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Yalew AZ, Olayemi OO, Yalew AW. Association between unintended pregnancy and maternal antenatal care services use in Ethiopia: analysis of Ethiopian demographic and health survey 2016. Front Med (Lausanne) 2023; 10:1151486. [PMID: 37153096 PMCID: PMC10155231 DOI: 10.3389/fmed.2023.1151486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Unintended pregnancy disproportionately affects women in low and middle-income countries including Ethiopia. Previous studies identified the magnitude and negative health outcomes of unintended pregnancy. However, studies that examined the relationship between antenatal care (ANC) utilization and unintended pregnancy are scarce. Objective This study aimed to examine the relationship between unintended pregnancy and ANC utilization in Ethiopia. Methods This is a cross-sectional study conducted using the fourth and most recent Ethiopian Demographic Health Survey (EDHS) data. The study comprised a weighted sample of 7,271 women with last alive birth and responded to questions on unintended pregnancy and ANC use. The association between unintended pregnancy and ANC uptake was determined using multilevel logistic regression models adjusted for possible confounders. Finally p < 5% was considered significant. Results Unintended pregnancy accounted for nearly a quarter of all pregnancies (26.5%). After adjusting for confounders, a 33% (AOR: 0.67; 95% CI, 0.57-0.79) lower odds of at least one ANC uptake and a 17% (AOR: 0.83; 95% CI, 0.70-0.99) lower odds of early ANC booking were found among women who had unintended pregnancy compared to women with intended pregnancy. However, this study founds no association (AOR: 0.88; 95% CI, 0.74, 1.04) between unintended pregnancy and four or more ANC visits. Conclusion Our study found that having unintended pregnancy was associated with a 17 and 33% reduction in early initiation and use of ANC services, respectively. Policies and programs designed to intervene against barriers to early initiation and use of ANC should consider unintended pregnancy.
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Affiliation(s)
- Ayalnesh Zemene Yalew
- Pan African University for Life and Earth Science Institute (Including Agriculture and Health), University of Ibadan, Ibadan, Nigeria
- School of Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- *Correspondence: Ayalnesh Zemene Yalew, ;
| | - Oladapo O. Olayemi
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Alemayehu Worku Yalew
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Stein RA, Grayon A, Katz A, Chervenak FA. The Zika virus: an opportunity to revisit reproductive health needs and disparities. Germs 2022; 12:519-537. [PMID: 38021183 PMCID: PMC10660223 DOI: 10.18683/germs.2022.1357] [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: 08/30/2022] [Revised: 10/24/2022] [Accepted: 12/29/2022] [Indexed: 12/01/2023]
Abstract
First isolated in 1947, the Zika virus was initially connected only to limited or sporadic human infections. In late 2015, the temporal clustering of a Zika outbreak and microcephaly in newborn babies from northeastern Brazil, and the identification of a causal link between the two, led to the characterization of the congenital Zika syndrome. In the wake of the epidemic, several countries from Latin America advised women to postpone pregnancies for periods ranging from six months to two years. These recommendations initiated critical conversations about the challenges of implementing them in societies with limited access to contraception, widespread socioeconomic inequalities, and high rates of unplanned and adolescent pregnancies. The messaging targeted exclusively women, despite a high prevalence of imbalances in the relationship power, and addressed all women as a group, failing to recognize that the decision to postpone pregnancies will impact different women in different ways, depending on their age at the time. Finally, in several countries affected by the Zika epidemic, due to restrictive reproductive policies, legally terminating a pregnancy is no longer an option even at the earliest time when brain malformations as part of the congenital Zika syndrome can be detected by ultrasonography. The virus continued to circulate after 2016 in several countries. Climate change models predict an expansion of the geographical area where local Zika transmission may occur, indicating that the interface between the virus, teratogenesis, and reproductive rights is a topic of considerable interest for medicine, social sciences, and public health for years to come.
