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Cellich P, Unger HW, Rogerson SJ, Mola GDL. Impact on pregnancy outcomes of intermittent preventive treatment with sulfadoxine-pyrimethamine in urban and peri-urban Papua New Guinea: a retrospective cohort study. Malar J 2024; 23:201. [PMID: 38970076 PMCID: PMC11225125 DOI: 10.1186/s12936-024-05010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/04/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) reduces malaria-attributable adverse pregnancy outcomes and may also prevent low birth weight (< 2,500 g) through mechanisms independent of malaria. Malaria transmission in Papua New Guinea (PNG) is highly heterogeneous. The impact of IPTp-SP on adverse birth outcomes in settings with little or no malaria transmission, such as PNG's capital city Port Moresby, is unknown. METHODS A retrospective cohort study was conducted amongst HIV-negative women with a singleton pregnancy who delivered at Port Moresby General Hospital between 18 July and 21 August 2022. The impact of IPTp-SP doses on adverse birth outcomes and anaemia was assessed using logistic and linear regression models, as appropriate. RESULTS Of 1,140 eligible women amongst 1,228 consecutive births, 1,110 had a live birth with a documented birth weight. A total of 156 women (13.7%) did not receive any IPTp-SP, 347 women (30.4%) received one, 333 (29.2%) received two, and 304 (26.7%) received the recommended ≥ 3 doses of IPTp-SP. A total of 65 of 1,110 liveborn babies (5.9%) had low birth weight and there were 34 perinatal deaths (3.0%). Anaemia (haemoglobin < 100 g/L) was observed in 30.6% (243/793) of women, and 14 (1.2%) had clinical malaria in pregnancy. Compared to women receiving 0-1 dose of IPTp-SP, women receiving ≥ 2 doses had lower odds of LBW (adjusted odds ratio [aOR] 0.50; 95% confidence interval [CI] 0.26, 0.96), preterm birth (aOR 0.58; 95% CI 0.32, 1.04), perinatal death (aOR 0.49; 95% CI 0.18, 1.38), LBW/perinatal death (aOR 0.55; 95% CI 0.27, 1.12), and anaemia (OR 0.50; 95% CI 0.36, 0.69). Women who received 2 doses versus 0-1 had 45% lower odds of LBW (aOR 0.55, 95% CI 0.27, 1.10), and a 16% further (total 61%) reduction with ≥ 3 doses (aOR 0.39, 95% CI 0.14, 1.05). Birth weights for women who received 2 or ≥ 3 doses versus 0-1 were 81 g (95% CI -3, 166) higher, and 151 g (58, 246) higher, respectively. CONCLUSIONS Provision of IPTp-SP in a low malaria-transmission setting in PNG appears to translate into substantial health benefits, in a dose-response manner, supporting the strengthening IPTp-SP uptake across all transmission settings in PNG.
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Affiliation(s)
- Philip Cellich
- Division of Obstetrics and Gynaecology, School of Medicine and Health Sciences, Port Moresby General Hospital, University of Papua New Guinea, Port Moresby, Papua New Guinea.
- Department of Obstetrics and Gynaecology, Canterbury Hospital, 575 Canterbury Road, Campsie 2194, NSW, Australia.
| | - Holger W Unger
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina 0810, NT, Australia.
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT, Australia.
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
- Department of Infectious Diseases, University of Melbourne, The Doherty Institute, Melbourne, VIC, Australia.
| | - Stephen J Rogerson
- Department of Infectious Diseases, University of Melbourne, The Doherty Institute, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, The Doherty Institute, Melbourne, VIC, Australia
| | - Glen D L Mola
- Division of Obstetrics and Gynaecology, School of Medicine and Health Sciences, Port Moresby General Hospital, University of Papua New Guinea, Port Moresby, Papua New Guinea
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
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Mekonnen Y, Wolde E, Bekele A, Mehari Z, Abebe S, Hagos T, Tadesse Y, Taye T, Asire G, Nigatu T, Kumar S, Girma S, Salasibew M. Effect of the enhancing nutrition and antenatal infection treatment (ENAT) intervention on birth weight in Ethiopia: a cluster randomized controlled trial. BMC Pregnancy Childbirth 2023; 23:620. [PMID: 37644454 PMCID: PMC10466862 DOI: 10.1186/s12884-023-05912-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The Enhancing Nutrition and Antenatal Infection Treatment (ENAT) intervention was implemented in Ethiopia to improve newborn birth weight (BW) by strengthening the contents and quality of antenatal care (ANC), especially point-of-care testing for maternal infections. This study examined the effect of the ENAT intervention on birth weight. METHODS We conducted a cluster randomized controlled trial of 22 clusters (health centers), randomized equally between 11 intervention and 11 control clusters. This study enrolled and followed pregnant women from ANC booking to the end of pregnancy or loss to follow-up. The primary outcome was mean BW, and the incidence of low birth weight (LBW) was the secondary outcome. We presented univariate comparisons of outcomes between the intervention and control arms for mean BW and LBW. Multilevel analyses using random effects models were performed to adjust for clustering and individual-level covariates. RESULTS We enrolled and followed up 4,868 and 4,821 pregnant women in the intervention and control arms, respectively, from March 2021-July 2022. During follow-up, 3445 pregnant women in the intervention and 3192 in the control delivered in the health centers, and BW measurements of their babies were recorded within 48 h. The mean BW was 3,152 g (standard deviation (SD) = 339.8 g) in the intervention and 3,044 g (SD = 353.8 g) in the control arms (mean difference, 108 g; 95% confidence interval (CI): 91.3-124.6; P = 0.000). Adjusting for clustering and several covariates, the mean BW remained significantly higher in the intervention arm than in the control arm (adjusted ß coef., 114.3; p = 0.011). The incidence of LBW was 4.7% and 7.3% in the intervention and control arms, respectively. The adjusted risk of LBW was significantly lower by 36% in the intervention arm than in the control arm (adjusted relative risk, 0.645; p = 0.027). CONCLUSION This study provided sufficient evidence of the effectiveness of the ENAT intervention in improving birth weight in the study population. The intervention demonstrated that an increase in birth weight can be attained by availing point-of-care testing, strengthening infection prevention, and maternal nutrition within the ANC platform of public health facilities in a low-income setting. TRIAL REGISTRATION Registered at Pan African Clinical Trial Registry (PACTR) database dated 09/05/2023, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25493 . The unique identification number for the registry is PACTR202305694761480.
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Affiliation(s)
- Y Mekonnen
- Mela Research, P.O. Box 34422, Addis Ababa, Ethiopia
| | - E Wolde
- Mela Research, P.O. Box 34422, Addis Ababa, Ethiopia
| | - A Bekele
- Children’s Investment Fund Foundation (CIFF), Addis Ababa, UK
| | - Z Mehari
- Children’s Investment Fund Foundation (CIFF), Addis Ababa, UK
| | - S Abebe
- Jhpiego Ethiopia, Addis Ababa, Ethiopia
| | - T Hagos
- Mela Research, P.O. Box 34422, Addis Ababa, Ethiopia
| | - Y Tadesse
- Jhpiego Ethiopia, Addis Ababa, Ethiopia
| | - T Taye
- Children’s Investment Fund Foundation (CIFF), Addis Ababa, UK
| | - G Asire
- Jhpiego Ethiopia, Addis Ababa, Ethiopia
| | - T Nigatu
- John Snow Inc., Addis Ababa, Ethiopia
| | - S Kumar
- Jhpiego Ethiopia, Addis Ababa, Ethiopia
| | - S Girma
- Jhpiego Ethiopia, Addis Ababa, Ethiopia
| | - M Salasibew
- Children’s Investment Fund Foundation (CIFF), Addis Ababa, UK
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Engdaw GT, Tesfaye AH, Feleke M, Negash A, Yeshiwas A, Addis W, Angaw DA, Engidaw MT. Effect of antenatal care on low birth weight: a systematic review and meta-analysis in Africa, 2022. Front Public Health 2023; 11:1158809. [PMID: 37441651 PMCID: PMC10335749 DOI: 10.3389/fpubh.2023.1158809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/25/2023] [Indexed: 07/15/2023] Open
Abstract
Background Risk identification, as well as the prevention and management of diseases associated with pregnancy or other conditions that may occur concurrently, is the essential component of ANC. Method The observational follow-up and cross-sectional studies on the effect of antenatal care on low birth weight in Africa were conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Five computerized bibliographic databases: Google Scholar, PubMed, Scopus, Cochrane Library, and Hinari Direct were searched for published studies written in English till May 2022. The risk of bias assessment tools developed by the Joanna Briggs Institute for cross-sectional and observational follow-up research was used, and the caliber of each included study was assessed. Seven papers were included, with a total of 66,690 children participating in the study. Results Seven studies met the selection criteria. Prenatal care and low birth weight were linked in four of the seven studies included in the review. The pooled odd ratio for low birth weight in the random-effects model was 0.46 (95% CI: 0.39, 0.53). The pooled odds ratio for low birth weight was 0.21 (95% CI: 0.19, 0.22) and 0.21 (95% CI: 0.19, 0.22), respectively, among pregnant women who had no antenatal care follow-up and those who had antenatal care follow up. Conclusion Women who attended at least one antenatal care appointment were more likely than their counterparts to have a baby of normal weight. Interventions to reduce low birth weight in Africa should focus on providing adequate antenatal care and quality healthcare services to women with low socioeconomic status.
