The outbreak of coronavirus disease in China: Risk perceptions, knowledge, and information sources among prenatal and postnatal women

Maternal mental health concerns during the COVID-19 pandemic in Iran: a content analysis study

BACKGROUND

As crises occur, attention to physical health usually becomes more than mental health, neglecting mental health, especially in some vulnerable groups such as pregnant women and new mothers, can have adverse consequences. Therefore, it is imperative to recognize and comprehend their mental health needs, particularly during critical situations such as the recent COVID-19 pandemic. The aim of this study was to explain the understanding and experience of mental health concerns faced by pregnant and postpartum women during this pandemic.

METHODS

This qualitative study was conducted from March 2021 to November 2021 in Iran. Data were collected using semi-structured in-depth interviews to understand mental health concerns in pregnancy and the postpartum period during the COVID-19 pandemic. Twenty-five purposefully retrieved and participated in the study. Due to the prevalence of coronavirus, most of the participants preferred tele interviews. When data saturation was achieved, the data were codified manually and analyzed using Graneheim and Lundman's approach 2004.

RESULTS

Based on the content analysis of the interviews, 2 main themes, 8 categories 23 subcategories were identified. The identified themes were as follows: (1) Maternal mental health threats and (2) Inadequate access to the required information.

CONCLUSION

The results of this study showed that the main concern and fear of pregnant and postpartum women in the COVID-19 pandemic was the fear of the possibility of death for themselves and/or their fetus/infant. The knowledge that was obtained from the understanding of pregnant women and new mothers about the mental health concerns during the COVID-19 pandemic can help managers in planning to improve and promote women's mental health, especially in critical situations.

Anxiety and depression among perinatal women during the long-term normal prevention of COVID-19 pandemic period in China: a cross-sectional study

BACKGROUND

COVID-19 has increased the probability of occurrence of maternal anxiety and depression in pregnant women. However, there is limited research on anxiety and depression among pregnant women during the long-term normal prevention of COVID-19 pandemic period. This study aimed to examine the anxiety and depression and influencing factors among perinatal women during the long-term normal prevention of COVID-19 pandemic period in China.

METHODS

A cross-sectional survey was designed. A total of 1338 pregnant women were studied. The prenatal anxiety and depression were assessed by the Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS), respectively. Postnatal depression was assessed by the Edinburgh Postpartum Depression Scale (EPDS) in 10-14 days after delivery. The data analysis was processed by SPSS9.0. Descriptive analysis was expressed by mean and standard deviation. The counting data were expressed by percentage, χ2 test, multiple linear regression and binary logistic regression.

RESULTS

The incidence of prenatal anxiety (SAS score ≥ 50) was 27.95% (374 cases), prenatal depression (SDS score ≥ 0.5) was 34.01% (455 cases), and postpartum depression (EPDS score ≥ 0.5) was 25.04% (335 cases). Both the prenatal SAS score (r = 0.635, P < 0.001) and prenatal SDS score (r = 0.738, P < 0.001) were related to postpartum depression. Pregnant women who were younger than 35 years, in middle household income, lower education level, underweight before pregnancy, primiparous, and fear of being infected were at increased risk for developing anxiety and depression during the long-term normal prevention of COVID-19 pandemic.

CONCLUSIONS

The incidences of postpartum depression among perinatal women during the long-term normal prevention of COVID-19 pandemic period were a little lower than those during the COVID-19 outbreak period, but still higher than those before the COVID-19.

Global knowledge, attitude, and practice towards COVID-19 among pregnant women: a systematic review and meta-analysis

BACKGROUND

Pregnant women form a specially vulnerable group due to unique changes in pregnancy, leading to a higher risk of getting a severe infection. As severe COVID-19 increases the risk of preeclampsia, preterm delivery, gestational diabetes, and low birth weight in pregnancy, there is a need to enhance pregnant women's knowledge, attitudes, and practices to prevent these complications. This systematic review and meta-analysis aimed to determine their levels of knowledge, attitudes, and practice (KAP) regarding COVID-19 at the global level.

METHODS

The systematic literature search was conducted in the English language, including Google Scholar, Scopus, PubMed/MEDLINE, Science Direct, Web of Science, EMBASE, Springer, and ProQuest, from the occurrence of the pandemic until September 2022. We used The Newcastle Ottawa scale for cross-sectional studies checklist to evaluate the risk of bias in the studies. Data were extracted by a Microsoft Excel spreadsheet and analyzed by STATA software version 14. We also employed Cochran Q statistics to assess the heterogeneity of studies and utilized Inverse variance random-effects models to estimate the pooled level of pregnant women's KAP towards COVID-19 infection prevention.

