High Parity Research Articles

Assessing the Relationship between Short Birth-to-Pregnancy Interval and the Maternal and Perinatal Outcomes among Multiparous Women in Northern Ghana

Introduction: The World Health Organization (WHO) recommends an optimal Birth-to-Pregnancy Interval (BPI) of 24-59 months, or a 33-month interval between two successive births, to reduce the risk of untoward maternal and newborn outcomes. Short Birth to Pregnancy Interval (SBPI) and unmet need for Family Planning (FP) are the major contributors to rapid population growth and increased maternal and newborn mortalities. The purpose of this study was to assess the adverse perinatal and maternal outcomes associated with SBPI among multiparous women in three municipalities of the Upper East Region (UER) of Ghana.
 Materials and Methods: We employed a cross-sectional design conducted among 904 women aged 15-49 attending Antenatal Care (ANC) clinics in three municipalities in the UER who had at least two successive live births prior to data collection. A multistage cluster sampling technique was employed to recruit respondents for this study. This was conducted in four steps. Out of the 46 health facilities, we randomly selected 25 respondents using the systematic random selection method. Data was collected using a structured questionnaire, incorporated into the electronic data collection tool (Kobo collect), and administered by trained research assistants. Birth interval was categorized according to the WHO’s classification: <24 months as SBPI, 24-≥59 months as Optimal Birth to Pregnancy Interval (OBPI), and >59 months as Long Birth to Pregnancy Interval (LBPI).
 Results: Of the 904 respondents, the majority (56.2%) had an OBPI, while 36.9% had a SBPI. Factors that influenced SBPI were parity, mode of delivery, and the educational status of woman’s partner. Participants with a higher parity (≥5 children) had 0.67 times the potential of spacing their births (AOR 0.67; 95% CI 0.46-0.98; p = 0.040). Women who experienced a Caesarean Section (CS) delivery were 3.28 times more likely to have LBPI (AOR 3.28; 95% CI 1.02–10.62; p=0.047). Respondents whose partners had secondary education had a 1.87 chance (AOR 2.07; 95% CI 1.09–3.96; p=0.027) of spacing their births. The birth complications reported were retained products of conception (41.9%), pregnancy-induced hypertension (27.9%), postpartum hemorrhage (11.6%), obstructed labor (10.5%), sepsis (38.1%), neonatal jaundice (23.8%), low birth weight (19%), and preterm birth (14.3%).
 Conclusion: A significant proportion of the participants in this study reported having a short duration between the birth of one child and the conception of the next. This was associated with various adverse maternal and perinatal outcomes, such as birth complications and mortalities. The study emphasizes the need for health professionals to address challenges in contraceptive uptake, especially among multiparous women, and promote optimal birth spacing to improve maternal and perinatal outcomes.

Trends, patterns and predictors of high-risk fertility behaviour among Indian women: evidence from National Family Health Survey.

Numerous studies have demonstrated that high-risk fertility behaviour (HRFB), which includes maternal age below 18 or above 34 years, short birth intervals (less than 24 months), and high parity (birth order above 4), is associated with adverse maternal and child health outcomes. There is a substantial research gap in the domain of high-risk fertility behaviour in the Indian context. Therefore, this study is designed to investigate the current trends and patterns in the prevalence of high-risk births among Indian women, with a primary focus on identifying contributing factors associated with this prevalence. The study utilized data from the nationally representative National Family Health Survey (NFHS), which has been conducted in five rounds since 1992-93. Data from all rounds were used to assess the overall trend. However, data from the most recent round of NFHS, conducted during 2019-21, were employed to evaluate current levels and patterns of HRFB prevalence and to identify socio-economic and demographic predictors of HRFB using binomial and multinomial logistic regression models. The prevalence of HRFB has exhibited a consistent decreasing pattern from 1992 to 93 to 2019-21 in India. However, 29.56% of married women continue to experience high-risk births with notably higher rates in several states (e.g., 49.85% in Meghalaya and 46.41% in Bihar). Furthermore, socio-demographic factors like wealth index, educational level, social group, religion, mass media exposure, family size, age at marriage, type and region of residence, and reproductive factors like birth intention, place and type of delivery, ANC visits and current contraceptive use were identified as significant predictors of high-risk births among women in India. Despite a 20.4 percentage point decline in HRFB prevalence over the past three decades, a significant proportion of women in specific regions and demographic subgroups continue to experience high-risk births. Therefore, the present study recommends interventions aimed at preventing high-risk births among women in India, with particular emphasis on states with high HRFB prevalence and women from socioeconomically disadvantaged backgrounds.

