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Newberry JA, Kaur J, Gurrapu S, Behl R, Darmstadt GL, Halpern-Felsher B, Rao GVR, Mahadevan SV, Strehlow MC. "So Why Should I Call Them?": Survivor Support Service Characteristics as Drivers of Help-Seeking in India. J Interpers Violence 2022; 37:NP7850-NP7879. [PMID: 33150827 DOI: 10.1177/0886260520970306] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Women in South Asia face the highest lifetime prevalence of intimate partner violence in the world, which is just one form of violence against women (VAW). In India, few women seek help after experiencing violence, particularly from formal resources, such as physicians or the police. While many studies have investigated the impact of survivor characteristics and patterns of violence on help-seeking behaviors, there is scant research on support service characteristics and their impact on help-seeking. The introduction of a novel crisis helpline in Gujarat, India provided an opportunity to better understand how successful help-seeking can be driven by the perceived and experienced characteristics of the helpline. We conducted in-depth interviews with helpline users to identify factors and pathways that promoted or discouraged help-seeking in general, help-seeking from a formal source, and help-seeking from this particular helpline. We analyzed 32 interviews of women who used the helpline. Participants were from eight districts across the state, representing a diverse range of sociodemographic backgrounds. After conducting a thematic analysis, we found that action-oriented service, timeliness, and women-focused staff influenced (positively and negatively) participants' feelings of safety, empowerment, and trust in the helpline, which ultimately impacted their decision to seek help from the helpline or even to seek help at all. This study illuminates how service characteristics, in and of themselves, can influence the likelihood that survivors will seek help, emphasizing the need for survivors to have a voice in the growth and refinement of VAW support services. Consequently, these areas must be a focus of future research and initiatives to improve help-seeking by VAW survivors.
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Affiliation(s)
| | | | | | | | | | | | - G V Ramana Rao
- GVK Emergency Management and Research Institute, Telangana, India
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Elias PM, Man MQ, Darmstadt GL. Optimised emollient mixture for skin barrier repair: Applications to global child health. J Glob Health 2022; 12:03019. [PMID: 35486585 PMCID: PMC9078150 DOI: 10.7189/jogh.12.03019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Peter M Elias
- Department of Dermatology, University of California, Northern California Institute for Research and Education, and Veterans Affairs Health Care Center, San Francisco, California, USA
| | - Mao-Qiang Man
- Department of Dermatology, University of California, Northern California Institute for Research and Education, and Veterans Affairs Health Care Center, San Francisco, California, USA
| | - Gary L Darmstadt
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Jahan F, Foote E, Rahman M, Shoab AK, Parvez SM, Nasim MI, Hasan R, El Arifeen S, Billah SM, Sarker S, Hoque MM, Shahidullah M, Islam MS, Ashrafee S, Darmstadt GL. Evaluation of community health worker's performance at home-based newborn assessment supported by mHealth in rural Bangladesh. BMC Pediatr 2022; 22:218. [PMID: 35459113 PMCID: PMC9027479 DOI: 10.1186/s12887-022-03282-6] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In low to middle-income countries where home births are common and neonatal postnatal care is limited, community health worker (CHW) home visits can extend the capability of health systems to reach vulnerable newborns in the postnatal period. CHW assessment of newborn danger signs supported by mHealth have the potential to improve the quality of danger sign assessments and reduce CHW training requirements. We aim to estimate the validity (sensitivity, specificity, positive and negative predictive value) of CHW assessment of newborn infants aided by mHealth compared to physician assessment. METHODS In this prospective study, ten CHWs received five days of theoretical and hands-on training on the physical assessment of newborns including ten danger signs. CHWs assessed 273 newborn infants for danger signs within 48 h of birth and then consecutively for three days. A physician repeated 20% (n = 148) of the assessments conducted by CHWs. Both CHWs and the physician evaluated newborns for ten danger signs and decided on referral. We used the physician's danger sign identification and referral decision as the gold standard to validate CHWs' identification of danger signs and referral decisions. RESULTS The referrals made by the CHWs had high sensitivity (93.3%), specificity (96.2%), and almost perfect agreement (K = 0.80) with the referrals made by the physician. CHW identification of all the danger signs except hypothermia showed moderate to high sensitivity (66.7-100%) compared to physician assessments. All the danger signs assessments except hypothermia showed moderate to high positive predictive value (PPV) (50-100%) and excellent negative predictive value (NPV) (99-100%). Specificity was high (99-100%) for all ten danger signs. CONCLUSION CHW's identification of neonatal danger signs aided by mHealth showed moderate to high validity in comparison to physician assessments. mHealth platforms may reduce CHW training requirements and while maintaining quality CHW physical assessment performance extending the ability of health systems to provide neonatal postnatal care in low-resource communities. TRIAL REGISTRATION clinicaltrials.gov NCT03933423 , January 05, 2019.
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Affiliation(s)
- Farjana Jahan
- Environmental Intervention Unit, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Eric Foote
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Mahbubur Rahman
- Environmental Intervention Unit, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abul Kasham Shoab
- Environmental Intervention Unit, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sarker Masud Parvez
- Environmental Intervention Unit, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Mizanul Islam Nasim
- Environmental Intervention Unit, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rezaul Hasan
- Environmental Intervention Unit, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Supta Sarker
- Environmental Intervention Unit, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Mahbubul Hoque
- Department of Neonatology, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh
| | | | - Muhammad Shariful Islam
- National Newborn Health Program (NNHP) and Integrated Management of Childhood Illness (IMCI), Directorate General of Health Services, Dhaka, Bangladesh
| | - Sabina Ashrafee
- National Newborn Health Program (NNHP) and Integrated Management of Childhood Illness (IMCI), Directorate General of Health Services, Dhaka, Bangladesh
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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Nesamoney SN, Mejía-Guevara I, Weber AM, Cislaghi B, Mbizvo MT, Darmstadt GL. The taboo gap: implications for adolescent risk of HIV infection. Lancet Child Adolesc Health 2022; 6:140-142. [PMID: 35012710 DOI: 10.1016/s2352-4642(21)00398-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Affiliation(s)
| | - Iván Mejía-Guevara
- Stanford Aging and Ethnogeriatrics (SAGE), Research Center, School of Medicine, Stanford University, Stanford, CA 94305, USA; Stanford Center for Population Health Sciences, School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Ann M Weber
- School of Public Health, University of Nevada, Reno, NV, USA
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Gary L Darmstadt
- Global Center for Gender Equality, School of Medicine, Stanford University, Stanford, CA 94305, USA; Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA 94305, USA.
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Kumar V, Kumar A, Mishra S, Kan P, Ashraf S, Singh S, Blanks KJH, Baiocchi M, Limcaoco M, Ghosh AK, Kumar A, Krishna R, Stevenson DK, Tian L, Darmstadt GL, Darmstadt GL, Elias PM, Ghosh AK, Kan P, Krishna R, Kumar A, Kumar A, Kumar V, Mehrotra H, Mishra S, Patil P, Sahu A, Singh P, Singh S, Singh V, Stevenson DK, Tian L, Yadav R. Effects of emollient therapy with sunflower seed oil on neonatal growth and morbidity in Uttar Pradesh, India: a cluster-randomized, open-label, controlled trial. Am J Clin Nutr 2022; 115:1092-1104. [PMID: 34982820 PMCID: PMC8970981 DOI: 10.1093/ajcn/nqab430] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/29/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Newborn oil massage is a widespread practice. Vigorous massage with potentially harmful products and forced removal of vernix may disrupt skin barrier integrity. Hospitalized, very-preterm infants treated with sunflower seed oil (SSO) have demonstrated improved growth but community-based data on growth and health outcomes are lacking. OBJECTIVES We aimed to test whether SSO therapy enhances neonatal growth and reduces morbidity at the population level. METHODS We conducted an open-label, controlled trial in rural Uttar Pradesh, India, randomly allocating 276 village clusters equally to comparison (usual care) and intervention comprised of promotion of improved massage practices exclusively with SSO, using intention-to-treat and per-protocol mixed-effects regression analysis. RESULTS We enrolled 13,478 and 13,109 newborn infants in demographically similar intervention and comparison arms, respectively. Adherence to exclusive SSO increased from 22.6% of intervention infants enrolled in the first study quartile to 37.2% in the last quartile. Intervention infants gained significantly more weight, by 0.94 g · kg-1 · d-1 (95% CI: 0.07, 1.82 g · kg-1 · d-1, P = 0.03), than comparison infants by intention-to-treat analysis. Restricted cubic spline regression revealed the largest benefits in weight gain (2-4 g · kg-1 · d-1) occurred in infants weighing <2000 g at birth. Weight gain in intervention infants was higher by 1.31 g · kg-1 · d-1 (95% CI: 0.17, 2.46 g · kg-1 · d-1; P = 0.02) by per-protocol analysis. Morbidities were similar by intention-to-treat analysis but in per-protocol analysis rates of hospitalization and of any illness were reduced by 36% (OR: 0.64; 95% CI: 0.44, 0.94; P = 0.02) and 44% (OR: 0.56; 95% CI: 0.40, 0.77; P < 0.001), respectively, in treated infants. CONCLUSIONS SSO therapy improved neonatal growth, and reduced morbidities when applied exclusively, across the facility-community continuum of care at the population level. Further research is needed to improve demand for recommended therapy inside hospital as well as in community settings, and to confirm these results in other settings.This trial was registered at www.isrctn.com as ISRCTN38965585 and http://ctri.nic.in as CTRI/2014/12/005282.
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Affiliation(s)
| | | | | | - Peiyi Kan
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | - Michael Baiocchi
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Mika Limcaoco
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | - David K Stevenson
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Lu Tian
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
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Hawken S, Ward V, Bota AB, Lamoureux M, Ducharme R, Wilson LA, Otieno N, Munga S, Nyawanda BO, Atito R, Stevenson DK, Chakraborty P, Darmstadt GL, Wilson K. Real world external validation of metabolic gestational age assessment in Kenya. PLOS Glob Public Health 2022; 2:e0000652. [PMID: 36962760 PMCID: PMC10021775 DOI: 10.1371/journal.pgph.0000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/20/2022] [Indexed: 11/29/2022]
Abstract
Using data from Ontario Canada, we previously developed machine learning-based algorithms incorporating newborn screening metabolites to estimate gestational age (GA). The objective of this study was to evaluate the use of these algorithms in a population of infants born in Siaya county, Kenya. Cord and heel prick samples were collected from newborns in Kenya and metabolic analysis was carried out by Newborn Screening Ontario in Ottawa, Canada. Postnatal GA estimation models were developed with data from Ontario with multivariable linear regression using ELASTIC NET regularization. Model performance was evaluated by applying the models to the data collected from Kenya and comparing model-derived estimates of GA to reference estimates from early pregnancy ultrasound. Heel prick samples were collected from 1,039 newborns from Kenya. Of these, 8.9% were born preterm and 8.5% were small for GA. Cord blood samples were also collected from 1,012 newborns. In data from heel prick samples, our best-performing model estimated GA within 9.5 days overall of reference GA [mean absolute error (MAE) 1.35 (95% CI 1.27, 1.43)]. In preterm infants and those small for GA, MAE was 2.62 (2.28, 2.99) and 1.81 (1.57, 2.07) weeks, respectively. In data from cord blood, model accuracy slightly decreased overall (MAE 1.44 (95% CI 1.36, 1.53)). Accuracy was not impacted by maternal HIV status and improved when the dating ultrasound occurred between 9 and 13 weeks of gestation, in both heel prick and cord blood data (overall MAE 1.04 (95% CI 0.87, 1.22) and 1.08 (95% CI 0.90, 1.27), respectively). The accuracy of metabolic model based GA estimates in the Kenya cohort was lower compared to our previously published validation studies, however inconsistency in the timing of reference dating ultrasounds appears to have been a contributing factor to diminished model performance.
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Affiliation(s)
- Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Victoria Ward
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - A Brianne Bota
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Monica Lamoureux
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Robin Ducharme
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lindsay A Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Nancy Otieno
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | - Stephen Munga
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | - Bryan O Nyawanda
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | - Raphael Atito
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | - David K Stevenson
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
- Departments of Pediatrics, and of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | - Gary L Darmstadt
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
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Darmstadt GL, Hamer DH, Carlin JB, Jeena PM, Mazzi E, Narang A, Deorari AK, Addo-Yobo E, Chowdhury MA, Kumar P, Abu-Sarkodie Y, Yeboah-Antwi K, Ray P, Bartos AE, Saha SK, Foote E, Bahl R, Weber MW. Validation of visual estimation of neonatal jaundice in low-income and middle-income countries: a multicentre observational cohort study. BMJ Open 2021; 11:e048145. [PMID: 34972760 PMCID: PMC8720979 DOI: 10.1136/bmjopen-2020-048145] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 11/17/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Determine the sensitivity and specificity of neonatal jaundice visual estimation by primary healthcare workers (PHWs) and physicians as predictors of hyperbilirubinaemia. DESIGN Multicentre observational cohort study. SETTING Hospitals in Chandigarh and Delhi, India; Dhaka, Bangladesh; Durban, South Africa; Kumasi, Ghana; La Paz, Bolivia. PARTICIPANTS Neonates aged 1-20 days (n=2642) who presented to hospitals for evaluation of acute illness. Infants referred for any reason from another health facility or those needing immediate cardiopulmonary resuscitation were excluded. OUTCOME MEASURES Infants were evaluated for distribution (head, trunk, distal extremities) and degree (mild, moderate, severe) of jaundice by PHWs and physicians. Serum bilirubin level was determined for infants with jaundice, and analyses of sensitivity and specificity of visual estimations of jaundice used bilirubin thresholds of >260 µmol/L (need for phototherapy) and >340 µmol/L (need for emergency intervention in at-risk and preterm babies). RESULTS 1241 (47.0%) neonates had jaundice. High sensitivity for detecting neonates with serum bilirubin >340 µmol/L was found for 'any jaundice of the distal extremities (palms or soles) OR deep jaundice of the trunk or head' for both PHWs (89%-100%) and physicians (81%-100%) across study sites; specificity was more variable. 'Any jaundice of the distal extremities' identified by PHWs and physicians had sensitivity of 71%-100% and specificity of 55%-95%, excluding La Paz. For the bilirubin threshold >260 µmol/L, 'any jaundice of the distal extremities OR deep jaundice of the trunk or head' had the highest sensitivity across sites (PHWs: 58%-93%, physicians: 55%-98%). CONCLUSIONS In settings where serum bilirubin cannot be measured, neonates with any jaundice on the distal extremities should be referred to a hospital for evaluation and management, where delays in serum bilirubin measurement and appropriate treatment are anticipated following referral, the higher sensitivity sign, any jaundice on the distal extremities or deep jaundice of the trunk or head, may be preferred.
