Maternal Education Research Articles

Examining Sociodemographic Variability in the Amount and Type of Interventions for Children With Autism.

Various intervention usage is associated with positive outcomes for children with autism. However, the intensity of these interventions tends to be below recommendations, especially for minoritized children. This study aimed to examine how average weekly intervention hours among children vary by sociodemographic factors. Regression analyses were conducted using data from 2,857 participants with autism included in the Simons Simplex Collection. Findings indicated the amount and type of intervention received varied by race, ethnicity, family income, and maternal education. This study marks an important step in documenting the extent of sociodemographic intervention disparities; and, helps to elucidate which therapy types are most readily underused and by which groups to help inform approaches to increase more equitable access.

Maternal education and antenatal attendance in Georgia: A cohort study

Abstract Background Antenatal care (ANC) and maternal education are important determinants for maternal and newborn health outcomes. Understanding the impact of maternal education on ANC is crucial. Purpose To examine the association between maternal education and ANC attendance. Methods A retrospective cohort study utilized nationwide electronic medical birth registry data (2020-2022) in Georgia. the study includes pregnant women and their newborns. A randomized sample was selected, and extracted variables included maternal age, parity, body mass index, education, year of delivery, gestational age, infant sex, Apgar score, birth weight, delivery type, and newborn status. Statistical analysis via IBM SPSS v23 involved chi-square, t-tests, and logistic regression. Results The sample size contains 4976 mothers after excluding cases with missing data (n = 25). The mean maternal age was 30.5 years (SD = 5.4), with a mean BMI of 28.0(SD = 4.8), and the mean gestational week was 38.4(SD = 2.0), with a mean birth weight of 3263.0 (SD = 568.0) grams. Highly educated women had more than 3 times higher odds (OR = 3.636,95%CI:2.575-5.134) of having at least one ANC visit compared to those with Unknown education. primiparous women had significantly higher odds of having at least one ANC visit compared to Multiparous women, OR = 1.519, (95%CI:1.081-2.135). The chi-square test showed significant difference between ANC visits and the number of liveborn/stillborn (χ² = 53.026, p < .001). Moreover, there was a significant association between birth weight categories and ANC visits (χ² = 167.095, p < .001). Conclusions Our study emphasizes the role of education in improving access to ANC among women with low education levels. We can increase ANC visits and improve maternal and newborn health outcomes by focusing educational efforts on pregnant women. Additionally, focusing on high-risk populations, and using tailored interventions can further improve ANC attendance along with maternal and neonatal health. Key messages • Boosting ANC access and improving maternal and neonatal health by tailored community programs. • Conservative communities and underrepresented communities require additional resources to promote tailored healthcare. and extra effort in education about ANC.

Living the first years in a pandemic: children's linguistic development and related factors in and out of the COVID-19 lockdowns.

This retrospective study provides insights on linguistic development in exceptional circumstances assessing 378 children (between 2;6 and 3;6) who lived their first years during the COVID-19 pandemic and comparing it with normative data collected before this period (CDI-III-PT; Cadime et al., 2021). It investigates the extent to which linguistic development was modulated by a complex set of factors, including sex, maternal education, book reading, language-promoting practices, COVID-19 infection, parental stress and sleeping problems, considering three periods (during lockdowns, out of lockdowns and at present). The results show a substantial negative effect of the pandemic on both lexical and syntactic development. Considering individual variation, structural equation modelling unveiled a complex scenario in which age, sex, book reading, language-promoting practices, sleeping problems and COVID-19 infection showed a direct effect on linguistic development. Maternal education and parental stress had an indirect effect on children's language, mediated by book reading and sleeping problems, respectively.

Low glycaemic index diet in pregnancy and child asthma: follow-up of the ROLO trial.

