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Atowoju I, Dawer P, Asrani M, Panjiyar B. Impact of maternal HIV infection on perinatal outcomes: A systematic review. Int J Gynaecol Obstet 2024; 166:35-43. [PMID: 38573155 DOI: 10.1002/ijgo.15528] [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: 11/08/2023] [Revised: 02/28/2024] [Accepted: 03/24/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Maternal HIV infection remains a significant global health concern with potential repercussions on perinatal outcomes. Emphasis on early intervention to improve peri- and postnatal outcomes in infected mothers and infants is a valid therapeutic concern. OBJECTIVES To comprehensively analyze perinatal outcomes associated with maternal HIV infection and evaluate adverse effects associated with the HIV infection in the existing literature. SEARCH STRATEGY A comprehensive search of PubMed, MEDLINE, and Google Scholar was conducted from 2013 to September 2023, using relevant MeSH terms. SELECTION CRITERIA The included studies encompassed original studies, cross-sectional, prospective, retrospective studies and observational studies focused on perinatal outcomes in the context of maternal HIV infection. DATA COLLECTION AND ANALYSIS The selected studies underwent rigorous data collection and comprehensive quality checks and adhered to the PRISMA guidelines. MAIN RESULTS Nine eligible studies from Brazil, China, India, Malawi, Nigeria, Tanzania, the USA, and Canada were included. These studies have consistently demonstrated that maternal HIV infection is associated with adverse perinatal outcomes. The analysis revealed a higher risk of preterm birth (OR 1.57, 95% CI: 1.39-1.78), low birth weight (OR 1.33, 95% CI: 1.18-1.49), and small for gestational age (OR 1.38, 95% CI: 1.24-1.53) among infants born to mothers living with HIV. Notably, the impact of antiretroviral treatment (ART) on these outcomes varied, but maternal HIV infection remained a significant risk factor regardless of income level and geographic region. CONCLUSION Maternal HIV infection is consistently associated with adverse perinatal outcomes, emphasizing the need for targeted interventions and improved prenatal care in pregnant women with HIV infection.
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Affiliation(s)
- Inioluwa Atowoju
- Department of Obstetrics and Gynecology, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Prachi Dawer
- University College of Medical Sciences, New Delhi, India
| | - Manisha Asrani
- Department of Obstetrics and Gynecology, Pramukh Swami Medical College, Karamsad, Anand, Gujarat, India
| | - Binay Panjiyar
- PGME GCSRT Harvard Medical School, Boston, Massachusetts, USA
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Lkhagvaa K, Tsogbadrakh B, Gochoosuren G, Badamdorj O, Stark A. The effect of outcome-based education on clinical performance and perception of pediatric care of the third-year nursing students in Mongolia. PLoS One 2024; 19:e0305298. [PMID: 38861566 PMCID: PMC11166271 DOI: 10.1371/journal.pone.0305298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/27/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Mongolian government has set improvement of clinical proficiency of nursing students as one of its priorities. Nursing professionals have the sentinel role in providing healthcare services in rural areas. Outcome-based education (OBE) offers a promising pedagogical approach to actively mentally engage students to strengthen their clinical proficiencies. We implemented a pilot project with the objective of comparing students' clinical performance under OBE with our traditional didactic techniques. METHODS The researchers implemented a non-equivalent two-armed quasi-experimental post-test-only' design approach study. The intervention arm (n = 34) received OBE pediatric training, while the control arm (n = 32) received the traditional pedagogical pediatric nursing training. Each arm of the study completed 16 hours of theory, 32 hours of clinical skills practice and 32 hours of seminars in pediatric nursing care. Data were collected using a five-section instrument, Demographic, Competency Inventory, Nursing Students' Satisfaction, Course Experience, and Objective Structured Clinical Examination. Performance and knowledge proficiencies were evaluated by applying the two-sided independent T-test. The distributions of categorical variables were assessed by Fisher's exact test or chi-squared test of significance. RESULTS The intervention arm had higher mean score value in the competency inventory ([Formula: see text] = 238.70, SD = ± 23.07) compared to the control arm ([Formula: see text] = 222.11, SD = ± 39.94) (P = 0.04); similarly, the mean value for nursing students' satisfaction was higher for the intervention arm ([Formula: see text] = 117.87, SD = ± 15.94) compared to the control group ([Formula: see text] = 109.76, SD = ± 16.94) (P = 0.049). Additionally, the difference in the mean value for course experience questionnaire between the intervention arm ([Formula: see text] = 125.33, SD = ± 19.30) and the control arm ([Formula: see text] = 110.41, SD = ± 11.28) was statistically significant (P = 0.0001). Finally, the intervention arm had a higher mean value ([Formula: see text] = 85.40, SD = ± 6.11) for objective structural clinical examination compared to the control arm ([Formula: see text] = 81.56, SD = ± 7.01) (P = 0.023). CONCLUSION OBE pedagogical approach offers promising benefits to improving nursing students' clinical competencies; additionally, the OBE approach seems to increase students' satisfactions with their clinical curriculum.
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Affiliation(s)
- Khishigdelger Lkhagvaa
- School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Basbish Tsogbadrakh
- School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Gankhuyag Gochoosuren
- School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Oyungoo Badamdorj
- School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Azadeh Stark
- School of Interdisciplinary Studies, University of Texas at Dallas, Richardson, Texas, United States of America
- Department of Pathology & Laboratory Medicine, Henry Ford Health, Detroit, Michigan, United States of America
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Zhang J, Wang X, Zhu P, Huang X, Cao X, Li J. Exploring the relationships between pre-pregnancy BMI, gestational weight gain, and nutritional intake: a real-world investigation in Shandong, China. PeerJ 2024; 12:e17099. [PMID: 38529313 PMCID: PMC10962341 DOI: 10.7717/peerj.17099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/21/2024] [Indexed: 03/27/2024] Open
Abstract
This study investigated the associations between gestational weight gain (GWG), pre-pregnancy body mass index (BMI), and prenatal diet quality in pregnant women from Shandong, China. We analyzed a sample of 532 early-stage pregnant women registered at an outpatient clinic. Diet quality was evaluated using the Chinese Healthy Dietary Index for Pregnancy (CHDI-P), encompassing three dimensions: diversity, adequacy, and limitation, with an overall score out of 100. Dietary intake was documented via 24-h dietary recalls spanning three consecutive days and subsequently translated to a CHDI-P score. At the time of enrollment, BMI was measured on-site and classified as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0). Pregnant women were also categorized into inadequate, adequate, and excessive weight gain groups based on their GWG. We employed a Tukey-adjusted generalized linear model to compare the CHDI-P scores between the pre-pregnancy BMI groups and GWG groups. The results revealed that the underweight group had significantly higher total scores and limitation total scores on the CHDI-P (p < 0.001). Conversely, the overweight and obese groups were more susceptible to suboptimal dietary quality. Notably, the inadequate weight gain group displayed significantly elevated food adequacy scores compared to the other two groups (p < 0.05). This indicates that greater GWGs do not necessarily align with principles of adequate nutrition.
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Affiliation(s)
- Juan Zhang
- Jinan Maternity and Child Care Hospital, Jinan, China
| | - Xue Wang
- Jinan Maternity and Child Care Hospital, Jinan, China
| | - Ping Zhu
- Jinan Maternity and Child Care Hospital, Jinan, China
| | - Xiaoge Huang
- Jinan Maternity and Child Care Hospital, Jinan, China
| | - Xingru Cao
- Jinan Maternity and Child Care Hospital, Jinan, China
| | - Junmin Li
- Jinan Maternity and Child Care Hospital, Jinan, China
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Adetutu OM, Oyinlola FF, Oyelakin TE, Ofili FL. Influence of intimate partner violence and male involvement on maternal healthcare services utilisation in Nigeria. Front Glob Womens Health 2024; 5:1353117. [PMID: 38559815 PMCID: PMC10978718 DOI: 10.3389/fgwh.2024.1353117] [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: 12/09/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Low maternal health care services utilisation, especially antenatal care attendance and skilled birth attendance, has been documented to be responsible for maternal mortality and morbidity in Nigeria. While available evidence suggests mixed findings on uptake of maternal health care services in the context of abusive spousal relationships, male involvement in household and health decision-making has been established to promote uptake of maternal health care services. Yet, studies which consider mediating influence of intimate partner violence on male involvement and maternal health care services uptake are sorely missing in Nigeria. We hypothesised that maternal health care services uptake in abusive marital unions has implications for male involvement in pregnancy care and this has been largely overlooked in Nigeria. Materials and methods This study extracted data from the 2018 Nigeria Demographic and Health Survey (NDHS). The 2018 NDHS is a nationally representative secondary data which collected population, demographic and health information on women, men and households in Nigeria. The secondary data used a two-stage stratified and multistage sampling technique to collect information from the respondents. In this study, data were extracted for women who were sexually active, within the reproductive age (15-49 years) and not pregnant in five years prior the survey (n = 7,847). Results The results indicated (77%) antenatal care attendance and (47%) skilled delivery. The mediating influence of IPV on male involvement resulted in women who experienced sexual violence more likely to use heath facility for antenatal care (OR = 3.20; C.I: 1.20-8.50). Women whose partners were involved in health decision making had lower odds of antenatal care attendance (OR = 0.64; C.I: 0.44-0.94). Also, women whose partners were involved in spending their earnings had lower probability of antenatal care attendance (OR = 0.72; C.I: 0.55-0.96). Yet, the mediating influence of intimate partner violence on male involvement resulted in a lower likelihood of use of skilled delivery for emotionally abused women (OR = 0.58; C.I: 0.39-0.85). Women whose partners were involved in spending their earnings had higher odds of using skilled delivery (OR = 2.15; C.I: 1.79-2.56). Yet, women whose partners were involved in their health decision-making had lower odds of using skilled delivery (OR = 0.46; C.I: 0.34-0.62). Conclusion This study held the philosophical stance that intimate partner violence mediated the influence of male involvement on maternal health care uptake while intimate partner violence had an inconsistent influence on maternal health care uptake. Policies and interventions should aim at addressing deep-rooted gender norms which promote IPV and limit male involvement in pregnancy care in Nigeria. Programme and policy interventions should focus on enhancing socioeconomic status of women.
