Postnatal Research Articles

High-Flow Oscillatory Ventilation: A Possible Therapeutic Option for Pediatric Patients with Cardiovascular Diseases

High-flow oscillatory ventilation (HFOV) is a common rescue treatment in infants and children with respiratory failure. This type of ventilation is an effective technique in numerous diseases that affect a child in the postnatal period, such as ARDS, meconium aspiration syndrome (MIS), postnatal pulmonary bleeding and idiopathic pulmonary hypertension (IPH). Although this ventilation technique is commonly recognized as a valuable therapeutic option in the general pediatric population, this is not the same for children with congenital cardiovascular diseases. The key mechanism of oscillatory ventilation is continuous positive pressure administered within the airways via a small tidal volume at high frequency. Tidal volumes are between 1 and 3 mL/kg delivered at 5–15 Hz, equivalent to 300–900 breaths per minute. A few older studies conducted on humans and animals highlight that HFOV may be dangerous for congenital heart patients. According to these evidences, hemodynamic parameters such as blood pressure, wedge pressure, central venous pressure, heart rate and inotrope level can be dangerously changed for patients with congenital heart disease; therefore, oscillatory ventilation should be avoided. Numerous retrospective studies have pointed out how oscillatory ventilation constitutes a valid therapeutic option in children with congenital heart disease. Recently, new evidences have highlighted how hemodynamic parameters are modified in a non-significant way by this type of ventilation, remaining beneficial as in the normal pediatric population. This narrative review aims to describe the mechanisms of oscillatory ventilation and collect all the available evidences to support its use in pediatric patients with congenital heart problems.

GDF15 knockout does not substantially impact perinatal body weight or neonatal outcomes in mice.

Growth differentiation factor-15 (GDF15) increases in circulation during pregnancy and has been implicated in food intake, weight loss, complications of pregnancy, and metabolic illness. We used a Gdf15 knockout mouse model (Gdf15-/-) to assess the role of GDF15 in body weight regulation and food intake during pregnancy. We found that Gdf15-/- dams consumed a similar amount of food and gained comparable weight during the course of pregnancy compared to Gdf15+/+ dams. Insulin sensitivity on gestational day 16.5 was also similar between genotypes. In the postnatal period, litter size, and survival rates were similar between genotypes. There was a modest reduction in birth weight of Gdf15-/- pups, but this difference was no longer evident postnatal day 3.5 to 14.5. We observed no detectable differences in milk volume production or milk fat percentage. These data suggest that GDF15 is dispensable for changes in food intake, and body weight as well as insulin sensitivity during pregnancy in a mouse model.

Low protein uptake during peripuberty impairs the testis, epididymis, and spermatozoa in pubertal and adult Wistar rats.

Protein malnutrition during critical periods poses significant risks to reproductive health. Thus, this study aims to evaluate the immediate and delayed effects of a 30-day low-protein diet on the postnatal development of the male reproductive system. For so, male rats were fed a protein-deficient diet from postnatal day 30-60, followed by evaluations of testis, epididymis, and spermatozoa both at the end of the diet and after a 60-day recovery period. Testicular and epididymal weight was lowered in pubertal animals. Several histological alterations were found in the testis, such as acidophilic cells and vacuoles in the seminiferous epithelium, and sperm production was compromised. In the epididymis, the luminal compartment was diminished, and the stroma was enlarged both in the caput and cauda; in the cauda, the epithelial compartment was enlarged; the transit time of spermatozoa through this organ was diminished. Testosterone production was lowered. Spermatozoa's motility, mitochondrial activation, and acrosomal integrity were impaired, and several alterations in morphology were observed. After the recovery period, testicular and epididymal weight was restored. Tissue remodulation was observed in the epididymis, but the spermatozoa's transit time in this organ was not altered. Sperm and testosterone production, spermatozoa motility, mitochondrial activation, and acrosomal integrity were also restored. However, testicular histological alterations and spermatic morphological abnormalities were maintained in protein-restricted animals. Protein restriction during peripuberty impairs the reproductive maturation of pubertal Wistar rats, impairing testicular and epididymal function, with lasting effects even after dietary correction.

