Neonatal Health Outcomes Research Articles

Uptake and Effectiveness of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine during Pregnancy in Africa: A Scoping Review.

Malaria poses a significant threat to pregnant women in sub-Saharan Africa, necessitating effective interventions like the intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). However, challenges persist in the uptake and effectiveness of this intervention. This scoping review aims to explore IPTp-SP uptake in African countries, identify influencing factors, and assess its effectiveness in preventing malaria and adverse outcomes in pregnancy. This scoping review follows Arksey and O'Malley's framework, employing the PRISMA-ScR guidelines for reporting. Searches were conducted in PubMed, Embase, Scopus, JSTOR, Web of Science, Google Scholar, and ProQuest, focusing on studies post-2000 published in the English language. The search produced 15,153 records, of which 104 full-text records were eligible and 101 papers were included in this review. The findings suggest varying IPTp-SP uptake rates, spanning from 5.3% to 98.9%, with their effectiveness supported by longitudinal studies, randomised controlled-trials (RCTs), cross-sectional surveys, and mixed-method studies. IPTp-SP demonstrates efficacy in reducing malaria during pregnancy, placental parasitaemia, and anaemia episodes, alongside improved birth outcomes. Common adverse effects of IPTp-SP include prematurity and low birth weight. Facilitators of IPTp-SP uptake include education and ANC attendance, while commonly reported barriers included inadequate knowledge and healthcare system challenges. The findings also suggest adverse effects such as prematurity, low birth weight, and maternal and perinatal mortality associated with IPTp-SP uptake. It is vital to strengthen antenatal care services by integrating comprehensive counselling on IPTp-SP and address healthcare system challenges. Community engagement, women's empowerment, and context-specific interventions are necessary for promoting IPTp-SP uptake and improving maternal and neonatal health outcomes in Africa.

Integrating Maternity Care Through Bundled Payments In The Netherlands: Early Results And Policy Lessons.

Bundled payments are increasingly used globally to move health care delivery in a value-based direction. However, evidence remains scant in key clinical areas. We evaluated bundled payments for maternity care in the Netherlands during the period 2016-18. We used a quasi-experimental difference-in-differences design to measure the association between the bundled payment model and changes in key clinical and economic outcomes. Bundled payments were associated with an increase in outpatient, midwife-led births and a reduction in in-hospital, obstetrician-led births, along with changes in the use of labor inductions and planned versus emergency cesarean deliveries. Total spending on maternity care decreased by US$328 (5percent) per pregnancy. No changes in maternal or neonatal health outcomes were observed. Several policy lessons emerged. First, bundled payments appeared to help affect providers' behavior in the maternity care setting. Second, bundled payments seemed to exert heterogeneous effects across participating maternity care networks, as the same financial incentive translated into different changes in clinical practices and outcomes. Third, alternative payment models should be designed with clear goals and definitions of success to guide evaluation and implementation.

A Comparative Study of Coagulation Profiles in Preeclamptic and Normotensive Patients in Relation to Maternal and Fetal Outcomes.

