Maternal Health Research Research Articles

Are Indigenous research principles incorporated into maternal health research? A scoping review of the global literature

BackgroundIndigenous women world-wide are diverse and heterogenous, yet many have similar experiences of colonization, land dispossession, and discrimination. These experiences along with inequitable access to, and quality of, maternal healthcare increase adverse maternal health outcomes. To improve health outcomes for Indigenous women, studies must be conducted with Indigenous involvement and reflect Indigenous research principles.Objectives/Aim: The aim of this review was to explore the range, extent, and nature of Indigenous maternal health research and to assess the reporting of Indigenous research principles in the global Indigenous maternal health literature. MethodsFollowing a systematic scoping review protocol, four scholarly electronic databases were searched. Articles were included if they reported empirical research published between 2000 and 2019 and had a focus on Indigenous maternal health. Descriptive data were extracted from relevant articles and descriptive analysis was conducted. Included articles were also assessed for reporting of Indigenous research principles, including Indigenous involvement, context of colonization, Indigenous conceptualizations of health, community benefits, knowledge dissemination to participants or communities, and policy or intervention recommendations. ResultsFour-hundred and forty-one articles met the inclusion criteria. While studies were conducted in all continents except Antarctica, less than 3% of articles described research in low-income countries. The most researched topics were access to and quality of maternity care (25%), pregnancy outcome and/or complications (18%), and smoking, alcohol and/or drug use during pregnancy (14%). The most common study design was cross-sectional (49%), and the majority of articles used quantitative methods only (68%). Less than 2% of articles described or reported all Indigenous research principles, and 71% of articles did not report on Indigenous People's involvement. ConclusionsBy summarizing the trends in published literature on Indigenous maternal health, we highlight the need for increased geographic representation of Indigenous women, expansion of research to include important but under-researched topics, and meaningful involvement of Indigenous Peoples.

Perinatal mental health in India: protocol for a validation and cohort study.

ABSTRACTBackgroundCommon mental disorders (CMD) are among the largest contributors to global maternal morbidity and mortality. Although research on perinatal mental health in India has grown in recent years, important evidence gaps remain, especially regarding CMD. Our study aims to improve understanding of CMD among perinatal and non-perinatal women of reproductive age across two settings in India: Bangalore (Karnataka) and Tanda (Himachal Pradesh).MethodsThe study is embedded within the Maternal and Perinatal Health Research Collaboration India (MaatHRI). This mixed-methods observational study comprises three consecutive phases: (i) focus group discussions and individual interviews to explore women’s knowledge and seek feedback on CMD screening tools; (ii) validation of CMD screening tools; and (iii) prospective cohort study to identify CMD incidence, prevalence and risk factors among perinatal and non-perinatal women. Results of the three phases will be analyzed using inductive thematic analysis, psychometric analysis and multivariable regression analysis, respectively.ConclusionImproving understanding, detection and management of CMD among women is key to improving women’s health and promoting gender equality. This study will provide evidence of CMD screening tools for perinatal and non-perinatal women in two diverse Indian settings, produce data on CMD prevalence, incidence and risk factors and enhance understanding of the specific contribution of the perinatal state to CMD.

227The use of cross-sectional series as a source of evidence for policymaker decision in Brazil

Abstract Background To verify the effectiveness of public policies, two or more cross-sectional studies can be carried out in series. The objective of this work is to present the maternal and child health research of Ceará (PESMIC), Brazil, a series of cross-sectional studies carried out in a partnership between the university and the local government. Methods PESMIC is a series of cross-sectional studies with constant methodology, a sample obtained in multiple stages, with systematic and clusters sampling, state-wide representative, which visits 8000 households in 1987, 1990, 1994, 2001, 2007 and 2017. Around 300 variables are collected, in three different questionnaires, for the home, mothers, and children. Results PESMIC demonstrated over 30 years the improvement of several indicators such as the drop in infant mortality from 120 to 10 per thousand, the reduction of child malnutrition from 26.8% to 8.6%, the increase in infant breastfeeding for six months from 3% to 99%, the increase in maternal literacy from 58% to 97%. Conclusions Over 30 years, PESMIC presented results that allowed the evaluation of public policies and the occurrence of epidemiological transitions that occurred at the population level. The use of oral rehydration serum applied by community health workers, both unprecedented in Brazil when they started in Ceará, had their effectiveness demonstrated by PESMIC and were expanded to the rest of the country soon afterward. We conclude that the transversal series are studies that can help guide decision making by public health managers. Key messages The use of cross-sectional series can be a feasible alternative for the formation of evidence to aid decision-making The use of the PESMIC transversal series in Ceará helps Brazil in making important decisions such as the expansion of the community health workers program

