International Journal of MCH and AIDS最新文献

Artificial Intelligence (AI) applications in medicine have grown considerably in recent years. AI in the forms of Machine Learning, Natural Language Processing, Expert Systems, Planning and Logistics methods, and Image Processing networks provide great analytical aptitude. While AI methods were first conceptualized for radiology, investigations today are established across all medical specialties. The necessity for proper infrastructure, skilled labor, and access to large, well-organized data sets has kept the majority of medical AI applications in higher-income countries. However, critical technological improvements, such as cloud computing and the near-ubiquity of smartphones, have paved the way for use of medical AI applications in resource-poor areas. Global health initiatives (GHI) have already begun to explore ways to leverage medical AI technologies to detect and mitigate public health inequities. For example, AI tools can help optimize vaccine delivery and community healthcare worker routes, thus enabling limited resources to have a maximal impact. Other promising AI tools have demonstrated an ability to: predict burn healing time from smartphone photos; track regions of socioeconomic disparity combined with environmental trends to predict communicable disease outbreaks; and accurately predict pregnancy complications such as birth asphyxia in low resource settings with limited patient clinical data. In this commentary, we discuss the current state of AI-driven GHI and explore relevant lessons from past technology-centered GHI. Additionally, we propose a conceptual framework to guide the development of sustainable strategies for AI-driven GHI, and we outline areas for future research.

We examined the trends in stillbirth across gestational age in the United States (US).We conducted a trend analysis using the U.S. Natality and Fetal Death datasets covering 1982 and 2017. We compared the incidence and rates of stillbirth for term, all preterm, moderate-to-late preterm, very preterm, and extreme preterm phenotypes. The incidence of stillbirth decreased for the entire birth cohort over the 36-year period. The rates of overall, term, all preterm, very preterm and moderate-to-late preterm stillbirth decreased from 1982 to 2017; however, the rates for extreme preterm stillbirth increased by about 7.6% over the same study period.

Background: Post-partum hemorrhage (PPH) is a leading cause of maternal mortality. Its first-line of prevention often entails uterotonic drugs like oxytocin and misoprostol which constitute a core point of management in low-resource settings of sub-Saharan Africa. This study aimed to assess the effectiveness of oxytocin alone compared with oxytocin plus misoprostol in two different eras (before and after the advert of misoprostol) of a semi-urban Cameroonian hospital.

Methods: This was a retrospective cohort study carried out between January 2015 to April 2015 and between January 2016 to April 2016 on a group of parturients (group A) who received only oxytocin and another administered oxytocin and misoprostol (group B), respectively. All participants delivered at the Bamenda Regional Hospital, Cameroon. The two different periods represent the era before and after the implementation of misoprostol in the prevention of PPH in this semi-urban hospital. Socio-demographic data, clinical characteristics and details of delivery as well as risk factors for PPH were studied from obstetric records.

Results: We studied the obstetric records of 1778 parturients were studied; 857 in group A and 879 in group B. Their mean age was 26.3 ±5.2 years. Both groups were comparable in several baseline sociodemographic and clinical characteristics. The prevalence of PPH was 2.7% (3.4% vs 2.2%; p = 0.0744). The risk of PPH in the oxytocin only group was about 1.5 times higher than in the oxytocin plus misoprostol group. The estimated blood loss between the two groups was statistically significant (1100 ± 150 vs 800 ± 100 ml, p< 0.0001). The active management of the third stage of labor without misoprostol was the only risk factor for PPH.

Conclusion and global health implications: The implementation of misoprostol plus oxytocin in the prevention of PPH in this low-resource setting improved the obstetrical outcome by reducing the risk and the amount of blood loss during delivery.

Background or objectives: Women living with HIV (WLHIV) are at increased risk of depression. In pregnancy, depression could affect health and pregnancy outcomes, as well as child rearing. We assessed depressive symptoms and quality of life of WLHIV during the perinatal period.