Characterization of per- and polyfluoroalkyl substances (PFAS) concentrations in a community-based sample of infants from Samoa

Per- and polyfluoroalkyl substances (PFAS) are persistent contaminants with documented harmful health effects. Despite increasing research, little attention has been given to studying PFAS contamination in low- and middle-income countries, including Samoa. Using data and biosamples collected through the Foafoaga o le Ola (“Beginning of Life”) Study, which recruited a sample of mothers and infants from Samoa, we conducted an exploratory study to describe concentrations of 40 PFAS analytes in infant cord blood collected at birth (n = 66) and infant dried blood spots (DBS) collected at 4 months post-birth (n = 50). Of the 40 PFAS analytes tested, 19 were detected in cord blood, with 10 detected in >50% of samples (PFBA, PFPeA, PFOA, PFNA, PFDA, PFUnA, PFTrDA, PFHxS, PFOS, and 9Cl-PF3ONS); and 12 analytes were detected in DBS, with 3 detected in >50% of samples (PFBA, PFHxS, and PFOS). PFAS concentrations were generally lower than those reported in existing literature, with the exception of PFHxS, which was detected at higher concentrations. In cord blood, we noted suggestive (p < 0.05) or significant (p < 0.006) associations between higher PFHxS and male sex; higher PFPeA and residence in Northwest ‘Upolu (NWU) compared to the Apia Urban Area (AUA); lower PFUnA and 9Cl-PF3ONS and greater socioeconomic resources; lower PFOA and higher parity; higher PFDA and higher maternal age; and lower PFUnA, PFTrDA, and 9Cl-PF3ONS and higher maternal BMI. In DBS, we found suggestive (p < 0.05) or significant (p < 0.025) associations between lower PFBA and residence in NWU versus AUA; lower PFBA and PFHxS and higher maternal age; and higher PFBA and higher maternal BMI. Finally, we observed associations between nutrition source at 4 months and DBS PFBA and PFHxS, with formula- or mixed-fed infants having higher concentrations compared to exclusively breastfed infants. This study represents the first characterization of PFAS contamination in Samoa. Additional work in larger samples is needed to identify potentially modifiable determinants of PFAS concentrations, information that is critical for informing environmental and health policy measures.

Trends in Twin Births and Survival in Bangladesh: An Analysis of Half a Century of Evidence.

This study assessed the trends in twin births and their survival in Bangladesh by analyzing over a quarter million live births during 1970-2018, pooled from all eight rounds of the Bangladesh Demographic and Health Survey. In these five decades, the twinning rate increased by 1.5 times, from 5.8 to 8.6 twins per 1000 maternities. The decadal twinning rates varied across maternal age, parity, body mass index, household wealth index, and geographic region. The gap in decadal neonatal, infant, and under-five cumulative survival probability between singleton and multiple births was found to be closing, using Kaplan-Meier curves. Child mortality decreased by 80% and 60% in singleton and multiple births respectively. However, the absolute size of child mortality in multiple births remained six times higher than in singletons and was concentrated in the neonatal period. The share of multiple births surged in all types of child mortality. We predict a further and faster rise in multiple births in the coming decades in the face of upward trends in maternal age overlapping with higher parities, education, career prospects, contraceptive use, and the future demand-supply of assisted reproductive technology. A particular focus on the improvement of perinatal and neonatal care with wider availability is warranted. Otherwise, increased multiple births might raise child mortality and create public health challenges.