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Affiliation(s)
- O. M. Adetutu
- Department of Demography and Social Statistics, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Peng R, Tong Y, Yang M, Wang J, Yang L, Zhu J, Liu Y, Wang H, Shi Z, Liu Y. Global burden and inequality of maternal and neonatal disorders: based on data from the 2019 Global Burden of Disease study. QJM 2024; 117:24-37. [PMID: 37773990 PMCID: PMC10849872 DOI: 10.1093/qjmed/hcad220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/04/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Maternal and neonatal disorders account for substantial health loss across the lifespan from early childhood. These problems may be related to health inequality. AIM To provide evidence for improvement in health policies regarding maternal and neonatal disorder inequity. DESIGN This was a population-based cross-sectional study based on 2019 Global Burden of Disease data. METHODS Annual cases and age-standardized rates (ASRs) of incidence, prevalence, death, and disability-adjusted life-years (DALYs) in maternal and neonatal disorders between 1990 and 2019 were collected from the 2019 Global Burden of Disease study. Concentration curves and concentration indices were used to summarize the degree of socioeconomic-related inequality. RESULTS For maternal disorders, the global ASRs of incidence, prevalence, death and DALYs were 2889.4 (95% uncertainty interval (UI), 2562.9-3251.9), 502.9 (95% UI 418.7-598.0), 5.0 (95% UI 4.4-5.8) and 324.9 (95% UI 284.0-369.1) per 100 000 women in 2019, respectively. The ASRs of maternal disorders were all obviously reduced and remained pro-poor from 1990 to 2019. In neonatal disorders, the global ASRs of incidence, prevalence, death and DALYs were 363.3 (95% UI 334.6-396.8), 1239.8 (95% UI 1142.1-1356.7), 29.1 (95% UI 24.8-34.5) and 2828.3 (95% UI 2441.6-3329.6) per 100 000 people in 2019, respectively. The global ASRs of incidence, death and DALYs in neonatal disorders have remained pro-poor. However, the socioeconomic-related fairness in the ASR of neonatal disorder prevalence is being levelled. CONCLUSIONS The global burden of maternal and neonatal disorders has remained high, and socioeconomic-related inequality (pro-poor) tended not to change between 1990 and 2019.
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Affiliation(s)
- R Peng
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - Y Tong
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - M Yang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - J Wang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - L Yang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - J Zhu
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - Yu Liu
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - H Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Sichuan, 610041, China
| | - Z Shi
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - Ya Liu
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
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Oyugi B, Nizalova O, Kendall S, Peckham S. Does a free maternity policy in Kenya work? Impact and cost-benefit consideration based on demographic health survey data. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:77-89. [PMID: 36781615 PMCID: PMC10799835 DOI: 10.1007/s10198-023-01575-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
This paper evaluates the overall effect of the Kenyan free maternity policy (FMP) on the main outcomes (early neonatal and neonatal deaths) and intermediate outcomes (delivery through Caesarean Section (CS), skilled birth attendance (SBA), birth in a public hospital and low birth weight (LBW)) using the 2014 Demographic Health Survey. We applied the difference-in-difference (DID) approach to compare births (to the same mothers) happening before and after the start of the policy (June 2013) and a limited cost-benefit analysis (CBA) to assess the net social benefit of the FMP. The probabilities of birth resulting in early neonatal and neonatal mortality are significantly reduced by 17-21% and 19-20%, respectively, after the FMP introduction. The probability of birth happening through CS reduced by 1.7% after implementing the FMP, while that of LBW birth is increased by 3.7% though not statistically significant. SBA and birth in a public facility did not moderate the policy's effects on early neonatal mortality, neonatal mortality, and delivery through CS. They were not significant determinants of the policy effects on the outcomes. There is a significant causal impact of the FMP in reducing the probability of early neonatal and neonatal mortality, but not the delivery through CS. The FMP cost-to-benefit ratio was 21.22, and there were on average 4015 fewer neonatal deaths in 2013/2014 due to the FMP. The net benefits are higher than the costs; thus, there is a need to expand and sustainably fund the FMP to avert more neonatal deaths potentially.
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Affiliation(s)
- Boniface Oyugi
- Centre for Health Services Studies (CHSS), University of Kent, George Allen Wing, Canterbury, CT2 7NF, England.
- University of Nairobi, College of Health Sciences, P.O BOX 19676-00202, Nairobi, Kenya.
| | - Olena Nizalova
- Centre for Health Services Studies (CHSS), University of Kent, George Allen Wing, Canterbury, CT2 7NF, England
- Personal Social Services Research Unit (PSSRU), University of Kent, Cornwallis Central, Canterbury, CT2 7NF, England
- School of Economics, University of Kent, Kennedy Building, Canterbury, CT2 7FS, England
| | - Sally Kendall
- Centre for Health Services Studies (CHSS), University of Kent, George Allen Wing, Canterbury, CT2 7NF, England
| | - Stephen Peckham
- Centre for Health Services Studies (CHSS), University of Kent, George Allen Wing, Canterbury, CT2 7NF, England
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Kamala BA, Ersdal H, Moshiro R, Mduma E, Baker U, Guga G, Kvaløy JT, Bishanga DR, Bundala F, Marwa B, Rutachunzibwa T, Simeo J, Rutatinisibwa HF, Ndungile Y, Kayera D, Kalabamu FS, Mdoe P. Improvements in Obstetric and Newborn Health Information Documentation following the Implementation of the Safer Births Bundle of Care at 30 Facilities in Tanzania. Healthcare (Basel) 2024; 12:319. [PMID: 38338204 PMCID: PMC10855407 DOI: 10.3390/healthcare12030319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
This paper examines changes in the completeness of documentation in clinical practice before and during the implementation of the Safer Births Bundle of Care (SBBC) project. This observational study enrolled parturient women with a gestation age of at least 28 weeks at the onset of labour. Data collectors extracted information from facility registers and then a central data manager summarised and reported weekly statistics. Variables of clinical significance for CQI were selected, and the proportion of non-documentation was analysed over time. A Pearson chi-square test was used to test for significant differences in non-documentation between the periods. Between 1 March 2021 and 31 July 2022, a total of 138,442 deliveries were recorded. Overall, 75% of all patient cases had at least one missing variable among the selected variables across both periods. A lack of variable documentation occurred more frequently at the district hospital level (81% of patient cases) and health centres (74%) than at regional referral hospitals (56%) (p < 0.001). Non-documentation decreased significantly from 79% to 70% after the introduction of the SBBC (p < 0.001). A tendency towards negative correlations was noted for most variables. We noted an increased attention to data quality and use which may have a positive impact on the completeness of documentation. However, halfway through the project's implementation, the completeness of documentation was still low. Our findings support the recommendation to establish short-spaced feedback loops of locally collected data using one data platform.
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Affiliation(s)
- Benjamin Anathory Kamala
- Department of Research, Haydom Lutheran Hospital, Haydom P.O. Box 9000, Tanzania; (R.M.); (E.M.); (G.G.); (P.M.)
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania; (D.R.B.); (F.B.); (F.S.K.)
| | - Hege Ersdal
- Faculty of Health Sciences, University of Stavanger, 4021 Stavanger, Norway;
- Department of Anesthesia, Stavanger University Hospital, 4011 Stavanger, Norway
| | - Robert Moshiro
- Department of Research, Haydom Lutheran Hospital, Haydom P.O. Box 9000, Tanzania; (R.M.); (E.M.); (G.G.); (P.M.)
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania; (D.R.B.); (F.B.); (F.S.K.)
| | - Estomih Mduma
- Department of Research, Haydom Lutheran Hospital, Haydom P.O. Box 9000, Tanzania; (R.M.); (E.M.); (G.G.); (P.M.)
| | - Ulrika Baker
- UNICEF Tanzania Country Office, Dar es Salaam P.O. Box 4076, Tanzania;
| | - Godfrey Guga
- Department of Research, Haydom Lutheran Hospital, Haydom P.O. Box 9000, Tanzania; (R.M.); (E.M.); (G.G.); (P.M.)
| | - Jan Terje Kvaløy
- Department of Mathematics and Physics, University of Stavanger, 4021 Stavanger, Norway;
- Department of Research, Stavanger University Hospital, 4011 Stavanger, Norway
| | - Dunstan R. Bishanga
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania; (D.R.B.); (F.B.); (F.S.K.)
- Ifakara Health Institute, Dar es Salaam P.O. Box 78373, Tanzania
| | - Felix Bundala
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania; (D.R.B.); (F.B.); (F.S.K.)
- Ministry of Health, Dodoma P.O. Box 743, Tanzania
| | - Boniphace Marwa
- President’s Office, Regional Administration and Local Government, Dodoma P.O. Box 1923, Tanzania; (B.M.); (T.R.); (J.S.); (H.F.R.); (Y.N.); (D.K.)
| | - Thomas Rutachunzibwa
- President’s Office, Regional Administration and Local Government, Dodoma P.O. Box 1923, Tanzania; (B.M.); (T.R.); (J.S.); (H.F.R.); (Y.N.); (D.K.)
| | - Japhet Simeo
- President’s Office, Regional Administration and Local Government, Dodoma P.O. Box 1923, Tanzania; (B.M.); (T.R.); (J.S.); (H.F.R.); (Y.N.); (D.K.)
| | - Honoratha Faustine Rutatinisibwa
- President’s Office, Regional Administration and Local Government, Dodoma P.O. Box 1923, Tanzania; (B.M.); (T.R.); (J.S.); (H.F.R.); (Y.N.); (D.K.)
| | - Yudas Ndungile
- President’s Office, Regional Administration and Local Government, Dodoma P.O. Box 1923, Tanzania; (B.M.); (T.R.); (J.S.); (H.F.R.); (Y.N.); (D.K.)
| | - Damas Kayera
- President’s Office, Regional Administration and Local Government, Dodoma P.O. Box 1923, Tanzania; (B.M.); (T.R.); (J.S.); (H.F.R.); (Y.N.); (D.K.)
| | - Florence Salvatory Kalabamu
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania; (D.R.B.); (F.B.); (F.S.K.)
