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Thompson E, Kassa GM, Fite RO, Pons-Duran C, Goddard FGB, Worku A, Haneuse S, Hunegnaw BM, Bekele D, Alemu K, Taddesse L, Chan GJ. Birth outcomes and survival by sex among newborns and children under 2 in the Birhan Cohort: a prospective cohort study in the Amhara Region of Ethiopia. BMJ Glob Health 2024; 9:e015475. [PMID: 39137954 PMCID: PMC11331882 DOI: 10.1136/bmjgh-2024-015475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 07/09/2024] [Indexed: 08/15/2024] Open
Abstract
INTRODUCTION Despite the progress in reducing child mortality, the rate remains high, particularly in sub-Saharan African countries. Limited data exist on child survival and other birth outcomes by sex. This study compared survival rates and birth outcomes by sex among neonates and children under 2 in Ethiopia. METHODS Women who gave birth after 28 weeks of gestation and their newborns were included in the analysis. Survival probabilities were estimated for males and females in the neonatal period as well as the 2-year period following birth using Kaplan-Meier curves. HRs and 95% CIs were compared between males and females under 2. Descriptive statistics and χ2 tests were used to determine the sex-disaggregated variation in the birth outcomes of preterm birth, low birth weight (LBW), stillbirth, small for gestational age (SGA) and large for gestational age (LGA). RESULTS The study included a total of 3904 women and child pairs. The neonatal mortality rate for males (3.4%, 95% CI 2.6% to 4.2%) was higher compared with females (1.7%, 95% CI 1.1% to 2.3%). The hazard of death during the first 28 days of life was approximately two times higher for males compared with females (HR 1.99, 95% CI 1.30 to 3.06) but was not significantly different after this period. While there was a non-significant difference between males and females in the proportion of preterm, LBW and LGA births, we found a significantly higher proportion of stillbirth (2.7% vs 1.3%, p=0.003) and SGA (20.5% vs 15.6%, p<0.001) for males compared with females. CONCLUSIONS This study identified a significant sex difference in mortality and birth outcomes. We recommend focusing future research on the mechanisms of these sex differences in order to better design intervention programmes to reduce disparities and improve outcomes for neonates.
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Affiliation(s)
- Emily Thompson
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Getachew Mullu Kassa
- Health System and Reproductive Health Research Directorate, EPHI, Addis Ababa, Ethiopia
| | - Robera Olana Fite
- HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia
| | - Clara Pons-Duran
- HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Frederick G B Goddard
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Alemayehu Worku
- HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Bezawit Mesfin Hunegnaw
- HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia
- Department of Pediatrics and Child Health, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Delayehu Bekele
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Kassahun Alemu
- HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia
| | - Lisanu Taddesse
- HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia
| | - Grace J Chan
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Broad J, Robertson RC, Evans C, Perussolo J, Lum G, Piper JD, Loucaides E, Ziruma A, Chasekwa B, Ntozini R, Bourke CD, Prendergast AJ. Maternal inflammatory and microbial drivers of low birthweight in low- and middle-income countries. Paediatr Int Child Health 2024; 44:79-93. [PMID: 39066726 DOI: 10.1080/20469047.2024.2380974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Low birthweight (LBW) is when an infant is born too soon or too small, and it affects one in seven infants in low- and middle-income countries. LBW has a significant impact on short-term morbidity and mortality, and it impairs long-term health and human capital. Antenatal microbial and inflammatory exposure may contribute to LBW. METHODS Ovid-Medline, Embase and Cochrane databases were searched for English-language articles evaluating inflammatory, microbial or infective causes of LBW, small-for-gestational age, intra-uterine growth restriction or prematurity. Inclusion criteria were human studies including published data; conference abstracts and grey literature were excluded. A narrative synthesis of the literature was conducted. RESULTS Local infections may drive the underlying causes of LBW: for example, vaginitis and placental infection are associated with a greater risk of prematurity. Distal infection and inflammatory pathways are also associated with LBW, with an association between periodontitis and preterm delivery and environmental enteric dysfunction and reduced intra-uterine growth. Systemic maternal infections such as malaria and HIV are associated with LBW, even when infants are exposed to HIV but not infected. This latter association may be driven by chronic inflammation, co-infections and socio-economic confounders. Antimicrobial prophylaxis against other bacteria in pregnancy has shown minimal impact in most trials, though positive effects on birthweight have been found in some settings with a high infectious disease burden. CONCLUSION Maternal inflammatory and infective processes underlie LBW, and provide treatable pathways for interventions. However, an improved understanding of the mechanisms and pathways underlying LBW is needed, given the impact of LBW on life-course.
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Affiliation(s)
- Jonathan Broad
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
- Paediatrics Department, Croydon University Hospital, London, UK
| | - Ruairi C Robertson
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Ceri Evans
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
- Institute of Infection, Veterinary and Ecological Sciences, Liverpool, UK
| | - Jeniffer Perussolo
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Gina Lum
- Centre for Genomics and Child Health, Barts and The London School of Medicine and Dentistry, London, UK
| | - Joe D Piper
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Eva Loucaides
- Paediatrics Department, Croydon University Hospital, London, UK
| | - Asaph Ziruma
- Blizard Institute, Queen Mary University of London, London, UK
| | - Bernard Chasekwa
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Robert Ntozini
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Claire D Bourke
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Andrew J Prendergast
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
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Wang Z, Cui X, Yu H, Chan EM, Shi Z, Shi S, Shen L, Sun Z, Song Q, Lu W, Ma W, Mai S, Zang J. Association of Beverage Consumption during Pregnancy with Adverse Maternal and Offspring Outcomes. Nutrients 2024; 16:2412. [PMID: 39125293 PMCID: PMC11314345 DOI: 10.3390/nu16152412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/18/2024] [Accepted: 07/18/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND As the global consumption of sugary and non-sugar sweetened beverages continues to rise, there is growing concern about their health impacts, particularly among pregnant women and their offspring. OBJECTIVE This study aimed to investigate the consumption patterns of various beverages among pregnant women in Shanghai and their potential health impacts on both mothers and offspring. METHOD We applied a multi-stage random sampling method to select participants from 16 districts in Shanghai. Each district was categorised into five zones. Two towns were randomly selected from each zone, and from each town, 30 pregnant women were randomly selected. Data were collected through face-to-face questionnaires. Follow-up data on births within a year after the survey were also obtained. RESULT The consumption rates of total beverages (TB), sugar-sweetened beverages (SSB), and non-sugar sweetened beverages (NSS) were 73.2%, 72.8%, and 13.5%, respectively. Logistic regression analysis showed that compared to non-consumers, pregnant women consuming TB three times or less per week had a 38.4% increased risk of gestational diabetes mellitus (GDM) (OR = 1.384; 95% CI: 1.129-1.696) and a 64.2% increased risk of gestational hypertension (GH) (OR = 1.642; 95% CI: 1.129-2.389). Those consuming TB four or more times per week faced a 154.3% higher risk of GDM (OR = 2.543; 95% CI: 2.064-3.314) and a 169.3% increased risk of GH (OR = 2.693; 95% CI: 1.773-4.091). Similar results were observed in the analysis of SSB. Regarding offspring health, compared to non-consumers, TB consumption four or more times per week was associated with a substantial increase in the risk of macrosomia (OR = 2.143; 95% CI: 1.304-3.522) and large for gestational age (LGA) (OR = 1.695; 95% CI: 1.219-2.356). In the analysis of NSS, with a significantly increased risk of macrosomia (OR = 6.581; 95% CI:2.796-13.824) and LGA (OR = 7.554; 95% CI: 3.372-16.921). CONCLUSION The high level of beverage consumption among pregnant women in Shanghai needs attention. Excessive consumption of beverages increases the risk of GDM and GH, while excessive consumption of NSS possibly has a greater impact on offspring macrosomia and LGA.
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Affiliation(s)
- Zhengyuan Wang
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China; (Z.W.); (Z.S.); (L.S.); (Z.S.); (W.L.); (W.M.); (S.M.)
| | - Xin Cui
- Shanghai Health Statistics Center, Shanghai 200040, China;
| | - Huiting Yu
- Division of Vital Statistics, Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China;
| | - Ee-Mien Chan
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China;
| | - Zehuan Shi
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China; (Z.W.); (Z.S.); (L.S.); (Z.S.); (W.L.); (W.M.); (S.M.)
| | - Shuwen Shi
- The College of Medical Technology, Shanghai University of Medicine and Health Sciences, Shanghai 200237, China;
| | - Liping Shen
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China; (Z.W.); (Z.S.); (L.S.); (Z.S.); (W.L.); (W.M.); (S.M.)
| | - Zhuo Sun
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China; (Z.W.); (Z.S.); (L.S.); (Z.S.); (W.L.); (W.M.); (S.M.)
| | - Qi Song
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China; (Z.W.); (Z.S.); (L.S.); (Z.S.); (W.L.); (W.M.); (S.M.)
| | - Wei Lu
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China; (Z.W.); (Z.S.); (L.S.); (Z.S.); (W.L.); (W.M.); (S.M.)
| | - Wenqing Ma
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China; (Z.W.); (Z.S.); (L.S.); (Z.S.); (W.L.); (W.M.); (S.M.)
| | - Shupeng Mai
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China; (Z.W.); (Z.S.); (L.S.); (Z.S.); (W.L.); (W.M.); (S.M.)
| | - Jiajie Zang
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China; (Z.W.); (Z.S.); (L.S.); (Z.S.); (W.L.); (W.M.); (S.M.)
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Ramasamy T, Varughese B, Singh M, Tailor P, Rao A, Misra S, Sharma N, Desiraju K, Thiruvengadam R, Wadhwa N, Kapoor S, Bhatnagar S, Kshetrapal P. Post-natal gestational age assessment using targeted metabolites of neonatal heel prick and umbilical cord blood: A GARBH-Ini cohort study from North India. J Glob Health 2024; 14:04115. [PMID: 38968007 PMCID: PMC11225965 DOI: 10.7189/jogh.14.04115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024] Open
Abstract
Background Accurate assessment of gestational age (GA) and identification of preterm birth (PTB) at delivery is essential to guide appropriate post-natal clinical care. Undoubtedly, dating ultrasound sonography (USG) is the gold standard to ascertain GA, but is not accessible to the majority of pregnant women in low- and middle-income countries (LMICs), particularly in rural areas and small secondary care hospitals. Conventional methods of post-natal GA assessment are not reliable at delivery and are further compounded by a lack of trained personnel to conduct them. We aimed to develop a population-specific GA model using integrated clinical and biochemical variables measured at delivery. Methods We acquired metabolic profiles on paired neonatal heel prick (nHP) and umbilical cord blood (uCB) dried blood spot (DBS) samples (n = 1278). The master data set consists of 31 predictors from nHP and 24 from uCB after feature selection. These selected predictors including biochemical analytes, birth weight, and placental weight were considered for the development of population-specific GA estimation and birth outcome classification models using eXtreme Gradient Boosting (XGBoost) algorithm. Results The nHP and uCB full model revealed root mean square error (RMSE) of 1.14 (95% confidence interval (CI) = 0.82-1.18) and of 1.26 (95% CI = 0.88-1.32) to estimate the GA as compared to actual GA, respectively. In addition, these models correctly estimated 87.9 to 92.5% of the infants within ±2 weeks of the actual GA. The classification models also performed as the best fit to discriminate the PTB from term birth (TB) infants with an area under curve (AUC) of 0.89 (95% CI = 0.84-0.94) for nHP and an AUC of 0.89 (95% CI = 0.85-0.95) for uCB. Conclusion The biochemical analytes along with clinical variables in the nHP and uCB data sets provide higher accuracy in predicting GA. These models also performed as the best fit to identify PTB infants at delivery.
