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Cai Q, Zhou Y, Chen D, Wang F, Xu X. Parental perceptions and experiences of kangaroo care for preterm infants in neonatal intensive care units in China: a qualitative study. BMC Pregnancy Childbirth 2024; 24:499. [PMID: 39054436 PMCID: PMC11271036 DOI: 10.1186/s12884-024-06622-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 06/05/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND kangaroo care (KC), endorsed by the World Health Organization, is an evidence-based intervention that plays a pivotal role in mitigating preterm infant mortality and morbidity. However, this intervention has not been fully integrated into healthcare systems in China. This study aimed to gain insight into parents' perceptions and experiences of KC for preterm infants to contribute to the KC implementation on a larger scale. METHODS This study employed a descriptive qualitative design, using face-to-face, semi-structured, in-depth interviews. Fifteen parents participating in KC for preterm infants in the neonatal intensive care units (NICUs) were purposively sampled from four hospitals across four cities in Zhejiang Province, China. Thematic analysis was employed to analyze the data. RESULTS Four themes and twelve subthemes regarding the parents' perceptions and experiences about KC were identified. The four themes included: (1) Low motivation upon initial engagement with KC, (2) Dynamic fluctuations of emotional states during KC, (3) Unexpected gains, and (4) Barriers to participation. CONCLUSIONS Parents' perceptions and experiences of KC was a staged process, with parents exhibiting distinct cognitive patterns and unique experiences at each stage. Overall, as KC progresses, parents' experiences tended to become increasingly positive, despite potential obstacles encountered along the way. To enhance the implementation of KC, healthcare providers could utilize prenatal and postnatal education programs. These programs aim to enhance the understanding of KC among parents of preterm infants, fostering sustained engagement in KC practices.
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Affiliation(s)
- Qian Cai
- Women's Hospital School of Medicine Zhejiang University, No.1 Xueshi Road, Shangcheng District, Hangzhou, Zhejiang Province, 310006, China
- Department of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yunxian Zhou
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Danqi Chen
- Women's Hospital School of Medicine Zhejiang University, No.1 Xueshi Road, Shangcheng District, Hangzhou, Zhejiang Province, 310006, China
- Department of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fang Wang
- Women's Hospital School of Medicine Zhejiang University, No.1 Xueshi Road, Shangcheng District, Hangzhou, Zhejiang Province, 310006, China.
| | - Xinfen Xu
- Women's Hospital School of Medicine Zhejiang University, No.1 Xueshi Road, Shangcheng District, Hangzhou, Zhejiang Province, 310006, China.
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Cai Q, Zhou Y, Hong M, Chen D, Xu X. Healthcare providers' perceptions and experiences of kangaroo mother care for preterm infants in four neonatal intensive care units in China: a qualitative descriptive study. Front Public Health 2024; 12:1419828. [PMID: 39040865 PMCID: PMC11260804 DOI: 10.3389/fpubh.2024.1419828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/20/2024] [Indexed: 07/24/2024] Open
Abstract
Background Kangaroo mother care (KMC) is an evidence-based intervention that can effectively reduce morbidity and mortality in preterm infants, but it has yet to be widely implemented in health systems in China. Most qualitative studies on KMC for preterm infants focused on the experiences and influencing factors from the perspective of preterm infant parents, while neglecting the perspective of healthcare providers, who played a critical role in guiding KMC practice. Therefore, this study aimed to explore the perceptions and experiences of healthcare providers regarding their involvement in KMC implementation for preterm infants to promote the contextualized implementation of KMC. Methods A descriptive qualitative approach was adopted. A purposive sampling was used to select healthcare providers involved in KMC implementation in the neonatal intensive care units (NICUs) as participants from four tertiary hospitals across four cities in Zhejiang Province, China. Face-to-face semi-structured interviews were conducted to collect information. Thematic analysis was employed to analyze the data. Results Seventeen healthcare professionals were recruited, including thirteen nurses and four doctors in the NICUs. Four themes and twelve subthemes emerged: different cognitions based on different perspectives (acknowledged effects and benefits, not profitable economically), ambivalent emotions regarding KMC implementation (gaining understanding, gratitude and trust from parents, not used to working under parental presence, and concerning nursing safety issues), barriers to KMC implementation (lack of unified norms and standards, lack of systematic training and communication platform, insufficient human resources, and inadequate parental compliance) and suggestions for KMC implementation (improving equipment and environment, strengthening collaboration between nurses and doctors, and support from hospital managers). Conclusions Despite acknowledging the clinical benefits of KMC, the lack of economic incentives, concerns about potential risks, and various barriers hindered healthcare providers' intrinsic motivation to implement KMC in NICUs in China. To facilitate the effective implementation of KMC, hospital managers should provide bonuses and training programs for healthcare providers, while giving them recognition and encouragement to enhance their motivation to implement KMC.