Asuhan Kebidanan Komprehensif Pada Ny. I Umur 32 Tahun Dengan Grande Multipara Dan Kurang Energi Kronik Di Puskesmas Bumiayu Tahun 2023

High parity pregnancies increase the risk of complications for both the mother and fetus. In the Bumiayu Community Health Center alone in 2021-2022 there were 45 cases of mother with grande multipara. To provide Comprehensive Midwifery Care service to pregnant, maternity, newborn, postpartum and family planing sevices in a comprehensif manner though a midwifery management approach according to Varney and SOAP. Based on the bacground above, the problem formulation is how to provide comprehensive midwifery care for Mrs. I aged 32 years in the Bumiayu Community Health Center, Brebes Regency in 2022. The author uses a quality descriptive research method with a case study approach. In pregnancy cases of anemia and CED were found, partus precipitatus birth accurred. As well as giving formula milk to babies and lack of personal hygiene in neonatus and the normal postpartum periode. Grande Multipara Comprehensive Midwifery Care, Presipitatus delivery, giving formula milk to babies, and lack of personal hygiene with newborn and normal postpartum bebies.

RISK FACTORS, MATERNAL, AND PERINATAL OUTCOME OF FETAL MACROSOMIA

Objective: Macrosomia is characterized by a birth weight exceeding 4000 g, regardless of gestational age, or &gt;90th percentile for gestational age. This condition is linked to significant risks of maternal and neonatal morbidity and mortality. Globally, the prevalence of infants weighing ≥4000 g is estimated to be 9%. Various risk factors contribute to the development of fetal macrosomia, including a high pre-pregnancy body mass index (BMI), excessive weight gain during the antenatal period, high parity, male gender of the fetus, prolonged pregnancy, and maternal diabetes mellitus. Methods: A retrospective cross-sectional study was undertaken in the Department of Obstetrics and Gynecology at GIMSR Teaching Hospital, over a 5-year period from May 2018 to May 2023. The study encompassed all singleton pregnancies with a birth weight equal to or exceeding 4000 g, irrespective of the delivery method. Maternal and neonatal records for the study population were systematically collected, and data were documented. Results: Throughout the study duration, there were 167 cases where the birth weight equalled or exceeded 4,000 g. Most common maternal complication was prolonged labor and postpartum hemorrhage. Shoulder dystocia was seen in 2.9% of all deliveries and 10.8% of all vaginal deliveries. Most common neonatal complication was hypoglycemia. Conclusion: The prevalence of macrosomia in our study was 3.86%. Main risk factors identified in our study were male gender, pre pregnancy BMI &gt;25, previous macrosomic births, and excessive weight gain during pregnancy.

Analysis of Age and Gravidity Factors with the Occurrence of Prolonged Parturition in the Midwifery Room of the Viqueque City District Hospital, Timor-Leste

Prolonged or obstructed labor constitutes 8% of the causes of maternal mortality globally and is also the cause of fetal death. One of the causes of prolonged labor is maternal age and gravidity. The purpose of this study was to analyze the factors of age and adolescence with the incidence of prolonged labor in the midwifery room of the Viqueque City Hospital, Tomor Leste.This study used an analytical research design with a cross sectional approach. The population was all women who gave birth for a long time in the midwifery room of the Viqueque City Hospital, Timor Leste, which could be 30 people. The sampling technique used accidental sampling. The research instrument used a questionnaire and observation sheet. The data analysis used Chi Square statistical test.The results showed that more than half of the respondents (66.7%) aged 20-35 years were 20 respondents and more than half (53.3%) were multigravidas as many as 16 respondents, more than half (60%) did not occur during prolonged labor, namely as many as 18 respondents.Based on the results of statistical tests using Chi Square calculations, it is not known that no one knows it is 0.002 &lt;0.05 so it can be shown that there is a relationship between the incidence of prolonged labor.Women with higher parity are at higher risk of prolonged labor because the uterus has weakened the uterine wall muscles due to a previous pregnancy. The solution that needs to be done regarding the results of the above research is to enable health education about the causes and risk factors for the old party to the mother by health workers and early detection of risk factors for prolonged labor must be improved.

Prevalence, risk factors and genotype distribution of human papillomavirus infection among women with and without invasive cervical cancer: Findings from a hospital-based study in Bihar, India.

