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Jaffe EF, Spach NC, Sullivan KA, Lyerly AD, Goldfarb IT. Experiences Navigating the Pregnancy Care Continuum During the COVID-19 Pandemic. Womens Health Issues 2022; 33:235-241. [PMID: 36496341 PMCID: PMC9640408 DOI: 10.1016/j.whi.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The COVID-19 pandemic led to unprecedented changes in care delivery across the pregnancy care continuum. Our primary objective with this research was to characterize the range of ways that the early months of the COVID-19 pandemic affected pregnancy, childbirth, and postpartum care experiences. METHODS Pregnant and recently pregnant patients (n = 20) from obstetrics and gynecology clinical sites associated with Massachusetts General Hospital were interviewed about their experiences with prenatal care, childbirth, and postpartum care during the first wave of the COVID-19 pandemic. Interview transcripts were analyzed for emergent themes. RESULTS This sample included 20 pregnant and postpartum people, including 11 individuals who tested positive for COVID-19 during pregnancy or postpartum and nine with suspected infection. The ways in which COVID-19 or suspected COVID-19 affected experiences of prenatal care, childbirth, and postpartum care were complex and varied. Three themes were identified across narratives of pregnancy, birth, and postpartum care: patient perceptions of diminished access to care, stigma due to COVID-19 infection, and limited capacity of providers to honor patient preferences. CONCLUSIONS A better understanding of pregnant and recently pregnant people's experiences during the early months of the COVID-19 pandemic can inform infection control policies and clinical care delivery practices that are more congruent with the needs and values of pregnant, birthing, and postpartum people as institutions craft responses to future pandemics. Approaches that maximize meaningful access across the pregnancy care continuum, center patients' priorities within adapted care models, and honor patient preferences as much as possible are important aspects of an appropriate response to future waves of COVID-19 and other pandemics.
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Affiliation(s)
- Elana F. Jaffe
- University of North Carolina School of Medicine, Chapel Hill, North Carolina,University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Natalie C. Spach
- University of North Carolina School of Medicine, Chapel Hill, North Carolina,University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Kristen A. Sullivan
- University of North Carolina School of Medicine, Chapel Hill, North Carolina,Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anne D. Lyerly
- University of North Carolina School of Medicine, Chapel Hill, North Carolina,Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ilona T. Goldfarb
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts,Correspondence to: Ilona T. Goldfarb, MD, MPH, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. Tel.: (617) 724-2229
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Anderson EJ, Ernst K, Garcia DO, Lopez E, Pogreba Brown K, Austhof E, Carr McCuin D, Hayden MH, Koss MP. Knowledge of Sexual Transmission of Zika Virus Among Women Who Are Pregnant or Intend to Become Pregnant, Arizona, 2017. Public Health Rep 2022; 137:488-497. [PMID: 33798396 PMCID: PMC9109529 DOI: 10.1177/00333549211006986] [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] [Accepted: 03/13/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Levels of knowledge about the sexual transmission of Zika virus are consistently low in populations at risk of a mosquito-borne outbreak, including among women of childbearing age and women who are pregnant or intend to become pregnant. We investigated the effectiveness of sources of public health messaging about sexual transmission to women who are pregnant or intend to become pregnant in Arizona. METHODS In 2017, we conducted an Arizona-statewide survey 15 months after the initial release of US guidelines on sexual transmission of Zika virus. We used Poisson regression, adjusting for demographic factors, to estimate the likelihood among women who were pregnant or intended to become pregnant of knowing that Zika virus is sexually transmitted relative to other women of childbearing age. We used multinomial logistic regression models to explore associations with most used health information sources, either in person (eg, medical providers) or online (eg, Facebook), categorized by extent of dependability. RESULTS Women who were pregnant or intended to become pregnant had similarly poor knowledge of the sexual transmission of Zika virus as compared with other women of childbearing age (adjusted prevalence ratio = 1.14 [95% CI, 0.83-1.55]). Only about one-third of all respondents reported knowledge of sexual transmission. Reliance on high- vs low-dependability information sources, whether in person or online, did not predict the extent of Zika virus knowledge among women who were pregnant or intended to become pregnant. CONCLUSION As late as the second year of local Zika virus transmission in the United States, in 2017, women in Arizona were not receiving sufficient information about sexual transmission, even though it was available. To prepare for possible future outbreaks, research should explore which aspects of Zika information campaigns were ineffective or inefficient.
