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Ranjbar M, Mousavi SM, Madadizadeh F, Dargani NH, Iraji S, Angell B, Assefa Y. Effect of the COVID-19 pandemic on utilization of essential health services in Iran evidence from an interrupted time series analysis. BMC Public Health 2024; 24:1006. [PMID: 38605406 PMCID: PMC11008029 DOI: 10.1186/s12889-024-18537-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The COVID-19 disrupted the provision of essential health services in numerous countries, potentially leading to outbreaks of deadly diseases. This study aims to investigate the effect of the COVID-19 pandemic on the utilization of essential health services in Iran. METHODS An analytical cross-sectional study was conducted using interrupted time series (ITS) analysis. Data about five indicators, including 'childhood vaccination, infant care, hypertension screening, diabetes screening, and breast cancer screening,' were obtained from the electronic health record System in two-time intervals: 15 months before (November 2018 to January 2020) and 15 months after (January 2020 to May 2021) the onset of the COVID-19 pandemic. The data were analyzed by utilizing ITS. In addition, a Poisson model was employed due to the usage of count data. The Durbin-Watson (DW) test was used to identify the presence of lag-1 autocorrelation in the time series data. All statistical analysis was performed using R 4.3.1 software, considering a 5% significance level. RESULTS The ITS analysis showed that the COVID-19 pandemic significantly affected the utilization of all essential health services (P < 0.0001). The utilization of hypertension screening (RR = 0.51, p < 0.001), diabetes screening (RR = 0.884, p < 0.001), breast cancer screening (RR = 0.435, p < 0.001), childhood vaccination (IRR = 0.947, p < 0.001), and infant care (RR = 1.666, p < 0.001), exhibited a significant decrease in the short term following the pandemic (P < 0.0001). However, the long-term trend for all service utilization, except breast cancer screening (IRR = 0.952, p < 0.001), demonstrated a significant increase. CONCLUSIONS The COVID-19 pandemic affected utilization of essential health care in Iran. It is imperative to utilize this evidence to develop policies that will be translated into targeted planning and implementation to sustain provision and utilization of essential health services during public health emergencies. It is also vital to raise awareness and public knowledge regarding the consequences of interruptions in essential health services. In addition, it is important to identify the supply- and demand-side factors contributing to these disruptions.
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Affiliation(s)
- Mohammad Ranjbar
- Department of Health Management and Economics, Health Policy & Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Masood Mousavi
- Department of Health Management and Economics, Health Policy & Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farzan Madadizadeh
- Department of Biostatistics and Epidemiology, Center for Healthcare Data Modeling, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nahid Hosseini Dargani
- Department of Health Management and Economics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Samaneh Iraji
- Yazd Health District, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Blake Angell
- Centre for Health Systems Science, the George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Yibeltal Assefa
- School of Public Health, the University of Queensland, Brisbane, Australia
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Afande Mukhola B, Kivuti-Bitok LW, Chepchirchir A. Challenges Faced by Mothers Practicing Kangaroo Mother Care (KMC) in a Resource-Limited Setting During the COVID-19 Pandemic: Insights From the Voices of Mothers of Preterm Babies and Their Suggested Solutions. Glob Pediatr Health 2023; 10:2333794X231213472. [PMID: 38024463 PMCID: PMC10666549 DOI: 10.1177/2333794x231213472] [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: 04/26/2023] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives. We investigated the challenges faced by mothers of preterm babies practicing KMC during the Covid-19 pandemic and documented the mothers' suggestions of possible interventions. Methods. We conducted a cross-sectional descriptive study at the New Born Unit of Kenyatta National Hospital(KNH). We interviewed 82 mothers using a researcher-administered questionnaire with closed and open-ended questions. Qualitative data generated from open-ended questions was analyzed thematically. Results. KMC was majorly affected by; fear of the baby contracting COVID-19, fear of contracting COVID-19, and social distancing restrictions. The mothers' suggested interventions included; the need for more KMC rooms, provision of appropriate clothing, strict application of COVID-19 prevention guidelines, and greater support of practice by the family. Conclusion. The mother's pivotal role as a partner in decision-making in regard to the improvement of KMC during pandemics and possibly other settings was demonstrated. Targeted interventions should incorporate the suggestions from the mothers.
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Steege R, Mwaniki H, Ogueji IA, Baraka J, Salimu S, Kumar MB, Kawaza K, Odedere O, Shamba D, Bokea H, Chiume M, Adudans S, Ezeaka C, Paul C, Banyira L, Lungu G, Salim N, Zimba E, Ngwala S, Tarus A, Bohne C, Gathara D, Lawn JE. Protecting small and sick newborn care in the COVID-19 pandemic: multi-stakeholder qualitative data from four African countries with NEST360. BMC Pediatr 2023; 23:572. [PMID: 37974092 PMCID: PMC10655439 DOI: 10.1186/s12887-023-04358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Health system shocks are increasing. The COVID-19 pandemic resulted in global disruptions to health systems, including maternal and newborn healthcare seeking and provision. Yet evidence on mitigation strategies to protect newborn service delivery is limited. We sought to understand what mitigation strategies were employed to protect small and sick newborn care (SSNC) across 65 facilities Kenya, Malawi, Nigeria and Tanzania, implementing with the NEST360 Alliance, and if any could be maintained post-pandemic. METHODS We used qualitative methods (in-depth interviews n=132, focus group discussions n=15) with purposively sampled neonatal health systems actors in Kenya, Malawi, Nigeria and Tanzania. Data were collected from September 2021 - August 2022. Topic guides were co-developed with key stakeholders and used to gain a detailed understanding of approaches to protect SSNC during the COVID-19 pandemic. Questions explored policy development, collaboration and investments, organisation of care, human resources, and technology and device innovations. Interviews were conducted by experienced qualitative researchers and data were collected until saturation was reached. Interviews were digitally recorded and transcribed verbatim. A common coding framework was developed, and data were coded via NVivo and analysed using a thematic framework approach. FINDINGS We identified two pathways via which SSNC was strengthened. The first pathway, COVID-19 specific responses with secondary benefit to SSNC included: rapid policy development and adaptation, new and collaborative funding partnerships, improved oxygen systems, strengthened infection prevention and control practices. The second pathway, health system mitigation strategies during the pandemic, included: enhanced information systems, human resource adaptations, service delivery innovations, e.g., telemedicine, community engagement and more emphasis on planned preventive maintenance of devices. Chronic system weaknesses were also identified that limited the sustainability and institutionalisation of actions to protect SSNC. CONCLUSION Innovations to protect SSNC in response to the COVID-19 pandemic should be maintained to support resilience and high-quality routine SSNC delivery. In particular, allocation of resources to sustain high quality and resilient care practices and address remaining gaps for SSNC is critical.
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Affiliation(s)
- Rosie Steege
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
- Liverpool School of Tropical Medicine, Liverpool, UK.
| | | | | | - Jitihada Baraka
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Sangwani Salimu
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Meghan Bruce Kumar
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Kenya Medical Research Institute, Wellcome Trust Research Program, Nairobi, Kenya
| | - Kondwani Kawaza
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Opeyemi Odedere
- Rice360 Institute for Global Health Technologies, Houston, Texas, USA
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Helen Bokea
- Rice360 Institute for Global Health Technologies, Houston, Texas, USA
| | - Msandeni Chiume
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Kamuzu Central Hospital, Lilongwe, Malawi
| | - Steve Adudans
- Academy for Novel Channels in Health and Operations Research (ACANOVA Africa), Nairobi, Kenya
| | - Chinyere Ezeaka
- College of Medicine, University of Lagos, Lagos State, Nigeria
| | - Catherine Paul
- Rice360 Institute for Global Health Technologies, Houston, Texas, USA
| | | | - Gaily Lungu
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Evelyn Zimba
- Rice360 Institute for Global Health Technologies, Houston, Texas, USA
| | - Samuel Ngwala
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Alice Tarus
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Christine Bohne
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
- Rice360 Institute for Global Health Technologies, Houston, Texas, USA
| | - David Gathara
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
- Kenya Medical Research Institute, Wellcome Trust Research Program, Nairobi, Kenya.
