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Fajolu IB, Dedeke IOF, Oluwasola TA, Oyeneyin L, Imam Z, Ogundare E, Campbell I, Akinkunmi B, Ayegbusi EO, Agelebe E, Adefemi AK, Awonuga D, Jagun O, Salau Q, Kuti B, Tongo OO, Adebayo T, Adebanjo-Aina D, Adenuga E, Adewumi I, Lavin T, Tukur J, Adesina O. Determinants and outcomes of preterm births in Nigerian tertiary facilities. BJOG 2024; 131 Suppl 3:30-41. [PMID: 38817153 DOI: 10.1111/1471-0528.17869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/18/2024] [Accepted: 05/01/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To describe the incidence, and sociodemographic and clinical factors associated with preterm birth and perinatal mortality in Nigeria. DESIGN Secondary analysis of data collected through the Maternal Perinatal Database for Quality, Equity and Dignity (MPD-4-QED) Programme. SETTING Data from births in 54 referral-level hospitals across Nigeria between 1 September 2019 and 31 August 2020. POPULATION A total of 69 698 births. METHODS Multilevel modelling was used to determine the factors associated with preterm birth and perinatal mortality. OUTCOME MEASURES Preterm birth and preterm perinatal mortality. RESULTS Of 62 383 live births, 9547 were preterm (153 per 1000 live births). Maternal age (<20 years - adjusted odds ratio [aOR] 1.52, 95% CI 1.36-1.71; >35 years - aOR 1.23, 95% CI 1.16-1.30), no formal education (aOR 1.68, 95% CI 1.54-1.84), partner not gainfully employed (aOR 1.94, 95% CI 1.61-2.34) and no antenatal care (aOR 2.62, 95% CI 2.42-2.84) were associated with preterm births. Early neonatal mortality for preterm neonates was 47.2 per 1000 preterm live births (451/9547). Father's occupation (manual labour aOR 1.52, 95% CI 1.20-1.93), hypertensive disorders of pregnancy (aOR 1.37, 95% CI 1.02-1.83), no antenatal care (aOR 2.74, 95% CI 2.04-3.67), earlier gestation (28 to <32 weeks - aOR 2.94, 95% CI 2.15-4.10; 32 to <34 weeks - aOR 1.80, 95% CI 1.3-2.44) and birthweight <1000 g (aOR 21.35, 95% CI 12.54-36.33) were associated with preterm perinatal mortality. CONCLUSIONS Preterm birth and perinatal mortality in Nigeria are high. Efforts should be made to enhance access to quality health care during pregnancy, delivery and the neonatal period, and improve the parental socio-economic status.
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Affiliation(s)
- Iretiola Bamikeolu Fajolu
- Department of Paediatrics, Lagos University Teaching Hospital & College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | | | - Timothy A Oluwasola
- Department of Obstetrics and Gynaecology, University College Hospital & College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Lawal Oyeneyin
- Department of Obstetrics and Gynaecology, University of Medical Sciences Teaching Hospital, Ondo, Ondo State, Nigeria
| | - Zainab Imam
- Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Ezra Ogundare
- Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Ibijoke Campbell
- Department of Paediatrics, Adeoyo Maternity Teaching Hospital, Ibadan, Oyo State, Nigeria
| | - Bola Akinkunmi
- Department of Paediatrics, University of Medical Sciences Teaching Hospital, Akure, Ondo State, Nigeria
| | - Ekundayo O Ayegbusi
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex & Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
| | - Efeturi Agelebe
- Department of Paediatrics, Bowen University Teaching Hospital, Ogbomosho, Ondo State, Nigeria
| | - Ayodeji K Adefemi
- Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - David Awonuga
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Abeokuta, Ogun State, Nigeria
| | - Olusoji Jagun
- Department of Obstetrics and Gynaecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Qasim Salau
- Department of Paediatrics, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Bankole Kuti
- Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Osun State, Nigeria
| | | | - Tajudeen Adebayo
- Department of Health Information Management, Federal Medical Centre, Owo, Ondo state, Nigeria
| | - Damilola Adebanjo-Aina
- Department of Health Information Management, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Emmanuel Adenuga
- Department of Health Information Management, Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria
| | - Idowu Adewumi
- Department of Health Information Management, University of Medical Sciences, Ondo, Ondo State, Nigeria
| | - Tina Lavin
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Jamilu Tukur
- Department of Ostetrics and Gynaecology, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Olubukola Adesina
- Department of Obstetrics and Gynaecology, University College Hospital & College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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Brown K, Cotaru C, Binks M. A retrospective, longitudinal cohort study of trends and risk factors for preterm birth in the Northern Territory, Australia. BMC Pregnancy Childbirth 2024; 24:33. [PMID: 38182975 PMCID: PMC10768210 DOI: 10.1186/s12884-023-06164-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 11/29/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Preterm birth (PTB) is the single most important cause of perinatal mortality and morbidity in high income countries. In Australia, 8.6% of babies are born preterm but substantial variability exists between States and Territories. Previous reports suggest PTB rates are highest in the Northern Territory (NT), but comprehensive analysis of trends and risk factors are lacking in this region. The objective of this study was to characterise temporal trends in PTB among First Nations and non-First Nations mothers in the Top End of the NT over a 10-year period and to identify perinatal factors associated with the risk of PTB. METHODS This was a retrospective population-based cohort study of all births in the Top End of the NT over the 10-year period from January 1st, 2008, to December 31st, 2017. We described maternal characteristics, obstetric complications, birth characteristics and annual trends in PTB. The association between the characteristics and the risk of PTB was determined using univariate and multivariate generalised linear models producing crude risk ratios (cRR) and adjusted risk ratios (aRR). Data were analysed overall, in First Nations and non-First Nations women. RESULTS During the decade ending in 2017, annual rates of PTB in the Top End of the NT remained consistently close to 10% of all live births. However, First Nations women experienced more than twice the risk of PTB (16%) compared to other women (7%). Leading risk factors for PTB among First Nations women as compared to other women included premature rupture of membranes (RR 12.33; 95% CI 11.78, 12.90), multiple pregnancy (RR 7.24; 95% CI 6.68, 7.83), antepartum haemorrhage (RR 4.36; 95% CI 3.93, 4.84) and pre-existing diabetes (RR 4.18; 95% CI 3.67, 4.76). CONCLUSIONS First Nations women experience some of the highest PTB rates globally. Addressing specific pregnancy complications provides avenues for intervention, but the story is complex and deeper exploration is warranted. A holistic approach that also acknowledges the influence of socio-demographic influences, such as remote dwelling and disadvantage on disease burden, will be required to improve perinatal outcomes.
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Affiliation(s)
- Kiarna Brown
- Menzies School of Health Research, Royal Darwin Hospital, Building 58, John Matthews Building, Tiwi, NT, 0810, Australia.
