Maternal Child Health Care Research Articles

Part II: Enhancing Breastfeeding Experience and Self-Efficacy in Opioid-Dependent Breastfeeding Mothers—Results From the PeriWell Intervention

Objective:The PeriWell project integrates the Positive Direction Model and the Tri-Core Breastfeeding Model into a virtual support program tailored to peripartum mothers in substance use recovery. PeriWell addresses the unique challenges this population faces by offering tailored, wraparound support. This manuscript, part of a two-part series, highlights the project’s outcomes, demonstrating significant implications for maternal health practices by fostering an environment of empowerment and lactation wraparound support.Methods:This longitudinal quality improvement (QI) project spanned 24 months (2019–2021) during the COVID-19 pandemic. It involved 15 peripartum mothers in substance use recovery engaging in a virtual, single-site program. The project was approved as a QI initiative by the Institutional Review Board (IRB reference 2018-19, #89), ensuring ethical adherence and participant safety. Participants provided voluntary consent and were recruited from obstetrics and gynecology offices in Upstate New York. To evaluate participants’ confidence and belief in their breastfeeding abilities, we received author permission and utilized the validated Breastfeeding Self-Efficacy Scale-Short Form (Dennis & Faux, 1999; Dennis, 2010), guiding the tailored support provided.Results:Results indicated a significant increase in prenatal breastfeeding confidence correlated with the PeriWell approach (r= .782,n= 14,p< .001). Participants reported improved self-confidence in latching techniques and a greater appreciation of the time commitment required for successful breastfeeding. Correlational relationships provided valuable insight to enhance and amplify breastfeeding support. The findings advocate for the inclusion of targeted specialized interventions in maternal care to better meet the needs of expecting individuals.Conclusion:Cultivating a supportive peripartum environment is fundamental to maternal-child healthcare, and the PeriWell project demonstrated the efficacy of integrating tailored, virtual peripartum and breastfeeding support for expecting and postpartum mothers in substance use recovery. This quality improvement project improved maternal and infant health outcomes, such as breastfeeding self-efficacy, and highlighted the importance and value of specialized, wraparound lactation support for vulnerable populations. These findings underscore the need for continued innovation in maternal health services, particularly through empowerment and promoting breastfeeding success in recovery settings.

Clinical Study of Cutaneous Manifestations in Neonates in A Tertiary Care Center in Eastern Nepal: A Descriptive Cross-sectional Study

Introduction: In the neonatal period, a variety of cutaneous symptoms are frequent. To minimize unneeded therapy and to reduce parents' stress, it's important to distinguish between transient and pathological newborn dermatoses. The purpose of this study is to describe the clinical pattern of cutaneous lesions in neonates. Methods: In this cross-sectional descriptive(IRC/1885/020) study , we enrolled 512 neonates born and admitted in maternal child health care ward and Post Natal ward of a tertiary health care cener irrespective of cutaneous manifestations. Convenience sampling technique was used. They were examined till their stay in hospital and followed up weekly via telephone for development of dermatological manifestations. Results: Out of 512 neonates examined, 415 (81.05%) of neonate had at least one cutaneous manifestation.393 (94.69%) had physiological skin lesions, 22 (5.31%) had pathological skin lesions. The most common physiological skin manifestations were sebaceous gland hyperplasia, mongolian spot, ETN, milia and epstein pearl. The pathological cutaneous manifestations though least common comprised of cradle cap, napkin dermatitis and bacterial infections. Most of the lesions were present within 24 hours of birth and many of them were physiological transient lesion. Conclusions: In conclusion, our study highlights the high prevalence of cutaneous manifestations in neonates, with the majority being physiological in nature. Medical personnel must be well versed in the skin changes of neonates which will further help prevent unnecessary treatment and identify life threatening situations that require additional attention.

