International Journal of MCH and AIDS最新文献

Background: Globally, there has been a marked decline in neonatal mortality and overall child mortality indicators from 1990 to date. In Kenya, neonatal deaths remain unacceptably high, contributing to 40% of under-five mortality rates (U5MR) making it an important health priority. The objective of this study was to identify the determinants of neonatal mortality in Kenya. An understanding of the determinants of neonatal mortality will provide evidence for better interventions to reduce these deaths.

Methods: Neonatal deaths from singleton live-born infants were extracted from women's dataset collected for the 5-year period preceding the study published in the Kenya Demographic and Health Survey (KDHS), 2014. Data were obtained from 18,951 births. There were 356 neonatal deaths recorded. Data were weighted using an individual weighting factor to adjust for the study design and reduce sample variability. Data were analyzed using SPSS version 20.0. Logistic regression was conducted to adjust for confounding factors.

Results: Neonatal mortality rate was established at 19/1000 (95% CI: 16.8-20.7). Mothers with no education had higher odds of experiencing deaths of neonates with adjusted Odds Ratio (aOR)=2.201, 95% CI: 1.43-4.15,p=0.049) compared to mothers with higher education. Low Birth Weight (LBW) neonates were 3.2 times likely to die in the first 28 days (aOR=3.206, 95% CI: 1.85-12.08, p=0.006) compared to neonates with >3.5 kilograms at birth. Mothers who did not attend ANC during pregnancy and those who attended between 1-3 ANC visits had higher odds of losing their infants (aOR=3.348, 95% CI: 1.616-8.53, p=0.041, and aOR=2.316, 95% CI: 1.10-4.88, p=0.027) respectively, compared to mothers who attended >4 ANC visits.

Conclusion and global health implications: Improving maternal health and nutrition during pregnancy should be enhanced to ensure adequate weight gain and reduce instances of low birth weight. Community referrals and follow-up for expectant women to take up the requisite 4 ANC visits should be encouraged. Girls' education should be emphasized to reduce the proportion of illiterate mothers.

Background: Despite the previous long-term decline and a recent increase in maternal mortality, detailed social inequalities in maternal mortality in the United States (US) have not been analyzed. This study examines trends and inequalities in US maternal mortality by maternal race/ethnicity, socioeconomic status, nativity/immigrant status, marital status, area deprivation, urbanization level, and cause of death.

Methods: National vital statistics data from 1969 to 2018 were used to compute maternal mortality rates by sociodemographic factors. Mortality trends by deprivation level were analyzed by using census-based deprivation indices. Rate ratios and log-linear regression were used to model mortality trends and differentials.

Results: Maternal mortality declined by 68% between 1969 and 1998. However, there was a recent upturn in maternal mortality, with the rate increasing from 9.9 deaths/100,000 live births in 1999 to 17.4 in 2018. The large racial disparity persisted over time; Black women in 2018 had a 2.4 times higher risk of maternal mortality than White women. During 2013-2017, the rate varied from 7.0 for Chinese women to 42.0 for non-Hispanic Black women. Unmarried status, US-born status, lower education, and rural residence were associated with 50-114% higher maternal mortality risks. Mothers in the most-deprived areas had a 120% higher risk of mortality than those in the most-affluent areas; both absolute and relative disparities in mortality by deprivation level widened between 2002 and 2018. Hemorrhage, pregnancy-related hypertension, embolism, infection, and chronic conditions were the leading causes of maternal death, with 31% of the deaths attributable to indirect obstetric causes.

Conclusions and global health implications: Despite the steep long-term decline in US maternal mortality, substantial racial/ethnic, socioeconomic, and rural-urban disparities remain. Monitoring disparities according to underlying social determinants is key to reducing maternal mortality as they give rise to inequalities in social conditions and health-risk factors that lead to maternal morbidity and mortality.

