International Journal of MCH and AIDS最新文献

Background and objective: High-quality prenatal care promotes adequate care throughout pregnancy by increasing patients' desires to return for follow-up visits. Almost 15% of women in the United States receive inadequate prenatal care, with 6% receiving late or no prenatal care. Only 63% of pregnant women in Florida receive adequate prenatal care, and little is known about their perceptions of high-quality prenatal care. Therefore, the objective of this study was to assess women's perceptions of the quality of their prenatal care and to describe their preferences for seeking prenatal care that meets their needs.

Methods: From April to December 2019, a qualitative study was conducted with postpartum women (n = 55) who received no or late prenatal care and delivered in Tampa, Florida, USA. Eligible women completed an open-ended qualitative survey and a semi-structured in-depth interview. The interview contextualized the factors influencing prenatal care quality perceptions. The qualitative data analysis was based on Donabedian's quality of care model.

Results: The qualitative data analysis revealed three key themes about women's perceptions and preferences for prenatal care that meets their needs. First, clinical care processes included provision of health education and medical assessments. Second, structural conditions included language preferences, clinic availability, and the presence of ancillary staff. Finally, interpersonal communication encompassed interactions with providers and continuity of care. Overall, participants desired patient-centered care and care that was informative, tailored to their needs, and worked within the constraints of their daily lives.

Conclusion and global health implications: Women seeking and receiving prenatal care prefer a welcoming, patient-centered health care environment. These findings should prompt health care providers and organizations to improve existing prenatal care models and develop new prenatal care models that provide early, accessible, and high-quality prenatal care to a diverse population of maternity patients.

Background: Limited research exists on the association between housing, life expectancy, and mortality disparities in the United States (US). Using longitudinal individual-level and pooled county-level mortality data from 1979 to 2020, we examine disparities in life expectancy, child and youth mortality, and all-cause and cause-specific mortality in the US by several housing variables.

Methods: Using the 1979-2011 National Longitudinal Mortality Study (N=1,313,627) and the 2011-2020 linked county-level National Mortality Database and American Community Survey, we analyzed disparities in life expectancy and all-cause and cause-specific disparities by housing tenure, household crowding, and housing stability. Multivariate Cox proportional hazards regression was used to analyze individual-level mortality differentials by housing tenure. Age-adjusted mortality rates and rate ratios were used to analyze area-level disparities in mortality by housing variables.

Results: US homeowners had, on average, a 3.5-year longer life expectancy at birth than renters (74.22 vs. 70.76 years), with advantages in longevity associated with homeownership being greater for males than for females; for American Indians/Alaska Natives, non-Hispanic Whites, and non-Hispanic Blacks than for Asian/Pacific islanders and Hispanics; and for the US-born than for immigrants. Compared with renters, homeowners had 22% lower risks of all-cause mortality, 15% lower child mortality, 17% lower youth mortality, and significantly lower mortality from cardiovascular diseases, all cancers combined, stomach, liver, esophageal and cervical cancer, diabetes, influenza and pneumonia, COPD, cirrhosis, kidney disease, HIV/AIDS, infectious diseases, unintentional injuries, suicide, and homicide.

Conclusion and global health implications: Several aspects of housing are strongly associated with life expectancy, child and youth mortality, and all-cause and cause-specific mortality in the US. Policies that aim to provide well-designed, accessible, and affordable housing to residents of both developed and developing countries are important policy options for addressing one of the most fundamental determinants of health for disadvantaged individuals and communities and for reducing health inequities globally.

A paramedic's role in the United Kingdom is to primarily respond and provide emergency medical care to patients in the community. Pediatric patients form a small percentage of ambulance call-outs per year, which impacts a paramedic's confidence and competence when implementing effective healthcare protocols due to few attempts and existing opportunities to address pediatric patients' needs. There are also pre-existing gaps and barriers in pediatric emergency paramedic education and the lack of exposure to that specific patient group for emergency medical service healthcare providers in the prehospital settings when responding to pediatric medical emergencies. Further guidance and support in paramedic practice and education could be advantageous in providing effective tools and knowledge to improve pediatric emergency care in prehospital settings.

"No man is an island unto himself" - John Donne According to the World Health Organization, health is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity." Our healthcare industry, public behaviors, and environment have grown exponentially with digital technologies in the era of the 4^th industrial revolution. Due to rapid digitalization and easy availability of the internet, we are now online round the clock on our digital devices, leaving behind digital traces/information. These digital footprints serve as an increasingly fruitful data source for social scientists, including those interested in demographic research. The collection and use of digital data (quantitative and qualitative) also present numerous statistical and computational opportunities, further motivating the development of new research approaches to address health issues. In this paper, we have described the concept of digital well-being and proposed how we can use digital information for good health.

