Frontiers in global women's health最新文献

Background: Climate change significantly affects Uganda's economy and human well-being, with disproportionate impacts on the sexual and reproductive health (SRH) services of women and girls. However, SRH remains largely absent from climate change policy frameworks. This study examines the extent to which SRH is integrated into Uganda's climate policy frameworks and explores stakeholder perceptions of the impacts of climate change on SRH to provide insights for more inclusive and integrated policies.

Methods: The study used a mixed-methods approach, combining policy document analysis with primary qualitative data. Key documents reviewed included climate change and health policies, strategies, plans, and national medium- and long-term development frameworks. Forty purposively selected key informants and 24 focus group discussions with 321 participants in Buikwe District were conducted. Qualitative data were analyzed using content analysis to identify key themes and gaps.

Results: Uganda's climate policy frameworks acknowledge the gender-differentiated impacts of climate change and highlight the importance of SRH services but fall short of outlining concrete actions to address SRH within climate adaptation and mitigation strategies. Key informants highlighted limited stakeholder awareness and weak institutional coordination as major barriers to integrating SRH into climate action. Community respondents noted that climate extremes degrade critical infrastructure, disrupt access to SRH services and increase vulnerabilities, including a heightened risk of gender-based violence.

Conclusions: The impact of the climate crisis on SRH is increasingly evident, particularly for women and girls, yet Uganda's key climate policies still exhibit lack of concrete actions to address SRH vulnerabilities. Prioritizing SRH within climate adaptation efforts, especially through resilient health systems and livelihood support such as climate resilient agricultural training and vocational programs for women and girls is key to advancing both gender and health equity, and climate resilience in Uganda. This should be supported by robust gender disaggregated data, stronger institutional coordination, and inclusive, community-led planning.

Introduction: Maternal sepsis is a leading cause of maternal mortality. In Australia, it is the third most common cause of maternal death despite a low overall maternal death rate (5.8 per 100,000 births). The objective of this study was to examine risk factors for maternal pyrexia, infection and sepsis, adherence to WHO maternal antibiotic prophylaxis guidelines and resistance patterns in women with Group B Streptococcus (GBS).

Methods: We conducted a retrospective observational cohort study using routinely collected data from four hospitals providing maternity care in New South Wales, Australia, including pathology data from one hospital. Women who gave birth between January 1, 2018, and December 31, 2020, were included. Definitions for pyrexia, infection, and sepsis were based on medical notes and the obstetrically modified Sequential Organ Failure Assessment criteria. We used multivariable logistic regression to identify risk factors and descriptive statistics to evaluate antibiotic prophylaxis adherence and resistance.

Results: Out of 23,016 women, 2,650 (11.5%) experienced pyrexia, infection, or sepsis. Women with pyrexia, infection, or sepsis were more likely to report a history of substance use and less likely to receive influenza vaccination. Hospital-based (non-continuity) midwifery care, nulliparity, and emergency Caesarean section and instrumental vaginal birth were associated with increased risk of pyrexia, infection, or sepsis. Documented adherence to antibiotic prophylaxis guidelines was suboptimal, with 35% of Caesarean sections and 29% of severe perineal tear cases documented as receiving antibiotics. In the subset of women with available pathology data, GBS screening was performed in 72.6% of cases, with 19.4% testing positive. Resistance to erythromycin (33.4%) and clindamycin (30.9%) was high, though no resistance to penicillin or ampicillin was observed.

Conclusion: Demographic and labour/birth factors conveying an increased risk of pyrexia, infection or sepsis were broadly in line with previous studies. Adherence to WHO prophylaxis guidelines was poorly documented and increased rates of antibiotic resistance to erythromycin and clindamycin were observed. Ongoing monitoring of resistance patterns and improving guideline adherence is important to optimise care.

Introduction: Providing care of preterm infants in the NICU is a significant source of psychological and emotional stress for both infants and parents. The purpose of the study was to investigate the relationship between gestational age (GA) and maternal stress levels in the neonatal intensive care unit (NICU) setting and to identify additional demographic and clinical factors that may contribute to or exacerbate maternal stress during the infant's NICU hospitalization.

