Distance matters: barriers to antenatal care and safe childbirth in a migrant population on the Thailand-Myanmar border from 2007 to 2015, a pregnancy cohort study

COVID-19 pandemic, pregnancy care, perinatal outcomes in Eastern Myanmar and North-Western Thailand: a retrospective marginalised population cohort

BACKGROUND

The COVID-19 pandemic disrupted routine health care and antenatal and birth services globally. The Shoklo Malaria Research Unit (SMRU) based at the Thailand-Myanmar border provides cross border antenatal care (ANC) and birth services to marginalised pregnant women. The border between the countries entered lockdown in March 2020 preventing cross-border access for women from Myanmar to Thailand. SMRU adapted by opening a new clinic during the COVID-19 pandemic in Myanmar. This study explored the impact of the COVID-19 pandemic and response on access to ANC and pregnancy outcomes for marginalised pregnant women in the border regions between Thailand and Myanmar.

METHODS

A retrospective review of medical records of all pregnancies delivered or followed at antenatal clinics of the SMRU from 2017 to the end of 2022. Logistic regression was done to compare the odds of maternal and neonatal outcomes between women who delivered pre-COVID (2017-2019) and women who delivered in the COVID-19 pandemic (2020-2022), grouped by reported country of residence: Thailand or Myanmar.

RESULTS

Between 2017 and the end of 2022, there were 13,865 (5,576 resident in Thailand and 8,276 in Myanmar) marginalised pregnant women who followed ANC or gave birth at SMRU clinics. Outcomes of pregnancy were known for 9,748 women with an EGA ≥ 28 weeks. Unknown outcome of pregnancy among women living in Thailand did not increase during the pandemic. However, there was a high (60%) but transient increase in unknown outcome of pregnancy for women with Myanmar residence in March 2020 following border closure and decreasing back to the baseline of 20-30% after establishment of a new clinic. Non-literate women were more likely to have an unknown outcome during the pandemic. There was no statistically significant increase in known stillbirths or maternal deaths during the COVID pandemic in this population but homebirth was over represented in maternal and perinatal mortality.

CONCLUSION

Decreasing barriers to healthcare for marginalised pregnant women on the Thailand-Myanmar border by establishment of a new clinic was possible in response to sudden border closure during the COVID-19 pandemic and most likely preventing an increase in maternal and perinatal mortality.

Exploring the association between multidimensional poverty and antenatal care utilization in two provinces of Papua New Guinea: a cross-sectional study

BACKGROUND

Although global poverty rates have declined in the last decade, the fall in the Asia-Pacific region has been slow relative to the rest of the world. Poverty continues to be a major cause of poor maternal and newborn health, and a barrier to accessing timely antenatal care. Papua New Guinea has one of the highest poverty rates and some of the worst maternal and neonatal outcomes in the Asia-Pacific region. Few studies have investigated equity in antenatal care utilization in this setting. We explored equity in antenatal care utilization and the determinants of service utilization, which include a measure of multidimensional poverty in Papua New Guinea.

METHODS

To explore the association between poverty and antenatal care utilization this study uses data from a ten-cluster randomized controlled trial. The poverty headcount, average poverty gap, adjusted poverty headcount, and multidimensional poverty index of antenatal clinic attendees are derived using the Alkire-Foster method. The distribution of service utilization is explored using the multidimensional poverty index, followed by multivariate regression analyses to evaluate the determinants of service utilization.

RESULTS

The poverty headcount was 61.06%, the average poverty gap 47.71%, the adjusted poverty headcount 29.13% and the average multidimensional poverty index was 0.363. Further, antenatal care utilization was regressive with respect to poverty. The regression analyses indicated that older women; being a widow (small number of widows (n = 3) asserts interpreting result with caution); or formally employed increase the likelihood of accessing antenatal care more often in pregnancy. Travelling for over an hour to receive care was negatively associated with utilization.

