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Woodson LL, Garcia Saldivar A, Brown HE, Magrath PA, Antunez de Mayolo N, Pettygrove S, Farland LV, Madhivanan P, Blas MM. The downstream effects of COVID-19 on adolescent girls in the Peruvian Amazon: qualitative findings on how the pandemic affected education and reproductive health. BMJ Glob Health 2024; 9:e012391. [PMID: 38688564 PMCID: PMC11085768 DOI: 10.1136/bmjgh-2023-012391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
Due to COVID-19, schools were closed to mitigate disease spread. Past studies have shown that disruptions in education have unintended consequences for adolescents, including increasing their risk of school dropout, exploitation, gender-based violence, pregnancy and early unions. In Peru, the government closed schools from March 2020 to March 2022, declaring a national emergency that affected an estimated 8 million children. These closures may have unintended consequences, including increased adolescent pregnancy, particularly in Peru's rural, largely indigenous regions. Loreto, located in the Peruvian Amazon, has one of the highest adolescent pregnancy rates in the country and poor maternal and child health outcomes. The underlying causes may not be fully understood as data are limited, especially as we transition out of the pandemic. This qualitative study investigated the downstream effects of COVID-19 on adolescent education and reproductive health in Loreto's districts of Nauta and Parinari. In-depth interviews (n=41) were conducted with adolescents and community leaders. These were held in June 2022, 3 months after the reinstitution of in-person classes throughout Peru. Focus group discussions (FGDs) were also completed with community health workers and educators from the same study area in October 2022 to supplement our findings (3 FGDs, n=15). We observed that the economic, educational and health effects of the COVID-19 pandemic contributed to reduced contraceptive use, and increased school abandonment, early unions and adolescent pregnancy. The interplay between adolescent pregnancy and both early unions and school abandonment was bidirectional, with each acting as both a cause and consequence of the other.
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Affiliation(s)
- Lisa L Woodson
- Department of Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | | | - Heidi E Brown
- Department of Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Priscilla A Magrath
- Department of Health Promotion Sciences, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | | | - Sydney Pettygrove
- Department of Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Magaly M Blas
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Woodson LL, Garcia Saldivar A, Brown HE, Magrath PA, Farland LV, Blas MM, Madhivanan P. 'You have a lot of mirrors': structural and socioecological factors impacting adolescent pregnancy and reproductive health in the Amazon basin, Peru, a qualitative study. Cult Health Sex 2024:1-17. [PMID: 38315608 DOI: 10.1080/13691058.2024.2308666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
Loreto, in the Peruvian Amazon, has one of the highest adolescent pregnancy rates in the country. However, underlying causes of adolescent pregnancy are not fully understood as data are limited in Indigenous and remote Amazonian communities. This study investigated adolescent reproductive health within Loreto using an ecological systems framework. Forty-one semi-structured interviews were conducted in June 2022: community leaders (n = 12) and adolescent participants between 15 and 17 years of age (pregnant girls, n = 11; never pregnant girls, n = 9; and boys, n = 9). We also conducted focus group discussions with community health workers and educators in October 2022 (three focus groups, n = 15). Adolescent reproductive health is complex with multi-layered factors that put girls at higher risk of pregnancy. We found a paradoxical relationship between expected social and gender norms and individual desires. This research provides a contextual understanding of the lived experience of adolescents and young people in the Amazon region of Peru. Our findings suggest the need for greater exploration of the contradictory ideas surrounding adolescent pregnancy and female sexuality.