Background Human papillomavirus (HPV) infection is largely responsible for the development of invasive cervical cancer (ICC). Its prevalence, risk factors and genotype distribution among women residing in Bihar (third most populous Indian state) with and without ICC are not well known. Methods In this hospital-based study, we followed up 1439 participants with cytology and HPV report. HPV detection and genotyping were performed using the TaqMan-based real-time PCR method. Clinical and sociodemographic data were collected and analysed using statistical methods. Results The overall prevalence of HPV infection was 37.3% (537/1439) and 11 different types of HPV genotypes were observed. Higher HPV positivity was found in premalignant, intraepithelial and invasive malignant lesions of the cervix; 73.8% (93/126) of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) and high-grade squamous intraepithelial lesions (HSIL) and 93.4% (114/122) of invasive malignancies were infected with HPV in comparison to only 26.1% (245/938) of negative for intraepithelial lesion or malignancy (NILM) cytology. Moreover, HPV was found in 95.2% (236/248) of histologically confirmed cases of carcinoma cervix. HPV16 and HPV18 infections were reported in 78.2% (194/248) and 8.9% (22/248), respectively. The remaining patients had infection with other high-risk strains/co-infection with multiple strains or were HPV-negative. Various socio-demographic factors including women >50 years of age, >10 years of marriage and high parity were significantly associated with HPV infection. Conclusion Our data suggest that HPV16 infection may be the major cause for ICC among women residing in Bihar. Our findings may serve as a baseline for developing an appropriate screening and vaccination strategy for Bihar.

Double burden of malnutrition and associated factors among women of reproductive age in sub-Saharan Africa: a multilevel multinomial logistic regression analysis

BackgroundGlobally, malnutrition among women of reproductive age is on the rise and significantly contributing to non-communicable disease, deaths and disability. Even though the double burden of malnutrition (DBM) is a...

Assessing the Relationship between Short Birth-to-Pregnancy Interval and the Maternal and Perinatal Outcomes among Multiparous Women in Northern Ghana

Introduction: The World Health Organization (WHO) recommends an optimal Birth-to-Pregnancy Interval (BPI) of 24-59 months, or a 33- month interval between two successive births to reduce the risk of untoward maternal and newborn outcomes. Short Birth to Pregnancy Interval (SBPI), and unmet need for Family Planning (FP) are the major contributors to rapid population growth and increased maternal and newborn mortalities. The purpose of this study was to assess the adverse perinatal and maternal outcomes associated with SBPI among multiparous women in three municipalities of the Upper East Region (UER) of Ghana. Materials and Methods:The study employed the Cross-sectional Design conducted among 904 women aged 15-49 years attending Antenatal Care (ANC) clinics in three municipalities in the UER who had at least two successive live births prior to data collection. Data was collected using structured questionnaire, incorporated into the electronic data collection tool, Kobo collect and administered by trained research assistants. Birth interval was categorized according to the WHO’s classification, &lt;24 months as SBPI, 24-≥59 months as Optimal Birth to Pregnancy Interval (OBPI) and &gt;59 months as Long Birth to Pregnancy Interval (LBPI). Results: Of the 904 respondents, the majority (56.2%) had an OBPI, while 36.9% had a SBPI. Factors that influenced SBPI were parity, mode of delivery, and the educational status of women’s partner. Participants with a higher parity (≥5 children) had 0.67 times the potential of spacing their births (AOR 0.67; 95% CI 0.46-0.98; p = 0.040). Women who experienced a Caesarean Section (CS) delivery were 3.28 times more likely to have LBPI (AOR 3.28; 95% CI 1.02-10.62; p=0.047). Respondents whose partners had secondary education had a 1.87 chance (AOR 2.07; 95% CI 1.09-3.96; p=0.027) of spacing their births. The birth complications reported were retained products of conception (41.9%), pregnancy-induced hypertension (27.9%), postpartum hemorrhage (11.6%), obstructed labor (10.5%), sepsis (38.1%), neonatal jaundice (23.8%), lowbirth-weight (19%), and preterm birth (14.3%). Conclusion and Global Health Implications: The study recommends health professionals in direct contact with maternal, reproductive, and child health to be proactive in FP counseling, and to support women decision making.

Family History of Twinning and Fertility Traits in Nigerian Mothers of Dizygotic Twins.