Background Hypertensive complications during pregnancy play a significant role in the increased rates of maternal and perinatal morbidity and mortality on a global scale. Preeclampsia is characterized by elevated blood pressure levels and the presence of protein in the urine and is associated with diverse hematological alterations, particularly impacting the coagulation cascade. The primary objective of this research was to conduct a comparative analysis of the coagulation profiles and pregnancy outcomes in women with preeclampsia versus those with normal blood pressure during pregnancy. Methods This was a prospective case-control study with 74 participants across two groups, conducted from September 2022 to May 2024. The participants were enrolled and divided into two groups, with 37 in the clinically diagnosed preeclampsia group and 37 in the normotensive group. Coagulation parameters including platelet count, bleeding time, clotting time, international normalized ratio (INR), activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen levels, alkaline phosphatase (ALP) levels, D-dimer levels, and fibrin degradation products (FDP) levels were assessed. Maternal and neonatal outcomes were also compared. In our study, we comprehensively examined both maternal and neonatal outcomes in preeclampsia and normotensive groups. Maternal complications analyzed included mode of delivery, incidence of eclampsia, placental abruption, hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, postpartum hemorrhage (PPH), and peripartum cardiomyopathy (PPCM). For neonatal outcomes, we assessed birth weight, appearance, pulse, grimace, activity, and respiration (APGAR) scores, and the duration of neonatal intensive care unit (NICU) stays. Results The results showed that mean platelet count was significantly lower in the preeclampsia group (151,503 ± 59,875/µL) compared to the normotensive group (245,405 ± 69,021/µL) (p < 0.0001). Bleeding time, INR, APTT, and PT showed significant elevation in the preeclampsia group, indicating a slower coagulation process. Fibrinogen levels, ALP levels, and D-dimer levels were significantly higher in the preeclampsia group (p < 0.0001). The preeclampsia group had a higher rate of cesarean sections (65% vs. 24%) and lower neonatal birth weights (mean 2.3 kg vs. 2.5 kg). APGAR scores were comparable between groups, but a higher number of neonates went to the NICU in the preeclampsia group (64.9% vs. 10.8%). The preeclampsia group also showed higher rates of low birth weight (27%), intrauterine growth restriction (27%), respiratory distress syndrome (10.8%), and asphyxia (5.4%). Conclusion Preeclampsia is associated with significant hematological changes, particularly in coagulation parameters, and adverse fetomaternal outcomes. Early identification and monitoring of these changes are crucial for timely intervention and improving maternal and neonatal health outcomes.

Perceptions, barriers, and facilitators of cannabis screening during pregnancy and labor: A qualitative study

BackgroundCannabis is the most commonly used federally illicit substance during pregnancy. Yet, little is known about women’s lived experiences of being screened for cannabis use during pregnancy. ObjectiveTo explore perceptions of cannabis use during pregnancy and childbirth, including experiences of being screened for cannabis use during the intrapartum period. MethodsWe conducted a phenomenological qualitative study using semi-structured, online interviews with 16 English-speaking women who gave birth at a U.S. hospital within the past three months. After transcription of interview recordings, two coders analyzed data using inductive thematic analysis. We also generated descriptive statistics for sociodemographic characteristics and cannabis use behaviors. FindingsMost participants were 25–34 years of age (75 %, n=12), Black (75.00 %. n=12), and had less than a bachelor’s degree (68.75 %, n=14). Participants reported low-risk perceptions of cannabis use during pregnancy and often used cannabis to alleviate mental health conditions and pain during pregnancy and childbirth. Women reported mixed perceptions of harm, using cannabis as a medicine and because they were addicted, being fearful of disclosing cannabis use due to potential involvement of child welfare and protective services, and perceiving negative provider communication a barrier to disclosing cannabis use. ConclusionsFindings underscore the importance of patient education about adverse maternal and neonatal health outcomes of prenatal cannabis use, regardless of whether disclosure occurs. To facilitate disclosure of use, close attention should be paid to verbal and non-verbal communication when screening and counseling women during pregnancy and childbirth. Additional studies are needed to further examine patient-provider cannabis-related communication, with a focus on identifying discriminatory behaviors and practices resulting in health inequities.

Assessment of the quality of guidelines on oral health care during pregnancy: a systematic review.

Importance of oral health during pregnancy has been well reported. To prevent the occurrence of oral diseases and maintenance of oral health, a number of guidelines have been developed by different organizations. However, despite numerous efforts in development of these guidelines, a critical evaluation of the quality of guidelines has not been carried out. Thus, we aimed to perform a systematic review to assess the quality of guidelines on oral health care during pregnancy. PubMed, Embase, Scopus and Cochrane Databases were electronically searched in March 2024. We included guidelines that were carried out within last 10 years and focused on oral health during pregnancy were included in this review. Guidelines focused for both oral health professionals and non-oral health professionals were included in this review. The assessment of the guidelines in this review was carried out using the AGREE II instrument. The four appraisers who carried out the assessment comprised of a gynecologists, a dental practioners, a public health expert and a dental public health professional. The instrument comprises of 23 key items within six domains and two additional global rating items. We included eight guidelines in this review. The AGREE II showed two domains with mean score of more than 70% scores across the guidelines. A comparative evaluation of all the guidelines revealed consistently higher scores in scope and purpose (81.71 + 6.3) and clarity of presentation (71.61 + 11.7). Lowest mean scores were reported for editorial independence (47.87 + 7.21) followed by rigour of development (56.19 + 16.97), applicability (57.50 + 13.7) and stakeholder involvement domain (63.17 + 14.31). Although many guidelines have demonstrated adherence to systematic methodologies, there still exists a scope of improvement in domains such as editorial independence, rigour of development, applicability and stakeholder involvement. Addressing these shortcomings is essential for promoting evidence-based oral health care practices and improving maternal and neonatal health outcomes.

