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Noble C, Mooney C, Makasi R, Ntozini R, Majo FD, Church JA, Tavengwa NV, Prendergast AJ, Humphrey JH, Manges A, Mangwadu G, Maluccio JA, Mbuya MNN, Moulton LH, Stoltzfus RJ, Tielsch JM, Smith LE, Chasokela C, Chigumira A, Heylar W, Hwena P, Kembo G, Mutasa B, Mutasa K, Rambanepasi P, Sauramba V, Van Der Keilen F, Zambezi C, Chidhanguro D, Chigodora D, Chipanga JF, Gerema G, Magara T, Mandava M, Mavhudzi T, Mazhanga C, Muzaradope G, Mwapaura MT, Phiri S, Tengende A, Banda C, Chasekwa B, Chidamba L, Chidawanyika T, Chikwindi E, Chingaona LK, Chiorera CK, Dandadzi A, Govha M, Gumbo H, Gwanzura KT, Kasaru S, Matsika AM, Maunze D, Mazarura E, Mpofu E, Mushonga J, Mushore TE, Muzira T, Nembaware N, Nkiwane S, Nyamwino P, Rukobo SD, Runodamoto T, Seremwe S, Simango P, Tome J, Tsenesa B, Amadu U, Bangira B, Chiveza D, Hove P, Jombe HA, Kujenga D, Madhuyu L, Mandina-Makoni P, Maramba N, Maregere B, Marumani E, Masakadze E, Mazula P, Munyanyi C, Musanhu G, Mushanawani RC, Mutsando S, Nazare F, Nyarambi M, Nzuda W, Sigauke T, Solomon M, Tavengwa T, Biri F, Chafanza M, Chaitezvi C, Chauke T, Chidzomba C, Dadirai T, Fundira C, Gambiza AC, Godzongere T, Kuona M, Mafuratidze T, Mapurisa I, Mashedze T, Moyo N, Musariri C, Mushambadope M, Mutsonziwa TR, Muzondo A, Mwareka R, Nyamupfukudza J, Saidi B, Sakuhwehwe T, Sikalima G, Tembe J, Chekera TE, Chihombe O, Chikombingo M, Chirinda T, Chivizhe A, Hove R, Kufa R, Machikopa TF, Mandaza W, Mandongwe L, Manhiyo F, Manyaga E, Mapuranga P, Matimba FS, Matonhodze P, Mhuri S, Mike J, Ncube B, Nderecha WTS, Noah M, Nyamadzawo C, Penda J, Saidi A, Shonhayi S, Simon C, Tichagwa M, Chamakono R, Chauke A, Gatsi AF, Hwena B, Jawi H, Kaisa B, Kamutanho S, Kaswa T, Kayeruza P, Lunga J, Magogo N, Manyeruke D, Mazani P, Mhuriyengwe F, Mlambo F, Moyo S, Mpofu T, Mugava M, Mukungwa Y, Muroyiwa F, Mushonga E, Nyekete S, Rinashe T, Sibanda K, Chemhuru M, Chikunya J, Chikwavaire VF, Chikwiriro C, Chimusoro A, Chinyama J, Gwinji G, Hoko-Sibanda N, Kandawasvika R, Madzimure T, Maponga B, Mapuranga A, Marembo J, Matsunge L, Maunga S, Muchekeza M, Muti M, Nyamana M, Azhuda E, Bhoroma U, Biriyadi A, Chafota E, Chakwizira A, Chamhamiwa A, Champion T, Chazuza S, Chikwira B, Chingozho C, Chitabwa A, Dhurumba A, Furidzirai A, Gandanga A, Gukuta C, Macheche B, Marihwi B, Masike B, Mutangandura E, Mutodza B, Mutsindikwa A, Mwale A, Ndhlovu R, Nduna N, Nyamandi C, Ruvata E, Sithole B, Urayai R, Vengesa B, Zorounye M, Bamule M, Bande M, Chahuruva K, Chidumba L, Chigove Z, Chiguri K, Chikuni S, Chikwanda R, Chimbi T, Chingozho M, Chinhamo O, Chinokuramba R, Chinyoka C, Chipenzi X, Chipute R, Chiribhani G, Chitsinga M, Chiwanga C, Chiza A, Chombe F, Denhere M, Dhamba E, Dhamba M, Dube J, Dzimbanhete F, Dzingai G, Fusira S, Gonese M, Gota J, Gumure K, Gwaidza P, Gwangwava M, Gwara W, Gwauya M, Gwiba M, Hamauswa J, Hlasera S, Hlukani E, Hotera J, Jakwa L, Jangara G, Janyure M, Jari C, Juru D, Kapuma T, Konzai