Association of FSHR gene polymorphism with fertility of Holstein cows

Relevance. The view of the mechanisms of hormonal regulation of the ovarian cycle of cows has allowed the development of a large number of synchronization programs. An active search is underway for biomarkers related to the fertility of cows, as well as to identify animals with a high ovarian response to the injection of exogenous gonadotropins. The aim of the work is to study the polymorphism of the FSHR gene and its association with reproduction indicators in black-and-white Holstein dairy cows.Results. Based on the results of genotyping cows (n = 128) using the FSHR gene, the frequency of occurrence of the CC genotype was determined at the level of 0.601, the CG genotype — 0.360, GG — 0.031. It was found that for productive insemination, animals with the CG genotype require fewer inseminations. At the same age, the frequency of insemination of heifers with the CG genotype was 1.43, with the CC genotype — 1.60. After the first calving, the animals with the CG genotype responded more actively to hormonal stimulation in the postpartum period. The interval from the first to fruitful insemination in cows with the CG genotype was 34.7 days, in cows with the CC genotype — 57.2 days (p < 0.05). The number of pregnant cows with the CG genotype re-inseminated after natural hunting was 2.1 times higher than the number of cows with the CC genotype (66.7% and 31.2%). It is assumed that exogenous hormone injection has a stimulating effect on the hypothalamus-pituitary-gonad system in cows with the CG genotype.

Dr. Meena and mission maternal health: building allies in the government hospital

Research methodology The case study is based on field data, including in-depth semi-structured interviews with the main protagonist and related stakeholders of a large government hospital in Western India. After informed consent, the interviews with the stakeholders were conducted, transcribed and analyzed verbatim. In addition, secondary data from policy reports, newspaper articles and government websites was used to create the case. Since the protagonist works in the government system, her identity and other identifying information are disguised to maintain confidentiality. Case overview/synopsis The case study investigates the leadership challenges in a healthcare facility/hospital in public health. It traces the evolution of Dr Meena Sharma (Dr Meena), a leader in the government hospital ecosystem facing challenges such as infrastructural deficiencies, manpower deficit, healthcare bureaucracy and heavy patient load. This first-generation medical practitioner who transitioned from a private practice to a governmental one juggles balancing her demanding clinical practice, administrative responsibilities and teaching in the government hospital with her family responsibilities setup. However, in the wake of the upcoming LaQshya – Labour Room Quality Improvement Initiative by the Ministry of Health & Family Welfare, she strives to put together and motivate her team to work toward improving the quality of care during delivery and the immediate postpartum period at her hospital. Various issues arise in the organizational leadership for a woman leader such as adopting appropriate leadership style and using appropriate motivation and communication strategies for optimal performance. Complexity academic level The case study is aimed at teaching/training a) departmental heads of public and private hospitals, b) health program managers at higher and middle-level leadership roles, c) health policymakers at various levels in the government and other organizations and d) graduate and postgraduate students of public health, hospital management/administration. In addition to this, it can also be used for general management programs to teach organizational behavior, communication and leadership courses.

Folk Wisdom and Traditional Knowledge: A Study of Mother and Child Healthcare Practices of Maram Nagas in India

Indigenous knowledge and healthcare practices are deeply embedded in the cultural fabric of tribal communities, influencing every aspect of life and ensuring the well-being of individuals. This paper delves into the Indigenous knowledge systems of the Maram Naga community in Manipur, India, mainly focusing on practices related to mother and child healthcare. The study is based on qualitative data gathered from 225 households across 12 Maram Naga villages through in-depth personal interviews and focus group discussions. It explains the beliefs, rituals, and other traditional cultural practices integral to the Maram Nagas in promoting the health and wellness of the mother and child in pre-natal and post-natal care.