Background and objective: Despite guidelines recommending an interval of at least 18-24 months between a live birth and the conception of the next pregnancy, nearly one-third of pregnancies in the United States are conceived within 18 months of a previous live birth. The purpose of this study was to examine the associations between multiple immigration-related variables and interbirth intervals among reproductive-aged immigrant and refugee women living in the United States.

Methods: This was a cross-sectional, quantitative study on the sexual and reproductive health (SRH) of reproductive-aged immigrant and refugee women in the United States. The data were collected via an online survey administered by Lucid LLC. We included data on women who had complete information on nativity and birth history in the descriptive analysis (n = 653). The exposure variables were immigration pathway, length of time since immigration, and country/region of birth. The outcome variable was interbirth interval (≤18, 19-35, or ≥36 months). We used multivariable ordinal logistic regression, adjusted for confounders, to determine the factors associated with having a longer interbirth interval among women with second- or higher-order births (n = 245).

Results: Approximately 37.4% of study participants had a short interbirth interval. Women who immigrated to the United States for educational (aOR = 4.57; 95% CI, 1.57-9.58) or employment opportunities (aOR = 2.27; 95% CI, 1.07-5.31) had higher odds of reporting a longer interbirth interval (19-35 or ≥36 months) than women born in the United States. Women born in an African country had 0.79 times the odds (aOR = 0.79; 95% CI, 0.02-0.98) of being in a higher category of interbirth interval.

Conclusion and global health implications: Although all birthing women should be counseled on optimal birth spacing through the use of postpartum contraception, immigrant and refugee women would benefit from further research and policy and program interventions to help them in achieving optimal birth spacing. SRH research in African immigrant and refugee communities is especially important for identifying ameliorable factors for improving birth spacing.

Background and objective: Following the recorded progress in the prevention of mother-to-child transmission of HIV in Yaoundé, Cameroon, the proportion of HIV-exposed infants who are uninfected (UIH) is increasing. These children are subject to infectious and non-infectious fragility. The purpose of this study was to assess infectious morbidity and mortality rates among UIH in Yaoundé, Cameroon.

Methods: We conducted a retrospective cohort study. Infants were included in the study and defined as the study subjects if they were between the ages of 24 months or younger, if they were born to HIV-positive mothers, and if they were confirmed to be HIV-negative. The main study outcomes were morbidity rate (defined as infectious, clinical events that required consultation or hospitalization) and death. Data were entered and saved in the Census and Survey Processing System (Cspro) 7.3. Statistical analyses were performed in R Software 3.6.2. The significance level was set at 0.05.

Results: In total, 240 subjects were recruited of whom 53.3% were males. Most of the HIV-positive mothers (95.7%) had used combination antiretroviral (ARV) therapy for at least four weeks during pregnancy. Among the subjects, 93.2% received ARV prophylaxis, 68.7% were exclusively breastfed for six months, 94.7% were fully vaccinated, and 60.6% had received cotrimoxazole up to the detection of the non-infection. Overall, the morbidity rate stood at 34.2%. The incidence of morbidity was 3 per 1,000 child months of the follow-up. The main pathologies were acute respiratory infections (60.79%) and malaria (17.65%). Three deaths were recorded, representing an overall mortality rate of 1.25% for an incidence of 1.1 per 1,000 child months of the follow-up (FU). Clinical events were more frequent in mothers diagnosed with HIV during pregnancy under the azidothymidine (AZT) + lamivudine (3TC) + névirapine (NVP) -based protocol (odds ratio of 3.83 [1.09-14.45; p = 0.039]). Morbidity was also higher for the follow-up periods of less than six months.

Conclusion and global health implications: The overall mortality rate among UIH was low. However, the morbidity rate was considerably higher. Emphasis should be focused on in-care retention for up to 24 months for all UIH, which should include monitoring of HIV-infected mothers prior to pregnancy.

Background and objective: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a newly emerged coronavirus that causes coronavirus disease-2019 (COVID-19) with varying degrees of disease manifestations. Vitamin C is an essential water-soluble vitamin with anti-inflammatory, antioxidant, antiviral, and immunomodulatory functions. The study aimed to investigate the association between serum vitamin C concentration and outcomes of COVID-19 among adults in the United Arab Emirates (UAE).

Methods: This retrospective observational study included 67 COVID-19 patients aged 30-59 years old. Measurement of vitamin C levels was performed at the National Reference Laboratory, UAE using liquid chromatography-tandem mass spectrometry (LC/MS-MS). The cut-off value was 0.4 mg/dl; plasma levels that ranged from 0.4 to 2 mg/dl were defined as sufficient. Values above 2 mg/dl were recognized as high and values less than 0.4 mg/dl are considered low or deficient.