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
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Giordano V, Fuiko R, Witting A, Unterasinger L, Steinbauer P, Bajer J, Farr A, Hoehl S, Deindl P, Olischar M, Berger A, Klebermass-Schrehof K. The impact of pandemic restrictive visiting policies on infant wellbeing in a NICU. Pediatr Res 2023; 94:1098-1103. [PMID: 36959317 PMCID: PMC10034238 DOI: 10.1038/s41390-023-02562-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Given the countrywide lockdown in the first pandemic period and the respective Hospital restrictive policies, we aimed to investigate if the SARS-COV-2 pandemic was associated to a reduced parental presence in the NICU and in which form this had an impact on infant wellbeing. METHODS Retrospective cohort study about altered NICUs parental presence (measured by number of visits and kangaroo care time) due to pandemic restrictive policies and its impact on infant wellbeing (measured through The Neonatal Pain Agitation and Sedation scale and nurses' descriptive documentation). RESULTS Presence of both parents at the same time was significantly lower during pandemic. Contrary, maternal presence only and total kangaroo-care time were higher within the pandemic (163.36 ± 94.07 vs 122.71 ± 64.03; p = 0.000). Lower NPASS values were documented during the lookdown (1.28 ± 1.7 vs 1.78 ± 2.2; p = 0.000). CONCLUSION Data collected through the pandemic confirm the importance of parental presence for infants' wellbeing in a NICU setting. IMPACT Parental support is an extremely important aspect for infants hospitalized in an intensive care unit. Their presence was limited in many NICUs worldwide during the SARS-COV-2 pandemic. This study confirm the importance of parental presence for infants' wellbeing also in a pandemic situation. Our results support a family-centered newborn individualized developmental care approach in the NICU.
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Affiliation(s)
- Vito Giordano
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria.
| | - Renate Fuiko
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Andrea Witting
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Lukas Unterasinger
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Philipp Steinbauer
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Johanna Bajer
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Alex Farr
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Stefanie Hoehl
- Department of Developmental and Educational Psychology, University of Vienna, Vienna, Austria
| | - Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Olischar
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
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5
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Chanda BM, Chen XQ. Breastfeeding during the COVID-19 pandemic. Front Pediatr 2023; 11:1120763. [PMID: 37342530 PMCID: PMC10277472 DOI: 10.3389/fped.2023.1120763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused many significant changes to all aspects of day to day life. The disease has spread and reached pandemic proportions. The principle route of transmission is the respiratory route. Infants, pregnant women and breastfeeding mothers have all been affected. Many interventions and guidelines from important societies have been instituted in order to curb the transmission of the disease. These have involved both pharmacological and non-pharmacological methods. COVID-19 vaccines have also emerged as important methods of primary prevention of the disease. But several questions have been raised concerning the safety and efficacy of their use in pregnant and breastfeeding mothers. It has also not been clear if the vaccines are effective in generating a robust immune response in the pregnant women and breastfeeding mothers to confer passive immunity to the fetuses and infants, respectively. And they have not been tested in infants. The aspect of infant feeding has equally been affected. Although breast milk has not been known to serve as the vehicle of transmission of the virus, there is still some lack of uniformity of practice regarding breastfeeding when a mother has SARS-CoV-2 infection. This has led to infant feeding being done by the use of commercial formula feeds, pasteurized human donor breast milk, feeding on the mother's own expressed breast milk by a care giver and directly breastfeeding with skin to skin contact. This is despite breast milk being the most physiologically appropriate type of feed for infants. Therefore the pertinent question remains; should breastfeeding continue during the pandemic continue? This review also seeks to analyse the vast amount of scientific information regarding the subject and to synthesize science-based information.
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Affiliation(s)
- Bwalya Mpelwa Chanda
- Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Qing Chen
- Department of Pediatrics, First Affiliation Hospital of Nanjing Medical University, Nanjing, China
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6
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Pillai A, Nayak A, Tiwari D, Pillai PK, Pandita A, Sakharkar S, Balasubramanian H, Kabra N. COVID-19 Disease in Under-5 Children: Current Status and Strategies for Prevention including Vaccination. Vaccines (Basel) 2023; 11:693. [PMID: 36992278 PMCID: PMC10058749 DOI: 10.3390/vaccines11030693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
Since the coronavirus disease (COVID-19) pandemic hit the globe in early 2020, we have steadily gained insight into its pathogenesis; thereby improving surveillance and preventive measures. In contrast to other respiratory viruses, neonates and young children infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have a milder clinical presentation, with only a small proportion needing hospitalization and intensive care support. With the emergence of novel variants and improved testing services, there has been a higher incidence of COVID-19 disease reported among children and neonates. Despite this, the proportion of young children with severe disease has not increased. Key mechanisms that protect young children from severe COVID-19 disease include the placental barrier, differential expression of angiotensin-converting enzyme 2 (ACE-2) receptors, immature immune response, and passive transfer of antibodies via placenta and human milk. Implementing mass vaccination programs has been a major milestone in reducing the global disease burden. However, considering the lower risk of severe COVID-19 illness in young children and the limited evidence about long-term vaccine safety, the risk-benefit balance in children under five years of age is more complex. In this review, we do not support or undermine vaccination of young children but outline current evidence and guidelines, and highlight controversies, knowledge gaps, and ethical issues related to COVID-19 vaccination in young children. Regulatory bodies should consider the individual and community benefits of vaccinating younger children in their local epidemiological setting while planning regional immunization policies.
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Affiliation(s)
- Anish Pillai
- Surya Hospitals, Mangal Ashirwad Building, Swami Vivekananda Road, Santacruz West, Mumbai 400054, Maharashtra, India
- British Columbia Children’s Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada
| | - Anuja Nayak
- Bai Jerabai Wadia Hospital for Children, Acharya Donde Marg, Parel East, Parel, Mumbai 400012, Maharashtra, India
| | - Deepika Tiwari
- Surya Hospitals, Mangal Ashirwad Building, Swami Vivekananda Road, Santacruz West, Mumbai 400054, Maharashtra, India
| | - Pratichi Kadam Pillai
- Surya Hospitals, Mangal Ashirwad Building, Swami Vivekananda Road, Santacruz West, Mumbai 400054, Maharashtra, India
| | - Aakash Pandita
- Medanta Super Specialty Hospital, Sector-A, Pocket-1, Amar Shaheed Path, Golf City, Lucknow 226030, Uttar Pradesh, India
| | - Sachin Sakharkar
- Surya Hospitals, Mangal Ashirwad Building, Swami Vivekananda Road, Santacruz West, Mumbai 400054, Maharashtra, India
| | | | - Nandkishor Kabra
- Surya Hospitals, Mangal Ashirwad Building, Swami Vivekananda Road, Santacruz West, Mumbai 400054, Maharashtra, India
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7
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Li Y, Hu Y, Chen Q, Li X, Tang J, Xu T, Feng Z, Mu D. Clinical practice guideline for kangaroo mother care in preterm and low birth weight infants. J Evid Based Med 2022; 15:408-424. [PMID: 36529837 DOI: 10.1111/jebm.12509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
Kangaroo mother care has reduced mortality and morbidity in preterm and low birth weight infants and has many benefits, such as promoting breastfeeding. Based on the current evidence in China and international, we developed a clinical practice guideline for kangaroo mother care in preterm and low birth weight infants using the Grading of Recommendations, Assessment, Development and Evaluation and proposed 34 recommendations for 20 key questions. Our goal is to promote the appropriate implementation of kangaroo mother care in clinical practice.