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Affiliation(s)
- Qian Cai
- Department of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Yunxian Zhou
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Mengxia Hong
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Danqi Chen
- Department of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinfen Xu
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
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Li X, Li L, Li Q, Zhuang L, Zhang Y, Li P, Zhang Q, Zhang S, Li T, Kong X, Feng Z. Development of capability lists for neonatal critical care at three levels in China: a modified Delphi study. BMJ Paediatr Open 2024; 8:e002441. [PMID: 38538105 PMCID: PMC10982761 DOI: 10.1136/bmjpo-2023-002441] [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: 12/07/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The standardised management of neonatal critical care centres can help improve health outcomes of vulnerable newborns. Guidance is required to update evidence related to construction and management of neonatal critical care centres in China. OBJECTIVE To establish expert consensus on the essential capability lists for neonatal critical care at three levels in China. DESIGN AND SETTING According to China's administrative divisions, the Chinese guidelines stratifies neonatal critical care into three levels: county level (basic and special care), city level (intensive care) and province level (comprehensive care including neonatal surgery and more subspecialty interventions). A modified Delphi study was conducted. A group of 20 neonatologists from the Chinese Association of Neonatologists rated the importance of capability items on a 5-point Likert scale. RESULTS At county level, the list consisted of 29 items related to basic and special care, and 3 items were unanimously rated very important by all experts: neonatal resuscitation, endotracheal intubation and continuous positive airway pressure ≥72 hours. At city level, group consensus defined 38 items as essential. Besides the essential items of county level, more items for intensive care were included in city level. At province level, 64 items reached consensus, including neonatal surgery and more advanced subspecialty interventions. The Kendall's W values showed good agreement among experts in both rounds, and an increase from round 1 to round 2. CONCLUSIONS We developed the capability lists for neonatal critical care at three levels in China. Neonatal resuscitation should be provided by all levels. Interventions for preterm newborns are stratified according to gestational age and birth weight. Congenital abnormalities requiring surgical services need to be managed in high-level centres.
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Affiliation(s)
- Xing Li
- Department of Neonatology, Faculty of Pediatrics, National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing Key Laboratory of Pediatric Organ Failure, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Lei Li
- Department of Neonatology, Faculty of Pediatrics, National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing Key Laboratory of Pediatric Organ Failure, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Qiuping Li
- Department of Neonatology, Faculty of Pediatrics, National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing Key Laboratory of Pediatric Organ Failure, The Seventh Medical Center of PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Lu Zhuang
- Department of Neonatology, Faculty of Pediatrics, National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing Key Laboratory of Pediatric Organ Failure, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Yanping Zhang
- Department of Neonatology, Faculty of Pediatrics, National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing Key Laboratory of Pediatric Organ Failure, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Pengpeng Li
- Department of Neonatology, Faculty of Pediatrics, National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing Key Laboratory of Pediatric Organ Failure, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Qian Zhang
- Department of Neonatology, Faculty of Pediatrics, National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing Key Laboratory of Pediatric Organ Failure, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Shan Zhang
- Department of Neonatology, Faculty of Pediatrics, National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing Key Laboratory of Pediatric Organ Failure, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Ting Li
- Department of Neonatology, Faculty of Pediatrics, National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing Key Laboratory of Pediatric Organ Failure, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Xiangyong Kong
- Department of Neonatology, Faculty of Pediatrics, National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing Key Laboratory of Pediatric Organ Failure, The Seventh Medical Center of PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhichun Feng
- Department of Neonatology, Faculty of Pediatrics, National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing Key Laboratory of Pediatric Organ Failure, The Seventh Medical Center of PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
