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Ararsa GG, Getachew MT, Diddana TZ, Alemayehu FR. Prevalence of undernutrition and associated factors among children aged 6-23 months: a cross-sectional analysis from South-East Ethiopia. J Nutr Sci 2023; 12:e127. [PMID: 38155807 PMCID: PMC10753458 DOI: 10.1017/jns.2023.109] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 12/30/2023] Open
Abstract
To meet the 2030 goal to end all types of malnutrition, thoroughly investigating and addressing context-specific factors of undernutrition is crucial. Therefore, this study assessed the prevalence of undernutrition and associated factors among children aged 6-23 months in South-East Ethiopia. A community-based cross-sectional study was conducted on 580 randomly sampled mother-child pairs in February 2022. Socio-demographic, dietary intake, household food security (HFS), maternal knowledge and practices of child feeding, and the child's weight and height data were collected. A multivariable logistic regression analysis was done. The prevalence of stunted, wasted, and underweight children was 32⋅1, 7, and 9 %, respectively. Being male (AOR = 1⋅75), not using the growth monitoring and promotion (GMP) service (AOR = 1⋅50), household food insecurity (HFI) (AOR = 1⋅67), lack of improved water (AOR = 2⋅26), and bottle-feeding (AOR = 1⋅54) were significantly associated with stunting. Being male (AOR = 3⋅02), having low maternal knowledge on child-feeding practices (AOR = 3⋅89), not listening to the radio/television (AOR = 3⋅69), having a history of fever (AOR = 3⋅39), bottle-feeding (AOR = 3⋅58), and HFI (AOR = 3⋅77) were significantly predicted wasting. Being male (AOR = 3⋅44), not using GMP service (AOR = 2⋅00), having a history of fever (AOR = 4⋅24), lack of knowledge on optimal breastfeeding duration (AOR = 3⋅58), low maternal knowledge on child feeding (AOR = 2⋅21), HFI (AOR = 2⋅04), and lack of improved water (AOR = 3⋅00) showed significant association with underweight. In conclusion, stunting is alarmingly common while wasting and underweight are sub-optimal. Prevention of infectious disease, providing basic education for fathers, ensuring HFS; enhancing media access, maternal knowledge about IYCFP and improving water access; and GMP service utilisation are crucial to improve child nutrition.
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Key Words
- 6–23 months aged children
- ANC, antenatal care
- AOR, adjusted odds ratio
- ARI, acute respiratory illness
- ASF, animal source food
- BF, breastfeeding
- CF, complementary feeding
- COR, crude odds ratio
- DDS, dietary diversity score
- EDHS, Ethiopian Demographic and Health Survey
- GMP, growth monitoring and promotion
- HAZ, height/length-for-age Z-score
- HIFAS, household food insecurity access score
- IYCFP, infant and young child feeding practices
- Lemubilbilo
- MAD, Minimum acceptable diet
- OFSP, orange fleshed sweet potato
- ORS, oral rehydration solution
- PNC, postnatal care
- South-east Ethiopia
- Undernutrition
- WAZ, weight-for-age Z-score
- WHO, World Health Organisation
- WHZ, weight-for-height/length Z-score
- mm, millimeter
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Affiliation(s)
- Gosa Girma Ararsa
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Meheret Tena Getachew
- Ethiopia Civil Society Coalition for Scaling Up Nutrition (ECSC-SUN), Scaling Up Nutrition (SUN), Civil Society Network, P.O. Box 384, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Tona Zema Diddana
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Fikadu Reta Alemayehu
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
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Wood SN, Yirgu R, Karp C, Tadesse MZ, Shiferaw S, Zimmerman LA. The impact of partner autonomy constraints on women's health-seeking across the maternal and newborn continuum of care. EClinicalMedicine 2022; 53:101715. [PMID: 36345400 PMCID: PMC9636056 DOI: 10.1016/j.eclinm.2022.101715] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Gendered health inequities impede women's reproductive autonomy over the life course. Pregnancy is a critical time point for assessing inequities and partners are integral actors in the achievement or impediment of women's and children's health during this time. METHODS Among a nationally representative cohort of Ethiopian women 5-9 weeks postpartum with data collected from October 2019-September 2020, this study aimed to 1) understand the prevalence and interplay of partner-related autonomy constraints (intimate partner violence (IPV), reproductive coercion (RC), lack of encouragement from seeking antenatal care (ANC), and lack of encouragement from seeking postnatal care (PNC), and 2) examine the impact of autonomy constraints on the maternal and newborn health (MNH) continuum of care. FINDINGS Sixty percent of women experienced a partner-related autonomy constraint prior to or during pregnancy. Approximately 20% of women were not encouraged to seek antenatal care and postpartum care, respectively, whereas fewer women experienced IPV during pregnancy (12.3%) and RC (11.0%). Less than one in five women completed the MNH continuum of care. Lack of encouragement of ANC and PNC were associated with decreased care-seeking at every point across the MNH continuum of care. Lack of encouragement of ANC (aOR = 0.45; p = 0.05) and of PNC (aOR = 0.16; p < 0.001) were associated with reductions in completing the continuum. INTERPRETATION Partner engagement, interventions, and messaging are critical to enhance MNH care-seeking behaviors. FUNDING This work was supported, in whole, by the Bill & Melinda Gates Foundation [INV 009466]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission.
