Reproductive Health最新文献

Background: Maternal Near-Miss (MNM) is a woman who nearly dies but survives complications during pregnancy, childbirth, or 42 days following termination of pregnancy. MNM has emerged as a proxy indicator for the quality of maternal health services. For every maternal death, there are 20-30 MNM cases. However, there is a dearth of comprehensive evidence on MNM according to the WHO's MNM approach, as well as inconsistencies in risk factors from primary studies. Hence, we conducted a systematic review and meta-analysis on the maternal near-miss incidence ratio, causes, and risk factors in East Africa.

Methods: The review was conducted according to PRISMA 2020 checklist guidelines. Studies were identified from MEDLINE, Scopus, CNIAHL, PsycINFO, ProQuest, Web of Science, Emcare, and Google Scholar. Random-effect meta-analyses were conducted to produce pooled estimates. Further, an influential leave-one-out sensitivity analyses were conducted to investigate the impact of each study on the pooled estimates.

Results: Thirty-nine primary studies on the MNM incidence ratio and/or causes and/or factors associated with MNM were included. The pooled MNM incidence ratio was 37.12 per 1,000 live births (95% CI: 20.22-54.03), ranging from 12 per 1,000 live births in Kenya to 53 per 1,000 live births in Ethiopia. The pooled proportion of direct causes of MNM were as follows: obstetric haemorrhage 29.9% (95%CI: 25.7%-34%), hypertensive disorder of pregnancy 27.8% (95%CI: 22.3%-33.3%), uterine rupture 13.8% (95%CI: 7.9%-19.6%), sepsis 9.9% (95%CI: 7.1-12.8%), abortion complications 8.1% (95%CI: 5.9%-10.3%), and ectopic pregnancy 7.3% (95%%CI: 3.1-11.5%). Several factors were significantly associated with MNM. Low-income women had higher odds of MNM (AOR 2.95, 95% CI: 1.28-4.61), while employed women had lower odds (AOR 0.53, 95% CI: 0.21-0.81). Parity ≥ 5 (AOR 1.65, 95% I: 1.14-2.16), history of abortion (AOR 1.63, 95%CI: 1.04-2.22), history of pregnancy complications (AOR 4.09, 95%CI: 1.43-6.78), history of cesarean section (CS) (AOR = 5.04, 95%CI: 3.17-6.90), lack of antenatal care (AOR 2.91, 95%CI: 2.02-3.78), lack of birth preparedness and complication readiness (AOR 4.18, 95%CI: 2.64-5.72), and long distance to health facility (AOR 3.06, 95%CI:1.09-5.03) were positively associated with MNM. Conversely, women admitted by provider referral had lower odds of MNM (AOR 0.31, 95% CI: 0.07-0.55).

Conclusions: The MNM incidence ratio in East Africa was high. Obstetric haemorrhage, hypertensive disorder of pregnancy, and uterine rupture were the three leading obstetric causes of MNM. Income, employment status, parity, ANC, history of CS, and distance to health facilities were found to be associated with MNM. Policymakers and healthcare workers need to consider these identified risk factors in interventions aimed at improving maternal health.

Antenatal Care (ANC) models have evolved to increase maternal and child health service utilization, especially in low- and middle-income countries. Recently, group antenatal care (G-ANC), where cohorts of pregnant women with similar gestational ages are followed throughout pregnancy, has shown promise in enhancing care utilization, patient satisfaction, and reducing maternal morbidity and mortality. However, the acceptability of G-ANC in Burkina Faso has not been assessed.This qualitative study aimed to evaluate the acceptability of G-ANC by pregnant women at six pilot sites in Burkina Faso and identify challenges for scaling up. We conducted six Focus Group Discussions (FGDs) with 58 women who attended at least one G-ANC session. Participants were selected through purposive sampling, and discussions were conducted using semi-structured interview guides. Thematic analysis was performed using N-VIVO software.Six themes emerged: overall experience, benefits and challenges of G-ANC, relationships with healthcare workers and partners, changes introduced by G-ANC, and suggestions for improvement. Women expressed high satisfaction with G-ANC, citing skill development and improved relationships as key benefits. Challenges included long session durations and inadequate space. A major recommendation was to hold sessions on weekends to allow partner participation. In conclusion, G-ANC is highly accepted by women in Burkina Faso. This low-cost, high-impact initiative holds potential for broader implementation in similar settings.

