High Maternal Mortality Research Articles

Lateral Flow Assay for Preeclampsia Screening Using DNA Hairpins and Surface-Enhanced Raman-Active Nanoprobes Targeting hsa-miR-17-5p

Preeclampsia (PE) is a serious complication that poses risks to both mothers and their children. This condition is typically asymptomatic until the second or even third trimester, which can lead to poor outcomes and can be costly. Detection is particularly challenging in low- and middle-income countries, where a lack of centralized testing facilities coincides with high rates of PE-related maternal mortality. Variations in the levels of hsa-miR-17-5p have been identified as constituting a potential early indicator for distinguishing between individuals with PE and those without PE during the first trimester. Thus, developing a screening test to measure hsa-miR-17-5p levels would not only facilitate rapid detection in the early stages of pregnancy but also help democratize testing globally. Here, we present a proof-of-principle lateral-flow assay (LFA) designed to measure hsa-miR-17-5p levels using DNA-hairpin recognition elements for enhanced specificity and nanoprobes for sensitive surface-enhanced resonance Raman scattering (SERS) signal transduction. The theoretical limit of detection for hsa-miR-17-5p was 3.84 × 10−4 pg/µL using SERS.

Bibliometric Analysis of Risk Factors Contributing to Maternal Mortality: Trends and Research Directions

ABSTRACT Maternal mortality remains a significant global health challenge, with high maternal mortality rates in many parts of the world being a key indicator of disparities in maternal health care. While great efforts have been made to reduce these mortality rates, the various contributing risk factors remain a major focus of efforts. This study aimed to conduct a bibliometric analysis of the scientific literature addressing risk factors contributing to maternal mortality over the period 2017 to 2024. In this study, data was obtained from 50 relevant articles retrieved from Google Scholar using Publish or Perish software. The articles were filtered based on relevance and analyzed in depth. The data collected included information on publication year, country of origin, publisher, number of citations, and article type. To generate a comprehensive bibliometric map, VOSviewer was used with the parameters of occurrence of at least 4 and 19 terms, as well as network visualization, overlay, and density. The analysis showed that research on maternal mortality has consistently focused on various risk factors and aspects of maternal health, with a significant emphasis on factors related to pregnancy complications, postnatal care, and socioeconomic health conditions. Developed countries such as the United States are often the primary location of research, indicating a high concentration of studies in these countries. In addition, the research highlighted consistent attention to the importance of adequate health care and specific health issues faced by pregnant women. The analysis also revealed that key themes in the current literature include the management of postpartum hemorrhage, postpartum infections, and the influence of socio-economic factors on maternal health. This study provides valuable insights into current research directions and trends in maternal health and underscores the importance of continuing to identify and mitigate risk factors that contribute to maternal mortality. The findings are expected to guide the development of more effective interventions and health policy strategies that can reduce maternal mortality globally and improve maternal health outcomes worldwide. Keywords: Maternal Mortality, Risk Factors, Bibliometric Analysis, Healthcare Interventions, Research Trends

Prophylactic red cell transfusions for sickle cell disease pregnancy: increased use of therapy could transform outcomes.

Pregnancy for people with sickle cell disease (SCD) is high risk with persistently high rates of severe maternal and fetal mortality and morbidity. Transfusion therapy is the best-studied treatment for SCD in pregnancy; hydroxyurea is not usually used because of teratogenicity concerns. In high-resource settings, red cell transfusions are likely underutilized, while in low-resource settings, they may be altogether unavailable. A randomized controlled trial and meta-analysis, two of the strongest forms of clinical research, show transfusion significantly reduces maternal and fetal death, painful crisis, thrombosis, and acute respiratory failure. Downstream benefits of treatment are less well measured and may include improving maternal anemia, reducing opioid exposure, and avoiding hospitalization, which presents risk for additional complications. Alloimmunization is a particular transfusion risk in SCD. However, many strategies can mitigate this risk. Accordingly, the American Society of Hematology classifies chronic transfusion in pregnancy as low risk. Given the low risk classification, lack of alternative therapies, dismal, stagnant pregnancy outcomes and the potential for profound treatment benefit, wider use of chronic transfusion therapy for SCD pregnancy is likely indicated. This review discusses the benefits and potential risks of prophylactic transfusions for SCD pregnancy. Use of chronic transfusions during pregnancy is indicated to help urgently transform outcomes.