RESULTS

Based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and inclusion criteria, 53 qualified studies were acquired from several countries. In total, 51 articles (17,319 participants) for knowledge, 15 articles (6,509 participants) for attitudes, and 24 articles (11,032 participants) for practice were included in this meta-analysis. The pooled good knowledge, positive attitude, and appropriate practice in pregnant women were estimated at 59%(95%CI: 52-66%), 57%(95%CI: 42-72%), and 53%(95%CI: 41-65%), respectively. According to subgroup analysis, the level of knowledge, attitude, and practice were 61%(95%CI: 49-72), 52%(95%CI: 30-74), and 50%(95%CI: 39-60), respectively, in Africa, and 58.8%(95%CI: 49.2-68.4), 60%(95%CI: 41-80) and 60% (95%CI: 41-78), respectively, in Asia.

CONCLUSION

The Knowledge, attitude, and practice towards COVID-19 infection prevention in pregnant women were low. It is suggested that health education programs and empowerment of communities, especially pregnant women, about COVID-19 continue with better planning. For future studies, we propose to investigate the KAP of COVID-19 in pregnant women in countries of other continents and geographical regions.

COVID-19-related attitude and risk perception among pregnant women attending antenatal care, and the associated factors, at public health facilities of East Gojjam Zone, Ethiopia, 2020: a multi-center cross-sectional study

Aim

This study aimed to assess COVID-19 (coronavirus disease 2019)-related attitude and risk perception among pregnant women attending antenatal care, and the associated factors, at public health facilities of the East Gojjam Zone, Ethiopia.

Subjects and methods

A multi-center cross-sectional study was conducted, from December 1-30, 2020. A total of 847 pregnant women were included in the study using a simple random sampling technique. To collect the data, we used an interviewer-administered questionnaire. Bi-variable and multi-variable logistic regression analyses were used to identify factors associated with pregnancy-related anxiety. A p-value of < 0.05 with a 95% confidence level was used to declare statistical significance.

Results

The magnitude of COVID-19-related positive attitude and high-level risk perception among pregnant women was 51.12% and 37.2% respectively. Having adequate knowledge [AOR: 2.09, 95% CI = (1.49-2.95)], ≥ 3 ANC visits [AOR: 1.43, 95% CI = 1.0-1.98], and a low level of risk perception [AOR: 6.27, 95% CI = (4.42-8.89)] were factors associated with a positive attitude of pregnant women with regard to the COVID-19 pandemic. Being urban residents [AOR: 2.24, 95% CI: 1.6-3.10], having wanted pregnancy [AOR: 3.35, 95% CI: 1.18-9.49], having a negative attitude [AOR: 6.21, 95% CI: 4.43-8.70], and a complicated pregnancy [AOR: 1.67, 95% CI: 1.02--2.75] were factors significantly associated with risk perception of pregnant women with regard to the COVID-19 pandemic.

Conclusions

Despite its high fatality, COVID-19 pandemic-related attitude and risk perception among pregnant women were low. As a result, health caregivers and other concerned bodies should consider interventions to improve pregnant women's risk perception and attitude during antenatal care and through various community information platforms.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-022-01797-x.

Navigating through motherhood in pregnancy and postpartum periods during the COVID-19 pandemic: A systematic review and qualitative meta-synthesis

AIM

The aim of this work is to critically appraise and synthesize the qualitative studies on the experiences, perspectives, and consequences of pregnant women experiencing motherhood during the COVID-19 pandemic.

BACKGROUND

The COVID-19 pandemic has posed a threat to the health of pregnant women. Such a pandemic disrupted their routine care, as well as normal daily life. However, little is known about their coping strategies to the changes brought by COVID-19.

EVALUATION

A qualitative systematic review was conducted according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist. A meta-aggregative approach rooted in pragmatism and Husserlian transcendental phenomenology was used to synthesize the findings. Dependability and credibility of both study findings and synthesized findings were appraised by Joanna Briggs Institute (JBI) ConQual process.

KEY ISSUES

Key issues include (a) pregnant women experienced changes in routine care, (b) pregnant women used a range of strategies to cope with the consequence of the pandemic, (c) pregnant women struggled to embrace motherhood, and (d) pregnant women received different levels of social support.

CONCLUSION

Facing challenges caused by the pandemic, pregnant women used a variety of strategies to cope with and adapt to the changes, but sometimes the adaption is limited. Emotional, instrumental, and informational support should be provided to them in an accessible way.

IMPLICATIONS FOR NURSING MANAGEMENT

As an essential part of policymakers, nursing managers should consider the balance between restriction and the accessibility of maternity care. It is also crucial for them to consider how to provide necessary support in an accessible way.

