four trials being undertaken by the international HeLTI consortium, aims to evaluate the effectiveness of a multifaceted, community-family-mother-child intervention on childhood OWO and non-communicable diseases risk. METHODS AND ANALYSIS This is a multicentre, cluster-randomised, controlled trial conducted in Shanghai, China. The unit of randomisation is the service area of Maternal Child Health Units (N=36). We will recruit 4500 women/partners/families in maternity and district level hospitals. Participants in the intervention group will receive a multifaceted, integrated package of health promotion interventions beginning in preconception or in the first trimester of pregnancy, continuing into infancy and early childhood. The intervention, which is centred on a modified motivational interviewing approach, will target early-life maternal and child risk factors for adiposity. Through the development of a biological specimen bank, we will study potential mechanisms underlying the effects of the intervention. The primary outcome for the trial is childhood OWO (body mass index for age ≥85th percentile) at 5 years of age, based on WHO sex-specific standards. The study has a power of 0.8 (α=0.05) to detect a 30% risk reduction in the proportion of children with OWO at 5 years of age, from 24.4% in the control group to 17% in the intervention group. Recruitment was launched on 30 August 2018 for the pilot study and 10 January 2019 for the formal study. ETHICS AND DISSEMINATION The study has been approved by the Medical Research Ethics Committee of the International Peace Maternity and Child Health Hospital in Shanghai, China, and the Research Ethics Board of the Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie-CHUS in Sherbrooke, Canada. Data sharing policies are consistent with the governance policy of the HeLTI consortium and government legislation. TRIAL REGISTRATION NUMBER ChiCTR1800017773. PROTOCOL VERSION November 11, 2020 (Version #5).
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Affiliation(s)
- Yanting Wu
- International Peace Maternity and Child Health Hospital, Shanghai, China
- Key Laboratory of Embryo Molecular Biology, Ministry of Health, Shanghai, China
| | - Isabelle Marc
- Department of Pediatrics, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche du CHUQ, Quebec City, Quebec, Canada
| | - Luigi Bouchard
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Biochemistry, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Fengxiu Ouyang
- Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai, China
| | - Zhong-Cheng Luo
- Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jianxia Fan
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Lise Dubois
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Benoît Mâsse
- School of Public Health, Université de Montréal, Montreal, Québec, Canada
- Unité de Recherche Clinique Appliquée, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Jun Zhang
- Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai, China
| | - Peter C K Leung
- The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynecology, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Xiang Peng Liao
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - C M Herba
- Department of Psychology, Université du Québec à Montréal, Montreal, Québec, Canada
- CHU Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
| | - Linda Booij
- CHU Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
- Department of Psychology, Concordia University, Montreal, Québec, Canada
| | - Jian Shen
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Antoine Lewin
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Hong Jiang
- Department of Maternal and Child Care, School of Public Health, Fudan University, Shanghai, China
| | - Liping Wang
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Jian Xu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Weibin Wu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Wenguang Sun
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Jiahao Wu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Hong Li
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Chen Lei
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Anita Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Sonia Semenic
- Ingram School of Nursing, McGill University, Montreal, Québec, Canada
| | - N Chaillet
- Department of Pediatrics, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche du CHUQ, Quebec City, Quebec, Canada
| | - Isabel Fortier
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Louise Masse
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Janelle Zhan
- Unité de Recherche Clinique Appliquée, CHU Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
| | - Catherine Allard
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Bartha Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, Québec, Canada
| | - Ma'n Zawati
- Centre of Genomics and Policy, McGill University, Montreal, Québec, Canada
| | - Jean-Patrice Baillargeon
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Maria P Velez
- Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
| | - Hanqiu Zhang
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Yamei Yu
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Wen Yu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Yan Ding
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Caroline Vaillancourt
- Department of Pediatrics, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche du CHUQ, Quebec City, Quebec, Canada
| | - Han Liu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Amelie Tetu
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Wenli Fang
- Changing Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
| | - Rong Zhang
- Department of Obstetrics and Gynecology, Shanghai Fengxian Central Hospital, Shanghai, China
| | - Xinzhi Zhao
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Yan Jin