Fathers’ knowledge of neonatal danger signs and its associated factors in Northwest Ethiopia: a community-based cross-sectional study

ObjectiveThis study aimed to assess fathers’ knowledge of neonatal danger signs and their associated factors in Northwest Ethiopia.DesignCommunity-based cross-sectional study.SettingEnarji and Enawga Woreda, Northwest Ethiopia.ParticipantsThe study was conducted on 613...

Element Changes Occurring in Brain Point at the White Matter Abnormalities in Rats Exposed to the Ketogenic Diet During Prenatal Life.

A large number of clinical studies demonstrate that the ketogenic diet (KD) may be an effective approach to the reduction of epileptic seizures in children and adults. Such dietary therapy could also help pregnant women with epilepsy, especially since most antiseizure drugs have teratogenic action. However, there is a lack of medical data, considering the safety of using KD during gestation for the progeny. Therefore, we examined the influence of KD used prenatally in rats on the elemental composition of the selected brain regions in their offspring. For this purpose, synchrotron radiation-induced X-ray fluorescence (SR-XRF) microscopy was utilized, and elements such as P, S, K, Ca, Fe, and Zn were determined. Moreover, to verify whether the possible effects of KD are temporary or long-term, different stages of animal postnatal development were taken into account in our experiment. The obtained results confirmed the great applicability of SR-XRF microscopy to track the element changes occurring in the brain during postnatal development as well as those induced by prenatal exposure to the high-fat diet. The topographic analysis of the brains taken from offspring of mothers fed with KD during pregnancy and appropriate control individuals showed a potential influence of such dietary treatment on the brain levels of elements such as P and S. In the oldest progeny, a significant reduction of the surface of brain areas characterized by an increased P and S content, which histologically/morphologically correspond to white matter structures, was noticed. In turn, quantitative elemental analysis showed significantly decreased levels of Fe in the striatum and white matter of 30-day-old rats exposed prenatally to KD. This effect was temporary and was not noticed in adult animals. The observed abnormalities may be related to the changes in the accumulation of sphingomyelin and sulfatides and may testify about disturbances in the structure and integrity of the myelin, present in the white matter.

Short-term reduction in feed intake by dairy cows in the postpartum period leads to subclinical ketosis development

Subclinical ketosis is widespread in highly productive dairy cows after calving and often remains undiagnosed, leading to reduced productivity. Physiologically controlled feeding in the first weeks after calving and during the intensive lactation period can reduce the incidence of ketosis. The study aimed to determine how a short-term reduction of feed after calving affects the formation of ketone bodies in blood, urine and milk of dairy cows. The group of ten Ukrainian black-spotted dairy breed cows after calving aged from 4 to 6 years was involved in the experiment lasted for 72 h. In 24 h the amount of compound feed, haylage, and silage received by cows was gradually reduced until complete exclusion in the diet. Blood, urine, and milk samples were collected three times a day. The content of ketone bodies, β-hydroxybutyrate and glucose was estimated with the corresponding sets of indicator strips. The content of total bilirubin, cholesterol, albumin and enzymes activity in the blood serum were determined on biochemical analyzer. It was found that in 24 h after the beginning of feed reduction the level of blood glucose decreased, persistent hypoglycemia within 48 and 72 h was developed, the concentration of β-hydroxybutyrate in blood and milk and of ketone bodies in urine was elevated. The increase in total bilirubin concentration and liver enzymes activity in the blood serum with a simultaneous decrease in albumin level and delayed sodium propionate conversion into glucose were observed. Thus, short-term reduction in feed intake by dairy cows after calving causes ketosis development and violation of liver functions. Keywords: dairy сows, feeding level, glucose, ketosis, liver damage, β-hydroxybutyrate

Trend and Determinants of Early Postnatal Care in Nepal with a Focus on Women’s Autonomy