COVID-19 and Children\u2019s Well-Being: A Rapid Research Agenda

PurposeUnderstanding the full impact of COVID-19 on U.S. children, families, and communities is critical to (a) document the scope of the problem, (b) identify solutions to mitigate harm, and (c) build more resilient response systems. We sought to develop a research agenda to understand the short- and long-term mechanisms and impacts of the COVID-19 pandemic on children’s healthy development, with the goal of devising and ultimately testing interventions to respond to urgent needs and prepare for future pandemics.DescriptionThe Life Course Intervention Research Network facilitated a series of virtual meetings that included members of 10 Maternal and Child Health (MCH) research programs, their research and implementation partners, as well as family and community representatives, to develop an MCH COVID-19 Research Agenda. Stakeholders from academia, clinical practice, nonprofit organizations, and family advocates participated in four meetings, with 30–35 participants at each meeting.AssessmentInvestigating the impacts of COVID-19 on children’s mental health and ways to address them emerged as the highest research priority, followed by studying resilience at individual and community levels; identifying and mitigating the disparate negative effects of the pandemic on children and families of color, prioritizing community-based research partnerships, and strengthening local, state and national measurement systems to monitor children’s well-being during a national crisis.ConclusionEnacting this research agenda will require engaging the community, especially youth, as equal partners in research co-design processes; centering anti-racist perspectives; adopting a “strengths-based” approach; and integrating young researchers who identify as Black, Indigenous, and People of Color (BIPOC). New collaborative funding models and investments in data infrastructure are also needed.

Serum Biomarkers Predict Symptom Duration in Long Term COVID-19 Across a Diverse Population