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Affiliation(s)
- Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - John B Carlin
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute & The University of Melbourne, Melbourne, Victoria, Australia
| | - Prakash M Jeena
- Department of Paediatrics and Child Health, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | - Eduardo Mazzi
- Department of Pediatrics, Hospital del Nino Dr Ovidio Aliaga Uria, La Paz, Plurinational State of Bolivia
| | - Anil Narang
- Departments of Pediatrics and Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - A K Deorari
- Department of Pediatrics, Division of Neonatology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Emmanuel Addo-Yobo
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Praveen Kumar
- Departments of Pediatrics and Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Yaw Abu-Sarkodie
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kojo Yeboah-Antwi
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Pallab Ray
- Departments of Pediatrics and Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Andres E Bartos
- Department of Pediatrics, Hospital Materno-Infantil, La Paz, Plurinational State of Bolivia
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Eric Foote
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Rajiv Bahl
- Newborn Health Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Martin W Weber
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Willson M, Kumar V, Darmstadt GL. Centering and humanising health systems: empowerment through Kangaroo Mother Care. J Glob Health 2021; 11:03105. [PMID: 34956631 PMCID: PMC8684780 DOI: 10.7189/jogh.11.03105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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59
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Pair E, Vicas N, Weber AM, Meausoone V, Zou J, Njuguna A, Darmstadt GL. Quantification of Gender Bias and Sentiment Toward Political Leaders Over 20 Years of Kenyan News Using Natural Language Processing. Front Psychol 2021; 12:712646. [PMID: 34955949 PMCID: PMC8703202 DOI: 10.3389/fpsyg.2021.712646] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Despite a 2010 Kenyan constitutional amendment limiting members of elected public bodies to < two-thirds of the same gender, only 22 percent of the 12th Parliament members inaugurated in 2017 were women. Investigating gender bias in the media is a useful tool for understanding socio-cultural barriers to implementing legislation for gender equality. Natural language processing (NLP) methods, such as word embedding and sentiment analysis, can efficiently quantify media biases at a scope previously unavailable in the social sciences. Methods: We trained GloVe and word2vec word embeddings on text from 1998 to 2019 from Kenya’s Daily Nation newspaper. We measured gender bias in these embeddings and used sentiment analysis to predict quantitative sentiment scores for sentences surrounding female leader names compared to male leader names. Results: Bias in leadership words for men and women measured from Daily Nation word embeddings corresponded to temporal trends in men and women’s participation in political leadership (i.e., parliamentary seats) using GloVe (correlation 0.8936, p = 0.0067, r2 = 0.799) and word2vec (correlation 0.844, p = 0.0169, r2 = 0.712) algorithms. Women continue to be associated with domestic terms while men continue to be associated with influence terms, for both regular gender words and female and male political leaders’ names. Male words (e.g., he, him, man) were mentioned 1.84 million more times than female words from 1998 to 2019. Sentiment analysis showed an increase in relative negative sentiment associated with female leaders (p = 0.0152) and an increase in positive sentiment associated with male leaders over time (p = 0.0216). Conclusion: Natural language processing is a powerful method for gaining insights into and quantifying trends in gender biases and sentiment in news media. We found evidence of improvement in gender equality but also a backlash from increased female representation in high-level governmental leadership.
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Affiliation(s)
- Emma Pair
- Department of Pediatrics, Global Center for Gender Equality, School of Medicine, Stanford University, Stanford, CA, United States
| | - Nikitha Vicas
- Department of Neuroscience, University of Texas - Dallas, Dallas, TX, United States
| | - Ann M Weber
- School of Public Health, University of Nevada, Reno, NV, United States
| | - Valerie Meausoone
- Research Computing Center, Stanford University, Stanford, CA, United States
| | - James Zou
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Amos Njuguna
- School of Graduate Studies, Research and Extension, United States International University - Africa, Nairobi, Kenya
| | - Gary L Darmstadt
- Department of Pediatrics, Global Center for Gender Equality, School of Medicine, Stanford University, Stanford, CA, United States
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60
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Mejía-Guevara I, Cislaghi B, Darmstadt GL. Men's Attitude Towards Contraception and Sexuality, Women's Empowerment, and Demand Satisfied for Family Planning in India. Front Sociol 2021; 6:689980. [PMID: 34977228 PMCID: PMC8717326 DOI: 10.3389/fsoc.2021.689980] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/15/2021] [Indexed: 05/02/2023]
Abstract
Whilst the prevalence of unmet need and contraceptive use remained unchanged for 10 years (between 2005-2015) in India, gender restrictive norms and power imbalances also have persisted, preventing married women from meeting their family planning desires. Data for this study are from the 2015-6 National Family Household Survey, which contains information on fertility preferences and family planning for women in reproductive age. As a proxy for men's attitudinal norms, we aggregated men's perceptions regarding contraception (contraception is women's business, women who use contraception may become promiscuous) and control over their wife (if his wife refuses to have sex, men have the right to deny financial support, have sex with another woman, or beat wife) at district level. Using a three-level random intercepts model, we assessed individual and contextual-level associations of men's attitudinal norms and met need for contraception among sexually active women (aged 15-49) with any demand for family planning, while adjusting for women's empowerment indicators [education, job status, and adult marriage] and individual demographic factors. Our results indicate that men's attitudinal norms are negatively associated with women's contraceptive use; for instance, a 1 standard deviation increase in the proportion of men who believe that contraception is women's business was associated with a 12% reduced likelihood of contraceptive use (OR = 0.88, 95% CI 0.82-0.95). Similar associations remained or were stronger after considering only modern methods, or when excluding female sterilization. Furthermore, our contextual effects analysis revealed that women's higher education or wealth did not improve contraceptive uptake in communities with strong attitudinal norms, but working women or women married as children were more likely to use contraception in those communities. Our results suggest that men's attitudinal norms may be dominating over women's empowerment regarding family planning choices among reproductive age women. However, employment appeared to play a strong protective role associated with women's contraceptive use. It is important for programs seeking to transform gender equality and empower women in making contraceptive choices to consider women's employment opportunities and to also address male attitudinal norms in the context of the ecosystem in which men and women coexist and interact.
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Affiliation(s)
- Iván Mejía-Guevara
- Stanford Aging and Ethnogeriatrics (SAGE) Research Center, Stanford University School of Medicine, Palo Alto, CA, United States
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Global Health, Makerere University, Kampala, Uganda
| | - Gary L. Darmstadt
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
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Cislaghi B, Weber AM, Shakya HB, Abdalla S, Bhatia A, Domingue BW, Mejía-Guevara I, Stark L, Seff I, Richter LM, Baptista Menezes AM, Victora CG, Darmstadt GL. Innovative methods to analyse the impact of gender norms on adolescent health using global health survey data. Soc Sci Med 2021; 293:114652. [PMID: 34915243 PMCID: PMC8819155 DOI: 10.1016/j.socscimed.2021.114652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 12/05/2022]
Abstract
Background Understanding how gender norms affect health is an important entry point into designing programs and policies to change norms and improve gender equality and health. However, it is rare for global health datasets to include questions on gender norms, especially questions that go beyond measuring gender-related attitudes, thus limiting gender analysis. Methods We developed five case studies using health survey data from six countries to demonstrate approaches to defining and operationalising proxy measures and analytic approaches to investigating how gender norms can affect health. Key findings, strengths and limitations of our norms proxies and methodological choices are summarised. Findings Case studies revealed links between gender norms and multiple adolescent health outcomes. Proxys for norms were derived from data on attitudes, beliefs, and behaviours, as well as differences between attitudes and behaviours. Data were cross-sectional, longitudinal, census- and social network-based. Analytic methods were diverse. We found that gender norms affect: 1) Intimate partner violence in Nigeria; 2) Unhealthy weight control behaviours in Brazil and South Africa; 3) HIV status in Zambia; 4) Health and social mobility in the US; and 5) Childbirth in Honduras. Interpretation Researchers can use existing global health survey data to examine pathways through which gender norms affect health by generating proxies for gender norms. While direct measures of gender norms can greatly improve the understanding of how gender affects health, proxy measures for norms can be designed for the specific health-related outcome and normative context, for instance by either aggregating behaviours or attitudes or quantifying the difference (dissonance) between them. These norm proxies enable evaluations of the influence of gender norms on health and insights into possible reference groups and sanctions for non-compliers, thus informing programmes and policies to shape norms and improve health. This article presents effective methods to study gender norms in existing global health survey data. We devised conceptual pathways linking gender norms to gender-based health disparities. We identified gender norms proxies and reference groups enforcing the norm. We tested hypotheses linking gender norms to health. These methods can aid policy and programme design to advance gender equality and health.
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Affiliation(s)
- Beniamino Cislaghi
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, UK
| | - Ann M Weber
- School of Public Health, University of Nevada, Reno, NV, USA
| | - Holly B Shakya
- Department of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, CA, USA
| | - Safa Abdalla
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Amiya Bhatia
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, UK
| | | | - Iván Mejía-Guevara
- Center for Population Health Sciences, Stanford University School of Medicine, Stanford, CA, USA; Stanford Aging and Ethnogeriatrics (SAGE) Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Lindsay Stark
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Ilana Seff
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Linda M Richter
- Centre of Excellence in Human Development, University of Witwatersrand, Durban, South Africa
| | - Ana Maria Baptista Menezes
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande de Sul, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande de Sul, Brazil
| | - Gary L Darmstadt
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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62
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Weber AM, Gupta R, Abdalla S, Cislaghi B, Meausoone V, Darmstadt GL. Gender-related data missingness, imbalance and bias in global health surveys. BMJ Glob Health 2021; 6:e007405. [PMID: 34836912 PMCID: PMC8628344 DOI: 10.1136/bmjgh-2021-007405] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/01/2021] [Indexed: 11/04/2022] Open
Abstract
Global surveys have built-in gender-related biases associated with data missingness across the gender dimensions of people's lives, imbalanced or incomplete representation of population groups, and biased ways in which gender information is elicited and used. While increasing focus is being placed on the integration of sex-disaggregated statistics into national programmes and on understanding effects of gender-based disparities on the health of all people, the data necessary for elucidating underlying causes of gender disparities and designing effective intervention programmes continue to be lacking. Approaches exist, however, that can reasonably address some shortcomings, such as separating questions of gender identification from biological sex. Qualitative research can elucidate ways to rephrase questions and translate gendered terms to avoid perpetuating historical gender biases and prompting biased responses. Non-health disciplines may offer lessons in collecting gender-related data. Ultimately, multidisciplinary global collaborations are needed to advance this evolving field and to set standards for how we measure gender in all its forms.
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Affiliation(s)
- Ann M Weber
- School of Public Health, University of Nevada Reno, Reno, Nevada, USA
| | - Ribhav Gupta
- Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Safa Abdalla
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Valerie Meausoone
- Stanford Research Computing Center, Stanford University, Stanford, California, USA
| | - Gary L Darmstadt
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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63
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Winter JC, Darmstadt GL, Lee SJ, Davis J. The potential of school-based WASH programming to support children as agents of change in rural Zambian households. BMC Public Health 2021; 21:1812. [PMID: 34625029 PMCID: PMC8501527 DOI: 10.1186/s12889-021-11824-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/20/2021] [Indexed: 02/01/2023] Open
Abstract
Background Water, sanitation, and hygiene (WASH) interventions frequently assume that students who learn positive WASH behaviors will disseminate this information to their families. This is most prominent in school-based programs, which rely on students to act as “agents of change” to translate impact from school to home. However, there is little evidence to support or contradict this assumption. Methods We conducted a quasi-experimental, prospective cohort study in 12 schools in rural, southern Zambia to measure the impact of WASH UP!, a school-based WASH program designed by the creators of Sesame Street. WASH UP! is an educational program that uses stories and interactive games to teach students in grades 1–4 about healthy behaviors, such as washing hands and using the latrine. We completed in-person interviews with grade 1 and 4 students (N = 392 and 369, respectively), their teachers (N = 24) and caregivers (N = 729) using structured surveys containing both open- and closed-ended questions. We measured changes in knowledge and whether students reported sharing WASH-related messages learned in school with their caregivers at home. Results Student knowledge increased significantly, but primarily among students in grade 1. Overall rates of students reporting that they shared messages from the curriculum with their caregivers rose from 7 to 23% (p < 0.001). Students in grade 4 were 5.2 times as likely as those in grade 1 to report sharing a WASH-related message with their caregivers (ARR = 5.2, 95% C.I. = (2.3, 8.9); p < 0.001). Conclusions Although we measured only modest levels of student dissemination of WASH UP! messages from the school to the home, students in grade 4 showed significantly more promise as agents of change than those in grade 1. Future work should prioritize developing curricula that reflect the variability in needs, capabilities and support in the home and community among primary school students rather than a single approach for a wide range of ages and contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11824-3.
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Affiliation(s)
- James C Winter
- Department of Civil and Environmental Engineering, Stanford University, Yang and Yamazaki Environment and Energy Building, 473 Via Ortega, Office 161, Stanford, CA, 94305, USA.