Materials and methods: This observational, cross-sectional prospective study included 247 mothers of preterm infants. Maternal stress and worry were assessed using the PSS: NICU questionnaires. PSS: NICU items were organized into three subscales: Sights and Sounds (S1), Infant Appearance and Behavior (S2), and Parental Role Alteration (S3).

Results: Moderate/high NICU-related stress among mothers of preterm infants was more common when infants were born before 32 weeks (p = 0.031), in cases of neonatal seizures (p = 0.027), sepsis (p = 0.032), and invasive ventilation (p = 0.027). Logistic regression showed that gestational age under 32 weeks and neonatal seizures significantly increased the risk of moderate/high maternal stress (OR = 2.90, 95% CI: 1.26-6.68, p = 0.012; OR = 9.83, 95% CI: 1.19-80.80, p = 0.033, respectively).

Conclusion: NICU-related stress among mothers of preterm infants significantly associated with gestational age below 32 weeks and exacerbated by neonatal seizures. These factors can help identify mothers at high risk who may need focused support in the NICU, considering both the infant's condition and the mother's psychological well-being.

Introduction: Disparate maternal health outcomes among non-Hispanic Black women stem from intricate, interrelated factors shaped by clinical, social, and structural influences. Traditional approaches often fall short in addressing these complexities, necessitating a shift toward systems thinking and community-driven solutions.

Methods and materials: This paper describes the lessons learned from the implementation of system dynamics group model building (SD GMB) workshops grounded in community-based participatory research (CBPR) principles in two separate projects focused on maternal health among Black women. We recruited 31 diverse stakeholders, including individuals with lived experience, and applied trauma-informed facilitation, wraparound support, and structured systems modeling activities. A descriptive analysis of workshop data was performed to accompany the identified lessons learned.

Results: Evaluation data from surveys and open-ended responses indicated high stakeholder satisfaction, increased capacity to apply systems thinking, and a shift from skepticism to agency. Stakeholders valued the inclusive design, reported meaningful learning, and expressed interest in future engagement. The workshops fostered transformative learning and generated actionable systems insights rooted in community experience.

Discussion: This work demonstrates how SD GMB, when integrated with CBPR, can build trust, elevate marginalized voices, and produce models that reflect structural realities. Future directions include quantifying the models, hosting learning labs to test interventions, and developing an open-access dashboard to simulate policy scenarios. These findings contribute to ongoing efforts to design more engaging, community-informed approaches to maternal health research and practice.

Background: Spontaneous abortion in the first trimester is a common adverse pregnancy outcome with significant implications for maternal health and public health practice. The description of associations with modifiable factors, including preconception care, can aid in planning strategies to improve pregnancy outcomes.

Methods: A retrospective analysis was conducted using data from 1,526 women, divided into two groups based on pregnancy outcomes: spontaneous abortion in the first trimester and live births. Binary and multivariate logistic regression analyses were performed to identify associations between factors (including preconception care) and the risk of spontaneous abortion in the first trimester.

Results: Age >35 years [[OR] = 2.02, 95% [CI] = 1.49-2.75], obesity [[OR] = 1.81, 95% [CI] = 1.12-2.91], and a history of spontaneous abortion [[OR] = 1.57, 95% [CI] = 1.01-2.43] were associated with higher odds of spontaneous abortion in the first trimester, whereas preconception care was associated with lower odds of spontaneous abortion in the first trimester [[OR] = 0.58, 95% [CI] = 0.45-0.75].

Conclusion: The findings may help clinicians stratify pregnant women who require additional monitoring and pre-pregnancy interventions. From a public health perspective, integrating preconception care into routine health services can enhance maternal and neonatal outcomes, reduce healthcare costs, and improve health equity by targeting vulnerable populations. However, the results should be interpreted as associations, and prospective studies are needed to assess the potential effects of preconception care on spontaneous abortion in the first trimester.

Background: Despite awareness of the benefits of facility-based deliveries, many women in Sub-Saharan Africa (SSA) still deliver outside healthcare settings, often without skilled birth attendants. Access to maternal healthcare encompasses affordability, physical accessibility, and acceptability.

Objective: This study aimed to explore the factors influencing maternal healthcare utilisation in South-South Nigeria, with a focus on identifying the "silences" surrounding women's access to care, and understanding the facilitators, barriers, and suggested improvements.