Epidemiological evidence suggests that a higher intake of sugar during pregnancy is associated with a higher risk of childhood asthma and atopy. However, randomised trial evidence supporting such a link is lacking. This study aimed to examine whether a low glycaemic index (GI) dietary intervention during pregnancy decreases the risk of childhood asthma and eczema. This is a secondary analysis of 514 children from the ROLO trial. Healthy women were randomised to receive an intervention of low GI dietary advice or routine care from early pregnancy. Mothers reported current doctor-diagnosed eczema in their children at 2 years (n 271) and current doctor-diagnosed asthma and eczema in their children at 5 (n 357) and 9-11 years (n 391) of age. Multivariable logistic regression models were used test the effect of the intervention on child outcomes overall and stratified by maternal education. There was a suggestion of a reduction in asthma at 5 years of age in children whose mothers received the low GI dietary intervention during pregnancy compared with usual care (adjusted OR 0·46 (95 % CI 0·19, 1·09); P = 0·08). In stratified adjusted analyses, the intervention was associated with a reduced risk of asthma at 5 years of age in children born to mothers with incomplete tertiary level education but not in those with complete tertiary level education (OR 0·14 (95 % CI 0·02, 0·69); P = 0·010 and OR 1·03 (95 % CI 0·34, 3·13); P = 0·94, respectively). A low GI diet in pregnancy may reduce the risk of developing asthma in childhood, particularly amongst children born to mothers with lower educational attainment.

Prenatal risk factors for child executive function at 3–5 years of age: the roles of maternal mood, substance use, and socioeconomic adversity in a prospective cohort study

BackgroundA growing body of literature links prenatal mood and substance use to children's cognitive and behavioral development. The relative contribution of these risk factors on children's executive function (EF) in the context of socioeconomic adversities needs further evaluation. To address this gap, we investigated the role of prenatal maternal anxiety and depression on childhood EF, specifically inhibitory control and working memory, within the context of socioeconomic adversities and prenatal substance use. We hypothesized that higher maternal mood symptoms, higher persistent prenatal drinking and smoking, and lower socioeconomic status would be associated with lower EF skills during early childhood.MethodsWe used data from 334 mother–child dyads followed prospectively through pregnancy and the offspring’s childhood. Prenatal maternal depression and anxiety were assessed via standardized questionnaires. Prenatal alcohol and tobacco consumption were assessed via a timeline follow-back interview. The EF touch battery assessed child inhibitory control and working memory at 3–5 years of age (4.76 ± 0.58 years, 171 females). Separate linear regression models were used to estimate the association of prenatal tobacco, alcohol, anxiety, and depression exposure with our two components of child EF, inhibitory control and working memory, while adjusting for gestational age, sex, and age at assessment. The following variables were also included as covariates: maternal educational achievement, employment status, parity, and household crowding index.ResultsChildren of mothers with high trait anxiety scores had reduced inhibitory control compared to children of mothers without trait anxiety or depression (β = -0.12, 95% CI:-0.22,-0.01). Children of mothers in the moderate to high continuous smoking group showed lower inhibitory control (β = − 0.19, 95% CI:-0.38,-0.01) compared to children of mothers in the none smoking group. Additionally, lower maternal education and higher household crowding were each associated with reduced inhibitory control. We found no significant association between prenatal maternal depression, anxiety, or socioeconomic factors with working memory.ConclusionsThese results underscore the need for comprehensive context-specific intervention packages, including mental health support for women to promote healthy inhibitory control development in children.

Early life social predictors of longitudinal relations between childhood BMI and overeating

