Newborn Deaths Research Articles

Maternal near miss as a predictor of adverse perinatal outcomes: findings from a prospective cohort study in southwestern Uganda

BackgroundDespite efforts, Uganda has not met the World Health Organization target of < 12 newborn deaths per 1,000 live births. Severe maternal morbidity or ‘near miss’ is a major contributor to adverse perinatal outcomes, particularly in low-resource settings. However, the specific impact of maternal near miss on perinatal outcomes in Uganda remains insufficiently investigated. We examined the association between maternal near miss and adverse perinatal outcomes at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda.MethodsWe conducted a prospective cohort study among women admitted for delivery at MRRH’s maternity ward from April 2022 to August 2022. We included mothers at ≥ 28 weeks of gestation with singleton pregnancies, while intrauterine fetal death cases were excluded. For the near-miss group, we consecutively included mothers with any one of the following: antepartum hemorrhage with shock, uterine rupture, hypertensive disorders, coma, and cardiac arrest; those without these complications constituted the non-near-miss group. We followed the mothers until delivery, and their infants until seven days postpartum or death. Adverse perinatal outcomes considered were low birth weight (< 2,500 g), low Apgar score (< 7 at five minutes), intrapartum stillbirths, early neonatal death, or admission to neonatal intensive care unit. Multivariable log-binomial regression was used to determine predictors of adverse perinatal outcomes.ResultsWe enrolled 220 participants (55 maternal near misses and 165 non-near misses) with a mean age of 27 ± 5.8 years. Most of the near misses were pregnancies with hypertensive disorders (49%). Maternal near misses had a four-fold (adjusted risk ratio [aRR] = 4.02, 95% CI: 2.32–6.98) increased risk of adverse perinatal outcomes compared to non-near misses. Other predictors of adverse perinatal outcomes were primigravidity (aRR = 1.53, 95%CI: 1.01–2.31), and gestational age < 34 weeks (aRR = 1.81, 95%CI: 1.19–2.77).ConclusionMaternal near misses, primigravidity, and preterm pregnancies were independent predictors of adverse perinatal outcomes in this study. We recommend implementing maternal near-miss surveillance as an integral component of comprehensive perinatal care protocols, to improve perinatal outcomes in Uganda and similar low-resource settings. Targeted interventions, including specialized care for women with maternal near misses, particularly primigravidas and those with preterm pregnancies, could mitigate the burden of adverse perinatal outcomes.

Relative Adrenal Insufficiency in Full-Term and Preterm Neonates with Neonatal Sepsis

Background: Neonatal sepsis is the third most common cause of death in newborns and a significant issue for public health, particularly in developing nations. This study aimed to assess the hypothalamic-pituitary-adrenal axis (HPA) response in full-term and preterm newborns diagnosed with neonatal sepsis in the neonatal intensive care unit (NICU).&#x0D; Methods: This cross-section observational research was done on neonates who were categorized into two main groups Group I: Sepsis neonates who were further subdivided into two groups according to the gestational age into 30 full-term neonates with neonatal sepsis and 30 preterm neonates with neonatal sepsis. Group II: Included 30 healthy control neonates.&#x0D; Results: HSS score and C reactive protein (CRP) level were correlated with serum cortisol level at (9 am: r=-0.273, P&lt;0.035 and r=-0.447, P&lt;0.001), (9 pm: r=-0.447, P&lt;0.001and r=-0.477, P&lt;0.001) ACTH at (9 am: r=-0.314, P&lt;0.015 and r=-0.377, P&lt;0.003) and at (9 pm: r= -0.362, P&lt;0.005 and r=-0.448, P&lt;0.001) and cortisol level post ACTH stimulation (r=-0.345, 0.007 and r=-0.497, P&lt;0.001) respectively. Regarding inotropes, sepsis type and oxygen support there was significant difference between both groups.&#x0D; Conclusions: 75% of the patients we evaluated with neonatal sepsis had relative adrenal insufficiency (RAI). ACTH and Cortisol values were correlated to CRP and HSS score as an inflammatory marker. This reflects suppressed HPA status in this critical clinical condition.