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Hu WH, Gao XY, Li XX, Lin QM, He LP, Lai YS, Hao YT. Spatial-temporal distribution of preterm birth in China, 1990-2020: A systematic review and modelling analysis. Paediatr Perinat Epidemiol 2024; 38:130-141. [PMID: 38168744 DOI: 10.1111/ppe.13028] [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: 01/18/2023] [Revised: 11/03/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Little is known about the long-term trends of preterm birth rates in China and their geographic variation by province. OBJECTIVES To estimate the annual spatial-temporal distribution of preterm birth rates in China by province from 1990 to 2020. DATA SOURCES We searched PubMed, EMBASE, Web of Science, CNKI, WANFANG and VIP from January 1990 to September 2023. STUDY SELECTION AND DATA EXTRACTION Studies that provided data on preterm births in China after 1990 were included. Data were extracted following the Guidelines for Accurate and Transparent Health Estimates Reporting. SYNTHESIS We assessed the quality of each survey using a 9-point checklist. We estimated the annual preterm birth risk by province using Bayesian multilevel logistic regression models considering potential socioeconomic, environmental, and sanitary predictors. RESULTS Based on 634 survey data from 343 included studies, we found a gradual increase in the preterm birth risk in most provinces in China since 1990, with an average annual increase of 0.7% nationally. However, the preterm birth rates in Inner Mongolia, Hubei, and Fujian Province showed a decline, while those in Sichuan were quite stable since 1990. In 2020, the estimates of preterm birth rates ranged from 2.9% (95% Bayesian credible interval [BCI] 2.1, 3.8) in Inner Mongolia to 8.5% (95% BCI 6.6, 10.9) in Jiangxi, with the national estimate of 5.9% (95% BCI 4.3, 8.1). Specifically, some provinces were identified as high-risk provinces for either consistently high preterm birth rates (e.g. Jiangxi) or relatively large increases (e.g. Shanxi) since 1990. CONCLUSIONS This study provides annual information on the preterm birth risk in China since 1990 and identifies high-risk provinces to assist in targeted control and intervention for this health issue.
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Affiliation(s)
- Wei-Hua Hu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, China
| | - Xin-Yuan Gao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiu-Xiu Li
- Department of Science and Education, Maternal and Child Health Center in Nanshan District, Shenzhen, China
| | - Qing-Mei Lin
- Department of Health Care, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
| | - Li-Ping He
- Department of Operating Room, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Ying-Si Lai
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Yuan-Tao Hao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, China
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Sun L, Wang X, Gao H, Li Z, Chen M, Qian X, Gu C. Development and psychometric testing of a Chinese version of the postnatal care experience scale for postpartum women. BMC Pregnancy Childbirth 2023; 23:868. [PMID: 38104121 PMCID: PMC10724998 DOI: 10.1186/s12884-023-06187-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/10/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Postnatal period is a critical transitional phase in the lives of mothers and newborn babies. In recent years the importance on promoting a positive experience of care following childbirth is increasingly emphasized. Yet published evidence of the methodological and psychometric quality of instruments to evaluate women's experience of comprehensive postnatal care is still lacking. OBJECTIVE This study aimed to develop and validate a unique scale (the Chinese version of the Postnatal Care Experience Scale, PCES) to measure women's overall experience of care during postnatal periods. METHODS The PCES instrument was developed and validated over three phases, including item development, scale development, and scale evaluation. The item pool of the PCES was generated through existing literature and in-depth semi-structured interviews, followed by assessment of content validity and rating of importance and feasibility of items through two-round Delphi surveys. Psychometric properties were examined in a convenience sample of 736 postpartum women. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to assess the construct validity of the developed PCES. The relationship between the total PCES score and the global item construct was estimated using Pearson product-moment coefficient. Reliability was assessed using Cronbach's alpha and Spearman Brown coefficients. RESULTS The content validity index of the Chinese version PCES was 0.867. Following item reduction analysis, this instrument consisted of 30 five-point Likert items. The Kaiser-Meyer-Olkin statistic was 0.964 and the chi-square value of the Bartlett spherical test was 11665.399 (P < .001). The scale explained 75.797% of the total variance and consisted of three subscales, including self-management, social support, and facility- and community-based care. The Pearson correlation coefficient between the total PCES score and the global item construct was 0.909. The CFA showed that the 3-factor model had suitable fitness for the data. Cronbach's alpha value and Spearman-Brown Split-half reliability for the total scale were 0.979 and 0.941, respectively. CONCLUSIONS The newly developed 30-item PCES is a psychometrically reliable and valid instrument that assesses women's overall experience of postnatal care. Future research should aim to use the PCES in various populations to obtain further evidence for its validity and reliability.