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Affiliation(s)
- Yingxin Li
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
- West China School of Nursing, Sichuan University, Chengdu, P.R. China
| | - Yanlin Hu
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
- West China School of Nursing, Sichuan University, Chengdu, P.R. China
| | - Qiong Chen
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
- West China School of Nursing, Sichuan University, Chengdu, P.R. China
| | - Xiaowen Li
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
- West China School of Nursing, Sichuan University, Chengdu, P.R. China
| | - Jun Tang
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
| | - Tao Xu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Zhichun Feng
- Department of Neonatology, Faculty of Pediatrics, Chinese PLA General Hospital, Beijing, P.R. China
| | - Dezhi Mu
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
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8
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Hendrix CL, Werchan D, Lenniger C, Ablow JC, Amstadter AB, Austin A, Babineau V, Bogat GA, Cioffredi LA, Conradt E, Crowell SE, Dumitriu D, Elliott AJ, Fifer W, Firestein M, Gao W, Gotlib I, Graham A, Gregory KD, Gustafsson H, Havens KL, Hockett C, Howell BR, Humphreys KL, Jallo N, King LS, Kinser PA, Levendosky AA, Lonstein JS, Lucchini M, Marcus R, Monk C, Moyer S, Muzik M, Nuttall AK, Potter AS, Rogers C, Salisbury A, Shuffrey LC, Smith BA, Smyser CD, Smith L, Sullivan E, Zhou J, Brito NH, Thomason ME. Geotemporal analysis of perinatal care changes and maternal mental health: an example from the COVID-19 pandemic. Arch Womens Ment Health 2022; 25:943-956. [PMID: 35962855 PMCID: PMC9375091 DOI: 10.1007/s00737-022-01252-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/29/2022] [Indexed: 01/21/2023]
Abstract
Our primary objective was to document COVID-19 induced changes to perinatal care across the USA and examine the implication of these changes for maternal mental health. We performed an observational cross-sectional study with convenience sampling using direct patient reports from 1918 postpartum and 3868 pregnant individuals collected between April 2020 and December 2020 from 10 states across the USA. We leverage a subgroup of these participants who gave birth prior to March 2020 to estimate the pre-pandemic prevalence of specific birthing practices as a comparison. Our primary analyses describe the prevalence and timing of perinatal care changes, compare perinatal care changes depending on when and where individuals gave birth, and assess the linkage between perinatal care alterations and maternal anxiety and depressive symptoms. Seventy-eight percent of pregnant participants and 63% of postpartum participants reported at least one change to their perinatal care between March and August 2020. However, the prevalence and nature of specific perinatal care changes occurred unevenly over time and across geographic locations. The separation of infants and mothers immediately after birth and the cancelation of prenatal visits were associated with worsened depression and anxiety symptoms in mothers after controlling for sociodemographic factors, mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic. Our analyses reveal widespread changes to perinatal care across the US that fluctuated depending on where and when individuals gave birth. Disruptions to perinatal care may also exacerbate mental health concerns, so focused treatments that can mitigate the negative psychiatric sequelae of interrupted care are warranted.
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Affiliation(s)
- Cassandra L Hendrix
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, USA.
| | - Denise Werchan
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, USA
| | - Carly Lenniger
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, USA
| | | | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Autumn Austin
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, USA
| | - Vanessa Babineau
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - G Anne Bogat
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | | | - Elisabeth Conradt
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
- Department of Psychiatry, University of Utah Medical School, Salt Lake City, UT, USA
- Department of Obstetrics and Gynecology, University of Utah Medical School, Salt Lake City, UT, USA
| | - Dani Dumitriu
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Amy J Elliott
- Department of Pediatrics, University of South Dakota School of Medicine, Vermillion, SD, USA
- Avera Research Institute, Sioux Falls, SD, USA
| | - William Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Morgan Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Wei Gao
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Biomedical Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ian Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Alice Graham
- Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, USA
| | - Kimberly D Gregory
- Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hanna Gustafsson
- Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, USA
| | - Kathryn L Havens
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Christine Hockett
- Department of Pediatrics, University of South Dakota School of Medicine, Vermillion, SD, USA
- Avera Research Institute, Sioux Falls, SD, USA
| | - Brittany R Howell
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
- Department of Human Development and Family Science, Virginia Tech University, Blacksburg, VA, USA
| | - Kathryn L Humphreys
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Nancy Jallo
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Lucy S King
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Patricia A Kinser
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Joseph S Lonstein
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel Marcus
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Sara Moyer
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Maria Muzik
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, VA, USA
| | - Amy K Nuttall
- Human Development and Family Studies, Michigan State University, East Lansing, MI, USA
| | | | - Cynthia Rogers
- Department of Psychiatry, Washington University Medical School in Saint Louis, Saint Louis, MO, USA
| | - Amy Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Lauren C Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Beth A Smith
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
- Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Los Angeles, CA, USA
- Division of Research On Children, Youth, and Families, Childrens Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher D Smyser
- Departments of Neurology, Pediatrics, and Radiology, Washington University Medical School in Saint Louis, Saint Louis, MO, USA
| | - Lynne Smith
- The Lundquist Institute, Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Elinor Sullivan
- Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, USA
| | - Judy Zhou
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Natalie H Brito
- Department of Applied Psychology, New York University, New York, NY, USA
| | - Moriah E Thomason
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, USA
- Neuroscience Institute, New York University Medical Center, New York, NY, USA
- Department of Population Health, New York University Medical Center, New York, NY, USA
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9
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Jones IHM, Thompson A, Dunlop CL, Wilson A. Midwives' and maternity support workers' perceptions of the impact of the first year of the COVID-19 pandemic on respectful maternity care in a diverse region of the UK: a qualitative study. BMJ Open 2022; 12:e064731. [PMID: 36127079 PMCID: PMC9490297 DOI: 10.1136/bmjopen-2022-064731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To explore midwives' and maternity support workers' perceptions of the impact of the COVID-19 pandemic on maternity services and understand factors influencing respectful maternity care. DESIGN A qualitative study. Eleven semistructured interviews were conducted (on Zoom) and thematically analysed. Inductive themes were developed and compared with components of respectful maternity care. SETTING Maternity services in a diverse region of the United Kingdom. PARTICIPANTS Midwives and maternity support workers who worked during the first year of the COVID-19 pandemic. RESULTS The findings offer insights into the experiences and challenges faced by midwives and maternity support workers during the first year of the COVID-19 pandemic in the UK (March 2020-2021). Three core themes were interpreted that impacted respectful maternity care: (1) communication of care, (2) clinical care and (3) support for families. 1. Midwives and maternity support workers felt changing guidance impaired communication of accurate information. However, women attending appointments alone encouraged safeguarding disclosures. 2. Maternity staffing pressures worsened and delayed care provision. The health service's COVID-19 response was thought to have discouraged women's engagement with maternity care. 3. Social support for women was reduced and overstretched staff struggled to fill this role. The continuity of carer model of midwifery facilitated supportive care. COVID-19 restrictions separated families and were considered detrimental to parents' mental health and newborn bonding. Overall, comparison of interview quotes to components of respectful maternity care showed challenges during the early COVID-19 pandemic in upholding each of the 10 rights afforded to women and newborns. CONCLUSIONS Respectful maternity care was impacted through changes in communication, delivery of clinical care and restrictions on social support for women and their infants in the first year of the COVID-19 pandemic. Future guidance for pandemic scenarios must make careful consideration of women's and newborns' rights to respectful maternity care.