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Affiliation(s)
- Elizabeth J. Anderson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman
College of Public Health, University of Arizona, Tucson, AZ, USA
- International Center for Research on Women, Washington, DC,
USA
| | - Kacey Ernst
- International Center for Research on Women, Washington, DC,
USA
| | - David O. Garcia
- Department of Health Promotion Sciences, Mel and Enid Zuckerman
College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Elise Lopez
- Department of Health Promotion Sciences, Mel and Enid Zuckerman
College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Kristen Pogreba Brown
- Department of Epidemiology & Biostatistics, Mel and Enid
Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Erika Austhof
- College of Public Health, Mel and Enid Zuckerman College of Public
Health, University of Arizona, Tucson, AZ, USA
| | - Dametreea Carr McCuin
- Department of Epidemiology & Biostatistics, Mel and Enid
Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Mary H. Hayden
- National Institute for Human Resilience, University of Colorado,
Colorado Springs, CO, USA
| | - Mary P. Koss
- Department of Health Promotion Sciences, Mel and Enid Zuckerman
College of Public Health, University of Arizona, Tucson, AZ, USA
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Hossein F. An overview of the current medical literature on Zika virus. Biophys Rev 2020; 12:1133-1138. [PMID: 32880054 DOI: 10.1007/s12551-020-00748-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/28/2020] [Indexed: 01/07/2023] Open
Abstract
Zika virus is a member of the family of Flaviviridae, which is primarily spread to humans by mosquito bites. It has been linked to microcephaly in neonates, and as such, it poses a significant risk to human pregnancy. Zika virus infection is also implicated in other severe neurological disorders such as Guillain-Barre syndrome. There is currently no vaccine available to treat Zika virus disease, and as such, it represents a serious challenge to public health. Antigenic similarities between Zika and dengue can suggest artificially high infection rates of Zika within specific population groups. Here, we review recent literature and provide an update on the status of the Zika outbreak, including a description of available medical countermeasure options and current diagnosis methodology.
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Affiliation(s)
- Fria Hossein
- School of Engineering, Nanotechnology and Integrated Bio-Engineering Centre (NIBEC), Ulster University, Shore Road, BT37 0QB, Newtownabbey, United Kingdom.
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Pinchoff J, Serino A, Merritt AP, Hunter G, Silva M, Parikh P, Hewett PC. Evidence-Based Process for Prioritizing Positive Behaviors for Promotion: Zika Prevention in Latin America and the Caribbean and Applicability to Future Health Emergency Responses. GLOBAL HEALTH: SCIENCE AND PRACTICE 2019; 7:404-417. [PMID: 31558597 PMCID: PMC6816817 DOI: 10.9745/ghsp-d-19-00188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/16/2019] [Indexed: 12/25/2022]
Abstract
To maximize the impact of Zika prevention programming efforts, a prioritization process for social and behavior change programming was developed based on a combination of research evidence and programmatic experience. Prioritized behaviors were: application of mosquito repellent, use of condoms, removing unintentional standing water, covering and scrubbing walls of water storage containers, seeking prenatal care, and seeking counseling on family planning if not planning to get pregnant. Since the 2015 Zika outbreak in Latin America and the Caribbean, a plethora of behavior change messages have been promoted to reduce Zika transmission. One year after the United States Agency for International Development (USAID) initiated its Zika response, more than 30 variants of preventive behaviors were being promoted. This situation challenged social and behavior change (SBC) programming efforts that require a coordinated response and agreed upon set of focus behaviors to be effective. To support USAID implementing partners in harmonizing prevention efforts to reduce Zika infection, we developed an evidence-based process to identify behaviors with the highest potential to reduce Zika infection and transmission. We compiled a full list of behaviors and selected the most promising for a full evidence review. The review included systematic keyword searches on Google Scholar, extraction of all relevant published articles on Aedes-borne diseases between 2012 and 2018, review of seminal papers, and review of gray literature. We examined articles to determine each behavior's potential effectiveness in preventing Zika transmission or reducing the Aedes aegypti population. We also developed assessment criteria to delineate the ease with which the target population could adopt each behavior, including: (1) required frequency; (2) feasibility of the behavior; and (3) accessibility and cost of the necessary materials in the setting. These behaviors were refined through a consensus-building process with USAID's Zika implementing partners, considering contextual factors. The resulting 7 evidence-based preventive behaviors have high potential to strengthen SBC programming's impact in USAID's Zika response: (1) apply mosquito repellent, (2) use condoms during pregnancy, (3) remove standing water, (4) cover water storage containers, (5) clean/remove mosquito eggs from water containers, (6) seek antenatal care, and (7) seek family planning counseling. This case study documents a flexible process that can be adapted to inform the prioritization of behaviors when there is limited evidence available, as during many emergency responses.
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Affiliation(s)
| | - Arianna Serino
- United States Agency for International Development, Washington DC, USA
| | | | - Gabrielle Hunter
- Johns Hopkins Center for Communication Programs, Baltimore MD, USA
| | | | - Priya Parikh
- Johns Hopkins Center for Communication Programs, Baltimore MD, USA
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Worsnop CZ. The Disease Outbreak-Human Trafficking Connection: A Missed Opportunity. Health Secur 2019; 17:181-192. [PMID: 31173508 DOI: 10.1089/hs.2018.0134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article examines the connection between disease outbreaks and human trafficking. A central challenge in combating trafficking is poor data on its nature and scope. One way to deal with these gaps in knowledge and still target resources effectively is to identify key "push and pull" factors that increase the likelihood of trafficking from origin countries and to destination countries. One under-examined push factor is the outbreak of disease. Outbreaks are associated with several well-documented trafficking risk factors, from the breakdown of rule of law and increase in criminal activity to competition for resources and diminished economic opportunity. Disease outbreaks can also disrupt family ties. For example, the 2014 Ebola outbreak in West Africa left thousands of orphans at increased risk of exploitation. The article outlines possible mechanisms through which outbreaks could increase trafficking risk and, using data on disease outbreaks and trafficking across states over the past 2 decades, provides evidence that countries that have recently experienced a disease outbreak are more likely to have trafficking outflows. The findings point to the importance of integrating trafficking prevention into outbreak response and call for a research agenda more fully examining the connection between trafficking and outbreaks (and potentially other types of natural disasters as well).