Agenda 2030 for sustainable development in Portuguese Speaking Countries, indicators inequalities

Abstract Background Achieving the SDG Sustainable Development goals represents a major global challenge. The Community of Portuguese Speaking Countries (CPLP) is made up of countries: Angola, Cape Verde, Guinea-Bissau, Equatorial Guinea, Mozambique, São Tomé and Príncipe, Brazil, Portugal, and East Timor. Studies on SDG indicators are little studied among these countries. The study analyzes SDG health indicators in the Community of Portuguese Speaking Countries (CPLP) and their projections for 2030, and investigates the correlation between the countries’ level of development and the performance of these indicators. Methods Ecological epidemiological study. Estimates from the Global Burden of Disease (GBD) study between 1990 and 2021 were analyzed, referring to fifteen indicators: universal health coverage, sanitation, smoking, maternal and child health, vaccination coverage and communicable diseases. The GBD study generated projections by calculating the annual change since 1990 for each country and year and then calculating the weighted annualized rate of change. The correlation between the Sociodemographic Index (SDI) and the SDG indicators was investigated using the Spearman test, at a significance level of 5%. Results The best performances of the analyzed indicators were seen for Portugal, followed by Brazil, Cape Verde and São Tomé and Príncipe. In other countries, high rates of infectious diseases, maternal and childhood mortality, malnutrition, low vaccination coverage and sanitation were observed. There was a negative correlation between the SDI and the indicators of childhood mortality rate (R=-0.82; p < 0.05), malnutrition (R=-0.7; p < 0.05), incidence of tuberculosis (R =-0.73; p < 0.05) and positive between SDI and sewage coverage (R=-0.83; p < 0.05). Conclusions The CPLP presents internal differences regarding the health indicators analyzed, making it essential to advance cooperation between countries to achieve the SDG targets in 2030. Key messages • There are great inequalities between SDG indicators in Portuguese-speaking countries. • It is important to advance technical cooperation between countries to formulate solutions and leave no one behind.

Influence of socio-economic factors on obstetric morbidity in Eastern India: A study based on NFHS 5

Abstract Background Obstetric morbidity encompasses health issues related to pregnancy or childbirth, excluding accidental causes. The whole process of childbearing is not just a biological phenomenon, rather it is governed by personal, social, cultural, and institutional factors. The entire eastern region of India including the four provinces of Bihar, Jharkhand, Odisha, and West Bengal is susceptible to high maternal mortality and morbidity. It presents a strong background to further envisage the factors responsible for such situation. Thus, the study aims to explore regional variations and socio-economic factors associated with obstetric morbidity among women in eastern India. Methods This study uses data from the 2019-2021 National Family and Health Survey (NFHS 5). The explanatory variable, obstetric morbidity, includes issues during pregnancy and delivery- vision difficulties, bleeding, swelling, convulsions, fever, breech presentation, and prolonged labor. Predictor variables include age, age at marriage and first birth, wealth index, residence, toilet facility, caste, working status, media exposure, religion, birth order, and education level. Bivariate and binary logistic regression analyses have been used as a methodological tool. Results In the eastern region, 53.76% women experience obstetric issues. Women belonging to 15-24 years with higher educational attainment increases the prevalence of obstetric morbidity. The probable reason is, with education, awareness about reproductive morbidity increases and in turn the reporting for morbidity increases. Therefore, the findings showed age, educational attainment, wealth quintile, media exposure, residence, work status, birth order and toilet facilities are highly associated with obstetric morbidity among women. Conclusions Implementing of targeted interventions, and awareness campaigns are crucial to reducing obstetric complications and maternal mortality in the eastern region of India Key messages • Socioeconomic correlates impact obstetric morbidity in eastern India in manifolds especially education, age, and wealth quintile of women in eastern India. • Obstetric morbidity is a growing concern in eastern India, thus implementing targeted interventions and awareness campaigns are much needed.