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Affiliation(s)
- Liping Sun
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xiaojiao Wang
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Hua Gao
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Zhaorun Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Meiyi Chen
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Xu Qian
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China.
- Global Health Institute, Fudan University, Shanghai, China.
| | - Chunyi Gu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
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Wang W, Wang Y, Zhang H, Yang G, Lin Y, Wang C, Huang X, Tian X, Xiao AY, Xu T, Tang K. A pilot study of Kangaroo mother care in early essential newborn care in resource-limited areas of China: the facilitators and barriers to implementation. BMC Pregnancy Childbirth 2023; 23:451. [PMID: 37330495 DOI: 10.1186/s12884-023-05720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/19/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Implementation of Kangaroo Mother Care (KMC) in resource-limited areas of China may face unique barriers, such as a lack of resources, geographic location and more traditional culture among others. This qualitative study analyses the facilitators and barriers to implementing KMC in county-level health facilities in resource-limited areas of China for the promotion of KMC on a larger scale. METHODS Participants from 4 of the 18 pilot counties where early essential newborn care was implemented through the Safe Neonatal Project and 4 control counties not enrolled in Safe Neonatal Project were selected using purposive sampling. A total of 155 participants were interviewed, including stakeholders of the Safe Neonatal Project such as national maternal health experts, relevant government officials and medical staff. Thematic analysis was used to process and analyse the interview content in order to summarise the facilitators and barriers to implementing KMC. RESULTS KMC was accepted in the pilot areas but still faced certain challenges due to institutional regulation, resource provision and the perceptions of health staff, postpartum mothers and their families as well as COVID-19 prevention and control regulations. The facilitators identified were government officials and medical staff acceptance and the incorporation of KMC into routine clinical care. The barriers identified were a lack of dedicated funding and other resources, the present scope of health insurance and KMC cost-sharing mechanism, providers' knowledge and practical abilities, parental awareness, postpartum discomfort, fathers' inadequate involvement, and the impact from COVID-19. CONCLUSION The Safe Neonatal Project pilot experience indicated the feasibility of implementing KMC in more areas of China. Optimising institutional regulations, providing necessary supporting resources and enhancing education and training may help to refine the implementation and scale-up of KMC practice in China.
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Affiliation(s)
- Wen Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yinghang Wang
- Institute for Hospital Management, Tsinghua University, Guangdong, China
| | - Hanxiyue Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Ge Yang
- Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Yun Lin
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chenran Wang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaona Huang
- United Nations Children's Fund Office for China, Beijing, China
| | - Xiaobo Tian
- United Nations Children's Fund Office for China, Beijing, China
| | - Angela Y Xiao
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Tao Xu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China.
