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Izulla P, Muriuki A, Kiragu M, Yahner M, Fonner V, Nitu SNA, Osir B, Bello F, de Graft-Johnson J. Proximate and distant determinants of maternal and neonatal mortality in the postnatal period: A scoping review of data from low- and middle-income countries. PLoS One 2023; 18:e0293479. [PMID: 37983214 PMCID: PMC10659187 DOI: 10.1371/journal.pone.0293479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/13/2023] [Indexed: 11/22/2023] Open
Abstract
Global maternal and neonatal mortality rates remain unacceptably high. The postnatal period, encompassing the first hour of life until 42 days, is critical for mother-baby dyads, yet postnatal care (PNC) coverage is low. Identifying mother-baby dyads at increased risk for adverse outcomes is critical. Yet few efforts have synthesized research on proximate and distant factors associated with maternal and neonatal mortality during the postnatal period. This scoping review identified proximate and distant factors associated with maternal and neonatal mortality during the postnatal period within low- and middle-income countries (LMICs). A rigorous, systematic search of four electronic databases was undertaken to identify studies published within the last 11 years containing data on risk factors among nationally representative samples. Results were synthesized narratively. Seventy-nine studies were included. Five papers examined maternal mortality, one focused on maternal and neonatal mortality, and the rest focused on neonatal mortality. Regarding proximate factors, maternal age, parity, birth interval, birth order/rank, neonate sex, birth weight, multiple-gestation, previous history of child death, and lack of or inadequate antenatal care visits were associated with increased neonatal mortality risk. Distant factors for neonatal mortality included low levels of parental education, parental employment, rural residence, low household income, solid fuel use, and lack of clean water. This review identified risk factors that could be applied to identify mother-baby dyads with increased mortality risk for targeted PNC. Given risks inherent in pregnancy and childbirth, adverse outcomes can occur among dyads without obvious risk factors; providing timely PNC to all is critical. Efforts to reduce the prevalence of risk factors could improve maternal and newborn outcomes. Few studies exploring maternal mortality risk factors were available; investments in population-based studies to identify factors associated with maternal mortality are needed. Harmonizing categorization of factors (e.g., age, education) is a gap for future research.
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Affiliation(s)
| | - Angela Muriuki
- Save the Children, Kenya Regional Office, Nairobi, Kenya
| | | | - Melanie Yahner
- Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Virginia Fonner
- Adroitz Consultants Limited, Nairobi, Kenya
- Department of Health and Nutrition, Save the Children, Dhaka, Bangladesh
| | - Syeda Nabin Ara Nitu
- Department of Global Health, Save the Children Federation Inc, Washington DC, United States of America
| | | | - Farahat Bello
- Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Joseph de Graft-Johnson
- Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, South Carolina, United States of America
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Memon Z, Fridman D, Soofi S, Ahmed W, Muhammad S, Rizvi A, Ahmed I, Wright J, Cousens S, Bhutta ZA. Predictors and disparities in neonatal and under 5 mortality in rural Pakistan: cross sectional analysis. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 15:100231. [PMID: 37614356 PMCID: PMC10442969 DOI: 10.1016/j.lansea.2023.100231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/14/2023] [Accepted: 05/24/2023] [Indexed: 08/25/2023]
Abstract
Background Adopted in 2015, the sustainable development goals (SDGs) have set specific targets (SDG 3.2) for countries to reduce their neonatal mortality rate (NMR) to below 12 deaths per 1000 live births and under 5 mortality rate (U5MR) to below 25 deaths per 1000 live births by 2030. For Pakistan to achieve these targets, there is a need to measure these rates and understand the predictors of child mortality at sub-national level. Launched in 2016, the Umeed-e-Nau (UeN) or New Hope project is based on scaling up proven and effective Maternal and Newborn Child Health (MNCH) interventions in 8 of the highest burden districts of the country, using existing public sector platforms in Pakistan at both the community and facility level. The primary aim of the project is to reduce perinatal mortality in these districts by 20% from baseline. Methods We report overall neonatal and post neonatal mortality rates for the two years