As Africa prepares to overcome the difficult challenges of COVID-19 vaccination roll-outs, a number of factors, including equitable access, effective and efficient sufficient supply chains, a scope of established determinants will need to be considered in order to enhance vaccine acceptability and uptake. In this commentary, we present six major determinants of vaccine acceptability and uptake in Africa. We summarize these determinants with the acronym VAMRIS: V= Vaccine hesitancy; A= Attitude and uptake by health care workers; M= Misinformation; R= Religion; I= Immunization roll out plans; S= Social influences and enabling environment. Understanding determinants of COVID-19 vaccine acceptability will guide public health officials make informed decisions. As the Vaccine becomes progressively available, strategies for efficient roll-out to achieve massive uptake by the targeted population will depend on a number of factors. These include: community engagement efforts; types of health promotion activities and/or messages; community sensitization to dispel myths and misconceptions; endorsements and buy-ins from local champions, celebrities, authorities; logistic considerations; and incentives to health counsellors/workers to create demand.

Background: Over the last decade, Uganda has registered a significant improvement in the utilization of maternity care services. Unfortunately, this has not resulted in a significant and commensurate improvement in the maternal and child health (MCH) indicators. More than half of all the stillbirths (54 per 1,000 deliveries) occur in the peripartum period. Understanding the predictors of preventable stillbirths (SB) will inform the formulation of strategies to reduce this preventable loss of newborns in the intrapartum period. The objective of this study was to determine the predictors of intrapartum stillbirth among women delivering at Mulago National Referral and Teaching Hospital in Central Uganda.

Methods: This was an unmatched case-control study conducted at Mulago Hospital from October 29, 2018 to October 30, 2019. A total of 474 women were included in the analysis: 158 as cases with an intrapartum stillbirth and 316 as controls without an intrapartum stillbirth. Bivariable and multivariable logistic regression was done to determine the predictors of intrapartum stillbirth.

Results: The predictors of intrapartum stillbirth were history of being referred from lower health units to Mulago hospital (aOR 2.5, 95% CI: 1.5-4.5); maternal age 35 years or more (aOR 2.9, 95% CI: 1.01- 8.4); antepartum hemorrhage (aOR 8.5, 95% CI: 2.4-30.7); malpresentation (aOR 6.29; 95% CI: 2.39-16.1); prolonged/obstructed labor (aOR 6.2; 95% CI: 2.39-16.1); and cesarean delivery (aOR 7.6; 95% CI: 3.2-13.7).

Conclusion and global health implications: Referral to hospital, maternal age 35 years and above, obstetric complication during labor, and cesarean delivery were predictors of intrapartum stillbirth in women delivering at Mulago hospital. Timely referral and improving access to quality intrapartum obstetric care have the potential to reduce the incidence of intrapartum SB in our community.

Currently, there is an insufficient representation of racial/ethnic minority groups in the maternal and child health (MCH) workforce. A student-run outreach organization, the Global Alliance for Maternal and Child Health (GLAM), seeks to address this disparity by increasing the representation of racial/ethnic minority groups in MCH workforce. Founded by students at Texas Southern University in Houston, Texas, United States, GLAM, seeks to establish productive alliances and create programs that would help improve the well-being of mothers, infants, and children locally, nationally, and internationally by engaging an active cadre of students passionate about MCH. Through community outreach and global engagement using evidence-based strategies, GLAM is committed to the elimination of health disparities plaguing the MCH population.

Background: Continuum-of-care (CoC) throughout pregnancy, childbirth and the postnatal period is essential for the health and survival of mothers and their babies. This study assesses the utilization, predictors, and gaps in the continuum of maternal and newborn health (MNH) services in Eastern Ghana.

Methods: A retrospective cross-sectional survey was conducted to assess utilization of MNH services and their determinants in the East Akim Municipality of Ghana. Three hundred and ten (310) mothers aged 15-49 years were sampled from 4 communities (3 rural; 1 urban) in the municipality using stratified sampling methodology. Logistic regression models were fitted to determine the likelihood of utilizing skilled birth attendance (SBA) and postnatal care (PNC) after antenatal care (ANC).

