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Groenewald P, Thomas J, Clark SJ, Morof D, Joubert JD, Kabudula C, Li Z, Bradshaw D. Agreement between cause of death assignment by computer-coded verbal autopsy methods and physician coding of verbal autopsy interviews in South Africa. Glob Health Action 2023; 16:2285105. [PMID: 38038664 PMCID: PMC10795603 DOI: 10.1080/16549716.2023.2285105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The South African national cause of death validation (NCODV 2017/18) project collected a national sample of verbal autopsies (VA) with cause of death (COD) assignment by physician-coded VA (PCVA) and computer-coded VA (CCVA). OBJECTIVE The performance of three CCVA algorithms (InterVA-5, InSilicoVA and Tariff 2.0) in assigning a COD was compared with PCVA (reference standard). METHODS Seven performance metrics assessed individual and population level agreement of COD assignment by age, sex and place of death subgroups. Positive predictive value (PPV), sensitivity, overall agreement, kappa, and chance corrected concordance (CCC) assessed individual level agreement. Cause-specific mortality fraction (CSMF) accuracy and Spearman's rank correlation assessed population level agreement. RESULTS A total of 5386 VA records were analysed. PCVA and CCVAs all identified HIV/AIDS as the leading COD. CCVA PPV and sensitivity, based on confidence intervals, were comparable except for HIV/AIDS, TB, maternal, diabetes mellitus, other cancers, and some injuries. CCVAs performed well for identifying perinatal deaths, road traffic accidents, suicide and homicide but poorly for pneumonia, other infectious diseases and renal failure. Overall agreement between CCVAs and PCVA for the top single cause (48.2-51.6) indicated comparable weak agreement between methods. Overall agreement, for the top three causes showed moderate agreement for InterVA (70.9) and InSilicoVA (73.8). Agreement based on kappa (-0.05-0.49)and CCC (0.06-0.43) was weak to none for all algorithms and groups. CCVAs had moderate to strong agreement for CSMF accuracy, with InterVA-5 highest for neonates (0.90), Tariff 2.0 highest for adults (0.89) and males (0.84), and InSilicoVA highest for females (0.88), elders (0.83) and out-of-facility deaths (0.85). Rank correlation indicated moderate agreement for adults (0.75-0.79). CONCLUSIONS Whilst CCVAs identified HIV/AIDS as the leading COD, consistent with PCVA, there is scope for improving the algorithms for use in South Africa.
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Affiliation(s)
- Pam Groenewald
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Jason Thomas
- Department of Sociology, The Ohio State University, Columbus, Ohio, USA
| | - Samuel J Clark
- Department of Sociology, The Ohio State University, Columbus, Ohio, USA
| | - Diane Morof
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Durban, South Africa
- United States Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Jané D. Joubert
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Chodziwadziwa Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of Witwatersrand, Johannesburg, South Africa
| | - Zehang Li
- Department of Statistics, University of California Santa Cruz, Santa Cruz, California, USA
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Public Health Medicine, School of Public Health, University of Cape Town, Cape Town, South Africa
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Groenewald P, Kallis N, Holmgren C, Glass T, Anthony A, Maud P, Akhalwaya Y, Afonso E, Niewoudt I, Martin LJ, De Vaal C, Cheyip M, Morof D, Prinsloo M, Matzopoulos R, Bradshaw D. Further evidence of misclassification of the injury deaths in South Africa: When will the barriers to accurate injury death statistics be removed? S Afr Med J 2023; 113:30-35. [PMID: 37882130 PMCID: PMC11017197 DOI: 10.7196/samj.2023.v113i9.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Contrary to the World Health Organization's internationally recommended medical certificate of cause of death, the South African (SA) death notification form (DNF) does not allow for the reporting of the manner of death to permit accurate coding of external causes of injury deaths. OBJECTIVES To describe the injury cause-of-death profile from forensic pathology records collected for the National Cause-of-Death Validation (NCoDV) Project and compare it with profiles from other sources of injury mortality data. In particular, the recording of firearm use in homicides is compared between sources. METHODS The NCoDV Project was a cross-sectional study of deaths that occurred during a fixed period in 2017 and 2018, from a nationally representative sample of 27 health subdistricts in SA. Trained fieldworkers scanned forensic records for all deaths investigated at the forensic mortuaries serving the sampled subdistricts during the study period. Forensic practitioners reviewed the records and completed a medical certificate of cause of death for each decedent. Causes of death were coded to the International Statistical Classification of Diseases, 10th revision (ICD-10), using Iris automated coding software. Cause-specific mortality fractions for injury deaths were compared with Injury Mortality Survey 2017 (IMS 2017) and Statistics South Africa 2017 (Stats SA 2017) datasets. The cause profile for all firearm-related deaths was compared between the three datasets. RESULTS A total of 5 315 records were available for analysis. Males accounted for 77.6% of cases, and most decedents were aged between 25 and 44 years. Homicide was the leading cause of death (34.7%), followed by transport injuries (32.6%) and suicide (14.7%). This injury cause profile was similar to IMS 2017 but differed markedly from the official statistics, which showed markedly lower proportions of these three causes (15.0%, 11.6% and 0.7%, respectively), and a much higher proportion of other unintentional causes. Investigation of firearm-related deaths revealed that most were homicides in NCoDV 2017/18 (88.5%) and IMS 2017 (93.1%), while in the Stats SA 2017 data, 98.7% of firearm deaths were classified as accidental. Approximately 7% of firearm-related deaths were suicides in NCoDV 2017/18 and IMS 2017, with only 0.3% in Stats SA 2017. CONCLUSION The official cause-of-death data for injuries in SA in 2017 differed substantially from findings from the NCoDV 2017/18 study and IMS 2017. Accurate data sources would ensure that public health interventions are designed to reduce the high injury burden. Inclusion of the manner of death on the DNF, as is recommended internationally, is critically important to enable more accurate, reliable and valid reporting of the injury profile.