Stolen Childhood and Desolate Future: On Child Marriage in the Makawanpur's Chepang Community

Child marriage remains a critical issue not only in Nepal but globally, predominantly affecting South Asia, Africa, and Latin America. In Nepal, the Terai region, rural areas, particularly among economically disadvantaged and Dalit communities, faces alarmingly high rates of child marriage. Main objective of this study is to investigate the causes and consequences of child marriage in the Chepang Community. This phenomenon is driven by poverty, social pressure to maintain ties, and the misconception that it offers protection. ADD Primary data has directly been taken from the Chepang community through interview, and Previous studies, book, articles, bulletin, journal are used as a secondary data. This paper employs qualitative research methods, including semi-structured interviews with twenty households and case studies involving two Chepang women, to explore the causes and consequences of child marriage in the study area. Its consequences are profound, directly impacting girls' health and education. Many girls drop out before completing primary education due to domestic responsibilities like cooking and household chores. Early pregnancies, despite physical immaturity, contribute to high maternal and child mortality rates. The statement effectively highlights the multifaceted issue of child marriage in the Chepang community, touching on key factors such as socio-cultural norms, purity, economic pressures, and educational limitations. It also emphasizes the negative impacts of early marriage on health, education, and economic independence, reinforcing cycles of poverty and gender inequality. The proposed solutions education, legal enforcement, awareness, and promoting gender equality are crucial for addressing this issue. However, a deeper exploration of specific interventions tailored to the Chepang community's context could further strengthen the argument.

Factors associated with modern contraceptive utilization among reproductive age women in Cambodia; evidenced by the recent Cambodia demographic and health survey

IntroductionCambodia is a low-income country with limited access to family planning (FP) in terms of modern contraceptive utilization. Despite several FP programs designed to make contraceptives accessible, adoption of contraceptives has been difficult in Cambodia, which has high rates of fertility and maternal mortality. This gap in essential care can put women and adolescent girls at greater risk of adverse outcomes such as stillbirth, spontaneous abortion, unwanted pregnancy, or even maternal death. One of the goals set by the government to decrease both maternal and child mortality and morbidity was increasing the modern contraceptives utilization. So, the main objective of this study was to evaluate spatial variations in modern contraceptives utilization and its contributing factors among women.MethodsData from the Cambodia 2021–22 Demographic and Health Survey datasets were used for secondary data analysis. A total of 19,496 women of reproductive age participated in the study. A spatial and multilevel mixed effects analysis was done on the factors affecting modern contraceptives utilization among Cambodian women. Finally, the percentage, odd ratio, together with their 95% confidence intervals and the results of the spatial analysis were provided.ResultThe prevalence of modern contraceptive use was 31.2% in Cambodia. Living in an urban area [AOR = 1.224; 95% CI = (1.126.1.330); P = 0.0001]; being married [AOR = 34.131; 95% CI= (12.673, 91.921); P = 0.0001]; and having a history of terminated pregnancy [AOR = 1.137; 95% CI= (1.055, 1.225); P = 0.0001] were found to be positively associated with modern contraceptive utilization. In contrast to this, being between the age range of 46–49 [AOR = 0.421; 95% CI = (0.364, 0.487); P = 0.0001]; being a female-headed household [AOR = 0.784; 95% CI = (0.723, 0.850); P = 0.0001]; and current breast feeding [AOR = 0.84; 95% CI = (0.75, 0.93); P = 0.010] were found to be negatively associated with modern contraceptive utilization. Additionally, the spatial analysis of modern contraceptive utilization showed that a higher proportion was utilized in the southern and southwest regions of Cambodia.ConclusionIn this study, living in urban area, being married and having history of terminated pregnancy were found positively associated with modern contraceptive utilization. In contrast to this, being old age, being female headed household and being currently breast-feeding women were found negatively associated with modern contraceptive utilization. In addition to this, there were geographic (spatial) variations in modern contraceptive utilization among Cambodian’s women across the country.

Individual and community-level factors associated with adequate antenatal care service utilization in sub-Saharan Africa