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Affiliation(s)
- Thirunavukkarasu Ramasamy
- Lab of Perinatal Research, Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Bijo Varughese
- Genetics Laboratory, Department of Paediatrics, Maulana Azad Medical College, New Delhi, India
| | - Mukesh Singh
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Pragya Tailor
- Lab of Perinatal Research, Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Archana Rao
- Lab of Perinatal Research, Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Sumit Misra
- Gurugram Civil Hospital, GCH, Haryana, India
| | - Nikhil Sharma
- Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Koundiya Desiraju
- Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Ramachandran Thiruvengadam
- Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Nitya Wadhwa
- Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - GARBH-Ini Study Group6
- Lab of Perinatal Research, Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
- Genetics Laboratory, Department of Paediatrics, Maulana Azad Medical College, New Delhi, India
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
- Gurugram Civil Hospital, GCH, Haryana, India
- Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
- Interdisciplinary Group for Advanced Research on Birth Outcomes - DBT India Initiative, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Seema Kapoor
- Genetics Laboratory, Department of Paediatrics, Maulana Azad Medical College, New Delhi, India
| | - Shinjini Bhatnagar
- Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Pallavi Kshetrapal
- Lab of Perinatal Research, Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
- Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
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Prabhakarrao Doke P, Paresh Chutke A, Hemant Palkar S, Sachin Gothankar J, Dnyandeo Pore P, Vasantrao Patil A, Vinayakrao Deshpande A, Kumar Bhuyan K, Vaman Karnataki M, Nishikant Shrotri A, Gopal Chaudhari R, Sitaram Bacchav M, Bajirao Patil M, Balasaheb Deshmukh R. Implementation of preconception care for preventing adverse pregnancy outcomes in rural and tribal areas of Nashik District, India. Prev Med Rep 2024; 43:102796. [PMID: 39026568 PMCID: PMC11257142 DOI: 10.1016/j.pmedr.2024.102796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 06/07/2024] [Accepted: 06/08/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction The World Health Organization has suggested preconception care to improve pregnancy outcomes. Hence, the study aimed to compare the effect of preconception care on pregnancy outcomes, particularly prematurity and low birth weight. Methods We carried out interventions in one tribal and one non-tribal block. For comparison, one adjacent tribal block and one non-tribal block were included in Nashik district, India. The total study period was from April 2018 to July 2021. All reproductive age group women desiring pregnancy within one year in selected four blocks participated in the study. The services included clinical examination, laboratory investigations, treatment, six-monthly deworming, anemia management, folic acid supplementation, family planning services, and behavioral change communication using different media. The existing healthcare workers provided services to the women until they became pregnant or until the end of the follow-up period (27 months). We monitored pregnancy outcomes, including abortion, stillbirth, and live birth; among live births, low birth weight, preterm birth, congenital physical anomaly, and neonatal death. Results The study enrolled 7,875 women, and 3,601 had outcomes. The proportion of preterm births in the intervention and comparison block was 11.18 % and 14.99 %, respectively (p = 0.001), and the proportion of low-birth-weight babies was 9.23 % and 11.25 %, respectively (p = 0.01). The adjusted prevalence ratio showed that the risk of preterm births in the absence of intervention was 1.3 (CI: 1.1-1.6). Preterm birth was a mediator between preconception care and low birth weight. Conclusion Reduction in proportion of low birth weight and preterm babies can be achieved through preconception care using minimal additional resources.
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Affiliation(s)
- Prakash Prabhakarrao Doke
- Bharati Vidyapeeth (Deemed to be University) Medical College, Department of Community Medicine, Pune 411043, India
| | - Amruta Paresh Chutke
- Bharati Vidyapeeth (Deemed to be University) Medical College, Department of Community Medicine, Pune 411043, India
| | - Sonali Hemant Palkar
- Bharati Vidyapeeth (Deemed to be University) Medical College, Department of Community Medicine, Pune 411043, India
| | - Jayashree Sachin Gothankar
- Bharati Vidyapeeth (Deemed to be University) Medical College, Department of Community Medicine, Pune 411043, India
| | - Prasad Dnyandeo Pore
- Bharati Vidyapeeth (Deemed to be University) Medical College, Department of Community Medicine, Pune 411043, India
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Bajwa N, Siddiqui M, Awais M, Rasool A, Amin A, Khan M, Afzal S. Risk Factors Associated With Low-Birth-Weight Babies in Tertiary Health Care Facilities in Lahore, Pakistan: A Case-Control Study. Cureus 2024; 16:e63832. [PMID: 39100019 PMCID: PMC11297706 DOI: 10.7759/cureus.63832] [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] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
Introduction Low birth weight (LBW) is a well-known contributing factor to neonatal health, emphasizing the importance of maternal health and socio-economic conditions. The birth weight of a newborn is a major public health problem, which is more common in low-middle-income countries (LMICs). Objective The objective of this study is to assess the association of different socio-economic and maternal factors with LBW babies in Lahore. Methods This case-control study was carried out at the Obstetrics and Gynecological Department in Mayo Hospital, Lahore, Pakistan from September 25, 2023 to December 31, 2023. A total of 186 mothers who delivered in the maternity ward, categorized into two groups (93 cases and 93 controls), were included and data was collected with the help of a self-administered structured tool. A chi-square test was used to identify maternal risk factors significant for LBW babies. The strength of association between maternal risk factors and LBW babies was presented using the odds ratio (OR) with the respective 95% confidence interval (CI). Results The study revealed that maternal anemia [OR: 3.378, 95% CI: 1.568, 7.275] and inadequate nutritional status [OR: 1.031, 95% CI: 0.014, 0.071] were more likely to cause delivery of LBW babies. Regarding socio-demographic factors, household income < 25000 [OR: 5.185, 95% CI: 2.770, 9.707] and illiterate mothers [OR: 3.325, 95% CI: 1.820, 6.074] were associated with increased likelihood of LBW babies. Maternal age < 20 had a strong association [OR: 10.920, 95% CI: 2.455,48.575] with delivery of LBW children. Conclusion The study concludes that multiple risk factors including anemia, inadequate nutritional status, household income < 25000, illiterate mother, and maternal age < 20 are strongly associated with LBW babies. It is apparent that a multimodal strategy is necessary to reduce the risk of LBW babies.
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Affiliation(s)
- Naila Bajwa
- Community Medicine, King Edward Medical University, Lahore, PAK
| | - Meha Siddiqui
- Community Medicine, King Edward Medical University, Lahore, PAK
| | - Muhammad Awais
- Community Medicine, King Edward Medical University, Lahore, PAK
| | - Alishba Rasool
- Community Medicine, King Edward Medical University, Lahore, PAK
| | - Ayesha Amin
- Community Medicine, Institute of Public Health, Lahore, PAK
| | - Mahnoor Khan
- Community Medicine, King Edward Medical University, Lahore, PAK
| | - Saira Afzal
- Public Health and Preventive Medicine, King Edward Medical University, Lahore, PAK
- Community Medicine, King Edward Medical University, Lahore, PAK
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Swarray-Deen A, Sepenu P, Mensah TE, Osei-Agyapong J, Sefogah PE, Appiah-Sakyi K, Ahmed B, Konje JC. Preterm birth in low-middle income Countries. Best Pract Res Clin Obstet Gynaecol 2024; 95:102518. [PMID: 38937155 DOI: 10.1016/j.bpobgyn.2024.102518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024]
Abstract
Preterm birth (PTB), remains a major cause of significant morbidity and mortality world-wide with about 12-15million preterm births occurring every year. Although the overall trend is decreasing, this is mainly in high-income countries (HIC). The rate remains high in low-and middle-income countries (LMIC) varying on average between 10 and 12% compared to 9% in HIC. The pathogenesis of PTB is complex and multifactorial. Attempts to reduce rates that have focused on PTB as a single condition have in general been unsuccessful. However, more recent attempts to phenotype PTB have resulted in targeted preventative approaches which are yielding better results. Prevention (primary or secondary) is the only approach that has been shown to make a difference to rates of PTB. These include identifying risk factors pre-pregnancy and during pregnancy and instituting appropriate measures to address these. In LMIC, although some approaches that have been shown to be effective in some HIC are adaptable, there is a need to involve stakeholders at all levels in utilizing evidence preferrably generated in LMIC to implement strategies that are likely to reduce the rate of PTB. In this review, we focus on prevention and how to involve policy makers in the process of applying evidence into policy that would reduce PTB in LMIC.
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Affiliation(s)
- Alim Swarray-Deen
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana; Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Perez Sepenu
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Teresa E Mensah
- Department of Obstetrics and Gynaecology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Jeff Osei-Agyapong
- Department of Obstetrics and Gynaecology, Greater Accra Regional Hospital Accra, Ghana
| | - Promise E Sefogah
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana; Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | | | - Badreldeen Ahmed
- Feto-Maternal Centre, Doha, Qatar; Deoartment of Obstetrics and Gynaecology, Qatar University, Doha, Qatar; Department of Obstetrics and Gynecology, Weill Cornell Medicine Qatar, Doha, Qatar
| | - Justin C Konje
- Feto-Maternal Centre, Doha, Qatar; Department of Obstetrics and Gynecology, Weill Cornell Medicine Qatar, Doha, Qatar; Department of Health Sciences, University of Leicester, UK.
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Rangel Bousquet Carrilho T, Wang D, Hutcheon JA, Wang M, Fawzi WW, Kac G. The Impact of Excluding Adverse Neonatal Outcomes on the Creation of Gestational Weight Gain Charts Among Women from Low- and Middle-income Countries with Normal and Overweight BMI. Am J Clin Nutr 2024; 119:1465-1474. [PMID: 38522618 DOI: 10.1016/j.ajcnut.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/29/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Existing gestational weight gain (GWG) charts vary considerably in their choice of exclusion/inclusion criteria, and it is unclear to what extent these criteria create differences in the charts' percentile values. OBJECTIVES We aimed to establish the impact of including/excluding pregnancies with adverse neonatal outcomes when constructing GWG charts. METHODS This is an individual participant data analysis from 31 studies from low- and middle-income countries. We created a dataset that included all participants and a dataset restricted to those with no adverse neonatal outcomes: preterm < 37 wk, small or large for gestational age, low birth weight < 2500 g, or macrosomia > 4000 g. Quantile regression models were used to create GWG curves from 9 to 40 wk, stratified by prepregnancy BMI, in each dataset. RESULTS The dataset without the exclusion criteria applied included 14,685 individuals with normal weight and 4831 with overweight. After removing adverse neonatal outcomes, 10,479 individuals with normal weight and 3466 individuals with overweight remained. GWG distributions at 13, 27, and 40 wk were virtually identical between the datasets with and without the exclusion criteria, except at 40 wk for normal weight and 27 wk for overweight. For the 10th and 90th percentiles, the differences between the estimated GWG were larger for overweight (∼1.5 kg) compared with normal weight (<1 kg). Removal of adverse neonatal outcomes had minimal impact on GWG trajectories of normal weight. For overweight, the percentiles estimated in the dataset without the criteria were slightly higher than those in the dataset with the criteria applied. Nevertheless, differences were <1 kg and virtually nonexistent at the end of pregnancy. CONCLUSIONS Removing pregnancies with adverse neonatal outcomes has little or no influence on the GWG trajectories of individuals with normal and overweight.
