International Journal of MCH and AIDS最新文献

Background and objective: While coronavirus disease-2019 (COVID-19) stressors on women's mental health have been studied in the United States (US), very few have focused on pregnant and postnatal women in Georgia, US. This study sought to identify the sources of the COVID-19 stressors on the mental health of pregnant and postnatal women in Georgia during the pandemic, the effects of COVID-19 stressors on their mental health, and to provide recommendations for protecting the mental health of this population during a future pandemic or health emergency. Although the global health emergency caused by the COVID-19 pandemic officially ended in 2023, and while its devastating effects have been largely overcome, its presence has left an indelible impression on populations worldwide.

Methods: A mixed-methods cross-sectional design was used to collect data from 66 study participants across eight domains using Qualtrics. Quantitative data were analyzed using the Statistical Package for the Social Sciences version 28 and the Statistical Analysis Software version 9. Qualitative data were manually analyzed using a thematic approach.

Results: Before the pandemic, anxiety was experienced by 21.2% of the study participants, depression by 12.1%, and post-traumatic stress disorder (PTSD) by 6.1%. These statistics almost doubled for anxiety (39.4%), more than doubled for depression (27.3%), and increased for PTSD (9.1%) during the pandemic. The fear of getting COVID-19 was the most prevalent stressor for both pregnant and postnatal women (39.4%), as well as the possibility of their babies or they themselves becoming sick. The most widespread effects of stressors caused by the pandemic were worry (50.0%), sadness (42.4%), and loneliness (36.4%). Very few of the study participants who experienced mental health conditions (25.6%) sought care from a mental health professional during the pandemic. Those who did not seek care (74.4%) said they coped by utilizing self-management strategies (cited 14 times), depended on family, partners, and friends for support (cited 11 times), or exercised (cited 7 times).

Conclusion and global health implications: The pandemic had a considerable impact on the mental health of pregnant and postnatal women in Georgia. It is essential for the local government and healthcare providers in Georgia and different parts of the world to be proactive and put in place mechanisms that will help to maintain the mental health of this population during a future pandemic or health emergency.

Background and objective: Early detection of abnormal labor progression helps prevent prolonged and stationary labor, which is one of the leading causes of maternal mortality. The objective of this study was to determine the prevalence and predictors of routine partograph use in Western Cameroon.

Methods: A cross-sectional study was conducted among caregivers in the Western region, from February 1 to June 30, 2024. A self-administered questionnaire was used to collect data. Data were entered into CSPro 7.3 software and exported to R (4.3.3) for analysis. Descriptive statistics and logistic regression analysis were performed. Statistical significance was determined using adjusted odds ratios (AOR) with 95% confidence intervals (CI) and p < 0.05.

Results: A total of 373 caregivers participated in the study. The prevalence of routine partograph use was 72.1% (95% CI: 67.3; 76.6). Less than two-thirds (59.8%) of healthcare providers had good knowledge of the partograph. On-job-training (AOR = 2.85 [95% CI: 1.45-5.81]) and routine partograph availability (AOR = 390 [95% CI: 75.4-7366]) were significantly associated with partograph use.

Conclusion and global health implications: Partograph use in this study was moderate. Interventions such as periodic on-job training on the partograph and ensuring its routine availability in maternity wards are recommended.

Background and objective: Although maternal mortality in India has declined significantly due to improved healthcare access and government initiatives, uterine rupture is re-emerging as a serious obstetric complication, largely driven by the rising incidence of cesarean deliveries. This study was conducted to evaluate the incidence, risk factors, and maternal and fetal outcomes of uterine rupture at a tertiary care center in Eastern Uttar Pradesh, India.

Methods: An observational cross-sectional study was conducted over 12 months (October 2019-September 2020) in the gynecology inpatient department of a tertiary care center. All clinically diagnosed and laparotomy-confirmed cases of uterine rupture were included. Maternal demographics, antenatal and perinatal risk factors, intraoperative findings, and maternal and fetal outcomes were analyzed. The occurrence of uterine rupture during COVID and non-COVID periods was compared using a Z test for proportion. The incidence was calculated from the total number of hospital deliveries during the study.

Results: Of 3,552 deliveries, 31 cases of uterine rupture were reported, yielding an incidence of 8.7/1,000- markedly higher than the national average. The incidence during the COVID-19 period increased, but was not statistically significant. Previous cesarean section (CS) with unsupervised labor was the leading risk factor. Maternal mortality was 6.45%, and 83.87% of women recovered without major complications. Perinatal mortality was alarmingly high at 96.77%, with only one neonate surviving.

Conclusion and global health implications: Uterine rupture remains a significant contributor to maternal and perinatal mortality in rural India, particularly due to unsafe labor practices and poor antenatal care. There is an urgent need to strengthen health systems, referral networks, and community education to prevent uterine rupture and improve maternal-child health outcomes. In addition, focused efforts are required to reduce the rate of unnecessary CS through adherence to evidence-based guidelines and promoting safe vaginal births when appropriate.