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Xin-Mei Liu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Huijuan Zhang
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Zhirou Chen
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Xi Yang
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Yan-Hui Hao
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Nadia Abdelouahab
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - William Fraser
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - He-Feng Huang
- International Peace Maternity and Child Health Hospital, Shanghai, China
- Key Laboratory of Embryo Molecular Biology, Ministry of Health, Shanghai, China
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Kelly J, Jones CC, Jomeen J, Martin C. Perinatal mental health and well-being of serving women and women veterans: a study protocol. BMJ Mil Health 2021; 168:1-4. [PMID: 33789979 DOI: 10.1136/bmjmilitary-2020-001756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Janet Kelly
- Midwifery and Child Health, University of Hull, Kingston upon Hull, UK
| | - C C Jones
- Midwifery and Child Health, University of Hull, Kingston upon Hull, UK
| | - J Jomeen
- Southern Cross University Lismore Campus, Lismore, New South Wales, Australia
| | - C Martin
- University of Hull, Kingston upon Hull, North Humberside, UK
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Abstract
OBJECTIVE The main objective of this study was to explore the factors affecting anaemia among women of reproductive age (WRA) in Nepal using spatial and multilevel epidemiological analysis. DESIGN This cross-sectional study analysed data from the 2016 Nepal Demographic and Health Survey. Spatial analysis was performed using ArcGIS software V.10.8 to identify the hot and cold spots of anaemia among WRA (15-49 years). Data were analysed using multilevel mixed-effect logistic regression analysis. SETTING Nepal. PARTICIPANTS A total of 6414 WRA were included in the analysis. MAIN OUTCOME MEASURE Anaemia defined by WHO as haemoglobin level less than 120 g/L in non-pregnant women and less than 110 g/L in pregnant women. RESULTS The spatial analysis showed that statistically significant hotspots of anaemia were in the southern Terai region (four districts in province 1, eight districts in province 2, one district in Bagmati province, two districts in province 5 and one district in Sudurpaschim province) of Nepal. At the individual level, women who underwent female sterilisation (adjusted OR, aOR: 3.61, 95% CI 1.10 to 11.84), with no education (aOR: 1.99, 95% CI: 1.17 to 3.39), and from middle socioeconomic class families (aOR: 1.65, 95% CI: 1.02 to 2.68) were more likely to be anaemic, whereas, older women (>35 years) (aOR: 0.51, 95% CI: 0.26 to 0.97) and those women who were using hormonal contraceptives (aOR: 0.63, 95% CI: 0.43 to 0.90) were less likely to be anaemic. At the community level, women from province 2 (aOR=2.97, 95% CI: 1.52 to 5.82) had higher odds of being anaemic. CONCLUSION WRA had higher odds of developing anaemia, and it varied by the geographical regions. Nutrition-specific and nutrition-sensitive interventions can be tailored based on the factors identified in this study to curb the high burden of anaemia.
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Affiliation(s)
- Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Armed Police Force Hospital, Kathmandu, Nepal
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
| | - Devendra Raj Singh
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Santosh Shrestha
- Agriculture Research, Agricultural Technology Center, Lalitpur, Nepal
| | - Pranil Man Singh Pradhan
- Department of Community Medicine, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal
- Nepalese Society of Community Medicine (NESCOM), Kathmandu, Nepal
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Abstract
OBJECTIVE To evaluate oxytocin use for augmentation of labour in relation to body mass index (BMI) on admission to the labour ward, focusing on cumulative oxytocin dose and maximum rate of oxytocin infusion during the first stage of labour. DESIGN Prospective observational study. SETTING Seven hospitals in Sweden. PARTICIPANTS 1097 nulliparous women with singleton cephalic presentation pregnancy, ≥37 weeks of gestation, spontaneous onset of labour and treatment with oxytocin infusion for labour augmentation. The study population was classified into three BMI subgroups on admission to the labour ward: normal weight (18.5-24.9), overweight (25.0-29.9) and obese (≥30.0). The cumulative oxytocin dose was measured from the start of oxytocin infusion until the neonate was born. PRIMARY OUTCOME Cumulative oxytocin dose. SECONDARY OUTCOME Maximum rate of oxytocin infusion during the active phase of first stage of labour. RESULTS The mean cumulative oxytocin dose increased in the BMI groups (normal weight 2278 mU, overweight 3108 mU and obese 4082 mU (p<0.0001)). However, when adjusted for the confounders (cervical dilatation when oxytocin infusion was started, fetal birth weight, epidural analgesia), the significant difference was no longer seen. The maximum oxytocin infusion rate during the first stage of labour differed significantly in the BMI groups when adjusted for the confounding factors individually but not when adjusted for all three factors simultaneously. In addition, the maximum oxytocin infusion rate was significantly higher in women with emergency caesarean section compared with women with vaginal delivery. CONCLUSIONS Women with increasing BMI with augmentation of labour received a higher cumulative oxytocin dose and had a higher maximum oxytocin infusion rate during first stage of labour, however, when adjusted for relevant confounders, the difference was no longer seen. In the future, the guidelines for augmentation of labour with oxytocin infusion might be reconsidered and include modifications related to BMI.