Trends and determinants of the use of episiotomy in a prospective population-based registry from central India

BackgroundFindings from research and recommendations from the World Health Organization favor restrictive use of episiotomy, but whether this guidance is being followed in India, and factors associated with its use, are not known. This study sought to document trends in use of episiotomy over a five-year period (2014–2018); to examine its relationship to maternal, pregnancy, and health-system characteristics; and to investigate its association with other obstetric interventions.MethodsWe conducted a secondary analysis of data collected by the Maternal Newborn Health Registry, a prospective population-based pregnancy registry established in Central India (Nagpur, Eastern Maharashtra). We examined type of birth and use of episiotomy in vaginal deliveries from 2014 to 2018, as well as maternal and birth characteristics, health systems factors, and concurrent obstetric interventions associations with its use with multivariable Poisson regression models.ResultsDuring the five-year interval, the rate of episiotomy in vaginal birth rose from 13 to 31% despite a decline in assisted vaginal birth. Associations with episiotomy were found for the following factors: prior birth, multiple gestations, seven or more years of maternal education, higher gestational age, higher birthweight, delivery by an obstetrician (as compared to midwife or general physician), and birth in hospital (as compared to clinic or health center). After adjusting for these factors, year over year rise in episiotomy was significant with an adjusted incidence rate ratio (AIRR) of 1.10 [95% confidence interval (CI) 1.08–1.12; p = 0.002]. We found an association between episiotomy and several other obstetric interventions, with the strongest relationship for maternal treatment with antibiotics (AIRR 4.23, 95% CI 3.12–5.73; p = 0.001).ConclusionsEpisiotomy in this population-based sample from central India steadily rose from 2014 to 2018. This increase over time was observed even after adjusting for patient characteristics, obstetric risk factors, and health system features, such as specialty of the birthing provider. Our findings have important implications for maternal-child health and respectful maternity care given that most women prefer to avoid episiotomy; they also highlight a potential target for antibiotic stewardship as part of global efforts to combat antimicrobial resistance.Trial RegistrationThe study was registered at ClinicalTrials.gov under reference number NCT01073475.

Data gaps, tenuity and measurement challenges in achieving sustainable maternal child healthcare ecosystem: an evidence based statistical evaluation

Data metrics in public health programs and interventions play a crucial role in reflecting the health and well-being of the population, along with the structural and biosyndemic factors influencing health, public health interventions, and system resources. The management of health data has emerged as a key focus area within the sustainable global agenda, aiming to ensure effective, efficient, timely, and safe quality healthcare through evidence-based clinical practices and high-quality data systems that support quality improvement strategies and interventions to achieve optimal standards of care. Recognized internationally as an integral part of the unfinished health goals and the Sustainable Development Agenda 2030, a high-quality health information system is deemed essential for positively impacting health outcomes. However, emerging economies like India face the significant challenge of developing complex data platforms to track SDG health goals effectively, thereby providing useful insights for policymakers, academics, researchers, and program implementers. This paper aims to contribute to the growing knowledge on the implications of poor data quality and the performance of health information systems. It outlines the availability, completeness, and accuracy of data related to key performance indicators in the maternal and child health domain, evaluates the capacity and readiness of healthcare systems to generate high-quality data metrics, and explores the challenges, determinants, and gaps in achieving a sustainable and effective data management system. The study utilizes a mixed-methods approach and the WHO-DQAT data quality framework, employing objective-subjective assessments, desk analysis, cross-sectional field validation surveys, and integrated mixed-triangulation data tools. By measuring data quality dimensions and identifying potential gaps and determinants, the paper sheds light on deficiencies in the structure, function, and capabilities of the system, particularly in data management processes. It emphasizes the importance of strengthening statistical capacities and creating dedicated data management systems at state and national levels, and urges stakeholders to recognize the significance of data in health information systems for evidence-based policymaking.

Young Child Undernutrition: Crucial to Prioritize Nutrition Interventions in the First 1000 Days of Life.

The implications of young childhood undernutrition on health, development and productivity are grave. In the last two decades, global and Indian studies on undernutrition in under five years have concluded that stunting and underweight rate increases steadily between 0-24 mo, and then stabilises. The available evidence highlights the significance of concentrating interventions to tackle child undernutrition in the first 1000 d of life, which should aim at universal coverage of essential nutrition interventions (ENIs) and maternal-child health care package comprising maternal nutrition care, adoption of appropriate infant and young child feeding practices (IYCF), iron-folic acid supplementation, immunization, deworming, appropriate management of childhood illness etc. Additionally, it is critical to address context specific nutrition sensitive measures such as socio-economic empowerment of women, preventing domestic violence, adolescent conception, appropriate water -sanitation-hygiene and family planning services etc. Mapping of the 'at risk' households having a member falling in the 1000 d window needs special attention and is central to the ongoing efforts in India through the National Nutrition Mission/ POSHAN Abhiyaan. However, for effective implementation, there is an urgent need to consider to shift the lead responsibility of ENIs in the first 1000 d of life to the health care system in India and strategize to integrate maternal nutrition care interventions and establishing of IYCF practices by ensuring optimum use of contacts with antenatal care and routine child immunization services.