Abstract Introduction The progression of obesity is a continuous process involving a complex system of genetic, environmental, and behavioural factors. Socioeconomic disadvantage as well as psychological distress may lead to overeating, subsequently associated with increased energy intake and weight gain. Recent evidence indicated that the association between childhood obesity and overeating might be bidirectional. Therefore, this study aimed to longitudinally investigate the directionality of the association between childhood BMI and overeating and to identify antecedent early childhood predictors. Methods The study sample included 5,777 children from the European Longitudinal Study of Parents and Children (ELSPAC), collected between 18 months and 11 years of child age. The outcomes were child BMI and overeating. Predictors included maternal BMI, maternal education, single-parent households, financial difficulties, and adverse childhood experiences (ACEs). The random intercept cross-lagged panel model (RI-CLPM) was applied. Results The results showed temporal stability in the development of overeating and BMI, with a bidirectional relationship that strengthened over time. The child’s BMI was predicted by maternal BMI (β = 0.37, p < 0.001). The child’s overeating was predicted by maternal BMI (β = 0.13, p < 0.001), but a stronger effect was found for ACEs (β = 0.24, p < 0.001). ACEs mediated the impact of maternal education, financial difficulties, and single parenthood on overeating with indirect effects of β = -0.01 (p = 0.005), β = 0.04, (p < 0.001), and β = 0.07 (p < 0.001), respectively. Conclusions We observed stable bidirectional longitudinal effects, with a stronger association from BMI to overeating. The results suggested two main pathways: one linked to maternal BMI and early childhood BMI increase followed by overeating, and the other associated with ACEs mediating the effect of early childhood socioeconomic factors on overeating, leading to gradual BMI gain. #NGEU Key messages • The study revealed a stable bidirectional association between childhood BMI and overeating, with a stronger association from BMI to overeating. • There are two potential pathways in childhood obesity development, one involving maternal BMI, and the second associated with social disadvantage and ACEs.

Supply of Alcohol in Early Childhood Leads to Higher Rates of Drinking in Adolescence

Abstract Background Adolescents often experience their first encounter with alcohol at home, provided by parents who perceive it as a means of safeguarding their children against later alcohol-related issues. However, research shows that parental supply of alcohol is a risk factor for adolescent drinking. Notably, existing studies solely focused on parental supply during adolescence, neglecting the prospective evaluation of parental alcohol provision during early childhood on later alcohol use. Methods The data came from the Czech part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC), a longitudinal birth cohort study (N = 5,777). Mothers reported on the frequency of offering alcohol to children when children were 3, 5, 7, and 11 years old. The outcome was adolescent alcohol use at ages 15 and 18, reported by adolescents, mothers, and pediatricians. Control variables included sex, maternal education, family structure, and parental alcohol consumption. Results Three classes of children were identified based on parental alcohol supply: abstainers (75.5% of sample), infrequent sippers (16.2%), and frequent sippers (8.3%). Parental drinking increased the risk of both infrequent and frequent sipping. These classes were entered into two structural models (age 15 and age 18 alcohol use modeled as latent factors), alongside covariates. Compared to abstainer class, infrequent and frequent childhood sippers exhibited significantly higher alcohol consumption at age 15 (β = .21, p < .001; β = .25, p < .001, respectively) and age 18 (β = .11, p < .05; β = .24, p < .001, respectively). Conclusions This study represents the first prospective investigation quantifying early childhood alcohol exposure and its subsequent association with adolescent alcohol consumption. Findings emphasize the influence of family dynamics on alcohol behaviors, underscoring the necessity for targeted preventive measures, particularly within families with higher parental alcohol consumption. Key messages • Offering alcohol to children at ages 3-11, even infrequently, significantly increases the risk of more frequent drinking at ages 15 and 18, compared to those with no early exposure. • Parents who drink are more likely to have children who sip alcohol early, leading to higher alcohol consumption in adolescence. Prevention efforts should focus on family habits and early education.