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Affiliation(s)
- Garedew Tadege Engdaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amensisa Hailu Tesfaye
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Maru Feleke
- Amhara Regional Health Beauro, Wogera Primary Hospital, Northwest, Ethiopia
| | - Aragaw Negash
- Amhara Regional Health Beauro, Wogera Primary Hospital, Northwest, Ethiopia
| | - Amanuel Yeshiwas
- Amhara Regional Health Beauro, Wogera Primary Hospital, Northwest, Ethiopia
| | - Wabiw Addis
- Amhara Regional Health Beauro, Wogera Primary Hospital, Northwest, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Tadege Engidaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Neupane S, Scott S, Piwoz E, Kim SS, Menon P, Nguyen PH. More is not enough: High quantity and high quality antenatal care are both needed to prevent low birthweight in South Asia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001991. [PMID: 37289728 DOI: 10.1371/journal.pgph.0001991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/05/2023] [Indexed: 06/10/2023]
Abstract
Antenatal care (ANC) is an opportunity to receive interventions that can prevent low birth weight (LBW). We sought to 1) estimate LBW prevalence and burden in South Asia, 2) describe the number of ANC visits (quantity) and interventions received (quality), and 3) explore associations between ANC quantity, quality and LBW. We used Demographic and Health Survey (DHS) data from Afghanistan (2015), Bangladesh (2018), India (2016), Nepal (2016), Pakistan (2018) and Sri Lanka (2016) (n = 146,284 children <5y). Women were categorized as follows: 1) low quantity (<4 ANC visits) and low quality (<5 of 10 interventions received during ANC), 2) low quantity and high quality (≥5 of 10 interventions), 3) high quantity (≥4 visits) and low quality, 4) high quantity and high quality. We used fixed effect logistic regressions to examine associations between ANC quality/quantity and LBW (<2500 grams). LBW prevalence was highest in Pakistan (23%) and India (18%), with India accounting for two-thirds of the regional burden. Only 8% of women in Afghanistan received high quantity and high quality ANC, compared to 42-46% in Bangladesh, India, and Pakistan, 65% in Nepal and 92% in Sri Lanka. Compared to the low quantity/quality reference group, children of women with high quantity/quality ANC had lower odds of LBW in India (Adjusted Odds Ratio 0.84, 95% CI 0.78-0.89), Nepal (0.57, 0.35-0.94), Pakistan (0.45, 0.23-0.86), and Sri Lanka (0.73, 0.57-0.92). Low quantity but high quality ANC was protective in India (0.90, 0.84-0.96), Afghanistan (0.53, 0.27-1.05) and Pakistan (0.49, 0.23-1.05). High quantity but low quality ANC was protective in Sri Lanka (0.76, 0.61-0.93). Neither frequent ANC without appropriate interventions nor infrequent ANC with appropriate interventions are sufficient to prevent LBW in most South Asian countries, though quality may be more important than quantity. Consistent measurement of interventions during ANC is needed.
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Affiliation(s)
- Sumanta Neupane
- International Food Policy Research Institute, New Delhi, India
| | - Samuel Scott
- International Food Policy Research Institute, New Delhi, India
| | - Ellen Piwoz
- Independent Researcher, Annapolis, Maryland, United States of America
| | - Sunny S Kim
- International Food Policy Research Institute, Washington DC, United States of America
| | - Purnima Menon
- International Food Policy Research Institute, New Delhi, India
| | - Phuong Hong Nguyen
- International Food Policy Research Institute, Washington DC, United States of America
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Mohammadi S, Shojaei K, Maraghi E, Motaghi Z. Care Providers' Perspectives on Quality Prenatal Care in High-risk Pregnancies: A Qualitative Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2023; 11:122-134. [PMID: 37114102 PMCID: PMC10126442 DOI: 10.30476/ijcbnm.2023.97603.2192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 04/29/2023]
Abstract
Background A high-risk pregnancy (HRP) is adversely affects the health of the mother, baby, or both. Most prenatal care research, rather than quality concepts, focuses on the adequacy of prenatal care and describes the emotional-psychological experiences of women with HRP. The main purpose of this study was to explore the perspectives of healthcare professionals regarding the quality of prenatal care for women with HRP. Methods This qualitative study was conducted in three university hospitals and 12 comprehensive health centers in Ahvaz (Iran) from December 2020 to May 2021. In the present study, 10 midwives, 2 executive directors, and 7 specialists were purposefully selected with maximum diversity. In-depth semi-structured individual interviews were used to collect the data. Data were analyzed concurrently using Elo and Kinga's content analysis. The MAXQDA software version 10 was used for data analysis. Results During data analysis, the 6 main categories "infrastructure for care provision", "optimal clinical care", "organizing referrals", "preconception care", "risk assessment", and "family-centered care" and 14 subcategories were identified. Conclusion Our findings showed that professional groups focused on the technical aspects of caring. The findings from this study highlight several conditions that can affect the quality of prenatal care for women with HRP. Healthcare providers can use these factors to effectively manage HRPs, thereby improving pregnancy outcomes among women with HRPs.
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Affiliation(s)
- Solmaz Mohammadi
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Kobra Shojaei
- Fertility, Infertility and Perinatology Research Center, Department of Obstetrics and Gynecology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elham Maraghi
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Motaghi
- Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
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Ghimire PR, Buck G, Jackson J, Woolley E, Bowman R, Fox L, Gallagher S, Sorrell M, Dubois L. Impact of Antenatal Care on Perinatal Outcomes in New South Wales, Australia: A Decade-Long Regional Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:977. [PMID: 36673735 PMCID: PMC9859161 DOI: 10.3390/ijerph20020977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Low birth weight (LBW) and preterm birth are adverse perinatal outcomes that pose a significant risk to a child's healthy beginning. While antenatal care (ANC) is an established intervention for pregnancy care, little is understood about how the number and timing of ANC visits can impact these adverse health outcomes. This study aimed to examine the impact of the number and timing of ANC visits on LBW and preterm birth in a regional setting. A decade-long perinatal dataset related to singleton live births that took place in the Southern New South Wales Local Health District (SNSWLHD) was utilized. The outcomes of interest were LBW and preterm birth, and the exposure variables were based on the Australian pregnancy guidelines on the number and timing of ANC visits. A multivariable logistic regression was performed to measure the association between outcome and exposure while adjusting for potential confounders. A greater level of protection against LBW and preterm birth was observed among mothers who had an adequate number of visits, with early entry (first trimester) into ANC. The protective effect of an adequate number of ANC visits against LBW and preterm birth among mothers with late entry into ANC (third trimester) was found to be statistically non-significant.