Background: Prolonged symptoms after SARS-CoV-2 infection are well-documented. However, which factors influence development of long-term symptoms, how symptoms vary across ethnic groups, and whether long-term symptoms correlate with serologic biomarkers remain elusive. Methods: Adult inpatient and outpatient SARS-CoV-2 RT-PCR positive patients were recruited at Stanford from March 2020 to February 2021. Study participants were seen for in-person visits at diagnosis and every 1-3 months for up to one year after diagnosis; they completed symptom surveys and underwent sampling procedures (blood draw and nasal swab) at each visit. Findings: Our cohort (n=617) ranged from asymptomatic to critical COVID-19 infections. 40% of participants reported at least one symptom associated with COVID-19 six months after diagnosis. Median time from diagnosis to first resolution of all symptoms was 44 days, median time from diagnosis to sustained symptom resolution with no recurring symptoms for one month or longer was 214 days. Serum anti-nucleocapsid IgG level in the first week of infection was predictive of time to symptom resolution. A prior diagnosis of lung disease was associated with longer time to symptom resolution. COVID-19 disease severity, ethnicity, sex, cytomegalovirus (CMV) seropositivity, and remdesivir use did not affect time to sustained symptom resolution. More than 90% of participants had SARS-CoV-2-specific antibody>1000 AU/mL nine months after diagnosis. Interpretation: Our findings showed that all disease severities had a similar risk of developing post-COVID-19 syndrome in an ethnically diverse population. Comorbid lung disease and lower levels of initial IgG response to SARS-CoV-2 nucleocapsid antigen were associated with longer symptom duration. Trial Registration: National clinical trial database NCT04664309.Funding: NIH CTSA grant, U54 NIH Grant, R21 NIEHS, Sean N Parker Center for Allergy and Asthma Research at Stanford University, the Sunshine Foundation, the Crown Foundation, and the Parker Foundation.Declaration of Interest: Dr. Boyd received support for the current manuscript from Meso Scale Discovery and NIH; 418 received consulting fees by Regeneron for expert testimony, has stocks or stock options in 419 AbCellera Biologics; Dr. Chinthrajah reports grants from NIAID, CoFAR, Aimmune, DBV 420 Technologies, Astellas, Regeneron, Stanford Maternal and Child Health Research Institute 421 (MCHRI), and FARE. She is an Advisory Board Member at Alladapt Therapeutics, Novartis, 422 Genentech, Sanofi, Allergenis, and Nutricia; Dr. Manisha Desai received support from Chan 423 Zuckerberg Foundation; Dr. Maecker received grants or contracts from NIH, Bill & Melinda 424 Gates Foundation, Ionis Corporation, Amgen Corporation; Consulting fees from Magarray Corp; 425 payment or honoraria from UCLA, UC Davis; leadership or fiduciary role at Cytek SAB; stocks 426 or stock options at BD Biosciences; Dr. Nadeau reports grants from National Institute of Allergy and Infectious Diseases (NIAID), National Heart, Lung, and Blood Institute (NHLBI), National Institute of Environmental Health Sciences (NIEHS), and Food Allergy Research & Education (FARE); Director of World Allergy Organization (WAO) , Advisor at Cour Pharma, Consultant for Excellergy, Red tree ventures, and Phylaxis, Co-founder of Before Brands, Alladapt, Latitude, and IgGenix; and National Scientific Committee member at Immune Tolerance Network (ITN), and National Institutes of Health (NIH) clinical research centers, outside the submitted work; patents include, “Mixed allergen composition and methods for using the same”, “Granulocyte-based methods for detecting and monitoring immune system disorders”, “Methods and Assays for Detecting and Quantifying Pure Subpopulations of White Blood Cells in Immune System Disorders,” and “Methods of isolating allergen-specific antibodies from humans and uses thereof”; Dr. Benjamin Pinsky received grants or contracts for the present manuscript from MesoScale Diagnostics; Dr. Angele Rogers was a Clinical Trials Advisory Board Member for Merck; Dr. Sindher reports support for the present manuscript from the NIH, Regeneron, DBV Technologies, Aimmune, Novartis, CoFAR, FARE, participated on a DSMB for Astra Zeneca, DBV, and received payment or honorarium from FARE; Neera Ahuja, Maja Artandi, Linda Barman, Catherine Blish, Andra Blomkalns, William Collins, MacKenzie Cox, Linda Geng, Xiaolin Jia, Megan Mahoney, Monali Manohar, Ruth O’hara, Rajan Puri, Katharina Roltgen, Laura Vaughan, Samuel Yang, Shu Cao, Iris Chang, Hena Din, Evan Do, Andrea Fernandez, Alexandra Lee, Natasha Purington, Yael Rosenberg-Hasson, Theo Snow, Daniel Solis, Michelle Verghese, and Yingjie Weng have no conflict of interest.Ethical Approval: This study was reviewed and approved by the Stanford Administrative Panel on Human Subjects in Medical Research.

Development and validation of a risk prediction index for severe maternal morbidity based on preconception comorbidities among infertile patients

To develop and validate a preconception risk prediction index for severe maternal morbidity (SMM), defined by the Centers for Disease Control and Prevention as indicators of a life-threatening complication, among infertile patients. Retrospective analysis of live births and stillbirths from 2007 to 2017 among infertile women. National commercial claims database. Infertile women identified on the basis of diagnosis, testing, or treatment codes. None. The primary outcome was SMM, identified as any indicator from the Centers for Disease Control and Prevention Index except blood transfusion alone, which was found to overestimate cases. Twenty preconception comorbidities associated with a risk of SMM were selected from prior literature. Targeted ensemble learning methods were used to rank the importance of comorbidities as potential risk factors for SMM. The independent strength of the association between each comorbidity and SMM was then used to define each comorbidity's risk score. Among 94,097 infertile women with a delivery, 2.3% (n = 2,181) experienced an SMM event. The highest risk of SMM was conferred by pulmonary hypertension, hematologic disorders, renal disease, and cardiac disease. Associated significant risks were lowest for substance abuse disorders, prior cesarean section, age ≥40 years, gastrointestinal disease, anemia, mental health disorders, and asthma. The receiver operating characteristic area under the curve for the developed comorbidity score was 0.66. Calibration plots showed good concordance between the predicted and actual risk of SMM. We developed and validated an index to predict the probability of SMM on the basis of preconception comorbidities in patients with infertility. This tool may inform preconception counseling of infertile women and support maternal health research initiatives.

Developing Biopsychosocial Research on Maternal Mental Health in Malawi: Community Perspectives and Concerns.