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Affiliation(s)
- Isobel H M Jones
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Amy Thompson
- Department of Obstetrics and Gynaecology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | | | - Amie Wilson
- Institute of Metabolism and Systems Research (IMSR), WHO Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
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10
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Coşkun Şimşek D, Günay U, Özarslan S. The impact of the COVID-19 pandemic on nursing care and nurses' work in a neonatal intensive care unit. J Pediatr Nurs 2022; 66:44-48. [PMID: 35635999 PMCID: PMC9135281 DOI: 10.1016/j.pedn.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/18/2022] [Accepted: 05/11/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE This study was conducted to determine the effects of the COVID-19 pandemic process on nursing care and nurses' work in neonatal intensive care units. DESIGN AND METHODS The study was conducted using a qualitative method. The data were collected by voice recording with a one-on-one in-depth interview technique, and a semi-structured question form was used in the interviews. The data obtained from voice recordings were evaluated using the qualitative content analysis method. RESULTS The main themes and subthemes of the study were as follows: (1) decrease in physical contact with newborns due to fear of transmitting Covid-19 (decrease in physical contact between neonatal nurses and newborns, decrease in physical contact between mothers and newborns, decrease in physical contact between fathers and newborns), (2) communication problems between healthcare professionals and parents (3) changes in the working conditions for neonatal nurses (increase in the frequency and duration of work intense working speed, exhaustion and decreased motivation due to use of protective equipment). CONCLUSION The COVID-19 pandemic process led to a decrease in nurses' and parents' touching newborns, nurses' experiencing problems with parents due to measures taken, heavier working conditions and a decrease in motivation for nurses. PRACTICE IMPLICATIONS This study will inform future research to be directed to nursing care and the work of nursing who work on the front line in the COVID-19 pandemic process.
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Affiliation(s)
- Didem Coşkun Şimşek
- Assistant Professor, Fırat University, Faculty of Health Sciences, Department of Pediatric Nursing, Elazığ, Turkey.
| | - Ulviye Günay
- Associate Professor, Inonu University, Faculty of Nursing, Department of Pediatric Nursing, Campus 44280 Malatya, Turkey.
| | - Sümeyye Özarslan
- Specialist Nurse, Inonu University, Health Sciences Institute, Malatya, Turkey
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11
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Yip KH, Yip YC, Tsui WK. The Lived Experiences of Women without COVID-19 in Breastfeeding Their Infants during the Pandemic: A Descriptive Phenomenological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159511. [PMID: 35954868 PMCID: PMC9368050 DOI: 10.3390/ijerph19159511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak in 2020 has led to several changes and disturbances in the daily lives of the general public. Particularly for new (first-time) mothers, there has been a significant impact on the practices of raising and feeding their babies. Social distancing measures everywhere have made mothers hesitant to breastfeed their babies anywhere else but at home. Combined with the fear of being infected with COVID-19, the present situation has created unprecedented barriers for breastfeeding mothers to accessing various types of support: emotional, instrumental, informational, and appraisal. There has been no research on the influence of the pandemic on social support regarding breastfeeding in Hong Kong. This study aimed to explore the social support and impact of COVID-19 on mothers breastfeeding their babies. Semi-structured interviews were conducted with 20 currently breastfeeding women in Hong Kong. Colaizzi’s seven-step method was used for data analysis. Two key themes emerged from the interview data: (1) positive influences on breastfeeding support during COVID-19 and (2) negative influences on breastfeeding support during COVID-19. Our findings may help mothers prepare to breastfeed their babies in places other than their homes.
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12
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Radoš SN, Motrico E, Mesquita AM, Ganho-Avila A, Vousoura E, Lalor J. Changes in perinatal mental healthcare during the COVID-19 pandemic: a protocol for a collaborative research study between the COST actions RISEUP-PPD and DEVOTION. BMJ Open 2022; 12:e052411. [PMID: 35882459 PMCID: PMC9329731 DOI: 10.1136/bmjopen-2021-052411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Significant changes in routine maternity care have been introduced globally in response to the COVID-19 pandemic to reduce infection risk, but also due to lack of medical facilities, staff shortages and the unpredictable nature of the disease. However, it is yet to be established if specialised perinatal mental health (PMH) services have been similarly affected. As a Task Force in PMH and COVID-19 pandemic within Riseup-PPD COST Action, this study aims to identify changes in PMH practices, policies and protocols during the COVID-19 pandemic in Europe. METHODS AND ANALYSIS An online survey of experts in the PMH who are members of the COST Action 'Riseup-PPD' and the COST Action ''DEVOTION" across 36 European countries will be conducted. A questionnaire on changes in PMH care practices during the COVID-19 Pandemic will be administered. It consists of open-ended questions, checklists and ratings on a 7-point scale addressing seven domains of interest in terms of PMH: (1) policies, guidelines and protocols; (2) PMH care practices at a national level; (3) evidence of best practice; (4) barriers to usual care; (5) resources invested; (6) benefits of investment in the policies and (7) short-term and long-term expectations of the policies. Data will be collected using Qualtrics. Descriptive statistics will be reported and differences between countries will be examined using the χ2 statistic or Student's t-test. ETHICS AND DISSEMINATION Ethical approval was obtained from The Ethics Committee for Research in Life and Health Sciences of the University of Minho (Portugal) to undertake an anonymous online survey. The findings will be disseminated to professional audience through peer-review publication and presentations and shared widely with stakeholders, policy-makers and service user groups. A position paper will be developed to influence policy-making at a European level to alleviate the adversities caused by COVID-19. TRIAL REGISTRATION NUMBER NCT04779775.
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Affiliation(s)
- Sandra Nakić Radoš
- Department of Psychology, Catholic University of Croatia, Zagreb, Croatia
| | - Emma Motrico
- Psychology, Universidad Loyola Andalucia, Dos Hermanas, Spain
| | - Ana M Mesquita
- Universidade do Minho - Campus de Gualtar, Braga, Portugal
| | - Ana Ganho-Avila
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - Eleni Vousoura
- Psychology, The American College of Greece, Athens, Greece
| | - Joan Lalor
- Faculty of Health Sciences, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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13
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Twanow JDE, McCabe C, Ream MA. The COVID-19 Pandemic and Pregnancy: Impact on Mothers and Newborns. Semin Pediatr Neurol 2022; 42:100977. [PMID: 35868726 PMCID: PMC9122838 DOI: 10.1016/j.spen.2022.100977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 pandemic has markedly, and likely permanently, changed health care. This includes changing the obstetric and perinatal care of mothers and infants, and by extension, the care of their families. Infection during pregnancy is associated with an increased risk for severe coronavirus disease 2019 illness and related complications that can significantly impact maternal health and the health of the neonate. Viral transmission from mother to fetus is possible, but rare during pregnancy, and current health care policies focusing on maternal masking, and hand washing allows infected mothers to safely care for neonates (including nursing or feeding with expressed breast milk). The newly developed vaccines have been shown to be safe and effective for pregnant and breast-feeding mothers, with measurable antibody levels in cord blood and breast milk potentially providing a level of passive immunity to neonates. While studies looking at short-term outcomes for neonates have been reassuring, it is critical that we continue to work to understand and improve the care of pregnant woman and newborns with coronavirus disease 2019 to optimize long term outcomes. Although the knowledge base continues to evolve, the available evidence influencing the care of pregnant women and their infants is summarized in this focused review.