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Affiliation(s)
- Richard A. Stein
- MD, PhD, NYU Tandon School of Engineering, Department of Chemical and Biomolecular Engineering, 6 MetroTech Center, Brooklyn 11201, NY, USA
| | - Alexis Grayon
- NYU Tandon School of Engineering, Department of Chemical and Biomolecular Engineering, 6 MetroTech Center, Brooklyn 11201, NY, USA
| | - Adi Katz
- MD, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, 110 E 77th Street, New York, NY, 10075, USA
| | - Frank A. Chervenak
- MD, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, 110 E 77th Street, New York, NY, 10075, USA
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Hailu GA, Weret ZS, Adasho ZA, Eshete BM. Quality of antenatal care and associated factors in public health centers in Addis Ababa, Ethiopia, a cross-sectional study. PLoS One 2022; 17:e0269710. [PMID: 35687552 PMCID: PMC9187099 DOI: 10.1371/journal.pone.0269710] [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] [Received: 10/01/2021] [Accepted: 05/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background Potentially, the risk of morbidity and mortality during pregnancy and child birth can be prevented through comprehensive, quality antenatal care services. The high maternal mortality rate in developing countries, including Ethiopia, is related to poor quality of antenatal care services and is still a major public health problem. The aim of this study is to assess the quality of antenatal care and associated factors in public health centers in Addis Ababa, Ethiopia. Methods An institution-based cross-sectional study was conducted using a quantitative method from December 10 to January 30, 2020. A total of 616 study participants were selected by a systematic random sampling technique. Data was collected using pre-tested structured interview administered questionnaires. The data was entered into Epi-info version 7.2.1 and analyzed by SPSS version 24. Bivariate and multivariable logistic regressions were performed to identify the presence and strength of the association between the outcome and predictor variables. Results Overall, 33% of pregnant women received good-quality antenatal care. Satisfaction with antenatal care service, antenatal care initiation time, maintaining confidentiality, and waiting time become significant predictors of the quality of antenatal care. As a result, a lack of confidential care (AOR = 0.37; 95% CI, (0.40, 0.88)), a long waiting time (AOR = 0.6, 95% CI, (0.48, 0.88)), and no satisfaction with ANC services (AOR = 0.26; 95% CI, (0.109, 0.36)) were identified as factors impeding the quality of antenatal care. While starting ANC later than four months of pregnancy was found to be a positive predictor of the quality of antenatal care (AOR = 1.9, 95% CI: (1.21, 3.12)). Conclusion Only one-third of pregnant mothers received good quality antenatal care. Lack of confidential care, long waiting time and no satisfaction with antenatal care services were factors hindering the quality of antenatal care. While initiation of antenatal care after four months of pregnancy was a positive predictor of the quality of antenatal care.
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Affiliation(s)
- Genet Atlabachew Hailu
- Department of Midwifery, Menelik II Medical and Health Science College, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Zewdu Shewngizaw Weret
- Department of Psychiatry, Menelik II Medical and Health Science College, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Zerihun Adraro Adasho
- Department of Neonatal Nursing, Menelik II Medical and Health Science College, Kotebe Metropolitan University, Addis Ababa, Ethiopia
- * E-mail:
| | - Belete Melesegn Eshete
- Department of Psychiatry, Menelik II Medical and Health Science College, Kotebe Metropolitan University, Addis Ababa, Ethiopia
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Mendez-Sanchez N, Arrese M, Gadano A, Oliveira CP, Fassio E, Arab JP, Chávez-Tapia NC, Dirchwolf M, Torre A, Ridruejo E, Pinchemel-Cotrim H, Castellanos Fernández MI, Uribe M, Girala M, Diaz-Ferrer J, Restrepo JC, Padilla-Machaca M, Dagher L, Gatica M, Olaechea B, Pessôa MG, Silva M. The Latin American Association for the Study of the Liver (ALEH) position statement on the redefinition of fatty liver disease. Lancet Gastroenterol Hepatol 2021; 6:65-72. [PMID: 33181118 DOI: 10.1016/s2468-1253(20)30340-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023]
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Khan MN, Harris ML, Oldmeadow C, Loxton D. Effect of unintended pregnancy on skilled antenatal care uptake in Bangladesh: analysis of national survey data. ACTA ACUST UNITED AC 2020; 78:81. [PMID: 32974015 PMCID: PMC7493902 DOI: 10.1186/s13690-020-00468-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 09/08/2020] [Indexed: 11/25/2022]
Abstract
Background Around 48% of all pregnancies in low- and middle-income countries are unintended. Unintended pregnancy may contribute to lower use of antenatal care (ANC); however, current research in the area is largely inconclusive due to the methodological approaches applied. Methods Responses from 4493 women extracted from the 2014 Bangladesh Demographic and Health Survey (BDHS) were used to assess the association between unintended pregnancy and subsequent uptake of at least one and at least four skilled ANC visits. For this, Bayesian multilevel logistic regression models with informative priors (representing a range of values within which the researcher is certain the true effect of the parameters included lies) were used, adjusting for other factors that affect ANC uptake. Informative priors were selected from the BDHS data collected in 2004, 2007, and 2011. Results Around 64% of women in Bangladesh who had at least one pregnancy within 3 years prior to the survey (that ended in a live birth) received ANC at least once, and of these around 32% used ANC at least four times. Mistimed (aOR, 0.73, 95% Cred I, 0.66–0.81) and unwanted (aOR, 0.69, 95% Cred I, 0.64–0.75) pregnancy were associated with reduced odds of attending the recommended minimum of four skilled ANC visits compared with wanted pregnancy. These likelihoods were even lower for at least one skilled ANC visit among women with a mistimed (aOR, 0.59, 95% Cred I, 0.53–0.65) or an unwanted pregnancy (aOR, 0.67, 95% Cred I, 0.61–0.74) than women with a wanted pregnancy. Conclusions In Bangladesh, more than one-quarter of women who report an unintended pregnancy at conception and do not terminate the pregnancy are at high risk of not using ANC. It is important for policies to include women with unintended pregnancy in mainstream healthcare services. This will increase the use of ANC and reduce associated adverse consequences.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Sciences, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh.,Priority Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Melissa L Harris
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Christopher Oldmeadow
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Deborah Loxton