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT, Australia.
| | - Carina Cotaru
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Michael Binks
- Menzies School of Health Research, Royal Darwin Hospital, Building 58, John Matthews Building, Tiwi, NT, 0810, Australia
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Belay DG, Alemu MB, Aragaw FM, Asratie MH. Time to initiation of antenatal care visit and its predictors among reproductive age women in Ethiopia: Gompertz inverse Gaussian shared frailty model. Front Glob Womens Health 2023; 4:917895. [PMID: 37854167 PMCID: PMC10579888 DOI: 10.3389/fgwh.2023.917895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/20/2023] [Indexed: 10/20/2023] Open
Abstract
Background Early initiation of antenatal care (ANC) is essential for the early detection of pregnancy-related problems and unfavorable pregnancy outcomes. However, a significant number of mothers do not initiate ANC at the recommended time. Therefore, this study aimed to determine the median time of ANC initiation and its predictors among reproductive-age women in Ethiopia. Methods We used the Ethiopian Demographic and Health Survey (EDHS) 2016 data set. The proportional hazard assumption was assessed using Schoenfeld residual test and log-log plot. A life table was used to determine the median survival time (time of ANC initiation). The Gompertz inverse Gaussian shared frailty model was the best-fitting model for identifying the predictors for the early initiation of ANC booking. Finally, the adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was used to determine the significance of predictors. Results A total of 7,501 reproductive-aged women gave recent birth in the last 5 years preceding the survey. Nearly three in five women [61.95% (95% CI: 60.85-63.04%)] booked their first ANC visit with a median time of 4.4 months. Women who attended primary education (AHR = 1.10, 95% CI: 1.01-1.20), secondary and above (AHR = 1.26, 95% CI: 1.11-1.44), media exposure (AHR = 1.07, 95% CI: 1.00-1.16), rich wealthy (AHR = 1.17, 95% CI: 1.06-1.30), grand multiparous (AHR = 0.82, 95% CI: 0.72-0.93), unwanted pregnancy (AHR = 0.88, 95% CI: 0.81-0.96), small periphery region (AHR = 0.58, 95% CI: 0.51-0.67), and rural residence (AHR = 0.86, 95% CI: 0.75-0.99) were significantly associated with first ANC visit. Conclusion According to this study, a significant number of women missed their first ANC visit. The education status of women, place of residence, region, wealth index, media exposure, unintended pregnancy, and multi-parity were significantly associated with the time of initiation of the first ANC visit. Therefore, policymakers should focus on improving the socioeconomic status (education, media coverage, and wealth) of reproductive-aged women by prioritizing women who live in small periphery regions and rural residences to improve the early initiation of ANC.
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Affiliation(s)
- Daniel Gashaneh Belay
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Birhanu Alemu
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Hunie Asratie
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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McHugh L, Regan AK, Sarna M, Moore HC, Van Buynder P, Pereira G, Blyth CC, Lust K, Andrews RM, Crooks K, Massey P, Binks MJ. Inequity of antenatal influenza and pertussis vaccine coverage in Australia: the Links2HealthierBubs record linkage cohort study, 2012-2017. BMC Pregnancy Childbirth 2023; 23:314. [PMID: 37150828 PMCID: PMC10164451 DOI: 10.1186/s12884-023-05574-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Pregnancy and early infancy are increased risk periods for severe adverse effects of respiratory infections. Aboriginal and/or Torres Strait Islander (respectfully referred to as First Nations) women and children in Australia bear a disproportionately higher burden of respiratory diseases compared to non-Indigenous women and infants. Influenza vaccines and whooping cough (pertussis) vaccines are recommended and free in every Australian pregnancy to combat these infections. We aimed to assess the equity of influenza and/or pertussis vaccination in pregnancy for three priority groups in Australia: First Nations women; women from culturally and linguistically diverse (CALD) backgrounds; and women living in remote areas or socio-economic disadvantage. METHODS We conducted individual record linkage of Perinatal Data Collections with immunisation registers/databases between 2012 and 2017. Analysis included generalised linear mixed model, log-binomial regression with a random intercept for the unique maternal identifier to account for clustering, presented as prevalence ratios (PR) and 95% compatibility intervals (95%CI). RESULTS There were 445,590 individual women in the final cohort. Compared with other Australian women (n = 322,848), First Nations women (n = 29,181) were less likely to have received both recommended antenatal vaccines (PR 0.69, 95% CI 0.67-0.71) whereas women from CALD backgrounds (n = 93,561) were more likely to have (PR 1.16, 95% CI 1.10-1.13). Women living in remote areas were less likely to have received both vaccines (PR 0.75, 95% CI 0.72-0.78), and women living in the highest areas of advantage were more likely to have received both vaccines (PR 1.44, 95% CI 1.40-1.48). CONCLUSIONS Compared to other groups, First Nations Australian families, those living in remote areas and/or families from lower socio-economic backgrounds did not receive recommended vaccinations during pregnancy that are the benchmark of equitable healthcare. Addressing these barriers must remain a core priority for Australian health care systems and vaccine providers. An extension of this cohort is necessary to reassess these study findings.
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Affiliation(s)
- Lisa McHugh
- School of Public Health, Division of Medicine, University of Queensland, Brisbane, Qld, 4001, Australia.
| | - Annette K Regan
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Hannah C Moore
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Paul Van Buynder
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- enAble Institute, Curtin University, Perth, WA, Australia
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Christopher C Blyth
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
- School of Medicine, The University of Western Australia, Perth, WA, Australia
- Department of Paediatric Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Perth, WA, Australia
| | - Karin Lust
- Women's and Newborn Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Department of Medicine, The University of Queensland, Brisbane Queensland, Australia
| | - Ross M Andrews
- Australian National University Canberra, Canberra, Australia
| | - Kristy Crooks
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Peter Massey
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Michael J Binks
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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5
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Zhang B, Mi B, Liu D, Liu H, Wang Y, Shi G, Jing H, Kang Y, Yang J, Dang S, Yan H. Association of maternity formula supplementation during pregnancy with small for gestational age birth in Chinese newborns. Nutrition 2023; 105:111856. [PMID: 36334530 DOI: 10.1016/j.nut.2022.111856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study aimed to explore the association between maternity formula supplementation and small for gestational age (SGA) status in Chinese newborns. METHODS Data were from a population-based cross-sectional survey conducted in Shaanxi, Northwest China between August and December 2013. A total of 27 780 women pregnant with singletons and 356 with twins were included in this survey. Information on use of maternity formulas fortified with vitamins, folic acid, pantothenic acid, calcium, iron, zinc, and docosahexaenoic acid (DHA) was collected. SGA was defined as birthweight <10th percentile of fetal growth. Generalized linear models and estimating equation models were used to estimate crude odds ratios (ORs) or adjusted ORs with 95% confidence intervals (CIs) for SGA. RESULTS The rate of maternity formula supplementation during the entire pregnancy was 13.0% in the overall population. There was no significant association between maternal formula supplementation during pregnancy and the risk of total SGA birth (OR: 1.00; 95% CI, 0.90-1.11; P = 0.950). However, maternity formula supplementation during pregnancy was related to a lower risk of SGA for twins (OR: 0.49; 95% CI, 0.31-0.80; P = 0.004), twin A (OR: 0.50; 95% CI, 0.25-0.98; P = 0.045), and twin B (OR: 0.48; 95% CI, 0.25-0.95; P = 0.034). Furthermore, maternity formula supplementation during the first trimester was inversely associated with the risk of SGA birth of twins (OR: 0.32; 95% CI, 0.15-0.65; P = 0.002). CONCLUSIONS No significant association was observed between maternity formula supplementation and total SGA birth. However, women supplemented with maternal formula during pregnancy, especially during the first trimester, may have a reduced risk of SGA birth of twins.