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Affiliation(s)
- P Groenewald
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - N Kallis
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - C Holmgren
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - T Glass
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - A Anthony
- Department of Health and Wellness, Western Cape Department of Health, Cape Town, South Africa.
| | - P Maud
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Y Akhalwaya
- Family Centre for Research with Ubuntu (FAM-CRU), Department of Paediatrics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - E Afonso
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - I Niewoudt
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - L J Martin
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Forensic Pathology Service, Western Cape Department of Health, Cape Town, South Africa.
| | - C De Vaal
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - M Cheyip
- US Centers for Disease Control and Prevention, Pretoria, South Africa.
| | - D Morof
- US Centers for Disease Control and Prevention, Pretoria, South Africa.
| | - M Prinsloo
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - R Matzopoulos
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - D Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
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Taback-Esra R, Morof D, Briggs-Hagen M, Savva H, Mthethwa S, Williams D, Drummond J, Rothgerber N, Smith M, McMorrow M, Ndlovu M, Adelekan A, Kindra G, Olivier J, Mpofu N, Motlhaoleng K, Khuzwayo L, Makapela D, Manjengwa P, Ochieng A, Porter S, Grund J, Diallo K, Lacson R. Use of Epidemiology Surge Support to Enhance Robustness and Expand Capacity of SARS-CoV-2 Pandemic Response, South Africa. Emerg Infect Dis 2022; 28:S177-S180. [PMID: 36502381 DOI: 10.3201/eid2813.212522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
As COVID-19 cases increased during the first weeks of the pandemic in South Africa, the National Institute of Communicable Diseases requested assistance with epidemiologic and surveillance expertise from the US Centers for Disease Control and Prevention South Africa. By leveraging its existing relationship with the National Institute of Communicable Diseases for >2 months, the US Centers for Disease Control and Prevention South Africa supported data capture and file organization, data quality reviews, data analytics, laboratory strengthening, and the development and review of COVID-19 guidance This case study provides an account of the resources and the technical, logistical, and organizational capacity leveraged to support a rapid response to the COVID-19 pandemic in South Africa.
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Quincer E, Philipsborn R, Morof D, Salzberg NT, Vitorino P, Ajanovic S, Onyango D, Ogbuanu I, Assefa N, Sow SO, Mutevedzi P, El Arifeen S, Tippet Barr BA, Scott JAG, Mandomando I, Kotloff KL, Jambai A, Akelo V, Cain CJ, Chowdhury AI, Gure T, Igunza KA, Islam F, Keita AM, Madrid L, Mahtab S, Mehta A, Mitei PK, Ntuli C, Ojulong J, Rahman A, Samura S, Sidibe D, Thwala BN, Varo R, Madhi SA, Bassat Q, Gurley ES, Blau DM, Whitney CG. Insights on the differentiation of stillbirths and early neonatal deaths: A study from the Child Health and Mortality Prevention Surveillance (CHAMPS) network. PLoS One 2022; 17:e0271662. [PMID: 35862419 PMCID: PMC9302850 DOI: 10.1371/journal.pone.0271662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction The high burden of stillbirths and neonatal deaths is driving global initiatives to improve birth outcomes. Discerning stillbirths from neonatal deaths can be difficult in some settings, yet this distinction is critical for understanding causes of perinatal deaths and improving resuscitation practices for live born babies. Methods We evaluated data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network to compare the accuracy of determining stillbirths versus neonatal deaths from different data sources and to evaluate evidence of resuscitation at delivery in accordance with World Health Organization (WHO) guidelines. CHAMPS works to identify causes of stillbirth and death in children <5 years of age in Bangladesh and 6 countries in sub-Saharan Africa. Using CHAMPS data, we compared the final classification of a case as a stillbirth or neonatal death as certified by the CHAMPS Determining Cause of Death (DeCoDe) panel to both the initial report of the case by the family member or healthcare worker at CHAMPS enrollment and the birth outcome as stillbirth or livebirth documented in the maternal health record. Results Of 1967 deaths ultimately classified as stillbirth, only 28 (1.4%) were initially reported as livebirths. Of 845 cases classified as very early neonatal death, 33 (4%) were initially reported as stillbirth. Of 367 cases with post-mortem examination showing delivery weight >1000g and no maceration, the maternal clinical record documented that resuscitation was not performed in 161 cases (44%), performed in 14 (3%), and unknown or data missing for 192 (52%). Conclusion This analysis found that CHAMPS cases assigned as stillbirth or neonatal death after DeCoDe expert panel review were generally consistent with the initial report of the case as a stillbirth or neonatal death. Our findings suggest that more frequent use of resuscitation at delivery and improvements in documentation around events at birth could help improve perinatal outcomes.
