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Moolla A, Mdewa W, Erzse A, Hofman K, Thsehla E, Goldstein S, Kohli-Lynch C. A cost-effectiveness analysis of a South African pregnancy support grant. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002781. [PMID: 38329926 PMCID: PMC10852248 DOI: 10.1371/journal.pgph.0002781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/14/2024] [Indexed: 02/10/2024]
Abstract
Poverty among expectant mothers often results in sub-optimal maternal nutrition and inadequate antenatal care, with negative consequences on child health outcomes. South Africa has a child support grant that is available from birth to those in need. This study aims to determine whether a pregnancy support grant, administered through the extension of the child support grant, would be cost-effective compared to the existing child support grant alone. A cost-utility analysis was performed using a decision-tree model to predict the incremental costs (ZAR) and disability-adjusted life years (DALYs) averted by the pregnancy support grant over a 2-year time horizon. An ingredients-based approach to costing was completed from a governmental perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were performed. The intervention resulted in a cost saving of R13.8 billion ($930 million, 95% CI: ZAR3.91 billion - ZAR23.2 billion/ $1.57 billion - $264 million) and averted 59,000 DALYs (95% CI: -6,400-110,000), indicating that the intervention is highly cost-effective. The primary cost driver was low birthweight requiring neonatal intensive care, with a disaggregated incremental cost of R31,800 ($2,149) per pregnancy. Mortality contributed most significantly to the DALYs accrued in the comparator (0.68 DALYs). The intervention remained the dominant strategy in the sensitivity analyses. The pregnancy support grant is a highly cost-effective solution for supporting expecting mothers and ensuring healthy pregnancies. With its positive impact on child health outcomes, there is a clear imperative for government to implement this grant. By investing in this program, cost savings could be leveraged. The implementation of this grant should be given high priority in public health and social policies.
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Affiliation(s)
- Aisha Moolla
- SAMRC/Wits Centre for Health Economics and Decision Science ‐ PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Winfrida Mdewa
- SAMRC/Wits Centre for Health Economics and Decision Science ‐ PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Agnes Erzse
- SAMRC/Wits Centre for Health Economics and Decision Science ‐ PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science ‐ PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Evelyn Thsehla
- SAMRC/Wits Centre for Health Economics and Decision Science ‐ PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Susan Goldstein
- SAMRC/Wits Centre for Health Economics and Decision Science ‐ PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ciaran Kohli-Lynch
- SAMRC/Wits Centre for Health Economics and Decision Science ‐ PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Huang Y, Xiang Y, Zhou W, Jiang Y, Wang Z, Fang S. Short working hours and perceived stress: Findings from a population-based nationwide study. Heliyon 2023; 9:e21919. [PMID: 38028004 PMCID: PMC10658322 DOI: 10.1016/j.heliyon.2023.e21919] [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: 07/07/2023] [Revised: 10/14/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Evidence on the potential negative health effects of short working hours remains limited. This study aimed to investigate the association between short working hours and perceived stress in a population-based sample from China. Methods This cross-sectional study included 4368 participants aged 18-65 years from the China Health and Nutrition Surveys (CHNS) 2015. Working hours were categorized into <35, 35-40, 41-54, and ≥55 h/week. Perceived stress was assessed using the Perceived Stress Scale-14 (PSS-14). Results Of the 4368 participants, 817 (18.7 %) reported short working hours (<35 h/week) and 1817 (41.6 %) reported perceived stress. Short working hours were associated with higher perceived stress compared to standard working hours (35-40 h/week) (Adjusted odds ratios (AOR) = 1.25, 95 % confidential intervals (CI): 1.04-1.51). Stratified analysis showed that short working hours were significantly associated with more perceived stress in subjects aged 36-50 years (AOR = 1.43, 95 % CI: 1.16-1.70), while long working hours (≥55 h/week) were significantly related to less perceived stress among low-income subjects (AOR = 0.56, 95 % CI: 0.33-0.94). Reduced income partially mediated the effects of short working hours on perceived stress (indirect effects = -0.002, 95 % CI: -0.007∼-0.001). Conclusion Reduced working hours may be associated with increased risk of perceived stress in China, particularly among people aged 36-50 years and those with low income. Reduced income may be a possible reason for the increased perceived stress caused by short working hours. Future longitudinal studies are needed to examine these relationships and to explore mechanisms.