Familial twinning and fertility traits were investigated in Nigerian mothers of dizygotic (DZ) twins (MoDZT; N = 972) and controls (N = 525) who responded to our person-to-person interview, which included questions on pregnancy history and family history of DZ twinning. Controls were defined as women who are not twins themselves and do not have twins in their first-degree relatives. Over 95% of the participants were Yoruba. We found that Nigerian MoDZT had an average of 4.0 (±2.6) pairs of twins among their relatives, and of these, the prevalence of DZ twins was significantly higher than that of monozygotic (MZ) twins (45.9% vs. 25.8%). Controls had an average of 0.5 (±0.4) pairs, and over 95% of the controls had no twins in their relatives. These results suggest genetic influences on DZ twinning in Nigerians. MoDZT were significantly younger in their mean age at first child, and had higher parity than controls, suggesting increased fertility in MoDZT. As compared to mothers with a single set of twins, mothers (N = 130) with multiple sets had significantly more twins among their relatives (5.4 pairs vs. 3.7 pairs) and had their first twins at a younger age (28.4 vs. 30.7 years), indicating that mothers with multiple sets of twins might have higher genetic propensity for twinning associated with earlier age at twin pregnancy. Our findings argue for genomewide association studies for DZ twinning in Nigerians, and may help to develop intervention strategies to overcome infertility/subfertility problems.

Determinants Of Retained Placenta At Malinau Hospital, North Kalimantan

Malinau Regency health profile data in 2018 recorded 268 deliveries, and 38 cases (14.1%) of them experienced retained placenta. Factors that cause retained placenta are placenta previa, caesarean section scar, repeated curettage, age, history of manual placenta, anemia, history of surgery and parity. Remaining placental remains in the uterus can cause weakened contractions which can cause postpartum bleeding. The aim of this study was to determine the determinants of the incidence of retained placenta in Malinau District Hospital, North Kalimantan.This research uses design correlational research with cross sectional approach. Respondents are recruited using accidental Sampling techniques with a sample of 36 people. Independent variables were parity and history of retained placenta. The dependent variable is incidence of retained placenta. Statistical test results using chi square.The research results showed that the majority of mothers giving birth at Malinau District Hospital had high parity, namely 23 (63.9%). The majority of mothers giving birth at Malinau Regional Hospital had a history of placental retention, 21 (58.3%), and the majority of mothers giving birth at Malinau Regional Hospital experienced placental retention, namely 25 (69.4%). The results of data analysis show that the significance level is 0.000 &lt; α = 0.005 so that H0 rejected and H1 Thus, it is accepted that there is a relationship between parity and a history of placental retention with the incidence of retention at Malinau Regional Hospital, North Kalimantan.The conclusion in this research is mothers who have a history retained placenta and high parity tend to have a risk of retained placenta in the next delivery

Paradoxical and Unmasking HIV Immune Reconstitution Inflammation Syndrome in Antiretroviral-Naïve Pregnant Women: A Prospective Cohort Study.

Following antiretroviral therapy (ART) initiation, HIV-associated immune reconstitution inflammatory syndrome (IRIS), indicated by an array of opportunistic infections, may occur, presenting as either paradoxical, a worsening of a previously treated infection, or unmasking, a flare-up of an underlying, previously undiagnosed infection. The impact of ART as the backbone of HIV treatment and prevention has prolonged the survival of people living with HIV. In pregnancy, benefits have been shown by slowing HIV progression and preventing perinatal transmission; however, there have been risks of adverse reactions with ART, including immune responses to both the fetus and mother. This study sought to estimate the incidence of HIV-IRIS cumulatively and by type either paradoxical or unmasking IRIS, determine the baseline maternal and HIV clinical markers as predictors of, and analyze the log-rank test for survival time to IRIS outcome assessed by relying on an increase in CD4 count and/or a rapid decrease in viral load. An active records study was conducted between June 2019 and March 2020 among ART-naïvepregnant women attending the antenatal care units (ANCu) at the Kenyatta National and MbagathiHospitals, Nairobi, Kenya. Participants were aged between 20 and 49 years and had a confirmed HIV-positive test. To ascertain a true case of IRIS, the diagnosis was adjudicated for accuracy and consistency by an independent review committee. Plasma HIV viral load, CD4 counts, and routine laboratory evaluations (hemoglobin, white blood cell count (WBC)) were performed by each hospital's clinical laboratory. The IRIS incidence was assessed using the International Network for Studies Against HIV-Associated IRIS (INSHI) during the first three months after ART initiation. Multivariate Cox regression with IRIS as the outcome, using the SPSSSurvival package, examined the relationship between baseline maternal characteristics and HIV clinical markers before ART initiation and IRIS, and finally, decision-tree analysis for predicting IRIS was performed. From a pool of 532 ART-naïvepregnant women, 133 (25%) developed IRIS, and 97 (72.9%) were in the unmasking category. The accumulated risk of experiencing IRIS symptoms increased from week two (hazard ratio (HR)=0.0287) to week 12 (HR=3.6158). Participants with a maternal BMI (MBMI) of 25-29.9 kg/m2 at baseline were at a higher risk of unmasking IRIS (HR=2.478; P=0.010). The WHO-HIV clinical stages 1 and 2 skewed towards paradoxical IRIS (regression coefficients =-0.111 and -0.276 (P<0.05)), while stage 4 skewed towards unmasking IRIS (regression coefficient=0.047, HR=1.048, P=0.941). A CD4 count > 500 cells/mm^3 skewed towards unmasking IRIS (regression coefficient=0.192, HR=1.211, P=0.416), while RNA-HIV viral loads >50 copies/ml towards paradoxical IRIS (regression coefficient=-0.199, HR=0.820, P=0.360. On decision tree analysis, 85% (P=0.001) of ART-naïve pregnant women with a baseline CD4 count below 500 copies/mm^3 presented with unmasking IRIS. For ART-naïvepregnant women, unmasking IRIS is the most common type, and an MBMI of 25-29.9 kg/m2, advanced HIV infection, a CD4 count <500 cells/mm^3, and a higher parity at baseline may be clinically useful predictors. The higher proportion of ART-naïvepregnant women experiencing unmasking as compared to paradoxical IRIS supports the need for earlier assessment based on potential predictors.