Epidemiological, anatomoclinical, and therapeutic profile of obstetric fistula in the Democratic Republic of the Congo: About 1267 patients.

Our aim is to describe the epidemiological, anatomoclinical and therapeutic profile of obstetric fistula (OF) in the Democratic Republic of the Congo (DRC). This was a descriptive retrospective study that collected 1416 obstetric fistulas in 1267 patients in seven provinces of the DRC, treated between January 2017 and December 2022. The variables studied were epidemiological, anatomoclinical and therapeutic. The mean age of patients at the time of surgical repair was 33.2 years (range: 15 and 77 years) and 32.8% of patients were aged between 20 and 29 years. The mean age of the fistula at repair was 10 years (range: 3.5 months and 56 years). At the time of fistula, 61.7% of patients had delivered vaginally and 28.7% by caesarean section and 8.2% of patients had a haemostasis hysterectomy. Labour lasted at least 3 days in 47.3% of these patients for the fistula birth. Deliveries took place either at home (27.4%) or in a health facility (72.6%); 83.6% of newborns resulting from these births had died. Taken as a whole, urogenital fistulas are more common than genito-digestive fistulas. Urethro-vaginal (26.2%) and vesico-uterine (24.7%) anatomoclinical entities were predominant among urogenital fistulas. A total of 1416 fistulas were surgically repaired in 1267 patients. These repairs were successful for 1226 (86.6%) fistulas. The main surgical route used was transvaginal (68.8%). In the DRC, obstetric fistula is common in young adult women. It often results from vaginal delivery, after prolonged labour. Fistula births often result in the death of newborns. Uro-genital obstetric fistulas are the most frequent with predominance of urethro-vaginal and vesico-uterine anatomoclinical entities. Fistulas remain untreated for a long time. Mostly done transvaginally, surgical repair gives a good result.

Mortality of neonates born to mothers of extreme reproductive age in Ethiopia; multilevel mixed effect analysis of Ethiopian demographic and health survey data of 2016.

Neonatal mortality is still a major public health problem in middle- and low-income countries like Ethiopia. Despite strategies and efforts made to reduce neonatal death, the mortality rate declines at a slower pace in the country. Though there are studies conducted on neonatal mortality and its determinants, our searches of the literature have found no study on the extent of mortality of neonates born to mothers of extreme reproductive age in the study area. Therefore, this study aimed to assess the magnitude and factors associated with the mortality of neonates born to mothers of extreme reproductive age in Ethiopia. Secondary data analysis was conducted using 2016 Ethiopian Demographic and Health Survey data. The final study contained an overall weighted sample of 2,269 live births. To determine the significant factors in newborn deaths, a multilevel binary logistic regression was fitted. For measuring the clustering impact, the intra-cluster correlation coefficient, median odds ratio, proportional change in variance, and deviation were employed for model comparison. The adjusted odds ratio with a 95% confidence interval was presented in the multivariable multilevel logistic regression analysis to identify statistically significant factors in neonatal mortality. A P-value of less than 0.05 was declared statistically significant. The neonatal mortality rate of babies born to extreme aged reproductive women in Ethiopia was 34 (95% Cl, 22.2%-42.23%) per 1,000 live birth. Being twin pregnancy (AOR = 10; 95% Cl: 8.61-20.21), being from pastoralist region (AOR = 3.9; 95% Cl: 1.71-8.09), having larger baby size (AOR = 2.93; 95% Cl: 1.4-9.12) increase the odds of neonatal mortality. On the other hand, individual level media exposure (AOR = 0.3; 95% Cl: 0.09-0.91) and community level media exposure (AOR = 0.24; 95% Cl: 0.07-0.83), being term gestation (AOR = 0.14; 95% Cl: 0.01-0.81) decreases the odds of neonatal mortality born to mothers of extreme reproductive age. Ethiopia had a greater rate of neonatal death among babies born at the extremes of reproductive age than overall reproductive life. Multiple pregnancies, larger baby sizes, emerging regions, term gestation, and media exposure were found to be significant factors associated with the mortality of neonates born to mothers of extreme reproductive age. Therefore, the concerned bodies should give emphasis to mothers giving birth before the age of 20 and above 35, access to media, healthy pregnancy, and special attention to pastoralists to reduce the burden of neonatal mortality.

