1
|
Goldenberg RL, Saleem S, Billah SM, Kim J, Moore JL, Ghanchi NK, Haque R, Figueroa L, Ayala A, Lokangaka A, Tshefu A, Goudar SS, Kavi A, Somannavar M, Esamai F, Mwenechanya M, Chomba E, Patel A, Das P, Emonyi WI, Edidi S, Deshmukh M, Hossain B, Siraj S, Mazariegos M, Garces AL, Bauserman M, Bose CL, Petri WA, Krebs NF, Derman RJ, Carlo WA, Liechty EA, Hibberd PL, Koso‐Thomas M, Peres‐da‐Silva N, Nolen TL, McClure EM. COVID-19 antibody positivity over time and pregnancy outcomes in seven low-and-middle-income countries: A prospective, observational study of the Global Network for Women's and Children's Health Research. BJOG 2023; 130:366-376. [PMID: 36504437 PMCID: PMC9877904 DOI: 10.1111/1471-0528.17366] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine COVID-19 antibody positivity rates over time and relationships to pregnancy outcomes in low- and middle-income countries (LMICs). DESIGN With COVID-19 antibody positivity at delivery as the exposure, we performed a prospective, observational cohort study in seven LMICs during the early COVID-19 pandemic. SETTING The study was conducted among women in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry (MNHR), a prospective, population-based study in Kenya, Zambia, the Democratic Republic of the Congo (DRC), Bangladesh, Pakistan, India (two sites), and Guatemala. POPULATION Pregnant women enrolled in an ongoing pregnancy registry at study sites. METHODS From October 2020 to October 2021, standardised COVID-19 antibody testing was performed at delivery among women enrolled in MNHR. Trained staff masked to COVID-19 status obtained pregnancy outcomes, which were then compared with COVID-19 antibody results. MAIN OUTCOME MEASURES Antibody status, stillbirth, neonatal mortality, maternal mortality and morbidity. RESULTS At delivery, 26.0% of women were COVID-19 antibody positive. Positivity increased over the four time periods across all sites: 13.8%, 15.4%, 21.0% and 40.9%. In the final period, positivity rates were: DRC 27.0%, Kenya 33.1%, Pakistan 32.8%, Guatemala 37.0%, Zambia 37.8%, Bangladesh 47.2%, Nagpur, India 57.4% and Belagavi, India 62.4%. Adjusting for site and maternal characteristics, stillbirth, neonatal mortality, low birthweight and preterm birth were not significantly associated with COVID-19. The adjusted relative risk (aRR) for stillbirth was 1.27 (95% CI 0.95-1.69). Postpartum haemorrhage was associated with antibody positivity (aRR 1.44; 95% CI 1.01-2.07). CONCLUSIONS In pregnant populations in LMICs, COVID-19 antibody positivity has increased. However, most adverse pregnancy outcomes were not significantly associated with antibody positivity.
Collapse
Affiliation(s)
| | | | - Sk Masum Billah
- International Centre for Diarrhoeal Disease Research (icddr,b)DhakaBangladesh
- University of SydneySydneyNew South WalesAustralia
| | - Jean Kim
- RTI InternationalDurhamNorth CarolinaUSA
| | | | | | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research (icddr,b)DhakaBangladesh
| | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y PanamáGuatemala CityGuatemala
| | - Alejandra Ayala
- Instituto de Nutrición de Centroamérica y PanamáGuatemala CityGuatemala
| | - Adrien Lokangaka
- Kinshasa School of Public HealthKinshasaDemocratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public HealthKinshasaDemocratic Republic of the Congo
| | - Shivaprasad S. Goudar
- KLE Academy Higher Education and Research, J N Medical College BelagaviKarnatakaIndia
| | - Avinash Kavi
- KLE Academy Higher Education and Research, J N Medical College BelagaviKarnatakaIndia
| | - Manjunath Somannavar
- KLE Academy Higher Education and Research, J N Medical College BelagaviKarnatakaIndia
| | | | | | - Elwyn Chomba
- University of Zambia University Teaching HospitalLusakaZambia
| | - Archana Patel
- Lata Medical Research FoundationNagpurIndia
- Datta Meghe Institute of Medical SciencesSawangiIndia
| | - Prabir Das
- Lata Medical Research FoundationNagpurIndia
| | | | - Samuel Edidi
- Laboratoire National de Référence du PNLSKinshasaDemocratic Republic of the Congo
| | | | - Biplob Hossain
- International Centre for Diarrhoeal Disease Research (icddr,b)DhakaBangladesh
| | - Shahjahan Siraj
- International Centre for Diarrhoeal Disease Research (icddr,b)DhakaBangladesh
| | - Manolo Mazariegos
- Instituto de Nutrición de Centroamérica y PanamáGuatemala CityGuatemala
| | - Ana L. Garces
- Instituto de Nutrición de Centroamérica y PanamáGuatemala CityGuatemala
| | - Melissa Bauserman
- University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Carl L. Bose
- University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | - Nancy F. Krebs
- University of Colorado School of MedicineDenverColoradoUSA
| | | | | | - Edward A. Liechty
- Indiana School of MedicineUniversity of IndianaIndianapolisIndianaUSA
| | | | - Marion Koso‐Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBethesdaMarylandUSA
| | | | | | | |
Collapse
|
2
|
Naqvi S, Saleem S, Naqvi F, Billah SM, Nielsen E, Fogleman E, Peres‐da‐Silva N, Figueroa L, Mazariegos M, Garces AL, Patel A, Das P, Kavi A, Goudar SS, Esamai F, Chomba E, Lokangaka A, Tshefu A, Haque R, Siraj S, Yousaf S, Bauserman M, Liechty EA, Krebs NF, Derman RJ, Carlo WA, Petri WA, Hibberd PL, Koso‐Thomas M, Thorsten V, McClure EM, Goldenberg RL. Knowledge, attitudes, and practices of pregnant women regarding COVID-19 vaccination in pregnancy in 7 low- and middle-income countries: An observational trial from the Global Network for Women and Children's Health Research. BJOG 2022; 129:2002-2009. [PMID: 35596701 PMCID: PMC9347929 DOI: 10.1111/1471-0528.17226] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/11/2022] [Accepted: 05/15/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We sought to determine the knowledge, attitudes and practices of pregnant women regarding COVID-19 vaccination in pregnancy in seven low- and middle-income countries (LMIC). DESIGN Prospective, observational, population-based study. SETTINGS Study areas in seven LMICs: Bangladesh, India, Pakistan, Guatemala, Democratic Republic of the Congo (DRC), Kenya and Zambia. POPULATION Pregnant women in an ongoing registry. METHODS COVID-19 vaccine questionnaires were administered to pregnant women in the Global Network's Maternal Newborn Health Registry from February 2021 through November 2021 in face-to-face interviews. MAIN OUTCOME MEASURES Knowledge, attitude and practice regarding vaccination during pregnancy; vaccination status. RESULTS No women were vaccinated except for small proportions in India (12.9%) and Guatemala (5.5%). Overall, nearly half the women believed the COVID-19 vaccine is very/somewhat effective and a similar proportion believed that the COVID-19 vaccine is safe for pregnant women. With availability of vaccines, about 56.7% said they would get the vaccine and a 34.8% would refuse. Of those who would not get vaccinated, safety, fear of adverse effects, and lack of trust predicted vaccine refusal. Those with lower educational status were less willing to be vaccinated. Family members and health professionals were the most trusted source of information for vaccination. CONCLUSIONS This COVID-19 vaccine survey in seven LMICs found that knowledge about the effectiveness and safety of the vaccine was generally low but varied. Concerns about vaccine safety and effectiveness among pregnant women is an important target for educational efforts to increase vaccination rates.
Collapse
Affiliation(s)
| | | | | | - Sk Masum Billah
- Maternal and Child Health DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
- University of VirginiaCharlottesvilleVirginiaUSA
| | | | | | | | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y PanamáGuatemala CityGuatemala
| | - Manolo Mazariegos
- Instituto de Nutrición de Centroamérica y PanamáGuatemala CityGuatemala
| | - Ana L. Garces
- Instituto de Nutrición de Centroamérica y PanamáGuatemala CityGuatemala
| | | | - Prabir Das
- Lata Medical Research FoundationNagpurIndia
| | - Avinash Kavi
- KLE Academy Higher Education and ResearchJ N Medical CollegeBelagaviIndia
| | | | | | | | - Adrien Lokangaka
- Department of PediatricsKinshasa School of Public HealthKinshasaDemocratic Republic of the Congo
| | - Antoinette Tshefu
- Department of PediatricsKinshasa School of Public HealthKinshasaDemocratic Republic of the Congo
| | - Rashidul Haque
- Maternal and Child Health DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Shahjahan Siraj
- Maternal and Child Health DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | | | - Melissa Bauserman
- University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Edward A. Liechty
- Department of PediatricsIndiana School of Medicine, University of IndianaIndianapolisIndianaUSA
| | - Nancy F. Krebs
- Section of Nutrition, Department of PediatricsUniversity of Colorado School of MedicineDenverColoradoUSA
| | | | | | | | | | - Marion Koso‐Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBethesdaMarylandUSA
| | | | | | - Robert L. Goldenberg
- Department of Obstetrics and GynecologyColumbia University School of MedicineNew YorkNew YorkUSA
| |
Collapse
|
3
|
Tang M, Weaver NE, Frank DN, Ir D, Robertson CE, Kemp JF, Westcott J, Shankar K, Garces AL, Figueroa L, Tshefu AK, Lokangaka AL, Goudar SS, Somannavar M, Aziz S, Saleem S, McClure EM, Hambidge KM, Hendricks AE, Krebs NF. Longitudinal Reduction in Diversity of Maternal Gut Microbiota During Pregnancy Is Observed in Multiple Low-Resource Settings: Results From the Women First Trial. Front Microbiol 2022; 13:823757. [PMID: 35979501 PMCID: PMC9376441 DOI: 10.3389/fmicb.2022.823757] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To characterize the changes in gut microbiota during pregnancy and determine the effects of nutritional intervention on gut microbiota in women from sub-Saharan Africa (the Democratic Republic of the Congo, DRC), South Asia (India and Pakistan), and Central America (Guatemala). Methods Pregnant women in the Women First (WF) Preconception Maternal Nutrition Trial were included in this analysis. Participants were randomized to receive a lipid-based micronutrient supplement either ≥3 months before pregnancy (Arm 1); started the same intervention late in the first trimester (Arm 2); or received no nutrition supplements besides those self-administered or prescribed through local health services (Arm 3). Stool and blood samples were collected during the first and third trimesters. Findings presented here include fecal 16S rRNA gene-based profiling and systemic and intestinal inflammatory biomarkers, including alpha (1)-acid glycoprotein (AGP), C-reactive protein (CRP), fecal myeloperoxidase (MPO), and calprotectin. Results Stool samples were collected from 640 women (DRC, n = 157; India, n = 102; Guatemala, n = 276; and Pakistan, n = 105). Gut microbial community structure did not differ by intervention arm but changed significantly during pregnancy. Richness, a measure of alpha-diversity, decreased over pregnancy. Community composition (beta-diversity) also showed a significant change from first to third trimester in all four sites. Of the top 10 most abundant genera, unclassified Lachnospiraceae significantly decreased in Guatemala and unclassified Ruminococcaceae significantly decreased in Guatemala and DRC. The change in the overall community structure at the genus level was associated with a decrease in the abundances of certain genera with low heterogeneity among the four sites. Intervention arms were not significantly associated with inflammatory biomarkers at 12 or 34 weeks. AGP significantly decreased from 12 to 34 weeks of pregnancy, whereas CRP, MPO, and calprotectin did not significantly change over time. None of these biomarkers were significantly associated with the gut microbiota diversity. Conclusion The longitudinal reduction of individual genera (both commensals and potential pathogens) and alpha-diversity among all sites were consistent and suggested that the effect of pregnancy on the maternal microbiota overrides other influencing factors, such as nutrition intervention, geographical location, diet, race, and other demographical variables.