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Assessment of Quality of Antenatal Care Services and Its Determinant Factors in Public Health Facilities of Hossana Town, Hadiya Zone, Southern Ethiopia: A Longitudinal Study. ADVANCES IN PUBLIC HEALTH 2020. [DOI: 10.1155/2020/5436324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Antenatal care is a care that links the woman and her family with the formal health system, increases the chance of using a skilled attendant at birth, and contributes to good health through the life cycle. Inadequate care during this time breaks a critical link in the continuum of care and affects both women and babies. Therefore, the main aim of this study was to determine the quality of ANC in Hadiya Zone, Southern Ethiopia. Method. A longitudinal facility-based study design was conducted among 1123 mothers whose gestational age of less than 16 weeks was identified and followed until birth and 40 days after birth to detect whether they gained the acceptable standard of quality of ANC from July 2017 to June 2018. A structured, predefined, and pretested observation check list and Likert scales were employed to obtain the necessary information after getting both written and verbal consent from the concerned bodies and study participants. Data was entered into Epi Info version 3.5 and transferred to STATA Version 14 software and cleaned by reviewing frequency tables, logical errors, and checking outliers. Generalized estimating equation (GEE) analysis was applied to get the average response observation of each visit of quality of ANC in the health facilities. Result. This study showed that the overall magnitude of good quality of antenatal care service that was provided in the whole visit at Hosanna Town’s public health facilities was 1230 (31.38%). The most frequently identified problems were inability to take full history, lack of proper counseling, poor healthcare provider and client interaction, and improper registration and there was a variation in providing quality of care in each visit. Quality of antenatal care was significantly associated with residence, educational status gravidity, parity, and visit. In conclusion, the overall quality of antenatal care is low, so the health facilities need further modification on the identified problems.
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Kolola T, Morka W, Abdissa B. Antenatal care booking within the first trimester of pregnancy and its associated factors among pregnant women residing in an urban area: a cross-sectional study in Debre Berhan town, Ethiopia. BMJ Open 2020; 10:e032960. [PMID: 32571853 PMCID: PMC7311019 DOI: 10.1136/bmjopen-2019-032960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to assess antenatal care (ANC) booking within the first trimester of pregnancy and its associated factors among urban dwellers of pregnant women in Debre Berhan town, Ethiopia. DESIGN Cross-sectional. SETTING Public and private health facilities that provide ANC services in Debre Berhan town. OUTCOME MEASURE First ANC booking within the first trimester of pregnancy. PARTICIPANTS Urban dwellers of pregnant women in Debre Berhan town (n=384). RESULTS A total of 387 pregnant women in Debre Berhan town were selected for this study, of which 384 responded giving a response rate of 99.2%. The proportion of pregnant women who had ANC booking within the first trimester of pregnancy was 156 (40.6%; 95% CI: 35.8% to 45.6%). In the multivariable analysis, the odds of first ANC booking within the first trimester was higher among pregnant women who had secondary school (adjusted OR (AOR): 1.84; 95% CI: 1.10 to 3.19) and more than secondary level of education (AOR: 2.26; 95% CI: 1.27 to 4.03) compared with those who had less than a secondary school level of education. Pregnant women who have any ill health with their current pregnancy (AOR: 1.99; 95% CI: 1.21 to 3.27) were more likely to start booking within the first trimester than their counterparts. The odds of ANC booking within the first trimester was threefold higher among women with knowledge of ANC (AOR: 3.05; 95% CI: 1.52 to 6.11) compared with their counterparts. CONCLUSION First ANC booking within the first trimester was found to be low among urban dwellers of Debre Berhan town. Secondary school and more educational level, having ill health during early pregnancy and women's knowledge about ANC services were statistically associated with ANC booking within the first trimester of pregnancy. Therefore, improving ANC booking according to the WHO recommendation requires due attention. Further qualitative research exploring why early ANC booking remains low among urban dwellers is important to design intervention modalities.
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Affiliation(s)
- Tufa Kolola
- Department of Public Health, Ambo University, Ambo, Oromia, Ethiopia
| | - Wogene Morka
- Department of Midwifery, Arsi University, Assela, Oromia, Ethiopia
| | - Bayisa Abdissa
- Department of Public Health, Ambo University, Ambo, Oromia, Ethiopia
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Jiwani SS, Amouzou-Aguirre A, Carvajal L, Chou D, Keita Y, Moran AC, Requejo J, Yaya S, Vaz LM, Boerma T. Timing and number of antenatal care contacts in low and middle-income countries: Analysis in the Countdown to 2030 priority countries. J Glob Health 2020; 10:010502. [PMID: 32257157 PMCID: PMC7101027 DOI: 10.7189/jogh.10.010502] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The 2016 World Health Organization (WHO) guidelines for antenatal care (ANC) shift the recommended minimum number of ANC contacts from four to eight, specifying the first contact to occur within the first trimester of pregnancy. We quantify the likelihood of meeting this recommendation in 54 Countdown to 2030 priority countries and identify the characteristics of women being left behind. Methods Using 54 Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) since 2012, we reported the proportion of women with timely ANC initiation and those who received 8-10 contacts by coverage levels of ANC4+ and by Sustainable Development Goal (SDG) regions. We identified demographic, socio-economic and health systems characteristics of timely ANC initiation and achievement of ANC8+. We ran four multiple regression models to quantify the associations between timing of first ANC and the number and content of ANC received. Results Overall, 49.9% of women with ANC1+ and 44.3% of all women had timely ANC initiation; 11.3% achieved ANC8+ and 11.2% received no ANC. Women with timely ANC initiation had 5.2 (95% confidence interval (CI) = 5.0-5.5) and 4.7 (95% CI = 4.4-5.0) times higher odds of receiving four and eight ANC contacts, respectively (P < 0.001), and were more likely to receive a higher content of ANC than women with delayed ANC initiation. Regionally, women in Central and Southern Asia had the best performance of timely ANC initiation; Latin America and Caribbean had the highest proportion of women achieving ANC8+. Women who did not initiate ANC in the first trimester or did not achieve 8 contacts were generally poor, single women, with low education, living in rural areas, larger households, having short birth intervals, higher parity, and not giving birth in a health facility nor with a skilled attendant. Conclusions Timely ANC initiation is likely to be a major driving force towards meeting the 2016 WHO guidelines for a positive pregnancy experience.