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Haque R, Keramat SA, Rahman SM, Mustafa MUR, Alam K. Association of maternal obesity with fetal and neonatal death: Evidence from South and South-East Asian countries. PLoS One 2021; 16:e0256725. [PMID: 34473759 PMCID: PMC8412251 DOI: 10.1371/journal.pone.0256725] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obesity prevalence is increasing in many countries in the world, including Asia. Maternal obesity is highly associated with fetal and neonatal deaths. This study investigated whether maternal obesity is a risk factor of fetal death (measured in terms of miscarriage and stillbirth) and neonatal mortality in South and South-East Asian countries. METHODS This cross-sectional study pooled the most recent Demographic and Health Surveys (DHS) from eight South and South-East Asian countries (2014-2018). Multivariate logistic regression was deployed to check the relationships between maternal obesity with fetal and neonatal deaths. Finally, multilevel logistic regression model was employed since the DHS data has a hierarchical structure. RESULTS The pooled logistic regression model illustrated that maternal obesity is associated with higher odds of miscarriage (adjusted odds ratio [aOR]: 1.26, 95% CI: 1.20-1.33) and stillbirths (aOR: 1.46, 95% CI: 1.27-1.67) after adjustment of confounders. Children of obese mothers were at 1.18 (aOR: 1.18, 95% CI: 1.08-1.28) times greater risk of dying during the early neonatal period than mothers with a healthy weight. However, whether maternal obesity is statistically a significant risk factor for the offspring's late neonatal deaths was not confirmed. The significant association between maternal obesity with miscarriage, stillbirth and early neonatal mortality was further confirmed by multilevel logistic regression results. CONCLUSION Maternal obesity in South and South-East Asian countries is associated with a greater risk of fetal and early neonatal deaths. This finding has substantial public health implications. Strategies to prevent and reduce obesity should be developed before planning pregnancy to reduce the fetal and neonatal death burden. Obese women need to deliver at the institutional facility centre that can offer obstetrics and early neonatal care.
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Affiliation(s)
- Rezwanul Haque
- Faculty of Arts and Social Sciences, Department of Economics, American International University-Bangladesh, Kuratoli, Khilkhet, Dhaka, Bangladesh
- * E-mail:
| | - Syed Afroz Keramat
- Economics Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Syed Mahbubur Rahman
- Faculty of Business Administration, American International University-Bangladesh, Kuratoli, Khilkhet, Dhaka, Bangladesh
| | - Maimun Ur Rashid Mustafa
- Department of Economics, American International University-Bangladesh, Kuratoli, Khilkhet, Dhaka, Bangladesh
| | - Khorshed Alam
- School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
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Deng K, Liang J, Mu Y, Liu Z, Wang Y, Li M, Li X, Dai L, Li Q, Chen P, Xie Y, Zhu J, Liu H. Preterm births in China between 2012 and 2018: an observational study of more than 9 million women. Lancet Glob Health 2021; 9:e1226-e1241. [PMID: 34416213 PMCID: PMC8386289 DOI: 10.1016/s2214-109x(21)00298-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Preterm birth rates have increased significantly worldwide over the past decade. Few epidemiological studies on the incidence of preterm birth and temporal trends are available in China. This study used national monitoring data from China's National Maternal Near Miss Surveillance System (NMNMSS) to estimate the rate of preterm birth and trends between 2012 and 2018 in China and to assess risk factors associated with preterm birth. METHODS In this observational study, data were sourced from the NMNMSS between Jan 1, 2012, and Dec 31, 2018. Pregnancies with at least one livebirth, with the baby born at 28 weeks of gestation or more or 1000 g or more birthweight were included. We estimated the rates of overall preterm, very preterm (born between 28 and 31 weeks' gestation), moderate preterm (born between 32 and 33 weeks' gestation), and late preterm (born between 34 and 36 weeks' gestation) births in singleton and multiple pregnancies and assessed their trends over time. We used logistic regression analysis to examine the associations between preterm birth and sociodemographic characteristics and obstetric complications, considering the sampling strategy and clustering of births within hospitals. Interrupted time series analysis was used to assess the changes in preterm birth rates during the period of the universal two child policy intervention. FINDINGS From Jan 1, 2012, to Dec 31, 2018, 9 645 646 women gave birth to at least one live baby, of whom 665 244 (6·1%) were born preterm. In all pregnancies, the overall preterm birth rate increased from 5·9% in 2012 to 6·4% in 2018 (8·8% increase; annual rate of increase [ARI] 1·3 [95% CI 0·6 to 2·1]). Late preterm births (8·8%; ARI 1·5% [0·9 to 2·2]) and very preterm births (13·3%; ARI 1·8% [0·5 to 3·0]) significantly increased from 2012 to 2018, whereas moderate preterm births did not (3·8%; ARI 0·3% [95% CI -0·9 to 1·5]). In singleton pregnancies, the overall preterm birth rate showed a small but significant 6·4% increase (ARI 1·0% [0·4 to 1·7]) over the 7 year period. In multiple pregnancies, the overall preterm birth rate significantly increased from 46·8% in 2012 to 52·7% in 2018 (12·4% increase; ARI 1·9% [1·2 to 2·6]). Compared with women who gave birth in 2012, those who gave birth in 2018 were more likely to be older (aged ≥35 years; 7·4% in 2012 vs 15·9% in 2018), have multiples (1·6% vs 1·9%), have seven or more antenatal visits (50·2% vs 70·7%), and have antepartum complications and medical disease (17·9% vs 35·1%), but they were less likely to deliver via caesarean section (47·5% vs 45·0%). Compared with the baseline period (January, 2012 to June, 2016), a higher increase in preterm birth was observed after the universal two child policy came into effect in July, 2016 (β=0·034; p=0·03). INTERPRETATION An increase in preterm births was noted for both singleton and multiple pregnancies between 2012 and 2018 in China. China's strategic investment in maternal and neonatal health has been crucial for the prevention of preterm birth. Due to rapid changes in sociodemographic and obstetric factors related to preterm birth-particularly within the context of the universal two child policy-such as advanced maternal age at delivery, maternal complications, and multiple pregnancies, greater efforts to reduce the burden of preterm birth are urgently needed. FUNDING National Key R&D Program of China, National Health Commission of the People's Republic of China, China Medical Board, WHO, and UNICEF.