Nepal has made significant strides in improving maternal and child health, notably reducing mortality rates over recent decades. However, challenges persist in meeting the maternal and newborn health targets outlined in the Sustainable Development Goals. Postnatal care is essential for the survival and well-being of both mothers and newborns, yet there is limited research on this topic in Nepal. This study aims to assess trends in early postnatal care coverage and analyze the factors influencing service uptake focusing on women’s autonomy. Using data from the Nepal Demographic and Health Surveys for 2011, 2016, and 2022, which included 10,991 mothers aged 15-49 with at least one live birth, the study revealed significant improvements in postnatal care coverage. The percentage of mothers receiving care within 48 hours increased from 43% in 2011 to 56% in 2016, reaching 72% in 2022. Despite this progress, 28% of mothers and newborns still lack timely postnatal care, which is crucial for their survival and well-being. Regression analysis indicated that women with greater decision-making autonomy are significantly more likely to receive postnatal care (adjusted OR 1.216, P < 0.01), even when accounting for socio-demographic factors. The study highlighted disparities in postnatal care coverage based on age, caste/ethnicity, education, occupation, province, urbanrural residence, wealth, and family size. These findings emphasize the need for targeted interventions to empower women and tailor maternal health programs to address the specific needs. Future research should focus on evaluating complete postnatal care coverage, assessing care quality, and exploring interventions to strengthen maternal health care.

Utilization Postnatal Care Services in Hyolmo Community

Postnatal care (PNC) utilization among the Hyolmo community highlights significant gaps in existing literature and underscores the critical need for targeted healthcare interventions in remote and ethnically distinct populations. This study reveals that, while considerable attention is given to urban and accessible rural populations, remote communities face unique challenges that can impede access to essential maternal health services. The results demonstrate that age, education, and socio-economic factors significantly influence PNC uptake, suggesting disparities that are compounded in remote areas like the Helambu Rural Municipality of Sindhupalchowk District. This study shows that younger mothers, often less aware or hindered by accessibility barriers, are less likely to utilize PNC services compared to their older counterparts. This disparity highlights the necessity for community-specific educational programs that can enhance understanding and encourage the use of PNC services among younger women. Additionally, the influence of education and socio-economic status on PNC utilization points to the broader implications of systemic inequities in healthcare access. Moreover, the study brings to light the role of cultural practices and beliefs in shaping healthseeking behaviors, which varies significantly across different communities. In the traditional beliefs may conflict with modern healthcare practices, there is a clear need for culturally sensitive health interventions that respect and integrate local customs and practices. This research not only contributes to a deeper understanding of the factors affecting PNC service uptake in a specific Nepalese community but also calls for comprehensive policy responses. By addressing the multifaceted challenges faced by the Hyolmo community ranging from geographic isolation to cultural and educational barriers the study advocates for a holistic approach to healthcare. This should include the development of policies that ensure equitable access to health services, enhance community health education, and promote cultural competence among healthcare providers. Ultimately, such efforts are essential for improving maternal and infant health outcomes in remote communities, ensuring that every individual, regardless of their socio-economic or cultural background, has access to the necessary postnatal care.

Physiotherapy management of acute perineal trauma: a patient satisfaction survey

Pelvic floor muscle (PFM) training is recommended in the immediate postpartum period because it can restore PFM function and prevent pelvic floor dysfunction. There are no national physiotherapy guidelines on how to deliver this intervention in the acute period. There is also no consensus on the need for outpatient follow-up to treat pelvic floor dysfunction that arises from perineal trauma, or as a preventative strategy in the long term. The aim of this study was to evaluate a current service provided for women with acute perineal trauma. The authors assessed patient satisfaction and compliance with physiotherapy advice, and identified preferences for future service development. One hundred and thirty patients completed satisfaction questionnaires after receiving inpatient physiotherapy treatment. Thirty consented to completing a retrospective telephone consultation about their care at 6–8 weeks postpartum. The questionnaire found high levels of satisfaction, and recorded a National Health Service Friends and Family Test score of 93. In the telephone consultation, 87% of the women reported that they were complying with ongoing PFM training. Eighty-five per cent of women who completed the questionnaire suggested that outpatient physiotherapy follow-up would be useful. Fifty per cent stated that options inclusive of outpatient follow-up would be useful for onward service development. Because of the high levels of satisfaction recorded and high compliance with the information provided in the acute postpartum period, it was concluded that the service should continue as it is. It is hoped that this service evaluation can be utilized as a benchmark for other acute and outpatient pelvic health physiotherapy services.