The relationship of probable clinical anxiety with attitude-behaviour, coping styles and social support in healthy pregnant women during the late period COVID-19 pandemic

The aim of the study is to investigate the prevalence of state and trait probable clinical anxiety and their relationship with socio-demographic factors, attitude-behaviour, coping styles and social support level in high-risk pregnant women in the late period of COVID-19 pandemic. The pregnant women followed up in the gynaecological outpatient clinic were evaluated during their admissions. About 191 healthy pregnant women were included in the study. Data were collected using the socio-demographic and pregnancy attitude-behaviour data form, STAI (Spielberger's State-Trait Anxiety Inventory), the Coping Styles Scale Brief Form (Brief-COPE) and the Multidimensional Scale of Perceived Social Support (MSPSS). Our study found that pregnant women had high anxiety levels (STAI-S:37.90 ± 8.88; STAI-T:42.46 ± 7.80) and probable clinical anxiety prevalences (STAI-S:81(42.4%); STAI-T:123(64.4%)) in the late period of the COVID-19 pandemic. The fact that COVID-19 determined the preference of the birth method and the level of knowledge about COVID-19 predicted state probable clinical anxiety. Educational status, concern for COVID-19 transmission to the baby during pregnancy/birth, behavioural disengagement, focussing on and venting emotions predicted trait probable clinical anxiety. Our results have emphasised the factors that should be taken into account and coping styles that may be functional to protect the mental well-being of healthy pregnants.IMPACT STATEMENTWhat is already known on this subject? The COVID-19 pandemic has been shown to increase the symptoms of stress, anxiety and depression of the general population and healthcare workers. There is limited studies about pregnant women.What do the results of this study add? According to our study, we can say that approximately half of the pregnant women in a pandemic need psychiatric evaluation due to probable clinical anxiety. The relationship between anxiety in the pandemic process and birth preference has been shown and coping styles in healthy pregnant women have been investigated for the first time, effective and ineffective coping styles have been shown. In addition, it has been found that the social support of pregnant women is effective in managing the pandemic process.What are the implications of these findings for clinical practice and/or further research? According to our current findings, a multidisciplinary approach in which pregnant women are screened with self-report psychiatry tests and appropriate pregnant women are consulted to psychiatry during pandemic processes will make it easier for obstetricians to manage the patient. Especially strengthening effective coping styles and social support will have a great effect in mental rehabilitation. In this respect, further studies on pregnant women are needed.

Anxiety, attitudes-behaviors, coping styles, and social support among high-risk pregnant women in the late period of the coronavirus disease 2019 pandemic

OBJECTIVE

The purpose of this study was to investigate the prevalence of anxiety among high-risk pregnant women in the late period of the coronavirus disease 2019 pandemic and to evaluate the relationship between anxiety levels, attitudes-behaviors, coping styles, and other psychometric parameters.

METHODS

Pregnant women who were followed up in our gynecology outpatient clinic were evaluated during their admissions between November 15, 2020 and February 15, 2021. This cross-sectional study analyzes prospectively collected data from a university hospital. Inclusion criteria were those being at risk of pregnancy and between the age of 18 and 45 years, while exclusion criteria were mental retardation and the presence of serious psychiatric illness. The study included 140 participants. Sociodemographic and pregnant attitudes-behaviors data form, State-Trait Anxiety Inventory, Coping Styles Scale Brief Form (Brief-COPE), and Multidimensional Scale of Perceived Social Support were used to collect data.

RESULTS

Participants had high anxiety levels (State-STAI: 40.32±9.88; Trait-STAI: 42.71±7.32) and high prevalence of probable clinical anxiety [State-STAI: 84 (60.0%); Trait-STAI: 92 (65.7%)]. The fact concerning the transmission of the coronavirus disease 2019 to the baby during pregnancy/birth, extent to which coronavirus disease 2019 pandemic prevents regular pregnancy checkups, and family subgroup-Multidimensional Scale of Perceived Social Support predicted state probable clinical anxiety. Use of disinfectants predicted trait probable clinical anxiety. Employment status predicted state/trait probable clinical anxiety. The existence of trait probable clinical anxiety was significantly associated with behavioral disengagement and substance use which are considered ineffective coping styles. Participants without trait probable clinical anxiety had significantly more adopted positive reinterpretation, one of emotion-focused coping styles.

CONCLUSION

Based on our results, the concern of the transmission of the coronavirus disease 2019 to the babies during pregnancy/birth may be the main factor influencing anxiety among high-risk pregnant women.

The postpartum period during the COVID-19 pandemic: investigating Turkish women's postpartum support and postpartum-specific anxiety

OBJECTIVES

This study aimed to examine how Turkish women were affected by the COVID-19 pandemic in the postpartum period in terms of postpartum support and anxiety variables.