Causal evidence of the association between green and blue spaces (GBS) and maternal and neonatal health: a systematic review and meta-analysis protocol

IntroductionPrevious systematic reviews investigating the effects of green and blue space (GBS) on maternal and neonatal health have mainly focused on cross-sectional evidence, limiting potential causal inferences. The last review...

A Comparative Study of Fetal and Maternal Outcomes in Registered and Unregistered Antenatal Cases in a Tertiary Care Center.

Background Antenatal care plays a crucial role in ensuring optimal maternal and neonatal health outcomes. However, disparities in access to prenatal care persist, with a subset of pregnant women failing to register for antenatal care, referred to as "unbooked" or "unregistered" pregnancies. This study aims to investigate the impact of registration status on pregnancy outcomes, considering various demographic, clinical, and socioeconomic factors. Understanding the factors influencing registration status and its implications on maternal and fetal health outcomes is essential for developing targeted interventions to improve prenatal care access and enhance overall pregnancy outcomes. Objective To see the difference in obstetrical complications along with feto-maternal outcomes in both registered and unregistered antenatal cases and to determine the correlation of maternal and fetal outcomes with antenatal care. Materials and methods This two-year observational study at Dr. D.Y. Patil Medical College's Obstetrics and Gynecology IPD in Pimpri, Pune, examined maternal and fetal outcomes in registered and unregistered pregnancies. Consent was obtained, and patients were categorized as registered and unregistered based on the number of antenatal visits. This was an observational prospective cohort study. Data on socioeconomic factors like income and education were analyzed to assess their association with registration status. Maternal outcomes included preterm delivery and complications such as preeclampsia, gestational diabetes, oligohydramnios, premature rupture of membranes, anemia, and postpartum complications. Fetal outcomes included birth weight and NICU admissions. Statistical analyses, including Chi-square tests, Fisher's exact test, and logistic regression, were used to examine relationships between variables and registration status. Results This study analyzed 502 cases, comprising 251 registered and 251 unregistered pregnancies, to investigate the impact of antenatal registration on maternal and fetal outcomes. Significant associations were observed between socioeconomic factors, such as lower income and education levels in unregistered pregnancies.Specifically, 46 (18.3%) unregistered cases were in the lowest income bracket, while 103 (41.0%) were in the lower-middle bracket, and the majority (132, 52.2%) had only completed secondary education. Unregistered pregnancies were linked to a higher prevalence of adverse outcomes, including preterm delivery (101, 40.23%), anemia (178, 70.9%), hypertensive disorders (30, 11.9%), gestational diabetes mellitus (16, 6.37%), fetal growth restriction (39, 15.3%), low birth weight (181, 72.1%), and NICU admissions (112, 44.6%), compared to registered pregnancies. Conclusion In conclusion, this study highlights the significant impact of registration status on pregnancy outcomes, emphasizing the need for comprehensive interventions to improve prenatal care access and to promote maternal and neonatal health equity. By addressing socioeconomic barriers and implementing targeted interventions, healthcare systems can strive towardensuring optimal pregnancy outcomes for all expectant mothers. This is done by ensuring that all antenatal patients are registered for prenatal care by involving a combination of strategies focused on support, education, and accessibility.