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Affiliation(s)
- Elizabeth Quincer
- Department of Pediatrics and Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia, United States of America
| | - Rebecca Philipsborn
- Department of Pediatrics and Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia, United States of America
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Diane Morof
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Durban, South Africa
| | - Navit T. Salzberg
- Public Health Informatics, The Task Force for Global Health, Atlanta, Georgia, United States of America
| | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
| | - Sara Ajanovic
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
| | | | | | - Nega Assefa
- College of Health Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Samba O. Sow
- Centre pour le Développement des Vaccines (CVD-Mali), Bamako, Mali
| | - Portia Mutevedzi
- MRC Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Beth A. Tippet Barr
- Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - J. Anthony G. Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- Instituto Nacional de Saúde [INS], Maputo, Mozambique
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Amara Jambai
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Victor Akelo
- Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | | | | | - Tadesse Gure
- College of Health Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | - Farzana Islam
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | | | - Lola Madrid
- College of Health Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sana Mahtab
- MRC Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Ashka Mehta
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Constance Ntuli
- MRC Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | | | - Afruna Rahman
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | | | | | - Bukiwe Nana Thwala
- Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- ISGlobal- Hospital Clinic—Universitat de Barcelona, Barcelona, Spain
| | - Shabir A. Madhi
- MRC Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- ISGlobal- Hospital Clinic—Universitat de Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital de Sant Joan de Deu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud, Madrid, Spain
| | - Emily S. Gurley
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dianna M. Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Cynthia G. Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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Shandley LM, Kipling LM, Spencer JB, Morof D, Mertens AC, Howards PP. Factors Associated with Unplanned Pregnancy Among Cancer Survivors. J Womens Health (Larchmt) 2021; 31:665-674. [PMID: 34860591 PMCID: PMC9133970 DOI: 10.1089/jwh.2021.0176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Approximately half of all pregnancies in the United States are unintended. However, women who are diagnosed with cancer in their reproductive years may be a unique population. This study examines the prevalence of and identifies factors associated with unplanned pregnancy among cancer survivors. Methods: Female cancer survivors aged 22-45 years, diagnosed between ages 20-35 years and at least 2 years postdiagnosis, and women with no history of cancer were interviewed about their reproductive histories, including pregnancy intention. Using a random matching process, comparison women were assigned an artificial age at cancer diagnosis equal to that of her cancer survivor match. An adjusted Cox model was fit examining time to unintended pregnancy after cancer for each of 1,000 matches. Cox proportional hazards models were also fit to assess associations between participant characteristics and unplanned pregnancy after cancer among survivors. Results: Cancer survivors (n = 1,282) and comparison women (n = 1,073) reported a similar likelihood of having an unplanned pregnancy in models adjusted for race, income, history of sexually-transmitted infection, and history of unplanned pregnancy before diagnosis (adjusted hazard ratio [aHR] 1.06, 95% simulation interval 0.85-1.36). After adjusting for confounders, unplanned pregnancy among survivors was associated with age <30 years at diagnosis (hazard ratio [HR]: 1.79, 95% confidence interval [CI]: 1.32-2.44), black race (HR: 1.55, 95% CI: 1.13-2.12; referent: white), receiving fertility counseling (aHR: 1.41, 95% CI: 1.04-1.92), and having at least one child before diagnosis (aHR: 1.44, 95% CI: 1.05-1.97). Conclusion: Cancer survivors and comparison women had similar likelihood of unplanned pregnancy. Rates of unplanned pregnancy after cancer were not higher for cancer survivors compared with comparison women, but 46.4% of survivors with a postcancer pregnancy reported an unplanned pregnancy. Cancer patients may benefit from patient-centered guidelines and counseling before cancer treatment that covers both risks of infertility and risks of unplanned pregnancy.
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Affiliation(s)
- Lisa M Shandley
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lauren M Kipling
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jessica B Spencer
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Diane Morof
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,U.S. Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Ann C Mertens
- Department of Pediatrics, Aflac Cancer Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Young MR, Morof D, Lathrop E, Haddad L, Blanton C, Maro G, Serbanescu F. Beyond adequate: Factors associated with quality of antenatal care in western Tanzania. Int J Gynaecol Obstet 2020; 151:431-437. [PMID: 32799345 DOI: 10.1002/ijgo.13349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/28/2020] [Accepted: 08/13/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine quality of antenatal care (ANC). Most literature focuses on ANC attendance and services. Less is known about quality of care (QoC). METHOD Data were analyzed from the 2016 Kigoma Reproductive Health Survey, a population-based survey of reproductive-aged women. Women with singleton term live births were included and principal component analysis (PCA) was used to create an ANC quality index using linear combinations of weights of the first principal component. Nineteen variables were selected for the index. The index was then used to assign a QoC score for each woman and linear regression used to identify factors associated with receiving higher QoC. RESULTS A total of 3178 women received some ANC. Variables that explained the most variance in the QoC index included: gave urine (0.35); gave blood (0.34); and blood pressure measured (0.30). In multivariable linear regression, factors associated with higher QoC included: ANC at a hospital (versus dispensary); older age; higher level of education; working outside the home; higher socioeconomic status; and having lower parity. CONCLUSION Using PCA methods, several basic components of ANC including maternal physical assessment were identified as important indicators of quality. This approach provides an affordable and effective means of evaluating ANC programs.
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Affiliation(s)
- Marisa R Young
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Diane Morof
- Division of Global HIV/AIDS and Tuberculosis, U.S. Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Eva Lathrop
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Lisa Haddad
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Curtis Blanton
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Godson Maro
- Bloomberg Philanthropies, Dar es Salaam, Tanzania
| | - Florina Serbanescu
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Fukunaga R, Morof D, Blanton C, Ruiz A, Maro G, Serbanescu F. Factors associated with local herb use during pregnancy and labor among women in Kigoma region, Tanzania, 2014-2016. BMC Pregnancy Childbirth 2020; 20:122. [PMID: 32085731 PMCID: PMC7035699 DOI: 10.1186/s12884-020-2735-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/09/2020] [Indexed: 11/11/2022] Open
Abstract
Background Despite research suggesting an association between certain herb use during pregnancy and delivery and postnatal complications, herbs are still commonly used among pregnant women in sub-Sahara Africa (SSA). This study examines the factors and characteristics of women using local herbs during pregnancy and/or labor, and the associations between local herb use and postnatal complications in Kigoma, Tanzania. Methods We analyzed data from the 2016 Kigoma Tanzania Reproductive Health Survey (RHS), a regionally representative, population-based survey of reproductive age women (15–49 years). We included information on each woman’s most recent pregnancy resulting in a live birth during January 2014–September 2016. We calculated weighted prevalence estimates and used multivariable logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for factors associated with use of local herbs during pregnancy and/or labor, as well as factors associated with postnatal complications. Results Of 3530 women, 10.9% (CI: 9.0–13.1) used local herbs during their last pregnancy and/or labor resulting in live birth. The most common reasons for taking local herbs included stomach pain (42.9%) and for the health of the child (25.5%). Adjusted odds of local herb use was higher for women reporting a home versus facility-based delivery (aOR: 1.6, CI: 1.1–2.2), having one versus three or more prior live births (aOR: 1.8, CI: 1.4–2.4), and having a household income in the lowest versus the highest wealth tercile (aOR: 1.4, CI: 1.1–1.9). Adjusted odds of postnatal complications were higher among women who used local herbs versus those who did not (aOR: 1.5, CI: 1.2–1.9), had four or more antenatal care visits versus fewer (aOR: 1.4, CI: 1.2–1.2), and were aged 25–34 (aOR: 1.1, CI: 1.0–1.3) and 35–49 (aOR: 1.3, CI: 1.0–1.6) versus < 25 years. Conclusions About one in ten women in Kigoma used local herbs during their most recent pregnancy and/or labor and had a high risk of postnatal complications. Health providers may consider screening pregnant women for herb use during antenatal and delivery care as well as provide information about any known risks of complications from herb use.