Collapse
Affiliation(s)
- Minghua Tang
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nicholas E. Weaver
- Department of Mathematical and Statistical Sciences, University of Colorado, Denver, Denver, CO, United States
| | - Daniel N. Frank
- Department of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Diana Ir
- Department of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Charles E. Robertson
- Department of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jennifer F. Kemp
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jamie Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kartik Shankar
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ana L. Garces
- Institute of Nutrition in Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Lester Figueroa
- Institute of Nutrition in Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Antoinette K. Tshefu
- Institute of Nutrition in Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Adrien L. Lokangaka
- Institute of Nutrition in Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Shivaprasad S. Goudar
- KLE Academy of Higher Education and Research (Deemed-to-be-University), Jawaharlal Nehru Medical College, Belagavi, India
| | - Manjunath Somannavar
- KLE Academy of Higher Education and Research (Deemed-to-be-University), Jawaharlal Nehru Medical College, Belagavi, India
| | - Sumera Aziz
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - K. Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Audrey E. Hendricks
- Department of Mathematical and Statistical Sciences, University of Colorado, Denver, Denver, CO, United States
| | - Nancy F. Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| |
Collapse
|
4
|
Naqvi F, Naqvi S, Billah SM, Saleem S, Fogleman E, Peres-da-Silva N, Figueroa L, Mazariegos M, Garces AL, Patel A, Das P, Kavi A, Goudar SS, Esamai F, Chomba E, Lokangaka A, Tshefu A, Haque R, Siraj S, Yousaf S, Bauserman M, Liechty EA, Krebs NF, Derman RJ, Carlo WA, Petri WA, Hibberd PL, Koso-Thomas M, Bann CM, McClure EM, Goldenberg RL. Knowledge, attitude and practices of pregnant women related to COVID-19 infection: A cross-sectional survey in seven countries from the Global Network for Women's and Children's Health. BJOG 2022; 129:1289-1297. [PMID: 35157346 PMCID: PMC9111113 DOI: 10.1111/1471-0528.17122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/11/2022] [Accepted: 01/20/2022] [Indexed: 12/02/2022]
Abstract
Pregnant women in 7 low and middle income sites often had incomplete knowledge related to COVID‐19 and practices to prevent COVID‐19 during pregnancy varied.
Collapse
Affiliation(s)
| | | | - Sk Masum Billah
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | | | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Manolo Mazariegos
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India.,Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Prabir Das
- Lata Medical Research Foundation, Nagpur, India
| | - Avinash Kavi
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, India
| | | | | | | | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shahjahan Siraj
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Melissa Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, Indiana, USA
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, Colorado, USA
| | | | | | - William A Petri
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | | | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, New York, USA
| |
Collapse
|
5
|
Bresnahan BW, Vodicka E, Babigumira JB, Malik AM, Yego F, Lokangaka A, Chitah BM, Bauer Z, Chavez H, Moore JL, Garrison LP, Swanson JO, Swanson D, McClure EM, Goldenberg RL, Esamai F, Garces AL, Chomba E, Saleem S, Tshefu A, Bose CL, Bauserman M, Carlo W, Bucher S, Liechty EA, Nathan RO. Cost estimation alongside a multi-regional, multi-country randomized trial of antenatal ultrasound in five low-and-middle-income countries. BMC Public Health 2021; 21:952. [PMID: 34016085 PMCID: PMC8135981 DOI: 10.1186/s12889-021-10750-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Improving maternal health has been a primary goal of international health agencies for many years, with the aim of reducing maternal and child deaths and improving access to antenatal care (ANC) services, particularly in low-and-middle-income countries (LMICs). Health interventions with these aims have received more attention from a clinical effectiveness perspective than for cost impact and economic efficiency. METHODS We collected data on resource use and costs as part of a large, multi-country study assessing the use of routine antenatal screening ultrasound (US) with the aim of considering the implications for economic efficiency. We assessed typical antenatal outpatient and hospital-based (facility) care for pregnant women, in general, with selective complication-related data collection in women participating in a large maternal health registry and clinical trial in five LMICs. We estimated average costs from a facility/health system perspective for outpatient and inpatient services. We converted all country-level currency cost estimates to 2015 United States dollars (USD). We compared average costs across countries for ANC visits, deliveries, higher-risk pregnancies, and complications, and conducted sensitivity analyses. RESULTS Our study included sites in five countries representing different regions. Overall, the relative cost of individual ANC and delivery-related healthcare use was consistent among countries, generally corresponding to country-specific income levels. ANC outpatient visit cost estimates per patient among countries ranged from 15 to 30 USD, based on average counts for visits with and without US. Estimates for antenatal screening US visits were more costly than non-US visits. Costs associated with higher-risk pregnancies were influenced by rates of hospital delivery by cesarean section (mean per person delivery cost estimate range: 25-65 USD). CONCLUSIONS Despite substantial differences among countries in infrastructures and health system capacity, there were similarities in resource allocation, delivery location, and country-level challenges. Overall, there was no clear suggestion that adding antenatal screening US would result in either major cost savings or major cost increases. However, antenatal screening US would have higher training and maintenance costs. Given the lack of clinical effectiveness evidence and greater resource constraints of LMICs, it is unlikely that introducing antenatal screening US would be economically efficient in these settings--on the demand side (i.e., patients) or supply side (i.e., healthcare providers). TRIAL REGISTRATION Trial number: NCT01990625 (First posted: November 21, 2013 on https://clinicaltrials.gov ).
Collapse
Affiliation(s)
- B W Bresnahan
- Department of Radiology, University of Washington, Seattle, WA, USA.
| | - E Vodicka
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - J B Babigumira
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - A M Malik
- Aga Khan University, Karachi, Pakistan
| | - F Yego
- Moi University, Eldoret, Kenya
| | - A Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Z Bauer
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - H Chavez
- University of Francisco Marroquin, Guatemala City, Guatemala
| | | | - L P Garrison
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - J O Swanson
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - D Swanson
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | | | | | | | - E Chomba
- University of Zambia, Lusaka, Zambia
| | - S Saleem
- Aga Khan University, Karachi, Pakistan
| | - A Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - C L Bose
- University of North Carolina, Chapel Hill, NC, USA
| | - M Bauserman
- University of North Carolina, Chapel Hill, NC, USA
| | - W Carlo
- University of Alabama Birmingham, Birmingham, AL, USA
| | - S Bucher
- Indiana University, Indianapolis, IN, USA
| | | | - R O Nathan
- Department of Radiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
6
|
Bauserman MS, Bann CM, Hambidge KM, Garces AL, Figueroa L, Westcott JL, Patterson JK, McClure EM, Thorsten VR, Aziz SA, Saleem S, Goldenberg RL, Derman RJ, Herekar V, Somannavar M, Koso-Thomas MW, Lokangaka AL, Tshefu AK, Krebs NF, Bose CL. Gestational weight gain in 4 low- and middle-income countries and associations with birth outcomes: a secondary analysis of the Women First Trial. Am J Clin Nutr 2021; 114:804-812. [PMID: 33876178 PMCID: PMC8326045 DOI: 10.1093/ajcn/nqab086] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 03/02/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Adequate gestational weight gain (GWG) is essential for healthy fetal growth. However, in low- and middle-income countries, where malnutrition is prevalent, little information is available about GWG and how it might be modified by nutritional status and interventions. OBJECTIVE We describe GWG and its associations with fetal growth and birth outcomes. We also examined the extent to which prepregnancy BMI, and preconception and early weight gain modify GWG, and its effects on fetal growth. METHODS This was a secondary analysis of the Women First Trial, including 2331 women within the Democratic Republic of Congo (DRC), Guatemala, India, and Pakistan, evaluating weight gain from enrollment to ∼12 weeks of gestation and GWG velocity (kg/wk) between ∼12 and 32 weeks of gestation. Adequacy of GWG velocity was compared with 2009 Institute of Medicine recommendations, according to maternal BMI. Early weight gain (EWG), GWG velocity, and adequacy of GWG were related to birth outcomes using linear and Poisson models. RESULTS GWG velocity (mean ± SD) varied by site: 0.22 ± 0.15 kg/wk in DRC, 0.30 ± 0.23 in Pakistan, 0.31 ± 0.14 in Guatemala, and 0.39 ± 0.13 in India, (P <0.0001). An increase of 0.1 kg/wk in maternal GWG was associated with a 0.13 cm (95% CI: 0.07, 0.18, P <0.001) increase in birth length and a 0.032 kg (0.022, 0.042, P <0.001) increase in birth weight. Compared to women with inadequate GWG, women who had adequate GWG delivered newborns with a higher mean length and weight: 47.98 ± 2.04 cm compared with 47.40 ± 2.17 cm (P <0.001) and 2.864 ± 0.425 kg compared with 2.764 ± 0.418 kg (P <0.001). Baseline BMI, EWG, and GWG were all associated with birth length and weight. CONCLUSIONS These results underscore the importance of adequate maternal nutrition both before and during pregnancy as a potentially modifiable factor to improve fetal growth.
Collapse
Affiliation(s)
| | | | - K Michael Hambidge
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ana L Garces
- INCAP (Institute of Nutrition of Central America and Panama), Guatemala City, Guatemala
| | - Lester Figueroa
- INCAP (Institute of Nutrition of Central America and Panama), Guatemala City, Guatemala
| | - Jamie L Westcott
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jackie K Patterson
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Sumera Ali Aziz
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Richard J Derman
- Department of Global Affairs, Thomas Jefferson University, Philadelphia, PA, USA
| | - Veena Herekar
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Manjunath Somannavar
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | | | - Adrien L Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Antoinette K Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carl L Bose
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | |
Collapse
|
7
|
Harrison MS, Garces AL, Goudar SS, Saleem S, Moore JL, Esamai F, Patel AB, Chomba E, Bose CL, Liechty EA, Krebs NF, Derman RJ, Hibberd PL, Carlo WA, Tshefu A, Koso-Thomas M, McClure EM, Goldenberg RL. Cesarean birth in the Global Network for Women's and Children's Health Research: trends in utilization, risk factors, and subgroups with high cesarean birth rates. Reprod Health 2020; 17:165. [PMID: 33334352 PMCID: PMC7745346 DOI: 10.1186/s12978-020-01021-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The objectives of this analysis were to document trends in and risk factors associated with the cesarean birth rate in low- and middle-income country sites participating in the Global Network for Women's and Children's Health Research (Global Network). METHODS This is a secondary analysis of a prospective, population-based study of home and facility births conducted in the Global Network sites. RESULTS Cesarean birth rates increased uniformly across all sites between 2010 and 2018. Across all sites in multivariable analyses, women younger than age twenty had a reduced risk of cesarean birth (RR 0.9 [0.9, 0.9]) and women over 35 had an increased risk of cesarean birth (RR 1.1 [1.1, 1.1]) compared to women aged 20 to 35. Compared to women with a parity of three or more, less parous women had an increased risk of cesarean (RR 1.2 or greater [1.2, 1.4]). Four or more antenatal visits (RR 1.2 [1.2, 1.3]), multiple pregnancy (RR 1.3 [1.3, 1.4]), abnormal progress in labor (RR 1.1 [1.0, 1.1]), antepartum hemorrhage (RR 2.3 [2.0, 2.7]), and hypertensive disease (RR 1.6 [1.5, 1.7]) were all associated with an increased risk of cesarean birth, p < 0.001. For multiparous women with a history of prior cesarean birth, rates of vaginal birth after cesarean were about 20% in the Latin American and Southeast Asian sites and about 84% at the sub-Saharan African sites. In the African sites, proportions of cesarean birth in the study were highest among women without a prior cesarean and a single, cephalic, term pregnancy. In the non-African sites, groups with the greatest proportion of cesarean births were nulliparous women with a single, cephalic, term pregnancy and all multiparous women with at least one previous uterine scar with a term, cephalic pregnancy. CONCLUSION Cesarean birth rates continue to rise within the Global Network. The proportions of cesarean birth are higher among women with no history of cesarean birth in the African sites and among women with primary elective cesarean, primary cesarean after induction, and repeat cesarean in the non-African sites.
Collapse
Affiliation(s)
- Margo S Harrison
- University of Colorado School of Medicine, Denver, CO, USA.
