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Khisa AM, Wao H, Brizuela V, Compaoré R, Baguiya A, López Gómez A, Bonet M, Kouanda S, Thorson A, Gitau E. Embedding research capacity strengthening in multi-country studies in low-and middle-income countries: learnings from sexual and reproductive health research. Glob Health Action 2024; 17:2338634. [PMID: 38607331 PMCID: PMC11018088 DOI: 10.1080/16549716.2024.2338634] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/31/2024] [Indexed: 04/13/2024] Open
Abstract
Research capacity strengthening (RCS) can empower individuals, institutions, networks, or countries to define and prioritize problems systematically; develop and scientifically evaluate appropriate solutions; and reinforce or improve capacities to translate knowledge into policy and practice. However, how to embed RCS into multi-country studies focusing on sexual and reproductive health and rights (SRHR) is largely undocumented. We used findings from a qualitative study, from a review of the literature, and from a validation exercise from a panel of experts from research institutions that work on SRHR RCS. We provide a framework for embedded RCS; suggest a set of seven concrete actions that research project planners, designers, implementers, and funders can utilise to guide embedded RCS activities in low- and middle-income countries; and present a practical checklist for planning and assessing embedded RCS in research projects.
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Affiliation(s)
- Anne M. Khisa
- Capacity Strengthening and SRHR Research, African Population and Health Research Center, Nairobi, Kenya
| | - Hesborn Wao
- Capacity Strengthening and SRHR Research, African Population and Health Research Center, Nairobi, Kenya
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rachidatou Compaoré
- Department of Biomedical and Public Health, Research Institute for Health Sciences, Ouagadougou, Burkina Faso
| | - Adama Baguiya
- Department of Biomedical and Public Health, Research Institute for Health Sciences, Ouagadougou, Burkina Faso
| | | | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Seni Kouanda
- Department of Biomedical and Public Health, Research Institute for Health Sciences, Ouagadougou, Burkina Faso
- African Institute of Public Health, Ouagadougou, Burkina Faso
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Evelyn Gitau
- Capacity Strengthening and SRHR Research, African Population and Health Research Center, Nairobi, Kenya
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Baguiya A, Bonet M, Brizuela V, Cuesta C, Knight M, Lumbiganon P, Abalos E, Kouanda S. Infection-related severe maternal outcomes and case fatality rates in 43 low and middle-income countries across the WHO regions: Results from the Global Maternal Sepsis Study (GLOSS). PLOS Glob Public Health 2024; 4:e0003109. [PMID: 38662723 PMCID: PMC11045079 DOI: 10.1371/journal.pgph.0003109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
The highest toll of maternal mortality due to infections is reported in low and middle-income countries (LMICs). However, more evidence is needed to understand the differences in infection-related severe maternal outcomes (SMO) and fatality rates across the WHO regions. This study aimed to compare the burden of infection-related SMO and case fatality rates across the WHO regions using the Global Maternal Sepsis Study (GLOSS) data. GLOSS was a hospital-based one-week inception prospective cohort study of pregnant or recently pregnant women admitted with suspected or confirmed infection in 2017. Four hundred and eight (408) hospitals from 43 LMICs in the six WHO regions were considered in this analysis. We used a logistic regression model to compare the odds of infection-related SMOs by region. We then calculated the fatality rate as the proportion of deaths over the total number of SMOs, defined as maternal deaths and near-misses. The proportion of SMO was 19.6% (n = 141) in Africa, compared to 18%(n = 22), 15.9%(n = 50), 14.7%(n = 48), 12.1%(n = 95), and 10.8%(n = 21) in the Western Pacific, European, Eastern Meditteranean, Americas, and South-Eastern Asian regions, respectively. Women in Africa were more likely to experience SMO than those in the Americas (aOR = 2.41, 95%CI: [1.78 to 2.83]), in South-East Asia (aOR = 2.60, 95%CI: [1.57 to 4.32]), and the Eastern Mediterranean region (aOR = 1.58, 95%CI: [1.08 to 2.32]). The case fatality rate was 14.3%[3.05% to 36.34%] (n/N = 3/21) and 11.4%[6.63% to 17.77%] (n/N = 16/141) in the South-East Asia and Africa, respectively. Infection-related SMOs and case fatality rates were highest in Africa and Southeast Asia. Specific attention and actions are needed to prevent infection-related maternal deaths and severe morbidity in these two regions.
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Affiliation(s)
- Adama Baguiya
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
- Doctoral School, Saint Thomas d’Aquin University, Ouagadougou, Burkina Faso
| | - Mercedes Bonet
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Vanessa Brizuela
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Cristina Cuesta
- Faculty of Economics and Statistics, National University of Rosario, Rosario, Argentina
| | - Marian Knight
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Pisake Lumbiganon
- Faculty of Medicine, Department of Obstetrics and Gynaecology, Khon Kaen University, Khon Kaen, Thailand
| | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Séni Kouanda
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
- Doctoral School, Saint Thomas d’Aquin University, Ouagadougou, Burkina Faso
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Fernández-García S, Del Campo-Albendea L, Sambamoorthi D, Sheikh J, Lau K, Osei-Lah N, Ramkumar A, Naidu H, Stoney N, Sundaram P, Sengupta P, Mehta S, Attarde S, Maddock S, Manning M, Meherally Z, Ansari K, Lawson H, Yap M, Kew T, Punnoose A, Knight C, Sadeqa E, Cherian J, Ravi S, Chen W, Walker K, O'Donoghue K, van Wely M, van Leeuwen E, Kostova E, Kunst H, Khalil A, Brizuela V, Kara E, Kim CR, Thorson A, Oladapo OT, Mofenson L, Gottlieb SL, Bonet M, Moss N, Zamora J, Allotey J, Thangaratinam S. Effectiveness and safety of COVID-19 vaccines on maternal and perinatal outcomes: a systematic review and meta-analysis. BMJ Glob Health 2024; 9:e014247. [PMID: 38580375 PMCID: PMC11002410 DOI: 10.1136/bmjgh-2023-014247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/26/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE To assess the effects of COVID-19 vaccines in women before or during pregnancy on SARS-CoV-2 infection-related, pregnancy, offspring and reactogenicity outcomes. DESIGN Systematic review and meta-analysis. DATA SOURCES Major databases between December 2019 and January 2023. STUDY SELECTION Nine pairs of reviewers contributed to study selection. We included test-negative designs, comparative cohorts and randomised trials on effects of COVID-19 vaccines on infection-related and pregnancy outcomes. Non-comparative cohort studies reporting reactogenicity outcomes were also included. QUALITY ASSESSMENT, DATA EXTRACTION AND ANALYSIS Two reviewers independently assessed study quality and extracted data. We undertook random-effects meta-analysis and reported findings as HRs, risk ratios (RRs), ORs or rates with 95% CIs. RESULTS Sixty-seven studies (1 813 947 women) were included. Overall, in test-negative design studies, pregnant women fully vaccinated with any COVID-19 vaccine had 61% reduced odds of SARS-CoV-2 infection during pregnancy (OR 0.39, 95% CI 0.21 to 0.75; 4 studies, 23 927 women; I2=87.2%) and 94% reduced odds of hospital admission (OR 0.06, 95% CI 0.01 to 0.71; 2 studies, 868 women; I2=92%). In adjusted cohort studies, the risk of hypertensive disorders in pregnancy was reduced by 12% (RR 0.88, 95% CI 0.82 to 0.92; 2 studies; 115 085 women), while caesarean section was reduced by 9% (OR 0.91, 95% CI 0.85 to 0.98; 6 studies; 30 192 women). We observed an 8% reduction in the risk of neonatal intensive care unit admission (RR 0.92, 95% CI 0.87 to 0.97; 2 studies; 54 569 women) in babies born to vaccinated versus not vaccinated women. In general, vaccination during pregnancy was not associated with increased risk of adverse pregnancy or perinatal outcomes. Pain at the injection site was the most common side effect reported (77%, 95% CI 52% to 94%; 11 studies; 27 195 women). CONCLUSION COVID-19 vaccines are effective in preventing SARS-CoV-2 infection and related complications in pregnant women. PROSPERO REGISTRATION NUMBER CRD42020178076.
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Affiliation(s)
- Silvia Fernández-García
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Laura Del Campo-Albendea
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBERESP, Madrid, Spain
| | | | - Jameela Sheikh
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Karen Lau
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Nana Osei-Lah
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Anoushka Ramkumar
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Harshitha Naidu
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Nicole Stoney
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Paul Sundaram
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | - Samay Mehta
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Shruti Attarde
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sophie Maddock
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Millie Manning
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | - Kehkashan Ansari
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Heidi Lawson
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Magnus Yap
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Tania Kew
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Andriya Punnoose
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Chloe Knight
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Eyna Sadeqa
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Jiya Cherian
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sangamithra Ravi
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Wentin Chen
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | | | - Madelon van Wely
- Amsterdam UMC Location AMC Center for Reproductive Medicine, Amsterdam, The Netherlands
| | - Elizabeth van Leeuwen
- Amsterdam UMC Location AMC Department of Obstetrics Gynecology, Amsterdam, The Netherlands
| | - Elena Kostova
- Amsterdam UMC Location AMC Center for Reproductive Medicine, Amsterdam, The Netherlands
| | - Heinke Kunst
- Queen Mary University of London Blizard Institute, London, UK
- Barts Health NHS Trust, London, UK
| | - Asma Khalil
- St George's University of London, London, UK
| | - Vanessa Brizuela
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Edna Kara
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Caron Rahn Kim
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Anna Thorson
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Olufemi T Oladapo
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Lynne Mofenson
- Research, Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, USA
| | - Sami L Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Mercedes Bonet
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | | | - Javier Zamora
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBERESP, Madrid, Spain
- NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, UK
| | - John Allotey
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Ribeiro-do-Valle CC, Bonet M, Brizuela V, Abalos E, Baguiya A, Bellissimo-Rodrigues F, Budianu M, Puscasiu L, Knight M, Lissauer D, Dunlop C, Jacob ST, Shakoor S, Gadama L, Assarag B, Souza JP, Cecatti JG. Aetiology and use of antibiotics in pregnancy-related infections: results of the WHO Global Maternal Sepsis Study (GLOSS), 1-week inception cohort. Ann Clin Microbiol Antimicrob 2024; 23:21. [PMID: 38402175 PMCID: PMC10894467 DOI: 10.1186/s12941-024-00681-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/19/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Pregnancy-related infections are important contributors to maternal sepsis and mortality. We aimed to describe clinical, microbiological characteristics and use of antibiotics by source of infection and country income, among hospitalized women with suspected or confirmed pregnancy-related infections. METHODS We used data from WHO Global Maternal Sepsis Study (GLOSS) on maternal infections in hospitalized women, in 52 low-middle- and high-income countries conducted between November 28th and December 4th, 2017, to describe the frequencies and medians of maternal demographic, obstetric, and clinical characteristics and outcomes, methods of infection diagnosis and causative pathogens, of single source pregnancy-related infection, other than breast, and initial use of therapeutic antibiotics. We included 1456 women. RESULTS We found infections of the genital (n = 745/1456, 51.2%) and the urinary tracts (UTI) (n = 531/1456, 36.5%) to be the most frequent. UTI (n = 339/531, 63.8%) and post-caesarean skin and soft tissue infections (SSTI) (n = 99/180, 55.0%) were the sources with more culture samples taken and microbiological confirmations. Escherichia coli was the major uropathogen (n = 103/118, 87.3%) and Staphylococcus aureus (n = 21/44, 47.7%) was the commonest pathogen in SSTI. For 13.1% (n = 191) of women, antibiotics were not prescribed on the same day of infection suspicion. Cephalosporins (n = 283/531, 53.3%) were the commonest antibiotic class prescribed for UTI, while metronidazole (n = 303/925, 32.8%) was the most prescribed for all other sources. Ceftriaxone with metronidazole was the commonest combination for the genital tract (n = 98/745, 13.2%) and SSTI (n = 22/180, 12.2%). Metronidazole (n = 137/235, 58.3%) was the most prescribed antibiotic in low-income countries while cephalosporins and co-amoxiclav (n = 129/186, 69.4%) were more commonly prescribed in high-income countries. CONCLUSIONS Differences in antibiotics used across countries could be due to availability, local guidelines, prescribing culture, cost, and access to microbiology laboratory, despite having found similar sources and pathogens as previous studies. Better dissemination of recommendations in line with antimicrobial stewardship programmes might improve antibiotic prescription.