Interest in maternal mental health research is growing around the world. Maternal mental health research studies in Malawi have, for instance, sought to determine and establish the incidence and prevalence of depression and anxiety in pregnant people and the factors that contribute to experiences of these states. This article reports stakeholder perspectives on potential community concerns with biopsychosocial mental health research (which might include collecting blood samples) in Malawi. These perspectives were generated through a town hall event that featured five focus group discussions with various participants. In this article, we reflect on key themes from these discussions, demonstrating the endurance of long-standing concerns and practices around autonomy, consent, and the drawing of blood. We conclude by arguing that, while maternal mental health research conducted in Malawi could benefit Malawian women and children, consultation with community stakeholders is necessary to inform whether and how such research should be conducted.

Gaps in maternal, newborn, and child health research: a scoping review of 72 years in Ethiopia

Background Despite significant reductions in maternal and child mortality over the past few decades, a disproportionate number of global deaths occur in low and middle-income country settings, such as Ethiopia. To prioritize research questions that would generate policy recommendations for better outcomes, we conducted a scoping review that gathers the current knowledge of maternal, newborn, and child health (MNCH) and illustrates remaining gaps in Ethiopia. Methods We conducted a search strategy from 1946-2018 in PubMed/MEDLINE, EMBASE, and the WHO African Index Medicus. The study team of reviewers independently screened titles, abstracts, and full-texts; abstracted data; and reconciled differences in pairs. Descriptive analyses were conducted. Results We identified 7,829 unique articles of which 2,170 were included. Most MNCH publications in Ethiopia (70.0%) were published in the last decade, 2010-2018. Most studies included children aged one to less than 10 years old (30.5%), women of reproductive age (22.0%), and pregnant women (21.9%); fewer studies included newborns (7.0%), infants (6.6%), and postpartum women (2.9%). Research topics included demographics and social determinants of health (43.4%), nutrition (15.3%), and infectious diseases (13.0%). There were limited studies on violence (1.4%), preterm birth (0.8%), antenatal/postpartum depression (0.7%), stillbirths (0.1%), and accidents (0.1%). Most study designs were cross-sectional (53.6%). A few study designs included prospective cohort studies (5.5%) and randomized control trials (2.3%). Conclusions This is the first scoping review to describe the landscape of MNCH research in Ethiopia. Understanding the depth of existing knowledge will support the prioritization and development of future research questions. Additional studies are needed to focus on the neonatal, infant, and postpartum populations as well as preterm and stillbirth outcomes.

Scoping review protocol of service delivery-related interventions to improve maternal and newborn health in low-income and middle-income countries

IntroductionThis review will explore the characteristics of service delivery-related interventions to improve maternal and newborn health in low-income and middle-income countries, comparing three common framing approaches of these interventions (referred...

Maternal and perinatal Health Research Collaboration, India (MaatHRI): methodology for establishing a hospital-based research platform in a low and middle income country setting

Background: Maternal and perinatal Health Research collaboration, India (MaatHRI) is a research platform that aims to improve evidence-based pregnancy care and outcomes for mothers and babies in India, a country with the second highest burden of maternal and perinatal deaths. The objective of this paper is to describe the methods used to establish and standardise the platform and the results of the process. Methods: MaatHRI is a hospital-based collaborative research platform. It is adapted from the UK Obstetric Surveillance System (UKOSS) and built on a pilot model (IndOSS-Assam), which has been extensively standardised using the following methods: (i) establishing a network of hospitals; (ii) setting up a secure system for data collection, storage and transfer; (iii) developing a standardised laboratory infrastructure; and (iv) developing and implementing regulatory systems. Results: MaatHRI was established in September 2018. Fourteen hospitals participate across four states in India – Assam, Meghalaya, Uttar Pradesh and Maharashtra. The research team includes 20 nurses, a project manager, 16 obstetricians, two pathologists, a public health specialist, a general physician and a paediatrician. MaatHRI has advanced standardisation of data and laboratory parameters, real-time monitoring of data and participant safety, and secure transfer of data. Four observational epidemiological studies are presently being undertaken through the platform. MaatHRI has enabled bi-directional capacity building. It is overseen by a steering committee and a data safety and monitoring board, a process that is not normally used, but was found to be highly effective in ensuring data safety and equitable partnerships in the context of low and middle income countries (LMICs). Conclusion: MaatHRI is the first prototype of UKOSS and other similar platforms in a LMIC setting. The model is built on existing methods but applies new standardisation processes to develop a collaborative research platform that can be replicated in other LMICs.