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Affiliation(s)
- Lisa Labita Woodson
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Heidi E Brown
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Priscilla A Magrath
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Magaly M Blas
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Blas MM, Reinders S, Alva A, Neuman M, Lange I, Huicho L, Ronsmans C. Effect of the Mamás del Río programme on essential newborn care: a three-year before-and-after outcome evaluation of a community-based, maternal and neonatal health intervention in the Peruvian Amazon. Lancet Reg Health Am 2023; 28:100634. [PMID: 38076412 PMCID: PMC10701122 DOI: 10.1016/j.lana.2023.100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 03/21/2024]
Abstract
Background Despite remarkable progress in maternal and neonatal health, regional inequalities persist in Peru. In rural areas of Amazonian Loreto, access to quality care is difficult, home births are frequent, and neonatal mortality is high. We conducted a prospective before-and-after study to assess the effect after implementation and over time of a community-based intervention on essential newborn care (ENC). Methods Mamás del Río consists of tablet-enhanced educational home visits by Community health workers (CHW) to pregnant women and mothers of newborns, with supportive training on ENC of traditional birth attendants and facility staff. The study area comprised 79 rural communities of three districts in Loreto. Primary outcomes were ENC practices in home births, secondary outcomes were ENC in facility births as well as healthcare seeking, measured at baseline before and at year 2 and year 3 after intervention implementation. Community censuses included questionnaires to women aged 15-49 years with a live birth. We calculated prevalence of outcomes at each time point and estimated adjusted prevalence differences (PD) between time points using post-estimation based on logistic regression. Findings Following implementation early 2019, 97% of communities had a trained CHW. At year 2 follow-up, 63% (322/530) of women received a CHW visit during pregnancy. Seven out of nine ENC indicators among home births improved, with largest adjusted prevalence differences in immediate skin-to-skin contact (50% [95% CI: 42-58], p < 0.0001), colostrum feeding (45% [35-54], p < 0.0001), and cord care (19% [10-28], p = 0.0001). Improvements were maintained at year 3, except for cord care. At year 2, among facility births only three ENC indicators improved, while more women gave birth in a facility. Sensitivity analyses showed ENC prevalence was similar before compared to after onset of Covid-19 lockdown. Interpretation ENC practices in home births improved consistently and changes were sustained over time, despite the onset of the Covid-19 pandemic. A community-based approach for behaviour-change in home-based newborn care appears effective. Process evaluation of mechanisms will help to explain observed effects and understand transferability of findings. Funding Grand Challenges Canada and Peruvian National Council of Science and Technology.
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Affiliation(s)
- Magaly M. Blas
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Stefan Reinders
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Angela Alva
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Melissa Neuman
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Isabelle Lange
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible, and Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Carine Ronsmans
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Ramos Rosas E, Winkler V, Huicho L, Blas MM, Brenner S, De Allegri M. Comprehensive Health Insurance and access to maternal healthcare services among Peruvian women: a cross-sectional study using the 2021 national demographic survey. BMC Pregnancy Childbirth 2023; 23:795. [PMID: 37968607 PMCID: PMC10647135 DOI: 10.1186/s12884-023-06086-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The government-subsidized health insurance scheme Seguro Integral de Salud ("SIS") was introduced in Peru initially to provide coverage to uninsured and poor pregnant women and children under five years old and was later extended to cover all uninsured members of the population following the Peruvian Plan Esencial de Aseguramiento Universal - "PEAS" (Essential UHC Package). Our study aimed to analyze the extent to which the introduction of SIS has increased equity in access and quality by comparing the utilization of maternal healthcare services among women with different insurance coverages. METHODS Relying on the 2021 round of the nationally-representative survey "ENDES" (Encuesta Nacional Demográfica y de Salud Familiar), we analyzed data for 19,181 women aged 15-49 with a history of pregnancy in the five years preceding the survey date. We used a series of logistic regressions to explore the association between health insurance coverage (defined as No Insurance, SIS, or Standard Insurance) and a series of outcome variables measuring access to and quality of all services along the available maternal healthcare continuum. RESULTS Only 46.5% of women across all insurance schemes reported having accessed effective ANC prevention. Findings from the adjusted logistic regression confirmed that insured women were more likely to have accessed ANC services compared with uninsured women. Our findings indicate that women in the "SIS" group were more likely to have accessed six ANC visits (aOR = 1.40; 95% CI 1.14-1.73) as well as effective ANC prevention (aOR = 1.32; 95% CI 1.17-1.48), ANC education (aOR = 1.59; 95% CI 1.41-1.80) and ANC screening (aOR = 1.46; 95% CI 1.27-1.69) during pregnancy, compared with women in the "Standard Insurance" group [aOR = 1.35 (95% CI 1.13-1.62), 1.22 (95% CI 1.04-1.42), 1.34 (95% CI 1.18-1.51) and 1.31(95% CI 1.15-1.49)] respectively. In addition, women in the "Standard Insurance" group were more likely to have received skilled attendance at birth (aOR = 2.17, 95% CI 1.33-3.55) compared with the women in the "SIS" insurance group (aOR = 2.12; 95% CI 1.41-3.17). CONCLUSIONS Our findings indicate the persistence of inequities in access to maternal healthcare services that manifest themselves not only in the reduced utilization among the uninsured, but also in the lower quality of service coverage that uninsured women received compared with women insured under "Standard Insurance" or "SIS". Further policy reforms are needed both to expand insurance coverage and to ensure that all women receive the same access to care irrespective of their specific insurance coverage.