preceding the UeN baseline household survey. Rates were calculated using the synthetic cohort probability method and predictors of neonatal and post neonatal mortality examined using Cox regression. To investigate spatial variations in the mortality rates, we calculated Moran's I at the district level using predicted probabilities of mortality. Finally, we create district level maps of predicted under 5 child mortality using a stochastic partial differentiation approach. Findings A total of 26,258 children contributed to the analysis of mortality with 838 deaths in the neonatal period and 2236 under-5 deaths during the observation period from March 1, 2015 to March 17, 2017. Overall, we estimated the NMR to be 29.2 per 1000 live births (95% CI: 26.9-31.4) and the U5MR to be 86.1 per 1000 live births (95% CI: 85.5-86.8). We found evidence of within-district geospatial clustering of under 5 mortality (P < 0.0001) and that social factors (poverty, illiteracy, multiparity), poor coverage of community health workers and distance from health facilities were strongly associated with child mortality. Interpretation Important factors associated with neonatal and post-neonatal mortality in our study population included maternal education, parity, household size and gender. Additionally, antenatal care coverage (at least 4 visits) was specifically associated with neonatal mortality only, whereas, LHW coverage and distance to health facility were strongly associated with post-neonatal mortality. These findings emphasise the need for comprehensive, multisectoral strategies to be implemented for future maternal and child health programs and outreach services in rural areas. Funding The study was funded by an unrestricted grant from the Bill & Melinda Gates Foundation to the Aga Khan University (Grant OPP 1148892).
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Affiliation(s)
- Zahid Memon
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Daniel Fridman
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sajid Soofi
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Wardah Ahmed
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Shah Muhammad
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Arjumand Rizvi
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Imran Ahmed
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - James Wright
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, United Kingdom
| | - Zulfiqar A. Bhutta
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
- London School of Hygiene and Tropical Medicine, United Kingdom
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Iqbal F, Satti MI, Irshad A, Shah MA. Predictive analytics in smart healthcare for child mortality prediction using a machine learning approach. Open Life Sci 2023; 18:20220609. [PMID: 37465102 PMCID: PMC10350886 DOI: 10.1515/biol-2022-0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 07/20/2023] Open
Abstract
In developing countries, child health and restraining under-five child mortality are one of the fundamental concerns. UNICEF adopted sustainable development goal 3 (SDG3) to reduce the under-five child mortality rate globally to 25 deaths per 1,000 live births. The under-five mortality rate is 69 deaths per 1,000 live child-births in Pakistan as reported by the Demographic and Health Survey (2018). Predictive analytics has the power to transform the healthcare industry, personalizing care for every individual. Pakistan Demographic Health Survey (2017-2018), the publicly available dataset, is used in this study and multiple imputation methods are adopted for the treatment of missing values. The information gain, a feature selection method, ranked the information-rich features and examine their impact on child mortality prediction. The synthetic minority over-sampling method (SMOTE) balanced the training dataset, and four supervised machine learning classifiers have been used, namely the decision tree classifier, random forest classifier, naive Bayes classifier, and extreme gradient boosting classifier. For comparative analysis, accuracy, precision, recall, and F1-score have been used. Eventually, a predictive analytics framework is built that predicts whether the child is alive or dead. The number under-five children in a household, preceding birth interval, family members, mother age, age of mother at first birth, antenatal care visits, breastfeeding, child size at birth, and place of delivery were found to be critical risk factors for child mortality. The random forest classifier performed efficiently and predicted under-five child mortality with accuracy (93.8%), precision (0.964), recall (0.971), and F1-score (0.967). The findings could greatly assist child health intervention programs in decision-making.