- Department of Pediatrics, Hubert Kairuki Memorial University, Dar es Salaam P.O. Box 65300, Tanzania
| | - Paschal Mdoe
- Department of Research, Haydom Lutheran Hospital, Haydom P.O. Box 9000, Tanzania; (R.M.); (E.M.); (G.G.); (P.M.)
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Arowosegbe AO, Dedeke IO, Shittu OB, Ojo DA, Amusan JS, Iwaloye O, Ekpo UF. Can Clean Delivery Kits Prevent Infections? Lessons from Traditional Birth Attendants in Nigeria. Ann Glob Health 2023; 89:85. [PMID: 38077261 PMCID: PMC10705026 DOI: 10.5334/aogh.4015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 11/03/2023] [Indexed: 12/18/2023] Open
Abstract
Background In resource-poor settings, perinatal infections contribute significantly to maternal and neonatal deaths, and the use of clean delivery kits (CDKs) has been proposed as a tool to reduce the risk of infection-related deaths. This study aims to assess the acceptability and effectiveness of CDKs in preventing infections in deliveries attended by traditional birth attendants (TBAs) in Abeokuta, Nigeria. Methods The study was a cluster-randomized trial with 67 birth centres/clusters, 453 births/mothers, and 457 babies randomized to intervention or control arms; intervention involved supplementation of delivery with JANMA CDKs. Interviews were conducted at the birth homes, and the primary outcomes were neonatal infection and puerperal fever. The association between infection and perinatal risk factors was tested using the Chi-square and Fisher's exact tests. Results CDKs were well accepted by TBAs. The incidence of puerperal fever and neonatal infection was 1.1% and 11.2%, respectively. Concurrent infection was found in 1 (0.22%) of the mother-neonate pair. There was no significant association between any of the sociodemographic factors and infection for both mothers and neonates. PROM and prolonged labour were significantly associated with puerperal infection. All mothers with puerperal fever were from the control group. Compared to the control group, the relative risk of puerperal infection and neonatal infection in the intervention group was 0.08 (0.004 -1.35, p = 0.079) and 0.64 (0.37 to 1.1, p = 0.10), respectively. Conclusion CDKs hold promising results in attenuating maternal infections in resource-poor settings. Larger studies with greater statistical power are required to establish statistically reliable information.
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Affiliation(s)
| | | | - Olufunke Bolatito Shittu
- Department of Microbiology, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
| | - David Ajiboye Ojo
- Department of Microbiology, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
| | - Joy Stephen Amusan
- Department of Public Health, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Opeoluwa Iwaloye
- Department of Microbiology, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
| | - Uwemedimo Friday Ekpo
- Department of Pure and Applied Zoology, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
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Oliveira D, de Oliveira JM, Martins MDR, Barroso MR, Castro R, Cordeiro L, Pereira F. Maternal Profiles and Pregnancy Outcomes: A Descriptive Cross-Sectional Study from Angola. Matern Child Health J 2023; 27:2091-2098. [PMID: 37815656 DOI: 10.1007/s10995-023-03782-6] [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] [Accepted: 09/26/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES To characterize pregnant women admitted to Irene Neto Maternity Hospital, Lubango city, Huíla province, and their pregnancy outcomes. METHODS We conducted a descriptive cross-sectional facility-based survey between October 2016 and September 2017, involving 500 pregnant women, followed from admission in labor until the end of delivery. Mean (SD) was computed for quantitative variables, while relative and absolute frequencies were determined for categorical variables. Additionally, confidence intervals were estimated. RESULTS Among pregnant women 18.3% were adolescents (≤ 19 years) and 14.5% had advanced maternal age (≥ 35 years). Illiteracy was reported by 8.2%. One in three (33.6%) had a short stature (< 1.55 m). Malaria was the most frequent infection during pregnancy (16.3%). Upon admission, 18.1% were anemic (Hb < 11 g/dl) and 36.0% had hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg), contrasting with the few cases reported of chronic hypertension and pregnancy-induced hypertension. There were 15 twin pregnancies. Cesarean section was performed in 25.2% of the women, although there was no medical indication for 23.0% of women having cesareans. Two maternal deaths occurred in our sample. Among live births from singleton pregnancies (97.1%), birth asphyxia (Apgar < 7 at 5 min) was observed in 22.7% and 10.3% had low birth weight (< 2.5 kg). CONCLUSIONS There are very few studies reporting pregnancy outcomes in Angola. This analysis presents data from Huíla province, the second most populous province. We identified characteristics for higher risk of adverse pregnancy outcomes: adolescence, illiteracy, and short stature. Among newborn outcomes, birth asphyxia and low birth weight demand special attention. Further research is needed to explore the non-medical indications for cesarean section and to better understand the twinning rate in Lubango.
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Affiliation(s)
- Dinamene Oliveira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical-Universidade Nova de Lisboa, Lisboa, Portugal.
| | | | - Maria do Rosário Martins
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical-Universidade Nova de Lisboa, Lisboa, Portugal
| | - Maria Rosalina Barroso
- Unidade de Cuidados Intensivos Neonatais, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Rita Castro
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical-Universidade Nova de Lisboa, Lisboa, Portugal
| | - Lemuel Cordeiro
- Gabinete de Ensino, Pesquisa e Pós-graduação, Clínica Girassol, Luanda, Angola
| | - Filomena Pereira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical-Universidade Nova de Lisboa, Lisboa, Portugal
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Johnson A, Vaithilingan S, Avudaiappan SL. The Interplay of Hypertension and Anemia on Pregnancy Outcomes. Cureus 2023; 15:e46390. [PMID: 37927714 PMCID: PMC10620472 DOI: 10.7759/cureus.46390] [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: 09/13/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Background Anemia and pregnancy-induced hypertension (PIH) are two significant high-risk conditions that can have a profound impact on maternal health during pregnancy. The scarcity of studies investigating the potential links and interactions between these two conditions adds to the gap in our understanding of their combined impact on pregnant women. This study aimed to assess the impact of PIH in conjunction with anemia and without anemia on pregnancy outcomes. Methods A prospective study was conducted among 150 primi pregnant women (third trimester of pregnancy) from a secondary-care hospital (Government General Headquarters Hospital, Cuddalore) in Tamil Nadu, India. The study population was selected using a purposive sampling technique. Data were collected using a structured questionnaire to assess sociodemographic characteristics, dietary patterns, and outcomes of pregnancy. Clinical parameters such as blood pressure were measured using a sphygmomanometer, and hemoglobin and urine tests for protein were obtained from the patient's medical records. Results The result showed that out of 150 primi pregnant women, 73 (49%) had PIH and 77 (51%) experienced both PIH and anemia. On comparing the outcomes, pregnant women with PIH accompanied by anemia exhibited developing preeclampsia (p<0.001), encountered maternal complications (p=0.034), delivered preterm babies (p=0.03), and gave birth to low-birth-weight babies (p<0.001), and their newborns admitted to the NICU (p=0.02). Additionally, pregnant women with both PIH and anemia demonstrated significantly higher levels of systolic blood pressure after delivery (p=0.009). Conclusion The study calls for the immediate attention of healthcare providers for vigilant monitoring and addressing anemia in conjunction with PIH to improve maternal and neonatal outcomes.
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Affiliation(s)
- Alby Johnson
- Department of Obstetrics and Gynaecological Nursing, Vinayaka Mission's Research Foundation (DU), Salem, IND
| | - Sasi Vaithilingan
- Department of Child Health Nursing, Vinayaka Mission's College of Nursing, Puducherry, IND
| | - Seetha Lakshmi Avudaiappan
- Department of Nursing Foundation, Sri Ramachandra College of Nursing, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Yingjuan L, Peng J, Liu Y, Xia W, Chen S, Yongcheng S, Lin Y. Association between maternal HIV infection and the risks of preterm birth and low birth weight in Chengdu, China: a propensity score matching approach. BMJ Open 2023; 13:e071205. [PMID: 37678947 PMCID: PMC10496673 DOI: 10.1136/bmjopen-2022-071205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/11/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVES To estimate the effect of HIV infection on the risk of preterm birth (PTB) and low birth weight (LBW) among Chinese pregnancy women. DESIGN A retrospective cohort study included HIV-positive pregnant women who gave birth to singletons in Chengdu between 2011 and 2020 and and HIV-negative pregnant women who delivered singletons at the Chengdu Women's and Children's Central Hospital in 2020. SETTING Data of pregnant women living with HIV were extracted from China's Information System of Prevention of Mother-to-Child Transmission of HIV Management. Additionally, information for HIV-negative pregnant women was extracted from the electronic medical record system of the Chengdu Women's and Children's Central Hospital. PARTICIPANTS 755 HIV-positive women and 15,094 HIV-negative pregnant women were included. PRIMARY OUTCOME MEASURES PTB and LBW rates, which were defined by gestational weeks and birth weight. RESULTS The incidences of PTB and LBW (13.51% and 14.17%, respectively) were significantly higher in the HIV-positive group compared with the HIV-negative group (6.82% and 4.65%). Propensity score matching was performed to improve comparability of the two groups, resulting in 1590 pregnancies with 558 HIV-positive and 1032 HIV-negative women in the final analysis. Conditional logistic regression was used to estimate the effect of maternal HIV status on adverse pregnancy outcomes. After propensity score matching and controlling the potential confounders, HIV infection was strongly associated with higher chances of LBW and PTB with adjusted odd ratios (95% confidence interval) of 2.53 (1.74 to 3.68) and 1.95 (1.33 to 2.85), respectively. CONCLUSIONS HIV infection was significantly associated with increased risks of PTB and LBW in Chinese pregnant women. Future studies should focus on investigating the mechanisms underlying the association between HIV infection and adverse birth outcomes, and on identifying strategies to reduce the incidence of PTB and LBW in pregnant women living with HIV.