Evaluation of Doppler Indices for Umbilical Artery in Hypertensive Women in Third Trimester of pregnancy

Background: The hypertensive disorders affect pregnant women and can create complications for the women in last trimester of pregnancy. To assess the impact of high hypertension, doppler scan is recommended in the third trimester.
 Objective: Present explores values of PSV, EDV, S/D ratio, RI and PI among normotensive and hypertensive pregnant women during third trimester of pregnancy in Islamabad, Pakistan.
 Material and Methods: A Cross-sectional study was conducted at PIMS hospital Islamabad with objectives to evaluate doppler indices in fetal umbilical artery among hypertensive pregnant women in the third trimester of pregnancy. Data were collected from 1st February 2022 to 15th May 2022. A total of 93 pregnant women were recruited from already registered at maternal child health care center of PIMS and recommended for doppler indices scan. Toshiba Aplio 300 Ultrasound System was used for the assessment. Data about S/D ratio, RI and PI was analyzed by using IBM SPSS® software platform.
 Results: Mean Age of pregnant women in our study conducted was 26.722 ± 4.133. Also the mean gestational week for pregnant women was 32.163 ± 2.35. Doppler indices were significantly raised in hypertensive women as compared to normotensive women. Doppler indices i.e. Pulsatility Index (Mean 1.049 ± 0.312 vs 1.360 ± 0.421), Resistivity Index (Mean 0.631 ± 0.114 vs 0.743 ± 0.01), Systolic/Diastolic flow (Mean 2.672 ± 0.512 vs 3.818 ± 0.986) were increased in third trimester of hypertensive women as compared to normotensive patients.
 Conclusion: In this study, among doppler indices pulsatility index and resistivity index were identified as significant after applying null hypothesis test. Doppler ultrasound should be used to identify vascular resistance and evaluating degree of fetoplacental blood flow in hypertensive pregnant women.

Trajectories and predictors of perinatal depressive symptoms among Kenyan women: a prospective cohort study

There are gaps in understanding longitudinal patterns and predictors of perinatal depressive symptoms in sub-Saharan Africa. This study aimed to explore trajectories of depressive symptoms and associated factors from pregnancy to 9 months post partum among Kenyan women. In this prospective cohort study, we analysed data from the PrEP Implementation for Mothers in Antenatal Care (PrIMA) study in which HIV-negative women were enrolled in pregnancy and followed up to 9 months post partum in 20 public sector maternal-child health clinics in western Kenya. Pregnant women were eligible for enrolment if they were not infected with HIV, aged 15 years or older, and were able to provide consent. Eligible participants were screened and enrolled between Jan 15, 2018, and July 31, 2019, and followed up to 9 months post partum, with the last participant study visit conducted on Jan 15, 2021. Study nurses serially assessed depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CESD-10), intimate partner violence with the Hurt, Insult, Threaten, Scream scale, and social support with the Medical Outcomes Study scale. Generalised estimating equations were used to identify correlates of moderate-to-severe depressive symptoms (CESD-10 score ≥10) and group-based trajectory modelling identified discrete trajectories of perinatal depressive symptoms. Among 4447 participants in the main PrIMA study, 3555 had complete depressive symptom data in pregnancy and depressive symptom data post partum and were included in the primary analysis. Median age was 24·0 years (IQR 21·0-28·7), 1330 (38%) participants had low social support, and 278 (8%) reported intimate partner violence in pregnancy. All participants (100%) were female and all (100%) were of African Kenyan ethnicity. Prevalence of moderate-to-severe depressive symptoms was higher in pregnancy than post partum (870 [24·5%; 95% CI 23·1-25·9] vs 597 [6·8%; 15·6-18·1]; p<0·0001). Five patterns of depressive symptoms were identified; persistent moderate-to-severe depressive symptoms in pregnancy and post partum (295 [8·3%]), moderate-to-severe depressive symptoms in pregnancy that resolved post partum (139 [3·9%]), moderate-to-severe depressive symptoms that emerged post partum (40 [1·1%]), chronically mild symptoms (2709 [76·2%]), and no depressive symptoms (372 [10·5%]). Emergent moderate-to-severe depressive symptoms were associated with older age. Emergent, persistent, and resolving moderate-to-severe depressive symptoms were associated with intimate partner violence during pregnancy; and persistent and resolving moderate-to-severe depressive symptoms were associated with low social support and high HIV risk (all p<0·05). Moderate-to-severe depressive symptom risk was significantly increased with intimate partner violence (adjusted odds ratio 2·07 [95% CI 1·81-2·31]; p<0·0001), low social support (1·74 [1·56-1·95]; p<0·0001), and partner HIV-positive status (1·48 [1·22-1·78]; p<0·0001). 23·34% (95% CI 18·77-27·65) of cases of perinatal moderate-to-severe depressive symptoms were attributable to low social support. One third of women had perinatal moderate-to-severe depressive symptoms; nearly half of these had higher severity phenotypes of resolving, persistent, and emerging moderate-to-severe depressive symptoms that might require tailored interventions. Perinatal women with comorbid psychosocial stressors such as intimate partner violence and previous pregnancy loss should be prioritised for mental health services that augment social support within routine maternal-child health care. National Institutes of Health. For the Kiswahili translation of the abstract see Supplementary Materials section.