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Affiliation(s)
- R Fukunaga
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. .,Epidemic Intelligence Service, Atlanta, Georgia, USA.
| | - D Morof
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,United States Public Health Service, Atlanta, USA
| | - C Blanton
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - A Ruiz
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - G Maro
- Bloomberg Philanthropies, New York, New York, United States
| | - F Serbanescu
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Serbanescu F, Clark TA, Goodwin MM, Nelson LJ, Boyd MA, Kekitiinwa AR, Kaharuza F, Picho B, Morof D, Blanton C, Mumba M, Komakech P, Carlosama F, Schmitz MM, Conlon CM. Impact of the Saving Mothers, Giving Life Approach on Decreasing Maternal and Perinatal Deaths in Uganda and Zambia. Glob Health Sci Pract 2019; 7:S27-S47. [PMID: 30867208 PMCID: PMC6519676 DOI: 10.9745/ghsp-d-18-00428] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/28/2019] [Indexed: 01/09/2023]
Abstract
Through district system strengthening, integrated services, and community engagement interventions, the Saving Mothers, Giving Life initiative increased emergency obstetric care coverage and access to, and demand for, improved quality of care that led to rapid declines in district maternal and perinatal mortality. Significant reductions in intrapartum stillbirth rate and maternal mortality ratios around the time of birth attest to the success of the initiative. Background: Maternal and perinatal mortality is a global development priority that continues to present major challenges in sub-Saharan Africa. Saving Mothers, Giving Life (SMGL) was a multipartner initiative implemented from 2012 to 2017 with the goal of improving maternal and perinatal health in high-mortality settings. The initiative accomplished this by reducing delays to timely and appropriate obstetric care through the introduction and support of community and facility evidence-based and district-wide health systems strengthening interventions. Methods: SMGL-designated pilot districts in Uganda and Zambia documented baseline and endline maternal and perinatal health outcomes using multiple approaches. These included health facility assessments, pregnancy outcome monitoring, enhanced maternal mortality detection in facilities, and district population-based identification and investigation of maternal deaths in communities. Results: Over the course of the 5-year SMGL initiative, population-based estimates documented a 44% reduction in the SMGL-supported district-wide maternal mortality ratio (MMR) in Uganda (from 452 to 255 maternal deaths per 100,000 live births) and a 41% reduction in Zambia (from 480 to 284 maternal deaths per 100,000 live births). The MMR in SMGL-supported health facilities declined by 44% in Uganda and by 38% in Zambia. The institutional delivery rate increased by 47% in Uganda (from 45.5% to 66.8% of district births) and by 44% in Zambia (from 62.6% to 90.2% of district births). The number of facilities providing emergency obstetric and newborn care (EmONC) rose from 10 to 26 in Uganda and from 7 to 13 in Zambia, and lower- and mid-level facilities increased the number of EmONC signal functions performed. Cesarean delivery rates increased by more than 70% in both countries, reaching 9% and 5% of all births in Uganda and Zambia districts, respectively. Maternal deaths in facilities due to obstetric hemorrhage declined by 42% in Uganda and 65% in Zambia. Overall, perinatal mortality rates declined, largely due to reductions in stillbirths in both countries; however, no statistically significant changes were found in predischarge neonatal death rates in predischarge either country. Conclusions: MMRs fell significantly in Uganda and Zambia following the introduction of the SMGL interventions, and SMGL's comprehensive district systems-strengthening approach successfully improved coverage and quality of care for mothers and newborns. The lessons learned from the initiative can inform policy makers and program managers in other low- and middle-income settings where similar approaches could be used to rapidly reduce preventable maternal and newborn deaths.
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Affiliation(s)
- Florina Serbanescu
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Thomas A Clark
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary M Goodwin
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa J Nelson
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | - Mary Adetinuke Boyd
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - Frank Kaharuza
- HIV Health Office, U.S. Agency for International Development, Kampala, Uganda
| | - Brenda Picho
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Diane Morof
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,U.S. Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Curtis Blanton
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maybin Mumba
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Patrick Komakech
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | - Fernando Carlosama
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michelle M Schmitz
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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9
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Serbanescu F, Goodwin MM, Binzen S, Morof D, Asiimwe AR, Kelly L, Wakefield C, Picho B, Healey J, Nalutaaya A, Hamomba L, Kamara V, Opio G, Kaharuza F, Blanton C, Luwaga F, Steffen M, Conlon CM. Addressing the First Delay in Saving Mothers, Giving Life Districts in Uganda and Zambia: Approaches and Results for Increasing Demand for Facility Delivery Services. Glob Health Sci Pract 2019; 7:S48-S67. [PMID: 30867209 PMCID: PMC6519679 DOI: 10.9745/ghsp-d-18-00343] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/29/2019] [Indexed: 11/24/2022]
Abstract
The Saving Mothers, Giving Life initiative used 3 coordinated approaches to reduce
maternal deaths resulting from a delay in deciding to seek health care, known as the
“first delay”: (1) promoting safe motherhood messages and facility delivery
using radio, theater, and community engagement; (2) encouraging birth preparedness and
increasing demand for facility delivery through community outreach worker visits; and (3)
providing clean delivery kits and transportation vouchers to reduce financial barriers for
facility delivery. These approaches can be adapted in other low-resource settings to
reduce maternal and perinatal mortality. Saving Mothers, Giving Life (SMGL), a 5-year initiative implemented in selected districts
in Uganda and Zambia, was designed to reduce deaths related to pregnancy and childbirth by
targeting the 3 delays to receiving appropriate care at birth. While originally the
“Three Delays” model was designed to focus on curative services that
encompass emergency obstetric care, SMGL expanded its application to primary and secondary
prevention of obstetric complications. Prevention of the “first delay”
focused on addressing factors influencing the decision to seek delivery care at a health
facility. Numerous factors can contribute to the first delay, including a lack of birth
planning, unfamiliarity with pregnancy danger signs, poor perceptions of facility care,
and financial or geographic barriers. SMGL addressed these barriers through community
engagement on safe motherhood, public health outreach, community workers who identified
pregnant women and encouraged facility delivery, and incentives to deliver in a health
facility. SMGL used qualitative and quantitative methods to describe intervention
strategies, intervention outcomes, and health impacts. Partner reports, health facility
assessments (HFAs), facility and community surveillance, and population-based mortality
studies were used to document activities and measure health outcomes in SMGL-supported
districts. SMGL's approach led to unprecedented community outreach on safe motherhood
issues in SMGL districts. About 3,800 community health care workers in Uganda and 1,558 in
Zambia were engaged. HFAs indicated that facility deliveries rose significantly in SMGL
districts. In Uganda, the proportion of births that took place in facilities rose from
45.5% to 66.8% (47% increase); similarly, in Zambia SMGL districts,
facility deliveries increased from 62.6% to 90.2% (44% increase). In
both countries, the proportion of women delivering in facilities equipped to provide
emergency obstetric and newborn care also increased (from 28.2% to 41.0% in
Uganda and from 26.0% to 29.1% in Zambia). The districts documented declines
in the number of maternal deaths due to not accessing facility care during pregnancy,
delivery, and the postpartum period in both countries. This reduction played a significant
role in the decline of the maternal mortality ratio in SMGL-supported districts in Uganda
but not in Zambia. Further work is needed to sustain gains and to eliminate preventable
maternal and perinatal deaths.