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Affiliation(s)
- Binyan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Baibing Mi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Danmeng Liu
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Huimeng Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Yutong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Guoshuai Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Hui Jing
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Yijun Kang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Jiaomei Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Shaonong Dang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
| | - Hong Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
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Subedi S, Hazel EA, Mohan D, Zeger S, Mullany LC, Tielsch JM, Khatry SK, LeClerq SC, Black RE, Katz J. Prevalence and predictors of spontaneous preterm births in Nepal: findings from a prospective, population-based pregnancy cohort in rural Nepal-a secondary data analysis. BMJ Open 2022; 12:e066934. [PMID: 36456014 PMCID: PMC9716942 DOI: 10.1136/bmjopen-2022-066934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Preterm birth can have short-term and long-term complications for a child. Socioeconomic factors and pregnancy-related morbidities may be important to predict and prevent preterm births in low-resource settings. The objective of our study was to find prevalence and predictors of spontaneous preterm birth in rural Nepal. DESIGN This is a secondary observational analysis of trial data (registration number NCT01177111). SETTING Rural Sarlahi district, Nepal. PARTICIPANTS 40 119 pregnant women enrolled from 9 September 2010 to 16 January 2017. OUTCOME MEASURES The outcome variable is spontaneous preterm birth. Generalized Estimating Equations Poisson regression with robust variance was fitted to present effect estimates as risk ratios. RESULT The prevalence of spontaneous preterm birth was 14.5% (0.5% non-spontaneous). Characteristics not varying in pregnancy associated with increased risk of preterm birth were maternal age less than 18 years (adjusted risk ratio=1.13, 95% CI: 1.02 to 1.26); being Muslim (1.53, 1.16 to 2.01); first pregnancy (1.15, 1.04 to 1.28); multiple births (4.91, 4.20 to 5.75) and male child (1.10, 1.02 to 1.17). Those associated with decreased risk were maternal education >5 years (0.81, 0.73 to 0.90); maternal height ≥150 cm (0.89, 0.81 to 0.98) and being from wealthier families (0.83, 0.74 to 0.93). Pregnancy-related morbidities associated with increased risk of preterm birth were vaginal bleeding (1.53, 1.08 to 2.18); swelling (1.37, 1.17 to 1.60); high systolic blood pressure (BP) (1.47, 1.08 to 2.01) and high diastolic BP (1.41, 1.17 to 1.70) in the third trimester. Those associated with decreased risk were respiratory problem in the third trimester (0.86, 0.79 to 0.94); having poor appetite, nausea and vomiting in the second trimester (0.86, 0.80 to 0.92) and third trimester (0.86, 0.79 to 0.94); and higher weight gain from second to third trimester (0.89, 0.87 to 0.90). CONCLUSION The prevalence of preterm birth is high in rural Nepal. Interventions that increase maternal education may play a role. Monitoring morbidities during antenatal care to intervene to reduce them through an effective health system may help reduce preterm birth.
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Affiliation(s)
- Seema Subedi
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project Sarlahi, Kathmandu, Nepal
| | - Elizabeth A Hazel
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Scott Zeger
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Luke C Mullany
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - James M Tielsch
- Department of Global Health, George Washington University School of Public Health and Health Services, Washington, District of Columbia, USA
| | | | - Steven C LeClerq
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project Sarlahi, Kathmandu, Nepal
| | - Robert E Black
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Kildea S, Roe Y. Utilising the RISE Framework to implement birthing services for First Nations families. Women Birth 2022; 35:521-523. [DOI: 10.1016/j.wombi.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hossain MA, Al Mamun ASM, Aik S, Karim MR, Zeshan MHL, Sabiruzzaman M, Islam MS, Ahmed S, Hossain MG. Preterm delivery and its associated factors among mothers in Bangladesh: survey in Rajshahi district. BMJ Open 2022; 12:e061920. [PMID: 36216425 PMCID: PMC9557306 DOI: 10.1136/bmjopen-2022-061920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Preterm delivery (PD) is a worldwide health burden particularly in low-income and middle-income countries such as Bangladesh. It is a key indicator of neonatal mortality and a risk of morbidity in later life. This study aimed to determine the prevalence of PD and its associated factors among mothers in Northern region of Bangladesh. SETTING AND PARTICIPANTS Multistage sampling technique was used to select samples covering all the population from 9 Upazilas in Rajshahi district with 233 community clinics. A total of 540 mothers and their under-5 children were enrolled for the study. Descriptive statistics, χ2 test and logistic regression model were used to analyse the data. RESULTS Among all live births, the prevalence of PD was found to be 14.6%. Multiple binary logistic regression model suggested five factors of PD: (1) mothers who used contraceptive pill had lower chance of PD (p<0.05); (2) mothers with high fever during pregnancy period were more likely to have PD (p<0.05); (3) mothers who did not receive antenatal care service less than four times during pregnancy period had higher chance of PD (p<0.01); (4) mothers first married before 18 years who were more likely to have PD (p<0.01); (5) PD delivered mothers had more chance to get low birth weight children (p<0.05). In addition, unadjusted model demonstrated that mothers delivered first baby before their age<20 years were more risk to get PD (p<0.05). CONCLUSION Approximately one in seven infants was born preterm in our study area. Family planning method, number of antenatal care visit, mothers' age at marriage and high fever during pregnancy were the most important predictors of PD, these factors could be considered to reduce PD among Bangladeshi mothers. PD risk could be reduced by counselling and encouraging women to take antenatal care facilities from trained health providers.