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Affiliation(s)
- Thais Rangel Bousquet Carrilho
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, United States
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Wafaie W Fawzi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Damodaran K, Brumberg HL, Jawale N, Giblin C, Shah S. Comparison of birth outcomes of mothers covered by Medicaid versus those privately insured when accounting for social determinants of health. J Perinatol 2024; 44:488-492. [PMID: 38082070 DOI: 10.1038/s41372-023-01842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/15/2023] [Accepted: 11/24/2023] [Indexed: 04/11/2024]
Abstract
OBJECTIVES To determine the association between maternal health insurance type and birth outcomes [prematurity, small for gestational age (SGA), Term/Appropriate for gestational age NICU admission (Term/AGA-NICU) & composite birth outcomes (CBO)] accounting for social determinants of health. DESIGN/METHODS A cross-sectional study of maternal surveys and birth certificate data of singleton live births in NY born to mothers with Medicaid (M) or Private Insurance (PI). RESULTS 1015 mothers [M = 631, PI = 384) included. Individual birth outcomes did not differ between groups. Adjusting for social, demographic and clinical covariates, M mothers had similar odds of preterm birth, SGA, Term/AGA-NICU admission and CBO compared to PI. CONCLUSIONS M mothers were as likely as PI mothers to deliver a preterm, SGA or a Term/AGA-NICU infant after controlling for social determinants of health. Despite more social adversity among enrollees, our study suggests NY Medicaid recipients have similar birth outcomes to privately insured, socially advantaged women.
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Affiliation(s)
- Kriti Damodaran
- Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Heather L Brumberg
- Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Nilima Jawale
- Division of Neonatology, UHS, Binghamton General Hospital, Binghamton, NY, USA
| | - Clare Giblin
- Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Shetal Shah
- Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA.
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Agarwal R, Agrawal R. Exploring Risk Factors and Perinatal Outcomes of Preterm Birth in a Tertiary Care Hospital: A Comprehensive Analysis. Cureus 2024; 16:e53673. [PMID: 38455809 PMCID: PMC10918306 DOI: 10.7759/cureus.53673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 03/09/2024] Open
Abstract
Background Preterm birth before 37 weeks of gestation is a global public health challenge, particularly in India, where the prevalence varies regionally. Understanding risk factors, such as maternal age and complications like hypertensive disorders, is vital. India's diverse healthcare landscape and regional disparities further complicate this issue. Preterm infants face increased mortality and morbidity risks like respiratory distress and intraventricular hemorrhage. This study in a tertiary care hospital aimed to analyze risk factors, assess perinatal outcomes, and contribute to the understanding of preterm birth in this complex context, providing valuable insights for maternal and child health strategies. Methods This retrospective cohort study was conducted at the Venkateshwara Institute of Medical Science, Rajabpur, over one year, extracting data from electronic health records. The study aimed to analyze risk factors associated with preterm delivery and assess perinatal outcomes. The study included diverse pregnancies, both singleton and multiple gestations, and employed sample size calculations to ensure statistical validity. Trained medical personnel collected extensive data on maternal characteristics, obstetric history, antenatal care, perinatal outcomes, and mode of delivery. Statistical analysis, utilizing SPSS (IBM, Chicago, USA), involved descriptive statistics, comparative analysis, chi-square tests, t-tests, Mann-Whitney U tests, and multivariate logistic regression models. Findings with a p-value <0.05 were considered significant. Results The study included 2042 deliveries, with a preterm birth prevalence of 14.2%. Multiparous women had higher preterm birth rates than primigravida (72.92% vs. 27.08%). Maternal age, history of preterm delivery, hypertensive disorders, inadequate antenatal care compliance, previous cesarean section, multiple gestations, antepartum hemorrhage (APH), polyhydramnios, oligohydramnios, and premature rupture of membranes (PROM) were significantly associated with preterm birth. Apgar scores at one minute and five minutes, neonatal complications, and mortality rates were notably worse among preterm births. Vaginal delivery rates were significantly lower in the preterm group (36.3%) compared to full-term deliveries (48.8%), with a higher rate of emergency cesarean sections (19.7% vs. 10.8%). Conclusion This study provides valuable insights into the risk factors and perinatal outcomes of preterm delivery at a tertiary care hospital, with precise values illustrating the extent of associations. The findings such as history of preterm delivery, hypertensive disorders, and inadequate antenatal care compliance as the most commonly associated conditions with preterm birth and management of such associated conditions may help reduce the rate of premature birth.
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Affiliation(s)
- Ritika Agarwal
- Obstetrics and Gynaecology, Venkateshwara Institute of Medical Science, Gajraula, IND
| | - Rajni Agrawal
- Obstetrics and Gynaecology, Venkateshwara Institute of Medical Science, Gajraula, IND
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11
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Tikmani SS, Brown N, Inayat A, Mårtensson A, Saleem S, Mårtensson T. Diagnostic accuracy of foot length measurement for identification of preterm newborn in rural Sindh, Pakistan. BMJ Paediatr Open 2024; 8:e002316. [PMID: 38267220 PMCID: PMC10824045 DOI: 10.1136/bmjpo-2023-002316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Assessing gestational age accurately is crucial for saving preterm newborns. In low and middle-income countries, such as Pakistan, where access to antenatal ultrasonography (A-USG) is limited, alternative methods are needed. This study evaluated the diagnostic accuracy of foot length (FL) measurement for identifying preterm newborns in rural Pakistan using A-USG as the reference standard. METHODS A test validation study was conducted between January and June 2023 in rural Sindh, Pakistan, within the catchment area of the Global Network for Maternal Newborn Health Registry, Thatta. Singleton newborns whose mothers had an A-USG before 20 weeks of gestation were enrolled. A research assistant measured FL three times using a rigid transparent plastic ruler within 48 hours of birth and the average FL was reported. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) and likelihood ratios were calculated. The optimal FL cut-off for the identification of preterm newborns was determined using the Youden Index. RESULTS A total of 336 newborns were included in the final analysis, of whom 75 (22.3%) were born before 37 weeks of gestation. The median gestational age of the newborns was 38.2 weeks, and the median FL was 7.9 cm. The area under the curve was 97.6%. The optimal FL cut-off for identifying preterm newborns was considered as ≤7.6 cm with a sensitivity of 90.8%, specificity of 96.0%, PPV of 86.7% and NPV of 97.3%. A lower cut-off of ≤7.5 cm had a sensitivity of 95.4%, specificity of 84.0%, PPV of 63.1% and NPV of 98.5%. CONCLUSION In conclusion, this study highlights the utility of FL measurement for identifying preterm newborns in rural settings where A-USG is unavailable before 20 weeks of gestation. Optimal cut-offs of ≤7.6 and ≤7.5 cm provide a simple, cost-effective and reliable tool for clinicians and frontline healthcare providers in rural areas, respectively. TRIAL REGISTRATION NUMBER NCT05515211.
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Affiliation(s)
- Shiyam Sundar Tikmani
- Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Nick Brown
- Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Alijaan Inayat
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Andreas Mårtensson
- Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Sarah Saleem
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Thomas Mårtensson
- Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
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Wainwright E, Sheikh I, Qureshi R, Yousuf S, Khan R, Elmes M. Evaluating the effect of maternal non-communicable disease on adverse pregnancy outcomes and birthweight in Pakistan, a facility based retrospective cohort study. Sci Rep 2024; 14:571. [PMID: 38177278 PMCID: PMC10766973 DOI: 10.1038/s41598-023-51122-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/31/2023] [Indexed: 01/06/2024] Open
Abstract
Non-communicable diseases (NCDs) claim 74% of global lives, disproportionately affecting lower and middle-income countries like Pakistan. NCDs may increase the risk of preterm birth (PTB), caesarean section (CS), and low birthweight. This study aims to determine whether the high prevalence of NCDs in Pakistan play a role in the high rates of preterm births, and CS. This retrospective cohort study from Aga Khan University Hospital, Pakistan, investigated effects of pre-existing NCDs on pregnancy outcomes of 817 pregnant women. Medical records were used to generate odds ratios for the risk of PTB, labour outcome and birthweight in women with type 1 and type 2 diabetes, hypertension, asthma and thyroid disorders. Multinomial logistic regression and general linear models were used to adjust for confounding variables using IBM SPSS Statistics (v27). Type 2 diabetes significantly increased the risk of PTB and elective CS (both P < 0.05). Elective CS was significantly increased by hypertension and asthma (both, P < 0.05). Surprisingly, asthma halved the risk of PTB (P < 0.05), while type 1 diabetes significantly increased birthweight from 2832 to 3253g (P < 0.001). In conclusion, pre-existing NCDs increase the risk of negative pregnancy outcomes, including PTB, elective CS and birthweight. Asthma, however reduced PTB and justifies further investigation.
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Affiliation(s)
- Esther Wainwright
- Division of Food, Nutrition and Dietetics, School of Biosciences, University of Nottingham, Loughborough, LE12 5RD, UK
| | - Irfan Sheikh
- Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Rahat Qureshi
- Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Sana Yousuf
- Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Raheela Khan
- School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Translational Medical Sciences Unit, Derby, DE22 3DT, UK
| | - Matthew Elmes
- Division of Food, Nutrition and Dietetics, School of Biosciences, University of Nottingham, Loughborough, LE12 5RD, UK.
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Feyisa BR, Mulatu Y, Fentahun F, Biru B, Atlantis E. Nutrition, stress, and healthcare use during pregnancy are associated with low birth weight: evidence from a case-control study in West Ethiopia. Front Public Health 2023; 11:1213291. [PMID: 37927874 PMCID: PMC10625415 DOI: 10.3389/fpubh.2023.1213291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Background Low Birth Weight (LBW) remains a major public health concern globally, especially in lower and middle-income countries. In Ethiopia in general and in the study area in particular there is limited evidence regarding maternal factors associated with low birth weight. This study aimed to identify the maternal factors associated with low birth weight among neonates born in public health facilities in the west Wollega zone, West Ethiopia. Methods We used a case-control study design and selected participant mothers with a newborn using the delivery database from three public hospitals and five health centers, between March 2022 and April 2022. Cases were identified using a newborn birth weight of <2,500 grams. Controls were identified using a newborn birth weight of ≥2,500 grams. An interviewer-administered structured questionnaire and chart review were used for data collection. Model fitness was assessed by Hosmer and Lemenshow goodness-of-fit test, including multi-collinearity checks. Candidate predictor variables were selected (using a value of p <0.25 in bivariable logistic regression models) for multivariable logistic regression to quantify the association between independent variables and LBW, expressed using Odds Ratios (OR) with a 95% Confidence Interval (CI). Mean and Standard Deviation (SD), all such values. Results A total of 324 mothers with their newborns (81 cases and 243 controls) were eligible for inclusion. The mean age of participants was 27.9 years (SD 6.4) in cases and 25 years (SD 3.9) in controls. Mean birth weight was 2,128 grams (SD 1,697) in cases and 2,988 grams (SD 378) in controls. In multivariable logistic regression analysis, lack of nutritional counseling (OR = 2.4; 95%CI: 1.24-4.72), maternal middle upper arm circumference of <23 cm (OR = 3.1; 95%CI: 1.64-5.91), maternal stress during pregnancy (OR = 2.8; 95% CI:1.23-6.36), and antenatal follow up less than four visits (OR = 2.8; 95% CI: 1.12-6.82) were independently associated with LBW. Conclusion In this study, lack of nutritional counseling, maternal undernutrition, maternal stress during pregnancy, and antenatal follow-up visits less than recommended were associated with LBW. Special attention should be given to promoting antenatal care and counseling mothers on nutrition and relaxation to prevent stress during pregnancy.
