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Verhasselt V, Marchant A, Kollmann TR. Per Os to Protection - Targeting the Oral Route to Enhance Immune-mediated Protection from Disease of the Human Newborn. J Mol Biol 2024; 436:168718. [PMID: 39094783 DOI: 10.1016/j.jmb.2024.168718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Affiliation(s)
- Valerie Verhasselt
- Larsson-Rosenquist Foundation Centre for Immunology and Breastfeeding, School of Medicine, University of Western Australia, Perth, WA, Australia; Immunology and Breastfeeding Team, Telethon Kids Institute, Perth, WA, Australia
| | - Arnaud Marchant
- European Plotkin Institute for Vaccinology, Université libre de Bruxelles, Brussels, Belgium
| | - Tobias R Kollmann
- Dalhousie University, Department of Microbiology & Immunology, Pediatric Infectious Diseases, Canada.
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2
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Olkaba BF, Alemayahu AA, Dukale YH, Yote NY, Wolde AI, Tura MR, Egu LM. Understanding perceptions and practices of mothers toward infant and young child feeding in Toke Kutaye districts: Community-based qualitative study. Nutrition 2024; 126:112508. [PMID: 39142069 DOI: 10.1016/j.nut.2024.112508] [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: 03/25/2024] [Revised: 05/13/2024] [Accepted: 05/30/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Complementary feeding is a process starting at 6 months of age when breastfeeding alone cannot provide the nutrients infants require. Foods and liquids are started along with breastfeeding up to 24 months, while complementary foods are available either from a garden or local market appropriate to complement breast milk at 6 months to satisfy the nutritional needs of the infant. Infancy is from birth to 12 months of age, and the term young child is used when referring to infants and children from 12 months to 2 years of age. Infants and young children require a sufficient diet that includes all nutrients that support overall growth and development. Appropriate feeding practices are crucial during infancy and early childhood. In addition to breastfeeding, complementary feeding should be started on time, administered safely and appropriately, and in sufficient amounts with regularity, consistency, and a variety of foods to meet nutritional needs. OBJECTIVES This work was designed to understand the perceptions and practices of infant and young child feeding among mothers with children under 2 years in the West Shewa Zone Toke Kutaye districts. METHODS The study was conducted from December 05 to December 30, 2023. Twenty-seven mothers with children under 2 years old participated. The study was a cross-sectional descriptive qualitative study that employed focus group discussions and in-depth interviews to gather perceptions, opinions, practices, beliefs, and experiences about infant and young child feeding. Before coding, texts were double-checked against audio files to ensure accuracy and consistency. Afan Oromo conducted verbatim transcriptions of the focus group discussions and in-depth interviews, transcribed into Microsoft Word 2010. RESULTS The study revealed that most infants were not initiated early into breastfeeding and were not exclusively breastfed because most mothers gave cow milk, especially after 2 months, when mothers returned to working on other activities. Most mothers begin complementary feeding at the age of 4 months. CONCLUSIONS The responses of mothers from all age strata regarding factors that hinder appropriate infant and young child feeding show a lack of awareness about initiating early breastfeeding. Extreme work overload prevented the feeding of breast milk and preparation of a complementary diet as per protocol, low utilization of family planning, and a perceived shortage of food items to prepare a balanced diet for complementary feeding were factors that hindered appropriate infant and young child feeding. Concerned stakeholders should work to alleviate the extreme workload among mothers with children under 2 years old and reduce their lack of awareness by designing appropriate infant and young child feeding education; cooking demonstrations are strongly recommended.
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Affiliation(s)
- Belete Feyera Olkaba
- Ambo University, College of Health Science and Referral Hospital, Ambo, Ethiopia.
| | | | - Yimar Hotessa Dukale
- Bule Hora University, Institute of Health, School of Public Health, Bule Hora, Ethiopia
| | | | - Amanauel Iyasu Wolde
- Bule Hora University, Institute of Health, School of Public Health, Bule Hora, Ethiopia
| | - Meseret Robi Tura
- Ambo University, College of Health Science and Referral Hospital, Ambo, Ethiopia
| | - Lema Mideksa Egu
- Ambo University, College of Health Science and Referral Hospital, Ambo, Ethiopia
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3
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Montante S, Ben-Othman R, Amenyogbe N, Angelidou A, van den Biggelaar A, Cai B, Chen Y, Darboe A, Diray-Arce J, Ford R, Idoko O, Lee A, Lo M, McEnaney K, Malek M, Martino D, Masiria G, Odumade OA, Pomat W, Shannon C, Smolen K, Consortium TEPIC, Ozonoff A, Richmond P, Tebbutt S, Levy O, Kampmann B, Brinkman R, Kollmann T. Breastfeeding and Neonatal Age Influence Neutrophil-Driven Ontogeny of Blood Cell Populations in the First Week of Human Life. J Immunol Res 2024; 2024:1117796. [PMID: 39081632 PMCID: PMC11288693 DOI: 10.1155/2024/1117796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/16/2024] [Accepted: 06/13/2024] [Indexed: 08/02/2024] Open
Abstract
The first few days of life are characterized by rapid external and internal changes that require substantial immune system adaptations. Despite growing evidence of the impact of this period on lifelong immune health, this period remains largely uncharted. To identify factors that may impact the trajectory of immune development, we conducted stringently standardized, high-throughput phenotyping of peripheral white blood cell (WBC) populations from 796 newborns across two distinct cohorts (The Gambia, West Africa; Papua New Guinea, Melanesia) in the framework of a Human Immunology Project Consortium (HIPC) study. Samples were collected twice from each newborn during the first week of life, first at Day of Life 0 (at birth) and then subsequently at Day of Life 1, 3, or 7 depending on the randomization group the newborn belongs to. The subsequent analysis was conducted at an unprecedented level of detail using flow cytometry and an unbiased automated gating algorithm. The results showed that WBC composition in peripheral blood changes along patterns highly conserved across populations and environments. Changes across days of life were most pronounced in the innate myeloid compartment. Breastfeeding, and at a smaller scale neonatal vaccination, were associated with changes in peripheral blood neutrophil and monocyte cell counts. Our results suggest a common trajectory of immune development in newborns and possible association with timing of breastfeeding initiation, which may contribute to immune-mediated protection from infection in early life. These data begin to outline a specific window of opportunity for interventions that could deliberately direct WBC composition, and with that, immune trajectory and thus ontogeny in early life. This trial is registered with NCT03246230.
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Affiliation(s)
| | - Rym Ben-Othman
- Telethon Kids InstitutePerth Children's Hospital, 15 Hospital Avenue, Nedlands 6009, WA, Australia
- RAN BioLinks Ltd., 10212 Yonge Street, 202, Richmond Hill L4C 3B6, Ontario, Canada
| | - Nelly Amenyogbe
- Telethon Kids InstitutePerth Children's Hospital, 15 Hospital Avenue, Nedlands 6009, WA, Australia
- Department of Microbiology and ImmunologyDepartment of Pediatrics;Dalhousie University, 6299 South Street, Halifax B3H 4R2, Canada
| | - Asimenia Angelidou
- Precision Vaccines ProgramDepartment of PediatricsBoston Children's Hospital, Boston, MA, USA
- Department of NeonatologyBeth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Anita van den Biggelaar
- Wesfarmers Centre of Vaccines and Infectious DiseasesTelethon Kids InstituteUniversity of Western Australia Perth, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - Bing Cai
- Department of PediatricsBC Children's HospitalUniversity of British Columbia, 4480 Oak Street, Vancouver V6H 3V4, BC, Canada
| | - Yixuan Chen
- BC Cancer Agency, 675 West 10th Avenue, Vancouver V5Z 1G1, BC, Canada
| | - Alansana Darboe
- Vaccines and Immunity ThemeMedical Research Council UnitThe Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Banjul P.O. Box 273, Gambia
| | - Joann Diray-Arce
- Precision Vaccines ProgramDepartment of PediatricsBoston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rebecca Ford
- Papua New Guinea Institute of Medical Research, Homate Street, 441, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Olubukola Idoko
- Department of Clinical ResearchFaculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Amy Lee
- Department of Molecular Biology and BiochemistrySimon Fraser University, 8888 University Dr. Burnaby V5A1S6, Burnaby, British Columbia, Canada
| | - Mandy Lo
- Telethon Kids InstitutePerth Children's Hospital, 15 Hospital Avenue, Nedlands 6009, WA, Australia
| | - Kerry McEnaney
- Precision Vaccines ProgramDepartment of PediatricsBoston Children's Hospital, Boston, MA, USA
| | - Mehrnoush Malek
- BC Cancer Agency, 675 West 10th Avenue, Vancouver V5Z 1G1, BC, Canada
| | - David Martino
- Wal-yan Respiratory Research CentreTelethon Kids InstituteUniversity of Western Australia, Perth, Australia
| | - Geraldine Masiria
- Papua New Guinea Institute of Medical Research, Homate Street, 441, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Oludare A. Odumade
- Precision Vaccines ProgramDepartment of PediatricsBoston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - William Pomat
- Papua New Guinea Institute of Medical Research, Homate Street, 441, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Casey Shannon
- PROOF Centre of Excellence, 10th floor, 1190 Hornby Street, Vancouver V6Z 2K5, British Columbia, Canada
- UBC Centre for Heart Lung InnovationSt. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Kinga Smolen
- Precision Vaccines ProgramDepartment of PediatricsBoston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Al Ozonoff
- Precision Vaccines ProgramDepartment of PediatricsBoston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Peter Richmond
- Telethon Kids InstitutePerth Children's Hospital, 15 Hospital Avenue, Nedlands 6009, WA, Australia
- Division of PediatricsSchool of MedicineUniversity of Western Australia, 35 Stirling Highway, Crawley 6009, WA, Australia
| | - Scott Tebbutt
- PROOF Centre of Excellence, 10th floor, 1190 Hornby Street, Vancouver V6Z 2K5, British Columbia, Canada
- UBC Centre for Heart Lung InnovationSt. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Ofer Levy
- Precision Vaccines ProgramDepartment of PediatricsBoston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Beate Kampmann
- Vaccines and Immunity ThemeMedical Research Council UnitThe Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Banjul P.O. Box 273, Gambia
- Centre for Global Health and Institute for International HealthCharite Universitatsmedizin, Berlin, Germany
| | - Ryan Brinkman
- BC Cancer Agency, 675 West 10th Avenue, Vancouver V5Z 1G1, BC, Canada
- Department of Medical GeneticsUniversity of British Columbia, 675 West 10th Avenue, Vancouver, British Columbia V6T1Z4, Canada
| | - Tobias Kollmann
- Telethon Kids InstitutePerth Children's Hospital, 15 Hospital Avenue, Nedlands 6009, WA, Australia
- Department of PediatricsBC Children's HospitalUniversity of British Columbia, 4480 Oak Street, Vancouver V6H 3V4, BC, Canada
- Microbiology and ImmunologyPediatric Infectious DiseasesDalhousie University, CEO, Born, Strong Initiative, Halifax, Nova Scotia, Canada
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4
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Harsono AAH, Bond CL, Enah C, Ngong MG, Kyeng RM, Wallace E, Turan JM, Szychowski JM, Carlo WA, Ambe LN, Halle-Ekane G, Muffih PT, Tita ATN, Budhwani H. Structural barriers to maternity care in Cameroon: a qualitative study. Reprod Health 2024; 21:108. [PMID: 39030544 PMCID: PMC11264682 DOI: 10.1186/s12978-024-01834-w] [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: 07/07/2023] [Accepted: 06/21/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND The maternal mortality and perinatal mortality rate in Cameroon are among the highest worldwide. To improve these outcomes, we conducted a formative qualitative assessment to inform the adaptation of a mobile provider-to-provider intervention in Cameroon. We explored the complex interplay of structural barriers on maternity care in this low-resourced nation. The study aimed to identify structural barriers to maternal care during the early adaptation of the mobile Medical Information Service via Telephone (mMIST) program in Cameroon. METHODS We conducted in-depth interviews and focus groups with 56 key stakeholders including previously and currently pregnant women, primary healthcare providers, administrators, and representatives of the Ministry of Health, recruited by purposive sampling. Thematic coding and analysis via modified grounded theory approach were conducted using NVivo12 software. RESULTS Three main structural barriers emerged: (1) civil unrest (conflict between Ambazonian militant groups and the Cameroonian government in the Northwest), (2) limitations of the healthcare system, (3) inadequate physical infrastructure. Civil unrest impacted personal security, transportation safety, and disrupted medical transport system. Limitations of healthcare system involved critical shortages of skilled personnel and medical equipment, low commitment to evidence-based care, poor reputation, ineffective health system communication, incentives affecting care, and inadequate data collection. Inadequate physical infrastructure included frequent power outages and geographic distribution of healthcare facilities leading to logistical challenges. CONCLUSION Dynamic inter-relations among structural level factors create barriers to maternity care in Cameroon. Implementation of policies and intervention programs addressing structural barriers are necessary to facilitate timely access and utilization of high-quality maternity care.
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Affiliation(s)
- Alfonsus Adrian Hadikusumo Harsono
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Alabama, USA.
| | - Christyenne Lily Bond
- Intervention Research and Implementation Science (IRIS) Lab, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Comfort Enah
- School of Nursing, College of Health Sciences, University of Massachusetts Lowell, Massachusetts, USA
| | - Mary Glory Ngong
- Cameroon Baptist Convention Heath Services, Bamenda, Northwest Region, Cameroon
| | - Rahel Mbah Kyeng
- Cameroon Baptist Convention Heath Services, Bamenda, Northwest Region, Cameroon
| | - Eric Wallace
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet M Turan
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffery M Szychowski
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Waldemar A Carlo
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lionel Neba Ambe
- Regional Delegation of Public Health, Bamenda, Northwest Region, Cameroon
| | | | - Pius Tih Muffih
- Cameroon Baptist Convention Heath Services, Bamenda, Northwest Region, Cameroon
| | - Alan Thevenet N Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Henna Budhwani
- Intervention Research and Implementation Science (IRIS) Lab, College of Nursing, Florida State University, Tallahassee, FL, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
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5
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Bayona-Vásquez NJ, Sullivan AH, Beaudry MS, Khan A, Baptista RP, Petersen KN, Bhuiyan M, Brunelle B, Robinson G, Chalmers RM, Alves-Ferreira E, Grigg ME, AlvesFerreira Kissinger JC, Glenn TC. WHOLE GENOME TARGETED ENRICHMENT AND SEQUENCING OF HUMAN-INFECTING CRYPTOSPORIDIUM spp. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.29.586458. [PMID: 38585809 PMCID: PMC10996700 DOI: 10.1101/2024.03.29.586458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Cryptosporidium spp. are protozoan parasites that cause severe illness in vulnerable human populations. Obtaining pure Cryptosporidium DNA from clinical and environmental samples is challenging because the oocysts shed in contaminated feces are limited in quantity, difficult to purify efficiently, may derive from multiple species, and yield limited DNA (<40 fg/oocyst). Here, we develop and validate a set of 100,000 RNA baits (CryptoCap_100k) based on six human-infecting Cryptosporidium spp. ( C. cuniculus , C. hominis , C. meleagridis , C. parvum , C. tyzzeri , and C. viatorum ) to enrich Cryptosporidium spp. DNA from a wide array of samples. We demonstrate that CryptoCap_100k increases the percentage of reads mapping to target Cryptosporidium references in a wide variety of scenarios, increasing the depth and breadth of genome coverage, facilitating increased accuracy of detecting and analyzing species within a given sample, while simultaneously decreasing costs, thereby opening new opportunities to understand the complex biology of these important pathogens.