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Affiliation(s)
- Luo Yingjuan
- Healthcare Department, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jieru Peng
- Medical Administration Department, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yang Liu
- Healthcare Department, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Wu Xia
- Healthcare Department, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Shan Chen
- Medical Administration Department, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Sheng Yongcheng
- Healthcare Department, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yonghong Lin
- Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
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12
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Nagineviciute M, Bartuseviciene E, Blazeviciene A. Woman-Centered Care: Standardized Outcomes Measure. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1537. [PMID: 37763656 PMCID: PMC10533153 DOI: 10.3390/medicina59091537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Patient- or woman-centered care, prioritizing women's perspectives, needs, and preferences, is a widely recommended approach to enhance the quality of maternity care services. It aligns with the broader principles of patient-centered care, emphasizing the importance of a collaborative and respectful relationship between healthcare providers and women. This study evaluates low-risk pregnancies managed by midwives and obstetrician-gynecologists in Lithuania using patient-reported outcome measures and patient-reported experience measures. Materials and Methods: A prospective cohort study was conducted between September 2022 and April 2023. Data were collected through patient-reported questionnaires. Results: A total of 153 pregnant women who had singleton, low-risk pregnancies participated in the study, of whom 24.8% had their pregnancies supervised by a midwife, and 75.2% of the participants had their pregnancies supervised by an obstetrician-gynecologist. The study found no statistically significant differences in assessed patient-reported outcome measures and patient-reported experience measures between both models of care. Conclusions: Adopting patient-centered approaches enables healthcare systems to understand and address women's specific needs and preferences, fostering high-quality and woman-centered care. This research adds to the growing evidence supporting midwife-led care and emphasizes the importance of personalized, woman-centered approaches in maternity care, ultimately enhancing maternal health outcomes and promoting positive experiences for low-risk pregnant women. The quality of care provided by midwives remains uncompromised and equivalently proficient compared to the care provided by collaborative teams.
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Affiliation(s)
- Milda Nagineviciute
- Department of Nursing, Faculty of Nursing, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Egle Bartuseviciene
- Department of Obstetrics and Gynecology, Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Aurelija Blazeviciene
- Department of Nursing, Faculty of Nursing, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
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Khan Z, Vowles Z, Fernandez Turienzo C, Barry Z, Brigante L, Downe S, Easter A, Harding S, McFadden A, Montgomery E, Page L, Rayment-Jones H, Renfrew M, Silverio SA, Spiby H, Villarroel-Williams N, Sandall J. Targeted health and social care interventions for women and infants who are disproportionately impacted by health inequalities in high-income countries: a systematic review. Int J Equity Health 2023; 22:131. [PMID: 37434187 DOI: 10.1186/s12939-023-01948-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Disadvantaged populations (such as women from minority ethnic groups and those with social complexity) are at an increased risk of poor outcomes and experiences. Inequalities in health outcomes include preterm birth, maternal and perinatal morbidity and mortality, and poor-quality care. The impact of interventions is unclear for this population, in high-income countries (HIC). The review aimed to identify and evaluate the current evidence related to targeted health and social care service interventions in HICs which can improve health inequalities experienced by childbearing women and infants at disproportionate risk of poor outcomes and experiences. METHODS Twelve databases searched for studies across all HICs, from any methodological design. The search concluded on 8/11/22. The inclusion criteria included interventions that targeted disadvantaged populations which provided a component of clinical care that differed from standard maternity care. RESULTS Forty six index studies were included. Countries included Australia, Canada, Chile, Hong Kong, UK and USA. A narrative synthesis was undertaken, and results showed three intervention types: midwifery models of care, interdisciplinary care, and community-centred services. These intervention types have been delivered singularly but also in combination of each other demonstrating overlapping features. Overall, results show interventions had positive associations with primary (maternal, perinatal, and infant mortality) and secondary outcomes (experiences and satisfaction, antenatal care coverage, access to care, quality of care, mode of delivery, analgesia use in labour, preterm birth, low birth weight, breastfeeding, family planning, immunisations) however significance and impact vary. Midwifery models of care took an interpersonal and holistic approach as they focused on continuity of carer, home visiting, culturally and linguistically appropriate care and accessibility. Interdisciplinary care took a structural approach, to coordinate care for women requiring multi-agency health and social services. Community-centred services took a place-based approach with interventions that suited the need of its community and their norms. CONCLUSION Targeted interventions exist in HICs, but these vary according to the context and infrastructure of standard maternity care. Multi-interventional approaches could enhance a targeted approach for at risk populations, in particular combining midwifery models of care with community-centred approaches, to enhance accessibility, earlier engagement, and increased attendance. TRIAL REGISTRATION PROSPERO Registration number: CRD42020218357.
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Affiliation(s)
- Zahra Khan
- Department of Women & Children's Health, King's College London, London, UK.
| | - Zoe Vowles
- Department of Women & Children's Health, King's College London, London, UK
| | | | - Zenab Barry
- Patient and Public Involvement and Engagement, NIHR ARC South London, London, UK
| | | | - Soo Downe
- University of Central Lancashire, Lancashire, UK
| | - Abigail Easter
- Department of Women & Children's Health, King's College London, London, UK
| | - Seeromanie Harding
- Department of Population Health Sciences, King's College London, London, UK
| | | | | | | | | | | | - Sergio A Silverio
- Department of Women & Children's Health, King's College London, London, UK
| | | | | | - Jane Sandall
- Department of Women & Children's Health, King's College London, London, UK
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Setu SP, Majumder U. A multilevel analysis to determine the factors affecting WHO recommended quantity antenatal care utilizations of pregnant women in Bangladesh. Heliyon 2023; 9:e16294. [PMID: 37274676 PMCID: PMC10238893 DOI: 10.1016/j.heliyon.2023.e16294] [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: 06/07/2022] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 06/06/2023] Open
Abstract
Antenatal Care utilizations have become an essential phenomenon to all pregnant women as a means of disease preclusion during pregnancy and safe live birth. To lessen maternal death and disease, proper (minimum eight) antenatal care (ANC) contacts are necessary according to World Health Organization (WHO) new guideline. The aim of this study is to assess the factors affecting proper antenatal care utilization of pregnant Bangladeshi women. The study used data from the most recent Bangladesh Demographic and Health Survey 2017-18 for conducting a two-level binary logistic regression model. A weighted sample of 4866 women and 675 clusters were considered as individual and community level respectively. The results exhibited only 11.6% women took proper antenatal care during pregnancy. The study found 23.9% variability in utilizations of Antenatal care belongs to community-level factors. At individual-level, mother's occupation, body mass index, birth-order, pregnancy intention, education, delivery place, and media access and at community-level, rural communities (AOR = 0.70, 95% C.I = 0.542-0.920), and communities having media access (AOR = 1.38, 95% C.I = 0.979-1.96) had significant relationship with proper antenatal care utilizations of pregnant women. After testing random slopes of individual-level variables, only education of women covariate was found to be varied from community to community. This study suggests that uptake of proper antenatal care depend on both individual and community level covariates and there lies extensive variation among them. Future studies on wider aspect are therefore suggested to determine obstacles in making proper Antenatal care utilizations.
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15
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Zhang L, Lu J, Takashi E, Matsumoto S. Rapid Manufacturing Approach of an Ultrathin Moisture Sensor for Health Monitoring. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23094262. [PMID: 37177469 PMCID: PMC10181125 DOI: 10.3390/s23094262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023]
Abstract
This study developed a rapid manufacturing approach for a moisture sensor based on contactless jet printing technology. A compact measurement system with ultrathin and flexure sensor electrodes was fabricated. The proposed sensor system focuses on continuous urine measurement, which can provide timely information on subjects to ensure efficient diagnosis and treatment. The obtained results verify that the proposed sensor system can exhibit a typical responsivity of up to -7.76 mV/%RH in the high-sensitivity range of 50-80 %RH. A preliminary field experiment was conducted on a hairless rat, and the effectiveness of the proposed ultrathin moisture sensor was verified. This ultrathin sensor electrode can be fabricated in the micrometer range, and its application does not affect the comfort of the user. The ultrathin electrode sensors can be printed directly on the diaper or undergarment of the user for in situ urine health monitoring, particularly of infants and the elderly.
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Affiliation(s)
- Lan Zhang
- Device Technology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba 305-8564, Japan
- New-Generation Medical Treatment and Diagnosis Research Laboratory, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba 305-8566, Japan
| | - Jian Lu
- Device Technology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba 305-8564, Japan
| | - En Takashi
- Faculty of Nursing, Nagano College of Nursing, Komagane 399-4117, Japan
| | - Sohei Matsumoto
- Device Technology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba 305-8564, Japan
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16
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Mary M, Maliqi B, Stierman EK, Dohlsten MA, Moran AC, Katwan E, Creanga AA. Assessing the neonatal health policy landscape in low- and middle-income countries: Findings from the 2018 WHO SRMNCAH policy survey. J Glob Health 2023; 13:04024. [PMID: 36867415 PMCID: PMC9983710 DOI: 10.7189/jogh.13.04024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Background We aimed to describe the availability of newborn health policies across the continuum of care in low- and middle-income countries (LMICs) and to assess the relationship between the availability of newborn health policies and their achievement of global Sustainable Development Goal and Every Newborn Action Plan (ENAP) neonatal mortality and stillbirth rate targets in 2019. Methods We used data from World Health Organization's 2018-2019 sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) Policy Survey and extracted key newborn health service delivery and cross-cutting health systems policies that align with the WHO health system building blocks. We constructed composite measures to represent packages of newborn health policies for five components along the continuum of care: antenatal care (ANC), childbirth, postnatal care (PNC), essential newborn care (ENC), and management of small and sick newborns (SSNB). We used descriptive analyses to present the differences in the availability of newborn health service delivery policies by World Bank income group in 113 LMICs. We employed logistic regression analysis to assess the relationship between the availability of each composite newborn health policy package and achievement of global neonatal mortality and stillbirth rate targets by 2019. Results In 2018, most LMICs had existing policies regarding newborn health across the continuum of care. However, policy specifications varied widely. While the availability of the ANC, childbirth, PNC, and ENC policy packages was not associated with having achieved global NMR targets by 2019, LMICs with existing policy packages on the management of SSNB were 4.4 times more likely to have reached the global NMR target (adjusted odds ratio (aOR) = 4.40; 95% confidence interval (CI) = 1.09-17.79) after controlling for income group and supporting health systems policies. Conclusions Given the current trajectory of neonatal mortality in LMICs, there is a dire need for supportive health systems and policy environments for newborn health across the continuum of care. Adoption and implementation of evidence-informed newborn health policies will be a crucial step in putting LMICs on track to meet global newborn and stillbirth targets by 2030.