CONCLUSION

This study indicated high levels of multidimensional poverty in PNG and that ANC utilization was regressive; highlighting the need to encourage pregnant women, especially those who are economically more vulnerable to visit clinics regularly throughout pregnancy.

COVID-19 vaccination intention among internally displaced persons in complex humanitarian emergency context, Northeast Nigeria

Internally displaced persons (IDPs) are at high risk for COVID-19 transmission because of congested and unsanitary living conditions. COVID-19 vaccination is essential to build population immunity and prevent severe disease among this population. We determined the prevalence and factors associated with intention to accept COVID-19 vaccine among IDPs in Northeast Nigeria. This cross-sectional study, conducted during July-December 2022, included 1,537 unvaccinated IDPs from 18 IDPs camps. We performed a complex sample survey analysis and described participants' characteristics and vaccination intention with weighted descriptive statistics. We fitted weighted logistic regression models and computed adjusted odds ratios with 95% confidence intervals to identify factors associated with intention to accept COVID-19 vaccine. Of 1,537 IDPs, 55.4% were 18-39 years old, 82.6% were females, and 88.6% had no formal education. Among them, 63.5% (95% CI: 59.0-68.1) expressed intention to accept COVID-19 vaccine. Among the IDPs who intended to reject vaccine, 42.8% provided no reason, 35.3% had COVID-19 misconceptions, 9.5% reported vaccine safety concerns, and 7.4% felt no need. IDPs who perceived COVID-19 as severe (Adjusted Odds Ratio (AOR) = 2.31, [95% CI: 1.35-3.96]), perceived COVID-19 vaccine as effective (AOR = 4.28, [95% CI: 2.46-7.44]) and resided in official camps (AOR = 3.29, [95% CI: 1.94-5.56]) were more likely to accept COVID-19 vaccine. However, IDPs who resided 2 kilometers or farther from the nearest health facility (AOR = 0.34, [95% CI: 0.20-0.58]) were less likely to accept vaccine. Intention to accept COVID-19 vaccine among the IDPs was suboptimal. To improve vaccination acceptance among this population, health education and risk communication should be intensified to counter misinformation, strengthen vaccine confidence, and shape perception of COVID-19 severity, focusing on IDPs in unofficial camps. Appropriate interventions to deliver vaccines to remote households should be ramped up.

Myanmar immigrant women's perceptions, beliefs, and information-seeking behaviors with nutrition and food practices during pregnancy in Thailand: a qualitative study

BACKGROUND

Although nutrition is an essential contributor to the quality of pregnancy outcomes, little is known about the experiences and influences affecting dietary behaviors during pregnancy among migrant women, particularly those from Myanmar, the largest immigrant population in Thailand. To fill this gap, we conducted a descriptive qualitative study to explore Myanmar immigrant women's perceptions, beliefs, and information-seeking behaviors concerning nutrition and food practices during pregnancy.

METHODS

We conducted focus group discussions (FGDs) with fifty Myanmar immigrant pregnant women aged 18-45 years across all trimesters, who were recruited using purposive sampling from a public tertiary hospital. The FGDs were conducted in Thai or Myanmar using semi-structured guides that probed women's pregnancy perceptions and experiences about nutrition and food patterns during pregnancy. The FGDs were audio-recorded, translated, and transcribed. Direct content analysis was used to guide the analysis through an ecological perspective framework.

RESULTS

The seven FGDs with fifty women revealed four major themes involving perceptions, beliefs, and information-seeking behaviors. The qualitative results consisted of (1) a positive attitude toward better changes under difficult conditions (setting goals for infant health; uncertainty about changes); (2) beliefs about eating patterns and dietary practices during pregnancy (taboos aimed at protecting women's health and ensuring safe childbirth; taboos aimed at guaranteeing infant safety); (3) limited access to appropriate information about nutrition (unclear dietary information from healthcare providers; ease of learning from experiences in informal social networks); and (4) difficult living conditions in a non-native setting (work-related influences on dietary behaviors; lack of comprehensible language to gain food literacy). In addition, the results were highlighted across four levels of ecological perspectives.