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Affiliation(s)
- Yeen Huang
- School of Public Health and Emergency Management, Southern University of Science and Technology, China
| | - Yingping Xiang
- Occupational Hazard Assessment Institute, Shenzhen Prevention and Treatment Center for Occupational Diseases, China
| | - Wei Zhou
- Occupational Hazard Assessment Institute, Shenzhen Prevention and Treatment Center for Occupational Diseases, China
| | - Yonghong Jiang
- School of Public Health and Emergency Management, Southern University of Science and Technology, China
| | - Zeshi Wang
- School of Public Health and Emergency Management, Southern University of Science and Technology, China
| | - Shenying Fang
- School of Public Health and Emergency Management, Southern University of Science and Technology, China
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Muthelo L, Mbombi MO, Bopape MA, Mothiba TM, Densmore M, van Heerden A, Norris SA, Dias NV, Griffiths P, Mackintosh N. Reflections on Digital Maternal and Child Health Support for Mothers and Community Health Workers in Rural Areas of Limpopo Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1842. [PMID: 36767230 PMCID: PMC9914499 DOI: 10.3390/ijerph20031842] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/14/2023] [Accepted: 01/15/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Digital health support using mobile and digital technologies, such as MomConnect and WhatsApp, is providing opportunities to improve maternal and child healthcare in low- and middle-income countries. Yet, the perspective of health service providers, pregnant women, and mothers as recipients of digital health support is under-researched in rural areas. MATERIAL AND METHODS An exploratory-descriptive qualitative research approach was adopted to reflect on the experiences of mothers, community leaders, and community health workers on mobile health opportunities in the context of maternal and child health in rural areas. Purposive sampling was used to select 18 participants who participated in the two focus groups and individual semi-structured interviews for data collection about digital maternal and child health support. The thematic open coding method of data analysis assisted authors in making sense of the given reflections of mothers, community leaders, and healthcare workers about digital health support. RESULTS Participants commented on different existing digital support apps and their importance for maternal and child health. For example, MoMConnect, Pregnancy+, WhatsApp, and non-digital resources were perceived as useful ways of communication that assist in improving maternal and child health. However, participants reported several challenges related to the use of digital platforms, which affect following the health instructions given to pregnant women and mothers. CONCLUSIONS Participants expressed the significant role of digital support apps in maternal and child health, which is impacted by various challenges. Addressing the lack of digital resources could improve access to health instructions for pregnant women and mothers.