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Affiliation(s)
- Safia S Jiwani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Agbessi Amouzou-Aguirre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Liliana Carvajal
- Data and Analytics Section, Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, New York, USA
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Youssouf Keita
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Jennifer Requejo
- Data and Analytics Section, Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, New York, USA
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada.,The George Institute for Global Health, The University of Oxford, Oxford, UK
| | - Lara Me Vaz
- Department of Global Health, Save the Children US, Washington, District of Columbia, USA
| | - Ties Boerma
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Jiwani SS, Amouzou-Aguirre A, Carvajal L, Chou D, Keita Y, Moran AC, Requejo J, Yaya S, Vaz LM, Boerma T. Timing and number of antenatal care contacts in low and middle-income countries: Analysis in the Countdown to 2030 priority countries. J Glob Health 2020. [PMID: 32257157 DOI: 10.7189/jogh.10.010502.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The 2016 World Health Organization (WHO) guidelines for antenatal care (ANC) shift the recommended minimum number of ANC contacts from four to eight, specifying the first contact to occur within the first trimester of pregnancy. We quantify the likelihood of meeting this recommendation in 54 Countdown to 2030 priority countries and identify the characteristics of women being left behind. Methods Using 54 Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) since 2012, we reported the proportion of women with timely ANC initiation and those who received 8-10 contacts by coverage levels of ANC4+ and by Sustainable Development Goal (SDG) regions. We identified demographic, socio-economic and health systems characteristics of timely ANC initiation and achievement of ANC8+. We ran four multiple regression models to quantify the associations between timing of first ANC and the number and content of ANC received. Results Overall, 49.9% of women with ANC1+ and 44.3% of all women had timely ANC initiation; 11.3% achieved ANC8+ and 11.2% received no ANC. Women with timely ANC initiation had 5.2 (95% confidence interval (CI) = 5.0-5.5) and 4.7 (95% CI = 4.4-5.0) times higher odds of receiving four and eight ANC contacts, respectively (P < 0.001), and were more likely to receive a higher content of ANC than women with delayed ANC initiation. Regionally, women in Central and Southern Asia had the best performance of timely ANC initiation; Latin America and Caribbean had the highest proportion of women achieving ANC8+. Women who did not initiate ANC in the first trimester or did not achieve 8 contacts were generally poor, single women, with low education, living in rural areas, larger households, having short birth intervals, higher parity, and not giving birth in a health facility nor with a skilled attendant. Conclusions Timely ANC initiation is likely to be a major driving force towards meeting the 2016 WHO guidelines for a positive pregnancy experience.
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Affiliation(s)
- Safia S Jiwani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Agbessi Amouzou-Aguirre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Liliana Carvajal
- Data and Analytics Section, Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, New York, USA
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Youssouf Keita
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Jennifer Requejo
- Data and Analytics Section, Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, New York, USA
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada.,The George Institute for Global Health, The University of Oxford, Oxford, UK
| | - Lara Me Vaz
- Department of Global Health, Save the Children US, Washington, District of Columbia, USA
| | - Ties Boerma
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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10
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Morón-Duarte LS, Ramirez Varela A, Segura O, Freitas da Silveira M. Quality assessment indicators in antenatal care worldwide: a systematic review. Int J Qual Health Care 2020; 31:497-505. [PMID: 30295805 DOI: 10.1093/intqhc/mzy206] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 08/15/2018] [Accepted: 09/14/2018] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To describe indicators used for the assessment of antenatal care (ANC) quality worldwide under the World Health Organization (WHO) framework and based on a systematic review of the literature. DATA SOURCES Searches were performed in MEDLINE, SciELO, BIREME and Web of Science for eligible studies published between January 2002 and September 2016. STUDY SELECTION Original articles describing women who had received ANC, any ANC model and, any ANC quality indicators were included. DATA EXTRACTION Publication date, study design and ANC process indicators were extracted. RESULTS OF DATA SYNTHESIS Of the total studies included, 69 evaluated at least one type of ANC process indicator. According to WHO ANC guidelines, 8.7% of the articles reported healthy eating counseling and 52.2% iron and folic acid supplementation. The evaluation indicators on maternal and fetal interventions were: syphilis testing (55.1%), HIV testing (47.8%), gestational diabetes mellitus screening (40.6%) and ultrasound (27.5%). Essential ANC activities assessment ranged from 26.1% report of fetal heart sound, 50.7% of maternal weight and 63.8% of blood pressure. Regarding preventive measures recommended by WHO, tetanus vaccine was reported in 60.9% of the articles. Interventions performed by health services to improve use and quality of ANC care, promotion of maternal and fetal health, and the number of visits to the ANC were evaluated in 65.2% of the studies. CONCLUSION Numerous ANC content indicators are being used to assess ANC quality. However, there is a need to use standardized indicators across countries and efforts to improve quality evaluation.