Background and objective: Fetal anomalies or birth defects are structural or functional abnormalities that occur before birth, often leading to significant health issues. The burden of fetal anomalies among antenatal mothers attending a public referral hospital in urban Bangalore is a critical public health concern, reflecting broader issues of maternal and child health in India. Factors such as consanguinity, genetic disorders, and delayed access to healthcare contribute to the high prevalence of anomalies in the country. This study aimed to determine the magnitude and types of fetal anomalies detected through routine ultrasound in an urban referral hospital in Bangalore and to explore associations with maternal demographic and socioeconomic factors.

Methods: This ambispective study analyzed data from 1432 antenatal mothers who underwent ultrasound screening from July 2021 to June 2022. It included a retrospective review of medical records and a prospective follow-up for pregnancies with detected anomalies. Data on maternal age, consanguinity, parity, and other maternal risk factors were collected using logistic regression to explore associations with congenital anomalies.

Results: Fetal anomalies were detected in 2.9% of pregnancies (n = 42), with renal system anomalies being the most prevalent (59.5%). Consanguinity was present in 9.9% of cases and showed a significant association with congenital anomalies (odds ratio [OR] = 2.14, p = 0.05). Preterm birth was significantly associated with anomalies (OR = 4.47, p = 0.001). Most anomalies were detected after 30 weeks of gestation, limiting the scope for early intervention.

Conclusions and global health implications: The study highlights congenital anomalies, particularly renal anomalies, that are prevalent in a public hospital in urban Bangalore. It emphasizes the importance of early antenatal care, targeted-screening, and genetic counseling for at-risk population due to consanguinity. Timely detection and intervention could improve maternal and neonatal outcomes.

Background and objective: Prolonged and obstructed labor is a leading cause of maternal death, preventable through effective and inexpensive health interventions such as the correct and systematic use of the partograph. The objective of this review was to determine the prevalence of partograph use in Sub-Saharan Africa.

Methods: We used the standard Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist. Three online databases were used: PubMed, Google Scholar, and African Index Medicus. We included observational studies reporting the prevalence of partograph utilization, conducted in Sub-Saharan African countries, and published in English or French. Extracted data were entered into an Excel spreadsheet and then exported to R version 4.3.3 for analysis.

Results: Of the 1,159 records identified in this review, 41 studies were included in this systematic review and meta-analysis. The overall pooled prevalence of partograph utilization was 51.17% (95% confidence interval: 43.05- 59.29). The study country and Sub-Saharan African region were sources of heterogeneity (p < 0.0001 for both), while the year of publication was not (p = 0.2385). The funnel plot and Egger's test (p = 0.7072) demonstrated the absence of potential publication bias.

Conclusion and global health implications: This study showed that the overall pooled prevalence of partograph use in Sub-Saharan African countries was low. Therefore, effective intervention strategies are strongly recommended to increase partograph utilization.

This perspective paper explores the recommendations to maintain a secure breastfeeding in the case of the Mpox epidemic in lactating populations of sub-Saharan Africa. An emphasis is placed on prioritizing breastfeeding by own mother's milk (OMM) through direct latching whenever possible. In case direct breastfeeding by OMM is impossible, clinicians and infant feeding counselors should promote expressed breast milk, pasteurized or not, and wet nursing. In all cases, policy makers and program managers will maintain the promotion of breastfeeding for the sake of infant survival.

Background and objective: Over 2.5 million people are living with human immunodeficiency virus (HIV) in India. The World Health Organization recommends HIV self-screening and partner notification services. Index testing is a case-finding approach that focuses on eliciting the sexual or needle-sharing partners and biological children of HIV-positive individuals. This review aims to understand the effectiveness of index case testing in the uptake of HIV diagnosis and care.

Methods: A scoping review was conducted to examine the effectiveness of HIV index case testing. Studies published between 2010 and 2024 in English were included. A total of 10 final studies were included in this scoping review. No such studies were found in the Indian context.

Results: The studies were from Zimbabwe, Malawi, Nigeria, South Africa, Lesotho, Kenya, Zambia, Mozambique, and Ukraine. Sample sizes ranged from under 1,000 individuals to large-scale community-based programs enrolling over 38,000 participants. The studies demonstrated the effectiveness of index case testing in identifying previously undiagnosed HIV infections among sexual partners (up to 51%) and children (4.0-5.8%) of people living with HIV. The studies also indicated high acceptance rates and feasibility of the approach.

Conclusion and global health implications: HIV index case testing presents a valuable strategy for reaching diverse populations at risk for HIV infection and improving care linkages. Further research is needed to explore cost-effectiveness and optimize implementation strategies for various contexts.

Background and objective: Human immunodeficiency virus (HIV) infection attacks and gradually weakens the immune system by destroying CD4 cells, with the most advanced stage of the infection known as acquired immunodeficiency syndrome (AIDS). Mother-to-child transmission (MTCT) of HIV remains the primary method of infection among children. Understanding the factors contributing to MTCT and current transmission rates is crucial for developing effective prevention strategies during pregnancy, childbirth, and breastfeeding. This study aims to determine MTCT of HIV, assess maternal viral load, and identify transmission-associated factors in the Adamawa Region of Cameroon.