COMMUNITY INTERVENTIONS TO REDUCE MATERNAL MORTALITY IN LOW-RESOURCE AREAS

Maternal mortality, defined as the death of women during pregnancy, childbirth or in the postpartum period, continues to be a serious public health problem, especially in low-resource areas. Factors such as limited access to quality healthcare, lack of infrastructure, shortage of qualified professionals and socio-economic inequalities contribute to high mortality rates. In many of these regions, community interventions have been key to reducing maternal mortality by providing direct assistance to pregnant women, promoting health care education and strengthening the link between communities and medical services. This study seeks to analyze community interventions implemented in low-resource areas to reduce maternal mortality, evaluating their strategies, challenges and the results obtained in improving maternal survival rates. This study is a systematic review that investigates the effectiveness of maternal health interventions in low- and middle-income countries, focusing on skilled birth attendant programs, community transport, and technological innovations. The analyses were carried out in databases such as PubMed, BMC Pregnancy and Childbirth and African Journal of Reproductive Health, using data from articles published between 2015 and 2021. Community interventions to reduce maternal mortality range from health education programs, training traditional birth attendants and strengthening maternal and child support networks. One of the main approaches involves training community health agents, who work directly in communities, providing basic prenatal care, referral to medical services in cases of risk and promoting knowledge about signs of pregnancy complications. These actions are especially important in remote areas, where access to health facilities is limited. Another key aspect of these interventions is the promotion of safe practices during childbirth and the strengthening of emergency transport systems, ensuring that pregnant women at risk can be transferred to health centers equipped to deal with complications. The introduction of simple technologies, such as clean delivery kits and essential medicines, has shown promising results in reducing infections and hemorrhages, which are primary causes of maternal mortality. Awareness campaigns also play a crucial role, educating the population about the importance of prenatal care, proper nutrition and birth assistance in controlled environments. These initiatives aim not only to improve knowledge about maternal health, but also to combat cultural and social barriers that can prevent pregnant women from seeking medical care in a timely manner. It is concluded that community interventions have proven to be an effective approach to reducing maternal mortality in low-resource areas. Training health workers, implementing safe delivery practices and raising awareness about antenatal care are strategies that have contributed significantly to improving maternal health outcomes. However, for these interventions to be sustainable and scaled up, continued public policy support, adequate funding and the integration of these actions with formal health systems are essential.

Physiotherapists working with pessaries

Pessaries and the physiotherapy profession have evolved over the past 10 years, and pelvic health physiotherapists can now prescribe vaginal pessaries. Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) is developing ways to support members with these skills. Globally, up to 50% of women will suffer from pelvic organ prolapse (POP) (Carroll et al. 2022), and this condition costs the UK National Health Service £45 million every year (PCWHF 2019). The most common symptom is a vaginal bulge. The National Institute for Health and Care Excellence guidelines recommend either doing nothing, or pelvic floor muscle exercises (PFMEs), vaginal pessaries or surgery (NICE 2019). Pessary services are provided in dedicated clinics, usually in general practice or secondary care. There has been an increase in physiotherapists delivering pessary care over the past decade: in 2013, it was reported that 1.4% were part of the pessary workforce compared to 5% in 2020 (Bugge et al. 2013; Brown et al. 2021). Currently, ineffective patient pathways, poor service provision and lack of training are barriers to treatment. Poorly designed patient pathways are frustrating, and women are often required to return to primary or secondary care to get a referral to a pessary clinic. Physiotherapists are well placed to offer a pessary alongside PFMEs since it is part of the range of conservative treatment options. They also build strong a rapport with their patients because of the therapeutic nature of the treatment sessions, and typically, offer longer appointments than postnatal period. A prospective multicentre trial demonstrated the acceptability of and compliance with using a pessary immediately after childbirth irrespective of any pelvic floor dysfunction or mode of delivery (Baessler et al. 2019). The majority of women used the pessary to treat the symptoms of POP. Further work is required to investigate pessary use and the prevention of pelvic floor dysfunction in this cohort of women. The results of the TOPSY [Treatment Of Prolapse with Self-care pessarY] trial (Hagen et al. 2023) highlighted that pessary self-management is cost-effective and reduces complications. This is excellent news because physiotherapists are well placed to teach women pessary self-management because of: generally longer appointments; and the well-established rapport built up over time while teaching PFMEs. Despite women reporting that pessary use during exercise relieves their symptoms, this is an under-researched area. The impact of exercise on POP, and whether there are any protective factors involved that prevent its progression, are not fully understood. There also remains a gap in the evidence with regard to the use of PFMEs and vaginal pessaries. Research proposals are currently in development to address this. A pessary course is being developed by POGP, and this will be launched in 2024 alongside a mentoring programme as part of the pessary accreditation scheme jointly written with the United Kingdom Continence Society. Further governance documents have been created by the Physiotherapists Working with Pessaries subgroup of POGP, including a standard operating procedure, emergency out-of-hours statement, note proformas and template letters (POGP 2024).