Spectrum of obstetric referral and their outcome at a Tertiary Care Center of Eastern Uttar Pradesh: An insight

Background: Pregnancy and childbirth, especially in high-risk women, necessitate proper antenatal, intranatal, and immediate postpartum care. Early detection of complications and prompt referral to the higher level of care can reduce the associated adverse maternal outcomes. Aims and Objectives: The aim of the study was to evaluate the spectrum of pregnancy-related referrals to our hospitals and their outcomes. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology, B.R.D Medical College, Gorakhpur, U.P, India, over a period of 1 year (October 2020–September 2021). All the referred cases of obstetric indications ≥28 weeks of gestation were analyzed for reasons of referral and their outcomes. Results: Obstetrics referral accounted for 31.15% of the total obstetrics admissions (1416/4545). The average age of study participants was 26.92 years and majority being primigravida. The major reasons for referring patient were hypertensive disorders of pregnancy (16.74%), previous cesarean section (12.78%), and severe anemia (7.70%). There were 70 maternal deaths leading to case fatality rate of 4.94% while 94.2% of patient were discharged healthy. Conclusion: Lack of knowledge, ignorance, and poor transport facilities are major contributors of poor pregnancy outcome. Timely and appropriate referral is crucial in improving maternal outcome. Improvement in the quality of Maternal Child Health care at Primary Health Centre, Community Health Centre level; regular training of health-care providers in emergency obstetrics care is required to curb unnecessary referrals and consequently in reducing fetomaternal morbidity and mortality.

Under-Utilization of Maternal-Child Healthcare Services and Adverse Outcomes of Unwanted Pregnancies in Urban and Rural Areas of Indonesia

The study examines the association of unwanted pregnancy and the utilization of maternal-child health services, and the adverse health outcomes in urban and rural settings. The study employed data from the 2017 Indonesia Demographic Health Survey that included 13,806 live births; the mothers were not pregnant at the interview and were married participants. The multiple logistic regression analysis concerning residential areas was conducted separately to compare outcomes related to unwanted pregnancy. Non-standard antenatal care visits (adjusted odds ratio [AOR]=1.7; 95% confidence interval [CI]=1.2–2.4), prolonged labor (AOR=1.6; 95% CI=1.2–2.1), the absence of child’s birth documentation (AOR=1.3; 95% CI=1.0–1.6), and smaller baby size (AOR=1.2; 95% CI=1.0–1.4) are associated with unwanted pregnancy in urban areas. In rural settings, on the other hand, unwanted pregnancy is associated with non-standard antenatal care (AOR=1.6; 95% CI=1.2–2.2). Therefore, in Indonesia, urban areas lack maternal-child healthcare services utilization and higher adverse events due to unwanted pregnancy than rural areas. An adjustment approach is required in maternal-child health-related programs in both areas, particularly for women living in urban.

Breastfeeding versus free distribution of infant formulas by the Public Health System.