BackgroundSub-Saharan Africa (sSA) continues to rank among the regions in the world with the highest rates of maternal mortality and the lowest rates of utilization of maternal health care. The risk of death for women in sSA is 268 times higher than that of women in high-income nations. Adequate antenatal care (ANC) services utilization is essential to the mother's and the baby's survival and well-being. This study aimed to identify both individual and community-level factors associated with adequate antenatal care services utilization in sSA.MethodWe used data from the most recent Health and Demographic Surveys (DHS), which were carried out between 2012 and 2022 in 33 sSA countries. A total of 240,792 women were included in this study. The two-level mixed-effects logistic regression model was used to identify the individual and community-level factors associated with the use of adequate ANC service.ResultsThe pooled prevalence of adequate ANC service utilization in sSA was 55.48% (95% CI: 55.28–55.68). The study showed that secondary and above-educated women (AOR = 2.13, 95% CI 2.07–2.19, secondary and above-educated husbands (AOR = 1.55, 95% CI 1.51–1.60), rich women AOR = 1.26, 95% CI 1.24–1.29), women 35–49 years of age (AOR = 1.36, 95% CI 1.32–1.41) and distance to a health facility is not a big problem (AOR = 1.13; 95% CI 1.11–1.16) was significantly and positively correlated with the use of adequate ANC services. However, rural women (AOR = 0.80; 95% CI 0.78–0.82), not having mass media access (AOR = 0.74, 95% CI 0.72–0.75), 5 and above birth order (AOR = 0.73, 95% CI 0.68–0.78) were significantly and negatively correlated with the use of adequate ANC services. Additionally, the random effects model showed that variables at the community and individual levels were responsible for approximately 62.60% of the variation in the use of adequate ANC services.ConclusionThe sSA countries had a low prevalence of adequate utilization of ANC with a significant variation among countries. Moreover, public health initiatives should focus on rural women, poor women, and uneducated women to enhance maternal health services utilization. Furthermore, policies and programs that address cluster variations in the utilization of adequate ANC services must be developed, and their implementation must be vigorously pursued.

Fatalism or vigilance? Exposure to infant and maternal deaths and subsequent use of maternal health services in Malawi

In developing contexts, where formal health services are still expanding, understanding what factors discourage individuals from using health services is critical to advance population health. A long theorized, but rarely investigated, conjecture is that in high-mortality contexts, exposure to death can beget fatalism, or even foster distrust of formal healthcare, locking families into cycles of low use of health services. A counter perspective, however, suggests exposure to death can encourage individuals’ health vigilance, corresponding with their higher use of health services. We test these competing ideas by analyzing the associations between women’s intimate exposure to death in the context of pregnancy and delivery via (1) a sister’s maternal death and (2) an infant child’s neonatal death, and their subsequent use of maternal health services. We focus on the context of Malawi, a setting that features high maternal and infant mortality rates, similar to those observed across much of sub-Saharan Africa, as well as persistent gaps in service use. Specifically, we use Malawi Demographic and Health Survey (2015–16) data to examine if a sister’s maternal death or a child’s neonatal death corresponds with a woman’s odds of attending full antenatal care during a subsequent pregnancy or delivering the pregnancy at a formal health facility. Given the qualitatively distinct nature of losing one’s only or first child, we also assess if the effect of a child’s neonatal death varies by birth order. The results show that maternal and neonate death exposures correspond generally with women’s higher use of maternal health services, challenging the notion that exposure to death fosters fatalism or distrust. Although the results vary in significance, the nuanced findings highlight women’s vigilance in the face of health threats, emphasizing their resilience amid a high burden of familial loss.

Socioeconomic inequality in postnatal care utilisation among reproductive age women in sub-Saharan African countries with high maternal mortality: a decomposition analysis.

To assess the socioeconomic inequality in postnatal care (PNC) utilisation and its contributors among women in 14 sub-Saharan African countries with high maternal mortality. Community-based cross-sectional study using Demographic Health Survey SETTING: Africa countries with the highest maternal mortality ratio (14 countries) PARTICIPANTS: All women who had given birth within 2 years prior to the survey (n=64 912) PRIMARY OUTCOMES: Postnatal care utilisation RESULTS: The percentage of women who had PNC utilisation was lowest in Ethiopia (23.4%: 95% CI: 22.1%, 24.7%) and highest in The Gambia (91.5%: 95% CI: 90.6%, 92.4%). There was statistically significant pro-rich inequality in the PNC utilisation in all countries except Liberia, meaning PNC utilisation was disproportionately concentrated among women from wealthier households. The weighted Erreygers Normalized Concentration Index (ECI) ranged from 0.0398 in The Gambia to 0.476 in Nigeria; the second-highest inequality was in Cameroon (0.382), followed by Guinea (0.344). The decomposition analysis revealed that the wealth index was the largest contributor to inequality in PNC utilisation in seven countries: Benin, Burundi, The Gambia, Guinea, Nigeria, Sierra Leone, Tanzania. In contrast, educational status emerged as the primary contibutor in Cameroon and Zimbabwe, media exposure in Mali and Mauritania, and distance to healthcare facilities in Ethiopia. However, in Liberia, the weighted ECI of 0.0012 with a p value of 0.96 indicate that there is no significant socioeconomic inequality in PNC utilisation, suggesting that the distribution of PNC utilisation is almost equal across different socioeconomic groups. Our study revealed a pro-rich inequality in PNC utilisation across all included sub-Saharan African countries with high maternal mortality, except Liberia. This implies that PNC utilisation disproportionately favours the wealthy. Therefore, financially better-off women are more likely to utilise PNC services compared to those who are poor. Addressing the identified contributors of socioeconomic inequalities in PNC utilisation in each country remains crucial for achieving equity in PNC utilisation.