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Affiliation(s)
- Livhuwani Muthelo
- Department of Nursing, University of Limpopo, Polokwane 0727, South Africa
| | | | | | - Tebogo M. Mothiba
- Department of Nursing, University of Limpopo, Polokwane 0727, South Africa
| | - Melissa Densmore
- Department of Computer Science, University of Cape Town, Cape Town 7700, South Africa
| | - Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg 3201, South Africa
| | - Shane A. Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa
| | - Nervo Verdezoto Dias
- School of Computer Science and Informatics, Cardiff University, Cardiff CF24 4Ag, UK
| | - Paula Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Ashby Road, Loughborough LE11 3TU, UK
| | - Nicola Mackintosh
- Department of Population Health Sciences, College of Life Sciences, University of Leicester, George Davies Centre, University Road, Leicester LE1 7RH, UK
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Phiri TM, Nyamaruze P, Akintola O. Stress and coping among unmarried pregnant university students in South Africa. BMC Pregnancy Childbirth 2021; 21:817. [PMID: 34886798 PMCID: PMC8656022 DOI: 10.1186/s12884-021-04288-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/25/2021] [Indexed: 11/27/2022] Open
Abstract
Background The improvement of maternal and child health (MCH) outcomes is an important part of the sustainable development goals (SDGs). MCH remains an important issue globally as the SDGs have not yet been achieved in most countries. Young women in universities are likely to experience unintended pregnancy due to risky sexual behaviors in tertiary institutions which is characterized by lack of condom and/or contraceptive use and coercion. Pregnant young women in an academic environment are susceptible to stressors associated with unintended pregnancy and academic demands of universities. However, very little is known about the stress and coping among young people in tertiary institutions who get pregnant during the course of their studies and choose to keep the pregnancy. Methods Participants were purposively selected among pregnant students and those in the puerperal period at the time of the study. Semi-structured qualitative interviews were undertaken to explore the experiences of pregnancy and early motherhood, with particular focus on the various stressors experienced and possible coping strategies employed by students. The data were audio-recorded and transcribed verbatim, then analysed using thematic analysis. Results The findings show that pregnancy and early motherhood was an experience that came with a lot of stress emanating from fear of parents’ reactions, academic pressure, financial constraints, relationship problems with male partners and experiences of social stigma. Participants used emotion-focused and problem-focused coping strategies to deal with the stressors confronting them during and after their pregnancy. Conclusion The experiences of pregnant students are multifaceted and generally characterised by financial crisis, academic challenges, shame, strenuous relationships and transitioning into a new identity. A multipronged approach to healthcare for pregnant students that focus on comprehensive antenatal services, health education, health promotion, psychosocial interventions including academic counselling will have positive outcomes for young mothers and their children. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04288-1.
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Affiliation(s)
- Thandiwe Msipu Phiri
- Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Patrick Nyamaruze
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Olagoke Akintola
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa.
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van Zyl C, van Wyk C. Exploring Factors That Could Potentially Have Affected the First 1000 Days of Absent Learners in South Africa: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052768. [PMID: 33803320 PMCID: PMC7967291 DOI: 10.3390/ijerph18052768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/26/2021] [Indexed: 12/04/2022]
Abstract
Background: The first 1000 days of life—from conception to the second birthday of children —is widely recognized as the most crucial development phase, which could have long lasting effects on the health and well-being of children throughout their lives. Purpose: The purpose of this study was to qualitatively explore and describe factors that could potentially have affected the first 1000 days of absent learners in the Foundation Phase within the Paarl-East community in the Western Cape of South Africa. Methods: The data for this qualitative descriptive study were collected through semi-structured interviews with 18 biological mothers of absent learners in the Foundation Phase, who resided in Paarl East. The transcribed texts were analyzed by making use of a thematic data analysis. Results: The findings revealed six predominant themes that played a role during the first 1000 days of the lives of these absent learners. Conclusion: It was concluded from the findings in this study that factors, such as health and nutrition of both the mothers and their children, substance use/abuse during pregnancy, toxic stress, support received by the mothers and their children, attachment, attentive care, and stimulation and play, could have affected the first 1000 days of the absent learners in this study. Since this study did not aim to confirm a correlation between the first 1000 days and absenteeism, but solely to explore factors affecting the first 1000 days, conclusions regarding cause and effect was not possible.