METHODS

The study was conducted with 130 women who gave birth during the COVID-19 period. Data were collected online using a personal information form, Postpartum Support Scale and Postpartum Specific Anxiety Scale. Descriptive statistics were used, with Kruskal-Wallis and regression analysis performed.

RESULTS

All postpartum women stated that they were affected negatively by COVID-19. The most common issues described were feeling alone (25.51%), having economic difficulties (15.5%) and experiencing difficulties accessing health services (21.7%). The mean Postpartum Support Scale score was 102.43 ± 27.67, while the mean Postpartum Specific Anxiety Scale score was 188.07 ± 96.71. COVID-19 exposure level had a significant effect on postpartum-specific anxiety (p=0.00). The variables of having a problem during pregnancy (p=0.006), having a baby willingly (p=0.007), and partner's educational status significantly predicted the degree of being affected by COVID-19 (p=0.025). The degree to which COVID-19 affected the women was determined by having problems during pregnancy, having a baby willingly, and a highly educated partner.

CONCLUSIONS

These variables may inform a resource to empower postpartum women during COVID-19. Healthcare systems need to be organised considering pandemic conditions to provide increased postpartum support, evaluate psychological health, deliver healthcare services, and consider pregnancy periods.

Pregnant during the COVID-19 pandemic: Knowledge, concerns, attitudes and practices of Pakistani women

INTRODUCTION

Data regarding pregnancy and related outcomes with COVID-19 are inconsistent, which leads to difficulties in counselling pregnant women. This brings uncertainty to pregnant women regarding mode of birth, transmission and issues that may occur in case they contract the disease. We conducted this study to assess the knowledge about COVID-19 risk during pregnancy and childbirth and to assess the concerns, attitudes, and practices of pregnant women during the pandemic.

METHODS

A cross-sectional survey was carried out among 376 consenting pregnant women attending antenatal clinics in Karachi, Pakistan, between 1 July and 16 July 2020, using pretested questionnaires.

RESULTS

A total of 376 pregnant women participated in the survey. Participants had inadequate knowledge about COVID-19 risk during pregnancy, including potential vertical transmission (58.5%), preferred route of delivery (52%), safety of breastfeeding (50%), birth defects (44.7%), rooming in and skin-to-skin contact (58.5%). The majority (85.1%) had a high concern score, and negative attitude (62.8%). Only 43.6% said that they would not hide their symptoms, while 37.2% stated that they will deliver at hospital if they tested positive. Only 30.9% of respondents had good practices. During visits, 39.4% maintained social distancing and sanitized hands while only 37.2% said that they did not bring more than one person with them.

CONCLUSIONS

The study population had inadequate knowledge, negative attitude, and poor practices regarding pregnancy during the COVID-19 pandemic. More than half of the respondents thought that concealing symptoms and delivering at home would be better. Awareness programs are urgently needed.

The Influence of Communication on College Students' Self-Other Risk Perceptions of COVID-19: A Comparative Study of China and the United States

This study aimed to explore cross-country differences in the characteristics and determinations of self–other risk perceptions of the COVID-19 pandemic. We distinguished perceived risk to self from perceived risk to others and subdivided risk perceptions into three levels: personal, group, and societal. We focused on the differential impact of multiple communication channels (i.e., interpersonal communication, traditional media exposure, and new media exposure) on risk perceptions at the three levels. A sample of 790 college students completed self-report online questionnaires from May to June 2020, including 498 in China and 292 in the United States. The results showed an “ascending pattern,” revealing that participants perceived higher levels of risk to others than to themselves. In addition, U.S. college students perceived higher risks of COVID-19 than Chinese college students at all levels. As for the relations between communication and risk perceptions, the results revealed that interpersonal communication and traditional media exposure were more effective with Chinese participants, whereas new media exposure was more effective with U.S. participants. Specifically, interpersonal communication was positively associated with risk perceptions at three levels, and the magnitude of the effect was higher in the Chinese group than in the U.S. group. Traditional media exposure increased societal risk perception only for Chinese college students, and new media exposure increased societal risk perception only for U.S. college students. Our findings provide theoretical implications for the characteristics and forming mechanisms of risk perceptions and also provide practical implications for policymakers in the two countries to implement effective measures to foster individuals’ risk perceptions in relation to preventive behaviors.