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Affiliation(s)
- Shannon N. Wood
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Corresponding author. 615 N. Wolfe Street Room E4009, Baltimore, MD, 21205, USA.
| | - Robel Yirgu
- Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Celia Karp
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Meseret Zelalem Tadesse
- Maternal, Child, and Nutrition Directorate, Ethiopia Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Solomon Shiferaw
- Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Linnea A. Zimmerman
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Sharma R, Dwivedi LK, Jana S, Banerjee K, Mishra R, Mahapatra B, Sahu D, Singh S. Survey implementation process and interviewer effects on skipping sequence of maternal and child health indicators from National Family Health Survey: An application of cross-classified multilevel model. SSM Popul Health 2022; 19:101252. [PMID: 36268137 PMCID: PMC9576585 DOI: 10.1016/j.ssmph.2022.101252] [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: 12/22/2021] [Revised: 08/28/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022] Open
Abstract
Implementing a large-scale survey involves a string of intricate procedures exposed to numerous types of survey errors. Uniform and systematic training protocols, comprehensive survey manuals, and multilayer supervision during survey implementation help reduce survey errors, providing a consistent fieldwork environment that should not result in any variation in the quality of data collected across interviewers and teams. With this background, the present study attempts to delineate the effect of field investigator (FI) teams and survey implementation design on the selected outcomes. Data on four of the bigger Empowered Action Group (EAG) states of India, namely Uttar Pradesh, Madhya Pradesh, Bihar, and Rajasthan, were obtained from the fourth round of the National Family Health Survey (NFHS-4) for analysis. A fixed-effect binary logistic regression model was used to assess the effect of FI teams and survey implementation design on the selected outcomes. To study the variation in the outcome variables at the interviewer level, a cross-classified multilevel model was used. Since one interviewer had worked in more than one primary sampling unit (PSU) & district and did not follow a perfect hierarchical structure, the cross-classified multilevel model was deemed suitable. In addition, since NFHS-4 used a two-stage stratified sampling design, two-level weights were adjusted for the models to compute unbiased estimates. This study demonstrated the presence of interviewer-level variation in the selected outcomes at both inter- and intra-field agencies across the selected states. The interviewer-level intra-class correlation coefficient (ICC) for women who had not availed antenatal care (ANC) was the highest for eastern Madhya Pradesh (0.23) and central Uttar Pradesh (0.20). For ‘immunisation card not seen’, Rajasthan (0.16) and western Uttar Pradesh (0.13) had higher interviewer-level ICC. Interviewer-level variations were insignificant for women who gave birth at home across all regions of Uttar Pradesh. Eastern Madhya Pradesh, Rajasthan, and Bihar showed higher interviewer-level variation across the selected outcomes, underlining the critical role of agencies and skilled interviewers in different survey implementation designs. The analysis highlights non-uniform adherence to survey protocols, which implies that not all interviewers and agencies performed in a similar manner in the field. This study recommends a refined mechanism for field implementation and supervision, including focused training on the challenges faced by FIs, random vigilance, and morale building. In addition, examining interviewer-level characteristics, field challenges, and field agency effects may also highlight the roots of interviewer-level variation in the data. However, based on the interviewer's performance in the field, the present study offers an intriguing insight into interviewer-level variations in the quality of data. With uniform survey implementation strategies, the interviewer should not have any effect in explaining the maternal and child health variables. Skipping of selected maternal and child health indicators curtails informativeness of the survey. Results confirms that information on vaccination card, antenatal care, maternal policy information, delivery cost and postnatal checkups have been skipped with negative response to opening questions. Cross-classified multilevel model confirms the presence of interviewer-level variation. The interviewer-level intra-class correlation coefficient (ICC) for ‘immunization card not seen’ was found to be highest in Rajasthan and western Uttar Pradesh. Interviewer-level variations were found to be not significant for women who gave birth at home across all the regions of Uttar Pradesh whereas the interviewer-level variations for women who had not availed ANC was found to be highest for eastern Madhya Pradesh central Uttar Pradesh. Results emphasizes that not all interviewers and agencies performed in a similar manner in the field. The study recommends a refined mechanism for field implementation and supervision, including focused training on challenges faced by field investigators, random vigilance, and morale building.