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Choi KW, Smit JA, Coleman JN, Mosery N, Bangsberg DR, Safren SA, Psaros C. Mapping a Syndemic of Psychosocial Risks During Pregnancy Using Network Analysis. Int J Behav Med 2019; 26:207-216. [PMID: 30805768 PMCID: PMC6628702 DOI: 10.1007/s12529-019-09774-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Psychosocial risks during pregnancy impact maternal health in resource-limited settings, and HIV-positive women often bear a heavy burden of these factors. This study sought to use network modeling to characterize co-occurring psychosocial risks to maternal and child health among at-risk pregnant women. METHODS Two hundred pregnant HIV-positive women attending antenatal care in South Africa were enrolled. Measured risk factors included younger age, low income, low education, unemployment, unintended pregnancy, distress about pregnancy, antenatal depression, internalized HIV stigma, violence exposure, and lack of social support. Network analysis between risk factors was conducted in R using mixed graphical modeling. Centrality statistics were examined for each risk node in the network. RESULTS In the resulting network, unintended pregnancy was strongly tied to distress about pregnancy. Distress about pregnancy was most central in the network and was connected to antenatal depression and HIV stigma. Unintended pregnancy was also associated with lack of social support, which was itself linked to antenatal depression, HIV stigma, and low income. Finally, antenatal depression was connected to violence exposure. CONCLUSIONS Our results characterize a network of psychosocial risks among pregnant HIV-positive women. Distress about pregnancy emerged as central to this network, suggesting that unintended pregnancy is particularly distressing in this population and may contribute to further risks to maternal health, such as depression. Prevention of unintended pregnancies and interventions for coping with unplanned pregnancies may be particularly useful where multiple risks intersect. Efforts addressing single risk factors should consider an integrated, multilevel approach to support women during pregnancy. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03069417.
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Affiliation(s)
- Karmel W Choi
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA, 02114, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jenni A Smit
- Maternal Adolescent and Child Health (MatCH) Research Unit, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, KwaZulu-Natal, South Africa
- School of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Jessica N Coleman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Nzwakie Mosery
- Maternal Adolescent and Child Health (MatCH) Research Unit, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, KwaZulu-Natal, South Africa
- School of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - David R Bangsberg
- MGH Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Hashmi AH, Paw MK, Nosten S, Darakamon MC, Gilder ME, Charunwatthana P, Carrara VI, Wickramasinghe K, Angkurawaranon C, Plugge E, McGready R. 'Because the baby asks for it': a mixed-methods study on local perceptions toward nutrition during pregnancy among marginalised migrant women along the Myanmar-Thailand border. Glob Health Action 2018; 11:1473104. [PMID: 29785874 PMCID: PMC5965027 DOI: 10.1080/16549716.2018.1473104] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Under- and over-nutrition during pregnancy are known risk factors for pregnancy complications and adverse pregnancy and infant outcomes. Understanding perceptions around nutrition in pregnancy can create culturally appropriate interventions for improved health outcomes. Objective: A mixed-methods study was performed to explore local perceptions and practices of diet and physical activity in pregnancy in a marginalised population along the Myanmar–Thailand border. Methods: From April to July 2017, a cross-sectional survey and focus group discussions were conducted with pregnant women reporting to antenatal care; in-depth interviews were conducted with senior midwives at participating organisations along the Myanmar–Thailand border. Results: A total of 388 pregnant women were interviewed at two clinic sites along the Myanmar–Thailand border. A high proportion of women had limited knowledge of and poor dietary practices. Consuming a sweetened drink in the last 24 hours as well as being a non-teenage, multigravida woman was significantly associated with high body mass index (BMI) compared to normal BMI. Qualitative analysis combined focus group discussions (n = 66) and in-depth interviews (n = 4) summarising emergent themes: common foods eaten or avoided and rationale; benefits of nutrition; perceptions of overweight and weight gain during pregnancy; barriers to a healthy diet; and sources of diet information. Conclusions: There is limited awareness about healthy diets and lifestyle in these marginalised, migrant communities along the Myanmar–Thailand border. This study suggests that simple, culturally appropriate messaging should be provided to women and communities with low health literacy to generate awareness about healthy lifestyles and their effects on pregnancy outcomes as an important element of a broader strategy to address maternal nutrition in this population. However, more studies to determine the effectiveness of a broad range of interventions in low- and middle-income countries (LMIC) are needed, especially in marginalised migrant populations.
