Prevalence and associated factors of anemia among full-term newborn babies at University of Gondar comprehensive specialized hospital, Northwest Ethiopia: a cross-sectional study

Association of prenatal Cleft Lip and Palate ultrasound abnormalities with copy number variants at a single Chinese tertiary center

BACKGROUD

A systematic analysis was conducted to investigate the molecular etiology of fetal cleft lip and/or palate (CL/P) and the association between various types of CL/P and copy number variations (CNVs), as well as their impact on birth outcomes.

METHODS

In this retrospective study conducted between January 2016 and July 2022, a cohort of pregnancies diagnosed with fetal CL/P was enrolled and comprehensive clinical data for all cases were extracted from our medical record database, including demographic data about the pregnancies, ultrasound findings, results of Chromosomal microarray (CMA), as well as relevant pregnant and perinatal outcomes.

RESULTS

Among the 358 cases, 32 clinically significant variants in 29 (8.1%) fetuses with CL/P were detected by CMA. In 338 singleton pregnancies, the diagnostic yield of CMA in the context of CL/P fetuses was determined to be 7.7% (26/338). CP cases exhibited a relatively higher prevalence of pathogenic/likely pathogenic CNVs at a rate of 25% (3/12), followed by CLP cases at 8.0% (23/288). Notably, the CL group did not demonstrate any pathogenic/likely pathogenic CNV findings among the examined cases (0/38). The diagnostic rate of clinically significant variants was notably higher in the non-isolated CL/P group than in the isolated CL/P group (11/33, 33.3% vs. 15/305, 4.9%, p < 0.001). Within the remaining 20 twin pregnancies, three clinically significant variants (15%) were observed.

CONCLUSIONS

This study provides powerful evidence supporting the efficacy of CMA as a valuable tool for facilitating the prenatal genetic diagnosis of fetal CL/P. The presence of CP and CLP in fetal cases demonstrated a relatively higher incidence of pathogenic/likely pathogenic CNVs. Moreover, when these cases were accompanied by additional ultrasound abnormalities, the likelihood of identifying diagnostic CNVs significantly increased. Conversely, cases of CL alone might not be associated with positive CNVs. The present data may significantly enhance prenatal diagnosis accuracy and facilitate informed genetic counseling for cases of fetal CL/P.

Prevalence and determinants of fetal macrosomia in Bangladesh

Background

Fetal macrosomia, marked by excessive birth weight, is a significant public health issue in developing countries, yet it has received less attention compared to low birth weight. This study aims to determine the prevalence of fetal macrosomia in Bangladesh and its associated factors.

Methods

The study utilized data from 4,754 women with complete birth weight information of their children from the Bangladesh Multiple Indicator Cluster Survey (MICS) -2019, defining fetal macrosomia as newborns with a birth weight ≥4,000 g regardless of gestational age. Bivariate logistic regression assessed associations between independent variables and fetal macrosomia, presenting adjusted odds ratios (AOR) and a 95% confidence interval (CI), while controlling for potential confounders such as women's age, wealth index, education, healthcare utilization, comorbidities, newborn sex, and place of residence.

Results

The prevalence of fetal macrosomia was 11.6%. Significant associations with fetal macrosomia included higher maternal age group (30-34 years) (AOR = 1.36, 95% CI = 1.07-1.74), secondary level of mother's education (AOR = 1.95, 95% CI = 1.43-2.66), experienced physical attacks (AOR = 1.41, 95% CI = 1.06-1.88), hypertension during pregnancy (AOR = 1.54, 95% CI = 1.15-2.07), and rural residence (AOR = 1.25, 95% CI = 1.15-1.49). Female infants had 18% lower odds of being macrosomic compared to male infants (AOR = 0.82, 95% CI = 0.72-0.93).

Conclusion

One in ten infants in Bangladesh are born with macrosomia, necessitating a multi-faceted approach involving improving maternal nutrition, promoting healthy lifestyles, enhancing access to quality prenatal care, and addressing socioeconomic, residential, and healthcare system challenges, underlining the importance of further community-based research to expand the study's scope.

Surface Roughness Examination of Glass Ionomer Restorative Cements Treated with Acidic and Basic Pediatric Medications: An In Vitro Study

Background

Consumption of different types of beverages and liquid drugs can affect of the surface properties of restorative material. This may lead to an increased probability of dental caries and periodontal inflammation.

Aim

This study evaluated and compared the effect of amoxicillin suspension (AMS) and azithromycin suspension (AZS) on the surface roughness (SR) of silver-reinforced glass ionomer (SGI) and nano resin-modified glass ionomer (NGI).

Material and Methods

Thirty disks (2 mm height × 4 mm diameter) of each glass ionomer (GI) type were prepared and subdivided into three groups (n = 10), which were separately exposed to AMS, AZS, and artificial saliva (AS). SR was evaluated by atomic force microscopy before and after three-immersion protocols repeated over a 3-week duration with 2-day intervals. In each protocol, the GI samples were exposed weekly to AMS three times daily, AZS once daily, and a full day to AS.

Results

This study demonstrated, for the first time, the effect of a basic drug (AZS) on the SR of GIs. Intra- and inter-group comparisons showed significant changes (P ˂ 0.05) in the SR pattern of the GIs after immersion cycles in AZS, AMS, and AS. However, the acidic medication (AMS) exhibited significantly higher changes in SGI than in NGI.

Conclusions

The SR of NGIs and SGIs can be significantly affected by the use of AMS and AZS suspensions. SGI demonstrated higher SR deterioration than NGI after immersion cycles in AMS.

Bayesian rank likelihood-based estimation: An application to low birth weight in Ethiopia

BACKGROUND

Low birth weight is a significant risk factor associated with high rates of neonatal and infant mortality, particularly in developing countries. However, most studies conducted on this topic in Ethiopia have small sample sizes, often focusing on specific areas and using standard models employing maximum likelihood estimation, leading to potential bias and inaccurate coverage probability.

METHODS

This study used a novel approach, the Bayesian rank likelihood method, within a latent traits model, to estimate parameters and provide a nationwide estimate of low birth weight and its risk factors in Ethiopia. Data from the Ethiopian Demographic and Health Survey (EDHS) of 2016 were used as a data source for the study. Data stratified all regions into urban and rural areas. Among 15, 680 representative selected households, the analysis included complete cases from 10, 641 children (0-59 months). The evaluation of model performance considered metrics such as the root mean square error, the mean absolute error, and the probability coverage of the corresponding 95% confidence intervals of the estimates.