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Gopal R, Tutuncuoglu E, Bakalov V, Wasserloos K, Li H, Lemley D, DeVito LJ, Constantinesco NJ, Reed DS, McHugh KJ, Chinnappan B, Andreas AR, Maloy A, Bain D, Alcorn JF, Pitt BR, Kaynar AM. Zinc deficiency enhances sensitivity to influenza A associated bacterial pneumonia in mice. Physiol Rep 2024; 12:e15902. [PMID: 38163670 PMCID: PMC10758336 DOI: 10.14814/phy2.15902] [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: 06/27/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024] Open
Abstract
Although zinc deficiency (secondary to malnutrition) has long been considered an important contributor to morbidity and mortality of infectious disease (e.g. diarrhea disorders), epidemiologic data (including randomized controlled trials with supplemental zinc) for such a role in lower respiratory tract infection are somewhat ambiguous. In the current study, we provide the first preclinical evidence demonstrating that although diet-induced acute zinc deficiency (Zn-D: ~50% decrease) did not worsen infection induced by either influenza A (H1N1) or methicillin-resistant staph aureus (MRSA), Zn-D mice were sensitive to the injurious effects of superinfection of H1N1 with MRSA. Although the mechanism underlying the sensitivity of ZnD mice to combined H1N1/MRSA infection is unclear, it was noteworthy that this combination exacerbated lung injury as shown by lung epithelial injury markers (increased BAL protein) and decreased genes related to epithelial integrity in Zn-D mice (surfactant protein C and secretoglobins family 1A member 1). As bacterial pneumonia accounts for 25%-50% of morbidity and mortality from influenza A infection, zinc deficiency may be an important pathology component of respiratory tract infections.
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Affiliation(s)
- Radha Gopal
- Department of PediatricsUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Egemen Tutuncuoglu
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Critical Care MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
- Present address:
Department of MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Veli Bakalov
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Critical Care MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
- Present address:
Medicine InstituteAllegheny Health NetworkPittsburghPennsylvaniaUSA
| | - Karla Wasserloos
- Department of Environmental and Occupational HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
- Present address:
R.D. 2PortersvillePennsylvaniaUSA
| | - HuiHua Li
- Department of Environmental and Occupational HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
- Present address:
Department of PathologyUniversity of WisconsinMadisonWisconsinUSA
| | - David Lemley
- Department of Environmental and Occupational HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
- Present address:
R.D. 2PortersvillePennsylvaniaUSA
| | - Louis J. DeVito
- Department of PediatricsUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | | | - Douglas S. Reed
- Center for Vaccine ResearchUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Kevin J. McHugh
- Department of PediatricsUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Baskaran Chinnappan
- Department of PediatricsUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Alexis R. Andreas
- Department of Critical Care MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
- Present address:
Department of MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Abigail Maloy
- Department of Critical Care MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Daniel Bain
- Department of Geology and Planetary ScienceUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - John F. Alcorn
- Department of PediatricsUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Bruce R. Pitt
- Department of Environmental and Occupational HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Ata Murat Kaynar
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Critical Care MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Anesthesiology and Perioperative MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
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Campbell JE, Beetch J, Cooper T, Cheng J. Infant mortality and its determinants in Uganda 2016: Using a geographically weighted regression approach. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002669. [PMID: 38117756 PMCID: PMC10732401 DOI: 10.1371/journal.pgph.0002669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/01/2023] [Indexed: 12/22/2023]
Abstract
Infant mortality (IM) represents the overall health of a country or region as it relates to access to medicine, health care, and clean water in a population. IM remains understudied in many areas of Uganda, as many studies are from urban the capital (Kampala). The long-term goal of this research is the mitigation of IM and poor pregnancy outcomes in Uganda. Insights gained from geographic distribution of IM will allow adaptation of diagnosis, treatments, and interventions within the studied areas. Through using OLS and geographically weighted regression, this study has explored the significant factors and their heterogeneous and scaling effects in 2016 across Uganda. The empirical findings from this study include a significant association between IM and both being unmarried and preferring to speak Luganda when interviewed. Those unmarried may lack a social network to assist with income, childcare, and household chores representing decreased resources. Additionally, being interviewed in Luganda was associated over a large geographic area, which may represent not being comfortable in English, which is the language of education, commerce, and presumably health care, thus suggesting a disconnect with health care settings. These data suggest that strides can be made in Uganda by providing targeted resources to areas with high rates of unmarried mothers and those areas with high rates of Luganda as their language of choice.
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Affiliation(s)
- Janis E. Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Jessica Beetch
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Townsend Cooper
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Jianquan Cheng
- Department of Natural Sciences, Manchester Metropolitan University, Chester, United Kingdom
- Key Laboratory of Environment Change and Resources Use in Beibu Gulf, Centre for Health Geographic Information and Education, Nanning Normal University, Nanning, PR China
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8
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Kanmiki EW, Mamun AA, Phillips JF, O'Flaherty M. Impact of a community-based primary healthcare programme on childhood diphtheria-tetanus-pertussis (DPT3) immunisation coverage in rural northern Ghana. RESEARCH IN HEALTH SERVICES & REGIONS 2023; 2:18. [PMID: 39177872 PMCID: PMC11281747 DOI: 10.1007/s43999-023-00032-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/31/2023] [Indexed: 08/24/2024]
Abstract
BACKGROUND Child healthcare services such as diphtheria-tetanus-pertussis (DPT3) vaccination are known to reduce childhood mortality and morbidity. However, inequalities in access to these services in developing countries continue to constrain global efforts aimed at improving child health. This study examines the impact and equity effect of a community-based primary healthcare programme known as the Ghana Essential Health Intervention Programme (GEHIP) on improving the uptake of childhood DPT3 immunisation coverage in a remote rural region of Ghana. METHODS Using baseline and end-line household survey data collected from mothers, the effect of GEHIP's community-based healthcare programme on DPT3 immunisation coverage is evaluated using difference-in-differences multivariate logistic regression models. Household wealth index and maternal educational attainment were used as equity measures. RESULTS At end-line, both intervention and comparison districts recorded increases in DPT3 immunisation coverage although intervention districts had a relatively higher coverage than comparison districts (90% versus 88%). While children resident in intervention areas had slightly higher rates than children resident in comparison areas, regression results show that this difference was not statistically significant (DiD = 0.038, p-value = 0.102). There were also no significant equity disparities in the coverage of DPT3 vaccination for both household wealth index and maternal educational attainment. CONCLUSION DPT3 vaccination coverage in both study arms met the global vaccine action plan targets. However, because estimated effects are not significantly higher among treatment area children than among comparison districts counterparts, no equity/inequity effects of the community-based healthcare programme on DPT 3 coverage is evident.
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Affiliation(s)
- Edmund Wedam Kanmiki
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, 4068, Australia.
- Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia.
- ARC Centre of Excellence for Children and Families Over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, 4068, Australia.
| | - Abdullah A Mamun
- Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, 4068, Australia
| | - James F Phillips
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Martin O'Flaherty
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, 4068, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, 4068, Australia
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9
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Ross SM. Microbiota and the Immune System, Part 1. Holist Nurs Pract 2023; 37:363-365. [PMID: 37851352 DOI: 10.1097/hnp.0000000000000620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Affiliation(s)
- Stephanie Maxine Ross
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
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10
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Kumar P, Ahmad S, Kumar S, K G N, Kumar P, Kumar N, Pandey S. Situational Analysis of Healthcare and Medical Diagnostic Testing Facility Availability in Selected Blocks of Muzaffarpur District, Bihar, India: A Cross-Sectional Study. Cureus 2023; 15:e46037. [PMID: 37900506 PMCID: PMC10603600 DOI: 10.7759/cureus.46037] [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] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION This study presents a comprehensive assessment of healthcare facilities, focusing on workforce composition, operational dynamics, diagnostic laboratory services, and accessibility considerations. The comparison between government and private healthcare sectors provides insights into service delivery and potential disparities. The study's rationale, objectives, and methodology are explored in the context of the Indian healthcare landscape. METHODS A cross-sectional analysis was conducted in Muzaffarpur district, Bihar, targeting selected urban and rural blocks. The study employed geolocation data to analyze accessibility to healthcare facilities. Data collection involved on-site visits, structured questionnaires, and consultation of the Indian Council of Medical Research (ICMR)'s framework. The assessment concentrated on the availability of tests offered by the LaBike platform, and workforce compositions were compared. RESULTS Government healthcare facilities exhibited a balanced distribution of doctors, nurses, and grassroot workers, reflecting comprehensive healthcare provisions. Private facilities, although featuring moderate doctor and nurse presence, lacked grassroot workers. Diagnostic test prevalence was evident, with core tests, such as CBC and blood glucose, available in over 85% of facilities. Government facilities provided tests free of charge, while private facilities showcased a diverse cost spectrum. Proposed interventions received strong support from both sectors, indicating the potential for innovative healthcare solutions. Accessibility analysis: Urban intervention and control sites demonstrated comparable accessibility, with facilities located within 2 km. In rural intervention and control sites, distances varied significantly. Mushahari, a rural intervention site, required participants to travel 6 km to the nearest facility, impacting healthcare access. By contrast, Marwan, a rural control site, featured a shorter distance of 3 km. CONCLUSION This study's comprehensive evaluation of healthcare facilities offers valuable insights into workforce dynamics, diagnostic services, and healthcare interventions in the context of government and private sectors. The findings underscore the significance of addressing workforce gaps and promoting equitable access to diagnostics. By informing evidence-based decision-making, this study contributes to the optimization of healthcare service delivery, aiming to enhance healthcare quality and accessibility for all.
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Affiliation(s)
- Pragya Kumar
- Community and Family Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Shamshad Ahmad
- Community and Family Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Saurabh Kumar
- Epidemiology and Public Health, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Naveen K G
- Community and Family Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Purushottam Kumar
- Community and Family Medicine, Maharshi Devraha Baba Medical College, Deoria, Patna, IND
| | - Neeta Kumar
- Epidemiology and Public Health, Indian Council of Medical Research, New Delhi, IND
| | - Sanjay Pandey
- Community and Family Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
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Hills AP, Norris SA, Byrne NM, Jayasinghe S, Murphy-Alford AJ, Loechl CU, Ismail LIC, Kurpad AV, Kuriyan R, Nyati LH, Santos IS, Costa CS, Wickramasinghe VP, Lucas MN, Slater C, Yameen A, Ariff S. Body composition from birth to 2 years. Eur J Clin Nutr 2023:10.1038/s41430-023-01322-7. [PMID: 37563231 DOI: 10.1038/s41430-023-01322-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/08/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
Providing all infants with the best start to life is a universal but challenging goal for the global community. Historically, the size and shape of infants, quantified by anthropometry and commencing with birthweight, has been the common yardstick for physical growth and development. Anthropometry has long been considered a proxy for nutritional status during infancy when, under ideal circumstances, changes in size and shape are most rapid. Developed from data collected in the Multicentre Growth Reference Study (MGRS), WHO Child Growth Standards for healthy infants and children have been widely accepted and progressively adopted. In contrast, and somewhat surprisingly, much less is understood about the 'quality' of growth as reflected by body composition during infancy. Recent advances in body composition assessment, including the more widespread use of air displacement plethysmography (ADP) across the first months of life, have contributed to a progressive increase in our knowledge and understanding of growth and development. Along with stable isotope approaches, most commonly the deuterium dilution (DD) technique, the criterion measure of total body water (TBW), our ability to quantify lean and fat tissue using a two-compartment model, has been greatly enhanced. However, until now, global reference charts for the body composition of healthy infants have been lacking. This paper details some of the historical challenges associated with the assessment of body composition across the first two years of life, and references the logical next steps in growth assessments, including reference charts.
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Affiliation(s)
| | - Shane A Norris
- University of the Witwatersrand, Johannesburg, South Africa
- University of Southampton, Southampton, United Kingdom
| | | | | | | | | | - Leila I Cheikh Ismail
- University of Sharjah, Sharjah, United Arab Emirates
- University of Oxford, Oxford, United Kingdom
| | | | | | | | | | | | | | | | | | - Ayesha Yameen
- Pakistan Institute of Nuclear Science and Technology (PINSTECH), Nilore, Pakistan
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12
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Rab F, Razavi D, Kone M, Sohani S, Assefa M, Tiwana MH, Rossi R. Implementing community-based health program in conflict settings: documenting experiences from the Central African Republic and South Sudan. BMC Health Serv Res 2023; 23:738. [PMID: 37422625 DOI: 10.1186/s12913-023-09733-9] [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: 09/15/2022] [Accepted: 06/22/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND The delivery of quality healthcare for women and children in conflict-affected settings remains a challenge that cannot be mitigated unless global health policymakers and implementers find an effective modality in these contexts. The International Committee of the Red Cross (ICRC) and the Canadian Red Cross (CRC) used an integrated public health approach to pilot a program for delivering community-based health services in the Central African Republic (CAR) and South Sudan in partnership with National Red Cross Societies in both countries. This study explored the feasibility, barriers, and strategies for context-specific agile programming in armed conflict affected settings. METHODS A qualitative study design with key informant interviews and focus group discussions using purposive sampling was used for this study. Focus groups with community health workers/volunteers, community elders, men, women, and adolescents in the community and key informant interviews with program implementers were conducted in CAR and South Sudan. Data were analyzed by two independent researchers using a content analysis approach. RESULTS In total, 15 focus groups and 16 key informant interviews were conducted, and a total of 169 people participated in the study. The feasibility of service delivery in armed conflict settings depends on well-defined and clear messaging, community inclusiveness and a localized plan for delivery of services. Security and knowledge gaps, including language barriers and gaps in literacy negatively impacted service delivery. Empowering women and adolescents and providing context-specific resources can mitigate some barriers. Community engagement, collaboration and negotiating safe passage, comprehensive delivery of services and continued training were key strategies identified for agile programming in conflict settings. CONCLUSION Using an integrative community-based approach to health service delivery in CAR and South Sudan is feasible for humanitarian organizations operating in conflict-affected areas. For agile, and responsive implementation of health services in conflict-affected settings, decision-makers should focus on effectively engaging communities, bridge inequities through the engagement of vulnerable groups, collaborate and negotiate for safe passage for delivery of services, keep logistical and resource constraints in consideration and contextualize service delivery with the support of local actors.
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Affiliation(s)
- Faiza Rab
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
- Health in Emergencies, Canadian Red Cross, Ottawa, ON, Canada.