Evaluating theory of change to improve the functioning of the network for improving quality of care for maternal, newborn and child health.

In 2017, WHO and global partners launched 'The Network for Improving Quality of Care for Maternal, Newborn and Child Health' (QCN) seeking to reduce in-facility maternal and newborn deaths and stillbirth by 50% in health facilities by 2022. We explored how the QCN theory of change guided what actually happened over 2018-2022 in order to understand what worked well, what did not, and to ultimately describe the consequences of QCN activities. We applied theory of change analysis criteria to investigate how well-defined, plausible, coherent and measurable the results were, how well-defined, coherent, justifiable, realistic, sustainable and measurable the assumptions were, and how independent and sufficient the causal links were. We found that the QCN theory of change was not used in the same way across implementing countries. While the theory stipulated Leadership, Action, Learning and Accountability as the principle to guide network activity implementation other principles and varying quality improvement methods have also been used; key conditions were missing at service integration and process levels in the global theory of change for the network. Conditions such as lack of physical resources were frequently reported to be preventing adequate care, or harm patient satisfaction. Key partners and implementers were not introduced to the network theory of change early enough for them to raise critical questions about their roles and the need for, and nature of, quality of care interventions. Whilst the theory of change was created at the outset of QCN it is not clear how much it guided actual activities or any monitoring and evaluation as things progressed. Enabling countries to develop their theory of change, perhaps guided by the global framework, could improve stakeholder engagement, allow local evaluation of assumptions and addressing of challenges, and better target QCN work toward achieving its goals.

Nascer no Brasil II: protocolo de investigação da saúde materna, paterna e da criança no pós-parto

Abstract: Pregnancy, parturition and birth bring major changes to the lives of mothers and fathers. This article presents a research protocol for estimating the prevalence of postpartum mental health outcomes in mothers and fathers, abuse and satisfaction in delivery/abortion care, and the correlations between them and socioeconomic, obstetric, and child health factors. As a 2-component research, it consists of a prospective cohort study with all postpartum women interviewed in the 465 maternity hospitals included at the Birth in Brazil II baseline survey conducted from 2021 to 2023, and a cross-sectional study with the newborns’ fathers/partners. Interviews will be conducted via telephone or self-completion link sent by WhatsApp with the mother at 2 and 4 months after delivery/abortion. Partners will be approached three months after birth (excluding abortions, stillbirths and newborn death) using the telephone number informed by the mother at the maternity ward. Postpartum women will be inquired about symptoms of depression, anxiety and post-traumatic stress disorder, abuse during maternity care and quality of the mother-newborn bond. Maternal and neonatal morbidity, use of postnatal services, and satisfaction with maternity care are also investigated. Fathers will be asked to report on symptoms of depression and anxiety, and the quality of the relationship with the partner and the newborn. The information collected in this research stage may help to plan and improve care aimed at the postpartum health of the mother-father-child triad.

Birth in Brazil II: a postpartum maternal, paternal and child health research protocol.

Pregnancy, parturition and birth bring major changes to the lives of mothers and fathers. This article presents a research protocol for estimating the prevalence of postpartum mental health outcomes in mothers and fathers, abuse and satisfaction in delivery/abortion care, and the correlations between them and socioeconomic, obstetric, and child health factors. As a 2-component research, it consists of a prospective cohort study with all postpartum women interviewed in the 465 maternity hospitals included at the Birth in Brazil II baseline survey conducted from 2021 to 2023, and a cross-sectional study with the newborns' fathers/partners. Interviews will be conducted via telephone or self-completion link sent by WhatsApp with the mother at 2 and 4 months after delivery/abortion. Partners will be approached three months after birth (excluding abortions, stillbirths and newborn death) using the telephone number informed by the mother at the maternity ward. Postpartum women will be inquired about symptoms of depression, anxiety and post-traumatic stress disorder, abuse during maternity care and quality of the mother-newborn bond. Maternal and neonatal morbidity, use of postnatal services, and satisfaction with maternity care are also investigated. Fathers will be asked to report on symptoms of depression and anxiety, and the quality of the relationship with the partner and the newborn. The information collected in this research stage may help to plan and improve care aimed at the postpartum health of the mother-father-child triad.