CONCLUSIONS

Immigrant pregnant women are a vulnerable population that should be treated with equity to ensure quality of life through optimal nutrition throughout pregnancy. Respectful care requires that healthcare providers develop culturally sensitive nutrition interventions to increase nutrition literacy, accessibility, and pregnancy outcomes.

Factors influencing late antenatal care of Muslim pregnant women: A predictive correlational study in Aceh, Indonesia

Background

Late antenatal care (ANC) has significant implications for maternal and infant morbidity and mortality among Muslim pregnant women in Indonesia. Existing literature has primarily focused on gestational weeks at the first ANC contact, with limited attention to the total number of ANC visits.

Objective

This study aimed to explore the factors predicting late antenatal care contact among Muslim pregnant women, including the gestational weeks of the first ANC contact and the total number of ANC visits in Aceh, Indonesia.

Methods

A predictive correlational study design was utilized. Eighty postpartum women who received late ANC were purposively sampled and included in the study. Data were collected in May 2023 using ANC knowledge, beliefs, and social support questionnaires. Statistical analyses included descriptive statistics, Spearman's rank correlation, Chi-Square tests, and binary logistic regression with the enter method.

Results

Pregnant women residing farther from home to ANC services were more likely to have their first ANC contact after 20 weeks than those with a shorter distance (AOR = 1.06; 95% CI: 1.02-1.10; p = 0.007). Additionally, women with a history of multiple abortions were more inclined to have four or more ANC visits compared to those with fewer abortions (AOR = 6.78; 95% CI: 1.64-28.09; p = 0.008).

Conclusion

Distance from home to healthcare services emerged as a significant barrier to ANC contact, while a history of abortion appeared to motivate pregnant women to seek ANC more frequently. To address these issues effectively, nurses should consider implementing telemedicine services for ANC provision, integrating information on pregnancy complications to better support pregnant women in their care journey.

Community-Based Health Education Led by Women's Groups Significantly Improved Maternal Health Service Utilization in Southern Ethiopia: A Cluster Randomized Controlled Trial

OBJECTIVE

This study aimed to evaluate the effect of health education intervention (HEI) on maternal health service utilization (MHSU) in southern Ethiopia.

METHODS

From 10 January to 1 August 2023, a community-based, two-arm, parallel-group cluster randomized controlled trial (cRCT) was conducted among pregnant mothers in the Northern Zone of Sidama National Regional State, Ethiopia. We utilized multilevel mixed-effects modified Poisson regression with robust variance to control for the effects of clustering and potential confounders. The level of significance was adjusted for multiple comparisons.

RESULTS

The overall utilization of at least one antenatal care (ANC) visit was 90.2% in the treatment group and 59.5% in the comparator group (χ2 = 89.22, p < 0.001). Health facility delivery (HFD) utilization was considerably different between the treatment group (74.3%) and the comparator group (50.8%) (χ2 = 70.50, p < 0.001). HEI significantly increased ANC utilization (adjusted risk ratio [ARR]: 1.32; 99% CI: 1.12-1.56) and HFD utilization (ARR: 1.24; 99% CI: 1.06-1.46). The utilization of at least one postnatal care (PNC) service was 65.4% in the treatment group and 52.1% in the comparator group (χ2 = 19.51, p = 0.01). However, after controlling for the effects of confounders and clustering, the impact of HEI on PNC utilization was insignificant between the two groups (ARR: 1.15; 99% CI: 0.89-1.48).

CONCLUSION

A community-based HEI significantly increased ANC and HFD utilization but did not increase PNC utilization. Expanding the HEI with certain modifications will have a superior effect on improving MHSU.

TRIAL REGISTRATION NUMBER

NCT05865873.