Women's suggestions on how to improve the quality of maternal and newborn care: A qualitative analysis from the IMAgiNE EURO survey in Italy during the two years of the COVID-19 pandemic.

Collecting women's views and suggestions for improving quality of maternal-newborn care (QMNC) is a crucial aspect of maternity care evaluation often overlooked in Italy and globally. Childbearing women experienced numerous challenges during the COVID-19 pandemic including the rapid and significant reorganization of maternity services and care. Their perspective on what to prioritize for QMNC improvement is hence pivotal. The aim of this study was to explore maternal suggestions for QMNC improvement from women who gave birth during the two years of the COVID-19 pandemic. Data were collected from an open-ended question included in a validated online questionnaire administered to mothers who gave birth in an Italian hospital between November 2020 to March 2022. The responses were analyzed using thematic analysis and mapped against the WHO Standards for improving QMNC and the WHO Framework of QMNC. The thematic analysis identified five main themes from the 2017 responses: 1) Support for mothers during the postnatal period; 2) Better use of resources; 3) Improvement of the maternity environment; 4) Reconsideration of organizational aspects; and 5) Guarantee of respectful practices. Women commented on all dimensions of the WHO framework except for two provision of care subdomains 'actionable information and functional referral systems'. This is the first qualitative study in Italy focusing on women's suggestions for improving QMNC during the COVID-19 pandemic. Its findings can be used to inform what aspects of QMNC need improvement in Italy. Collection of women's views should be incorporated in routine monitoring of the QMNC, and data should be used for quality improvement purposes.

Gender Norms, Attitudes and Perceptions towards Male Involvement in Maternal Health in Kafue District, Lusaka

Male involvement in maternal health remains a major issue despite efforts by the international community. Despite the many benefits of male involvement in antenatal care there has been an observed low participation. Community gender norms, attitudes and perceptions towards male involvement in maternal health may affect the utilization of services offered by health facilities. The gap observed in many studies is that the attitude and perception of men regarding maternal health have largely been neglected. Therefore, this study sought to investigate the gender norms, attitudes and perceptions towards male involvement in maternal health in Kafue district of Zambia. The study adopted a descriptive research design. Both quantitative and qualitative paradigms were utilized in this study. A sample of 150 participants was used. Data was collected by the help of questionnaire and in-depth interviews. Results showed that respondents from Kafue were knowledgeable on antenatal care. Additionally, it was also revealed that respondents had a positive attitude towards male involvement in maternal health. However, due to gender norms their roles were limited when it came to delivery and child care. Nevertheless, the findings showed that men were involved in supporting their wives and helping out with house chores and providing money for antenatal care, skilled birth at a hospital, postnatal care, childcare and any necessities required for delivery. Men who were married were more likely to be involved in maternal health than men who were not married. The study also revealed that men were not comfortable with discussing their wives’ pregnancy with a health care provider due to lack of privacy. Findings suggested that there were many factors affecting male involvement in maternal health. Lack of messages and programs targeting men, health stuff attitude during delivery, gender norms such as men not being allowed to attend to women when in labor and hospital infrastructure were identified by the respondents as a cause to low male involvement. In this study, it was also revealed that men and women had a positive perception towards pregnancy being a shared responsibility, men supporting and caring for their wives during and after delivery. However, both men and women had a negative perception towards men’s presence in the delivery ward.