A Community-Informed Maternal and Infant Health Needs Assessment in Alabama.

Maternal mortality is a global clinical and public health crisis. Researchers and leading organizations have highlighted the need for local partnerships to implement evidence-based strategies to mitigate poor outcomes. Alabama has the third highest maternal mortality rate in the nation. Research on the complexity of maternity mortality is strengthening, but poor outcomes in Alabama persist and there is limited data highlighting the perspectives of those on the frontlines of providing and receiving care. We conducted a qualitative, statewide, community-informed, maternal and infant health research assessment with physicians, providers, professionals, and birthing persons to identify challenges and solutions to addressing the states' poor perinatal health outcomes. METHODS: Data were collected using a four-phase, research design that included semi-structured interviews, focus groups, one state-wide data sharing event, and five regional data sharing events. Data were collected between January 2020 and October 2021. The data were analyzed using consensus coding and thematic analysis. Fifty-nine (N = 59) individuals participated. Three themes emerged: 1) "They were making me feel so overlooked.": A disconnect between perinatal healthcare services and patient needs; 2) "That shouldn't be something you have to ask for": Limitations to providing respectful perinatal healthcare; and 3) "If they work together, they can have all the tools they need.": Building a case for collaborative care. Participants advocated for a collaborative perinatal healthcare model that focuses on the provision of respectful, quality perinatal healthcare. Our approach can be applied across contexts and used to support the effective implementation contextually relevant maternity care practices.

Intraoperative temperature management during emergency cesarean section: a retrospective observational study.

Intraoperative hypothermia is a common complication during cesarean section (C-section) and associated with the high maternal mortality and morbidity. This study aimed to explore the risk factors associated with the incidence of intraoperative hypothermia in women who underwent emergency C-section deliveries. We retrospectively enrolled women who underwent emergency cesarean deliveries from August 2022 to Dec 2023 at Suzhou Municipal Hospital of Anhui Province. Baseline characteristics, thermal status, and perioperative information were extracted. Hypothermia was defined as the onset of a core temperature below 36°C. Data were compared between patients with and without a hypothermia during surgery. Logistic regression analyses were performed to determine the risk factors for low-temperature-status. Overall, 87 patients were included, and 30 underwent hypothermia during surgery. For women with a normal temperature status, women in the hypothermia group had a lower incidence of receiving active warming methods (52.6% vs. 30%, P = 0.044). In the logistic regression model involving core temperature, a pre-surgery core temperature < 36.5°C (OR 4.22, 95% CI 1.13-15.63, p = 0.032) and a long surgery duration (per 10min, OR 1.97, 95% CI 1.24-3.11, p = 0.004) were associated with a high probability of hypothermia. Administering active warming methods to women can reduce the risk of experiencing a hypothermia during emergency C-sections (OR 0.19, 95% CI 0.05-0.63; p = 0.007). Hypothermia is common in emergency C-section deliveries. It is recommended that active warming methods should be applied to parturient undergoing emergency C-sections more proactively, especially for women who have a low baseline core temperature (< 36.5°C) and are expected to have a long surgery duration.