Comparison of perinatal outcome and mode of birth of twin and singleton pregnancies in migrant and refugee populations on the Thai Myanmar border: A population cohort

BACKGROUND

In low- and middle-income countries twin births have a high risk of complications partly due to barriers to accessing hospital care. This study compares pregnancy outcomes, maternal and neonatal morbidity and mortality of twin to singleton pregnancy in refugee and migrant clinics on the Thai Myanmar border.

METHODS

A retrospective review of medical records of all singleton and twin pregnancies delivered or followed at antenatal clinics of the Shoklo Malaria Research Unit from 1986 to 2020, with a known outcome and estimated gestational age. Logistic regression was done to compare the odds of maternal and neonatal outcomes between twin and singleton pregnancies.

RESULTS

Between 1986 and 2020 this unstable and migratory population had a recorded outcome of pregnancy of 28 weeks or more for 597 twin births and 59,005 singleton births. Twinning rate was low and stable (<9 per 1,000) over 30 years. Three-quarters (446/597) of the twin pregnancies and 96% (56,626/59,005) of singletons birthed vaginally. During pregnancy, a significantly higher proportion of twin pregnancies compared to singleton had pre-eclampsia (7.0% versus 1.7%), gestational hypertension (9.9% versus 3.9%) and eclampsia (1.0% versus 0.2%). The stillbirth rate of twin 1 and twin 2 was higher compared to singletons: twin 1 25 per 1,000 (15/595), twin 2 64 per 1,000 (38/595) and singletons 12 per 1,000 (680/58,781). The estimated odds ratio (95% confidence interval (CI)) for stillbirth of twin 1 and twin 2 compared to singletons was 2.2 (95% CI 1.3-3.6) and 5.8 (95% CI 4.1-8.1); and maternal death 2.0 (0.95-11.4), respectively, As expected most perinatal deaths were 28 to <32 week gestation.

CONCLUSION

In this fragile setting where access to hospital care is difficult, three in four twins birthed vaginally. Twin pregnancies have a higher maternal morbidity and perinatal mortality, especially the second twin, compared to singleton pregnancies.

Factors associated with antepartum pilgrimage at a reference maternity hospital in Ceará

OBJECTIVE

To identify factors associated with antepartum pilgrimage in pregnant women in Fortaleza, Ceará, Brazil.

METHOD

A cross-sectional study with 300 postpartum women from a state reference maternity hospital, carried out from March 2020 to January 2021. The frequency of pilgrimage was estimated according to socioeconomic characteristics and prenatal care. Analysis with Pearson's chi-square test selected variables for adjusted Poisson regression.

RESULTS

The frequency of antepartum pilgrimage to more than one health service was 34.3%. Not knowing the reference maternity hospital (1.16; 95%CI: 1.04-1.30) and not living close to the reference maternity hospital (1.16; 95%CI: 1.03-1.31) were associated with the occurrence of pilgrimage among women. Personal characteristics and prenatal care were not associated.

CONCLUSION

There was an association between antepartum pilgrimage and lack of knowledge of the reference maternity hospital and residence far from that maternity hospital, which requires better team communication and the guarantee of easier access to obstetric care services, through effective implementation of regionalization of maternal care.

Availability and readiness of healthcare facilities and their effects on antenatal care services uptake in Bangladesh

BACKGROUND

Sustainable Development Goal (SDG) 3.7 aims to ensure universal access to sexual and reproductive healthcare services, where antenatal care (ANC) is a core component. This study aimed to examine the influence of health facility availability and readiness on the uptake of four or more ANC visits in Bangladesh.

METHODS

The 2017/18 Bangladesh Demographic and Health Survey data were linked with the 2017 Health Facility Survey and analyzed in this study. The associations of health facility-level factors with the recommended number of ANC uptakes were determined. A multilevel mixed-effect logistic regression model was used to determine the association, adjusting for potential confounders.