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Affiliation(s)
- Jaime-Dawn E. Twanow
- Nationwide Children's Hospital Columbus, OH,The Ohio State University College of Medicine, Columbus, OH,Address reprint requests to Jaime-Dawn E. Twanow, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205
| | - Corinne McCabe
- Nationwide Children's Hospital Columbus, OH,The Ohio State University College of Medicine, Columbus, OH
| | - Margie A. Ream
- Nationwide Children's Hospital Columbus, OH,The Ohio State University College of Medicine, Columbus, OH
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14
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Rodo M, Singh L, Russell N, Singh NS. A mixed methods study to assess the impact of COVID-19 on maternal, newborn, child health and nutrition in fragile and conflict-affected settings. Confl Health 2022; 16:30. [PMID: 35659039 PMCID: PMC9162897 DOI: 10.1186/s13031-022-00465-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/28/2022] [Indexed: 11/15/2022] Open
Abstract
Background The impacts of COVID-19 are unprecedented globally. The pandemic is reversing decades of progress in maternal, newborn, child health and nutrition (MNCHN), especially fragile and conflict-affected settings (FCAS) whose populations were already facing challenges in accessing basic health and nutrition services. This study aimed to investigate the collateral impact of COVID-19 on funding, services and MNCHN outcomes in FCAS, as well as adaptations used in the field to continue activities. Methods A scoping review of peer-reviewed and grey literature published between 1st March 2020–31st January 2021 was conducted. We analysed 103 publications using a narrative synthesis approach. 39 remote semi-structured key informant interviews with humanitarian actors and donor staff within 12 FCAS were conducted between October 2020 and February 2021. Thematic analysis was undertaken independently by two researchers on interview transcripts and supporting documents provided by key informants, and triangulated with literature review findings. Results Funding for MNCHN has been reduced or suspended with increase in cost of continuing the same activities, and diversion of MNCHN funding to COVID-19 activities. Disruption in supply and demand of interventions was reported across different settings which, despite data evidence still being missing, points towards likely increased maternal and child morbidity and mortality. Some positive adaptations including use of technology and decentralisation of services have been reported, however overall adaptation strategies have been insufficient to equitably meet additional challenges posed by the pandemic, and have not been evaluated for their effectiveness. Conclusions COVID-19 is further exacerbating negative women’s and children’s health outcomes in FCAS. Increased funding is urgently required to re-establish MNCHN activities which have been deprioritised or halted. Improved planning to sustain routine health services and enable surge planning for emergencies with focus on the community/service users throughout adaptations is vital for improved MNCHN outcomes in FCAS. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-022-00465-x.
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15
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Sakalidis VS, Perrella SL, Prosser SA, Geddes DT. Breastfeeding in a COVID-19 world. Curr Opin Clin Nutr Metab Care 2022; 25:188-194. [PMID: 35142722 DOI: 10.1097/mco.0000000000000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The coronavirus disease 2019 (COVID-19) pandemic has changed the birthing and postnatal experience of women. This review highlights how policy changes have affected pregnant and breastfeeding women, the evidence for continued breastfeeding and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines, and how the pandemic's unexpected consequences have affected these women's wellbeing. Additionally, we postulate the future of lactation and perinatal support as the pandemic continues. RECENT FINDINGS Women who have given birth during the pandemic have had restricted access to postnatal care. Although pregnant and breastfeeding women who contract SARS-CoV-2 are more vulnerable to poor health outcomes than their nonpregnant counterparts, they are also at higher risk of mental health difficulties, with limited access to support. Continued breastfeeding may be protective to the infant, offering passive immunity against SARS-CoV-2, and vaccination against COVID-19 is safe and effective for pregnant and lactating women. Innovative and adaptable lactation care, including holistic perinatal, mental health, and social support services, both digital and in-person, will help mothers continue breastfeeding during future outbreaks. SUMMARY Continued breastfeeding and vaccination may confer protection to the infant against SARS-CoV-2 infection. New mothers should not be isolated in future pandemics. Prioritizing lactation and perinatal care, including in-person services, remains paramount to optimizing breastfeeding during COVID-19.
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Affiliation(s)
- Vanessa S Sakalidis
- School of Molecular Sciences, University of Western Australia, Perth, WA, Australia
| | - Sharon L Perrella
- School of Molecular Sciences, University of Western Australia, Perth, WA, Australia
- One For Women, Mt Lawley, WA, Australia
| | - Stuart A Prosser
- School of Molecular Sciences, University of Western Australia, Perth, WA, Australia
- One For Women, Mt Lawley, WA, Australia
| | - Donna T Geddes
- School of Molecular Sciences, University of Western Australia, Perth, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
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16
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Kostenzer J, von Rosenstiel-Pulver C, Hoffmann J, Walsh A, Mader S, Zimmermann LJI. Parents' experiences regarding neonatal care during the COVID-19 pandemic: country-specific findings of a multinational survey. BMJ Open 2022; 12:e056856. [PMID: 35393317 PMCID: PMC8990262 DOI: 10.1136/bmjopen-2021-056856] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has disrupted healthcare systems, challenging neonatal care provision globally. Curtailed visitation policies are known to negatively affect the medical and emotional care of sick, preterm and low birth weight infants, compromising the achievement of the 2030 Development Agenda. Focusing on infant and family-centred developmental care (IFCDC), we explored parents' experiences of the disruptions affecting newborns in need of special or intensive care during the first year of the pandemic. DESIGN Cross-sectional study using an electronic, web-based questionnaire. SETTING Multicountry online-survey. METHODS Data were collected between August and November 2020 using a pretested online, multilingual questionnaire. The target group consisted of parents of preterm, sick or low birth weight infants born during the first year of the COVID-19 pandemic and who received special/intensive care. The analysis followed a descriptive quantitative approach. RESULTS In total, 1148 participants from 12 countries (Australia, Brazil, Canada, China, France, Italy, Mexico, New Zealand, Poland, Sweden, Turkey and Ukraine) were eligible for analysis. We identified significant country-specific differences, showing that the application of IFCDC is less prone to disruptions in some countries than in others. For example, parental presence was affected: 27% of the total respondents indicated that no one was allowed to be present with the infant receiving special/intensive care. In Australia, Canada, France, New Zealand and Sweden, both the mother and the father (in more than 90% of cases) were allowed access to the newborn, whereas participants indicated that no one was allowed to be present in China (52%), Poland (39%), Turkey (49%) and Ukraine (32%). CONCLUSIONS The application of IFCDC during the COVID-19 pandemic differs between countries. There is an urgent need to reconsider separation policies and to strengthen the IFCDC approach worldwide to ensure that the 2030 Development Agenda is achieved.
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Affiliation(s)
- Johanna Kostenzer
- Scientific Affairs, European Foundation for the Care of Newborn Infants, Munich, Germany
| | | | - Julia Hoffmann
- Scientific Affairs, European Foundation for the Care of Newborn Infants, Munich, Germany
| | - Aisling Walsh
- Scientific Affairs, European Foundation for the Care of Newborn Infants, Munich, Germany
| | - Silke Mader
- Scientific Affairs, European Foundation for the Care of Newborn Infants, Munich, Germany
| | - Luc J I Zimmermann
- Scientific Affairs, European Foundation for the Care of Newborn Infants, Munich, Germany
- Department of Paediatrics, Research School Oncology and Development, Maastricht UMC+, Maastricht, The Netherlands
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17
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Wesołowska A, Orczyk-Pawiłowicz M, Bzikowska-Jura A, Gawrońska M, Walczak B. Protecting Breastfeeding during the COVID-19 Pandemic: A Scoping Review of Perinatal Care Recommendations in the Context of Maternal and Child Well-Being. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3347. [PMID: 35329035 PMCID: PMC8949921 DOI: 10.3390/ijerph19063347] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 12/14/2022]
Abstract
The objective of this scoping review is to determine to what extent the recommendations on perinatal care protect breastfeeding during the COVID-19 pandemic. The review follows the PRISMA ScR Extension guidelines. The research was conducted in Scopus, Medline via Pubmed, and Web of Science databases from 1 March 2020 to 31 May 2021, using 392 combinations of keywords. We searched for reviews and original papers published in English providing recommendations on delivery mode, companion during labor, the possibility of skin-to-skin contact (SSC), breastfeeding, and visitors policy. After screening, 86 out of 8416 publications qualified for data extraction. The majority of them indicated that COVID-19 infection is not a sufficient reason for a cesarean section; however, on a national level, cesarean births in severely ill patients were overrepresented. A significant number of recommendations deprived mothers of the necessary support during their labor and stay in the maternity ward. A shared decision-making model was hardly visible. Only the earliest COVID-19 recommendations suspended direct breastfeeding; in later publications, decisions were related to the mother's health, but other options of natural feeding were rarely discussed.