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Affiliation(s)
- Anna Ramö Isgren
- Department of Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, University Hospital, Linköping University, Linköping, Sweden
| | - Preben Kjölhede
- Department of Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, University Hospital, Linköping University, Linköping, Sweden
| | - Sara Carlhäll
- Department of Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, University Hospital, Linköping University, Linköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, University Hospital, Linköping University, Linköping, Sweden
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Pons-Duran C, Llach M, Sanz S, Ramírez M, Méndez S, Roman E, Tholandi M, Pagnoni F, Menendez C, González R. Community delivery of malaria intermittent preventive treatment in pregnancy: protocol of a quasi-experimental evaluation through multistage cluster sampling household surveys in four sub-Saharan African countries. BMJ Open 2021; 11:e044680. [PMID: 33766844 PMCID: PMC7996653 DOI: 10.1136/bmjopen-2020-044680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa (SSA), millions of pregnant women are exposed to malaria infection. The cornerstone of the WHO strategy to prevent malaria in pregnancy in moderate to high-transmission areas is the administration of intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine at each scheduled antenatal care (ANC) visit. However, overall coverage remains low. 'Transforming IPT for Optimal Pregnancy' (TIPTOP) project aims at delivering IPTp at the community level (C-IPTp) to complement ANC provision with the goal of increasing IPTp coverage and improving maternal and infant's health. This protocol describes the approach to measure the effect of this strategy through household surveys (HHS) in four SSA countries: Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria. METHODS AND ANALYSIS A quasi-experimental evaluation has been designed. Delivery of C-IPTp will start first in one area per country, and later it will be extended to two more areas per country. HHS will be carried out before C-IPTp implementation in all study sites, at midterm in initial implementation areas, and after the implementation in all project areas. A multistage cluster sampling method will be followed for the selection of participants. Women of reproductive age who had a pregnancy that ended in the 6 or 12 months prior to the interview, depending on the survey, will be invited to participate by responding to a questionnaire. The main indicators will be coverage of three or more doses of IPTp and attendance to at least four ANC visits. A difference-in-difference analysis will be performed to evaluate the effectiveness of C-IPTp. ETHICS AND DISSEMINATION The project has been reviewed by the ethics committees of WHO, Hospital Clinic of Barcelona and all project country boards. Project results will be disseminated to in-country stakeholders and at regional and international meetings. TIPTOP project aims to develop and disseminate global recommendations for C-IPTp delivery. TRIAL REGISTRATION NUMBER NCT03600844; Pre-results.
