Frontiers in global women's health最新文献

Background: Increasing evidence links Polycystic ovary syndrome (PCOS) with adverse mental health outcomes, particularly depression and anxiety. These challenges may be amplified in low- and middle-income countries (LMICs) due to limited awareness, restricted healthcare access, and sociocultural stigma.

Objectives: To estimate the pooled prevalence of depression and anxiety among women of reproductive age with PCOS in LMICs and to examine clinical factors associated with these outcomes.

Methods: Following PRISMA guidelines (PROSPERO CRD420251069068), we systematically searched PubMed, Scopus, Web of Science, and CINAHL for studies published between January 2005 and June 2025. Eligible studies included observational research reporting the prevalence of depression and/or anxiety in women aged 15-49 years with clinically diagnosed PCOS and assessed using validated tools. Data were pooled using a random-effects model. Subgroup and meta-regression analyses explored variations by study design, age, body mass index (BMI), country, and assessment tools. Heterogeneity was quantified with the I² statistic, and publication bias was assessed using funnel plots and Egger's test. Study quality was evaluated with the Joanna Briggs Institute checklist.

Results: From 3,860 records, 40 studies met the inclusion criteria. All were rated low risk of bias (quality scores 75%-100%). The pooled prevalence of depression was 51% (95% CI: 43-59; I² = 97%), and anxiety was 45% (95% CI: 36-54; I² = 96%). The highest prevalence was observed among women aged 20-25 years (depression: 63%; anxiety: 56%) and in studies conducted in India (depression: 55%; anxiety: 51%). Clinical features such as infertility, hirsutism, and acne showed non-significant associations with depression or anxiety. No publication bias was detected.

Conclusion: Depression and anxiety are highly prevalent among women with PCOS in LMICs, affecting nearly half of this population. These findings underscore the urgent need for integrating routine mental health screening and culturally tailored interventions into PCOS management in resource-limited settings.

Systematic review registration: PROSPERO CRD420251069068.

Background: Maternal mortality in Ghana remains high at 263 deaths per 100,000 live births, with the Volta Region showing particularly concerning figures; 37.2% of women give birth without a skilled provider. Many rely on Traditional Birth Attendants (TBAs), whose role remains unofficial and unregulated. Causes of maternal death include hemorrhage, sepsis, hypertensive disorders, and unsafe abortions, compounded by limited access to emergency care and mistrust in clinical settings. To create a dialogue between the stakeholders to reduce maternal mortality, we want to screen the documentary Among Us Women. The documentary is set in rural Ethiopia, explores the choice between home and hospital birth. A first screening in Ghana revealed similar challenges-highlighting women's trust in TBAs and dissatisfaction with clinical care. The film successfully opened dialogue between midwives and TBAs, showing potential for collaboration.

Hypothesis: We propose that film screenings followed by inclusive dialogue will improve mutual respect and cooperation between TBAs and clinical staff in rural areas, leading to earlier interventions and reduced maternal deaths within one year.

Method: A shortened, Ewe-dubbed version of the film will be shown in 60 randomly selected communities in the Volta Region, reaching 500+ stakeholders. Roundtables will follow each screening, supported by trained facilitators. Discussions and follow-up evaluations will inform a "community needs catalog" and provide data for potential national scale-up.

Discussion: The main question is if setting up an efficient dialogue as a result of a film screening in other communities is replicable. To set up a reliable study, test screenings of the film upfront will refine the approach, addressing language, group size, and ethical concerns. Using relatable storytelling and dialogue, the project fosters empathy, shared responsibility, and cultural sensitivity; laying the groundwork for long-term improvements in maternal health.

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality, particularly in low- and- middle-income countries. The E-MOTIVE trial demonstrated a 60% reduction in severe PPH and related complications with the E-MOTIVE intervention compared to usual care. This nested observational study explored clinical care practices between the time of vaginal birth and the removal of the obstetric drape. Specifically, we assessed the frequency of postpartum maternal assessments, including blood pressure, pulse, uterine tone, vaginal blood flow, and cumulative blood loss assessment-unique to the intervention. We also evaluated diagnostic methods, and blood loss thresholds used for PPH, and how these practices may have contributed to differences in PPH diagnosis and outcomes between E-MOTIVE intervention hospitals and usual care hospitals.