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Affiliation(s)
- Pramesh Raj Ghimire
- Priority Populations, Southern New South Wales Local Health District, Queanbeyan, NSW 2620, Australia
| | - Gretchen Buck
- Priority Populations, Southern New South Wales Local Health District, Queanbeyan, NSW 2620, Australia
| | - Jackie Jackson
- Aboriginal Health, Southern New South Wales Local Health District, Batemans Bay, NSW 2536, Australia
| | - Emma Woolley
- Priority Populations, Southern New South Wales Local Health District, Queanbeyan, NSW 2620, Australia
| | - Rebekah Bowman
- Nursing and Midwifery, Southern New South Wales Local Health District, Queanbeyan, NSW 2620, Australia
| | - Louise Fox
- Integrated Care and Allied Health, Southern New South Wales Local Health District, Queanbeyan, NSW 2620, Australia
| | - Shirlena Gallagher
- People and Wellbeing, Southern New South Wales Local Health District, Batemans Bay, NSW 2536, Australia
| | | | - Lorraine Dubois
- Priority Populations, Southern New South Wales Local Health District, Queanbeyan, NSW 2620, Australia
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Aguiar DMD, de Andrade AM, Ramalho AA, Martins FA, Koifman RJ, Opitz SP, da Silva IF. Effect of prenatal care quality on the risk of low birth weight, preterm birth and vertical transmission of HIV, syphilis, and hepatitis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001716. [PMID: 36989229 DOI: 10.1371/journal.pgph.0001716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 02/21/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Averse birth-outcomes still affect newborns worldwide. Although high-quality prenatal care is the main strategy to prevent these outcomes, the effect of prenatal care based on Kotelchuck index combined with consultation contents is still unclear. Thus, this article to evaluate the effect of the quality of prenatal care (PC) process on birth indicators in a cohort of puerperaes who attended maternity hospitals in Brazilian western Amazon, city of Rio Branco, in the state of Acre, Brazil, in 2015. METHODS This research was a hospital-based cohort study. The sample consisted of 1,030 women who gave birth in maternity hospitals in the city between April 6 and June 30, 2015. This research was a hospital-based cohort study. The sample consisted of 1,030 women who gave birth in maternity hospitals in Rio Branco between April 6th. and June 30th., 2015. Prenatal care was classified as fully adequate when started ≤4th month; ≥80.0-109% expected consultations for GA according to the Kotelchuck Index; ≥5 records of blood pressure, weight, GA, fundal height, ≥4 records of fetal heart rate, fetal movements or equivalent to 75% of the number of consultations; in addition to recording ABO/RH, hemoglobin, VDRL, urine, glucose, anti-HIV and anti-toxoplamosis during the 1st trimester. The evaluated outcomes were low birth weight (LBW), preterm birth and vertical transmission of human immunodeficiency virus (HIV)/hepatitis/syphilis. Differences between proportions were assessed using the X² test, and the crude and adjusted odds ratios (OR) (95% CI) were estimated using unconditional logistic regression. RESULTS Overall cohort, the outcomes incidences were 8.8% for LBW, 9.2% for preterm birth, and 1.1% for vertical transmission (syphilis/HIV/hepatitis). Crude and adjusted OR showed that inadequate PC increased the risk statistically significant of LBW (ORcrude: 1.84; 95%CI: 0.99-3.44; ORadjusted: 1.87; 95%CI: 1.00-3.52), and preterm birth (ORcrude: 1.79; 95%CI: 1.00-3.29; ORadjusted: 3.98; 95%CI: 1.40-11.29). CONCLUSION The results draw attention to the importance of quality PC in reducing the risks of LBW, preterm birth, and vertical transmission of syphilis/HIV/hepatitis. Moreover, using this proposed quality prenatal care indicator based on Kotelchuck index combined with consultations contents adjusted by GA may accurately predict unfavorable outcomes.
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Affiliation(s)
- Debora Melo de Aguiar
- Postgraduate Program in Public Health, Federal University of Acre, Rio Branco, State of Acre, Brazil
| | | | - Alanderson Alves Ramalho
- Postgraduate Program in Public Health, Federal University of Acre, Rio Branco, State of Acre, Brazil
| | - Fernanda Andrade Martins
- Postgraduate Program in Public Health, Federal University of Acre, Rio Branco, State of Acre, Brazil
| | - Rosalina Jorge Koifman
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Simone Perufo Opitz
- Postgraduate Program in Public Health, Federal University of Acre, Rio Branco, State of Acre, Brazil
| | - Ilce Ferreira da Silva
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Rio de Janeiro, Rio de Janeiro, Brazil
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Seboka BT, Mamo TT, Mekonnen T. Identifying geographical inequalities of maternal care utilization in Ethiopia: a Spatio-temporal analysis from 2005 to 2019. BMC Health Serv Res 2022; 22:1455. [PMID: 36451235 PMCID: PMC9714149 DOI: 10.1186/s12913-022-08850-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Inequalities in maternal care utilization pose a significant threat to maternal health programs. This study aimed to describe and explain the spatial variation in maternal care utilization among pregnant women in Ethiopia. Accordingly, this study focuses on identifying hotspots of underutilization and mapping maternal care utilization, as well as identifying predictors of spatial clustering in maternal care utilization. METHODS We evaluated three key indicators of maternal care utilization: pregnant women who received no antenatal care (ANC) service from a skilled provider, utilization of four or more ANC visits, and births attended in a health facility, based the Ethiopian National Demographic and Health Survey (EDHS5) to 2019. Spatial autocorrelation analysis was used to measure whether maternal care utilization was dispersed, clustered, or randomly distributed in the study area. Getis-Ord Gi statistics examined how Spatio-temporal variations differed through the study location and ordinary Kriging interpolation predicted maternal care utilization in the unsampled areas. Ordinary least squares (OLS) regression was used to identify predictors of geographic variation, and geographically weighted regression (GWR) examined the spatial variability relationships between maternal care utilization and selected predictors. RESULT A total of 26,702 pregnant women were included, maternal care utilization varies geographically across surveys. Overall, statistically significant low maternal care utilization hotspots were identified in the Somali region. Low hotspot areas were also identified in northern Ethiopia, stretching into the Amhara, Afar, and Beneshangul-Gumuz regions; and the southern part of Ethiopia and the Gambella region. Spatial regression analysis revealed that geographical variations in maternal care utilization indicators were commonly explained by the number of under-five children, the wealth index, and media access. In addition, the mother's educational status significantly explained pregnant women, received no ANC service and utilized ANC service four or more times. Whereas, the age of a mother at first birth was a spatial predictor of pregnant who received no ANC service from a skilled provider. CONCLUSION In Ethiopia, it is vital to plan to combat maternal care inequalities in a manner suitable for the district-specific variations. Predictors of geographical variation identified during spatial regression analysis can inform efforts to achieve geographical equity in maternal care utilization.
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Affiliation(s)
- Binyam Tariku Seboka
- grid.472268.d0000 0004 1762 2666School of Public Health, Dilla University, Dilla, Ethiopia
| | - Tizalegn Tesfaye Mamo
- grid.472268.d0000 0004 1762 2666School of Public Health, Dilla University, Dilla, Ethiopia
| | - Tensae Mekonnen
- grid.1029.a0000 0000 9939 5719Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW 2751, Australia
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Roro M, Deressa W, Lindtjørn B. Antenatal care utilization and compliance with national and WHO guidelines in rural Ethiopia: a cohort study. BMC Pregnancy Childbirth 2022; 22:849. [DOI: 10.1186/s12884-022-05171-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Antenatal health care utilization has the potential to influence maternal and new-born health. In this study, we assessed compliance of antenatal care utilization with national and World Health Organization (WHO) guidelines. We also examined association of antenatal care utilization with adverse pregnancy outcomes as secondary outcome.
Methods
This was a community-based cross sectional study conducted from July 2016 to November 2017 in rural south-central Ethiopia. We described antenatal care received by pregnant women, whom we followed at three prescheduled visits during pregnancy and collected birth data at time of delivery. Extent of antenatal care content received, timing of antenatal care, place of antenatal care and place and mode of delivery were obtained and computed in accordance with national and WHO guidelines. For adverse pregnancy outcomes, computed as sum of low birth weight, preterm birth, intrauterine foetal death, and stillbirth, the exposure variable used was antenatal care utilization.