Results: Sixty-six percent (66%) of mothers surveyed received the full complement of MNH services (ANC, SBA, PNC) for their most-recent birth. While 98% of mothers made at least one ANC visit with 83.5% receiving the World Health Organization-recommended 4+ visits, only 74% accessed SBA indicating a 24% attrition in the CoC from ANC to SBA, and an 8% attrition from SBA to PNC. About 86% of mothers accessed PNC within 42 days postpartum. Distance to health facility, urban residence, and exposure to media information were strong predictors of the full complement of MNH continuum-of-care utilization.

Conclusion and global health implications: The study found a remarkable utilization of MNH services in East Akim with significant attrition along the continuum-of-care. Efforts to enhance utilization of the MNH continuum-of-care should focus on increasing access to SBA in particular, through equitable distribution of MNH services in hard-to-reach areas and innovative communication approaches for reducing attrition at each level of the continuum-of-care. Evidence from this study can inform strategies for achieving universal access and utilization of the MNH continuum-of-care towards global goals and improved health outcomes in Ghana and other countries.

Background: Although much is known about the rapidly spreading COVID-19 disease, a lot of knowledge is still evolving. The knowledge, attitude and practice (KAP) of healthcare workers (HCWs) towards COVID-19 remain key in protecting themselves and in fighting the "war" against the disease. This study assessed the KAP of HCWs in Kano, northern Nigeria.

Methodology: A cross-section of different cadre of healthcare workers was recruited online via google forms. Using a link, the participants completed an adapted from a similar study, pre-tested questionnaire on KAP regarding COVID-19. Predictors of KAP were assessed using logistic regression modelling.

Results: Among the 651 HCWs invited to participate, 233 respondents responded giving a response rate of 35.8%. Of these, 195 (83.7%) had good knowledge, 183 (78.9%) had a positive attitude and 180 (77.6%) had good practice towards prevention of COVID-19. The odds of having good knowledge were significantly lower among Community Health Officers/Community Health Extension workers (aOR=0.2, 95% CI: 0.1-0.6;p<0.001) and other health workers compared to doctors. Positive attitude was predicted by good knowledge (aOR=4.8, 95% CI:1.7-010.2;p=0.003), being in the fifth decade of life (aOR=5.5, 95% CI: 1.1-29.3, p=0.04), female gender (aOR=3.0, 95% CI: 1.1-8.3;p=0.04), Christian faith (aOR=7.0, 95% CI: 1.3-40.4; p=0.03), and having a bachelors' or medical degree (aOR=4.6, 95% CI: 1.3-16.5).The only predictor of good practice was good knowledge on COVID-19 (aOR=7.8, 95% CI 2.8-12.4;p<0.001).

Conclusion and global health implications: Majority of the HCWs at the study site have good knowledge, attitude and practice regarding COVID-19. Continuous dissemination of information on prevention of spread of COVID-19 to all HCWs will strengthen the health workforce in the fight against it.

Objectives: Socioeconomic disparities in life expectancy in the United States (US) are marked and have widened over time. However, there is limited research using individual-level socioeconomic variables as such information is generally lacking or unreliable in vital records used for life table construction. Using longitudinal cohort data, we computed life expectancy for US adults by social determinants such as education, income/poverty level, occupation, and housing tenure.

Methods: We analyzed the 1997-2014 National Health Interview Survey prospectively linked to mortality records in the National Death Index (N=1,146,271). Standard life table methodologies were used to compute life expectancy and other life table functions at various ages according to socioeconomic variables stratified by sex and race/ethnicity.

Results: Adults with at least a Master's degree had 14.7 years higher life expectancy at age 18 than those with less than a high school education and 8.3 years higher life expectancy than those with a high school education. Poverty was inversely related to life expectancy. Individuals living in poverty had 10.5 years lower life expectancy at age 18 than those with incomes ≥400% of the poverty threshold. Laborers and those employed in craft and repair occupations had, respectively, 10.9 years and 8.6 years lower life expectancy at age 18 than those with professional and managerial occupations. Male and female renters had, respectively, 4.0 years and 4.6 years lower life expectancy at age 18 than homeowners. Women in the most advantaged socioeconomic group outlived men in the most disadvantaged group by 23.5 years at age 18.