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Affiliation(s)
- Bikila Regassa Feyisa
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Yosef Mulatu
- World Vision Ethiopia-Gulliso, Addis Ababa, Ethiopia
| | - Firehiwot Fentahun
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Bayise Biru
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
- Department of Human Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Evan Atlantis
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
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Fanello C, Lee SJ, Bancone G, Kayembe D, Ndjowo P, Badjanga B, Gornsawun G, Chotthanawathit P, Waithira N, White NJ, Onyamboko M. Prevalence and Risk Factors of Neonatal Hyperbilirubinemia in a Semi-Rural Area of the Democratic Republic of Congo: A Cohort Study. Am J Trop Med Hyg 2023; 109:965-974. [PMID: 37669757 PMCID: PMC10551084 DOI: 10.4269/ajtmh.23-0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/13/2023] [Indexed: 09/07/2023] Open
Abstract
Neonatal hyperbilirubinemia (NH) is a frequent condition that, if left untreated, can lead to neurological disability and death. We assessed the prevalence of NH and associated neonatal and maternal risk factors in 362 mothers and 365 newborns in a semi-rural area of the Democratic Republic of Congo. In addition, we explored the knowledge and practices of mothers regarding this condition. We collected demographic data, anthropometric data, and obstetric and medical anamneses. We examined newborns at birth and at 24, 48, and 72 hours and measured bilirubin at birth in umbilical cord and capillary blood and thereafter in capillary blood. Hemoglobin, hematocrit, ABO group, Rhesus factor, glucose-6-phosphate dehydrogenase (G6PD) deficiency, Hemoglobin S (HbS), and malaria were assessed in mothers and newborns. Among 296 newborns (all time points available), 5.7% developed NH (95% CI: 3.4-9.0) between 24 and 72 hours according to National Institute for Health and Care Excellence (NICE) UK guidelines. There was a significantly higher risk in newborns with G6PD deficiency (homo- and hemizygous adjusted Odd Ratio [aOR]: 21.0, 95% CI: 4.1-105.9), preterm births (aOR: 6.1, 95% CI: 1.4-26.9), newborns with excessive birth weight loss (aOR: 5.8, 95% CI: 1.4-23.2), and hyperbilirubinemia at birth (aOR: 14.8, 95% CI: 2.7-79.6). Newborns with feto-maternal ABO incompatibility and G6PD deficiency had significantly higher bilirubin at birth than others. More than 60% of mothers had adequate knowledge of NH, but compliance with phototherapy in the absence of symptoms was low. Although risk factors for NH are common in this area, prevalence was not high, suggesting a need for better case definition. Implementation of point-of-care devices for diagnosis and awareness programs on risk prevention could help reduce neonatal morbidity and mortality associated with hyperbilirubinemia in these areas.
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Affiliation(s)
- Caterina Fanello
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Kinshasa-Oxford Medical Research Unit, Kinshasa, Democratic Republic of Congo
| | - Sue Jean Lee
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Germana Bancone
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Daddy Kayembe
- Kinshasa-Oxford Medical Research Unit, Kinshasa, Democratic Republic of Congo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Pauline Ndjowo
- Kinshasa-Oxford Medical Research Unit, Kinshasa, Democratic Republic of Congo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Benjamen Badjanga
- Kinshasa-Oxford Medical Research Unit, Kinshasa, Democratic Republic of Congo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Gornpan Gornsawun
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Paphapisa Chotthanawathit
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Naomi Waithira
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas John White
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Marie Onyamboko
- Kinshasa-Oxford Medical Research Unit, Kinshasa, Democratic Republic of Congo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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Torres-Muñoz J, Alberto Cedeño D, Murillo J, Torres-Figueroa S, Torres-Figueroa J. Sociodemographic determinants and mortality of premature newborns in a medium and low-income population in Colombia, 2017-2019. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:385-.95. [PMID: 37871568 PMCID: PMC10624478 DOI: 10.7705/biomedica.6863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/15/2023] [Indexed: 10/25/2023]
Abstract
Introduction The birth of premature babies is a public health problem with a high impact on infant morbidity and mortality. About 40% of mortality in children under five years occurs in the first month of life. Objective To identify the association between maternal sociodemographic factors, premature birth, and mortality in newborns under 37 weeks in Santiago de Cali, 2017-2019. Materials and methods We conducted a descriptive, cross-sectional study. We evaluated the records of Cali's Municipal Public Health Office. We calculated the crude and adjusted odd ratios and confidence intervals (95%) using the logistic regression model, data processing in Stata 16, and georeferencing the cases in the QGIS software. Results From 2017 to 2019, premature babies in Cali corresponded to 11% of births. Poor prenatal care increased 3.13 times the risk of being born before 32 weeks (adjusted OR = 3.13; 95% CI = 2.75 - 3.56) and 1.27 times among mothers from outside the city (adjusted OR = 1.27; 95% CI = 1.15-1.41). Mortality was 4.29 per 1,000 live births. The mortality risk in newborns weighing less than 1,000 g increased 3.42 times (OR = 3.42; 95% CI = 2.85-4.12), delivery by cesarean section in 1.46 (OR = 1.46; CI 95% = 1.14-1.87) and an Apgar score - five minutes after birth- lower than seven in 1.55 times (OR = 1.55; CI 95% = 1.23-1.96). Conclusions We found that less than three prenatal controls, mothers living outside Cali, afro-ethnicity, and cesarean birth were associated with prematurity of less than 32 weeks. We obtained higher mortality in newborns weighing less than 1,000 g.
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Affiliation(s)
- Javier Torres-Muñoz
- INSIDE Research Group, Departmento de Pediatría, Universidad del Valle, Cali, Colombia,.
| | | | - Jennifer Murillo
- INSIDE Research Group, Departmento de Pediatría, Universidad del Valle, Cali, Colombia,.
| | - Sofía Torres-Figueroa
- INSIDE Research Group, Departmento de Pediatría, Universidad del Valle, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad ICESI, Cali, Colombia.
| | - Julián Torres-Figueroa
- INSIDE Research Group, Departmento de Pediatría, Universidad del Valle, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad ICESI, Cali, Colombia.
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Giri S, Sahoo S, Sundaram S, Shukla A. Maternal and fetal outcomes in pregnant patients with non-cirrhotic portal hypertension: A systematic review and meta-analysis. Obstet Med 2023; 16:170-177. [PMID: 37719996 PMCID: PMC10504878 DOI: 10.1177/1753495x221143864] [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: 05/26/2022] [Accepted: 11/21/2022] [Indexed: 09/19/2023] Open
Abstract
Background Concerned studies with respect to the outcome of pregnant patients with non-cirrhotic portal hypertension are limited. Thus, a systematic review and meta-analysis of the available literature was conducted. Methods A literature search was conducted from 1999 to December 2021 for studies evaluating pregnancy outcomes in patients with non-cirrhotic portal hypertension. Results Twelve studies were included in the meta-analysis. The pooled rate of variceal bleeding, ascites and severe anemia requiring blood transfusion were 9.6%, 2.3%, and 14.9%, respectively. The pooled rate of spontaneous miscarriage, gestational hypertension, delivery by cesarean section, and postpartum hemorrhage were 11.9%, 4.5%, 36.7%, and 4.7%, respectively. The pooled stillbirth rate was 2.5% and among the live births, the pooled rates of preterm birth, low birth weight, intensive care unit admission, and neonatal mortality were 21.6%, 18.7%, 15.5%, and 1.8%, respectively. Conclusion Pregnancy in patients with non-cirrhotic portal hypertension is associated with increased maternal & fetal morbidity but mortality remains low.
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Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Nizam's Institute of Medical Science, Hyderabad, Telangana, India
| | - Shradhanjali Sahoo
- Maternal and Fetal Medicine, Fernandez Hospital, Hyderabad, Telangana, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, TATA Memorial Hospital, Mumbai, Maharashtra, India
| | - Akash Shukla
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Patronick J, Glazer S, Sidol C, Parikh NA, Wade SL. Parenting Interventions Targeting Behavior for Children Born Preterm or Low Birth Weight: A Systematic Review. J Pediatr Psychol 2023; 48:676-687. [PMID: 37290433 DOI: 10.1093/jpepsy/jsad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE To systematically review and summarize the outcomes of parenting interventions designed to improve child and/or parenting behavior for children born preterm and/or low birth weight (LBW). METHODS We conducted systematic searches of Embase, Scopus, PubMed, PsycInfo, and CINAHL in September 2021. We identified articles published at any time that describe the outcomes of parenting interventions targeting the child and/or parenting behavior of children born preterm/LBW and their caregivers. Two independent raters assessed the risk of bias using the Revised Cochrane Risk-of-Bias Tool. RESULTS Eight hundred sixteen titles and abstracts were screened, followed by 71 full-text articles, resulting in 24 eligible articles reporting on nine interventions with 1,676 participants. Eligible articles had an adequate risk of bias ratings. Sample characteristics, intervention components, and intervention effects were tabulated and described narratively by the intervention type. Preventative and treatment programs demonstrated positive intervention effects on externalizing behavior, parenting stress, and parenting behaviors, with mixed effects on internalizing behavior and emotion regulation. The few studies with longitudinal follow-up found little evidence of effects beyond 6 months postintervention. CONCLUSION Behavior problems in children born preterm/LBW may be modifiable, and interventions targeting parenting behavior are promising. However, existing interventions may not produce long-lasting changes and are not designed for children older than four. Existing treatment programs may require adaptation for the neurocognitive, medical, and family needs of children born preterm/LBW (e.g., processing speed deficits, post-traumatic stress). Interventions that account for theories of sustained change may promote long-term effectiveness and the developmental tailoring of parenting skills.
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Affiliation(s)
- Jamie Patronick
- Department of Psychology, University of Cincinnati, USA
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, USA
| | - Sandra Glazer
- Department of Psychology, University of Cincinnati, USA
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, USA
| | - Craig Sidol
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, USA
| | - Nehal A Parikh
- The Perinatal Institute, Cincinnati Children's Hospital Medical Center, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Shari L Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, USA
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18
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Evans CR, Nieves CI, Erickson N, Borrell LN. Intersectional inequities in the birthweight gap between twin and singleton births: A random effects MAIHDA analysis of 2012-2018 New York City birth data. Soc Sci Med 2023; 331:116063. [PMID: 37467517 DOI: 10.1016/j.socscimed.2023.116063] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
Birthweight is a widely-used biomarker of infant health, with inequities patterned intersectionally by maternal age, race/ethnicity, nativity/immigration status, and socioeconomic status in the United States. However, studies of birthweight inequities almost exclusively focus on singleton births, neglecting high-risk twin births. We address this gap using a large sample (N = 753,180) of birth records, obtained from the 2012-2018 New York City (NYC) Department of Health and Mental Hygiene, Bureau of Vital Statistics, representing 99% of all births registered in NYC, and a novel random coefficients intersectional MAIHDA (Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy) model. Our results show evidence of intersectional inequities in birthweight outcomes for both twin and singleton births by maternal age, race/ethnicity, education, and nativity status. Twins have considerably lower predicted birthweights than singletons overall (-930 g on average), and this is especially true for babies born to mothers who are younger (11-19 years), older (40+), racial/ethnic minoritized, foreign-born, and have lower education. However, the magnitude of this birthweight 'gap' between twins and singletons varies considerably across social identity strata, ranging between 830.8 g (observed among 40+ year old Black foreign-born mothers with high school degrees) and 1013.7 g (observed among 30-39 year old Hispanic/Latina foreign-born mothers with less than high school degrees). This study underscored the needs of a high-risk population and the need for aggressive social policies to address health inequities and dismantle intersectional systems of marginalization, oppression, and socioeconomic inequality. In addition to our substantive contributions, we add to the growing methods literature on intersectional quantitative analysis by demonstrating how to apply intersectional MAIHDA with random coefficients and random slopes. We conclude with a discussion of the significant potential for this methodological extension in future research on inequities.