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Affiliation(s)
- Clara Pons-Duran
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mireia Llach
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Sergi Sanz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Máximo Ramírez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Susana Méndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | | | - Franco Pagnoni
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Clara Menendez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Raquel González
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Humphries B, León-García M, Bates S, Guyatt G, Eckman M, D'Souza R, Shehata N, Jack S, Alonso-Coello P, Xie F. Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP): a sequential explanatory mixed methods pilot study protocol. BMJ Open 2021; 11:e046021. [PMID: 33753445 PMCID: PMC7986891 DOI: 10.1136/bmjopen-2020-046021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Decision analysis is a quantitative approach to decision making that could bridge the gap between decisions based solely on evidence and the unique values and preferences of individual patients, a feature especially important when existing evidence cannot support clear recommendations and there is a close balance between harms and benefits for the treatments options under consideration. Low molecular weight heparin (LMWH) for the prevention of venous thromboembolism (VTE) during pregnancy represents one such situation. The objective of this paper is to describe the rationale and methodology of a pilot study that will explore the application of decision analysis to a shared decision-making process involving prophylactic LMWH for pregnant women or those considering pregnancy who have experienced a VTE. METHODS AND ANALYSIS We will conduct an international, mixed methods, explanatory, sequential study, including quantitative data collection and analysis followed by qualitative data collection and analysis. In step I, we will ask women who are pregnant or considering pregnancy and have experienced VTE to participate in a shared decision-making intervention for prophylactic LMWH. The intervention consists of three components: a direct choice exercise, a values elicitation exercise and a personalised decision analysis. After administration of the intervention, we will ask women to make a treatment decision and measure decisional conflict, self-efficacy and satisfaction. In step II, which follows the analysis of quantitative data, we will use the results to inform the qualitative interview. Step III will be a qualitative descriptive study that explores participants' experiences and perceptions of the intervention. In step IV, we will integrate findings from the qualitative and quantitative analyses to obtain meta-inferences. ETHICS AND DISSEMINATION Site-specific ethics boards have approved the study. All participants will provide informed consent. The research team will take an integrated approach to knowledge translation.
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Affiliation(s)
- Brittany Humphries
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Montserrat León-García
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Catalunya, Spain
| | - Shannon Bates
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mark Eckman
- Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, Ohio, USA
| | - Rohan D'Souza
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nadine Shehata
- Departments of Medicine, Laboratory Medicine and Pathobiology, Institute of Health Policy Management and Evaluation, University of Toronto, Division of Hematology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Susan Jack
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
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241
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Alobo G, Ochola E, Bayo P, Muhereza A, Nahurira V, Byamugisha J. Why women die after reaching the hospital: a qualitative critical incident analysis of the 'third delay' in postconflict northern Uganda. BMJ Open 2021; 11:e042909. [PMID: 33753439 PMCID: PMC7986759 DOI: 10.1136/bmjopen-2020-042909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To critically explore and describe the pathways that women who require emergency obstetrics and newborn care (EmONC) go through and to understand the delays in accessing EmONC after reaching a health facility in a conflict-affected setting. DESIGN This was a qualitative study with two units of analysis: (1) critical incident technique (CIT) and (2) key informant interviews with health workers, patients and attendants. SETTING Thirteen primary healthcare centres, one general private-not-for-profit hospital, one regional referral hospital and one teaching hospital in northern Uganda. PARTICIPANTS Forty-nine purposively selected health workers, patients and attendants participated in key informant interviews. CIT mapped the pathways for maternal deaths and near-misses selected based on critical case purposive sampling. RESULTS After reaching the health facility, a pregnant woman goes through a complex pathway that leads to delays in receiving EmONC. Five reasons were identified for these delays: shortage of medicines and supplies, lack of blood and functionality of operating theatres, gaps in staff coverage, gaps in staff skills, and delays in the interfacility referral system. Shortage of medicines and supplies was central in most of the pathways, characterised by three patterns: delay to treat, back-and-forth movements to buy medicines or supplies, and multiple referrals across facilities. Some women also bypassed facilities they deemed to be non-functional. CONCLUSION Our findings show that the pathway to EmONC is precarious and takes too long even after making early contact with the health facility. Improvement of skills, better management of the meagre human resource and availing essential medical supplies in health facilities may help to reduce the gaps in a facility's emergency readiness and thus improve maternal and neonatal outcomes.