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Affiliation(s)
- Farrukh Iqbal
- Department of Computer Science, Shaheed Zulfikar Ali Bhutto Institute of Science and Technology (SZABIST), Karachi, Pakistan
| | - Muhammad Islam Satti
- Department of Computer Science, Millennium Institute of Technology & Entrepreneurship (MiTE), Karachi, Pakistan
- Department of Computing and IT (DOCIT), The Millennium Universal College (TMUC), Islamabad 44000, Pakistan
| | - Azeem Irshad
- Faculty of Computer Science, Asghar Mall College Rawalpindi, HED, Govt. of Punjab, Pakistan
| | - Mohd Asif Shah
- Department of Economics, Kabridahar University, Po Box 250, Somali, Ethiopia
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Budhwani H, Enah C, Bond CL, Halle-Ekane G, Wallace E, Turan JM, Szychowski JM, Long DM, Carlo WA, Tih PM, Tita ATN. mHealth Phone Intervention to Reduce Maternal Deaths and Morbidity in Cameroon: Protocol for Translational Adaptation. Int J Womens Health 2022; 14:677-686. [PMID: 35572348 PMCID: PMC9093609 DOI: 10.2147/ijwh.s353919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/14/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose The purpose of this NIH-funded protocol is to adapt (Aim 1) and pilot test (Aim 2) an mHealth intervention to improve maternal and child health in Cameroon. We will adapt the 24/7 University of Alabama at Birmingham Medical Information Service via Telephone (MIST) provider support system to mMIST (mobile MIST) for peripheral providers who provide healthcare to pregnant and postpartum women and newborns in Cameroon. Methods In Aim 1, we apply qualitative and participatory methods (in-depth interviews and focus groups with key stakeholders) to inform the adaptation of mMIST for use in Cameroon. We use the sequential phases of the ADAPT-ITT framework to iteratively adapt mMIST incorporating qualitative findings and tailoring for local contexts. In Aim 2, we test the adapted intervention for feasibility and acceptability in Ndop, Cameroon. Results This study is ongoing at the time that this protocol is published. Conclusion The adaptation, refinement, and pilot testing of mMIST will be used to inform a larger-scale stepped wedged cluster randomized controlled effectiveness trial. If successful, this mHealth intervention could be a powerful tool enabling providers in low-resource settings to deliver improved pregnancy care, thereby reducing maternal and fetal deaths.
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Affiliation(s)
- Henna Budhwani
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA,Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA,Correspondence: Henna Budhwani, Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, 330C Ryals Public Health Building, 1720 University Boulevard, Birmingham, AL, 35294, USA, Tel +1 205 975 7613, Fax +1 205 975 7685, Email
| | - Comfort Enah
- School of Nursing, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Christyenne L Bond
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gregory Halle-Ekane
- Department of Obstetrics and Gynaecology, University of Buea, Buea, Cameroon
| | - Eric Wallace
- Depatrment of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet M Turan
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA,Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA,School of Medicine, Koç University, Istanbul, Turkey
| | - Jeff M Szychowski
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dustin M Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Waldemar A Carlo
- Depatrment of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pius M Tih
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Alan T N Tita
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA,Depatrment of Obstetrics and Gynecology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Complex Survival System Modeling for Risk Assessment of Infant Mortality Using a Parametric Approach. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7745628. [PMID: 35495893 PMCID: PMC9042624 DOI: 10.1155/2022/7745628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/06/2022] [Accepted: 03/31/2022] [Indexed: 11/17/2022]
Abstract
Pakistan is still one of the five countries contributing to half of the child deaths worldwide and holds a low ratio of infant survival. A high rate of poverty, low level of education, limited health facilities, rural-urban inequalities, and political uncertainty are the main reasons for this condition. Survival models that evaluate the performance of models over simulated and real data set may serve as an effective technique to determine accurate complex systems. The present study proposed an efficient extension of the recent parametric technique for risk assessment of infant mortality to address complex survival systems in the presence of extreme observations. This extended method integrated four distributions with the basic algorithm using a real data set of infant survival without extreme observations. The proposed models are compared with the standard partial least squares-Cox regression (PLS-CoxR), and higher efficiency of these proposed algorithms is observed for handling complex survival time systems for risk assessment. The algorithm is also used to analyze simulated data set for further verification of results. The optimal model revealed that the mother's age, type of residence, wealth index, permission to go to a medical facility, distance to a health facility, and awareness about tuberculosis significantly affected the survival time of infants. The flexibility and continuity of extended parametric methods support the implementation of public health surveillance data effectively for data-oriented evaluation. The findings may support projecting targeted interventions, producing awareness, and implementing policies planned to reduce infant mortality.