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Affiliation(s)
- Clare R Evans
- Department of Sociology, University of Oregon, Eugene, OR, USA.
| | - Christina I Nieves
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA
| | | | - Luisa N Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA
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19
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Mukosha M, Jacobs C, Kaonga P, Musonda P, Vwalika B, Lubeya MK, Mwila C, Mudenda S, Zingani E, Kapembwa KM. Determinants and outcomes of low birth weight among newborns at a tertiary hospital in Zambia: A retrospective cohort study. Ann Afr Med 2023; 22:271-278. [PMID: 37417013 PMCID: PMC10445713 DOI: 10.4103/aam.aam_22_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/17/2022] [Accepted: 01/07/2023] [Indexed: 07/08/2023] Open
Abstract
Context Newborns' low birth weight (LBW) has been linked to early infant morbidity and mortality. However, our understanding of the determinants and outcomes of LBW in this population is still poor. Aim This study aimed to assess determinants and outcomes of LBW among newborns at a tertiary hospital. Settings and Design Retrospective cohort study at Women and Newborn Hospital in Lusaka Zambia. Subjects and Methods We reviewed delivery case records and neonatal files between January 1, 2018, and September 30, 2019, for newborns admitted to the neonatal intensive care unit. Statistical Analysis Used Logistic regression models were used to establish determinants of LBW and describe the outcomes. Results Women living with human immunodeficiency virus infection were more likely to deliver LBW infants (adjusted odds ratio [AOR] = 1.46; 95% confidence interval [CI]: 1.16-1.86). Other maternal determinants of LBW were; increased parity (AOR = 1.22; 95% CI: 1.05-1.43), preeclampsia (AOR = 6.91; 95% CI: 1.48-32.36), and gestational age <37 weeks compared to 37 weeks or more (AOR = 24.83; 95% CI: 13.27-46.44). LBW neonates were at higher odds of early mortality (AOR = 2.16; 95% CI: 1.85-2.52), developing respiratory distress syndrome (AOR = 2.96; 95% CI: 2.53-3.47), and necrotizing enterocolitis (AOR = 1.66; 95% CI: 1.16-2.38) than neonates with a birth weight of 2500 g or more. Conclusions These findings underscore the importance of effective maternal and neonatal interventions to reduce the risk of morbidity and mortality for neonates with LBW in Zambia and other similar settings.
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Affiliation(s)
- Moses Mukosha
- Department of Pharmacy, School of Health Sciences, University of Zambia, Zambia
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
- Lusaka Zambia, HIV and Women's Health Research Group, University Teaching Hospital, Lusaka, Zambia
| | - Choolwe Jacobs
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Patrick Kaonga
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
- Department of Internal Medicine, School of Medicine, Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Patrick Musonda
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Bellington Vwalika
- Lusaka Zambia, HIV and Women's Health Research Group, University Teaching Hospital, Lusaka, Zambia
- Department of Obstetrics and Gynecology, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Mwansa Ketty Lubeya
- Lusaka Zambia, HIV and Women's Health Research Group, University Teaching Hospital, Lusaka, Zambia
- Department of Obstetrics and Gynecology, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Chiluba Mwila
- Department of Pharmacy, School of Health Sciences, University of Zambia, Zambia
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Zambia
| | - Ellah Zingani
- Department of Pharmacy, School of Health Sciences, University of Zambia, Zambia
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20
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Milford C, Smith E, Ngure K, Thuo NB, Newmann S, Lazarus N, Beksinska M, Mugo N, Rand L. Cultural considerations and beliefs surrounding preterm birth in Kenya and South Africa. Reprod Health 2023; 20:87. [PMID: 37309003 DOI: 10.1186/s12978-023-01633-9] [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: 11/04/2022] [Accepted: 06/05/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Preterm birth (PTB) is a global health epidemic, sub-Saharan Africa is severely impacted due to its limited healthcare resources. Pregnancy knowledge, cultural beliefs and practices play a role in the identification of risk and management of PTB. This study explored knowledge, understandings, cultural beliefs and attitudes to pregnancy and PTB, as well as cultural considerations for the introduction of an intravaginal device which could be used to identify PTB risk. METHODS Qualitative research was conducted in South Africa and Kenya. In-depth interviews were conducted using semi-structured guides with women with a history of PTB (n = 10), healthcare providers (n = 16) and health systems experts (n = 10); and 26 focus group discussions with pregnant women seeking antenatal care (n = 132) and community male partners/fathers (n = 54). Interviews/discussions were transcribed, translated, and analysed thematically. RESULTS Pregnancy knowledge, especially for first time pregnancies was poor, with many reporting late entry to antenatal care. Knowledge about PTB was understood in terms of gestational age, weight or small size of baby, with concerns about long term health and stigma. Various risk factors for PTB were described, including those related to traditions and beliefs of witchcraft/curses. Cultural practices, such as the use of traditional medicines and pica, and religion and its impact on health seeking behaviour were also viewed as risk factors. Although insertion of intravaginal devices was not widely acceptable in traditional communities, especially during pregnancy, it was felt that the use of one to detect risk of PTB would be accepted if proven effective in reducing PTB risk. CONCLUSIONS Various culturally-informed beliefs exist which explain understandings of and attitudes toward pregnancy, pregnancy risk, and PTB. An inclusive exploratory process is critical to facilitate an understanding of the beliefs and traditions which could impact the introduction and design of a product to detect the risk of PTB.
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Affiliation(s)
- Cecilia Milford
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, 11th Floor, Commercial City Building, 40 Dr AB Xuma Street, Durban, 4001, South Africa.
| | - Emma Smith
- Albert Einstein School of Medicine, New York, USA
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Nicholas B Thuo
- Center for Clinical Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Sara Newmann
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Nalinie Lazarus
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, 11th Floor, Commercial City Building, 40 Dr AB Xuma Street, Durban, 4001, South Africa
| | - Mags Beksinska
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, 11th Floor, Commercial City Building, 40 Dr AB Xuma Street, Durban, 4001, South Africa
| | - Nelly Mugo
- Center for Clinical Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Larry Rand
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
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21
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Akum LA, Offei EA, Kpordoxah MR, Yeboah D, Issah AN, Boah M. Compliance with the World Health Organization's 2016 prenatal care contact recommendation reduces the incidence rate of adverse birth outcomes among pregnant women in northern Ghana. PLoS One 2023; 18:e0285621. [PMID: 37289811 PMCID: PMC10249792 DOI: 10.1371/journal.pone.0285621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/26/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Children born with adverse birth outcomes (ABOs) have a greater risk of mortality, stunting, and poor cognitive development. In 2016, the World Health Organization (WHO) recommended at least eight antenatal care (ANC) contacts before delivery for a healthy mother and baby. We examined the association between compliance with this recommendation and the risk of ABOs, such as low birthweight (LBW) and preterm birth (PTB), in the Tamale Metropolitan Area of the northern region of Ghana. METHODS We conducted a cross-sectional study in the Tamale Metropolis of the northern region of Ghana. We analysed a systematic random sample of 402 postnatal women aged 15-49 drawn from five public health facilities. We gathered information electronically on their birth outcomes, specifically their birthweight and gestation at delivery, using a structured questionnaire. Information on women's background characteristics, including the number of ANC contacts made before delivery, was also collected. The association between the number of ANC contacts and ABOs was investigated using regression models. RESULTS We found that 37.6% (95% CI: 32.9, 42.4) of our sample had at least eight ANC contacts before delivery. We estimated that 18.9% of babies were born prematurely and 9.0% were born LBW. ABOs were found in 22.9% (95% CI: 19.0, 27.3) of babies. A minimum of eight ANC contacts before delivery reduced the risk of ABOs (adjusted IRR = 0.43; 95% CI: 0.25, 0.73), PTB (AOR = 0.28; 95% CI: 0.14, 0.58), and LBW (AOR = 0.36; 95% CI: 0.14, 0.91). CONCLUSION In the current study's setting, about a quarter of newborns have ABOs, jeopardising their survival, health, and development. Compliance with at least eight ANC contacts prior to birth was associated with a reduced incidence rate ratio of ABOs. However, less than four out of every ten pregnant women make at least eight ANC contacts before delivery. Efforts are needed to increase coverage of eight contacts among pregnant women before delivery to reduce the risk of ABOs in the study setting.
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Affiliation(s)
- Leticia Achangebe Akum
- Department of Population and Reproductive Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Eunice Amina Offei
- Department of Midwifery and Women’s Health, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Mary Rachael Kpordoxah
- Department of Global and International Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Daudi Yeboah
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Abdul-Nasir Issah
- Department of Health Services, Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Michael Boah
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
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22
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Zewdu D, Tantu T. Preterm Birth Among Intrapartum Cesarean Deliveries at Public Hospitals in Southern Ethiopia: A Multicenter Retrospective Analysis of Risk Factors. Int J Womens Health 2023; 15:869-879. [PMID: 37283992 PMCID: PMC10239637 DOI: 10.2147/ijwh.s398830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/27/2023] [Indexed: 06/08/2023] Open
Abstract
Purpose Although the underlying causes for preterm birth are thought to be multifactorial irrespective of delivery mode, no study investigated its risk factors amongst cesarean deliveries (CD). Thus, we aimed to identify potential risk factors for the occurrence of preterm birth (PTB) among intrapartum CD. Methods Data from 1659 singleton intrapartum CDs were retrospectively recruited using medical records and an obstetric database. Gestational age was calculated using the last menstrual period (LMP) and ultrasound report of early onset pregnancy. A multivariable logistic regression analysis was performed to identify potential risk factors associated with PTB. Odds ratios (ORs) and 95% confidence intervals (95% CI) were used. Statistical analysis was performed using SPSS version 26.0. Results In this study, the prevalence of PTB among intrapartum CD was 6.1% (95% CI: 4.9, 7.2%). In the multivariable logistic regression model; grand parity ≥5 (adjusted odds ratio (AOR) = 2.43, 95% CI: 1.72-4.73), maternal age <20 years (AOR=2.63, 95% CI, 1.03-6.71), maternal age ≥35 years (AOR=3.83, 95% CI, 1.49-5.35), cesarean section scar ≥2 (AOR=4.86, 95% CI: 2.68-8.94), antepartum hemorrhage (AOR=4.37, 95% CI: 2.22-8.63), pregnancy-induced hypertension (AOR=2.92, 95% CI: 1.41-6.04), and premature rupture of membranes (AOR=4.56; 95% CI: 1.95-10.65) were significantly associated with PTB. Conclusion The current study showed an association between PTB and a multitude of obstetric variables, including grand parity ≥5, CS scar ≥2, antepartum hemorrhage, pregnancy-induced hypertension, and premature rupture of the membrane. Understanding these factors could help to implement improved quality of obstetric and neonatal care to increase survival and reduce morbidity among preterm birth.
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Affiliation(s)
- Dereje Zewdu
- Department of Anesthesia, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Temesgen Tantu
- Department of Obstetrics and Gynecology, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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23
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Espinosa CA, Khan W, Khanam R, Das S, Khalid J, Pervin J, Kasaro MP, Contrepois K, Chang AL, Phongpreecha T, Michael B, Ellenberger M, Mehmood U, Hotwani A, Nizar A, Kabir F, Wong RJ, Becker M, Berson E, Culos A, De Francesco D, Mataraso S, Ravindra N, Thuraiappah M, Xenochristou M, Stelzer IA, Marić I, Dutta A, Raqib R, Ahmed S, Rahman S, Hasan ASMT, Ali SM, Juma MH, Rahman M, Aktar S, Deb S, Price JT, Wise PH, Winn VD, Druzin ML, Gibbs RS, Darmstadt GL, Murray JC, Stringer JSA, Gaudilliere B, Snyder MP, Angst MS, Rahman A, Baqui AH, Jehan F, Nisar MI, Vwalika B, Sazawal S, Shaw GM, Stevenson DK, Aghaeepour N. Multiomic signals associated with maternal epidemiological factors contributing to preterm birth in low- and middle-income countries. SCIENCE ADVANCES 2023; 9:eade7692. [PMID: 37224249 PMCID: PMC10208584 DOI: 10.1126/sciadv.ade7692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/20/2023] [Indexed: 05/26/2023]
Abstract
Preterm birth (PTB) is the leading cause of death in children under five, yet comprehensive studies are hindered by its multiple complex etiologies. Epidemiological associations between PTB and maternal characteristics have been previously described. This work used multiomic profiling and multivariate modeling to investigate the biological signatures of these characteristics. Maternal covariates were collected during pregnancy from 13,841 pregnant women across five sites. Plasma samples from 231 participants were analyzed to generate proteomic, metabolomic, and lipidomic datasets. Machine learning models showed robust performance for the prediction of PTB (AUROC = 0.70), time-to-delivery (r = 0.65), maternal age (r = 0.59), gravidity (r = 0.56), and BMI (r = 0.81). Time-to-delivery biological correlates included fetal-associated proteins (e.g., ALPP, AFP, and PGF) and immune proteins (e.g., PD-L1, CCL28, and LIFR). Maternal age negatively correlated with collagen COL9A1, gravidity with endothelial NOS and inflammatory chemokine CXCL13, and BMI with leptin and structural protein FABP4. These results provide an integrated view of epidemiological factors associated with PTB and identify biological signatures of clinical covariates affecting this disease.