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Affiliation(s)
- Carolina C Ribeiro-do-Valle
- Department of Gynaecology and Obstetrics, Faculty of Medical Sciences, University of Campinas, R. Alexander Fleming, 101, Campinas, São Paulo, CEP 13083-888, Brazil
| | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland
| | - Vanessa Brizuela
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland
| | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Adama Baguiya
- Kaya Health and Demographic Surveillance System (Kaya-HDSS), Research Institute of Health Sciences (IRSS), Ouagadougou, Burkina Faso
| | | | - Mihaela Budianu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Târgu Mureş, Romania
| | - Lucian Puscasiu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Târgu Mureş, Romania
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - David Lissauer
- University of Liverpool, Blantyre, Malawi
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | | | - Shevin T Jacob
- Walimu, Mbarara, Uganda
- Department of Clinical Services, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
- Department of Microbiology, Aga Khan University, Karachi, Pakistan
| | - Luis Gadama
- Department of Obstetrics and Gynaecology, University of Malawi, Zomba, Malawi
| | | | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, Ribeirão Preto, Brazil
| | - Jose G Cecatti
- Department of Gynaecology and Obstetrics, Faculty of Medical Sciences, University of Campinas, R. Alexander Fleming, 101, Campinas, São Paulo, CEP 13083-888, Brazil.
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Sacks E, Brizuela V, Javadi D, Kim Y, Elmi N, Finlayson K, Crossland N, Langlois EV, Ziegler D, Parmar SM, Bonet M. Immigrant women's and families' views and experiences of routine postnatal care: findings from a qualitative evidence synthesis. BMJ Glob Health 2024; 8:e014075. [PMID: 38351019 PMCID: PMC10897958 DOI: 10.1136/bmjgh-2023-014075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/06/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Uptake of postnatal care (PNC) is low and inequitable in many countries, and immigrant women may experience additional challenges to access and effective use. As part of a larger study examining the views of women, partners, and families on routine PNC, we analysed a subset of data on the specific experiences of immigrant women and families. METHODS This is a subanalysis of a larger qualitative evidence synthesis. We searched MEDLINE, PUBMED, CINAHL, EMBASE, EBM-Reviews and grey literature for studies published until December 2019 with extractable qualitative data with no language restrictions. For this analysis, we focused on papers related to immigrant women and families. Two reviewers screened each study independently; inclusion was agreed by consensus. Data abstraction and quality assessment were carried out using a study-specific extraction form and established quality assessment tools. Study findings were identified using thematic analysis. Findings are presented by confidence in the finding, applying the GRADE-CERQual approach. FINDINGS We included 44 papers, out of 602 full-texts, representing 11 countries where women and families sought PNC after immigrating. All but one included immigrants to high-income countries. Four themes were identified: resources and access, differences from home country, support needs, and experiences of care. High confidence study findings included: language and communication challenges; uncertainty about navigating system supports including transportation; high mental health, emotional, and informational needs; the impact of personal resources and social support; and the quality of interaction with healthcare providers. These findings highlight the importance of care experiences beyond clinical care. More research is also needed on the experiences of families migrating between low-income countries. CONCLUSIONS Immigrant families experience many challenges in getting routine PNC, especially related to language, culture, and communication. Some challenges may be mitigated by improving comprehensive and accessible information on available services, as well as holistic social support. TRIAL REGISTRATION NUMBER CRD42019139183.
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Affiliation(s)
- Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Dena Javadi
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Yoona Kim
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Nika Elmi
- School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth Finlayson
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Etienne V Langlois
- Partnership for Maternal, Newborn, and Child Health, World Health Organization, Geneva, Switzerland
| | - Daniela Ziegler
- Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | | | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Abstract
Mentorship is an important contributor to strengthening research capacity among health researchers. Formal mentorship programmes, targeting women mentees can help mitigate some of the gendered power dynamics and can also help early career researchers learn from others' experiences of navigating these challenges. In 2020, the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction at the World Health Organization launched a mentorship programme geared towards early career women researchers. This paper describes the process of designing and implementing a mentorship programme for early career women sexual and reproductive health and rights researchers from low- and middle-income countries including valuable lessons learned vis-à-vis existing evidence. Some of these findings have been incorporated into iterations of the programme launched in 2022. Critical points include: ensuring considerations for language and geographical distribution; allowing mentees to participate in the matching process; providing training and opportunities to network and learn from other participants; offering the support and structure for developing these relationships. Providing women researchers with the tools - through mentorship - to navigate the unique challenges they face in their career journeys, can have a lasting impact on research capacity. Countries and institutions committed to strengthening research capacity need to focus on the holistic growth and motivation of individuals in a way that ensures gender equality.
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Affiliation(s)
- Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland,CONTACT Vanessa Brizuela UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, Geneva1211, Switzerland
| | - Joy J. Chebet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Asim M, Gatheru PM, Chebet JJ, Shah MG, Thorson A, Brizuela V. Support, networks, and relationships: Findings from a mixed-methods evaluation of a mentorship programme for early career women researchers in sexual and reproductive health and rights. PLoS One 2023; 18:e0295577. [PMID: 38113215 PMCID: PMC10729955 DOI: 10.1371/journal.pone.0295577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023] Open
Abstract
Low research output among women researchers in health research has been linked to inadequate mentorship opportunities for early career women researchers and particularly in sexual and reproductive health and rights (SRHR) field. Mentorship has been recognized as a contributor to strengthening research capacity and as beneficial for both mentors and mentees. Women researchers oftentimes experience negative impacts of organizational and structural gender inequities related to formal and informal mentoring. In 2020, the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction at WHO launched a mentorship programme for early career SRHR women researchers from low- and middle-income countries. The programme sought to provide professional skill-building, promote and share networking opportunities, and offer support in navigating personal and professional life. We conducted a convergent parallel mixed-methods evaluation of the 2020 pilot programme, which included 26 participants, through an online survey and semi-structured in-depth interviews (IDIs). Data collection occurred between March and May 2022. Nineteen responded to the online survey (12 mentees, 7 mentors) and 11 IDIs (7 mentees, 4 mentors) were completed. Based on a preliminary framework, we used deductive and inductive methods to identify six themes: views on mentorship; reasons for applying and expectations of participation in the programme; preferred aspects of programme implementation; challenges with the programme implementation; perceived lasting benefits of the programme; and recommendations for improvement. All participants found the initial training useful, most discussed work-life prioritization throughout the mentorship relationship, and most planned to continue with the relationship. There appear to be ample benefits to mentorship, especially when planned and implemented in a structured manner. These attributes can be particularly beneficial when they are conceived as a two-way relationship of mutual learning and support, and especially for women at the start of their research careers as they navigate structural gender inequities.
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Affiliation(s)
- Muhammad Asim
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
- Population Research Center, University of Texas at Austin, Austin, TX, United States of America
| | - Peter Muriuki Gatheru
- African Population and Health Research Center (APHRC), Nairobi, Kenya
- Department of Population, Family and Reproductive Health, University of Ghana, Accra, Ghana
| | - Joy J. Chebet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mehr G. Shah
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Perrotta C, Downey V, Elabbasy D, Ingram C, Lo C, Naseer A, Thorson A, Brizuela V. Remote training for strengthening capacity in sexual and reproductive health and rights research: a systematic review. BMC Public Health 2023; 23:1964. [PMID: 37817136 PMCID: PMC10566165 DOI: 10.1186/s12889-023-16851-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/27/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Training has been used to develop research skills among sexual and reproductive health and rights (SRHR) researchers. Remote education may accelerate transfer of skills and reduce barriers to strengthening research capacity. This systematic review aimed to assess the effectiveness of remote training on SRHR research and describe enablers and barriers of effective remote training. METHODS PubMed, Embase, and Scielo were searched up to December 2022 for studies that evaluated in any language online research training programmes either on a SRHR topic or tailored for professionals working in SRHR published since 1990. Characteristics of included studies, the programmes they evaluated, the programme's effectiveness, and reported barriers and enablers to remote learning were extracted. Three researchers synthesized and described findings on effectiveness, impact and outcomes mapping them against the Kirkpatrick model. Additionally, thematic analysis from qualitative data was conducted to identify themes relating to the barriers and enablers of remote learning. RESULTS Of 1,510 articles retrieved, six studies that included 2,058 remote learners met the inclusion criteria. Five out of six studies described empirical improvements in participant research knowledge/skills and three studies reported improvements in attitudes/self-efficacy towards research. Follow-up surveys from four studies revealed frequent application of new research skills and improved opportunities for career advancement and publication following online trainings. Cited barriers to effective online SRHR research training included time management challenges and participants' competing professional obligations; limited opportunities for interaction; and lack of support from home institutions. Cited enablers included well-structured and clear courses, learning objectives and expectations with participants; ensuring a manageable workload; facilitating interactions with mentors and hands-on experience; and selecting programme topics relevant to participants' jobs. CONCLUSION Remote SRHR training can lead to improvements in research knowledge, skills, and attitudes, particularly when course learning objectives, structure, and expectations are outlined clearly, and ongoing mentorship is provided.
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Affiliation(s)
- Carla Perrotta
- School of Public Health Physiotherapy and Sports Science, University College Dublin, ROI, Woodview House, Belfield, Dublin 4, Ireland.
| | - Vicky Downey
- School of Public Health Physiotherapy and Sports Science, University College Dublin, ROI, Woodview House, Belfield, Dublin 4, Ireland
| | - Darin Elabbasy
- School of Public Health Physiotherapy and Sports Science, University College Dublin, ROI, Woodview House, Belfield, Dublin 4, Ireland
| | - Carolyn Ingram
- School of Public Health Physiotherapy and Sports Science, University College Dublin, ROI, Woodview House, Belfield, Dublin 4, Ireland
| | - Chungwan Lo
- School of Public Health Physiotherapy and Sports Science, University College Dublin, ROI, Woodview House, Belfield, Dublin 4, Ireland
| | - Amara Naseer
- School of Public Health Physiotherapy and Sports Science, University College Dublin, ROI, Woodview House, Belfield, Dublin 4, Ireland
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, CH, Switzerland
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, CH, Switzerland
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Javadi D, Sacks E, Brizuela V, Finlayson K, Crossland N, Langlois EV, Ziegler D, Chandra-Mouli V, Bonet M. Factors that influence the uptake of postnatal care among adolescent girls: a qualitative evidence synthesis. BMJ Glob Health 2023; 8:e011560. [PMID: 37137533 PMCID: PMC10163540 DOI: 10.1136/bmjgh-2022-011560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Adolescent pregnancy is associated with increased risk of maternal and child morbidity and mortality globally. Access to safe, appropriate and affordable antenatal, childbirth and postnatal care (PNC) is essential in mitigating this risk. PNC is an often undervalued, underused, and understudied component of the continuum of maternal health services; however, it provides an important opportunity for adolescent girls to have access to health information and resources as they navigate the transition to motherhood and/or recovery from childbirth. This qualitative evidence synthesis seeks to highlight the experiences and perspectives of adolescent girls and their partners in accessing and using routine PNC. METHODS Papers were selected from a primary review on PNC where a global search of databases was conducted to identify studies with qualitative data focused on PNC utilisation. Within this primary review, a subset of studies focused on adolescents was tagged for subanalysis. A data extraction form drawing on an a priori framework was used to extract data from each study. Review findings were grouped across studies and mapped onto relevant themes, which were then adapted, as appropriate, to best reflect emergent themes from included studies. RESULTS Of 662 papers identified for full text review, 15 were included in this review on adolescents' experiences. Fourteen review findings were mapped onto four themes including: resources and access, social norms, experiences of care, and tailored support needs. CONCLUSION Improving uptake of PNC by adolescent girls requires multipronged approaches in improving availability of and access to adolescent-sensitive maternal health services and reducing feelings of shame and stigma in the postpartum period. Much should be done to address structural barriers to access, but tangible steps to improving the quality and responsiveness of available services can be taken immediately. PROSPERO REGISTRATION NUMBER CRD42019139183.