- Health in International Long-Term Programming, Canadian Red Cross, London, Canada.
| | - Donya Razavi
- Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada
| | - Mariam Kone
- Health in Emergencies, Canadian Red Cross, Ottawa, ON, Canada
- Health in International Long-Term Programming, Canadian Red Cross, London, Canada
| | - Salim Sohani
- Health in Emergencies, Canadian Red Cross, Ottawa, ON, Canada
| | - Mekdes Assefa
- Health in Emergencies, Canadian Red Cross, Ottawa, ON, Canada
| | | | - Rodolfo Rossi
- Health Unit, International Committee of the Red Cross, Geneva, Switzerland
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13
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Escobar MF, Gallego JC, Echavarria MP, Fernandez P, Posada L, Salazar S, Gutierrez I, Alarcon J. Maternal and perinatal outcomes in mixed antenatal care modality implementing telemedicine in the southwestern region of Colombia during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:259. [PMID: 36922841 PMCID: PMC10017345 DOI: 10.1186/s12913-023-09255-4] [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: 10/06/2022] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Contingency measures due to the COVID-19 pandemic limited access to routine prenatal care for pregnant women, increasing the risk of pregnancy complications due to poor prenatal follow-up, especially in those patients at high obstetric risk. This prompted the implementation and adaptation of telemedicine. OBJECTIVE We aim to evaluate the maternal and perinatal outcomes of patients who received prenatal care in-person and by telemedicine. METHODS We conducted a retrospective observational cohort study of pregnant women who received exclusive in-person and alternate (telemedicine and in-person) care from March to December 20,202, determining each group's maternal and neonatal outcomes. RESULTS A total of 1078 patients were included, 156 in the mixed group and 922 in the in-person group. The patients in the mixed group had a higher number of prenatal controls (8 (6-9) vs 6 (4-8) p < 0.001), with an earlier gestational age at onset (7.1 (6-8.5) vs 9.3 (6.6-20.3), p < 0.001), however, they required a longer hospital stay (26 (16,67%) vs 86 (9,33%), p = 0.002) compared to those attended in-person; there were no significant differences in the development of obstetric emergencies, maternal death or neonatal complications. DISCUSSION Incorporating telemedicine mixed with in-person care could be considered as an alternative for antenatal follow-up of pregnant women in low- and middle-income countries with barriers to timely and quality health care access.
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Affiliation(s)
- María Fernanda Escobar
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cra 98 Nro.18-49, 7600.2, Cali, Colombia.
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia.
- Department of Telemedicine, Fundación Valle del Lili, Cali, Colombia.
| | - Juan Carlos Gallego
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cra 98 Nro.18-49, 7600.2, Cali, Colombia
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - María Paula Echavarria
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cra 98 Nro.18-49, 7600.2, Cali, Colombia
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Paula Fernandez
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Leandro Posada
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Shirley Salazar
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Isabella Gutierrez
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Juliana Alarcon
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
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Chen R, Huang X, Li N, Li B. Analysis of pregnancy outcomes in patients undergoing ultrasound-indicated cerclage and identification the influence factors for predicting preterm birth: A retrospective study of 87 cases. Taiwan J Obstet Gynecol 2023; 62:304-310. [PMID: 36965900 DOI: 10.1016/j.tjog.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 03/27/2023] Open
Abstract
OBJECTIVE To investigate the factors influencing preterm birth in patients after ultrasound-indicated cerclage with different cervical lengths (CL), and explore the optimal cut-off value of CL. MATERIALS AND METHODS The retrospective study included 87 pregnant women with a history of preterm birth and second-trimester loss that received ultrasound-indicated cerclage in our hospital between January 2004 and April 2021. Groups were divided by CL at the demarcation point of 1.0, 1.5 and 2.0 cm respectively. The pregnancy outcomes were compared. Logistic regression analysis was performed to assess the independent influence factors. Receiver-operating characteristic (ROC) curves were constructed and the area under the curve (AUC) was used to compare the prediction capability of the associated factors. RESULTS Significant difference was found in terms of patients delivered at ≥32 weeks of gestation (19 [55.9%]vs. 41 [77.4%], p < 0.05) and neonatal birth weight (2495 [1138,3185]vs. 2995 [2155,3235] g, p < 0.05), when the CL was categorized at the demarcation point of 1.5 cm. Body mass index (BMI) (odds ratio [OR] = 1.224, p < 0.05), a history of preterm birth and second-trimester loss (OR = 3.153, p < 0.05), and C-reactive protein (CRP) > 5 mg/L (OR = 8.097, p < 0.05) were independent risk factors for gestational age more than 28 weeks. The AUC of joint predictor A included those factors was 0.849 (95% CI: 0.701-0.998, p < 0.05). CRP>5 mg/L was found to be a significant independent risk factor for different gestational age at delivery. CONCLUSIONS A CL of 1.5 cm was the optimal cut-off value that could help women who underwent serial CL surveillance choose ultrasound-indicated cerclage at an appropriate time. High BMI, more history of preterm birth and second-trimester loss and abnormal CRP could be used as combined predictors to recognize the risk of preterm birth (<28 weeks) post-surgery.
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Affiliation(s)
- Ruizhe Chen
- Department of Diagnosis & Treatment Centre of Cervical Diseases, Women's Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou, 310006, China
| | - Xiaoxiu Huang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou, 310006, China
| | - Na Li
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou, 310006, China
| | - Baohua Li
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou, 310006, China.
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15
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Shekhar S, Brar NK, Petersen FC. Suppressive effect of therapeutic antibiotic regimen on antipneumococcal Th1/Th17 responses in neonatal mice. Pediatr Res 2023; 93:818-826. [PMID: 35778498 DOI: 10.1038/s41390-022-02115-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/21/2022] [Accepted: 05/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Antibiotics are commonly used in human neonates, but their impact on neonatal T cell immunity remains poorly understood. The aim of this study was to investigate the impact of the antibiotic piperacillin with the beta-lactamase inhibitor tazobactam on neonatal CD4+ and CD8+ T cell responses to Streptococcus pneumoniae. METHODS Splenic and lung cells were isolated from the neonatal mice receiving piperacillin and tazobactam or saline (sham) and cultured with S. pneumoniae to analyze T cell cytokine production by ELISA and flow cytometry. RESULTS Antibiotic exposure to neonatal mice resulted in reduced numbers of CD4+/CD8+ T cells in the spleen and lungs compared to control mice. Upon in vitro stimulation with S. pneumoniae, splenocytes and lung cells from antibiotic-exposed mice produced lower levels of IFN-γ (Th1)/IL-17A (Th17) and IL-17A cytokines, respectively. Flow cytometric analysis revealed that S. pneumoniae-stimulated splenic CD4+ T cells from antibiotic-exposed mice expressed decreased levels of IFN-γ and IL-17A compared to control mice, whereas lung CD4+ T cells produced lower levels of IL-17A. However, no significant difference was observed for IL-4 (Th2) production. CONCLUSIONS Neonatal mice exposure to piperacillin and tazobactam reduces the number of CD4+ and CD8+ T cells, and suppresses Th1 and Th17, but not Th2, responses to S. pneumoniae. IMPACT Exposure of neonatal mice with a combination of piperacillin and tazobactam reduces CD4+/CD8+ T cells in the spleen and lungs. Antibiotic exposure suppresses neonatal Th1 and Th17, but not Th2, responses to Streptococcus pneumoniae. Our findings may have important implications for developing better therapeutic strategies in the neonatal intensive care unit.
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Affiliation(s)
| | - Navdeep K Brar
- Institute of Oral Biology, University of Oslo, Oslo, Norway
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16
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Shekhar S, Brar NK, Håkansson AP, Petersen FC. Treatment of Mouse Infants with Amoxicillin, but Not the Human Milk-Derived Antimicrobial HAMLET, Impairs Lung Th17 Responses. Antibiotics (Basel) 2023; 12:antibiotics12020423. [PMID: 36830333 PMCID: PMC9952748 DOI: 10.3390/antibiotics12020423] [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: 01/16/2023] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 02/23/2023] Open
Abstract
Emerging evidence suggests differential effects of therapeutic antibiotics on infant T cell responses to pathogens. In this study, we explored the impact of the treatment of mouse infants with amoxicillin and the human milk-derived antimicrobial HAMLET (human alpha-lactalbumin made lethal to tumor cells) on T cell responses to Streptococcus pneumoniae. Lung cells and splenocytes were isolated from the infant mice subjected to intranasal administration of amoxicillin, HAMLET, or a combination of HAMLET and amoxicillin, and cultured with S. pneumoniae to measure T cell responses. After in-vitro stimulation with S. pneumoniae, lung cells from amoxicillin- or amoxicillin plus HAMLET-treated mice produced lower levels of Th17 (IL-17A), but not Th1 (IFN-γ), cytokine than mice receiving HAMLET or PBS. IL-17A/IFN-γ cytokine levels produced by the stimulated splenocytes, on the other hand, revealed no significant difference among treatment groups. Further analysis of T cell cytokine profiles by flow cytometry showed that lung CD4+, but not CD8+, T cells from amoxicillin- or HAMLET plus amoxicillin-treated mice expressed decreased levels of IL-17A compared to those from HAMLET-exposed or control mice. Collectively, these results indicate that exposure of infant mice to amoxicillin, but not HAMLET, may suppress lung Th17 responses to S. pneumoniae.
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Affiliation(s)
| | | | - Anders P. Håkansson
- Division of Experimental Infection Medicine, Department of Translational Medicine, Lund University, 21428 Malmö, Sweden
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17
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Women's multidimensional empowerment index and essential newborn care practice in Bangladesh: The mediating role of skilled antenatal care follow-ups. PLoS One 2023; 18:e0281369. [PMID: 36749769 PMCID: PMC9904503 DOI: 10.1371/journal.pone.0281369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/22/2023] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The World Health Organization recommended a set of five neonatal care practices that are most essential for good health of a newborn. As good essential newborn care (ENC) practice reduces the risk of neonatal morbidity and mortality, this paper focuses how women's multidimensional empowerment index is associated with this practice through the skilled antenatal care. To the best of knowledge, no such study has been conducted yet. The composite index of women's multidimensional empowerments was constructed using family decision, intimate partner violence, social status, healthcare access and economic status of women; and skilled antenatal care was defined if a pregnant woman received eight or more checkups during pregnancy from skilled health professionals. MATERIALS AND METHODS Data extracted from Bangladesh Demographic and Health Survey, 2017-18 have been utilized in the study. A total of 2441 mothers have been considered who delivered their last live birth at home within three years preceding the survey. A mediation analysis was performed considering the structural equation modeling to find out the adjusted association of women's empowerment on both skilled antenatal care and good ENC practice, but the unadjusted associations were also checked using a chi-square test. To test the indirect as well as total effect of women's empowerment through skilled antenatal care on good ENC practice, bias-corrected standard errors were estimated using a bootstrapping sampling. RESULTS Good ENC practice was considerably low in Bangladesh with 7.6% of newborns receiving the practice. Both adjusted and unadjusted analyses showed the significant association of women's empowerment with both skilled antenatal care and good ENC practice. The study revealed that the indirect effect of high empowerment through skilled antenatal care was greater than its direct effect on good ENC practice. CONCLUSION This study explored that the prevalence of good ENC practice can be accelerated through women's empowerment, where skilled antenatal care plays an important mediating role in improving good ENC practice among highly empowered mothers. The study suggests that a woman should follow the latest guidelines recommended by WHO for antenatal care follow-up. Policymakers can modify some of the maternal and child health care interventions based on the research findings.
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Sakai J, Yang J, Chou CK, Wu WW, Akkoyunlu M. B cell receptor-induced IL-10 production from neonatal mouse CD19 +CD43 - cells depends on STAT5-mediated IL-6 secretion. eLife 2023; 12:83561. [PMID: 36735294 PMCID: PMC9934864 DOI: 10.7554/elife.83561] [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: 09/19/2022] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Newborns are unable to reach the adult-level humoral immune response partly due to the potent immunoregulatory role of IL-10. Increased IL-10 production by neonatal B cells has been attributed to the larger population of IL-10-producting CD43+ B-1 cells in neonates. Here, we show that neonatal mouse CD43- non-B-1 cells also produce substantial amounts of IL-10 following B cell antigen receptor (BCR) activation. In neonatal mouse CD43- non-B-1 cells, BCR engagement activated STAT5 under the control of phosphorylated forms of signaling molecules Syk, Btk, PKC, FAK, and Rac1. Neonatal STAT5 activation led to IL-6 production, which in turn was responsible for IL-10 production in an autocrine/paracrine fashion through the activation of STAT3. In addition to the increased IL-6 production in response to BCR stimulation, elevated expression of IL-6Rα expression in neonatal B cells rendered them highly susceptible to IL-6-mediated STAT3 phosphorylation and IL-10 production. Finally, IL-10 secreted from neonatal mouse CD43- non-B-1 cells was sufficient to inhibit TNF-α secretion by macrophages. Our results unveil a distinct mechanism of IL-6-dependent IL-10 production in BCR-stimulated neonatal CD19+CD43- B cells.
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Affiliation(s)
- Jiro Sakai
- Laboratory of Bacterial Polysaccharides, Division of Bacterial Parasitic and Allergenic Products, Center for Biologics Evaluation and Research, The US Food and Drug AdministrationSilver SpringUnited States
| | - Jiyeon Yang
- Laboratory of Bacterial Polysaccharides, Division of Bacterial Parasitic and Allergenic Products, Center for Biologics Evaluation and Research, The US Food and Drug AdministrationSilver SpringUnited States
| | - Chao-Kai Chou
- Facility for Biotechnology Resources, Center for Biologics Evaluation and Research, United States Food and Drug AdministrationSilver SpringUnited States
| | - Wells W Wu
- Facility for Biotechnology Resources, Center for Biologics Evaluation and Research, United States Food and Drug AdministrationSilver SpringUnited States
| | - Mustafa Akkoyunlu
- Laboratory of Bacterial Polysaccharides, Division of Bacterial Parasitic and Allergenic Products, Center for Biologics Evaluation and Research, The US Food and Drug AdministrationSilver SpringUnited States
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Bartsch YC, St Denis KJ, Kaplonek P, Kang J, Lam EC, Burns MD, Farkas EJ, Davis JP, Boribong BP, Edlow AG, Fasano A, Shreffler WG, Zavadska D, Johnson M, Goldblatt D, Balazs AB, Yonker LM, Alter G. SARS-CoV-2 mRNA vaccination elicits robust antibody responses in children. Sci Transl Med 2022; 14:eabn9237. [PMID: 35881018 PMCID: PMC9348753 DOI: 10.1126/scitranslmed.abn9237] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 07/01/2022] [Indexed: 01/11/2023]
Abstract
Although children have been largely spared from coronavirus disease 2019 (COVID-19), the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) with increased transmissibility, combined with fluctuating mask mandates and school reopenings, has led to increased infections and disease among children. Thus, there is an urgent need to roll out COVID-19 vaccines to children of all ages. However, whether children respond equivalently to adults to mRNA vaccines and whether dosing will elicit optimal immunity remain unclear. Here, we aimed to deeply profile the vaccine-induced humoral immune response in 6- to 11-year-old children receiving either a pediatric (50 μg) or adult (100 μg) dose of the mRNA-1273 vaccine and to compare these responses to vaccinated adults, infected children, and children who experienced multisystem inflammatory syndrome in children (MIS-C). Children elicited an IgG-dominant vaccine-induced immune response, surpassing adults at a matched 100-μg dose but more variable immunity at a 50-μg dose. Irrespective of titer, children generated antibodies with enhanced Fc receptor binding capacity. Moreover, like adults, children generated cross-VOC humoral immunity, marked by a decline of omicron-specific receptor binding domain, but robustly preserved omicron spike protein binding. Fc receptor binding capabilities were also preserved in a dose-dependent manner. These data indicate that both the 50- and 100-μg doses of mRNA vaccination in children elicit robust cross-VOC antibody responses and that 100-μg doses in children result in highly preserved omicron-specific functional humoral immunity.