Vitamin D status and its determinants in pregnant women form the Faroe Islands

Abstract Background In regions like the Faroe Islands, where sunlight may be insufficient for vitamin D synthesis, alternative sources such as diet and supplements become crucial. This study focuses on assessing the vitamin D status of pregnant women in the Faroe Islands during the early second trimester, considering the potential implications for maternal and fetal health. Methods A nationwide cross-sectional study (June 2020-April 2022) with 652 women providing blood samples and a questionnaire on demographics, vitamin D intake, and diet. Binary logistic regression assessed predictors of low 25-hydroxyvitamin D (25OHD) levels (<50nmol/L). Plasma 25OHD concentrations were analysed at the local National Hospital using the Alinity i 25-OH Vitamin D assay, employing chemiluminescence microparticle immunoassay (CMIA) for quantitative determination. Results The mean age was 30.7 (SD, 4.9) years; 86% were locally born; 45% resided in the capital area; 49% were overweight (BMI ≥25.0), with a mean pre-pregnancy BMI of 26.0. Most participants (95%) reported vitamin D intake (median of 10µg/day) and consumed vitamin D-rich foods 5.3 times per week. Low 25OHD concentrations were observed in 26% of participants, associated with residency, vitamin D intake, dietary habits, overweight, and sampling time. Maternal age, education, BMI, smoking, and traditional food showed no significant associations. During winter, vitamin D intake correlated more strongly with plasma 25OHD levels (Spearman’s rho, winter: 0.4, p < 0.001; summer: 0.2, p = 0.002). Conclusions Our study’s findings are essential for the health of Faroese pregnant women. 74% of them had sufficient 25OHD levels, which is encouraging. However, low levels were associated with residence, diet, overweight, and winter. This underscores the need for public health efforts to focus on monitoring vitamin D status, promoting vitamin D-rich foods, especially in winter, and monitoring dietary intake to protect maternal and fetal health. Key messages • No previous data on vitamin D status in Faroese pregnant women. • Seasonal variation is observed.

Maternal and Paternal Education on Italian Monolingual Toddlers’ Language Skills

Background. Language development in toddlers can be influenced by social interactions in environments and proximal contexts with mothers and fathers. We present the literature on mothers’ and fathers’ education level and socioeconomic status on the child’s language development; further evidence is needed in the Italian-speaking context. Aims. The study aims to confirm the role of mother and father education level on toddlers’ language skills assessed with direct and indirect measures. Methods and Procedures. Participants were 51 Italian-speaking children aged 33 to 41 months. Children were tested with a lexical test (PinG test) for comprehension and production of nouns and predicates and a morpho-syntactic test for grammar comprehension (PCGO). Parents of the children completed a demographic form and the Italian adaptation of the MacArthur-Bates CDI long version. Two series of one-way ANCOVAs were performed to study the role of mothers’ and fathers’ level of education on separate measures of their child’s language. Outcomes and Results. Findings suggest that in most families, mothers’ level of education is higher than fathers’ level of education. There was no significant difference between children of parents with low–middle level of education and children of parents with high level of education for the grammar comprehension tasks (PCGO) and indirect measure of vocabulary production (MacArthur-Bates CDI). However, both mothers’ and fathers’ level of education appears to be significant for the direct measurement of word production. Conclusions and Implications. This study provides new evidence for the role of mothers’ and fathers’ education on the development of word production in children aged 33 to 41 months, contributing to enriching the literature on the Italian context; it lays the groundwork for future research on the social and environmental factors that can affect language development.

Correlation between vaccine hesitancy, vaccine reliability and perceptions of infectious diseases

Abstract Background Vaccine hesitancy is a delay in vaccine acceptance or refusal despite the availability of vaccination services. In recent years, the rise in vaccine hesitancy has attracted attention. This study aimed to evaluate the perception of vaccine hesitancy, vaccine safety, and infectious diseases among parents. Methods This cross-sectional study was conducted with 503 parents who applied to the pediatrics outpatient clinic of a university hospital. The questionnaire used in the study included questions on sociodemographic characteristics, factors related to vaccine hesitancy, The Vaccine Hesitancy Scale (VAS), the Vaccine Safety Scale (VSS), and the Perception Scale for Infectious Diseases (PPSID). Multivariate Linear Regression Analysis was used to find the variables associated with vaccine hesitancy. Results The mean age of the parents was 37.6±7.6 years. Parents’ scores on the ATS ranged from 17-85, with a mean score of 20.1±6.6 points. A moderate negative correlation was found between parents’ VAS and VSS scores, and between VAS and PPSID scores (r=-0.412, p < 0.001; r=-0.409, p < 0.001, respectively). According to the multivariate linear regression analysis the variables found to be associated with vaccine hesitancy, income status, maternal education level, child’s age group, having information about childhood vaccination schedule, child’s immunization status, the necessity of childhood vaccines, having sufficient information about the safety of vaccines, vaccine safety level, and infectious disease perception level were found to be significant predictors of vaccine hesitancy (F: 12,844, p ≤ 0.001, R2: 0.334). Conclusions This study determined that vaccine hesitancy was higher in families with lower income, who have not completed the schedule nor been vaccinated, doubt the necessity of vaccines to prevent infectious diseases, lack of knowledge about the reliability of vaccines, and whose children are still in primary school. Key messages • Health professionals have a critical role in reducing vaccine hesitancy. • It would be appropriate to plan face-to-face or online programs with parents.