ABSTRACTObjective:To characterize the situation of breastfeeding and the adequacy of prescription of infant formulas to infants assisted by a secondary care program of the Public Health System.Methods:This is a cross-sectional study with analysis of medical records of 350 infants from zero to 6 months, followed up between February to April 2019.Results:The possibility of breastfeeding was present in 97.0% of mothers and no infant presented an acceptable medical condition for proscription of breastfeeding. Despite this, only 47.2% of cases were on exclusive breastfeeding before being referred to the program. Regarding the reasons for the introduction of infant formulas, complementation to breast milk was the most present (75.8%), followed by mothers returning to the job market (20.1%). The general rates of inadequacy of those prescribed were 65% before arriving at the program, increasing to 69% (standard formulas) and 80% (formulas for special purposes) during follow-up.Conclusion:The low rate of exclusive breastfeeding and the indiscriminate prescription of infant formulas are a concern for damage to maternal-child healthcare and sound finances of the Public Health System.

Effects of COVID-19 on maternal, child healthcare (MCH) services in slums: lessons from India

BackgroundThe study aims to understand the effect of COVID lockdown on MCH for slum dwellers and coping mechanisms adopted in Indore and Agra, India. Slum women's perspectives on seeking, delaying, avoiding healthcare in COVID-19, barriers and facilitators were explored.MethodsIn-person qualitative interviews were conducted in slums in Sept-Oct 2020 with mothers who had deliveries; pregnant women needing ante-natal care; mothers with children <2 yrs needing immunization during COVID lockdown. 30 mothers requiring these MCH services during April -June 2020 (lockdown phase) were interviewed. We chose qualitative study over quantitative as a shorter and useful precedent to replicate in similar situations.ResultsGovt. and most private hospitals refused non-COVID services during lockdown.; Police restricted movement on roads. Being on COVID duty, frontline health functionaries were not doing outreach health sessions. Women missed ante-natal check-up, Iron Folate, Tetanus toxoid; Demand side challenges included fear of COVID infection, lack of money due to livelihood loss; Home deliveries by self, neighbors were resorted to; Maternal, neonatal deaths ensued; Children missed immunization e.g., Measles, DPT. Few peri-urban slum families visited nearby rural health facility for delivery. Some families borrowed money from community saving's groups for delivery in private hospitals. Few families visited low-cost private doctor/nurse for immunization of pregnant mother, children.ConclusionsDemand and supply side factors led to pregnant women and children not receiving care during lockdown. Peri-urban slum families should be encouraged to link with nearby rural health facility for MCH services during COVID-19 or similar situations. Govt. partnering with private providers near slums will help access during challenging times. Promoting community savings groups as mandated under National Urban Health Mission can enable slum families borrow with ease when in need.Key messages Government health system should set up emergency (e.g., mobile clinic) MCH services for future epidemic, disaster, should partner with private doctors/nurses near slums.Rural health infrastructure serving nearby peri-urban slums formally recognized by Govt. despite separate jurisdictions is an approach adaptable in LMIC cities.

Access to Essential Contraception, Family Planning, and Safe Motherhood Services During COVID-19 Pandemic: Single Secondary Level Care Hospital Experience

OBJECTIVE: During the COVID-19 pandemic, more precisely as a result of restrictions on movement and continuing altered perception of essential health care services, women’s health is disproportionately affected due to reduced access to services as per reports and statements made by different global and national level Government and non-government agencies. We aimed to evaluate the health care impacts related to contraception, family planning, and safe motherhood in an Indian Armed Forces secondary level care hospital during the COVID-19 pandemic. STUDY DESIGN: Immediate health care effect on women’s sexual and reproductive life during pandemic months (April to August of the year 2020) is analyzed through a retrospective observational cohort study in a single Indian Armed Forces secondary level care hospital experience. RESULTS: It has shown more late reported unintended pregnancies requiring surgical intervention, more late-registered antenatal cases and consequently delayed essential evaluations, increased trend in high-risk cases requiring in-patient care (IPD), and reduced access to contraception and family planning services in comparison to those in the previous two years. CONCLUSION: Considering these negative impacts noted in this observation, with the help of policymakers, government, and other non-government agencies, all services should be made available to women including un-interrupted out-patient (OPD) and IPD services in all hospitals, along with continued basic infection prevention and control precautions (IPC) to both clientele and health care workers (HCW). Telemedicine can also play a supplementary role in various aspects of women’s health to avoid upcoming population explosion and for better maternal-child health care.