Spatial distribution of teenage pregnancy and its associated factors in Ethiopia: spatial and multilevel analysis of EDHS 2019

BackgroundOne of the reasons for the high rates of maternal and child morbidity and mortality in Sub-Saharan Africa is the rising proportion of teenage pregnancy. Preventing teenage pregnancy is critical to meeting sustainable development goal number three which aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. To support the achievement of this goal, this study aimed to assess the spatial variation and factors associated with teenage pregnancy in Ethiopia using the recent nationally representative data.MethodsA secondary data analysis of the 2019 Ethiopian mini Demographic and Health Survey was conducted with a total weighted sample of 2211 (unweighted 2100) teenagers. The Bernoulli model was fitted using SaTScan version 9.6 to identify hotspot areas and the geospatial pattern and prediction of teenage pregnancy were mapped using ArcGIS version 10.7. A multilevel logistic regression model was fitted to identify factors associated with teenage pregnancy among teenagers. Adjusted OR with 95% CI was calculated and variables having a p-value less than 0.05 were statistically significant factors of teenage pregnancy.ResultThe prevalence of teenage pregnancy among adolescents aged 15–19 years in Ethiopia was 12.89% (95% CI: 11.56%, 14.36%). The SaTScan analysis identified a primary cluster in the Gambella region of Ethiopia (log-likelihood ratio = 14.02, p < 0.001). A high prevalence of teenage pregnancy was observed in Somalia, Afar, Gambella, and the southern part of the Oromia regions of Ethiopia. Age, educational status- primary and secondary, religion- protestant, having television, contraceptive knowledge, household head-female, and region- Small peripheral were significant determinants of teenage pregnancy.ConclusionThe spatial distribution of teenage pregnancy in Ethiopia was nonrandom. Age, educational status, religion, having television, contraceptive knowledge, sex of household head, and region were significant determinants of teenage pregnancy. Therefore, concerned government bodies and other stakeholders should organize periodic educational campaigns and youth-friendly reproductive health services. Collaboration between healthcare professionals, and religious and community leaders could also form a strategic partnership that makes interventions more comprehensive, culturally sensitive, and effective in reducing teenage pregnancy.

Barriers to healthcare access among reproductive age women in extremely high and very high maternal mortality countries: Multilevel mixed effect analysis.

It is widely recognized that maternal deaths in low-resource countries are attributed to deprived access to maternal health services. Therefore, the aim of this study was to assess barriers to healthcare access among reproductive age women in extremely high and very high maternal mortality countries. A community based cross sectional surveys were conducted among 181,472 reproductive age women. Stata version 17.0 was used to analyze the data. Mixed effect binary logistic regression model was analyzed. Odds ratio along with 95% CI was generated to identify factors associated with barriers to healthcare access. A p-value less than 0.05 was declared as statistical significance. A total of 64.3% (95% CI: 64.06, 64.54) reproductive age women faced barriers to healthcare access. Young age, no formal education, poor wealth index, no media exposure, multiparty, no health insurance coverage, and rural residence were significantly associated with barriers to healthcare access. More than six in ten reproductive age women had barriers to healthcare access in extremely high and very high maternal mortality countries. Increasing extensive health education, minimizing financial hardship by expanding health insurance may minimize barriers to healthcare access with attention to rural resident reproductive age women.

“We do these audits, but in the end, it’s useless.” How can facility-based maternal death reviews improve the quality of care in Benin?

Benin scaled up facility-based Maternal Death Reviewss (MDRs) in 2013 to address its high maternal mortality rate. This study aims to assess the extent to which facilitybased MDR captured the complex causes of maternal deaths in 2022. In this mixedmethod study, we first conducted a quantitative analysis of dysfunctions, root causes,and recommendations extracted from all facility-based MDR reports that occurred in Benin's health facilities in 2022. We calculated frequency distributions based on the systemic maternal care quality assessment framework's components and the iceberg model for system thinking's layers. Second, we conducted in-depth and informal interviews and (non)participant observations and reviewed facility-based MDR policyrelated documents. Content analysis was applied to qualitative data. facility-based MDR teams identified 1295 dysfunctions, 1216 root causes, and 1082 recommendations in facility-based MDR reports of 540 maternal deaths. One-fifth of reports were uninformative, lacking dysfunctions, root causes, or recommendations.Within the health system components, leadership and governance received the least attention regarding dysfunctions (1 %) and root causes (12 %).Most dysfunctions (87 %) and root causes (73 %) focused on the iceberg's tip, leading to reactive recommendations rather than addressing deeper systemic issues. Two main factors emerged: non-compliance with facility-based MDR requirements (time constraints, unreliable data, fear of strained provider relationships) and limitations in facility-based MDR processes (data collection and analysis tool constraints),