- University of Colorado, Mail Stop B198-2, Academic Office 1, 12631 E. 17th Avenue, Rm 4211, Aurora, CO, 80045, USA.
| | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala, Guatemala
| | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research J N Medical College, Belagavi, Karnataka, India
| | | | | | | | | | | | - Carl L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| |
Collapse
|
8
|
Aziz A, Saleem S, Nolen TL, Pradhan NA, McClure EM, Jessani S, Garces AL, Hibberd PL, Moore JL, Goudar SS, Dhaded SM, Esamai F, Tenge C, Patel AB, Chomba E, Mwenechanya M, Bose CL, Liechty EA, Krebs NF, Derman RJ, Carlo WA, Tshefu A, Koso-Thomas M, Siddiqi S, Goldenberg RL. Why are the Pakistani maternal, fetal and newborn outcomes so poor compared to other low and middle-income countries? Reprod Health 2020; 17:190. [PMID: 33334329 PMCID: PMC7745345 DOI: 10.1186/s12978-020-01023-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pakistan has among the poorest pregnancy outcomes worldwide, significantly worse than many other low-resource countries. The reasons for these differences are not clear. In this study, we compared pregnancy outcomes in Pakistan to other low-resource countries and explored factors that might help explain these differences. METHODS The Global Network (GN) Maternal Newborn Health Registry (MNHR) is a prospective, population-based observational study that includes all pregnant women and their pregnancy outcomes in defined geographic communities in six low-middle income countries (India, Pakistan, Democratic Republic of Congo, Guatemala, Kenya, Zambia). Study staff enroll women in early pregnancy and follow-up soon after delivery and at 42 days to ascertain delivery, neonatal, and maternal outcomes. We analyzed the maternal mortality ratios (MMR), neonatal mortality rates (NMR), stillbirth rates, and potential explanatory factors from 2010 to 2018 across the GN sites. RESULTS From 2010 to 2018, there were 91,076 births in Pakistan and 456,276 births in the other GN sites combined. The MMR in Pakistan was 319 per 100,000 live births compared to an average of 124 in the other sites, while the Pakistan NMR was 49.4 per 1,000 live births compared to 20.4 in the other sites. The stillbirth rate in Pakistan was 53.5 per 1000 births compared to 23.2 for the other sites. Preterm birth and low birthweight rates were also substantially higher than the other sites combined. Within weight ranges, the Pakistani site generally had significantly higher rates of stillbirth and neonatal mortality than the other sites combined, with differences increasing as birthweights increased. By nearly every measure, medical care for pregnant women and their newborns in the Pakistan sites was worse than at the other sites combined. CONCLUSION The Pakistani pregnancy outcomes are much worse than those in the other GN sites. Reasons for these poorer outcomes likely include that the Pakistani sites' reproductive-aged women are largely poorly educated, undernourished, anemic, and deliver a high percentage of preterm and low-birthweight babies in settings of often inadequate maternal and newborn care. By addressing the issues highlighted in this paper there appears to be substantial room for improvements in Pakistan's pregnancy outcomes.
Collapse
Affiliation(s)
- Aleha Aziz
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA.
| | | | | | | | | | | | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala, Guatemala
| | | | | | - Shivaprasad S Goudar
- J N Medical College, KLE Academy Higher Education and Research, Belagavi, Karnataka, India
| | - Sangappa M Dhaded
- J N Medical College, KLE Academy Higher Education and Research, Belagavi, Karnataka, India
| | | | | | | | | | | | - Carl L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| |
Collapse
|
9
|
Patel AB, Bann CM, Garces AL, Krebs NF, Lokangaka A, Tshefu A, Bose CL, Saleem S, Goldenberg RL, Goudar SS, Derman RJ, Chomba E, Carlo WA, Esamai F, Liechty EA, Koso-Thomas M, McClure EM, Hibberd PL. Development of the Global Network for Women's and Children's Health Research's socioeconomic status index for use in the network's sites in low and lower middle-income countries. Reprod Health 2020; 17:193. [PMID: 33334359 PMCID: PMC7745356 DOI: 10.1186/s12978-020-01034-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/30/2020] [Indexed: 12/05/2022] Open
Abstract
Background Socioeconomic status (SES) is an important determinant of health globally and an important explanatory variable to assess causality in epidemiological research. The 10th Sustainable Development Goal is to reduce disparities in SES that impact health outcomes globally. It is easier to study SES in high-income countries because household income is representative of the SES. However, it is well recognized that income is poorly reported in low- and middle- income countries (LMIC) and is an unreliable indicator of SES. Therefore, there is a need for a robust index that will help to discriminate the SES of rural households in a pooled dataset from LMIC. Methods The study was nested in the population-based Maternal and Neonatal Health Registry of the Global Network for Women’s and Children’s Health Research which has 7 rural sites in 6 Asian, sub-Saharan African and Central American countries. Pregnant women enrolling in the Registry were asked questions about items such as housing conditions and household assets. The characteristics of the candidate items were evaluated using confirmatory factor analyses and item response theory analyses. Based on the results of these analyses, a final set of items were selected for the SES index. Results Using data from 49,536 households of pregnant women, we reduced the data collected to a 10-item index. The 10 items were feasible to administer, covered the SES continuum and had good internal reliability and validity. We developed a sum score-based Item Response Theory scoring algorithm which is easy to compute and is highly correlated with scores based on response patterns (r = 0.97), suggesting minimal loss of information with the simplified approach. Scores varied significantly by site (p < 0.001). African sites had lower mean SES scores than the Asian and Central American sites. The SES index demonstrated good internal consistency reliability (Cronbach’s alpha = 0.81). Higher SES scores were significantly associated with formal education, more education, having received antenatal care, and facility delivery (p < 0.001). Conclusions While measuring SES in LMIC is challenging, we have developed a Global Network Socioeconomic Status Index which may be useful for comparisons of SES within and between locations. Next steps include understanding how the index is associated with maternal, perinatal and neonatal mortality. Trial Registration NCT01073475 Plain English summary Socioeconomic status (SES) is an important determinant of health globally, and improving SES is important to reduce disparities in health outcomes. It is easier to study SES in high-income countries because it can be measured by income and what income is spent on, but this concept does not translate easily to low and middle income countries. We developed a questionnaire that includes 10 items to determine SES in low-resource settings that was added to an ongoing Maternal and Neonatal Health Registry that is funded by the National Institutes of Child Health and Human Development’s Global Network. The Registry includes sites that collect outcomes of pregnancies in women and their babies in rural areas in 6 countries in South Asia, sub-Saharan Africa and Central America. The Registry is population based and tracks women from early in pregnancy to day 42 post-partum. The questionnaire is easy to administer and has good reliability and validity. Next steps include understanding how the index is associated with maternal, fetal and neonatal mortality.
Collapse
Affiliation(s)
- Archana B Patel
- Lata Medical Research Foundation, Nagpur, India.,Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Carla M Bann
- RTI International, Research Triangle Park, NC, USA
| | | | | | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Carl L Bose
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, India
| | | | | | | | | | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
| | | | - Patricia L Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
| |
Collapse
|
10
|
Bauserman M, Thorsten VR, Nolen TL, Patterson J, Lokangaka A, Tshefu A, Patel AB, Hibberd PL, Garces AL, Figueroa L, Krebs NF, Esamai F, Nyongesa P, Liechty EA, Carlo WA, Chomba E, Goudar SS, Kavi A, Derman RJ, Saleem S, Jessani S, Billah SM, Koso-Thomas M, McClure EM, Goldenberg RL, Bose C. Maternal mortality in six low and lower-middle income countries from 2010 to 2018: risk factors and trends. Reprod Health 2020; 17:173. [PMID: 33334343 PMCID: PMC7745363 DOI: 10.1186/s12978-020-00990-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. METHODS We analyzed data from women enrolled in the NICHD Global Network for Women's and Children's Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. RESULTS We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites. CONCLUSIONS The MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and delivery characteristics associated with increased risk of death, some might be confounded by indication. Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals target of below 70 per 100,000 live births by 2030. TRIAL REGISTRATION The MNHR is registered at NCT01073475 .
Collapse
Affiliation(s)
- Melissa Bauserman
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA.
| | | | | | - Jackie Patterson
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Archana B Patel
- Lata Medical Research Foundation, Nagpur, India
- Adjunct Faculty Medical Research, Datta Meghe Institute of Medical Sciences, Sawangi, India
| | | | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | | | | | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Belgaum, Karnataka, India
| | - Avinash Kavi
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Belgaum, Karnataka, India
| | | | | | | | - Sk Masum Billah
- Maternal and Child Health Division (icddr, b), Dhaka, Bangladesh
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| | - Carl Bose
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA
| |
Collapse
|
11
|
Marete I, Ekhaguere O, Bann CM, Bucher SL, Nyongesa P, Patel AB, Hibberd PL, Saleem S, Goldenberg RL, Goudar SS, Derman RJ, Garces AL, Krebs NF, Chomba E, Carlo WA, Lokangaka A, Bauserman M, Koso-Thomas M, Moore JL, McClure EM, Esamai F. Regional trends in birth weight in low- and middle-income countries 2013-2018. Reprod Health 2020; 17:176. [PMID: 33334365 PMCID: PMC7745347 DOI: 10.1186/s12978-020-01026-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Birth weight (BW) is a strong predictor of neonatal outcomes. The purpose of this study was to compare BWs between global regions (south Asia, sub-Saharan Africa, Central America) prospectively and to determine if trends exist in BW over time using the population-based maternal and newborn registry (MNHR) of the Global Network for Women'sand Children's Health Research (Global Network). METHODS The MNHR is a prospective observational population-based registryof six research sites participating in the Global Network (2013-2018), within five low- and middle-income countries (Kenya, Zambia, India, Pakistan, and Guatemala) in threeglobal regions (sub-Saharan Af rica, south Asia, Central America). The birth weights were obtained for all infants born during the study period. This was done either by abstracting from the infants' health facility records or from direct measurement by the registry staff for infants born at home. After controlling for demographic characteristics, mixed-effect regression models were utilized to examine regional differences in birth weights over time. RESULTS The overall BW meanswere higher for the African sites (Zambia and Kenya), 3186 g (SD 463 g) in 2013 and 3149 g (SD 449 g) in 2018, ascompared to Asian sites (Belagavi and Nagpur, India and Pakistan), 2717 g (SD450 g) in 2013 and 2713 g (SD 452 g) in 2018. The Central American site (Guatemala) had a mean BW intermediate between the African and south Asian sites, 2928 g (SD 452) in 2013, and 2874 g (SD 448) in 2018. The low birth weight (LBW) incidence was highest in the south Asian sites (India and Pakistan) and lowest in the African sites (Kenya and Zambia). The size of regional differences varied somewhat over time with slight decreases in the gap in birth weights between the African and Asian sites and slight increases in the gap between the African and Central American sites. CONCLUSIONS Overall, BWmeans by global region did not change significantly over the 5-year study period. From 2013 to 2018, infants enrolled at the African sites demonstrated the highest BW means overall across the entire study period, particularly as compared to Asian sites. The incidence of LBW was highest in the Asian sites (India and Pakistan) compared to the African and Central American sites. Trial registration The study is registered at clinicaltrials.gov. ClinicalTrial.gov Trial Registration: NCT01073475.