Child rearing or childbearing? Risk of cardiovascular diseases associated to parity and number of children

BackgroundAn increased risk of cardiovascular diseases (CVD) has been associated with women’s parity, but whether or not this association reflects a direct pregnancy effect, or exposure to factors related to childrearing, still appears unclear. We assessed the CVD risk associated with number of children separately by gender and tested effect modification by socioeconomic position (SEP) and employment status, in order to elucidate the possible mechanisms underlying this association.MethodsThe study population was composed of 20,904 men and 25,246 women who were interviewed in one of two National Health Surveys conducted in 2000 and 2005 in Italy. These subjects were followed for CVD incidence up to 2014 through record-linkage with national archives of mortality and hospitalisations. CVD risk was estimated by Cox regression models that were adjusted for socio-demographics, perceived health, lifestyles, biological CVD risk factors and for other potential confounders.ResultsCVD incidence was significantly increased among men with 3 or more children (HR = 1.26, 95% CI: 1.02–1.56) and among women with 2 and with 3 or more children (HR = 1.42, 95% CI: 1.10–1.83; and HR = 1.39, 95% CI: 1.03–1.87, respectively) compared to subjects without children and no significant gender differences were observed. Subjects with lower SEP displayed stronger associations with parity and a higher number of children for both genders; by contrast, no modifying effect of employment status was observed.ConclusionsTaken together, the significant association between higher parity and CVD risk in both genders, and the higher risk of CVD associated with higher parity among lower SEP parents, suggests that childrearing has a potential effect on the development of CVD that is more pronounced among disadvantaged families, although a concurrent effect of childbearing cannot be completely excluded.

Association of parity with the prevalence of hypertension in Japan: The Tohoku Medical Megabank Community-based cohort study.

This study investigated the association of parity with hypertension prevalence in Japanese women while considering a clinical history of hypertensive disorders of pregnancy (HDP) and menopausal status. This cross-sectional study included 30,530 Japanese women (6700 premenopausal; 23830 postmenopausal). The association between parity and the prevalence of hypertension was evaluated using a multiple logistic regression model with possible confounders. In premenopausal women, no statistically significant association between parity and hypertension prevalence was found. When not adjusted for current body mass index (BMI), a linear graded association was observed between parity and the prevalence of hypertension in postmenopausal women. However, the association between parity and hypertension prevalence in postmenopausal women was attenuated after adjustment for current BMI. Both current BMI and a clinical history of HDP were significantly associated with a high risk of hypertension in both premenopausal and postmenopausal women. Our results also suggest that continuous surveillance and preventive measures for hypertension should be provided for women with HDP and high parity.