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Key Words
- ANC, antenatal care
- CAPI, computer-assisted personal interviewing
- Cross-classified multilevel model
- EAG, empowered action group
- FA, field agencies
- FI, field investigator
- ICC, intra-class correlation coefficient
- Interviewer effect
- Level weights
- MP, Madhya Pradesh
- Maternal and child health
- NFHS, National Family Health Survey
- PSU, primary sampling unit
- SDGs, Sustainable Development Goals
- Survey design
- Survey implementation
- Team level variation
- UP, Uttar Pradesh
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Affiliation(s)
- Radhika Sharma
- International Institute for Population Sciences, Mumbai, India
| | - Laxmi Kant Dwivedi
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, India
- Corresponding author.
| | - Somnath Jana
- International Institute for Population Sciences, Mumbai, India
| | - Kajori Banerjee
- SVKM's Narsee Monjee Institute of Management Studies (NMIMS), Mumbai, India
| | | | | | - Damodar Sahu
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - S.K. Singh
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, India
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Berhane A, Belachew T. Effect of Picture-based health education and counselling on knowledge and adherence to preconception Iron-folic acid supplementation among women planning to be pregnant in Eastern Ethiopia: a randomized controlled trial. J Nutr Sci 2022; 11:e58. [PMID: 35912303 PMCID: PMC9305079 DOI: 10.1017/jns.2022.51] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/05/2022] Open
Abstract
The present study examined the effect of picture-based nutrition education on knowledge and adherence to pre-conception iron-folic acid supplement (IFAS) in Ethiopia, a country where there is a high burden of neural tube defects (NTDs) and anaemia. In eastern Ethiopia, a parallel randomised controlled trial design was employed among women planning to get pregnant. The interventional arm (n 122) received a preconception picture-based nutrition education and counselling along with an IFAS and the control arm (n 122) received only a preconception IFAS. The effects of the intervention between-group differences were assessed using a χ 2 and independent sample t-test. Bivariate and multivariable linear regression model was fitted to detect independent variables affecting the outcome. The outcome measures regarding the knowledge and adherence to the IFAS intake during the three months of the intervention period were deteremined. It was observed that large proportion of women in the intervention group (42⋅6 %) had an adherence to IFAS compared to the control group (3⋅3 %); (P < 0⋅0001). Based on bivariate and multivariable linear regression analyses, among NTDs affecting pregnancy, the history of spontaneous abortion and knowledge were independently associated with adherence to the IFAS (P < 0⋅05). Preconception nutrition education with regular follow-ups could be effective in improving knowledge and adherence to the IFAS intake. This intervention is very short, simple, cost-effective and has the potential for adaptation development to a large-scale implementation in the existing healthcare system in Ethiopia to prevent NTDs and adverse birth outcomes among women who plan to get pregnant. This clinical trial was registered on 6 April 2021 under the ClinicalTrials.gov with an identifier number PACTR202104543567379.
