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Nisha MK, Alam A, Islam MT, Huda T, Raynes-Greenow C. Risk of adverse pregnancy outcomes associated with short and long birth intervals in Bangladesh: evidence from six Bangladesh Demographic and Health Surveys, 1996-2014. BMJ Open 2019; 9:e024392. [PMID: 30798311 PMCID: PMC6398728 DOI: 10.1136/bmjopen-2018-024392] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine the effect of short (<36 months) and long (≥60 months) birth intervals on adverse pregnancy outcomes in Bangladesh. DESIGN, SETTING AND PARTICIPANTS We analysed data from six Bangladesh Demographic and Health Surveys (1996-1997, 1999-2000, 2004, 2007, 2011 and 2014). We included all singleton non-first live births, most recently born to mothers within 5 years preceding each survey (n=21 382). We defined birth interval according to previous research which suggests that a birth interval between 36 and 59 months is the most ideal interval. Bivariate and multivariable analyses were conducted to obtain the crude and adjusted ORs (aOR) respectively to assess the odds of first-day neonatal death, early neonatal death and small birth size for both short (<36 months) and long (≥60 months) spacing between births. MAIN OUTCOME MEASURES First-day neonatal death, early neonatal death and small birth size. RESULTS In the multivariable analysis, compared with births spaced 36-59 months, infants with a birth interval of <36 months had increased odds of first-day neonatal death (aOR: 2.11, 95% CI: 1.17 to 3.78) and early neonatal death (aOR: 1.58, 95% CI: 1.13 to 2.22). Compared with births spaced 36-59 months, infants with a birth interval of ≥60 months had increased odds of first-day neonatal death (aOR: 2.02, 95% CI: 1.10 to 3.73) and small birth size (aOR: 1.17, 95% CI: 1.02 to 1.34). When there was a history of any previous pregnancy loss, there was an increase in the odds of first-day and early neonatal death for both short and long birth intervals, although it was not significant. CONCLUSIONS Birth intervals shorter than 36 months and longer than 59 months are associated with increased odds of adverse pregnancy outcomes. Care-providers, programme managers and policymakers could focus on promoting an optimal birth interval between 36 and 59 months in postpartum family planning.
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Affiliation(s)
- Monjura Khatun Nisha
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ashraful Alam
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Tanvir Huda
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Camille Raynes-Greenow
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Ejigu AG, Yismaw AE, Limenih MA. The effect of sex of last child on short birth interval practice: the case of northern Ethiopian pregnant women. BMC Res Notes 2019; 12:75. [PMID: 30717796 PMCID: PMC6360797 DOI: 10.1186/s13104-019-4110-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/31/2019] [Indexed: 01/29/2023] Open
Abstract
Objective Improving short birth interval practice is a key strategy to reduce maternal mortality, neonatal mortality, adverse pregnancy outcomes, high fertility rate and undermining economic development efforts. However, there were limited evidences on short birth interval practice and its determinant factors in Ethiopia. This study aimed to determine the prevalence of short birth interval practice and associated factors among pregnant women. Institutional based cross-sectional study was conducted among 418 pregnant mothers using stratified sampling technique. Multivariable logistic regression analysis was performed at the level of significance of P-value < 0.05. Result Short birth interval practice was found to be 40.9%. Child death (AOR = 3.60, 95% CI 1.35, 9.59), female child (AOR = 2.03, 95% CI 1.12, 3.67), younger maternal age (AOR = 4.23, 95% CI 1.14, 12.66), contraceptive non-use (AOR = 8.15, 95% CI 4.17, 15.94), increase duration of breastfeeding (AOR = 4.72, 95 CI% 1.10, 20.60) and home delivery (AOR = 4.75, 95 CI% 2.30, 9.79) were found to be significantly associated with short birth interval practice. The prevalence of short birth interval practice is high. Multi disciplinary approach through improving maternal and child health care are recommended to prevent short birth interval practice.
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Affiliation(s)
- Amare Genetu Ejigu
- Department of Midwifery, College of Health Science, Mizantepi University, Mizantepi, Ethiopia
| | - Ayenew Engida Yismaw
- Department of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Miteku Andualem Limenih
- Department of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Shafiqullah H, Morita A, Nakamura K, Seino K. The family planning conundrum in Afghanistan. Health Promot Int 2018; 33:311-317. [PMID: 28334747 DOI: 10.1093/heapro/daw081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction In Afghanistan, despite the high awareness levels of contraceptive methods, the contraceptive prevalence is low and short birth spacing is common. The aim of this study was to understand the perception about family planning and contraceptive utilization among reproductive-aged married women, their husbands, their mothers-in-law, religious leaders and healthcare providers. Methods Focus group discussions and semi-structured interviews were conducted among married women of reproductive age (n = 482), their husbands (n = 133), their mothers-in-law (n = 194), their religious leaders (n = 16), and healthcare providers (n = 36) in rural and urban areas in five provinces. Results Bigger family size was generally considered as desirable for emotional, economic and social well-being. The majority endorsed contraception. However, some religious scholars and their followers argued that contraception is a sinful act in Islam by interpreting contraception as equivalent to infanticide and suppression of the increase of the Muslim population. Healthcare providers attempted to disseminate health benefits of modern contraception on a family basis. However, fear of various side effects and doubts about their effectiveness due to irregular supply were prevalent in communities. Discussion It is important to increase awareness on the health benefits of appropriate birth spacing at community level. Public health campaigns supported by Islamic religious scholars and a system that ensures appropriate counselling and a steady supply of contraceptives are likely to increase contraceptive utilization.