Determinants of late antenatal care attendance among high parity women in Uganda: analysis of the 2016 Uganda demographic and health survey

BackgroundTimely and adequate Antenatal Care (ANC) effectively prevents adverse pregnancy outcomes and is crucial for decreasing maternal and neonatal mortality. High-parity women (5 + children) are at higher risk of maternal mortality. Limited information on the late timing of ANC among this risky group continues to hamper Uganda’s efforts to reduce maternal mortality ratios and improve infant and child survival. This study aimed to determine factors associated with attendance of the first ANC after 12 weeks of gestation among high-parity women in Uganda.MethodsThis study was based on nationally representative data from the 2016 Uganda Demographic and Health Survey. The study sample comprised 5,266 women (aged 15–49) with five or more children. A complementary log-log regression model was used to identify factors associated with late ANC attendance among high-parity women in Uganda.ResultsOur findings showed that 73% of high parity women delayed seeking their first ANC visit. Late ANC attendance among high-parity women was associated with distance to the health facility, living with a partner, partner’s education, delivery in a health facility, and Desire for more children. Women who did not find the distance to the health facility when going for medical help to be a big problem had increased odds of attending ANC late compared to women who found distance a big problem (AOR = 1.113, CI: 1.004–1.234), women not living with partners (AOR = 1.196, 95% CI = 1.045–1.370) having had last delivery in a health facility (AOR = 0.812, 95% CI = 0.709–0.931), and women who desired to have another child (AOR = 0.887, 95% CI = 0.793–0.993) had increased odds compared to their counterparts.ConclusionsTo increase mothers’ timely attendance and improve maternal survival among high-parity women in Uganda, programs could promote and strengthen health facility delivery and integrate family planning with other services such as ANC and postnatal care education to enable women to seek antenatal care within the recommended first trimester. This study calls for increased support for programs for education, sensitization, and advocacy for health facility-based deliveries. This could be done through strengthened support for VHT and community engagement activities.

Twin births in Yucatan, Mexico during 2008–2020: trends in maternal sociodemographic factors and differences in birth weight and length according to sex of co-twin

Background: Over the years, there has been a noticeable increase in the incidence of multiple pregnancies, due in part to the increased use of assisted reproductive technologies in recent years. The increase in twin pregnancies constitutes a public health challenge due to the adverse outcomes sometimes they entail. Twin pregnancies inherently carry a higher risk of complications, and one of the critical associated factors is the risk of low birth weight. Twin birth weight discordance among different populations can be attributed to differences in non-shared environmental influences. The presence of two or more fetuses in the uterus may lead to an unequal distribution of nutritional and oxygen resources, increasing the likelihood that at least one of the twins will experience insufficient fetal development. Other factors, such as ethnicity, genetics, sociodemographic characteristics, gestational age, parity, and chorion type, have also been related to the birth weight discordance in twin pregnancies. However, it is unclear to what extent the associations between these factors can explain the differences in birth and length size. The frequency of twin births varies among populations and over time, so it is crucial to gain a deeper understanding of the factors contributing to the rise in the twinning rate. The official records of twins continue to make significant contributions to our understanding of the causes of individual differences, and new twin registries are still being created. The recent availability of data from developing countries allows the analysis of trends in regions with sociodemographic and reproductive profiles. Obtaining a more comprehensive understanding of the epidemiology, as well as the related morbidity and mortality, is clinically crucial. Objectives: The aim of the study was to describe the trends of twin births in Yucatan, Mexico during 2008–2021, analyze their association with maternal sociodemographic factors, and compare birth outcomes between types of twin pairs: female-female, male-male, and female-male. Methods: A retrospective cohort analysis was conducted using data from the Mexican Ministry of Health, encompassing information on all births registered in the State of Yucatán, Mexico, from 2008 through 2021. The data was obtained from both public and private hospitals. The variables, including date of birth, sex, gestational age, birth weight and length of newborns, mother´s date of birth, educational level, and number of previous live offspring, were extracted from each dataset. Multiple births (three or more) were excluded from the study. We graphically analyzed the rates (per 1000 births) and percentages of twins according to maternal age, education level, and parity during the study period. A multiple logistic regression model was used to analyze the association between maternal sociodemographic factors and the occurrence of twin births. Comparisons of the gestational age and birth weight and length between types of twin pairs were performed using analysis of variance. Results: A total of 478,118 live births, including 1.4% twins (accounting 6,766 twin births), were analyzed. The rates increased from 11.21 during 2008–2011 to 13.34 during 2012–2017 and reached 20.08 in 2019. The percentages increased in women aged ≥30 years and those with higher educational levels. Older maternal age (coefficient = 0.03; OR = 1.03, per each year), greater education level (coefficient = 0.55 and OR= 1.74 for medium and coefficient = 1.05; OR = 2.57 for high level, compared with no education) and higher parity (coefficient= 0.26; OR = 1.30 per each previous offspring) increased the odds for having twins. Twins’ male-male showed a slightly increased of preterm birth than a co-twin female. Opposite-sex twins showed measurable but small increases in birth weight and length compared with same-sex twins. Conclusion: The rate of twins in Yucatan increased substantially during 2008–2020 in specific sociodemographic groups. Opposite-sex twins were slightly larger than same-sex twins at birth.