Background: Cervical cancer screening among Zimbabwean women is suboptimal. Integrating cervical cancer screening with HIV and sexual and reproductive health services can improve uptake. To inform optimisation of integrated models, we explored evolution of women's and health worker views on integration and cervical cancer screening.

Methods: Over three phases between Nov-2013 and Mar-2016, we collected serial multiple methods data from female attendees and health workers at four clinics providing integrated cervical cancer screening and HIV and sexual/reproductive health services. Using program data, we examined trends in uptake of cervical cancer screening.

Results: Between 2013 and 2016, 38,342 women were screened for cervical cancer at three clinics. Program data showed increasing trends in uptake, capping at clinic capacity. Qualitative studies showed that clinic attendees and health workers viewed integration positively across phases because: (i) information on cervical cancer screening was easily disseminated, leading to improved uptake; (ii) co-location of services was convenient. As knowledge increased, demand exceeded supply, requiring operation of strict appointment-based systems. Other facilitators to cervical cancer screening included offer of services for free, personal experience of friends/family who suffered cervical cancer, peer encouragement, spousal/partner support, and having suspicious signs/symptoms. Barriers were more pronounced in earlier phases and largely centred around myths that spread in communities or clinic waiting rooms. Lack of training among health workers impeded implementation.

Conclusions: Integrating cervical cancer screening with HIV and sexual/reproductive health services was feasible and acceptable, with less pronounced barriers as programs matured. Addressing individual and program-level barriers can optimise uptake of services.

Background: The birth of a preterm baby and subsequent hospitalization in the neonatal intensive care unit (NICU) pose significant emotional challenges for fathers. Fathers often suppress their feelings to fulfill a supportive role, but active participation in caregiving may alleviate their stress and enhance bonding. This study aimed to evaluate the impact of a support program on the stress and anxiety of fathers during their first encounter with a preterm baby.

Methods: This randomized clinical trial (RCT) was conducted with a 1:1 allocation ratio at Shahid Motahari Hospital, Urmia, Iran. Eligible fathers (n = 80) of preterm babies were randomly assigned to either an experimental (n = 40) or a control (n = 40) group using a random block method with block sizes of four. Due to dropouts, 37 fathers in the experimental group and 36 in the control group were included in the analysis. The experimental group received a support program, including individualized informational and emotional support, in addition to standard NICU support. The control group received only standard NICU support. Anxiety was measured using the State-Trait Anxiety Inventory (Only the state anxiety subscale), before the first encounter and three days post-birth. Stress was assessed on day three using the Parental Stressor Scale: NICU (PSS: NICU).

Results: Post-intervention, the experimental group exhibited significantly lower mean PSS: NICU scores (M = 64.32, SD = 24.12) compared to the control group (M = 109.75, SD = 22.24; mean difference=-45.43, 95% CI [-34.58, -56.26], p < 0.001). Among the subscales of stress, the parent-child relationship and parenting roles, despite a significant decrease after the intervention in the experimental group, still had the highest stress for fathers with preterm babies. The mean State anxiety score in the experimental group (M = 43.21, SD = 9.68) was significantly lower than in the control group (M = 54.22, SD = 10.39; mean difference= -11.01, 95% CI [-6.31, -15.69], p < 0.001), indicating reduced anxiety.

Conclusion: The structured support program significantly reduced stress and anxiety among fathers of preterm babies. These findings suggest that health policymakers should consider integrating such interventions into NICU care protocols to support paternal well-being and family-centered care.

Trial registration: IRCT20200120046200N1. Dated 11/5/2020 prospectively registered. ( https://irct.behdasht.gov.ir/user/trial/46722/view ).