Results
Seven hundred and four (704) women participated in the study, and 536 (76.1%) had attended at least one antenatal care visit. Among women who attended antenatal care visit, majority, 421 (79.3%), had done so at health centres and hospitals, while 110 (20.7%) attended at health post. Average number of antenatal care visits was 2.5, which is less than that recommended in national and WHO guidelines. Only 18 (2.6%) women had attended antenatal care in their first trimester, which is low in contrast to the expected 100% specified in the guidelines. Less than half (47%) of the women delivered in a health facility. This is in contrast to the 100% expected health institution deliveries. Low birth weight was 7.9% (n = 48), and preterm birth was 4.9% (n = 31). There were 12 twin pregnancies, three stillbirths, 11 spontaneous abortions, and two intrauterine foetal deaths. We did not find significant association between adverse pregnancy outcomes and antenatal care utilization (COR = 1.07, 95% CI 0.62, 1.86).
Conclusion
This study showed that antenatal care service utilization in the study area was markedly low compared to that recommended in national and WHO guidelines. The obtained antenatal health care utilization was not associated with the registered adverse pregnancy outcomes.
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Arsyi M, Besral B, Herdayati M, Phalkey R. Antenatal Care Services and Incidence of Low Birth Weight: A Comparison of Demographic and Health Surveys in 4 ASEAN Countries. J Prev Med Public Health 2022; 55:559-567. [PMID: 36475321 DOI: 10.3961/jpmph.22.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to assess the effect of complete coverage and content of available antenatal care (ANC) on the incidence of low birth weight (LBW) in 4 countries belonging to the Association of Southeast Asian Nations (ASEAN). METHODS Measures of complete coverage and content of ANC services included the frequency of ANC visits and the seven service components (blood pressure measurement, iron supplementation, tetanus toxoid immunization, explanations of pregnancy complications, urine sample test, blood sample test, and weight measurement). The complete coverage and content of ANC services were assessed as high if more than 4 ANC visits and all seven components were delivered. Multivariable logistic regression with complex survey designs was conducted using Demographic Health Survey data from the 4 ASEAN countries in question from 2014 to 2017. RESULTS The proportion of LBW infants was higher in the Philippines (13.8%) than in Indonesia (6.7%), Cambodia (6.7%), or Myanmar (7.5%). Poor ANC services were associated with a 1.30 times higher incidence of LBW than a high level of complete coverage and content of ANC services (adjusted odds ratio [aOR], 1.30; 95% confidence interval [CI], 1.11 to 1.52). In addition, the risk of LBW was higher in the Philippines than in other countries (aOR, 2.25; 95% CI, 2.01 to 2.51) after adjusting for mothers' demographic/socioeconomic factors, health behaviors, and other factors. CONCLUSIONS In sum, complete coverage and content of ANC services were significantly associated with the incidence of LBW in Indonesia, Cambodia, and Myanmar. The Philippines did not show statistically significant results for this relationship, but had a higher risk of LBW with poor ANC.
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Affiliation(s)
- Miftahul Arsyi
- Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Besral Besral
- Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Milla Herdayati
- Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Revati Phalkey
- Heidelberg Institute for Global Health, University of Heidelberg, Heidelberg, Germany.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
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Waleewong O, Yueayai K. Patterns of Socioeconomic Inequities in SDGs Relating to Children's Well-Being in Thailand and Policy Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13626. [PMID: 36294206 PMCID: PMC9603103 DOI: 10.3390/ijerph192013626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Thailand faces many wealth inequities and child health-related problems. This study aimed to describe Thai child health and determine socioeconomic inequities following the child flourishing index, a tool used to measure children's wellbeing based on the key relevant Sustainable Development Goals. The data from Thailand Multiple Indicator Cluster Survey 2019 were used to examine five indicators where Thailand had not yet achieved good results. The association of socioeconomic status with the five outcomes was explored using logistic regressions, comparing pseudo R-squared, and population attributable fraction analyses. Household wealth, urbanization, education, and primary language were significantly associated with Thai child health. Over 10% of children under 5 years were stunted and had a low birth weight. Fourteen percent of teenage girls had already become mothers. Living in poor households and rural areas, having a head-of-household who was non-Thai speaking, non-Buddhist, and had a low education were identified as risk factors for children with undernutrition status and low birth weight. However, having a head-of-household who spoke a non-Thai language was a protective factor against teenage mothers and having early marriages. Households with better economic status and education provided significant benefits for children and women's health. The result of this study calls for public policies and multisectoral actions in the wider social and economic spheres that address the social determinants that span across lives and generations. Furthermore, specific social protection programs should be designed to be accessible by these most vulnerable and disadvantaged people.
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Affiliation(s)
- Orratai Waleewong
- The International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Khanuengnij Yueayai
- Office of Disease Prevention and Control 9, Nakhon Ratchasima 30000, Thailand
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12
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Weyori AE, Seidu AA, Aboagye RG, Holmes FA, Okyere J, Ahinkorah BO. Antenatal care attendance and low birth weight of institutional births in sub-Saharan Africa. BMC Pregnancy Childbirth 2022; 22:283. [PMID: 35382792 PMCID: PMC8985289 DOI: 10.1186/s12884-022-04576-4] [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: 03/13/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low birth weight (LBW) remains a major health problem that affects newborns worldwide. However, there has been growing evidence that antenatal care (ANC) is associated with LBW. Yet, there is a dearth of research investigating the association between ANC attendance and LBW in sub-Saharan Africa (SSA). This study examined the association between the number of ANC visits and LBW using data from 10 sub-Saharan African countries. METHODS This study pooled data from the recent Demographic and Health Survey (DHS) of 10 sub-Saharan African countries conducted from 2018 to 2020. A total of 33,585 women aged 15-49 who had live births in the five years preceding the survey were included in this study. Bivariable and multivariable multilevel regression models were fitted to show the association between the number of ANC visits and LBW. Crude odds ratio (cOR) and adjusted odds ratio (aOR) at 95% confidence intervals (CIs) were used in presenting the results of the regression analysis. RESULTS The pooled prevalence of LBW was 5.7%. The highest prevalence of LBW was recorded in Gambia (7.2%) with the lowest found in Sierra Leone (2.9%). In terms of eight or more ANC visits, the overall prevalence was 14.5%. Nigeria had the highest prevalence of eight or more ANC visits (43.5%) with the lowest in Rwanda (0.2%). We found a statistically significant association between the number of ANC visits and LBW. Mothers who had eight or more ANC visits were less likely to have LBW children compared to mothers who had less than eight ANC visits [cOR = 0.66; CI = 0.55 - 0.79] and this persisted after controlling for the covariates [aOR = 0.68; CI = 0.56 - 0.82]. Covariates associated with LBW were maternal age, marital status, level of education, age of child, and wealth index. CONCLUSION This study has shown a statistically significant association between ANC and LBW in SSA, with women who had eight or more ANC visits being at lower risks of giving birth to children with LBW. We found that eight or more ANC attendance was a protective factor against LBW in SSA. Therefore, it is important for sub-Saharan African countries with low prevalence of eight or more ANC attendance and high LBW prevalence to channel their efforts towards promoting more ANC attendance.
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Affiliation(s)
- Alirah Emmanuel Weyori
- Institute of Development and Agricultural Economics, Leibniz Universitat Hannover, Hannover, Germany
| | - Abdul-Aziz Seidu
- Department of Real Estate Management, Faculty of Build and Natural Environment, Takoradi Technical University, Takoradi, Ghana.,Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Richard Gyan Aboagye
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Francis Arthur- Holmes
- Department of Sociology and Social Policy, Lingnan University, TuenMun, 8 Castle Peak Road, Tuen Mun, Hong Kong
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Family Income and Low Birth Weight in Term Infants: a Nationwide Study in Israel. Matern Child Health J 2022; 26:1820-1832. [PMID: 35129767 DOI: 10.1007/s10995-022-03379-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To explore the influence of income on Low Birth Weight (LBW), taking into account other socio-economic measurements. METHODS This retrospective cohort study is based on the Israel National Insurance Institute (NII) database. The study population included 58,454 women who gave birth between 2008 and 2013 to 85,605 infants. Only singleton births at term (gestational age in weeks = 37 and later) were included. Logistic regression models with a Generalized Estimating Equation approach were used in order to assess the independent effect of income and Socio-Economic Regional Index (SERI), maternal age, family status, population group and occupational status on LBW. In addition, sibling analysis was conducted to assess the influence of a change in income on birth weight (BW) among 21,998 women. RESULTS Lower income was associated with higher odds of LBW (odds ratio (OR) = 1.266; 95% CI:1.115-1.437. Immigrants from Ethiopia, Bedouins from the Negev, the youngest, the oldest, and single mothers had higher odds for LBW newborns. Compared to women whose income quartile had not changed between the most recent and the first births, for women who experienced a deterioration of three and two quartiles in family income, significantly lower birth weight was observed at the time point with lower income: 103 g (p = .049) and 71 g (p = .008), respectively. Improvement in income revealed an almost linear increase in birth weight. CONCLUSIONS FOR PRACTICE In an effort to prevent LBW associated mortality and diseases, interventions should be focused first of all on women from population groups who are disadvantaged.