Maternal pre-gestational and gestational diabetes and risk of offspring epilepsy: A cohort study

Abstract Background Despite growing evidence linking maternal diabetes to impaired brain physiology and neurodevelopment in offspring, evidence on its effect on epilepsy remains scarce. This study aims to determine if intrauterine exposure to maternal pre-existing and gestational diabetes mellitus is associated with risk of offspring epilepsy. Methods We studied >2.3 million singletons live-born in Sweden between 1998 and 2021, with final follow up until October 31, 2023. The Swedish Medical Birth Register was linked to the National Patient Register to identify gestational diabetes (GDM), maternal pre-gestational type 1 (T1DM) and type 2 diabetes (T2DM), and offspring epilepsy. The incidence of epilepsy, comparing offspring of mothers with versus without diabetes, was calculated as hazard ratios (HR), adjusting for maternal education, smoking, body mass index, hypertension, epilepsy and other important confounders. Paternal T1DM and T2DM were additionally analysed as negative control exposures to assess genetic confounding. Results Of the 2,335,245 offspring analysed (48.9% female), 13,883 (0.6%) were exposed to maternal T1DM, 4477 (0.2%) to T2DM, and 37,253 (1.6%) to GDM. During a median follow up of 13 years (range 0-26 years), 18,732 offspring were diagnosed with epilepsy. Maternal T1DM (HR 1.27, 95% confidence intervals [CI] 1.08-1.49) and T2DM (HR 1.34, 95% CI 1.00-1.49) were associated with higher hazards of epilepsy in offspring, compared with no exposure to maternal diabetes. Preterm birth and birth-asphyxia jointly mediated 63% and 39% of these associations, respectively. No association was found between maternal GDM and epilepsy. Paternal T1DM and T2DM did not show association with epilepsy. Conclusions In this nationwide population-based cohort study, children of mothers with T1DM or T2DM showed an elevated risk of epilepsy. The results from paternal comparison and mediation analyses suggest a key role of the intrauterine environment in the aetiology of epilepsy. Key messages • Maternal pre-existing T1DM and T2DM might be risk factors for epilepsy in offspring and are likely to influence the risk through the intrauterine environment independent of genetic mechanisms. • In the context of a globally rising prevalence of diabetes in women who get pregnant, it is crucial that the diabetes is well-regulated and birth complications associated with diabetes are prevented.

Knowledge, Attitude and Practice Regarding Use of ORS in Diarrhoea by Mothers in an Island of Bangladesh

Introduction: The second leading cause of death in under-five children is diarrhea. ORS is a simple and highly effective therapy for managing diarrhea. However inappropriate knowledge of preparation and lack of use of ORS leads to health hazards including increased rate of mortality and morbidity. So aim of this study to assess the knowledge, attitude, and Practice of mothers towards the use of oral rehydration solution in the treatment of acute diarrhea in children. Methods: A cross-sectional study was carried out over eight months (1st May to 30th December 2023) among 510 mothers who had children of six months to five years and had recent episodes of diarrhea. Data were collected by using a semi-structured questionnaire in face-to-face interview. Data were analyzed by using SPSS software program.Results: Among 510 mothers, 47.05% were 20-30 years old, 29.80% were below 20 years and 23.13% were over 30 years. One fourth of them had no institutional education and 36.27% had primary, 20.78% and 18.23% had secondary and tertiary level of education respectively. 40.39% were from lower socioeconomic condition, 31.97% were from middle and 27.64% from upper socioeconomic condition. 100% of family used sanitary latrine though 73.72% use safe drinking water as a preventive part of diarrhea.89.98% of mother was aware about ORS but only 75.88% used ORS in recent episode of diarrhea, among them 63.03% prepared ORS correctly and 60.98% used adequate amount. Age of mothers was not corresponds with the correct preparation and practice of ORS but socioeconomic condition and level of education carried statistically significant value. Conclusion: Knowledge and practice of ORS preparation and used of ORS in recent episode of diarrhea among the mother was unsatisfactory. Improve the Maternal education and socioeconomic status will improve ORS correct preparation and use. Mothers should be taught the importance of optimal use and correct preparation of ORS in diarrhea. EWMCJ Vol. 12, No. 1&2, January-July 2024: 43-49