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Affiliation(s)
- Anteneh Berhane
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Machekera S, Boas P, Temu P, Mosende Z, Lote N, Kelly-Hanku A, Mahiane SG, Glaubius R, Rowley J, Gurung A, Korenromp E. Strategic options for syphilis control in Papua New Guinea- impact and cost-effectiveness projections using the syphilis interventions towards elimination (SITE) model. Infect Dis Model 2021; 6:584-597. [PMID: 33869906 PMCID: PMC8039768 DOI: 10.1016/j.idm.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/19/2022] Open
Abstract
Objectives Papua New Guinea (PNG) has among the highest rates of sexually transmitted infections (STIs) globally and is committed to reducing their incidence. The Syphilis Interventions Towards Elimination (SITE) model was used to explore the expected impact and cost of alternative syphilis intervention scale-up scenarios. Methods SITE is a dynamical model of syphilis transmission among adults 15-49 years. Individuals are divided into nine groups based on sexual behaviour and into six stages of infection. The model was calibrated to PNG using data from routine surveillance, bio-behavioural surveys, research studies and program records. Inputs included syphilis prevalence, risk behaviours, intervention coverage and service delivery unit costs. Scenarios compared different interventions (clinical treatment, contact tracing, syphilis screening, and condom promotion) for incidence and cost per infection averted over 2021-2030. Results Increasing treatment coverage of symptomatic primary/secondary-stage syphilis cases from 25-35% in 2020 to 60% from 2023 onwards reduced estimated incidence over 2021-2030 by 55%, compared to a scenario assuming constant coverage at 2019-2020 levels. The introduction of contact tracing in 2020, assuming 0.4 contacts per symptomatic person treated, reduced incidence over 2021-2030 by 10%. Increasing screening coverage by 20-30 percentage points from the 2019-2020 level reduced incidence over 2021-2030 by 3-16% depending on the target population. Scaling-up clinical, symptom-driven treatment and contact tracing had the lowest cost per infection averted, followed by condom promotion and periodic screening of female sex workers and men who have sex with men. Conclusions PNG could considerably reduce its syphilis burden by scaling-up clinical treatment and contact tracing alongside targeted behavioural risk reduction interventions. SITE is a useful tool countries can apply to inform national STI programming and resource allocation.
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Key Words
- (I)BBS, (Integrated) Bio-Behavioural Survey
- ANC, antenatal care
- Cost-effectiveness
- DHS, Demographic and Health Survey
- FSW, Female Sex Worker
- GUD, Genital Ulcer Disease
- MSM, Men who have sex with men
- National program strategy
- PNG, Papua New Guinea
- PoM, Port Moresby
- Prevention
- RPR, Rapid Plasma Reagin test
- Resource allocation
- STI, sexually transmitted infection
- Syphilis
- TPHA, Treponema pallidum hemagglutination assay
- TPPA, Treponema pallidum particle agglutination assay
- Treatment
- VDRL, Venereal Disease Research Laboratory
- WHO, World Health Organization
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Affiliation(s)
- Shepherd Machekera
- Government of Papua New Guinea, National Department of Health, AOPI Center, Waigani Drive, PO Box, 5896, Port Moresby, Papua New Guinea
- World Vision International, Ruta Place, Morata St, Gordons. P.O Box 4254, Boroko, National Capital District, Port Moresby, Papua New Guinea
| | - Peniel Boas
- Government of Papua New Guinea, National Department of Health, AOPI Center, Waigani Drive, PO Box, 5896, Port Moresby, Papua New Guinea
| | - Poruan Temu
- Government of Papua New Guinea, National Department of Health, AOPI Center, Waigani Drive, PO Box, 5896, Port Moresby, Papua New Guinea
| | | | - Namarola Lote
- Government of Papua New Guinea, National Department of Health, AOPI Center, Waigani Drive, PO Box, 5896, Port Moresby, Papua New Guinea
- WHO Papua New Guinea Country Office, Communicable Disease & Health Emergency Dept., AOPI Centre, Waigani Drive, Port Moresby, Papua New Guinea
| | - Angela Kelly-Hanku
- Papua New Guinea Institute of Medical Research, 441 Homate Street, PO Box 60, Goroka, Eastern Highland Province, Papua New Guinea
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, UNSW Australia Kensington, NSW 2052, Sydney, Australia
| | - S. Guy Mahiane
- Avenir Health, Modelling, Planning and Policy Analysis Dept., 655 Winding Brook Drive, Glastonbury, CT, 06033, USA
| | - Robert Glaubius
- Avenir Health, Modelling, Planning and Policy Analysis Dept., 655 Winding Brook Drive, Glastonbury, CT, 06033, USA
| | - Jane Rowley
- Independent Consultant, 135 Gloucester Terrace, W2 6DX, London, UK
| | - Anup Gurung
- WHO Papua New Guinea Country Office, Communicable Disease & Health Emergency Dept., AOPI Centre, Waigani Drive, Port Moresby, Papua New Guinea
| | - Eline Korenromp
- Avenir Health, Modelling, Planning and Policy Analysis Dept., 150 Route de Ferney, PO box 2100, CH-1211 Geneva 2, Switzerland
- Corresponding author.