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Affiliation(s)
- Meighan Mary
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Blerta Maliqi
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Elizabeth K Stierman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Martin Aj Dohlsten
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Elizabeth Katwan
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Andreea A Creanga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Maharani M, Sutrisno S. Analysis of Causes of Maternal Death in East Java Province, Indonesia. Open Access Maced J Med Sci 2023. [DOI: 10.3889/oamjms.2023.9549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND: The maternal mortality rate is an indicator that reflects the mother’s health status, especially the risk of death for the mother during pregnancy and childbirth. Measles, Mumps, and Rubella (MMR) has a close relationship with efforts to increase human development. Therefore, efforts are needed to reduce MMR by identifying the factors that influence MMR.
AIM: The aim of the study was to analyze the factors causing the incidence of Maternal Death in East Java Province.
METHODS: The research design used in this research is a quantitative research using descriptive-analytical. The population of this research is districts/cities in East Java Province, with a sample of 38 districts/cities. The research period starts from August to September 2021. Data analysis using grouping and percentage of cases.
RESULTS: The results of the study found that cases of maternal death in East Java due to postpartum hemorrhage in 2021 were 131 cases. Cases due to hypertension as many as 115 cases. Cases due to infection as many as 25 cases. The incidence of maternal death due to abortion is 1 case. There were 13 cases of maternal death due to blood disorders. There were 6 cases of maternal death due to metabolic disorders — cases of maternal death due to Heart as many as 54 cases. Maternal deaths due to COVID-19 were 793 cases.
CONCLUSION: Factors causing maternal death in East Java Province, namely, hypertension bleeding, infection, abortion, blood disorders, heart metabolic disorders, and COVID-19. The most influential factor in maternal mortality in 2021 is COVID-19.
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Komolafe AO, Oyelade OO, Adedini SA, Irinoye OO. Understanding context in the implementation of emergency obstetric and neonatal care in health facilities in Osun State, Nigeria- a mixed-methods study. BMC Pregnancy Childbirth 2022; 22:934. [PMID: 36514021 PMCID: PMC9746005 DOI: 10.1186/s12884-022-05278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Successful implementation of Emergency Obstetric and Neonatal Care (EmONC) is likely to improve pregnancy outcomes and is essential for quality maternity care. Context in implementation is described as factors that enabled or disabled implementation of interventions. While the context of implementation is important for the effectiveness of evidence-based interventions, the context of EmONC implementation has not been widely studied in Nigeria. METHODS The research design was cross-sectional descriptive. A mixed-methods approach was used to assess and explore the context of implementing EmONC in referral centres in Osun state. A purposive sampling technique was used to select the three tertiary health facilities in Osun State and six secondary health facilities from the six administrative zones in the State. A total of 186 healthcare providers in these referral centres participated in the quantitative part of the study, and eighteen in-depth interviews were conducted for its qualitative aspect. An adapted questionnaire from Context Assessment Index and an interview guide were used to collect data. Quantitative data were analysed using descriptive and inferential statistics at 0.05 significance level, while qualitative data were analysed using the thematic approach. RESULTS The percentage mean score of context strength in EmONC implementation was 63% ± 10.46 in secondary and 68% ± 10.47 in tertiary health facilities. There was a significant difference in the leadership (F (1, 184) = 8.35, p < 0.01), evaluation (F (1, 184) = 5.35, p = 0.02) and overall context (F (1, 184) = 6.46, p = 0.01) of EmONC implementation in secondary and tertiary health facilities. Emerging themes in EmONC context were: Resources for EmONC implementation; Demand for EmONC; Efficiency of funding; Institutional leadership; and Performance evaluation. CONCLUSIONS The context of EmONC implementation in the referral health facilities was generally weak. The secondary health facilities' weaknesses were worse compared to the tertiary health facilities. The five key contextual factors could inform strategies for improving EmONC implementation in health facilities to ensure improved access to care that will reduce deaths from obstetric complications in Nigeria.
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Affiliation(s)
| | | | - Sunday Adepoju Adedini
- Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Musarandega R, Cresswell J, Magwali T, Makosa D, Machekano R, Ngwenya S, Nystrom L, Pattinson R, Munjanja S. Maternal mortality decline in Zimbabwe, 2007/2008 to 2018/2019: findings from mortality surveys using civil registration, vital statistics and health system data. BMJ Glob Health 2022; 7:bmjgh-2022-009465. [PMID: 35926916 PMCID: PMC9358939 DOI: 10.1136/bmjgh-2022-009465] [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: 04/26/2022] [Accepted: 07/24/2022] [Indexed: 11/07/2022] Open
Abstract
Background Sustainable Development Goal (SDG) 3.1 target is to reduce the global maternal mortality ratio (MMR) to less than 70 maternal deaths per 100 000 live births by 2030. In the Ending Preventable Maternal Mortality strategy, a supplementary target was added, that no country has an MMR above 140 by 2030. We conducted two cross-sectional reproductive age mortality surveys to analyse changes in Zimbabwe’s MMR between 2007–2008 and 2018–2019 towards the SDG target. Methods We collected data from civil registration, vital statistics and medical records on deaths of women of reproductive ages (WRAs), including maternal deaths from 11 districts, randomly selected from each province (n=10) using cluster sampling. We calculated weighted mortality rates and MMRs using negative binomial models, with 95% CIs, performed a one-way analysis of variance of the MMRs and calculated the annual average reduction rate (ARR) for the MMR. Results In 2007–2008 we identified 6188 deaths of WRAs, 325 pregnancy-related deaths and 296 maternal deaths, and in 2018–2019, 1856, 137 and 130, respectively. The reproductive age mortality rate, weighted by district, declined from 11 to 3 deaths per 1000 women. The MMR (95% CI) declined from 657 (485 to 829) to 217 (164 to 269) deaths per 100 000 live births at an annual ARR of 10.1%. Conclusions Zimbabwe’s MMR declined by an annual ARR of 10.1%, against a target of 10.2%, alongside declining reproductive age mortality. Zimbabwe should continue scaling up interventions against direct maternal mortality causes to achieve the SDG 3.1 target by 2030.
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Affiliation(s)
- Reuben Musarandega
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa .,Unit of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jenny Cresswell
- Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland
| | - Thulani Magwali
- Unit of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Davidzoyashe Makosa
- Department of Reproductive Health (fomerly), Ministry of Health and Child Care, Harare, Zimbabwe
| | - Rhoderick Machekano
- Department of Biostatistics and Epidemiology, Stellenbosch University, Cape Town, South Africa
| | - Solwayo Ngwenya
- Department of Obstetrics and Gynaecology, National University of Science and Technology, Bulawayo, Zimbabwe
| | - Lennarth Nystrom
- Department of Epidemiology and Global Health, Umea University, Umea, Sweden
| | - Robert Pattinson
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
| | - Stephen Munjanja
- Unit of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Enríquez Canto Y. [Inequalities in the Coverage and Quality of Prenatal Care in Peru, 2009-2019Desigualdades na cobertura e na qualidade da assistência pré-natal no Peru, 2009-2019]. Rev Panam Salud Publica 2022; 46:e47. [PMID: 35702717 PMCID: PMC9186097 DOI: 10.26633/rpsp.2022.47] [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: 09/27/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022] Open
Abstract
Objetivo. Describir la cobertura en la atención prenatal de calidad y la evolución de sus desigualdades en embarazadas peruanas en el período 2009-2019. Métodos. Análisis transversal con datos de la Encuesta Demográfica y de Salud Familiar de los años 2009, 2014 y 2019 sobre los cuidados prenatales; se consideró el número de visitas durante el embarazo y su calidad. Se calcularon medidas absolutas y relativas de desigualdad en salud de grupos estratificados. Resultados. La cobertura del número de visitas prenatales aumentó de 77,22% en el 2009 a 87,52% en el 2019. Asimismo, entre las mujeres de áreas rurales y urbanas, la brecha relativa por área de residencia disminuyó de 15% (2009) a 3% (2019), mientras que el porcentaje de embarazadas sin acceso a visitas de calidad decreció de 45,16% (2009) a 29,35% (2019). En el acceso a la calidad de controles, la desigualdad absoluta por quintiles de riqueza se redujo a casi la mitad, de 55,96% a 25,95%. Sin embargo, en este indicador, para el 2019 la diferencia relativa aún favorece a las universitarias 37% más respecto a las embarazadas sin escolaridad. Conclusiones. En Perú se han ido cerrando las brechas de las desigualdades de acceso a las visitas prenatales. Sin embargo, el conjunto de los datos nacionales oculta desigualdades entre poblaciones en la atención de calidad. La desigualdad en el acceso a la calidad de atención debería ser utilizada como indicador que permita el monitoreo de la cobertura de visitas prenatales.