RESULTS

Nearly 44% of mothers reported four or more ANC uptakes, with significant variations across several areas in Bangladesh. The average distance of mothers' homes from the nearest health facilities was 6.36 km, higher in Sylhet division (8.25 km) and lower in Dhaka division (4.45 km). The overall uptake of the recommended number of ANC visits was positively associated with higher scores for the management (adjusted odds ratio (aOR) 1.85; 95% CI, 1.16-2.82) and infrastructure (aOR, 1.59; 95% CI, 1.09-2.19) of health facilities closest to mothers' homes. The odds of using the recommended number of ANC in mothers increased by 3.02 (95% CI, 2.01-4.19) and 2.36 (95% CI, 2.09-3.16) folds for each unit increase in the availability and readiness scores to provide ANC services at the closest health facilities, respectively. Every kilometer increase in the average regional-level distance between mothers' homes and the nearest health facilities reduced the likelihood of receiving the recommended number of ANC visits by nearly 42% (aOR, 0.58, 95% CI, 0.42-0.74).

CONCLUSION

The availability of healthcare facilities close to residence, as well as their improved management, infrastructure, and readiness to provide ANC, plays a crucial role in increasing ANC services uptake. Policies and programs should prioritize increasing the availability, accessibility, and readiness of health facilities to provide ANC services.

The sexual and reproductive healthcare challenges when dealing with female migrants and refugees in low and middle-income countries (a qualitative evidence synthesis)

BACKGROUND

Migrants and refugees face unprecedented inequalities in accessing sexual and reproductive health (SRH) in developed and developing countries. Most attention has focused on the rich world perspective, while there are huge numbers of migrants and refugees moving towards less developed countries. This article synthesizes the barriers to proper SRH care from low and middle-income countries perspective.

METHODS

We performed a systematic review of articles containing primary source qualitative and quantitative studies with thick qualitative descriptions. Articles from various databases, including PubMed, Science Direct, HINARI, and Google Scholar, published between 2012 and 2022 were included. Because the context differed, we excluded articles dealing with migrants and refugees from low- and middle-income countries living in high-income countries. To select articles, a preferred reporting item for systematic reviews and meta-analyses (PRISMA) was used. The articles' quality was assessed using the standard QASP checklist. We used a socio-ecological model to investigate barriers at various levels, and thematic analysis was used to identify the strongest themes at each level of the model. This synthesis is registered under PROSPERO number CRD42022341460.

RESULTS

We selected fifteen articles from a total of 985 for the final analysis. The results show that despite the diversity of the participants' homes and countries of origin, their experiences using SRH services were quite similar. Most female migrants and refugees claimed to have encountered discrimination from service providers, and linguistic and cultural obstacles played a significant role in their experiences. In nations lacking universal healthcare coverage, the cost of care was a barrier to the use of SRH services. Other main obstacles to using SRH services were a lack of knowledge about these programs, worries about privacy, inadequate communication, stigma in the community, and gender-related power imbalances.

CONCLUSION

To enhance the use of SRH by female migrants and refugees, it is vital to provide person-centered care and involve husbands, parents, in-laws, and communities in SRH coproduction. Training on cultural competency, compassion, and respect must be provided to healthcare personnel. Increasing financial access for migrant and refugee healthcare is crucial, as is meeting their basic requirements.

Giving birth on the way to the clinic: undocumented migrant women's perceptions and experiences of maternal healthcare accessibility along the Thailand-Myanmar border

BACKGROUND

Millions of women give birth annually without the support of a trained birth attendant. Generally and globally, countries provide maternal health services for their citizens but there is a coverage gap for undocumented migrant women who often can't access the same care due to their legal status. The objective of this investigation is to explore undocumented migrants' experiences and perceptions of maternal healthcare accessibility.

METHODS

We held focus groups discussions with 64 pregnant women at 3 migrant health clinics on the Thailand-Myanmar border and asked how they learned about the clinic, their health care options, travel and past experiences with birth services. In this context undocumented women could sign up for migrant health insurance at the clinic that would allow them to be referred for tertiary care at government hospitals if needed.