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Affiliation(s)
- Kui Deng
- National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, China
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, China
| | - Yi Mu
- National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, China
| | - Zheng Liu
- National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, China
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, China
| | - Mingrong Li
- National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, China
| | - Xiaohong Li
- National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, China
| | - Li Dai
- National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, China
| | - Qi Li
- National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, China
| | - Peiran Chen
- National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, China
| | - Yanxia Xie
- National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Hanmin Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- Key Laboratory of Chronobiology (Sichuan University), National Health Commission of China, Chengdu, China
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Bai R, Jiang S, Guo J, Jiang S, Lee SK, Li Z, Cao Y. Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study. Front Pediatr 2021; 9:760646. [PMID: 34869117 PMCID: PMC8636048 DOI: 10.3389/fped.2021.760646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background: To compare outcomes and care practices of preterm infants born at <34 weeks' gestation in the different regions of China from 2015 to 2018. Methods: This cohort study enrolled all infants born at <34 weeks and admitted to 25 tertiary neonatal intensive care units across China from May 1st, 2015, to April 30th, 2018. The participating hospitals were categorized into three groups according to their distinct geographic locations: eastern China, central China, and western China. Multilevel mixed-effects logistic regression models were used to assess the independent association between neonatal outcomes and regions. Results: A total of 27,532 infants at <34 weeks' gestation were enrolled in our study. Overall, 14,178 (51.5%) infants were from 12 hospitals in eastern China, 8,069 (29.3%) from 9 hospitals in central China, and 5,285 (19.2%) from 4 hospitals in western China. Infants in eastern China had the lowest rates of mortality or any morbidity (23.3%), overall mortality (7.6%), in-hospital mortality (3.7%), and discharge against medical advice (DAMA, 6.3%), compared with central (27.8, 11.3, 5.0, and 10.6%, respectively) and western China (37.4, 19.4, 7.7, and 19.4%, respectively). Multilevel mixed-effects logistic regression showed that infants in western China were exposed to the highest risks of mortality or any morbidity, overall mortality, in-hospital mortality, and DAMA. Significant variations of care practices existed in three regions. Infants in central China had the longest duration of the first course of invasive ventilation, the lowest rate of continuous positive airway pressure within 24 h after birth, the lowest rate of breast milk feeding, the latest initiation of feeds, and the longest duration of total parenteral nutrition among the three regions. Conclusions: We identified marked disparities in outcomes and clinical care practices of preterm infants born at <34 weeks' gestation in different regions of China. Targeted quality improvement efforts are needed to improve the outcomes of premature infants in different regions of China.
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Affiliation(s)
- Ruimiao Bai
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, China
| | - Siyuan Jiang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, China
| | - Jinzhen Guo
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, China
| | - Shanyu Jiang
- Department of Neonatology, The Affiliated Wuxi Maternity and Child Health Hospital of Nanjing Medical University, Nanjing, China
| | - Shoo K Lee
- Maternal-Infant Care Research Centre and Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Department of Obstetrics and Gynecology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Zhankui Li
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, China
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