2023 Korean sexually transmitted infections guidelines for non-gonococcal bacterial infection (chlamydia, syphilis, etc.) by the Korean Association of Urogenital Tract Infection and Inflammation.

Non-gonococcal sexually transmitted infections (STIs) include chlamydia, syphilis, and chancroids. Chlamydia is the most common STI caused by Chlamydia trachomatis and is mainly transmitted through sexual intercourse or vertical transmission at birth. Although symptoms are mostly absent or mild, untreated chlamydial infections in females can lead to pelvic inflammatory disease, chronic pelvic pain, and infertility due to the narrowing of fallopian tubes. Syphilis is caused by Treponema pallidum and is divided into phase I, phase II, latent syphilis, and phase III. The incidence of syphilis, including congenital syphilis, has significantly increased in the United States in recent years. The chronic status of this disease can significantly increase morbidity and potentially affect almost all body organs, which, in rare cases, can lead to death. Additionally, untreated maternal syphilis can lead to fetal death and fatal congenital infections in newborns. Chancroid is an STI caused by Haemophilus ducreyi, and its prevalence is gradually decreasing in Korea and worldwide. The symptoms include shallow genital ulcers with suppurative granulomatous inflammation and tender inguinal lymphadenopathy. Chancroids can be differentiated from syphilitic chancres based on their appearance. In contrast to painless chancres, chancroids are painful. Ureaplasma urealyticum, Ureaplasma parvum, and Mycoplasma hominis are considered symbiotic bacteria. Infections caused by these bacteria are usually not considered STIs and do not require treatment unless they are suspected of being associated with infertility. This article presents the 2023 Korean STI guidelines for non-gonococcal bacterial infections.

Community voices from modern maternal waiting home users in Zambia.

This study aimed to understand community voices on factors influencing utilisation of MMWHs in Zambia. The study employed a mixed method study design in four selected health facilities across Zambia districts between January 2021 and December 2022. Purposeful sampling was used to select study participants using MMWH registers as the sampling frame for mothers who had utilised MMWHs and their spouses. Sampling of participants through face-to-face, in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted to saturation in all targeted health facilities Data was transcribed verbatim and analysed thematically. Results found that the comfortable state of the MMWHs, long distances to health facilities, fear of maternal complications, availability and positive attitudes of specialized health personnel, and the information on childcare provided were major factors. Spouses supported their partners using MMWHs due to the quality of care and the availability of modern equipment and furniture. However, some spouses indicated that utilisation of MMWHs has a bearing on a household's financial resources. MMWHs are a pivotal intervention in improving maternal outcomes. All health facilities had no maternal and newborn complications or deaths over the study period.

A retrospective study on the outcome of sepsis among neonates admitted to the neonatal intensive care unit at a tertiary care hospital in Western India