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Amir-Ud-Din R, Mahmood HZ, Abbas F, Muzammil M, Kumar R, Pongpanich S. Association of breast feeding and birth interval with child mortality in Pakistan: a cross-sectional study using nationally representative Demographic and Health Survey data. BMJ Open 2022; 12:e053196. [PMID: 35017244 PMCID: PMC8753421 DOI: 10.1136/bmjopen-2021-053196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study analysed the association between breast feeding (BF) and birth interval (BI) (both succeeding and preceding) with neonatal mortality (NM), infant mortality (IM) and under-5 mortality (U5M). DESIGN This cross-sectional study used data from the Pakistan Demographic and Health Survey 2017-2018. SETTINGS All provinces, Islamabad and Federally Administered Tribal Areas were included in the analysis. PARTICIPANTS A total of 12 769 children born to ever-married multiparous women aged 30-49 years who gave live birth within 5 years preceding the interview. Multiple births are not included. DATA ANALYSIS Multivariate logistic regression analysis was used. RESULTS We found that BF was associated with nearly 98% lower risk of NM (OR 0.015; 95% CI: 0.01 to 0.03; p<0.001), 96% lower risk of IM (OR 0.038; 95% CI: 0.02 to 0.06; p<0.001) and 94% lower risk of U5M (OR 0.050; 95% CI: 0.03 to 0.08; p<0.001). Compared with optimal preceding birth interval (PBI) (36+ months), short PBI (<18 months) was associated with around six times higher risk of NM (OR 5.661; 95% CI: 2.78 to 11.53; p<0.001), over five times risk of IM (OR 4.704; 95% CI: 2.70 to 8.19; p<0.001) and over five times risk of U5M (OR 4.745; 95% CI: 2.79 to 8.07; p<0.001). Disaggregating the data by child's gender, place of residence and mother's occupational status showed that being ever breast fed was associated with a smaller risk of NM, IM and U5M in all three disaggregations. However, the risk of smaller PBI <18 months was generally more pronounced in female children (NM and U5M) or when the children lived in rural areas (NM, IM and U5M). PBI <18 months was associated with greater risk of NM and IM, and smaller risk of U5M when mothers did a paid job. CONCLUSION This study's significance lies in the fact that it has found BF and BI to be consistent protective factors against NM, IM and U5M. Given Pakistan's economic constraints, optimal BF and BI are the most cost-effective interventions to reduce child mortality.
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Affiliation(s)
- Rafi Amir-Ud-Din
- Department of Economics, COMSATS University Islamabad, Lahore Campus, Lahore, Pakistan
| | - Hafiz Zahid Mahmood
- Department of Economics, COMSATS University Islamabad, Lahore Campus, Lahore, Pakistan
| | - Faisal Abbas
- Department of Economics, School of Social Sciences and Humanities (S3H), National University of Sciences and Technology, Islamabad, Pakistan
| | - Muhammad Muzammil
- Department of Economics, COMSATS University Islamabad, Lahore Campus, Lahore, Pakistan
| | - Ramesh Kumar
- Department of Public Health, Health Services Academy, Islamabad, Pakistan
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Trends for Neonatal Deaths in Nepal (2001-2016) to Project Progress Towards the SDG Target in 2030, and Risk Factor Analyses to Focus Action. Matern Child Health J 2020; 24:5-14. [PMID: 31773465 PMCID: PMC7048722 DOI: 10.1007/s10995-019-02826-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction
Nepal has made considerable progress on improving child survival during the Millennium Development Goal period, however, further progress will require accelerated reduction in neonatal mortality. Neonatal survival is one of the priorities for Sustainable Development Goals 2030. This paper examines the trends, equity gaps and factors associated with neonatal mortality between 2001 and 2016 to assess the likelihood of Every Newborn Action Plan (ENAP) target being reached in Nepal by 2030. Methods This study used data from the 2001, 2006, 2011 and 2016 Nepal Demographic and Health Surveys. We examined neonatal mortality rate (NMR) across the socioeconomic strata and the annual rate of reduction (ARR) between 2001 and 2016. We assessed association of socio-demographic, maternal, obstetric and neonatal factors associated with neonatal mortality. Based on the ARR among the wealth quintile between 2001 and 2016, we made projection of NMR to achieve the ENAP target. Using the Lorenz curve, we calculated the inequity distribution among the wealth quintiles between 2001 and 2016. Results