Improving Maternal and Neonatal Health Outcomes of Women Through Deep Antenatal Education Analysis With Health Belief Model

This ponder investigates the adequacy of antenatal instruction programs in making strides maternal and neonatal wellbeing results, pivotal measurements for surveying advance towards Economic Improvement Objective 3. Despite restorative progressions, maternal and neonatal horribleness and mortality rates stay concerning, particularly in moo- and middle-income nations. Antenatal instruction programs, planned to prepare hopeful moms with basic information and aptitudes, are proposed interventions. While a few ponders appear stamped enhancements in maternal self-efficacy and infant care hones, others uncover constrained effect on key wellbeing markers. Understanding the components contributing to these results is pivotal. Socially delicate programs custom fitted to populaces and the mode of conveyance impact viability. Integration into broader healthcare models and continuous back encourage upgrades impact. A precise survey and blend of existing investigate uncover solid relationships between the number of antenatal sessions gone to and viability scores. Relapse examination underscores the positive relationship between participation and program adequacy, maternal wellbeing results, and neonatal wellbeing results. Expanding the number of antenatal sessions essentially upgrades both maternal and neonatal wellbeing results, with factual examination demonstrating a coefficient of 0.3292 for program adequacy, 0.3433 for maternal wellbeing results, and 0.3283 for neonatal wellbeing results, all with p-values &lt; 0.005. These discoveries offer profitable experiences for policymakers and healthcare suppliers pointing to make strides open wellbeing mediations.

A Health Technology Assessment Perspective on Communicating Local Knowledge of Hippolite O. Amadi et al.'s Neonatal Interventions in Global Health Research

Background: This study employed a health technology assessment approach to explore the impact of Hippolite O. Amadiet al.’s neonatal care interventions. Methods: The research design was a qualitative desk research method. The purposive sampling procedure was adopted focusing on a subset of 10 out of a population of 45 journal articles authored by Amadi and others. Textual analysis was the method of data collection and interpretation analysis was used to analyze the data. Results: Locally tailored interventions such as the ‘handy approach’ temperature control, Neonatal Rescue Scheme, PoliteO2blend®, community-integrated neonatal care, Initial-Setpoint-Algorithm, weatherproof nursery designs, and the recycled incubator technique. These health technology interventions, designed to address challenges in low- and middle-income countries like Nigeria, underscored the significance of locally derived solutions in improving neonatal health outcomes. Conclusion: The study advocated for leveraging scientific journals as a pivotal medium for health technology assessment and science communication, facilitating the seamless exchange of local knowledge and innovations in neonatal care. By highlighting Hippolite Amadi’s research publications, the research emphasized the transformative role of journals in disseminating local innovations globally, promoting collaboration, and knowledge exchange beyond geographical boundaries. Recommendation: This study underscored the importance of active stakeholder involvement in optimizing neonatal outcomes through effective science communication, with a focus on prioritizing journals to facilitate the dissemination of local innovations on a global scale and foster collaboration among healthcare professionals, researchers, and local communities to address unique challenges faced by low- and middle-income countries in neonatal care practices.

The Impact of Maternal Risk Factors on Neonatal Morbidity and Mortality in a Tertiary Care Neonatal Intensive Care Unit (NICU): An Observational Study.

Neonatal morbidity and mortality continue to be major public health issues globally, especially for infants admitted to neonatal intensive care units (NICUs). This study aims to investigate the incidence of morbidities among neonates born to high-risk mothers and to evaluate the impact of various maternal risk factors on neonatal morbidity and mortality in the NICU setting. This prospective observational study was conducted on 1,000 newborns up to 28 days of life, all with maternal risk factors, born in our tertiary care center, and admitted to the NICU. Most NICU admissions occurred during the 34-36 weeks of gestation, comprising 412 (41.20%) of the total admissions. Additionally, there was a female predominance, with 552 cases, representing 55.20% of the admissions. Most of the NICU patients came from rural background 594 (59.40%) and belonged to socioeconomic status (SES) IV 764 (76.40%). Higher percentages of neonatal morbidities were observed among children of illiterate and primarily educated mothers, amounting to 913 cases (91.30%). After evaluating patients in the NICU, we found that mortality was 172 (17.20%). Mothers with previous bad obstetric histories were at greater risk of poor neonatal outcomes. Cesarean sections were more commonly associated with NICU admissions, accounting for 555 cases (55.50%).The primary risk factors included pregnancy-induced hypertension, previous lower segment cesarean section, fetal distress, and premature rupture of membranes. Significant neonatal morbidities included respiratory distress syndrome (RDS) due to prematurity 79 (45.9%), intrauterine growth retardation19 (11.0%), meconium aspiration syndrome 16 (9.3%), birth asphyxia, sepsis 29 (16.8%), and congenital anomalies 12 (6.9%). RDS was identified as the leading cause of morbidity. The present study highlights several critical factors associated with NICU admissions and neonatal morbidities, underscoring the need for targeted interventions to improve neonatal health outcomes.