Background: In underdeveloped nations, sepsis is one of the main causes of newborn death. A timely detection of this can reduce the burden of neonatal mortality as well as morbidity. Objective: The aim of this study was to evaluate the prognosis of sepsis at a tertiary care facility in Western India to identify risk factors and increase infant survival rates. Materials and Methods: A retrospective study was conducted on neonates admitted between November 16, 2021, and November 15, 2022 (for 1 year duration), at the neonatal intensive care unit (NICU) of GMERS Medical College, Gandhinagar. A dataset was created consisting of neonates with the final diagnosis of sepsis, and the outcome was analyzed based on various parameters. Results: Out of 1309 NICU admissions, 130 (9.93%) were sepsis cases. Out of 130 sepsis cases, 72 (55.38%) were male and 58 (44.62%) were female, 62 (47.69%) were inborn and 68 (52.31%) were outborn, and 26 (20%) cases were low birth weight (LBW), 18 (13.84%) were very LBW, 12 (9.23%) were extreme LBW, and 74 (56.92%) were normal birth weight neonates. Out of 130 sepsis cases, 84 (64.61%) cases were preterm, and 46 (35.39%) cases were full-term. In 105 cases, out of 130 total sepsis patients, pathogens were isolated. The most common organism was Staphylococcus (62 cases/59.04%). Conclusion: According to this study, the likelihood of developing sepsis was inversely associated with birth weight. A high percentage of neonatal sepsis cases (9.93%) were found, where 96 (73.84%) neonates were successfully discharged. This study is helpful to identify multiple risk factors such as preterm (64.61%), male gender (55.35%), and outborn (52.31%). Antibiotic susceptibility pattern reveals that more number of resistance cases will be coming, posing a serious threat of neonatal sepsis morbidity.

Usage of Maternal Health Services for Fertility Regulation in India: A Retrospective Study

The use of maternal health services in India is influenced by various socioeconomic factors, with higher maternal morbidity during reproductive ages 15 to 49. The Indian government has launched programs like Maternity Safety Scheme (Janani Suraksha Yojana) and Maternity and Child Protection Programme (Janani Shishu Suraksha Karyakaram) to provide free health services to women. However, the burden of these services is disproportionately high among the poorest women, leading to high mother and newborn death rates. In the study, secondary data from the National Family Health Survey (NFHS-3) found that place of residence, exposure to mass media, education, caste, religion, and wealth were all significant predictors of maternal health care utilization. The study also found that location of residence; age, birth order, education, caste, religion, and wealth were substantially and significantly associated with the use of antenatal care, skilled attendants at birth, and postnatal care in India. Women aged 25-34 were 54.8% more likely to receive antenatal care (ANC) services than those aged 15-24. Women aged 35-49 experienced a 52.7% increase in ANC services. Rural women were 23.8% less likely to use ANC than urban women. Muslims were 43.8% less likely to seek ANC assistance compared to Hindus. Women with the highest education levels were 5 times more likely to seek ANC than those who were not educated. Schedule Tribes were 1.5 times more likely to participate in ANC than Schedule Castes. Women aged 35-49 had an 86.8% higher likelihood of seeking postnatal care than those aged 15-24 years. Media exposure had a 1.3 times higher chance of receiving this care than those who had none. Muslim women were 17.8% less likely to choose PNC services than Hindu women.

A Study to Assess the Effectiveness of Structured Teaching Program on Knowledge and Practice Regarding Warm Chain in the Prevention of Hypothermia in Newborn Babies among Staff Nurses in Selected Hospital in Jaipur

Abstract: Thermal protection of the newborn is a series of measures taken at birth and in the first days of life to ensure that the newborn does not become either cold or overheated and maintains a normal body temperature of 36.5—37.50C. The newborn cannot regulate its temperature as well as an adult. The poor utilization of this care arises in many high-risk cases and sometimes it leads to the death of newborns. So the present study aim at knowledge and practice regarding warm chain in the prevention of hypothermia in newborn babies among staff nurse. Design/methodology/approach: The experimental research design was used for the study Information can be gathered by direct questioning and through observation method ( 60 samples) of staff nurses. The data were analyzed through chi-square by using pre-test and post-test knowledge. Findings: the findings show the significant influence of demographic variables in terms of age, gender, professional qualification, professional experience, experience in the labor room, working department, and previous knowledge Research limitations: the study was limited to hospitals of Jaipur with limited demographic variables.