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
| | - Samantha J Lee
- Department of Civil and Environmental Engineering, Stanford University, Yang and Yamazaki Environment and Energy Building, 473 Via Ortega, Office 161, Stanford, CA, 94305, USA
| | - Jennifer Davis
- Department of Civil and Environmental Engineering, Stanford University, Yang and Yamazaki Environment and Energy Building, 473 Via Ortega, Office 161, Stanford, CA, 94305, USA.,Woods Institute for the Environment, Stanford University, Yang and Yamazaki Environment and Energy Building, 473 Via Ortega, Office 161, Stanford, CA, 94305, USA
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64
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Mony PK, Tadele H, Gobezayehu AG, Chan GJ, Kumar A, Mazumder S, Beyene SA, Jayanna K, Kassa DH, Mohammed HA, Estifanos AS, Kumar P, Jadaun AS, Hailu Abay T, Washington M, W/Gebriel F, Alamineh L, Fikre A, Kumar A, Trikha S, Ashebir Gebregizabher F, Kar A, Bilal SM, Belew ML, Debere MK, Krishna R, Dalpath SK, Amare SY, Mohan HL, Brune T, Sibley LM, Tariku A, Sahu A, Kumar T, Hadush MY, Gowda PD, Aziz K, Duguma D, Singh PK, Darmstadt GL, Agarwal R, Gebremariam DS, Martines J, Portela A, Jaiswal HV, Bahl R, Rao Pn S, Tadesse BT, Cranmer JN, Hailemariam D, Kumar V, Bhandari N, Medhanyie AA. Scaling up Kangaroo Mother Care in Ethiopia and India: a multi-site implementation research study. BMJ Glob Health 2021; 6:bmjgh-2021-005905. [PMID: 34518203 PMCID: PMC8438727 DOI: 10.1136/bmjgh-2021-005905] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 04/02/2021] [Accepted: 07/07/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives Kangaroo Mother Care (KMC), prolonged skin-to-skin care of the low birth weight baby with the mother plus exclusive breastfeeding reduces neonatal mortality. Global KMC coverage is low. This study was conducted to develop and evaluate context-adapted implementation models to achieve improved coverage. Design This study used mixed-methods applying implementation science to develop an adaptable strategy to improve implementation. Formative research informed the initial model which was refined in three iterative cycles. The models included three components: (1) maximising access to KMC-implementing facilities, (2) ensuring KMC initiation and maintenance in facilities and (3) supporting continuation at home postdischarge. Participants 3804 infants of birth weight under 2000 g who survived the first 3 days, were available in the study area and whose mother resided in the study area. Main outcome measures The primary outcomes were coverage of KMC during the 24 hours prior to discharge and at 7 days postdischarge. Results Key barriers and solutions were identified for scaling up KMC. The resulting implementation model achieved high population-based coverage. KMC initiation reached 68%–86% of infants in Ethiopian sites and 87% in Indian sites. At discharge, KMC was provided to 68% of infants in Ethiopia and 55% in India. At 7 days postdischarge, KMC was provided to 53%–65% of infants in all sites, except Oromia (38%) and Karnataka (36%). Conclusions This study shows how high coverage of KMC can be achieved using context-adapted models based on implementation science. They were supported by government leadership, health workers’ conviction that KMC is the standard of care, women’s and families’ acceptance of KMC, and changes in infrastructure, policy, skills and practice. Trial registration numbers ISRCTN12286667; CTRI/2017/07/008988; NCT03098069; NCT03419416; NCT03506698.
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Affiliation(s)
- Prem K Mony
- Division of Epidemiology & Population Health, St John's Medical College and Research Institute, Bangalore, India
| | - Henok Tadele
- College of Health Sciences, Department of Paediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Grace J Chan
- Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Department of Epidemiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aarti Kumar
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | - Sarmila Mazumder
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Selemawit Asfaw Beyene
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Krishnamurthy Jayanna
- Karnataka Health Promotion Trust, Bangalore, India.,Ramaiah University of Applied Sciences, Bangalore, India
| | - Dejene Hailu Kassa
- College of Medicine and Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia
| | | | | | - Pankaj Kumar
- National Health Mission, Government of Uttar Pradesh, Lucknow, Uttar Pradesh, India
| | - Arun Singh Jadaun
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Tedros Hailu Abay
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Maryann Washington
- St John's Research Institute, St John's Medical College, Bangalore, India
| | - Fitsum W/Gebriel
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Addisalem Fikre
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Alok Kumar
- Governent of Uttar Pradesh, Lucknow, Uttar Pradesh, India
| | - Sonia Trikha
- State Health Systems Resource Center, Panchkula, Haryana, India
| | | | - Arin Kar
- Karnataka Health Promotion Trust, Rajajinagar, India
| | - Selamawit Mengesha Bilal
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | | | - Raghav Krishna
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | | | - Samson Yohannes Amare
- Department of Software Engineering, School of Computing, College of Science and Technology, Mekelle University, Mekelle, Ethiopia
| | - H L Mohan
- Karnataka Health Promotion Trust, Rajajinagar, India
| | - Thomas Brune
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | | | - Abraham Tariku
- Maternal & Child Health Department, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Arti Sahu
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | - Tarun Kumar
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Marta Yemane Hadush
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Prabhu Deva Gowda
- Directorate of Health & Family Welfare Services, Government of Karnataka, Bangalore, India
| | - Khalid Aziz
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Ramesh Agarwal
- Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Dawit Seyoum Gebremariam
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Jose Martines
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Harsh Vardhan Jaiswal
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Suman Rao Pn
- Department of Neonatology, St John's Medical College Hospital, Bangalore, India
| | - Birkneh Tilahun Tadesse
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | | | | | - Nita Bhandari
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Araya Abrha Medhanyie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.,School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
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Paulson KR, Kamath AM, Alam T, Bienhoff K, Abady GG, Abbas J, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abd-Elsalam SM, Abdoli A, Abedi A, Abolhassani H, Abreu LG, Abu-Gharbieh E, Abu-Rmeileh NME, Abushouk AI, Adamu AL, Adebayo OM, Adegbosin AE, Adekanmbi V, Adetokunboh OO, Adeyinka DA, Adsuar JC, Afshari K, Aghaali M, Agudelo-Botero M, Ahinkorah BO, Ahmad T, Ahmadi K, Ahmed MB, Aji B, Akalu Y, Akinyemi OO, Aklilu A, Al-Aly Z, Alam K, Alanezi FM, Alanzi TM, Alcalde-Rabanal JE, Al-Eyadhy A, Ali T, Alicandro G, Alif SM, Alipour V, Alizade H, Aljunid SM, Almasi-Hashiani A, Almasri NA, Al-Mekhlafi HM, Alonso J, Al-Raddadi RM, Altirkawi KA, Alumran AK, Alvis-Guzman N, Alvis-Zakzuk NJ, Ameyaw EK, Amini S, Amini-Rarani M, Amit AML, Amugsi DA, Ancuceanu R, Anderlini D, Andrei CL, Ansari F, Ansari-Moghaddam A, Antonio CAT, Antriyandarti E, Anvari D, Anwer R, Aqeel M, Arabloo J, Arab-Zozani M, Aripov T, Ärnlöv J, Artanti KD, Arzani A, Asaad M, Asadi-Aliabadi M, Asadi-Pooya AA, Asghari Jafarabadi M, Athari SS, Athari SM, Atnafu DD, Atreya A, Atteraya MS, Ausloos M, Awan AT, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Azari S, Azarian G, Azene ZN, B DB, Babaee E, Badiye AD, Baig AA, Banach M, Banik PC, Barker-Collo SL, Barqawi HJ, Bassat Q, Basu S, Baune BT, Bayati M, Bedi N, Beghi E, Beghi M, Bell ML, Bendak S, Bennett DA, Bensenor IM, Berhe K, Berman AE, Bezabih YM, Bhagavathula AS, Bhandari D, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bhattarai S, Bhutta ZA, Bikbov B, Biondi A, Birihane BM, Biswas RK, Bohlouli S, Bragazzi NL, Breusov AV, Brunoni AR, Burkart K, Burugina Nagaraja S, Busse R, Butt ZA, Caetano dos Santos FL, Cahuana-Hurtado L, Camargos P, Cámera LA, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Cerin E, Chang JC, Chanie WF, Charan J, Chatterjee S, Chattu SK, Chattu VK, Chaturvedi S, Chen S, Cho DY, Choi JYJ, Chu DT, Ciobanu LG, Cirillo M, Conde J, Costa VM, Couto RAS, Dachew BA, Dahlawi SMA, Dai H, Dai X, Dandona L, Dandona R, Daneshpajouhnejad P, Darmstadt GL, Das JK, Dávila-Cervantes CA, Davis AC, Davletov K, De la Hoz FP, De Leo D, Deeba F, Denova-Gutiérrez E, Dervenis N, Desalew A, Deuba K, Dey S, Dharmaratne SD, Dhingra S, Dhungana GP, Dias da Silva D, Diaz D, Dorostkar F, Doshmangir L, Dubljanin E, Duraes AR, Eagan AW, Edinur HA, Efendi F, Eftekharzadeh S, El Sayed I, El Tantawi M, Elbarazi I, Elgendy IY, El-Jaafary SI, Emami A, Enany S, Eyawo O, Ezzikouri S, Faris PS, Farzadfar F, Fattahi N, Fauk NK, Fazlzadeh M, Feigin VL, Ferede TY, Fereshtehnejad SM, Fernandes E, Ferrara P, Filip I, Fischer F, Fisher JL, Foigt NA, Folayan MO, Foroutan M, Franklin RC, Freitas M, Friedman SD, Fukumoto T, Gad MM, Gaidhane AM, Gaidhane S, Gaihre S, Gallus S, Garcia-Basteiro AL, Garcia-Gordillo MA, Gardner WM, Gaspar Fonseca M, Gebremedhin KB, Getacher L, Ghashghaee A, Gholamian A, Gilani SA, Gill TK, Giussani G, Gnedovskaya EV, Godinho MA, Goel A, Golechha M, Gona PN, Gopalani SV, Goudarzi H, Grivna M, Gugnani HC, Guido D, Guimarães RA, Gupta RD, Gupta R, Hafezi-Nejad N, Haider MR, Haj-Mirzaian A, Hamidi S, Hanif A, Hankey GJ, Hargono A, Hasaballah AI, Hasan MM, Hasan SS, Hassan A, Hassanipour S, Hassankhani H, Havmoeller RJ, Hayat K, Heidari-Soureshjani R, Henry NJ, Herteliu C, Hole MK, Holla R, Hossain N, Hosseini M, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Huang J, Humayun A, Hwang BF, Iavicoli I, Ibitoye SE, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Inamdar S, Inbaraj LR, Iqbal K, Iqbal U, Islam MM, Islam SMS, Iso H, Iwagami M, Iwu CCD, Jaafari J, Jacobsen KH, Jagnoor J, Jain V, Janodia MD, Javaheri T, Javanmardi F, Jayaram S, Jayatilleke AU, Jenabi E, Jha RP, Ji JS, John O, Jonas JB, Joo T, Joseph N, Joukar F, Jozwiak JJ, Jürisson M, Kabir A, Kabir Z, Kalankesh LR, Kamyari N, Kanchan T, Kapoor N, Karami Matin B, Karch A, Karimi SE, Kassahun G, Kayode GA, Kazemi Karyani A, Kemmer L, Khalid N, Khalilov R, Khammarnia M, Khan EA, Khan G, Khan M, Khan MN, Khang YH, Khatab K, Khater AM, Khater MM, Khayamzadeh M, Khosravi A, Kim D, Kim YE, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Kissoon N, Kopec JA, Kosen S, Koul PA, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Krishnamoorthy V, Kuate Defo B, Kucuk Bicer B, Kulkarni V, Kumar GA, Kumar M, Kumar N, Kurmi OP, Kusuma D, La Vecchia C, Lacey B, Lalloo R, Lami FH, Landires I, Larsson AO, Lasrado S, Lassi ZS, Lauriola P, Lee PH, Lee SWH, Lee YH, Leigh J, Leonardi M, Lewycka S, Li B, Li S, Liang J, Lim LL, Limenih MA, Lin RT, Liu X, Lodha R, Lopez AD, Lozano R, Lugo A, Lunevicius R, Mackay MT, Madhava Kunjathur S, Magnani FG, Mahadeshwara Prasad DR, Maheri M, Mahmoudi M, Majeed A, Maled V, Maleki A, Maleki S, Malekzadeh R, Malik AA, Malta DC, Mamun AA, Mansouri B, Mansournia MA, Martinez G, Martini S, Martins-Melo FR, Masoumi SZ, Maulik PK, McAlinden C, McGrath JJ, Medina-Solís CE, Mehrabi Nasab E, Mejia-Rodriguez F, Memish ZA, Mendoza W, Menezes RG, Mengesha EW, Mensah GA, Meretoja A, Meretoja TJ, Mersha AM, Mestrovic T, Miazgowski B, Miazgowski T, Michalek IM, Miller TR, Mini GK, Miri M, Mirica A, Mirrakhimov EM, Mirzaei H, Mirzaei M, Moazen B, Moghadaszadeh M, Mohajer B, Mohamad O, Mohammad Y, Mohammadi SM, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Molokhia M, Monasta L, Mondello S, Moni MA, Moore CE, Moradi G, Moradi M, Moradzadeh R, Moraga P, Morawska L, Morrison SD, Mosser JF, Mousavi Khaneghah A, Mustafa G, Naderi M, Nagarajan AJ, Nagaraju SP, Naghavi M, Naghshtabrizi B, Naimzada MD, Nangia V, Narasimha Swamy S, Nascimento BR, Naveed M, Nazari J, Ndejjo R, Negoi I, Negoi RI, Nena E, Nepal S, Netsere HB, Nguefack-Tsague G, Ngunjiri JW, Nguyen CTY, Nguyen CT, Nguyen HLT, Nigatu YT, Nigussie SN, Nixon MR, Nnaji CA, Nomura S, Noor NM, Noubiap JJ, Nuñez-Samudio V, Nwatah VE, Oancea B, Odukoya OO, Ogbo FA, Olusanya BO, Olusanya JO, Omar Bali A, Onwujekwe OE, Ortiz A, Otoiu A, Otstavnov N, Otstavnov SS, Owolabi MO, P A M, Padubidri JR, Pakhale S, Pakshir K, Pal PK, Palladino R, Pana A, Panda-Jonas S, Pandey A, Pandey A, Pandi-Perumal SR, Pangaribuan HU, Pardo-Montaño AM, Park EK, Patel SK, Patton GC, Pawar S, Pazoki Toroudi H, Peden AE, Pepito VCF, Peprah EK, Pereira J, Pérez-Gómez J, Perico N, Pesudovs K, Pilgrim T, Pinheiro M, Piradov MA, Pirsaheb M, Platts-Mills JA, Pokhrel KN, Postma MJ, Pourjafar H, Prada SI, Prakash S, Pupillo E, Quazi Syed Z, Rabiee N, Radfar A, Rafiee A, Rafiei A, Raggi A, Rahimzadeh S, Rahman MHU, Rahmani AM, Ramezanzadeh K, Rana J, Ranabhat CL, Rao SJ, Rasella D, Rastogi P, Rathi P, Rawaf DL, Rawaf S, Rawasia WF, Rawassizadeh R, Reiner Jr RC, Remuzzi G, Renzaho AMN, Reshmi B, Resnikoff S, Rezaei N, Rezaei N, Rezapour A, Riahi SM, Ribeiro D, Rickard J, Roever L, Ronfani L, Rothenbacher D, Rubagotti E, Rumisha SF, Ryan PM, Saddik B, Sadeghi E, Saeedi Moghaddam S, Sagar R, Sahebkar A, Salahshoor MR, Salehi S, Salem MR, Salimzadeh H, Salomon JA, Samodra YL, Samy AM, Sanabria J, Santric-Milicevic MM, Saraswathy SYI, Sarker AR, Sarrafzadegan N, Sarveazad A, Sathian B, Sathish T, Sattin D, Saxena S, Saya GK, Saylan M, Schiavolin S, Schlaich MP, Schwebel DC, Schwendicke F, Senthilkumaran S, Sepanlou SG, Serván-Mori E, Sha F, Shafaat O, Shahabi S, Shahbaz M, Shaheen AA, Shahid I, Shaikh MA, Shakiba S, Shalash AS, Shams-Beyranvand M, Shannawaz M, Sharafi K, Sheikh A, Sheikhbahaei S, Shiferaw WS, Shigematsu M, Shin JI, Shiri R, Shiue I, Shuval K, Siddiqi TJ, Sidemo NB, Sigfusdottir ID, Sigurvinsdottir R, Silva JP, Silverberg JIS, Simonetti B, Singh BB, Singh JA, Singhal D, Sinha DN, Skiadaresi E, Skryabin VY, Skryabina AA, Sleet DA, Sobaih BH, Sobhiyeh MR, Soltani S, Soriano JB, Spurlock EE, Sreeramareddy CT, Steiropoulos P, Stokes MA, Stortecky S, Sufiyan MB, Suliankatchi Abdulkader R, Sulo G, Swope CB, Sykes BL, Szeto MD, Szócska M, Tabarés-Seisdedos R, Tadesse EG, Taherkhani A, Tamiru AT, Tareque MI, Tehrani-Banihashemi A, Temsah MH, Tesfay FH, Tessema GA, Tessema ZT, Thankappan KR, Thapar R, Tolani MA, Tovani-Palone MR, Traini E, Tran BX, Tripathy JP, Tsapparellas G, Tsatsakis A, Tudor Car L, Uddin R, Ullah A, Umeokonkwo CD, Unim B, Unnikrishnan B, Upadhyay E, Usman MS, Vacante M, Vaezi M, Valadan Tahbaz S, Valdez PR, Vasankari TJ, Venketasubramanian N, Verma M, Violante FS, Vlassov V, Vo B, Vu GT, Wado YD, Waheed Y, Wamai RG, Wang Y, Wang Y, Wang YP, Ward P, Werdecker A, Westerman R, Wickramasinghe ND, Wilner LB, Wiysonge CS, Wu AM, Wu C, Xie Y, Yahyazadeh Jabbari SH, Yamagishi K, Yandrapalli S, Yaya S, Yazdi-Feyzabadi V, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yousefi Z, Yousefinezhadi T, Yu C, Yusuf SS, Zaidi SS, Zaman SB, Zamani M, Zamanian M, Zastrozhin MS, Zastrozhina A, Zhang Y, Zhang ZJ, Zhao XJG, Ziapour A, Hay SI, Murray CJL, Wang H, Kassebaum NJ. Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019. Lancet 2021; 398:870-905. [PMID: 34416195 PMCID: PMC8429803 DOI: 10.1016/s0140-6736(21)01207-1] [Citation(s) in RCA: 183] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. METHODS We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. FINDINGS Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3-74·0) in 2000 to 37·1 (33·2-41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8-29·5) in 2000 to 17·9 (16·3-19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05-10·30) in 2000 and 5·05 million (4·27-6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53-4·02]) in 2000 to 48% (2·42 million; 2·06-2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71-0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27-1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35-2·58; 37% [95% UI 32-43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier. INTERPRETATION Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère and Hospital Research Institutes, Ottawa Ontario, Canada