Antenatal care implementation between two asian countries: A study from Indonesia and Taiwan

Background: Antenatal care (ANC) is essential for safeguarding the health of both mothers and their unborn children troughout pregnancy. Understanding the differences from other county provides valuable insight for enhancing maternal and neonatal health outcomes in various healthcare environments. Aims: This study compares the implementation of ANC between Indonesia and Taiwan. Method: A qualitative approach was used to explore ANC implementation between Indonesia and Taiwan. Participants were recruited using purposive sampling, consisting of 6 healthcare providers, 10 pregnant women, and 3 experts from Taiwan and Indonesia. Data were collected through interview, focused group discussions, and document review. Collaizi’s strategy was used to analyze the data. To ensure the trustworthiness of the study, credibility, transferability, dependability, and confirmability were encouraged. Result: There are three themes emerged from this study with twleve following sub-themes. The themes are institutional and structural framework of ANC, ANC education and awareness, and self-empowerment and encourage of pregnant women. Conclusion: By adopting best practices from Taiwan, Indonesia can enhance its ANC services and empower pregnant women, leading to improved maternal and neonatal health outcomes.

Interventions for intimate partner violence during the perinatal period: A scoping review: A systematic review.

Intimate partner violence (IPV) is a prevalent global health problem. IPV that occurs before pregnancy often continues during the perinatal period, resulting in ongoing violence and many adverse maternal, obstetrical, and neonatal outcomes. This scoping review is designed to broadly capture all potential interventions for perinatal IPV and describe their core components and measured outcomes. We conducted a search for empirical studies describing IPV interventions in the perinatal population in June 2022. The search was conducted in MEDLINE, EMBASE, PsycInfo, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science, Applied Social Sciences Index & Abstracts, ClinicalTrials.gov and MedRxiv. Hand searching of references from select articles was also performed. Included studies described an intervention for those experiencing IPV during the perinatal period, including 12 months before pregnancy, while pregnant or in the 12 months post-partum. The search encompassed January 2000 to June 2022 and only peer-reviewed studies written in either English or French were included. Included interventions focused on the survivor exposed to IPV, rather than healthcare professionals administering the intervention. Interventions designed to reduce IPV revictimization or any adverse maternal, obstetrical, or neonatal health outcomes as well as social outcomes related to IPV victimization were included. We used standard methodological procedures expected by The Campbell Collaboration. In total, 10,079 titles and abstracts were screened and 226 proceeded to full text screening. A total of 67 studies included perinatal IPV interventions and were included in the final sample. These studies included a total of 27,327 participants. Included studies originated from 19 countries, and the majority were randomized controlled trials (n = 43). Most studies were of moderate or low quality. Interventions included home visitation, educational modules, counseling, and cash transfer programs and occurred primarily in community obstetrician and gynecologist clinics, hospitals, or in participants' homes. Most interventions focused on reducing revictimization of IPV (n = 38), improving survivor knowledge or acceptance of violence, knowledge of community resources, and actions to reduce violence (n = 28), and improving maternal mental health outcomes (n = 26). Few studies evaluated the effect of perinatal IPV interventions on obstetrical, neonatal or child health outcomes. The majority of intervention studies for perinatal IPV focus on reducing revictimization and improving mental health outcomes, very few included obstetrical, neonatal, and other physical health outcomes. Future interventions should place a larger emphasis on targeting maternal and neonatal outcomes to have the largest possible impact on the lives and families of IPV survivors and their infants.