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Affiliation(s)
- Md Aslam Hossain
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Abu Sayed M Al Mamun
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Saw Aik
- Department of Orthopaedic Surgery, University Malaya Medical Centre, Kuala Lumpur 59100, Malaysia
| | - Md Reazul Karim
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh
| | | | - Md Sabiruzzaman
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Md Shariful Islam
- Department of Public Health, First Capital University of the Bangladesh, Chuadanga 7200, Bangladesh
| | - Sharmin Ahmed
- Specialist, Quality Assurance, Communicable Diseases Program, BRAC, Mohakhali, Dhaka 1212, Bangladesh
| | - Md Golam Hossain
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh
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Hassan AM. Incidence of Preterm Infants, Indications of Admission, Risk Factors, and Discharge Outcome: A Retrospective Study. Open Nurs J 2022. [DOI: 10.2174/18744346-v16-e2203250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Prematurity is still a major cause of neonatal and infant mortality and morbidity.
Aim:
This study aimed to describe the incidence of preterm infants, indications of admission, risk factors, and discharge outcome.
Materials and Methods:
A retrospective, descriptive design was used. A sample of 692 preterm infants admitted to the Neonatal Intensive Care Unit (NICU) was included. A structured sheet was used to gather the necessary data. It involved two parts: characteristics of preterm infants and their mothers and risk factors concerning preterm birth.
Results:
The study found that 49.4% of admitted neonates were preterm; among them, 48.1% died on discharge. Moreover, there were significant relations between the type of gestation (p=0.000), mothers' age (p=0.001), anemia, pregnancy-induced hypertension, preeclampsia, antepartum hemorrhage, premature rupture of membranes, obstructed labor, family history of medical diseases, and mothers' history of medical diseases with preterm infants' gestational age (p=0.01, 0.001, 0.02, 0.01, 0.000, 0.000, 0.000, 0.000, respectively). Moreover, it was observed that higher admission of preterm infants who had respiratory problems, followed by gastrointestinal problems.
Conclusion:
There was a higher prevalence with a higher mortality rate of admitted preterm infants to NICU. Likewise, the type of gestation, mothers' age, presence of complications during pregnancy, bad obstetric history, and family and medical history of diseases were the most common risk factors of prematurity. Moreover, respiratory problems were the main etiology for admission of preterm infants to NICU. Therefore, early screening of diseases and obstetric complications during pregnancy is recommended.
Implications for Nursing Practice:
Providing educational programs for pediatric nurses will increase their level of awareness regarding incidence, indications, risk factors, and discharge outcome of prematurity, thus reducing the rate of mortality and morbidity among preterm infants.
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10
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Dart A. Sociodemographic determinants of chronic kidney disease in Indigenous children. Pediatr Nephrol 2022; 37:547-553. [PMID: 34032921 DOI: 10.1007/s00467-021-05110-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/07/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022]
Abstract
Rates of chronic kidney disease (CKD) are disproportionately increased in Indigenous peoples. The focus has traditionally been on adults, as they experience the highest rates of kidney failure requiring kidney replacement therapy. The impacts of colonization, systemic racism, and sociodemographic marginalization however impact the health of Indigenous peoples across the lifespan. This review presents the social context within which Indigenous children develop and the impact relevant to kidney health across the developmental stages. In utero exposures impact nephron endowment which can manifest in glomerular hyperfiltration and sclerosis as well as an increased risk of congenital anomalies of the kidney and urinary tract. Young children are at increased risk of autoimmune conditions, secondary to infectious and environmental exposures, and are also exposed to the impacts of a Western lifestyle manifesting early onset overweight/obesity. Adolescents begin to manifest more severe metabolic complications such as type 2 diabetes. The impacts of early onset diabetes are associated with aggressive kidney complications and high rates of kidney failure in young adulthood. Finally, the key elements of successful prevention and treatment strategies are discussed including the importance of screening for asymptomatic, modifiable early disease, linked with clinical primary and tertiary care follow-up, and culturally relevant and safe care.
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Affiliation(s)
- Allison Dart
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, Health Sciences Centre, University of Manitoba, CE-208 Children's Hospital, 840 Sherbrook St, Winnipeg, MV, R3A 1S1, Canada. .,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
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11
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Beks H, Walsh SM, Binder MJ, Jones M, Versace VL. Contribution of nurse leaders to rural and remote health research in Australia: A non-systematic scoping review. Collegian 2021. [DOI: 10.1016/j.colegn.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Brown K, Langston-Cox A, Unger HW. A better start to life: Risk factors for, and prevention of, preterm birth in Australian First Nations women - A narrative review. Int J Gynaecol Obstet 2021; 155:260-267. [PMID: 34455588 DOI: 10.1002/ijgo.13907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/05/2021] [Accepted: 08/27/2021] [Indexed: 11/08/2022]
Abstract
The unacceptable discrepancies in health outcomes between First Nations and non-Indigenous Australians begin at birth. Preterm birth (birth before 37 completed weeks of gestation) is a major contributor to adverse short- and long-term health outcomes and mortality. Australian First Nations infants are more commonly born too early. No tangible reductions in preterm births have been made in First Nations communities. Factors contributing to high preterm birth rates in Australian First Nations infants are reviewed and interventions to reduce preterm birth in Australian First Nations women are discussed. More must be done to ensure Australian First Nations infants get a better start to life. This can only be achieved with ongoing and improved research in partnership with Australian First Nations peoples.
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Affiliation(s)
- Kiarna Brown
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Annie Langston-Cox
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Holger W Unger
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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13
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Inkster AM, Fernández-Boyano I, Robinson WP. Sex Differences Are Here to Stay: Relevance to Prenatal Care. J Clin Med 2021; 10:3000. [PMID: 34279482 PMCID: PMC8268816 DOI: 10.3390/jcm10133000] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/02/2021] [Indexed: 12/27/2022] Open
Abstract
Sex differences exist in the incidence and presentation of many pregnancy complications, including but not limited to pregnancy loss, spontaneous preterm birth, and fetal growth restriction. Sex differences arise very early in development due to differential gene expression from the X and Y chromosomes, and later may also be influenced by the action of gonadal steroid hormones. Though offspring sex is not considered in most prenatal diagnostic or therapeutic strategies currently in use, it may be beneficial to consider sex differences and the associated mechanisms underlying pregnancy complications. This review will cover (i) the prevalence and presentation of sex differences that occur in perinatal complications, particularly with a focus on the placenta; (ii) possible mechanisms underlying the development of sex differences in placental function and pregnancy phenotypes; and (iii) knowledge gaps that should be addressed in the development of diagnostic or risk prediction tools for such complications, with an emphasis on those for which it would be important to consider sex.
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Affiliation(s)
- Amy M. Inkster
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada; (A.M.I.); (I.F.-B.)
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Icíar Fernández-Boyano
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada; (A.M.I.); (I.F.-B.)
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Wendy P. Robinson
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada; (A.M.I.); (I.F.-B.)