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Affiliation(s)
- Lina Sofia Morón-Duarte
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Andrea Ramirez Varela
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Omar Segura
- SMC-AS Research Unit - Segura, Moron & Castañeda Health Consultants Ltd., Bogotá, D.C., Colombia
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Jiwani SS, Carrillo-Larco RM, Hernández-Vásquez A, Barrientos-Gutiérrez T, Basto-Abreu A, Gutierrez L, Irazola V, Nieto-Martínez R, Nunes BP, Parra DC, Miranda JJ. The shift of obesity burden by socioeconomic status between 1998 and 2017 in Latin America and the Caribbean: a cross-sectional series study. Lancet Glob Health 2019; 7:e1644-e1654. [PMID: 31708145 PMCID: PMC7613084 DOI: 10.1016/s2214-109x(19)30421-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/12/2019] [Accepted: 09/19/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The burden of obesity differs by socioeconomic status. We aimed to characterise the prevalence of obesity among adult men and women in Latin America and the Caribbean by socioeconomic measures and the shifting obesity burden over time. METHODS We did a cross-sectional series analysis of obesity prevalence by socioeconomic status by use of national health surveys done between 1998 and 2017 in 13 countries in Latin America and the Caribbean. We generated equiplots to display inequalities in, the primary outcome, obesity by wealth, education, and residence area. We measured obesity gaps as the difference in percentage points between the highest and lowest obesity prevalence within each socioeconomic measure, and described trends as well as changing patterns of the obesity burden over time. FINDINGS 479 809 adult men and women were included in the analysis. Obesity prevalence across countries has increased over time, with distinct patterns emerging by wealth and education indices. In the most recent available surveys, obesity was most prevalent among women in Mexico in 2016, and the least prevalent among women in Haiti in 2016. The largest gap between the highest and lowest obesity estimates by wealth was observed in Honduras among women (21·6 percentage point gap), and in Peru among men (22·4 percentage point gap), compared with a 3·7 percentage point gap among women in Brazil and 3·3 percentage points among men in Argentina. Urban residents consistently had a larger burden than their rural counterparts in most countries, with obesity gaps ranging from 0·1 percentage points among women in Paraguay to 15·8 percentage points among men in Peru. The trend analysis done in five countries suggests a shifting of the obesity burden across socioeconomic groups and different patterns by gender. Obesity gaps by education in Mexico have reduced over time among women, but increased among men, whereas the gap has increased among women but remains relatively constant among men in Argentina. INTERPRETATION The increase in obesity prevalence in the Latin American and Caribbean region has been paralleled with an unequal distribution and a shifting burden across socioeconomic groups. Anticipation of the establishment of obesity among low socioeconomic groups could provide opportunities for societal gains in primordial prevention. FUNDING None.
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Affiliation(s)
- Safia S Jiwani
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Rodrigo M Carrillo-Larco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Akram Hernández-Vásquez
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Ana Basto-Abreu
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Laura Gutierrez
- South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Vilma Irazola
- South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Ramfis Nieto-Martínez
- South Florida Veterans Affairs Foundation for Research and Education and Geriatric Research, Education and Clinical Center, Miami VA Healthcare System, Miami, FL, USA; Foundation for Clinical, Public Health, and Epidemiology Research in Venezuela, Caracas, Venezuela
| | - Bruno P Nunes
- Postgraduate Program of Nursing, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Diana C Parra
- Program of Physical Therapy and Department of Surgery, Institute for Public Health, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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12
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Khan MN, Harris ML, Shifti DM, Laar AS, Loxton D. Effects of unintended pregnancy on maternal healthcare services utilization in low- and lower-middle-income countries: systematic review and meta-analysis. Int J Public Health 2019; 64:743-754. [PMID: 31041453 DOI: 10.1007/s00038-019-01238-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/20/2019] [Accepted: 03/23/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To examine the association between unintended pregnancy and maternal healthcare services utilization in low- and lower-middle-income countries. METHODS A systematic literature search of Medline, Cinahl, Embase, PsycINFO, Cochrane Library, Popline, Maternity and Infant Care, and Scopus databases published since the beginning of the Millennium Development Goals (i.e. January 2000) to June 2018 was performed. We estimated the pooled odds ratios using random effect models and performed subgroup analysis by participants and study characteristics. RESULTS A total of 38 studies were included in the meta-analysis. Our study found the occurrence of unintended pregnancy was associated with a 25-39% reduction in the use of antenatal, delivery, and postnatal healthcare services. Stratified analysis found the differences of healthcare services utilization across types of pregnancy unintendedness (e.g. mistimed, unwanted). CONCLUSIONS Integrating family planning and maternal healthcare services should be considered to encourage women with unintended pregnancies to access maternal healthcare services.