Effect of community – facility linked interventions on maternal health service utilization and newborn care in rural low-resource settings in Eastern Uganda

BackgroundImproving maternal and newborn care (MNC) in hard-to-reach areas is essential for accelerating progress towards sustainable development goals (SDGs). We implemented the “Communities in which Mothers and Newborns Thrive (COMONETH) project” in rural settings of eastern Uganda between 2017 and 2020 to reduce barriers to accessing MNC services. We evaluated the effect of the COMONETH intervention on enhancing the utilization of MNC services and the adoption of appropriate care practices in Luuka district, Uganda.MethodsWe used a pre- and post-comparison design to measure the effect of a demand-supply linked COMONETH intervention on MNC indicators. We trained Community Health Workers (CHW) to educate and refer expectant mothers to health facilities when needed. We also showed videos to pregnant women on identification of pregnancy danger signs, mentored and simulated health workers with PRONTO, and improved obstetric surgery at the referral facilities. We assessed antenatal care (ANC), facility delivery, postnatal care (PNC), and newborn care practices. We used optimal full propensity score matching, and weighted logistic regression and then estimated average treatment effect on the treated (ATT) of the intervention on MNC outcomes on the odds ratio scale.ResultsA total of 583 women at baseline and 619 at endline participated in the study. The intervention was associated with increased odds of attending 4 ANC visits (OR = 1.26, 95% CI = 1.07–1.49), 8 ANC visits (OR = 2.27, 95% CI = 1.06–4.82) and utilization of PNC services (OR = 1.40, 95% CI = 1.20–1.63). We did not observe a significant association between intervention and early ANC attendance (OR = 0.88, 95% CI 0.80–1.00) and facility deliveries (OR = 0.99, 95% CI = 0.93–1.06). The intervention strategy was associated with improvements in practices: delayed bathing (OR = 1.22, 95% CI = 1.06–1.40), putting nothing on the cord (OR = 1.42, 95% CI = 1.27–1.59) and wrapping of babies immediately (OR = 1.08, 95% CI = 1.03–1.14).ConclusionsThe findings demonstrated the potential of a demand-supply linked intervention to improve MNC outcomes in low-resource settings and should be promoted in similar settings. Interventions that strengthen the quality of care at health facilities and bridge demand-side gaps can improve MNC practices and reduce morbidity and mortality in rural settings.

The nexus between maternal antenatal care attendance, newborn postnatal care and neonatal mortality in India: a matched case-control study

IntroductionOur study examines the relationship between newborn postnatal care and neonatal mortality stratified by maternal antenatal care attendance under a matched case-control framework.MethodsData from the fifth round of the National Family Health Survey was used. A total of 172,079 recent births to eligible women (15–49 years) in five years preceding the survey were included in the study. We used the conditional logistic regression model, a commonly used regression model to fit matched case-control data to examine the effects of newborn postnatal care on neonatal mortality. The mother’s age at birth of the newborn, previous birth intervals, birth order of the newborn, and birthsize of the newborn were included as the matching variables.ResultsNewborns receiving postnatal care within two days or more than two days of birth are less likely to die during the neonatal period. Preferences for newborn postnatal care were also observed to increase with more maternal antenatal care visits. Our study also found a lower risk of neonatal mortality among those newborns whose umbilical cord was examined within two days of birth, regardless of the number of maternal antenatal care visits. Similarly, the risk of newborn deaths was lower among babies whose body temperature was measured within two days of birth. The tendency to breastfeed their newborns within an hour after delivery was considerably higher among those births that occurred to mothers who had a higher number of maternal antenatal care visits. The risk of newborn deaths was also observed to be lower among those born in public or private healthcare facilities.ConclusionConsidering the cohesive nature of the relationship between neonatal mortality and maternal and child healthcare utilisation, strategic planning and management of the existing policies and programmes related to accessibility, availability, and affordability of maternal and child healthcare services is needed to achieve goal 3.2 of the Sustainable Development Goals. Promoting cost-effective measures such as continuous monitoring of the baby’s body temperature and umbilical cord care could also effectively help reduce neonatal mortality.