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Affiliation(s)
- Camilo A. Espinosa
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Waqasuddin Khan
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sayan Das
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Javairia Khalid
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Jesmin Pervin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Margaret P. Kasaro
- University of North Carolina Global Projects Zambia, Lusaka, Zambia
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kévin Contrepois
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Alan L. Chang
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Thanaphong Phongpreecha
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Basil Michael
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Mathew Ellenberger
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Usma Mehmood
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Ambreen Nizar
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Furqan Kabir
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Ronald J. Wong
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Martin Becker
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Eloise Berson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Anthony Culos
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
- Department of Computer Science, Columbia University, New York, NY, USA
| | - Davide De Francesco
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Samson Mataraso
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Neal Ravindra
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Melan Thuraiappah
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Maria Xenochristou
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Ina A. Stelzer
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ivana Marić
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Arup Dutta
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Rubhana Raqib
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | | | - Said M. Ali
- Public Health Laboratory—Ivo de Carneri, Pemba, Zanzibar, Tanzania
| | - Mohamed H. Juma
- Public Health Laboratory—Ivo de Carneri, Pemba, Zanzibar, Tanzania
| | - Monjur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shaki Aktar
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Saikat Deb
- Centre for Public Health Kinetics, New Delhi, Delhi, India
- Public Health Laboratory—Ivo de Carneri, Pemba, Zanzibar, Tanzania
| | - Joan T. Price
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Paul H. Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Virginia D. Winn
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Maurice L. Druzin
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ronald S. Gibbs
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary L. Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Jeffrey S. A. Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael P. Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Martin S. Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Anisur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Abdullah H. Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Muhammad Imran Nisar
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Sunil Sazawal
- Centre for Public Health Kinetics, New Delhi, Delhi, India
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gary M. Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - David K. Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
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Nieves CI, Borrell LN, Evans CR, Jones HE, Huynh M. The application of intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to examine birthweight inequities in New York City. Health Place 2023; 81:103029. [PMID: 37119694 DOI: 10.1016/j.healthplace.2023.103029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/20/2023] [Accepted: 04/14/2023] [Indexed: 05/01/2023]
Abstract
Exploring the intersection of dimensions of social identity is critical for understanding drivers of health inequities. We used multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to examine the intersection of age, race/ethnicity, education, and nativity status on infant birthweight among singleton births in New York City from 2012 to 2018 (N = 725,875). We found evidence of intersectional effects of various systems of oppression on birthweight inequities and identified U.S.-born Black women as having infants of lower-than-expected birthweights. The MAIHDA approach should be used to identify intersectional causes of health inequities and individuals affected most to develop policies and interventions redressing inequities.
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Affiliation(s)
- Christina I Nieves
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, United States.
| | - Luisa N Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, United States
| | - Clare R Evans
- Department of Sociology, University of Oregon, Eugene, OR, United States
| | - Heidi E Jones
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, United States; Institute for Implementation Science, City University of New York, New York, NY, United States
| | - Mary Huynh
- New York City Department of Health and Mental Hygiene, New York, NY, United States
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Bucher S, Nowak K, Otieno K, Tenge C, Marete I, Rutto F, Kemboi M, Achieng E, Ekhaguere OA, Nyongesa P, Esamai FO, Liechty EA. Birth weight and gestational age distributions in a rural Kenyan population. BMC Pediatr 2023; 23:112. [PMID: 36890485 PMCID: PMC9993805 DOI: 10.1186/s12887-023-03925-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND With the increased availability of access to prenatal ultrasound in low/middle-income countries, there is opportunity to better characterize the association between fetal growth and birth weight across global settings. This is important, as fetal growth curves and birthweight charts are often used as proxy health indicators. As part of a randomized control trial, in which ultrasonography was utilized to establish accurate gestational age of pregnancies, we explored the association between gestational age and birthweight among a cohort in Western Kenya, then compared our results to data reported by the INTERGROWTH-21st study. METHODS This study was conducted in 8 geographical clusters across 3 counties in Western Kenya. Eligible subjects were nulliparous women carrying singleton pregnancies. An early ultrasound was performed between 6 + 0/7 and 13 + 6/7 weeks gestational age. At birth, infants were weighed on platform scales provided either by the study team (community births), or the Government of Kenya (public health facilities). The 10th, 25th, median, 75th, and 90th BW percentiles for 36 to 42 weeks gestation were determined; resulting percentile points were plotted, and curves determined using a cubic spline technique. A signed rank test was used to quantify the comparison of the percentiles generated in the rural Kenyan sample with those of the INTERGROWTH-21st study. RESULTS A total of 1291 infants (of 1408 pregnant women randomized) were included. Ninety-three infants did not have a measured birth weight. The majority of these were due to miscarriage (n = 49) or stillbirth (n = 27). No significant differences were found between subjects who were lost to follow-up. Signed rank comparisons of the observed median of the Western Kenya data at 10th, 50th, and 90th birthweight percentiles, as compared to medians reported in the INTERGROWTH-21st distributions, revealed close alignment between the two datasets, with significant differences at 36 and 37 weeks. Limitations of the current study include small sample size, and detection of potential digit preference bias. CONCLUSIONS A comparison of birthweight percentiles by gestational age estimation, among a sample of infants from rural Kenya, revealed slight differences as compared to those from the global population (INTERGROWTH-21st). TRIAL REGISTRATION This is a single site sub-study of data collected in conjunction with the Aspirin Supplementation for Pregnancy Indicated Risk Reduction In Nulliparas (ASPIRIN) Trial, which is listed at ClinicalTrials.gov , NCT02409680 (07/04/2015).
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Affiliation(s)
- Sherri Bucher
- School of Medicine, Indiana University, Indianapolis, IN, USA.
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Indianapolis, IN, USA.
| | - Kayla Nowak
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, Durham, NC, USA
| | - Kevin Otieno
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Constance Tenge
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Irene Marete
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Faith Rutto
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Millsort Kemboi
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Emmah Achieng
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | | | - Paul Nyongesa
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Fabian O Esamai
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
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Okeke SR, Idriss-Wheeler D, Yaya S. Adolescent pregnancy in the time of COVID-19: what are the implications for sexual and reproductive health and rights globally? Reprod Health 2022; 19:207. [PMID: 36335354 PMCID: PMC9636616 DOI: 10.1186/s12978-022-01505-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The COVID-19 pandemic has aggravated pre-existing challenges associated with adolescents’ sexual and reproductive health and rights (SRHR). Evolving evidence suggest that it could adversely impact the progress made towards improving sexual and reproductive health outcomes among young people. The pandemic has stalled achievements in reducing adolescent pregnancy and child marriage by reinforcing contextual and structural determinants of these reproductive health outcomes, especially among girls. The pandemic has increased disruptions to schooling, decreased access to sexual and reproductive health services and compounded pre-existing socio-economic vulnerabilities. The consequences of neglecting adolescent sexual and reproductive health services over the past 2 years, to focus on COVID-19, continue to emerge. This commentary argues for targeted and responsive approaches to adolescent SRHR that tackle preventable consequences resulting from inequities faced by adolescents globally, particularly girls.
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Affiliation(s)
- Sylvester Reuben Okeke
- grid.1005.40000 0004 4902 0432Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Dina Idriss-Wheeler
- grid.28046.380000 0001 2182 2255Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Sanni Yaya
- grid.28046.380000 0001 2182 2255School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON K1N 6N5 Canada ,grid.7445.20000 0001 2113 8111The George Institute for Global Health, Imperial College London, London, UK
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Hossain MA, Al Mamun ASM, Aik S, Karim MR, Zeshan MHL, Sabiruzzaman M, Islam MS, Ahmed S, Hossain MG. Preterm delivery and its associated factors among mothers in Bangladesh: survey in Rajshahi district. BMJ Open 2022; 12:e061920. [PMID: 36216425 PMCID: PMC9557306 DOI: 10.1136/bmjopen-2022-061920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Preterm delivery (PD) is a worldwide health burden particularly in low-income and middle-income countries such as Bangladesh. It is a key indicator of neonatal mortality and a risk of morbidity in later life. This study aimed to determine the prevalence of PD and its associated factors among mothers in Northern region of Bangladesh. SETTING AND PARTICIPANTS Multistage sampling technique was used to select samples covering all the population from 9 Upazilas in Rajshahi district with 233 community clinics. A total of 540 mothers and their under-5 children were enrolled for the study. Descriptive statistics, χ2 test and logistic regression model were used to analyse the data. RESULTS Among all live births, the prevalence of PD was found to be 14.6%. Multiple binary logistic regression model suggested five factors of PD: (1) mothers who used contraceptive pill had lower chance of PD (p<0.05); (2) mothers with high fever during pregnancy period were more likely to have PD (p<0.05); (3) mothers who did not receive antenatal care service less than four times during pregnancy period had higher chance of PD (p<0.01); (4) mothers first married before 18 years who were more likely to have PD (p<0.01); (5) PD delivered mothers had more chance to get low birth weight children (p<0.05). In addition, unadjusted model demonstrated that mothers delivered first baby before their age<20 years were more risk to get PD (p<0.05). CONCLUSION Approximately one in seven infants was born preterm in our study area. Family planning method, number of antenatal care visit, mothers' age at marriage and high fever during pregnancy were the most important predictors of PD, these factors could be considered to reduce PD among Bangladeshi mothers. PD risk could be reduced by counselling and encouraging women to take antenatal care facilities from trained health providers.