The Role of Parents in Preventing Teenage Pregnancy in Rural Areas of Banyumas District

Background:One of the factors contributing to Indonesia's high maternal mortality rate is the high incidence of teenage pregnancy in Banyumas. The family, particularly parents, plays a crucial role in influencing teenage pregnancy, as they are expected to act as educators, motivators, supervisors, communicators, and counselors for their teenagers. Objective:The purpose of this study was to identify the factors that influence the role of parents in the prevention of teenage pregnancy. Methods:A cross-sectional study design was employed, focusing on female participants. A cluster random sampling technique was used to obtain a sample size of 150 parents from the study population, using the proportion estimation formula. The validity and reliability of the questionnaire used were tested. Data were analyzed using logistic regression. Results:The univariate analysis revealed that 93.2% of respondents were female, 25.3% were aged between 38 and 42, 61.3% had only completed elementary school, 63.3% were housewives, 58% had incomes below IDR 1.350.000, 52% had monthly family expenses under IDR 1.350.000, and 42.7% had five or more dependents. The bivariate chi-square test showed an association between parental resources, the role of health professionals, knowledge, attitudes, and societal values in the prevention of teenage pregnancy. The multivariate analysis using logistic regression indicated that the value of people and resources significantly impacts the role of parents in this regard. Conclusion:The role of parents in preventing teenage pregnancy is influenced by the value placed on people and resources. Keywords: Maternal mortality; adolescent pregnancy; role of parents; knowledge; attitudes

Examining the Cultural Appropriateness and Acceptability of a Traditional Birth Attendants' Training Program in Rural Guatemala.

While there has been notable global advancement in reducing maternal mortality rates (MMRs) in Latin America, the rates among indigenous women remain alarmingly high. This disparity persists in Guatemala, where indigenous women face a two-fold higher MMR compared to their non-indigenous counterparts. Most of the obstetrical care is performed by traditional Mayan birth attendants (TBAs), also known as comadronas, who have minimal formalized clinical training in obstetrical care. Considering there was no national comprehensive training program for TBAs, a unique training program was established in 2014. This program, the School of PowHER (Providing Outreach in Women's Health and Educational Resources), aims to ensure sustainable education led by TBAs for TBAs in rural Guatemala with the ultimate goal of helping TBAs provide basic antenatal care and learn how to identify and refer high-risk pregnancies.The aim of this proposed study is to examine the cultural appropriateness and sensitivity of the training program through a mixed-methods approach. We utilized a mixed-methods strategy, combining quantitative and qualitative methodologies. The quantitative aspect involved a 14-item written survey using a three-point Likert scale for responses, while the qualitative part utilized a semi-structured interview guide to conduct a focus group discussion. The survey (n=33) showed that 32 comadronasfound the curriculum applicable (97%) and comprehensible (97%). However,only 26 comadronas (79%) were comfortable with anatomy terminology. Opinions on teaching tools varied: 13 comadronas (39%) felt they were always representative, 13 comadronas (39%)sometimes, and seven comadronas (21%) never. Group discussions echoed this lack of representation. In the learning environment, 32 comadronas felt welcomed (97%) and 31 felt understood (94%), but five comadronas (15%) were not comfortable asking questions. Thirty-one comadronas (94%) believed training made pregnant women trust comadronas more. Group interviews highlighted increased confidence, better care, and perceived lower maternal mortality. This study found the program to be culturally sensitive and effective. Group interviews highlighted increased confidence, improved patient care, and perceived reductions in maternal mortality. Feedback emphasized the need for more culturally relevant materials, resources, and collaboration with the Ministry of Health. This program's community-centered approach could serve as a model for similar initiatives in low- and middle-income countries addressing high maternal mortality rates, despite language and access challenges.