Causes and treatment measures for deformation of retaining soil and slope

To explore reasons for deformation of retaining soil and slope in the Maternal-Child Health Care Hospital of Hanyuan County, the meteorology, geological lithology, geological structure, and hydrological conditions were surveyed. Moreover, types and distributions of weak intercalated layers were found out by drilling, and physical and mechanical properties were obtained through physical mechanics and field shear test. Meanwhile, by means of drilling and monitoring, deformation range and characteristics of retaining soil and slope were determined, and deformation mechanism was obtained through monitoring crack opening and deep displacement. The structures showed that deformation occurred at new 2# counterweight retaining wall is caused by shallow slip control surface RJ0; the pulling and crack of settlement joints between the new 2# counterweight retaining wall and the new 1# slab-pile wall are caused by the deformation of shallow slip control surface RJ0; the deformation and failure of new 2# counterweight retaining wall and new 1# slab-pile wall and their foundation rock mass at the lower part are caused by creep displacement of “shallow weak intercalated layers” RJ0 and RJ1; in addition, the deep creep control surface RJ2 has certain influence on the deformation of upper building and its foundation rock mass. Therefore, anti-slide piles should be used to control the shallow slipping control surface RJ1, with the depth reaching the structural plane where the deep creep control surface RJ2 is located.

The Proof of Economic Welfare Is in the Eating of Nutritious Diets by the Resource-Poor: A Political Economy Analysis of the International Evidence of Dietary Consumption in Rural Africa

This paper provides a summary of the international literature published in the thematic area of household dietary diversity with emphasis on the importance of sustainable approaches to global hunger and malnutrition. The paper highlights the correlation between inadequate household dietary diversity, child mortality and death. It also draws attention to the subtle combinations of social, economic and political interactions in enhancing nutritional welfare. The paper further raises a major argument that contemporary explorations of dietary diversity have failed to sustain the important tension and dialectical debate between diverse empirical realities and wider theorization of the concrete linkage of economic welfare to dietary diversity. The paper sets the tone for wider conceptualization of the phenomenon by clearly outlining the role of multiple relations of low incomes, inadequate maternal-child health care as well as poor environmental sanitation as leading predicators of under-nutrition in rural Africa. This theorization makes the case that, studying the relations and conjunctions of economic welfare via the agency of dietary consumption, is critical for emergent processes of change as the given-evidence of under-nutrition does not allow economists to draw solid conclusions on status of dietary diversity in rural Africa without a dynamic understanding and explicit recognition of the wider abstractions of political economy undercurrents in economic welfare and nutritional well-being literature. That said, the paper re-affirms the subtle evidence that under-nutrition and reduced body-mass of adults, often cited in the development literature as proxy-indicators of poor dietary diversity, needs to be re-evaluated as reduced body-mass in adults could be an indication of other incidences of environmental-stresses rather than of food-energy stress. In this vein, the review sustains a new argument that, resource-poor households modify attitude to food consumption in order to self-protect against income losses in household production systems. This position has implications for economic welfare and nutritional diversity research as food may not always come first for the resource-poor. It also opens new avenues for economic research by projecting the hypothesis that consumption of nutritious diets cannot be seen as a unique object to be sought by resource-poor to the exclusion of all other priorities including raising income frontiers through savings for wealth accumulation. The pre-eminence of food security over income diversification activities of rural households as a broader strategy to reduce malnutrition and poverty in the developing world could be re-examined to give livelihood activities a central role in household dietary diversity research.

Integrating Prevention of Mother-to-Child Transmission of HIV Care into General Maternal Child Health Care in Western Kenya.