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Affiliation(s)
- Gasthony Alobo
- Obstetrics and Gynecology, Lira University, Lira, Uganda
- Obstetrics and Gynecology, St Mary's Hospital Lacor, Gulu, Uganda
| | - Emmanuel Ochola
- Public Health, St Mary's Hospital Lacor, Gulu, Uganda
- Public Health, Gulu University Faculty of Medicine, Gulu, Uganda
| | - Pontius Bayo
- Obstetrics and Gynecology, Torit State Hospital, Torit, South Sudan
| | - Alex Muhereza
- Maternal and Newborn Care, RHITES - North Acholi, Gulu, Uganda
| | | | - Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Makerere University, Kampala, Uganda
- Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
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242
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Uwisanze S, Ngabonzima A, Bazirete O, Hategeka C, Kenyon C, Asingizwe D, Kanazayire C, Cechetto D. Mentors' perspectives on strengths and weaknesses of a novel clinical mentorship programme in Rwanda: a qualitative study. BMJ Open 2021; 11:e042523. [PMID: 33741662 PMCID: PMC7986684 DOI: 10.1136/bmjopen-2020-042523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify mentors' perspectives on strengths and weaknesses of the Training, Support and Access Model for Maternal, Newborn and Child Health (TSAM-MNCH) clinical mentorship programme in Rwandan district hospitals. Understanding the perspectives of mentors involved in this programme can aid in the improvement of its implementation. DESIGN The study used a qualitative approach with in-depth interviews. SETTING Mentors of TSAM-MNCH clinical mentorship programme mentoring health professionals at district hospitals of Rwanda. PARTICIPANTS 14 TSAM mentors who had at least completed six mentorship visits on a regular basis in three selected district hospitals. RESULTS Mentors' accounts demonstrated an appreciation of the two mentoring structures which are interprofessional collaboration and training. These structures are highlighted as the strengths of the mentoring programme and they play a significant role in the successful implementation of the mentorship model. Inconsistency of mentoring activities and lack of resources emerged as major weaknesses of the clinical mentorship programme which could hinder the effectiveness of the mentoring scheme. CONCLUSION The findings of this study highlight the strengths and weaknesses perceived by mentors of the TSAM-MNCH clinical mentorship programme, providing insights that can be used to improve its implementation. The study represents unique TSAM-MNCH structural settings, but its findings shed light on Rwandan health system issues that need to be further addressed to ensure better quality of care for mothers, newborns and children.
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Affiliation(s)
- Sandrine Uwisanze
- School of Social and Political Science, The University of Edinburgh, Edinburgh, UK
| | | | - Oliva Bazirete
- Midwifery Department, College of Medicine and Health Sciences- University of Rwanda, Kigali, Rwanda
| | - Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Cynthia Kenyon
- Perinatal Medicine, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Domina Asingizwe
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | | | - David Cechetto
- Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
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243
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Metodiev Y, Braveman F. Anaesthesia and neurological disorders in pregnancy. BJA Educ 2021; 21:210-217. [PMID: 34026274 DOI: 10.1016/j.bjae.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Y Metodiev
- Cardiff & Vale University Health Board, Cardiff, UK
| | - F Braveman
- University of Minnesota, Minneapolis, MN, USA
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Miranda L, Kugasia I, Han L, Chandy D, Epelbaum O. Tuberculous placenta: a rare bird but not extinct. Postgrad Med J 2021; 98:e27-e28. [PMID: 37066564 DOI: 10.1136/postgradmedj-2021-139902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/20/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Laura Miranda
- Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Irfanali Kugasia
- Department of Pulmonary and Critical Care, Baylor Scott and White Medical Center, Waxahachie, Texas, USA
| | - Liying Han
- Department of Pathology, Westchester Medical Center, Valhalla, New York, USA
| | - Dipak Chandy
- Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center Health Network, Valhalla, New York, USA
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Thomson K, Moffat M, Arisa O, Jesurasa A, Richmond C, Odeniyi A, Bambra C, Rankin J, Brown H, Bishop J, Wing S, McNaughton A, Heslehurst N. Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis. BMJ Open 2021; 11:e042753. [PMID: 33722867 PMCID: PMC7959237 DOI: 10.1136/bmjopen-2020-042753] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE There has been an unprecedented rise in infant mortality associated with deprivation in recent years in the United Kingdom (UK) and Republic of Ireland. A healthy pregnancy can have significant impacts on the life chances of children. The objective of this review was to understand the association between individual-level and household-level measures of socioeconomic status and adverse pregnancy outcomes. DESIGN Systematic review and meta-analysis. DATA SOURCES Nine databases were searched (Medline, Embase, Scopus, ASSIA, CINAHL, PsycINFO, BNI, MIDRIS and Google Scholar) for articles published between 1999 and August 2019. Grey literature searches were also assessed. STUDY SELECTION CRITERIA Studies reporting associations between individual-level or household socioeconomic factors on pregnancy outcomes in the UK or Ireland. RESULTS Among the 82 353 search results, 53 821 titles were identified and 35 unique studies met the eligibility criteria. Outcomes reported were neonatal, perinatal and maternal mortality, preterm birth, birth weight and mode of delivery. Pooled effect sizes were calculated using random-effects meta-analysis. There were significantly increased odds of women from lower levels of occupation/social classes compared with the highest level having stillbirth (OR 1.40, 95% CI 1.23 to 1.59, I298.62%), neonatal mortality (OR 1.39, 95% CI 1.22 to 1.57, I297.09%), perinatal mortality (OR 1.39, 95% CI 1.23 to 1.57, I298.69%), preterm birth (OR 1.41, 95% CI 1.33 to 1.50, I270.97%) and low birth weight (OR 1.40, 95% CI 1.19 to 1.61, I299.85%). Limitations relate to available data, unmeasured confounders and the small number of studies for some outcomes. CONCLUSIONS This review identified consistent evidence that lower occupational status, especially manual occupations and unemployment, were significantly associated with increased risk of multiple adverse pregnancy outcomes. Strategies to improve pregnancy outcomes should incorporate approaches that address wider determinants of health to provide women and families with the best chances of having a healthy pregnancy and baby and to decrease pregnancy-related health inequalities in the general population. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019140893.