Factors associated with facility childbirth and skilled birth attendance in Migori County, Kenya and the effect of Lwala Community Alliance intervention: a cross-sectional assessment from the 2019 and 2021 Lwala household surveys

BackgroundDespite evidence of the beneficial effects of skilled birth attendance (SBA) on maternal health and childbirth outcomes, there are disparities in access across counties in Kenya. These include Migori County which has historically recorded high maternal mortality rates. In 2007, the Lwala Community Alliance was founded to improve health outcomes in this county. The objective of this study is to provide a baseline status of facility childbirth and SBA in Migori and to characterize the effect of Lwala intervention on these outcomes.MethodsA cross-sectional household survey was designed for a 10-year study to evaluate the effectiveness of Lwala initiatives. The 2019 and 2021 household surveys were conducted in Lwala intervention wards and in comparison wards with sample sizes of 3,846 and 5,928 mothers, respectively. The survey captured demographic, health, and socioeconomic data at each household, data on SBA and facility childbirth, and explanatory variables. A generalized linear model was used to determine factors associated with SBA. A secondary trend analysis was conducted to determine change over time in the explanatory variables and SBA. To determine the change in SBA rate due to Lwala intervention, controlling for background temporal trends, a difference-in-differences (DiD) model compared SBA rates in intervention wards and comparison wards.ResultsSBA increased in all surveyed wards and across all explanatory variables from 2019 to 2021. The DiD analysis showed that the SBA rate increased more in Lwala intervention wards than in comparison wards (Adjusted Prevalence Rate Ratio 1.05, p &amp;lt; 0.001, 95%CI 1.03–1.08). The 2021 survey found the highest rates of both facility childbirths (97.9%, 95%CI 96.5–98.7) and SBA (98.2%, 95%CI 97.0–99.0) in North Kamagambo, the oldest ward of Lwala intervention. Higher educational status, four or more ANC visits, marriage/cohabitation, and wealth were significantly associated with increased SBA.ConclusionsWe provide the first quasi-experimental evidence that Lwala interventions are significantly improving SBA which may inform related initiatives in similar settings. The household-survey data provides a baseline for continued evaluation of Lwala programs, and the breakdown by ward allows for development of specific programmatic targets.

Expert System for Pregnancy Risk Diagnosis Using Decision Tree and Dempster-Shafer Method

The high Maternal Mortality Rate (MMR) remains a severe concern in maternal healthcare. One of the reasons is the delay in recognizing early danger signs during pregnancy. To address this issue, there is a proposed solution in the form of developing an expert system aimed at swiftly and efficiently diagnosing pregnancy risks in pregnant women using the Decision Tree and Dempster Shafer methods. The Decision Tree method is employed for symptom classification, while Dempster Shafer provides confidence values for existing facts. This research collects data from the dataset, the Poedji Rochjati Score Card (KSPR), and qualitative data through expert interviews. From the collected data, knowledge acquisition processes are then carried out to extract knowledge using the ID3 Decision Tree and combine all symptoms from the gathered data. The processed data is then represented as a decision tree and assigned confidence values. The development of this expert system utilizes the Laravel framework with PHP language and MySQL database. System validation involves patients as participants and midwives as experts and testers. Testing was conducted on March 13 and 16, 2024, involving 16 patients at the Gatak Community Health Center. The system evaluation results show an accuracy rate of 93.75%. This value indicates that the system can operate effectively. Thus, it can be recommended for use in diagnosing pregnancy risks.

Revolutionizing Maternal Health: The Role of Artificial Intelligence in Enhancing Care and Accessibility.

Maternal health remains a critical global health challenge, with disparities in access to care and quality of services contributing to high maternal mortality and morbidity rates. Artificial intelligence (AI) has emerged as a promising tool for addressing these challenges by enhancing diagnostic accuracy, improving patient monitoring, and expanding access to care. This review explores the transformative role of AI in maternal healthcare, focusing on its applications in the early detection of pregnancy complications, personalized care, and remote monitoring through AI-driven technologies. AI tools such as predictive analytics and machine learning can help identify at-risk pregnancies and guide timely interventions, reducing preventable maternal and neonatal complications. Additionally, AI-enabled telemedicine and virtual assistants are bridging healthcare gaps, particularly in underserved and rural areas, improving accessibility for women who might otherwise face barriers to quality maternal care. Despite the potential benefits, challenges such as data privacy, algorithmic bias, and the need for human oversight must be carefully addressed. The review also discusses future research directions, including expanding AI applications in maternal health globally and the need for ethical frameworks to guide its integration. AI holds the potential to revolutionize maternal healthcare by enhancing both care quality and accessibility, offering a pathway to safer, more equitable maternal outcomes.