Methods: An exploratory qualitative design was adopted to investigate women's perceptions of the hidden factors influencing maternal healthcare utilisation. Data were collected from women of reproductive age (20-49 years) in one of the tertiary health hospitals in Nigeria. Eight semi-structured interviews were performed and transcribed. Data were analysed thematically using the Silences Framework.

Results: Three themes emerged: facilitators, barriers, and suggestions. Facilitators included women's recognition of skilled providers and the safety offered by emergency care. Despite dissatisfaction, many continued facility use due to trust in medical expertise. Barriers included negative staff attitudes, breaches of confidentiality, domestic violence, financial constraints, and systemic inefficiencies. Stigma further silenced discussion of sensitive issues, reinforcing under-utilisation. Some women turned to traditional birth attendants or private clinics, valuing compassion despite costs or risks. Suggestions centred on staff training in compassionate care, improved monitoring, better equipment, and stronger policies to uphold dignity and privacy.

Conclusion: The study emphasises the importance of addressing both systemic issues and interpersonal dynamics to improve maternal healthcare services. Women balance the perceived necessity of skilled care with negative experiences in formal facilities. While competence drives use, poor attitudes and systemic gaps reduce trust. Tackling both structural and interpersonal barriers is critical. Respectful, culturally sensitive care and stronger accountability are essential. These findings offer practical guidance for reforming maternal healthcare in Nigeria.

Introduction: Violence during childbirth, widely conceptualized as obstetric violence, is a precarious and pressing public health concern. These include brutal acts of physical violence, humiliation, forced medical care, as well as denial of treatment. The World Health Organization recognizes it as torturous acts that put the lives of many women at risk. This paper explores the dynamics of obstetric violence through the birth narratives of women in rural and urban Ghana.

Methods: Qualitative phenomenological research was conducted in eight rural and urban public health facilities in the Western and Ashanti Regions of Ghana. A total of 35 women (20 from urban areas and 15 from rural areas) who had given birth in the last 24 months at health facilities were purposively selected and interviewed between August 2021 and February 2022 using a semi-structured interview guide. Thematic data analysis was conducted using the NVivo qualitative data analysis software.

Results: The findings of the study revealed that there is a pervasive culture of violence surrounding childbirth, with women describing their childbirth memories with sadness and regret. Obstetric violence manifests in the form of physical violence, where sutures after episiotomies are performed without anesthesia, and women are beaten or slapped for their inability to push. In addition, women are grossly abandoned, usually during the second stage of labor. Sometimes, the entire care is halted when healthcare workers are provoked or feel that the women do not make enough efforts. In some cases, women are even left to deliver unassisted. Yelling, shouting, and verbal abuse of women were very dominant, and this particularly instilled fear in women, which prevented them from seeking help in critical situations, thereby increasing the risk of birth complications. Teenage mothers and HIV-positive women are predominantly discriminated against. Psychological trauma, mistrust in health institutions, and preference for unskilled birth attendants are the major consequences of obstetric violence.

Discussion: Overall, obstetric violence is a major setback in Ghana's effort to achieve the global target of reduced maternal mortality. There is a critical need for the Ghanaian government to develop interventions to tackle this challenge.

Background: Gastroesophageal reflux disease (GERD) is a common chronic digestive disorder characterized by the reflux of gastroduodenal contents into the esophagus, causing uncomfortable symptoms and potential tissue damage. It affects over 1 billion people worldwide, imposing substantial economic and health burdens. Notably, women of childbearing age face unique challenges due to hormonal fluctuations, pregnancy, and gender-specific social roles, yet systematic global analyses of GERD burden in this population remain scarce.

Methods: This study evaluated the global, regional, and national burden of GERD among WCBA from 1990 to 2021 and projected trends through 2050. Data were sourced from the 2021 Global Burden of Disease (GBD) study, including incidence, prevalence, years lived with disability (YLDs), and their age-standardized rates. Temporal trends were analyzed using joinpoint regression (average annual percentage change, AAPC), and future projections were generated via Bayesian age-period-cohort models. Associations with the Socio-demographic Index (SDI) were explored.