The impact of COVID-19 during pregnancy on maternal and neonatal outcomes: a systematic review

Several months after the onset of the epidemic, COVID-19 remains a global health issue. Scientific data on pregnancy, perinatal outcomes and vertical transmission of SARS-CoV-2 are constantly emerging but are still limited and unclear. The purpose of this systematic review was to summarize current evidence on vertical transmission rates, maternal, perinatal and neonatal outcomes and mode of delivery in pregnancies affected by COVID-19. An extensive search was conducted in PubMed, Google Scholar, Embase, and Scopus databases up to June 20, 2020. A total of 133 articles (51 case reports, 31 case series, 40 cohort studies and 2 case-control studies) reporting data from 8,092 subjects (6,046 pregnant women and 2,046 neonates) were considered eligible for inclusion in the systematic review. A substantial proportion of pregnant women with COVID-19 underwent caesarean section (case reports 82.2%, case series 74.2% and cohort studies 66.0%). Regarding vertical transmission, most neonates were tested negative (case reports 92.7%, case series studies 84.2%, cohort studies 97.1% and case control studies 100%). Maternal mortality rates ranged from 1% in cohort studies to 5.7% in case reports; neonatal mortality ranged from 2% in case reports to 3.3% in case series. Vertical transmission of SARS-CoV-2 from mother to child is rare. Careful screening of pregnant women seems important and specific guidelines with evidence-based decision algorithms for the mode of delivery in the context of a pregnancy affected by COVID-19 should be established.

Being in the shadow of the unknown - Swedish women's lived experiences of pregnancy during the COVID-19 pandemic, a phenomenological study

Background

The COVID-19 pandemic has had a profound effect on the emotional well-being of expecting mothers. Sweden’s unique strategy for managing COVID-19 involved no national lockdown. Emphasis was instead placed on limiting crowding and asking citizens to practice social distancing measures.

Aim

To gain a deeper understanding of how women not infected by SARS-CoV-2 experienced pregnancy during the COVID-19 pandemic in Sweden.

Methods

This was a qualitative study with a reflective lifeworld approach. Fourteen women that had not contracted COVID-19 and who were pregnant during the first and second wave of the pandemic were interviewed. Data were analysed with a phenomenological reflective lifeworld approach.

Findings

The essence of the women’s experiences of being pregnant during the COVID-19 pandemic was best described as being in the shadow of the unknown, where the COVID-19 pandemic could at times totally overshadow the experience of being pregnant, while at other times, rays of sunlight pierced through the clouds. The experience was characterised by having to deal with the uncertainties caused by the pandemic and feelings of being in an information echo. Women felt socially isolated and had to face maternal check-ups without the support of their partners. There was, however, a strong trust in maternal health-care services despite the lack of information available.

Conclusion

Being in the shadow of the unknown represents the uncertainties posed by the COVID-19 pandemic on the experience of pregnancy. Sufficient information, a companion of choice and screening for emotional well-being are important factors in maternity care during pandemics.

Knowledge, Attitude and Practice Toward Corona virus Infection Among Pregnant Women Attending Antenatal Care at Public Hospitals in Three Wollega Zones, Ethiopia

BACKGROUND

Pregnancy is an immune-suppressed state which makes pregnant women generally more susceptible to COVID-19 infection and severe illness. Extensive precautions have been recommended to avoid exposure to the virus. Knowledge and attitude toward the disease play an integral role in readiness to accept public health measures. This study aimed to assess the knowledge, attitude and practice towards COVID-19 among pregnant women attending antenatal clinics in three Wollega zones, Ethiopia.

METHODS

Institution-based cross-sectional study was employed among 415 pregnant women attending antenatal care at public hospitals in three Wollega zones, Ethiopia from July to August 2020. The data were collected using an interviewer-administered structured questionnaire. The level of knowledge was assessed using 12 multiple choice questions; the score of above or equal to mean was considered as adequate knowledge. Binary logistic regression was performed and the adjusted odds ratio with P-value ≤0.05 at 95% CI was taken as statistically significant.

RESULTS

This study indicates that more than two-thirds (75.4%; 95% CI: 71.1-79.3%) and 43.6% of the pregnant women had adequate knowledge and good practice about the coronavirus pandemic, respectively. The pregnant women who attended secondary school and above and were urban residents were more likely to have good knowledge, AOR = 2.99 (1.7-5.0) and 1.6 (1.2-2.7), respectively. Maternal age ≤ 25 yearsand being an urban resident were the two predictors of good practice of preventive measures, AOR = 1.7 (1.2-2.6) and 2.3 (1.3-4.0), respectively.

CONCLUSIONS AND RECOMMENDATIONS

The target population demonstrated acceptable knowledge and poor practice toward COVID-19. Health-care providers should give more attention to educating pregnant women at any point of contact; legal enforcement should be implemented to improve practice of preventive measures. Special consideration should be given to those who are from rural areas, and to less-educated pregnant women.

The effects of the COVID 19 pandemic on vaccine decisions in pregnant women

Background

Pregnancy is an important time for developing attitudes and beliefs about childhood vaccinations. Vaccinations are among the most effective way of preventing some infectious diseases. Discussions on vaccinations have increased due to the Covid-19 pandemic and there is an opportunity to give society correct information on vaccinations.