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Affiliation(s)
- Ahmar H Hashmi
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand.,b Department of Family Medicine, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Moo Kho Paw
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand
| | - Suphak Nosten
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand
| | - Mu Chae Darakamon
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand
| | - Mary Ellen Gilder
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand
| | | | - Verena I Carrara
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand
| | - Kremlin Wickramasinghe
- d WHO European Office for the Prevention and Control of Non-Communicable Disease , Moscow, Russia
| | - Chaisiri Angkurawaranon
- b Department of Family Medicine, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Emma Plugge
- e Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine , University of Oxford , Oxford , UK
| | - Rose McGready
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand.,e Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine , University of Oxford , Oxford , UK
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Rosen JG, Clermont A, Kodish SR, Matar Seck A, Salifou A, Grais RF, Isanaka S. Determinants of dietary practices during pregnancy: A longitudinal qualitative study in Niger. MATERNAL & CHILD NUTRITION 2018; 14:e12629. [PMID: 29956458 PMCID: PMC6175447 DOI: 10.1111/mcn.12629] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 04/22/2018] [Accepted: 04/25/2018] [Indexed: 11/28/2022]
Abstract
Undernutrition is associated with maternal morbidity and poor pregnancy outcomes. This qualitative study seeks to understand the multilevel factors influencing maternal dietary practices in Niger, including the impact of pregnancy illnesses on diet. Criterion-based, purposive sampling was used to select pregnant women and household members from 24 villages in a rural district of the Maradi Region in south-central Niger. Semistructured interviews (n = 153) and focus group discussions (n = 38) explored 4 primary themes: (a) perceptions of ideal diet during pregnancy, (b) barriers to consuming the ideal diet, (c) coping strategies including dietary responses related to pregnancy illnesses, and (d) changes in perceptions from early to late pregnancy. Longitudinal data collection allowed for repeated interviews of pregnant women to document changes in dietary practices throughout pregnancy. Transcripts were coded using an inductive approach informed by grounded theory methodology. Participants categorized foods into 4 primary dietary taxonomies when discussing ideal maternal diets but cited constraints related to accessibility and availability impeding routine consumption of these foods. Perceptions of "modern," urban foods as healthy, coupled with key structural barriers such as food costs, were identified. Maternal morbidity influenced food consumption, as women reported reducing food intake early in pregnancy in response to illness episodes. Although awareness of optimal foods for supporting healthy pregnancies was moderately high, some misconceptions were observed and multilevel barriers to food security restricted opportunities for consuming these foods. Nutrition-specific and nutrition-sensitive interventions could improve access and availability of acceptable foods for supporting increased dietary intake during pregnancy.
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Affiliation(s)
- Joseph G. Rosen
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Adrienne Clermont
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Stephen R. Kodish
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | | | | | | | - Sheila Isanaka
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of ResearchEpicentreParisFrance
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
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Mlotshwa L, Manderson L, Merten S. Personal support and expressions of care for pregnant women in Soweto, South Africa. Glob Health Action 2018; 10:1363454. [PMID: 28874098 PMCID: PMC5645695 DOI: 10.1080/16549716.2017.1363454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Pregnancy is life changing, making great demands on women to adapt physically, psychologically, and socially. Social relationships and the support that flow from these provide a critical role in managing health problems in pregnancy. Isolation and lack of care, in contrast, may lead women to experience increased distress during this time. Objective: This study aimed to explore South African women's perception and experience of care and support in pregnancy. Methods: A life history approach was employed to explore women’s experiences of pregnancy and sexual behaviour, with each participant encouraged to narrate important life events from her own perspective. We drew on narrative interviews with 15 pregnant women, conducted between July and October 2015, in which we explored questions regarding pregnancy planning and the provision and receipt of care. A thematic approach was employed to code and analyse the data. Results: Themes that emerged from the interviews showed that participants gained a sense of stability in their lives when they had support in their pregnancy, especially when dealing with challenging situations. This support came variously from family, friends, and social networks. Overall, those participants who mentioned the most support, and its diversity across different groups, reported a better experience of pregnancy. Conclusions: Women emphasised the importance of social and emotional support in pregnancy. Understanding women’s experiences can assist in making pregnancy less overwhelming, and can add to a woman’s ability to deal with different challenges before and after the arrival of the new baby.