Collapse
Affiliation(s)
- Irene Marete
- Moi University School of Medicine, Eldoret, Kenya.
| | - Osayame Ekhaguere
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Sherri L Bucher
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Karnataka, India
| | | | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | | | | |
Collapse
|
12
|
Goudar SS, Goco N, Somannavar MS, Kavi A, Vernekar SS, Tshefu A, Chomba E, Garces AL, Saleem S, Naqvi F, Patel A, Esamai F, Bose CL, Carlo WA, Krebs NF, Hibberd PL, Liechty EA, Koso-Thomas M, Nolen TL, Moore J, Iyer P, McClure EM, Goldenberg RL, Derman RJ. Institutional deliveries and stillbirth and neonatal mortality in the Global Network's Maternal and Newborn Health Registry. Reprod Health 2020; 17:179. [PMID: 33334337 PMCID: PMC7745350 DOI: 10.1186/s12978-020-01001-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Few studies have shown how the move toward institutional delivery in low and middle-income countries (LMIC) impacts stillbirth and newborn mortality. Objectives The study evaluated trends in institutional delivery in research sites in Belagavi and Nagpur India, Guatemala, Kenya, Pakistan, and Zambia from 2010 to 2018 and compared them to changes in the rates of neonatal mortality and stillbirth. Methods We analyzed data from a nine-year interval captured in the Global Network (GN) Maternal Newborn Health Registry (MNHR). Mortality rates were estimated from generalized estimating equations controlling for within-cluster correlation. Cluster-level analyses were performed to assess the association between institutional delivery and mortality rates. Results From 2010 to 2018, a total of 413,377 deliveries in 80 clusters across 6 sites in 5 countries were included in these analyses. An increase in the proportion of institutional deliveries occurred in all sites, with a range in 2018 from 57.7 to 99.8%. In 2010, the stillbirth rates ranged from 19.3 per 1000 births in the Kenyan site to 46.2 per 1000 births in the Pakistani site and by 2018, ranged from 9.7 per 1000 births in the Belagavi, India site to 40.8 per 1000 births in the Pakistani site. The 2010 neonatal mortality rates ranged from 19.0 per 1000 live births in the Kenyan site to 51.3 per 1000 live births in the Pakistani site with the 2018 neonatal mortality rates ranging from 9.2 per 1000 live births in the Zambian site to 50.2 per 1000 live births in the Pakistani site. In multivariate modeling, in some but not all sites, the reductions in stillbirth and neonatal death were significantly associated with an increase in the institutional deliveries. Conclusions There was an increase in institutional delivery rates in all sites and a reduction in stillbirth and neonatal mortality rates in some of the GN sites over the past decade. The relationship between institutional delivery and a decrease in mortality was significant in some but not all sites. However, the stillbirth and neonatal mortality rates remain at high levels. Understanding the relationship between institutional delivery and stillbirth and neonatal deaths in resource-limited environments will enable development of targeted interventions for reducing the mortality burden. Trial registration The study is registered at clinicaltrials.gov. ClinicalTrial.gov Trial Registration: NCT01073475.
Collapse
Affiliation(s)
- Shivaprasad S Goudar
- KLE Academy of Higher Education and Research Jawaharlal Nehru Medical College, Belagavi, Karnataka, India.
| | | | - Manjunath S Somannavar
- KLE Academy of Higher Education and Research Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Avinash Kavi
- KLE Academy of Higher Education and Research Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Sunil S Vernekar
- KLE Academy of Higher Education and Research Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | | | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | | | | | | | | | - Carl L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | | | | | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| | | |
Collapse
|
13
|
Saleem S, Naqvi F, McClure EM, Nowak KJ, Tikmani SS, Garces AL, Hibberd PL, Moore JL, Nolen TL, Goudar SS, Kumar Y, Esamai F, Marete I, Patel AB, Chomba E, Mwenechanya M, Bose CL, Liechty EA, Krebs NF, Derman RJ, Carlo WA, Tshefu A, Koso-Thomas M, Siddiqi S, Goldenberg RL. Neonatal deaths in infants born weighing ≥ 2500 g in low and middle-income countries. Reprod Health 2020; 17:158. [PMID: 33256782 PMCID: PMC7706246 DOI: 10.1186/s12978-020-01013-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Babies born weighing ≥ 2500 g account for more than 80% of the births in most resource-limited locations and for nearly 50% of the 28-day neonatal deaths. In contrast, in high-resource settings, 28-day neonatal mortality among this group represents only a small fraction of the neonatal deaths. Yet mortality risks for birth weight of ≥ 2500 g is limited. Knowledge regarding the factors associated with mortality in these babies will help in identifying interventions that can reduce mortality. Methods The Global Network’s Maternal Newborn Health Registry (MNHR) is a prospective, population-based observational study that includes all pregnant women and their pregnancy outcomes in defined geographic communities that has been conducted in research sites in six low-middle income countries (India, Pakistan, Democratic Republic of Congo, Guatemala, Kenya and Zambia). Study staff enroll all pregnant women as early as possible during pregnancy and conduct follow-up visits to ascertain delivery and 28-day neonatal outcomes. We analyzed the neonatal mortality rates (NMR) and risk factors for deaths by 28 days among all live-born babies with a birthweight ≥ 2500 g from 2010 to 2018 across the Global Network sites. Results Babies born in the Global Network sites from 2010 to 2018 with a birthweight ≥ 2500 g accounted for 84.8% of the births and 45.4% of the 28-day neonatal deaths. Among this group, the overall NMR was 13.1/1000 live births. The overall 28-day NMR for ongoing clusters was highest in Pakistan (29.7/1000 live births) and lowest in the Zambian/Kenyan sites (9.3/1000) for ≥ 2500 g infants. ≥ 2500 g NMRs declined for Zambia/Kenya and India. For Pakistan and Guatemala, the NMR remained almost unchanged over the period. The ≥ 2500 g risks related to maternal, delivery and newborn characteristics varied by site. Maternal factors that increased risk and were common for all sites included nulliparity, hypertensive disease, previous stillbirth, maternal death, obstructed labor, severe postpartum hemorrhage, and abnormal fetal presentation. Neonatal characteristics including resuscitation, hospitalization, congenital anomalies and male sex, as well as lower gestational ages and birthweights were also associated with increased mortality. Conclusions Nearly half of neonatal deaths in the Global Network sites occurred in infants born weighing ≥ 2500 g. The NMR for those infants was 13.1 per 1000 live births, much higher than rates usually seen in high-income countries. The changes in NMR over time varied across the sites. Even among babies born ≥ 2500 g, lower gestational age and birthweight were largely associated with increased risk of mortality. Since many of these deaths should be preventable, attention to preventing mortality in these infants should have an important impact on overall NMR. Trial registration: https://ClinicalTrials.gov Identifier: NCT01073475
Collapse
Affiliation(s)
| | | | | | | | | | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | | | | | | | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | - Yogesh Kumar
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | | | - Irene Marete
- Moi University School of Medicine, Eldoret, Kenya
| | | | | | | | - Carl L Bose
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| |
Collapse
|
14
|
Patel AB, Simmons EM, Rao SR, Moore J, Nolen TL, Goldenberg RL, Goudar SS, Somannavar MS, Esamai F, Nyongesa P, Garces AL, Chomba E, Mwenechanya M, Saleem S, Naqvi F, Bauserman M, Bucher S, Krebs NF, Derman RJ, Carlo WA, Koso-ThomasMcClure MEM, Hibberd PL. Evaluating the effect of care around labor and delivery practices on early neonatal mortality in the Global Network's Maternal and Newborn Health Registry. Reprod Health 2020; 17:156. [PMID: 33256790 PMCID: PMC7708898 DOI: 10.1186/s12978-020-01010-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal deaths in first 28-days of life represent 47% of all deaths under the age of five years globally and are a focus of the United Nation's (UN's) Sustainable Development Goals. Pregnant women are delivering in facilities but that does not indicate quality of care during delivery and the postpartum period. The World Health Organization's Essential Newborn Care (ENC) package reduces neonatal mortality, but lacks a simple and valid composite index that measures its effectiveness. METHODS Data on 5 intra-partum and 3 post-partum practices (indicators) recommended as part of ENC, routinely collected in NICHD's Global Network's (GN) Maternal Newborn Health Registry (MNHR) between 2010 and 2013, were included. We evaluated if all 8 practices (Care around Delivery - CAD), combined as an index was associated with reduced early neonatal mortality rates (days 0-6 of life). RESULTS A total of 150,848 live births were included in the analysis. The individual indicators varied across sites. All components were present in 19.9% births (range 0.4 to 31% across sites). Present indicators (8 components) were associated with reduced early neonatal mortality [adjusted RR (95% CI):0.81 (0.77, 0.85); p < 0.0001]. Despite an overall association between CAD and early neonatal mortality (RR < 1.0 for all early mortality): delivery by skilled birth attendant; presence of fetal heart and delayed bathing were associated with increased early neonatal mortality. CONCLUSIONS Present indicators (8 practices) of CAD were associated with a 19% reduction in the risk of neonatal death in the diverse health facilities where delivery occurred within the GN MNHR. These indicators could be monitored to identify facilities that need to improve compliance with ENC practices to reduce preventable neonatal deaths. Three of the 8 indicators were associated with increased neonatal mortality, due to baby being sick at birth. Although promising, this composite index needs refinement before use to monitor facility-based quality of care in association with early neonatal mortality. Trial registration The identifier of the Maternal Newborn Health Registry at ClinicalTrials.gov is NCT01073475.
Collapse
Affiliation(s)
- Archana B Patel
- Lata Medical Research Foundation, Nagpur, India.
- Datta Meghe Institute of Medical Sciences, Wardha, India.
| | | | - Sowmya R Rao
- School of Public Health, Boston University, Boston, MA, USA
| | | | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | - Manjunath S Somannavar
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | | | | | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | | | | | | | | | | | | | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | | | | |
Collapse
|
15
|
McClure EM, Garces AL, Hibberd PL, Moore JL, Goudar SS, Saleem S, Esamai F, Patel A, Chomba E, Lokangaka A, Tshefu A, Haque R, Bose CL, Liechty EA, Krebs NF, Derman RJ, Carlo WA, Petri W, Koso-Thomas M, Goldenberg RL. The Global Network Maternal Newborn Health Registry: a multi-country, community-based registry of pregnancy outcomes. Reprod Health 2020; 17:184. [PMID: 33256769 PMCID: PMC7708188 DOI: 10.1186/s12978-020-01020-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/18/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The Global Network for Women's and Children's Health Research (Global Network) conducts clinical trials in resource-limited countries through partnerships among U.S. investigators, international investigators based in in low and middle-income countries (LMICs) and a central data coordinating center. The Global Network's objectives include evaluating low-cost, sustainable interventions to improve women's and children's health in LMICs. Accurate reporting of births, stillbirths, neonatal deaths, maternal mortality, and measures of obstetric and neonatal care is critical to determine strategies for improving pregnancy outcomes. In response to this need, the Global Network developed the Maternal Newborn Health Registry (MNHR), a prospective, population-based registry of pregnant women, fetuses and neonates receiving care in defined catchment areas at the Global Network sites. This publication describes the MNHR, including participating sites, data management and quality and changes over time. METHODS Pregnant women who reside in or receive healthcare in select communities are enrolled in the MNHR of the Global Network. For each woman and her offspring, sociodemographic, health care, and the major outcomes through 42-days post-delivery are recorded. Study visits occur at enrollment during pregnancy, at delivery and at 42 days postpartum. RESULTS From 2010 through 2018, the Global Network MNHR sites were located in Guatemala, Belagavi and Nagpur, India, Pakistan, Democratic Republic of Congo, Kenya, and Zambia. During this period at these sites, 579,140 pregnant women were consented and enrolled in the MNHR, nearly 99% of all eligible women. Delivery data were collected for 99% of enrolled women and 42-day follow-up data for 99% of those delivered. In this supplement, the trends over time and assessment of differences across geographic regions are analyzed in a series of 18 manuscripts utilizing the MNHR data. CONCLUSIONS Improving maternal, fetal and newborn health in countries with poor outcomes requires an understanding of the characteristics of the population, quality of health care and outcomes. Because the worst pregnancy outcomes typically occur in countries with limited health registration systems and vital records, alternative registration systems may prove to be highly valuable in providing data. The MNHR, an international, multicenter, population-based registry, assesses pregnancy outcomes over time in support of efforts to develop improved perinatal healthcare in resource-limited areas. Trial Registration The Maternal Newborn Health Registry is registered at Clinicaltrials.gov (ID# NCT01073475). Registered February 23, 2019. https://clinicaltrials.gov/ct2/show/NCT01073475.