Prevalence of Stunting Among Under 5 Children in Al-Rajaiya Health Center, Ash-Shamayatayn District - Taiz, Yemen

Background: Yemen is one of the low-income countries, with 80% of the population living below the poverty line and almost half the population lacks adequate access to nutritious food. The low-birth-weight rate is 24.6%, and the overall infant mortality rate is 47 per 1,000 births. The risk of death of newborns varies depending on social, demographic, and economic factors. Objectives: This study aims to evaluate the effect of the ongoing war on stunting prevalence among children under five years in Al-Rajaiya Health Center, Ash-Shamayatayn District - Taiz, Yemen. Methods: This study is an observational analytic with a cross-sectional design. It was conducted from January to June 2022, following purposive sampling gathered 254 participants. Results: The data revealed that the prevalence of severe stunting in 6- to 23-month-old children was higher in urban areas than in rural areas (45% vs. 43.7%); it was also higher in girls than in boys (58.4% vs. 30.3%). Furthermore, in 24- to 59-month-old children, it was higher in urban areas than in rural areas (50% vs. 12.5%) and higher in girls than in boys (42.9% vs. 19.6%) with p-value (0.040, 0.018, 0.001 and &gt;.001) respectively. Conclusions: Findings demonstrated that the ongoing war has a significant effect on the stunting prevalence among children under five years. Early childhood undernutrition is linked to several adverse outcomes in adulthood, and it is plausible that undernutrition in early childhood may be a significant factor in explaining the health disparities faced by Yemeni children under five.

A Review on the Best Practices of Poverty Reduction in Developing Countries

Due to its detrimental effects on human wellbeing, extreme poverty, which exists in many developing nations, is a serious issue that requires immediate attention. It entails inadequate food and nutrition, inadequate housing, unsafe drinking water, low literacy rates, high rates of infant and maternal death, high unemployment, and a sense of helplessness and vulnerability. Reducing poverty can be accomplished through increasing employment and educational opportunities for the underprivileged; implementing institutional and economic reforms to increase productivity and optimize resource use; endorsing microfinance initiatives to lift barriers to small-scale business, innovation, and entrepreneurship; and creating and refining marketing strategies to boost output. Conducting this review is based on an analysis of old and recent literature. It looks at the development and meaning of poverty. Additionally, based on current discussions on the idea, the review shows the disparities in interpretations in developing nations and emphasizes the varied viewpoints regarding the concept of poverty

The Adverse Outcomes of Chorioamnionitis on the Pregnant Female and Their Fetus

Introduction: Chorioamnionitis is an intra-amniotic infection caused by an ascending polymicrobial bacterial infection. Triple I (intrauterine inflammation or infection or both) is also proposed to replace chorioamnionitis due to its imprecise definition and variable clinical manifestations. Intraamniotic infection is characterized by inflammation of the amniotic fluid, placenta, fetus, fetal membranes, or decidua. Maternal fever, uterine tenderness, maternal tachycardia, fetal tachycardia, and purulent fluid coming from the cervical os (the cervical opening can be external, near the vagina, or internal, near the uterus) are the key clinical findings that are crucial for the diagnosis of clinical chorioamnionitis. Clinically, intra-amnionitic infections have been linked to severe morbidity and death in pregnant women, fetuses, and newborns. Method: A systematic search of PubMed, Embase, LitCovid, MedRxiv, BioRxiv, Google Scholar, EBSCO MEDLINE, CINAHL and Scopus electronic database was done using key words like Chorioamnionitis, adverse complication in pregnancy to mother and her fetus associated with intrauterine infection, Intraamniotic inflammation and triple I. Studies have been included from January 2015 to December 2022. Result: Chorioamnionitis is most typically caused by ascending infection and is frequently linked with premature membrane rupture. Chorioamnionitis is typically caused by a polymicrobial infection, with Ureaplasma urealyticum, Mycoplasma hominis, and Gram-negative anaerobes being common pathogens. Antimicrobial drugs, antipyretics, rapid treatment, and supportive care are the mainstays of management. Conclusion: Overall, this review provides a better understanding of Chorioamnionitis and its potential impact on public health. By shedding light on this emerging disease, we hope to contribute to ongoing efforts to prevent and treat of this serious disorder. Keywords: Chorioamnionitis, Intrauterine Infection, Pregnancy, adverse complication, Triple I, Intraamniotic Inflammation

Development and Pilot Implementation of Neotree, a Digital Quality Improvement Tool Designed to Improve Newborn Care and Survival in 3 Hospitals in Malawi and Zimbabwe: Cost Analysis Study.