Methods: This cross-sectional study was conducted at 15 hospitals in Chiang Mai, Thailand. The Patient Health Questionnaire-9 and the World Health Organization quality of life questionnaire (WHOQOL-BREF_THAI) were used to screen for depressive symptoms and to assess quality of life (QOL), respectively. Statistical analysis was performed by the SPSS. Descriptive statistics were reported. Factors associated with depressive symptoms were assessed by univariate and multivariate analyses. Linear regression analysis was performed to determine association between depressive symptom scores and QOL. Regression coefficient (b) and 95% confidence intervals (CI) were reported. P-values < 0.05 were considered statistically significant.

Results: One hundred WLHIV were enrolled and the mean age was 29.2 ±7.5 years. The overall prevalence of depressive symptoms was 30 (30%), 95% CI 21-39; specifically, 34 (34%) in pregnant and 27 (27%) in postpartum women. Overall, depressive symptoms were mild in 22 (22%), moderate in 7 (7%), and moderately severe in one (1%). Multivariate logistic regression analysis revealed that verbal abuse by partner (b=4.751 (95% CI=2.306-9.790), p< 0.001) and lifetime alcohol use (b=3.403 (95% CI=1.427-8.115), p=0.006) were associated with depressive symptoms. The overall perception of own health and quality of life of WLHIV in all domains were lower than that of HIV-negative women. WLHIV with depressive symptoms had a significantly lower QOL than those without.

Conclusion and global health implications: In this study, the prevalence of depressive symptoms in women living with HIV was similar to that in HIV-negative women. WLHIV with depressive symptoms had a significantly lower QOL than those without. Mental health screening in antenatal and postpartum clinic is warranted.

Background: Evidence on recent trends regarding the impact and cost-benefits of ultrasound in resource-constrained settings is limited. This study presents a systematic review to determine recent trends in the utility and applicability of ultrasound use in low and middle income countries (LMIC). The review includes characterizing and evaluating trends in (1) the geographic and specialty specific use of ultrasound in LMICs, (2) the innovative applications and the accompanying research findings, and (3) the development of associated educational and training programs.

Methods: The electronic databases Medline OVID, EMBASE, and Cochrane were searched from 2010 to 2018 for studies available in English, French, and Spanish. Commentaries, opinion articles, reviews and book chapters were excluded. Two categories were created, one for reported applications of ultrasound use in LMICs and another for novel ultrasound studies.

Results: A total of 6,276 articles were identified and screened, 4,563 studies were included for final review. 287 studies contained original or novel applications of ultrasound use in LMICs. Nearly 70% of studies involved ultrasound usage originating from Southeast Asia and sub-Saharan Africa, the latter being the region with the highest number of innovative ultrasound use. Educational studies, global collaborations, and funded studies were a substantial subset of overall ultrasound research. Our findings are limited by the lack of higher quality evidence and limited number of randomized clinical trials reported.

Conclusion and global health implications: Our systematic literature review of ultrasound use in LMICs demonstrates the growing utilization of this relatively low-cost, portable imaging technology in low resource settings.

We are thrilled to present this special collection of articles entitled "Current and Emerging Issues in Global Health." This special collection pursued three main goals. First, the collection presents an opportunity for innovation. Second, it presents an opportunity to engage the field and community around a common theme. Finally, the collection provides a reality-check for the journal editors to support the field in evaluating the extent to which we have collectively attempted to confront the global maternal and child health (MCH) issues of our time regardless of where in the world we live. Unique to this special collection is the geographical spread of the article submissions. We have articles and contributions from researchers and research groups from three continents in a single edition: Africa, Asia and North America, making the articles opportunities for cross-fertilization of ideas across the global North and South. Public health is passing through a seismic transformation. Whether at the global, national, state, and local levels, disease outbreaks, patient demographics, and health technology have changed the global health landscape in a way never imagined. Our hope is that papers in this special collection will spark new ideas for invention, improved patient care, and transform population health.