Aim

The aim of the study was to determine the opinions of pregnant women on vaccinations in pregnancy and childhood and the effect of the Covid-19 pandemic on these views.

Methods

The study was conducted as a cross-sectional study. The sample included 152 pregnant women. Data were collected through a 25-item online questionnaire created by the researchers.

Results

It was found in our study that 29.6% of pregnant women using forum websites exhibited hesitant attitudes towards vaccinations. The vaccine hesitancy rate was found to be high in pregnant women who said that their economic level was low and who worried about the risks of vaccination. The Covid-19 pandemic was reported to be the cause of a decrease in vaccine hesitancy in 28.9% of the participants.

Conclusion

The events surrounding the pandemic provided an opportunity to explain how pregnant women feel about vaccinations. Providing pregnant women with access to correct information from health workers may reduce the problem of trust, which is among the most important reasons for vaccine hesitancy.

Knowledge About COVID-19 Among Adults in China: Cross-sectional Online Survey

BACKGROUND

A detailed understanding of the public's knowledge and perceptions of COVID-19 could inform governments' public health actions in response to the pandemic.

OBJECTIVE

The aim of this study was to determine the knowledge and perceptions of COVID-19 among adults in China and its variation among provinces and by sociodemographic characteristics.

METHODS

Between May 8 and June 8, 2020, we conducted a cross-sectional online survey among adults in China who were registered with the private survey company KuRunData. We set a target sample size of 10,000 adults, aiming to sample 300-360 adults from each province in China. Participants were asked 25 questions that tested their knowledge about COVID-19, including measures to prevent infection, common symptoms, and recommended care-seeking behavior. We disaggregated responses by age; sex; education; province; household income; rural-urban residency; and whether or not a participant had a family member, friend, or acquaintance who they know to have been infected with SARS-CoV-2. All analyses used survey sampling weights.

RESULTS

There were 5079 men and 4921 women who completed the questionnaire and were included in the analysis. Out of 25 knowledge questions, participants answered a mean and median of 21.4 (95% CI 21.3-21.4) and 22 (IQR 20-23) questions correctly, respectively. A total of 83.4% (95% CI 82.7%-84.1%) of participants answered four-fifths or more of the questions correctly. For at least one of four ineffective prevention measures (using a hand dryer, regular nasal irrigation, gargling mouthwash, and taking antibiotics), 68.9% (95% CI 68.0%-69.8%) of participants answered that it was an effective method to prevent a SARS-CoV-2 infection. Although knowledge overall was similar across provinces, the percent of participants who answered the question on recommended care-seeking behavior correctly varied from 47.0% (95% CI 41.4%-52.7%) in Tibet to 87.5% (95% CI 84.1%-91.0%) in Beijing. Within provinces, participants who were male, were middle-aged, were residing in urban areas, and had higher household income tended to answer a higher proportion of the knowledge questions correctly.

CONCLUSIONS

This online study of individuals across China suggests that the majority of the population has good knowledge of COVID-19. However, a substantial proportion still holds misconceptions or incorrect beliefs about prevention methods and recommended health care-seeking behaviors, especially in rural areas and some less wealthy provinces in Western China. This study can inform the development of tailored public health policies and promotion campaigns by identifying knowledge areas for which misconceptions are comparatively common and provinces that have relatively low knowledge.

A survey of postpartum depression and health care needs among Chinese postpartum women during the pandemic of COVID-19

BACKGROUND

The COVID-19 pandemic seriously endangers the public's mental health, especially to pregnant and postpartum women. But little is known about postpartum depression and health care needs among Chinese postpartum women.

AIM

To investigate the status and risk factors of postpartum depression and health care needs among Chinese postpartum women during the COVID-19 pandemic.

METHODS

In this cross-sectional study, 209 Chinese postpartum women were recruited from May to July 2020 by convenience sampling and assessed online with self-designed Maternal General Information Questionnaire, Edinburgh Postpartum Depression Scale (EPDS) and Chinese Version of the Perceived Stress Scale (CPSS). Descriptive statistics, chi-square test, independent samples t-test, one-way ANOVA, Pearson correlation and multiple linear regression were used for data analysis.

RESULTS

With the EPDS cut-off value of 10, the incidence of postpartum depressive symptoms was 56.9%. Age, history of abortion and perceived stress were the influencing factors of postpartum depression (adjusted R² = 0.432, F = 23.611, p < .001). The top three health care needs were infant rearing guidance (78.0%), maternal and infant protection guidance (60.3%) and dietary guidance (45.0%). The proportion of psychological rehabilitation guidance needs in the depressed group was significantly higher than that in the non-depressed group (34.5% vs. 20.0%, p < .05).