RESULTS

Women learned about care options through a network approach often relying on information from community members and trusted care providers. For many, choice of alternate care was limited by lack of antenatal care services close to their homes, limited knowledge of other services and inability to pay fees associated with hospital care. Women travelled up to 4 h to get to the clinic by foot, bicycle, tractor, motorcycle or car, sometimes using multiple modes of transport. Journeys from the Myanmar side of the border were sometimes complicated by nighttime border crossing closures, limited transport and heavy rain.

CONCLUSIONS

Undocumented migrant women in our study experienced a type of conditional or variable accessibility where time of day, transport and weather needed to align with the onset of labour to ensure that they could get to the migrant clinic on time to give birth. We anticipate that undocumented migrants in other countries may also experience conditional accessibility to birth care, especially where travel is necessary due to limited local services. Care providers may improve opportunities for undocumented pregnant women to access maternal care by disseminating information on available services through informal networks and addressing travel barriers through mobile services and other travel supports. Trial registration The research project was approved by Research Ethics Committee at the Faculty of Medicine, Chiang Mai University (FAM-2560-05204), and the Department of Community Medicine and Global Health at the University of Oslo-Norwegian Centre for Research Data (58542).

Loss to Hospital Follow-Up in Pediatric Cerebral Malaria Survivors: A Case-Control Study

Children surviving central nervous system (CNS) infections are at high risk of neurological, behavioral, and cognitive sequalae. Early identification, characterization, and treatment of these sequelae may improve child and family health. In Africa, it is unclear if there are demographic or clinical factors that increase the risk of post-hospital loss to follow-up in children with CNS infections. If these factors exist, targeted educational efforts to increase rates of post-hospital retention could be focused on families at highest risk. We performed a case-control study of Malawian children with cerebral malaria, a locally common CNS infection, previously admitted to a specialized research unit in Blantyre, Malawi. Routine survivor post-hospital follow-up was scheduled for 1 month, 6 months, and 12 months. We compared demographic and clinical characteristics between 84 children who missed one or more of these post-hospital visits with 120 children who attended all visits. There were no statistically significant differences in demographic or clinical characteristics between children whose families returned for all follow-up visits and those who did not. Specifically, when comparing these groups, we found no differences in age (P = 00.646), sex (P = 0.789), duration of hospitalization (P = 0.903), distance from home to hospital (P = 0.355), type or severity of neurological sequelae (P = 0.837), guardian literacy (P = 0.057), or number of discharge medications (P = 0.464). No factors assessed in this study were associated with higher risk of loss to follow-up in Malawian child survivors of CNS infections. During hospitalization, educational efforts to increase post-hospital retention should focus on all families.

Relationships of deworming drug consumption and animal protein intake with stunting

By the end of 2022, the nationwide incidence of stunting remained high, including in Lampung Province, where it was 15.8%, above the target of 14% to be achieved by 2024. Since 2019, stunting has become a national priority due to suspected factors such as low nutrition intake, especially from animal protein sources, high rates of worm infections, and low compliance of under-fives in consuming deworming drugs. Therefore, this research aimed to analyze the relationship between deworming consumption, adequacy of animal protein intake, and stunting incidence in children aged 12-59 months in Bandar Lampung in 2022. This research used an analytic survey with a cross-sectional approach to analyze the relationship between deworming consumption, adequacy of animal protein intake, and stunting in under-fives at two priority stunting handling neighbourhoods in Bandar Lampung, namely Way Gubak and Karang Maritim. The sample consisted of 262 under fives and their mothers who visited the integrated health post in the selected neighbourhoods from November to December 2022, and the data obtained were analyzed using logistic regression. The results revealed a relationship between the consumption of an deworming and varying animal protein consumption with stunting incidence. This indicated a need to promote the importance of consuming deworming and adequate consumption of animal protein with variation to prevent stunting in children in Bandar Lampung.