Understanding the influence of children’s mental health, cognitive development, and environmental factors on learning outcomes in Chile

Mental health, cognitive development, and social background are related to educational success. While growing evidence is available in cultural settings other than Western countries, more knowledge is needed, especially regarding interactions among these dimensions. Rather than studying isolated factors, we propose an integrated approach to consider the diverse interrelated dimensions influencing children’s learning. Life course theory supports this approach underlying the role of early events in subsequent life paths and the multidisciplinary nature of these events. The sample consisted of 610 children (49.1% male) attending first grade. The children completed reading, mathematics, and visuospatial working memory (VWM) assessments. Parents completed the Strengths and Difficulties Questionnaire (SDQ-P) and reported their demographic information. A multilevel path model was estimated, including direct relationships between (i) children’s socioemotional behavior (SEB) and learning, (ii) VWM and learning, and (iii) SEB and VWM. The effects of sex and maternal education were also controlled. School and student level variances were modeled. At the school level, VWM, reading, and mathematics have variance, whereas SEB does not. At the student level, VWM, SEB, and maternal education have significant and differential effects on learning. Hyperactivity and peer problems were negatively related to reading and mathematics, while emotional problems were not, and conduct problems exhibited mixed results. These results reinforce developmental life course approaches, that is, from the beginning of schooling, promoting positive mental health can improve children’s learning outcomes.

Attrition in a large-scale habituation task administered at home.

Infant research often struggles with selective samples, especially when focusing on behavioural measures, such as those drawn from habituation tasks. However, selectivity may threaten the generalizability and interpretation of results, which is why the current study investigates attrition in a habituation task administered in a household setting in 7-month-old infants. We used a large-scale German dataset, focusing on the children's socioeconomic background, and investigated two aspects of attrition, namely, participation and task completion. The findings suggest significant effects of the children's socioeconomic background on attrition: Maternal education, parental occupation, household income and household language (German vs. other) were positively related to participation and task completion. The analyses indicate that multiple barriers may prevent parents from lower socioeconomic backgrounds from letting their children participate. The study concludes with a critical discussion of possible mechanisms of selectivity in behavioural measures as well as the household setting, in which the data were collected.

Determinants of rural‑urban child malnutrition disparities in Ethiopia

Child malnutrition is a significant issue in Ethiopia, with high prevalence rates. However, there is limited information on the rural‑urban disparities in child malnutrition of all its forms (stunting, wasting, and underweight) in the country. Therefore, this study aimed to address this gap by analysing data from the 2019 Ethiopian Demographic Health Survey (EDHS). This study examined the rural‑urban child malnutrition gaps in Ethiopia using an extended Oaxaca-Blinder decomposition technique. The analysis reveals significant ruralurban disparities in prevalence rates of wasting, underweight, and stunting. The findings highlighted that children in rural areas are more malnourished than their urban counterparts. Additionally, the study identified key determinants of these disparities, including maternal and parental education, household economic status, women’s age at first birth, childbirth size, and working status of women. The results also indicate that institutional delivery, household size, and dependency ratio contribute to widening the rural‑urban disparities in child malnutrition. This study highlighted the importance of targeted policies and interventions to address these disparities and reduce child malnutrition at the national level.