RESULTS

Based on the values of root mean square error, mean absolute error, and probability coverage, the estimates obtained from the proposed model outperform the classical estimates. According to the result, 40.92% of the children were born with low birth weight. The study also found that low birth weight is unevenly distributed across different regions of the country with the highest amounts of variation observed in the Afar, Somali and Southern Nations, Nationalities, and Peoples regions as represented by the latent trait parameter of the model. In contrast, the lowest low birth weight variation was recorded in the Addis Ababa, Dire Dawa, and Amhara regions. Furthermore, there were significant associations between birth weight and several factors, including the age of the mother, number of antenatal care visits, order of birth and the body mass index as indicated by the average posterior beta values of (β1= -0.269, CI=-0.320, -0.220), (β2= -0.235, CI=-0.268, -0.202), (β3= -0.120, CI=-0.162, -0.074) and (β5= -0.257, CI=-0.291, -0.225).

CONCLUSIONS

The study showed that the low birth weight estimates obtained from the latent trait model outperform the classical estimates. The study also revealed that the prevalence of low birth weight varies between different regions of the country, indicating the need for targeted interventions in areas with a higher prevalence. To effectively reduce the prevalence of low birth weight and improve maternal and child health outcomes, it is important to concentrate efforts on regions with a higher burden of low birth weight. This will help implement interventions that are tailored to the unique challenges and needs of each area. Health institutions should take measures to reduce low birth weight, with a special focus on the factors identified in this study.

Confluence of Newborn's sex and their Mother's characteristics resulting in fetal macrosomia among Indian neonates

BACKGROUND

A newborn's birth weight ≥4000 g is defined as fetal macrosomia, which is recognized as a reproductive and serious child health concern.

OBJECTIVES

Our study aims to reveal existence of any connection between maternal factors and newborn sex in giving birth to newborn ≥4000 g in an Indian context.

METHODS

Data were drawn from the fifth round of National Family Health Survey (NFHS-5). A cross-sectional observational study was carried out with a total of 152,827 children born to women in reproductive age group (15-49) who had most recent live birth in the five years preceding the survey. Descriptive analyses, cross-tabulation, test of association and multivariate logistic regression analyses were performed.

RESULTS

In India, the prevalence of macrosomia was found in 3.8% of the total study participants. Considering newborn characteristics, fetal macrosomia was more prevalent among male neonates than female (AOR: 0.730; 95% CI: 0.687-0.775). Regarding maternal characteristics, overweight (AOR: 1.468; 95% CI: 2.042-2.559) and obese (AOR: 2.764; 95% CI: 2.394-3.192) motherswith gestational diabetes (AOR: 1.731, 95% CI: 1.385-2.164) and hypertension (AOR: 1.288, 95% CI: 1.116-1.488) were more likely to giving birth of macrosomic babies. Multiparous mothers (AOR: 1.207, 95% CI: 1.128-1.293) and women who did not undergo proper antenatal care (ANC) follow up had also greater risk of developing fetal macrosomia. Muslim women (AOR: 1.223, 95% CI: 1.119-1.338), and women belonging to a tribe (AOR: 1.476, 95% CI: 0.922-2.361) were significantly associated with the risk of having newborn ≥4000 g.

CONCLUSION

Emphasis should be given on counseling for mothers for desired weight management before and during pregnancy, gestational diabetes and hypertension screening, physical activity during pregnancy, adequate ANC follow up and balanced dietary intake among pregnant women.

Prevalence and Risk Factors for Newborn Anemia in Southwestern Uganda: A Cross-Sectional Study

Introduction

The global prevalence of maternal anemia is about 42%, and in sub-Saharan Africa, the prevalence of newborn anemia ranges from 25% to 30%. Anemia in newborn babies may cause complications such as delayed brain maturation and arrested growth. However, there is limited data on the prevalence of newborn anemia and its risk factors in people living in resource-limited settings.

Objectives

We determined the prevalence and risk factors for newborn anemia and its correlation with maternal anemia in southwestern Uganda.

Methods

This was a cross sectional study of 352 pregnant women presenting to the Mbarara Regional Referral Hospital for delivery. We collected maternal blood in labor and umbilical cord blood from the placental vein. We measured hemoglobin using a point-of-care Hemocue machine. We used summary statistics to characterize the study participants and compared demographic characteristics and outcomes using chi-square, t-test, and Wilcoxon rank sum analyses. We defined newborn anemia as umbilical cord hemoglobin <13 g/dl and measured the relationship between maternal and umbilical cord hemoglobin using linear regression analysis.

Results

The prevalence of newborn anemia was 17%. Maternal parity was significantly higher for anemic than nonanemic newborns (3 versus 2, P=0.01). The mean age in years (SD) was significantly lower for participants with umbilical cord hemoglobin <13 g/dl than those ≥13 g/dl (26 years [5.6] versus 28 [6.3], P=0.01). In multivariable linear regression analysis, a 1-point decrease in maternal hemoglobin was associated with a 0.14-point decrease in umbilical cord hemoglobin (P=0.02). Each one-unit increase in parity was associated with a 0.25-point decrease in umbilical cord hemoglobin (P=0.01). Cesarean delivery was associated with a 0.46-point lower umbilical cord hemoglobin level compared with vaginal delivery (P=0.03).

Conclusions

We found a significant association between maternal and newborn hemoglobin, underscoring the importance of preventing and correcting maternal anemia in pregnancy. Furthermore, maternal anemia should be considered a risk factor for neonatal anemia.

Prevalence and Associated Factors of Anemia among Newborns at Jimma Medical Center, South-west Ethiopia

Background

Newborn anemia is among the most common hematological problems and it can cause asymptomatic or severe to acute life-threatening events. It leads to impairment in brain maturation and development, tissue hypoxia, and stunted growth and then arrested growth if left untreated. The prevalence of anemia among newborns ranges from 23.4-66% in sub-Saharan Africa. But, there is limited information in Ethiopia regarding the prevalence of newborn anemia and its risk factors. Therefore, this study aimed to determine the prevalence of newborn anemia and its associated factors at Jimma Medical Center (JMC), South-west Ethiopia.