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Affiliation(s)
- Katie Thomson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Malcolm Moffat
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Oluwatomi Arisa
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Catherine Richmond
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Adefisayo Odeniyi
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Heather Brown
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Julie Bishop
- Health Improvement Division, Public Health Wales, Cardiff, UK
| | - Susan Wing
- Health Improvement Division, Public Health Wales, Cardiff, UK
| | - Amy McNaughton
- Health Improvement Division, Public Health Wales, Cardiff, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
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Hossain-López S, Ruiz-Berdún D. Being a woman, being a soldier, being a mother: a qualitative analysis of perceptions of pregnancy on working lives of women in the Spanish Armed Forces. BMJ Mil Health 2021; 168:64-69. [PMID: 33688081 DOI: 10.1136/bmjmilitary-2020-001722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/30/2021] [Accepted: 02/09/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Thirty-two years after Spain first allowed women to join the armed forces, 12% of active troops are women, although there are no data on how many of them are mothers. There is a lack of research related to the impact of motherhood on their careers and the challenges they face as well. Previous quantitative research, within North Atlantic Treaty Organization (NATO) forces, has focused on the increased vulnerability and reduced performance of women returning to service after childbirth. However, no study to date has examined the narratives of these women. METHODS A qualitative, cross-sectional study was carried out by means of individual interviews which were subsequently analysed employing the interpretative approach of hermeneutic phenomenology. All the interviews were conducted by videoconference, being recorded for subsequent transcription and analysis with MAXQDA v.2018. RESULTS Servicewoman reported experiencing fear of informing their command chain of their pregnancy. Many women described feelings of constantly having to prove their worth, and thus perceived the physical restrictions associated with pregnancy and/or postpartum as a threat to their previous achievements. This sometimes led to behaviours that posed a risk to the health of mothers and babies, or eventually resulted in both acute and chronic conditions. CONCLUSIONS Some restrictions put in place to protect them during their pregnancies become a source of additional anxiety. Returning to active service, we found that women's desire to fulfil their duties can cause long-term damage to their physical and psychological health. The attitudes servicewomen perceive towards pregnant women and mothers seems to exert a strong influence on the risks they are willing to assume. Understanding and addressing the needs of servicewomen after childbirth, either now, as active members of the Armed Forces, or in the foreseeable future, as veterans, is crucial to both military and civilian healthcare providers.