Collapse
Affiliation(s)
- Elizabeth M McClure
- Social, Statistical and Environmental Health Sciences, RTI International, 3040 Cornwallis Rd., Durham, NC, 27709, USA.
| | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | | | - Janet L Moore
- Social, Statistical and Environmental Health Sciences, RTI International, 3040 Cornwallis Rd., Durham, NC, 27709, USA
| | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | | | | | | | | | | | | | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Carl L Bose
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| |
Collapse
|
16
|
Figueroa L, McClure EM, Swanson J, Nathan R, Garces AL, Moore JL, Krebs NF, Hambidge KM, Bauserman M, Lokangaka A, Tshefu A, Mirza W, Saleem S, Naqvi F, Carlo WA, Chomba E, Liechty EA, Esamai F, Swanson D, Bose CL, Goldenberg RL. Oligohydramnios: a prospective study of fetal, neonatal and maternal outcomes in low-middle income countries. Reprod Health 2020; 17:19. [PMID: 32000798 PMCID: PMC6993413 DOI: 10.1186/s12978-020-0854-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 01/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background Oligohydramnios is a condition of abnormally low amniotic fluid volume that has been associated with poor pregnancy outcomes. To date, the prevalence of this condition and its outcomes has not been well described in low and low-middle income countries (LMIC) where ultrasound use to diagnose this condition in pregnancy is limited. As part of a prospective trial of ultrasound at antenatal care in LMICs, we sought to evaluate the incidence of and the adverse maternal, fetal and neonatal outcomes associated with oligohydramnios. Methods We included data in this report from all pregnant women in community settings in Guatemala, Pakistan, Zambia and the Democratic Republic of Congo (DRC) who received a third trimester ultrasound as part of the First Look Study, a randomized trial to assess the value of ultrasound at antenatal care. Using these data, we conducted a planned secondary analysis to compare pregnancy outcomes of women with to those without oligohydramnios. Oligohydramnios was defined as measurement of an Amniotic Fluid Index less than 5 cm in at least one ultrasound in the third trimester. The outcomes assessed included maternal morbidity and fetal and neonatal mortality, preterm birth and low-birthweight. We used pairwise site comparisons with Tukey-Kramer adjustment and multivariable logistic models using general estimating equations to account for the correlation of outcomes within cluster. Results Of 12,940 women enrolled in the clusters in Guatemala, Pakistan, Zambia and the DRC in the First Look Study who had a third trimester ultrasound examination, 87 women were diagnosed with oligohydramnios, equivalent to 0.7% of those studied. Prevalence of detected oligohydramnios varied among study sites; from the lowest of 0.2% in Zambia and the DRC to the highest of 1.5% in Pakistan. Women diagnosed with oligohydramnios had higher rates of hemorrhage, fetal malposition, and cesarean delivery than women without oligohydramnios. We also found unfavorable fetal and neonatal outcomes associated with oligohydramnios including stillbirths (OR 5.16, 95%CI 2.07, 12.85), neonatal deaths < 28 days (OR 3.18, 95% CI 1.18, 8.57), low birth weight (OR 2.10, 95% CI 1.44, 3.07) and preterm births (OR 2.73, 95%CI 1.76, 4.23). The mean birth weight was 162 g less (95% CI -288.6, − 35.9) with oligohydramnios. Conclusions Oligohydramnos was associated with worse neonatal, fetal and maternal outcomes in LMIC. Further research is needed to assess effective interventions to diagnose and ultimately to reduce poor outcomes in these settings. Trial registration NCT01990625.
Collapse
Affiliation(s)
- Lester Figueroa
- Instituto de Nutrición de Centro América y Panamá (INCAP), Guatemala City, Guatemala
| | - Elizabeth M McClure
- Social Statistical and Environmental Health Sciences, RTI International, Durham, NC, USA.
| | - Jonathan Swanson
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Robert Nathan
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Ana L Garces
- Instituto de Nutrición de Centro América y Panamá (INCAP), Guatemala City, Guatemala
| | - Janet L Moore
- Social Statistical and Environmental Health Sciences, RTI International, Durham, NC, USA
| | - Nancy F Krebs
- Department of Pediatrics, University of Colorado, Denver, CO, USA
| | | | - Melissa Bauserman
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Waseem Mirza
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Farnaz Naqvi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elwyn Chomba
- Department of Pediatrics, University of Zambia, Lusaka, Zambia
| | - Edward A Liechty
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | | | - David Swanson
- Department of Radiology, Harborview Medical Center, University of Washington Medical Center, Seattle, WA, USA
| | - Carl L Bose
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | |
Collapse
|
17
|
Swanson DL, Franklin HL, Swanson JO, Goldenberg RL, McClure EM, Mirza W, Muyodi D, Figueroa L, Goldsmith N, Kanaiza N, Naqvi F, Pineda IS, López-Gomez W, Hamsumonde D, Bolamba VL, Newman JE, Fogleman EV, Saleem S, Esamai F, Bucher S, Liechty EA, Garces AL, Krebs NF, Hambidge KM, Chomba E, Bauserman M, Mwenechanya M, Carlo WA, Tshefu A, Lokangaka A, Bose CL, Nathan RO. Including ultrasound scans in antenatal care in low-resource settings: Considering the complementarity of obstetric ultrasound screening and maternity waiting homes in strengthening referral systems in low-resource, rural settings. Semin Perinatol 2019; 43:273-281. [PMID: 30979599 PMCID: PMC6597951 DOI: 10.1053/j.semperi.2019.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Recent World Health Organization (WHO) antenatal care recommendations include an ultrasound scan as a part of routine antenatal care. The First Look Study, referenced in the WHO recommendation, subsequently shows that the routine use of ultrasound during antenatal care in rural, low-income settings did not improve maternal, fetal or neonatal mortality, nor did it increase women's use of antenatal care or the rate of hospital births. This article reviews the First Look Study, reconsidering the assumptions upon which it was built in light of these results, a supplemental descriptive study of interviews with patients and sonographers that participated in the First Look study intervention, and a review of the literature. Two themes surface from this review. The first is that focused emphasis on building the pregnancy risk screening skills of rural primary health care personnel may not lead to adaptations in referral hospital processes that could benefit the patient accordingly. The second is that agency to improve the quality of patient reception at referral hospitals may need to be manufactured for obstetric ultrasound screening, or remote pregnancy risk screening more generally, to have the desired impact. Stemming from the literature, this article goes on to examine the potential for complementarity between obstetric ultrasound screening and another approach encouraged by the WHO, the maternity waiting home. Each approach may address existing shortcomings in how the other is currently understood. This paper concludes by proposing a path toward developing and testing such a hybrid approach.
Collapse
Affiliation(s)
- David L. Swanson
- University of Washington, Seattle, WA, United States,Corresponding author.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jamie E. Newman
- RTI International, Research Triangle Park, NC, United States
| | | | | | | | - Sherri Bucher
- Indiana University, Indianapolis, IN, United States.
| | | | | | | | | | | | - Melissa Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | | | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Carl L. Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | |
Collapse
|
18
|
Tikmani SS, Ali SA, Saleem S, Bann CM, Mwenechanya M, Carlo WA, Figueroa L, Garces AL, Krebs NF, Patel A, Hibberd PL, Goudar SS, Derman RJ, Aziz A, Marete I, Tenge C, Esamai F, Liechty E, Bucher S, Moore JL, McClure EM, Goldenberg RL. Trends of antenatal care during pregnancy in low- and middle-income countries: Findings from the global network maternal and newborn health registry. Semin Perinatol 2019; 43:297-307. [PMID: 31005357 PMCID: PMC7027164 DOI: 10.1053/j.semperi.2019.03.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Antenatal care (ANC) is an important opportunity to diagnose and treat pregnancy-related complications and to deliver interventions aimed at improving health and survival of both mother and the infant. Multiple individual studies and national surveys have assessed antenatal care utilization at a single point in time across different countries, but ANC trends have not often been studied in rural areas of low-middle income countries (LMICs). The objective of this analysis was to study the trends of antenatal care use in LMICs over a seven-year period. METHODS Using a prospective maternal and newborn health registry study, we analyzed data collected from 2011 to 2017 across five countries (Guatemala, India [2 sites], Kenya, Pakistan, and Zambia). Utilization of any ANC along with use of select services, including vitamins/iron, tetanus toxoid vaccine and HIV testing, were assessed. We used a generalized linear regression model to examine the trends of women receiving at least one and at least four antenatal care visits by site and year, controlling for maternal age, education and parity. RESULTS Between January 2011 and December 2017, 313,663 women were enrolled and included in the analysis. For all six sites, a high proportion of women received at least one ANC visit across this period. Over the years, there was a trend for an increasing proportion of women receiving at least one and at least four ANC visits in all sites, except for Guatemala where a decline in ANC was observed. Regarding utilization of specific services, in India almost 100% of women reported receiving tetanus toxoid vaccine, vitamins/iron supplementation and HIV testing services for all study years. In Kenya, a small increase in the proportion of women receiving tetanus toxoid vaccine was observed, while for Zambia, tetanus toxoid use declined from 97% in 2011 to 89% in 2017. No trends for tetanus toxoid use were observed for Pakistan and Guatemala. Across all countries an increasing trend was observed for use of vitamins/iron and HIV testing. However, HIV testing remained very low (<0.1%) for Pakistan. CONCLUSION In a range of LMICs, from 2011 to 2017 nearly all women received at least one ANC visit, and a significant increase in the proportion of women who received at least four ANC visits was observed across all sites except Guatemala. Moreover, there were variations regarding the utilization of preventive care services across all sites except for India where rates were generally high. More research is required to understand the quality and influences of ANC.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Nancy F. Krebs
- University of Colorado School of Medicine, Aurora, CO, United States
| | | | | | | | | | - Aleha Aziz
- Columbia University, New York, NY, United States
| | | | | | | | | | | | | | - Elizabeth M. McClure
- RTI International, Durham, NC, United States,Corresponding author. (E.M. McClure)
| | | |
Collapse
|
19
|
Harrison MS, Saleem S, Ali S, Pasha O, Chomba E, Carlo WA, Garces AL, Krebs NF, Hambidge KM, Goudar SS, Dhaded SM, Kodkany B, Derman RJ, Patel A, Hibberd PL, Esamai F, Liechty EA, Tshefu A, Lokangaka A, Bauserman M, Bose CL, Althabe F, Belizan JM, Buekens P, Moore JL, Wallace DD, Miodovnik M, Koso-Thomas M, McClure EM, Goldenberg RL. A Prospective, Population-Based Study of Trends in Operative Vaginal Delivery Compared to Cesarean Delivery Rates in Low- and Middle-Income Countries, 2010-2016. Am J Perinatol 2019; 36:730-736. [PMID: 30372772 PMCID: PMC6488442 DOI: 10.1055/s-0038-1673656] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Few data are available on cesarean delivery and operative vaginal delivery trends in low- and middle-income countries. Our objective was to analyze a prospective population-based registry including eight sites in seven low- and middle-income countries to observe trends in operative vaginal delivery versus cesarean delivery rates over time, across sites. STUDY DESIGN A prospective population-based study, including home and facility births among women enrolled from 2010 to 2016, was performed in communities in Argentina, Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia. Women were enrolled during pregnancy and delivery outcome data were collected. RESULTS We analyzed 354,287 women; 4,119 (1.2%) underwent an operative vaginal delivery and 45,032 (11.2%) delivered by cesarean. Across all sites with data for 7 years, rates of operative vaginal delivery decreased from 1.6 to 0.3%, while cesarean delivery increased from 6.4 to 14.4%. Similar trends were seen when individual country data were analyzed. Operative vaginal delivery rates decreased in both hospitals and clinics, except in the hospital setting at one of the Indian sites. CONCLUSION In low- and middle-income countries, operative vaginal delivery is becoming less utilized while cesarean delivery is becoming an increasingly common mode of delivery.