P, Mabhodha M, Maburutse S, Macheka C, Machigaya T, Machingauta F, Machokoto E, Madhumba E, Madziise L, Madziva C, Madzivire M, Mafukise M, Maganga M, Maganga S, Mageja E, Mahanya M, Mahaso E, Mahleka S, Makanhiwa P, Makarudze M, Makeche C, Makopa N, Makumbe R, Mandire M, Mandiyanike E, Mangena E, Mangiro F, Mangwadu A, Mangwengwe T, Manhidza J, Manhovo F, Manono I, Mapako S, Mapfumo E, Mapfumo T, Mapuka J, Masama D, Masenge G, Mashasha M, Mashivire V, Matunhu M, Mavhoro P, Mawuka G, Mazango I, Mazhata N, Mazuva D, Mazuva M, Mbinda F, Mborera J, Mfiri U, Mhandu F, Mhike C, Mhike T, Mhuka A, Midzi J, Moyo S, Mpundu M, Msindo NM, Msindo D, Mtisi C, Muchemwa G, Mujere N, Mukaro E, Muketiwa K, Mungoi S, Munzava E, Muoki R, Mupura H, Murerwa E, Murisi C, Muroyiwa L, Muruvi M, Musemwa N, Mushure C, Mutero J, Mutero P, Mutumbu P, Mutya C, Muzanango L, Muzembi M, Muzungunye D, Mwazha V, Ncube T, Ndava T, Ndlovu N, Nehowa P, Ngara D, Nguruve L, Nhigo P, Nkiwane S, Nyanyai L, Nzombe J, Office E, Paul B, Pavari S, Ranganai S, Ratisai S, Rugara M, Rusere P, Sakala J, Sango P, Shava S, Shekede M, Shizha C, Sibanda T, Tapambwa N, Tembo J, Tinago N, Tinago V, Toindepi T, Tovigepi J, Tuhwe M, Tumbo K, Zaranyika T, Zaru T, Zimidzi K, Zindo M, Zindonda M, Zinhumwe N, Zishiri L, Ziyambi E, Zvinowanda J, Bepete E, Chiwira C, Chuma N, Fari A, Gavi S, Gunha V, Hakunandava F, Huku C, Hungwe G, Maduke G, Manyewe E, Mapfumo T, Marufu I, Mashiri C, Mazenge S, Mbinda E, Mhuri A, Muguti C, Munemo L, Musindo L, Ngada L, Nyembe D, Taruvinga R, Tobaiwa E, Banda S, Chaipa J, Chakaza P, Chandigere M, Changunduma A, Chibi C, Chidyagwai O, Chidza E, Chigatse N, Chikoto L, Chingware V, Chinhamo J, Chinhoro M, Chiripamberi A, Chitavati E, Chitiga R, Chivanga N, Chivese T, Chizema F, Dera S, Dhliwayo A, Dhononga P, Dimingo E, Dziyani M, Fambi T, Gambagamba L, Gandiyari S, Gomo C, Gore S, Gundani J, Gundani R, Gwarima L, Gwaringa C, Gwenya S, Hamilton R, Hlabano A, Hofisi E, Hofisi F, Hungwe S, Hwacha S, Hwara A, Jogwe R, Kanikani A, Kuchicha L, Kutsira M, Kuziyamisa K, Kuziyamisa M, Kwangware B, Lozani P, Mabuto J, Mabuto V, Mabvurwa L, Machacha R, Machaya C, Madembo R, Madya S, Madzingira S, Mafa L, Mafuta F, Mafuta J, Mahara A, Mahonye S, Maisva A, Makara A, Makover M, Mambongo E, Mambure M, Mandizvidza E, Mangena G, Manjengwa E, Manomano J, Mapfumo M, Mapfurire A, Maphosa L, Mapundo J, Mare D, Marecha F, Marecha S, Mashiri C, Masiya M, Masuku T, Masvimbo P, Matambo S, Matarise G, Matinanga L, Matizanadzo J, Maunganidze M, Mawere B, Mawire C, Mazvanya Y, Mbasera M, Mbono M, Mhakayakora C, Mhlanga N, Mhosva B, Moyo N, Moyo O, Moyo R, Mpakami C, Mpedzisi R, Mpofu E, Mpofu E, Mtetwa M, Muchakachi J, Mudadada T, Mudzingwa K, Mugwira M, Mukarati T, Munana A, Munazo J, Munyeki O, Mupfeka P, Murangandi G, Muranganwa M, Murenjekwa J, Muringo N, Mushaninga T, Mutaja F, Mutanha D, Mutemeri P, Mutero B, Muteya E, Muvembi S, Muzenda T, Mwenjota A, Ncube S, Ndabambi T, Ndava N, Ndlovu E, Nene E, Ngazimbi