Access to health care for migrants in French Guiana in 2022: a qualitative study of health care system actors

Background

Access to health care is a major public health issue. The social determinants of health have a role in accessing health care and in meeting the health needs of populations. With 281 million international migrants around the world, population movements are another major issue. Migrants are particularly exposed to precariousness during their migratory journey and after their settlement. These vulnerabilities may have deleterious effects on their health status and on their social conditions. In French Guiana, 36% of the population is of foreign origin. The objective of this study is to explore the barriers and the facilitators to accessing health care for migrants in French Guiana in 2022, from the perspective of health care professionals, social workers and local NGO actors.

Methods

This research is an exploratory qualitative study based on the experiential knowledge of health care professionals, social workers and local NGO actors in French Guiana. 25 semi-structured interviews were conducted with these professionals and actors between April and June 2022, using an interview guide to explore their practices, representations and beliefs of access to health care and accompaniment of migrants in their patient journey. The interviews were transcribed and analyzed using the thematic analysis method.

Results

A total of 25 health care professionals, social workers and local NGO actors were included in the study. Participants highlighted that migrants are exposed to many factors hindering their access to health care in French Guiana (administrative complexity, language barriers, financial barriers, mobility issues, etc.). With the situations of great precariousness and the inadequacies of the public authorities, associative support (social, health and legal accompaniment process provided by NGOs and associations) has an important role in providing close support to migrants. Moreover, health mediation supports migrants in their social and health care journey to lead them toward empowerment. Health mediators contribute to promote a better understanding between professionals and migrants.

Conclusion

In French Guiana, associative support and health mediation promote access to health care and social accompaniment for migrants. This article highlights the issues surrounding access to health care, associative support and health mediation in the Guianese context, which is marked by significant socio-cultural diversity and precariousness. Considering the benefits of associative support and health mediation, as well as social inequalities in health, is essential for health care professionals, social workers, local NGO actors, associations, public health authorities and political decision-makers to initiate concrete and suitable actions in favor of access to health care and social support for migrants in French Guiana.

Born too soon in a resource-limited setting: A 10-year mixed methods review of a special care baby unit for refugees and migrants on the Myanmar-Thailand border

Background

Preterm birth is a major public health concern with the largest burden of morbidity and mortality falling within low- and middle-income countries (LMIC).

Materials and methods

This sequential explanatory mixed methods study was conducted in special care baby units (SCBUs) serving migrants and refugees along the Myanmar-Thailand border. It included a retrospective medical records review, qualitative interviews with mothers receiving care within SCBUs, and focus group discussions with health workers. Changes in neonatal mortality and four clinical outcomes were described. A mix of ethnographic phenomenology and implementation frameworks focused on cultural aspects, the lived experience of participants, and implementation outcomes related to SCBU care.

Results

From 2008-2017, mortality was reduced by 68% and 53% in very (EGA 28-32 weeks) and moderate (EGA 33-36 weeks) preterm neonates, respectively. Median SCBU stay was longer in very compared to moderate preterm neonates: 35 (IQR 22, 48 days) vs. 10 days (IQR 5, 16). Duration of treatments was also longer in very preterm neonates: nasogastric feeding lasted 82% (IQR 74, 89) vs. 61% (IQR 40, 76) of the stay, and oxygen therapy was used a median of 14 (IQR 7, 27) vs. 2 (IQR 1, 6) days respectively. Nine interviews were conducted with mothers currently receiving care in the SCBU and four focus group discussions with a total of 27 local SCBU staff. Analysis corroborated quantitative analysis of newborn care services in this setting and incorporated pertinent implementation constructs including coverage, acceptability, appropriateness, feasibility, and fidelity. Coverage, acceptability, and appropriateness were often overlapping outcomes of interest highlighting financial issues prior to or while admitted to the SCBU and social issues and support systems adversely impacting SCBU stays. Interview and FGD findings highlight the barriers in this resource-limited setting as they impact the feasibility and fidelity of providing evidence-based SCBU care that often required adaptation to fit the financial and environmental constraints imposed by this setting.