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Affiliation(s)
- Md Aslam Hossain
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Abu Sayed M Al Mamun
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Saw Aik
- Department of Orthopaedic Surgery, University Malaya Medical Centre, Kuala Lumpur 59100, Malaysia
| | - Md Reazul Karim
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh
| | | | - Md Sabiruzzaman
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Md Shariful Islam
- Department of Public Health, First Capital University of the Bangladesh, Chuadanga 7200, Bangladesh
| | - Sharmin Ahmed
- Specialist, Quality Assurance, Communicable Diseases Program, BRAC, Mohakhali, Dhaka 1212, Bangladesh
| | - Md Golam Hossain
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh
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Odongkara B, Nankabirwa V, Ndeezi G, Achora V, Arach AA, Napyo A, Musaba M, Mukunya D, Tumwine JK, Thorkild T. Incidence and Risk Factors for Low Birthweight and Preterm Birth in Post-Conflict Northern Uganda: A Community-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12072. [PMID: 36231374 PMCID: PMC9564590 DOI: 10.3390/ijerph191912072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Annually, an estimated 20 million (13%) low-birthweight (LBW) and 15 million (11.1%) preterm infants are born worldwide. A paucity of data and reliance on hospital-based studies from low-income countries make it difficult to quantify the true burden of LBW and PB, the leading cause of neonatal and under-five mortality. We aimed to determine the incidence and risk factors for LBW and preterm birth in Lira district of Northern Uganda. METHODS This was a community-based cohort study, nested within a cluster-randomized trial, designed to study the effect of a combined intervention on facility-based births. In total, 1877 pregnant women were recruited into the trial and followed from 28 weeks of gestation until birth. Infants of 1556 of these women had their birthweight recorded and 1279 infants were assessed for preterm birth using a maturity rating, the New Ballard Scoring system. Low birthweight was defined as birthweight <2.5kg and preterm birth was defined as birth before 37 completed weeks of gestation. The risk factors for low birthweight and preterm birth were analysed using a multivariable generalized estimation equation for the Poisson family. RESULTS The incidence of LBW was 121/1556 or 7.3% (95% Confidence interval (CI): 5.4-9.6%). The incidence of preterm births was 53/1279 or 5.0% (95% CI: 3.2-7.7%). Risk factors for LBW were maternal age ≥35 years (adjusted Risk Ratio or aRR: 1.9, 95% CI: 1.1-3.4), history of a small newborn (aRR: 2.1, 95% CI: 1.2-3.7), and maternal malaria in pregnancy (aRR: 1.7, 95% CI: 1.01-2.9). Intermittent preventive treatment (IPT) for malaria, on the other hand, was associated with a reduced risk of LBW (aRR: 0.6, 95% CI: 0.4-0.8). Risk factors for preterm birth were maternal HIV infection (aRR: 2.8, 95% CI: 1.1-7.3), while maternal education for ≥7 years was associated with a reduced risk of preterm birth (aRR: 0.2, 95% CI: 0.1-0.98) in post-conflict northern Uganda. CONCLUSIONS About 7.3% LBW and 5.0% PB infants were born in the community of post-conflict northern Uganda. Maternal malaria in pregnancy, history of small newborn and age ≥35 years increased the likelihood of LBW while IPT reduced it. Maternal HIV infection was associated with an increased risk of PB compared to HIV negative status. Maternal formal education of ≥7 years was associated with a reduced risk of PB compared to those with 0-6 years. Interventions to prevent LBW and PBs should include girl child education, and promote antenatal screening, prevention and treatment of malaria and HIV infections.
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Affiliation(s)
- Beatrice Odongkara
- Department of Paediatrics and Child Health, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
- Centre for International Health, University of Bergen, 5020 Bergen, Norway
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Victoria Nankabirwa
- School of Public Health, College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Vincentina Achora
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
| | - Anna Agnes Arach
- Department of Midwifery, Lira University, Lira P.O. Box 1035, Uganda
| | - Agnes Napyo
- Department of Public Health, College of Health Sciences, Busitema University, Mbale P.O. Box 1460, Uganda
| | - Milton Musaba
- Department of Public Health, College of Health Sciences, Busitema University, Mbale P.O. Box 1460, Uganda
| | - David Mukunya
- Department of Public Health, College of Health Sciences, Busitema University, Mbale P.O. Box 1460, Uganda
| | - James K. Tumwine
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Tylleskar Thorkild
- Centre for International Health, University of Bergen, 5020 Bergen, Norway
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Jhirwal M, Sharma C, Shekhar S, Singh P, Meena SP, Kathuria P, Tak A. Maternal and Perinatal Outcome in Pregnancy Complicated by Intrahepatic Cholestasis. Cureus 2022; 14:e28512. [PMID: 36185921 PMCID: PMC9514157 DOI: 10.7759/cureus.28512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Intrahepatic cholestasis of pregnancy (IHCP) is characterized by pruritus of the hand and sole with abnormal liver function test and bile acid metabolism. IHCP occurs in the second and third trimesters of pregnancy and usually resolves after delivery. The overall prevalence is about 1.2 to 1.5%. This study was conducted to assess the fetomaternal outcome according to maternal serum bile acids levels and its correlation with liver function tests in patients with IHCP. Material and methods This ambispective observational study was conducted in the department of Obstetrics and Gynecology (OBG) for two years at AIIMS Jodhpur, Rajasthan. It included all the pregnant women attending the outpatient department of OBG with the complaint of pruritis in the palm and sole after 28 weeks of pregnancy and diagnosed with intrahepatic cholestasis of pregnancy after investigations. Results Only 152 patients were diagnosed with IHCP out of 4,148 deliveries, with a prevalence of 3.6%. Among these, 140 (92.11%) had mild IHCP, 10 (6.58%) had moderate IHCP and two (1.32%) had severe IHCP. There was a significant difference between the birth weight in mild, moderate and severe IHCP (P-value 0.004). About 12.5% (n=19) of patients had meconium-stained liquor during delivery. Two patients (1.32%) with moderate IHCP had intrauterine fetal death in the third trimester, and 6.58% (n=10) neonates were kept on continuous positive airway pressure. Conclusions IHCP is associated with adverse fetal outcomes like spontaneous or iatrogenic preterm delivery, low birth weight, increase in the rate of lower section cesarean section (LSCS) and intrauterine death of a fetus. A significant correlation found between raised bile acid levels and variables of liver function test, hence cost-effectiveness and feasibility of liver function test (LFT) should be considered for the management of IHCP.
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Hazel EA, Mohan D, Zeger S, Mullany LC, Tielsch JM, Khatry SK, Subedi S, LeClerq SC, Black RE, Katz J. Demographic, socio-economic, obstetric, and behavioral factors associated with small-and large-for-gestational-age from a prospective, population-based pregnancy cohort in rural Nepal: a secondary data analysis. BMC Pregnancy Childbirth 2022; 22:652. [PMID: 35986258 PMCID: PMC9389767 DOI: 10.1186/s12884-022-04974-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/09/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND In South Asia, a third of babies are born small-for-gestational age (SGA). The risk factors are well described in the literature, but many studies are in high-and-middle income countries or measure SGA on facility births only. There are fewer studies that describe the prevalence of risk factors for large-for-gestational age (LGA) in low-income countries. We aim to describe the factors associated with SGA and LGA in a population-based cohort of pregnant women in rural Nepal. METHODS This is a secondary data analysis of community-based trial on neonatal oil massage (22,545 women contributing 39,479 pregnancies). Demographic, socio-economic status (SES), medical/obstetric history, and timing of last menstruation were collected at enrollment. Vital signs, illness symptoms, and antenatal care (ANC) attendance were collected throughout the pregnancy and neonatal weight was measured for live births. We conducted multivariate analysis using multinomial, multilevel logistic regression, reporting the odds ratio (OR) with 95% confidence intervals (CIs). Outcomes were SGA, LGA compared to appropriate-for-gestational age (AGA) and were multiply imputed using birthweight recalibrated to time at delivery. RESULTS SGA was associated with nulligravida (OR: 2.12 95% CI: 1.93-2.34), gravida/nulliparous (OR: 1.86, 95% CI: 1.26-2.74), interpregnancy intervals less than 18 months (OR: 1.16, 95% CI: 1.07-1.27), and poor appetite/vomiting in the second trimester, (OR: 1.27, 95% CI: 1.19-1.35). Greater wealth (OR: 0.78, 95% CI: 0.69-0.88), swelling of hands/face in the third trimester (OR: 0.81, 95% CI: 0.69-0.94) parity greater than five (OR: 0.77, 95% CI: 0.65-0.92), male fetal sex (OR: 0.91, 95% CI: 0.86-0.98), and increased weight gain (OR: 0.93 per weight kilogram difference between 2nd and 3rd trimester, 95% CI: 0.92-0.95) were protective for SGA. Four or more ANC visits (OR: 0.53, 95% CI: 0.41-0.68) and respiratory symptoms in the third trimester (OR: 0.67, 95% CI: 0.54-0.84) were negatively associated with LGA, and maternal age < 18 years (OR: 1.39, 95% CI: 1.03-1.87) and respiratory symptoms in the second trimester (OR: 1.27, 95% CI: 1.07-1.51) were positively associated with LGA. CONCLUSIONS Our findings are in line with known risk factors for SGA. Because the prevalence and mortality risk of LGA babies is low in this population, it is likely LGA status does not indicate underlaying illness. Improved and equitable access to high quality antenatal care, monitoring for appropriate gestational weight gain and increased monitoring of women with high-risk pregnancies may reduce prevalence and improve outcomes of SGA babies. TRIAL REGISTRATION The study used in this secondary data analysis was registered at Clinicaltrials.gov NCT01177111.
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Affiliation(s)
- Elizabeth A. Hazel
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. Room W5504, Baltimore, MD 21205 USA
| | - Diwakar Mohan
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. Room W5504, Baltimore, MD 21205 USA
| | - Scott Zeger
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. Room W5504, Baltimore, MD 21205 USA
| | - Luke C. Mullany
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. Room W5504, Baltimore, MD 21205 USA
| | - James M. Tielsch
- grid.21107.350000 0001 2171 9311George Washington University Milken Institute School of Public Health, Washington, DC USA
| | - Subarna K. Khatry
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. Room W5504, Baltimore, MD 21205 USA ,Nepal Nutrition Intervention Project-Sarlahi, Sarlahi, Nepal
| | - Seema Subedi
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. Room W5504, Baltimore, MD 21205 USA
| | - Steven C. LeClerq
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. Room W5504, Baltimore, MD 21205 USA
| | - Robert E. Black
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. Room W5504, Baltimore, MD 21205 USA
| | - Joanne Katz
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. Room W5504, Baltimore, MD 21205 USA
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Mohapatra V, Saraogi S, Misra S. Demographic Profile, Etiology, and Perinatal Outcome Associated With Preterm Birth in a Tertiary Hospital of Eastern India: A Retrospective Study. Cureus 2022; 14:e26066. [PMID: 35865435 PMCID: PMC9293265 DOI: 10.7759/cureus.26066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Preterm birth (PB), defined as birth occurring at less than 37 weeks of gestation, is a leading cause of perinatal mortality and morbidity in the world. Objectives This study aimed to evaluate the socio-demographic characteristics and etiological factors associated with preterm birth and consequent adverse perinatal outcomes retrospectively at a tertiary care hospital. Methods A single-centre retrospective observational study was conducted in the department of Obstetrics & Gynaecology, Fakir Mohan Medical College & Hospital, Balasore, Odisha, India, from April 2019 to March 2020. Data were retrieved from the antenatal ward admission register, case files, theatre records, and neonatal care unit records and reviewed. Descriptive statistics were used to describe data. Chi-square test and student’s t-test were used to find significance of difference between variables. Results The incidence of preterm birth in the study population was 5.52%. The mean gestational age of preterm deliveries was 34.39 ± 1.92 weeks. The bulk of the women hailed from a rural background and belonged to the lower socioeconomic strata. About 47.29% of the women were nulliparous and spontaneous preterm birth was noted in 70.40%. Premature rupture of membranes (PROM), anaemia, intrauterine growth restriction (IUGR), preeclampsia, and eclampsia were the most common adverse pregnancy conditions prevalent in these women. Preterm deliveries comprised 31.21% of all neonatal intensive care unit (NICU) admissions. Respiratory distress syndrome, birth asphyxia, neonatal sepsis, and jaundice were the most common complications. Neonatal death occurred in 51 (9.21%) preterm infants with birth asphyxia being the commonest cause of such deaths. Maternal factors and adverse neonatal outcome variables were compared between the spontaneous and iatrogenic/medically indicated preterm birth groups. Preeclampsia, IUGR, and cesarean section were more significantly associated with the iatrogenic group. Conclusion Our study provides a general overview of the associated etiological factors and perinatal health concerns associated with preterm birth in a rural/semi-urban setting in Eastern India. The findings might provide essential data for taking steps toward the prevention and management of preterm birth from a developing country’s perspective.