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Affiliation(s)
- Dena Javadi
- Social and Behavioral Sciences, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Emma Sacks
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Kenneth Finlayson
- Research in Childbirth and Health (ReaCH) Unit, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- Research in Childbirth and Health (ReaCH) Unit, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Etienne V Langlois
- Partnership for Maternal, Newborn & Child Health (PMNCH), World Health Organization, Geneva, Switzerland
| | - Daniela Ziegler
- Library, Centre Hospitalier de l'Universite de Montreal, Montreal, Québec, Canada
| | - Venkatraman Chandra-Mouli
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Finlayson K, Sacks E, Brizuela V, Crossland N, Cordey S, Ziegler D, Langlois EV, Javadi D, Comrie-Thomson L, Downe S, Bonet M. Factors that influence the uptake of postnatal care from the perspective of fathers, partners and other family members: a qualitative evidence synthesis. BMJ Glob Health 2023; 8:e011086. [PMID: 37137532 PMCID: PMC10163465 DOI: 10.1136/bmjgh-2022-011086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/14/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Postnatal care (PNC) is a key component of maternity provision and presents opportunities for healthcare providers to optimise the health and well-being of women and newborns. However, PNC is often undervalued by parents, family members and healthcare providers. As part of a larger qualitative review exploring the factors that influence PNC uptake by relevant stakeholders, we examined a subset of studies highlighting the views of fathers, partners and family members of postpartum women. METHODS We undertook a qualitative evidence synthesis using a framework synthesis approach. We searched multiple databases and included studies with extractable qualitative data focusing on PNC utilisation. We identified and labelled a subset of articles reflecting the views of fathers, partners and other family members. Data abstraction and quality assessment were carried out using a bespoke data extraction form and established quality assessment tools. The framework was developed a priori based on previous research on the topic and adapted accordingly. Findings were assessed for confidence using the GRADE-CERQual approach and are presented by country income group. RESULTS Of 12 678 papers identified from the original search, 109 were tagged as 'family members views' and, of these, 30 were eligible for this review. Twenty-nine incorporated fathers' views, 7 included the views of grandmothers or mothers-in-law, 4 incorporated other family member views and 1 included comothers. Four themes emerged: access and availability; adapting to fatherhood; sociocultural influences and experiences of care. These findings highlight the significant role played by fathers and family members on the uptake of PNC by women as well as the distinct concerns and needs of fathers during the early postnatal period. CONCLUSION To optimise access to postnatal care, health providers should adopt a more inclusive approach incorporating flexible contact opportunities, the availability of more 'family-friendly' information and access to psychosocial support services for both parents.
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Affiliation(s)
- Kenneth Finlayson
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Vanessa Brizuela
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Nicola Crossland
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Sarah Cordey
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Daniela Ziegler
- Direction de l'enseignement et l'Académie CHUM | Bibliothèque du CHUM, Centre Hospitalier de l'Universite de Montreal, Montreal, Québec, Canada
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), World Health Organization, Geneva, Switzerland
| | - Dena Javadi
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Liz Comrie-Thomson
- Global Women's and Newborn's Health Group, Burnet Institute, Melbourne, Victoria, Australia
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Mercedes Bonet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Brizuela V, Bahamondes L, Gómez Ponce de León R, Aslanyan G, Feletto M, Bonet M, Thorson A. Strengthening locally led research to respond to the sexual and reproductive health and rights of migrants from Venezuela and Central America. Rev Panam Salud Publica 2023; 47:e36. [PMID: 36895678 PMCID: PMC9989552 DOI: 10.26633/rpsp.2023.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 03/08/2023] Open
Affiliation(s)
- Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerlandUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Luis Bahamondes
- Department of Obstetrics and GynaecologyUniversity of Campinas Medical FacultyCampinasBrazilDepartment of Obstetrics and Gynaecology, University of Campinas Medical Faculty, Campinas, Brazil.
| | - Rodolfo Gómez Ponce de León
- Center for PerinatologyWomen’s, and Reproductive Health (CLAP-PAHO/WHO)MontevideoUruguayCenter for Perinatology, Women’s, and Reproductive Health (CLAP-PAHO/WHO), Montevideo, Uruguay.
| | - Garry Aslanyan
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR)World Health OrganizationGenevaSwitzerlandUNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland.
| | - Marta Feletto
- Alliance for Health Policy and Systems ResearchWorld Health OrganizationGenevaSwitzerlandAlliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland.
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerlandUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerlandUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
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Brizuela V, Bahamondes L, Gómez Ponce de León R, Aslanyan G, Feletto M, Bonet M, Thorson A. Fortalecimiento de la investigación local para abordar la salud y los derechos sexuales y reproductivos de las personas migrantes de Venezuela y América Central *. Rev Panam Salud Publica 2023; 47:e37. [PMID: 36895676 PMCID: PMC9989547 DOI: 10.26633/rpsp.2023.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 03/08/2023] Open
Affiliation(s)
- Vanessa Brizuela
- Programa Especial de Investigación, Desarrollo y Capacitación en Investigación sobre Reproducción Humana (HRP) de PNUD/UNFPA/UNICEF/OMS/Banco MundialDepartamento de Salud Sexual y Reproductiva e Investigaciones relacionadasOrganización Mundial de la SaludGinebraSuizaPrograma Especial de Investigación, Desarrollo y Capacitación en Investigación sobre Reproducción Humana (HRP) de PNUD/UNFPA/UNICEF/OMS/Banco Mundial, Departamento de Salud Sexual y Reproductiva e Investigaciones relacionadas, Organización Mundial de la Salud, Ginebra, Suiza.
- Vanessa Brizuela, .
| | - Luis Bahamondes
- Departamento de Obstetricia y GinecologíaFacultad de Medicina de la Universidad de CampinasCampinasBrasilDepartamento de Obstetricia y Ginecología, Facultad de Medicina de la Universidad de Campinas, Campinas, Brasil.
| | - Rodolfo Gómez Ponce de León
- Centro Latinoamericano de PerinatologíaSalud de la Mujer y Reproductiva (CLAP-OPS/OMS)MontevideoUruguayCentro Latinoamericano de Perinatología, Salud de la Mujer y Reproductiva (CLAP-OPS/OMS), Montevideo, Uruguay.
| | - Garry Aslanyan
- Programa Especial de Capacitación e Investigación en Enfermedades Tropicales (TDR) de UNICEF/PNUD/Banco Mundial/OMSOrganización Mundial de la SaludGinebraSuizaPrograma Especial de Capacitación e Investigación en Enfermedades Tropicales (TDR) de UNICEF/PNUD/Banco Mundial/OMS, Organización Mundial de la Salud, Ginebra, Suiza.
| | - Marta Feletto
- Alianza para la Investigación en Políticas y Sistemas de SaludOrganización Mundial de la SaludGinebraSuizaAlianza para la Investigación en Políticas y Sistemas de Salud, Organización Mundial de la Salud, Ginebra, Suiza.
| | - Mercedes Bonet
- Programa Especial de Investigación, Desarrollo y Capacitación en Investigación sobre Reproducción Humana (HRP) de PNUD/UNFPA/UNICEF/OMS/Banco MundialDepartamento de Salud Sexual y Reproductiva e Investigaciones relacionadasOrganización Mundial de la SaludGinebraSuizaPrograma Especial de Investigación, Desarrollo y Capacitación en Investigación sobre Reproducción Humana (HRP) de PNUD/UNFPA/UNICEF/OMS/Banco Mundial, Departamento de Salud Sexual y Reproductiva e Investigaciones relacionadas, Organización Mundial de la Salud, Ginebra, Suiza.
| | - Anna Thorson
- Programa Especial de Investigación, Desarrollo y Capacitación en Investigación sobre Reproducción Humana (HRP) de PNUD/UNFPA/UNICEF/OMS/Banco MundialDepartamento de Salud Sexual y Reproductiva e Investigaciones relacionadasOrganización Mundial de la SaludGinebraSuizaPrograma Especial de Investigación, Desarrollo y Capacitación en Investigación sobre Reproducción Humana (HRP) de PNUD/UNFPA/UNICEF/OMS/Banco Mundial, Departamento de Salud Sexual y Reproductiva e Investigaciones relacionadas, Organización Mundial de la Salud, Ginebra, Suiza.
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Cecatti JG, Bahamondes L, Ali M, Alangea DO, Brizuela V, Nahyuha Chomi E, Kouanda S, Karmaliani R, Ladak L, Lumbiganon P, Emefa M, Jen S, Kuganantham H, Kim C. Issues related to pregnancy, pregnancy prevention and abortion in the context of the COVID-19 pandemic: a WHO qualitative study protocol. BMJ Open 2022; 12:e063317. [PMID: 36202583 PMCID: PMC9539649 DOI: 10.1136/bmjopen-2022-063317] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION WHO has generated standardised clinical and epidemiological research protocols to address key public health questions for SARS-CoV-2 (COVID-19) pandemic. We present a standardised protocol with the aim to fill a gap in understanding the needs, attitudes and practices related to sexual and reproductive health in the context of COVID-19 pandemic, focusing on pregnancy, pregnancy prevention and abortion. METHODS AND ANALYSIS PLAN This protocol is a prospective qualitative research, using semi-structured interviews with at least 15 pregnant women at different gestational ages and after delivery, 6 months apart from the first interview. At least 10 partners, 10 non-pregnant women and 5 healthcare professionals will be interviewed once during the course of the research. Higher number of subjects may be needed if a saturation is not achieved with these numbers. Data collection will be performed in a standardised way by skilled trained interviewers using written notes or audio-record of the interview. The data will be explored using the thematic content analysis and the researchers will look for broad patterns, generalisations or theories from these categories. ETHICS AND DISSEMINATION The current protocol was first technically assessed and approved by the WHO scientific committee and then approved by its ethics review committee as a guidance document. It is expected that each country/setting implementing such a generic protocol adapted to their conditions also obtain local ethical approval. Comments for the user's consideration are provided the document, as the user may need to modify methods slightly because of the local context in which this study will be carried out.