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada
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14
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Salama E EIAS, Salama HS, Alobaidly SH. Socioeconomic Risk Factors for Preterm Birth in the state of Qatar: A Population-based Study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021186. [PMID: 34212910 PMCID: PMC8343749 DOI: 10.23750/abm.v92i3.11292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
Objectives: To review the demographics and socioeconomic determinants of preterm birth (PTB) compared to term births among the Qatari population. Methods: This was a retrospective data analysis of 59,308 births. Data were retrieved from a Population-based Cohort Study. Data were gathered from the PEARL-Peristat maternal newborn registry for 2011, 2012, 2017, and 2018. We compared the preterm births group (delivery < 37 weeks) with the term group (delivery ≥ 37 weeks) regarding socioeconomic factors, including maternal nationality, religion, level of education, mother’s occupation, family income, housing, consanguinity, early childbearing, high-risk pregnancy, smoking, assisted conception, antenatal care, and place of delivery. Results: The prevalence of preterm birth was 9%. There were more Saudi nations in the preterm group compared to term (33% vs. 28%, p-value < 0.001). There were more preterm births than term births among working mothers (40% vs. 35%), high-risk pregnancies (24% vs. 18%), those that has used assisted conception (18% vs. 3%), those without antenatal care (11% vs. 5.6%), and those delivered in a tertiary women hospital (88.5% vs. 84.5%) (all p-values < 0.001). There were more women living in villas (41% vs. 38%, p = 0.01) and more smokers (0.8% vs. 0.5%, p = 0.030) in the preterm group than in the term group. There were no differences between the two groups regarding religion, level of maternal education, family income, and early childbearing. Conclusion: In our population, we identified several factors associated with preterm births. (www.actabiomedica.it)
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15
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Gardiner FW, Richardson A, Roxburgh C, Gillam M, Churilov L, McCuaig R, Carter S, Arthur C, Wong C, Morton A, Callaway L, Lust K, Davidson SJ, Foxcroft K, Oates K, Zhang L, Jayawardane S, Coleman M, Peek M. Characteristics and in-hospital outcomes of patients requiring aeromedical retrieval for pregnancy, compared to non-retrieved metropolitan cohorts. Aust N Z J Obstet Gynaecol 2021; 61:519-527. [PMID: 33426679 DOI: 10.1111/ajo.13308] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/23/2020] [Accepted: 12/16/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Limited access to obstetrics and gynaecology (O&G) services in rural and remote Australia is believed to contribute to suboptimal birth outcomes. AIMS To describe the characteristics of pregnancy aeromedical transfers, in-hospital outcomes, and patient access to O&G services, as compared to whole of Australia data. MATERIALS AND METHODS We conducted a cohort study of women who required aeromedical retrieval for pregnancy-related issues between the 1 January 2015 and 31 December 2017. RESULTS Hospital outcome data were collected on 2171 (65.2%) mothers and 2438 (100.0%) babies. The leading retrieval reason was threatened preterm labour and delivery (n = 883; 40.7%). Most patients were retrieved from rural and remote areas (n = 2224; 93.0%). Retrieved patients were significantly younger (28.0 vs 30.0 years, 95% CI 27.7-28.3), more likely to be overweight or obese (52.2% vs 45.1%, 95% CI 47.5-56.9) and to have smoked during their pregnancy (14.0% vs 9.9%, 95% CI 12.5-15.5) compared to Australian pregnant women overall. Over one-third of transferred women gave birth by Caesarean section (n = 812; 37.4%); the median gestational age at birth was 33.0 (95% CI 32.7-33.3) weeks. Early gestation is associated with low birth weights (median = 2579.5 g; 95% CI 2536.1-2622.9), neonatal resuscitation (35.4%, 95% CI 33.5-37.3), and special care nursery admission (41.2%, 95% CI 39.3-43.2). There were 42 (1.7%, 95% CI 1.2-2.2) stillbirths, which was significantly higher than seen Australia-wide (n = 6441; 0.7%). CONCLUSION This study found that pregnant women retrieved by the Royal Flying Doctor Service were younger, with higher rates of obesity and smoking.
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Affiliation(s)
- Fergus W Gardiner
- Royal Flying Doctor Service, Canberra, Australian Capital Territory, Australia.,The Rural Clinical School of Western Australia, The University of Western Australia, Albany, Western Australia, Australia
| | - Alice Richardson
- Statistical Consulting Unit, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Carly Roxburgh
- The Rural Clinical School of Western Australia, The University of Western Australia, Albany, Western Australia, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - Leonid Churilov
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Ruth McCuaig
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Sean Carter
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | | | - Cynthia Wong
- Townsville University Hospital, Townsville, Queensland, Australia
| | - Adam Morton
- Mater Health Services Public Hospital, Brisbane, Queensland, Australia
| | - Leonie Callaway
- Royal Brisbane Women`s Hospital, Brisbane, Queensland, Australia
| | - Karin Lust
- Royal Brisbane Women`s Hospital, Brisbane, Queensland, Australia
| | - Sarah J Davidson
- Royal Brisbane Women`s Hospital, Brisbane, Queensland, Australia.,Duke University School of Medicine, Durham, North Carolina, USA
| | - Katie Foxcroft
- Royal Brisbane Women`s Hospital, Brisbane, Queensland, Australia
| | - Kiri Oates
- Dubbo Hospital, Dubbo, New South Wales, Australia
| | - Lucy Zhang
- Dubbo Hospital, Dubbo, New South Wales, Australia
| | | | - Mathew Coleman
- The Rural Clinical School of Western Australia, The University of Western Australia, Albany, Western Australia, Australia
| | - Michael Peek
- Australian National University Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
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16
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Barreto CTG, Tavares FG, Theme-Filha M, Farias YN, Pantoja LDN, Cardoso AM. Baixo peso ao nascer, prematuridade e restrição de crescimento intra-uterino: resultados dos dados de base da primeira coorte de nascimentos indígenas no Brasil (coorte de nascimentos Guarani). BMC Pregnancy Childbirth 2020; 20:748. [PMID: 33267830 PMCID: PMC7709282 DOI: 10.1186/s12884-020-03396-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/04/2020] [Indexed: 12/24/2022] Open
Abstract