Inequalities in use of hospitals for childbirth among rural women in sub-Saharan Africa: a comparative analysis of 18 countries using Demographic and Health Survey data

IntroductionRising facility births in sub-Saharan Africa (SSA) mask inequalities in higher-level emergency care—typically in hospitals. Limited research has addressed hospital use in women at risk of or with complications, such...

Factors Affecting the Utilization of Maternal and Child Health Services in Urban Primary Health Care Centers in Enugu State (Abakpa and Uwani)'

10.18103/mra.v12i1.5064 Background/Aim: Poor Maternal and Child Health service indicators have been a recurring Public Health challenge in Nigeria since the documentation of National Maternal, Newborn, and Child Health (NMNCH) statistics began in the early 1990s. This study was aimed at identifying the factors that affect the utilization of Maternal and Child Health services among women of childbearing age attending urban Primary Health Care centers in Enugu State (Abakpa and Uwani). Methodology: This was a retrospective and descriptive cross-sectional study and data was collected through a self-administered questionnaire. 296 respondents participated and analysis of data was done using Statistical Package for Social Sciences (SPSS) version 20.0. The findings revealed that the number of deliveries in the health centers was highest in 2018 with a total of 378 deliveries compared to 2016 &amp; 2017 with 280 and 254 deliveries respectively. The total number of under 5 children receiving yellow fever/ measles vaccine in the health center increased throughout the years with a total of 1493 vaccinations in 2016, 1510 in 2017, and 2083 in 2018. Results: It was also observed that the main factors that enhanced Maternal and Child Health (MCH) services in the health centers were decreased maternal age, maternal educational status, affordability of services rendered, good attitude of health workers, and the proximity of both health centers to the homes of the respondents. On the other hand, increased maternal age, poor maternal education, high parity, and long waiting hours experienced by the patients were the major factors hindering the utilization of services rendered in the health centers. Conclusion: To improve utilization of MCH services as identified by the women include; advocacy and sensitization campaigns, community dialogue, and upgrading of the existing health care centers.

Children's sex composition and modern contraceptive use among mothers in Bangladesh.

The stagnation and relatively low use of modern contraceptives are ongoing public health concerns in Bangladesh and other low- and middle-income countries. Although a cultural preference for sons may be linked to the current use of contraceptives, this linkage has not been adequately explored in the Bangladesh context. We investigated the effects of child sex composition on the current use of modern contraceptives. We extracted and analysed data from 17,333 women who participated in the 2017/18 Bangladesh Demographic and Health Survey. The outcome variable was the current use of modern contraceptive methods. The study factor was the parity and sex composition of the living children. We used multilevel logistic regressions to determine the association between the study factor and outcome variables, adjusting for potential covariates at the individual-, household-, and community-levels. Women with relatively high parity had higher odds of currently using modern contraceptives. Among the individual parities, compared to women with no live sons, women with one or more live sons were more likely to report currently using modern contraceptives. However, this association is significant for women up to three children. When examining both parity and children's sex composition in a regression model, in each parity category, the likelihood of using modern contraceptives tend to rise with an increasing number of sons compared to women with just one daughter. The findings of this study suggest that while the use of modern contraceptives by women increases with the increasing number of children and son preference is prevalent in Bangladesh, women also want to have a mixed composition of son and daughter. The study findings can be used in family planning programmes to customise contraceptive promotion and counselling messages.