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Affiliation(s)
- Florina Serbanescu
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Mary M Goodwin
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susanna Binzen
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diane Morof
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,U.S. Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Alice R Asiimwe
- Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
| | - Laura Kelly
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA. Now with Deloitte Consulting, LLP, Atlanta, GA, USA
| | | | - Brenda Picho
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jessica Healey
- U.S. Agency for International Development, Lusaka, Zambia. Now based in Monrovia, Liberia
| | - Agnes Nalutaaya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Leoda Hamomba
- Division of Global HIV and TB, Centers for Disease Control and Prevention-Zambia, Lusaka, Zambia
| | - Vincent Kamara
- Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
| | - Gregory Opio
- Infectious Diseases Institute, Makerere University, Kibaale, Uganda
| | - Frank Kaharuza
- Bureau for Global Health, U.S. Agency for International Development, Washington, DC, USA
| | - Curtis Blanton
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fredrick Luwaga
- Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
| | - Mona Steffen
- Bureau for Global Health, U.S. Agency for International Development, Washington, DC. Now with ICF, Rockville, MD, USA
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Morof D, Serbanescu F, Goodwin MM, Hamer DH, Asiimwe AR, Hamomba L, Musumali M, Binzen S, Kekitiinwa A, Picho B, Kaharuza F, Namukanja PM, Murokora D, Kamara V, Dynes M, Blanton C, Nalutaaya A, Luwaga F, Schmitz MM, LaBrecque J, Conlon CM, McCarthy B, Kroelinger C, Clark T. Addressing the Third Delay in Saving Mothers, Giving Life Districts in Uganda and Zambia: Ensuring Adequate and Appropriate Facility-Based Maternal and Perinatal Health Care. Glob Health Sci Pract 2019; 7:S85-S103. [PMID: 30867211 PMCID: PMC6519670 DOI: 10.9745/ghsp-d-18-00272] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/21/2018] [Indexed: 12/21/2022]
Abstract
Saving Mothers, Giving Life used 6 strategies to address the third delay—receiving adequate health care after reaching a facility—in maternal and newborn health care. The intervention approaches can be adapted in low-resource settings to improve facility-based care and reduce maternal and perinatal mortality. Background: Saving Mothers, Giving Life (SMGL) is a 5-year initiative implemented in participating districts in Uganda and Zambia that aimed to reduce deaths related to pregnancy and childbirth by targeting the 3 delays to receiving appropriate care: seeking, reaching, and receiving. Approaches to addressing the third delay included adequate health facility infrastructure, specifically sufficient equipment and medications; trained providers to provide quality evidence-based care; support for referrals to higher-level care; and effective maternal and perinatal death surveillance and response. Methods: SMGL used a mixed-methods approach to describe intervention strategies, outcomes, and health impacts. Programmatic and monitoring and evaluation data—health facility assessments, facility and community surveillance, and population-based mortality studies—were used to document the effectiveness of intervention components. Results: During the SMGL initiative, the proportion of facilities providing emergency obstetric and newborn care (EmONC) increased from 10% to 25% in Uganda and from 6% to 12% in Zambia. Correspondingly, the delivery rate occurring in EmONC facilities increased from 28.2% to 41.0% in Uganda and from 26.0% to 29.1% in Zambia. Nearly all facilities had at least one trained provider on staff by the endline evaluation. Staffing increases allowed a higher proportion of health centers to provide care 24 hours a day/7 days a week by endline—from 74.6% to 82.9% in Uganda and from 64.8% to 95.5% in Zambia. During this period, referral communication improved from 93.3% to 99.0% in Uganda and from 44.6% to 100% in Zambia, and data systems to identify and analyze causes of maternal and perinatal deaths were established and strengthened. Conclusion: SMGL's approach was associated with improvements in facility infrastructure, equipment, medication, access to skilled staff, and referral mechanisms and led to declines in facility maternal and perinatal mortality rates. Further work is needed to sustain these gains and to eliminate preventable maternal and perinatal deaths.