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Affiliation(s)
- Yordanis Enríquez Canto
- Facultad de Ciencias de la Salud Universidad Católica Sedes Sapientiae Lima Perú Facultad de Ciencias de la Salud Universidad Católica Sedes Sapientiae, Lima, Perú
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21
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Lundin R, Mariani I, Peven K, Day LT, Lazzerini M. Quality of routine health facility data used for newborn indicators in low- and middle-income countries: A systematic review. J Glob Health 2022. [PMCID: PMC9031513 DOI: 10.7189/jogh.12.04019] [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] [Indexed: 11/26/2022] Open
Abstract
Background High-quality data are fundamental for effective monitoring of newborn morbidity and mortality, particularly in high burden low- and middle-income countries (LMIC). Methods We conducted a systematic review on the quality of routine health facility data used for newborn indicators in LMIC, including measures employed. Five databases were searched from inception to February 2021 for relevant observational studies (excluding case-control studies, case series, and case reports) and baseline or control group data from interventional studies, with no language limits. An adapted version (19-point scale) of the Critical Appraisal Tool to assess the Quality of Cross-Sectional Studies (AXIS) was used to assess methodological quality, and results were synthesized using descriptive analysis. Results From the 19 572 records retrieved, 34 studies in 16 LMIC countries were included. Methodological quality was high (>14/19) in 32 studies and moderate (10-14/19) in two. Studies were mostly from African (n = 30, 88.2%) and South-East Asian (n = 24, 70.6%) World Health Organization (WHO) regions, with very few from Eastern Mediterranean (n = 2, 5.9%) and Western Pacific (n = 1, 2.9%) ones. We found that only data elements used to calculate neonatal indicators had been assessed, not the indicators themselves. 41 data elements were assessed, most frequently birth outcome. 20 measures of data quality were used, most along three dimensions: 1) completeness and timeliness, 2) internal consistency, and 3) external consistency. Data completeness was very heterogeneous across 26 studies, ranging from 0%-100% in routine facility registers, 0%-100% in patient case notes, and 20%-68% in aggregate reports. One study reported on the timeliness of aggregate reports. Internal consistency ranged from 0% to 96.2% in four studies. External consistency (21 studies) varied widely in measurement and findings, with specificity (6.4%-100%), sensitivity (23.6%-97.6%), and percent agreement (24.6%-99.4%) most frequently reported. Conclusions This systematic review highlights a gap in the published literature on the quality of routine LMIC health facility data for newborn indicators. Robust evidence is crucial in driving data quality initiatives at national and international levels. The findings of this review indicate that good quality data collection is achievable even in high-burden LMIC settings, but more efforts are needed to ensure uniformly high data quality for neonatal indicators.
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Affiliation(s)
- Rebecca Lundin
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” – WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” – WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
| | - Kimberly Peven
- London School of Hygiene & Tropical Medicine, London, UK
| | - Louise T Day
- London School of Hygiene & Tropical Medicine, London, UK
| | - Marzia Lazzerini
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” – WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
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22
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Agarwal S, Scher MS. Fetal-neonatal neurology program development: Continuum of care during the first 1000 days. J Perinatol 2022; 42:165-168. [PMID: 34848849 DOI: 10.1038/s41372-021-01282-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/10/2021] [Accepted: 11/17/2021] [Indexed: 11/09/2022]
Abstract
Global estimates show that 10-20% of persons express developmental disability. During critical and sensitive periods of developmental neuroplasticity over the first 1000 days, adverse gene-environment interactions are likely to contribute to permanent life-long disabilities and early mortality. This article describes fetal-neonatal neurology (FNN) program development that integrates vertical and horizontal diagnostic perspectives. Trimester-specific conditions to the maternal-placental-fetal triad begin at conception, followed by pediatric patient care over the first two years of life to address changing phenotypic form and function. While fetal and neonatal neurology trainees prepare to offer person-centric healthcare, population-based considerations address obstacles to optimal health relevant to resource-rich and poor nations. Maternal and pediatric care practices over the first 1000 days underscore equitable health policy. Global initiatives apply geographic distance, biosocial dynamics, and cultural differences to developmental origins and life-course theories, to more effectively reduce disease burden over the life continuum.
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Affiliation(s)
- Sonika Agarwal
- Division of Neurology, Assistant Professor, University of Pennsylvania, Children's Hospital of Philadelphia, 3500 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Mark S Scher
- Emeritus Full Professor of Pediatrics and Neurology, Rainbow Babies and Children's Hospital/MacDonald Hospital for Women, University Hospitals Cleveland Medical Center, Case Western Reserve University, School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
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23
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Exley J, Gupta PA, Schellenberg J, Strong KL, Requejo JH, Moller AB, Moran AC, Marchant T. A rapid systematic review and evidence synthesis of effective coverage measures and cascades for childbirth, newborn and child health in low- and middle-income countries. J Glob Health 2022; 12:04001. [PMID: 35136594 PMCID: PMC8801924 DOI: 10.7189/jogh.12.04001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Effective coverage measures aim to estimate the proportion of a population in need of a service that received a positive health outcome. In 2020, the Effective Coverage Think Tank Group recommended using a 'coverage cascade' for maternal, newborn, child and adolescent health and nutrition (MNCAHN), which organises components of effective coverage in a stepwise fashion, with each step accounting for different aspects of quality of care (QoC), applied at the population level. The cascade outlines six steps that increase the likelihood that the population in need experience the intended health benefit: 1) the population in need (target population) who contact a health service; 2) that has the inputs available to deliver the service; 3) who receive the health service; 4) according to quality standards; 5) and adhere to prescribed medication(s) or health workers instructions; and 6) experience the expected health outcome. We examined how effective coverage of life-saving interventions from childbirth to children aged nine has been defined and assessed which steps of the cascade are captured by existing measures. METHODS We undertook a rapid systematic review. Seven scientific literature databases were searched covering the period from May 1, 2017 to July, 8 2021. Reference lists from reviews published in 2018 and 2019 were examined to identify studies published prior to May 2017. Eligible studies reported population-level contact coverage measures adjusted for at least one dimension of QoC. RESULTS Based on these two search approaches this review includes literature published from 2010 to 2021. From 16 662 records reviewed, 33 studies were included, reporting 64 effective coverage measures. The most frequently examined measures were for childbirth and immediate newborn care (n = 24). No studies examined measures among children aged five to nine years. Definitions of effective coverage varied across studies. Key sources of variability included (i) whether a single effective coverage measure was reported for a package of interventions or separate measures were calculated for each intervention; (ii) the number and type of coverage cascade steps applied to adjust for QoC; and (iii) the individual items included in the effective coverage definition and the methods used to generate a composite quality measure. CONCLUSION In the MNCAHN literature there is substantial heterogeneity in both definitions and construction of effective coverage, limiting the comparability of measures over time and place. Current measurement approaches are not closely aligned with the proposed cascade. For widespread adoption, there is a need for greater standardisation of indicator definitions and transparency in reporting, so governments can use these measures to improve investments in MNACHN and implement life-saving health policies and programs.
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Affiliation(s)
- Josephine Exley
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Prateek Anand Gupta
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathleen L Strong
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Jennifer Harris Requejo
- Division of Data, Analytics, Planning & Monitoring, United Nations Children’s Fund, New York, USA
| | - Ann-Beth Moller
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Child Health Accountability Tracking Technical Advisory Group (CHAT) and the Mother and Newborn Information for Tracking Outcomes and Results Technical Advisory Group (MoNITOR)
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
- Division of Data, Analytics, Planning & Monitoring, United Nations Children’s Fund, New York, USA
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Jolivet RR, Gausman J, Kapoor N, Langer A, Sharma J, Semrau KEA. Operationalizing respectful maternity care at the healthcare provider level: a systematic scoping review. Reprod Health 2021; 18:194. [PMID: 34598705 PMCID: PMC8485458 DOI: 10.1186/s12978-021-01241-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ensuring the right to respectful care for maternal and newborn health, a critical dimension of quality and acceptability, requires meeting standards for Respectful Maternity Care (RMC). Absence of mistreatment does not constitute RMC. Evidence generation to inform definitional standards for RMC is in an early stage. The aim of this systematic review is clear provider-level operationalization of key RMC principles, to facilitate their consistent implementation. METHODS Two rights-based frameworks define the underlying principles of RMC. A qualitative synthesis of both frameworks resulted in seven fundamental rights during childbirth that form the foundation of RMC. To codify operational definitions for these key elements of RMC at the healthcare provider level, we systematically reviewed peer-reviewed literature, grey literature, white papers, and seminal documents on RMC. We focused on literature describing RMC in the affirmative rather than mistreatment experienced by women during childbirth, and operationalized RMC by describing objective provider-level behaviors. RESULTS Through a systematic review, 514 records (peer-reviewed articles, reports, and guidelines) were assessed to identify operational definitions of RMC grounded in those rights. After screening and review, 54 records were included in the qualitative synthesis and mapped to the seven RMC rights. The majority of articles provided guidance on operationalization of rights to freedom from harm and ill treatment; dignity and respect; information and informed consent; privacy and confidentiality; and timely healthcare. Only a quarter of articles mentioned concrete or affirmative actions to operationalize the right to non-discrimination, equality and equitable care; less than 15%, the right to liberty and freedom from coercion. Provider behaviors mentioned in the literature aligned overall with seven RMC principles; yet the smaller number of available research studies that included operationalized definitions for some key elements of RMC illustrates the nascent stage of evidence-generation in this area. CONCLUSIONS Lack of systematic codification, grounded in empirical evidence, of operational definitions for RMC at the provider level has limited the study, design, implementation, and comparative assessment of respectful care. This qualitative systematic review provides a foundation for maternity healthcare professional policy, training, programming, research, and program evaluation aimed at studying and improving RMC at the provider level.
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Affiliation(s)
- R Rima Jolivet
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Jewel Gausman
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Neena Kapoor
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Ana Langer
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Jigyasa Sharma
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Katherine E A Semrau
- BetterBirth Program, Ariadne Labs
- Brigham and Women's Hospital and Harvard TH Chan School of Public Health, Boston, MA, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA
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25
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Strong KL, Requejo J, Agweyu A, Billah SM, Boschi-Pinto C, Horiuchi S, Jamaluddine Z, Lazzerini M, Maiga A, McKerrow N, Munos M, Schellenberg J, Weigel R. Revitalizing child health: lessons from the past. Glob Health Action 2021; 14:1947565. [PMID: 34320911 PMCID: PMC8330761 DOI: 10.1080/16549716.2021.1947565] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Essential health, education and other service disruptions arising from the COVID-19 pandemic risk reversing some of the hard-won gains in improving child survival over the past 40 years. Although children have milder symptoms of COVID-19 disease than adults, pandemic control measures in many countries have disrupted health, education and other services for children, often leaving them without access to birth and postnatal care, vaccinations and early childhood preventive and treatment services. These disruptions mean that the SARS-CoV-2 virus, along with climate change and shifting epidemiological and demographic patterns, are challenging the survival gains that we have seen over the past 40 years. We revisit the initiatives and actions of the past that catalyzed survival improvements in an effort to learn how to maintain these gains even in the face of today's global challenges.