Methods: Blood samples were collected from 119 mothers living with HIV and their children (mother-infant pair) in 15 different HIV/AIDS treatment units/facilities across the Adamawa Region and analyzed at the Ngaoundere Regional Hospital. Early infant diagnosis was performed using the GenXpert system, and viral load quantification was performed using the Cobas 5800 system.

Results: The findings showed that the MTCT rate of HIV was 1.7% (2/119), with an incidence rate of 33.6 cases/1000 person-years. Maternal viral load suppression rate was 96.6% (115/119). Among the participants, 47.1% (56/119) had undetectable viral loads (<20 copies/mL) and 49.6% (59/119) had suppressed viral loads of 20-<1000 copies/mL. Only 3.4% (4/119) had unsuppressed viral loads ≥1000 copies/mL. There was no statistically significant association between maternal age, duration of antiretroviral therapy (ART), type of ART, and number of antenatal visits. Significant associations were observed between MTCT and place of birth (p = 0.001) and maternal viral load (p < 0.001).

Conclusions and global health implications: The transmission rate of HIV infection in infants born to HIV-positive mothers was below the national target of 2%. There was high viral suppression in lactating mothers, which was associated with a high adherence rate to ART. Maternal viral load and delivery location were significant risk factors for transmission.

Background and objective: There is a global effort to eliminate new human immunodeficiency virus (HIV) infections among children. However, mother-to-child transmission (MTCT) of HIV, which accounts for nearly all pediatric infections, remains disproportionately high in Africa, including Ghana. This study aims to determine the prevalence and identify the key predictors of MTCT of HIV among HIV-exposed infants in the Ashanti Region of Ghana.

Methods: A retrospective cohort analysis of routine follow-up records of HIV-infected mothers and their exposed infants was conducted between August 2023 and June 2024 in four hospitals. A convenient consecutive sampling technique was employed to include exposed infants who were at least 18 months old, had ceased breastfeeding, and had definite HIV test results. A structured form was used to collect sociodemographic, clinical, and treatment data of mother-infant pairs. The data were entered into an Excel sheet and exported to STATA version 17.0 for analysis. Bivariate and multivariate logistic regression models were used to determine key predictors of MTCT.

Results: Out of the 220 records reviewed, 24 infants tested positive for HIV, giving an overall prevalence of 10.9%. The prevalence was 17.5% (21/120) among participants living in rural communities, compared to 0.03% (3/100) in urbanized areas. Maternal viral load ≥1000 copies/mL (adjusted odds ratio [aOR]: 13.13; 95% confidence interval [CI]: 2.75-62.69), no antiretroviral (ARV) prophylaxis in infant (aOR: 11.05; 95% CI: 2.18-55.91), and mixed feeding during the first 6 months of life of the infant (aOR: 5.65; 95% CI: 1.34-23.87) were the main predictors of MTCT of HIV.

Conclusion and global health implications: The prevalence of MTCT of HIV is high, especially in rural settings. Eliminating MTCT will require effective maternal viral suppression through optimal ART adherence, ensuring prompt ARV prophylaxis for infants at birth and promoting safer feeding practices during the infant's first 6 months of life.

Background and objective: Human immunodeficiency virus (HIV) is a major public health concern among pregnant women in Nigeria, with seven in every hundred women likely to have an HIV infection. Understanding factors associated with HIV infection among pregnant women is critical to improving prevention strategies, especially in conflict regions. This study investigates demographic, socio-economic, and behavioral determinants of HIV among pregnant women in Nigeria, with conflict exposure included as a key predictor in the analysis.

Methods: This study is a cross-sectional design using data from the 2018 Nigeria HIV/Acquired Immunodeficiency Syndrome (AIDS) Indicator and Impact Survey, the largest population-based HIV survey globally, implemented between July and December 2018 across all 36 states and the Federal Capital Territory of Nigeria. We analyzed weighted data from 3,879,192 pregnant women (both HIV-positive and negative), conducting bivariate and multivariate analyses to identify predictors of HIV infection among women aged 15-49 years while adjusting for potential confounders. Adjusted Odds Ratios (AORs) with 95% confidence intervals (CIs) were generated using unconditional logistic regression models to determine significant predictors.

Results: Our analysis revealed that women in conflict zones were younger, less educated, and more likely to be in polygynous marriages and the lowest wealth quintile compared to those in non-conflict zones. In a multivariable analysis, residence in a conflict zone was associated with nearly twofold adjusted odds of HIV positivity (AOR = 1.93; CI: 0.98-3.82; p = 0.057). Increasing maternal age (AOR = 1.06; CI: 1.02-1.10; p = 0.002) and middle to fourth wealth quintile status (AOR = 4.10 and 3.80, respectively; p < 0.05) were significantly associated with a higher likelihood of HIV infection. Recent non-marital sexual activity was also significantly associated with HIV positivity (AOR = 2.96; p = 0.037).

Conclusion and global health implications: The study identifies conflict exposure and socio-economic status as significant predictors of HIV infection among pregnant women in Nigeria. Our analysis reveals important demographic, socio-economic, and behavioral factors associated with HIV prevalence in this population. These findings underscore the need for comprehensive HIV prevention strategies that address the complex interplay of social determinants, particularly in vulnerable populations.