In NDHS of 2001, 2006, 2011 and 2016, a total of 8400, 8600, 13,485 and 13,089 women were interviewed respectively. There were significant disparities between wealth quintiles that widened over the 15 years. The ARR for NMR declined with an average of 4.0% between 2001 and 2016. Multivariate analysis of the 2016 data showed that women who had not been vaccinated against tetanus had the highest risk of neonatal mortality (adjusted odds ratio [AOR] 3.38; 95% confidence interval [CI] 1.20–9.55), followed by women who had no education (AOR 1.87; 95% CI 1.62–2.16). Further factors significantly associated with neonatal mortality were the mother giving birth before the age of 20 (AOR 1.76; CI 95% 1.17–2.59), household air pollution (AOR 1.37; CI 95% 1.59–1.62), belonging to a poorest quintile (AOR 1.37; CI 95% 1.21–1.54), residing in a rural area (AOR 1.28; CI 95% 1.13–1.44), and having no toilet at home (AOR 1.21; CI 95% 1.06–1.40). If the trend of neonatal mortality rate of 2016 continues, it is projected that the poorest family will reach the ENAP target in 2067. Conclusions Although neonatal mortality is declining in Nepal, if the current trend continues it will take another 50 years for families in the poorest group to attain the 2030 ENAP target. There are different factors associated with neonatal mortality, reducing the disparities for maternal and neonatal care will reduce mortality among the poorest families. Electronic supplementary material The online version of this article (10.1007/s10995-019-02826-0) contains supplementary material, which is available to authorized users.
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Wanga I, Helova A, Abuogi LL, Bukusi EA, Nalwa W, Akama E, Odeny TA, Turan JM, Onono M. Acceptability of community-based mentor mothers to support HIV-positive pregnant women on antiretroviral treatment in western Kenya: a qualitative study. BMC Pregnancy Childbirth 2019; 19:288. [PMID: 31409297 PMCID: PMC6693232 DOI: 10.1186/s12884-019-2419-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 07/19/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Option B+ is a comprehensive antiretroviral treatment (ART) designed for HIV-infected pregnant/ postpartum women. However, barriers to implementing Option B+ and establishing long-term ART adherence while facilitating retention in prevention of mother to child transmission of HIV (PMTCT) services remain. Community-based mentor mothers (cMMs) who can provide home-based support for PMTCT services may address some of the barriers to successful adoption and retention in Option B+. Thus, we evaluated the acceptability of using cMMs as home-based support for PMTCT services. METHODS Gender-matched in-depth interviews were conducted between September-November 2014 for HIV-infected pregnant/postpartum women and their male partners living in southwestern Kenya (n = 40); additionally, we conducted four focus groups involving 30 health workers (n = 70) within four health facilities. Audio-recordings were transcribed, translated, and then coded using a thematic analytical approach in which data were deductively and inductively coded with support from prior literature, identified themes within the interview guides, and emerging themes from the transcripts utilizing Dedoose software. RESULTS Overall, the study results suggest high acceptability of cMMs among individual participants and health workers. Stigma reduction, improvement of utilization of health care services, as well as ART adherence were most frequently discussed potential benefits of cMMs. Participants pictured a cMM as someone acting as a role model and confidant, and who was over 30 years old. Many respondents raised concerns about breaches of confidentiality and inadvertent disclosure. Respondent suggestions to overcome these issues included the cMM working in different communities than where she lives and attending home-visits with no identifying clothing as an HIV-related health worker. CONCLUSIONS The home-based cMM approach may be a beneficial and acceptable strategy for promoting ART adherence and retention within PMTCT services for pregnant/postpartum women living with HIV. Considering the risks of inadvertent disclosure of HIV-infected status and related negative consequences for pregnant/postpartum women living with HIV, similar cMM program designs may benefit from recognizing and addressing these risks. TRIAL REGISTRATION The MOTIVATE! study was registered on July 7, 2015 at the ClinicalTrials.gov ( NCT02491177 ).