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Affiliation(s)
- Diane Morof
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA. .,U.S. Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Florina Serbanescu
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary M Goodwin
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Alice R Asiimwe
- Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
| | - Leoda Hamomba
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Masuka Musumali
- Family Health Division, U.S. Agency for International Development, Lusaka, Zambia
| | - Susanna Binzen
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Brenda Picho
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Frank Kaharuza
- HIV Health Office, U.S. Agency for International Development, Kampala, Uganda
| | | | - Dan Murokora
- Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
| | - Vincent Kamara
- Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
| | - Michelle Dynes
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,U.S. Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Curtis Blanton
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Agnes Nalutaaya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fredrick Luwaga
- Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
| | - Michelle M Schmitz
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonathan LaBrecque
- Bureau for Global Health, U.S. Agency for International Development, Washington DC. Now with Boston Children's Hospital, Boston, MA, USA
| | | | - Brian McCarthy
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Charlan Kroelinger
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas Clark
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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11
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Mpofu JJ, Soud F, Lyman M, Koroma AP, Morof D, Ellington S, Kargbo SS, Callaghan W. Clinical presentation of pregnant women in isolation units for Ebola virus disease in Sierra Leone, 2014. Int J Gynaecol Obstet 2019; 145:76-82. [PMID: 30706470 DOI: 10.1002/ijgo.12775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/28/2018] [Accepted: 01/30/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To examine Ebola virus disease (EVD) symptom prevalence and EVD status among pregnant women in Ebola isolation units in Sierra Leone. METHODS In an observational study, data were obtained for pregnant women admitted to Ebola isolation units across four districts in Sierra Leone from June 29, 2014, to December 20, 2014. Women were admitted to isolation units if they had suspected EVD exposures or fever (temperature >38°C) and three or more self-reported symptoms suggestive of EVD. Associations were examined between EVD status and each symptom using χ2 tests and logistic regression adjusting for age/labor status. RESULTS Of 176 pregnant women isolated, 55 (32.5%) tested positive for EVD. Using logistic regression models adjusted for age, EVD-positive women were significantly more likely to have fever, self-reported fatigue/weakness, nausea/vomiting, headache, muscle/joint pain, chest pain, vaginal bleeding, unexplained bleeding, or sore throat upon admission. In models adjusted for age/labor, only women with fever or vaginal bleeding upon admission were significantly more likely to be EVD-positive. CONCLUSIONS Several EVD symptoms and complications increased the odds of testing EVD-positive; some of these were also signs and symptoms of labor/pregnancy complications. The study results highlight the need to refine screening for pregnant women with EVD.
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Affiliation(s)
- Jonetta J Mpofu
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.,US Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Fatma Soud
- Zambia Country Office, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Meghan Lyman
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Office of Public Health Scientific Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Diane Morof
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.,US Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Sascha Ellington
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - William Callaghan
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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Dynes MM, Bernstein E, Morof D, Kelly L, Ruiz A, Mongo W, Chaote P, Bujari RN, Serbanescu F. Client and provider factors associated with integration of family planning services among maternal and reproductive health clients in Kigoma Region, Tanzania: a cross-sectional study, April-July 2016. Reprod Health 2018; 15:152. [PMID: 30208913 PMCID: PMC6134585 DOI: 10.1186/s12978-018-0593-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 08/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integration of family planning (FP) services into non-FP care visits is an essential strategy for reducing maternal and neonatal mortality through reduction of short birth intervals and unplanned pregnancies. METHODS Cross-sectional surveys were conducted across 61 facilities in Kigoma Region, Tanzania, April-July 2016. Multilevel, mixed effects logistic regression analyses were conducted on matched data from providers (n = 330) and clients seeking delivery (n = 935), well-baby (n = 272), pregnancy loss (PL; n = 229), and other routine (postnatal, HIV/STI, other; n = 69) services. Outcomes of interest included receipt of FP information and a modern FP method (significance level p < 0.05). RESULTS Clients had significantly greater odds of receiving FP information if the primary reason for seeking care was for PL versus (vs) any other types of care (aOR 1.97), had four or more pregnancies vs fewer (aOR 1.78), and had had a FP discussion with their partner vs no FP discussion (aOR 1.73). Clients had lower odds of receiving FP information if they were aged 40-49 vs 15-19 (aOR 0.50) and reported attending religious services at least weekly vs less frequently (aOR 0.61). Clients of providers who perceived that in-service training had helped vs had not helped job performance (aOR 2.27), and clients of providers having high vs low recent FP training index scores (aOR 1.58) had greater odds of receiving FP information. Clients had greater odds of receiving a modern method when they received information on two or more vs fewer methods (aOR 7.13), had had a FP discussion with their partner vs no discussion (aOR 5.87), if the primary reason for seeking care was for PL vs any other types of care (aOR 4.08), had zero vs one or more live births (aOR 3.92), made their own FP decisions vs not made own FP decisions (aOR 3.17), received FP information from two or more vs fewer sources (aOR 3.12), and were in the middle or high vs the low wealth tercile (aOR 1.99 and 2.30, respectively). Well-baby care clients, Other routine services clients, and married clients had significantly lower odds of receiving a method (aOR 0.14; aOR 0.08; and aOR 0.41, respectively) compared to their counterparts. CONCLUSIONS Strategies that better integrate FP into routine care visits, encourage women to have FP discussions with their partners and providers, increase FP training among providers, and expand FP options and sources of information may help reduce the unmet need for FP, and ultimately lower maternal and neonatal mortality.
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Affiliation(s)
- M M Dynes
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA.
| | - E Bernstein
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA
| | - D Morof
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA
| | - L Kelly
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA
| | - A Ruiz
- Centers for Disease Control and Prevention, Division of Reproductive Health (CDCF Contractor), Atlanta, USA
| | - W Mongo
- EngenderHealth, Washington, DC, USA
| | - P Chaote
- Regional Medical Officer, Kigoma, Kigoma Region, Tanzania
| | - R N Bujari
- AMCA Inter Consult, Dar es Salaam, Tanzania
| | - F Serbanescu
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA
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13
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Ellington S, Perez M, Morof D, Zotti ME, Callaghan W, Meaney-Delman D, Glover M, Ha QC, Jamieson DJ. Addressing Maternal Health During CDC's Ebola Response in the United States. J Womens Health (Larchmt) 2018; 26:1141-1145. [PMID: 29140769 DOI: 10.1089/jwh.2017.6719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Previous outbreaks suggest that pregnant women with Ebola virus disease (EVD) are at increased risk for severe disease and death. Healthcare workers who treat pregnant women with EVD are at increased risk of body fluid exposure. Despite the absence of pregnant women with EVD in the United States, CDC activated the Maternal Health Team (MHT), a functional unit dedicated to emergency preparedness and response issues, on October 18, 2014. We describe major activities of the MHT. A high-priority MHT activity was to publish guiding principles early in the response. The MHT also prepared guidance documents, provided guidance and technical support for hospital preparedness, and addressed inquiries. We analyzed maternal health inquiries received through CDC-INFO, MHT, and CDC's Medical Investigations Team from August 2014 to December 2015. Internal call logs used to capture, monitor, and track inquiries for the three data sources were merged. Inquiries not related to maternal health issues and duplicates were removed. Each inquiry was categorized by route (email/phone), inquirer type, and topic. In total, 201 inquiries were received from clinicians, public health professionals, and the public. The predominant topic was related to infection control for high-risk situations such as labor and delivery. During the Ebola response, most inquiries were received via email rather than telephone, a notable shift compared to the H1N1 emergency response. Lessons learned during the H1N1 and Ebola responses are currently informing CDC's Zika Response, an unprecedented emergency response primarily focused on reproductive health issues.