| | - Victoria Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Pranesh Chakraborty
- Department of Pediatrics, Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
- Newborn Screening Ontario, Ottawa, Ontario, Canada
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Kumar A, Mishra S, Singh S, Ashraf S, Kan P, Ghosh AK, Kumar A, Krishna R, Stevenson DK, Tian L, Elias PM, Darmstadt GL, Kumar V. Effect of sunflower seed oil emollient therapy on newborn infant survival in Uttar Pradesh, India: A community-based, cluster randomized, open-label controlled trial. PLoS Med 2021; 18:e1003680. [PMID: 34582448 PMCID: PMC8478176 DOI: 10.1371/journal.pmed.1003680] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 06/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hospitalized preterm infants with compromised skin barrier function treated topically with sunflower seed oil (SSO) have shown reductions in sepsis and neonatal mortality rate (NMR). Mustard oil and products commonly used in high-mortality settings may possibly harm skin barrier integrity and enhance risk of infection and mortality in newborn infants. We hypothesized that SSO therapy may reduce NMR in such settings. METHODS AND FINDINGS This was a population-based, cluster randomized, controlled trial in 276 clusters in rural Uttar Pradesh, India. All newborn infants identified through population-based surveillance in the study clusters within 7 days of delivery were enrolled from November 2014 to October 2016. Exclusive, 3 times daily, gentle applications of 10 ml of SSO to newborn infants by families throughout the neonatal period were recommended in intervention clusters (n = 138 clusters); infants in comparison clusters (n = 138 clusters) received usual care, such as massage practice typically with mustard oil. Primary analysis was by intention-to-treat with NMR and post-24-hour NMR as the primary outcomes. Secondary analysis included per-protocol analysis and subgroup analyses for NMR. Regression analysis was adjusted for caste, first-visit weight, delivery attendant, gravidity, maternal age, maternal education, sex of the infant, and multiple births. We enrolled 13,478 (52.2% male, mean weight: 2,575.0 grams ± standard deviation [SD] 521.0) and 13,109 (52.0% male, mean weight: 2,607.0 grams ± SD 509.0) newborn infants in the intervention and comparison clusters, respectively. We found no overall difference in NMR in the intervention versus the comparison clusters [adjusted odds ratio (aOR) 0.96, 95% confidence interval (CI) 0.84 to 1.11, p = 0.61]. Acceptance of SSO in the intervention arm was high at 89.3%, but adherence to exclusive applications of SSO was 30.4%. Per-protocol analysis showed a significant 58% (95% CI 42% to 69%, p < 0.01) reduction in mortality among infants in the intervention group who were treated exclusively with SSO as intended versus infants in the comparison group who received exclusive applications of mustard oil. A significant 52% (95% CI 12% to 74%, p = 0.02) reduction in NMR was observed in the subgroup of infants weighing ≤1,500 g (n = 589); there were no statistically significant differences in other prespecified subgroup comparisons by low birth weight (LBW), birthplace, and wealth. No severe adverse events (SAEs) were attributable to the intervention. The study was limited by inability to mask allocation to study workers or participants and by measurement of emollient use based on caregiver responses and not actual observation. CONCLUSIONS In this trial, we observed that promotion of SSO therapy universally for all newborn infants was not effective in reducing NMR. However, this result may not necessarily establish equivalence between SSO and mustard oil massage in light of our secondary findings. Mortality reduction in the subgroup of infants ≤1,500 g was consistent with previous hospital-based efficacy studies, potentially extending the applicability of emollient therapy in very low-birth-weight (VLBW) infants along the facility-community continuum. Further research is recommended to develop and evaluate therapeutic regimens and continuum of care delivery strategies for emollient therapy for newborn infants at highest risk of compromised skin barrier function. TRIAL REGISTRATION ISRCTN Registry ISRCTN38965585 and Clinical Trials Registry-India (CTRI/2014/12/005282) with WHO UTN # U1111-1158-4665.
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Affiliation(s)
- Aarti Kumar
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | - Shambhavi Mishra
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
- Department of Statistics, Lucknow University, Lucknow, Uttar Pradesh, India
| | | | - Sana Ashraf
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | - Peiyi Kan
- Prematurity Research Center, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | | | | | - Raghav Krishna
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | - David K. Stevenson
- Prematurity Research Center, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Lu Tian
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
| | - Peter M. Elias
- Department of Dermatology, University of California, San Francisco, California, United States of America
| | - Gary L. Darmstadt
- Prematurity Research Center, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Vishwajeet Kumar
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
- * E-mail:
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Costa JC, Weber AM, Abdalla S, Darmstadt GL, Victora CG. Levels and potential drivers of under-five mortality sex ratios in low- and middle-income countries. Paediatr Perinat Epidemiol 2021; 35:549-556. [PMID: 34080692 PMCID: PMC8453971 DOI: 10.1111/ppe.12763] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 01/29/2021] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Non-biological childhood mortality sex ratios may reflect community sex preferences and gender discrimination in health care. OBJECTIVE We assessed the association between contextual factors and gender bias in under-five mortality rates (U5MR) in low- and middle-income countries. METHODS Full birth histories available from Demographic and Health Surveys and Multiple Indicator Cluster Surveys (2010-2018) in 80 countries were used to estimate U5MR male-to-female sex ratios. Expected sex ratios and their residuals (difference of observed and expected) were derived from a linear regression model, adjusted for overall mortality. Negative residuals indicate more likelihood of discrimination against girls, and we refer to this as a measure of potential gender bias. Associations between residuals and national development and gender inequality indices and with survey-derived child health care indicators were tested using Spearman's correlation. RESULTS Mortality residuals for under-five mortality were not associated with national development, education, religion, or gender inequality indices. Negative residuals were more common in countries where boys were more likely to be taken to health services than girls (rho -0.24, 95% confidence interval -0.45, -0.01). CONCLUSIONS Countries where girls were more likely to die than boys, accounting for overall mortality levels, were also countries where boys were more likely to receive health care than girls. Further research is needed to understand which national characteristics explain the presence of gender bias, given that the analyses of development levels and gender equality did not discriminate between countries with or without excess mortality of girls. Reporting on child mortality separately by sex is required to enable such advances.
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Affiliation(s)
- Janaína Calu Costa
- International Center for Equity in HealthPostgraduate Program in EpidemiologyFederal University of PelotasPelotasBrazil
| | - Ann M. Weber
- School of Community Health SciencesUniversity of NevadaRenoNVUSA
| | - Safa Abdalla
- Department of PediatricsStanford University School of MedicineStanfordCAUSA
| | - Gary L. Darmstadt
- Department of PediatricsStanford University School of MedicineStanfordCAUSA
| | - Cesar G. Victora
- International Center for Equity in HealthPostgraduate Program in EpidemiologyFederal University of PelotasPelotasBrazil
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Hasanuzzaman M, Saha S, Malaker R, Rahman H, Sajib MSI, Das RC, Islam M, Hamer DH, Darmstadt GL, Saha SK. Comparison of Culture, Antigen Test, and Polymerase Chain Reaction for Pneumococcal Detection in Cerebrospinal Fluid of Children. J Infect Dis 2021; 224:S209-S217. [PMID: 34469562 PMCID: PMC8409532 DOI: 10.1093/infdis/jiab073] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Sensitivity of culture for the detection of Streptococcus pneumoniae is limited by prior antibiotic exposure. Immunochromatographic test (ICT) is highly sensitive and specific for pneumococcal antigen detection in the cerebrospinal fluid (CSF) of meningitis cases. We determined the specificity and sensitivity of culture, ICT, and polymerase chain reaction (PCR) and the effect of antibiotic exposure on their performance. Methods CSF specimens from suspected meningitis cases admitted to Dhaka Shishu Hospital, Bangladesh, were tested using culture, ICT and PCR. Additionally, 165 specimens collected from 69 pneumococcal cases after antibiotic treatment were tested. Results Of 1883 specimens tested, culture detected 9, quantitative PCR (qPCR) detected 184, and ICT detected 207 pneumococcal cases (including all culture and qPCR positives). In comparison to ICT, sensitivity of culture was 4.4% and of qPCR was 90.6%; both were 100% specific. After antibiotic exposure, culture sensitivity plummeted rapidly; conventional PCR and qPCR sensitivity disappeared after day 6 and 20, respectively. ICT detected pneumococcal antigen for >10 weeks. Conclusions While culture provides the most information about bacterial characteristics, in high antibiotic exposure settings, ICT exhibits maximum sensitivity. We recommend culture and ICT as mainstay for pneumococcal diagnosis and surveillance; qPCR can generate additional molecular data where possible.
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Affiliation(s)
- Md Hasanuzzaman
- Child Health Research Foundation, Dhaka, Bangladesh.,Microbiology Program, Department of Mathematics and Natural Sciences, Brac University, Dhaka, Bangladesh
| | - Senjuti Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Roly Malaker
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Rajib C Das
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.,Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,National Emerging Infectious Disease Laboratory, Boston University, Boston, Massachusetts, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh.,Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh.,Bangladesh Institute of Child Health, Dhaka, Bangladesh
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Blanks KJ, Musaba MW, Ren L, Burgoine K, Mukunya D, Clarke A, Williams S, Gebremichael T, Waiswa P, Darmstadt GL. Protocol for a scoping review of neonatal emollient therapy and massage practices throughout sub-Saharan Africa. Gates Open Res 2021; 5:142. [PMID: 35299830 PMCID: PMC8901585 DOI: 10.12688/gatesopenres.13359.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Serious infections and other complications from very low birth weight and prematurity are the leading causes of death for neonates worldwide. Infections partly result from the compromised skin barrier function in preterm neonates. Optimal skin care practices for neonates, especially in settings with limited access to adequate hygienic conditions, hold potential to reduce infection and avoid these preventable preterm neonatal deaths. The purpose of this protocol is to support a scoping review of neonatal skin care, emollient therapy and massage practices throughout sub-Saharan Africa. Protocol: The proposed review will follow a methodological framework consisting of the following five steps: (i) identifying the research question, (ii) identifying relevant studies, (iii) selection of eligible studies, (iv) charting the data, and (v) collating and summarizing the results. In addition, we will reflect on the implications of the findings for the feasibility and design of randomized controlled trials to examine the impact of emollient therapy on survival, growth, infection and neurodevelopment of very low birth weight infants in sub-Saharan Africa. We will search domestic and international databases for literature published in English between January 1, 2000, and July 12, 2021. Articles will be chosen based on standardized inclusion criteria. The primary criteria for inclusion will be a report on skin care practices administered to neonates in Africa. Conclusions: Documentation of common neonatal skin care practices throughout Africa has the potential to highlight opportunities for skin care intervention and future research on neonatal skin care practices in sub-Saharan Africa, and support the development of future emollient intervention trials for preterm and low birthweight neonates in low- and middle-income countries.