E, Ngwalati A, Nyama T, Nzembe A, Pabwaungana E, Phiri S, Pukuta R, Rambanapasi M, Rera T, Samanga V, Shirichena S, Shoko C, Shonhe M, Shuro C, Sibanda J, Sibangani E, Sibangani N, Sibindi N, Sitotombe M, Siwawa P, Tagwirei M, Taruvinga P, Tavagwisa A, Tete E, Tete Y, Thandiwe E, Tibugari A, Timothy S, Tongogara R, Tshuma L, Tsikira M, Tumba C, Watinaye R, Zhiradzango E, Zimunya E, Zinengwa L, Ziupfu M, Ziyambe J. Antenatal and delivery practices and neonatal mortality amongst women with institutional and non-institutional deliveries in rural Zimbabwe: observational data from a cluster randomized trial. BMC Pregnancy Childbirth 2022; 22:981. [PMID: 36585673 PMCID: PMC9805263 DOI: 10.1186/s12884-022-05282-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite achieving relatively high rates of antenatal care, institutional delivery, and HIV antiretroviral therapy for women during pregnancy, neonatal mortality has remained stubbornly high in Zimbabwe. Clearer understanding of causal pathways is required to inform effective interventions. METHODS This study was a secondary analysis of data from the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial, a cluster-randomized community-based trial among pregnant women and their infants, to examine care during institutional and non-institutional deliveries in rural Zimbabwe and associated birth outcomes. RESULTS Among 4423 pregnant women, 529 (11.9%) delivered outside a health institution; hygiene practices were poorer and interventions to minimise neonatal hypothermia less commonly utilised for these deliveries compared to institutional deliveries. Among 3441 infants born in institutions, 592 (17.2%) were preterm (< 37 weeks gestation), while 175/462 (37.9%) infants born outside health institutions were preterm (RR: 2.20 (1.92, 2.53). Similarly, rates of stillbirth [1.2% compared to 3.0% (RR:2.38, 1.36, 4.15)] and neonatal mortality [2.4% compared to 4.8% (RR: 2.01 1.31, 3.10)] were higher among infants born outside institutions. Among mothers delivering at home who reported their reason for having a home delivery, 221/293 (75%) reported that precipitous labor was the primary reason for not having an institutional delivery while 32 (11%), 34 (12%), and 9 (3%), respectively, reported distance to the clinic, financial constraints, and religious/personal preference. CONCLUSIONS Preterm birth is common among all infants in rural Zimbabwe, and extremely high among infants born outside health institutions. Our findings indicate that premature onset of labor, rather than maternal choice, may be the reason for many non-institutional deliveries in low-resource settings, initiating a cascade of events resulting in a two-fold higher risk of stillbirth and neonatal mortality amongst children born outside health institutions. Interventions for primary prevention of preterm delivery will be crucial in reducing neonatal mortality in Zimbabwe. TRIAL REGISTRATION The trial is registered with ClinicalTrials.gov, number NCT01824940.
