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Sikorski C, Van Hees S, Lakhanpaul M, Benton L, Martin J, Costello A, Heys M. Could Postnatal Women's Groups Be Used to Improve Outcomes for Mothers and Children in High-Income Countries? A Systematic Review. Matern Child Health J 2018; 22:1698-1712. [PMID: 30155582 PMCID: PMC6245133 DOI: 10.1007/s10995-018-2606-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Introduction Participatory postnatal women’s groups have been shown to have a significant impact on maternal and neonatal mortality in low-income countries. However, it is not clear whether this approach can be translated to high-income countries (HICs). We conducted a systematic review to answer the question: “Can postnatal women’s groups improve health outcomes for mothers and children in high-income countries?” Methods MEDLINE, EMBASE and Cochrane databases were searched for randomised controlled trials testing any group-based intervention during the postnatal period, in HICs. No limitations were applied to stated outcomes. Results Nine trials, including 3029 women, fulfilled the criteria. Group-based interventions, facilitated by health professionals, ranged from didactic to participant-led. Three trials addressed postnatal depression, one addressed physical activity, whilst the remainder looked at multiple health or social outcomes. Three trials reported a significant association between their intervention and at least one outcome measure. Study limitations included poor and inequitable intervention uptake, low participant retention, small sample size and incomplete intervention description. Discussion This review found limited and incompletely described evidence testing the use of postnatal group-based interventions to improve health outcomes in HICs. Promising results were reported when the obstacles of sample size and group attendance were overcome. Studies reporting positive impacts on primary outcomes reported higher attendance rates and involved a psychoeducational or cognitive behavioural component in their group approaches. Further research should design and evaluate implementation strategies, assess the use of lay support workers in community settings to improve attendance and retention, and examine the effect of the group environment on outcomes.
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Affiliation(s)
| | | | - Monica Lakhanpaul
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Lorna Benton
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jennifer Martin
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Anthony Costello
- Institute for Global Health, University College, London, UK.,Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Michelle Heys
- Institute for Global Health, University College, London, UK. .,Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
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Heys M, Gibbons F, Haworth E, Medeiros E, Tumbahangphe KM, Wickenden M, Shrestha M, Costello A, Manandhar D, Pellicano E. The Estimated Prevalence of Autism in School-Aged Children Living in Rural Nepal Using a Population-Based Screening Tool. J Autism Dev Disord 2018; 48:3483-3498. [PMID: 29855757 PMCID: PMC6153945 DOI: 10.1007/s10803-018-3610-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Few data exist on the prevalence of autism in low-income countries. We translated, adapted and tested the acceptability of a Nepali-language version of a screening tool for autism (Autism Quotient-10). Using this tool, we estimated autism prevalence in 4098 rural Nepali children aged 9-13 years. Fourteen children scored > 6 out of 10, indicative of elevated autistic symptomatology, of which 13 also screened positive for disability. If the AQ-10 screening tool is as sensitive and specific in the Nepali population as it is in the UK, this would yield an estimated true prevalence of 3 in 1000 (95% confidence interval 2-5 in 1000). Future research is required to validate this tool through in-depth assessments of high-scoring children.
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Affiliation(s)
- Michelle Heys
- UCL Institute for Global Health, University College London, London, UK.
- Great Ormond Street Institute of Child Global Health, University College London, London, UK.
| | | | - Ed Haworth
- Great Ormond Street Institute of Child Global Health, University College London, London, UK
| | - Emilie Medeiros
- UCL Institute for Global Health, University College London, London, UK
| | | | - Mary Wickenden
- UCL Institute for Global Health, University College London, London, UK
| | - Merina Shrestha
- Autism Care Society, Kathmandu, Nepal
- Tribhuvan University Teaching Hospital, Department of Child Health, Kathmandu, Nepal
| | - Anthony Costello
- UCL Institute for Global Health, University College London, London, UK
- Department of Maternal, Newborn, Child and Adolescent Health (MCA), World Health Organization, Geneva, Switzerland
| | | | - Elizabeth Pellicano
- Centre for Research in Autism and Education (CRAE), UCL Institute of Education, University College London, London, UK
- Department of Educational Studies, Macquarie University, Sydney, Australia
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