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Affiliation(s)
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Moazzam Ali
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Deda Ogum Alangea
- Department of Population, Family and Reproductive Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland
| | | | - Seni Kouanda
- Institut de Recherche en Sciences de la Sante, Ouagadougou, Burkina Faso
| | - Rozina Karmaliani
- Aga Khan University School of Nursing & Midwifery, Karachi, Pakistan
| | - Laila Ladak
- Aga Khan University School of Nursing & Midwifery, Karachi, Pakistan
| | - Pisake Lumbiganon
- Department of Obstetrics & Gynecology, Khon Kaen University, Khon Kaen, Thailand
| | - Modey Emefa
- Dept. of Population, Family & Reproductive Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Sothornwit Jen
- Department of Obstetrics and Gynaecology, Khon Kaen University, Khon Kaen, Thailand
| | - Hamsadvani Kuganantham
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland
| | - Caron Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Sacks E, Finlayson K, Brizuela V, Crossland N, Ziegler D, Sauvé C, Langlois ÉV, Javadi D, Downe S, Bonet M. Factors that influence uptake of routine postnatal care: Findings on women's perspectives from a qualitative evidence synthesis. PLoS One 2022; 17:e0270264. [PMID: 35960752 PMCID: PMC9374256 DOI: 10.1371/journal.pone.0270264] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 06/07/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Effective postnatal care is important for optimal care of women and newborns-to promote health and wellbeing, identify and treat clinical and psychosocial concerns, and to provide support for families. Yet uptake of formal postnatal care services is low and inequitable in many countries. As part of a larger study examining the views of women, partners, and families requiring both routine and specialised care, we analysed a subset of data on the views and experiences of women related to routine postnatal care. METHODS We undertook a qualitative evidence synthesis, using a framework analysis approach. We included studies published up to December 2019 with extractable qualitative data, with no language restriction. We focused on women in the general population and their accounts of routine postnatal care utilization. We searched MEDLINE, PUBMED, CINAHL, EMBASE, EBM-Reviews, and grey literature. Two reviewers screened each study independently; inclusion was agreed by consensus. Data abstraction and scientific quality assessment were carried out using a study-specific extraction form and established quality assessment tools. The analysis framework was developed a priori based on previous knowledge and research on the topic and adapted. Due to the number of included texts, the final synthesis was developed inductively from the initial framework by iterative sampling of the included studies, until data saturation was achieved. Findings are presented by high versus low/middle income country, and by confidence in the finding, applying the GRADE-CERQual approach. FINDINGS Of 12,678 papers, 512 met the inclusion criteria; 59 articles were sampled for analysis. Five themes were identified: access and availability; physical and human resources; external influences; social norms; and experience of care. High confidence study findings included the perceived low value of postnatal care for healthy women and infants; concerns around access and quality of care; and women's desire for more emotional and psychosocial support during the postnatal period. These findings highlight multiple missed opportunities for postnatal care promotion and ensuring continuity of care. CONCLUSIONS Factors that influence women's utilization of postnatal care are interlinked, and include access, quality, and social norms. Many women recognised the specific challenges of the postnatal period and emphasised the need for emotional and psychosocial support in this time, in addition to clinical care. While this is likely a universal need, studies on mental health needs have predominantly been conducted in high-income settings. Postnatal care programmes and related research should consider these multiple drivers and multi-faceted needs, and the holistic postpartum needs of women and their families should be studied in a wider range of settings. REGISTRATION This protocol is registered in the PROSPERO database for systematic reviews: CRD42019139183.
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Affiliation(s)
- Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Kenneth Finlayson
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Vanessa Brizuela
- Department of Reproductive Health and Research, World Health Organization, Genève, Switzerland
| | - Nicola Crossland
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Daniela Ziegler
- Centre Hospitalier de l’Universite de Montreal, Montreal, Canada
| | - Caroline Sauvé
- Centre Hospitalier de l’Universite de Montreal, Montreal, Canada
| | - Étienne V. Langlois
- Partnership for Maternal, Newborn, and Child Health, World Health Organization, Genève, Switzerland
| | - Dena Javadi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Mercedes Bonet
- Department of Reproductive Health and Research, World Health Organization, Genève, Switzerland
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Kouanda S, Nahyuha Chomi E, Kim C, Jen S, Bahamondes L, Cecatti JG, Lumbiganon P, Emefa M, Brizuela V, Kuganantham H, Seuc AH, Ali M. Health systems analysis and evaluation of the barriers to availability, utilisation and readiness of sexual and reproductive health services in COVID-19-affected areas: a WHO mixed-methods study protocol. BMJ Open 2022; 12:e057810. [PMID: 35649598 PMCID: PMC9160592 DOI: 10.1136/bmjopen-2021-057810] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION COVID-19 has led to an unprecedented increase in demand on health systems to care for people infected, necessitating the allocation of significant resources, especially medical resources, towards the response. This, compounded by the restrictions on movement instituted may have led to disruptions in the provision of essential services, including sexual and reproductive health (SRH) services. This study aims to assess the availability of contraception, comprehensive abortion care, sexually transmitted infection prevention and treatment and sexual and gender-based violence care and support services in local health facilities during COVID-19 pandemic. This is a standardised generic protocol designed for use across different global settings. METHODS AND ANALYSIS This study adopts both quantitative and qualitative methods to assess health facilities' SRH service availability and readiness, and clients' and providers' perceptions of the availability and readiness of these services in COVID-19-affected areas. The study has two levels: (1) perceptions of clients (and the partners) and healthcare providers, using qualitative methods, and (2) assessment of infrastructure availability and readiness to provide SRH services through reviews, facility service statistics for clients and a qualitative survey for healthcare provider perspectives. The health system assessment will use a cross-sectional panel survey design with two data collection points to capture changes in SRH services availability as a result of the COVID-19 epidemic. Data will be collected using focus group discussions, in-depth interviews and a health facility assessment survey. ETHICS AND DISSEMINATION Ethical approval for this study was obtained from the WHO Scientific and Ethics Review Committee (protocol ID CERC.0103). Each study site is required to obtain the necessary ethical and regulatory approvals that are required in each specific country.
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Affiliation(s)
- Seni Kouanda
- Reproductive Health Unit, Institute for Research in Health Sciences, Ouagadougou, Burkina Faso
| | - Eunice Nahyuha Chomi
- Reproductive Health Unit, Institute for Research in Health Sciences, Ouagadougou, Burkina Faso
| | - Caron Kim
- Department of Sexual and Reproductive Health, World Health Organization, Geneve, Switzerland
| | - Sothornwit Jen
- Department of Obstetrics and Gynaecology, Khon Kaen University, Nai Mueang, Thailand
| | - Luis Bahamondes
- Department of Obstetrics and Gynaecology, State University of Campinas-UNICAMP, Campinas, Brazil
| | | | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Khon Kaen University, Nai Mueang, Thailand
| | - Modey Emefa
- Department of population, family and Reproductive Health, University of Ghana, Legon, Ghana
| | - Vanessa Brizuela
- Department of Sexual and Reproductive Health, World Health Organization, Geneve, Switzerland
| | - Hamsadvani Kuganantham
- Department of Sexual and Reproductive Health, World Health Organization, Geneve, Switzerland
| | - Armando Humberto Seuc
- Department of Sexual and Reproductive Health, World Health Organization, Geneve, Switzerland
| | - Moazzam Ali
- Department of Sexual and Reproductive Health, World Health Organization, Geneve, Switzerland
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16
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Allotey J, Chatterjee S, Kew T, Gaetano A, Stallings E, Fernández-García S, Yap M, Sheikh J, Lawson H, Coomar D, Dixit A, Zhou D, Balaji R, Littmoden M, King Y, Debenham L, Llavall AC, Ansari K, Sandhu G, Banjoko A, Walker K, O'Donoghue K, van Wely M, van Leeuwen E, Kostova E, Kunst H, Khalil A, Brizuela V, Broutet N, Kara E, Kim CR, Thorson A, Oladapo OT, Zamora J, Bonet M, Mofenson L, Thangaratinam S. SARS-CoV-2 positivity in offspring and timing of mother-to-child transmission: living systematic review and meta-analysis. BMJ 2022; 376:e067696. [PMID: 35296519 PMCID: PMC8924705 DOI: 10.1136/bmj-2021-067696] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the rates of SARS-CoV-2 positivity in babies born to mothers with SARS-CoV-2 infection, the timing of mother-to-child transmission and perinatal outcomes, and factors associated with SARS-CoV-2 status in offspring. DESIGN Living systematic review and meta-analysis. DATA SOURCES Major databases between 1 December 2019 and 3 August 2021. STUDY SELECTION Cohort studies of pregnant and recently pregnant women (including after abortion or miscarriage) who sought hospital care for any reason and had a diagnosis of SARS-CoV-2 infection, and also provided data on offspring SARS-CoV-2 status and risk factors for positivity. Case series and case reports were also included to assess the timing and likelihood of mother-to-child transmission in SARS-CoV-2 positive babies. DATA EXTRACTION Two reviewers independently extracted data and assessed study quality. A random effects model was used to synthesise data for rates, with associations reported using odds ratios and 95% confidence intervals. Narrative syntheses were performed when meta-analysis was inappropriate. The World Health Organization classification was used to categorise the timing of mother-to-child transmission (in utero, intrapartum, early postnatal). RESULTS 472 studies (206 cohort studies, 266 case series and case reports; 28 952 mothers, 18 237 babies) were included. Overall, 1.8% (95% confidence interval 1.2% to 2.5%; 140 studies) of the 14 271 babies born to mothers with SARS-CoV-2 infection tested positive for the virus with reverse transcriptase polymerase chain reaction (RT-PCR). Of the 592 SARS-CoV-2 positive babies with data on the timing of exposure and type and timing of tests, 14 had confirmed mother-to-child transmission: seven in utero (448 assessed), two intrapartum (18 assessed), and five during the early postnatal period (70 assessed). Of the 800 SARS-CoV-2 positive babies with outcome data, 20 were stillbirths, 23 were neonatal deaths, and eight were early pregnancy losses; 749 babies were alive at the end of follow-up. Severe maternal covid-19 (odds ratio 2.4, 95% confidence interval 1.3 to 4.4), maternal death (14.1, 4.1 to 48.0), maternal admission to an intensive care unit (3.5, 1.7 to 6.9), and maternal postnatal infection (5.0, 1.2 to 20.1) were associated with SARS-CoV-2 positivity in offspring. Positivity rates using RT-PCR varied between regions, ranging from 0.1% (95% confidence interval 0.0% to 0.3%) in studies from North America to 5.7% (3.2% to 8.7%) in studies from Latin America and the Caribbean. CONCLUSION SARS-CoV-2 positivity rates were found to be low in babies born to mothers with SARS-CoV-2 infection. Evidence suggests confirmed vertical transmission of SARS-CoV-2, although this is likely to be rare. Severity of maternal covid-19 appears to be associated with SARS-CoV-2 positivity in offspring. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020178076. READERS' NOTE This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.