Results: Globally, the number of incident and prevalent GERD cases among WCBA increased by 64.09% and 66.44% from 1990 to 2021, reaching almost 99.1 million and 245.2 million in 2021, respectively. The AAPCs for age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized YLD rate (ASYR) were 0.24, 0.23, and 0.23, respectively. Regionally, South Asia had the highest absolute burden, while Tropical Latin America had the highest ASRs. Nationally, the Republic of India reported the highest incidence, the People's Republic of China the highest prevalence, Brazil the highest ASRs, and Norway the lowest. SDI was negatively correlated with GERD burden, with the most notable upward trends in middle SDI regions. By age, burden increased with age and peaked in the 25-29 years group. Joinpoint analysis showed accelerated growth post-2011. Projections to 2,050 forecast continued rises in incidence, prevalence, and ASRs.

Conclusion: The global GERD burden among WCBA is increasing, with marked regional, national, and SDI-related disparities. Physiological characteristics, lifestyle changes, and healthcare accessibility are key drivers. Targeted interventions such as strengthening primary care, lifestyle guidance, and region-specific policies are critical to mitigate risks. This study fills a research gap, providing evidence to inform global strategies for GERD prevention and management in this population.

Objectives: Urinary tract infections (UTIs) are common during pregnancy and can lead to adverse maternal and neonatal outcomes. Despite their significance, data on UTI prevalence and associated factors among pregnant women in Jordan remain limited. This study aimed to determine the prevalence of UTI and its associated factors among pregnant women in the northern Jordan.

Methods: We conducted a retrospective study using a convenience sampling method to review the records of pregnant women registered in the King Abdullah University Hospital database between January 2017 and January 2020.

Results: The study found that the prevalence of urinary tract infection (UTI) was 8.9%. Positive predictors included an interaction between chronological age and level of education (OR = 1.139; 95% CI: 1.040-1.248; p = 0.01), being in the third trimester of pregnancy (OR = 1.856; 95% CI: 1.052-3.273; p = 0.03), prolonged hospitalization (OR = 6.784; 95% CI: 4.075-11.292; p < 0.001), and anemia (OR = 3.662; 95% CI: 2.185-6.138; p < 0.001). Negative predictors included having a university degree (OR = 0.027; 95% CI: 0.002-0.344; p = 0.01) and being at the younger or older age during pregnancy (OR = 0.904; 95% CI: 0.839-0.974; p = 0.01).

Conclusion: The study concluded that the prevalence of UTI among singleton primigravida pregnant women was high, given the potential consequences of infection during pregnancy. Therefore, appropriate interventional measures should be implemented by the government and relevant stakeholders to reduce the prevalence of the infection and its associated complications.

Introduction: Pregnant women with neglected tropical diseases like snakebites are considered doubly neglected due to the intersection of multiple vulnerabilities, including compounded challenges stemming from socio-economic marginalization, inadequate healthcare access and most importantly, the lack of targeted public health interventions. Despite these concerns, there is a substantial gap in the literature regarding the presentation, management and outcomes of snakebites among pregnant women, especially in low-resource settings like northeastern Nigeria.

Methods: Consequently, a retrospective observational study was conducted at the Snakebite Treatment and Research Hospital (SBTRH) in Kaltungo, Northeastern Nigeria. Six years of patient folders were searched to identify patients of all ages that were pregnant at the time of presentation.

Results: Between 2019 and 2024, 77 pregnant women presented to SBTRH with snakebites. The median age among pregnant women presenting with snakebite was 26 [interquartile range (IQR) 20-30], and most had not completed any level of education (n = 70, 91%). On average, patients were not experiencing their first pregnancy (median gravidity 3, IQR 1-5), and the median gestational age at admission was 22 weeks (IQR 16-28 weeks). Most patients (n = 73, 95%) visited a traditional healer prior to arriving at SBTRH. All patients recovered from snakebite. Of the two women that gave birth prior to discharge, one underwent spontaneous vaginal delivery followed by neonatal death, and one underwent caesarean section, where both mother and child survived.

Discussion: These findings underscore the urgent need to recognize and respond to the unique vulnerabilities of pregnant women affected by snakebite in northeastern Nigeria. There is a need to integrate snakebite education during antenatal care period, engaging traditional healers in referral networks, developing pregnancy-specific clinical protocols and strengthening surveillance systems to capture maternal and foetal outcomes comprehensively.