Results: Among the included patients, 58.2% suffered from vitamin C deficiency. We found a statistically significant correlation between the concentration of serum vitamin C and age (p=0.03), the presence of hypertension (p=0.013), diabetes (p=0.01), and the development of pneumonia (p=0.012). There was no significant correlation between the concentration of serum vitamin C and the need for mechanical ventilation, Intensive Care Unit (ICU) admission, COVID-19 severity, or mortality. The risk of COVID-19 severity decreased in patients with sufficient vitamin C levels by 52% compared to patients with vitamin C deficiency (p=0.177). There was a statistically significant correlation between vitamin C sufficiency and low lactate dehydrogenase, C-reactive protein (CRP), and fibrinogen. However, the odds of vitamin C sufficiency in COVID-19 patients were significantly associated with lowering CRP levels (OR=0.99, 95% CI (0.98-1.00), p=0.024).

Conclusion and global health implications: Low serum vitamin C concentrations were associated with several demographic characteristics of patients, the presence of pneumonia, and inflammation. Furthermore, improving our social determinants, such as how we live, eat, drink, and vitamin C supplementation could positively impact the future health of the individual, community, and population.

Polymerase chain reaction (PCR) for the detection of nucleic acids is the gold standard test for the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, there is the probability of false-negative results with this test, which poses a threat to public health. Here, we highlight some important factors that should be considered for reducing the false-negative results of the SARS-CoV-2 PCR test.

Background and objectives: Despite a well-established universal HIV diagnosis and treatment program, Botswana continues to face a high HIV prevalence, in large part due to persistent stigma, which particularly affects pregnant women and interferes with healthcare engagement. Tackling stigma as a fundamental cause of HIV disparities is an important but understudied aspect of current HIV interventions. Our multinational and multicultural team used a theory-driven, multi-stage iterative process to develop measures and interventions to first identify and then target the most culturally-salient aspects of stigma for mothers living with HIV in Botswana. This methodology report examines the stage-by-stage application of the "What Matters Most" (WMM) theory and lessons learned, sharing a replicable template for developing culturally-shaped anti-stigma interventions.

Methods: First, we conducted initial qualitative work based on the WMM theory to identify key structural and cultural factors shaping stigma for women living with HIV in Botswana. Second, we developed a psychometrically validated scale measuring how "what matters most" contributes to and protects against stigma for this population. Third, we designed an anti-stigma intervention, "Mothers Moving towards Empowerment" (MME), centered on the local values identified using WMM theory that underly empowerment and motherhood by adapting a cognitive behavioral therapy (CBT)-informed, group-based, and peer-co-led anti-stigma intervention specifically for pregnant women living with HIV. Fourth, we conducted a pilot study of MME in which participants were allocated to two trial arms: intervention or treatment-as-usual control.

Results: Our qualitative research identified that bearing and caring for children are capabilities essential to the concept of respected womanhood, which can be threatened by a real or perceived HIV diagnosis. These values informed the development and validation of a scale to measure these culturally-salient aspects of stigma for women living with HIV in Botswana. These findings further informed our intervention adaptation and pilot evaluation, in which the intervention group showed significant decreases in HIV stigma and depressive symptoms compared to the control group. Participants reported overcoming reluctance to disclose their HIV status to family, leading to improved social support.

Conclusion and global health implications: Previous studies have not utilized culturally-based approaches to assess, resist, and intervene with HIV-related stigma. By applying WMM in each stage, we identified cultural and gendered differences that enabled participants to resist HIV stigma. Focusing on these capabilities that enable full personhood, we developed an effective culturally-tailored anti-stigma intervention for pregnant women living with HIV in Botswana. This theory-driven, multi-stage approach can

For decades now, malaria has been an important public health concern in Africa, which bears the greatest burden for the disease, affecting children and adults alike. Although a few countries (Australia, Brunei, Singapore, and Algeria, among others) have previously eliminated malaria, the World Health Organization (WHO), on June 30, 2021, declared China malaria-free. This commentary seeks to explore what China did differently to eliminate malaria and what Africa can learn from China's experience. First, Africa can use innovative tools and strategies used by China to attain success. Second, Africa can create a multi-sector collaboration among Heads of States in high burden malaria-affected countries by involving all stakeholders such as ministries of health, finance, research, education, development, public security, the army, police, commerce, industry, and information technology, customs, media and tourism to jointly fight malaria in all African countries. Furthermore, African countries could adapt the genetics-based approaches used by China in the elimination of mosquito breeding grounds. Finally, Africa can also adapt a better surveillance system of reporting on malaria daily as China did in their experience.