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Affiliation(s)
- Hemat Shafiqullah
- Health Promotion, Ministry of Public Health, Afghanistan.,Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayako Morita
- Department of Global Health Promotion, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan
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Baqui AH, Ahmed S, Begum N, Khanam R, Mohan D, Harrison M, Al Kabir A, McKaig C, Brandes N, Norton M, Ahmed S. Impact of integrating a postpartum family planning program into a community-based maternal and newborn health program on birth spacing and preterm birth in rural Bangladesh. J Glob Health 2018; 8:020406. [PMID: 30023053 PMCID: PMC6036944 DOI: 10.7189/jogh.08.020406] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Short birth intervals are associated with an increased risk of adverse perinatal outcomes. However, reduction of rates of short birth intervals is challenging in low-resource settings where majority of the women deliver at home with limited access to family planning services immediately after delivery. This study examines the feasibility of integrating a post-partum family planning intervention package within a community-based maternal and newborn health intervention package, and evaluates the impact of integration on reduction of rates of short birth intervals and preterm births. Methods In a quasi-experimental trial design, unions with an average population of about 25 000 and a first level health facility were allocated to an intervention arm (n = 4) to receive integrated post-partum family planning and maternal and newborn health (PPFP-MNH) interventions, or to a control arm (n = 4) to receive the MNH interventions only. Trained community health workers were the primary outreach service providers in both study arms. The primary outcomes of interest were birth spacing and preterm births. We also examined if there were any unintended consequences of integration. Results At baseline, short birth intervals of less than 24 months and preterm birth rates were similar among women in the intervention and control arms. Integrating PPFP into the MNH intervention package did not negatively influence maternal and neonatal outcomes; during the intervention period, there was no difference in community health workers’ home visit coverage or neonatal care practices between the two study arms. Compared to the control arm, women in the intervention arm had a 19% lower risk of short birth interval (adjusted relative risk (RR) = 0.81, 95% confidence interval (CI) = 0.69-0.95) and 21% lower risk of preterm birth (adjusted RR = 0.79; 95% CI = 0.63-0.99). Conclusions Study findings demonstrate the feasibility and effectiveness of integrating PPFP interventions into a community based MNH intervention package. Thus, MNH programs should consider systematically integrating PPFP as a service component to improve pregnancy spacing and reduce the risk of preterm birth.
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Affiliation(s)
- Abdullah H Baqui
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Nazma Begum
- Johns Hopkins University-Bangladesh, Dhaka, Bangladesh
| | - Rasheda Khanam
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Diwakar Mohan
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Meagan Harrison
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ahmed Al Kabir
- Research, Training and Management (RTM) International, Dhaka, Bangladesh
| | | | - Neal Brandes
- US Agency for International Development, Washington, D.C., USA
| | - Maureen Norton
- US Agency for International Development, Washington, D.C., USA
| | - Saifuddin Ahmed
- Department of Population, Family and reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Abstract
The negative relationship between birth interval length and neonatal mortality risks is well documented, but heterogeneity in this relationship has been largely ignored. Using the Bangladesh Maternal Mortality and Health Care Survey 2010, this study investigates how the effect of birth interval length on neonatal mortality risks varies by maternal age at birth and maternal education. There is significant variation in the effect of interval length on neonatal mortality along these dimensions. Young mothers and those with little education, both of which make up a large share of the Bangladeshi population, can disproportionately benefit from longer intervals. Because these results were obtained from within-family models, they are not due to unobservable heterogeneity between mothers. Targeting women with these characteristics may lead to significant improvements in neonatal mortality rates, but there are significant challenges in reaching them.
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von Dadelszen P, Magee LA. Strategies to reduce the global burden of direct maternal deaths. Obstet Med 2017; 10:5-9. [PMID: 28491124 DOI: 10.1177/1753495x16686287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 11/28/2016] [Indexed: 12/14/2022] Open
Abstract
The leading direct causes of the estimated 196 maternal deaths per 100,000 live births globally are postpartum haemorrhage, the hypertensive disorders of pregnancy, obstructed labour, unsafe abortion and obstetric sepsis. Of the Sustainable Development Goals, one (Sustainable Development Goal 3.1) specifically addresses maternal mortality; by 2030, the goal is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. Eleven other Sustainable Development Goals provide opportunities to intervene. Unapologetically, this review focusses the reader's attention on health advocacy and its central role in altering the risks that many of the world's women face from direct obstetric causes of mortality. Hard work to alter social determinants of health and health outcomes remains. That work needs to start today to improve the health and social equality of today's girls who will be the women delivering their babies in 2030.