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Affiliation(s)
- Md Nuruzzaman Khan
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, West Wing, Level 4, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,Department of Population Sciences, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh.
| | - Melissa L Harris
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, West Wing, Level 4, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Desalegn Markos Shifti
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, West Wing, Level 4, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Alexander Suuk Laar
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, West Wing, Level 4, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Deborah Loxton
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, West Wing, Level 4, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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13
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McNellan CR, Dansereau E, Wallace MCG, Colombara DV, Palmisano EB, Johanns CK, Schaefer A, Ríos-Zertuche D, Zúñiga-Brenes P, Hernandez B, Iriarte E, Mokdad AH. Antenatal care as a means to increase participation in the continuum of maternal and child healthcare: an analysis of the poorest regions of four Mesoamérican countries. BMC Pregnancy Childbirth 2019; 19:66. [PMID: 30755183 PMCID: PMC6371485 DOI: 10.1186/s12884-019-2207-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/28/2019] [Indexed: 11/22/2022] Open
Abstract
Background Antenatal care (ANC) is a means to identify high-risk pregnancies and educate women so that they might experience a healthier delivery and outcome. There is a lack of evidence about whether receipt of ANC is an effective strategy for keeping women in the system so they partake in other maternal and child interventions, particularly for poor women. The present analysis examines whether ANC uptake is associated with other maternal and child health behaviors in poor mothers in Guatemala, Honduras, Nicaragua, and Mexico (Chiapas). Methods We conducted a cross-sectional survey of women regarding their uptake of ANC for their most recent delivery in the last two years and their uptake of selected services and healthy behaviors along a continuity of maternal and child healthcare. We conducted logistic regressions on a sample of 4844 births, controlling for demographic, household, and maternal characteristics to understand the relationship between uptake of ANC and later participation in the continuum of care. Results Uptake of four ANC visits varied by country from 17.0% uptake in Guatemala to 81.4% in Nicaragua. In all countries but Nicaragua, ANC was significantly associated with in-facility delivery (IFD) (Guatemala odds ratio [OR] = 5.28 [95% confidence interval [CI] 3.62–7.69]; Mexico OR = 5.00 [95% CI: 3.41–7.32]; Honduras OR = 2.60 [95% CI: 1.42–4.78]) and postnatal care (Guatemala OR = 4.82 [95% CI: 3.21–7.23]; Mexico OR = 4.02 [95% CI: 2.77–5.82]; Honduras OR = 2.14 [95% CI: 1.26–3.64]), but did not appear to have any positive relationship with exclusive breastfeeding habits or family planning methods, which may be more strongly determined by cultural influences. Conclusions Our results demonstrate that uptake of the WHO-recommended four ANC visits has limited effectiveness on uptake of services in some poor populations in Mesoamérica. Our study highlights the need for continued and varied efforts in these populations to increase both the uptake and the effectiveness of ANC in encouraging positive and lasting effects on women’s uptake of health care services.
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Affiliation(s)
- Claire R McNellan
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA.
| | - Emily Dansereau
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Marielle C G Wallace
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Casey K Johanns
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Diego Ríos-Zertuche
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá city, Panamá
| | - Paola Zúñiga-Brenes
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá city, Panamá
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA.,University of Washington Department of Health Metrics Sciences and Department of Global Health, 1510 San Juan Rd, Seattle, WA, 98195, USA
| | - Emma Iriarte
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá city, Panamá
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
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14
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Abstract
Objective: The purpose of the study was to examine the relationship of maternal complications during pregnancy and prenatal exposures with childhood asthma among low-income families in Karachi, Pakistan. Methods: Parents/guardians of children with and without asthma visiting a charity hospital were enrolled. Information about prenatal and perinatal exposures was collected. Univariable and multiple stepwise logistic regression analysis were conducted to explore the relationship of socio-demographic, maternal complications during pregnancy, access to prenatal care, and exposure to animals and pests while pregnant with childhood asthma. Results: Maternal symptoms of nocturnal cough (adjusted OR [aOR = 2.87, 95% CI = 1.60-5.14) and wheezing (aOR = 5.57, 95% CI = 2.32-13.37) during pregnancy significantly increased the odds of childhood asthma. The family history of asthma or hay fever, also elevated the odds of childhood asthma (adjusted OR [aOR] = 5.86 (3.03-11.34). The odds of asthma among children whose mothers received prenatal care by Dai, an unskilled health worker, were significantly elevated. Lastly, prenatal exposure to rats/mice and contact with goats while pregnant was significantly associated with childhood asthma. Whereas, prenatal exposure to cows/cattle reduces the odds of childhood asthma. Conclusions: This study identified important maternal and prenatal risk factors for childhood asthma, the majority of which are avoidable. Appropriate steps are needed to create awareness about the prenatal risk factors in this population.