ABSTRATO FUNDO: O baixo peso ao nascer (BPN) continua sendo um importante problema de saúde global, associado a uma série de resultados adversos de saúde ao longo da vida. As evidências sugerem que o BPN é um determinante relevante de morbidade e mortalidade em grupos indígenas, que geralmente têm acesso limitado às políticas públicas de saúde e nutrição. O conhecimento da prevalência de BPN e de suas causas subjacentes pode contribuir com etapas essenciais para a prevenção de seus efeitos sobre a saúde. O estudo teve como objetivo estimar as prevalências de BPN, prematuridade e restrição de crescimento intra-uterino (RCIU) e investigar seus determinantes na primeira coorte de nascimentos indígenas no Brasil. MéTODOS: Este estudo transversal utilizou dados de linha de base coletados da primeira coorte de nascimentos indígenas no Brasil, a Coorte de Nascimentos Guarani. O Brasil é um dos países com maior diversidade étnica do mundo, com 305 povos indígenas e 274 línguas nativas. Os Guarani são uma das cinco maiores etnias, com aldeias localizadas principalmente na região sul. Todos os nascimentos únicos de 1º de junho de 2014 a 31 de maio de 2016 foram selecionados em 63 aldeias indígenas Guarani nas regiões Sul e Sudeste. Foi realizada regressão logística múltipla hierárquica. RESULTADOS As taxas de prevalência de BPN, prematuridade e RCIU foram 15,5, 15,6 e 5,7%, respectivamente. As chances de BPN foram menores em recém-nascidos de mães que vivem em casas de tijolo e argamassa (OR: 0,25; IC 95%: 0,07-0,84) e foram maiores em filhos de mães ≤20 anos de idade (OR: 2,4; IC 95%: 1,29-4,44) e com anemia crônica antes da gravidez (OR: 6,41; IC 95%: 1,70-24,16). A prematuridade foi estatisticamente associada ao tipo de fonte de energia para cozinhar (fogão a lenha - OR: 3,87; IC 95%: 1,71-8,78 e fogueiras - OR: 2,57; IC 95%: 1,31-5,01). RCIU foi associado à primiparidade (OR: 4,66; IC 95%: 1,68-12,95) e anemia materna crônica antes da gravidez (OR: 7,21; IC 95%: 1,29-40,38). CONCLUSõES: Idade materna, estado nutricional e paridade, condições de moradia e exposição à poluição interna foram associados com resultados perinatais na população indígena Guarani. Esses resultados indicam a necessidade de investir no acesso e melhoria da assistência pré-natal; também no fortalecimento do Subsistema de Saúde Indígena, e em ações intersetoriais para o desenvolvimento de políticas habitacionais e de saneamento e melhorias ambientais ajustadas às necessidades e conhecimentos dos povos indígenas.
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Affiliation(s)
- Carla Tatiana Garcia Barreto
- Universidade do Estado do Rio de Janeiro (UERJ), Av. Marechal Rondon, 381. São Francisco Xavier, Rio de Janeiro, RJ, CEP: 20950-000, Brazil.
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
| | - Felipe Guimarães Tavares
- Escola de Enfermagem Aurora de Afonso Costa. Faculdade de Enfermagem, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Mariza Theme-Filha
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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Gurung A, Wrammert J, Sunny AK, Gurung R, Rana N, Basaula YN, Paudel P, Pokhrel A, Kc A. Incidence, risk factors and consequences of preterm birth - findings from a multi-centric observational study for 14 months in Nepal. ACTA ACUST UNITED AC 2020; 78:64. [PMID: 32695337 PMCID: PMC7368758 DOI: 10.1186/s13690-020-00446-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/03/2020] [Indexed: 01/02/2023]
Abstract
Background Preterm birth is a worldwide epidemic and a leading cause of neonatal mortality. In this study, we aimed to evaluate the incidence, risk factors and consequences of preterm birth in Nepal. Methods This was an observational study conducted in 12 public hospitals of Nepal. All the babies born during the study period were included in the study. Babies born < 37 weeks of gestation were classified as preterm births. For the association and outcomes for preterm birth, univariate followed by multiple regression analysis was conducted. Results The incidence of preterm was found to be 93 per 1000 live births. Mothers aged less than 20 years (aOR 1.26;1.15–1.39) had a high risk for preterm birth. Similarly, education of the mother was a significant predictor for preterm birth: illiterate mothers (aOR 1.41; 1.22–1.64), literate mothers (aOR 1.21; 1.08–1.35) and mothers having basic level of education (aOR 1.17; 1.07–1.27). Socio-demographic factors such as smoking (aOR 1.13; 1.01–1.26), use of polluted fuel (aOR 1.26; 1.17–1.35) and sex of baby (aOR 1.18; 1.11–1.26); obstetric factors such as nulliparity (aOR 1.33; 1.20–1.48), multiple delivery (aOR 6.63; 5.16–8.52), severe anemia during pregnancy (aOR 3.27; 2.21–4.84), antenatal visit during second trimester (aOR 1.13; 1.05–1.22) and third trimester (aOR 1.24; 1.12–1.38), < 4 antenatal visits during pregnancy (aOR 1.49; 1.38–1.61) were found to be significant risk factors of preterm birth. Preterm has a risk for pre-discharge mortality (10.60; 9.28–12.10). Conclusion In this study, we found high incidence of preterm birth. Various socio-demographic, obstetric and neonatal risk factors were associated with preterm birth. Risk factor modifications and timely interventions will help in the reduction of preterm births and associated mortalities. Trial registration ISRCTN30829654.
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Affiliation(s)
| | - Johan Wrammert
- Department of Women's and Children's Health, Uppsala University, 75237 Uppsala, Sweden
| | | | | | - Netra Rana
- Lumbini Provincial Hospital, Government of Nepal, Butwal, Nepal
| | | | - Prajwal Paudel
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Amrit Pokhrel
- Syangya District Hospital, Government of Nepal, Syangya, Nepal
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, 75237 Uppsala, Sweden
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Newnham JP, White SW, Lee HS, Arrese CA, Watts JC, Pedretti MK, Dickinson JE, Doherty DA. The elements of success in a comprehensive state-wide program to safely reduce the rate of preterm birth. PLoS One 2020; 15:e0234033. [PMID: 32497072 PMCID: PMC7272053 DOI: 10.1371/journal.pone.0234033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background In 2014, a whole-of-population and multi-faceted preterm birth prevention program was introduced in Western Australia with the single aim of safely lowering the rate of preterm birth. The program included new clinical guidelines, print and social media, and a dedicated new clinic. In the first full calendar year the rate of preterm birth fell by 7.6% and the reduction extended from the 28–31 week gestational age group upwards. Objective The objective of this study was to evaluate outcomes in greater depth and to also include the first three years of the program. Study design This was a prospective population-based cohort study of perinatal outcomes in singleton pregnancies before and after commencement of the program. Results There was a significant reduction in preterm birth in the tertiary center which extended from 28 weeks gestation onwards and was ongoing. In non-tertiary centers there was an initial reduction, but this was not sustained past the first year. The greatest reduction was observed in pregnancies classified at first attendance as low risk. No benefit was observed in the private sector, but a significant reduction was seen in the remote region of the Kimberley where the program was first launched and vaginal progesterone had been made free-of-charge. Conclusion Preterm birth rates can be safely reduced by a multi-faceted and whole-of-population program but the effectiveness requires continuing effort and will be greatest where the strategies are most targeted.