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Affiliation(s)
- Yannic C Bartsch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Kerri J St Denis
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Paulina Kaplonek
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Jaewon Kang
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Evan C Lam
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Madeleine D Burns
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA 02114, USA
| | - Eva J Farkas
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA 02114, USA
| | - Jameson P Davis
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA 02114, USA
| | - Brittany P Boribong
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA 02114, USA
| | - Andrea G Edlow
- Massachusetts General Hospital Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Vincent Center for Reproductive Biology, Boston, MA 02114, USA
| | - Alessio Fasano
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA 02114, USA
| | - Wayne G Shreffler
- Massachusetts General Hospital Food Allergy Center, Division of Pediatric Allergy and Immunology, Boston, MA 02114, USA
| | - Dace Zavadska
- Children's Clinical University Hospital, Riga, LV-1004, Latvia
| | - Marina Johnson
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London WC1N 1EH, UK
| | - David Goldblatt
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London WC1N 1EH, UK
| | | | - Lael M Yonker
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA 02114, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
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20
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Meher A. Role of Transcription Factors in the Management of Preterm Birth: Impact on Future Treatment Strategies. Reprod Sci 2022; 30:1408-1420. [PMID: 36131222 DOI: 10.1007/s43032-022-01087-7] [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: 06/01/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2022]
Abstract
Preterm birth is defined as the birth of a neonate before 37 weeks of gestation and is considered as a leading cause of the under five deaths of neonates. Neonates born preterm are known to have higher perinatal mortality and morbidity with associated risks of low birth weight, respiratory distress syndrome, gastrointestinal, immunologic, central nervous system, hearing, and vision problems, cerebral palsy, and delayed development. India leads the list of countries with the greatest number of preterm births. The studies focusing on the molecular mechanisms related to the etiology of preterm birth have described the role of different transcription factors. With respect to this, transcription factors like peroxisome proliferator activated receptors (PPAR), nuclear factor kappa β (NF-kβ), nuclear erythroid 2-related factor 2 (Nrf2), and progesterone receptor (PR) are known to be associated with preterm labor. All these transcription factors are linked together with a common cascade involving inflammatory processes. Thus, the current review describes the possible cross-talk between these transcription factors and their therapeutic potential to prevent or manage preterm labor.
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Affiliation(s)
- Akshaya Meher
- Central Research Laboratory, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, Maharashtra, India, 422003.
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21
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Jamee AR, Kumar Sen K, Bari W. Skilled maternal healthcare and good essential newborn care practice in rural Bangladesh: A cross-sectional study. Health Sci Rep 2022; 5:e791. [PMID: 35989946 PMCID: PMC9382035 DOI: 10.1002/hsr2.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 07/14/2022] [Accepted: 08/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background and Aims Essential newborn care (ENC) practices play an important role in reducing the risk of infant mortality and morbidity. Therefore, more studies are needed on ENC practices. Skilled maternal healthcare can be a good strategy to increase the practice. Learn about the independent and joint effects of skilled maternal healthcare during pregnancy and childbirth on newborn care practices. Methods The study used a cross-sectional data obtained from Bangladesh Multiple Indicator Cluster Survey, 2019. To investigate the association between maternal healthcare utilization and good ENC practice (cord care, delayed bathing, and immediate breast-feeding), χ 2 test and t-test in bivariate and binary logistic regression analysis, respectively have been performed after taking into account complex survey design. Results Only about 24% (95% confidence interval [CI]: 22.95%-25.89%) women given birth at home in rural Bangladesh followed good newborn care practice. The results obtained from adjusted regression analysis showed that a woman was 24%, 49%, and 75% more likely of having good ENC practice if she received four or more skilled checkups during antenatal period only (adjusted odds ratios [AOR]: 1.24, 95% CI: 0.97, 1.60), received assistance from SBA during delivery only (AOR: 1.49, 95% CI 1.12, 1.97) and received skilled healthcare in both pregnancy and delivery (AOR: 1.75, 95% CI 1.13, 2.71), respectively compared to a woman who did not get an opportunity to receive skilled healthcare during pregnancy and delivery. Among the selected confounders, maternal age at birth, birth order, education of household heads and religion showed a significant association with good ENC practice. Conclusion The study revealed that proper maternal healthcare during pregnancy and childbirth from skilled health personnel can improve the rate of ENC practices. For this, more training programs should be started, especially at the community level, and health promotion activities are needed to create awareness about efficient maternal healthcare practices.
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Affiliation(s)
| | | | - Wasimul Bari
- Department of StatisticsUniversity of DhakaDhakaBangladesh
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22
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Kassie DG, Assimamaw NT, Tamir TT, Alemu TG, Techane MA, Wubneh CA, Belay GM, Ewuntie AW, Terefe B, Muhye AB, Tarekegn BT, Ali MS, BeletechFentie, Gonete AT, Tekeba B, Kassa SF, Desta BK, Ayele AD, Dessie MT, Atalell KA. Spatial distribution and determinants of newbornsnot receiving postnatal check-up withintwodays after birth in Ethiopia: a spatial and multilevel analysis of EDHS 2016. BMC Pediatr 2022; 22:495. [PMID: 35996110 PMCID: PMC9396843 DOI: 10.1186/s12887-022-03506-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Accessibility and utilization of postnatal newborn check-ups within 2 days after delivery are critical for a child’s survival, growth, and development. However, the service delivery is not yet improved and fluctuates across the geographical locations in Ethiopia. Therefore, this study aimed to assess the spatial distribution and determinants of newborns not received postnatal check-ups within 2 days after birth in Ethiopia. Methods A secondary data analysis of the Ethiopia Demographic and Health Survey (EDHS) 2016 was done among live births within 2 years preceding the survey. A multilevel binary logistic regression model was fitted to identify the factors associated with the outcome variable. Adjusted Odds Ratio with 95% (Confidence Interval) was calculated and used as a measure of associations and variables with a p-value < 0.05, were declared as statistically significant. Results A total of 4036 live newborns in Ethiopia were included in the analysis, of whom half (51.21%) were females. The mean age of the mothers was 33+ SD 1.3, and more than 60 % (61.56%) of the mothers were not educated. The national prevalence of newborns not receiving postnatal check-ups within 2 days after birth was 84.29 (95% CI: 83.10–85.41) with significant spatial variations across the study area. Mothers who had no ANC visits were 58% higher than (AOR = 0.42(0.27–0.66) mothers who had > 4 ANC visits. Mothers who gave birth at home and others were 80% (AOR = 0.02(0.01–0.29) and 25% (AOR = 0.76(0.59–0.99), higher than mothers delivered at hospital. Rural mothers were 1.90 times higher (AOR = 1.90(1.29–2.81) than urban mothers, and mothers live in administrative regions of Afar 66% (AOR = 0.34(0.16–0.69), Oromia 47% (AOR = 0.53(0.30–0.91), Somali 60% (AOR = 0.40 (0.22–0.74),Benishangul 50% (AOR = 0.50 (0.27–0.92), SNNPR 67% (AOR = 0.33(0.19–0.57), Gambela 70% (AOR = 0.30 (0.16–0.56), Harari 56% (AOR = 0.44 (0.25–0.78), and Dire Dawa70% (AOR = 0.30 (0.17–0.54) were higher than Addis Abeba for not receiving postnatal checkup of new born within the first 2 days, respectively. Conclusions Low postnatal check-up utilization remains a big challenge in Ethiopia, with significant spatial variations across regional and local levels. Spatial clustering of not receiving postanal check-ups within 2 days was observed in Afar, Oromia, Gambela, Benishangul, SNNPR, Harari, and Dire Dawa regions. Residence, ANC visits, place of delivery, and administrative regions were significantly associated with not receiving postnatal check-ups. Geographically targeted interventions to improve ANC follow-up and institutional delivery should be strengthened.
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Affiliation(s)
- Destaye Guadie Kassie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Nega Tezera Assimamaw
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Masresha Asmare Techane
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Chalachew Adugna Wubneh
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Getaneh Mulualem Belay
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Amare Wondim Ewuntie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Bewuketu Terefe
- Department of Community Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Adiss Bilal Muhye
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Bethelihem Tigabu Tarekegn
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - BeletechFentie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Berhan Tekeba
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Selam Fisiha Kassa
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Bogale Kassahun Desta
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Amare Demsie Ayele
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Melkamu Tilahun Dessie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Kendalem Asmare Atalell
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Kumar P, Kundu S, Bawankule R. District Level Geospatial Analysis of Utilization of ICDS Services Among Children in India. Front Public Health 2022; 10:874104. [PMID: 35874987 PMCID: PMC9302607 DOI: 10.3389/fpubh.2022.874104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Integrated Child Developmental Services (ICDS) is the most extensive government-run health program for children with its foot spread across the complete Indian Territory. ICDS Scheme, has been provided for 40 years and has been successful in some ways. The program in reducing the undernourishment among children over the past decade has been modest and slow in India than what has been reached in other countries with comparable socio-economic measure. Therefore, this study aims to identify the district level clustering of the utilization of ICDS services in India, and the present research also tried to relate it with socio-economic and demographic factors. Materials and Methods The data from the fourth round of the National Family Health Survey (NFHS-4) conducted in 2015-16 in India is used to carry out the analysis. We classified the country in 640 districts and employed geospatial techniques like Moran's I, univariate and bivariate local indicators of spatial association (LISA), and spatial error regression. Results The non-utilization under ICDS scheme varied between 93% in West Siang district of Arunachal Pradesh and around 7% in the Kandhamal district of Odisha in 2015-16 in India. The univariate LISA results suggest striking geographic clustering of utilization of ICDS services among children in India (Moran's I: 0.612). On another hand, there were regions with substantially low-low clustering of non-utilization of ICDS services in southeast India, including districts in Andhra Pradesh, Chhattisgarh, Southern Madhya Pradesh, Odisha, Telangana, and West Bengal. The findings also suggest that the proportion of the rural population (-0.190), and poor households (-0.132) in the district were significantly and negatively related while the proportion of uneducated women (0.450) was positively related to the non-utilization of ICDS services within the district. Conclusion This is the first-ever study that examined the complex interplay of the rural population, female illiteracy, poverty, SC/ST population, and Hindu population with non-utilization of ICDS services among children in the district in India. The study highlights the inter-district geographical disparities in the non-utilization of ICDS services. Further, it confirms that underprivileged districts in terms of the rural population and poor households are also disadvantageous in the utilization of ICDS services.
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Affiliation(s)
- Pradeep Kumar
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India
| | - Sampurna Kundu
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
| | - Rahul Bawankule
- Department of Biostatistics, MGM Institute of Health Sciences, Mumbai, India
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24
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Neonatal care practice and associated factors among mothers of infants 0-6 months old in North Shewa zone, Oromia region, Ethiopia. Sci Rep 2022; 12:10709. [PMID: 35739180 PMCID: PMC9439999 DOI: 10.1038/s41598-022-14895-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/14/2022] [Indexed: 11/08/2022] Open
Abstract
Worldwide, the magnitudes of neonatal mortality are estimated to be about 3 million due to insufficient care. The burden of neonatal mortality is high in Ethiopia as compared to high and middle-income countries. The study aimed to assess the neonatal care practice and associated factors among mothers of infants 0-6 months old in Northern Shewa, Ethiopia. A community-based cross-sectional study design was undertaken on a mother living in the North Shewa zone from September 2019 to June 2020. Neonatal care practice was assessed by World Health Organization (WHO) minimum neonatal care package indicators. Over the study period, a total of 245 (62.0%) mothers had a good neonatal care practice. Being urban areas [AOR 5.508, 95% CI 2.170, 13.984], having ANC follow-up [AOR 3.042, 95% CI 1.031, 12.642], lack of adequate information [AOR 0.123, 95% CI 0.054, 0.282] and post-natal care (PNC) [AOR 5.779, 95% CI 2.315, 14.425] were predictors of good neonatal care practice. In our study, there was moderate neonatal care practice among mothers. Therefore, all elements of neonatal care packages should be studied at large.
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25
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Battini V, Mari A, Gringeri M, Casini F, Bergamaschi F, Mosini G, Guarnieri G, Pozzi M, Nobile M, Zuccotti G, Clementi E, Radice S, Fabiano V, Carnovale C. Antibiotic-Induced Neutropenia in Pediatric Patients: New Insights From Pharmacoepidemiological Analyses and a Systematic Review. Front Pharmacol 2022; 13:877932. [PMID: 35721197 PMCID: PMC9201445 DOI: 10.3389/fphar.2022.877932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/19/2022] [Indexed: 12/04/2022] Open
Abstract
Aim: to characterize pediatric cases of antibiotic-associated neutropenia through a multidisciplinary approach, focusing on the temporal association between the wide spectrum of treatment options and the occurrence of this relatively uncommon but potentially clinically relevant adverse event. Methods: we carried out a pharmacoepidemiological analysis based on the FDA Adverse Event Reporting System (FAERS) database, a retrospective chart review and a systematic review of the literature, focusing on the time to onset (TTO) of this side effect, in the pediatric clinical setting. Results: A total of 281 antibiotic-related neutropenia events, involving 11 categories of antibiotics, were included in the time to onset analysis. The median TTO ranged from 4 to 60 days after the start of the therapy. A shorter median TTO was found from the retrospective chart review [16 patients: median days (25th-75th percentiles) = 4 (3–5)], compared to 15 (9–18) vs. 10 (6–18) for literature (224 patients) and FAERS (41 cases), respectively. The Anatomical Therapeutic Chemical classes, J01X, J01F, J01E and J04A, and the median TTOs retrieved from more than one source revealed high accordance (p > 0.05), with J01X causing neutropenia in less than a week and J01F/J01E/J04A in more than 10 days. Antibiotics were discontinued in nearly 34% of cases. In FDA Adverse Event Reporting System reports, half of the patients experiencing neutropenia were hospitalized. Conclusion: Whereas antibiotic associated neutropenia is benign in the majority of cases, yet it should not be neglected as, even if rarely, it may put children at higher risk of clinical consequences. Clinicians’ awareness of antibiotic-associated neutropenia and its mode of presentation contributes to the continuous process of monitoring safety of antibiotics.