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Affiliation(s)
- Sascha Ellington
- 1 Division of Reproductive Health (DRH), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC) , Atlanta, Georgia
| | - Mirna Perez
- 1 Division of Reproductive Health (DRH), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC) , Atlanta, Georgia
| | - Diane Morof
- 1 Division of Reproductive Health (DRH), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC) , Atlanta, Georgia
| | - Marianne E Zotti
- 1 Division of Reproductive Health (DRH), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC) , Atlanta, Georgia
| | - William Callaghan
- 1 Division of Reproductive Health (DRH), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC) , Atlanta, Georgia
| | - Dana Meaney-Delman
- 2 National Center for Emerging and Zoonotic Infectious Diseases , CDC, Atlanta, Georgia
| | - Maleeka Glover
- 3 Division of Emergency Operations, Office of Public Health Emergency Preparedness and Response , CDC, Atlanta, Georgia
| | - Quynh-Chau Ha
- 4 Division of Communication Services, CDC-INFO, Office of the Associate Director for Communication , CDC, Atlanta, Georgia
| | - Denise J Jamieson
- 1 Division of Reproductive Health (DRH), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC) , Atlanta, Georgia
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14
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Lyman M, Mpofu JJ, Soud F, Oduyebo T, Ellington S, Schlough GW, Koroma AP, McFadden J, Morof D. Maternal and perinatal outcomes in pregnant women with suspected Ebola virus disease in Sierra Leone, 2014. Int J Gynaecol Obstet 2018; 142:71-77. [PMID: 29569244 DOI: 10.1002/ijgo.12490] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/05/2018] [Accepted: 03/20/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To describe maternal and perinatal outcomes among pregnant women with suspected Ebola virus disease (EVD) in Sierra Leone. METHODS Observational investigation of maternal and perinatal outcomes among pregnant women with suspected EVD from five districts in Sierra Leone from June to December 2014. Suspected cases were ill pregnant women with symptoms suggestive of EVD or relevant exposures who were tested for EVD. Case frequencies and odds ratios were calculated to compare patient characteristics and outcomes by EVD status. RESULTS There were 192 suspected cases: 67 (34.9%) EVD-positive, 118 (61.5%) EVD-negative, and 7 (3.6%) EVD status unknown. Women with EVD had increased odds of death (OR 10.22; 95% CI, 4.87-21.46) and spontaneous abortion (OR 4.93; 95% CI, 1.79-13.55) compared with those without EVD. Women without EVD had a high frequency of death (30.2%) and stillbirths (65.9%). One of 14 neonates born following EVD-negative and five of six neonates born following EVD-positive pregnancies died. CONCLUSION EVD-positive and EVD-negative women with suspected EVD had poor outcomes, highlighting the need for increased attention and resources focused on maternal and perinatal health during an urgent public health response. Capturing pregnancy status in nationwide surveillance of EVD can help improve understanding of disease burden and design effective interventions.
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Affiliation(s)
- Meghan Lyman
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonetta Johnson Mpofu
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.,US Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Fatma Soud
- Prevention Care and Treatment Branch, Centers for Disease Control and Prevention, c/o American Embassy, Lusaka, Zambia
| | - Titilope Oduyebo
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sascha Ellington
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gabriel W Schlough
- West African Medical Missions Inc, Freetown, Sierra Leone.,Partners in Health, Freetown, Sierra Leone
| | | | - Jevon McFadden
- Division of State and Local Readiness, Centers for Disease Control and Prevention assigned to the Michigan department of Community Health, Lansing, MI, USA
| | - Diane Morof
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.,US Public Health Service Commissioned Corps, Rockville, MD, USA
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Barrett G, Morroni C, Stephenson J, Hall J, Morof D, Rocca CH. Regarding "identifying women at risk of unintended pregnancy: a comparison of two pregnancy readiness measures": measuring pregnancy intention. Ann Epidemiol 2013; 24:78-9. [PMID: 24263000 DOI: 10.1016/j.annepidem.2013.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 09/21/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Geraldine Barrett
- School of Health Sciences and Social Care, Brunel University, West London, UK; Research Department of Reproductive Health, Institute for Women's Health, University College London, UK
| | - Chelsea Morroni
- Research Department of Reproductive Health, Institute for Women's Health, University College London, UK
| | - Judith Stephenson
- Research Department of Reproductive Health, Institute for Women's Health, University College London, UK
| | - Jennifer Hall
- Institute of Global Health and Institute for Women's Health, University College London, UK
| | - Diane Morof
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Corinne H Rocca
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
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Morof D, Cookson ST, Laver S, Chirundu D, Desai S, Mathenge P, Shambare D, Charimari L, Midzi S, Blanton C, Handzel T. Community mortality from cholera: urban and rural districts in Zimbabwe. Am J Trop Med Hyg 2013; 88:645-50. [PMID: 23400576 DOI: 10.4269/ajtmh.11-0696] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In 2008-2009, Zimbabwe experienced an unprecedented cholera outbreak with more than 4,000 deaths. More than 60% of deaths occurred at the community level. We conducted descriptive and case-control studies to describe community deaths. Cases were in cholera patients who died outside health facilities. Two surviving cholera patients were matched by age, time of symptom onset, and location to each case-patient. Proxies completed questionnaires regarding mortality risk factors. Cholera awareness and importance of rehydration was high but availability of oral rehydration salts was low. A total of 55 case-patients were matched to 110 controls. The odds of death were higher among males (adjusted odd ratio [AOR] = 5.00, 95% confidence interval [CI] = 1.54-14.30) and persons with larger household sizes (AOR = 1.21, 95% CI = 1.00-1.46). Receiving home-based rehydration (AOR = 0.21, 95% CI = 0.06-0.71) and visiting cholera treatment centers (CTCs) (AOR = 0.07, 95% CI = 0.02-0.23) were protective. Receiving cholera information was associated with home-based rehydration and visiting CTCs. When we compared cases and controls who did not go to CTCs, males were still at increased odds of death (AOR = 5.00, 95% CI = 1.56-16.10) and receiving home-based rehydration (AOR = 0.14, 95% CI = 0.04-0.53) and being married (AOR = 0.26, 95% CI = 0.08-0.83) were protective. Inability to receive home-based rehydration or visit CTCs was associated with mortality. Community education must reinforce the importance of prompt rehydration and CTC referral.