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Affiliation(s)
- Eduardo Ramos Rosas
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Volker Winkler
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Luis Huicho
- Centro de Investigación en Salud Materna E Infantil, Centro de Investigación Para El Desarrollo Integral y Sostenible and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Magaly M Blas
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Stephan Brenner
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Cueva GAH, Ramírez RGN, Visconti-Lopez FJ, Bendezu-Quispe G, Vargas-Fernández R. Association Between the Autonomy of Peruvian Women and the Choice of the Place of Delivery: Analysis of a National Survey, 2019. Matern Child Health J 2023; 27:1823-1833. [PMID: 37329422 DOI: 10.1007/s10995-023-03740-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES To determine the association between Peruvian women's autonomy and place of delivery. METHODS An analytical cross-sectional study of secondary data from the Demographic and Family Health Survey 2019 was carried out. The dependent variable was institutionalized childbirth, and the independent variable was women's autonomy. Likewise, the association between women's autonomy and institutionalized childbirth was evaluated using Poisson family generalized linear models with logarithmic link function, and crude (PR) and adjusted prevalence ratios (aPR) with their respective 95% confidence interval (CI) were estimated. RESULTS The analysis included 15,334 women aged 15-49 years. It was found that a high proportion of women had a low level of autonomy (42.6%; 95% CI: 41.5-43.7), while 92.1% (95% CI: 91.3-92.9) had institutionalized childbirth. Moderate (PR: 1.10; 95% CI: 1.08-1.12) and high (PR: 1.13; 95% CI: 1.12-1.15) levels of women's autonomy were found to be associated with institutionalized childbirth, and the same association was found in the adjusted analysis. CONCLUSION Being a woman with a higher level of autonomy was related to a higher prevalence of institutionalized childbirth. Therefore, as decision-making is a multifactorial characteristic, it is necessary to study in depth the determinants of non-institutionalized childbirth in women with less autonomy.
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Affiliation(s)
| | | | | | - Guido Bendezu-Quispe
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
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Samsamshariat T, Madhivanan P, Reyes Fernández Prada A, Moya EM, Meza G, Reinders S, Blas MM. Hear my voice: understanding how community health workers in the Peruvian Amazon expanded their roles to mitigate the impact of the COVID-19 pandemic through community-based participatory research. BMJ Glob Health 2023; 8:e012727. [PMID: 37832965 PMCID: PMC10583076 DOI: 10.1136/bmjgh-2023-012727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/30/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic led to the collapse of the Peruvian health system, disrupting healthcare access for indigenous communities in the Amazon. Our study analysed how community health workers (CHWs) from indigenous communities in the Peruvian Amazon expanded their roles to mitigate the effects of the COVID-19 pandemic. METHODS Fourteen CHWs from Loreto, Peru, participated in a community-based participatory research project using Photovoice, a technique encouraging vulnerable groups to take photos and develop stories illustrating their lived experiences. Participants were recruited from Mamás del Río, a local university-based programme, through purposive sampling. CHWs were asked to photograph how the pandemic affected their lives and work. Participants met four times over 5 months to share photos and develop action items. Data were organised into key themes using thematic analysis. CHWs shared photo galleries with policy-makers in Loreto and Lima. RESULTS CHWs produced 36 photos with 33 texts highlighting their roles during COVID-19. Three core themes emerged: the (1) collapse of health infrastructure, (2) use of medicinal plants versus pharmaceuticals and (3) community adaptations and struggles. The leadership of CHWs emerged as a cross-cutting theme as CHWs supported COVID-19 efforts without government training or resources. CHWs asked policy-makers for formal integration into the health system, standardisation of training and management of community pharmacies. CONCLUSION CHWs demonstrated their leadership and expanded their roles during the pandemic with little to no training from the government. Global investment in robust CHW programmes can fortify healthcare delivery.