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Gebremichael B, Beletew Abate B, Tesfaye T. Mothers had inadequate knowledge towards key essential nutrition action messages in mainly rural Northeast Ethiopia. J Nutr Sci 2021; 10:e19. [PMID: 33889402 DOI: 10.1017/jns.2021.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/26/2021] [Accepted: 02/17/2021] [Indexed: 11/06/2022] Open
Abstract
Essential nutrition action (ENA) is one of the most effective preventive actions for combating nutritional problems in young children. There is, however, a paucity of evidence about mother's knowledge and attitude regarding key ENA messages. The objective of the present study was to assess the knowledge and attitude of mothers towards key ENA messages and associated factors. A representative sample of 563 mothers of children from birth up to 24 months in mainly rural North Ethiopia was included in the study. The findings showed that 66⋅4 % of the mothers have a good knowledge and 68⋅9 % have a good attitude. In the multivariable analysis using logistic regression, mothers who attended secondary school or higher education were six times more likely to have a good knowledge (AOR 6⋅1; CI 2⋅945, 12⋅719) compared with those who are illiterate. Besides, women who resided in an urban area (AOR 2⋅2; CI 1⋅14, 4⋅25), attended antenatal care (ANC) visits (AOR 3⋅7; CI 2⋅421, 5⋅742), attended postnatal care (PNC) visits (AOR 2⋅2; CI 1⋅37, 3⋅4) and heard nutritional-related information (AOR 1⋅9; CI 1⋅14, 3⋅49) were found to have a good knowledge. On the other hand, mothers who attended ANC visits were almost four times (AOR 3⋅9; CI 2⋅7, 5⋅8) more likely to have a good attitude towards key ENA. Mothers who delivered at health institutions and who attended PNC visits were also more likely to have a good attitude. In conclusion, the present study determined the level of knowledge and attitudes of mothers about ENA and several factors that influence mother's knowledge and attitude regarding ENA.
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Brummaier T, Kabeer BSA, Chaussabel D, Utzinger J, McGready R, Paris DH. Blood gene transcript signature profiling in pregnancies resulting in preterm birth: A systematic review. Eur J Obstet Gynecol Reprod Biol X 2020; 8:100118. [PMID: 33024956 PMCID: PMC7528201 DOI: 10.1016/j.eurox.2020.100118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To pursue a systematic review and summarise the current evidence for the potential of transcriptome molecular profiling in investigating the preterm phenotype. STUDY DESIGN We systematically reviewed the literature, using readily available electronic databases (i.e. PubMed/Medline, Embase, Scopus and Web of Science) from inception until March 2020 to identify investigations of maternal blood-derived RNA profiling in preterm birth (PTB). Studies were included if circulating coding or non-coding RNA was analysed in maternal blood during pregnancy and/or at delivery. Interventional trials were not included. The primary outcome was the availability of whole genome expression patterns evaluated in pregnancies resulting in preterm deliveries. RESULTS A total of 35 articles were included in the final analysis. Most of the studies were conducted in high-income countries and published in the last decade. Apart from spontaneous PTB, a variety of phenotypes leading to preterm delivery were reported. Differences in sampling methods, target gene selection and laboratory protocols severely limited any quantitative comparisons. Most of the studies revealed that gene expression profiling during pregnancy has high potential for identifying women at risk of spontaneous and/or non-spontaneous PTB as early as in the first trimester. CONCLUSION Assessing maternal blood-derived transcriptional signatures for PTB risk in pregnant women holds promise as a screening approach. However, longitudinally followed, prospective pregnancy cohorts are lacking. These are relevant for identifying causes leading to PTB and whether prediction of spontaneous PTB or co-morbidities associated with PTB is achievable. More emphasis on widely employed standardised protocols is required to ensure comparability of results.