Collapse
Affiliation(s)
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sumera Ali
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Omrana Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Elwyn Chomba
- University Teaching Hospital, University of Zambia, Lusaka, Zambia
| | | | - Ana L. Garces
- Unidad de Planificación Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala City, Guatemala
| | - Nancy F. Krebs
- University of Colorado School of Medicine, Denver, Colorado
| | | | | | - S. M. Dhaded
- KLE University’s Jawaharlal Nehru Medical College, Belgaum, India
| | - Bhala Kodkany
- KLE University’s Jawaharlal Nehru Medical College, Belgaum, India
| | | | - Archana Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | | | | | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Melissa Bauserman
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Carl L. Bose
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Fernando Althabe
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jose M. Belizan
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Pierre Buekens
- Tulane School of Public Health and Tropic Medicine, New Orleans, Louisiana
| | | | | | - Menachem Miodovnik
- Eunice Kennedy Shriver, National Institute of Child Health and Human Development, Rockville, Maryland
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver, National Institute of Child Health and Human Development, Rockville, Maryland
| | | | | |
Collapse
|
20
|
Belizán JM, Minckas N, McClure EM, Saleem S, Moore JL, Goudar SS, Esamai F, Patel A, Chomba E, Garces AL, Althabe F, Harrison MS, Krebs NF, Derman RJ, Carlo WA, Liechty EA, Hibberd PL, Buekens PM, Goldenberg RL. An approach to identify a minimum and rational proportion of caesarean sections in resource-poor settings: a global network study. Lancet Glob Health 2019; 6:e894-e901. [PMID: 30012270 PMCID: PMC6357956 DOI: 10.1016/s2214-109x(18)30241-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 03/03/2018] [Accepted: 04/26/2018] [Indexed: 11/30/2022]
Abstract
Background Caesarean section prevalence is increasing in Asia and Latin America while remaining low in most African regions. Caesarean section delivery is effective for saving maternal and infant lives when they are provided for medically-indicated reasons. On the basis of ecological studies, caesarean delivery prevalence between 9% and 19% has been associated with better maternal and perinatal outcomes, such as reduced maternal land fetal mortality. However, the specific prevalence of obstetric and medical complications that require caesarean section have not been established, especially in low-income and middle-income countries (LMICs). We sought to provide information to inform the approach to the provision of caesarean section in low-resource settings. Methods We did a literature review to establish the prevalence of obstetric and medical conditions for six potentially life-saving indications for which caesarean section could reduce mortality in LMICs. We then analysed a large, prospective population-based dataset from six LMICs (Argentina, Guatemala, Kenya, India, Pakistan, and Zambia) to determine the prevalence of caesarean section by indication for each site. We considered that an acceptable number of events would be between the 25th and 75th percentile of those found in the literature. Findings Between Jan 1, 2010, and Dec 31, 2013, we enrolled a total of 271 855 deliveries in six LMICs (seven research sites). Caesarean section prevalence ranged from 35% (3467 of 9813 deliveries in Argentina) to 1% (303 of 16 764 deliveries in Zambia). Argentina’s and Guatemala’s sites all met the minimum 25th percentile for five of six indications, whereas sites in Zambia and Kenya did not reach the minimum prevalence for caesarean section for any of the indications. Across all sites, a minimum overall caesarean section of 9% was needed to meet the prevalence of the six indications in the population studied. Interpretation In the site with high caesarean section prevalence, more than half of the procedures were not done for life-saving conditions, whereas the sites with low proportions of caesarean section (below 9%) had an insufficient number of caesarean procedures to cover those life-threatening causes. Attempts to establish a minimum caesarean prevalence should go together with focusing on the life-threatening causes for the mother and child. Simple methods should be developed to allow timely detection of life-threatening conditions, to explore actions that can remedy those conditions, and the timely transfer of women with those conditions to health centres that could provide adequate care for those conditions.
Collapse
Affiliation(s)
- José M Belizán
- Institute for Clinical Effectiveness, Buenos Aires, Argentina.
| | - Nicole Minckas
- Institute for Clinical Effectiveness, Buenos Aires, Argentina
| | | | - Sarah Saleem
- Department of Community Health, Aga Khan University, Karachi, Pakistan
| | | | - Shivaprasad S Goudar
- Jawaharlal Nehru Medical College, Karnataka Lingayat Education University, Belagavi, India
| | - Fabian Esamai
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | | | - Elwyn Chomba
- Department of Pediatrics, University Teaching Hospital, University of Zambia, Lusaka, Zambia
| | - Ana L Garces
- Instituto de Nutrición de Centro América y Panamá (INCAP), Guatemala City, Guatemala
| | | | - Margo S Harrison
- Department of Obstetrics and Gynecology, Columbia University, New York City, NY, USA
| | - Nancy F Krebs
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | | | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AB, USA
| | - Edward A Liechty
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - Patricia L Hibberd
- Department of Global Health, Boston University School of Public Health, Boston University, Boston, MA, USA
| | - Pierre M Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York City, NY, USA
| |
Collapse
|
21
|
Duffy CR, Moore JL, Saleem S, Tshefu A, Bose CL, Chomba E, Carlo WA, Garces AL, Krebs NF, Hambidge KM, Goudar SS, Derman RJ, Patel A, Hibberd PL, Esamai F, Liechty EA, Wallace DD, McClure EM, Goldenberg RL. Malpresentation in low- and middle-income countries: Associations with perinatal and maternal outcomes in the Global Network. Acta Obstet Gynecol Scand 2018; 98:300-308. [PMID: 30414270 DOI: 10.1111/aogs.13502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/26/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Uncertainty exists regarding the impact of malpresentation on pregnancy outcomes and the optimal mode of delivery in low- and middle-income countries. We sought to compare outcomes between cephalic and non-cephalic pregnancies. MATERIAL AND METHODS Using the NICHD Global Network's prospective, population-based registry of pregnancy outcomes from 2010 to 2016, we studied outcomes in 436 112 singleton pregnancies. Robust Poisson regressions were used to estimate the risk of adverse outcomes associated with malpresentation. We examined rates of cesarean delivery for malpresentation and compared outcomes between cesarean and vaginal delivery by region. RESULTS Across all regions, stillbirth and neonatal mortality rates were higher among deliveries with malpresentation. In adjusted analysis, malpresentation was significantly associated with stillbirth (adjusted relative risk [aRR] 4.0, 95% confidence interval [CI] 3.7-4.5) and neonatal mortality (aRR 2.3, 95% CI 2.1-2.6). Women with deliveries complicated by malpresentation had higher rates of morbidity and mortality. Rates of cesarean delivery for malpresentation ranged from 27% to 87% among regions. Compared with cesarean delivery, vaginal delivery for malpresentation was associated with increased maternal risk, especially postpartum hemorrhage (aRR 5.0, 95% CI; 3.6-7.1). CONCLUSIONS In a cohort of deliveries in low- and middle-income countries, malpresentation was associated with increased perinatal and maternal risk. Further research is needed to determine the best management of these pregnancies.
Collapse
Affiliation(s)
- Cassandra R Duffy
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Janet L Moore
- Social, Statistical and Environmental Health Sciences, Durham, NC, USA
| | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Carl L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Ana L Garces
- Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | | | | | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, India
| | | | | | | | | | | | - Dennis D Wallace
- Social, Statistical and Environmental Health Sciences, Durham, NC, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | |
Collapse
|
22
|
Franklin HL, Mirza W, Swanson DL, Newman JE, Goldenberg RL, Muyodi D, Figueroa L, Nathan RO, Swanson JO, Goldsmith N, Kanaiza N, Naqvi F, Pineda IS, López-Gomez W, Hamsumonde D, Bolamba VL, Fogleman EV, Saleem S, Esamai F, Liechty EA, Garces AL, Krebs NF, Michael Hambidge K, Chomba E, Mwenechanya M, Carlo WA, Tshefu A, Lokangaka A, Bose CL, Koso-Thomas M, Miodovnik M, McClure EM. Factors influencing referrals for ultrasound-diagnosed complications during prenatal care in five low and middle income countries. Reprod Health 2018; 15:204. [PMID: 30541560 PMCID: PMC6291965 DOI: 10.1186/s12978-018-0647-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/23/2018] [Indexed: 11/16/2022] Open
Abstract
Background Ultrasound during antenatal care (ANC) is proposed as a strategy for increasing hospital deliveries for complicated pregnancies and improving maternal, fetal, and neonatal outcomes. The First Look study was a cluster-randomized trial conducted in the Democratic Republic of Congo, Guatemala, Kenya, Pakistan and Zambia to evaluate the impact of ANC-ultrasound on these outcomes. An additional survey was conducted to identify factors influencing women with complicated pregnancies to attend referrals for additional care. Methods Women who received referral due to ANC ultrasound findings participated in structured interviews to characterize their experiences. Cochran-Mantel-Haenszel statistics were used to examine differences between women who attended the referral and women who did not. Sonographers’ exam findings were compared to referred women’s recall. Results Among 700 referred women, 510 (71%) attended the referral. Among referred women, 97% received a referral card to present at the hospital, 91% were told where to go in the hospital, and 64% were told that the hospital was expecting them. The referred women who were told who to see at the hospital (88% vs 66%), where to go (94% vs 82%), or what should happen, were more likely to attend their referral (68% vs 56%). Barriers to attending referrals were cost, transportation, and distance. Barriers after reaching the hospital were substantial. These included not connecting with an appropriate provider, not knowing where to go, and being told to return later. These barriers at the hospital often led to an unsuccessful referral. Conclusions Our study found that ultrasound screening at ANC alone does not adequately address barriers to referrals. Better communication between the sonographer and the patient increases the likelihood of a completed referral. These types of communication include describing the ultrasound findings, including the reason for the referral, to the mother and staff; providing a referral card; describing where to go in the hospital; and explaining the procedures at the hospital. Thus, there are three levels of communication that need to be addressed to increase completion of appropriate referrals-communication between the sonographer and the woman, the sonographer and the clinic staff, and the sonographer and the hospital. Trial registration NCT01990625.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Carl L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | |
Collapse
|
23
|
Short VL, Geller SE, Moore JL, McClure EM, Goudar SS, Dhaded SM, Kodkany BS, Saleem S, Naqvi F, Pasha O, Goldenberg RL, Patel AB, Hibberd PL, Garces AL, Koso-Thomas M, Miodovnik M, Wallace DD, Derman RJ. The Relationship between Body Mass Index in Pregnancy and Adverse Maternal, Perinatal, and Neonatal Outcomes in Rural India and Pakistan. Am J Perinatol 2018; 35:844-851. [PMID: 29365329 PMCID: PMC6233294 DOI: 10.1055/s-0037-1621733] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this study was to describe the relationship between early pregnancy body mass index (BMI) and maternal, perinatal, and neonatal outcomes in rural India and Pakistan. STUDY DESIGN In a prospective, population-based pregnancy registry implemented in communities in Thatta, Pakistan and Nagpur and Belagavi, India, we obtained women's BMI prior to 12 weeks' gestation (categorized as underweight, normal, overweight, and obese following World Health Organization criteria). Outcomes were assessed 42 days postpartum. RESULTS The proportion of women with an adverse maternal outcome increased with increasing maternal BMI. Less than one-third of nonoverweight/nonobese women, 47.2% of overweight women, and 56.0% of obese women experienced an adverse maternal outcome. After controlling for site, maternal age and parity, risks of hypertensive disease/severe preeclampsia/eclampsia, cesarean/assisted delivery, and antibiotic use were higher among women with higher BMIs. Overweight women also had significantly higher risk of perinatal and early neonatal mortality compared with underweight/normal BMI women. Overweight women had a significantly higher perinatal mortality rate. CONCLUSION High BMI in early pregnancy was associated with increased risk of adverse maternal, perinatal, and neonatal outcomes in rural India and Pakistan. These findings present an opportunity to inform efforts for women to optimize weight prior to conception to improve pregnancy outcomes.