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Affiliation(s)
- Diane Morof
- Epidemic Intelligence Service Officer assigned to International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Morof D, Sami S, Austin J, Blanton C, Tomczyk B. O474 SETTING OPERATIONAL RESEARCH PRIORITIES FOR REPRODUCTIVE HEALTH IN CRISIS SETTINGS: USING THE CHILD HEALTH AND NUTRITION RESEARCH INITIATIVE METHODOLOGY. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60904-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Morof D, Steinauer J, Haider S, Liu S, Darney P, Barrett G. Evaluation of the London Measure of Unplanned Pregnancy in a United States population of women. PLoS One 2012; 7:e35381. [PMID: 22536377 PMCID: PMC3334919 DOI: 10.1371/journal.pone.0035381] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 03/15/2012] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate the reliability and validity of the London Measure of Unplanned Pregnancy (a U.K.-developed measure of pregnancy intention), in English and Spanish translation, in a U.S. population of women. Methods A psychometric evaluation study of the London Measure of Unplanned Pregnancy (LMUP), a six-item, self-completion paper measure was conducted with 346 women aged 15–45 who presented to San Francisco General Hospital for termination of pregnancy or antenatal care. Analyses of the two language versions were carried out separately. Reliability (internal consistency) was assessed using Cronbach's alpha and item-total correlations. Test-retest reliability (stability) was assessed using weighted Kappa. Construct validity was assessed using principal components analysis and hypothesis testing. Results Psychometric testing demonstrated that the LMUP was reliable and valid in both U.S. English (alpha = 0.78, all item-total correlations >0.20, weighted Kappa = 0.72, unidimensionality confirmed, hypotheses met) and Spanish translation (alpha = 0.84, all item-total correlations >0.20, weighted Kappa = 0.77, unidimensionality confirmed, hypotheses met). Conclusion The LMUP was reliable and valid in U.S. English and Spanish translation and therefore may now be used with U.S. women.
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Affiliation(s)
- Diane Morof
- Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco General Hospital and the Bixby Center for Global Reproductive Health, University of California San Francisco, San Francisco, California, United States of America.
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Morof D, Levine D, Grable I, Barnewolt C, Estroff J, Fishman S, Rahbar R, Jennings RW. Oropharyngeal Teratoma: Prenatal Diagnosis and Assessment Using Sonography, MRI, and CT with Management by Ex Utero Intrapartum Treatment Procedure. AJR Am J Roentgenol 2004; 183:493-6. [PMID: 15269046 DOI: 10.2214/ajr.183.2.1830493] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Diane Morof
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Morof D, Wahasoka A, Nivia H, Lupiwa T, Mgone C. Sex Workers' Sexual Health and Peer Education Project in Goroka, Eastern Highlands Province, Papua New Guinea. P N G Med J 2004; 47:50-64. [PMID: 16496515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
We conducted a survey among female sex workers in Goroka, Eastern Highlands Province, Papua New Guinea to evaluate the frequency of sexually transmitted disease (STD) symptoms they suffered, their STD and HIV (human immunodeficiency virus) transmission knowledge and health-seeking behaviours, the forms that their HIV risk perception took, and the types and quantities of educational resources to which they had access and in fact used. This survey was a part of a larger study of sex workers that was carried out in two other cities, Lae, the capital of Morobe Province, and Port Moresby, the nation's capital. We interviewed 190 self-identified female sex workers who had been recruited between January 1999 and October 1999 through peer-mediated contacts. In an average one-week period, the women had intercourse with two customers, two to three times, and one boyfriend once or twice. In the surveyed group, 83% of the women had a history of symptomatic STDs and 73% had gone to an STD clinic for treatment. Of the women who used condoms at all, 7% used them each time they had sex with clients, but only 3% used them each time they had sex with steady partners. The remaining 93% of the women used condoms on some occasions or not at all. Most women (72%) knew about male-female transmission of HIV, but fewer cited other sexual and non-sexual modes of transmission. The majority of the women (71%) felt that they were of low or unknown risk of acquiring HIV infection. When asked where or to whom they would go when concerned about AIDS (acquired immune deficiency syndrome) or STDs, most women (93%) said that they would go to a health care provider. Evaluating the sex workers' understanding of STDs and HIV has been essential in designing education and intervention projects so as better to address the future morbidity and mortality associated with STDs and AIDS.
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Abstract
OBJECTIVE To investigate the sexual health experiences of depressed and nondepressed postnatal women within a 6-month postnatal period. METHODS This cross-sectional study used obstetric records and postal survey 6 months after delivery from a cohort of primiparous women (n = 796) delivering a live-born infant at St. George's NHS Trust, London. Women self-reported sexual problems and sexual behaviors and completed the Edinburgh Postnatal Depression Scale. RESULTS Of the 796 parturients, 484 responded (61%), and 468 completed the survey questions on depression and sexual health (97%). Of the latter, 57 (12%) fit the Edinburgh Postnatal Depression Scale criteria. Comparing the depressed with nondepressed women, resumption of sexual activity occurred with 77% versus 90% (P =.003), and the median number of specific sexual problems reported was two versus one, respectively (P =.009). CONCLUSION Sexual health problems were common after childbirth in both depressed and nondepressed women; however, depressed women were less likely to have resumed intercourse at 6 months and more likely to report sexual health problems. Given the frequency of sexual health problems, postnatal sexual morbidity cannot be assumed to be simply a product of the depressed mental state.
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Affiliation(s)
- Diane Morof
- Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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