Discussion

This study provides an in-depth look at the nature of providing preterm neonatal interventions in a SCBU for a vulnerable population in a resource-limited setting. These findings support implementation of basic evidence-based interventions for preterm and newborn care globally, particularly in LMICs.

A Systematic Scoping Review on Migrant Health Coverage in Thailand

(1) Background: Thailand is a major migrant receiving country and pioneer of migrant health policy in the ASEAN region. However, on the ground, coverage of migrants is faced with multiple barriers. (2) Objectives: We aim to scope and analyse the types of available evidence on migrant health coverage in Thailand and identify knowledge gaps. Specifically, we characterise the literature along year of publication, migrant subpopulation, health domain, scope of coverage, methods, study design, objectives and results. (3) Methods: We searched PubMed, Web of Science, Google Scholar, Cochrane Database, Worldwide Science and the Asian Citation Index for peer-reviewed and grey literature in October 2021 for studies analysing original data on health coverage of migrants in Thailand. To conceptualise health coverage, we used the three dimensions availability, accessibility and acceptability. (4) Results: 101 articles were included in the final analysis. Sixty-three were published after 2016, 39 focused on migrant workers and 18 on migrants in general. Forty-two concentrated on health in broader terms, followed by reproductive and maternal health (n = 31). Thirty-eight assessed coverage of specific services and 36 health coverage in general. Migrants themselves and key informants were the main data sources in 80 and 43 of the articles, respectively. Forty publications were qualitative, while 38 applied quantitative methods (22% descriptive; 7% analytical). Among the health coverage components, 79 articles included aspects of accessibility, followed by acceptability (n = 59) and availability (n = 30). (5) Conclusions: While there is a high number and broad range of studies on migrant health coverage in Thailand, we found that research on migrant subgroups, such as victims of trafficking and migrant children, as well as on the health domains, non-communicable diseases and occupational and mental health is neglected.

Contribution of genetic factors to high rates of neonatal hyperbilirubinaemia on the Thailand-Myanmar border

Very high unconjugated bilirubin plasma concentrations in neonates (neonatal hyperbilirubinaemia; NH) may cause neurologic damage (kernicterus). Both increased red blood cell turn-over and immaturity of hepatic glucuronidation contribute to neonatal hyperbilirubinaemia. The incidence of NH requiring phototherapy during the first week of life on the Thailand-Myanmar border is high (approximately 25%). On the Thailand-Myanmar border we investigated the contribution of genetic risk factors to high bilirubin levels in the first month of life in 1596 neonates enrolled in a prospective observational birth cohort study. Lower gestational age (<38 weeks), mutations in the genes encoding glucose-6-phosphate dehydrogenase (G6PD) and uridine 5'-diphospho-glucuronosyltransferase (UGT) 1A1 were identified as the main independent risk factors for NH in the first week, and for prolonged jaundice in the first month of life. Population attributable risks (PAR%) were 61.7% for lower gestational age, 22.9% for hemi or homozygous and 9.9% for heterozygous G6PD deficiency respectively, and 6.3% for UGT1A1*6 homozygosity. In neonates with an estimated gestational age ≥ 38 weeks, G6PD mutations contributed PARs of 38.1% and 23.6% for "early" (≤ 48 hours) and "late" (49-168 hours) NH respectively. For late NH, the PAR for UGT1A1*6 homozygosity was 7.7%. Maternal excess weight was also a significant risk factor for "early" NH while maternal mutations on the beta-globin gene, prolonged rupture of membranes, large haematomas and neonatal sepsis were risk factors for "late" NH. For prolonged jaundice during the first month of life, G6PD mutations and UGT1A1*6 mutation, together with lower gestational age at birth and presence of haematoma were significant risk factors. In this population, genetic factors contribute considerably to the high risk of NH. Diagnostic tools to identify G6PD deficiency at birth would facilitate early recognition of high risk cases.