Integrating Mobile Health Technology in Community Based Doula Programs to Extend Childcare Related Support to Adolescent Single Mothers

The effect of all aspects of maternal health before, during, and after pregnancy on prenatal and early childhood health and well-being is well documented. Early childhood outcomes have been empirically established as predictors of well-being in later life (Heckman et. al., 2013). Research on motherhood indicates that social and instrumental support from family of origin has a greater positive impact on adolescent mothers than adult mothers (Nath et. al., 1991). However, the absence of such forms of support among adolescent single mothers might have detrimental implications for maternal and child well-being outcomes. The role of doulas in providing physical, emotional, and informational support to mothers during labor and post-partum, and fostering positive mother-infant relationships is widely recognized in maternal and child health research. (Ahlemeyer, J., & Mahon, S., 2015, & Hans et. al., 2013). Therefore, community-based doula programs can be an effective way to improve maternal and child health outcomes in populations of adolescent single mothers. This paper proposes adaptation of existing community-based doula programs to the unique features of adolescent parenting by integrating mobile health technology to build an alert virtual ecosystem that facilitates immediate provision of social and instrumental support, and childcare related services to adolescent single mothers at high risk of detrimental birth outcomes.

Gaps in Maternal, Newborn, and Child Health Research: A Scoping Review of 72 Years in Ethiopia

Background: Despite significant reductions in maternal and child mortality over the past few decades, a disproportionate number of global deaths occur in low and middle-income country settings, such as Ethiopia. To prioritize research questions that would generate policy recommendations for better outcomes, we conducted a scoping review that gathers the current knowledge of maternal, newborn, and child health (MNCH) and illustrates remaining gaps in Ethiopia. Methods: We conducted a search strategy from 1946-2018 in PubMed/MEDLINE, EMBASE, and the WHO African Index Medicus. The study team of reviewers independently screened titles, abstracts, and full-texts; abstracted data; and reconciled differences in pairs. Descriptive analyses were conducted. Findings: We identified 7,829 unique articles of which 2,170 were included. Most MNCH publications in Ethiopia (70·0%) were published in the last decade, 2010-2018. Most studies included children aged one to less than 10 years old (30·5%), women of reproductive age (22·0%), and pregnant women (21·9%); fewer studies included newborns (7·0%), infants (6·6%), and postpartum women (2·9%). Research topics included demographics and social determinants of health (43·4%), nutrition (15·3%), and infectious diseases (13·0%). There were limited studies on violence (1∙4%), preterm birth (0·8%), antenatal/postpartum depression (0·7%), stillbirths (0·1%), and accidents (0·1%). Most study designs were cross-sectional (53·6%). A few study designs included prospective cohort studies (5·5%) and randomized control trials (2·3%). Interpretation: This is the first scoping review to describe the landscape of MNCH research in Ethiopia. Understanding the depth of existing knowledge will support the prioritization and development of future research questions. Additional studies are needed to focus on the neonatal, infant, and postpartum populations as well as preterm and stillbirth outcomes. Funding Statement: Bill & Melinda Gates Foundation. Declaration of Interests: We declare no conflicting interests.

AJRH gets new numbers and a social science editor.

AJRH gets new numbers and a social science editor.

A novel approach using hand-held echocardiography to guide the diagnosis of heart failure in pregnant women in a low-resource setting; Maternal and Perinatal Health Research Collaboration