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Affiliation(s)
- Kathleen L Strong
- Maternal, Newborn, Child and Adolescent Health and Aging Department, World Health Organization, Geneva, Switzerland
| | - Jennifer Requejo
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, NY, USA
| | - Ambrose Agweyu
- Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kenya
| | - Sk Masum Billah
- Maternal and Child Health Division, Icddr, b, Dhaka, Bangladesh
| | - Cynthia Boschi-Pinto
- Department of Epidemiology and Biostatistics, University Federal Fluminense Rio De Janeiro, Brazil
| | - Sayaka Horiuchi
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
| | | | - Marzia Lazzerini
- Center for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Abdoulaye Maiga
- Global Disease epidemiology and control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neil McKerrow
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.,Department of Paediatrics and Child Health, University of Cape Town, Rondebosch, South Africa.,Global Child Health, Witten/Herdecke University, Witten-Herdecke, Germany
| | - Melinda Munos
- Global Disease epidemiology and control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ralf Weigel
- Global Child Health, Witten/Herdecke University, Witten-Herdecke, Germany
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Tola Y, Ayele G, Boti N, Yihune M, Gethahun F, Gebru Z. Health-Related Quality-of-Life and Associated Factors Among Post-Partum Women in Arba Minch Town. Int J Womens Health 2021; 13:601-611. [PMID: 34188554 PMCID: PMC8232860 DOI: 10.2147/ijwh.s295325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/13/2021] [Indexed: 12/03/2022] Open
Abstract
Background It is generally accepted that pregnancy and childbirth are natural physiological processes. However, these significantly affect the quality of mothers’ lives. Little is known about the level of quality-of-life and associated factors among postpartum women in Ethiopia, particularly in the study area. Methods A community-based cross-sectional study was conducted among 409 randomly selected post-partum women who were living in Arba Minch town. Systematic random sampling was employed to select the study participants. The standard quality-of-life assessment tool which is known as the short-form SF 36 tool was used to assess health-related quality-of-life. The logistic regression model was used to identify associated factors. Statistically significant variables at a p-value<0.25 in the bi-variable analysis were candidate variables for multi-variable analysis and statistical significance which was declared at a p-value<0.05. Results Among the study participants, 255 (62.3%) had lower level health-related quality-of-life (HRQoL). About 46.2% of the study participants had lower physical HRQoL and about 79% of the study participants had lower mental HRQoL. The overall mean score of HRQoL was 45.15 (±8.13). Factors associated with lower overall HRQoL were age group 17–24 years (AOR=2.73, 95% CI=1.22–6.10), no formal education [AOR 2.02, 95% CI (1.05–3.89)], and cesarean delivery (AOR=0.49, 95% CI=0.24–0.97). A factor associated with lower physical HRQoL was cesarean delivery (AOR=0.34, 95% CI=0.13–0.88). Factors associated with lower mental HRQoL were age group 17–24 (AOR=3.37, 95% CI=1.60–7.04), not receiving antenatal care (AOR=3.65, 95% CI=1.45–9.16), and having postpartum depression (AOR=2.27, 95% CI=1.30–3.93). Conclusion The results suggest that the majority of post-partum women had a lower HRQoL, particularly women’s mental health was compromised. In this study, a suggestion is made that the respective bodies need to give particular attention to mothers during the post-partum period to prevent poor quality-of-life.
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Affiliation(s)
- Yirgalem Tola
- Arba Minch Health Science College, Department of Midwifery, Arba Minch, Ethiopia
| | - Gistane Ayele
- Arba Minch University, College of Medicine & Health Sciences, School of Public Health, Arba Minch, Ethiopia
| | - Negussie Boti
- Arba Minch University, College of Medicine & Health Sciences, School of Public Health, Arba Minch, Ethiopia
| | - Manaye Yihune
- Arba Minch University, College of Medicine & Health Sciences, School of Public Health, Arba Minch, Ethiopia
| | - Firdawek Gethahun
- Arba Minch University, College of Medicine & Health Sciences, School of Public Health, Arba Minch, Ethiopia
| | - Zeleke Gebru
- Arba Minch University, College of Medicine & Health Sciences, School of Public Health, Arba Minch, Ethiopia
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Came H, Matheson A, Kidd J. Smashing the patriarchy to address gender health inequities: Past, present and future perspectives from Aotearoa (New Zealand). Glob Public Health 2021; 17:1540-1550. [PMID: 34097588 DOI: 10.1080/17441692.2021.1937272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The second wave feminist dream of smashing the patriarchy remains a task yet to be completed on a complex to do list. Women, particularly able-bodied cis-gendered white women however do enjoy the privilege of living longer than men. But our longer lives take place within patriarchal-capitalist systems where many women's social and cultural rights continue to be compromised. How do we ensure that all women can exercise our right to health and wellbeing? In this paper, the authors examine, critique, review and re-vision the dynamics of power and patriarchy over three distinct time periods - 1999, 2019 and 2039. We look to the past to track progress; we look to the present to see what we have achieved and look to the future for what might be. This conceptual paper is informed by the authors' expert knowledge, a review of the literature and the novel use of speculative ethnography. The authors conclude that patriarchy remains not only a negative determinant of women's health that needs to be smashed, but is also a threat to all people and to planetary health.
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Affiliation(s)
- Heather Came
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Anna Matheson
- School of Health, Victoria University, Melbourne, Australia
| | - Jacquie Kidd
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Babaoglu AB, Tekindal MA. Modelling the Number of People per Physician, Nurse, and Midwives in Turkey in Terms of Reproductive Health Indicators. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211020873. [PMID: 34078168 PMCID: PMC8182186 DOI: 10.1177/00469580211020873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health worker density and distribution is critical for a strong health system and therefore has been listed among 1 of the Sustainable Development Goal (SDG) targets. The present study aims to model the number of persons per physician, nurse, and midwives in Turkey until 2030 and to make estimates for better reproductive health outcomes. We used time series of people per physician, nurse, and midwife between the years 1928 and 2018. Estimates were obtained via the Box-Jenkins and Brown Exponential Smoothing Methods. The results of this study showed that both designed models provide a high diagnostic value to predict the number of person per doctor, nurse, and midwives. The goodness of fit criteria for both models was statistically significant. The results predict a slight decrease in the number of people per physician, a more significant decrease in the number of people per nurse, but no decrease in the number of people per midwives until 2030. We argue that there will not be much progress in reproductive health indicators if the health workforce progresses with the same trend in the coming years. We recommend decision-makers to re-consider the health workforce planning, especially in terms of the number of the person per nurses, for better reproductive health outcomes.
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Babughirana G, Gerards S, Mokori A, Baigereza IC, Mukembo A, Rukanda G, Kremers SPJ, Gubbels J. Can the Timed and Targeted Counseling Model Improve the Quality of Maternal and Newborn Health Care? A Process Analysis in the Rural Hoima District in Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094410. [PMID: 33919191 PMCID: PMC8122283 DOI: 10.3390/ijerph18094410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 11/27/2022]
Abstract
Each year, more than half a million women die worldwide from causes related to pregnancy and childbirth, and nearly 4 million newborns die within 28 days of birth. In Uganda, 15 women die every single day from pregnancy and childbirth-related causes, 94 babies are stillborn, and 81 newborn babies die. Cost-effective solutions for the continuum of care can be achieved through Village Health Teams to improve home care practices and health care-seeking behavior. This study aims at examining the implementation of the timed and targeted counseling (ttC) model, as well as improving maternal and newborn health care practices. We conducted a quantitative longitudinal study on pregnant mothers who were recruited on suspicion of the pregnancy and followed-up until six weeks post-delivery. The household register was the primary data source, which was collected through a secondary review of the ttC registers. All outcome and process variables were analyzed using descriptive statistics. The study enrolled 616 households from 64 villages across seven sub-counties in Hoima district with a 98.5% successful follow-up rate. Over the course of the implementation period of ttC, there was an increase of 29.6% in timely 1st antenatal care, 28.7% in essential newborn care, 25.5% in exclusive breastfeeding, and 17.5% in quality of antenatal care. All these improvements were statistically significant. The findings from this study show that the application of the ttC model through Village Health Teams has great potential to improve the quality of antenatal and newborn care and the health-seeking practices of pregnant and breastfeeding mothers in rural communities.
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Affiliation(s)
- Geoffrey Babughirana
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 GT Maastricht, The Netherlands; (S.G.); (S.P.J.K.); (J.G.)
- Correspondence:
| | - Sanne Gerards
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 GT Maastricht, The Netherlands; (S.G.); (S.P.J.K.); (J.G.)
| | - Alex Mokori
- Independent Researcher, 627 Ntinda, Kampala 10302, Uganda;
| | - Isaac Charles Baigereza
- World Vision International, Hoima Plot 15B, Nakasero Road, Kampala 5319, Uganda; (I.C.B.); (A.M.)
| | - Alex Mukembo
- World Vision International, Hoima Plot 15B, Nakasero Road, Kampala 5319, Uganda; (I.C.B.); (A.M.)
| | - Grace Rukanda
- Lutheran World Federation, Kyangwali Plot 1401 Gaba Road, Kampala 5827, Uganda;
| | - Stef P. J. Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 GT Maastricht, The Netherlands; (S.G.); (S.P.J.K.); (J.G.)
| | - Jessica Gubbels
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 GT Maastricht, The Netherlands; (S.G.); (S.P.J.K.); (J.G.)