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Affiliation(s)
- John Allotey
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | | | - Tania Kew
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Andrea Gaetano
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Elena Stallings
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Magnus Yap
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Jameela Sheikh
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Heidi Lawson
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Dyuti Coomar
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Anushka Dixit
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Dengyi Zhou
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Rishab Balaji
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Megan Littmoden
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | - Luke Debenham
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | - Kehkashan Ansari
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Gurimaan Sandhu
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Adeolu Banjoko
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | | | - Madelon van Wely
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Elizabeth van Leeuwen
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Elena Kostova
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Heinke Kunst
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | | | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Nathalie Broutet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Edna Kara
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Caron Rahn Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Javier Zamora
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Lynne Mofenson
- Elizabeth Glaser Paediatric AIDS Foundation, Washington DC, USA
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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17
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Gonsalves L, Hunter EC, Brizuela V, Tucker JD, Srinivas ML, Gitau E, Mercer CH, Bajos N, Collins D. Cognitive testing of a survey instrument to assess sexual practices, behaviours, and health outcomes: a multi-country study protocol. Reprod Health 2021; 18:249. [PMID: 34923998 PMCID: PMC8684588 DOI: 10.1186/s12978-021-01301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population level data on sexual practices, behaviours and health-related outcomes can ensure that responsive, relevant health services are available for all people of all ages. However, while billions of dollars have been invested in attempting to improve sexual and reproductive health (including HIV) outcomes, far less is understood about associated sexual practices and behaviours. Therefore, the World Health Organization embarked on a global consultative process to develop a short survey instrument to assess sexual health practices, behaviours and health outcomes. In order for the resulting draft survey instrument to be published as a 'global' standard instrument, it is important to first determine that the proposed measures are globally comprehensible and applicable. This paper describes a multi-country study protocol to assess the interpretability and comparability of the survey instrument in a number of diverse countries. METHODS This study will use cognitive interviewing, a qualitative data collection method that uses semi-structured interviews to explore how participants process and respond to survey instruments. We aim to include study sites in up to 20 countries. The study procedures consist of: (1) localizing the instrument using forward and back-translation; (2) using a series of cognitive interviews to understand how participants engage with each survey question; (3) revising the core instrument based on interview findings; and (4) conducting an optional second round of cognitive interviews. Data generated from interviews will be summarised into a predeveloped analysis matrix. The entire process (a 'wave' of data collection) will be completed simultaneously by 5+ countries, with a total of three waves. This stepwise approach facilitates iterative improvements and sharing across countries. DISCUSSION An important output from this research will be a revised survey instrument, which when subsequently published, can contribute to improving the comparability across contexts of measures of sexual practices, behaviours and health-related outcomes. Site-specific results of the feasibility of conducting this research may help shift perceptions of who and what can be included in sexual health-related research.
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Affiliation(s)
- Lianne Gonsalves
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.
| | - Erin C Hunter
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Vanessa Brizuela
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Joseph D Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, USA
| | - Megan L Srinivas
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, USA
| | - Evelyn Gitau
- African Population and Health Research Center, Nairobi, Kenya
| | - Catherine H Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London, UK
| | - Nathalie Bajos
- Institut National de la Santé et de la Recherche Medicale (INSERM), IRIS-EHESS, Paris, France
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18
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Giesbers S, Goh E, Kew T, Allotey J, Brizuela V, Kara E, Kunst H, Bonet M, Thangaratinam S. Treatment of COVID-19 in pregnant women: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 267:120-128. [PMID: 34768118 PMCID: PMC8527829 DOI: 10.1016/j.ejogrb.2021.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 07/14/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 12/15/2022]
Abstract
Objective Clinical trials evaluating
pharmacological and non-pharmacological treatment of COVID-19, either
excluded pregnant women or included very few women. Unlike the numerous
systematic reviews on prevalence, symptoms and adverse outcomes of
COVID-19 in pregnancy, there are very few on the effects of treatment on
maternal and neonatal outcomes in pregnancy. We undertook a systematic
review of all published and unpublished studies on the effects of
pharmacological and non-pharmacological interventions for COVID-19 on
maternal and neonatal pregnancy outcomes. Data sources We performed a systematic literature
search of the following databases: Medline, Embase, Cochrane database,
WHO (World Health Organization) COVID-19 database, China National
Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December
2019 to 1 December 2020. Study eligibility criteria Studies were only included if they
involved pregnant or postnatal women who were exposed to pregnancy
specific interventions like the mode of delivery and type of anaesthesia,
pharmacological or non-pharmacological interventions. Study appraisal and synthesis
methods We first screened the titles and
abstracts of studies and then assessed the full text of the selected
studies in detail for eligibility. Data on study design, population, type
of screening for COVID-19, country, hospital, country status (high or low
and middle income), treatment given (mode of delivery, type of
anaesthesia, type of pharmacological and non-pharmacological treatment
was extracted. The pre-defined maternal outcomes we collected were mode
of delivery (vaginal or by caesarean section), severe or critical
COVID-19 (as defined by the authors), symptomatic COVID-19, maternal
death, maternal hospital admission, ICU admission, mechanical
ventilation, ECMO and maternal pneumonia. The pre-defined neonatal
outcomes we extracted were preterm birth (<37 weeks), stillbirth,
neonatal death, NICU admission, neonatal COVID-19 positive, neonatal
acidosis (pH<7.0) and Apgar scores (<8 after 5 minutes). Study
quality assessment was performed. Results From a total of 342 potential
eligible studies, we included 27 studies in our systematic review,
including 4943 pregnant women (appendix 3). Sixteen studies had a
retrospective cohort design and 11 a prospective cohort design. There
were no randomised controlled trials. There was a significant association
between caesarean section and admission to ICU (OR 4.99, 95% CI 1.24 to
20.12; 4 studies, 153 women, I2=0%), and
diagnosis of maternal COVID-19 pneumonia as defined by study authors (OR
3.09, 95% CI 1.52 to 6.28; 2 studies, 228 women, I2=0%). Women who had a preterm birth were more likely to
have the baby via caesarean section (OR 3.03, 95% CI 1.71 to 5.36, 12
studies; 314 women, I2=0%). For
pharmacological and non-pharmacological we provided estimates of the
expected rates of outcomes in women exposed to various treatment of
COVID-19. Comparative data for pregnant women, in particular for
treatments proven to be effective in the general population, however, is
lacking to provide clinically meaningful interpretation. Conclusions We found associations for pregnancy
specific interventions, like mode of delivery and outcomes of the
disease, but there were too few data on pharmacological and
non-pharmacological treatments in pregnant women with COVID-19. We report
the rates of complications found in the literature. We encourage
researchers to include pregnant women in their trials and report the data
on pregnant women separately.
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Affiliation(s)
- Steven Giesbers
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Edwina Goh
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Tania Kew
- Birmingham Medical School, Birmingham, United Kingdom
| | - John Allotey
- University of Birmingham, WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, United Kingdom; Institute of Applied Health Research, Birmingham, United Kingdom
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Edna Kara
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Heinke Kunst
- Blizard Institute, Queen Mary University of London, London, United Kingdom; Barts Health NHS Trust, London, United Kingdom
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shakila Thangaratinam
- University of Birmingham, WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, United Kingdom; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom.
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19
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Baguiya A, Bonet M, Cecatti JG, Brizuela V, Curteanu A, Minkauskiene M, Jayaratne K, Ribeiro-do-Valle CC, Budianu MA, Souza JP, Kouanda S. Perinatal outcomes among births to women with infection during pregnancy. Arch Dis Child 2021; 106:946-953. [PMID: 34475107 PMCID: PMC8461398 DOI: 10.1136/archdischild-2021-321865] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study is part of the Global Maternal Sepsis Study (GLOSS). It aimed to estimate neonatal near-miss (NNM) and perinatal death frequency and maternal risk factors among births to women with infection during pregnancy in low-income and middle-income countries (LMIC). DESIGN We conducted a 1-week inception hospital-based cohort study. SETTING The study was carried out in 408 hospitals in 43 LMIC of all the WHO regions in 2017. PATIENTS We included women with suspected or confirmed infection during pregnancy with at least 28 weeks of gestational age up to day-7 after birth. All babies born to those women were followed from birth until the seventh day after childbirth. Perinatal outcomes were considered at the end of the follow-up. MAIN OUTCOME MEASURES Perinatal outcomes were (i) babies alive without severe complication, (ii) NNM and (iii) perinatal death (stillbirth and early neonatal death). RESULTS 1219 births were analysed. Among them, 25.9% (n=316) and 10.1% (n=123) were NNM and perinatal deaths, respectively. After adjustment, maternal pre-existing medical condition (adjusted odds ratios (aOR)=1.5; 95% CI 1.1 to 2.0) and maternal infection suspected or diagnosed during labour (aOR=1.9; 95% CI 1.2 to 3.2) were the independent risk factors of NNM. Maternal pre-existing medical condition (aOR=1.7; 95% CI 1.0 to 2.8), infection-related severe maternal outcome (aOR=3.8; 95% CI 2.0 to 7.1), mother's infection suspected or diagnosed within 24 hours after childbirth (aOR=2.2; 95% CI 1.0 to 4.7) and vaginal birth (aOR=1.8; 95% CI 1.1 to 2.9) were independently associated with increased odds of perinatal death. CONCLUSIONS Overall, one-third of births were adverse perinatal outcomes. Pre-existing maternal medical conditions and severe infection-related maternal outcomes were the main risk factors of adverse perinatal outcomes.
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Affiliation(s)
- Adama Baguiya
- Kaya Health and Demographic Surveillance System (Kaya-HDSS), Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - José Guilherme Cecatti
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Campinas, SP, Brazil
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ala Curteanu
- Department of Perinatology, Mother and Child Institute, Chisinau, Moldova
| | - Meile Minkauskiene
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kapila Jayaratne
- Maternal & Child Morbidity & Mortality Surveillance Unit, Family Health Bureau, Colombo, Sri Lanka
| | | | - Mihaela-Alexandra Budianu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Mureș, Romania
| | - João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Séni Kouanda
- Ecole docotorale ED2ST, Saint Thomas d'Aquin University (USTA), Ouagadougou, Burkina Faso,Biomedical and Public Health Department, Research Institute of Health Sciences, Ouagadougou, Burkina Faso
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20
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Brizuela V, Cuesta C, Bartolelli G, Abdosh AA, Abou Malham S, Assarag B, Castro Banegas R, Díaz V, El-Kak F, El Sheikh M, Pérez AM, Souza JP, Bonet M, Abalos E. Availability of facility resources and services and infection-related maternal outcomes in the WHO Global Maternal Sepsis Study: a cross-sectional study. Lancet Glob Health 2021; 9:e1252-e1261. [PMID: 34273300 PMCID: PMC8370881 DOI: 10.1016/s2214-109x(21)00248-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/30/2021] [Accepted: 05/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Infections are among the leading causes of maternal mortality and morbidity. The Global Maternal Sepsis and Neonatal Initiative, launched in 2016 by WHO and partners, sought to reduce the burden of maternal infections and sepsis and was the basis upon which the Global Maternal Sepsis Study (GLOSS) was implemented in 2017. In this Article, we aimed to describe the availability of facility resources and services and to analyse their association with maternal outcomes. METHODS GLOSS was a facility-based, prospective, 1-week inception cohort study implemented in 713 health-care facilities in 52 countries and included 2850 hospitalised pregnant or recently pregnant women with suspected or confirmed infections. All women admitted for or in hospital with suspected or confirmed infections during pregnancy, childbirth, post partum, or post abortion at any of the participating facilities between Nov 28 and Dec 4 were eligible for inclusion. In this study, we included all GLOSS participating facilities that collected facility-level data (446 of 713 facilities). We used data obtained from individual forms completed for each enrolled woman and their newborn babies by trained researchers who checked the medical records and from facility forms completed by hospital administrators for each participating facility. We described facilities according to country income level, compliance with providing core clinical interventions and services according to women's needs and reported availability, and severity of infection-related maternal outcomes. We used a logistic multilevel mixed model for assessing the association between facility characteristics and infection-related maternal outcomes. FINDINGS We included 446 facilities from 46 countries that enrolled 2560 women. We found a high availability of most services and resources needed for obstetric care and infection prevention. We found increased odds for severe maternal outcomes among women enrolled during the post-partum or post-abortion period from facilities located in low-income countries (adjusted odds ratio 1·84 [95% CI 1·05-3·22]) and among women enrolled during pregnancy or childbirth from non-urban facilities (adjusted odds ratio 2·44 [1·02-5·85]). Despite compliance being high overall, it was low with regards to measuring respiratory rate (85 [24%] of 355 facilities) and measuring pulse oximetry (184 [57%] of 325 facilities). INTERPRETATION While health-care facilities caring for pregnant and recently pregnant women with suspected or confirmed infections have access to a wide range of resources and interventions, worse maternal outcomes are seen among recently pregnant women located in low-income countries than among those in higher-income countries; this trend is similar for pregnant women. Compliance with cost-effective clinical practices and timely care of women with particular individual characteristics can potentially improve infection-related maternal outcomes. FUNDING UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Merck for Mothers, and US Agency for International Development.