Two-thirds of the 2.4 million newborn deaths that occurred in 2020 within the first 28 days of life might have been avoided by implementing existing low-cost evidence-based interventions for all sick and small newborns. An open-source digital quality improvement tool (Neotree) combining data capture with education and clinical decision support is a promising solution for this implementation gap. We present results from a cost analysis of a pilot implementation of Neotree in 3 hospitals in Malawi and Zimbabwe. We combined activity-based costing and expenditure approaches to estimate the development and implementation cost of a Neotree pilot in 1 hospital in Malawi, Kamuzu Central Hospital (KCH), and 2 hospitals in Zimbabwe, Sally Mugabe Central Hospital (SMCH) and Chinhoyi Provincial Hospital (CPH). We estimated the costs from a provider perspective over 12 months. Data were collected through expenditure reports, monthly staff time-use surveys, and project staff interviews. Sensitivity and scenario analyses were conducted to assess the impact of uncertainties on the results or estimate potential costs at scale. A pilot time-motion survey was conducted at KCH and a comparable hospital where Neotree was not implemented. Total cost of pilot implementation of Neotree at KCH, SMCH, and CPH was US $37,748, US $52,331, and US $41,764, respectively. Average monthly cost per admitted child was US $15, US $15, and US $58, respectively. Staff costs were the main cost component (average 73% of total costs, ranging from 63% to 79%). The results from the sensitivity analysis showed that uncertainty around the number of admissions had a significant impact on the costs in all hospitals. In Malawi, replacing monthly web hosting with a server also had a significant impact on the costs. Under routine (nonresearch) conditions and at scale, total costs are estimated to fall substantially, up to 76%, reducing cost per admitted child to as low as US $5 in KCH, US $4 in SMCH, and US $14 in CPH. Median time to admit a baby was 27 (IQR 20-40) minutes using Neotree (n=250) compared to 26 (IQR 21-30) minutes using paper-based systems (n=34), and the median time to discharge a baby was 9 (IQR 7-13) minutes for Neotree (n=246) compared to 3 (IQR 2-4) minutes for paper-based systems (n=50). Neotree is a time- and cost-efficient tool, comparable with the results from limited similar mHealth decision-support tools in low- and middle-income countries. Implementation costs of Neotree varied substantially between the hospitals, mainly due to hospital size. The implementation costs could be substantially reduced at scale due to economies of scale because of integration to the health systems and reductions in cost items such as staff and overhead. More studies assessing the impact and cost-effectiveness of large-scale mHealth decision-support tools are needed.

Development of progesterone electrospun nanofibers to coat Arabin pessaries as a dual preventive and therapeutic approach for preterm labor

Preterm labor is a growing health problem that causes newborn death, and safe and effective therapy is significantly needed. Arabin pessaries and progesterone are preventive and therapeutic approaches that can be applied to managing the short cervix; hence, reducing the risk of preterm labor. The main goal of current work is to fabricate a novel nanofiber formulation based on polycaprolactone (PCL) and loaded with progesterone to coat for Arabin pessaries to be used as dual preventive and therapeutic approaches for local vaginal delivery. Several important criteria were considered in this study to assess the prepared nanofibers (i.e.; nanofiber diameter, progesterone loading efficiency, progesterone release profiles and in vitro cytotoxicity assessment). The results showed a dimeter of 397 ± 88 nm, drug loading of 142 ± 3 µg/mg and encapsulation efficiency of 99 ± 2 % for the progesterone-loaded nanofibers. Approximately, 17 % of progesterone was released from the nanofibers after 90 days. The in vitro assessment showed that the application of progesterone is safe upon 24 and 48-hours incubation on HFF-1 cell line at concentrations ≤ 32 µg/mL and within 72-hours at a dose of ≤ 8 µg/mL. To conclude, the data recommended that progesterone-loaded nanofibers can coat the Arabin pessaries with the potential of being a safe and effective dual preventive and therapeutic tool for preterm labor.