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Affiliation(s)
- Sheima Hossain-López
- Surgery, Medical and Social Sciences, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá de Henares, Alcala de Henares, Madrid, Spain
| | - D Ruiz-Berdún
- Surgery, Medical and Social Sciences, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá de Henares, Alcala de Henares, Madrid, Spain
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McRae DN, Portela A, Waldron T, Bergen N, Muhajarine N. Understanding the implementation (including women's use) of maternity waiting homes in low-income and middle-income countries: a realist synthesis protocol. BMJ Open 2021; 11:e039531. [PMID: 33658257 PMCID: PMC7931758 DOI: 10.1136/bmjopen-2020-039531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Maternity waiting homes in low-income and middle-income countries provide accommodation near health facilities for pregnant women close to the time of birth to promote facility-based birth and birth with a skilled professional and to enable timely access to emergency obstetric services when needed. To date, no studies have provided a systematic, comprehensive synthesis explaining facilitators and barriers to successful maternity waiting home implementation and whether and how implementation strategies and recommendations vary by context. This synthesis will systematically consolidate the evidence, answering the question, 'How, why, for whom, and in what context are maternity waiting homes successfully implemented in low-income and middle-income countries?'. METHODS AND ANALYSIS Methods include standard steps for realist synthesis: determining the scope of the review, searching for evidence, appraising and extracting data, synthesising and analysing the data and developing recommendations for dissemination. Steps are iterative, repeating until theoretical saturation is achieved. Searching will be conducted in 13 electronic databases with results managed in Eppi-Reviewer V.4. There will be no language, study-type or document-type restrictions. Items documented prior to 1990 will be excluded. To ensure our initial and revised programme theories accurately reflect the experiences and knowledge of key stakeholders, most notably the beneficiaries, interviews will be conducted with maternity waiting home users/nonusers, healthcare staff, policymakers and programme designers. All data will be analysed using context-mechanism-outcome configurations, refined and synthesised to produce a final programme theory. ETHICS AND DISSEMINATION Ethics approval for the project will be obtained from the Mozambican National Bioethical Commission, Jimma University College of Health Sciences Institutional Review Board and the University of Saskatchewan Bioethical Research Ethics Board. To ensure results of the evaluation are available for uptake by a wide range of stakeholders, dissemination will include peer-reviewed journal publication, a plain-language brief, and conference presentations to stakeholders' practice audiences. PROSPERO REGISTRATION NUMBER CRD42020173595.
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Affiliation(s)
- Daphne N McRae
- Department of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Saskatchewan, Canada
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Tamara Waldron
- Department of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Nicole Bergen
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Saskatchewan, Canada
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248
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Shetty SS, Moray KV, Chaurasia H, Joshi BN. Cost of managing atonic postpartum haemorrhage with uterine balloon tamponade devices in public health settings of Maharashtra, India: an economic microcosting study. BMJ Open 2021; 11:e042389. [PMID: 33653747 PMCID: PMC7929829 DOI: 10.1136/bmjopen-2020-042389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Postpartum haemorrhage (PPH) is the worldwide leading cause of preventable maternal mortality. India offers free treatment for pregnancy and related complications in its public health facilities. Management with uterine balloon tamponade (UBT) is recommended for refractory atonic PPH cases. As part of health technology assessment to determine the most cost-effective UBT device, this study estimated costs of atonic PPH management with condom-UBT, Every Second Matters (ESM) UBT and Bakri balloon UBT in public health system of Maharashtra, India. DESIGN Health system cost was estimated using primary economic microcosting, data from Health Management Information System and published literature for event probabilities. SETTINGS Four public health facilities from the state of Maharashtra, India representing primary, secondary and tertiary level care were chosen for primary costing. OUTCOME MEASURES Unit, package and annual cost of atonic PPH management with three UBT devices were measured. This included cost of medical treatment, UBT intervention and PPH related surgeries undertaken in public health system of Maharashtra for year 2017-2018. RESULTS Medical management of atonic PPH cost the health system US$37 (95% CI 29 to 45) per case, increasing to US$44 (95% CI 36 to 53) with condom-UBT and surgical interventions for uncontrolled cases. Similar cost was estimated for ESM-UBT. Bakri-UBT reported a higher cost of US$59 (95% CI 46 to 73) per case. Overall annual cost of managing 27 915 atonic PPH cases with condom-UBT intervention in Maharashtra was US$1 226 610 (95% CI 870 250 to 1 581 596). CONCLUSIONS Atonic PPH management in public health facilities of Maharashtra with condom-UBT, ESM-UBT or Bakri-UBT accounts to 3.8%, 3.8% or 5.2% of the state's annual spending on reproductive and child health services. These findings can guide policy-makers to include PPH complication management in publicly financed health schemes. Economic evaluation studies can use this evidence to determine cost effectiveness of UBT in Indian settings.