Methods

A hospital-based cross-sectional study design was implemented from January 14 to February 28, 2021, involving 288 full-term newborns by employing consecutive convenient sampling technique for study participant selection. Socio-demographic data and other associated factors were collected through interviews and a review of medical records by a structured questionnaire. Three mL umbilical cord blood samples from each newborn were collected and analyzed for a complete blood count by an automated hematological analyzer. Data were entered into Epi Data version 3.1 and exported to Statistical Package for Social Science version 20 for analysis. Binary logistic regression were used to identify the predictors of newborn anemia.

Results

The overall prevalence of anemia among newborns was 26.4%; of them, 65.8%, 25%, and 9.2% were mild, moderate, and severe anemia types, respectively. Maternal vegetable consumption habit (AOR = 0.26, 95% CI: 0.11, 0.62) and maternal anemia (AOR = 0.34, 95% CI: 0.17, 0.69) were significantly associated with anemia in newborns.

Conclusion

In general, newborn anemia in this study was a moderate public health problem. Based on this study, early screening of anemia among newborns may reduce further complications. Prevention of maternal anemia during pregnancy by improving their nutritional status especially vegetable consumption had a positive impact on reducing anemia among newborns.

Poor treatment outcome and associated factors of hyperglycemic emergencies among diabetic patients in Ethiopia: A systematic review and meta-analysis

Background

Despite the fact that hyperglycemic crisis poses a significant threat to the health care systems of developing countries like Ethiopia, there is a dearth of reliable data regarding the poor treatment outcome and associated factors among hyperglycemic emergencies in Ethiopia. Therefore, this review aimed to assess poor treatment outcome and associated factors of hyperglycemic emergencies among diabetic patients in Ethiopia.

Methods

Published articles regarding poor treatment outcome and associated factors of hyperglycemic emergencies among diabetic patients in Ethiopia were extensively searched from PubMed, Google Scholar, Cochrane library, and African journal online. After extraction, data were exported to Stata software version 11 (Stata Corp LLC, TX, USA) for analysis. Statistically, the Cochrane Q-test and I2 statistics were used to determine the presence or absence of heterogeneity.

Results

3650 duplicates were eliminated from the 4291 papers (PubMed [18], Google scholar (1170), African journal online [21], and Cochrane library (3082)). The pooled estimate of poor treatment outcome among hyperglycemic emergencies in Ethiopia is found to be 16.21% (95% CI: 11.01, 21.41, P < 0.001). Creatinine level >1.2 mg/dl, stroke, sepsis and comorbidity were associated factors of poor treatment outcome.

Conclusion

Poor treatment outcome from hyperglycemic emergencies among diabetic patients was found to be high. Poor treatment outcome was predicted for those patients who had creatinine level >1.2 mg/dl, stroke, sepsis and comorbidity. As a result, we recommend healthcare providers to monitor thoroughly and have close follow-ups for patients with the identified predictors to improve poor treatment outcome from hyperglycemic crises.

An overview of a preliminary multicenter retrospective study on food and drug allergies in Moroccan pediatric population

Introduction

this study aimed to investigate the prevalence and management of food allergies (FA) and drug allergies (DA) in Morocco. Sparse and conflicting epidemiological data exist on the exact prevalence of allergies in the country. The rise in allergies can be attributed to various factors.

Methods

the study analyzed data from patients with suspected FA and DA who sought medical attention. Statistical tests were used to analyze the data, percentages were computed for qualitative variables, and for quantitative variables, medians or means accompanied by standard deviations (SD) were calculated. The Chi-square test was employed to assess categorical variables. A p-value < 0.05 was considered statistically significant.

Results

Cow's milk was the most reported food allergen (58.2%), followed by egg and nuts (23.4% and 12.1%, respectively). The most affected age group was children under 5 years. Antibiotics were the leading cause of reported drug allergies (44.8%), particularly Beta-lactams. Immediate reactions were commonly associated with antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs). Symptoms of FA included acute urticaria, vomiting, anaphylactic shock, and facial edema. Urticaria was the most frequent symptom of DA. Antihistamines and corticosteroids were the main treatments used for both FA and DA.

Conclusion

the prevalence of FA and DA in Morocco remains uncertain due to limited data. There is a need for centralized data collection and awareness among clinicians and the general population regarding allergies. The study highlights the importance of proper diagnosis and management of allergies to ensure patient safety. The findings emphasize the necessity of establishing a mandatory center for allergy care in Morocco to improve the understanding and management of allergic conditions.

Risk factors associated with preterm birth among mothers delivered at Lira Regional Referral Hospital

BACKGROUND

The World Health Organization (WHO) defines Preterm Birth (PTB) as "a live birth taking place before the expected 37 weeks of gestation". Annually, approximately 15 million infants are born prematurely, constituting significantly to infant mortality during the initial four weeks of life, responsible for 40% of deaths among children under the age of five. Evidently, preterm deliveries have contributed to 46% of admissions to the neonatal intensive care unit (NICU) at Lira Regional Referral Hospital (LRRH) over the past three years. Paradoxically, while the prevalence of preterm births remains high, there is a lack of documented information regarding the underlying risk factors. Consequently, the primary objective of this study was to assess the potential risk factors associated with preterm birth at LRRH.

METHODS

An analytical cross-sectional research was undertaken at LRRH, employing a quantitative methodology. The study utilized secondary data obtained from a total of 590 comprehensive maternal medical records, of deliveries that occurred at the facility between April 2020 and July 2021. The collected data underwent analysis using STATA version 17 software. To identify predictors of preterm birth, a Logistic regression model was applied, yielding adjusted odds ratios (AOR) alongside 95% confidence intervals (CI). The significance level was set at p < 0.05 to establish statistical significance. Furthermore, assessments for multicollinearity and model fitness were conducted using the Variance Inflation Factor (VIF) and linktest, respectively.

RESULTS

The prevalence of preterm delivery among mothers who gave birth at LRRH stood at 35.8%. The outcomes of logistic regression analysis revealed that maternal employment status had a statistically significant association with preterm birth (AOR = 0.657, p = 0.037, 95%CI: 0.443-0.975); having a baby with low birth weight (AOR = 0.228, p < 0.001, 95% CI: 0.099-0.527) and experiencing preeclampsia (AOR = 0.142, p < 0.001, 95% CI: 0.088-0.229) were also identified as significant predictors of preterm birth in the study.