Trends and predictors of full immunization coverage in Nigeria

BackgroundImmunization plays a significant role in global health, yet many children in Nigeria do not receive full immunization due to several influencing factors. Therefore, this study examined the trends in Nigeria’s full immunization coverage and identified key predictors that influence full coverage.MethodsThe data for children aged one to five years, across the six geopolitical zones of Nigeria was retrieved from the 2007, 2011, 2016/17, and 2021 national Multiple Indicator Cluster surveys We analyzed the data using univariate logistic regression. Results were presented as adjusted odds ratios (aORs), and statistical significance was set at 0.05.ResultsThe results showed that 12,229 children (74.2%) had been fully immunized. The trend of immunization coverage was 63.6%, 82%, 63.7%, and 76.4% in 2007, 2011, 2016/17, and 2021 respectively. Children of educated mothers (aOR: 2.6; 95% CI 1.45, 4.76) and from the richest families (aOR: 2.1; 95% CI 1.41, 3.11), were more likely to be fully immunized. Conversely, children in rural areas (aOR: 0.6; 95% CI 0.42, 0.81) and from families of more than five (aOR: 0.6; 95% CI 0.46, 0.81) were less likely to be fully immunized.ConclusionAs of 2021, the rate of full immunization coverage in Nigeria was 76.4%, an improvement from the low 2003 rate (12.3%). Maternal education and wealth index are significant sociodemographic determinants for full immunization coverage. Adopting policies that improve access to education for females nationally and access to healthcare, especially in rural areas may significantly increase full immunization coverage.

Hemoglobinopathy Awareness Among Middle and High School Students In Karataş, Türkiye

Objective:Hemoglobinopathies are complex and inherited genetic disorders with no definitive cure; however, preventive measures such as genetic counseling and premarital screening may dramatically reduce their prevalence. Therefore, having sufficient information about the mentioned preventive measures is crucial. Methods:All students attending middle and high schools were included without a sample selection. A survey form was administered to students in order to evaluate their knowledge level and attitudes regarding hemoglobinopathies. The results were evaluated using Chi-square and logistic regression analysis with 95% confidence interval (CI). Results:The total number of students agreeing to participate in the study was 877. The mean age of the participants was 14.8 ± 1.5 years; 50.5% of them were male.Of the participating students, 40.3% were previously informed about hemoglobinopathies.The lowest correct response rate among questions in terms of students’ knowledge about hemoglobinopathies was observed in the question that asked the transmission route of the disorders with 13.7%.In the multivariate analysis, maternal education level (OR=1.417; 95% CI) and knowing an affected patient (OR=4.215; 95% CI) were associated with a greater likelihood of being previously informed. Conclusions:Our study demonstrated that students had insufficient knowledge on hemoglobinopathies in a region where the disorders are prevalent. Organizing and sustaining educational activities related to hemoglobinopathies - particularly genetic basics of the disorders - to students, who are the parents of the future, may be useful in combating hemoglobinopathies. Keywords:Hemoglobinopathies, Awareness, School Health, Middle School Students, High School Students

Making it work for all: equity in single ventricle monitoring.

Interstage monitoring programs for single ventricle disease have been developed to reduce morbidity and mortality. There is increased use of telemedicine and mobile application monitoring. It is unknown if there are disparities in use based on patient socio-demographic factors. We conducted a retrospective cohort study of patients enrolled in the single ventricle monitoring program and KidsHeart application at a single centre from 4/21/2021 to 12/31/2023. We investigated the association of socio-demographic factors with telemedicine usage, mobile application enrollment and usage. We assessed resource utilisation and weight changes by program era. There were 94 children in the cohort. Patients with Norwood and ductal stent had higher mean telemedicine visits per month (1.8 visits, p = 0.004), without differences based on socio-demographic factors. There were differences in application enrollment with more Black patients enrolled compared to White patients (p = 0.016). There were less Hispanic patients enrolled than Non-Hispanic patients (p = 0.034). There were no Spaish speaking patient's enrolled (p = 0.0015). There were no patients with maternal education of less than high school enrolled and all those with maternal education of advanced degree were enrolled (p = 0.0016). There was decreased mobile application use in those from neighbourhoods in the lowest income quartile. There were decreased emergency department visits with mobile application monitoring. Mean weight-for-age z-scores had increased from start to completion of the program in all eras. Differences were seen in mobile application enrollment and usage based on socio-demographic factors. Further work is needed to ensure that all patients have access to mobile application usage.