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Affiliation(s)
- Langelihle Mlotshwa
- a Department of Epidemiology and Public Health , Swiss Tropical Public Health Institute , Basel , Switzerland.,b Department of Epidemiology and Public Health , University of Basel , Basel , Switzerland.,c Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Lenore Manderson
- d School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Sonja Merten
- a Department of Epidemiology and Public Health , Swiss Tropical Public Health Institute , Basel , Switzerland.,b Department of Epidemiology and Public Health , University of Basel , Basel , Switzerland
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Coelho APF, Beck CLC, Silva RMD, Vedootto DDO, Silva JDRPD. TRABALHO FEMININO E SAÚDE NA VOZ DE CATADORAS DE MATERIAIS RECICLÁVEIS. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072018002630016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: analisar a interface trabalho feminino e saúde na perspectiva de mulheres catadoras de materiais recicláveis e realizar uma atividade educativa em direção ao seu empoderamento. Método: estudo qualitativo realizado com base na Pesquisa Convergente-Assistencial. As participantes foram 11 mulheres catadoras de uma cooperativa de materiais recicláveis. Os dados foram produzidos entre abril e junho de 2015 por intermédio da observação não sistemática participante, entrevistas semiestruturadas e grupo de convergência. A análise seguiu os passos estabelecidos pelo referencial metodológico (apreensão, síntese, teorização e transferência). Resultados: da análise emergiram duas categorias temáticas que apontam para trajetórias de vida marcadas por fragilidades econômicas, familiares e sociais, tais como a vivência do trabalho infantil, exclusão do mercado de trabalho, dificuldades impostas pela maternidade e casamento, bem como o preconceito racial. Apontam, ainda, a visão das catadoras acerca do trabalho na vida da mulher, evidenciando-se elementos como o machismo, a divisão sexual do trabalho e a interface entre trabalho e família. A atividade educativa em grupo em direção ao empoderamento se mostrou positiva e ajudou as catadoras a reavivar os sentimentos de confiança em suas capacidades. Conclusão: o trabalho feminino é um fator relevante para a saúde da mulher. Nesse sentido, ações educativas de enfermagem que estimulem o empoderamento como elemento para a saúde podem ser eficazes junto a grupos singulares, como as catadoras de materiais recicláveis.
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van Heyningen T, Honikman S, Myer L, Onah MN, Field S, Tomlinson M. Prevalence and predictors of anxiety disorders amongst low-income pregnant women in urban South Africa: a cross-sectional study. Arch Womens Ment Health 2017; 20:765-775. [PMID: 28852868 PMCID: PMC6086488 DOI: 10.1007/s00737-017-0768-z] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 07/28/2017] [Indexed: 02/07/2023]
Abstract
Anxiety is highly prevalent in many populations; however, the burden of anxiety disorders amongst pregnant women in low-resource settings is not well documented. We investigated the prevalence and predictors of antenatal anxiety disorders amongst low-income women living with psychosocial adversity. Pregnant women were recruited from an urban, primary level clinic in Cape Town, South Africa. The Mini-International Neuropsychiatric Interview diagnostic interview assessed prevalence of anxiety disorders. Four self-report questionnaires measured psychosocial characteristics. Logistic regression models explored demographic and socioeconomic characteristics, psychosocial risk factors and psychiatric comorbidity as predictors for anxiety disorders. Amongst 376 participants, the prevalence of any anxiety disorder was 23%. Although 11% of all women had post-traumatic stress disorder, 18% of the total sample was diagnosed with other anxiety disorders. Multivariable analysis revealed several predictors for anxiety including a history of mental health problems (adjusted odds ratio [AOR] 4.11; 95% confidence interval (CI) 2.03-8.32), Major depressive episode (MDE) diagnosis (AOR 3.83; CI 1.99-7.31), multigravidity (AOR 2.87; CI 1.17-7.07), food insecurity (AOR 2.57; CI 1.48-4.46), unplanned and unwanted pregnancy (AOR 2.14; CI 1.11-4.15), pregnancy loss (AOR 2.10; CI 1.19-3.75) and experience of threatening life events (AOR 1.30; CI 1.04-1.57). Increased perceived social support appeared to reduce the risk for antenatal anxiety (AOR 0.95; CI 0.91-0.99). A range of antenatal anxiety disorders are prevalent amongst pregnant women living in low-resource settings. Women who experience psychosocial adversity may be exposed to multiple risk factors, which render them vulnerable to developing antenatal anxiety disorders.