Collapse
Affiliation(s)
- Vanessa L. Short
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Stacie E. Geller
- Center for Research on Women and Gender, University of Illinois, Chicago, IL, USA
| | - Janet L. Moore
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC USA
| | - Elizabeth M. McClure
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC USA
| | | | - Sangappa M. Dhaded
- KLE University’s Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | | | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Farnaz Naqvi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Omrana Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Medical School, New York, NY, USA
| | | | | | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Menachem Miodovnik
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Dennis D. Wallace
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC USA
| | - Richard J. Derman
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
24
|
Goldenberg RL, Nathan RO, Swanson D, Saleem S, Mirza W, Esamai F, Muyodi D, Garces AL, Figueroa L, Chomba E, Chiwala M, Mwenechanya M, Tshefu A, Lokangako A, Bolamba VL, Moore JL, Franklin H, Swanson J, Liechty EA, Bose CL, Krebs NF, Michael Hambidge K, Carlo WA, Kanaiza N, Naqvi F, Pineda IS, López-Gomez W, Hamsumonde D, Harrison MS, Koso-Thomas M, Miodovnik M, Wallace DD, McClure EM. Routine antenatal ultrasound in low- and middle-income countries: first look - a cluster randomised trial. BJOG 2018; 125:1591-1599. [PMID: 29782696 DOI: 10.1111/1471-0528.15287] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Ultrasound is widely regarded as an important adjunct to antenatal care (ANC) to guide practice and reduce perinatal mortality. We assessed the impact of ANC ultrasound use at health centres in resource-limited countries. DESIGN Cluster randomised trial. SETTING Clusters within five countries (Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia) METHODS: Clusters were randomised to standard ANC or standard care plus two ultrasounds and referral for complications. The study trained providers in intervention clusters to perform basic obstetric ultrasounds. MAIN OUTCOME MEASURES The primary outcome was a composite of maternal mortality, maternal near-miss mortality, stillbirth, and neonatal mortality. RESULTS During the 24-month trial, 28 intervention and 28 control clusters had 24 263 and 23 160 births, respectively; 78% in the intervention clusters received at least one study ultrasound; 60% received two. The prevalence of conditions noted including twins, placenta previa, and abnormal lie was within expected ranges. 9% were referred for an ultrasound-diagnosed condition, and 71% attended the referral. The ANC (RR 1.0 95% CI 1.00, 1.01) and hospital delivery rates for complicated pregnancies (RR 1.03 95% CI 0.89, 1.20) did not differ between intervention and control clusters nor did the composite outcome (RR 1.09 95% CI 0.97, 1.23) or its individual components. CONCLUSIONS Despite availability of ultrasound at ANC in the intervention clusters, neither ANC nor hospital delivery for complicated pregnancies increased. The composite outcome and the individual components were not reduced. TWEETABLE ABSTRACT Antenatal care ultrasound did not improve a composite outcome that included maternal, fetal, and neonatal mortality.
Collapse
Affiliation(s)
| | - R O Nathan
- University of Washington, Seattle, WA, USA
| | - D Swanson
- University of Washington, Seattle, WA, USA
| | - S Saleem
- Aga Khan University, Karachi, Pakistan
| | - W Mirza
- Aga Khan University, Karachi, Pakistan
| | | | | | | | | | - E Chomba
- University of Zambia, Lusaka, Zambia
| | - M Chiwala
- University of Zambia, Lusaka, Zambia
| | | | - A Tshefu
- Kinshasa School of Public Health, Kinshasa, DRC
| | - A Lokangako
- Kinshasa School of Public Health, Kinshasa, DRC
| | - V L Bolamba
- Kinshasa School of Public Health, Kinshasa, DRC
| | | | | | - J Swanson
- University of Washington, Seattle, WA, USA
| | | | - C L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - N F Krebs
- University of Colorado, Denver, CO, USA
| | | | - W A Carlo
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - F Naqvi
- Aga Khan University, Karachi, Pakistan
| | - I S Pineda
- San Carlos University, Guatemala City, Guatemala
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Pasha O, McClure EM, Saleem S, Tikmani SS, Lokangaka A, Tshefu A, Bose CL, Bauserman M, Mwenechanya M, Chomba E, Carlo WA, Garces AL, Figueroa L, Hambidge KM, Krebs NF, Goudar S, Kodkany BS, Dhaded S, Derman RJ, Patel A, Hibberd PL, Esamai F, Tenge C, Liechty EA, Moore JL, Wallace DD, Koso-Thomas M, Miodovnik M, Goldenberg RL. A prospective cause of death classification system for maternal deaths in low and middle-income countries: results from the Global Network Maternal Newborn Health Registry. BJOG 2018; 125:1137-1143. [PMID: 29094456 DOI: 10.1111/1471-0528.15011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the causes of maternal death in a population-based cohort in six low- and middle-income countries using a standardised, hierarchical, algorithmic cause of death (COD) methodology. DESIGN A population-based, prospective observational study. SETTING Seven sites in six low- to middle-income countries including the Democratic Republic of the Congo (DRC), Guatemala, India (two sites), Kenya, Pakistan and Zambia. POPULATION All deaths among pregnant women resident in the study sites from 2014 to December 2016. METHODS For women who died, we used a standardised questionnaire to collect clinical data regarding maternal conditions present during pregnancy and delivery. These data were analysed using a computer-based algorithm to assign cause of maternal death based on the International Classification of Disease-Maternal Mortality system (trauma, termination of pregnancy-related, eclampsia, haemorrhage, pregnancy-related infection and medical conditions). We also compared the COD results to healthcare-provider-assigned maternal COD. MAIN OUTCOME MEASURES Assigned causes of maternal mortality. RESULTS Among 158 205 women, there were 221 maternal deaths. The most common algorithm-assigned maternal COD were obstetric haemorrhage (38.6%), pregnancy-related infection (26.4%) and pre-eclampsia/eclampsia (18.2%). Agreement between algorithm-assigned COD and COD assigned by healthcare providers ranged from 75% for haemorrhage to 25% for medical causes coincident to pregnancy. CONCLUSIONS The major maternal COD in the Global Network sites were haemorrhage, pregnancy-related infection and pre-eclampsia/eclampsia. This system could allow public health programmes in low- and middle-income countries to generate transparent and comparable data for maternal COD across time or regions. TWEETABLE ABSTRACT An algorithmic system for determining maternal cause of death in low-resource settings is described.
Collapse
Affiliation(s)
- O Pasha
- Aga Khan University, Karachi, Pakistan.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - S Saleem
- Aga Khan University, Karachi, Pakistan
| | | | - A Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - A Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - C L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - E Chomba
- University Teaching Hospital, Lusaka, Zambia
| | - W A Carlo
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - K M Hambidge
- University of Colorado, School of Medicine, Denver, CO, USA
| | - N F Krebs
- University of Colorado, School of Medicine, Denver, CO, USA
| | - S Goudar
- KLE University's JN Medical College, Belagavi, India
| | - B S Kodkany
- KLE University's JN Medical College, Belagavi, India
| | - S Dhaded
- KLE University's JN Medical College, Belagavi, India
| | - R J Derman
- Thomas Jefferson University, Philadelphia, PA, USA
| | - A Patel
- Lata Medical Research Foundation, Nagpur, India
| | | | | | - C Tenge
- Moi University, Eldoret, Kenya
| | | | | | | | | | | | - R L Goldenberg
- Columbia University School of Medicine, New York, NY, USA
| |
Collapse
|
26
|
Garces AL, McClure EM, Pérez W, Hambidge KM, Krebs NF, Figueroa L, Bose CL, Carlo WA, Tenge C, Esamai F, Goudar SS, Saleem S, Patel AB, Chiwila M, Chomba E, Tshefu A, Derman RJ, Hibberd PL, Bucher S, Liechty EA, Bauserman M, Moore JL, Koso-Thomas M, Miodovnik M, Goldenberg RL. The Global Network Neonatal Cause of Death algorithm for low-resource settings. Acta Paediatr 2017; 106:904-911. [PMID: 28240381 DOI: 10.1111/apa.13805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/20/2017] [Accepted: 02/22/2017] [Indexed: 10/20/2022]
Abstract
AIM This study estimated the causes of neonatal death using an algorithm for low-resource areas, where 98% of the world's neonatal deaths occur. METHODS We enrolled women in India, Pakistan, Guatemala, the Democratic Republic of Congo, Kenya and Zambia from 2014 to 2016 and tracked their delivery and newborn outcomes for up to 28 days. Antenatal care and delivery symptoms were collected using a structured questionnaire, clinical observation and/or a physical examination. The Global Network Cause of Death algorithm was used to assign the cause of neonatal death, analysed by country and day of death. RESULTS One-third (33.1%) of the 3068 neonatal deaths were due to suspected infection, 30.8% to prematurity, 21.2% to asphyxia, 9.5% to congenital anomalies and 5.4% did not have a cause of death assigned. Prematurity and asphyxia-related deaths were more common on the first day of life (46.7% and 52.9%, respectively), while most deaths due to infection occurred after the first day of life (86.9%). The distribution of causes was similar to global data reported by other major studies. CONCLUSION The Global Network algorithm provided a reliable cause of neonatal death in low-resource settings and can be used to inform public health strategies to reduce mortality.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Carl L. Bose
- University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Harrison MS, Pasha O, Saleem S, Ali S, Chomba E, Carlo WA, Garces AL, Krebs NF, Hambidge KM, Goudar SS, Kodkany B, Dhaded S, Derman RJ, Patel A, Hibberd PL, Esamai F, Liechty EA, Tshefu AK, Bauserman M, Moore JL, Wallace D, McClure EM, Miodovnik M, Koso-Thomas M, Belizan J, Goldenberg RL. A prospective study of maternal, fetal and neonatal outcomes in the setting of cesarean section in low- and middle-income countries. Acta Obstet Gynecol Scand 2017; 96:410-420. [PMID: 28107771 PMCID: PMC5665564 DOI: 10.1111/aogs.13098] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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: 09/05/2016] [Accepted: 01/09/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cesarean section (CS) rates are increasing globally with an unclear effect on pregnancy outcomes. The study objective was to quantify maternal and perinatal morbidity and mortality associated with CS compared with vaginal delivery (VD) both within and across sites in low- and middle-income countries. MATERIAL AND METHODS A prospective population-based study including home and facility births in 337 153 women with a VD and 47 308 women with a CS from 2010 to 2015 was performed in Guatemala, India, Kenya, Pakistan, Zambia and Democratic Republic of Congo. Women were enrolled during pregnancy; delivery and 6-week follow-up data were collected. RESULTS Across all sites, CS rates increased from 8.6% to 15.2%, but remained low in African sites. Younger, nulliparous women were more likely to have a CS, as were women with higher education and those delivering an infant weighing 1500-2499 g. Across all sites, maternal and neonatal mortality was higher, and stillbirths were lower, in pregnancies delivered by CS. Antepartum and postpartum complications as well as obstetric interventions and treatments were more common among women who underwent CS. In stratified analyses, all outcomes were worse in women with a CS compared with VD in African compared to non-African sites. CONCLUSIONS CS rates increased across all sites during the study period, but at more pronounced rates in the non-African sites. CS was associated with reduced postpartum hemorrhage and lower rates of stillbirths in the non-African sites. In the African sites, CS was associated with an increase in all adverse outcomes. Further studies are necessary to better understand the increase in adverse outcomes with CS in the African sites.