CONCLUSIONS AND RECOMMENDATIONS

The occurrence of preterm delivery is significantly higher (35.8%) among mothers who gave birth at LRRH when compared to the national average (13.6%). The prevalence of preterm birth among mothers was linked to factors such as employment status, delivery of low birth weight infants, and the presence of preeclampsia. Consequently, the research proposes a set of recommendations. Firstly, the Ministry of Health (MoH) should evaluate the present state of readiness within the healthcare system to effectively handle cases of preterm birth both within medical facilities and the community. Secondly, the Ministry of Gender, Labour, and Social Development should leverage Labor Officers to implement and uphold the regulations stipulated in the Employment Act and Labor Laws.

Endocrine manifestations of COVID-19 in children: A scoping review

In this review, we explore associations between SARS CoV-2 infection and the endocrine system and metabolism in children and adolescents. PubMed, Scopus and Google scholar databases were searched to identify published data on endocrine manifestations of COVID-19 in children up to 31 March 2023, including diabetes, obesity, puberty, thyroid disorders, adrenal disorders and pituitary disorders. Data on changes in disease pattern/ incidence, disease control, and other effects due to the COVID-19 pandemic, as well as effects of pre-existing endocrine conditions on severity of COVID-19 infection are presented, and practice points and research needs provided under each section.

Prevalence and risk factors for newborn anemia in southwestern Uganda: a prospective cohort study

Introduction

The global prevalence of anemia in pregnancy is about 42%, and in sub-Saharan Africa, the prevalence of newborn anemia ranges from 25-30%. Anemia in newborn babies may cause complications such as delayed brain maturation and arrested growth. However, there is limited data on prevalence of newborn anemia and its risk factors in people living in resource-limited settings.

Objectives

We determined the prevalence and risk factors for newborn anemia and its correlation with maternal anemia in southwestern Uganda.

Methods

This was a prospective cohort study of 352 pregnant women presenting to Mbarara Regional Referral Hospital for delivery. We collected maternal blood in labor and umbilical cord blood from the placental vein, as a proxy for newborn hemoglobin. We estimated hemoglobin using a point-of-care Hemocue machine. We used summary statistics to characterize the cohort, and compared demographic characteristics and outcomes using Chi-square, t-test, and Wilcoxon Ranksum analyses. We defined newborn anemia as umbilical cord hemoglobin < 13g/dl and estimated the relationship between maternal and umbilical cord hemoglobin using linear regression analysis, adjusting for potential confounders.

Results

The prevalence of newborn anemia was 17%. The average maternal parity was significantly higher for anemic and non-anemic newborns (3.5 versus 2.8, P = 0.01). Mean age [SD] was significantly lower for participants with umbilical cord hemoglobin < 13g/dl than those > = 13 g/dl, (26 [5.6] versus 28 [6.3], P = 0.01). In multivariable linear regression analysis, a 1-point decrease in maternal hemoglobin was associated with a 0.14-point decrease in umbilical cord hemoglobin (P = 0.02). Each one-unit increase in maternal parity was associated with a 0.25-point decrease in umbilical cord hemoglobin (P = 0.01). Cesarean delivery was associated with a 0.46-point lower umbilical cord hemoglobin level compared to vaginal delivery (P = 0.03).

Conclusions

We found a significant correlation between maternal and newborn hemoglobin levels, underscoring the importance of preventing and correcting maternal anemia in pregnancy. Furthermore, maternal anemia should be considered a risk factor neonatal anemia.

Effect of screen time on behavior of pre-schoolers in Islamabad

Objective

Early years of childhood form the basis of intelligence, personality, social behaviour, and capacity to learn and nurture oneself as an adult. Our objective was to find out the effects of screen time on behavior of pre-schoolers, which could provide scientific grounds to the control of digital screen time.

Method

A cross sectional survey was conducted in four private preschools of Islamabad from June -November 2021. A sample size of 200 children ages three-five years were selected through multistage random sampling using a parental questionnaire. Children were grouped based on daily screen time of ≤60 minutes or >60 minutes. Analysis was made based on the Child behavior checklist for ages eighteen months-five years results. Cronbach's alpha coefficient was found to be 0.925. It was analyzed using SPSS version 22. Chi-square test, independent sample t-test and multi linear regression were applied to determine the association and significance levels between the variables.

Results

Study results indicate increased screen time was statistically significant with child's age, education level and employment status of mothers. It was observed that pre-schoolers with screen time of > 60 minutes tend to suffer more from withdrawal syndrome (11.94±3.91, p = 0.014) sleep problems (10.97±3.20, p = 0.010) and Autism spectrum problems (17.66±5.89, p = 0.047) as compared to pre-schoolers with screen time ≤60 minutes. Strongest predictor of outcome variable was found to be mothers education level (ß = 21.53).

Conclusion

Study findings revealed that excessive screen time has deleterious effect and is associated with behavioural problems of pre-schoolers.

A New Artificial Intelligence Approach Using Extreme Learning Machine as the Potentially Effective Model to Predict and Analyze the Diagnosis of Anemia

The procedure to diagnose anemia is time-consuming and resource-intensive due to the existence of a multitude of symptoms that can be felt physically or seen visually. Anemia also has several forms, which can be distinguished based on several characteristics. It is possible to diagnose anemia through a quick, affordable, and easily accessible laboratory test known as the complete blood count (CBC), but the method cannot directly identify different kinds of anemia. Therefore, further tests are required to establish a gold standard for the type of anemia in a patient. These tests are uncommon in settings that offer healthcare on a smaller scale because they require expensive equipment. Moreover, it is also difficult to discern between beta thalassemia trait (BTT), iron deficiency anemia (IDA), hemoglobin E (HbE), and combination anemias despite the presence of multiple red blood cell (RBC) formulas and indices with differing optimal cutoff values. This is due to the existence of several varieties of anemia in individuals, making it difficult to distinguish between BTT, IDA, HbE, and combinations. Therefore, a more precise and automated prediction model is proposed to distinguish these four types to accelerate the identification process for doctors. Historical data were retrieved from the Laboratory of the Department of Clinical Pathology and Laboratory Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia for this purpose. Furthermore, the model was developed using the algorithm for the extreme learning machine (ELM). This was followed by the measurement of the performance using the confusion matrix and 190 data representing the four classes, and the results showed 99.21% accuracy, 98.44% sensitivity, 99.30% precision, and an F1 score of 98.84%.