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Affiliation(s)
- Aleksandra Wesołowska
- Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Department of Medical Biology, Medical University of Warsaw, Litewska 14/16, 00-575 Warsaw, Poland; (A.W.); (A.B.-J.)
- Human Milk Bank Foundation, Podkowy Str. 128 J, 04-937 Warsaw, Poland;
| | - Magdalena Orczyk-Pawiłowicz
- Department of Biochemistry and Immunochemistry, Division of Chemistry and Immunochemistry, Wroclaw Medical University, M. Skłodowskiej-Curie 48/50, 50-369 Wrocław, Poland;
| | - Agnieszka Bzikowska-Jura
- Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Department of Medical Biology, Medical University of Warsaw, Litewska 14/16, 00-575 Warsaw, Poland; (A.W.); (A.B.-J.)
| | - Małgorzata Gawrońska
- Human Milk Bank Foundation, Podkowy Str. 128 J, 04-937 Warsaw, Poland;
- Faculty of Sociology, University of Warsaw, Karowa 18, 00-927 Warsaw, Poland
| | - Bartłomiej Walczak
- Institute of Applied Social Sciences, University of Warsaw, Nowy Świat 69, 00-927 Warsaw, Poland
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18
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Impact of the Coronavirus Disease (COVID-19) Pandemic on Neonatal Nutrition: Focus on Low- and Middle-Income Countries. CURRENT TROPICAL MEDICINE REPORTS 2022; 9:218-224. [PMID: 36415223 PMCID: PMC9672601 DOI: 10.1007/s40475-022-00272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 11/19/2022]
Abstract
Purpose of Review This review serves to account for the published literature regarding the changing impact of the COVID-19 pandemic with a focus on neonatal nutrition in low- and middle-income countries. Recent Findings Initial national and international guidelines regarding breastfeeding were often contradictory. Lack of clear guidelines resulted in separation of mother-neonate dyads and the reliance on non-human sources of milk at institutional levels. Mothers and families were less likely to initiate and/or continue breastfeed during the pandemic due to confusion regarding guidelines, lack of support for lactation, and concern for infection transmission to their neonates. Continued research in neonatal nutrition, however, continues to support the use of breastmilk as the optimal nutritional source for neonates. Summary Despite concerns for increased risk of COVID-19 transmission with breastfeeding, the use of breastmilk with preserved and combined mother-baby care is associated with improved neonatal nutrition.
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19
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Neonates and COVID-19: state of the art : Neonatal Sepsis series. Pediatr Res 2022; 91:432-439. [PMID: 34961785 PMCID: PMC8712275 DOI: 10.1038/s41390-021-01875-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/20/2021] [Accepted: 11/05/2021] [Indexed: 12/12/2022]
Abstract
The SARS-CoV-2 pandemic has had a significant impact worldwide, particularly in middle- and low-income countries. While this impact has been well-recognized in certain age groups, the effects, both direct and indirect, on the neonatal population remain largely unknown. There are placental changes associated, though the contributions to maternal and fetal illness have not been fully determined. The rate of premature delivery has increased and SARS-CoV-2 infection is proportionately higher in premature neonates, which appears to be related to premature delivery for maternal reasons rather than an increase in spontaneous preterm labor. There is much room for expansion, including long-term data on outcomes for affected babies. Though uncommon, there has been evidence of adverse events in neonates, including Multisystem Inflammatory Syndrome in Children, associated with COVID-19 (MIS-C). There are recommendations for reduction of viral transmission to neonates, though more research is required to determine the role of passive immunization of the fetus via maternal vaccination. There is now considerable evidence suggesting that the severe visitation restrictions implemented early in the pandemic have negatively impacted the care of the neonate and the experiences of both parents and healthcare professionals alike. Ongoing collaboration is required to determine the full impact, and guidelines for future management. IMPACT: Comprehensive review of current available evidence related to impact of the COVID-19 pandemic on neonates, effects on their health, impact on their quality of care and indirect influences on their clinical course, including comparisons with other age groups. Reference to current evidence for maternal experience of infection and how it impacts the fetus and then neonate. Outline of the need for ongoing research, including specific areas in which there are significant gaps in knowledge.
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20
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Semaan A, Dey T, Kikula A, Asefa A, Delvaux T, Langlois EV, van den Akker T, Benova L. "Separated during the first hours"-Postnatal care for women and newborns during the COVID-19 pandemic: A mixed-methods cross-sectional study from a global online survey of maternal and newborn healthcare providers. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000214. [PMID: 36962168 PMCID: PMC10022345 DOI: 10.1371/journal.pgph.0000214] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/23/2022] [Indexed: 01/22/2023]
Abstract
Routine postnatal care (PNC) allows monitoring, early detection and management of complications, and counselling to ensure immediate and long-term wellbeing of mothers and newborns; yet effective coverage is sub-optimal globally. The COVID-19 pandemic disrupted availability and quality of maternal and newborn care despite established guidelines promoting continuity of essential services. We conducted a cross-sectional global online survey of 424 maternal and newborn healthcare providers from 61 countries, to explore PNC provision, availability, content and quality following the early phase of the COVID-19 pandemic. The questionnaire (11 languages), included four multiple-choice and four open-text questions on changes to PNC during the pandemic. Quantitative and qualitative responses received between July and December 2020 were analysed separately and integrated during reporting. Tightened rules for visiting postpartum women were reported in health facilities, ranging from shorter visiting hours to banning supportive companions and visitors. A quarter (26%) of respondents reported that mothers suspected/confirmed with COVID-19 were routinely separated from their newborns. Early initiation of breastfeeding was delayed due to waiting for maternal SARS-CoV-2 test results. Reduced provision of breastfeeding support was reported by 40% of respondents in high-income countries and 7% in low-income countries. Almost 60% reported that women were discharged earlier than usual and 27% perceived a reduction in attendance to outpatient PNC. Telemedicine and home visits were mostly reported in high-income countries to ensure safe care provision. Beyond the early phase of the COVID-19 pandemic, severe disruptions to content and quality of PNC continued to exist, whereas disruptions in availability and use were less commonly reported. Depriving women of support, reducing availability of PNC services, and mother-newborn separation could lead to negative long-term outcomes for women, newborns and families, and deny their rights to respectful care. Protecting these essential services is imperative to promoting quality woman-centred PNC during and beyond the pandemic.