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Affiliation(s)
- Thandi van Heyningen
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Simone Honikman
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Michael N Onah
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Canada
| | - Sally Field
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mark Tomlinson
- Alan J. Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Ashaba S, Kaida A, Burns BF, O'Neil K, Dunkley E, Psaros C, Kastner J, Tsai AC, Bangsberg DR, Matthews LT. Understanding coping strategies during pregnancy and the postpartum period: a qualitative study of women living with HIV in rural Uganda. BMC Pregnancy Childbirth 2017; 17:138. [PMID: 28482821 PMCID: PMC5423027 DOI: 10.1186/s12884-017-1321-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/03/2017] [Indexed: 01/03/2023] Open
Abstract
Background In sub-Saharan Africa, 58% of adults living with HIV are women. In Uganda, HIV prevalence is 8.3% for women compared to 6.1% for men. Access to antiretroviral therapy (ART) and prevention of mother to child transmission (PMTCT) programs have enabled women living with HIV (WLWH) to have children with minimal risk of perinatal transmission. Nevertheless, pregnant WLWH face many challenges. We explored women’s perceptions of how they cope with the challenges of pregnancy and the postpartum period as HIV-infected women. Methods We conducted semi-structured interviews with postpartum WLWH accessing ART who had a pregnancy within 2 years prior to recruitment between February–August, 2014. Childbearing associated stressors and coping strategies were discussed. We used content analysis to identify major themes and NVivo 10 software facilitated data analysis. Results Twenty women were interviewed with median age 33 (IQR: 28–35) years, CD4 cell count 677 cells/mm3 (IQR: 440–767), number of live births 4 (IQR: 2–6), and number of living children 3 (IQR: 2–4.3). We summarize five identified coping strategies within a socio-ecological framework according to Bronfenbrenner’s Ecological Model. Coping strategies on the individual level included acceptance of self and HIV status, and self-reliance. On the interpersonal level, participants reported coping through support from partners, family, and friends. On the organizational level, participants reported coping through HIV-related healthcare delivery and system supports. At the community level, women reported coping through support from church and spirituality. Conclusions The results highlight coping strategies used by WLWH to manage the myriad challenges faced during pregnancy and the postpartum period. Intervention programs for WLWH must emphasize psychosocial care and incorporate strategies that address psychosocial challenges in the HIV care package in order to optimize well-being. Additionally policies that support networks of WLWH should be put in place and funding support should be provided through existing funding mechanisms in order to respond to the needs and challenges of WLWH. Programmes that support WLWH for economic empowerment and improved livelihoods should be strengthened across all regions in the country. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1321-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Scholastic Ashaba
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | - Kasey O'Neil
- MGH Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Emma Dunkley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jasmine Kastner
- Research Institute McGill University Health Centre Montreal, Montreal, Canada
| | - Alexander C Tsai
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - David R Bangsberg
- MGH Global Health, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Lynn T Matthews
- MGH Global Health, Massachusetts General Hospital, Boston, MA, USA.,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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13
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Heyningen TV, Myer L, Onah M, Tomlinson M, Field S, Honikman S. Antenatal depression and adversity in urban South Africa. J Affect Disord 2016; 203:121-129. [PMID: 27285725 PMCID: PMC5777271 DOI: 10.1016/j.jad.2016.05.052] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 05/22/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND In low and middle-income countries (LMIC), common mental disorders affecting pregnant women receive low priority, despite their disabling effect on maternal functioning and negative impact on child health and development. We investigated the prevalence of risk factors for antenatal depression among women living in adversity in a low-resource, urban setting in Cape Town, South Africa. METHODS The MINI Neuropsychiatric Interview (MINI Plus) was used to measure the diagnostic prevalence of depression amongst women attending their first antenatal visit at a primary-level, community-based clinic. Demographic data were collected followed by administration of questionnaires to measure psychosocial risk. Analysis examined the association between diagnosis of depression and psychosocial risk variables, and logistic regression was used to investigate predictors for major depressive episode (MDE). RESULTS Among 376 women participating, the mean age was 26 years. The MINI-defined prevalence of MDE was 22%, with 50% of depressed women also expressing suicidality. MDE diagnosis was significantly associated with multiple socioeconomic and psychosocial risk factors, including a history of depression or anxiety, food insecurity, experience of threatening life events and perceived support from family. LIMITATIONS The use of self-report measures may have led to recall bias. Retrospective collection of clinical data limited our ability to examine some known risk factors for mental distress. CONCLUSION These findings confirm the high prevalence of MDE among pregnant women in LMIC settings. Rates of depression may be increased in settings where women are exposed to multiple risks. These risk factors should be considered when planning maternal mental health interventions.