Abstract Background Point of care imaging devices are promising tools for cardiovascular imaging in low-resource settings. Purpose Our aim was to determine whether hand-held echocardiography scans performed by obstetricians can help to identify the cardiac phenotypes in pregnant women with heart failure in India. Methods In November 2018, eighteen obstetricians from 10 hospitals across the states of Assam, Meghalaya and Uttar Pradesh were given 2 days of hands-on training in image acquisition using Philips Lumify devices. Obstetricians were asked to follow a simplified protocol of image acquisition and optimisation designed by the Oxford Cardiovascular Clinical Research Facility team. The protocol includes 3 key echocardiography views; parasternal long axis, parasternal short axis, and apical four chamber. Remote supervision and constructive feedback on performance was provided to improve image quality. Echocardiographic images of 269 pregnant women (with and without suspected heart failure) were acquired by the trained obstetricians, between February 2018 and January 2020. The first 147 scans were transferred with end-to-end encryption to the University of Oxford Research Echocardiography Core Laboratory (ORECL). Image interpretation and formal quality assessment was performed by 2 experienced echocardiographers. Results Parasternal long axis image quality was assessed as good in 78.3%, and was superior to both the parasternal short axis view (76.5%) and the apical 4-chamber view (61.9%). Image depth and gain optimisation was the main reason for loss of quality. The acquisition quality was related to reported clinical disease severity, and advanced pregnancy status. Left ventricular systolic function was impaired in 32 participants (21.9%), and 23.3% of the cohort had a dilated left atrium. Rheumatic heart disease was found in 12 participants (8.3%), in which the mitral valve was stenotic; 10 severe and 1 moderate. Mitral regurgitation was reported in 29 cases (20.8%); 6 severe, 7 moderate and 16 mild. Tricuspid and aortic valve abnormalities were also detected. Pericardial effusion was reported in 45 participants (30.8%). Conclusion Obstetricians with supervised training, using hand-held echocardiography have demonstrated acceptable image acquisition quality which could be assessed through core laboratory analysis to detect cardiac abnormalities. Such an approach could be useful to guide the diagnosis of heart failure in pregnant women in low-resource settings. Further training for the obstetricians and image quality assurance have been implemented in the ongoing MaatHRI study with plans to conduct a validation analysis. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Medical Research Council (MRC), UK Fellowship for M Nair.

Arsenic and Immune Response to Influenza Vaccination in Pregnant Women and Newborns

Background/AimsThere is a gap in understanding of whether arsenic exposure during pregnancy alters the maternal immune response and antibody transfer to the infant. We aimed to establish a birth cohort in a region with low-moderate drinking water arsenic concentrations to investigate the relationship between arsenic exposure and immunogenicity of a seasonal quadrivalent inactivated influenza vaccine (IIV) in pregnant women and infants.MethodsWe established a birth cohort (NCT03930017) at the JiVitA Maternal and Child Health and Nutrition Research Project site, which covers ~650,000 people over 500 km2 in rural northern Bangladesh. We planned to enroll 850 pregnancies to achieve a desired sample size of 400 mother-infant pairs at three-months postpartum, based on minimum detectable differences in geometric mean hemagglutination inhibition antibody titers for seasonal quadrivalent IIV antigens when comparing the highest and lowest quartiles of arsenic exposure. From July 2018 to June 2019, we screened women of reproductive age to identify incident pregnancies. Multiparous pregnant women were enrolled in gestational weeks (GW) 13-16. At enrollment, we collected drinking water, urine, blood, and saliva, and administered IIV.ResultsWe screened 52,000 women to identify 2,623 incident pregnancies in multiparous women. Of these, 1,338 were identified prior to GW 16, 846 consented, and 784 enrolled. We followed 567 mother-infant pairs to three-months postpartum. At enrollment, all participants contributed drinking water, urine, blood (processed as plasma, serum, and peripheral blood mononuclear cells), and saliva. An analysis of 40 drinking water samples selected at random found that arsenic concentrations were comparable to arsenic-endemic regions of the U.S. (geometric mean: 3.03 µg/L, geometric standard deviation: 9.54 µg/L, range: 0.05 to 96.83 µg/L).ConclusionsThe number of pregnancies enrolled in our cohort yielded the sample size needed to investigate prespecified aims related to low-moderate arsenic exposure and altered maternal and child immune response.

Use of weekly mobile phone call-unit to screen pregnant women and their newborns for acute respiratory and gastrointestinal illness symptoms in rural Bangladesh