The Importance of Fetal Echocardiography in the Early Detection and Management of Postnatal Cardiac Anomalies

Congenital heart anomalies are a significant cause of infant morbidity and mortality globally, requiring complex care from the prenatal period through adulthood. Fetal echocardiography stands out as an essential tool for the early diagnosis of these anomalies, allowing for planned therapeutic interventions and reducing the risk of severe complications after birth. The aim of this literature review is to compare neonatal outcomes between cases diagnosed in utero and those not diagnosed in utero, in order to provide solid evidence to improve clinical practices and enhance health outcomes for newborns affected by congenital heart anomalies. Additionally, it aims to promote health education in this region and in the medical field of diagnostic imaging. Studies show that prenatal diagnosis is associated with better neonatal outcomes, including lower morbidity and mortality and a reduction in the need for emergency surgeries. Despite advances in technology, the examination is still not accessible to everyone and is not routinely prescribed, resulting in the detection of heart anomalies only after birth, leading to serious complications. The literature review highlights the importance of multidisciplinary collaboration and the need for health education to improve access to early diagnosis in resource-limited areas. The review demonstrates that fetal echocardiography plays a crucial role in the early identification and effective management of congenital heart anomalies, significantly improving neonatal health outcomes.

Adolescent girls and young women’s (AGYW) access to and use of contraception services in Cape Town: perspectives from AGYW and health care providers

BackgroundAccess and use of contraception services by adolescent girls and young women (AGYW) remains suboptimal, exposing AGYW to early and often unexpected pregnancy. Unexpected pregnancies are a public health concern, associated with poor neonatal and maternal health outcomes, as well as school dropout, which may result in economic hardships. This study aimed to explore (a) AGYW perceptions and experiences of receiving contraception services from health care providers and (b) health care providers’ perceptions and experiences of providing contraception services to AGYW.MethodsData were collected through semi-structured individual interviews with AGYW aged 15–24 years old and health care providers working in eight health care facilities around the Cape Town metropolitan area, in South Africa’s Western Cape Province. Thematic analysis was used to analyse the data.ResultsAGYW and health care providers voiced varying, and often contrasting, perceptions of some of the barriers that hinder AGYW’s access to contraception services. AGYW indicated that provider-imposed rules about when to access contraceptive services hindered access, while health care providers felt that these rules were necessary for coordinating their work. In addition, AGYW highlighted health care providers’ hostile attitudes towards them as an important factor discouraging access. On the contrary, health care providers did not think that their attitudes hampered AGYW’s access to and use of contraception services, instead they emphasised that challenges at the health system level were a major issue, which they feel they have little control over. Such challenges made health care providers’ work unpleasant and frustrating, impacting on their work approach and how they receive and offer services to AGYW.ConclusionThe expectation of negative attitudes from health care providers continues to be at the centre of AGYW discouragement towards accessing contraception services. System challenges are among some of the key drivers of health care provider’s hostile attitudes, posing challenges to the efficient provision of services. In order to improve AGYW’s access to and use of contraception services, and subsequently achieve the country’s SDGs, conscious efforts need to be directed towards improving the workload and working conditions of health care providers.

Investigating the Challenges, Successes, and Strategies of Implementing Advanced Neonatal Care Interventions in Low-Resource Settings: A Clinical Study.

Neonatal care interventions are crucial for reducing infant mortality rates, particularly in low-resource settings where access to advanced medical facilities is limited. Implementing these interventions poses significant challenges due to resource constraints and infrastructural limitations. This clinical study investigated the challenges, successes, and strategies involved in implementing advanced neonatal care interventions in a low-resource setting. A retrospective analysis was conducted on the data collected from a neonatal care unit in a resource-limited area over a period of two years. The study assessed the availability of medical equipment, healthcare personnel training, and the efficacy of interventions in improving neonatal health outcomes. The analysis revealed that despite resource constraints, significant strides were made in implementing advanced neonatal care interventions. Availability of essential medical equipment increased by 30%, and healthcare personnel received targeted training programs resulting in a 25% improvement in neonatal survival rates. Strategies such as task-shifting and community outreach programs played a pivotal role in overcoming infrastructural limitations. Implementing advanced neonatal care interventions in low-resource settings is challenging but feasible with targeted strategies. While resource constraints remain a barrier, innovative approaches such as task-shifting and community involvement can significantly improve neonatal health outcomes. Continued investment in infrastructure, training, and community engagement is essential for sustainable progress in reducing neonatal mortality rates in resource-limited areas.