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Affiliation(s)
- Tina Samsamshariat
- The University of Arizona College of Medicine, Phoenix, Arizona, USA
- Department of Emergency Medicine, LAC USC Medical Center, Los Angeles, California, USA
| | - Purnima Madhivanan
- Mel & Enid Zuckerman College of Public Health, University of Arizona Medical Center - University Campus, Tucson, Arizona, USA
| | | | - Eva M Moya
- Department of Social Work, The University of Texas, El Paso, Texas, USA
| | - Graciela Meza
- Faculty of Medicine, Universidad Nacional de la Amazonia Peruana, Iquitos, Peru
| | - Stefan Reinders
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Magaly M Blas
- Epidemiology, STD, HIV Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Ani-Amponsah M, Richter S, Adam MAH, Osei EA, Mustapha M, Oti-Boadi E. Hot fomentation of newborn fontanelles as an indigenous practice in Ghana: implications for policy and integrated community-based health care in Covid-19 pandemic and beyond. Int J Equity Health 2023; 22:37. [PMID: 36850018 PMCID: PMC9969019 DOI: 10.1186/s12939-023-01852-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 02/22/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE African newborns undergo numerous traditional and religious practices ranging from fontanelle fomentation to total head shaving, scalp molding, skin scarification and ano-genital irrigation which can negatively impact the health of neonates. Hot fomentation of fontanelles has been a predominant indigenous home-based postnatal practice in Ghana and among Africans in the diaspora. Mobility restrictions during the Covid-19 pandemic has impacted direct access to facility-based care as well as home care. The flourishing of newborn traditional practices among African populations during this Covid-19 pandemic offers opportunities to rethink the provision of family healthcare support for newborns during the ongoing pandemic and beyond. Hence, the aim of this critical review was to examine and describe a common indigenous practice-hot fontanelle fomentation to inform home birth support, discharge planning, and the delivery of optimal home-based care support. STUDY DESIGN This study is a review of literature on hot fomentation of newborn fontanelles. METHODS Literature search in CINAHL, PubMed, African Index Medicus and Scopus, was conducted and evidence synthesised from articles ranging from 1983-2022. Sixty articles were reviewed; however, 10 manuscripts were excluded prior to screening. The other 19 were exempted because they were either below 1983 or were not the best fit for the study purpose. In all, 31 studies were included in the study. The study was guided by Madeleine Leininger's Culture Care Diversity and Universality care theory. RESULTS The current study identifies hot fomentation of newborn fontanelles practices in Ghana, the description of hot fomentation practices and the dangers associated with it. The findings and suggested ways to help overcome this challenge. CONCLUSION There are several neonatal indigenous practices including fontanelle fomentation which pose threat to the health of the neonate as discussed in this study. Future research needs to investigate innovative ways of fontanelle fomentation where necessary instead of the use of hot water by mothers, especially in this Covid-19 pandemic where health and mobility restrictions impact physical access to timely health care. This research will help educate mothers about the dangers of fontanel fomentation and reduce the practice, especially in rural areas of developing countries. This could help reduce neonatal mortality and unnecessary healthcare costs.