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Outcomes and Disease Spectrum of LBW Neonates in a Secondary Health Facility. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9974636. [PMID: 35126962 PMCID: PMC8813240 DOI: 10.1155/2022/9974636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022]
Abstract
Globally, 30 million low birth weight (LBW) babies are born every year and 95% of them are from developing countries. LBW neonates are at a high risk of mortality, morbidity, and long-term disability. The objective of this study is to investigate outcomes and disease spectrum among low birth weight neonates. This is a prospective, observational study conducted on 540 neonates admitted in the Mother and Child Hospital, Akure, Ondo State, Nigeria, from 2017 to 2018. Questionnaire, interview, clinical, and diagnostic procedures were used as research tools. There were 137 low birth weight (LBW) neonates, with the mean mothers’ age of 31.92 ± 6.60. Of the 540 neonates, 69 (50.4%) and 68 (49.6%) were term and preterm, respectively. There were 64 female neonates (46.7%) and 73 male neonates (53.3%). The mean weight of the neonates was 1.82 ± 0.44 kg, and mean number of days on admission was 6.42 ± 6.75 days. Neonatal sepsis (NNS) was the highest morbidity 51 (37.2%) among the LBW neonates, followed by prematurity 47 (34.4%) and neonatal jaundice (NNJ) 18 (13.1%). Sex (χ2 = 3.584,
), mode of delivery (χ2 = 4.669,
), and gestational age (χ2 = 3.904,
) were not a significant determinant of outcome among LBW neonates. Men were 2.36 times more likely to be preterm (OR = 2.36, 95% CL = 1.01–5.54,
) among LBW neonates. Outcomes of LBW neonates who were delivered by SVD were not significant compared to preterm delivered by CS (OR = 0.46, 95% CL = 0.13–1.65,
). Sixty percent (60%) of the mothers had Prolonged Rupture of Membranes (PROM). Morbidities such as hypothermia (72.2%), apnoea (63.6%), haemorrhagic disease of the newborn (HDN) (66.7%), and respiratory distress syndrome (RDS) (66.7%) were more observed with preterm LBW neonates. Importance of qualitative antenatal care (ANC) should be emphasized; anticipation and prevention of LBW births can help mitigate some of the problems they are prone to.
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Belay A, Astatkie T, Abebaw S, Gebreamanule B, Enbeyle W. Prevalence and factors affecting the utilization of antenatal care in rural areas of Southwestern Ethiopia. BMC Pregnancy Childbirth 2022; 22:30. [PMID: 35031008 PMCID: PMC8759251 DOI: 10.1186/s12884-021-04362-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antenatal care (ANC) is a health care intervention intended to ensure the safety of pregnancy. According to the World Health Organization, at least four ANC visits are recommended for a healthy pregnancy. However, whether this recommended number of visits was followed or not in the rural areas of Southwestern Ethiopia is not known. Therefore, the study aimed to investigate the prevalence of, and the associated factors of ANC utilization by pregnant women in the rural areas of Southwestern Ethiopia. METHODS A community-based cross-sectional study design was used in three rural zones. The data were collected from n = 978 women through a structured questionnaire with face-to-face interview. The collected data were analyzed using descriptive statistics and a multiple binary logistic regression model. RESULTS The results showed that 56% of women made the recommended minimum number of ANC visits and the remaining 44% of them underutilized the ANC service. The multiple binary logistic regression model identified zone, marital status of the woman, educational level of the husband, occupation of the husband, knowledge of danger signs of pregnancy, birth interval, source of information, timely visits, and transportation problem to be statistically significant factors affecting the prevalence of ANC visit utilization of women. Bench Maji zone had smaller odds ratio of ANC visit prevalence as compared to Kaffa zone. Women who lived in the rural area of Sheko zone are 2.67 times less likely to utilize ANC visit than those who lived in the rural area of Kaffa zone keeping other variables constant. CONCLUSION The study results highlight the need to increase the number of ANC visits, and the importance of using an appropriate model to determine the important socio-demographic factors that ANC service providers shall focus on to improve the health of the unborn baby and the mother during pregnancy.
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Affiliation(s)
- Assaye Belay
- Department of Statistics, Mizan-Tepi University, Tepi, Ethiopia.
| | - Tessema Astatkie
- Faculty of Agriculture, Dalhousie University, Truro, NS, B2N 5E3, Canada
| | - Solomon Abebaw
- Department of Statistics, Mizan-Tepi University, Tepi, Ethiopia
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16
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Abbas F, Kumar R, Mahmood T, Somrongthong R. Impact of children born with low birth weight on stunting and wasting in Sindh province of Pakistan: a propensity score matching approach. Sci Rep 2021; 11:19932. [PMID: 34620917 PMCID: PMC8497567 DOI: 10.1038/s41598-021-98924-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
Low Birth Weight (LBW) is considered as a major public health issue and leading cause of neonatal death. Almost one in four newborns are reported as underweight in Pakistan. Children born with low birth weight are highly vulnerable to develop diseases and death and/or remain undernourished (i.e., stunted and wasted). This study determines the LBW newborns are more prone to develop stunting and wasting in province of Sindh, Pakistan. Moreover, regression-based estimation of the impact of LBW on the child health outcomes of under five years of age, may be prone to selection bias because of the nature of non-experimental data set, thus, propensity score matching methods are used in this study. Data for this study was used from Multiple Indicators Cluster Survey (MICS-2014). MICS is a two-stage, stratified cluster sampling household level data covering urban and rural areas and consists of 19,500 households from five administrative divisions and 28 districts of Sindh province of Pakistan. The total sample size of children less than five years of age after cleaning the data are 7781, of which 2095 are LBW having birth weight categorized as "smaller than average and very small" and 5686 are normal birth weight (NBW) having birth weight very large, larger than average, and average. This study employed propensity score matching (PSM) regression methods to understand whether the children born as low birth weight are more prone to stunting and wasting and/or both. In province of Sindh, moderate wasting children under five years were 21%, severe wasting 6% and both wasting and stunting 10%. The propensity score results are shown significant in all groups. Specifically, all four types of PSM methods confirm a significant difference in the potential outcome variables-meaning that a child born with LBW has a significant adverse effect on the potential child health outcome variables (stunting, wasting and both). Thus, the propensity score matching findings confirm a significant and adverse effect of LBW on potential health outcomes of under five children. Similarly, low birth weight children are significantly more likely to be moderately wasted (OR = 1.5, CI = 1.3-1.6) and severely wasted (OR = 1.6, CI = 1.3-2.0) and both (stunted and wasted, OR = 2.0, CI = 1.7-2.3) as compared to children with normal birth weight. Male children, if born with low birth weight, are significantly more likely to be moderately wasted (OR = 1.3, CI = 1.1-1.5) and both (wasted and stunted, OR = 1.3, CI = 1.1-1.5) than girls. This large data analysis finding proved that the LBW newborns are on higher risk to develop wasting and stunting in Pakistan.
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Affiliation(s)
- Faisal Abbas
- Department of Economics, School of Social Sciences and Humanities (S3H), National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
| | - Ramesh Kumar
- Department of Public Health, Health Services Academy, Islamabad, Pakistan.