Background/Aims Acute respiratory and gastrointestinal illnesses are major contributors to morbidity and mortality worldwide, particularly in vulnerable populations of pregnant women and infants. It is critical to understand the burden of these illnesses in low-resource settings where infectious, nutritional, and immunotoxicological risk factors overlap and access to medical care may be limited.Methods We established a birth cohort (NCT03930017) at the JiVitA Maternal and Child Health and Nutrition Research Project site in rural Bangladesh enrolling pregnant women during gestational weeks 13-16. In collaboration with the Government of Bangladesh Institute of Epidemiology, Disease Control and Research (IEDCR), we established a mobile phone-based research support system call-center to ascertain acute respiratory and gastrointestinal symptoms in the cohort of pregnant women and their newborns at weekly intervals from study enrollment to 3-months postpartum. Further, if a participant reported acute respiratory illness or influenza-like illness (ILI) symptoms a confirmatory nasal swab specimen was collected, and real time qPCR analysis and subtyping was conducted for influenza types A and B.Results From October 2018 to January 2020, IEDCR completed 24,915 weekly mobile phone call-based interviews with 765 mothers (94% completion rate) and 11,230 weekly call-based interviews with caretakers who described morbidity for 638 infants (93% completion rate). Incident cases of ILI were recorded at a rate of 3.2 per 100 interviews among mothers and 7.7 per 100 interviews for infants. We also observed 1.6 and 1.8 incident cases of diarrhea per 100 interviews among mothers and infants, respectively. 850 nasal swabs were collected for confirmatory RT-qPCR analysis.Conclusions A mobile phone call-unit was established and produced high degree of data completeness in a pregnancy and birth cohort in rural Bangladesh. These longitudinal acute respiratory and gastrointestinal morbidity symptom data can support future planned analyses of associations with biomarkers of co-infections, micronutrient deficiency, and immunotoxicant exposure.

Maternal and newborn health priority setting partnership in rural Uganda in association with the James Lind Alliance: a study protocol

BackgroundMaternal and newborn deaths and ill health are relatively common in low income countries, but can adequately be addressed through locally, collaboratively designed, and responsive research. This has the potential to enable the affected women, their families and health workers themselves to explore ‘why maternal and newborn adverse outcomes continue to occur. The objectives of the study include;To work with seldom heard groups of mothers, their families, and health workers to identify unanswered research questions for maternal and newborn health in villages and health facilities in rural UgandaTo establish locally responsive research questions for maternal and newborn health that could be prioritised together with the public in UgandaTo support the case for locally responsive research in maternal and newborn health by the ministry of health, academic researchers and funding bodies in Uganda.MethodsThe present study will follow the James Lind Alliance (JLA) Priority Setting Partnership (PSP) methodology. The project was initiated by an academic research group and will be managed by a research team at the Sanyu Africa Research Institute on a day to day basis. A steering group with a separate lay mothers’ group and partners’ group (individuals or organisations with interest in maternal and newborn health) will be recruited. The PSP will be initiated by launch meetings, then a face-to-face initial survey for the collection of raw unanswered questions; followed by data collation. A face-to-face interim prioritisation survey will then be performed to choose questions before the three separate final prioritisation workshops.The PSP will involve many participants from an illiterate, non-internet population in rural eastern Uganda, but all with an interest in strategies to avert maternal and newborn deaths or morbidities in rural eastern Uganda. This includes local rural women, their families, health and social workers, and relevant local groups or organisations.We will generate a top 10 list of maternal and newborn health research priorities from a group with no prior experience in setting a research agenda in rural eastern Uganda.DiscussionThe current protocol elaborates the JLA methods for application with a new topic and in a new setting translating the JLA principles not just into the local language, but into a rural, vulnerable, illiterate, and non-internet population in Uganda. The face-to-face human interaction is powerful in eliciting what exactly matters to individuals in this particular context as opposed to online surveys.This will be the first time that mothers and lay public with current or previous experience of maternal or neonatal adverse outcomes will have the opportunity to identify and prioritise research questions that matter to them in Uganda. We will be able to compare how the public would prioritise maternal health research questions over newborn health in this setting.

Maternal and perinatal Health Research Collaboration, India (MaatHRI): methodology for establishing a hospital-based research platform in a low and middle income country setting