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Affiliation(s)
- Vera Battini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Alessandra Mari
- Unit of Pediatrics, Department of Biomedical and Clinical Sciences, "Vittore Buzzi" Children's University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Michele Gringeri
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Francesca Casini
- Unit of Pediatrics, Department of Biomedical and Clinical Sciences, "Vittore Buzzi" Children's University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Francesco Bergamaschi
- Unit of Pediatrics, Department of Biomedical and Clinical Sciences, "Vittore Buzzi" Children's University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Giulia Mosini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Greta Guarnieri
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Marco Pozzi
- Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Maria Nobile
- Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Gianvincenzo Zuccotti
- Unit of Pediatrics, Department of Biomedical and Clinical Sciences, "Vittore Buzzi" Children's University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy.,Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Valentina Fabiano
- Unit of Pediatrics, Department of Biomedical and Clinical Sciences, "Vittore Buzzi" Children's University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
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26
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Stiller M, Bärnighausen T, Wilson ML. Intimate partner violence among pregnant women in Kenya: forms, perpetrators and associations. BMC Womens Health 2022; 22:210. [PMID: 35672817 PMCID: PMC9172160 DOI: 10.1186/s12905-022-01761-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intimate Partner violence (IPV) among pregnant women is a significant problem of public health importance. Nevertheless, there are relatively few studies which have examined the phenomenon in sub-Saharan settings. The aim of this study was to provide an overview of the prevalence, perpetrators, and associated factors of IPV during pregnancy in Kenya. METHODS We were making use of the 2014 Kenyan Demographic and Health Survey (KDHS) data and included women and girls of reproductive age (15-49 years) who have ever been pregnant ([Formula: see text]). A weighted sample of respondents who have experienced violence during pregnancy ([Formula: see text]) were selected for further bivariate and multivariable logistic regression analyses in order to examine the association between IPV and socio-demographic factors. RESULTS The prevalence of violence among pregnant women in Kenya was 9.2%, perpetrated mostly by the current husband or partner (47.6%), followed by the former husband or partner (31.5%). Physical violence was the most common (78.6%), followed by emotional (67.8%) and sexual (34.8%). Having one or two children ([Formula: see text]; [Formula: see text]), having secondary or higher education ([Formula: see text]; [Formula: see text]) and being 18 years and above at first cohabitation ([Formula: see text]; [Formula: see text]) and at sexual debut ([Formula: see text]; [Formula: see text]) were significantly associated with fewer reports of violence during pregnancy. Pregnant women who were divorced, separated or widowed ([Formula: see text]; [Formula: see text]), who were employed ([Formula: see text]; [Formula: see text]), who had witnessed their fathers beat their mothers ([Formula: see text]; [Formula: see text]) and who had primary education ([Formula: see text]; [Formula: see text]) were significantly more likely to experience violence. CONCLUSIONS To prevent violence among pregnant women in Kenya, training health care providers should go hand in hand with interventions sensitising and mobilising community members, both addressing the socio-demographic drivers of IPV during pregnancy and directing a particular attention to the most vulnerable ones.
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Affiliation(s)
- Mariella Stiller
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michael Lowery Wilson
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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27
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Marye S, Atav S. Global policies to reduce pandemic intensified violence against women. Public Health Nurs 2022; 39:1300-1307. [PMID: 35666995 PMCID: PMC9348340 DOI: 10.1111/phn.13099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/04/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022]
Abstract
Violence against women (VAW) worsened globally during the Covid-19 pandemic lockdowns. For example, a woman in France was killed every 3 days during lockdown. At the same time in South Africa, a woman was killed every 3 h. This paper presents and analyzes the risk factors that have worsened during the Covid-19 pandemic lockdowns and the subsequent economic consequences of mitigation policies. The purpose of this paper is twofold: (a) to conduct a critical review of international extant literature regarding government policies related to VAW since the beginning of the worldwide Covid-19 pandemic lockdowns that began in early 2020, and (b) to suggest opportunities for nurses to influence health policy development and social norms related to VAW. Thematic synthesis of the findings present interventions that helped to mitigate VAW during Covid-19 and is followed by a discussion of findings in relation to social determinants of health and human rights. A gender-based policy approach that focuses on the human right to be free of all forms of violence must be a leading strategy as governments reallocate resources and rebuild economies in the wake of this pandemic.
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Affiliation(s)
- Stacey Marye
- Decker College of Nursing and Health ScienceBinghamton UniversityState University of New YorkBinghamtonNew YorkUSA
| | - Serdar Atav
- Decker College of Nursing and Health ScienceBinghamton UniversityState University of New YorkBinghamtonNew YorkUSA
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28
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Budhwani H, Enah C, Bond CL, Halle-Ekane G, Wallace E, Turan JM, Szychowski JM, Long DM, Carlo WA, Tih PM, Tita ATN. mHealth Phone Intervention to Reduce Maternal Deaths and Morbidity in Cameroon: Protocol for Translational Adaptation. Int J Womens Health 2022; 14:677-686. [PMID: 35572348 PMCID: PMC9093609 DOI: 10.2147/ijwh.s353919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/14/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose The purpose of this NIH-funded protocol is to adapt (Aim 1) and pilot test (Aim 2) an mHealth intervention to improve maternal and child health in Cameroon. We will adapt the 24/7 University of Alabama at Birmingham Medical Information Service via Telephone (MIST) provider support system to mMIST (mobile MIST) for peripheral providers who provide healthcare to pregnant and postpartum women and newborns in Cameroon. Methods In Aim 1, we apply qualitative and participatory methods (in-depth interviews and focus groups with key stakeholders) to inform the adaptation of mMIST for use in Cameroon. We use the sequential phases of the ADAPT-ITT framework to iteratively adapt mMIST incorporating qualitative findings and tailoring for local contexts. In Aim 2, we test the adapted intervention for feasibility and acceptability in Ndop, Cameroon. Results This study is ongoing at the time that this protocol is published. Conclusion The adaptation, refinement, and pilot testing of mMIST will be used to inform a larger-scale stepped wedged cluster randomized controlled effectiveness trial. If successful, this mHealth intervention could be a powerful tool enabling providers in low-resource settings to deliver improved pregnancy care, thereby reducing maternal and fetal deaths.
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Affiliation(s)
- Henna Budhwani
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA,Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA,Correspondence: Henna Budhwani, Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, 330C Ryals Public Health Building, 1720 University Boulevard, Birmingham, AL, 35294, USA, Tel +1 205 975 7613, Fax +1 205 975 7685, Email
| | - Comfort Enah
- School of Nursing, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Christyenne L Bond
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gregory Halle-Ekane
- Department of Obstetrics and Gynaecology, University of Buea, Buea, Cameroon
| | - Eric Wallace
- Depatrment of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet M Turan
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA,Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA,School of Medicine, Koç University, Istanbul, Turkey
| | - Jeff M Szychowski
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dustin M Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Waldemar A Carlo
- Depatrment of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pius M Tih
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Alan T N Tita
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA,Depatrment of Obstetrics and Gynecology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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29
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Khaliq A, Wraith D, Nambiar S, Miller Y. A review of the prevalence, trends, and determinants of coexisting forms of malnutrition in neonates, infants, and children. BMC Public Health 2022; 22:879. [PMID: 35505427 PMCID: PMC9063291 DOI: 10.1186/s12889-022-13098-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/22/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Coexisting Forms of Malnutrition (CFM) refers to the presence of more than one type of nutritional disorder in an individual. Worldwide, CFM affects more than half of all malnourished children, and compared to standalone forms of malnutrition, CFM is associated with a higher risk of illness and death. This review examined published literature for assessing the prevalence, trends, and determinants of CFM in neonates, infants, and children. METHODS A review of community-based observational studies was conducted. Seven databases, (CINAHL, Cochrane Library, EMBASE, Medline, PubMed, Scopus, and Web of Science) were used in December-2021 to retrieve literature. Google, Google Scholar and TROVE were used to search for grey literature. Key stakeholders were also contacted for unpublished documents. Studies measuring the prevalence, and/or trends, and/or determinants of CFM presenting in individuals were included. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools for prevalence and longitudinal studies. RESULTS The search retrieved 14,207 articles, of which 24 were included in this review. The prevalence of CFM varied by geographical area and specific types. In children under 5 years, the coexistence of stunting with overweight/obesity ranged from 0.8% in the United States to over 10% in Ukraine and Syria, while the prevalence of coexisting wasting with stunting ranged from 0.1% in most of the South American countries to 9.2% in Niger. A decrease in CFM prevalence was observed in all countries, except Indonesia. Studies in China and Indonesia showed a positive association between rurality of residence and coexisting stunting with overweight/obesity. Evidence for other risk and protective factors for CFM is too minimal or conflicting to be conclusive. CONCLUSION Evidence regarding the prevalence, determinants and trends for CFM is scarce. Apart from the coexistence of stunting with overweight/obesity, the determinants of other types of CFM are unclear. CFM in any form results in an increased risk of health adversities which can be different from comparable standalone forms, thus, there is an urgent need to explore the determinants and distribution of different types of CFM.
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Affiliation(s)
- Asif Khaliq
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia.
| | - Darren Wraith
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia
| | - Smita Nambiar
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, 4059, Australia
| | - Yvette Miller
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia
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Pernica JM, Arscott-Mills T, Steenhoff AP, Mokomane M, Moorad B, Bapabi M, Lechiile K, Mangwegape O, Batisani B, Mawoko N, Muthoga C, Vanniyasingam T, Ewusie J, Lowe A, Bonsu JM, Gezmu AM, Smieja M, Mazhani L, Stordal K, Thabane L, Kelly MS, Goldfarb DM. Optimising the management of childhood acute diarrhoeal disease using a rapid test-and- treat strategy and/or Lactobacillus reuteri DSM 17938: a multicentre, randomised, controlled, factorial trial in Botswana. BMJ Glob Health 2022; 7:bmjgh-2021-007826. [PMID: 35418412 PMCID: PMC9014020 DOI: 10.1136/bmjgh-2021-007826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/14/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The study aim was to determine if rapid enteric diagnostics followed by the provision of targeted antibiotic therapy ('test-and-treat') and/or Lactobacillus reuteri DSM 17938 would improve outcomes in children hospitalised in Botswana with acute gastroenteritis. METHODS This was a multicentre, randomised, factorial, controlled, trial. Children aged 2-60 months admitted for acute non-bloody diarrhoea to four hospitals in southern Botswana were eligible. Participants were assigned to treatment groups by web-based block randomisation. Test-and-treat results were not blinded, but participants and research staff were blinded to L. reuteri/placebo assignment; this was dosed as 1×108 cfu/mL by mouth daily and continued for 60 days. The primary outcome was 60-day age-standardised height (HAZ) adjusted for baseline HAZ. All analyses were by intention to treat. The trial was registered at Clinicaltrials.gov. RESULTS Recruitment began on 12 June 2016 and continued until 24 October 2018. There were 66 participants randomised to the test-and-treat plus L. reuteri group, 68 randomised to the test-and-treat plus placebo group, 69 to the standard care plus L. reuteri group and 69 to the standard care plus placebo group. There was no demonstrable impact of the test-and-treat intervention (mean increase of 0.01 SD, 95% CI -0.14 to 0.16 SD) or the L. reuteri intervention (mean decrease of 0.07 SD, 95% CI -0.22 to 0.08 SD) on adjusted HAZ at 60 days. CONCLUSIONS In children hospitalised for acute gastroenteritis in Botswana, neither a test-and-treat algorithm targeting enteropathogens, nor a 60-day course of L. reuteri DSM 17938, were found to markedly impact linear growth or other important outcomes. We cannot exclude the possibility that test-and-treat will improve the care of children with significant enteropathogens (such as Shigella) in their stool. TRIAL REGISTRATION NUMBER NCT02803827.
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Affiliation(s)
- Jeffrey M Pernica
- Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada .,Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Tonya Arscott-Mills
- Botswana-UPenn Partnership, Gaborone, Botswana.,The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrew P Steenhoff
- Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Margaret Mokomane
- Department of Microbiology, University of Botswana, Gaborone, South-East District, Botswana
| | | | | | | | | | | | | | - Charles Muthoga
- Botswana-UPenn Partnership, Gaborone, Botswana.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Gaborone, Botswana
| | - Thuvaraha Vanniyasingam
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Joycelyne Ewusie
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.,The Research Institute-Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Amy Lowe
- Department of Global Health, McMaster University, Hamilton, Ontario, Canada
| | - Janice M Bonsu
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alemayehu M Gezmu
- Department of Pediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Marek Smieja
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Loeto Mazhani
- Department of Pediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Ketil Stordal
- Pediatric Research Institute, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Lehana Thabane
- Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.,The Research Institute-Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,University of Johannesburg Faculty of Health Sciences, Johannesburg, South Africa
| | - Matthew S Kelly
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Dasgupta RR, Mao W, Ogbuoji O. Addressing child health inequity through case management of under-five malaria in Nigeria: an extended cost-effectiveness analysis. Malar J 2022; 21:81. [PMID: 35264153 PMCID: PMC8905868 DOI: 10.1186/s12936-022-04113-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 03/02/2022] [Indexed: 11/27/2022] Open
Abstract
Background Under-five malaria in Nigeria is a leading cause of global child mortality, accounting for 95,000 annual child deaths. High out-of-pocket medical expenditure contributes to under-five malaria mortality by discouraging care-seeking and use of effective anti-malarials in the poorest households. The significant inequity in child health outcomes in Nigeria stresses the need to evaluate the outcomes of potential interventions across socioeconomic lines. Methods Using a decision tree model, an extended cost-effectiveness analysis was done to determine the effects of subsidies covering the direct and indirect costs of case management of under-five malaria in Nigeria. This analysis estimates the number of child deaths averted, out-of-pocket (OOP) expenditure averted, cases of catastrophic health expenditure (CHE) averted, and cost of implementation. An optimization analysis was also done to determine how to optimally allocate money across wealth groups using different combinations of interventions. Results Fully subsidizing direct medical, non-medical, and indirect costs could annually avert over 19,000 under-five deaths, 8600 cases of CHE, and US$187 million in OOP spending. Per US$1 million invested, this corresponds to an annual reduction of 76 under-five deaths, 34 cases of CHE, and over US$730,000 in OOP expenditure. Due to low initial treatment coverage in poorer socioeconomic groups, health and financial-risk protection benefits would be pro-poor, with the poorest 40% of Nigerians accounting for 72% of all deaths averted, 55% of all OOP expenditure averted, and 74% of all cases of CHE averted. Subsidies targeted to the poor would see greater benefits per dollar spent than broad, non-targeted subsidies. In an optimization scenario, the strategy of fully subsidizing direct medical costs would be dominated by a partial subsidy of direct medical costs as well as a full subsidy of direct medical, nonmedical, and indirect costs. Conclusion Subsidizing case management of under-five malaria for the poorest and most vulnerable would reduce illness-related impoverishment and child mortality in Nigeria while preserving limited financial resources. This study is an example of how focusing a targeted policy-intervention on a single, high-burden disease can yield large health and financial-risk protection benefits in a low and middle-income country context and address equity consideration in evidence-informed policymaking. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04113-w.
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Affiliation(s)
- Rishav Raj Dasgupta
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA. .,Center for Policy Impact in Global Health at Duke Global Health Institute, Durham, NC, USA.
| | - Wenhui Mao
- Center for Policy Impact in Global Health at Duke Global Health Institute, Durham, NC, USA
| | - Osondu Ogbuoji
- Center for Policy Impact in Global Health at Duke Global Health Institute, Durham, NC, USA. .,Duke Margolis Center for Health Policy, Durham, NC, USA.
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32
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Bartsch YC, St Denis KJ, Kaplonek P, Kang J, Lam EC, Burns MD, Farkas EJ, Davis JP, Boribong BP, Edlow AG, Fasano A, Shreffler W, Zavadska D, Johnson M, Goldblatt D, Balazs AB, Yonker LM, Alter G. Comprehensive antibody profiling of mRNA vaccination in children. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2022:2021.10.07.463592. [PMID: 35018376 PMCID: PMC8750651 DOI: 10.1101/2021.10.07.463592] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
While children have been largely spared from COVID-19 disease, the emergence of viral variants of concern (VOC) with increased transmissibility, combined with fluctuating mask mandates and school re-openings have led to increased infections and disease among children. Thus, there is an urgent need to roll out COVID-19 vaccines to children of all ages. However, whether children respond equivalently to adults to mRNA vaccines and whether dosing will elicit optimal immunity remains unclear. Given the recent announcement of incomplete immunity induced by the pediatric dose of the BNT162b2 vaccine in young children, here we aimed to deeply profile and compare the vaccine-induced humoral immune response in 6-11 year old children receiving the pediatric (50μg) or adult (100μg) dose of the mRNA-1273 vaccine compared to adults and naturally infected children or children that experienced multi inflammatory syndrome in children (MIS-C) for the first time. Children elicited an IgG dominant vaccine induced immune response, surpassing adults at a matched 100μg dose, but more variable immunity at a 50μg dose. Irrespective of titer, children generated antibodies with enhanced Fc-receptor binding capacity. Moreover, like adults, children generated cross-VOC humoral immunity, marked by a decline of omicron receptor binding domain-binding, but robustly preserved omicron Spike-receptor binding, with robustly preserved Fc-receptor binding capabilities, in a dose dependent manner. These data indicate that while both 50μg and 100μg of mRNA vaccination in children elicits robust cross-VOC antibody responses, 100ug of mRNA in children results in highly preserved omicron-specific functional humoral immunity.