Background:Health systems integration is becoming increasingly important as the global health community transitions from acute, disease-specific health programming to models of care built for chronic diseases, primarily designed to strengthen public-sector health systems. In many countries across sub-Saharan Africa, including Kenya, prevention of mother-to-child transmission of HIV (pMTCT) services are being integrated into the general maternal child health (MCH) clinics. The objective of this study was to evaluate the benefits and challenges for integration of care within a developing health system, through the lens of an evaluative framework.Methods:A framework adapted from the World Health Organization’s six critical health systems functions was used to evaluate the integration of pMTCT services with general MCH clinics in western Kenya. Perspectives were collected from key stakeholders, including pMTCT and MCH program leadership and local health providers. The benefits and challenges of integration across each of the health system functions were evaluated to better understand this approach.Results: Key informants in leadership positions and MCH staff shared similar perspectives regarding benefits and challenges of integration. Benefits of integration included convenience for families through streamlining of services and reduced HIV stigma. Concerns and challenges included confidentiality issues related to HIV status, particularly in the context of high-volume, crowded clinical spaces.Conclusion and Global Health Implications: The results from this study highlight areas that need to be addressed to maximize the effectiveness and clinical flow of the pMTCT-MCH integration model. The lessons learned from this integration may be applied to other settings in sub-Saharan Africa attempting to integrate HIV care into the broader public-sector health system.

Access to maternal-child health and HIV services for women in North-Central Nigeria: A qualitative exploration of the male partner perspective.

BackgroundIn much of sub-Saharan Africa, male partners play influential roles in women's access to maternal-child healthcare, including prevention of mother-to-child transmission of HIV services. We explored male partner perspectives on women’s access to maternal-child healthcare in North-Central Nigeria.MethodsThree focus groups were conducted with 30 men, purposefully-selected on the basis of being married, and rural or urban residence. Major themes explored were men’s maternal-child health knowledge, gender power dynamics in women’s access to healthcare, and peer support for pregnant and postpartum women. Data were manually analyzed using Grounded Theory, which involves constructing theories out of data collected, rather than applying pre-formed theories.ResultsMean participant age was 48.3 years, with 36.7% aged <40 years, 46.7% between 41 and 60 years, and 16.6% over 60 years old. Religious affiliation was self-reported; 60% of participants were Muslim and 40% were Christian. There was consensus on the acceptability of maternal-child health services and their importance for optimal maternal-infant outcomes. Citing underlying patriarchal norms, participants acknowledged that men had more influence in family health decision-making than women. However, positive interpersonal couple relationships were thought to facilitate equitable decision-making among couples. Financial constraints, male-unfriendly clinics and poor healthcare worker attitudes were major barriers to women’s access and male partner involvement. The provision of psychosocial and maternal peer support from trained women was deemed highly acceptable for both HIV-positive and HIV-negative women.ConclusionsStrategic engagement of community leaders, including traditional and religious leaders, is needed to address harmful norms and practices underlying gender inequity in health decision-making. Gender mainstreaming, where the needs and concerns of both men and women are considered, should be applied in maternal-child healthcare education and delivery. Clinic fee reductions or elimination can facilitate service access. Finally, professional organizations can do more to reinforce respectful maternity care among healthcare workers.

Correlation between Gestational Age and Head Circumference in Third Trimester

Introduction: In today’s advanced medical world maternal child health care the important part of the healthcare system and import components is estimation fetal gestational age.Gestational age is age of unborn baby, defined in weeks as beginning from first day of last menstrualperiod prior to conception. Trimester is period of three calendar months during a pregnancy. Clinically, thegestational period is divided into three trimesters. Estimation of gestational age and thereby forecastingexpected date of delivery (EDD) is not only concern of the Individual but it is invaluable in the diagnosis ofintrauterine growth retardation of fetus and obstetric planning other fetal parameters are useful Hence; weplanned the present study to estimate fetal HC length for measuring the gestational age and compare it withother parameters.Material and methods: The study Correlation between gestational age and head circumference in Thirdtrimester was carried out at Govt. Medical College and Hospital, Nanded, between July 2011 to July 2013period . The study included 132 pregnant women the data so collected was then subjected to statisticalanalysis by expert statistician with the help of SYSTAT Crainsoft version 12 software. Standard statisticalmethods, parametric methods were used for the evaluation and significance.Results: As the value of R is 0.8612, the variation in fetal growth on the basis of Head Circumference duringthird trimester can be explained to the extent of 86.12%. The value of R is highly significant (Student’s‘t’test value = 228.92, p<0.0001, very highly significant) showing that there is statistically highly Positive orstrong positive association between gestational age and head CircumferenceConclusion: From the present study Head Circumference found to be statistically highly significant. Theregression equations derived for growth parameter for estimating gestational age in a normally developingfetus, increase with gestational age, showed good correlation with gestational age. In Present study, Headcircumference is the sensitive parameter and a result of present study was comparable with previous studies.