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand.
| | - Tahir Mahmood
- Department of Economics, University of Chitral, Chitral, Pakistan
| | - Ratana Somrongthong
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Hu W, Hu H, Zhao W, Huang A, Yang Q, Di J. Current status of antenatal care of pregnant women-8 provinces in China, 2018. BMC Public Health 2021; 21:1135. [PMID: 34120600 PMCID: PMC8201670 DOI: 10.1186/s12889-021-11154-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antenatal care (ANC) played a crucial role in ensuring maternal and child safety and reducing the risk of complications, disability, and death in mothers and their infants. The objective of this study was to evaluate the current status of ANC emphasizing the number, timing, and content of examinations on a national scale. METHODS The data was collected from maternal and newborn's health monitoring system at 8 provinces in China. After ethical approval, all pregnant women registered in the system at their first prenatal care visit, we included 49,084 pregnant women who had delivered between January 1, 2018 and December 31, 2018. Descriptive statistics of all study variables were calculated proportions and chi-square for categorical variables. RESULTS Of the 49,084 women included in this study, the mean number of ANC visits was 6.95 ± 3.45. By percentage, 78.79% women received ANC examinations at least five times, 39.93% of the women received ANC examinations at least eight times and 16.66% of the women received ANC examinations at least 11 times. The proportion of first ANC examination in first trimester was 61.87%. The percentage of normative ANC examinations and the percentage of qualified ANC examinations were 30.98 and 8.03% respectively. Only 49.40% of the total women received all six kinds of examination items in first ANC examination: 91.47% received a blood test, 91.62% received a urine test, 81.56% received a liver function examination, 80.52% received a renal function examination, 79.07% received a blood glucose test, and 86.66% received a HIV/HBV/syphilis tests. 50.85% women received the first ANC examination in maternal and child health care (MCH) institutions, 14.07% in a general hospital, 18.83% in a township hospital, 13.15% in a community health services center, and 3.08% in an unspecified place. The proportion of women who received each of the ANC examination items in community health services center was the highest, but that in the MCH institutions was the lowest. CONCLUSIONS There is a big difference between the results of this study and the data in official reports, this study found the current status of antenatal care is not optimal in China, findings from this study suggest that the systematization, continuity and quality of ANC examinations need to be improved.
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Affiliation(s)
- Wenling Hu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No.12, Dahuisi Road, Beijing, 100081, China
| | - Huanqing Hu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No.12, Dahuisi Road, Beijing, 100081, China
| | - Wei Zhao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No.12, Dahuisi Road, Beijing, 100081, China
| | - Aiqun Huang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No.12, Dahuisi Road, Beijing, 100081, China
| | - Qi Yang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No.12, Dahuisi Road, Beijing, 100081, China
| | - Jiangli Di
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No.12, Dahuisi Road, Beijing, 100081, China.
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Rodríguez López S, Tumas N, Ortigoza A, de Lima Friche AA, Diez-Roux AV. Urban social environment and low birth weight in 360 Latin American cities. BMC Public Health 2021; 21:795. [PMID: 33902522 PMCID: PMC8073945 DOI: 10.1186/s12889-021-10886-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Using data compiled by the SALURBAL project (Urban Health in Latin America; 'Salud Urbana en América Latina') we quantified variability in low birth weight (LBW) across cities in Latin America, and evaluated the associations of socio-economic characteristics at various levels (maternal, sub-city and city) with the prevalence of LBW. METHODS The sample included 8 countries, 360 cities, 1321 administrative areas within cities (sub-city units) and birth registers of more than 4.5 million births for the year 2014. We linked maternal education from birth registers to data on socioeconomic characteristics of sub-cities and cities using the closest available national population census in each country. We applied linear and Poisson random-intercept multilevel models for aggregated data. RESULTS The median prevalence of city LBW by country ranged from a high of 13% in Guatemala to a low of 5% in Peru (median across all cities was 7.8%). Most of the LBW variability across sub-cities was between countries, but there were also significant proportions between cities within a country, and within cities. Low maternal education was associated with higher prevalence of LBW (Prevalence rate ratios (PRR) for less than primary vs. completed secondary or more 1.12 95% CI 1.10, 1.13) in the fully adjusted model. In contrast, higher sub-city education and a better city social environment index were independently associated with higher LBW prevalence after adjustment for maternal education and age, city population size and city gross domestic product (PRR 1.04 95% CI 1.03, 1.04 per SD higher sub-city education and PRR 1.02 95% CI 1.00, 1.04 per SD higher SEI). Larger city size was associated with a higher prevalence of LBW (PRR 1.06; 95% CI 1.01, 1.12). CONCLUSION Our findings highlight the presence of heterogeneity in the distribution of LBW and the importance of maternal education, local and broader social environments in shaping LBW in urban settings of Latin America. Implementing context-sensitive interventions guided to improve women's education is recommended to tackle LBW in the region.
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Affiliation(s)
- Santiago Rodríguez López
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas y Universidad Nacional de Córdoba, Córdoba, Argentina.
- Facultad de Ciencias Exactas, Físicas y Naturales, Universidad Nacional de Córdoba, Córdoba, Argentina.
| | - Natalia Tumas
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas y Universidad Nacional de Córdoba, Córdoba, Argentina
- Facultad de Ciencias de la Salud, Universidad Católica de Córdoba, Córdoba, Argentina
- Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Ana Ortigoza
- Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | | | - Ana V Diez-Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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Maternal dietary diversity during pregnancy and risk of low birth weight in newborns: a systematic review. Public Health Nutr 2021; 24:4671-4681. [PMID: 33472725 DOI: 10.1017/s1368980021000276] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Maternal nutrition during pregnancy is a key factor influencing birth outcome. Dietary diversity is a proxy for multiple macro- and/or micronutrient sufficiency of an individual's diet. This systematic review aimed to summarise the findings on the association between maternal dietary diversity during pregnancy and the risk of low birth weight (LBW) in newborns. DESIGN This is a systematic review study. SETTING Google and the PubMed, Scopus and Google Scholar databases were searched to extract original studies on humans published until June 2020, without date restrictions. There was no limitation regarding geographic region or economic condition of countries. Duplicated and irrelevant studies were screened out and data were obtained through critical analysis. PARTICIPANTS Articles that examined the association between maternal dietary diversity during pregnancy and the risk of LBW in infants were included. RESULTS Of the ninety-eight studies retrieved, fifteen articles were included in the final review. All included articles represent low- and middle-income countries. Eighty percentage of the studies (n 12) indicated that low maternal dietary diversity during pregnancy is associated with an increased risk of LBW infants. Three studies that included a small number of LBW infants and did not take into account factors which may bias study results failed to show this association. CONCLUSION The results suggest that low maternal dietary diversity during pregnancy may be associated with the risk of LBW, more specifically in developing countries. Dietary diversity might be a valuable predictor of maternal nutrition during pregnancy and the chance of giving birth to a LBW infant.
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Wu T, Niu J, Yin X, Zhao C, Huang X, Wang X. China's antenatal care promoting early childhood development: evidence from a cross-sectional survey. Ann N Y Acad Sci 2021; 1493:90-101. [PMID: 33455003 DOI: 10.1111/nyas.14559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/05/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
The Chinese government has established a three-tier maternal care system covering the entire country and providing integrated antenatal care (ANC) for pregnancies. This study aimed to analyze the direct and indirect effects of ANC services on early childhood development. A community-based cross-sectional survey was conducted for mothers' ANC visits and assessments of early childhood development in Shanxi and Guizhou provinces, China. A total of 1660 mother-child dyads were included in current analyses: 29.2% of mothers did not receive any ANC (ANC1), 23.3% of mothers received ANC three or fewer times (ANC2), and 47.5% of mothers received ANC four or more times (ANC3). Children whose mothers received ANC services had a significantly lower risk of overall developmental delay (OR = 0.60, 95% CI: 0.44-0.81 for ANC2; and OR = 0.44, 95% CI: 0.34-0.59 for ANC3) and social-emotional developmental delay (OR = 0.68, 95% CI: 0.49-0.94 for ANC3). Furthermore, a significant pathway relationship mediated by maternal depression and nurturing care was found between ANC and developmental delay. This study showed ANC services significantly reduced the risk of developmental delay in offspring. We also suggest that a nationwide ANC system can be a good delivery platform for scaled-up early childhood development interventions.