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Affiliation(s)
| | | | - Paulina Kaplonek
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA, USA
- Massachusetts General Hospital Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Vincent Center for Reproductive Biology, Boston, MA, USA
- Massachusetts General Hospital Food Allergy Center, Division of Pediatric Allergy and Immunology, Boston, MA, USA
- Children's Clinical University Hospital, Riga, Latvia
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | - Jaewon Kang
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Evan C Lam
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Madeleine D Burns
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA, USA
| | - Eva J Farkas
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA, USA
| | - Jameson P Davis
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA, USA
| | - Brittany P Boribong
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA, USA
| | - Andrea G Edlow
- Massachusetts General Hospital Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Vincent Center for Reproductive Biology, Boston, MA, USA
| | - Alessio Fasano
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA, USA
| | - Wayne Shreffler
- Massachusetts General Hospital Food Allergy Center, Division of Pediatric Allergy and Immunology, Boston, MA, USA
| | - Dace Zavadska
- Children's Clinical University Hospital, Riga, Latvia
| | - Marina Johnson
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | - David Goldblatt
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | | | - Lael M Yonker
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
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Pienaar MA, Sempa JB, Luwes N, Solomon LJ. An Artificial Neural Network Model for Pediatric Mortality Prediction in Two Tertiary Pediatric Intensive Care Units in South Africa. A Development Study. Front Pediatr 2022; 10:797080. [PMID: 35281234 PMCID: PMC8916561 DOI: 10.3389/fped.2022.797080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/01/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The performance of mortality prediction models remain a challenge in lower- and middle-income countries. We developed an artificial neural network (ANN) model for the prediction of mortality in two tertiary pediatric intensive care units (PICUs) in South Africa using free to download and use software and commercially available computers. These models were compared to a logistic regression model and a recalibrated version of the Pediatric Index of Mortality 3. DESIGN This study used data from a retrospective cohort study to develop an artificial neural model and logistic regression model for mortality prediction. The outcome evaluated was death in PICU. SETTING Two tertiary PICUs in South Africa. PATIENTS 2,089 patients up to the age of 13 completed years were included in the study. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The AUROC was higher for the ANN (0.89) than for the logistic regression model (LR) (0.87) and the recalibrated PIM3 model (0.86). The precision recall curve however favors the ANN over logistic regression and recalibrated PIM3 (AUPRC = 0.6 vs. 0.53 and 0.58, respectively. The slope of the calibration curve was 1.12 for the ANN model (intercept 0.01), 1.09 for the logistic regression model (intercept 0.05) and 1.02 (intercept 0.01) for the recalibrated version of PIM3. The calibration curve was however closer to the diagonal for the ANN model. CONCLUSIONS Artificial neural network models are a feasible method for mortality prediction in lower- and middle-income countries but significant challenges exist. There is a need to conduct research directed toward the acquisition of large, complex data sets, the integration of documented clinical care into clinical research and the promotion of the development of electronic health record systems in lower and middle income settings.
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Affiliation(s)
- Michael A Pienaar
- Paediatric Critical Care Unit, Department of Paediatrics and Child Health, University of the Free State, Bloemfontein, South Africa
| | - Joseph B Sempa
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Nicolaas Luwes
- Department of Electrical, Electronic and Computer Engineering, Faculty of Engineering, Built Environment and Information Technology, Central University of Technology, Bloemfontein, South Africa
| | - Lincoln J Solomon
- Paediatric Critical Care Unit, Department of Paediatrics and Child Health, University of the Free State, Bloemfontein, South Africa
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Khaliq A, Wraith D, Miller Y, Nambiar-Mann S. Prevalence, Trends, and Socioeconomic Determinants of Coexisting Forms of Malnutrition Amongst Children under Five Years of Age in Pakistan. Nutrients 2021; 13:4566. [PMID: 34960118 PMCID: PMC8707290 DOI: 10.3390/nu13124566] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 12/21/2022] Open
Abstract
In Pakistan, malnutrition is a chronic issue. Concerns regarding coexisting forms of malnutrition (CFM) in an individual child are emerging, as children suffering from CFM have a 4 to 12-fold higher risk of death compared with healthy children. This study assessed the prevalence, trends, and socioeconomic determinants of various types of CFM using Pakistan Demographic and Health Survey (PDHS) datasets. Data from children aged 0-5 years old, with complete height and weight information, and valid anthropometry, from all regions of Pakistan (except residents of Azad Jammu Kashmir (AJK) and Federally Administered Tribal Areas (FATA), and non-de jure residents), were included. The prevalence of CFM was 30.6% in 2012-2013 and 21.5% in 2017-2018 PDHS. Both PDHSs reported a significantly higher prevalence of CFM in Sindh and Baluchistan compared with other regions of Pakistan. Improved socioeconomic status significantly reduced the odds of various types of CFM, except the coexistence of underweight with wasting. The high prevalence of CFM in Pakistan can be averted by multisectoral collaboration and by integrating nutrition-sensitive and nutrition-specific interventions.
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Affiliation(s)
- Asif Khaliq
- School of Public Health and Social Work, Queensland University of Technology, Brisbane 4059, Australia; (D.W.); (Y.M.)
| | - Darren Wraith
- School of Public Health and Social Work, Queensland University of Technology, Brisbane 4059, Australia; (D.W.); (Y.M.)
| | - Yvette Miller
- School of Public Health and Social Work, Queensland University of Technology, Brisbane 4059, Australia; (D.W.); (Y.M.)
| | - Smita Nambiar-Mann
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane 4059, Australia;
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Kodish SR, Farhikhtah A, Mlambo T, Hambayi MN, Jones V, Aburto NJ. Leveraging the Scaling Up Nutrition Movement to Operationalize Stunting Prevention Activities: Implementation Lessons From Rural Malawi. Food Nutr Bull 2021; 43:104-120. [PMID: 34747237 DOI: 10.1177/03795721211046140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The rural district of Ntchisi is in the central region of Malawi. Among children aged 6 to 23 months, the stunting prevalence is 40% to 50%. To address this high prevalence, the World Food Programme, with cooperating partners, supported the Government of Malawi to implement an integrated stunting prevention program entitled The Right Foods at the Right Time from 2013 to 2018. OBJECTIVE To provide implementation lessons learned from systematic documentation of how the Scaling Up Nutrition (SUN) movement, combined with other international and national initiatives and policies, was translated into tailored programming. METHODS During program conception, early design, and implementation, this descriptive study systematically documented the process of translating SUN principles and government policies into an operational stunting prevention program in rural Malawi. RESULTS We identified 8 factors that contributed to successful translation of policy into program activities: (1) well-structured National SUN framework, (2) reliable coordination platforms and district ownership, (3) systematic and evidence-informed program design, (4) multiple forms of data used to inform program planning, (5) multisectoral implementation approaches to stunting prevention, (6) innovation in technology to improve overall program efficiency, (7) systematic collaboration among diverse stakeholders, and (8) strong public health nutrition capacity of program team members. CONCLUSIONS Lessons from this nutrition program in Ntchisi, Malawi, provide one case illustrating how the SUN movement, government policies, and global evidence base can be operationalized into tailored programming for improving nutrition.
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Affiliation(s)
- Stephen R Kodish
- United Nations World Food Programme Headquarters, Rome, Italy.,The Pennsylvania State University, University Park, PA, USA
| | - Arghanoon Farhikhtah
- United Nations World Food Programme Headquarters, Rome, Italy.,Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Trust Mlambo
- United Nations World Food Programme, Lilongwe, Malawi
| | | | - Vanessa Jones
- United Nations World Food Programme Headquarters, Rome, Italy
| | - Nancy J Aburto
- United Nations World Food Programme Headquarters, Rome, Italy.,Food and Agriculture Organization of the United Nations, Rome, Italy
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Bezerra IMP, Ramos JLS, Pianissola MC, Adami F, da Rocha JBF, Ribeiro MAL, de Castro MR, Bezerra JDF, Smiderle FRN, Sousa LVDA, Siqueira CE, de Abreu LC. Perinatal Mortality Analysis in Espírito Santo, Brazil, 2008 to 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11671. [PMID: 34770185 PMCID: PMC8583128 DOI: 10.3390/ijerph182111671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 12/17/2022]
Abstract
This is an ecological and time-series study using secondary data on perinatal mortality and its components from 2008 to 2017 in Espírito Santo, Brazil. The data were collected from the Mortality Information System (SIM) and Live Births Information System (SINASC) of the Unified Health System Informatics Department (DATASUS) in June 2019. The perinatal mortality rate (×1000 total births) was calculated. Time series were constructed from the perinatal mortality rate for the regions and Espírito Santo. To analyze the trend, the Prais-Winsten model was used. From 2008 to 2017 there were 8132 perinatal deaths (4939 fetal and 3193 early neonatal) out of a total of 542,802 births, a perinatal mortality rate of 15.0/1000 total births. The fetal/early neonatal ratio was 1.5:1, with a strong positive correlation early neonatal mortality rate, perinatal mortality rate, r (9) = 0.8893, with a significance level of p = 0.000574. The presence of differences in trends by health region was observed. Risk factors that stood out were as follows: mother's age ranging between 10 and 19 or 40 and 49 years old, with no education, a gestational age between 22 and 36 weeks, triple and double pregnancy, and a birth weight below 2499 g. Among the causes of death, 49.70% of deaths were concentrated in category of the tenth edition of the International Classification of Diseases, fetuses and newborns affected by maternal factors and complications of pregnancy, labor, and delivery (P00-P04), and 11.03% were in the category of intrauterine hypoxia and birth asphyxia (P20-P21), both related to proper care during pregnancy and childbirth. We observed a slow reduction in the perinatal mortality rate in the state of Espírito Santo from 2008 to 2017.
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Affiliation(s)
- Italla Maria Pinheiro Bezerra
- Departamento de Pós-Graduação em Políticas Públicas e Desenvolvimento Local, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil
- Departamento de Enfermagem, Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil; (J.L.S.R.); (M.C.P.); (F.R.N.S.)
| | - José Lucas Souza Ramos
- Departamento de Enfermagem, Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil; (J.L.S.R.); (M.C.P.); (F.R.N.S.)
| | - Micael Colodetti Pianissola
- Departamento de Enfermagem, Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil; (J.L.S.R.); (M.C.P.); (F.R.N.S.)
| | - Fernando Adami
- Laboratório de Epidemiologia do Centro Universitário ABC (FMABC), Santo André 09060590, Brazil;
| | - João Batista Francalino da Rocha
- Ciências da Saúde no Centro Universitário ABC (FMABC), Santo André 09060870, Brazil; (J.B.F.d.R.); (M.A.L.R.)
- Centro de Ciências da Saúde e do Desporto (CCSD), Universidade Federal do Acre (UFAC), Rio Branco 69920900, Brazil
| | - Mariane Albuquerque Lima Ribeiro
- Ciências da Saúde no Centro Universitário ABC (FMABC), Santo André 09060870, Brazil; (J.B.F.d.R.); (M.A.L.R.)
- Centro de Ciências da Saúde e do Desporto (CCSD), Universidade Federal do Acre (UFAC), Rio Branco 69920900, Brazil
| | - Magda Ribeiro de Castro
- Departamento de Enfermagem da Universidade Federal do Espírito Santo (UFES), Vitória 29075910, Brazil;
| | - Juliana da Fonsêca Bezerra
- Departamento de Enfermagem Materno Infantil (DEMI) da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941901, Brazil;
| | - Fabiana Rosa Neves Smiderle
- Departamento de Enfermagem, Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil; (J.L.S.R.); (M.C.P.); (F.R.N.S.)
| | | | - Carlos Eduardo Siqueira
- Environment and Public Health, School for the Environment, Transnational Brazilian Project, The Mauricio Gastón Institute for Latino Community Development and Public Policy, UMass Boston, Boston, MA 02125, USA;
| | - Luiz Carlos de Abreu
- Departamento de Educação Integrada em Saúde na Universidade Federal do Espírito Santo (UFES), Vitória 29027502, Brazil;
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Kayastha R, Mueller S, Yadav P, Kelman I, Boscor A, Saville N, Arjyal A, Baral S, Fordham M, Hearn G, Kostkova P. Do Women in Nepal Like Playing a Mobile Game? MANTRA: A Mobile Gamified App for Improving Healthcare Seeking Behavior in Rural Nepal. Front Public Health 2021; 9:645837. [PMID: 34805057 PMCID: PMC8603420 DOI: 10.3389/fpubh.2021.645837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
In Low and Middle Income Countries (LMIC), one of the causes of maternal and child mortality is a lack of medical knowledge and consequently the inability to seek timely healthcare. Mobile health (mHealth) technology is gradually becoming a universal intervention platform across the globe due to ubiquity of mobile phones and network coverage. MANTRA is a novel mHealth intervention developed to tackle maternal and child health issues through a serious mobile game app in rural Nepal, which demonstrated a statistically significant knowledge improvement in rural women. This paper explores the perceptions and usability of the MANTRA app amongst rural women and Female Community Health Volunteers (FCHVs) in Nepal. Despite the challenges of a target user group with limited educational levels and low smartphone experience, all participants viewed the MANTRA app with approval and enthusiasm. They were willing to engage further with the mHealth intervention and to share their experience and knowledge with fellow community members. Participants also showed an increase in awareness of danger signs enabling them to make better informed health decisions in the future. FCHVs viewed the app as a validation tool providing and support for greater impact of their efforts in rural Nepal. Growing mobile ownership, network coverage and availability of smartphones along with acceptance of the prototype MANTRA app in rural communities suggest encouraging prospects for mHealth interventions to be incorporated in the national health infrastructure in Nepal and other LMICs.