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Affiliation(s)
- Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland.
| | - Cristina Cuesta
- School of Economics and Statistics, National University of Rosario, Rosario, Argentina
| | - Gino Bartolelli
- School of Economics and Statistics, National University of Rosario, Rosario, Argentina
| | | | - Sabina Abou Malham
- Faculty of Medicine and Health Sciences, School of Nursing, Université de Sherbrooke, Longueuil, QC, Canada
| | | | | | - Virginia Díaz
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Faysal El-Kak
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, Ribeirão Preto, Brazil
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
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21
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Brizuela V, Kapilashrami A, Bonet M, Khosla R, Kobeissi L, Say L, Thorson A. Sexual and reproductive health and rights of migrants: strengthening regional research capacity. Bull World Health Organ 2021; 99:402-404. [PMID: 33958830 PMCID: PMC8061669 DOI: 10.2471/blt.20.270447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Anuj Kapilashrami
- School of Health and Social Care, University of Essex, Essex, England
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Rajat Khosla
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Loulou Kobeissi
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Lale Say
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
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Sacks E, Brizuela V, Perrotta C. It's the Destination and the Journey-A Mapping of the Challenges in Transport and Referral for Maternal and Newborn Health in Pandemics and Beyond. Front Public Health 2021; 9:612409. [PMID: 33937164 PMCID: PMC8085309 DOI: 10.3389/fpubh.2021.612409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Vanessa Brizuela
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | - Carla Perrotta
- School of Public Health, University College Dublin, Dublin, Ireland
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23
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Compaoré R, Brizuela V, Khisa AM, Gómez AL, Baguiya A, Bonet M, Thorson A, Gitau E, Kouanda S. 'We always find things to learn from.' Lessons from the implementation of the global maternal sepsis study on research capacity: a qualitative study. BMC Health Serv Res 2021; 21:208. [PMID: 33685446 PMCID: PMC7938552 DOI: 10.1186/s12913-021-06195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 02/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background Research capacity strengthening could be an indirect outcome of implementing a research project. The objective of this study was to explore the ability of the global maternal sepsis study (GLOSS), implemented in 52 countries, to develop and strengthen sexual and reproductive health research capacity of local participants in low- and middle- income participating countries. Methods We carried out a qualitative study employing grounded theory in sixteen countries in Africa and Latin America. We used inductive and deductive methods through a focus group discussion and semi-structured interviews for the emergence of themes. Participants of the focus group discussion (n = 8) were GLOSS principal investigators (PIs) in Latin America. Interviewees (n = 63) were selected by the country GLOSS PIs in both Africa and Latin America, and included a diverse sample of participants involved in different aspects of study implementation. Eighty-two percent of the participants were health workers. We developed a conceptual framework that took into consideration data obtained from the focus group and refined it based on data from the interviews. Results Six themes emerged from the data analysis: recognized need for research capacity, unintended effects of participating in research, perceived ownership and linkage with the research study, being just data collectors, belonging to an institution that supports and fosters research, and presenting study results back to study implementers. Research capacity strengthening needs were consistently highlighted including involvement in protocol development, training and technical support, data analysis, and project management. The need for institutional support for researchers to conduct research was also emphasised. Conclusion This study suggests that research capacity strengthening of local researchers was an unintentional outcome of the large multi-country study on maternal sepsis. However, for sustainable research capacity to be built, study coordinators and funders need to deliberately plan for it, addressing needs at both the individual and institutional level. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06195-9.
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Affiliation(s)
| | - Vanessa Brizuela
- UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Anne M Khisa
- African Population and Health Research Centre, Nairobi, Kenya
| | - Alejandra López Gómez
- Programme of Gender, Reproductive Health and Sexuality/Institute of Psychology of Health, School of Psychology, University of the Republic, Montevideo, Uruguay
| | - Adama Baguiya
- Research Institute for Health Sciences, Ouagadougou, Burkina Faso
| | - Mercedes Bonet
- UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Anna Thorson
- UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Evelyn Gitau
- African Population and Health Research Centre, Nairobi, Kenya
| | - Seni Kouanda
- Research Institute for Health Sciences, Ouagadougou, Burkina Faso
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24
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Taylor MM, Kobeissi L, Kim C, Amin A, Thorson AE, Bellare NB, Brizuela V, Bonet M, Kara E, Thwin SS, Kuganantham H, Ali M, Oladapo OT, Broutet N. Inclusion of pregnant women in COVID-19 treatment trials: a review and global call to action. Lancet Glob Health 2020; 9:e366-e371. [PMID: 33340453 PMCID: PMC7832459 DOI: 10.1016/s2214-109x(20)30484-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/23/2020] [Accepted: 11/04/2020] [Indexed: 12/31/2022]
Abstract
Inclusion of pregnant women in COVID-19 clinical trials would allow evaluation of effective therapies that might improve maternal health, pregnancy, and birth outcomes, and avoid the delay of developing treatment recommendations for pregnant women. We explored the inclusion of pregnant women in treatment trials of COVID-19 by reviewing ten international clinical trial registries at two timepoints in 2020. We identified 155 COVID-19 treatment studies of non-biological drugs for the April 7–10, 2020 timepoint, of which 124 (80%) specifically excluded pregnant women. The same registry search for the July 10–15, 2020 timepoint, yielded 722 treatment studies, of which 538 (75%) specifically excluded pregnant women. We then focused on studies that included at least one of six drugs (remdesivir, lopinavir–ritonavir, interferon beta, corticosteroids, chloroquine and hydroxychloroquine, and ivermectin) under evaluation for COVID-19. Of 176 such studies, 130 (74%) listed pregnancy as an exclusion criterion. Of 35 studies that evaluated high-dose vitamin treatment for COVID-19, 27 (77%) excluded pregnant women. Despite the surge in treatment studies for COVID-19, the proportion excluding pregnant women remains consistent. Exclusion was not well justified as many of the treatments being evaluated have no or low safety concerns during pregnancy. Inclusion of pregnant women in clinical treatment trials is urgently needed to identify effective COVID-19 treatment for this population.
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Affiliation(s)
- Melanie M Taylor
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland; Department of Global Programmes of HIV, Hepatitis, and STI, WHO, Geneva, Switzerland; Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Loulou Kobeissi
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland.
| | - Caron Kim
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Avni Amin
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Anna E Thorson
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Nita B Bellare
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Vanessa Brizuela
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Edna Kara
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Soe Soe Thwin
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | | | - Moazzam Ali
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Olufemi T Oladapo
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
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Yap M, Debenham L, Kew T, Chatterjee SR, Allotey J, Stallings E, Coomar D, Lee SI, Qiu X, Yuan M, Clavé Llavall A, Dixit A, Zhou D, Balaji R, van Wely M, Kostova E, van Leeuwen E, Mofenson L, Kunst H, Khalil A, Tiberi S, Thomas J, Brizuela V, Broutet N, Kara E, Kim C, Thorson A, Rayco-Solon P, Pardo-Hernandez H, Oladapo OT, Zamora J, Bonet M, Thangaratinam S. Clinical manifestations, prevalence, risk factors, outcomes, transmission, diagnosis and treatment of COVID-19 in pregnancy and postpartum: a living systematic review protocol. BMJ Open 2020; 10:e041868. [PMID: 33268430 PMCID: PMC7712931 DOI: 10.1136/bmjopen-2020-041868] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Rapid, robust and continually updated evidence synthesis is required to inform management of COVID-19 in pregnant and postpartum women and to keep pace with the emerging evidence during the pandemic. METHODS AND ANALYSIS We plan to undertake a living systematic review to assess the prevalence, clinical manifestations, risk factors, rates of maternal and perinatal complications, potential for mother-to-child transmission, accuracy of diagnostic tests and effectiveness of treatment for COVID-19 in pregnant and postpartum women (including after miscarriage or abortion). We will search Medline, Embase, WHO COVID-19 database, preprint servers, the China National Knowledge Infrastructure system and Wanfang databases from 1 December 2019. We will supplement our search with studies mapped by Cochrane Fertility and Gynaecology group, Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), COVID-19 study repositories, reference lists and social media blogs. The search will be updated every week and not be restricted by language. We will include observational cohort (≥10 participants) and randomised studies reporting on prevalence of COVID-19 in pregnant and postpartum women, the rates of clinical manifestations and outcomes, risk factors in pregnant and postpartum women alone or in comparison with non-pregnant women with COVID-19 or pregnant women without COVID-19 and studies on tests and treatments for COVID-19. We will additionally include case reports and series with evidence on mother-to-child transmission of SARS-CoV-2 in utero, intrapartum or postpartum. We will appraise the quality of the included studies using appropriate tools to assess the risk of bias. At least two independent reviewers will undertake study selection, quality assessment and data extraction every 2 weeks. We will synthesise the findings using quantitative random effects meta-analysis and report OR or proportions with 95% CIs and prediction intervals. Case reports and series will be reported as qualitative narrative synthesis. Heterogeneity will be reported as I2 and τ2 statistics. ETHICS AND DISSEMINATION Ethical approval is not required as this is a synthesis of primary data. Regular updates of the results will be published on a dedicated website (https://www.birmingham.ac.uk/research/who-collaborating-centre/pregcov/index.aspx) and disseminated through publications, social media and webinars. PROSPERO REGISTRATION NUMBER CRD42020178076.