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Affiliation(s)
- Thandi van Heyningen
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, South Africa.
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Michael Onah
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Mark Tomlinson
- Alan J. Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, South Africa
| | - Sally Field
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Simone Honikman
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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Wabiri N, Chersich M, Shisana O, Blaauw D, Rees H, Dwane N. Growing inequities in maternal health in South Africa: a comparison of serial national household surveys. BMC Pregnancy Childbirth 2016; 16:256. [PMID: 27581489 PMCID: PMC5007803 DOI: 10.1186/s12884-016-1048-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 08/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rates of maternal mortality and morbidity vary markedly, both between and within countries. Documenting these variations, in a very unequal society like South Africa, provides useful information to direct initiatives to improve services. The study describes inequalities over time in access to maternal health services in South Africa, and identifies differences in maternal health outcomes between population groups and across geographical areas. METHODS Data were analysed from serial population-level household surveys that applied multistage-stratified sampling. Access to maternal health services and health outcomes in 2008 (n = 1121) were compared with those in 2012 (n = 1648). Differences between socio-economic quartiles were quantified using the relative (RII) and slope (SII) index of inequality, based on survey weights. RESULTS High levels of inequalities were noted in most measures of service access in both 2008 and 2012. Inequalities between socio-economic quartiles worsened over time in antenatal clinic attendance, with overall coverage falling from 97.0 to 90.2 %. Nationally, skilled birth attendance remained about 95 %, with persistent high inequalities (SII = 0.11, RII = 1.12 in 2012). In 2012, having a doctor present at childbirth was higher than in 2008 (34.4 % versus 27.8 %), but inequalities worsened. Countrywide, levels of planned pregnancy declined from 44.6 % in 2008 to 34.7 % in 2012. The RII and SII rose over this period and in 2012, only 22.4 % of the poorest quartile had a planned pregnancy. HIV testing increased substantially by 2012, though remains low in groups with a high HIV prevalence, such as women in rural formal areas, and from Gauteng and Mpumalanga provinces. Marked deficiencies in service access were noted in the Eastern Cape ad North West provinces. CONCLUSIONS Though some population-level improvements occurred in access to services, inequalities generally worsened. Low levels of planned pregnancy, antenatal clinic access and having a doctor present at childbirth among poor women are of most concern. Policy makers should carefully balance efforts to increase service access nationally, against the need for programs targeting underserved populations.
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Affiliation(s)
- Njeri Wabiri
- Epidemiology and Strategic Information Unit, Human Sciences Research Council, Pretoria, South Africa
| | - Matthew Chersich
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Olive Shisana
- Evidence Based Solutions, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Duane Blaauw
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Rees
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ntabozuko Dwane
- Epidemiology and Strategic Information Unit, Human Sciences Research Council, Pretoria, South Africa
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