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Affiliation(s)
- Siddesh Sitaram Shetty
- Regional Resource Hub for Health Technology Assessment in India, Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, India
| | - Kusum Venkobrao Moray
- Regional Resource Hub for Health Technology Assessment in India, Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, India
| | - Himanshu Chaurasia
- Regional Resource Hub for Health Technology Assessment in India, Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, India
| | - Beena Nitin Joshi
- Department of Operational Research, Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, India
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Jafree SR, Bukhari N, Muzamill A, Tasneem F, Fischer F. Digital health literacy intervention to support maternal, child and family health in primary healthcare settings of Pakistan during the age of coronavirus: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e045163. [PMID: 33653760 PMCID: PMC7929637 DOI: 10.1136/bmjopen-2020-045163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION There is a need to continue primary healthcare services through digital communication for disadvantaged women living in underdeveloped areas of Pakistan, especially in the age of the coronavirus pandemic, social distancing and lockdown of communities. This project will be the first of its kind in aiming to implement a digital health literacy intervention, using smartphone and internet, to disadvantaged women through female community healthcare workers. Improved health literacy in women of reproductive years is known to promote maternal, child and family health overall. METHODS AND ANALYSIS The study will include a baseline survey, a pre- and post-test survey and a 3-month lasting intervention on (1) hygiene and prevention and (2) coronavirus awareness and prevention. Women of reproductive years will be sampled from disadvantaged areas across the four provinces of Pakistan (Baluchistan, Khyber Pakhtunkhwa, Punjab and Sindh), and the selection criteria will be poor, semiliterate or illiterate, belonging to underdeveloped neighbourhoods devoid of universal healthcare coverage and dependent on free primary health services. A target of 1000 women will comprise the sample, with 500 women each assigned randomly to the intervention and control groups. Analysis of variance and multivariate analysis will be used for analysing the intervention's effects compared with the control group. ETHICS AND DISSEMINATION Ethics approval for this study has been received from the Internal Review Board of the Forman Christian College University (reference number: IRB-252/06-2020). Results will be published in academic journals of repute and dissemination to the international scientific community and stakeholders will also be planned through workshops. TRIAL REGISTRATION NUMBER NCT04603092.
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Affiliation(s)
- Sara Rizvi Jafree
- Department of Sociology, Forman Christian College University, Lahore, Pakistan
| | - Nadia Bukhari
- School of Pharmacy, University College London, London, UK
| | - Anam Muzamill
- Department of Mass Communications, Forman Christian College University, Lahore, Pakistan
| | - Faiza Tasneem
- Department of Business, Forman Christian College University, Lahore, Pakistan
| | - Florian Fischer
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany
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250
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Majewska A, Stanirowski P, Wielgoś M, Bomba-Opoń D. Flash glucose monitoring in gestational diabetes mellitus: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e041486. [PMID: 33653744 PMCID: PMC7929891 DOI: 10.1136/bmjopen-2020-041486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is a glucose intolerance occurring in 3%-10% of pregnant women and being a risk factor for multiple maternal and fetal complications. The risk of perinatal complications is proportional to the level of maternal hyperglycaemia. Proper glycaemic control is therefore one of the key elements of GDM therapy. Until recently, determination of blood glucose concentration was performed using glucose meters, which involved multiple fingerpricks. Nowadays, due to the flash glucose monitoring (FGM) availability, it is possible to collect measurements at any time without routine puncturing. The aim of the presented study is to assess the impact of FGM on the efficacy of treatment in population of patients diagnosed with GDM. METHODS AND ANALYSIS This is a prospective, randomised study, that will recruit 100 women at 24-28 weeks of gestation at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland. Women diagnosed with GDM, who will meet the inclusion criteria, will be individually randomised to the FGM or self-monitoring of blood glucose groups. Further on, clinical and laboratory results of the mother and their newborns will be collected for analysis during the course of pregnancy. Primary outcome is mean glycaemia result in each group after 1 month analysis and percentage of results in the target glycaemic range. The secondary objectives will be to compare the two groups for maternal and neonatal outcomes in conjunction with long-term glycaemic control using blood glycated haemoglobin and fructosamine serum concentrations. ETHICS AND DISSEMINATION The study is exempt from regional ethics review due to its nature of quality improvement in patient care. The study has been approved by the Bioethics Committee at the Medical University of Warsaw and the patient privacy protection boards governing over the recruitment sites. Results of the study will be presented in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER NCT04422821.
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Affiliation(s)
- Agata Majewska
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Stanirowski
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Mirosław Wielgoś
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Bomba-Opoń
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
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