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Key Words
- ANC, antenatal care
- Antenatal screening
- DNA, deoxyribonucleic acid
- EGA, estimated gestational age
- FGR, fetal growth restriction
- Gene expression profiling
- HIC, high-income country
- LIC, low-income country
- LMP, last menstrual period
- MIC, middle-income country
- NGS, next generation sequencing
- PCR, polymerase chain reaction
- PICo, Population phenomenon of Interest and Context
- PPROM, preterm premature rupture of membranes
- PROSPERO, Prospective Register of Systematic Reviews
- PTB, preterm birth
- PTL, preterm labour
- PoA, proportion of agreement
- Preterm birth
- RIN, RNA integrity number
- RNA, Ribonucleic acid
- SDG, Sustainable Development Goal
- SGA, small for gestational age
- Systematic review
- Transcriptome
- WBC, white blood cells
- WHO, World Health Organization
- mRNA, messenger RNA
- miRNA, microRNA
- sPTB, spontaneous preterm birth
- sPTL, spontaneous preterm labour
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Affiliation(s)
- Tobias Brummaier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Daniel H Paris
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Bhan N, McDougal L, Singh A, Atmavilas Y, Raj A. Access to women physicians and uptake of reproductive, maternal and child health services in India. EClinicalMedicine 2020; 20:100309. [PMID: 32300752 PMCID: PMC7152807 DOI: 10.1016/j.eclinm.2020.100309] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Low availability of women physicians in rural areas can compromise women's health care seeking, where need can be greatest. We examined the associations between availability of women physicians and maternal and child health service utilization in India. METHODS We analyzed cross-sectional district-level data from all 256 districts in 18 states, from India's District-Level Household and Facility Survey (2012-13) and the National Family Health Survey (2015-16). Assessed measures included lady medical officers (LMOs) availability at Primary Health Centers (PHCs, which are largely rural serving), modern contraceptive use, antenatal care (ANC), skilled birth attendance (SBA), maternal postnatal care (PNC), infant PNC, and child immunization. Multilevel regression models nesting districts in states examined associations between LMO availability and health service utilization, adjusting for district-level socioeconomic status (SES) indicators (e.g., women's education, household water access), urbanicity, health insurance coverage and sampled PHCs (15 on average) within districts. FINDINGS Only 72 of 256 districts (28.1%) reported >50% of PHCs with LMOs. In multivariable models, LMO availability in PHCs was associated with higher district prevalence (%) of modern contraceptive use [β=0.04 (95% CI: 0.007, 0.08)], 4+ ANC [β =0.07 (95% CI: 0.008, 0.13)], skilled birth attendance [β=0.09 (0.03, 0.14) and maternal PNC [β=0.08 (95% CI: 0.03, 0.12)], but not infant PNC or child immunization. INTERPRETATION Higher district availability of women physicians is associated with higher maternal health care utilization but not child health care utilization. Improving gender parity in the physician workforce and rural women physician access may improve maternal health care use in India.
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Key Words
- ANC, antenatal care
- ANM, Auxiliary Nurse Midwife
- Abbreviations. AHS, Annual Health Survey
- BCG, bacillus Calmette Guerin
- DHS, Demographic and Health Surveys
- DLHS, District level Household and Facility Survey
- DPT, diphtheria pertussis and tetanus
- Female physicians
- Gender equity
- HIC, high income countries
- HMIS, Health Management Information System
- Health workforce
- IIPS, International Institute for Population Sciences
- ILO, International Labor Organization
- IPHS, Indian Public Health Standards
- LHV, lady health visitor
- LMIC, low-and-middle income countries
- LMO, Lady Medical Officer
- Maternal and child health services
- MoHFW, Ministry of Health & Family Welfare
- NFHS, National Family Health Survey
- NHM, National Health Mission
- NHRM, National Rural Health Mission
- NUHM, National Urban Health Mission
- OLS, ordinary least squares
- PHC, Primary Health Center
- PNC, postnatal care
- RMCH, reproductive, maternal and child health
- Women doctors
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Affiliation(s)
- Nandita Bhan
- Center on Gender Equity and Health, University of California, San Diego, CA, United States
- Corresponding author.