Since its outbreak, COVID-19 pandemic has been the biggest global concern with exponentially increasing number of cases and associated deaths across all habitable continents. Various countries around the world with their diverse health care systems, have responded to the pandemic in very distinctive ways. In this paper, we: compared COVID-19 mortality rates across global geographic regions; and assessed differences in COVID-19-related case fatality rate (CFR) based on presence or absence of Universal Health Coverage (UHC). We found that as of May 6, 2020, Europe had experienced the highest CFR globally of 9.6%, followed by 5.9% in North America. Although the pandemic originated in Asia, the continent ranked second to the last in terms of CFR (3.5%). Countries with UHC had lower number of cases of 37.6%, but the CFR of countries with UHC was twice that of countries without UHC (10.5% versus 4.9%). In conclusion, UHC does not appear to protect against mortality in a pandemic environment such as with COVID-19.

Background and objectives: HIV transmission from persons unaware of their HIV status occurs more commonly than those who are aware of their status. Knowledge of one's HIV status may encourage preventive behaviors. Anecdotal evidence suggests that many international students may be willing to accept HIV screening, but empirical evidence to support this claim is lacking. We sought to determine the willingness of international students in the United States (US) to accept HIV screening, if offered.

Methods: We conducted a cross-sectional study using an online survey of international students at Western Illinois University, USA. The independent variable was the sociodemographic data of our participants; the dependent variable was the acceptance of HIV screening. The covariates were knowledge about HIV and the factors associated with the acceptance of the screening. Descriptive statistics and multivariate analysis were conducted.

Results: A total of 185 respondents out of 491 students participated in the online survey. Of these, 107 (57.8%) were males, and 78 (42.8%) were females. Most of the respondents were from Asian countries (64.9%) and African countries (24.9%). The prevalence of acceptance of HIV screening was 74%. Among participants willing to accept screening, if offered, 90% perceived screening would be beneficial to their health. Meanwhile, 83% of those who would refuse the screening were not sexually active.

Conclusion and global health implications: Many international students may be interested in getting HIV screening if offered. Awareness of the benefits of HIV screening may influence the decision to screen. Findings may inform further studies that will lead to policy formulations for the health of international students in the US.

Background or objectives: Intimate partner violence (IPV) against women is common globally, and is associated with several adverse consequences. This study provides a comparative analysis of potential regional differences in the association between IPV and knowledge and use of contraceptives within Africa.

Methods: A multi-country cross-sectional study was conducted using data on women of reproductive age 15-49 years from the Demographic and Health Surveys covering five African regions. Exposure and outcome variables were IPV and reproductive literacy (comprising modern contraception knowledge and contraception usage) respectively. We used survey log-binomial regression models to generate prevalence ratios that estimated the association between IPV versus knowledge and usage of modern contraception.

Results: Overall IPV prevalence in Africa was 30.8% with notable regional differences. Demographic, socioeconomic, and reproductive history markers of IPV were more pronounced in younger women, rural residents, women of low socioeconomic status and those with copious knowledge but poor usage of modern contraception. The level of knowledge of contraception was 84% greater among African women who were victims of IPV compared to their counterparts who were not victims of IPV (p < 0.0001). IPV was not associated with actual usage of modern contraception (p = 0.21).

Conclusion and global health implications: IPV against women in Africa may incentivize knowledge seeking of modern contraception as protective mechanisms. Regional variations notwithstanding, understanding the existing and new characteristics predictive of IPV may inform policy development, resource allocation and prevention of IPV globally.

We analysed Natality data obtained from the National Vital Statistics System from 1971 through 2018. Overall, the rates of singletons declined among all racial groups over the five decades of the study. However, the rates of twins and higher-order multiples increased over the same period although for the past two decades, the rates of higher-order multiples had substantially plummeted. The global health implication of these findings is that policy changes in the US in the form of professional practice guidelines have succeeded in reducing the birth of vulnerable populations (i.e., higher-order multiples) who are predominantly created using assisted reproductive technology.