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Affiliation(s)
- Iris Wanga
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 19464 - 00202, Nairobi, Kenya
| | - Anna Helova
- Department of Health Care Policy and Organization, School of Public Health, University of Alabama at Birmingham, 517 RPHB 1665 University Blvd, Birmingham, AL 35294 USA
| | - Lisa L. Abuogi
- Department of Pediatrics, University of Colorado Denver, 13199 East Montview Blvd, Suite 310 Mail Stop A090, Aurora, CO 80045 USA
| | - Elizabeth A. Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 19464 - 00202, Nairobi, Kenya
| | - Wafula Nalwa
- Maseno University School of Medicine, Box 3365-40100, Kisumu, Kenya
| | - Eliud Akama
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 19464 - 00202, Nairobi, Kenya
| | - Thomas A. Odeny
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 19464 - 00202, Nairobi, Kenya
| | - Janet M. Turan
- Department of Health Care Policy and Organization, School of Public Health, University of Alabama at Birmingham, 517 RPHB 1665 University Blvd, Birmingham, AL 35294 USA
| | - Maricianah Onono
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 19464 - 00202, Nairobi, Kenya
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Budhwani H, Hearld KR, Dionne-Odom J, Manga S, Nulah K, Khan M, Welty T, Welty E, Tita AT. HIV Status and Contraceptive Utilization among Women in Cameroon. J Int Assoc Provid AIDS Care 2019; 18:2325958219826596. [PMID: 30776955 PMCID: PMC6748529 DOI: 10.1177/2325958219826596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 11/15/2018] [Accepted: 12/14/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We examined patterns of contraceptive utilization by HIV status among women in Cameroon, hypothesizing that women living with HIV would utilize contraception at higher rates than their HIV-negative peers. METHODS Deidentified, clinical data from the Cameroon Baptist Convention Health Services (2007-2013) were analyzed (N = 8995). Frequencies compared outcomes between women living with HIV (15.1%) and uninfected women. Multivariate analyses examined associates of contraceptive utilization and desire to become pregnant. RESULTS Contraceptive utilization was associated with higher education, living with HIV, monogamy, and higher parity ( P < .001). Women living with HIV had 66% higher odds of using contraceptives than their negative peers (odds ratio [OR]: 1.66, confidence interval [CI]: 1.45-1.91, P < .001). Polygamous women had 37% lower odds of using contraceptives compared to monogamous women (OR: 0.63, 95% CI: 0.52-0.75, P < .001). CONCLUSION Increasing contraceptive utilization in resource-constrained settings should be a priority for clinicians and researchers. Doing so could improve population health by reducing HIV transmission between partners and from mother to child.
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Affiliation(s)
- Henna Budhwani
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristine Ria Hearld
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jodie Dionne-Odom
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Simon Manga
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Kathleen Nulah
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Michelle Khan
- Kaiser Permanente Northern California, San Leandro, CA, USA
| | - Thomas Welty
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Edith Welty
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Alan Thevenet Tita
- Center for women’s Reproductive Health and Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
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Examining the Relationship Between Individual Characteristics, Community-Level Traits, Multidimensional Empowerment, and Maternal Health Care Utilization in the Islamic Republic of Pakistan. Matern Child Health J 2018; 22:1319-1326. [DOI: 10.1007/s10995-018-2512-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Duby J, Sharma R, Bhutta ZA. Opportunities and Challenges in Global Perinatal Research. Neonatology 2018; 114:93-102. [PMID: 29768264 DOI: 10.1159/000488310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/11/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The global plight of stillbirths and neonatal mortality is concentrated in low- and middle-income countries. The ambitious targets introduced by the World Health Organization in the Every Newborn Action Plan demand a commitment to research that promotes equitable perinatal outcomes. OBJECTIVES The aim of this review was to understand the opportunities for global perinatal research and the accompanying challenges. METHODS We conducted a literature search to identify research prioritization exercises from 2014 to 2018 pertaining to global perinatal health. The top 50 questions with the highest research prioritization scores were extracted and analyzed. RESULTS The greatest priorities centered on community-based, implementation research targeting major causes of stillbirth and neonatal mortality in low-resource settings. The priorities are saddled with prerequisite conditions, design obstacles, and ethical considerations that require attention. CONCLUSIONS While the challenges are undeniable, the need to make the perinatal period healthier for babies worldwide has never been clearer.
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Affiliation(s)
- Jessica Duby
- Division of Neonatology, University of Toronto, Toronto, Ontario, Canada
| | - Renee Sharma
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
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