Methods: This prospective observational study, nested within the E-MOTIVE trial, involved passive, direct observations of healthcare workers providing postpartum care to women and managing PPH across 78 hospitals in Nigeria, Kenya, Tanzania, and South Africa. We conducted a descriptive analysis of the frequency and timing of postpartum maternal assessments, diagnostic methods and blood loss thresholds used to diagnose PPH, comparing clinical practices between E-MOTIVE care and usual care.

Results: Between June and December 2022, the study included 2,578 women at E-MOTIVE care hospitals and 2,834 at usual care hospitals. At E-MOTIVE hospitals, 88% (2,272/2,578) of women received at least one postpartum maternal assessment, 71% (1,825/2,578) at least two, 57% (1,479/2,578) at least three, and 48% (1,234/2,578) four, with assessments conducted earlier and more frequently than at usual care hospitals. Objective blood loss quantification improved diagnosis, with the most common method and blood loss threshold at E-MOTIVE hospitals being ≥300 mL plus at least one abnormal clinical sign, used in 47% (140/295) of PPHs. Postpartum haemorrhage was diagnosed earlier and more frequently at E-MOTIVE hospitals: 76% (223/295) within 30 min, 97% (287/295) within 60 min, and 100% 295/295) within 90 min (median: 17 min; IQR 11-30), compared to 54% (119/219), 79% (173/219), 96% (210/219) respectively, and 100% within 134 min in usual care (median: 26 min; IQR 13-56).

Discussion: Frequent and timely postpartum maternal assessments, along with objective blood loss thresholds of with at least one abnormal clinical sign and ≥500 mL may enhance early PPH diagnosis. The first 90 min postpartum has been identified as a critical window for early diagnosis, termed the "Golden 90 min for PPH diagnosis." Incorporating these insights into clinical training and guidelines may support improved maternal outcomes related to PPH.

Bladder prolapse, also known as cystocoele, is the most common form of pelvic organ prolapse (POP), significantly affecting women's physical, sexual, and psychosocial health, particularly in low- and middle-income countries (LMICs). Despite its widespread prevalence and disabling consequences, bladder prolapse remains under-recognised and inadequately addressed in global health strategies. Prevalence estimates vary widely across regions, from 3%-64.6%, influenced by diagnostic methods and cultural reporting biases. Common risk factors include high parity, early childbirth, prolonged labour, poor postpartum care, malnutrition, obesity, and ageing. Clinical diagnosis often relies on simplified grading systems in resource-limited settings. Conservative treatments like pelvic floor muscle training and pessary use are underutilised due to lack of staff training, and cultural barriers. Surgical management, primarily native tissue anterior repair, is often inaccessible or inconsistently performed. Key challenges include sociocultural stigma, lack of epidemiological data, inadequate provider training, and limited access to specialised care. Bladder prolapse remains a hidden burden in LMICs due to structural, sociocultural, and health system gaps. Addressing it requires integrating prolapse screening into routine maternal care, expanding conservative management, training healthcare providers, reducing stigma, and investing in locally relevant research and national guidelines. Here, we argue for evidence-based practices in LMICs to improve our understanding through epidemiology, risk factors, clinical presentation, diagnostic practices, treatment approaches, and sociocultural barriers. Elevating bladder prolapse as a public health and gender equity issue can improve health outcomes and quality of life for millions of women in Africa, Asia, and the Middle East.

Older women are increasingly experiencing the trauma of homelessness. The precipitants and concomitants of homelessness are also traumas, are multifold, and reflect women's intersectional identities and experiences over their life course. Older women with experiences of homelessness and other traumas require pathways to healing, a life they experience as full and valued. Housing is a necessary and non-negotiable ingredient in addressing the well-being of older women with experiences of homelessness and other traumas. Research indicates that housing alone is not sufficient to achieve healing from homelessness and other traumas; rather, the combination of Permanent Supportive Housing (PSH) and Trauma-Informed Care (TIC) is essential and foundational. Promising approaches to support healing are examined and proposed as future directions to complement the foundation of PSH and TIC. Multiple structural inequities underlying older women's homelessness must also be addressed through policy action. The need for a fundamental shift in how we, as a society, regard and implement public assistance to combat homelessness is discussed in the context of the "Duty-to-Assist" framework.