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Affiliation(s)
| | - Milton W. Musaba
- Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Pallisa, Mbale, PO Box 1460, Uganda
| | - Lily Ren
- Lane Medical Library & Knowledge Management Center, Stanford Medicine, Stanford University, 300 Pasteur Drive, L109, Stanford, CA, 94305, USA
| | - Kathy Burgoine
- Mbale Clinical Research Institute, Plot 29, 33 Pallisa, Mbale, Uganda
| | - David Mukunya
- Busitema University Faculty of Health Sciences, Pallisa, Mbale, PO Box 1460, Uganda
- Sanyu Africa Research Institute, Mbale, PO Box 2190, Uganda
| | - Andrew Clarke
- Global Programs, Save the Children UK, 1 St John's Ln, London, EC1M 4AR, UK
| | - Sarah Williams
- Global Programs, Save the Children UK, 1 St John's Ln, London, EC1M 4AR, UK
| | | | - Peter Waiswa
- Makerere University, University Rd, Kampala, Uganda
| | - Gary L. Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, Stanford, CA, 94304, USA
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Fischer N, Darmstadt GL, Shahunja KM, Crowther JM, Kendall L, Gibson RA, Ahmed T, Relman DA. Topical emollient therapy with sunflower seed oil alters the skin microbiota of young children with severe acute malnutrition in Bangladesh: A randomised, controlled study. J Glob Health 2021; 11:04047. [PMID: 34386216 PMCID: PMC8325932 DOI: 10.7189/jogh.11.04047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Topical emollient therapy with sunflower seed oil (SSO) reduces risk of sepsis and mortality in very preterm infants in low- or middle-income countries (LMICs). Proposed mechanisms include modulation of skin and possibly gut barrier function. The skin and gut microbiota play important roles in regulating barrier function, but the effects of emollient therapy on these microbiotas are poorly understood. Methods We characterised microbiota structure and diversity with 16S rRNA gene amplicon sequence data and ecological statistics in 20 children with severe acute malnutrition (SAM) aged 2-24 months, at four skin sites and in stool, during a randomised, controlled trial of emollient therapy with SSO in Bangladesh. Microbes associated with therapy were identified with tree-based sparse discriminant analysis. Results The skin microbiota of Bangladeshi children with SAM was highly diverse and displayed significant variation in structure as a function of physical distance between sites. Microbiota structure differed between the study groups (P = 0.005), was more diverse in emollient-treated subjects–including on the forehead which did not receive direct treatment–and changed with each day (P = 0.005) at all skin sites. Overall, Prevotellaceae were the most differentially affected by emollient treatment; several genera within this family became more abundant in the emollient group than in the controls across several skin sites. Gut microbiota structure was associated with sample day (P = 0.045) and subject age (P = 0.045), but was not significantly affected by emollient treatment (P = 0.060). Conclusions Emollient therapy altered the skin microbiota in a consistent and temporally coherent manner. We speculate that therapy with SSO enhances skin barrier function in part through alterations in the microbiota, and through systemic mechanisms. Strategies to strengthen skin and gut barrier function in populations at risk, such as children in LMICs like Bangladesh, might include deliberate manipulation of their skin microbiota. Trial registration ClinicalTrials.gov: NCT02616289.
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Affiliation(s)
- Natalie Fischer
- Division of Infectious Diseases & Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Gary L Darmstadt
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - K M Shahunja
- Nutrition and Clinical Services Division, International Centre for Diarroheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarroheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - David A Relman
- Division of Infectious Diseases & Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.,Nutrition and Clinical Services Division, International Centre for Diarroheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.,Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, California, USA.,Infectious Diseases Section, Veterans Affairs Palo Alto Health Care System 154T, Palo Alto, California, USA
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Desai S, Mehta KM, Singh RJ, Westley AK, Dirisu O, Wong C, De Hoop T, Darmstadt GL. Effects of integrated economic and health interventions with women's groups on health-related knowledge, behaviours and outcomes in low-income and middle-income countries: a systematic review protocol. BMJ Open 2021; 11:e046856. [PMID: 34253668 PMCID: PMC8276287 DOI: 10.1136/bmjopen-2020-046856] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Economic groups, such as microfinance or self-help groups are widely implemented in low-income and middle-income countries (LMICs). Women's groups are voluntary groups, which aim to improve the well-being of members through activities, such as joint savings, credit, livelihoods development and/or health activities. Health interventions are increasingly added on to existing women's economic groups as a public health intervention for women and their families. Here, we present the protocol for a mixed-methods systematic review we will conduct of the evidence on integrated economic and health interventions on women's groups to assess whether and how they improve health-related knowledge, behaviour and outcomes in LMICs. METHODS AND ANALYSIS We will search seven electronic databases for published literature, along with manual searches and consultation. The review will include (1) randomised trials and non-randomised quasiexperimental studies of intervention effects of integrated economic and health interventions delivered through women's groups in LMICs, and (2) sibling studies that examine factors related to intervention content, context, implementation processes and costs. We will appraise risk of bias and study quality using standard tools. High and moderate quality studies will be grouped by health domain and synthesised without meta-analysis. Qualitative evidence will be thematically synthesised and integrated into the quantitative synthesis using a matrix approach. ETHICS AND DISSEMINATION This protocol was reviewed and deemed exempt by the institutional review board at the American Institutes for Research. Findings will be shared through peer-reviewed publication and disseminated with programme implementers and policymakers engaged with women's groups. PROSPERO REGISTRATION NUMBER CRD42020199998.
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Affiliation(s)
- Sapna Desai
- Population Council India, New Delhi, Delhi, India
| | - Kala M Mehta
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | | | | | | | - Connie Wong
- Lane Medical Library, Stanford University School of Medicine, Stanford, California, USA
| | - Thomas De Hoop
- International Development Division, American Institutes for Research, Washington, DC, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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73
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Stelzer IA, Ghaemi MS, Han X, Ando K, Hédou JJ, Feyaerts D, Peterson LS, Rumer KK, Tsai ES, Ganio EA, Gaudillière DK, Tsai AS, Choisy B, Gaigne LP, Verdonk F, Jacobsen D, Gavasso S, Traber GM, Ellenberger M, Stanley N, Becker M, Culos A, Fallahzadeh R, Wong RJ, Darmstadt GL, Druzin ML, Winn VD, Gibbs RS, Ling XB, Sylvester K, Carvalho B, Snyder MP, Shaw GM, Stevenson DK, Contrepois K, Angst MS, Aghaeepour N, Gaudillière B. Integrated trajectories of the maternal metabolome, proteome, and immunome predict labor onset. Sci Transl Med 2021; 13:13/592/eabd9898. [PMID: 33952678 DOI: 10.1126/scitranslmed.abd9898] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/01/2020] [Accepted: 04/14/2021] [Indexed: 12/28/2022]
Abstract
Estimating the time of delivery is of high clinical importance because pre- and postterm deviations are associated with complications for the mother and her offspring. However, current estimations are inaccurate. As pregnancy progresses toward labor, major transitions occur in fetomaternal immune, metabolic, and endocrine systems that culminate in birth. The comprehensive characterization of maternal biology that precedes labor is key to understanding these physiological transitions and identifying predictive biomarkers of delivery. Here, a longitudinal study was conducted in 63 women who went into labor spontaneously. More than 7000 plasma analytes and peripheral immune cell responses were analyzed using untargeted mass spectrometry, aptamer-based proteomic technology, and single-cell mass cytometry in serial blood samples collected during the last 100 days of pregnancy. The high-dimensional dataset was integrated into a multiomic model that predicted the time to spontaneous labor [R = 0.85, 95% confidence interval (CI) [0.79 to 0.89], P = 1.2 × 10-40, N = 53, training set; R = 0.81, 95% CI [0.61 to 0.91], P = 3.9 × 10-7, N = 10, independent test set]. Coordinated alterations in maternal metabolome, proteome, and immunome marked a molecular shift from pregnancy maintenance to prelabor biology 2 to 4 weeks before delivery. A surge in steroid hormone metabolites and interleukin-1 receptor type 4 that preceded labor coincided with a switch from immune activation to regulation of inflammatory responses. Our study lays the groundwork for developing blood-based methods for predicting the day of labor, anchored in mechanisms shared in preterm and term pregnancies.
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Affiliation(s)
- Ina A Stelzer
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Mohammad S Ghaemi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA.,Digital Technologies Research Centre, National Research Council Canada, Toronto, ON M5T 3J1, Canada
| | - Xiaoyuan Han
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA.,Department of Biomedical Sciences, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA 94103, USA
| | - Kazuo Ando
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Julien J Hédou
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Dorien Feyaerts
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Laura S Peterson
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Kristen K Rumer
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Eileen S Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Edward A Ganio
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Dyani K Gaudillière
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Amy S Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Benjamin Choisy
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Lea P Gaigne
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Franck Verdonk
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Danielle Jacobsen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Sonia Gavasso
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA.,Department of Neurology, NeuroSys-Med, Haukeland University Hospital, 5021 Bergen, Norway
| | - Gavin M Traber
- Department of Genetics, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Mathew Ellenberger
- Department of Genetics, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Natalie Stanley
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA.,Department of Biomedical Data Science, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Martin Becker
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA.,Department of Biomedical Data Science, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Anthony Culos
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA.,Department of Biomedical Data Science, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Ramin Fallahzadeh
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA.,Department of Biomedical Data Science, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Ronald J Wong
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Gary L Darmstadt
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Maurice L Druzin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Virginia D Winn
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Ronald S Gibbs
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Xuefeng B Ling
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Karl Sylvester
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Michael P Snyder
- Department of Genetics, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Gary M Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - David K Stevenson
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Kévin Contrepois
- Department of Genetics, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Martin S Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA.,Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94305, USA.,Department of Biomedical Data Science, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Brice Gaudillière
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA. .,Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94305, USA
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74
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Erickson AK, Abdalla S, Serenska A, Demeke B, Darmstadt GL. Association between maternity waiting home stay and obstetric outcomes in Yetebon, Ethiopia: a mixed-methods observational cohort study. BMC Pregnancy Childbirth 2021; 21:482. [PMID: 34217232 PMCID: PMC8254337 DOI: 10.1186/s12884-021-03913-3] [Citation(s) in RCA: 4] [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: 03/13/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background A strategy for reducing adverse pregnancy outcomes is the expanded implementation of maternity waiting homes (MWHs). We assessed factors influencing MWH use, as well as the association between MWH stay and obstetric outcomes in a hospital in rural Ethiopia. Methods Data from medical records of the Glenn C. Olson Memorial Primary Hospital obstetric ward were cross matched with records from the affiliated MWH between 1 and 2011 to 31 March 2014. Poisson regression with robust variance was conducted to estimate the relative risk (RR) of childbirth complications associated with MWH use vs. non-use. Five key informant interviews of a convenience sample of three MWH staff and two users were conducted and a thematic analysis performed of social, cultural, and economic factors underlying MWH use. Results During the study period, 489 women gave birth at the hospital, 93 of whom were MWH users. Common reasons for using the MWH were post-term status, previous caesarean section/myomectomy, malposition/malpresentation, and low-lying placenta, placenta previa, or antepartum hemorrhage, and hypertension or preeclampsia. MWH users were more likely than non-users to have had a previous caesarean Sec. (15.1 % vs. 5.3 %, p < 0.001) and to be post-term (21.5 % vs. 3.8 %, p < 0.001). MWH users were also more likely to undergo a caesarean Sec. (51.0 % vs. 35.4 %, p < 0.05) and less likely (p < 0.05) to have a spontaneous vaginal delivery (49.0 % vs. 63.6 %), obstructed labor (6.5 % vs. 14.4 %) or stillbirth (1.1 % vs. 8.6 %). MWH use (N = 93) was associated with a 77 % (adjusted RR = 0.23, 95 % Confidence Interval (CI) 0.12–0.46, p < 0.001) lower risk of childbirth complications, a 94 % (adjusted RR = 0.06, 95 % CI 0.01–0.43, p = 0.005) lower risk of fetal and newborn complications, and a 73 % (adjusted RR = 0.27, 95 % CI 0.13–0.56, p < 0.001) lower risk of maternal complications compared to MWH non-users (N = 396). Birth weight [median 3.5 kg (interquartile range 3.0-3.8) vs. 3.2 kg (2.8–3.5), p < 0.001] and 5-min Apgar scores (adjusted difference = 0.25, 95 % CI 0.06–0.44, p < 0.001) were also higher in offspring of MWH users. Opportunity costs due to missed work and need to arrange for care of children at home, long travel times, and lack of entertainment were suggested as key barriers to MWH utilization. Conclusions This observational, non-randomized study suggests that MWH usage was associated with significantly improved childbirth outcomes. Increasing facility quality, expanding services, and providing educational opportunities should be considered to increase MWH use. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03913-3.
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Affiliation(s)
- Anne K Erickson
- Stanford University School of Medicine, Stanford, CA, USA.,Present address: Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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75
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Weber AM, Diop Y, Gillespie D, Ratsifandrihamanana L, Darmstadt GL. Africa is not a museum: the ethics of encouraging new parenting practices in rural communities in low-income and middle-income countries. BMJ Glob Health 2021; 6:e006218. [PMID: 34266849 PMCID: PMC8286753 DOI: 10.1136/bmjgh-2021-006218] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/29/2021] [Indexed: 01/11/2023] Open
Abstract
The Nurturing Care Framework for Early Childhood Development urges stakeholders to implement strategies that help children worldwide achieve their developmental potential. Related programmes range from the WHO's and UNICEF's Care for Child Development intervention, implemented in 19 countries, to locally developed programmes, such as non-governmental organisation Tostan's Reinforcement of Parental Practices in Senegal. However, some researchers argue that these programmes are unethical as they impose caregiving practices and values from high-income countries (HICs) on low-income communities, failing to consider local culture, communities' goals for their children and generalisability of scientific findings from HICs. We explore these criticisms within a public health framework, applying principles of beneficence, autonomy and justice to the arguments. To facilitate the change communities themselves desire for their children, we recommend that practitioners codevelop programmes and cooperate with communities in implementation to harness local beliefs and customs and promote evidence-based and locally adapted practices.