Determinants of maternal healthcare utilisation among pregnant women in Southern Ethiopia: a multi-level analysis

BACKGROUND

Despite efforts to make maternal health care services available in rural Ethiopia, utilisation status remains low. Therefore, this study aimed to assess maternal health care services' status and determinants in rural Ethiopia.

METHODS

The study used quasi-experimental pre- and post-comparison baseline data. A pretested, semi-structured, interviewer-administered questionnaire was used to collect data. A multilevel, mixed-effects logistic regression was used to identify individual and communal level factors associated with utilisation of antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). The adjusted odds ratio (AOR) and corresponding 95% confidence intervals (CI) were estimated with a p-value of less than 0.05, indicating statistical significance.

RESULTS

Seven hundred and twenty-seven pregnant women participated, with a response rate of 99.3%. Four hundred and sixty-one (63.4%) of the women visited ANC services, while 46.5% (CI: 42-50%) of births were attended by SBA, and 33.4% (CI: 30-36%) had received PNC. Women who reported that their pregnancy was planned (aOR = 3.9; 95% CI: 1.8-8.3) and were aware of pregnancy danger signs (aOR = 6.8; 95% CI: 3.8-12) had a higher likelihood of attending ANC services. Among the cluster-level factors, women who lived in lowlands (aOR = 4.1; 95% CI: 1.1-14) and had easy access to transportation (aOR = 1.9; 95% CI: 1.1-3.7) had higher odds of visiting ANC services. Moreover, women who were employed (aOR = 3.1; 95% CI: 1.3-7.3) and attended ANC (aOR = 3.3; 95% CI: 1.8-5.9) were more likely to have SBA at delivery. The likelihood of being attended by SBA during delivery was positively correlated with shorter travel distances (aOR = 2.9; 95% CI: 1.4-5.8) and ease of access to transportation (aOR = 10; 95% CI: 3.6-29) to the closest healthcare facilities. Being a midland resident (aOR = 4.7; 95% CI: 1.7-13) and having SBA during delivery (aOR = 2.1; 95% CI: 1.2-3.50) increased the likelihood of attending PNC service.

CONCLUSIONS

Overall, maternal health service utilisation is low in the study area compared with the recommended standards. Women's educational status, awareness of danger signs, and pregnancy planning from individual-level factors and being a lowland resident, short travel distance to health facilities from the cluster-level factors play a crucial role in utilising maternal health care services. Working on women's empowerment, promotion of contraceptive methods to avoid unintended pregnancy, and improving access to health care services, particularly in highland areas, are recommended to improve maternal health service utilisation.

Postnatal Care Utilization and Associated Factors among Mothers who gave Birth in the Aysaeta District, Northeast Ethiopia: A Community Based Cross-sectional Study

Background

Postnatal care is given to mothers and newborn babies within 42 days of delivery. It is a period of high maternal and newborn mortality and is also the most neglected in terms of maternal health services in many parts of the world. This study aimed to assess postnatal care and associated factors among mothers who gave birth in the year preceding the survey of the Ayssaeta district.

Methods

A community-based cross-sectional study was conducted among 406 mothers who gave birth in the year preceding the survey from August 02-30, 2020. Bivariable and multivariable logistic regression analyses were done to identify factors associated with postnatal care utilization.

Results

Slightly greater than four out of ten mothers have visited postnatal care units at least once. Living in urban areas, giving birth in a health facility, having complications during labor and after, and getting advice during antenatal care visits were associated with higher odds of postnatal care utilization.

Conclusion

Less than half of the mothers received postnatal care following the delivery of their last child. Living in an urban, place of delivery, experiencing labor and postpartum complications, and receiving postnatal care advice during antenatal care have affected the utilization of postnatal care. Promoting skilled delivery and antenatal care with a focus on rural areas can help mothers learn about postnatal care and increase the number of mothers who use it.

Lactobacillus rhamnosus Sepsis Associated with Probiotic Therapy in a Term Infant with Congenital Heart Disease

BACKGROUND

Congenital heart diseases (CHD) are the most common birth defects. Necrotizing enterocolitis (NEC) is an important cause of morbidity and mortality in premature infants, and probiotics can be used to protect NEC.

CASE REPORT

We present a term infant with aortic coarctation who developed sepsis with Lactobacillus rhamnosus GG after probiotic use, successfully treated with ampicillin. The baby unfortunately died of acute cardiac arrest on the 90th day of life.

CONCLUSION

Probiotic-associated sepsis may develop in infants with various risk factors such as central catheterization, long-term mechanical ventilation and in those at risk for NEC.

An evaluation of abrocitinib for moderate-to-severe atopic dermatitis

INTRODUCTION

Atopic dermatitis (AD) is a common itchy inflammatory skin condition that affects many individuals. For many years, the landscape of AD treatment remained unchanged; however, there has been developing therapies that directly target the underlying immunological mechanism of AD. Janus kinase (JAK) inhibitors are small molecules that have shown anti-inflammatory and anti-itch effects in AD. Recently, abrocitinib, an oral JAK 1 inhibitor, was approved by the Food and Drug Administration for atopic dermatitis.

AREAS COVERED

By downregulating the immune cascade, abrocitinib has demonstrated the ability to curb symptoms of AD, including rapidly reducing pruritus in 2-3 days, and is safe and well-tolerated overall despite a low increased risk in infection. The data discussed was obtained from a comprehensive literature review utilizing PubMed.

EXPERT OPINION

Abrocitinib has strong efficacy, likely due to its broader mechanism of action provided by the inhibition of key regulatory molecule, JAK. Results have demonstrated that it is more efficacious at curbing symptoms of AD than dupilumab, the current treatment of choice for refractory, moderate-to-severe AD. While abrocitinib provides a great alternative treatment, particularly for non-responders and AD subtypes, it also demonstrates a stronger side effect profile that must be considered.