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Affiliation(s)
- Magnus Yap
- Birmingham Medical School, College Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Luke Debenham
- Birmingham Medical School, College Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tania Kew
- Birmingham Medical School, College Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Shaunak Rhiju Chatterjee
- Birmingham Medical School, College Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - John Allotey
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Elena Stallings
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Dyuti Coomar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Xiu Qiu
- Department of Woman and Child Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Mingyang Yuan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Anna Clavé Llavall
- Birmingham Medical School, College Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anushka Dixit
- Birmingham Medical School, College Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Dengyi Zhou
- Birmingham Medical School, College Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rishab Balaji
- Birmingham Medical School, College Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Madelon van Wely
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Elena Kostova
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Elisabeth van Leeuwen
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Lynne Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, Maryland, USA
| | - Heinke Kunst
- Blizard Institute, Queen Mary University of London, London, UK
| | - Asma Khalil
- Department of Obstetrics and Gynaecology, St George's University London, London, UK
| | - Simon Tiberi
- Blizard Institute, Queen Mary University of London, London, UK
- Department of Infectious Diseases, Barts Health NHS Trust, London, UK
| | - James Thomas
- UCL Institute of Education, University College London, London, UK
| | - Vanessa Brizuela
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Edna Kara
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Caron Kim
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Anna Thorson
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Pura Rayco-Solon
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Hector Pardo-Hernandez
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Olufemi Taiwo Oladapo
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Javier Zamora
- Women's Health Research Unit, Queen Mary University of London, London, UK
| | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, Debenham L, Llavall AC, Dixit A, Zhou D, Balaji R, Lee SI, Qiu X, Yuan M, Coomar D, Sheikh J, Lawson H, Ansari K, van Wely M, van Leeuwen E, Kostova E, Kunst H, Khalil A, Tiberi S, Brizuela V, Broutet N, Kara E, Kim CR, Thorson A, Oladapo OT, Mofenson L, Zamora J, Thangaratinam S. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020; 370:m3320. [PMID: 32873575 PMCID: PMC7459193 DOI: 10.1136/bmj.m3320] [Citation(s) in RCA: 1154] [Impact Index Per Article: 288.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed coronavirus disease 2019 (covid-19). DESIGN Living systematic review and meta-analysis. DATA SOURCES Medline, Embase, Cochrane database, WHO COVID-19 database, China National Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December 2019 to 6 October 2020, along with preprint servers, social media, and reference lists. STUDY SELECTION Cohort studies reporting the rates, clinical manifestations (symptoms, laboratory and radiological findings), risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed covid-19. DATA EXTRACTION At least two researchers independently extracted the data and assessed study quality. Random effects meta-analysis was performed, with estimates pooled as odds ratios and proportions with 95% confidence intervals. All analyses will be updated regularly. RESULTS 192 studies were included. Overall, 10% (95% confidence interval 7% to 12%; 73 studies, 67 271 women) of pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed as having suspected or confirmed covid-19. The most common clinical manifestations of covid-19 in pregnancy were fever (40%) and cough (41%). Compared with non-pregnant women of reproductive age, pregnant and recently pregnant women with covid-19 were less likely to have symptoms (odds ratio 0.28, 95% confidence interval 0.13 to 0.62; I2=42.9%) or report symptoms of fever (0.49, 0.38 to 0.63; I2=40.8%), dyspnoea (0.76, 0.67 to 0.85; I2=4.4%) and myalgia (0.53, 0.36 to 0.78; I2=59.4%). The odds of admission to an intensive care unit (odds ratio 2.13, 1.53 to 2.95; I2=71.2%), invasive ventilation (2.59, 2.28 to 2.94; I2=0%) and need for extra corporeal membrane oxygenation (2.02, 1.22 to 3.34; I2=0%) were higher in pregnant and recently pregnant than non-pregnant reproductive aged women. Overall, 339 pregnant women (0.02%, 59 studies, 41 664 women) with confirmed covid-19 died from any cause. Increased maternal age (odds ratio 1.83, 1.27 to 2.63; I2=43.4%), high body mass index (2.37, 1.83 to 3.07; I2=0%), any pre-existing maternal comorbidity (1.81, 1.49 to 2.20; I2=0%), chronic hypertension (2.0, 1.14 to 3.48; I2=0%), pre-existing diabetes (2.12, 1.62 to 2.78; I2=0%), and pre-eclampsia (4.21, 1.27 to 14.0; I2=0%) were associated with severe covid-19 in pregnancy. In pregnant women with covid-19, increased maternal age, high body mass index, non-white ethnicity, any pre-existing maternal comorbidity including chronic hypertension and diabetes, and pre-eclampsia were associated with serious complications such as admission to an intensive care unit, invasive ventilation and maternal death. Compared to pregnant women without covid-19, those with the disease had increased odds of maternal death (odds ratio 2.85, 1.08 to 7.52; I2=0%), of needing admission to the intensive care unit (18.58, 7.53 to 45.82; I2=0%), and of preterm birth (1.47, 1.14 to 1.91; I2=18.6%). The odds of admission to the neonatal intensive care unit (4.89, 1.87 to 12.81, I2=96.2%) were higher in babies born to mothers with covid-19 versus those without covid-19. CONCLUSION Pregnant and recently pregnant women with covid-19 attending or admitted to the hospitals for any reason are less likely to manifest symptoms such as fever, dyspnoea, and myalgia, and are more likely to be admitted to the intensive care unit or needing invasive ventilation than non-pregnant women of reproductive age. Pre-existing comorbidities, non-white ethnicity, chronic hypertension, pre-existing diabetes, high maternal age, and high body mass index are risk factors for severe covid-19 in pregnancy. Pregnant women with covid-19 versus without covid-19 are more likely to deliver preterm and could have an increased risk of maternal death and of being admitted to the intensive care unit. Their babies are more likely to be admitted to the neonatal unit. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020178076. READERS' NOTE This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This version is update 1 of the original article published on 1 September 2020 (BMJ 2020;370:m3320), and previous updates can be found as data supplements (https://www.bmj.com/content/370/bmj.m3320/related#datasupp). When citing this paper please consider adding the update number and date of access for clarity.
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Affiliation(s)
- John Allotey
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Elena Stallings
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Magnus Yap
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | - Tania Kew
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Luke Debenham
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | - Anushka Dixit
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Dengyi Zhou
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Rishab Balaji
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
- Department of Woman and Child Health Care, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
- Department of Obstetrics and Gynaecology, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
| | - Mingyang Yuan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
| | - Dyuti Coomar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jameela Sheikh
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Heidi Lawson
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Kehkashan Ansari
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Madelon van Wely
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Elizabeth van Leeuwen
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Elena Kostova
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Heinke Kunst
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Asma Khalil
- St George's, University of London, London, UK
| | - Simon Tiberi
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Nathalie Broutet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Edna Kara
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Caron Rahn Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Lynne Mofenson
- Elizabeth Glaser Paediatric AIDS Foundation, Washington DC, USA
| | - Javier Zamora
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Women's Health Research Unit, Queen Mary University of London, London, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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27
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Adanu R, Bahamondes L, Brizuela V, Gitau E, Kouanda S, Lumbiganon P, Nguyen TTH, Saleem S, Thorson A, Torpey K. Strengthening research capacity through regional partners: the HRP Alliance at the World Health Organization. Reprod Health 2020; 17:131. [PMID: 32847605 PMCID: PMC7448306 DOI: 10.1186/s12978-020-00965-0] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Improvements in health cannot occur without cutting-edge research informing the design and implementation of health programmes and policies, highlighting the need for qualified and capable researchers and institutions in countries where disease burden is high and resources are limited. MAIN BODY Research capacity strengthening efforts in low- and middle-income countries have included provision of training scholarships for postgraduate degrees, often in high-income countries, internships at research universities/centres, short courses, as well as involvement with research groups for hands-on experience, among others. The HRP Alliance provides opportunities for developing local research capacity in sexual and reproductive health and rights through institutions based in low- and middle-income countries linked with ongoing and past collaborative studies. It is a network of HRP research partner institutions, World Health Organization (WHO) country and regional offices, WHO special programmes and partnerships, and WHO collaborating centres. CONCLUSION It is through the HRP Alliance that HRP seeks to improve population health by strengthening local research capacity in sexual and reproductive health across the globe, with focus in low- and middle-income countries, in alignment with WHO's quest of promoting healthier populations.
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Affiliation(s)
- Richard Adanu
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Luis Bahamondes
- Department of Obstetrics and Gynaecology, University of Campinas Medical Faculty, Campinas, SP, Brazil
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.
| | - Evelyn Gitau
- African Population and Health Research Center, Nairobi, Kenya
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Thi Thuy Hanh Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
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Brizuela V, Bonet M, Trigo Romero CL, Abalos E, Baguiya A, Fawole B, Knight M, Lumbiganon P, Minkauskienė M, Nabhan A, Bique Osman N, Qureshi ZP, Souza JP. Early evaluation of the 'STOP SEPSIS!' WHO Global Maternal Sepsis Awareness Campaign implemented for healthcare providers in 46 low, middle and high-income countries. BMJ Open 2020; 10:e036338. [PMID: 32444432 PMCID: PMC7247401 DOI: 10.1136/bmjopen-2019-036338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate changes in awareness of maternal sepsis among healthcare providers resulting from the WHO Global Maternal Sepsis Study (GLOSS) awareness campaign. DESIGN Independent sample precampaign/postcampaign through online and paper-based surveys available for over 30 days before campaign roll-out (pre) and after study data collection (post). Descriptive statistics were used for campaign recognition and exposure, and odds ratio (OR) and percentage change were calculated for differences in awareness, adjusting for confounders using multivariate logistic regression. SETTING AND PARTICIPANTS Healthcare providers from 398 participating facilities in 46 low, middle and high-income countries. INTERVENTION An awareness campaign to accompany GLOSS launched 3 weeks prior to data collection and lasting the entire study period (28 November 2017 to 15 January 2018) and beyond. MAIN OUTCOME MEASURES Campaign recognition and exposure, and changes in awareness. RESULTS A total of 2188 surveys were analysed: 1155 at baseline and 1033 at postcampaign. Most survey respondents found the campaign materials helpful (94%), that they helped increase awareness (90%) and that they helped motivate to act differently (88%). There were significant changes with regard to: not having heard of maternal sepsis (-63.4% change, pre-OR/post-OR 0.35, 95% CI 0.18 to 0.68) and perception of confidence in making the right decisions with regard to maternal sepsis identification and management (7.3% change, pre-OR/post-OR 1.44, 95% CI 1.01 to 2.06). CONCLUSIONS Awareness raising campaigns can contribute to an increase in having heard of maternal sepsis and an increase in provider perception of confidence in making correct decisions. Offering the information to make accurate and timely decisions while promoting environments that enable self-confidence and support could improve maternal sepsis identification and management.
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Affiliation(s)
- Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Adama Baguiya
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Bukola Fawole
- Department of Obstetrics and Gynaecology, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
| | - Pisake Lumbiganon
- Obstetrics and Gynecology Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Meilė Minkauskienė
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ashraf Nabhan
- Department of Obstetrics and Gynaecology, Ain Shams University, Cairo, Egypt
| | - Nafissa Bique Osman
- Department of Obstetrics/Gynaecology, Eduardo Mondlane University, Maputo, Mozambique
| | - Zahida P Qureshi
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, Ribeirão Preto, Brazil
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Torloni MR, Brizuela V, Betran AP. Mass media campaigns to reduce unnecessary caesarean sections: a systematic review. BMJ Glob Health 2020; 5:e001935. [PMID: 32296554 PMCID: PMC7146028 DOI: 10.1136/bmjgh-2019-001935] [Citation(s) in RCA: 11] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction The worldwide increase in unnecessary caesarean sections (CSs) is a major global health issue. Mass media campaigns have been used in several countries to reduce this trend. The objectives of this systematic review were to identify, critically appraise and synthesise the findings, including the barriers and enablers, of mass media campaigns directed at lay people to reduce unnecessary CS. Methods We included any study design that reported health communication mass media campaigns directed at lay people with the specific objective of reducing unnecessary CS, created by any agent, in any format. We searched seven electronic databases without language restrictions, from inception to February 2019. Experts in the field were contacted. Results The search yielded 14 320 citations; 50 were selected for full-text reading; and one was included. Six other reports were included. The seven campaigns were conducted in 2009–2017, mostly in Latin America. Most campaigns were independent efforts by non-governmental or activist organisations. Only one campaign conducted formative research and pretested the intervention. All campaigns used indirect communication, mostly through internet channels; two campaigns also used direct communication with the public. None assessed their effects on CS rates. Only two campaigns measured their impacts on participants’ knowledge, attitudes and birth preferences but only in the short term. The main barriers were lack of financial and human resources. The main enablers were the enthusiasm of volunteers, the participation of famous persons/celebrities and the involvement of communication professionals. Conclusions There are few mass media campaigns directed at lay people to reduce CS. Most campaigns did not use key principles recommended for the creation and implementation of health communication interventions, and none assessed their effects in reducing CS rates. If media campaigns can play a role in modifying population views towards CS, there is a need for more rigorous studies including impact assessment. PROSPERO registration number CRD42019120314.