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Affiliation(s)
- Ann M Weber
- School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Yatma Diop
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Diane Gillespie
- Emeritus, Community Psychology, University of Washington, Bothell, Washington, USA
| | | | - Gary L Darmstadt
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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76
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Shahunja KM, Sévin DC, Kendall L, Ahmed T, Hossain MI, Mahfuz M, Zhu X, Singh K, Singh S, Crowther JM, Gibson RA, Darmstadt GL. Effect of topical applications of sunflower seed oil on systemic fatty acid levels in under-two children under rehabilitation for severe acute malnutrition in Bangladesh: a randomized controlled trial. Nutr J 2021; 20:51. [PMID: 34092255 PMCID: PMC8183055 DOI: 10.1186/s12937-021-00707-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/11/2020] [Accepted: 05/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background Children with severe acute malnutrition (SAM) have inadequate levels of fatty acids (FAs) and limited capacity for enteral nutritional rehabilitation. We hypothesized that topical high-linoleate sunflower seed oil (SSO) would be effective adjunctive treatment for children with SAM. Methods This study tested a prespecified secondary endpoint of a randomized, controlled, unblinded clinical trial with 212 children with SAM aged 2 to 24 months in two strata (2 to < 6 months, 6 to 24 months in a 1:2 ratio) at Dhaka Hospital of icddr,b, Bangladesh between January 2016 and December 2017. All children received standard-of-care management of SAM. Children randomized to the emollient group also received whole-body applications of 3 g/kg SSO three times daily for 10 days. We applied difference-in-difference analysis and unsupervised clustering analysis using t-distributed stochastic neighbor embedding (t-SNE) to visualize changes in FA levels in blood from day 0 to day 10 of children with SAM treated with emollient compared to no-emollient. Results Emollient therapy led to systematically higher increases in 26 of 29 FAs over time compared to the control. These effects were driven primarily by changes in younger subjects (27 of 29 FAs). Several FAs, especially those most abundant in SSO showed high-magnitude but non-significant incremental increases from day 0 to day 10 in the emollient group vs. the no-emollient group; for linoleic acid, a 237 μg/mL increase was attributable to enteral feeding and an incremental 98 μg/mL increase (41%) was due to emollient therapy. Behenic acid (22:0), gamma-linolenic acid (18:3n6), and eicosapentaenoic acid (20:5n3) were significantly increased in the younger age stratum; minimal changes were seen in the older children. Conclusions SSO therapy for SAM augmented the impact of enteral feeding in increasing levels of several FAs in young children. Further research is warranted into optimizing this novel approach for nutritional rehabilitation of children with SAM, especially those < 6 months. Trial registration ClinicalTrials.gov: NCT02616289. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-021-00707-3.
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Affiliation(s)
- K M Shahunja
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Daniel C Sévin
- Cellzome GmbH, GlaxoSmithKline R&D, Meyerhofstrasse 1, 69117, Heidelberg, Germany
| | - Lindsay Kendall
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Iqbal Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Xinyi Zhu
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Krishan Singh
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Sunita Singh
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | | | - Rachel A Gibson
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, 1701 Page Mill Road, Room 121, Palo Alto, Stanford, CA, 94304, USA.
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77
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Stevenson DK, Aghaeepour N, Maric I, Angst MS, Darmstadt GL, Druzin ML, Gaudilliere B, Ling XB, Moufarrej MN, Peterson LS, Quake SR, Relman DA, Snyder MP, Sylvester KG, Shaw GM, Wong RJ. Understanding how biologic and social determinants affect disparities in preterm birth and outcomes of preterm infants in the NICU. Semin Perinatol 2021; 45:151408. [PMID: 33875265 PMCID: PMC9159791 DOI: 10.1016/j.semperi.2021.151408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To understand the disparities in spontaneous preterm birth (sPTB) and/or its outcomes, biologic and social determinants as well as healthcare practice (such as those in neonatal intensive care units) should be considered. Disparities in sPTB have been largely intractable and remain obscure in most cases, despite a myriad of identified risk factors for and causes of sPTB. We still do not know how they lead to the different outcomes at different gestational ages and if they are independent of NICU practices. Here we describe an integrated approach to study the interplay between the genome and exposome, which may drive biochemistry and physiology and lead to health disparities.
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Affiliation(s)
- David K. Stevenson
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 1265 Welch Rd, X157, Stanford, CA 94305-5415, USA,Corresponding author. (D.K. Stevenson)
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Ivana Maric
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 1265 Welch Rd, X157, Stanford, CA 94305-5415, USA
| | - Martin S. Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Gary L. Darmstadt
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 1265 Welch Rd, X157, Stanford, CA 94305-5415, USA
| | - Maurice L. Druzin
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Xuefeng B. Ling
- Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA,Clinical and Translational Research Program, Betty Irene Moore Children’s Heart Center, Lucile Packard Children’s Hospital, Palo Alto, CA 94306, USA
| | - Mira N. Moufarrej
- Department of Bioengineering and Applied Physics, Stanford University and Chan Zuckerberg Biohub, Stanford, CA 94305, USA
| | - Laura S. Peterson
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 1265 Welch Rd, X157, Stanford, CA 94305-5415, USA
| | - Stephen R. Quake
- Department of Bioengineering and Applied Physics, Stanford University and Chan Zuckerberg Biohub, Stanford, CA 94305, USA
| | - David A. Relman
- Department of Medicine, Stanford University School of Medicine and the Chan Zuckerberg Biohub Stanford, CA 94305, USA,Infectious Diseases Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Michael P. Snyder
- Stanford Center for Genomics and Personalized Medicine, Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Karl G. Sylvester
- Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Gary M. Shaw
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 1265 Welch Rd, X157, Stanford, CA 94305-5415, USA
| | - Ronald J. Wong
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 1265 Welch Rd, X157, Stanford, CA 94305-5415, USA
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78
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Darmstadt GL, Khan NZ, Rosenstock S, Muslima H, Parveen M, Mahmood W, Ahmed ASMNU, Chowdhury MAKA, Zeger S, Saha SK. Impact of emollient therapy for preterm infants in the neonatal period on child neurodevelopment in Bangladesh: an observational cohort study. J Health Popul Nutr 2021; 40:24. [PMID: 34039435 PMCID: PMC8152128 DOI: 10.1186/s41043-021-00248-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Topical treatment with sunflower seed oil (SSO) or Aquaphor® reduced sepsis and neonatal mortality in hospitalized preterm infants <33 weeks' gestational age in Bangladesh. We sought to determine whether the emollient treatments improved neurodevelopmental outcomes during early childhood. METHODS 497 infants were randomized to receive SSO, Aquaphor®, or neither through the neonatal period or hospital discharge. 159 infant survivors were enrolled in the longitudinal follow-up study using a validated Rapid Neurodevelopmental Assessment tool and the Bayley Scales of Infant Development II (BSID II) administered at three-monthly intervals for the first year and thereafter at six-monthly intervals. Lowess smoothing was used to display neurodevelopmental status across multiple domains by age and treatment group, and Generalized Estimating Equations (GEE) were used to compare treatment groups across age points. RESULTS 123 children completed at least one follow-up visit. Lowess graphs suggest that lower proportions of children who received massage with either SSO or Aquaphor® had neurodevelopmental delays than control infants in a composite outcome of disabilities. In GEE analysis, infants receiving SSO showed a significant protective effect on the development of fine motor skills [odds ratio (OR) 0.92, 95% confidence interval (CI) 0.86-0.98, p=0.006]. The Psychomotor Development Index (PDI) in the BSID II showed significantly lower disability rates in the Aquaphor group (23.6%) compared to the control (55.2%) (OR 0.21, 95% CI 0.06-0.72, p=0.004). CONCLUSIONS Emollient massage of very preterm, hospitalized newborn infants improved some child neurodevelopmental outcomes over the first 2 years of follow-up. Findings warrant further confirmatory research. TRIAL REGISTRATION ClinicalTrials.gov (98-04-21-03-2) under weblink https://clinicaltrials.gov/ct2/show/NCT00162747.
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Affiliation(s)
- Gary L Darmstadt
- Prematurity Research Center, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA.
| | - Naila Z Khan
- Clinical Neurosciences Center, Bangladesh Protibondhi Foundation, Dhaka, Bangladesh
| | - Summer Rosenstock
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Humaira Muslima
- Clinical Neurosciences Center, Bangladesh Protibondhi Foundation, Dhaka, Bangladesh
| | - Monowara Parveen
- Clinical Neurosciences Center, Bangladesh Protibondhi Foundation, Dhaka, Bangladesh
| | - Wajeeha Mahmood
- Prematurity Research Center, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
| | - A S M Nawshad Uddin Ahmed
- Department of Neonatology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - M A K Azad Chowdhury
- Department of Neonatology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Scott Zeger
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Samir K Saha
- Department of Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
- Child Health Research Foundation , Dhaka, Bangladesh
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Nesamoney SN, Darmstadt GL, Wise PH. Gendered effects of COVID-19 on young girls in regions of conflict. Lancet 2021; 397:1880-1881. [PMID: 34022981 PMCID: PMC9751750 DOI: 10.1016/s0140-6736(21)00936-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Sophia N Nesamoney
- King Center on Global Development, Stanford University, Stanford, CA, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
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80
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Nesamoney SN, Darmstadt GL, Wise PH. Addressing the impacts of COVID-19 on gender equality and global health security in regions of violent conflict. J Glob Health 2021; 11:03074. [PMID: 34055324 PMCID: PMC8141325 DOI: 10.7189/jogh.11.03074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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81
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Pedersen CJ, Uddin MJ, Saha SK, Darmstadt GL. Prevalence and psychosocial impact of atopic dermatitis in Bangladeshi children and families. PLoS One 2021; 16:e0249824. [PMID: 33861780 PMCID: PMC8051797 DOI: 10.1371/journal.pone.0249824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/02/2020] [Accepted: 03/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Skin conditions are the fourth leading cause of nonfatal disease globally, with atopic dermatitis (AD) a major and rising contributor. Though atopic dermatitis (AD) is rising in prevalence, little is known about its psychosocial effects on children and families in low- and middle-income countries (LMICs). METHODS We conducted a community-based, cross-sectional survey of 2242 under-5 children in rural Bangladesh using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire to measure AD prevalence and severity, the Patient-Oriented Eczema Measure (POEM) to measure severity, and the Infants' Dermatitis Quality of Life index (IDQoL) and Dermatitis Family Index (DFI) to measure quality of life. FINDINGS Overall AD prevalence in under-five children was 11.9% [95% confidence interval (CI) 10.6-13.3%]. Prevalence was highest in children age 30-35 months [16.2% (95% CI 11.4-21.0)]. IDQoL was significantly higher in males (2.67) vs. females (1.95, p = 0.015), the lowest (3.06) vs. highest (1.63) wealth quintile (p<0.001), and among mothers with < primary (2.41) vs. > secondary (1.43) education (p = 0.039). POEM severity was correlated with IDQoL (r = 0.77, p<0.001) and DFI (r = 0.56, p<0.001). Severe disease as rated by caretakers was correlated with POEM (r = 0.73, p<0.001), IDQoL (r = 0.82, p<0.001) and DFI (r = 0.57, p<0.001). CONCLUSIONS Severe AD significantly affects quality of life for children and families in Bangladesh. As access to healthcare expands in LMICs, identification and treatment of both the medical and psychosocial morbidities associated with the disease are needed.
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Affiliation(s)
- Courtney J. Pedersen
- Stanford University School of Medicine, Stanford, California, United States of America
| | | | | | - Gary L. Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
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82
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Monaghan S, Akale MA, Demeke B, Darmstadt GL. Prevalence and Stigma of Postpartum Common Mental Disorders in the Gurage Region of Ethiopia: A Mixed-Methods Observational Cohort Study. Front Psychol 2021; 12:626797. [PMID: 33897534 PMCID: PMC8062741 DOI: 10.3389/fpsyg.2021.626797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/04/2020] [Accepted: 03/09/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives: Mental disorders are vastly underdiagnosed in low-income countries that disproportionately affect women. We aimed to evaluate the prevalence of common mental disorders in newly postpartum women, and stigma associated with mental health reporting in an Ethiopian community using a validated World Health Organization survey. Methods: The Self Reporting Questionnaire (SRQ) for psychological distress was administered in Amharic by nurses to 118 women aged 18–37 years who had given birth in the prior 3 months in the Glenn C. Olsen Memorial Primary Hospital in Yetebon. Mental health stigma among the four nursing staff was assessed using Link and Phelan's Components of Stigma. Results: Among 118 women surveyed, 18% had a probable common mental disorder using the SRQ 4/5 cutoff and 2% admitted to suicidal thoughts. Presence of stigma in the healthcare staff was verified, including labeling, stereotyping, separating, and status loss and discrimination. Conclusion: Postpartum mental health disorders as well as stigma against such diagnoses are common in the Yetebon community. There is an urgent need for increased availability of properly trained and supervised healthcare staff in the identification and referral of postpartum women with common mental disorders.
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Affiliation(s)
| | | | | | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
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83
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Kobeissi L, Nair M, Evers ES, Han MD, Aboubaker S, Say L, Rollins N, Darmstadt GL, Blanchet K, Garcia DM, Hagon O, Ashorn P. Setting research priorities for sexual, reproductive, maternal, newborn, child and adolescent health in humanitarian settings. Confl Health 2021; 15:16. [PMID: 33771212 PMCID: PMC7995567 DOI: 10.1186/s13031-021-00353-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/15/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background An estimated 70.8 million people are forcibly displaced worldwide, 75% of whom are women and children. Prioritizing a global research agenda to inform guidance, service delivery, access to and quality of services is essential to improve the survival and health of women, children and adolescents in humanitarian settings. Method A mixed-methods design was adapted from the Child Health and Nutrition Research Initiative (CHNRI) methodology to solicit priority research questions across the sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) domains in humanitarian settings. The first step (CHNRI) involved data collection and scoring of perceived priority questions, using a web-based survey over two rounds (first, to generate the questions and secondly, to score them). Over 1000 stakeholders from across the globe were approached; 177 took part in the first survey and 69 took part in the second. These research questions were prioritized by generating a research prioritization score (RPP) across four dimensions: answerability, program feasibility, public health relevance and equity. A Delphi process of 29 experts followed, where the 50 scored and prioritized CHRNI research questions were shortlisted. The top five questions from the CHNRI scored list for each SRMNCAH domain were voted on, rendering a final list per domain. Results A total of 280 questions were generated. Generated questions covered sexual and reproductive health (SRH) (n = 90, 32.1%), maternal health (n = 75, 26.8%), newborn health (n = 42, 15.0%), child health (n = 43, 15.4%), and non-SRH aspects of adolescent health (n = 31, 11.1%). A shortlist of the top ten prioritized questions for each domain were generated on the basis of the computed RPPs. During the Delphi process, the prioritized questions, based on the CHNRI process, were further refined. Five questions from the shortlist of each of the SRMNCAH domain were formulated, resulting in 25 priority questions across SRMNCAH. For example, one of the prioritized SRH shortlisted and prioritized research question included: “What are effective strategies to implement good quality comprehensive contraceptive services (long-acting, short-acting and EC) for women and girls in humanitarian settings?” Conclusion Data needs, effective intervention strategies and approaches, as well as greater efficiency and quality during delivery of care in humanitarian settings were prioritized. The findings from this research provide guidance for researchers, program implementers, as well as donor agencies on SRMNCAH research priorities in humanitarian settings. A global research agenda could save the lives of those who are at greatest risk and vulnerability as well as increase opportunities for translation and innovation for SRMNCAH in humanitarian settings. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00353-w.