The effect of maternal anaemia on low birth weight among newborns in Northwest Ethiopia

Low birth weight is an indicator of maternal-related multifactorial problems such as malnutrition, illness, and work overload. As a result, low birth weight is associated with maternal anaemia, and both of them were significant public health issues in developing nations. Low birth weight and anaemia are caused by insufficient nutrient intake, which is especially severe during pregnancy. So, this study aimed to assess the effect of maternal anaemia during the late trimester on low birth weight among newborns in Northwest Ethiopia. A systematic random sampling technique was used to select 211 participants for the primary data collection. Face-to-face interviews were used to collect data, while blood samples were collected using standard operating procedures. For further analysis, the data file was imported into Stata version 16 (MP) software. The binary logistic regression model was used to investigate significant factors related to low birth weight. Finally, the statistical significance of the variables was determined using a p value of ≤ 0.05. The prevalence of anaemia among pregnant women in the late trimester and newborns was 34 (16.11%, 95% CI: 11.42, 21.78) and 64 (30.33%, 95% CI: 24.20, 37.01), respectively. The mean ± standard deviation of the newborn babies' weight was 3.19 ± 0.49 kg. The proportion of low birth weight among newborns was 26 (12.32%, 95% CI: 8.20, 17.53%). The independent effect of anaemia on low birth weight was 4.19 times while all other factors were constant (COR = 4.19, 95% CI: 1.70, 10.30). Maternal educational status [unable to read and write (AOR = 10.94, 95% CI: 1.74, 68.58) and attained secondary education (AOR = 8.06, 95% CI: 1.53, 42.36)], and maternal anaemia (AOR = 3.51, 95% CI: 1.29, 9.55) were associated with low birth weight after adjusting with all other variables. In this study, the proportion of low birth weight was high. Here, maternal anaemia alone had a significant independent role in the development of low birth weight. Maternal education status and anaemic conditions were associated with low birth weight among newborns. Early detection and treatment of maternal anaemia during pregnancy is crucial with the usual nutritional-related care.

Prevalence and Associated Factors of Anemia Among Newborns at Tibebe Ghion Specialized Hospital, Northwest Ethiopia

Introduction

Anemia is a common hematological problem in neonatal admissions. Poor detection rate and inappropriate treatment adversely affect the growing infant. Data on the magnitude and risk factors of anemia in sick newborns are lacking in Ethiopia, so knowing the prevalence and risk factors may reduce the long-term untreated complications of anemia.

Objective

The overall aim of this study was to assess the prevalence and associated factors of anemia among newborns admitted to Tibebe Ghion specialized hospital.

Methods

A hospital-based cross-sectional study was conducted among 272 newborns admitted to Tibebe Ghion Specialized Hospital from February 1 to May 30, 2021. A pretested structured questionnaire containing socio-demographic, clinical, and laboratory parameters was used for the data collection. Data were collected by trained nurses and residents after obtaining ethical clearance. The data were entered through Epi-data version 4.6 and analyzed using SPSS version 23.0 computer software. Descriptive statistics were performed using frequency, mean and standard deviation. Bivariable and multivariable binary logistic regressions were done to identify risk factors of anemia. Adjusted odds ratio with 95% confidence interval at a p-value <0.05 was declared as a statistically significant variable in the multivariable logistic regression.

Results

About two-thirds 177 (65.1%) of the newborn babies were male and 152 (55.9%) of the newborn had a birth weight of ≥2500 grams. The most commonly diagnosed medical conditions were sepsis 218 (80.1%) and prematurity of birth 78 (28.7%). The prevalence of anemia among newborns in this study was 63 (23.2%) [19.1–28.7%]. Gestational age of 33–36 weeks (AOR=0.36: 95% CI=0.17–0.96) and maternal anemia (AOR=3.81: 95% CI=1.29–11.23) were significantly associated with newborn anemia.

Conclusion

The prevalence of anemia among newborns in Tibebe Ghion specialized hospital was high. Gestational age and maternal anemia were significantly associated with newborn anemia. So, it is better to properly educate and advise women about newborn anemia during antenatal care follow-up.

Uptake of postnatal care and its determinants in Ethiopia: a positive deviance approach

BACKGROUND

Postnatal care (PNC) services are an essential intervention for improving maternal and child health. In Ethiopia, PNC service has been poorly implemented, despite the governments and partners' attempt to improve maternal and child health service utilization. Moreover, many literatures identified that women with no education are significantly underutilized the PNC services. Thus, this study aimed to assess the PNC service uptake among women at high risk for underutilization of PNC services and to identify the individual and community level determinants of PNC services uptake in Ethiopia using the positive deviance approach.

METHODS

Data from the Ethiopia Demographic and Health Survey 2016 were used. A total of 2417 deviant women (women with no education) were identified through a two-stage stratified sampling technique and included in this analysis. A multilevel mixed-effect binary logistic regression analysis was computed to identify the individual and community-level determinants of PNC services uptake among deviant women. In the final model, a p-value of less than 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to declare statistically significant determinants of PNC services uptake.

RESULTS

In this analysis, the uptake of PNC service among deviant women was 5.8% [95% CI: 4.9-6.8]. Working in the agriculture (AOR = 2.15, 95% CI: 1.13-3.52), being Orthodox religion follower (AOR = 2.56, 95% CI: 1.42-4.57), living in the highest wealth quantile (AOR = 2.22, 95% CI: 1.25-3.91) were the individual level determinants, whereas residing in the city administration (AOR: 3.17, 95% CI: 1.15-8.71), and living closer to health facility (AOR: 1.57, 95% CI: 1.03-2.39) were the community level determinants.

CONCLUSION

The study highlighted a better PNC service uptake among deviant women who are working in the agriculture, follows orthodox religion, lives in highest household wealth status, resides in city administration, and living closer to the health facility. The positive deviance approach provides evidences for health policy makers and program implementers to improve health behavior in specific target population, and ultimately to bring better maternal and child health outcomes, despite acknowledged adverse risk profile. Such strategy and knowledge could facilitate targeted efforts aimed at achieving national goals of maternal and newborn mortality reduction in the country.