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Affiliation(s)
- Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Teesta Dey
- Department of Women's and Children's Health, University of Liverpool, Liverpool, United Kingdom
| | - Amani Kikula
- Muhimbili University of Health and Allied Sciences, Upanga-West, Dar es salaam, Tanzania
| | - Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), World Health Organization (WHO), Geneva, Switzerland
| | - Thomas van den Akker
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Hedstrom A, Mubiri P, Nyonyintono J, Nakakande J, Magnusson B, Vaughan M, Waiswa P, Batra M. Impact of the early COVID-19 pandemic on outcomes in a rural Ugandan neonatal unit: A retrospective cohort study. PLoS One 2021; 16:e0260006. [PMID: 34914748 PMCID: PMC8675646 DOI: 10.1371/journal.pone.0260006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/30/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND During the early COVID-19 pandemic travel in Uganda was tightly restricted which affected demand for and access to care for pregnant women and small and sick newborns. In this study we describe changes to neonatal outcomes in one rural central Ugandan newborn unit before and during the early phase of the COVID-19 pandemic. METHODS We report outcomes from admissions captured in an electronic dataset of a well-established newborn unit before (September 2019 to March 2020) and during the early COVID-19 period (April-September 2020) as well as two seasonally matched periods one year prior. We report excess mortality as the percent change in mortality over what was expected based on seasonal trends. FINDINGS The study included 2,494 patients, 567 of whom were admitted during the early COVID-19 period. During the pandemic admissions decreased by 14%. Patients born outside the facility were older on admission than previously (median 1 day of age vs. admission on the day of birth). There was an increase in admissions with birth asphyxia (22% vs. 15% of patients). Mortality was higher during COVID-19 than previously [16% vs. 11%, p = 0.017]. Patients born outside the facility had a relative increase of 55% above seasonal expected mortality (21% vs. 14%, p = 0.028). During this period patients had decreased antenatal care, restricted transport and difficulty with expenses and support. The hospital had difficulty with maternity staffing and supplies. There was significant community and staff fear of COVID-19. INTERPRETATION Increased newborn mortality during the early COVID-19 pandemic at this facility was likely attributed to disruptions affecting maternal and newborn demand for, access to and quality of perinatal healthcare. Lockdown conditions and restrictions to public transit were significant barriers to maternal and newborn wellbeing, and require further focus by national and regional health officials.
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Affiliation(s)
- Anna Hedstrom
- Departments of Pediatrics and Global Health, Neonatology, Seattle Children’s Hospital, University of Washington, Seattle, WA, United States of America
| | - Paul Mubiri
- Makerere University School of Public Health, Mulago, Kampala, Uganda
| | | | | | | | | | - Peter Waiswa
- Makerere University School of Public Health, Mulago, Kampala, Uganda
| | - Maneesh Batra
- Departments of Pediatrics and Global Health, Neonatology, Seattle Children’s Hospital, University of Washington, Seattle, WA, United States of America
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22
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Kim JI, Im Y, Song JE, Jang SJ. Healthcare Considerations for Special Populations during the COVID-19 Pandemic: A Review. J Korean Acad Nurs 2021; 51:511-524. [PMID: 34737245 DOI: 10.4040/jkan.21156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 12/21/2022]
Abstract
The coronavirus disease 2019 (COVID-19) has emerged as a threat to human health and public safety. People of all ages are susceptible to severe acute respiratory syndrome coronavirus 2 infection. However, the clinical manifestations of this infection differ by age. This study purposes to describe healthcare considerations for special populations, such as children, pregnant and lactating women, and older adults, who may have unique healthcare needs, in the pandemic situation. To realize the research purpose, we conducted a review of the practice guidelines of public documents and qualified studies that were published online/offline during a specific period. The review identified current knowledge on care for newborns, children in schools, pregnant women (from antenatal to postpartum care), and older adults suffering from high-risk conditions. Subsequently, we summarize vaccination guidance for special populations and, finally, discuss the issues currently affecting special populations. Therefore, this current knowledge on care for special populations helps nurses to provide accurate information on vaccinations aimed at preventing COVID-19 and protecting the masses from infection. Currently, the scarcity of information on COVID-19 variants necessitates further research on measures to reduce pandemic spread.
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Affiliation(s)
- Jeung-Im Kim
- School of Nursing, Soonchunhyang University, Cheonan, Korea
| | - YeoJin Im
- College of Nursing Science · East-West Nursing Research Institute, Kyung Hee University, Seoul, Korea
| | - Ju-Eun Song
- College of Nursing · Research Institute of Nursing Science, Ajou University, Suwon, Korea.
| | - Sun Joo Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea.
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23
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Kostenzer J, Hoffmann J, von Rosenstiel-Pulver C, Walsh A, Zimmermann LJ, Mader S. Neonatal care during the COVID-19 pandemic - a global survey of parents' experiences regarding infant and family-centred developmental care. EClinicalMedicine 2021; 39:101056. [PMID: 34401688 PMCID: PMC8355909 DOI: 10.1016/j.eclinm.2021.101056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic restrictions affect provision and quality of neonatal care. This global study explores parents' experiences regarding the impact of the restrictions on key characteristics of infant and family-centred developmental care (IFCDC) during the first year of the pandemic. METHODS For this cross-sectional study, a pre-tested online survey with 52 questions and translated into 23 languages was used to collect data between August and November 2020. Parents of sick or preterm infants born during the pandemic and receiving special/intensive care were eligible for participation. Data analysis included descriptive statistics and statistical testing based on different levels of restrictive measures. FINDINGS In total, 2103 participants from 56 countries provided interpretable data. Fifty-two percent of respondents were not allowed to have another person present during birth. Percentages increased with the extent of restrictions in the respondents' country of residence (p = 0·002). Twenty-one percent of total respondents indicated that no-one was allowed to be present with the infant receiving special/intensive care. The frequency (p < 0·001) and duration (p = 0·001) of permitted presence largely depended on the extent of restrictions. The more restrictive the policy measures were, the more the respondents worried about the pandemic situation during pregnancy and after birth. INTERPRETATION COVID-19 related restrictions severely challenged evidence-based cornerstones of IFCDC, such as separating parents/ legal guardians and their newborns. Our findings must therefore be considered by public health experts and policy makers alike to reduce unnecessary suffering, calling for a zero separation policy. FUNDING EFCNI received an earmarked donation by Novartis Pharma AG in support of this study.
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Affiliation(s)
- Johanna Kostenzer
- European Foundation for the Care of Newborn Infants (EFCNI), Scientific Affairs, Hofmannstrasse 7A, Munich 81379, Germany
| | - Julia Hoffmann
- European Foundation for the Care of Newborn Infants (EFCNI), Scientific Affairs, Hofmannstrasse 7A, Munich 81379, Germany
| | | | - Aisling Walsh
- European Foundation for the Care of Newborn Infants (EFCNI), Scientific Affairs, Hofmannstrasse 7A, Munich 81379, Germany
| | - Luc J.I. Zimmermann
- European Foundation for the Care of Newborn Infants (EFCNI), Scientific Affairs, Hofmannstrasse 7A, Munich 81379, Germany
- Department of Paediatrics, Research School Oncology and Development, Maastricht UMC+, Maastricht, the Netherlands
| | - Silke Mader
- European Foundation for the Care of Newborn Infants (EFCNI), Scientific Affairs, Hofmannstrasse 7A, Munich 81379, Germany
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24
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Ranjbar F, Allahqoli L, Ahmadi S, Mousavi R, Gharacheh M, Eshraghi N, Alkatout I. Changes in pregnancy outcomes during the COVID-19 lockdown in Iran. BMC Pregnancy Childbirth 2021; 21:577. [PMID: 34420514 PMCID: PMC8380188 DOI: 10.1186/s12884-021-04050-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/12/2021] [Indexed: 12/14/2022] Open
Abstract
Background The Covid-19 pandemic response is influencing maternal and neonatal health care services especially in developing countries. However, the indirect effects of Covid-19 on pregnancy outcomes remain unknown. The aim of the present study was to compare pregnancy outcomes before and after the beginning of the Covid-19 pandemic in Iran. Methods We performed a retrospective analysis of the medical records of 2,503 pregnant women with singleton pregnancies, admitted to the maternity department of a women’s hospital in Tehran, Iran, during the pre-Covid-19 pandemic (February 19 to April 19, 2019) and the intra-Covid- 19 pandemic (February 19 to April 19, 2020) period. Results We included 2,503 women admitted to the hospital; 1,287 (51.4 %) were admitted before the Covid-19 lockdown and 1,216 (48.6 %) during the Covid-19 lockdown. There were no significant differences in stillbirth rates (p = 0.584) or pregnancy complications (including preeclampsia, pregnancy-induced hypertension and gestational diabetes) (p = 0.115) between pregnant women in the pre- and intra-pandemic periods. However, decreases in preterm births (p = 0.001), and low birth weight (p = 0.005) were observed in the pandemic period compared to the pre-pandemic period. No significant difference in the mode of delivery, and no maternal deaths were observed during the two time periods. Conclusions In our study we observed a decrease in preterm births and low birth weight, no change in stillbirths, and a rise in the admission rates of mothers to the ICU during the initial Covid-19 lockdown period compared to pre-Covid-19 lockdown period. Further research will be needed to devise plan for immediate post-pandemic care and future health care crises.