| | - Lotus McDougal
- Center on Gender Equity and Health, Department of Medicine, University of California, San Diego, CA, United States
| | - Abhishek Singh
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Yamini Atmavilas
- Gender Equality, India Country Office, Bill & Melinda Gates Foundation, New Delhi, India
| | - Anita Raj
- Division of Social Sciences Director, Center on Gender Equity and Health (GEH), University of California, San Diego, CA, United States
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Enkhbat E, Korenromp EL, Badrakh J, Zayasaikhan S, Baya P, Orgiokhuu E, Jadambaa N, Munkhbaatar S, Khishigjargal D, Khad N, Mahiané G, Ishikawa N, Jagdagsuren D, Taylor MM. Adult female syphilis prevalence, congenital syphilis case incidence and adverse birth outcomes, Mongolia 2000-2016: Estimates using the Spectrum STI tool. Infect Dis Model 2018; 3:13-22. [PMID: 30839908 PMCID: PMC6326223 DOI: 10.1016/j.idm.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/26/2018] [Accepted: 03/08/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Mongolia's health ministry prioritizes control of Sexually Transmitted Infections, including syphilis screening and treatment in antenatal care (ANC). Methods Adult syphilis prevalence trends were fitted using the Spectrum-STI estimation tool, using data from ANC surveys and routine screening over 1997–2016. Estimates were combined with programmatic data to estimate numbers of treated and untreated pregnant women with syphilis and associated incidence congenital syphilis (CS) and CS-attributable adverse birth outcomes (ABO), which we compared with CS case reports. Results Syphilis prevalence in pregnant women was estimated at 1.7% in 2000 and 3.0% in 2016. We estimated 652 CS cases, of which 410 ABO, in 2016. Far larger, annually increasing numbers of CS cases and ABO were estimated to have been prevented: 1654 cases, of which 789 ABO in 2016 − thanks to increasing coverages of ANC (99% in 2016), ANC-based screening (97% in 2016) and treatment of women diagnosed (81% in 2016). The 42 CS cases reported nationally over 2016 (liveborn infants only) represented 27% of liveborn infants with clinical CS, but only 7% of estimated CS cases among women found syphilis-infected in ANC, and 6% of all estimated CS cases including those born to women with undiagnosed syphilis. Discussion/Conclusion Mongolia's ANC-based syphilis screening program is reducing CS, but maternal prevalence remains high. To eliminate CS (target: <50 cases per 100,000 live births), Mongolia should strengthen ANC services, limiting losses during referral for treatment, and under-diagnosis of CS including still-births and neonatal deaths, and expand syphilis screening and prevention programs.
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Key Words
- ABO, Adverse Birth Outcome
- ANC, antenatal care
- ANC-1, attendance of antenatal care at least once during a pregnancy
- Antenatal care
- CI, confidence interval
- CS, Congenital Syphilis
- Congenital syphilis
- Epidemiological modelling
- F, women
- N, sample size tested
- NCCD, Mongolia National Center for Communicable Diseases
- RPR, Rapid Plasma Reagin test
- STI, sexually transmitted infection
- Screening
- Surveillance
- Syphilis
- TP, Treponema pallidum
- WHO, World Health Organization
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Affiliation(s)
- Erdenetungalag Enkhbat
- Mongolia National Centre for Communicable Disease, AIDS/STI Surveillance and Research Department, Ulaanbaatar, 210648, Bayanzurkh District, Nam-Yan-Ju Street, Mongolia
| | - Eline L Korenromp
- Avenir Health, Geneva, Switzerland, 1 route de Morillons / 150 Route de Ferney (WCC, Office 164), PO Box 2100, CH-1211 Geneva 2, Switzerland
| | - Jugderjav Badrakh
- Mongolia National Centre for Communicable Disease, AIDS/STI Surveillance and Research Department, Ulaanbaatar, 210648, Bayanzurkh District, Nam-Yan-Ju Street, Mongolia