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Affiliation(s)
- Mary Ani-Amponsah
- Maternal & Child Health Department, School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana
| | - Solina Richter
- Faculty of Nursing, ECHA 5-2381, Edmonton Clinic Health Academy (ECHA), University of Alberta, 11405 87 Avenue, Edmonton, T6G 1C9, Canada
| | | | | | - Mahama Mustapha
- Department of Child Health, Tamale Teaching Hospital, Tamale, Northern Region, Ghana
| | - Ezekiel Oti-Boadi
- Department of Nursing, School of Nursing and Midwifery, Valley View University, Accra, Ghana
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Reinders S, Blas MM, Neuman M, Huicho L, Ronsmans C. Prevalence of essential newborn care in home and facility births in the Peruvian Amazon: analysis of census data from programme evaluation in three remote districts of the Loreto region. Lancet Reg Health Am 2022; 18:100404. [PMID: 36844009 PMCID: PMC9950545 DOI: 10.1016/j.lana.2022.100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/16/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
Background Essential newborn care (ENC) covers optimal breastfeeding, thermal care, and hygienic cord care. These practices are fundamental to save newborn lives. Despite neonatal mortality remaining high in some parts of Peru, no comprehensive data on ENC is available. We sought to estimate the prevalence of ENC and assess differences between facility and home births in the remote Peruvian Amazon. Methods We used baseline data from a household census of rural communities of three districts in Loreto region, collected as part of the evaluation of a maternal-neonatal health (MNH) programme. Women between 15 and 49 years with a live birth in the last 12 months were invited to complete a questionnaire about MNH-related care and ENC. Prevalence of ENC was calculated for all births and disaggregated by place of birth. Adjusted prevalence differences (PD) were post-estimated from logistic regression models on the effect of place of birth on ENC. Findings All 79 rural communities with a population of 14,474 were censused. Among 324 (>99%) women interviewed, 70% gave birth at home, most (93%) without skilled birth assistance. Among all births, prevalence was lowest for immediate skin-to-skin contact (24%), colostrum feeding (47%), and early breastfeeding (64%). ENC was consistently lower in home compared to facility births. After adjusting for confounders, largest PD were found for immediate skin-to-skin contact (50% [95% CI: 38-62]), colostrum feeding (26% [16-36]), and clean cord care (23% [14-32]). ENC prevalence in facilities ranged between 58 and 93%; delayed bathing was lower compared to home births (-19% [-31 to -7]). Interpretation Low prevalence of ENC practices among home births in a setting with high neonatal mortality and difficult access to quality care in facilities suggests potential for a community-based intervention to promote ENC practices at home, along with promotion of healthcare seeking and simultaneous strengthening of routine facility care. Funding Grand Challenges Canada and Peruvian National Council of Science, Technology, and Technology Innovation.
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Affiliation(s)
- Stefan Reinders
- Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú,Corresponding author. Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Magaly M. Blas
- Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Melissa Neuman
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK,MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Carine Ronsmans
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Cuervo-Amore LG, Blas MM. Social innovations for health. Biomedica 2022; 42:422-8. [PMID: 36122280 DOI: 10.7705/biomedica.6725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Indexed: 11/21/2022]
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Sands K, Spiller OB, Thomson K, Portal EAR, Iregbu KC, Walsh TR. Early-Onset Neonatal Sepsis in Low- and Middle-Income Countries: Current Challenges and Future Opportunities. Infect Drug Resist 2022; 15:933-946. [PMID: 35299860 PMCID: PMC8921667 DOI: 10.2147/idr.s294156] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/17/2022] [Indexed: 12/18/2022] Open
Abstract
Neonatal sepsis is defined as a systemic infection within the first 28 days of life, with early-onset sepsis (EOS) occurring within the first 72h, although the definition of EOS varies in literature. Whilst the global incidence has dramatically reduced over the last decade, neonatal sepsis remains an important cause of neonatal mortality, highest in low- and middle-income countries (LMICs). Symptoms at the onset of neonatal sepsis can be subtle, and therefore EOS is often difficult to diagnose from clinical presentation and laboratory testing and blood cultures are not always conclusive or accessible, especially in resource limited countries. Although the World Health Organisation (WHO) currently advocates a ß-lactam, and gentamicin for first line treatment, availability and cost influence the empirical antibiotic therapy administered. Antibiotic treatment of neonatal sepsis in LMICs is highly variable, partially caused by factors such as cost of antibiotics (and who pays for them) and access to certain antibiotics. Antimicrobial resistance (AMR) has increased considerably over the past decade and this review discusses current microbiology data available in the context of the diagnosis, and treatment for EOS. Importantly, this review highlights a large variability in data availability, methodology, availability of diagnostics, and aetiology of sepsis pathogens.
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Affiliation(s)
- Kirsty Sands
- Ineos Institute of Antimicrobial Research, Department of Zoology, University of Oxford, Oxford, UK
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Owen B Spiller
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Kathryn Thomson
- Ineos Institute of Antimicrobial Research, Department of Zoology, University of Oxford, Oxford, UK
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | | | | | - Timothy R Walsh
- Ineos Institute of Antimicrobial Research, Department of Zoology, University of Oxford, Oxford, UK
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
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