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Affiliation(s)
- John P Newnham
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Scott W White
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Han-Shin Lee
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Catherine A Arrese
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Jared C Watts
- Department of Obstetrics and Gynaecology, WA Country Health Service, Kimberley, Western Australia, Australia.,Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
| | - Michelle K Pedretti
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.,Department of Ultrasound, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Jan E Dickinson
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Dorota A Doherty
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
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Hao J, Zhang F, Chen D, Liu Y, Liao L, Shen C, Liu T, Liao J, Ma L. Association between ambient air pollution exposure and infants small for gestational age in Huangshi, China: a cross-sectional study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:32029-32039. [PMID: 31493084 PMCID: PMC6875112 DOI: 10.1007/s11356-019-06268-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/16/2019] [Indexed: 05/05/2023]
Abstract
Small for gestational age (SGA) is defined as intrauterine growth retardation or small sample, referring to the 10th percentile of birth weight lower or two standard deviations less than the average weight at the same gestational age. SGA infants bring great economic and psychological burdens to families and society. The association between exposure to air pollution and SGA in underdeveloped cities with poor air quality remains unclear. Thus, this study is conducted to estimate the effects of maternal exposure to air pollutants on SGA numbers. Birth information was collected from the Huangshi Maternity and Children's Health Hospital from January 1st to December 31st in 2017. Data of pregnancy exposure were accessed using stationary monitors. These data included particulate matter less than or equal to 10 μm in aerodynamic diameter (PM10), particulate matter less than or equal to 2.5 μm in aerodynamic diameter (PM2.5), nitrogen dioxide (NO2), and sulfur dioxide (SO2). Multivariate logistic regression models were performed to estimate the association between ambient air pollution and the risk of SGA during different exposure windows. It was found that a 1 μg/m3 increase in air pollution concentrations during the entire pregnancy was associated with a higher risk of SGA, with an adjusted odds ratio (OR) and 95% confidence interval (CI) of 1.055 (1.035-1.076), 1.084 (1.053-1.116), 1.000 (0.953-1.049), and 1.051 (0.968-1.141) for PM10, PM2.5, NO2, and SO2, respectively. Thus, it is suggested that exposure to air pollution is associated with an increased risk of SGA. The effects of PM10 and PM2.5 were more stable than NO2 and SO2.
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Affiliation(s)
- Jiayuan Hao
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan, 430071, China
| | - Faxue Zhang
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan, 430071, China
| | - Dieyi Chen
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan, 430071, China
| | - Yanyun Liu
- Huangshi Maternity and Children's Health Hospital of Edong Healthcare Group, Huangshi, Hubei Province, China
| | - Lina Liao
- Huangshi Maternity and Children's Health Hospital of Edong Healthcare Group, Huangshi, Hubei Province, China
| | - Cui Shen
- Huangshi Maternity and Children's Health Hospital of Edong Healthcare Group, Huangshi, Hubei Province, China
| | - Tianyu Liu
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan, 430071, China
| | - Jingling Liao
- Department of Public Health, Wuhan University of Science and Technology School of Medicine, Wuhan, China
| | - Lu Ma
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan, 430071, China.
- Global Health Institute, Wuhan University, Wuhan, 430071, China.
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20
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McHugh L, Binks MJ, Gao Y, Andrews RM, Ware RS, Snelling T, Kildea S. Influenza vaccination in pregnancy among a group of remote dwelling Aboriginal and Torres Strait Islander mothers in the Northern Territory: The 1+1 Healthy Start to Life study. ACTA ACUST UNITED AC 2019; 43. [PMID: 31426733 DOI: 10.33321/cdi.2019.43.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Remote-living Aboriginal and Torres Strait Islander women experience a higher burden of influenza infection during pregnancy than any other Australian women. Despite recommendations of inactivated influenza vaccination (IIV) in pregnancy, uptake and safety data are scarce for this population. We examined uptake of IIV in pregnancy and report adverse birth outcomes amongst a predominantly unvaccinated group of remote-living Aboriginal and Torres Strait Islander women from the Northern Territory (NT), using data from the 1+1 Healthy Start to Life study. Data were deterministically linked with the NT Immunisation Register to ascertain IIV exposure in pregnant women during 2003-2006 and 2009-2011 inclusive. Overall, IIV uptake in pregnancy was 3% (n=20/697 pregnancies); 0% (0/414) pre-influenza A(H1N1)pdm09 and 7% (20/293) post-influenza A(H1N1)pdm09 (2009-2011). Vaccine uptake was poor in this cohort and it is unclear at what stage this policy failure occurred. Women with known comorbidities and/or high risk factors were not targeted for vaccination. Much larger study participant numbers are required to validate between group comparisons but there was no clinically nor statistically significant difference in median gestational ages (38 weeks for both groups), mean infant birthweights (3,001 g unvaccinated vs 3,175 g IIV vaccinated), nor birth outcomes between the few women who received IIV in pregnancy and those who did not. There were no stillbirths in women who received an IIV in pregnancy.
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Affiliation(s)
- Lisa McHugh
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Michael J Binks
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Yu Gao
- Mater Midwifery Research Unit - University of Queensland, Women's Health and Newborn Services (Maternity) Mater Health Service; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia; Applied Epidemiology Program, National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Tom Snelling
- Infectious Disease Implementation Research, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Perth Children's Hospital, Perth, Western Australia, Australia; Curtin University, School of Public Health, Perth, Western Australia, Australia
| | - Sue Kildea
- Mater Research Institute - University of Queensland, Women's Health and Newborn Services (Maternity) Mater Health Service; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
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Smith R, Mohapatra L, Hunter M, Evans TJ, Oldmeadow C, Holliday E, Hure A, Attia J. A case for not adjusting birthweight customized standards for ethnicity: observations from a unique Australian cohort. Am J Obstet Gynecol 2019; 220:277.e1-277.e10. [PMID: 30403974 DOI: 10.1016/j.ajog.2018.10.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/24/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Low birthweight is more common in infants of indigenous (Aboriginal and/or Torres Strait Islander) than of White Australian mothers. Controversy exists on whether fetal growth is normally different in different populations. OBJECTIVE We sought to determine the relationships of birthweight, birthweight percentiles, and smoking with perinatal outcomes in indigenous vs nonindigenous infants to determine whether the White infant growth charts could be applied to indigenous infants. STUDY DESIGN Data were analyzed for indigenous status, maternal age and smoking, and perinatal outcomes in 45,754 singleton liveborn infants of at least 20 weeks gestation or 400 g birthweight delivered in New South Wales, Australia, between June 2010 and July 2015. RESULTS Indigenous infants (n=6372; 14%) had a mean birthweight 67 g lower than nonindigenous infants (P<.0001; with adjustment for infant sex and maternal body mass index). Indigenous mean birthweight percentile was 4.2 units lower (P<.0001). Adjustment for maternal age, smoking, body mass index, and infant sex reduced the difference in birthweight/percentiles to nonsignificance (12 g; P=.07). CONCLUSION Disparities exist between indigenous and non-indigenous Australian infants for birthweight, birthweight percentile, and adverse outcome rates. Adjustment for smoking and maternal age removed any significant difference in birthweights and birthweight percentiles for indigenous infants. Our data indicate that birthweight percentiles should not be adjusted for indigenous ethnicity because this normalizes disadvantage; because White and indigenous Australians have diverged for approximately 50,000 years, it is likely that the same conclusions apply to other ethnic groups. The disparities in birthweight percentiles that are associated with smoking will likely perpetuate indigenous disadvantage into the future because low birthweight is linked to the development of chronic noncommunicable disease and poorer educational attainment; similar problems may affect other indigenous populations.