| | - Setsen Zayasaikhan
- Mongolia National Centre for Communicable Disease, AIDS/STI Surveillance and Research Department, Ulaanbaatar, 210648, Bayanzurkh District, Nam-Yan-Ju Street, Mongolia
| | - Purevsuren Baya
- Mongolia National Centre for Communicable Disease, AIDS/STI Surveillance and Research Department, Ulaanbaatar, 210648, Bayanzurkh District, Nam-Yan-Ju Street, Mongolia
| | - Enkhjargal Orgiokhuu
- Mongolia National Centre for Communicable Disease, AIDS/STI Surveillance and Research Department, Ulaanbaatar, 210648, Bayanzurkh District, Nam-Yan-Ju Street, Mongolia
| | | | - Sergelen Munkhbaatar
- Mongolia Global Fund Supported Project on AIDS and TB, Peace Avenue 13/3, Sukhbaatar District, Ulaanbaatar, Mongolia
| | - Delgermaa Khishigjargal
- Mongolia Center for Health Development, Enkhtaivan Street - 13b, Sukhbaatar District, Ulaanbaatar, Mongolia
| | - Narantuya Khad
- Mongolia Center for Health Development, Enkhtaivan Street - 13b, Sukhbaatar District, Ulaanbaatar, Mongolia
| | - Guy Mahiané
- Avenir Health, 655 Winding Brook Drive, Glastonbury, CT, CT-06033, USA
| | - Naoko Ishikawa
- World Health Organization, Western Pacific Regional Office, PO Box 2932 (United Nations Avenue), 1000 Manila, Philippines
| | - Davaalkham Jagdagsuren
- Mongolia National Centre for Communicable Disease, AIDS/STI Surveillance and Research Department, Ulaanbaatar, 210648, Bayanzurkh District, Nam-Yan-Ju Street, Mongolia
| | - Melanie M Taylor
- World Health Organization, Department of Reproductive Health and Research, 8 Avenue Appia (L152), 1211 Geneva, Switzerland.,Centers for Disease Control and Prevention, Atlanta GA, USA
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Abstract
In 1988, the generalised HIV/AIDS epidemic in Thailand began and in the same year the first HIV-exposed infant in Thailand was born at King Chulalongkorn Memorial Hospital, Bangkok. From the early to mid-1990s, an epidemic wave of HIV-infected women and infants occurred. Heterosexual HIV transmission, as described in the Asian Epidemic Model, was the major mode of spread in Thailand, causing an increasing number of HIV-infected pregnant women. The early and concerted multi-sectoral response of Thai society reduced the prevalence of HIV infection in pregnant women from 2% in the mid-1990s to 0.6% in 2015 and mother-to-child transmission of HIV (MTCT) from an estimated 20-40% to 1.9%. Thus, Thailand became the first Asian country to achieve the World Health Organization's (WHO) targets for the elimination of MTCT. In this narrative review, the key historic evolutions of the science and policy of prevention of mother-to-child transmission of HIV (PMTCT) in Thailand that addressed the four prongs of the recommended WHO PMTCT strategy are described, and the lessons learned are discussed.
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Key Words
- AEM, Asian Epidemic Model
- ANC, antenatal care
- ART, anti-retroviral therapy
- Asian epidemic model
- CDC, communicable disease control
- CMR, child mortality rate
- EID, early infant diagnosis
- EPP, Estimation and Projection Package
- FSW, female commercial sex worker
- HAART, highly active anti-retroviral therapy
- HIV
- HSM, heterosexual men
- IDU, intravenous drug users
- MOPH, Ministry of Public Health
- NGO, non-government organisation
- PACTG, Paediatric AIDS Clinical Trials Group
- PCR, polymerase chain reaction
- PHIMS, Perinatal HIV Intervention Monitoring System
- PHOMS, Perinatal HIV Outcome Monitoring System
- PLWHA, people living with HIV/AIDS
- PROM, premature rupture of membranes
- STI, sexually transmitted infection
- TDR, triple-drug regimen
- TRCS, Thai Red Cross Society
- Thailand
- WLWHA, women living with HIV/AIDS
- elimination
- mother-to-child
- policy
- transmission
- vertical
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