The effect of text-messaging on the utilisation of health facilities among pregnant women during delivery in Cross River State, Nigeria

Objective: Uptake of skilled care during delivery is associated with positive maternal and neonatal health outcomes. Studies reveal Nigeria accounts for a significant percentage of global maternal deaths, which have been associated with poor skilled attendants at delivery. Text messaging has proven to be effective in promoting health facilities’ utilisation in Nigeria. Therefore, this research assessed the influence of text messaging intervention on the utilisation of health facilities during delivery in Cross River State Methods: Quasi-experimental research design was employed. A sample size of thirty per LGA in two LGAs was used. Participants were purposively selected and grouped into text messaging and Control Groups ). The experimental group received text briefs three times per week for four weeks, while the control group received regular ANC sessions. A structured and validated questionnaire with Cronbach’s alpha coefficients ranging from 0.76 to 0.81 was used for data collection. Data were analyzed using descriptive and inferential statistics at a 5% level of significance. Results: At baseline, the proportion of women who utilised HFs during delivery was 13.3% (experimental group) and 33.3% (control group). Furthermore, at the 8th-week follow-up, there was a significant difference (p &lt; 0.05) in T-M (76.7%), compared with CG (33.3%) with an increase of 63.4% for the T-M compared to CG (3.3%, p &gt; 0.05). Conclusion: T-M intervention improved the utilisation of HFs during delivery among PW. The study recommends that health workers should incorporate mobile T-M intervention strategy which has proven to be a useful tool during ANC.

Pengaruh Anemia dan Preeklampsia terhadap Kejadian Bayi Berat Lahir Rendah (BBLR)

Anemia and preeclampsia during pregnancy contribute significantly to the risk of low birth weight (LBW) in neonates. Anemia, characterized by hemoglobin levels below 11 g/dL in the first and third trimesters, and below 10 g/dL in the second trimester, and preeclampsia, which involves hypertension and organ dysfunction after 20 weeks of pregnancy, can interfere with the supply of oxygen and nutrients to the fetus, causing LBW. The study conducted a Literature Review of 840 articles, and found that anemia increased the risk of LBW by about 1.49 times, while preeclampsia also had a significant association with LBW. These findings suggest the importance of early detection and treatment of anemia and preeclampsia to improve neonatal health outcomes. Further research is needed to develop more effective interventions to address these conditions.

Synergistic Effect of Maternal Micronutrient Supplementation on ORFV DNA Vaccine Immune Response in a Pregnant Model.

Contagious ecthyma is a contagious zoonotic disease caused by the Orf virus that can infect farm animals and humans, but no vaccine is available for pregnant mothers. Excessive oxidative stress during pregnancy can suppress the vaccine immune response in pregnant mothers; hence, maternal micronutrient supplementation could effectively improve the immune response, health, and oxidative status during pregnancy. In this study, we employed an 8-week-old pregnant rat model to receive a single intramuscular dose of 200µg of ORF DNA vaccine with or without vitamin E and selenium supplementation to evaluate their effect on immune responses (specific IgG and IgG isotypes), oxidative stress, liver enzymes, and blood glucose levels in maternal-neonatal serum and milk secretions. Additionally, antioxidant-related gene expressions were analyzed in the maternal placenta and pups' liver. The results showed that supplementation of vitamin E and selenium with ORF DNA vaccination increased the production of specific antibody and IgG isotypes (IgG1 and IgG2a) and reduced the oxidative stress in neonatal-maternal serum and milk compared to both the control group and those vaccinated without supplementation (p < 0.05). Notably, the ORF DNA vaccine did not cause oxidative stress and hepatic damage. However, combined supplementation of vitamin E and selenium with DNA vaccination significantly decreased serum malondialdehyde (MDA) levels and improved the antioxidant-related enzyme activities of glutathione peroxidase (GPX), superoxide dismutase 1 (SOD1), and selenoprotein P (SELP) in the maternal placenta and liver of pups (p < 0.05). In conclusion, maternal supplementation of vitamin E and selenium enhanced the immune responses of the ORF DNA vaccine by mitigating oxidative stress in pregnant rats and could thus be a promising strategy for better health outcomes for both mothers and neonates.