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Affiliation(s)
- Tianchen Wu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Jieqiong Niu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Xiaohan Yin
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Chunxia Zhao
- Section of Health, Nutrition, and Water, Environment and Sanitation, The United Nations Children's Fund in China Office, Beijing, China
| | - Xiaona Huang
- Section of Health, Nutrition, and Water, Environment and Sanitation, The United Nations Children's Fund in China Office, Beijing, China
| | - Xiaoli Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.,Key Laboratory of Reproductive Health, National Health Commission, Beijing, China
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21
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Shiferaw K, Mengiste B, Gobena T, Dheresa M. The effect of antenatal care on perinatal outcomes in Ethiopia: A systematic review and meta-analysis. PLoS One 2021; 16:e0245003. [PMID: 33444374 PMCID: PMC7808692 DOI: 10.1371/journal.pone.0245003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/18/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The estimated annual global perinatal and neonatal death is four million. Stillbirths are almost equivalent to neonatal mortality, yet they have not received the same attention. Antenatal care is generally thought to be an effective method of improving pregnancy outcomes, but its effectiveness as a means of reducing perinatal mortality has not been evaluated in Ethiopia. Therefore, we will identify the pooled effect of antenatal care on perinatal outcomes in Ethiopia. METHODS Medline, Embase, Cinahl, African journal online and Google Scholar was searched for articles published in English language between January 1990 and May 2020. Two independent assessors selected studies and extracted data from eligible articles. The Risk of Bias Assessment tool for Non-Randomized Studies was used to assess the quality of each included study. Data analysis was performed using RevMan 5.3. Heterogeneity and publication bias were assessed using I2 test statistical significance and Egger's test for small-study effects respectively. The random effect model was employed, and forest plot was used to present the risk ratio (RR) with 95% confidence interval (CI). RESULTS Thirteen out of seventeen included studies revealed antenatal care utilization had a significant association with perinatal outcomes. The pooled risk ratio by the random-effects model for perinatal death was 0.42 (95% CI: 0.34, 0.52); stillbirth 0.34 (95% CI: 0.25, 0.46); early neonatal death 0.85 (95% CI: 0.21. 3.49). CONCLUSION Women who attended at least one antenatal care visit were more likely to give birth to an alive neonate that survives compared to their counterpart. Therefore, the Ethiopian Ministry of health and other stakeholders should design tailored interventions to increase antenatal care utilization since it has been shown to reduce perinatal mortality.
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Affiliation(s)
- Kasiye Shiferaw
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bizatu Mengiste
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tesfaye Gobena
- Department of Environmental Health Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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22
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Banchani E, Tenkorang EY. Determinants of Low Birth Weight in Ghana: Does Quality of Antenatal Care Matter? Matern Child Health J 2020; 24:668-677. [PMID: 32026325 DOI: 10.1007/s10995-020-02895-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Low birth weight is a public health issue that contributes to perinatal and infant mortality, especially in limited-resource settings, but there is limited understanding of the determinants of low birth weight and the contributions of quality antenatal care to maintaining healthy birth weights for newborns in such settings. This study aims at establishing links between birthweight and quality antenatal care in Ghana. METHODS We used data collected from the recent 2017 Ghana Maternal Health Survey and applied complementary log-log models to investigate relationships between the quality of antenatal care (screening/diagnostic procedures, clinical interventions, type of health provider) and low birth weight in Ghana. RESULTS The results reveal that compared to women who received low quality clinical interventions, those who received high quality interventions were significantly less likely to have a low birth weight baby. Similarly, women who made the recommended number of antenatal visits (at least eight) were significantly less likely to have a baby with low birth weight than women making fewer visits. CONCLUSION Our findings suggest that while the number of antenatal visits is important, the quality of care received during such visits is equally relevant to reducing low birth weight in Ghana.
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Affiliation(s)
- Emmanuel Banchani
- Department of Sociology, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Eric Y Tenkorang
- Department of Sociology, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada.
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23
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Oliveira D, Pereira F, Martins MDR, Castro R, Cordeiro L, Fronteira I. A systematic review of the maternal and neonatal complications in hepatitis B infection. J Clin Virol 2020; 133:104680. [PMID: 33186874 DOI: 10.1016/j.jcv.2020.104680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 10/14/2020] [Accepted: 10/23/2020] [Indexed: 02/08/2023]
Abstract
The association between hepatitis B virus (HBV) infection and maternal, obstetric and newborn outcomes remains controversial, as previous studies have reported conflicting and inconsistent results on the matter. The aim was to investigate whether HBV infection increases the risk of maternal, obstetric and newborn complications. We conducted a systematic literature review, according to PRISMA statement guidelines. Studies were eligible for inclusion if they were observational cohort, case-control or cross-sectional studies, comparing maternal, obstetric or newborn complications in HBV-infected and uninfected pregnant women. PubMed was searched for published literature in English, with no date restrictions, using combinations of keywords. The titles and abstracts were independently screened for eligibility by three authors. Two authors assessed the quality of each included study and no meta-analysis was performed. We retrieved 275 records and included 15 papers. The methodological and statistical heterogeneity as well as a great variation on the types of maternal, obstetric and newborn complications studied did not allow quantitative analysis of results and conclusions about the level of evidence. Seven studies are of good quality, which makes their results more reliable. Three of them revealed that maternal HBV infection increased the risk of miscarriage, preterm birth, pregnancy-induced hypertension, fetal distress and macrosomia. These three studies were performed in China and the one with the largest number of participants only included women from rural areas. Larger, more robust, well-designed prospective cohort studies are needed. These must include adjusted estimates for confounding factors, such as other possible complications determinants, like the antenatal care quality.
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Affiliation(s)
- Dinamene Oliveira
- Posto Médico do Lubango, Clínica Girassol, Lubango, Huíla, Angola; Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
| | - Filomena Pereira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Maria do Rosário Martins
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Rita Castro
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Lemuel Cordeiro
- Gabinete de Ensino, Pesquisa e Pós-graduação, Clínica Girassol, Luanda, Angola
| | - Inês Fronteira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
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24
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Pereyra I, Bustos P. Trend and factors associated with adverse birth weight in Uruguayan children between 2009 and 2015. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2020. [DOI: 10.1590/1806-93042020000300009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to identify trendand factors associated with adverse birth weight. Methods: cross-sectional design. The analysis uses the 2009-2015 Uruguay Perinatal Computer Systemdata on 303,625 newborns. Results: the prevalence of macrosomia (> 3,999g) has increased from 7.0% to 8.4%. The prevalence of low birth weight (LBW) (< 2,500g) decreased, standing at 6.6% in the last year. The factors that determines more possibilities of LBW were preeclampsia (OR = 4.80; CI95%= 4.57-5.05), inadequate controls (OR = 2.29; CI95%= 2.20-2.39), shorter duration of pregnancy (OR = 2.52; CI95%= 2.50-2.55), previous hypertension (OR = 2.11; CI95%= 1.96-2.27), hypertensive disease of pregnancy (OR = 1.82; CI95%= 1.74-1.90), low prematernal maternal weight (OR = 1.65; CI95%= 1.58-1.74). Macrosomia was associated with type 1 diabetes (OR = 2.21; CI95%= 1.86-2.61), Type 2 or Gestational (OR = 1.78; CI95%= 1.70-1.87), obesity maternal (OR = 2.33; CI95%= 2.24-2.43) and longer gestation duration (OR = 2.62; CI95%= 2.53-2.72). Conclusions: the LBW decreases while the macrosomia increases. The health and nutritional status of women at the beginning of pregnancy, pathologies of the last trimester, smoking, shorter duration of pregnancy and inadequate controls are associated with BPN. Overweight, obesity and metabolic diseases determine macrosomia.