CONCLUSIONS

Maternal postpartum depression in China was at a high level during the COVID-19 pandemic. Women aged 25-34, with a history of abortion and high stress levels were at higher risk for postpartum depression. Timely psychological counselling, intervention and COVID-19-related health education are in great need for postpartum women.

Relationship Between Acute Stress Responses and Quality of Life in Chinese Health Care Workers During the COVID-19 Outbreak

This study aimed to determine the relationship between acute stress and quality of life and explore their influencing factors on health care workers. A descriptive cross-sectional study was conducted, and a sample of 525 health care workers was recruited from 15 hospitals through a convenient sampling method. Participants completed an online self-report questionnaire to assess their acute stress and quality of life. Descriptive and multiple linear regression statistics were used for this analysis. The results regarding acute stress responses varied significantly among the differences in marital status, physical activity, work status, perceived risk of contracting COVID-19, and the expected duration of the pandemic. Moreover, a younger age, lack of physical activity, being a front-line medical staff, and higher acute stress scores indicated a worse quality of life. Healthcare workers’ acute stress was negatively correlated with their quality of life. Therefore, the authorities should pay special attention to health care workers’ mental health and provide them with timely protection during the pandemic.

Perspectives of pregnant women during the COVID-19 pandemic: A qualitative study

Background

The current COVID-19 pandemic has been shown to have profound effects on pregnant women globally, particularly, on their psycho-social wellbeing. Despite this, there has been limited qualitative inquiry into the experiences of pregnant women during the pandemic.

Aim

This original research aimed to study the perspectives of pregnant women in Australia in relation to the impact of the COVID-19 pandemic on their pregnancy experience.

Methods

A qualitative descriptive study design with semi-structured interviews was adopted. The study was performed in Melbourne, Australia. A total of fifteen interviews were conducted. Data was analysed thematically to develop major themes and subthemes.

Results

A total of four major themes were developed: support for a positive experience, impact on preparedness in pregnancy and beyond, facing uncertainty of a pandemic, and retaining resilience and optimism.

Conclusions

The COVID-19 pandemic has affected the experience of pregnant women with potential to compromise their psycho-social wellbeing. The major themes identified in this study offer insight to organisations to develop woman-centred care during the pandemic and optimise the psycho-social wellbeing of pregnant women.

The prevalence and risk factors of depression in prenatal and postnatal women in China with the outbreak of Corona Virus Disease 2019

BACKGROUND

The prevalence of depression increase with the outbreaks of epidemic disease. The prevalence of depression during the outbreak of Corona Virus Disease 2019 (COVID-19) in prenatal and postnatal women was examined in China.

METHODS

2201 prenatal and postnatal women in mainland China were recruited in this cross-sectional study from February 28^th to April 26^th, 2020. The Patient Health Questionnaire (PHQ-9) was used to assess depression in prenatal and postnatal women.

RESULTS

The prevalence rate of depression was 35.4%. The risk factors for depression included drinking (p = 0.04; adjusted OR = 2.81, 95%CI: 1.26~6.24), nausea and vomiting during pregnancy (p < 0.001; adjusted OR = 3.54, 95%CI: 1.10~11.44), pregnancy's influence on mobility (p = 0.02; adjusted OR = 1.42, 95%CI: 1.11~1.83), anxiety (p < 0.001; adjusted OR = 1.66, 95%CI: 1.57~1.75), insomnia (p < 0.001; adjusted OR = 1.17, 95%CI: 1.14~1.21) and daily attention to fetal movement (p < 0.001; adjusted OR = 0.41, 95%CI: 0.31~0.56).

LIMITATIONS

This study used a cross-sectional design, and cannot compare changes in the incidence of depression before and after the COVID-19 outbreak.

CONCLUSIONS

During the COVID-19 outbreak, the prevalence rate of depression among Chinese prenatal and postnatal women was 35.4%. Moreover, anxiety, insomnia, drinking, nausea and vomiting during pregnancy, as well as the impaired movement and less daily monitoring of fetal movement were risk factors for depression.

Access to and Quality of Healthcare for Pregnant and Postpartum Women During the COVID-19 Pandemic