Objective: This study aimed to evaluate associations of hemoglobin trajectories during pregnancy and time spent within clinically recommended hemoglobin ranges (Hb-TITR) with adverse pregnancy outcomes.

Methods: A retrospective cohort study was conducted using pregnancy records from Shanghai First Maternity and Infant Hospital (from January 2022 to December 2024), involving 7,653 pregnant women with complete serial hemoglobin measurements. Hemoglobin trajectories were categorized as stable, descending, or ascending. Hb-TITR was calculated based on clinically recommended hemoglobin ranges throughout pregnancy. Logistic regression analyses were performed to determine associations with adverse outcomes, adjusting for maternal age, pre-pregnancy BMI, and gestational age.

Results: Among participants, 85.2% exhibited stable hemoglobin trajectories, 10.4% descending, and 4.4% ascending. Descending trajectory was significantly associated with increased risk of composite adverse outcomes [adjusted odds ratio (OR) 3.92; 95% CI, 3.30-4.66] compared with the stable group. Conversely, ascending trajectory showed no significant risk elevation (OR 1.13; 95% CI, 0.83-1.51). Reduced Hb-TITR (<80%) significantly increased the odds of adverse outcomes (OR 1.35; 95% CI, 1.10-1.65), whereas longer Hb-TITR was protective. Descending trajectories notably increased risks of PROM, cesarean section, postpartum hemorrhage, macrosomia, SGA, and LGA infants.

Conclusion: Descending hemoglobin trajectories and reduced time spent within recommended hemoglobin ranges during pregnancy were significantly associated with increased risks of adverse maternal and neonatal outcomes, highlighting the importance of monitoring hemoglobin dynamics throughout pregnancy.

Background: The COVID-19 pandemic posed significant challenges to healthcare systems worldwide. Maintaining essential health services, including maternal and child health (MCH), while addressing the pandemic is an enormous task. This study aimed to assess the impact of the COVID-19 pandemic on the utilization of MCH services in India's public primary care. It extends prior work by applying nationwide HMIS data within an interrupted time-series framework with seasonal and ARMA adjustments to estimate counterfactual trends, thereby providing national-level insights into both immediate and evolving disruptions.

Methods: A retrospective analysis using Health Management Information System (HMIS) data examined 12 indicators of service utilization, covering maternal health, child health, deliveries, and newborn care. Interrupted time-series analysis compared pre-pandemic (April 2017-March 2020) and pandemic (March 2020-May 2021) was performed using Ordinary Least Squares (OLS) and Generalized Least Squares (GLS) regression models, adjusting for seasonality and autocorrelation with ARMA terms.

Results: Antenatal care (ANC) registrations decreased by 346,420 cases (-12.8%, p = 0.026) following the onset of the pandemic, with no significant recovery in the subsequent months. Tetanus toxoid vaccinations also declined markedly, with Td1 and Td2 falling by 276,152 (-13.9%, p = 0.029) and 306,607 (-16.9%, p = 0.010) cases, respectively, and remaining consistently below expected levels. Institutional deliveries dropped by 272,441 (-13.7%, p = 0.067), while home deliveries attended by skilled birth attendants decreased by 5,054 cases (-22.8%, p = 0.014). Child health services, including referrals to Special Newborn Care Units (SNCUs) and inborn admissions, were also lower than anticipated (-20.4% and -19.2%, respectively), though these changes were not statistically significant. Among all indicators, the largest and most persistent disruptions occurred in obstetric complications (maximum decline during Winter 2020-21) and SNCU inborn admissions (also at their lowest in Winter 2020-21). These two services showed minimal signs of recovery throughout the study period, underscoring the particular vulnerability of emergency obstetric and neonatal care during public health crises.