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Affiliation(s)
- Loulou Kobeissi
- SRH Integration in Health Systems (SHS), Department of Sexual and Reproductive Health and Research (SRH), World Health Organization (WHO), Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland.
| | - Mahalakshmi Nair
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA),World Health Organization, Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | - Egmond Samir Evers
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA),World Health Organization, Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | - Mansuk Daniel Han
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA),World Health Organization, Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | | | - Lale Say
- SRH Integration in Health Systems (SHS), Department of Sexual and Reproductive Health and Research (SRH), World Health Organization (WHO), Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA),World Health Organization, Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | - Gary L Darmstadt
- Maternal and Child Health, Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, USA
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, the Graduate Institute, Geneva, Switzerland
| | - Daniel Martinez Garcia
- Women and Child Health Unit, Medical Department of Médecins Sans Frontières (MSF), Geneva, Switzerland
| | - Olivier Hagon
- Center for Humanitarian Medicine and Disaster Management (CHMDM), WHO Collaborative center, Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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84
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Shahunja KM, Ahmed T, Hossain MI, Mahfuz M, Kendall L, Zhu X, Singh K, Crowther JM, Singh S, Gibson RA, Darmstadt GL. Topical emollient therapy in the management of severe acute malnutrition in children under two: A randomized controlled clinical trial in Bangladesh. J Glob Health 2021; 10:010414. [PMID: 32509290 PMCID: PMC7243074 DOI: 10.7189/jogh.10.010414] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Topical emollient therapy can improve neonatal health and growth and potentially provides an additional avenue for augmenting the provision of nutrition to children with severe acute malnutrition (SAM). We hypothesised that topical treatment of hospitalised children with SAM using sunflower seed oil (SSO), in addition to standard-of-care for SAM, would improve skin barrier function and weight gain, reduce risk of infection, and accelerate clinical recovery. Methods We conducted a randomised, two-arm, controlled, unblinded clinical trial in 212 subjects aged 2 to 24 months who were admitted for care of SAM at the ‘Dhaka Hospital’ of icddr,b during January 2016 to November 2017. Enrollment was age-stratified into 2 to <6 months and 6 to 24 months age groups in a 1:2 ratio. All children received SAM standard-of-care, and the SSO group was also treated with 3 g of SSO per kg body weight three times daily for 10 days. Primary outcome was rate of weight gain over the 10-day study period. Secondary endpoints included rate of nosocomial infection, time to recovery from acute illness, skin condition score, rate of transepidermal water loss (TEWL) and C-reactive protein (CRP) level. Results Rate of weight gain was higher in the SSO than the control group (adjusted mean difference, AMD = 0.90 g/kg/d, 95% confidence interval (CI) = -1.22 to 3.03 in the younger age stratum), but did not reach statistical significance. Nosocomial infection rate was significantly lower in the SSO group in the older age stratum (adjusted odds ratio (OR) = 0.41, 95% CI = 0.19 to 0.85; P = 0.017), but was comparable in the younger age stratum and overall. Skin condition score improved (AMD = -14.88, 95% CI = -24.12 to -5.65, P = 0.002) and TEWL was reduced overall (AMD = -2.59, 95% CI = -3.86 to -1.31, P < 0.001) in the SSO group. Reduction in CRP level was significantly greater in the SSO group (median: -0.28) than the control group (median 0.00) (P = 0.019) in the younger age stratum. Conclusions Topical therapy with SSO was beneficial for children with SAM when applied as adjunctive therapy. A community-based trial with a longer intervention period is recommended to validate these results. Trial registration ClinicalTrials.gov: NCT02616289
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Affiliation(s)
- K M Shahunja
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Iqbal Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lindsay Kendall
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Xinyi Zhu
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Krishan Singh
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | | | - Sunita Singh
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Rachel A Gibson
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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85
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Abdalla S, Katz EG, Darmstadt GL. Gender and the impact of COVID-19 on demand for and access to health care: analysis of data from Kenya, Nigeria, and South Africa. Lancet Glob Health 2021. [DOI: 10.1016/s2214-109x(21)00115-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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86
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Bota AB, Ward V, Hawken S, Wilson LA, Lamoureux M, Ducharme R, Murphy MSQ, Denize KM, Henderson M, Saha SK, Akther S, Otieno NA, Munga S, Atito RO, Stringer JSA, Mwape H, Price JT, Mujuru HA, Chimhini G, Magwali T, Mudawarima L, Chakraborty P, Darmstadt GL, Wilson K. Metabolic gestational age assessment in low resource settings: a validation protocol. Gates Open Res 2021; 4:150. [PMID: 33501414 PMCID: PMC7801859 DOI: 10.12688/gatesopenres.13155.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Accepted: 01/22/2021] [Indexed: 11/20/2022] Open
Abstract
Preterm birth is the leading global cause of neonatal morbidity and mortality. Reliable gestational age estimates are useful for quantifying population burdens of preterm birth and informing allocation of resources to address the problem. However, evaluating gestational age in low-resource settings can be challenging, particularly in places where access to ultrasound is limited. Our group has developed an algorithm using newborn screening analyte values derived from dried blood spots from newborns born in Ontario, Canada for estimating gestational age within one to two weeks. The primary objective of this study is to validate a program that derives gestational age estimates from dried blood spot samples (heel-prick or cord blood) collected from health and demographic surveillance sites and population representative health facilities in low-resource settings in Zambia, Kenya, Bangladesh and Zimbabwe. We will also pilot the use of an algorithm to identify birth percentiles based on gestational age estimates and weight to identify small for gestational age infants. Once collected from local sites, samples will be tested by the Newborn Screening Ontario laboratory at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa, Canada. Analyte values will be obtained through laboratory analysis for estimation of gestational age as well as screening for other diseases routinely conducted at Ontario's newborn screening program. For select conditions, abnormal screening results will be reported back to the sites in real time to facilitate counseling and future clinical management. We will determine the accuracy of our existing algorithm for estimation of gestational age in these newborn samples. Results from this research hold the potential to create a feasible method to assess gestational age at birth in low- and middle-income countries where reliable estimation may be otherwise unavailable.
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Affiliation(s)
- A. Brianne Bota
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Victoria Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephen Hawken
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Lindsay A. Wilson
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Monica Lamoureux
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Robin Ducharme
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Malia S. Q. Murphy
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Kathryn M. Denize
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Matthew Henderson
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Samir K. Saha
- Child Health Research Foundation, Mizapur, Bangladesh
| | - Salma Akther
- Child Health Research Foundation, Mizapur, Bangladesh
| | - Nancy A. Otieno
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | - Stephen Munga
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | - Raphael O. Atito
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | | | | | - Joan T. Price
- Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, NC, USA
| | - Hilda Angela Mujuru
- Department of Paediatrics and Child Health, University of Zimbabwe, Avondale, Zimbabwe
| | - Gwendoline Chimhini
- Department of Paediatrics and Child Health, University of Zimbabwe, Avondale, Zimbabwe
| | - Thulani Magwali
- Department of Obstetrics and Gynaecology, University of Zimbabwe, Avondale, Zimbabwe
| | - Louisa Mudawarima
- Department of Paediatrics and Child Health, University of Zimbabwe, Avondale, Zimbabwe
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Gary L. Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Bruyère Research Institute, Otttawa, Canada
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87
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Winter JC, Darmstadt GL, Davis J. The role of piped water supplies in advancing health, economic development, and gender equality in rural communities. Soc Sci Med 2021; 270:113599. [PMID: 33485713 DOI: 10.1016/j.socscimed.2020.113599] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/04/2020] [Accepted: 12/06/2020] [Indexed: 12/27/2022]
Abstract
In rural areas of sub-Saharan Africa, one in eight households obtain drinking water from a piped system; the rest fetch water from improved and unimproved sources located at some distance from their homes. This task falls primarily to women and girls, creating time poverty and risks to safety and health. In this paper, we present a conceptual model that elaborates the mechanisms linking access to piped water with food security and long-term economic impacts. These hypotheses were tested in a quasi-experimental study of four villages in rural Zambia using a combination of household surveys, Global Positioning System transponders, and water meters to measure time spent fetching water, water consumption, and how water was being utilized for domestic and productive activities. Households receiving the piped water intervention spent a median of 3.8 h per week less fetching water, savings that accrued primarily to women and girls. Household water consumption increased 32%, which was used for both domestic and productive uses. Increases in the frequency of gardening and the size of garden plots in treatment households were observed. Households receiving piped water reported being happier, healthier, and having more time to participate in work inside or outside the home. We find that piped water supplies can promote the economic development and well-being of rural households, with particular benefits to women and girls, conditional upon pricing and management models that ensure sustainable service.
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Affiliation(s)
- James C Winter
- Department of Civil and Environmental Engineering, Yang and Yamazaki Environment and Energy Building, Stanford University, 473 Via Ortega, Stanford, CA, 94305, USA.
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA.
| | - Jennifer Davis
- Department of Civil and Environmental Engineering, Yang and Yamazaki Environment and Energy Building, Stanford University, 473 Via Ortega, Stanford, CA, 94305, USA; Woods Institute for the Environment, Yang and Yamazaki Environment and Energy Building, Stanford University, 473 Via Ortega, Stanford, CA, 94305, USA.
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88
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Mehta KM, Ward VC, Darmstadt GL. Best practices in global health evaluation: Reflections on learning from an independent program analysis in Bihar, India. J Glob Health 2021; 10:020395. [PMID: 33403103 PMCID: PMC7750022 DOI: 10.7189/jogh.10.020395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Kala M Mehta
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Victoria C Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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89
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Stevenson DK, Wong RJ, Aghaeepour N, Maric I, Angst MS, Contrepois K, Darmstadt GL, Druzin ML, Eisenberg ML, Gaudilliere B, Gibbs RS, Gotlib IH, Gould JB, Lee HC, Ling XB, Mayo JA, Moufarrej MN, Quaintance CC, Quake SR, Relman DA, Sirota M, Snyder MP, Sylvester KG, Hao S, Wise PH, Shaw GM, Katz M. Towards personalized medicine in maternal and child health: integrating biologic and social determinants. Pediatr Res 2021; 89:252-258. [PMID: 32454518 PMCID: PMC8061757 DOI: 10.1038/s41390-020-0981-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022]
Affiliation(s)
- David K Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Ronald J Wong
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA.
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Ivana Maric
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Martin S Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Kevin Contrepois
- Stanford Center for Genomics and Personalized Medicine, Department of Genetics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Maurice L Druzin
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Michael L Eisenberg
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Urology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Ronald S Gibbs
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Ian H Gotlib
- Department of Psychology, Stanford University School of Humanities and Science, Stanford, CA, 94305, USA
| | - Jeffrey B Gould
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Henry C Lee
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Xuefeng B Ling
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Clinical and Translational Research Program, Betty Irene Moore Children's Heart Center, Lucile Packard Children's Hospital, Palo Alto, CA, 94306, USA
| | - Jonathan A Mayo
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Mira N Moufarrej
- Departments of Bioengineering and Applied Physics, Stanford University, and Chan Zuckerberg Biohub, Stanford, CA, 94305, USA
| | - Cecele C Quaintance
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Stephen R Quake
- Departments of Bioengineering and Applied Physics, Stanford University, and Chan Zuckerberg Biohub, Stanford, CA, 94305, USA
| | - David A Relman
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Infectious Diseases Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94306, USA
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Michael P Snyder
- Stanford Center for Genomics and Personalized Medicine, Department of Genetics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Karl G Sylvester
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Shiying Hao
- Clinical and Translational Research Program, Betty Irene Moore Children's Heart Center, Lucile Packard Children's Hospital, Palo Alto, CA, 94306, USA
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Michael Katz
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
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Mehta KM, Irani L, Chaudhuri I, Mahapatra T, Schooley J, Srikantiah S, Abdalla S, Ward V, Carmichael SL, Bentley J, Creanga A, Wilhelm J, Tarigopula UK, Bhattacharya D, Atmavilas Y, Nanda P, Weng Y, Pepper KT, Darmstadt GL. Health layering of self-help groups: impacts on reproductive, maternal, newborn and child health and nutrition in Bihar, India. J Glob Health 2020. [DOI: 10.7189/jogh.10.0201007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ward VC, Raheel H, Weng Y, Mehta KM, Dutt P, Mitra R, Sastry P, Godfrey A, Shannon M, Chamberlain S, Kaimal R, Carmichael SL, Bentley J, Abdalla S, Pepper KT, Mahapatra T, Srikantiah S, Borkum E, Rangarajan A, Sridharan S, Rotz D, Nanda P, Tarigopula UK, Atmavilas Y, Bhattacharya D, Darmstadt GL. Impact of mHealth interventions for reproductive, maternal, newborn and child health and nutrition at scale: BBC Media Action and the Ananya program in Bihar, India. J Glob Health 2020. [DOI: 10.7189/jogh.10.0201005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Darmstadt GL, Weng Y, Pepper KT, Ward VC, Mehta KM, Borkum E, Bentley J, Raheel H, Rangarajan A, Bhattacharya D, Tarigopula UK, Nanda P, Sridharan S, Rotz D, Carmichael SL, Abdalla S, Munar W. Impact of the Ananya program on reproductive, maternal, newborn and child health and nutrition in Bihar, India: early results from a quasi-experimental study. J Glob Health 2020. [DOI: 10.7189/jogh.10.0201002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ward VC, Raheel H, Weng Y, Mehta KM, Dutt P, Mitra R, Sastry P, Godfrey A, Shannon M, Chamberlain S, Kaimal R, Carmichael SL, Bentley J, Abdalla S, Pepper KT, Mahapatra T, Srikantiah S, Borkum E, Rangarajan A, Sridharan S, Rotz D, Nanda P, Tarigopula UK, Atmavilas Y, Bhattacharya D, Darmstadt GL. Impact of mHealth interventions for reproductive, maternal, newborn and child health and nutrition at scale: BBC Media Action and the Ananya program in Bihar, India. J Glob Health 2020; 10:021005. [PMID: 33425329 PMCID: PMC7758913 DOI: 10.7189/jogh.10.021005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Mobile health (mHealth) tools have potential for improving the reach and quality of health information and services through community health workers in low- and middle-income countries. This study evaluates the impact of an mHealth tool implemented at scale as part of the statewide reproductive,maternal, newborn and child health and nutrition (RMNCHN) program in Bihar, India. Methods Three survey-based data sets were analysed to compare the health-related knowledge, attitudes and behaviours amongst childbearing women exposed to the Mobile Kunji and Dr. Anita mHealth tools during their visits with frontline workers compared with those who were unexposed. Results An evaluation by Mathematica (2014) revealed that exposure to Mobile Kunji and Dr. Anita recordings were associated with significantly higher odds of consuming iron-folic acid tablets (odds ratio (OR) = 2.3, 95% confidence interval (CI) = 1.8-3.1) as well as taking a set of three measures for delivery preparedness (OR = 2.8, 95% CI = 1.9-4.2) and appropriate infant complementary feeding (OR = 1.9, 95% CI = 1.0-3.5). CARE India’s Community-based Household Surveys (2012-2017) demonstrated significant improvements in early breastfeeding (OR = 1.64, 95% CI = 1.5-1.78) and exclusive breastfeeding (OR = 1.46, 95% CI = 1.33-1.62) in addition to birth preparedness practices. BBC Media Action’s Usage & Engagement Survey (2014) demonstrated a positive association between exposure to Mobile Kunji and Dr. Anita and exclusive breastfeeding (58% exposed vs 43% unexposed, P < 0.01) as well as maternal respondents’ trust in their frontline worker. Conclusions Significant improvements in RMNCHN-related knowledge and behaviours were observed for Bihari women who were exposed to Mobile Kunji and Dr. Anita. This analysis is unique in its rigorous evaluation across multiple data sets of mHealth interventions implemented at scale. These results can help inform global understanding of how best to use mHealth tools, for whom, and in what contexts. Study registration ClinicalTrials.gov number NCT02726230.