Introduction: During the COVID-19 pandemic, obstetric care has adopted new precautions to ensure services can be maintained for pregnant women. The aim of this study was to describe access to and quality of obstetric care for pregnant and postpartum women during the COVID-19 pandemic and to identify factors that predict quality of care at this time. Methods: Between May 3 and June 28, 2020, we recruited women who were pregnant or within the first 6 months after delivery to participate in an online survey. This included questions on access to obstetric healthcare (type and place of health care provider, changes to obstetric appointments/services, appointment preferences) and the Quality of Prenatal Care Questionnaire (QPCQ). Results: Of the 917 eligible women, 612 (67%) were pregnant and 305 (33%) were in the first 6 months after delivery. Sixty-two percent (n = 571) reported that COVID-19 had affected their healthcare; appointments were rearranged, canceled or occurred via virtual means for 29% (n = 166), 29% (n = 167), and 31% (n = 175) of women, respectively. The majority preferred to physically attend appointments (74%; n = 676) and perceived the accompaniment of birth partners as important (77%; n = 471). Sixty-two percent (n = 380) were permitted a birth partner at delivery, 18% (n = 111) were unsure of the rules while 4% (n = 26) were not permitted accompaniment. During pregnancy, QPCQ was negatively associated with disruption to obstetric services including exclusion or uncertainty regarding birth partner permissions [F (7, 433) = 11.5, p < 0.001, R 2 = 0.16] while QPCQ was negatively associated with inadequate breastfeeding support postpartum [F (1, 147) = 12.05, p = 0.001, R 2 = 0.08]. Conclusion: Pregnant and postpartum have experienced disruption in their access to obstetric healthcare. Perceived quality of obstetric care was negatively influenced by cancellation of appointment(s), suspension of services and exclusion of birth partners at delivery. During this time, continuity of care can be fulfilled via virtual and/or phone appointments and women should receive clear guidance on changes to services including birth partner permissions to attend delivery.

Knowledge and practices: Risk perceptions of COVID-19 and satisfaction with preventive measures at workplace among maternity care providers in Pakistan

INTRODUCTION

While all healthcare services across the globe deferred non-urgent surgeries, labor wards provided maternity care during the COVID-19 pandemic continuously. This study assesses the knowledge and practices of obstetricians and midwives about personal protective equipment (PPE); their risk perception of COVID-19 and satisfaction with the preventive measures adopted at their workplace.

METHODS

A questionnaire designed according to the World Health Organization’s advice on rational use of personal protective equipment for COVID-19 was administered to 452 Pakistani maternity care providers between 1 July and 30 July 2020.

RESULTS

Most (85%) had adequate knowledge and 78.8% had good practices regarding PPE use. The perceived risk of contracting COVID-19 was lower than for influenza and tuberculosis. Perceived risk of contracting COVID-19 was highest for outpatient clinics. Fewer midwives compared to obstetricians (23.3% vs 32.9 %, p=0.001) were satisfied with the job security provided. Only 19.5% were satisfied with the social distancing measures at their setups. Less than one-third (31%) were satisfied with the PPE available to them.

CONCLUSIONS

The participants had good knowledge and practices regarding PPE. The perceived risk of contracting COVID-19 was lower than for contracting influenza; however, they were concerned about contracting COVID-19 in outpatient clinics and emergency rooms. They had poor satisfaction with the measures adopted by hospital managements regarding job security and social distancing.

Development and psychometric assessment of the public health emergency risk perception scale: Under the outbreak of COVID-19

OBJECTIVE

Correctly understanding and evaluating the level of public risk perception toward public health emergencies not only helps experts and decision-makers understand the public's preventative health behaviors to these emergencies but also enhances their risk information communication with the public. The aim of this study was to develop a risk perception scale for public health emergencies and test its validity and reliability during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

Guided by the theoretical model of risk perception, an initial scale was generated through literature review, group meetings, resident interviews, and expert consultation. A pretest and item screening were then conducted to develop a formal risk perception scale for public health emergencies. Finally, the reliability and validity of the scale were validated through a questionnaire survey of 504 Chinese adults.

RESULTS

The final scale had 9 items. The content validity index of the scale was 0.968, and the content validity index of individual items ranged from 0.83 to 1.00. Three common factors, dread risk perception, severe risk perception, and unknown risk perception, were extracted for exploratory factor analysis, and together they explained 66.26% of the variance in the score. Confirmatory factor analysis showed that the model had a satisfactory fit, where χ 2/df = 1.384, the goodness-of-fit index (GFI) = 0.989, root mean square error of approximation (RMSEA) = 0.028, root mean square residual (RMR) = 0.018, comparative fit index (CFI) = 0.995, normed fit index (NFI) = 0.982, and non-normed fit index (NNFI) = 0.990. The correlations between dimensions ranged from 0.306 to 0.483 (P < 0.01). Cronbach's α was 0.793 for the total scale and ranged between 0.687 and 0.801 for the individual dimensions. The split-half coefficient was 0.861 for the total scale and ranged from 0.727 to 0.856 for induvial dimensions. The test-retest coefficient was 0.846 for the total scale and ranged from 0.843 to 0.868 for induvial dimensions.

CONCLUSION

The developed scale for the risk perception of public health emergencies showed acceptable levels of reliability and validity, suggesting that it is suitable for evaluating residents' risk perception of public health emergencies.