High Magnitude of Neonatal Anemia Among Sick Newborns Admitted to University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Introduction

Anemia is a global health problem that affects all ages, particularly children under five years. If not treated early, childhood anemia results in impaired growth, delayed cognitive development, and organ dysfunction. There is a scarcity of studies on the prevalence of anemia among hospitalized sick neonates, especially in developing countries.

Objective

This study aimed to determine the magnitude of anemia and associated factors among hospitalized sick newborns at the University of Gondar Comprehensive Specialized Hospital (UOGCSH).

Methods

An institutional-based cross-sectional study was conducted among admitted newborns from June 1 to September 30, 2020. All newborns whose gestational age (GA) ≥28 weeks and postnatal age ≤28 days, admitted to UOGCSH during the study period were included in the study. Data were collected by pediatric residents and a systematic random sampling technique was used to select the study participants. Statistical analysis was performed using SPSS version 20. Binary logistic regression was used to identify associated factors with neonatal anemia. P-value <0.05 was considered statistically significant.

Results

During the study period, 272 newborns were enrolled. The mean hemoglobin value was 15.74 ± 4.27 gm/dL. The prevalence of neonatal anemia in the study population was 30.1% (95% CI: 24.6-35.7). Neonatal age >7 days (AOR = 4.41, 95% CI: 1.86-10.5), maternal anemia (AOR = 9.93, 95% CI: 4.36-21.6), antepartum hemorrhage (AOR = 4.05, 95% CI: 1.54-10. 7), being multiple births (AOR = 4.70, 95% CI: 1.73-12.8), subgaleal hemorrhage (AOR = 7.56, 95%: 1.87-30.6), and hyperbilirubinemia (AOR = 3.84, 95% CI: 1.58-9.31) were associated with neonatal anemia.

Conclusion and Recommendation

The prevalence of anemia among hospitalized newborns was high. The current study recommends that healthcare providers should screen anemia among sick newborns who had risk factors. Prevention of maternal anemia and early treatment of obstetric complications will reduce the burden of anemia in sick neonates.

Social Consequences of the COVID-19 Pandemic. A Systematic Review

OBJECTIVES

To provide a systematic review of the social consequences of COVID-19 pandemic.

METHODS

In the present study, articles indexed in Persian and Latin databases (Web Of Science, Scopus, PubMed, Embase, Google Scholar and Magiran). 43 documents published in the last 3 years in Persian or English language were reviewed. The research steps were performed according to PRISMA writing standard and the quality assessment was done by two researchers independently with Newcastle Ottawa Scale tools for observational studies according to the inclusion criteria.

RESULTS

Measures to break the chain of virus transmission and to control the COVID-19 pandemic have caused major problems in the economic, social, political and psychological spheres and have affected billions of people worldwide. The COVID-19 pandemic crisis has caused widespread unrest in society and unprecedented changes in lifestyle, work and social interactions, and increasing social distance has severely affected human relations.

CONCLUSIONS

The COVID-19 pandemic has social consequences in certain groups can exacerbate their unfavorable situation. Special groups in crisis situations should be given more attention, and clear and precise policies and programs should be developed to support them.

Case report: Morphological changes evident after manual therapy in two cases of late-diagnosed developmental dysplasia of the hip

BACKGROUND

Late diagnosed Developmental Dysplasia of the Hip (DDH) is the detection of DDH after 3 months of age and is associated with significantly poorer outcomes than when diagnosed and managed early. Late diagnosed DDH has lower rates of success with bracing, higher rates of surgery and higher rates of complications, including avascular necrosis of the femoral head and early osteoarthritis of the hip. We describe two cases of late-diagnosed DDH which demonstrated changes in femoroacetabular joint morphology on radiographic interpretation after a 6-month trial period of manual therapy.

CASE PRESENTATION

Two cases (13 and 30 months of age) with late-diagnosed DDH presented to a private chiropractic clinic for conservative, non-bracing management. One case had unilateral DDH and the other bilateral DDH. A trial of manual therapy was utilized over a 6-month period. Both cases demonstrated changes to femoroacetabular morphology as well as improvements in gross motor activity and lower extremity muscle tone.

CONCLUSION

Manual therapy, as an adjunct or alternative to static bracing, may be of benefit in individuals with late-diagnosed DDH not responding to bracing, and prior to more invasive interventions. Additional cases of manual therapy-based management of this condition are required to inform the design of future trials to investigate this hypothesis.

Assessment of Hearing Loss in Two-Year Follow-up Study of Neonates with Congenital Cytomegalovirus Infection

Objectives

Congenital Cytomegalovirus (cCMV) infection constitutes the main cause of sensory neural hearing loss (SNHL) worldwide. The rate of Cytomegalovirus (CMV)-induced SNHL is not well documented in developing countries, such as Iran. Therefore, this prospective follow-up study aimed to evaluate this rate among neonates with cCMV infection in Iran.

Materials & Methods

Neonates with cCMV infection admitted to neonatal intensive care units and neonates with CMV infection identified in two other prospective screening studies in Tehran, Iran, were enrolled in this study. Audiological assessments, including otoacoustic emission and auditory brainstem response tests, were performed for all the cases. Antiviral therapy was administered for the newborns in case of having severe symptoms.

Results

A total of 22 neonates with cCMV infection were entered into the study, of whom 8 and 14 subjects had symptomatic and asymptomatic cCMV infection, respectively. In total, 3 of 22 newborns had SNHL (13.6%; 95% CI: 2.8-39.8), 2 of 8 cases with symptomatic cCMV infection (25.0%; 95% CI: 3-90) and 1 of 14 cases with asymptomatic cCMV infection (7.1%; 95% CI: 0.1-39). No association was observed between SNHL and CMV-related risk factors in newborns.

Conclusion

The findings of this study revealed that the rate of cCMV-induced SNHL is high among neonates born in Tehran. The severe sequelae of cCMV infection indicate the need for screening for CMV infection at birth to reduce the risk of CMV complications and the financial load of treatment imposed on healthcare and treatment systems in Iran.

Developments in pediatrics in 2020: choices in allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, ortopedics, respiratory tract illnesses and rheumatology

In this article, we describe the advances in the field of pediatrics that have been published in the Italian Journal of Pediatrics in 2020. We report progresses in understanding allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, orthopedics, respiratory tract illnesses, rheumatology in childhood.