Pregnancy-Associated Maternal Mortality Within One Year After Childbirth: Population-Based Cohort Study.

The objective of this study is to assess associations between pregnancy complications and pregnancy-associated maternal mortality (PAM) within 1 year after childbirth. Population-based cohort study. Norway, 1967-2020. 1 237 254 mothers with one or more singleton pregnancies registered in the Medical Birth Registry, 1967-2019 and followed in the Cause of Death Registry to 2020. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for maternal education, age, year of first childbirth and chronic medical conditions. PAM by lifetime history of pregnancy complications: placental abruption, preeclampsia, preterm birth, perinatal death, small for gestational age (< 2.5 percentile), gestational diabetes and gestational hypertension. Crude OR for PAM was 4.24 (95% CI 3.53-5.10), if complications occurred in the last pregnancy, whereas 2.52 (2.08-3.06) if complications occurred in the first pregnancy, compared to mothers without complications in any pregnancy. Adjusted ORs for PAM when complications occurred in the last pregnancy were, for placental abruption 3.75 (1.20-11.72), preeclampsia: 4.42 (3.17-6.15), preterm birth: 4.32 (3.25-5.75), perinatal death: 24.18 (16.66-35.08), small for gestational age: 2.90 (1.85-4.54), gestational diabetes: 1.43 (0.63-3.25) and pregnancy hypertension: 2.05 (1.12-3.74) compared to mothers without complications. The OR for PAM increased slightly by increasing the number of complicated pregnancies but the trend was stronger for increasing number of complications in the last pregnancy (e.g., during 1999-2019: one complication; 4.14 [2.79-6.13], two complications; 11.50 [6.81-19.43]). Complications in the last pregnancy were more strongly associated with PAM than those in the first pregnancy.

Contextual success and pitfalls of mHealth service for maternal and child health in Africa: An Intervention, Context, Actors, Mechanism, and Outcome (ICAMO) framework guided systematic review of qualitative evidence

IntroductionMobile health (mHealth) interventions have shown potential to improve maternal and child health outcomes in Africa, but their effectiveness depends on specific interventions, context, and implementation quality. Challenges such as limited infrastructure, low digital literacy, and sustainability need to be addressed. Further evaluation studies are essential to summarize the impact of mHealth interventions. Thus, this synthesis focuses on qualitative evidence of the impact of mHealth on maternal and child health in Africa to summarize such evidence to help policy decisions.MethodsA qualitative systematic review guided by the concepts of Intervention, Context, Mechanism, and Outcome (ICAMO) was employed in this study. The GRADE CERQual assessment and methodological constraints tools were utilized in the review to ascertain the level of confidence in the evidence and to examine the methodological limitations. The JBI checklist for qualitative research appraisal was also consulted during the review.ResultsThe current review contains 32 eligible studies from databases such as CINAHL, EMBASE, MEDLINE, Scopus, Web of Science, HINARI, and Cochrane Library. The review demonstrated substantial improvements in the HCP-woman relationship, communication system, maternal and child healthcare uptake, health-seeking behavior, and HCP skills. Economic capacities, maternal education, and the low quality of existing services challenged participants.ConclusionmHealth significantly improves maternal and child health outcomes in Africa. This review showed it can improve healthcare access, empower women, and contribute to the region's goal of universal health coverage. However, the challenges such as low partner support, high costs for services, and poor quality of current care as narrated by women need commitment from health authorities in the continent. The evidence from this review suggests that mHealth can be implemented to improve maternal and child health in Africa.Trial registrationPROSPERO: CRD42023461425.