Rates In High-income Countries Research Articles

Epidemiology of carbapenem-resistant Acinetobacter baumannii colonization in neonatal intensive care units: A systematic review and meta-analysis

BACKGROUND The rising prevalence of carbapenem-resistant Acinetobacter baumannii (CRAB) in neonatal intensive care units (NICUs) represents an escalating challenge in healthcare settings, particularly in managing hospital-acquired infections (HAIs). Studies across various World Health Organization regions have documented a significant incidence of CRAB-related HAIs, with rates as high as 41.7 cases per 1000 patients in ICUs, accounting for 13.6% of all HAIs. These infections pose a doubled mortality risk compared to infections with carbapenem-susceptible Acinetobacter baumannii . A particularly concerning aspect of CRAB colonization is its asymptomatic nature, enabling its transmission through healthcare workers (HCWs) or the NICU environment to vulnerable neonates with developing immune systems. AIM To explore the prevalence of CRAB colonization in NICUs, focusing on neonates, healthcare workers, and the environmental samples, to enhance epidemiological understanding and inform targeted interventions. METHODS We conducted according to PRISMA 2020 checklist guidelines, a comprehensive literature search across multiple databases including MEDLINE (Ovid), EMBASE (Ovid), Global Health (Ovid), Web of Science, and Global Index Medicus. Studies were selected based on predetermined criteria, primarily involving neonates, HCWs, and environmental swabs, using culture or molecular methods to detect CRAB colonization. We excluded studies that did not specifically focus on NICUs, were duplicates, or lacked necessary data. The study selection and quality assessment were conducted independently by two reviewers. Data extraction involved collecting comprehensive details about each study. Our statistical analysis used a random-effects model to calculate the pooled prevalence and confidence intervals, stratifying results by regional location. We assessed study heterogeneity using Cochran's Q statistic and I ² statistic, with regression tests employed to evaluate potential publication bias. RESULTS We analyzed 737 records from five databases, ultimately including 13 studies from ten countries. For neonates, the pooled prevalence was 4.8% (95%CI: 1.1% to 10.5%) with the highest rates observed in South-East Asia (10.5%; 95%CI: 2.4% to 23.3%). Among HCWs, a single Indian study reported a 3.3% prevalence. Environmental samples showed a prevalence of 2.3% (95%CI: 0% to 9.3%), with the highest rates in South-East Asia (10%; 95%CI: 4.2% to 17.7%). Significant heterogeneity was found across studies, and no publication bias was detected. CONCLUSION This systematic review highlights a significant prevalence of CRAB colonization in neonates across various regions, particularly in South-East Asia, contrasting with lower rates in high-income countries. The study reveals a gap in research on HCWs colonization, with only a single study from India reporting moderate prevalence. Environmental samples indicate moderate levels of CRAB contamination, again higher in South-East Asia. These findings underscore the need for more extensive and focused research on CRAB colonization in NICUs, including exploring the roles of HCWs and the environment in transmission, understanding antimicrobial resistance patterns, and developing effective prevention measures.

General Anesthesia for Cesarean Delivery for Thrombocytopenia in Hypertensive Disorders of Pregnancy: Findings From the Obstetric Airway Management Registry

(Anesth Analg. 2023;136:992–998) In Africa, maternal morality following cesarean delivery is 50× more likely compared to morality rates in high-income countries, and spinal anesthesia (SA) is the preferred anesthetic method during cesarean delivery. For parturient patients with hypertensive disorders (ie, preeclampsia, eclampsia, or gestational hypertension), there is an increased risk for adverse outcomes, including spinal epidural hematoma following SA, so thrombocytopenia should be excluded before neuraxial blockade. An accurate platelet count is necessary before SA in emergent situations of fetal distress, which can be complicated when laboratory services are unavailable or off-site. The primary aim of this study was to determine which patients received general anesthesia (GA) when the presence of thrombocytopenia was known versus suspected. The secondary aim was perioperative platelet counts of patients with suspected thrombocytopenia to determine how often GA may have been avoided in favor of SA if platelet count was known.

30-Day Readmission Rate of Patients with COPD and Its Associated Factors: A Retrospective Cohort Study from a Tertiary Care Hospital.

Readmission of chronic obstructive pulmonary disease (COPD) has been used as a measure of performance for COPD care. This study aimed to determine the rate of readmission of COPD in tertiary care hospital in Malaysia and its associated factors. A retrospective cohort study was conducted at a tertiary care hospital in Malaysia from 1st January to 21st May 2019. Seventy admissions for COPD exacerbation involving 58 patients were analyzed. The majority of the patients were male (89.8%), had a mean age of 71.95 ± 7.24 years and a median smoking history of 40 (IQR = 25) pack-years, 84.5% were in GOLD group D and 91.4% had a mMRC grading of 2 or greater. Approximately 60.3% had upper or lower respiratory tract infection as the cause of exacerbation; one in five patients had uncompensated hypercapnic respiratory failure at presentation, and 27.6% needed mechanical ventilatory support. Approximately 43.1% of patients had a history of exacerbation that required hospitalisation in the past year. The mean blood eosinophil concentration was 0.38 ± 0.46 x109 cells/L. The 30-day readmission rate was 20.3%, revisit rate to the emergency room within 30 days after discharge was 3.4%, and in-hospital mortality rate was 1.7%. Among all characteristics, a higher baseline mMRC grade (p = 0.038) and history of exacerbation in the past 1 year (p < 0.001) were statistically associated with 30-day readmission. The 30-day readmission rate for COPD exacerbation in a Malaysian tertiary hospital is similar to the rates in high-income countries. Exacerbation in the previous year and a higher baseline mMRC grading were significant risk factors for 30-day readmission in patients with COPD. Strategies of COPD management should concentrate on improvement of symptoms control by optimisation of pharmacotherapy, and early initiation of pulmonary rehabilitation, and structured integrated care programs to reduce readmission rates.