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Parvin I, Das SK, Ahmed S, Rahman A, Shahid ASMSB, Shahrin L, Afroze F, Ackhter MM, Alam T, Jahan Y, Palit P, Sarker MHR, Das J, Hoque ME, Magalhães RJS, Mamun AA, Faruque ASG, Ahmed T, Chisti MJ. Toxoplasma gondii Infection Is Associated with Low Birth Weight: Findings from an Observational Study among Rural Bangladeshi Women. Pathogens 2022; 11:pathogens11030336. [PMID: 35335660 PMCID: PMC8954211 DOI: 10.3390/pathogens11030336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Gestational Toxoplasma gondii (T. gondii) infection may cause substantial adverse effects on developing fetuses, newborns and also mothers. This study aims to estimate the seroprevalence of T. gondii among rural Bangladeshi pregnant women and determine the risk of a low birth weight (LBW). We followed a longitudinal design where 208 pregnant women were followed until the birth of their infants. Levels of IgG and IgM of T. gondii were assessed using chemiluminescent immunoassay. Modified Poisson regression was used to estimate crude and adjusted associations and multiple regression analysis was performed to understand the confounding and modifying effects of the variables. Thirty-nine (19%) children were born with LBW, among whom 15 (39%) mothers were positive for T. gondii IgG during pregnancy. After adjusting for several confounders and modifiers, pregnant women with T. gondii IgG or IgM seropositivity were significantly associated with LBW of infants (aRR: 2.00, 95% CI: 1.17–3.42). The strength of this association increased after adjusting for maternal education (aRR: 4.88, 95% CI: 1.74–13.69). The final model had an AROC of 0.84 with a sensitivity of 36% and specificity of 97%. Although causality is yet to be established, the study observed an association between T. gondii infection during pregnancy among rural Bangladeshi women and LBW of newborns.
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Affiliation(s)
- Irin Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Sumon Kumar Das
- Menzies—School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia
- Correspondence: or (S.K.D.); (A.S.G.F.)
| | - Shahnawaz Ahmed
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4067, Australia;
| | - Aminur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Abu Sadat Mohammad Sayeem Bin Shahid
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Lubaba Shahrin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Farzana Afroze
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Mst. Mahmuda Ackhter
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Tahmina Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Yasmin Jahan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Parag Palit
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Mohammad Habibur Rahman Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Jui Das
- Mater Research Institute, The University of Queensland, Brisbane, QLD 4067, Australia;
| | - Mohammad Enamul Hoque
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW 2006, Australia;
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD 4067, Australia;
| | - Ricardo J. Soares Magalhães
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia;
- Children’s Health and Environment Program, UQ Child Health Research Centre, The University of Queensland, Brisbane, QLD 4067, Australia
| | - Abdullah Al Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD 4067, Australia;
| | - Abu Syed Golam Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
- Correspondence: or (S.K.D.); (A.S.G.F.)
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
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Chaya S, Zar HJ, Gray DM. Lung Function in Preschool Children in Low and Middle Income Countries: An Under-Represented Potential Tool to Strengthen Child Health. Front Pediatr 2022; 10:908607. [PMID: 35769219 PMCID: PMC9234953 DOI: 10.3389/fped.2022.908607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/10/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The burden of respiratory disease is high in low-middle income countries (LMIC). Pulmonary function tests are useful as an objective measure of lung health and to track progression. Spirometry is the commonest test, but its use is limited in preschool children. Other lung function methods have been developed but their use in LMIC has not been well described. AIM To review the use of preschool lung function testing in children in LMIC, with particular reference to feasibility and clinical applications. METHODS Electronic databases "PubMed", "Scopus"," Web of Science", and "EBSCO host" were searched for publications in low and middle income countries on preschool lung function testing, including spirometry, fractional exhaled nitric oxide (FeNO), oscillometry, interrupter technique, tidal breathing and multiple breath washout (MBW), from 1 January 2011 to 31 January 2022. Papers in English were included and those including only children ≥6 years were excluded. RESULT A total of 61 papers from LMIC in Asia, South America, Africa, Eurasia or the Middle East were included. Of these, 40 included spirometry, 7 FeNO, 15 oscillometry, 2 interrupter technique, and 2 tidal breathing. The papers covered test feasibility (19/61), clinical application (46/61) or epidemiological studies (13/61). Lung function testing was successful in preschool children from LMIC. Spirometry was the most technically demanding and success gradually increased with age. CONCLUSION Preschool lung function testing is under-represented in LMIC for the burden of respiratory disease. These tests have the potential to strengthen respiratory care in LMIC, however access needs to be improved.
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Affiliation(s)
- Shaakira Chaya
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Bountogo M, Sié A, Zakané A, Compaoré G, Ouédraogo T, Lebas E, Brogdon J, Nyatigo F, Arnold BF, Lietman TM, Oldenburg CE. Antenatal care attendance and risk of low birthweight in Burkina Faso: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21:825. [PMID: 34903190 PMCID: PMC8667364 DOI: 10.1186/s12884-021-04310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/01/2021] [Indexed: 11/22/2022] Open
Abstract
Background Low birthweight is a major contributor to infant mortality. We evaluated the association between antenatal care (ANC) attendance and low birthweight among newborns in 5 regions of Burkina Faso. Methods We utilized data from the baseline assessment of a randomized controlled trial evaluating azithromycin distribution during the neonatal period for prevention of infant mortality. Neonates were eligible for the trial if the weighed at least 2500 g at enrollment and were 8–27 days of age. Data on ANC attendance and birthweight was extracted from each child’s carnet de santé, a government-issued health card on which pregnancy and birth-related data are recorded. We used linear and logistic regression models adjusting for potentially confounding variables to evaluate the relationship between ANC attendance (as total number of visits and ≥ 4 antenatal care visits) and birthweight (continuously and categorized into < 2500 g versus ≥2500 g). Results Data from 21,223 births were included in the analysis. The median number of ANC visits was 4 (interquartile range 3 to 5) and 69% of mothers attended at least 4 visits. Mean birthweight was 2998 g (standard deviation 423) and 8.1% of infants were low birthweight (< 2500 g). Birthweight was 63 g (95% CI 46 to 81 g, P < 0.001) higher in newborns born to mothers who had attended ≥4 ANC visits versus < 4 visits. The odds of low birthweight among infants born to mothers with ≥4 ANC visits was 0.71 (95% CI 0.63 to 0.79, P < 0.001) times the odds of low birthweight among infants born to mothers who attended < 4 ANC visits. Conclusions We observed a statistically significant association between ANC attendance and birthweight, although absolute differences were small. Improving access to ANC for all women may help improve birth outcomes. Trial registration The parent trial is registered at clinicaltrials.gov: NCT03682653; first registered 24 September 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04310-6.
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Affiliation(s)
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | | | | | - Elodie Lebas
- Francis I Proctor Foundation, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94143, USA
| | - Jessica Brogdon
- Francis I Proctor Foundation, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94143, USA
| | - Fanice Nyatigo
- Francis I Proctor Foundation, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94143, USA
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94143, USA.,Department of Ophthalmology, University of California, San Francisco, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94143, USA.,Department of Ophthalmology, University of California, San Francisco, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94143, USA. .,Department of Ophthalmology, University of California, San Francisco, USA. .,Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
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Van Schalkwyk EA, Gerber B. Vulnerable mothers' experience of feeding their preterm infant in neonatal care. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2021; 68:e1-e9. [PMID: 34797109 PMCID: PMC8603148 DOI: 10.4102/sajcd.v68i1.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/27/2021] [Accepted: 08/10/2021] [Indexed: 11/06/2022] Open
Abstract
Background Worldwide, preterm birth is a rising threat to maternal and child health. The universal challenges of being the mother of a preterm infant, combined with context-specific challenges such as poverty and poor linguistic and cultural representation, bring about risks for both mother and infant. This includes poor maternal mental health; poor mother–infant bonding and attachment and potential suboptimal developmental outcomes for the infant. Objective This article describes how Afrikaans-speaking mothers living in poverty experienced feeding their preterm infants in neonatal care. Method The study implemented a cross-sectional, qualitative design. Mothers of preterm infants (chronological ages between 3 and 6 months) were selected through a purposive sampling method and participated in individual semi-structured interviews. Nine interviews were thematically analysed. The participants were a vulnerable group, about whom little research literature was available. Results Feeding was perceived as a progressive task that worked towards the goal of discharge from the hospital. It was stressful because of various factors, but insufficient breastmilk supply was a significant contributor. The hospital setting was perceived as something that added to the participants’ anxiety surrounding feeding, but at the same time, it had the potential to decrease their anxiety. When the mother–infant dyad was able to breastfeed successfully, it made the participants feel like mothers at last after an extended period of anticipation. Conclusion Feeding their preterm infant was a prominent experience for the mothers, especially whilst in neonatal care. Increased feeding support is required from the healthcare team providing neonatal care in order to optimally use the neonatal period.
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Affiliation(s)
- Elanie A Van Schalkwyk
- Department of Speech, Language and Hearing Therapy, Faculty of Medicine and Health, Stellenbosch University, Cape Town.
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36
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Rattani S, Farooqi J, Hussain AS, Jabeen K. Spectrum and Antifungal Resistance of Candidemia in Neonates With Early- and Late-Onset Sepsis in Pakistan. Pediatr Infect Dis J 2021; 40:814-820. [PMID: 33941745 DOI: 10.1097/inf.0000000000003161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neonatal candidemia leads to high morbidity and mortality in developing countries. We studied the trends, spectrum and antifungal resistance in neonatal candidemia isolates from the year 2014 to 2019. METHODS This was a cross-sectional study conducted at the Aga Khan University, Pakistan. Neonates with positive blood cultures with Candida species were retrospectively identified from the laboratory database (2014-2018) and prospectively in 2019 where clinical information was also collected as part of routine laboratory reporting. RESULTS We identified 669 neonates with Candida species in blood cultures. Three hundred forty-six neonates had early-onset disease (EOD age ≤7 days) and 323 had late-onset disease (LOD age >7 days). Non-albicans Candida species (86.7%) were predominant versus C. albicans (13.3%; P-value 0.024) with Candida tropicalis being most common in both EOD and LOD. Candida pelliculosa and Candida guilliermondii were associated with EOD and C. albicans with LOD. Isolation of fluconazole nonsusceptible non-albicans Candida species was significantly higher in early-onset (5.9%) versus late-onset (2%) neonatal candidemia (P-value 0.005; crude odds ratio [COR] 2.73, 95% CI: 1.34-5.53). LOD in neonates was more likely associated with the use of vancomycin (COR 3.89, 95% CI: 1.39-10.89). EOD was more likely seen in patients with vaginal delivery (COR 4.16, 95% CI: 1.42-12.23) and in neonates with respiratory distress leading to intensive care unit admission (COR 3.31, 95% CI: 1.05-10.42). CONCLUSIONS Non-albicans Candida species were increasingly isolated from neonates with candidemia during recent years from Pakistan. Amphotericin remains first-line option for neonatal candidemia in our setting as fluconazole nonsusceptible Candida species are commonly isolated.
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Affiliation(s)
- Salima Rattani
- From the Department of Pathology & Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Joveria Farooqi
- From the Department of Pathology & Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Ali Shabbir Hussain
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi, Pakistan
| | - Kauser Jabeen
- From the Department of Pathology & Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
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Goldenberg RL, Goudar SS, Saleem S, Hibberd PL, Tolosa JE, Koso-Thomas M, McClure EM. Reports from the NICHD Global Network's Maternal and Newborn Health Registry: supplement introduction. Reprod Health 2020; 17:177. [PMID: 33256779 PMCID: PMC7703731 DOI: 10.1186/s12978-020-01024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Shivaprasad S Goudar
- Women's and Children's Health Research Unit, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Patricia L Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Jorge E Tolosa
- Oregon Health and Science University, Portland, OR, USA
- St. Luke's University Health Network, Bethlehem, PA, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Elizabeth M McClure
- Social Statistical and Environmental Health Sciences, RTI International, Durham, NC, USA.
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