Defining Preterm Birth and Stillbirth in the Western Pacific: A Systematic Review

Linking weather and health outcomes: Examining the potential influences of weather factors and particulate matter pollution on adverse pregnancy outcomes in the Kavre district, Nepal

INTRODUCTION

Adverse pregnancy outcomes (APOs) include stillbirth, preterm birth, and low birthweight (LBW). Studies exploring the impact of weather factors and air pollution on APOs are scarce in Nepal. We examined the impacts of prenatal exposure to temperature, precipitation, and air pollution (PM2.5) on APOs among women living in Kavre, Nepal.

METHODS

We conducted a hospital and rural health centers-based historical cohort study that included health facility birth records (n = 1716) from the Nepali fiscal year 2017/18 through 2019/20. We linked health records to temperature, precipitation, and PM2.5 data for Kavre for the six months preceding each birth. A random intercept model was used to analyze birthweight, while a composite APO variable, was analyzed using multivariable logistic regression in relation to environmental exposures.

RESULTS

The proportion of LBW (<2500 gm), preterm birth (babies born alive before 37 weeks of gestation), and stillbirth was 13%, 4.3%, and 1.5%, respectively, in this study. Overall, around 16% of the study participants had one or more APOs. Total precipitation (β: 0.17, 95% CI 0.01 to 0.33, p = 0.03) had a positive effect on birthweight in the wetter season. Negative effects for mean maximum (β: 33.37, 95% CI -56.68 to -10.06, p = 0.005), mean (β: 32.35, 95% CI -54.44 to -10.27, p = 0.004), and mean minimum temperature (β: 29.28, 95% CI -49.58 to -8.98, p = 0.005) on birthweight was also observed in the wetter season.

CONCLUSION

A positive effect of temperature (mean maximum, mean, and mean minimum) and total precipitation on birthweight was found in the wetter season. This study emphasizes the need for future research using larger cohorts to elucidate these complex relationships in Nepal.

Improving maternal and newborn health and reducing stillbirths in the Western Pacific Region - current situation and the way forward

Despite positive trends in many indicators, there remains an unacceptable burden of preventable maternal, newborn deaths and stillbirths every year. This paper provides an overview of the maternal and perinatal outcomes across 22 Pacific Island Countries and Territories, including Papua New Guinea. We highlight some unique challenges and provide examples of initiatives in three of the larger countries to contribute to safer childbirth. There are high maternal and perinatal morbidity and mortality rates in many of the countries, although reliable data are limited. There are currently no data relating to the burden of intrapartum-related maternal and perinatal morbidity or stillbirth or the quality of intrapartum care. Varying definitions across countries for perinatal indicators mean that meaningful comparisons are difficult and unreliable. There is need for midwives and other maternal and newborn health providers to improve maternal and newborn indicators as countries advance towards the 2030 Sustainable Development Goals.

An integrative review on the maternal health literacy among maternal and child workers

AIMS

This study aim to capture the most comprehensive evidence-based dimensions of maternal health literacy, including summarizing the definitions, theoretical frameworks, measuring instruments, and the association between maternal health literacy and health behaviours.

BACKGROUND

Maternal health literacy has been recognized as an important approach to achieving high-quality maternal and child health; however, little is known about maternal health literacy comprehensively and scientifically.

EVALUATION

An integrative review retrieved articles from 11 databases, following the methodology of Whittemore and Knafl. Inductive content analysis and narrative synthesis were conducted, guided by the aim of this review.

KEY ISSUES

A total of 5580 articles were retrieved and 23 articles were finally identified. Existing definitions and theoretical frameworks took less consideration of maternal applicability and failed to summarize maternal health literacy from a dynamic and systematic perspective. Measurement instruments were set up with many items that make it difficult to quickly screen for poor maternal health literacy. Most articles proved the association between maternal health literacy and health behaviours through correlation analysis or regression analysis but less explored the influence pathways between them.

CONCLUSION

The definition and theoretical framework need to focus on maternal applicability and explain the process of individual mothers acquiring and understanding health knowledge and skills from a dynamic and systematic perspective. A rapid instrument for maternal health literacy should be developed and high-quality empirical research was conducted to understand the associated mechanisms between maternal health literacy and health behaviours.

IMPLICATIONS FOR NURSING MANAGEMENT

It is necessary to strengthen maternal and child health education of primary health care nurses and enhance their ability to help perinatal women use maternal and child health information effectively.

Spatial dynamics of fetal mortality and the relationship with social vulnerability

OBJECTIVES

To analyze the spatial-temporal patterns of fetal mortality according to its relationship with social vulnerability, identifying priority areas for intervention.

METHODS

Ecological study conducted in the state of Pernambuco, Northeast region of Brazil, from 2011 to 2018. The mean fetal mortality rate per city was calculated for the studied period. A cluster analysis was performed to select cities with homogeneous characteristics regarding fetal mortality and social vulnerability, then the Attribute Weighting Algorithm and Pearson correlation techniques were employed. In the spatial analysis it was used the local empirical Bayesian modeling and global and local Moran statistics.

RESULTS

Twelve thousand nine hundred and twelve thousand fetal deaths were registered. The fetal mortality rate for the period was 11.44 fetal deaths per 1,000 births. The number of groups formed was 7, in which correlation was identified between fetal mortality and dimensions, highlighting the correlations between fetal mortality rate and the Index of Social Vulnerability urban infrastructure for the municipalities in group 1 and 5, the values of the correlations found were 0.478 and 0.674 respectively. The spatial analysis identified areas of higher risk for fetal mortality distributed in regions of medium, high and very high social vulnerability.

CONCLUSIONS

The study allowed observing the existing correlations between fetal mortality and social vulnerability and identifying priority areas for intervention, with a view to reducing fetal mortality in the state.