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Affiliation(s)
- Maria Regina Torloni
- Evidence Based Healthcare Postgraduation Program, Department of Medicine, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Thorson A, Aslanyan G, Brizuela V, Perez F, Gómez Ponce de León R, Reeder JC, Serruya SJ, Espinal M, Askew I. Research and research capacity strengthening in the context of an emerging epidemic: Zika virus in Latin America. Int J Gynaecol Obstet 2020; 148 Suppl 2:1-3. [PMID: 31975399 DOI: 10.1002/ijgo.13040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Garry Aslanyan
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Freddy Perez
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization (PAHO), Washington, DC, USA
| | | | - John C Reeder
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Suzanne J Serruya
- Center for Perinatology, Women's Health, and Reproduction (CLAP/PAHO), Montevideo, Uruguay
| | - Marcos Espinal
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization (PAHO), Washington, DC, USA
| | - Ian Askew
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Brizuela V, Bonet M, Souza JP, Tunçalp Ö, Viswanath K, Langer A. Factors influencing awareness of healthcare providers on maternal sepsis: a mixed-methods approach. BMC Public Health 2019; 19:683. [PMID: 31159751 PMCID: PMC6547516 DOI: 10.1186/s12889-019-6920-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/27/2018] [Accepted: 04/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An awareness campaign set to accompany the Global Maternal Sepsis Study (GLOSS) was launched in 2017. In order to better develop and evaluate the campaign, we sought to understand the factors that influence awareness of maternal sepsis by exploring healthcare providers' knowledge, perception of enabling environments, and perception of severity of maternal sepsis. METHODS We used a mixed-methods approach that included 13 semi-structured interviews to GLOSS regional and country coordinators and 1555 surveys of providers working in GLOSS participating facilities. Directed content analysis and grounded theory were used for qualitative analysis, based on a framework including four overarching themes around maternal health conditions, determinants of maternal health, barriers and facilitators to sepsis identification and management, plus 24 additional sub-topics that emerged during the interviews. Descriptive statistics for frequencies and percentages were used for the quantitative analysis; significance was tested using Pearson χ2. Logistic regressions were performed to adjust for selected variables. RESULTS Analysis of interviews described limited availability of resources, poor quality of care, insufficient training and lack of protocols as some of the barriers to maternal sepsis identification and management. Analysis from the quantitative survey showed that while 92% of respondents had heard of maternal sepsis only 15% were able to correctly define it and 43% to correctly identify initial management. Provider confidence, perceived availability of resources and of a supportive environment were low (33%, 38%, and 48% respectively). Overall, the predictor that most explained awareness was training. Respondents from the survey and interviewees identified sepsis among the main conditions affecting women at their facilities. CONCLUSIONS Awareness on maternal sepsis, while acknowledged as important, remains low. Healthcare providers need resources and support to feel confident about the correct identification and management of sepsis, as a prerequisite for the improvement of awareness of maternal sepsis. Similarly, providers need to know about maternal sepsis and its severity to understand the importance of reducing sepsis-related mortality and morbidity. Awareness raising campaigns can help bring neglected maternal health conditions, such as sepsis, to the forefront of global and local agendas.
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Affiliation(s)
- Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ana Langer
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Brizuela V, Leslie HH, Sharma J, Langer A, Tunçalp Ö. Measuring quality of care for all women and newborns: how do we know if we are doing it right? A review of facility assessment tools. The Lancet Global Health 2019; 7:e624-e632. [DOI: 10.1016/s2214-109x(19)30033-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/10/2018] [Accepted: 01/17/2019] [Indexed: 12/27/2022]
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Bonet M, Souza JP, Abalos E, Fawole B, Knight M, Kouanda S, Lumbiganon P, Nabhan A, Nadisauskiene R, Brizuela V, Metin Gülmezoglu A. The global maternal sepsis study and awareness campaign (GLOSS): study protocol. Reprod Health 2018; 15:16. [PMID: 29382352 PMCID: PMC5791346 DOI: 10.1186/s12978-017-0437-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 11/21/2017] [Accepted: 12/04/2017] [Indexed: 12/31/2022] Open
Abstract
Background Maternal sepsis is the underlying cause of 11% of all maternal deaths and a significant contributor to many deaths attributed to other underlying conditions. The effective prevention, early identification and adequate management of maternal and neonatal infections and sepsis can contribute to reducing the burden of infection as an underlying and contributing cause of morbidity and mortality. The objectives of the Global Maternal Sepsis Study (GLOSS) include: the development and validation of identification criteria for possible severe maternal infection and maternal sepsis; assessment of the frequency of use of a core set of practices recommended for prevention, early identification and management of maternal sepsis; further understanding of mother-to-child transmission of bacterial infection; assessment of the level of awareness about maternal and neonatal sepsis among health care providers; and establishment of a network of health care facilities to implement quality improvement strategies for better identification and management of maternal and early neonatal sepsis. Methods This is a facility-based, prospective, one-week inception cohort study. This study will be implemented in health care facilities located in pre-specified geographical areas of participating countries across the WHO regions of Africa, Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific. During a seven-day period, all women admitted to or already hospitalised in participating facilities with suspected or confirmed infection during any stage of pregnancy through the 42nd day after abortion or childbirth will be included in the study. Included women will be followed during their stay in the facilities until hospital discharge, death or transfer to another health facility. The maximum intra-hospital follow-up period will be 42 days. Discussion GLOSS will provide a set of actionable criteria for identification of women with possible severe maternal infection and maternal sepsis. This study will provide data on the frequency of maternal sepsis and uptake of effective diagnostic and therapeutic interventions in obstetrics in different hospitals and countries. We will also be able to explore links between interventions and maternal and perinatal outcomes and identify priority areas for action. Electronic supplementary material The online version of this article (10.1186/s12978-017-0437-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Joao Paulo Souza
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. .,Department of Social Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, SP, Brazil.
| | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, SF, Argentina
| | - Bukola Fawole
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Marian Knight
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population, University of Oxford, Oxford, UK
| | - Seni Kouanda
- HIV/AIDS and Reproductive Health Unit, Research Institute for Health Sciences, Ouagadougou, Burkina Faso
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ashraf Nabhan
- Department of Obstetrics & Gynaecology, Ain Shams University, Cairo, Egypt
| | - Ruta Nadisauskiene
- Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - A Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Simioni AT, Llanos O, Romero M, Ramos S, Brizuela V, Abalos E. [Regionalization of perinatal health care in the province of Santa Fe, Argentina]. Rev Panam Salud Publica 2017; 41:e38. [PMID: 28591333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/20/2016] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE Improve the performance of the regionalization policy in the province of Santa Fe, Argentina, as a strategy to improve perinatal health care by analyzing implementation processes and building consensus among decision makers and stakeholders around an action plan. METHODS Implementation research was conducted using mixed methodology. A needs assessment established tracer indicators to measure adherence to the components of the policy. Actors were studied to identify the barriers and facilitators of implementation. Training was provided on the development of consensus- and evidence-based policies, through workshops in which policy briefs were prepared and through a deliberative dialogue. RESULTS There were improvements in the number of births in appropriate hospitals and in the number of births in maternity hospitals with Essential Obstetric and Neonatal Care (CONE). Barriers were identified in the referral systems and in communication on policy, which resulted in an initial agreement on the need for guidelines and specific technical training on the transfer of babies and mothers. CONCLUSIONS The participation of health workers in identifying barriers and strategies to overcome them, and the use of tools to report this to management, permit the adoption of consensus- and evidence-based strategies to improve policy implementation.
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Affiliation(s)
- Alberto Tomás Simioni
- Dirección Provincial por la Salud en la Niñez, Adolescencia, Sexual y Reproductiva (DPSNASyR), Ministerio de Salud de la Provincia de Santa Fe, Argentina
| | - Oraldo Llanos
- Dirección Provincial por la Salud en la Niñez, Adolescencia, Sexual y Reproductiva (DPSNASyR), Ministerio de Salud de la Provincia de Santa Fe, Argentina
| | - Mariana Romero
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvina Ramos
- Centro de Estudios de Estado y Sociedad (CEDES), Ciudad Autónoma de Buenos Aires, Argentina
| | - Vanessa Brizuela
- Centro de Estudios de Estado y Sociedad (CEDES), Ciudad Autónoma de Buenos Aires, Argentina
| | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
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Abstract
In 2015, 17 sustainable development goals were established for 2030. These global goals aim to ensure healthy lives and promote wellbeing for all. In support of the sustainable development goals, the World Health Organization proposed a new global strategy for women's, children's, and adolescents' health in 2016 with three overarching objectives: to survive, to thrive, and to transform. We are now globally seeking not only to end preventable deaths but also to ensure health and wellbeing, and expand enabling environments. This strategy builds on several prior initiatives in maternal and newborn health, such as the Every Woman, Every Child initiative, and the strategy to end preventable maternal mortality and implementation of an action plan to end preventable newborn death. This confluence of initiatives, strategies, and novel financing mechanisms under the umbrella of the sustainable development goals and the global strategy pave the way for a global agenda in which securing women's health is critical.
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Affiliation(s)
| | - Özge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Ramos S, Romero M, Ortiz Z, Brizuela V. [Safe and family-centered maternity hospitals: organizational culture of maternity hospitals in the province of Buenos Aires]. ARCH ARGENT PEDIATR 2015. [PMID: 26593796 DOI: 10.5546/aap.2015.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION In 2010, the Safe and Family-Centered Maternity Hospitals initiative was launched in order to transform large public maternity centers into settings where safe practices are implemented and the rights of women, newborn infants and families are warranted. As a result, the paradigm of perinatal care was modified. This article reports on the findings of organizational culture as a component for the implementation of the initiative. POPULATION AND METHODS The sample was selected in a non-probabilistic way and was made up of 29 public hospitals located in the province of Buenos Aires that participated in the initiative. During 2011 and 2012, an anonymous, self-administered survey was completed by members of the Department of Neonatology and the Department of Obstetrics. The survey collected information on three dimensions of the organizational culture: organizational environment, safe practices, and facilitation of change. RESULTS A total of 1828 surveys were collected; 51% of survey respondents stated that there is a need to improve communication by having more meetings, while 60% made a positive assessment of various aspects of leadership. Work overload was described as the main cause of conflicts by 60%. Approximately 25% agreed and showed commitment with the initiative of transforming maternity centers. Adherence to practices was dissimilar depending on the practice, but half of survey respondents reported that there were genuine reasons for change. CONCLUSIONS The assessment of the organizational culture showed that commitment to the Safe and Family-Centered Maternity Hospitals initiative is yet to be consolidated, and the evaluation of leadership is not comprehensive. Work overload and communication failures are the main reasons for conflict.
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González-Llaven J, Palma-Aguirre JA, García-Arreola R, Brizuela V, Nava-Rangel J, Morán-Lira S, Vela-Ojeda J, Castañeda-Hernández G, Flores-Murrieta FJ. Comparative bioavailability evaluation of two cyclosporine oral formulations in healthy Mexican volunteers. Arch Med Res 1999; 30:315-9. [PMID: 10573634 DOI: 10.1016/s0188-0128(99)00034-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The use of conventional cyclosporine (Sandimmune) requires great care, as this drug exhibits a narrow therapeutic index and wide interindividual variability in its pharmacokinetics. Recently, a new microemulsion formulation (Neoral) was developed. With this formulation, cyclosporine is absorbed at the small intestine without the presence of bile. Therefore, the objective of this study was to compare the bioavailability of cyclosporine after the administration of conventional and microemulsion formulations in healthy Mexican volunteers in order to approach the optimal dosage regimen of microemulsion in the Mexican population. METHODS The trial was conducted using 23 healthy volunteers according to a randomized crossover design. Volunteers received one 7.5-mg/kg dose as each formulation, with a 1-week washout period between treatments. Blood samples of 0.5 mL were obtained according to the following schedule: 0, 0.5, 1, 2, 3, 4, 5, 6, 8, 12, and 24 h after medication. RESULTS These indicated that Cmax and AUC0-24 values were higher with the microemulsion than with the conventional formulation. CONCLUSIONS The microemulsion had a better absorption profile than the conventional formulation, because plasma levels with the conventional formulation demonstrated oscillations rather than reflecting an erratic absorption. Lower doses of the microemulsion are required to obtain Cmax values similar to those obtained with conventional cyclosporine.
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Affiliation(s)
- J González-Llaven
- Servicio de Hematología, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, México, D.F., Mexico
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