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Affiliation(s)
- Victoria C Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Hina Raheel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Yingjie Weng
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Kala M Mehta
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | | | | | | | | | | | | | - Rajani Kaimal
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jason Bentley
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Kevin T Pepper
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | | | | | | | | | - Dana Rotz
- Mathematica, Princeton, New Jersey, USA
| | - Priya Nanda
- Bill and Melinda Gates Foundation, Delhi, India
| | | | | | | | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
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Mehta KM, Irani L, Chaudhuri I, Mahapatra T, Schooley J, Srikantiah S, Abdalla S, Ward VC, Carmichael SL, Bentley J, Creanga A, Wilhelm J, Tarigopula UK, Bhattacharya D, Atmavilas Y, Nanda P, Weng Y, Pepper KT, Darmstadt GL. Health impact of self-help groups scaled-up statewide in Bihar, India. J Glob Health 2020. [DOI: 10.7189/jogh.10.0201006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ward VC, Weng Y, Bentley J, Carmichael SL, Mehta KM, Mahmood W, Pepper KT, Abdalla S, Atmavilas Y, Mahapatra T, Srikantiah S, Borkum E, Rangarajan A, Sridharan S, Rotz D, Bhattacharya D, Nanda P, Tarigopula UK, Shah H, Darmstadt GL. Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens. J Glob Health 2020. [DOI: 10.7189/jogh.10.0201011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mehta KM, Irani L, Chaudhuri I, Mahapatra T, Schooley J, Srikantiah S, Abdalla S, Ward VC, Carmichael SL, Bentley J, Creanga A, Wilhelm J, Tarigopula UK, Bhattacharya D, Atmavilas Y, Nanda P, Weng Y, Pepper KT, Darmstadt GL. Health impact of self-help groups scaled-up statewide in Bihar, India. J Glob Health 2020; 10:021006. [PMID: 33425330 PMCID: PMC7761401 DOI: 10.7189/jogh.10.021006] [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] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The objective of this study was to assess the impact of self-help groups (SHGs) and subsequent scale-up on reproductive, maternal, newborn, child health, and nutrition (RMNCHN) and sanitation outcomes among marginalised women in Bihar, India from 2014-2017. METHODS We examined RMNCHN and sanitation behaviors in women who were members of any SHGs compared to non-members, without differentiating between types of SHGs. We analysed annual surveys across 38 districts of Bihar covering 62 690 women who had a live birth in the past 12 months. All analyses utilised data from Community-based Household Surveys (CHS) rounds 6-9 collected in 2014-2017 by CARE India as part of the Bihar Technical Support Program funded by the Bill & Melinda Gates Foundation. We examined 66 RMNCHN and sanitation indicators using survey logistic regression; the comparison group in all cases was age-comparable women from the geographic contexts of the SHG members but who did not belong to SHGs. We also examined links between discussion topics in SHGs and changes in relevant behaviours, and stratification of effects by parity and mother's age. RESULTS SHG members had higher odds compared to non-SHG members for 60% of antenatal care indicators, 22% of delivery indicators, 70% of postnatal care indicators, 50% of nutrition indicators, 100% of family planning and sanitation indicators and no immunisation indicators measured. According to delivery platform, most FLW performance indicators (80%) had increased odds, followed by maternal behaviours (57%) and facility care and outreach service delivery (22%) compared to non-SHG members. Self-report of discussions within SHGs on specific topics was associated with increased related maternal behaviours. Younger SHG members (<25 years) had attenuated health indicators compared to older group members (≥25 years), and women with more children had more positive indicators compared to women with fewer children. CONCLUSIONS SHG membership was associated with improved RMNCHN and sanitation indicators at scale in Bihar, India. Further work is needed to understand the specific impacts of health layering upon SHGs. Working through SHGs is a promising vehicle for improving primary health care. STUDY REGISTRATION ClinicalTrials.gov number NCT02726230.
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Affiliation(s)
- Kala M Mehta
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | | | - Indrajit Chaudhuri
- Project Concern International, Delhi, India and San Diego, California, USA
| | | | - Janine Schooley
- Project Concern International, Delhi, India and San Diego, California, USA
| | | | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Victoria C Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jason Bentley
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andreea Creanga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jess Wilhelm
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Priya Nanda
- Bill and Melinda Gates Foundation, Delhi, India
| | - Yingjie Weng
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Kevin T Pepper
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
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Affiliation(s)
- Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Jehan F, Sazawal S, Baqui AH, Nisar MI, Dhingra U, Khanam R, Ilyas M, Dutta A, Mitra DK, Mehmood U, Deb S, Mahmud A, Hotwani A, Ali SM, Rahman S, Nizar A, Ame SM, Moin MI, Muhammad S, Chauhan A, Begum N, Khan W, Das S, Ahmed S, Hasan T, Khalid J, Rizvi SJR, Juma MH, Chowdhury NH, Kabir F, Aftab F, Quaiyum A, Manu A, Yoshida S, Bahl R, Rahman A, Pervin J, Winston J, Musonda P, Stringer JSA, Litch JA, Ghaemi MS, Moufarrej MN, Contrepois K, Chen S, Stelzer IA, Stanley N, Chang AL, Hammad GB, Wong RJ, Liu C, Quaintance CC, Culos A, Espinosa C, Xenochristou M, Becker M, Fallahzadeh R, Ganio E, Tsai AS, Gaudilliere D, Tsai ES, Han X, Ando K, Tingle M, Marić I, Wise PH, Winn VD, Druzin ML, Gibbs RS, Darmstadt GL, Murray JC, Shaw GM, Stevenson DK, Snyder MP, Quake SR, Angst MS, Gaudilliere B, Aghaeepour N. Multiomics Characterization of Preterm Birth in Low- and Middle-Income Countries. JAMA Netw Open 2020; 3:e2029655. [PMID: 33337494 PMCID: PMC7749442 DOI: 10.1001/jamanetworkopen.2020.29655] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Worldwide, preterm birth (PTB) is the single largest cause of deaths in the perinatal and neonatal period and is associated with increased morbidity in young children. The cause of PTB is multifactorial, and the development of generalizable biological models may enable early detection and guide therapeutic studies. OBJECTIVE To investigate the ability of transcriptomics and proteomics profiling of plasma and metabolomics analysis of urine to identify early biological measurements associated with PTB. DESIGN, SETTING, AND PARTICIPANTS This diagnostic/prognostic study analyzed plasma and urine samples collected from May 2014 to June 2017 from pregnant women in 5 biorepository cohorts in low- and middle-income countries (LMICs; ie, Matlab, Bangladesh; Lusaka, Zambia; Sylhet, Bangladesh; Karachi, Pakistan; and Pemba, Tanzania). These cohorts were established to study maternal and fetal outcomes and were supported by the Alliance for Maternal and Newborn Health Improvement and the Global Alliance to Prevent Prematurity and Stillbirth biorepositories. Data were analyzed from December 2018 to July 2019. EXPOSURES Blood and urine specimens that were collected early during pregnancy (median sampling time of 13.6 weeks of gestation, according to ultrasonography) were processed, stored, and shipped to the laboratories under uniform protocols. Plasma samples were assayed for targeted measurement of proteins and untargeted cell-free ribonucleic acid profiling; urine samples were assayed for metabolites. MAIN OUTCOMES AND MEASURES The PTB phenotype was defined as the delivery of a live infant before completing 37 weeks of gestation. RESULTS Of the 81 pregnant women included in this study, 39 had PTBs (48.1%) and 42 had term pregnancies (51.9%) (mean [SD] age of 24.8 [5.3] years). Univariate analysis demonstrated functional biological differences across the 5 cohorts. A cohort-adjusted machine learning algorithm was applied to each biological data set, and then a higher-level machine learning modeling combined the results into a final integrative model. The integrated model was more accurate, with an area under the receiver operating characteristic curve (AUROC) of 0.83 (95% CI, 0.72-0.91) compared with the models derived for each independent biological modality (transcriptomics AUROC, 0.73 [95% CI, 0.61-0.83]; metabolomics AUROC, 0.59 [95% CI, 0.47-0.72]; and proteomics AUROC, 0.75 [95% CI, 0.64-0.85]). Primary features associated with PTB included an inflammatory module as well as a metabolomic module measured in urine associated with the glutamine and glutamate metabolism and valine, leucine, and isoleucine biosynthesis pathways. CONCLUSIONS AND RELEVANCE This study found that, in LMICs and high PTB settings, major biological adaptations during term pregnancy follow a generalizable model and the predictive accuracy for PTB was augmented by combining various omics data sets, suggesting that PTB is a condition that manifests within multiple biological systems. These data sets, with machine learning partnerships, may be a key step in developing valuable predictive tests and intervention candidates for preventing PTB.
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Affiliation(s)
- Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sunil Sazawal
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Abdullah H. Baqui
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Muhammad Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Usha Dhingra
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Rasheda Khanam
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Muhammad Ilyas
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Arup Dutta
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Dipak K. Mitra
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Usma Mehmood
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Saikat Deb
- Centre for Public Health Kinetics, New Delhi, Delhi, India
- Public Health Laboratory-Ivo de Carneri, Pemba Island, Zanzibar
| | - Arif Mahmud
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Sayedur Rahman
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ambreen Nizar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Mamun Ibne Moin
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sajid Muhammad
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Nazma Begum
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Waqasuddin Khan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sayan Das
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Salahuddin Ahmed
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tarik Hasan
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Javairia Khalid
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Syed Jafar Raza Rizvi
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Nabidul Haque Chowdhury
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Furqan Kabir
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fahad Aftab
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Abdul Quaiyum
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alexander Manu
- Maternal, Newborn, Child and Adolescent Health Research, World Health Organization, Geneva, Switzerland
| | - Sachiyo Yoshida
- Maternal, Newborn, Child and Adolescent Health Research, World Health Organization, Geneva, Switzerland
| | - Rajiv Bahl
- Maternal, Newborn, Child and Adolescent Health Research, World Health Organization, Geneva, Switzerland
| | - Anisur Rahman
- Matlab Health Research Centre, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jesmin Pervin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jennifer Winston
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Patrick Musonda
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Jeffrey S. A. Stringer
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill
| | - James A. Litch
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington
| | - Mohammad Sajjad Ghaemi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Digital Technologies Research Centre, National Research Council Canada, Toronto, Ontario, Canada
| | - Mira N. Moufarrej
- Department of Bioengineering, Stanford University, Stanford, California
| | - Kévin Contrepois
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Songjie Chen
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Ina A. Stelzer
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Natalie Stanley
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Alan L. Chang
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ghaith Bany Hammad
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ronald J. Wong
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Candace Liu
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | | | - Anthony Culos
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Camilo Espinosa
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Maria Xenochristou
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Martin Becker
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ramin Fallahzadeh
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Edward Ganio
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Amy S. Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Dyani Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Eileen S. Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Xiaoyuan Han
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Kazuo Ando
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Martha Tingle
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ivana Marić
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Paul H. Wise
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Virginia D. Winn
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Maurice L. Druzin
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Ronald S. Gibbs
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Gary L. Darmstadt
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | | | - Gary M. Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - David K. Stevenson
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Michael P. Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Stephen R. Quake
- Department of Bioengineering, Stanford University, Stanford, California
| | - Martin S. Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- Department of Biomedical Informatics, Stanford University School of Medicine, Stanford, California
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Abdalla S, Pair E, Mehta1, KM, Ward VC, Darmstadt GL. Geospatial variations in trends of reproductive, maternal, newborn and child health and nutrition indicators at block level in Bihar, India, during scale-up of Ananya program interventions. J Glob Health 2020. [DOI: 10.7189/jogh.10.0201004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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