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Affiliation(s)
- Rachya Kayastha
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Sonja Mueller
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
| | - Punam Yadav
- Centre for Gender and Disaster, Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
| | - Ilan Kelman
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Andrei Boscor
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
| | - Naomi Saville
- Institute for Global Health, University College London, London, United Kingdom
| | - Abriti Arjyal
- Health Research and Social Development Forum (HERD International), Kathmandu, Nepal
| | - Sushil Baral
- Health Research and Social Development Forum (HERD International), Kathmandu, Nepal
| | | | - Gareth Hearn
- Centre for Gender and Disaster, Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
| | - Patty Kostkova
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
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Salm L, Verstraeten R, Nisbett N, Booth A. Exploring the drivers of malnutrition in West Africa from health and social science perspectives: A comparative methodological review. METHODOLOGICAL INNOVATIONS 2021. [DOI: 10.1177/20597991211051445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
West Africa has a high burden of malnutrition and the drivers are often complex, highly context-specific, and cut across individual, social, political and environmental domains. Public health research most often considers immediate individual health and diet drivers, at the expense of wider considerations that may fall outside of a health agenda. The objective of this systematic mapping review is to map the broad drivers of malnutrition in West Africa, from public health and social science perspectives, and to evaluate the additional value of an interdisciplinary approach. Evidence was gathered from one public health (MEDLINE) and one social science (International Bibliography of Social Science) database using a detailed search syntax tailored to each disciplinary configuration. Literature was screened against pre-determined eligibility criteria and extracted from abstracts. Studies published in English or French between January 2010 and April 2018 were considered for inclusion. Driver categories (immediate, underlying and basic drivers) were coded against the UNICEF conceptual framework of malnutrition. A total of 358 studies were included; 237 were retrieved from the public health database and 124 from the social science database, 3 studies were included in both. The public health and social science literature document different drivers, with MEDLINE most often reporting immediate drivers of malnutrition and the International Bibliography of Social Science database reporting underlying and basic drivers. The combined literature offers more balanced representation across categories. An interdisciplinary approach proved successful in achieving complementarity in search results while upholding rigorous methods. We recommend that interdisciplinary approaches are utilised to bridge recognised gaps between defined disciplines.
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Affiliation(s)
- Leah Salm
- Health and Nutrition Cluster, Institute of Development Studies, Brighton, UK
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Roosmarijn Verstraeten
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Dakar, Senegal
| | - Nicholas Nisbett
- Health and Nutrition Cluster, Institute of Development Studies, Brighton, UK
| | - Andrew Booth
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Tanou M, Kishida T, Kamiya Y. The effects of geographical accessibility to health facilities on antenatal care and delivery services utilization in Benin: a cross-sectional study. Reprod Health 2021; 18:205. [PMID: 34649581 PMCID: PMC8518195 DOI: 10.1186/s12978-021-01249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background The world is making progress toward achieving maternal and child health (MCH) related components of the Sustainable Development Goals. Nevertheless, the progress of many countries in Sub-Saharan Africa is lagging. Geographical accessibility from residence to health facilities is considered a major obstacle hampering the use of appropriate MCH services. Benin, a country where the southern and northern parts belong to different geographical zones, has among the highest maternal mortality rate in the world. Adequate use of MCH care is important to save lives of women and their babies. This study assessed the effect of geographical accessibility to health facilities on antenatal care and delivery services utilization in Benin, with an emphasis on geographical zones. Methods We pooled two rounds of Benin Demographic and Health Surveys (BDHS). The sample included 18,105 women aged 15–49 years (9111 from BDHS-2011/2012 and 8994 from BDHS-2017/2018) who had live births within five years preceding the surveys. We measured the distance and travel time from residential areas to the closest health center by merging the BDHS datasets with Benin’s geographic information system data. Multivariate logistic regression analysis was performed to estimate the effect of geographical access on pregnancy and delivery services utilization. We conducted a propensity score-matching analysis to check for robustness. Results Regression results showed that the distance to the closest health center had adverse effects on the likelihood of a woman receiving appropriate maternal healthcare. The estimates showed that one km increase in straight-line distance to the closest health center reduces the odds of the woman receiving at least one antenatal care by 0.042, delivering in facility by 0.092, and delivering her baby with assistance of skilled birth attendants by 0.118. We also confirmed the negative effects of travel time and altitude of women’s residence on healthcare utilization. Nonetheless, these effects were mainly seen in the northern part of Benin. Conclusions Geographical accessibility to health facilities is critically important for the utilization of antenatal care and delivery services, particularly in the northern part of Benin. Improving geographical accessibility, especially in rural areas, is significant for further use of maternal health care in Benin. Maternal and neonatal mortality rates are still high in many countries in Sub-Saharan Africa. Antenatal care (ANC) visits and institutional delivery with skilled birth attendants are important to prevent maternal and neonatal deaths. Nevertheless, women’s utilization of ANC and delivery services has decreased recently in Benin, a country where the southern and northern parts belong to different geographical zones. Geographical accessibility from residence to health facilities is considered a major obstacle hampering the use of appropriate maternal healthcare. This study assessed the effect of geographical accessibility on ANC and delivery services utilization in Benin by considering the geographical characteristics. We used the two rounds of the Benin Demographic and Health Survey 2011/2012 and 2017/2018 and conducted regression analysis. This study has three important findings: (1) We confirmed adverse effects of distance and travel time on the likelihood of a women receiving appropriate ANC and delivery services in Benin, but this effect was mainly observed in the northern part; (2) Distance and travel time to health facilities had a negative effect on the use of at least one ANC but no significant effect for four or more ANC; (3) Regarding the threshold of distance, we confirmed that women living within 5 km from the closest health center were more likely to use maternal healthcare compared to their counterparts. In conclusion, geographical accessibility to health facilities is critically important for the utilization of antenatal care and delivery services, particularly in the northern part of Benin.
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Affiliation(s)
- Mariam Tanou
- Ministry of Infrastructure, Building Lamizana, 03BP7011, Ouagadougou, Burkina Faso.
| | - Takaaki Kishida
- Graduate School of International Cooperation Studies, Kobe University, 2-1 Rokkodai, Nada-ku, Kobe, 657-8501, Japan
| | - Yusuke Kamiya
- Faculty of Economics, Ryukoku University, 67 Tsukamoto-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8577, Japan
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Balaj M, York HW, Sripada K, Besnier E, Vonen HD, Aravkin A, Friedman J, Griswold M, Jensen MR, Mohammad T, Mullany EC, Solhaug S, Sorensen R, Stonkute D, Tallaksen A, Whisnant J, Zheng P, Gakidou E, Eikemo TA. Parental education and inequalities in child mortality: a global systematic review and meta-analysis. Lancet 2021; 398:608-620. [PMID: 34119000 PMCID: PMC8363948 DOI: 10.1016/s0140-6736(21)00534-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/31/2021] [Accepted: 02/25/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The educational attainment of parents, particularly mothers, has been associated with lower levels of child mortality, yet there is no consensus on the magnitude of this relationship globally. We aimed to estimate the total reductions in under-5 mortality that are associated with increased maternal and paternal education, during distinct age intervals. METHODS This study is a comprehensive global systematic review and meta-analysis of all existing studies of the effects of parental education on neonatal, infant, and under-5 child mortality, combined with primary analyses of Demographic and Health Survey (DHS) data. The literature search of seven databases (CINAHL, Embase, MEDLINE, PsycINFO, PubMed, Scopus, and Web of Science) was done between Jan 23 and Feb 8, 2019, and updated on Jan 7, 2021, with no language or publication date restrictions. Teams of independent reviewers assessed each record for its inclusion of individual-level data on parental education and child mortality and excluded articles on the basis of study design and availability of relevant statistics. Full-text screening was done in 15 languages. Data extracted from these studies were combined with primary microdata from the DHS for meta-analyses relating maternal or paternal education with mortality at six age intervals: 0-27 days, 1-11 months, 1-4 years, 0-4 years, 0-11 months, and 1 month to 4 years. Novel mixed-effects meta-regression models were implemented to address heterogeneity in referent and exposure measures among the studies and to adjust for study-level covariates (wealth or income, partner's years of schooling, and sex of the child). This study was registered with PROSPERO (CRD42020141731). FINDINGS The systematic review returned 5339 unique records, yielding 186 included studies after exclusions. DHS data were compiled from 114 unique surveys, capturing 3 112 474 livebirths. Data extracted from the systematic review were synthesized together with primary DHS data, for meta-analysis on a total of 300 studies from 92 countries. Both increased maternal and paternal education showed a dose-response relationship linked to reduced under-5 mortality, with maternal education emerging as a stronger predictor. We observed a reduction in under-5 mortality of 31·0% (95% CI 29·0-32·6) for children born to mothers with 12 years of education (ie, completed secondary education) and 17·3% (15·0-18·8) for children born to fathers with 12 years of education, compared with those born to a parent with no education. We also showed that a single additional year of schooling was, on average, associated with a reduction in under-5 mortality of 3·04% (2·82-3·23) for maternal education and 1·57% (1·35-1·72) for paternal education. The association between higher parental education and lower child mortality was significant for both parents at all ages studied and was largest after the first month of life. The meta-analysis framework incorporated uncertainty associated with each individual effect size into the model fitting process, in an effort to decrease the risk of bias introduced by study design and quality. INTERPRETATION To our knowledge, this study is the first effort to systematically quantify the transgenerational importance of education for child survival at the global level. The results showed that lower maternal and paternal education are both risk factors for child mortality, even after controlling for other markers of family socioeconomic status. This study provides robust evidence for universal quality education as a mechanism to achieve the Sustainable Development Goal target 3.2 of reducing neonatal and child mortality. FUNDING Research Council of Norway, Bill & Melinda Gates Foundation, and Rockefeller Foundation-Boston University Commission on Social Determinants, Data, and Decision Making (3-D Commission).
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Affiliation(s)
- Mirza Balaj
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hunter Wade York
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Sociology and Office of Population Research, Princeton University, Princeton, NJ, USA
| | - Kam Sripada
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Elodie Besnier
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hanne Dahl Vonen
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Aleksandr Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Applied Mathematics, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Joseph Friedman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Magnus Rom Jensen
- Library Section for Humanities, Education and Social Sciences, University Library, Norwegian University of Science & Technology, Trondheim, Norway
| | - Talal Mohammad
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erin C Mullany
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Solvor Solhaug
- Library Section for Humanities, Education and Social Sciences, University Library, Norwegian University of Science & Technology, Trondheim, Norway
| | - Reed Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Donata Stonkute
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andreas Tallaksen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Joanna Whisnant
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Terje Andreas Eikemo
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway.
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Appropriateness of Care for Common Childhood Infections at Low-Level Private Health Facilities in a Rural District in Western Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157742. [PMID: 34360041 PMCID: PMC8345429 DOI: 10.3390/ijerph18157742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 12/02/2022]
Abstract
In Uganda, >50% of sick children receive treatment from primary level-private health facilities (HF). We assessed the appropriateness of care for common infections in under-five-year-old children and explored perspectives of healthcare workers (HCW) and policymakers on the quality of healthcare at low-level private health facilities (LLPHF) in western Uganda. This was a mixed-methods parallel convergent study. Employing multistage consecutive sampling, we selected 110 HF and observed HCW conduct 777 consultations of children with pneumonia, malaria, diarrhea or neonatal infections. We purposively selected 30 HCW and 8 policymakers for in-depth interviews. Care was considered appropriate if assessment, diagnosis, and treatment were correct. We used univariable and multivariable logistic regression analyses for quantitative data and deductive thematic analysis for qualitative data. The proportion of appropriate care was 11% for pneumonia, 14% for malaria, 8% for diarrhea, and 0% for neonatal infections. Children with danger signs were more likely to receive appropriate care. Children with diarrhea or ability to feed orally were likely to receive inappropriate care. Qualitative data confirmed care given as often inappropriate, due to failure to follow guidelines. Overall, sick children with common infections were inappropriately managed at LLPHF. Technical support and provision of clinical guidelines should be increased to LLPHF.
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Blanchard AK, Colbourn T, Prost A, Ramesh BM, Isac S, Anthony J, Dehury B, Houweling TAJ. Associations between community health workers' home visits and education-based inequalities in institutional delivery and perinatal mortality in rural Uttar Pradesh, India: a cross-sectional study. BMJ Open 2021; 11:e044835. [PMID: 34253660 PMCID: PMC8276308 DOI: 10.1136/bmjopen-2020-044835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 06/20/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION India's National Health Mission has trained community health workers called Accredited Social Health Activists (ASHAs) to visit and counsel women before and after birth. Little is known about the extent to which exposure to ASHAs' home visits has reduced perinatal health inequalities as intended. This study aimed to examine whether ASHAs' third trimester home visits may have contributed to equitable improvements in institutional delivery and reductions in perinatal mortality rates (PMRs) between women with varying education levels in Uttar Pradesh (UP) state, India. METHODS Cross-sectional survey data were collected from a representative sample of 52 615 women who gave birth in the preceding 2 months in rural areas of 25 districts of UP in 2014-2015. We analysed the data using generalised linear modelling to examine the associations between exposure to home visits and education-based inequalities in institutional delivery and PMRs. RESULTS Third trimester home visits were associated with higher institutional delivery rates, in particular public facility delivery rates (adjusted risk ratio (aRR) 1.32, 95% CI 1.30 to 1.34), and to a lesser extent private facility delivery rates (aRR 1.09, 95% CI 1.04 to 1.13), after adjusting for confounders. Associations were stronger among women with lower education levels. Having no compared with any third trimester home visits was associated with higher perinatal mortality (aRR 1.18, 95% CI 1.09 to 1.28). Having any versus no visits was more highly associated with lower perinatal mortality among women with lower education levels than those with the most education, and most notably among public facility births. CONCLUSIONS The results suggest that ASHAs' home visits in the third trimester contributed to equitable improvements in institutional deliveries and lower PMRs, particularly within the public sector. Broader strategies must reinforce the role of ASHAs' home visits in reaching the sustainable development goals of improving maternal and newborn health and leaving no one behind.
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Affiliation(s)
- Andrea Katryn Blanchard
- Institute for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tim Colbourn
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Audrey Prost
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Banadakoppa Manjappa Ramesh
- Institute for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shajy Isac
- Institute for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- India Health Action Trust, Lucknow, India
| | - John Anthony
- Institute for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- India Health Action Trust, Lucknow, India
| | | | - Tanja A J Houweling
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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Maldonado LY, Bone J, Scanlon ML, Anusu G, Chelagat S, Jumah A, Ikemeri JE, Songok JJ, Christoffersen-Deb A, Ruhl LJ. Improving maternal, newborn and child health outcomes through a community-based women's health education program: a cluster randomised controlled trial in western Kenya. BMJ Glob Health 2021; 5:bmjgh-2020-003370. [PMID: 33293295 PMCID: PMC7725102 DOI: 10.1136/bmjgh-2020-003370] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 02/01/2023] Open
Abstract
Introduction Community-based women’s health education groups may improve maternal, newborn and child health (MNCH); however, evidence from sub-Saharan Africa is lacking. Chamas for Change (Chamas) is a community health volunteer (CHV)-led, group-based health education programme for pregnant and postpartum women in western Kenya. We evaluated Chamas’ effect on facility-based deliveries and other MNCH outcomes. Methods We conducted a cluster randomised controlled trial involving 74 community health units in Trans Nzoia County. We included pregnant women who presented to health facilities for their first antenatal care visits by 32 weeks gestation. We randomised clusters 1:1 without stratification or matching; we masked data collectors, investigators and analysts to allocation. Intervention clusters were invited to bimonthly, group-based, CHV-led health lessons (Chamas); control clusters had monthly, individual CHV home visits (standard of care). The primary outcome was facility-based delivery at 12-month follow-up. We conducted an intention-to-treat approach with multilevel logistic regression models using individual-level data. Results Between 27 November 2017 and 8 March 2018, we enrolled 1920 participants from 37 intervention and 37 control clusters. A total of 1550 (80.7%) participants completed the study with 822 (82.5%) and 728 (78.8%) in the intervention and control arms, respectively. Facility-based deliveries improved in the intervention arm (80.9% vs 73.0%; risk difference (RD) 7.4%, 95% CI 3.0 to 12.5, OR=1.58, 95% CI 0.97 to 2.55, p=0.057). Chamas participants also demonstrated higher rates of 48 hours postpartum visits (RD 15.3%, 95% CI 12.0 to 19.6), exclusive breastfeeding (RD 11.9%, 95% CI 7.2 to 16.9), contraceptive adoption (RD 7.2%, 95% CI 2.6 to 12.9) and infant immunisation completion (RD 15.6%, 95% CI 11.5 to 20.9). Conclusion Chamas participation was associated with significantly improved MNCH outcomes compared with the standard of care. This trial contributes robust data from sub-Saharan Africa to support community-based, women’s health education groups for MNCH in resource-limited settings. Trial registration number NCT03187873.