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Affiliation(s)
- Catherine Z Worsnop
- Catherine Z. Worsnop, PhD, is an Assistant Research Professor in the School of Public Policy, University of Maryland, College Park, Maryland
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Pooransingh S, Parasram R, Nandram N, Bhagwandeen B, Dialsingh I. Zika virus disease-knowledge, attitudes and practices among pregnant women-implications for public health practice. Public Health 2018; 165:146-151. [PMID: 30448643 DOI: 10.1016/j.puhe.2018.09.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 09/01/2018] [Accepted: 09/18/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Mosquito-borne diseases continue to pose a threat to Latin America and the Caribbean. Zika virus disease entered the Caribbean in 2013 with increased reporting of cases across the region in 2016, affecting more than 50 countries. This study aimed to ascertain the knowledge of, attitudes and practices towards Zika virus disease among antenatal clinic attenders in Trinidad and Tobago during the 2016 outbreak. STUDY DESIGN A cross-sectional questionnaire survey was undertaken. METHODS A knowledge attitudes and practices survey was conducted among antenatal clinic attenders at publicly funded primary care health centres. All counties of Trinidad (except St Patrick, Caroni and Victoria) and Tobago were included in the study. Within each county, three health centres were selected at random. At the antenatal clinic of each selected health centre, antenatal clients were selected by randomly selecting their patient file from that day's antenatal clinic patient files. Data collection occurred from September to November 2016. The knowledge, attitudes and practice survey was administered by an interviewer-administered questionnaire. The World Health Organization Knowledge, Attitudes and Practice surveys Zika virus disease and potential complications Resource pack was adapted for use as the data collection tool. All data collected were analysed using SPSS software, version 23. Tests with P-values less than 0.05 were deemed significant. RESULTS Seventy-four percent (74%) of responders did not think there was a link between sexual transmission and Zika. About 19% stated that abstaining could prevent Zika but only 6.6% actually practiced this. Seventy-six percent knew the risk of microcephaly, and this knowledge of the risk of microcephaly was found to be significantly associated with the number of weeks' gestation. Less than 40% knew the risk of Guillain-Barre syndrome. Doctors at health centres followed by private doctors were the top two trusted information sources for responders. Responders thought that the government could spray insecticide, clean drains, educate community members and clean overgrown vacant lots of land. CONCLUSION The government and healthcare workers need to reach specific target groups with accurate messages to minimize the associated morbidity and thereby safeguarding national and global health security.
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Affiliation(s)
- S Pooransingh
- Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago.
| | - R Parasram
- Office of the Chief Medical Officer, The Ministry of Health Trinidad and Tobago
| | - N Nandram
- Insect Vector Control Division, The Ministry of Health, Trinidad and Tobago
| | - B Bhagwandeen
- Faculty of Science and Technology, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - I Dialsingh
- Faculty of Science and Technology, The University of the West Indies, St Augustine, Trinidad and Tobago
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Abstract
BACKGROUND Zika virus (ZIKV) is an emergent flavivirus, transmitted predominately by Aedes genus mosquitos that recently reached the Americas and was soon implicated in an increase in microcephaly and other serious birth defects. PURPOSE This report provides updated information and recommendations on testing, screening, and care for pregnant women and infants affected by ZIKV. METHODS Current published recommendations from the Centers for Disease Control and Prevention, the World Health Organization, and the American Academy of Pediatrics were reviewed and included in this report. RESULTS Although largely a self-limiting disease usually without symptoms, pregnant women and their fetuses are at greatest risk. Maternal transmission of ZIKV to the fetus can lead to congenital Zika infection with potentially devastating sequelae to the infant. The available evidence suggests that infection during the first trimester of pregnancy, in which the fetus' central nervous system is being formed, is associated with higher risk of brain abnormalities and perinatal loss. IMPLICATIONS FOR PRACTICE Uncertainties remain about the course of the disease, and the full spectrum of effects of the virus on the developing infant is not yet understood. Infants with congenital Zika syndrome need coordinated follow-up and long-term specialty care, as well as support for the family. IMPLICATIONS FOR RESEARCH There is no known cure for ZIKV infection and no vaccine is currently available. The full spectrum of developmental disabilities and other adverse early childhood outcomes associated with congenital ZIKV infection needs to be studied.
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