Conclusions: The COVID-19 pandemic caused declines in MCH service utilization, with varying recovery across indicators. While services like antenatal care and vaccinations showed some stabilization over time, child health admissions and obstetric complications remained below pre-pandemic trends. Strengthening healthcare systems to maintain essential services and support recovery during and after public health emergencies is critical.

Introduction: Limited studies have assessed the accuracy of mid-upper arm circumference (MUAC) in diagnosing nutritional status among pregnant women in Sub-Saharan Africa, and none in Rwanda. This study aimed to evaluate the effectiveness of MUAC in detecting obesity among pregnant women at Kacyiru Hospital in Kigali, Rwanda.

Methods: This cross-sectional study was conducted at Kacyiru Hospital, a district hospital in Kigali, Rwanda. Standard procedures were used to measure MUAC, weight, and height, from which body mass index (BMI) was calculated. Receiver operating characteristic (ROC) curves were created to determine cutoff points using Youden's index (YI).

Results: A total of 689 women were enrolled. The median (interquartile range) age and gravidity were 29.0 (26.0-33.0) years and 2 (1-3), respectively. Among the 592 women (85.9%) with gestational ages of ≥20.0 weeks, 5 (0.7%) were underweight and 195 (28.3%) were obese. There was a significant correlation between BMI and MUAC (r = 0.78) across all women and within the early (r = 0.774) and late pregnancy subgroups. The optimal MUAC cutoff for detecting obesity (BMI ≥ 30.0 kg/m²) was ≥27.5 cm in both early and late pregnancies (YI = 0.58, sensitivity = 0.91, specificity = 0.67), with a high predictive value [area under the receiver operating characteristic curve (AUROCC) = 0.88, 95% confidence interval (CI) = 0.85-0.90]. In early pregnancy, the best MUAC cutoff was ≥29.5 cm (YI = 0.73, sensitivity = 0.92, specificity = 0.80), with a high predictive value (AUROCC = 0.87, 95% CI = 0.77-0.97). In late pregnancy, the best MUAC cutoff was ≥27.5 cm (YI = 0.62, sensitivity = 0.92, specificity = 0.71), with a high predictive value (AUROCC = 0.89, 95% CI = 0.87-0.92).

Conclusion: MUAC is a reliable indicator for detecting obesity in pregnant women. Further research with larger sample sizes and follow-up studies is needed to assess MUAC's ability to detect underweight status and related adverse pregnancy effects.

Background: Maternal health remains a critical public health priority, particularly in low- and middle-income countries where maternal mortality rates are alarmingly high. Early antenatal care (ANC) initiation within the first trimester is essential for identifying and managing potential health risks for both mothers and their babies. Despite global efforts to promote early ANC, significant disparities persist, especially in Nigeria. This study investigates the sociodemographic determinants and regional disparities influencing the timing of ANC initiation among Nigerian women.

Methods: This study utilized data from the 2018 Nigeria Demographic and Health Survey (NDHS), analyzing a sample of 16,542 women aged 15-49 who had given birth within five years of the survey. A multivariable multilevel logistic regression model was employed to assess the impact of individual and community-level factors on early ANC initiation. The model accounted for regional clustering to identify the most significant predictors of first-trimester ANC contact.

Results: The analysis revealed that only 24.0% (n = 3,970) of Nigerian women-initiated ANC in the first trimester, with substantial regional disparities. The South West region had the highest prevalence (34.5%, n = 1,045), while the North West region had the lowest (12.5%, n = 609). Multivariable analysis showed that women with higher education were nearly twice as likely to initiate ANC early (AOR = 1.98, 95% CI: 1.65-2.37). Muslim women had lower odds of early ANC initiation than Catholics (AOR = 0.64, 95% CI: 0.47-0.87). Wealthier women had a significantly higher likelihood of early ANC, with the richest women being nearly three times more likely than the poorest (AOR = 2.88, 95% CI: 2.49-3.33). The final multilevel model showed a reduced intraclass correlation coefficient (ICC) of 2.6%, indicating that regional variation in ANC initiation.

Conclusion: The findings highlight significant sociodemographic and regional disparities in the timing of ANC initiation among Nigerian women. To improve early ANC uptake, targeted interventions that address both individual barriers, such as education and economic status, and broader regional disparities are essential.