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Affiliation(s)
- Christie Noble
- grid.4868.20000 0001 2171 1133Blizard Institute, Queen Mary University of London, London, UK
| | - Ciaran Mooney
- Northern Ireland Medical and Dental Training Agency (NIMDTA), Beechill House, 42 Beechill Rd, Belfast, BT8 7RL UK
| | - Rachel Makasi
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence D. Majo
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - James A. Church
- grid.4868.20000 0001 2171 1133Blizard Institute, Queen Mary University of London, London, UK ,grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume V. Tavengwa
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Andrew J. Prendergast
- grid.4868.20000 0001 2171 1133Blizard Institute, Queen Mary University of London, London, UK ,grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe ,grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Jean H. Humphrey
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe ,grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Desai A, Mbuya MN, Chigumira A, Chasekwa B, Humphrey JH, Moulton LH, Pelto G, Gerema G, Stoltzfus RJ. Traditional oral remedies and perceived breast milk insufficiency are major barriers to exclusive breastfeeding in rural Zimbabwe. J Nutr 2014; 144:1113-9. [PMID: 24828026 PMCID: PMC4056649 DOI: 10.3945/jn.113.188714] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Only 5.8% of Zimbabwean infants are exclusively breastfed for the first 6 mo of life despite substantial investment in exclusive breastfeeding (EBF) promotion throughout the country. We conducted a survey of 295 mothers of infants <6 mo of age who were recruited from rural immunization clinics and outreach sites in the Midlands Province of Zimbabwe. We explored infant feeding knowledge, beliefs and attitudes, and details regarding facilitators for EBF mothers and first foods fed by non-EBF mothers to identify and understand barriers to EBF. Among mothers of infants <1 mo, 1 to <2 mo, and 2-6 mo of age, 54%, 30%, and 12%, respectively, were practicing EBF. In adjusted multivariate analyses, EBF practice was positively associated with belief in the sufficiency of EBF (P = 0.05), belief in the avoidance of cooking oil feeding (a common traditional practice) in the first 6 mo (P = 0.001), and perceived pressure from others regarding infant feeding and traditional medicine use (P = 0.03). Psychosocial support and viewing breast milk as sufficient were reported as primary facilitators of EBF practice. Maternal responses to open-ended questions identified protection, nutrition, and crying as the main reasons for EBF interruption. During the first 2 mo of life, "protection feedings" using traditional oral remedies (such as cooking oil and water) to prevent or treat perceived illness, specifically colic and sunken/depressed fontanel, made up 78.5% of the non-breast milk feeds. From the second month of life, "nutrition feedings," mainly of water and porridge, were given when mothers believed their breast milk was insufficient in quantity or quality to meet the hunger or thirst needs of their infants. Our findings underscore the importance of exploring cultural beliefs and practices as they pertain to infant feeding and care and present insights for designing and targeting EBF promotion interventions.
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Affiliation(s)
- Amy Desai
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mduduzi N.N. Mbuya
- Zvitambo Institute for Maternal Child Health, Harare, Zimbabwe,Division of Nutritional Sciences, Cornell University, Ithaca, NY; and
| | - Ancikaria Chigumira
- National Nutrition Unit, Zimbabwe Ministry of Health and Child Welfare, Harare, Zimbabwe
| | | | - Jean H. Humphrey
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Zvitambo Institute for Maternal Child Health, Harare, Zimbabwe,To whom correspondence should be addressed. E-mail:
| | - Lawrence H. Moulton
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Gretel Pelto
- Division of Nutritional Sciences, Cornell University, Ithaca, NY; and
| | - Grace Gerema
- Zvitambo Institute for Maternal Child Health, Harare, Zimbabwe
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