Conclusions and global health implications: Marked socioeconomic gradients in US life expectancy were found across all sex and racial/ethnic groups. Adults with lower education, higher poverty levels, in manual occupations, and with rental housing had substantially lower life expectancy compared to their counterparts with higher socioeconomic position.

Strengthening Our Commitment to Racial and Social Justice to Improve Public Health The fourth annual summer research summit organized by the Center of Excellence (COE) in Health Equity, Training and Research, Baylor College of Medicine (BCM) was held on May 20, 2021. The theme of this year's summit was 'Strengthening Our Commitment to Racial and Social Justice to Improve Public Health.' Given the ongoing pandemic, the summit was conducted virtually through digital platforms. This program was intended for both BCM and external audiences interested in advancing health equity, diversity and inclusion in healthcare among healthcare providers and trainees, biomedical scientists, social workers, nurses, individuals involved in talent acquisition and development such as hiring managers (HR professionals), supervisors, college and hospital affiliate leadership and administrators, as well as diversity and inclusion excellence practitioners. We had attendees from all regions of the United States, India, Pakistan and the Demographic Republic of the Congo. The content in this Book of Abstracts encapsulates a summary of the research efforts by the BCM COE scholars (which includes post-baccalaureate students, medical students, clinical fellows and junior faculty from BCM) as well as the external summit participants. The range of topics in this year's summit was quite diverse encompassing disparities in relation to maternal and child health (MCH), immigrant heath, cancers, vaccination uptakes and COVID-19 infections. Various solutions were ardently presented to address these disparities including community engagement and partnerships, improvement in health literacy and development of novel technologies and therapeutics. With this summit, BCM continues to build on its long history of educational outreach initiatives to promote diversity in medicine by focusing on programs aimed at increasing the number of diverse and highly qualified medical professionals ready to introduce effective and innovative approaches to reduce or eliminate health disparities. These programs will improve information resources, clinical education, curricula, research and cultural competence as they relate to minority health issues and social determinants of health. The summit received very positive response in terms of zealous participation and outstanding evaluations; and overall, it was a great success. Copyright © 2021 Dongarwar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Background: Maternal and child health (MCH) clinics represent an integrated approach for providing healthcare to pregnant women and children 0-59 months of age. Although MCH clinics are also charged with monitoring child development, which involves tracking developmental milestones, it is unclear how these services are provided or perceived within the clinic. This study aimed to describe self-reported knowledge, perceptions, and practice of developmental monitoring in selected MCH clinics in western Kenya.

Methods: This cross-sectional descriptive study was conducted within six clinics. We administered a descriptive survey to measure caregiver and healthcare staff attitudes towards and awareness of developmental monitoring; we also reviewed MCH booklets to identify services received at the clinic. Data collection occurred over a period of one day at each of the six clinic sites. The data were analyzed using descriptive statistics.

Results: During the study period, 78 caregiver-child pairs presented to the clinics and had their MCH booklets reviewed. The median child age was three months (interquartile range [IQR]: 1-8 months). Most caregivers were aware of weight monitoring and immunization services; however, when asked specifically about developmental monitoring, only 2.6% of caregivers were aware this service was available at the clinics. Nearly 80% of caregivers reported that they would be very interested in developmental monitoring services. Thirty-three MCH healthcare staff were interviewed about services provided and goals of clinical care. Fewer healthcare staff (60.6%) identified their roles in developmental monitoring compared to their roles in growth (90.9%) and nutritional monitoring (84.8%). Developmental milestones had not been recorded in any of the 78 MCH booklets. However, 78.1% of healthcare staff indicated support for developmental screening.

Conclusion and global health implications: While developmental monitoring was valued by healthcare providers, it was not consistently performed at the six clinics in our study. We recommend further work to raise awareness about developmental monitoring and to measure the implications of increased caregiver knowledge and perceptions on developmental monitoring practice.