Background: Maternal and perinatal Health Research collaboration, India (MaatHRI) is a research platform that aims to improve evidence-based pregnancy care and outcomes for mothers and babies in India, a country with the second highest burden of maternal and perinatal deaths. The objective of this paper is to describe the methods used to establish and standardise the platform and the results of the process. Methods: MaatHRI is a hospital-based collaborative research platform. It is adapted from the UK Obstetric Surveillance System (UKOSS) and built on a pilot model (IndOSS-Assam), which has been extensively standardised using the following methods: (i) establishing a network of hospitals; (ii) setting up a secure system for data collection, storage and transfer; (iii) developing a standardised laboratory infrastructure; and (iv) developing and implementing regulatory systems. Results: MaatHRI was established in September 2018. Fourteen hospitals participate across four states in India – Assam, Meghalaya, Uttar Pradesh and Maharashtra. The research team includes 20 nurses, a project manager, 16 obstetricians, two pathologists, a public health specialist, a general physician and a paediatrician. MaatHRI has advanced standardisation of data and laboratory parameters, real-time monitoring of data and participant safety, and secure transfer of data. Four observational epidemiological studies are presently being undertaken through the platform. MaatHRI has enabled bi-directional capacity building. It is overseen by a steering committee and a data safety and monitoring board, a process that is not normally used, but was found to be highly effective in ensuring data safety and equitable partnerships in the context of low and middle income countries (LMICs). Conclusion: MaatHRI is the first prototype of UKOSS and other similar platforms in a LMIC setting. The model is built on existing methods but applies new standardisation processes to develop a collaborative research platform that can be replicated in other LMICs.

Mapping the maternal health research landscape in Nunavut: A systematic search & critical review of methodology.

Nunavut's maternal healthcare system is characterized by rapid transition from community-based birth to a practice of obstetric evacuation and institutionalized birth. Given calls for Inuit self-determination in research, maternal health research - which informs healthcare practices and policies - may need to be conducted differently, using different research methodologies, to include Inuit women's voices and lived experiences. In light of these calls, this article systematically synthesized the published maternal health literature in Nunavut and critically examined reported research methods. This systematic search and critical review involved a comprehensive database search and multi-level eligibility screening conducted by two independent reviewers. Data on the temporal, geographic, methodological, and topical range of studies were extracted, then descriptive statistics were calculated to summarize these data. A hybrid inductive and deductive qualitative analysis of the full-text articles was conducted to critically analyze research methodology. The initial search yielded 2656 distinct articles and twenty-eight articles met the inclusion criteria. These articles were published from 1975 to 2016, mostly used quantitative research methodology (71.4%), were written from clinical perspectives (57.1%), and focused on maternity care (53.6%). Emergent themes related to both the contributions and areas for growth of research methodology in the conceptualization, initiation, implementation, reporting, and knowledge mobilization stages of the research process. This review revealed opportunities for maternal health researchers to: redress the ongoing impacts of colonization; further include Inuit definitions of health and perspectives on birth in study designs; explore new methodologies that resonate with Inuit ways of knowing; continue (re)aligning research with community priorities; and move from consultation and collaborative partnership in research to Inuit leadership and data ownership. Indeed, this review illustrates that at each step of the research process, opportunity exists for Inuit perspectives and active involvement to shape and define maternal health research in Nunavut.

Syndemic Perspectives to Guide Black Maternal Health Research and Prevention During the COVID-19 Pandemic.

The coronavirus 2019 (COVID-19) pandemic and related policies have led to an unequal distribution of morbidity and mortality in the U.S. For Black women and birthing people, endemic vulnerabilities and disparities may exacerbate deleterious COVID-19 impacts. Historical and ongoing macro-level policies and forces over time have induced disproportionately higher rates of maternal morbidity and mortality among Black women and birthing people, and contemporary macroeconomic and healthcare policies and factors continue to hold particular consequence. These factors induce detrimental psychological, health, and behavioral responses that contribute to maternal health disparities. The COVID-19 pandemic is likely to disproportionately impact Black women and birthing people, as policy responses have failed to account for the their unique socioeconomic and healthcare contexts. The resulting consequences may form a ‘vicious cycle’, with upstream impacts that exacerbate upstream macro-level policies and forces that can further perpetuate the clustering of maternal morbidity and mortality in this population. Understanding the impacts of COVID-19 among Black women and birthing people requires theoretical frameworks that can sufficiently conceptualize their multi-level, interacting, and dynamic nature. Thus, we advocate for the proliferation of syndemic perspectives to guide maternal disparities research and prevention during the COVID-19 pandemic. These perspectives can enable a holistic and nuanced understanding of the intersection of endemic and COVID-19-specific vulnerabilities and disparities experienced by Black women and birthing people. Syndemic-informed research can then lead to impactful multi-level prevention strategies that simultaneously tackle both endemic and COVID-19-specific factors and outcomes that lead to the clustering of vulnerabilities and disparities over time.