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Affiliation(s)
- Fahimeh Ranjbar
- Reproductive Health, Nursing Care Research Centre, Iran University of Medical Sciences, P.O. Box 19395-4798, Rashid Yasemi St., Valiasr Ave., Tehran, Iran
| | - Leila Allahqoli
- Reproductive Health, Nursing Care Research Centre, Iran University of Medical Sciences, P.O. Box 19395-4798, Rashid Yasemi St., Valiasr Ave., Tehran, Iran
| | - Soheila Ahmadi
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Robab Mousavi
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Gharacheh
- Reproductive Health, Nursing Care Research Centre, Iran University of Medical Sciences, P.O. Box 19395-4798, Rashid Yasemi St., Valiasr Ave., Tehran, Iran.
| | - Nooshin Eshraghi
- Department of Perinatology, Shahid Akbarabadi hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy. Campus Kiel, University Hospitals Schleswig-Holstein, Kiel, Germany
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25
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Sutton HJ, Dargaville PA, Spotswood NE. Unravelling the epidemiology and clinical impact of SARS-CoV-2 infection in neonates. Acta Paediatr 2021; 110:2482-2483. [PMID: 34053113 PMCID: PMC8222888 DOI: 10.1111/apa.15899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/24/2021] [Accepted: 04/28/2021] [Indexed: 12/24/2022]
Affiliation(s)
| | - Peter A. Dargaville
- Menzies Institute for Medical Research University of Tasmania Hobart Tas Australia
- Department of Paediatrics Royal Hobart Hospital Hobart Tas Australia
| | - Naomi E. Spotswood
- Department of Paediatrics Royal Hobart Hospital Hobart Tas Australia
- Maternal, Child and Adolescent Health Program Burnet Institute Melbourne Vic Australia
- Department of Medicine Faculty of Medicine Dentistry and Health Sciences University of Melbourne Melbourne Vic Australia
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26
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Supporting Breastfeeding in 2021 and Beyond-Lessons from the Pandemic. Pediatr Rep 2021; 13:289-301. [PMID: 34205900 PMCID: PMC8293422 DOI: 10.3390/pediatric13020037] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 01/20/2023] Open
Abstract
The COVID-19 pandemic has affected maternal and infant health globally both directly from infection with the SARS-CoV-2 virus and indirectly from changes in health care resulting from social, economic, and health care policies unique to each country. The developing countries have to share the disproportionate burden on maternal and infant health. In this review, we discuss the uncertainties resulting from SARS-CoV-2 infection in pregnancy, vertical transmission of the virus, and its effects on breastfeeding of the newborn. The problems of families and communities caring for mothers with COVID-19 and its impact on breastfeeding in newborns are discussed. The challenges posed by the pandemic have forced us to think and devise innovative solutions, including telemedicine help for antenatal counseling, breastfeeding education, and lactation support. Optimal utilization of resources and technology to find creative solutions at the individual and the community level will help in facilitating maternal-infant bonding soon after birth. Appropriate health care policies to support pregnant and lactating mothers will go a long way in meeting healthy child development goals.
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27
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Rao SPN, Minckas N, Medvedev MM, Gathara D, Y N P, Seifu Estifanos A, Silitonga AC, Jadaun AS, Adejuyigbe EA, Brotherton H, Arya S, Gera R, Ezeaka CV, Gai A, Gobezayehu AG, Dube Q, Kumar A, Naburi H, Chiume M, Tumukunde V, Medhanyie AA, Plange-Rhule G, Shabini J, Ohuma EO, Tadele H, W/Gebriel F, Hadgu A, Alamineh L, Mehta R, Molyneux E, Lawn JE. Small and sick newborn care during the COVID-19 pandemic: global survey and thematic analysis of healthcare providers' voices and experiences. BMJ Glob Health 2021; 6:e004347. [PMID: 33716220 PMCID: PMC7959239 DOI: 10.1136/bmjgh-2020-004347] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic is disrupting health systems globally. Maternity care disruptions have been surveyed, but not those related to vulnerable small newborns. We aimed to survey reported disruptions to small and sick newborn care worldwide and undertake thematic analysis of healthcare providers' experiences and proposed mitigation strategies. METHODS Using a widely disseminated online survey in three languages, we reached out to neonatal healthcare providers. We collected data on COVID-19 preparedness, effects on health personnel and on newborn care services, including kangaroo mother care (KMC), as well as disruptors and solutions. RESULTS We analysed 1120 responses from 62 countries, mainly low and middle-income countries (LMICs). Preparedness for COVID-19 was suboptimal in terms of guidelines and availability of personal protective equipment. One-third reported routine testing of all pregnant women, but 13% had no testing capacity at all. More than 85% of health personnel feared for their own health and 89% had increased stress. Newborn care practices were disrupted both due to reduced care-seeking and a compromised workforce. More than half reported that evidence-based interventions such as KMC were discontinued or discouraged. Separation of the mother-baby dyad was reported for both COVID-positive mothers (50%) and those with unknown status (16%). Follow-up care was disrupted primarily due to families' fear of visiting hospitals (~73%). CONCLUSION Newborn care providers are stressed and there is lack clarity and guidelines regarding care of small newborns during the pandemic. There is an urgent need to protect life-saving interventions, such as KMC, threatened by the pandemic, and to be ready to recover and build back better.
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Affiliation(s)
- Suman P N Rao
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, India
| | - Nicole Minckas
- Institute for Global Health, University College London, London, UK
| | - Melissa M Medvedev
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - David Gathara
- Kenya Medical Research Institute-, Wellcome Trust Research Program, Nairobi, Kenya
| | - Prashantha Y N
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, India
| | - Abiy Seifu Estifanos
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alfrida Camelia Silitonga
- Department of Reproductive, Maternal, Newborn, Child and Adolescent Health, World Health Organization, Country Office Indonesia, Jakarta, Indonesia
| | - Arun Singh Jadaun
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | - Helen Brotherton
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Medical Research Council Unit The Gambia, at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Sugandha Arya
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rani Gera
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Chinyere V Ezeaka
- Department of Pediatrics, University of Lagos and Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Abdou Gai
- Medical Research Council Unit The Gambia, at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | | | - Queen Dube
- Department of Pediatrics and Child Health, University of Malawi College of Medicine and Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Helga Naburi
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Msandeni Chiume
- Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Victor Tumukunde
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Araya Abrha Medhanyie
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | - Gyikua Plange-Rhule
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Josephine Shabini
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamayo, Tanzania
| | - Eric O Ohuma
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Henok Tadele
- Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Amanuel Hadgu
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | | | - Rajesh Mehta
- Regional Office, South East Asia, World Health Organisation, New Delhi, India
| | - Elizabeth Molyneux
- Department of Pediatrics and Child Health, University of Malawi College of Medicine and Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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