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Bajpai J, Simha V, Shylasree TS, Sarin R, Pathak R, Popat P, Mokal S, Dandekar S, Bhansal V, Ghosh J, Nair N, Gulia S, Rath S, Joshi S, Wadasadawala T, Sheth T, Parmar V, Banavali SD, Badwe RA, Gupta S. Pregnancy associated breast cancer (PABC): Report from a gestational cancer registry from a tertiary cancer care centre, India. Breast 2021; 56:88-95. [PMID: 33640524 PMCID: PMC7933532 DOI: 10.1016/j.breast.2021.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Pregnancy associated breast cancer (PABC) is a rare entity and defined as breast cancer diagnosed during pregnancy or one-year post-partum. There is sparse data especially from low and middle-income countries (LMIC) and merits exploration. Methods The study (2013–2020) evaluated demographics, treatment patterns and outcomes of PABC. Results There were 104 patients, median age of 31 years; 43 (41%) had triple-negative disease, 31(29.8%) had hormone-receptor (HR) positive and HER2 negative, 14 (13.5%) had HER2-positive and HR negative and 16(15.4%) had triple positive disease. 101(97%) had IDC grade III tumors and 74% had delayed diagnosis. 72% presented with early stage (24, EBC) or locally advanced breast cancer (53, LABC) and received either neoadjuvant (n = 49) or adjuvant (n = 26) chemotherapy and surgery. Trastuzumab, tamoxifen, and radiotherapy were administered post-delivery. At a median follow up of 27 (IQR:19–35) months, the estimated 3-year event-free survival (EFS) for EBC and LABC was 82% (95% CI: 65.2–100) and 56% (95% CI: 42–75.6%) and for metastatic 24% (95% CI: 10.1%–58.5%) respectively. Of the 104 patients, 34 were diagnosed antepartum (AP) and 15 had termination, 2 had preterm and 16 had full-term deliveries(FTDs). Among postpartum cohort (n = 70), 2 had termination, 1 had preterm, 67 had FTDs. 83(including 17 from AP) children from both cohorts were experiencing normal milestones. Conclusion Data from the first Indian PABC registry showed that the majority had delayed diagnosis and aggressive features(TNBC, higher grade). Treatment was feasible in majority and stage matched outcomes were comparable to non-PABCs. Pregnancy associated breast cancer (PABC) is a rare and Challenging entity with lack of data from low-middle income countries. First Indian data showed that stage matched oncologic outcomes were comparable to non-PABC. Obstetric outcomes were similar to non-cancer associated pregnancies with normal cognitive development. Creating awareness and early diagnosis is of utmost importance to improve prognosis in this unique entity
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Affiliation(s)
- Jyoti Bajpai
- Medical Oncology,Tata Memorial Centre, Mumbai, India.
| | - Vijay Simha
- Medical Oncology,Tata Memorial Centre, Mumbai, India
| | | | - Rajeev Sarin
- Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Reema Pathak
- Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Palak Popat
- Radio-diagnosis, Tata Memorial Centre, Mumbai, India
| | - Smruti Mokal
- Biostatistics, Tata Memorial Centre, Mumbai, India
| | | | | | - Jaya Ghosh
- Medical Oncology,Tata Memorial Centre, Mumbai, India
| | - Neeta Nair
- Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Seema Gulia
- Medical Oncology,Tata Memorial Centre, Mumbai, India
| | - Sushmita Rath
- Medical Oncology,Tata Memorial Centre, Mumbai, India
| | - Shalaka Joshi
- Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | | | | | - Vani Parmar
- Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - S D Banavali
- Medical Oncology,Tata Memorial Centre, Mumbai, India
| | - R A Badwe
- Medical Oncology,Tata Memorial Centre, Mumbai, India
| | - Sudeep Gupta
- Medical Oncology,Tata Memorial Centre, Mumbai, India
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Tesema GA, Yeshaw Y, Kasie A, Liyew AM, Teshale AB, Alem AZ. Spatial clusters distribution and modelling of health care autonomy among reproductive-age women in Ethiopia: spatial and mixed-effect logistic regression analysis. BMC Health Serv Res 2021; 21:74. [PMID: 33472619 PMCID: PMC7818720 DOI: 10.1186/s12913-020-06052-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While millions of women in many African countries have little autonomy in health care decision-making, in most low and middle-income countries, including Ethiopia, it has been poorly studied. Hence, it is important to have evidence on the factors associated with women's health care decision making autonomy and the spatial distribution across the country. Therefore, this study aimed to investigate the spatial clusters distribution and modelling of health care autonomy among reproductive-age women in Ethiopia. METHODS We used the 2016 Ethiopian Demographic and Health Survey (EDHS) data for this study. The data were weighted for design and representativeness using strata, weighting variable, and primary sampling unit to get a reliable estimate. A total weighted sample of 10,223 married reproductive-age women were included in this study. For the spatial analysis, Arc-GIS version 10.6 was used to explore the spatial distribution of women health care decision making and spatial scan statistical analysis to identify hotspot areas. Considering the hierarchical nature of EDHS data, a generalized linear mixed-effect model (mixed-effect logistic regression) was fitted to identify significant determinants of women's health care decision making autonomy. The Intra-Class Correlation (ICC) were estimated in the null model to estimate the clustering effect. For model comparison, deviance (-2LLR), Akakie Information Criteria (AIC), and Bayesian Information Criteria (BIC) parameters were used to choose the best-fitted model. Variables with a p-value < 0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable mixed-effect logistic regression analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare the strength and significance of the association between women's decision-making autonomy and independent variables. RESULTS In this study, about 81.6% (95% CI: 80.6%, 82.2%) of women have autonomy in making health care decisions. The spatial distribution of women's autonomy in making health decisions in Ethiopia was non-random (global Moran's I = 0.0675, p < 0.001). The significant hotspot areas of poor women's autonomy in making health care decisions were found in north Somali, Afar, south Oromia, southwest Somali, Harari, and east Southern Nations Nationalities and Peoples (SNNP) regions. In the mixed-effect logistic regression analysis; being urban (AOR = 1.59, 95% CI: 1.04, 2.45), having secondary education (AOR = 1.60, 95% CI: 1.06, 2.41), having an occupation (AOR = 1.19, 95% CI: 1.01, 1.40) and being from the richest household (AOR = 2.14, 95% CI: 1.45, 3.14) were significantly associated with women autonomy in deciding for health care. CONCLUSIONS The spatial distribution of women's autonomy in making the decision for health care was non-random in Ethiopia. Maternal education, residence, household wealth status, region, and maternal occupation were found to influence women's autonomy. Public health interventions targeting the hotspot areas of poor women autonomy through enhancing maternal occupation and employment is needed to improve women empowerment in making decisions for health care.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Yigizie Yeshaw
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Kasie
- Department of Health Education and Behavioral Science, Institute of Public Health, College of Medicine and Health Sciences and comprehensive specialized hospital, University of Gondar, Gondar, Ethiopia
| | - Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Bewley MC, Gautam L, Jagadeeshaprasad MG, Gowda DC, Flanagan JM. Molecular architecture and domain arrangement of the placental malaria protein VAR2CSA suggests a model for carbohydrate binding. J Biol Chem 2020; 295:18589-18603. [PMID: 33122198 PMCID: PMC7939466 DOI: 10.1074/jbc.ra120.014676] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/13/2020] [Indexed: 11/29/2022] Open
Abstract
VAR2CSA is the placental-malaria-specific member of the antigenically variant Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1) family. It is expressed on the surface of Plasmodium falciparum-infected host red blood cells and binds to specific chondroitin-4-sulfate chains of the placental proteoglycan receptor. The functional ∼310 kDa ectodomain of VAR2CSA is a multidomain protein that requires a minimum 12-mer chondroitin-4-sulfate molecule for specific, high affinity receptor binding. However, it is not known how the individual domains are organized and interact to create the receptor-binding surface, limiting efforts to exploit its potential as an effective vaccine or drug target. Using small angle X-ray scattering and single particle reconstruction from negative-stained electron micrographs of the ectodomain and multidomain constructs, we have determined the structural architecture of VAR2CSA. The relative locations of the domains creates two distinct pores that can each accommodate the 12-mer of chondroitin-4-sulfate, suggesting a model for receptor binding. This model has important implications for understanding cytoadherence of infected red blood cells and potentially provides a starting point for developing novel strategies to prevent and/or treat placental malaria.
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Affiliation(s)
- Maria C Bewley
- Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Lovely Gautam
- Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Mashanipalya G Jagadeeshaprasad
- Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - D Channe Gowda
- Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
| | - John M Flanagan
- Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
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Ahinkorah BO, Seidu AA, Budu E, Armah-Ansah EK, Agbaglo E, Adu C, Hagan JE, Yaya S. Proximate, intermediate, and distal predictors of under-five mortality in Chad: analysis of the 2014-15 Chad demographic and health survey data. BMC Public Health 2020; 20:1873. [PMID: 33287797 PMCID: PMC7720533 DOI: 10.1186/s12889-020-09869-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Under-five mortality in Chad reached a minimum value of 119 deaths per 1000 live births in 2018, compared with a maximum of 250 in 1972. Despite this decline in the mortality trend, for every six children in Chad, one dies before the age of five. This study, therefore, investigated the proximate, intermediate, and distal determinants of under-five mortality in Chad. METHODS We used data from the 2014-15 Chad's Demographic and Health Survey. Data of 7782 children below 5 years were used for the study. Both descriptive and multivariable hierarchical logistic regression analyses were performed. Statistical significance was declared at p < 0.05. RESULTS Under-five mortality was found to be 130 deaths per 1000 live births in Chad, with variations across the various population sub-groups. For distal predictors, the likelihood of death was higher in children born in the FChari Baguirmi region (AOR = 3.83, 95% CI: 1.81-8.14). Children whose mothers belonged to the Baguirmi/Barma ethnic group (AOR = 8.04, 95% CI: 1.75-36.99) were more likely to die before the age of five. On the contrary, the likelihood of under-five mortality was low among children born in rural areas (AOR = 0.73, 95% CI: 0.55-0.97). With the intermediate predictors, the likelihood of under-five deaths was higher among children whose mothers had no formal education (AOR = 1.72, 95% CI: 1.06-2.77). Regarding the proximate predictors, the odds of under-five deaths was higher among male children (AOR = 1.03, 95% CI: 1.05-1.63) and first rank children (AOR = 1.58, 95% CI: 1.13-2.21). CONCLUSION The study found that the determinants of under-five mortality in Chad are region of residence, place of residence, ethnicity, education, sex of child, and birth rank. These findings show that both socio-economic and proximate factors explain the disparities in under-five mortality in Chad. The identification of these factors can be pivotal towards the design of evidence-based interventions intended to improve child survival. Therefore, improving maternal education while refocusing and re-packaging existing strategies to target selected sub-regional populations with high under-five mortality is urgently required.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Collins Adu
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, The University of Oxford, Oxford, UK
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