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Affiliation(s)
- Peter von Dadelszen
- Molecular and Clinical Sciences Research Institute, St George's, University of London, UK.,Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK
| | - Laura A Magee
- Molecular and Clinical Sciences Research Institute, St George's, University of London, UK.,Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK
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Kujala S, Waiswa P, Kadobera D, Akuze J, Pariyo G, Hanson C. Trends and risk factors of stillbirths and neonatal deaths in Eastern Uganda (1982-2011): a cross-sectional, population-based study. Trop Med Int Health 2016; 22:63-73. [PMID: 27910181 DOI: 10.1111/tmi.12807] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To identify mortality trends and risk factors associated with stillbirths and neonatal deaths 1982-2011. METHODS Population-based cross-sectional study based on reported pregnancy history in Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) in Uganda. A pregnancy history survey was conducted among women aged 15-49 years living in the HDSS during May-July 2011 (n = 10 540). Time trends were analysed with cubic splines and linear regression. Potential risk factors were examined with multilevel logistic regression with adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULTS 34 073 births from 1982 to 2011 were analysed. The annual rate of decrease was 0.9% for stillbirths and 1.8% for neonatal mortality. Stillbirths were associated with several risk factors: multiple births (AOR 2.57, CI 1.66-3.99), previous adverse outcome (AOR 6.16, CI 4.26-8.88) and grand multiparity among 35- to 49-year-olds (AOR 1.97, CI 1.32-2.89). Neonatal deaths were associated with multiple births (AOR 6.16, CI 4.80-7.92) and advanced maternal age linked with parity of 1-4 (AOR 2.34, CI 1.28-4.25) and grand multiparity (AOR 1.44, CI 1.09-1.90). Education, marital status and household wealth were not associated with the outcomes. CONCLUSIONS The slow decline in mortality rates and easily identifiable risk factors calls for improving quality of care at birth and a rethinking of how to address obstetric risks, potentially a revival of the risk approach in antenatal care.
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Affiliation(s)
- Sanni Kujala
- Department of Public Health Sciences - Global Health, Karolinska Institutet, Stockholm, Sweden
| | - Peter Waiswa
- Department of Public Health Sciences - Global Health, Karolinska Institutet, Stockholm, Sweden.,Maternal and Newborn Centre of Excellence, Makerere University School of Public Health, Kampala, Uganda.,The INDEPTH Network Maternal and Newborn Working Group, Iganga-Mayuge Health and Demographic Surveillance Site, Iganga, Uganda
| | - Daniel Kadobera
- The INDEPTH Network Maternal and Newborn Working Group, Iganga-Mayuge Health and Demographic Surveillance Site, Iganga, Uganda.,Mental Health Program, Clinical Services Division, Ministry of Health, Kampala, Uganda
| | - Joseph Akuze
- Maternal and Newborn Centre of Excellence, Makerere University School of Public Health, Kampala, Uganda
| | - George Pariyo
- The INDEPTH Network Maternal and Newborn Working Group, Iganga-Mayuge Health and Demographic Surveillance Site, Iganga, Uganda.,Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Claudia Hanson
- Department of Public Health Sciences - Global Health, Karolinska Institutet, Stockholm, Sweden.,Faculty of Infectious & Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK
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von Dadelszen P, Magee LA. Preventing deaths due to the hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 36:83-102. [PMID: 27531686 PMCID: PMC5096310 DOI: 10.1016/j.bpobgyn.2016.05.005] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/25/2016] [Accepted: 05/29/2016] [Indexed: 02/08/2023]
Abstract
In this chapter, taking a life cycle and both civil society and medically oriented approach, we will discuss the contribution of the hypertensive disorders of pregnancy (HDPs) to maternal, perinatal and newborn mortality and morbidity. Here we review various interventions and approaches to preventing deaths due to HDPs and discuss effectiveness, resource needs and long-term sustainability of the different approaches. Societal approaches, addressing sustainable development goals (SDGs) 2.2 (malnutrition), 3.7 (access to sexual and reproductive care), 3.8 (universal health coverage) and 3c (health workforce strengthening), are required to achieve SDGs 3.1 (maternal survival), 3.2 (perinatal survival) and 3.4 (reduced impact of non-communicable diseases (NCDs)). Medical solutions require greater clarity around the classification of the HDPs, increased frequency of effective antenatal visits, mandatory responses to the HDPs when encountered, prompt provision of life-saving interventions and sustained surveillance for NCD risk for women with a history of the HDPs.
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Affiliation(s)
- Peter von Dadelszen
- Institute of Cardiovascular and Cell Sciences, St George's University of London, UK; Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Laura A Magee
- Institute of Cardiovascular and Cell Sciences, St George's University of London, UK; Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
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