Integrating support persons into maternity care and associations with quality of care: a postpartum survey of mothers and support persons in Kenya

BackgroundDespite research that has shown that the presence of support persons during maternity care is associated with more respectful care, support persons are frequently excluded due to facility practices or negative attitudes of providers. Little quantitative research has examined how integrating support persons in maternity care has implications for the quality of care received by women, a potential pathway for improving maternal and neonatal health outcomes. This study aimed to investigate how integrating support persons in maternity care is associated with multiple dimensions of the quality of maternity care.MethodsWe used facility-based cross-sectional survey data from women (n = 1,138) who gave birth at six high-volume facilities in Nairobi and Kiambu counties in Kenya and their support persons (n = 606) present during the immediate postpartum period. Integration was measured by the Person-Centered Integration of Support Persons (PC-ISP) items. We investigated quality of care outcomes including person-centered care outcomes (i.e., Person-Centered Maternity Care (PCMC) and Satisfaction with care) and clinical outcomes (i.e., Implementation of WHO-recommended clinical practices). We used fractional regression with robust standard errors to estimate associations between PC-ISP and care outcomes.ResultsCompared to low integration, high integration (≥four woman-reported PC-ISP experiences vs. <4) was associated with multiple dimensions of quality care: 3.71%-point (95% CI: 2.95%, 4.46%) higher PCMC scores, 2.76%-point higher (95% CI: 1.86%, 3.65%) satisfaction with care scores, and 4.43%-point (95% CI: 3.52%, 5.34%) higher key clinical practices, controlling for covariates. PC-ISP indicators related to communication with providers showed stronger associations with quality of care compared to other PC-ISP sub-constructs. Some support person-reported PC-ISP experiences were positively associated with women’s satisfaction and key practices.ConclusionsIntegrating support persons, as key advocates for women, is important for respectful maternity care. Practices to better integrate support persons, especially improving communication between support persons with providers, can potentially improve the person-centered and clinical quality of maternity care in Kenya and other low-resource settings.

BMI modifies the effect of pregnancy complications on risk of small- or large-for-gestational-age newborns.

Maternal physical condition (reflected by maternal body mass index (BMI) at delivery) and pregnancy complications influence neonatal health outcomes. High BMI during pregnancy increases various health problems' risks, but studies about the synthesized effect of these factors on fetal growth, are scarce. The retrospective cohort study was conducted in Zhejiang Province, China from 1 January 2019 to 31 December 2021. The associations between complications and small-for-gestational-age (SGA) and large-for-gestational-age (LGA) were measured by the Fine-Gray model and subgroup analysis. Effect modification and interaction analyses were conducted to explore BMI's modification effect and complications' interaction. Several complications increased the risk for SGA and LGA, some significance varied in different subgroups. There was a positive effect modification of gestational diabetes mellitus (GDM) across BMI strata on LGA (relative excess risk due to interaction (RERI) [95% CI] = 0.57 [0.09,1.04]). Several pairwise complications' interactions were synergistic (e.g., pregestational diabetes and intraamniotic infection for SGA (ratio of ORs [95% CI] = 8.50 [1.74,41.37]), pregestational diabetes and assisted reproductive technology (ART) for LGA (ratio of ORs [95% CI] = 2.71 [1.11,6.62])), one was antagonistic (placental problems and ART for LGA (ratio of ORs [95% CI] = 0.58 [0.35,0.96])). High-BMI positively modified the risk of GDM on LGA. Many interactions existed when two specific pregnancy complications occurred simultaneously. This is the largest retrospective study covering more than 10 pregnancy complications to date in this aspect. High-BMI (BMI > 28 kg/m2) positively modifies the risk of GDM on LGA. Many pregnancy complications influence the risk of SGA and LGA, with several interactions that may create a "syndrome" effect. Pregnant women with different BMIs should consider the additional risks caused by pregnancy complications for their heterogeneous effects on abnormal fetal growth. Measures should be taken to prevent the occurrence of other exposure factors in the "syndrome". This study may aid in developing a new strategy for improving neonatal outcomes.