Anaerostipes caccae CML199 enhances bone development and counteracts aging-induced bone loss through the butyrate-driven gut–bone axis: the chicken model

BackgroundThe gut microbiota is a key regulator of bone metabolism. Investigating the relationship between the gut microbiota and bone remodeling has revealed new avenues for the treatment of bone-related disorders. Despite significant progress in understanding gut microbiota-bone interactions in mammals, research on avian species remains limited. Birds have unique bone anatomy and physiology to support egg-laying. However, whether and how the gut microbiota affects bone physiology in birds is still unknown. In this study, we utilized laying hens as a research model to analyze bone development patterns, elucidate the relationships between bone and the gut microbiota, and mine probiotics with osteomodulatory effects.ResultsAging led to a continuous increase in bone mineral density in the femur of laying hens. The continuous deposition of medullary bone in the bone marrow cavity of aged laying hens led to significant trabecular bone loss and weakened bone metabolism. The cecal microbial composition significantly shifted before and after sexual maturity, with some genera within the class Clostridia potentially linked to postnatal bone development in laying hens. Four bacterial strains associated with bone development, namely Blautia coccoides CML164, Fournierella sp002159185 CML151, Anaerostipes caccae CML199 (ANA), and Romboutsia lituseburensis CML137, were identified and assessed in chicks with low bacterial loads and chicken primary osteoblasts. Among these, ANA demonstrated the most significant promotion of bone formation both in vivo and in vitro, primarily attributed to butyrate in its fermentation products. A long-term feeding experiment of up to 72 weeks confirmed that ANA enhanced bone development during sexual maturity by improving the immune microenvironment of the bone marrow in laying hens. Dietary supplementation of ANA for 50 weeks prevented excessive medullary bone deposition and mitigated aging-induced trabecular bone loss.ConclusionsThese findings highlight the beneficial effects of ANA on bone physiology, offering new perspectives for microbial-based interventions for bone-related disorders in both poultry and possibly extending to human health.3YvVhM8B6L-RxYm8AZskZyVideo Graphical

Correlations between Metabolic Parameters, Blood Cytokine Levels, and Behavioral Parameters in Male and Female Rats of Different Age after Intrauterine Stress.

We studied interrelationships between behavioral parameters, metabolic processes, and cytokine content in the blood of male and female rats at different stages of postnatal ontogeny after intrauterine stress (mothers were forced to swim in cold water from the 10th to the 16th day of pregnancy). Correlations between behavioral and metabolic parameters in prenatally stressed rats were revealed at an earlier age (day 21 of life) than in controls. In comparison with intact rats, in males exposed to intrauterine stress no relationships between these parameters were revealed at older age, while in females, their direction and character change on day 60 of life. In prenatally stressed males, correlations of the blood levels of IL-6 were revealed: inverse relationships with behavioral parameters on the days 21 and 30 and direct relationships with metabolic parameters on day 60 of life. In prenatally stressed females on day 30 of life, we observed negative correlations between IL-4 levels and metabolic parameters that were absent under normal conditions. Thus, intrauterine stress leads to reorganization of the relationships between the parameters of metabolic and immune processes, which are essential for the purposeful behavior of mammals. The effects of stress seem to depend on the sex of the offspring and stage of postnatal development.