Effectiveness of community health workers in improving early initiation and exclusive breastfeeding rates in a low-resource setting: A cluster-randomized longitudinal study.

Little evidence exists in Kenya on the potential of community health workers (CHWs) in promoting exclusive breastfeeding (EBF) and early breastfeeding initiation (EBI) in resource‐restricted settings where very low EBF rates (2% to 12%) have been documented. The study utilized CHWs and assessed their effectiveness in promoting EBF and EBI. The cluster‐randomized longitudinal design was used and sixteen villages from Kiandutu Slum in Thika randomly assigned into either intervention group (IG) or comparison group (CG). Pregnant women attending Maternal Child Health (MCH) clinic were recruited. The IG received nutrition education sessions conducted by CHWs at home, two prenatally and six postnatally, plus the routine MCH care. The CG went through routine MCH care only. Infants feeding data were collected at 6, 10, 14, and 24 weeks postpartum by research assistants blinded to the intervention allocation. Differences in EBF and EBI in the two groups were tested using χ 2 tests, Kaplan–Meier survival analysis and generalized estimating equations. Of the 526 recruited in the study, 431 remained and were included in the analysis (IG = 176) and CG (225). The prevalence of EBF at 24 weeks was 45.3% in the IG compared with 15.0% in the CG, revealing a statistically significant difference log rank = 20.277, (1, n = 314) p < .001. The difference was not statistically significant in EBI prevalence between the IG (58.2%) and CG (60.3%; χ 2 = 0.008, p = .928). The CHWs have potential effectiveness in promoting EBF but not EBI. The link between the health center and CHWs should be strengthened to promote EBF.

Improving the effective maternal-child health care coverage through synergies between supply and demand-side interventions: evidence from Mexico.

BackgroundOver the last two decades, the Mexican government has released several efforts to achieve universal health coverage (UHC), based on the principles of fairness and social protection, to reduce the inequities in utilization, access, and quality of care existing in the health system. Two of the most important social public policies that have targeted the population without access to social security include the 1997 conditional cash transfers (CCT) program known as Prospera (formerly Oportunidades or Progresa) and the Seguro Popular de Salud (SPS by its Spanish initials), launched in 2003. These two programs, so far, have survived changes in the federal administrations being the most longstanding social programs targeting poor (or unprotected) populations ever in the history of modern Mexico. We tested the existence of positive synergies between demand-side (or CCT-Prospera) and supply-side (or Seguro Popular de Salud, SPS) social programs in the achievement of effective coverage (EC) of maternal-child health interventions in Mexico.MethodsWe performed a retrospective-cohort analysis to 6413 women aged 12-49 years who participated in a probabilistic survey conducted in 2012. We calculated EC as the product of three indexes: need, utilization and quality of health care. Correlates of EC were identified estimating a logistic regression model. We also presented adjusted EC by specific women groups.ResultsEC among beneficiaries of both programs was similar to estimates in Social Security affiliates (54%). For those not affiliated to any of the programs or those who received benefits for only one of them, the EC was 47.6% and 45.5% respectively. Adjusted estimates of EC suggest that overall, having both programs (Prospera + SPS) has a positive effect on maternal and child care coverage, which makes the observed differences in EC not statistically significant between those affiliated to both programs in comparison with the observed in the population with social security.ConclusionsResults support positive synergies between Prospera and SPS in the reduction of the gaps in EC. The most vulnerable population groups need to be reached by the combination of these programs so that public health efforts translate into greater EC of maternal health services and better maternal-child outcomes.

Precautionary Principle: Cancer Prevention Efforts During Critical Periods of Growth and Development.

Although the mechanisms of action for all cancer types are not fully known, best practice recommends promoting a healthy lifestyle while avoiding certain substances. Based on environmental science, the precautionary principle is a guideline that suggests that preventive action should be taken when the effects of a substance are unknown or disputed. Oncology nurses and maternal child healthcare professionals can improve cancer prevention through efforts during pregnancy, childhood, adolescence, and adulthood. This article reviews the application of the precautionary principle during critical periods of growth and development and provides recommendations that may prevent epigenetic changes and reduce the risk for cancer.