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25
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Shibre G, Zegeye B, Idriss-Wheeler D, Ahinkorah BO, Oladimeji O, Yaya S. Socioeconomic and geographic variations in antenatal care coverage in Angola: further analysis of the 2015 demographic and health survey. BMC Public Health 2020; 20:1243. [PMID: 32799833 PMCID: PMC7429730 DOI: 10.1186/s12889-020-09320-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/30/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In African countries, including Angola, antenatal care (ANC) coverage is suboptimal and maternal mortality is still high due to pregnancy and childbirth-related complications. There is evidence of disparities in the uptake of ANC services, however, little is known about both the socio-economic and geographic-based disparity in the use of ANC services in Angola. The aim of this study was to assess the extent of socio-economic, urban-rural and subnational inequality in ANC coverage in Angola. METHODS We analyzed data from the 2015 Angola Demographic and Health Survey (ADHS) using the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) software. The analysis consisted of disaggregated ANC coverage rates using four equity stratifiers (economic status, education, residence, and region) and four summary measures (Difference, Population Attributable Risk, Ratio and Population Attributable Fraction). To measure statistical significance, an uncertainty interval (UI) of 95% was constructed around point estimates. RESULTS The study showed both absolute and relative inequalities in coverage of ANC services in Angola. More specifically, inequality favored women who were rich (D = 54.2, 95% UI; 49.59, 58.70, PAF = 43.5, 95% UI; 40.12, 46.92), educated (PAR = 19.9, 95% UI; 18.14, 21.64, R = 2.14, 95% UI; 1.96, 2.32), living in regions such as Luanda (D = 51.7, 95% UI; 43.56, 59.85, R = 2.64, 95% UI; 2.01, 3.26) and residing in urban dwellings (PAF = 20, 95% UI; 17.70, 22.38, PAR = 12.3, 95% UI; 10.88, 13.75). CONCLUSION The uptake of ANC services were lower among poor, uneducated, and rural residents as well as women from the Cuanza Sul region. Government policy makers must consider vulnerable subpopulations when designing needed interventions to improve ANC coverage in Angola to achieve the 2030 Sustainable Development Goal of reducing global maternal mortality ratio to 70 deaths per 100,000 live births.
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Affiliation(s)
- Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Betregiorgis Zegeye
- Shewarobit Field Office, HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia
| | - Dina Idriss-Wheeler
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
| | - Olanrewaju Oladimeji
- Department of Public Health, Walter Sisulu University, Mthatha, Eastern Cape South Africa
- Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON K1N 6N5 Canada
- The George Institute for Global Health, The University of Oxford, Oxford, UK
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26
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Antenatal Care Attendance and Factors Influenced Birth Weight of Babies Born between June 2017 and May 2018 in the Wa East District, Ghana. Int J Reprod Med 2020; 2020:1653076. [PMID: 32766299 PMCID: PMC7387973 DOI: 10.1155/2020/1653076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 02/01/2023] Open
Abstract
Background In sub-Saharan Africa, there is high coverage of the recommended four or more times antenatal care (ANC) visits during pregnancy without complications; notwithstanding this achievement, the negative birth outcomes related to childbirth such as low birth weights and stillbirths are still high despite the increased access to antenatal services. Hence, the study assessed the association between antenatal attendance and birth weight in the Wa East District. Method The cross-sectional study design was used with a semistructured questionnaire to collect data from mothers who delivered within a one-year period through a review of antenatal and birth records from health facilities where the women delivered and interviewed. The chi-squared test and univariate and multivariate logistic regression were performed to establish the association between normal birth weight and ANC services the woman received and other predictor variables, and p value < 0.05 was considered a significant association between dependent and independent variables. Result The study involved 233 women. About 62.2% attended ANC clinics 4+ times before giving birth, 70.0% did not received the minimum ANC services required for every pregnant woman, 0.9% of pregnancies resulted in stillbirth, and 24.5% of babies born had a birth weight < 2.5 kg. Women marital status (legally married) [AOR: 2.05, 95% CI: 1.33-6.89, p = 0.044], religion (Islam) [AOR: 0.33, 95% CI: 0.08-0.39, p = 0.013], and educational level (SHS/tertiary) [AOR: 4.27, 95% CI: 0.08-0.88, p = 0.031] were the background characteristics associated with normal birth weight (2.5-40 kg). Also, women who had their urine tested at the ANC clinics [AOR: 6.59, 95% CI: 8.48–15.07, p < 0.001] and women who received a long-lasting insecticide-treated net [AOR: 2.17, 95% CI: 0.03-0.92, p = 0.039] from the ANC clinic were associated with normal birth weight. Conclusion Notwithstanding the benefits of antenatal care services, only 62.2% of pregnant women attended 4 or more ANC visits before giving birth, while 70% did not received the services they need. These might have influence the 24.5% of babies born with a low birth weight. Therefore, there is a need for special attention from all stakeholders to reverse the trend.
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27
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Bater J, Lauer JM, Ghosh S, Webb P, Agaba E, Bashaasha B, Turyashemererwa FM, Shrestha R, Duggan CP. Predictors of low birth weight and preterm birth in rural Uganda: Findings from a birth cohort study. PLoS One 2020; 15:e0235626. [PMID: 32658895 PMCID: PMC7357758 DOI: 10.1371/journal.pone.0235626] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Approximately 20.5 million infants were born weighing <2500 g (defined as low birthweight or LBW) in 2015, primarily in low- and middle-income countries (LMICs). Infants born LBW, including those born preterm (<37 weeks gestation), are at increased risk for numerous consequences, including neonatal mortality and morbidity as well as suboptimal health and nutritional status later in life. The objective of this study was to identify predictors of LBW and preterm birth among infants in rural Uganda. METHODS Data were derived from a prospective birth cohort study conducted from 2014-2016 in 12 districts across northern and southwestern Uganda. Birth weights were measured in triplicate to the nearest 0.1 kg by trained enumerators within 72 hours of delivery. Gestational age was calculated from the first day of last menstrual period (LMP). Associations between household, maternal, and infant characteristics and birth outcomes (LBW and preterm birth) were assessed using bivariate and multivariable logistic regression with stepwise, backward selection analyses. RESULTS Among infants in the study, 4.3% were born LBW (143/3,337), and 19.4% were born preterm (744/3,841). In multivariable analysis, mothers who were taller (>150 cm) (adjusted Odds Ratio (aOR) = 0.42 (95% CI = 0.24, 0.72)), multigravida (aOR = 0.62 (95% CI = 0.39, 0.97)), or with adequate birth spacing (>24 months) (aOR = 0.60 (95% CI = 0.39, 0.92)) had lower odds of delivering a LBW infant Mothers with severe household food insecurity (aOR = 1.84 (95% CI = 1.22, 2.79)) or who tested positive for malaria during pregnancy (aOR = 2.06 (95% CI = 1.10, 3.85)) had higher odds of delivering a LBW infant. In addition, in multivariable analysis, mothers who resided in the Southwest (aOR = 0.64 (95% CI = 0.54, 0.76)), were ≥20 years old (aOR = 0.76 (95% CI = 0.61, 0.94)), with adequate birth spacing (aOR = 0.76 (95% CI = 0.63, 0.93)), or attended ≥4 antenatal care (ANC) visits (aOR = 0.56 (95% CI = 0.47, 0.67)) had lower odds of delivering a preterm infant; mothers who were neither married nor cohabitating (aOR = 1.42 (95% CI = 1.00, 2.00)) or delivered at home (aOR = 1.25 (95% CI = 1.04, 1.51)) had higher odds. CONCLUSIONS In rural Uganda, severe household food insecurity, adolescent pregnancy, inadequate birth spacing, malaria infection, suboptimal ANC attendance, and home delivery represent modifiable risk factors associated with higher rates of LBW and/or preterm birth. Future studies on interventions to address these risk factors may be warranted.
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Affiliation(s)
- Jorick Bater
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jacqueline M. Lauer
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, United States of America
- USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, Massachusetts, United States of America
| | - Shibani Ghosh
- USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, Massachusetts, United States of America
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University, Boston, Massachusetts, United States of America
| | - Patrick Webb
- USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, Massachusetts, United States of America
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University, Boston, Massachusetts, United States of America
| | - Edgar Agaba
- USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, Massachusetts, United States of America
| | - Bernard Bashaasha
- Department of Agribusiness and Natural Resource Economics, Makerere University, Kampala, Uganda
| | | | - Robin Shrestha
- USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, Massachusetts, United States of America
| | - Christopher P. Duggan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, United States of America
- USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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