Collapse
Affiliation(s)
- Margo S. Harrison
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Omrana Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sumera Ali
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Elwyn Chomba
- University Teaching Hospital, University of Zambia, Lusaka, Zambia
| | | | - Ana L. Garces
- Planning Unit, Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Nancy F. Krebs
- School of Medicine, University of Colorado, Denver, CO, USA
| | | | | | - Bhala Kodkany
- Jawaharlal Nehru Medical College, KLE University, Belgaum, India
| | - Sangappa Dhaded
- Jawaharlal Nehru Medical College, KLE University, Belgaum, India
| | - Richard J. Derman
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | | | - Antoinette K Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Melissa Bauserman
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | | | | | - Menachem Miodovnik
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Marion Koso-Thomas
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Jose Belizan
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | |
Collapse
|
28
|
Patel AB, Meleth S, Pasha O, Goudar SS, Esamai F, Garces AL, Chomba E, McClure EM, Wright LL, Koso-Thomas M, Moore JL, Saleem S, Liechty EA, Goldenberg RL, Derman RJ, Hambidge KM, Carlo WA, Hibberd PL. Impact of exposure to cooking fuels on stillbirths, perinatal, very early and late neonatal mortality - a multicenter prospective cohort study in rural communities in India, Pakistan, Kenya, Zambia and Guatemala. Matern Health Neonatol Perinatol 2015; 1:18. [PMID: 27057335 PMCID: PMC4823690 DOI: 10.1186/s40748-015-0019-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/25/2015] [Indexed: 01/03/2023] Open
Abstract
Background Consequences of exposure to household air pollution (HAP) from biomass fuels used for cooking on neonatal deaths and stillbirths is poorly understood. In a large multi-country observational study, we examined whether exposure to HAP was associated with perinatal mortality (stillbirths from gestation week 20 and deaths through day 7 of life) as well as when the deaths occurred (macerated, non-macerated stillbirths, very early neonatal mortality (day 0–2) and later neonatal mortality (day 3–28). Questions addressing household fuel use were asked at pregnancy, delivery, and neonatal follow-up visits in a prospective cohort study of pregnant women in rural communities in five low and lower middle income countries participating in the Global Network for Women and Children’s Health’s Maternal and Newborn Health Registry. The study was conducted between May 2011 and October 2012. Polluting fuels included kerosene, charcoal, coal, wood, straw, crop waste and dung. Clean fuels included electricity, liquefied petroleum gas (LPG), natural gas and biogas. Results We studied the outcomes of 65,912 singleton pregnancies, 18 % from households using clean fuels (59 % LPG) and 82 % from households using polluting fuels (86 % wood). Compared to households cooking with clean fuels, there was an increased risk of perinatal mortality among households using polluting fuels (adjusted relative risk (aRR) 1.44, 95 % confidence interval (CI) 1.30-1.61). Exposure to HAP increased the risk of having a macerated stillbirth (adjusted odds ratio (aOR) 1.66, 95%CI 1.23-2.25), non-macerated stillbirth (aOR 1.43, 95 % CI 1.15-1.85) and very early neonatal mortality (aOR 1.82, 95 % CI 1.47-2.22). Conclusions Perinatal mortality was associated with exposure to HAP from week 20 of pregnancy through at least day 2 of life. Since pregnancy losses before labor and delivery are difficult to track, the effect of exposure to polluting fuels on global perinatal mortality may have previously been underestimated. Trial registration ClinicalTrials.gov NCT01073475
Collapse
Affiliation(s)
- Archana B Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra 440022 India
| | - Sreelatha Meleth
- RTI International, Research Triangle Park, North Carolina, 27709 USA
| | - Omrana Pasha
- Department of Community Health Sciences & Family Medicine, Aga Khan University, Karachi, Pakistan
| | | | | | - Ana L Garces
- IMSALUD, San Carlos University, Guatemala City, Guatemala
| | | | | | - Linda L Wright
- Center for Research of Mothers and Children, NIH, Rockville, MD 20852 USA
| | - Marion Koso-Thomas
- Center for Research of Mothers and Children, NIH, Rockville, MD 20852 USA
| | - Janet L Moore
- RTI International, Research Triangle Park, North Carolina, 27709 USA
| | - Sarah Saleem
- Department of Community Health Sciences & Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Edward A Liechty
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Robert L Goldenberg
- Department of Obstetrics/Gynecology, Columbia University, New York, NY 10032 USA
| | | | | | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Patricia L Hibberd
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, MA 02114 USA
| |
Collapse
|
29
|
Althabe F, Belizán JM, McClure EM, Hemingway-Foday J, Berrueta M, Mazzoni A, Ciganda A, Goudar SS, Kodkany BS, Mahantshetti NS, Dhaded SM, Katageri GM, Metgud MC, Joshi AM, Bellad MB, Honnungar NV, Derman RJ, Saleem S, Pasha O, Ali S, Hasnain F, Goldenberg RL, Esamai F, Nyongesa P, Ayunga S, Liechty EA, Garces AL, Figueroa L, Hambidge KM, Krebs NF, Patel A, Bhandarkar A, Waikar M, Hibberd PL, Chomba E, Carlo WA, Mwiche A, Chiwila M, Manasyan A, Pineda S, Meleth S, Thorsten V, Stolka K, Wallace DD, Koso-Thomas M, Jobe AH, Buekens PM. A population-based, multifaceted strategy to implement antenatal corticosteroid treatment versus standard care for the reduction of neonatal mortality due to preterm birth in low-income and middle-income countries: the ACT cluster-randomised trial. Lancet 2015; 385:629-639. [PMID: 25458726 PMCID: PMC4420619 DOI: 10.1016/s0140-6736(14)61651-2] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Antenatal corticosteroids for pregnant women at risk of preterm birth are among the most effective hospital-based interventions to reduce neonatal mortality. We aimed to assess the feasibility, effectiveness, and safety of a multifaceted intervention designed to increase the use of antenatal corticosteroids at all levels of health care in low-income and middle-income countries. METHODS In this 18-month, cluster-randomised trial, we randomly assigned (1:1) rural and semi-urban clusters within six countries (Argentina, Guatemala, India, Kenya, Pakistan, and Zambia) to standard care or a multifaceted intervention including components to improve identification of women at risk of preterm birth and to facilitate appropriate use of antenatal corticosteroids. The primary outcome was 28-day neonatal mortality among infants less than the 5th percentile for birthweight (a proxy for preterm birth) across the clusters. Use of antenatal corticosteroids and suspected maternal infection were additional main outcomes. This trial is registered with ClinicalTrials.gov, number NCT01084096. FINDINGS The ACT trial took place between October, 2011, and March, 2014 (start dates varied by site). 51 intervention clusters with 47,394 livebirths (2520 [5%] less than 5th percentile for birthweight) and 50 control clusters with 50,743 livebirths (2258 [4%] less than 5th percentile) completed follow-up. 1052 (45%) of 2327 women in intervention clusters who delivered less-than-5th-percentile infants received antenatal corticosteroids, compared with 215 (10%) of 2062 in control clusters (p<0·0001). Among the less-than-5th-percentile infants, 28-day neonatal mortality was 225 per 1000 livebirths for the intervention group and 232 per 1000 livebirths for the control group (relative risk [RR] 0·96, 95% CI 0·87-1·06, p=0·65) and suspected maternal infection was reported in 236 (10%) of 2361 women in the intervention group and 133 (6%) of 2094 in the control group (odds ratio [OR] 1·67, 1·33-2·09, p<0·0001). Among the whole population, 28-day neonatal mortality was 27·4 per 1000 livebirths for the intervention group and 23·9 per 1000 livebirths for the control group (RR 1·12, 1·02-1·22, p=0·0127) and suspected maternal infection was reported in 1207 (3%) of 48,219 women in the intervention group and 867 (2%) of 51,523 in the control group (OR 1·45, 1·33-1·58, p<0·0001). INTERPRETATION Despite increased use of antenatal corticosteroids in low-birthweight infants in the intervention groups, neonatal mortality did not decrease in this group, and increased in the population overall. For every 1000 women exposed to this strategy, an excess of 3·5 neonatal deaths occurred, and the risk of maternal infection seems to have been increased. FUNDING Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Collapse
Affiliation(s)
- Fernando Althabe
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.
| | - José M Belizán
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | | | - Mabel Berrueta
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Agustina Mazzoni
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Alvaro Ciganda
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina; UNICEM, Montevideo, Uruguay
| | - Shivaprasad S Goudar
- Women's and Children's Health Research Unit, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Bhalachandra S Kodkany
- Women's and Children's Health Research Unit, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Niranjana S Mahantshetti
- Women's and Children's Health Research Unit, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Sangappa M Dhaded
- Women's and Children's Health Research Unit, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | | | - Mrityunjay C Metgud
- Women's and Children's Health Research Unit, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Anjali M Joshi
- Women's and Children's Health Research Unit, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Mrutyunjaya B Bellad
- Women's and Children's Health Research Unit, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Narayan V Honnungar
- Women's and Children's Health Research Unit, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Richard J Derman
- Department of Obstetrics and Gynecology, Christiana Health Care Services, Newark, DE, USA
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Omrana Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sumera Ali
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Farid Hasnain
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | | | | | - Silas Ayunga
- Moi University School of Medicine, Eldoret, Kenya
| | | | - Ana L Garces
- Fundación para la Alimentación y Nutrición de Centro América y Panamá, Guatemala City, Guatemala; Francisco Marroquin University, Guatemala City, Guatemala
| | - Lester Figueroa
- Fundación para la Alimentación y Nutrición de Centro América y Panamá, Guatemala City, Guatemala
| | | | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India; Indira Gandhi Government Medical College, Nagpur, India
| | | | | | | | | | | | | | | | | | - Sayury Pineda
- Fundación para la Alimentación y Nutrición de Centro América y Panamá, Guatemala City, Guatemala
| | | | | | | | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Alan H Jobe
- Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Pierre M Buekens
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| |
Collapse
|
30
|
Kadir MM, McClure EM, Goudar SS, Garces AL, Moore J, Onyamboko M, Kaseba C, Althabe F, Castilla EE, Freire S, Parida S, Saleem S, Wright LL, Goldenberg RL. Exposure of pregnant women to indoor air pollution: a study from nine low and middle income countries. Acta Obstet Gynecol Scand 2010; 89:540-548. [PMID: 19961275 DOI: 10.3109/00016340903473566] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We studied exposure to solid fuel and second-hand tobacco smoke among pregnant women in south Asia, Africa and Latin America. DESIGN Prospective cross-sectional survey. SETTING Antenatal clinics in Argentina, Brazil, Ecuador, Guatemala, Uruguay, Democratic Republic of Congo, Zambia, India and Pakistan. SAMPLE A total of 7,961 pregnant women in ten sites in nine countries were interviewed between October 2004 and September 2005. METHODS A standardized questionnaire on exposure to indoor air pollution (IAP) and second-hand smoke was administered to pregnant women during antenatal care. MAIN OUTCOME MEASURES Exposure to IAP and second-hand tobacco smoke. RESULTS South Asian pregnant women commonly reported use of wood (49.1-89.7%), crop residue and animal dung as cooking and heating fuel. African pregnant women reported higher use of charcoal (85.4-93.5%). Latin American pregnant women had greater use of petroleum gas. Among south Asian women, solid fuel use and cooking on an open flame inside the home were common. There was a significant association between solid fuel use and allowing smoking within the home at the Asian sites and in Zambia (p < 0.05). CONCLUSIONS Pregnant women from low/middle income countries were commonly exposed to IAP secondary to use of solid fuels. Among these populations, exposure to second-hand tobacco smoke was also common. This combination of exposures likely increases the risk of poor pregnancy outcomes among the most vulnerable women. Our study highlights the importance of further research on the combined impact of IAP and second-hand tobacco smoke exposures on adverse maternal and perinatal outcomes.
Collapse
Affiliation(s)
| | | | | | - Ana L Garces
- San Carlos University, Guatemala City, Guatemala
| | - Janet Moore
- Research Triangle Institute, Durham, NC, USA
| | - Marie Onyamboko
- Kinshasa School of Public Health, University of Kinshasa, Democratic Republic of Congo
| | | | - Fernando Althabe
- Institute of Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Eduardo E Castilla
- Estudio Colaborativo Latinoamericano de Malformaciones Congenitas, Rio de Janeiro, Brazil
| | | | | | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Linda L Wright
- National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | | |
Collapse
|
31
|
Bloch M, Althabe F, Onyamboko M, Kaseba-Sata C, Castilla EE, Freire S, Garces AL, Parida S, Goudar SS, Kadir MM, Goco N, Thornberry J, Daniels M, Bartz J, Hartwell T, Moss N, Goldenberg R. Tobacco use and secondhand smoke exposure during pregnancy: an investigative survey of women in 9 developing nations. Am J Public Health 2008; 98:1833-40. [PMID: 18309125 DOI: 10.2105/ajph.2007.117887] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined pregnant women's use of cigarettes and other tobacco products and the exposure of pregnant women and their young children to secondhand smoke (SHS) in 9 nations in Latin America, Asia, and Africa. METHODS Face-to-face surveys were administered to 7961 pregnant women (more than 700 per site) between October 2004 and September 2005. RESULTS At all Latin American sites, pregnant women commonly reported that they had ever tried cigarette smoking (range: 78.3% [Uruguay] to 35.0% [Guatemala]). The highest levels of current smoking were found in Uruguay (18.3%), Argentina (10.3%), and Brazil (6.1%). Experimentation with smokeless tobacco occurred in the Democratic Republic of the Congo and India; one third of all respondents in Orissa, India, were current smokeless tobacco users. SHS exposure was common: between 91.6% (Pakistan) and 17.1% (Democratic Republic of the Congo) of pregnant women reported that smoking was permitted in their home. CONCLUSIONS Pregnant women's tobacco use and SHS exposure are current or emerging problems in several low- and middle-income nations, jeopardizing ongoing efforts to improve maternal and child health.
Collapse
Affiliation(s)
- Michele Bloch
- Tobacco Control Research Branch, National Cancer Institute, Executive Plaza North, Room 4038, 6130 Executive Blvd, MSC 7337, Bethesda, MD 20892-7337, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|