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Affiliation(s)
- Lauren Y Maldonado
- Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA .,Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Jeffrey Bone
- Obstetrics and Gynecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael L Scanlon
- Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya.,Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Gertrude Anusu
- Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Sheilah Chelagat
- Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Anjellah Jumah
- Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Justus E Ikemeri
- Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Julia J Songok
- Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya.,Child Health and Paediatrics, Moi University College of Health Sciences, Eldoret, Kenya
| | - Astrid Christoffersen-Deb
- Obstetrics and Gynecology, The University of British Columbia, Vancouver, British Columbia, Canada.,Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Laura J Ruhl
- Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya.,Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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[Improving provision of mother-and-child care in Chad at the community level: A quasi-experimental study]. Rev Epidemiol Sante Publique 2021; 69:193-203. [PMID: 34030893 DOI: 10.1016/j.respe.2021.04.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/23/2020] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chad is among the countries with the highest maternal and infant mortality rates in the world. An initiative aimed at improving mother-and-child health services was implemented from 2016 to 2019 in three rural health districts in southern Chad, with strong community input, while concomitantly increasing the supply and demand for care. The objective of this study is to evaluate the effects of this program on health service use. METHODS Interrupted time-series analyses with a control group was used to measure the effects of the intervention by applying a quasi-experimental approach. Monthly attendance data were collected from the registries of the 18 health centres that participated in the program and 18 centres that did not participate (control group), before (18 months) and after (24 months) the start of implementation. RESULTS On average, there were 10.98 (95% CI: 6.57-15.39, P<0.001) additional paediatric visits and 0.68 additional deliveries (95% CI: 0.42-0.95, P<0.001) each month in the participation group compared to the control group. Community involvement decisively contributed to the change. CONCLUSION During the 24 months of implementation, the initiative significantly increased the use of essential mother-and-child health services in Chad. This study highlights the benefits of a strong partnership with communities trained and involved in health system activities, with the objective of achieving universal health coverage.
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Pirjani R, Moini A, Heshmati J, Mardi-Mamaghani A, Esmaeili M, Shafaatdoost M, Maleki-Hajiagha A, Karimi E, Hossein-Boroujerdi M, Shokri F, Mosanezhad Z, Bajool N, Noori M, Hosseini L, Persad E, Sepidarkish M. Mothers and their children's health (MATCH): a study protocol for a population-based longitudinal cohort. BMC Pregnancy Childbirth 2021; 21:297. [PMID: 33845792 PMCID: PMC8042918 DOI: 10.1186/s12884-021-03732-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 03/17/2021] [Indexed: 11/27/2022] Open
Abstract
Background The quality of prenatal care is critical for the prevention of adverse pregnancy outcomes. However, according to the World Health Organization (WHO), only 64 % of women worldwide have access to over four sessions of prenatal care throughout their pregnancy. Thus, studies that address factors affecting maternal and child health status before and after pregnancy are of immense importance. The primary aim of the mothers and their children’s health (MATCH) cohort study is to evaluate the effect of nutrition, sleep quality, and lifestyle on maternal and neonatal outcomes. Methods A prospective cohort of > 2500 pregnant women in the first trimester (before 12 weeks’ gestation) will be recruited at Arash Women’s Hospital in Tehran, Iran between February 2020 and August 2021. All eligible pregnant women will be followed from their first trimester of pregnancy until delivery at four time points and assessed through a series of in-person visits with interviewer-administered questionnaires and telephone interviews. Detailed data will be collected on maternal demographics, lifestyle, medical history, reproductive history, obstetric history, dietary intake, sleep pattern, blood specimens, and anthropometric measurements, alongside paternal demographics, lifestyle, and family history. The outcomes will include antenatal, peripartum, and postnatal maternal complications and infant growth and neurodevelopment. Discussion The results of the MATCH cohort study will support the development of contextual interventions that can enhance antenatal, peripartum, and postnatal status, neonatal outcomes, and longevity mother and child.
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Affiliation(s)
- Reihaneh Pirjani
- Obstetrics and Gynecology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashraf Moini
- Obstetrics and Gynecology Department, Tehran University of Medical Sciences, Tehran, Iran.,Breast Disease Research Center (BDRC), Tehran University of Medical Science, Tehran, Iran.,Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Javad Heshmati
- Department of Nutritional Science, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Azar Mardi-Mamaghani
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mahnaz Esmaeili
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mehrnoosh Shafaatdoost
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Maleki-Hajiagha
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Karimi
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Hossein-Boroujerdi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Shokri
- Department of Health Education and Promotion, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Mosanezhad
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Niloofar Bajool
- Department Cell and Molecular Biology, College of BioScience, Islamic Azad University North Tehran Branch, Tehran, Iran
| | - Matina Noori
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ladan Hosseini
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Emma Persad
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran.
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García JI, Allué-Guardia A, Tampi RP, Restrepo BI, Torrelles JB. New Developments and Insights in the Improvement of Mycobacterium tuberculosis Vaccines and Diagnostics Within the End TB Strategy. CURR EPIDEMIOL REP 2021; 8:33-45. [PMID: 33842192 PMCID: PMC8024105 DOI: 10.1007/s40471-021-00269-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW The alignment of sustainable development goals (SDGs) with the End Tuberculosis (TB) strategy provides an integrated roadmap to implement key approaches towards TB elimination. This review summarizes current social challenges for TB control, and yet, recent developments in TB diagnosis and vaccines in the context of the End TB strategy and SDGs to transform global health. RECENT FINDINGS Advances in non-sputum based TB biomarkers and whole genome sequencing technologies could revolutionize TB diagnostics. Moreover, synergistic novel technologies such as mRNA vaccination, nanovaccines and promising TB vaccine models are key promising developments for TB prevention and control. SUMMARY The End TB strategy depends on novel developments in point-of-care TB diagnostics and effective vaccines. However, despite outstanding technological developments in these fields, TB elimination will be unlikely achieved if TB social determinants are not fully addressed. Indeed, the End TB strategy and SDGs emphasize the importance of implementing sustainable universal health coverage and social protection.
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Affiliation(s)
- Juan Ignacio García
- Population Health Program, Tuberculosis Group, Texas Biomedical Research Institute, 8715 W. Military Dr, San Antonio, TX 78227 USA
| | - Anna Allué-Guardia
- Population Health Program, Tuberculosis Group, Texas Biomedical Research Institute, 8715 W. Military Dr, San Antonio, TX 78227 USA
| | - Radhika P. Tampi
- PhD Program in Health Policy, Harvard University, Cambridge, MA 02138 USA
| | - Blanca I. Restrepo
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville, TX 78520 USA
- School of Medicine, South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX 78539 USA
| | - Jordi B. Torrelles
- Population Health Program, Tuberculosis Group, Texas Biomedical Research Institute, 8715 W. Military Dr, San Antonio, TX 78227 USA
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Artese C, Paterlini G, Mascheroni E, Montirosso R. Barriers and Facilitators to Conducting Kangaroo Mother Care in Italian Neonatal Intensive Care Units. J Pediatr Nurs 2021; 57:e68-e73. [PMID: 33189484 DOI: 10.1016/j.pedn.2020.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/20/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This work aimed to investigate obstacles and facilitators for carrying out Kangaroo Mother Care (KMC) across Italian NICUs. DESIGN AND METHODS A survey that investigated Unit's characteristics, policies toward parents and KMC practice and policies was carried out. Data from 86 NICUs (80.4%) was collected. Descriptive statistics and Multiple Regression Models were computed. RESULTS Eighty-one NICUs provided KMC. These NICUs had a less restricted parental access policies (chi2 = 7.373, p = .007). More than the 70% of the units did not have adequate facilities for parents. KMC daily length was positively predicted (R2 = 0.18, F = 7.91, p = .001) by repeated sessions and documentation of KMC. CONCLUSION The implementation of KMC is characterized by different barriers and facilitators that determine the parent's possibility to provide KMC. Structural factors (e.g., adequate space and facilities) can support families in providing KMC. A unique result of this survey is that KMC documentation on medical records appears critical for improving its practice. PRACTICE IMPLICATIONS Although most of the Italian units provide KMC as a routine practice, improving its practical support would be beneficial to its implementation. A more formalized approach to KMC may strengthen staff habits to consider KMC like a standard care treatment.
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Affiliation(s)
- Claudia Artese
- SOD Neonatology and Neonatal Intensive Care Unit, Careggi Hospital-University, Italy
| | - Giuseppe Paterlini
- Department of Mother's and Child's Health, Neonatology and Neonatal Intensive Care Unit, Poliambulanza Foundation Hospital Institute, Italy
| | - Eleonora Mascheroni
- 0-3 Center for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy.
| | - Rosario Montirosso
- 0-3 Center for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
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48
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Untargeted and Targeted Metabolomic Profiling of Preterm Newborns with EarlyOnset Sepsis: A Case-Control Study. Metabolites 2021; 11:metabo11020115. [PMID: 33670629 PMCID: PMC7922887 DOI: 10.3390/metabo11020115] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 12/15/2022] Open
Abstract
Sepsis is a major concern in neonatology, but there are no reliable biomarkers for its early diagnosis. The aim of the study was to compare the metabolic profiles of plasma and urine samples collected at birth from preterm neonates with and without earlyonset sepsis (EOS) to identify metabolic perturbations that might orient the search for new early biomarkers. All preterm newborns admitted to the neonatal intensive care unit were eligible for this proof-of-concept, prospective case-control study. Infants were enrolled as “cases” if they developed EOS, and as “controls”if they did not. Plasma samples collected at birth and urine samples collected within 24 h of birth underwent untargeted and targeted metabolomic analysis using mass spectrometry coupled with ultra-performance liquid chromatography. Univariate and multivariate statistical analyses were applied. Of 123 eligible newborns, 15 developed EOS. These 15 newborns matched controls for gestational age and weight. Metabolomic analysis revealed evident clustering of the cases versus controls, with the glutathione and tryptophan metabolic pathways markedly disrupted in the former. In conclusion, neonates with EOS had a metabolic profile at birth that clearly distinguished them from those without sepsis, and metabolites of glutathione and tryptophan pathways are promising as new biomarkers of neonatal sepsis.
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49
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Taylor J, Forgeron P, Vandyk A, Finley A, Lightfoot S. Pediatric Health Outcome Evaluation in Low-and Middle-Income Countries: A Scoping Review of NGO Practice. Glob Pediatr Health 2021; 8:2333794X21991011. [PMID: 33614849 PMCID: PMC7868502 DOI: 10.1177/2333794x21991011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/03/2021] [Accepted: 01/09/2021] [Indexed: 11/17/2022] Open
Abstract
Objective. The purpose of this study was to explore the research on the delivery and evaluation of pediatric health services by non-governmental organizations in low-and middle-income countries to better understand how they contribute to positive and sustainable health outcomes. Methods. A scoping review was completed using a 2-step study selection procedure. Results. Of the 5742 studies, 17 met criteria, including quantitative and mixed method designs, representing 10 different non-governmental organizations with programs in 33 low-and middle-income countries. Health outcomes were reported 89 times across the studies. A total of 56 different outcomes were identified in total, of which 24 were positive, 27 were negative, and 5 were unchanged. Conclusions. Widespread variation between non-governmental organizations exist, however, comprehensive pediatric health outcome evaluation is growing. Further emphasis should be given to adolescent specific research and robust measurement of quality of life.
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Affiliation(s)
| | | | | | - Allen Finley
- Dalhousie University & IWK Health Centre, Halifax, NS, Canada
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50
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Lirussi D, Weissmann SF, Ebensen T, Nitsche-Gloy U, Franz HBG, Guzmán CA. Cyclic Di-Adenosine Monophosphate: A Promising Adjuvant Candidate for the Development of Neonatal Vaccines. Pharmaceutics 2021; 13:pharmaceutics13020188. [PMID: 33535570 PMCID: PMC7912751 DOI: 10.3390/pharmaceutics13020188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/18/2022] Open
Abstract
Underdeveloped immunity during the neonatal age makes this period one of the most dangerous during the human lifespan, with infection-related mortality being one of the highest of all age groups. It is also discussed that vaccination during this time window may result in tolerance rather than in productive immunity, thus raising concerns about the overall vaccine-mediated protective efficacy. Cyclic di-nucleotides (CDN) are bacterial second messengers that are rapidly sensed by the immune system as a danger signal, allowing the utilization of these molecules as potent activators of the immune response. We have previously shown that cyclic di-adenosine monophosphate (CDA) is a potent and versatile adjuvant capable of promoting humoral and cellular immunity. We characterize here the cytokine profiles elicited by CDA in neonatal cord blood in comparison with other promising neonatal adjuvants, such as the imidazoquinoline resiquimod (R848), which is a synthetic dual TLR7 and TLR8 agonist. We observed superior activity of CDA in eliciting T helper 1 (Th1) and T follicular helper (TfH) cytokines in cells from human cord blood when compared to R848. Additional in vivo studies in mice showed that neonatal priming in a three-dose vaccination schedule is beneficial when CDA is used as a vaccine adjuvant. Humoral antibody titers were significantly higher in mice that received a neonatal prime as compared to those that did not. This effect was absent when using other adjuvants that were reported as suitable for neonatal vaccination. The biological significance of this immune response was assessed by a challenge with a genetically modified influenza H1N1 PR8 virus. The obtained results confirmed that CDA performed better than any other adjuvant tested. Altogether, our results suggest that CDA is a potent adjuvant in vitro on human cord blood, and in vivo in newborn mice, and thus a suitable candidate for the development of neonatal vaccines.
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Affiliation(s)
- Darío Lirussi
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, 38124 Braunschweig, Germany; (S.F.W.); (C.A.G.)
- Correspondence: (D.L.); (T.E.); Tel.: +49-531-61814607 (T.E.); Fax: +49-531-618414699 (T.E.)
| | - Sebastian Felix Weissmann
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, 38124 Braunschweig, Germany; (S.F.W.); (C.A.G.)
| | - Thomas Ebensen
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, 38124 Braunschweig, Germany; (S.F.W.); (C.A.G.)
- Correspondence: (D.L.); (T.E.); Tel.: +49-531-61814607 (T.E.); Fax: +49-531-618414699 (T.E.)
| | - Ursula Nitsche-Gloy
- Women’s Clinic, Hospital Marienstift GmbH, Helmstedter Strasse 35, 38102 Braunschweig, Germany;
| | - Heiko B. G. Franz
- Department of Obstetrics and Gynecology, Women’s Clinic, Braunschweig Central Hospital, Celler Strasse 38, 38114 Braunschweig, Germany;
| | - Carlos A. Guzmán
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, 38124 Braunschweig, Germany; (S.F.W.); (C.A.G.)
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