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Affiliation(s)
- Ahmed A Arif
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Shelby D Veri
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
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15
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Gamlin J, Holmes S. Preventable perinatal deaths in indigenous Wixárika communities: an ethnographic study of pregnancy, childbirth and structural violence. BMC Pregnancy Childbirth 2018; 18:243. [PMID: 29914405 PMCID: PMC6006582 DOI: 10.1186/s12884-018-1870-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 05/31/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Preventable maternal and infant mortality continues to be significantly higher in Latin American indigenous regions compared to non-indigenous, with inequalities of race, gender and poverty exacerbated by deficiencies in service provision. Standard programmes aimed at improving perinatal health have had a limited impact on mortality rates in these populations, and state and national statistical data and evaluations of services are of little relevance to the environments that most indigenous ethnicities inhabit. This study sought a novel perspective on causes and solutions by considering how structural, cultural and relational factors intersect to make indigenous women and babies more vulnerable to morbidity and mortality. METHODS We explored how structural inequalities and interpersonal relationships impact decision-making about care seeking during pregnancy and childbirth in Wixarika communities in Northwestern Mexico. Sixty-two women were interviewed while pregnant and followed-up after the birth of their child. Observational data was collected over 18 months, producing more than five hundred pages of field notes. RESULTS Of the 62 women interviewed, 33 gave birth at home without skilled attendance, including 5 who delivered completely alone. Five babies died during labour or shortly thereafter, we present here 3 of these events as case studies. We identified that the structure of service provision, in which providers have several contiguous days off, combined with a poor patient-provider dynamic and the sometimes non-consensual imposition of biomedical practices acted as deterrents to institutional delivery. Data also suggested that men have important roles to play supporting their partners during labour and birth. CONCLUSIONS Stillbirths and neonatal deaths occurring in a context of unnecessary lone and unassisted deliveries are structurally generated forms of violence: preventable morbidities or mortalities that are the result of systematic inequalities and health system weaknesses. These results counter the common assumption that the choices of indigenous women to avoid institutional delivery are irrational, cultural or due to a lack of education. Rather, our data indicate that institutional arrangements and interpersonal interactions in the health system contribute to preventable deaths. Addressing these issues requires important, but achievable, changes in service provision and resource allocation in addition to long term, culturally-appropriate strategies.
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Affiliation(s)
- Jennie Gamlin
- University College London Institute for Global Health, London, UK.
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16
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Weinstein JR, Thompson LM, Díaz Artiga A, Bryan JP, Arriaga WE, Omer SB, McCracken JP. Determining gestational age and preterm birth in rural Guatemala: A comparison of methods. PLoS One 2018; 13:e0193666. [PMID: 29554145 PMCID: PMC5858755 DOI: 10.1371/journal.pone.0193666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/15/2018] [Indexed: 01/24/2023] Open
Abstract
Background Preterm birth is the leading cause of death among children <5 years of age. Accurate determination of prematurity is necessary to provide appropriate neonatal care and guide preventive measures. To estimate the most accurate method to identify infants at risk for adverse outcomes, we assessed the validity of two widely available methods—last menstrual period (LMP) and the New Ballard (NB) neonatal assessment—against ultrasound in determining gestational age and preterm birth in highland Guatemala. Methods Pregnant women (n = 188) were recruited with a gestational age <20 weeks and followed until delivery. Ultrasound was performed by trained physicians and LMP was collected during recruitment. NB was performed on infants within 96 hours of birth by trained study nurses. LMP and NB accuracy at determining gestational age and identifying prematurity was assessed by comparing them to ultrasound. Results By ultrasound, infant mean gestational age at birth was 38.3 weeks (SD = 1.6) with 16% born at less than 37 gestation. LMP was more accurate than NB (mean difference of +0.13 weeks for LMP and +0.61 weeks for NB). However, LMP and NB estimates had low agreement with ultrasound-determined gestational age (Lin’s concordance<0.48 for both methods) and preterm birth (κ<0.29 for both methods). By LMP, 18% were judged premature compared with 6% by NB. LMP underestimated gestational age among women presenting later to prenatal care (0.18 weeks for each additional week). Gestational age for preterm infants was overestimated by nearly one week using LMP and nearly two weeks using NB. New Ballard neuromuscular measurements were more predictive of preterm birth than those measuring physical criteria. Conclusion In an indigenous population in highland Guatemala, LMP overestimated prematurity by 2% and NB underestimated prematurity by 10% compared with ultrasound estimates. New, simple and accurate methods are needed to identify preterm birth in resource-limited settings worldwide.