Prevalence of Anemia and Associated Factors Among Term Newborns in Nekemte Specialized Hospital, Western Ethiopia

Background

Anemia is a global public health problem that affects approximately one-third of the global population. Infants and children are the ones to develop both short-term and long-term devastating complications from anemia. Although anemia is a very big public health concern, newborns, especially in developing countries, are usually overlooked and undiagnosed.

Purpose

The aim of this study was to assess the prevalence of anemia and associated factors among term newborns in Nekemte Specialized Hospital, Western Ethiopia.

Methods

A facility-based cross-sectional study involving 278 newborns was conducted from October to November, 2020 with an interview-based questionnaire that included maternal socio-demographic and obstetrics characteristics, newborn’s weight and sex. The data were analyzed with SPSS version 20. The prevalence of newborn anemia was shown in percentage and as a pie-chart. Bivariate analysis and binary logistic regression were used to identify the predictors of anemia in the term newborn.

Results

The overall prevalence of newborn anemia in the hospital was 29.1%. Maternal anemia (AOR: 3.95, 95% C.I.: 1.97–7.92), delivery by cesarean section (AOR: 4.17, 95% C.I.: 1.89–9.20), vaginal bleeding during pregnancy (AOR: 5.43, 95% C.I.: 1.60–18.39), and maternal failure to take iron-folate supplements during pregnancy (AOR: 2.17, 95% C.I.:1.07–4.41) were factors associated with newborn anemia.

Conclusion

Anemia among newborns in the hospital was a moderate public health problem. Policy makers should consider maternal health education and appropriate health interventions to reduce the problem. In addition, further longitudinal studies are needed to identify specific causes of newborn anemia in order to prevent the possible complications.

Evaluation of soft skills among Italian Healthcare Rehabilitators: A cross sectional study

BACKGROUND

Healthcare rehabilitator skills can be grouped into hard and soft skills. Hard skills are specific and teachable, which can be defined and measured, while soft skills are less tangible and more difficult to quantify. The aim of this study is to investigate the level of knowledge of soft skills among Italian healthcare rehabilitators, and how they were acquired.

DESIGN AND METHODS

Two hundred healthcare rehabilitators, who worked in Southern Italy were enrolled from September 1st to October 31st 2017, and interviewed with Computer-Assisted-Web-Interview (CAWI) software, to assess their level of soft skills.

RESULTS

Healthcare rehabilitators showed significant satisfaction with university education (59.5%), particularly for theoretical training (64%), while significant dissatisfaction was found for technical-practical training (63.5%), training in patients' family management (66.5%) and stages participation to improve soft skills (59%). Dissatisfied rehabilitators were found for university education of soft skills (59%), particularly for interpersonal relationships with patients family (66.5%) and technical-practical train in(63.5%). Women considered the training courses about soft skills acquisition more useful than men (43.8%).

CONCLUSIONS

Healthcare rehabilitator training is lacking in the teaching of both technical-practical and soft skills. It is striking that in a healthcare profession like that of the rehabilitator, where practical and empathic skills are fundamental in the relationship with the patients, such skills are not treated in analogously with theoretical training.

Determinants of completing recommended antenatal care utilization in sub-Saharan from 2006 to 2018: evidence from 36 countries using Demographic and Health Surveys

BACKGROUND

Every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth, with 99% of these maternal deaths occurring in low and lower-middle-income countries. Sub-Saharan Africa (SSA) alone accounts for roughly 66%. If pregnant women gained recommended ANC (Antenatal Care), these maternal deaths could be prevented. Still, many women lack recommended ANC in sub-Saharan Africa. This study aimed at determining the pooled prevalence and determinants of recommended ANC utilization in SSA.

METHODS

We used the most recent standard demographic and health survey data from the period of 2006 to 2018 for 36 SSA countries. A total of 260,572 women who had at least one live birth 5 years preceding the survey were included in this study. A meta-analysis of DHS data of the Sub-Saharan countries was conducted to generate pooled prevalence, and a forest plot was used to present it. A multilevel multivariable logistic regression model was fitted to identify determinants of recommended ANC utilization. The AOR (Adjusted Odds Ratio) with their 95% CI and p-value ≤0.05 was used to declare the recommended ANC utilization determinates.

RESULTS

The pooled prevalence of recommended antenatal care utilization in sub-Saharan Africa countries were 58.53% [95% CI: 58.35, 58.71], with the highest recommended ANC utilization in the Southern Region of Africa (78.86%) and the low recommended ANC utilization in Eastern Regions of Africa (53.39%). In the multilevel multivariable logistic regression model region, residence, literacy level, maternal education, husband education, maternal occupation, women health care decision autonomy, wealth index, media exposure, accessing health care, wanted pregnancy, contraceptive use, and birth order were determinants of recommended ANC utilization in Sub-Saharan Africa.

CONCLUSION

The coverage of recommended ANC service utilization was with high disparities among the region. Being a rural residence, illiterate, low education level, had no occupation, low women autonomy, low socioeconomic status, not exposed to media, a big problem to access health care, unplanned pregnancy, not use of contraceptive were determinants of women that had no recommended ANC utilization in SSA. This study evidenced the existence of a wide gap between SSA regions and countries. Special attention is required to improve health accessibility, utilization, and quality of maternal health services.

SARS-CoV-2 pandemia in Lombardy: the impact on family Paediatricians

As health care workers (HCWs) who care for children, who usually demonstrate milder symptoms than adults, family paediatricians have an increased risk of exposure to coronavirus. In April 2020, the Sindacato Medici Pediatri di Famiglia (SIMPeF), provided its members with rapid tests to detect antibodies against SARS-CoV-2; 1240 individuals, including 377 paediatricians, 108 staff members of pediatric clinics, and 755 cohabitant relatives of paediatricians, were tested in Lombardy, the most affected Italian region. The global prevalence of IgG antibodies in these individuals was 20.7%, which is higher than that of the general population and other HCWs. More than 70% of subjects with IgG antibodies presented symptoms, and 4.9% needed hospitalization. In addition, 64.2% of the study participants reported close contacts with a suspected case of COVID-19, while 72.9% of the family paediatricians reported occupational exposure to the disease. The initiative of the SIMPeF has been useful in assessing the impact of the COVID-19 pandemic on paediatric settings, as well as in raising paediatricians' awareness of the spreading of coronavirus.