An integrated newborn care kit (iNCK) to save newborn lives and improve health outcomes in Gilgit Baltistan (GB), Pakistan: study protocol for a cluster randomized controlled trial

BackgroundOngoing high neonatal mortality rates (NMRs) represent a global challenge. In 2021, of the 5 million deaths reported worldwide for children under five years of age, 47% were newborns. Pakistan has one of the five highest national NMRs in the world, with an estimated 39 neonatal deaths per 1,000 live births. Reducing newborn deaths requires sustainable, evidence-based, and cost-effective interventions that can be integrated within existing community healthcare infrastructure across regions with high NMR.MethodsThis pragmatic, community-based, parallel-arm, open-label, cluster randomized controlled trial aims to estimate the effect of Lady Health Workers (LHWs) providing an integrated newborn care kit (iNCK) with educational instructions to pregnant women in their third trimester, compared to the local standard of care in Gilgit-Baltistan, Pakistan, on neonatal mortality and other newborn and maternal health outcomes. The iNCK contains a clean birth kit, 4% chlorhexidine topical gel, sunflower oil emollient, a ThermoSpot™ temperature monitoring sticker, a fleece blanket, a click-to-heat reusable warmer, three 200 μg misoprostol tablets, and a pictorial instruction guide and diary. LHWs are also provided with a handheld scale to weigh the newborn. The primary study outcome is neonatal mortality, defined as a newborn death in the first 28 days of life.DiscussionThis study will generate policy-relevant knowledge on the effectiveness of integrating evidence-based maternal and newborn interventions and delivering them directly to pregnant women via existing community health infrastructure, for reducing neonatal mortality and morbidity, in a remote, mountainous area with a high NMR.Trial registrationNCT04798833, March 15, 2021.

Is the economic uncertainty- human health relationship nonlinear? An empirical analysis for the China.

The health costs of economic uncertainty always remain a major concern among policymakers of China. The theoretical and empirical literature on the economic uncertainty-human health nexus is still in its infancy stage. This study is firmly rooted in the economic uncertainty theory advanced by Baker, Bloom, & Davis. In this study, the primary objective of the analysis is to estimate the asymmetric impact of economic uncertainty on human health in China's economy. In order to evaluate the short and long-run estimates of economic uncertainty on human health across various quantiles, we have employed the linear and nonlinear QARDL models. The linear QARDL model shows that the long-run relationship between economic uncertainty and the infant mortality rate is positive and significant at all quantiles, while the long-run relationship between economic uncertainty and the death rate is positive and significant at higher quantiles. The nonlinear QARDL model reveals that, in the long run, the relationship between the positive shock of economic uncertainty and the infant mortality rate is positive and significant at quantiles 0.30 to 0.95, while the long-run relationship between the positive shock of economic uncertainty and the death rate is positive and significant at higher quantiles. The relationship between the negative shock of economic uncertainty and the infant mortality rate is negative and significant at the highest quantiles, while the relationship between the negative shock of economic uncertainty and death rate is negative and significant at higher quantiles in the long run. The findings indicate a positive relationship between economic uncertainty in China and higher rates of infant mortality and death. Thus, adopting suitable policies for controlling economic uncertainty can help in improving human health in China.

Advances in understanding RSV glycoproteins: Insights into viral entry and implications for vaccines and therapeutic development

Respiratory syncytial virus (RSV) causes a significant number of deaths in newborns annually due to respiratory infections. Since its first isolation in 1955, great progress has been made in the development of related vaccines and monoclonal antibodies. Currently, two RSV vaccines and two monoclonal antibodies have been approved for marketing. Understanding the structure, function, and mechanism of RSV glycoproteins interaction with their receptors involved in its entry is of great significance for the development of vaccines and therapeutic drugs. In this review, we will introduce the substantial progress made in the understanding of the structure of RSV glycoproteins, the receptors they bind with, and the process of RSV entry. Progress made in developing vaccines and neutralizing antibodies which benefit from these studies will also be briefly discussed. Finally, we will outline the unresolved issues and controversies in RSV glycoprotein and entry mechanism research, propose some possible approaches to address these issues, and provide insights into future drug and vaccine development.