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Affiliation(s)
- John R. Weinstein
- School of Nursing, University of California, San Francisco, San Francisco, California, United States of America
| | - Lisa M. Thompson
- School of Nursing, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Anaité Díaz Artiga
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Joe P. Bryan
- Central American Regional Office, Centers for Disease Control and Prevention, Guatemala City, Guatemala
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William E. Arriaga
- Ministerio de Salud Pública y Asistencia Social, Quetzaltenango, Guatemala
| | - Saad B. Omer
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - John P. McCracken
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
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Bahamondes L, Villarroel C, Frías Guzmán N, Oizerovich S, Velázquez-Ramírez N, Monteiro I. The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations. Hum Reprod Open 2018; 2018:hox030. [PMID: 30895242 PMCID: PMC6276683 DOI: 10.1093/hropen/hox030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/18/2017] [Accepted: 12/25/2017] [Indexed: 12/19/2022] Open
Abstract
STUDY QUESTION Can the high rate and associated burden of unintended pregnancy (UP) and adolescent pregnancy in Latin America and the Caribbean (LAC) be reduced through wider access to and use of long-acting reversible contraceptive (LARC) methods? SUMMARY ANSWER Studies show that impoved access to and use of LARC methods is an effective tool for reducing the high rates of UP, unsafe abortion and abortion-related complications, and maternal deaths (as well as reducing their social and financial burden), and we have provided recommendations to help achieve this in LAC. WHAT IS KNOWN ALREADY LAC comprises 46 countries with 650 million inhabitants, and shows large disparities in socioeconomic development, access to health services and attention to sexual and reproductive health rights. The exercise of these rights and universal access to sexual and reproductive health (SRH) programmes is a key strategy for improving maternal health by reducing the number of UPs, the rate of women's and child mortality and morbidity, and the number of unsafe abortions. The implementation of SRH programmes in the region has contributed to a decrease in pregnancy rates of more than 50% over 40 years. However, despite this progress, the numbers of UP and adolescent pregnancies are still among the highest worldwide, which can be attributed in large part to the low prevalence of use of LARC methods. STUDY DESIGN SIZE DURATION This is a position paper with the objective of reviewing the magnitude and burden of UP in LAC, as well as available LARC methods and barriers to their access, with the goal of increasing knowledge and awareness among healthcare professionals (HCP), policymakers and the general public about the potential to reduce UP rates through the increased use of LARC. PARTICIPANTS/MATERIALS SETTING METHOD We searched the electronic databases of PubMed and EMBASE to identify studies published up to May 2017. We also searched for websites regarding LAC, LARC methods, and UP including, for example, those from the United Nations, the World Health Organization, Pan American Health Organization, the Alan Guttmacher Institute and the United States Agency for International Development. Studies were included if they investigated mainly UP and their consequences as well as the use of LARC methods in the region. During 3 days of meetings, the importance of the studies identified and the appropriateness of inclusion were discussed. MAIN RESULTS AND THE ROLE OF CHANCE LAC is not one unit and shows great ethnic diversity as well as economic and cultural differences among the various countries. These differences must be taken into account when developing policies related to disseminating information and combatting misinformation regarding the use of LARC among different audiences, such as adolescents and young women, nulligravidas, indigenous populations and women with disabilities. Furthermore, only some governments have made efforts to increase accessibility to LARC methods, and there is a need to implement training programmes for HCPs, launch education campaigns for the general public, increase access and review the cost-benefit analyses specific to LARC, which have already demonstrated that the upfront cost of LARC is less than the cummulative expense of short-term contraceptives. Recommendations to achieve these goals are presented. LIMITATIONS REASONS FOR CAUTION Knowledge and awareness of the contraceptive method itself and of the mix of individual countries in the region is essential to the development of specific strategies and actions, tailored to each particular country situation, aimed at increasing access to modern contraceptive methods, especially LARC. WIDER IMPLICATIONS OF THE FINDINGS Healthcare systems in LAC should consider LARC as a primary option for decreasing UP and adolescent pregnancy. Disseminating information, increasing awareness of their efficacy, removing barriers and improving access to LARC methods are the urgent actions recommended for government, academia, professional organizations, insurance companies and policymakers in order to address this major public health problem in LAC. STUDY FUNDING/COMPETING INTERESTS This manuscript was supported by a grant from the Americas Health Foundation (AHF), a 501(c)3 nonprofit organization dedicated to improving healthcare throughout the Latin American Region. LB and IM received additional support from the São Paulo Research Foundation (FAPESP) award # 2015/20504-9. The authors declare no conflict of interest.
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Affiliation(s)
- Luis Bahamondes
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) Medical School, Caixa Postal 6181, 13084-971, Campinas, SP, Brazil
| | - Claudio Villarroel
- Institute for Mother and Child Research (IDIMI), University of Chile, Av. Santa Rosa 1234, Santiago, Chile
| | - Natalia Frías Guzmán
- Cervical Cancer Education and Early Detection Programme, Arabia #1, Arroyo Hondo, Santo Domingo, Dominican Republic
| | - Silvia Oizerovich
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Buenos Aires, Paraguay 2155, C1121 ABG, Buenos Aires, Argentina
| | - Norma Velázquez-Ramírez
- Department of Sexual and Reproductive Health Care (Reproductive Biology), Instituto Nacional de Perinatología (INPER), Montes Urales 800, Lomas 11000, CDMX, Mexico
| | - Ilza Monteiro
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) Medical School, Caixa Postal 6181, 13084-971, Campinas, SP, Brazil
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