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Barreto CTG, Tavares FG, Theme-Filha M, Cardoso AM. Factors Associated with Low Birth Weight in Indigenous Populations: a systematic review of the world literature. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2019. [DOI: 10.1590/1806-93042019000100002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: we aimed to identify etiological factors for low birth weight (LBW), prematurity and intrauterine growth restriction (IUGR) in the Indigenous Population. Methods: for this systematic review, publications were searched in Medline/PubMed, Scopus, Web of Science, and Lilacs until April 2018. The description in this review was based on the PRISMA guideline (Study protocol CRD42016051145, registered in the Centre for Reviews and Dissemination at University of York). We included original studies that reported any risk factor for one of the outcomes in the Indigenous Population. Two of the authors searched independently for papers and the disagreements were solved by a third reviewer Results: twenty-four studies were identified, most of them were from the USA, Canada and Australia. The factors associated were similar to the ones observed in the non-indigenous including unfavorable obstetric conditions, maternal malnutrition, smoking, and maternal age at the extremes of childbearing age, besides environmental factors, geographic location, and access to health care in indigenous communities. Conclusions: etiologic factors for LBW in Indigenous Population have been receiving little attention, especially in Latin America. The three outcomes showed common causes related to poverty and limited access to healthcare. New studies should ensure explicit criteria for ethnicity, quality on the information about gestational age, and the investigation on contextual and culture-specific variables.
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McHugh L, Andrews R, Leckning B, Snelling T, Binks M. Baseline incidence of adverse birth outcomes and infant influenza and pertussis hospitalisations prior to the introduction of influenza and pertussis vaccination in pregnancy: a data linkage study of 78 382 mother-infant pairs, Northern Territory, Australia, 1994-2015. Epidemiol Infect 2019; 147:e233. [PMID: 31364572 PMCID: PMC6627012 DOI: 10.1017/s0950268819001171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/16/2019] [Accepted: 05/31/2019] [Indexed: 11/18/2022] Open
Abstract
We conducted probabilistic data linkage of three population datasets for the Northern Territory (NT), Australia, to describe the incidence of preterm births, stillbirths, low birthweight and small for gestational age (SGA) per 1000 NT births; and influenza and pertussis hospitalisations per 1 00 000 NT births in infants <7 months of age, in a pre-maternal vaccination era. The Perinatal Trends dataset (1994-2014) formed the cohort of 78 382 births. Aboriginal mother-infant pairs (37%) had disproportionately higher average annual rates (AR) for all adverse birth outcomes compared to their non-Aboriginal counterparts; rate ratios: preterm births 2.2 (AR 142.4 vs. 64.7); stillbirths 2.3 (AR 10.8 vs. 4.6); low birthweight 2.9 (AR 54 vs. 19); and SGA 1.7 (AR 187 vs. 111). Hospitalisation (2000-2015) and Immunisation Register datasets (1994-2015), showed that influenza hospitalisations (n = 53) and rates were 42.3 times higher in Aboriginal infants (AR 254 vs. 6); and that pertussis hospitalisations (n = 37) were 7.1 times higher in Aboriginal infants (AR 142.5 vs. 20.2) compared to non-Aboriginal infants. These baseline data are essential to assess the safety and effectiveness of influenza and pertussis vaccinations in pregnant women from the NT. Remote living Aboriginal women and infants stand to benefit the most from these vaccines.
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Affiliation(s)
- L. McHugh
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - R.M. Andrews
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
- National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - B. Leckning
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - T. Snelling
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
- Curtin University, School of Public Health, Perth, Western Australia
- University of Western Australia Perth, Western Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia
| | - M.J. Binks
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
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Chhea C, Ir P, Sopheab H. Low birth weight of institutional births in Cambodia: Analysis of the Demographic and Health Surveys 2010-2014. PLoS One 2018; 13:e0207021. [PMID: 30408102 PMCID: PMC6224106 DOI: 10.1371/journal.pone.0207021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Low birth weight (LBW), an important risk factor for early childhood mortality and morbidity, is a major public health concern in developing countries including Cambodia. This study examined the prevalence of LBW across provinces in Cambodia and changes over time, and identified the factors associated with such condition. METHODS We used children datasets from Cambodia Demographic and Health Survey (CDHS) 2010 and 2014. There were 3,522 children and 4,991 children in both surveys. Maps illustrating provincial variation in LBW prevalence were constructed. Then, multivariate analyses were conducted to assess factors independently associated with LBW in CDHS 2014. RESULTS LBW prevalence remained stable between 2010 and 2014, at around 7.0% 95% CI: 5.8-8.1). all institutional births, but within significant variation across provinces. Factors independently associated with LBW included mother's no education compared with those whose mothers had secondary or higher education (AOR = 1.6, 95% CI: 1.0-2.6), babies born to mothers with < 4 antenatal care (ANC) visits during the pregnancy compared with those whose mothers had at least 4 ANC visits (AOR = 2.0, 95% CI: 1.5-2.8). Also, first-born babies were at greater risk of LBW compared with second-born babies (AOR = 1.4, 95% CI: 1.0-2.0). CONCLUSION The study points to key sub-populations at greater risk and regions where LBW is particularly prevalent. Programs should target provinces where LBW prevalence remains high. Illiterate women, especially those pregnant for the first time should be the program priority. The current national program policy, which recommends that pregnant women have ≥ 4 ANC visits during pregnancy should be further reinforced and implemented. Program design should consider ways to communicate the importance of making the recommended number of ANC visits among women with no formal education.
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Affiliation(s)
- Chhorvann Chhea
- School of Public Health at the National Institute of Public Health, Tuol Kork District, Phnom Penh, Cambodia
| | - Por Ir
- School of Public Health at the National Institute of Public Health, Tuol Kork District, Phnom Penh, Cambodia
| | - Heng Sopheab
- School of Public Health at the National Institute of Public Health, Tuol Kork District, Phnom Penh, Cambodia
- * E-mail:
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