PDGF, NGF, and EGF as main contributors to tumorigenesis in high-risk retinoblastoma.

Retinoblastoma (RB) is the most common form of eye cancer experienced in childhood. Its aggressive malignancy is associated with excellent survival rates in high-income countries; however, the prognosis in third-world countries is less favorable. Early diagnosis can maximize the patient's visual outcomes and their survival rate. Therapy should be conducted in highly specialized treatment centers. Intravenous chemotherapy (IVC) in bilaterally affected children currently forms the majority of therapy. Local destructive procedures and local chemotherapies such as intra-arterial chemotherapy (IAC) or intravitreal chemotherapy can be taken into consideration depending on the extent and size of the tumor. Nonetheless, children and parents remain under constant stress, revisiting doctors for medical treatment and fearing vision loss and even enucleation of the eye. Adequate molecular patient stratification to improve targeted therapy is still lacking. This retrospective study analyzed formalin-fixed paraffin-embedded specimens from a cohort of 21 RB samples. A total of 11 of those samples showed undifferentiated retinoblastoma (URB) histopathological risk features, and the other 10 showed differentiated retinoblastoma (DRB) histopathological grading. RNA from all samples was isolated and analyzed via digital gene expression patterns. Conductors of cell survival and DNA repair were dominant in the DRB samples. In contrast, the agents responsible for cell-cycle progression and apoptosis were overexpressed in URB samples. Our work reveals the importance of molecular mechanisms within the immune system subjected to histologic subtypes of RB, providing more detailed background on their genetic behavior. This is of great interest for therapeutic strategies, such as targeted immune- and gene-based therapies, for retinoblastoma.

Analyzing the impact of natural capital on socio- economic objectives under the framework of sustainable development goals

Natural capital plays an essential role in achieving socio-economic objectives and is connected to the basic conditions for human survival. Here, we discuss the role played by natural capital in sustainable socio-economic objectives (SDG1, 3, 5, and 8) in 131 countries and territories during the period 2000–2018. In the long term, the increased dependence on natural capital can contribute to decent work and economic growth, but it has negative impacts on poverty reduction as well as the promotion of good health, well-being, and gender equality. The relationship between natural capital and each socio-economic objectives changes with different levels of socio-economic. In addition, the regression results of countries at different stages of development show heterogeneity. Unlike low-income countries, the dependence on natural capital reduces poverty rates in high-income countries, and is conducive to gender equality in middle-income countries. Governments should create incentives to protect and enhance natural wealth to prevent the depletion of natural capital or its unsustainable conversion into other forms of capital.

Trends in childhood cancers at Tygerberg Hospital from 1994 to 2014

Background. There is a paucity of data regarding childhood cancer incidence in low- and middle-income countries owing to a lack ofdisease-specific, hospital- and population-based registries.Objective. To describe the disease profile and outcome of children with cancer, treated at a single institution in South Africa between1994 and 2014.Methods. Data collected included demographic data (age at diagnosis, sex, stage or risk group, race) and 5-year overall survival (OS) of children aged ≤15 years diagnosed with cancer. Time to event and factors associated with 5-year outcomes were analysed, using Kaplan-Meier curves and Cox regression analysis.Results. The most common malignancies were leukaemia (27.7%), brain tumours (18.4%), lymphomas (14.1%), nephroblastoma (8.0%)and soft-tissue sarcomas (7.4%) for 935 patient records. Limited-disease solid tumours and standard-risk haematological malignancieshad good OS rates of 77.7% and 85.9%, respectively, although OS for the whole group was 60.2%. Nephroblastoma (89.3%), retinoblastoma (86.7%), Hodgkin’s lymphoma (89.7%) and Burkitt lymphoma (75.5%) had the best OS. Type of cancer (p&lt;0.01), solid-tumour stage (p&lt;0.001) and risk classification for haematological malignancies (p&lt;0.001) were significantly associated with mortality.Conclusions. Underlying cancer diagnosis, stage and risk group remained significant factors influencing survival with good OS for limited disease in solid tumours and standard-risk haematological malignancies, which was comparable with survival rates in high-income countries.

Does Artificial Intelligence Threaten Working Places?

In recent years, Artificial Intelligence (AI) has made significant progress in non-routine, cognitive tasks. The May 2023 CfM-CEPR survey asked the members of its European panel to predict the impact of AI on global economic growth and unemployment rates in high-income countries over the upcoming decade. Most respondents believe that AI is likely to boost global growth to 4-6% per annum. It is also stated that AI is unlikely to affect employment rates in high-income countries, with the remainder split between predicting an increase and a decrease in unemployment rates. From farming and education to healthcare and the military, AI is poised to make sweeping changes to the workplace. This paper makes an attempt to answer the question: can it have a positive impact, or are we in for a darker future? This study presents AI implementation into the labor progress model and predicts its possible influence. The suggested model is highly adaptive and will be useful both for practical and academic purposes.

Global Variations in Heart Failure Etiology, Management, and Outcomes

Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Multinational HF registry of 23 341 participants in 40 high-income, upper-middle-income, lower-middle-income, and low-income countries, followed up for a median period of 2.0 years. HF cause, HF medication use, hospitalization, and death. Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper-middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower-middle-income countries (39.5%) (P < .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper-middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower-middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper-middle-income countries (ratio = 2.4), similar in lower-middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper-middle-income countries (9.7%), then lower-middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower-middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally.

Overview of thermal ablation devices for treating precancerous cervical lesions in low-resource settings

In 2020, there were an estimated 604 000 cases and 341 000 deaths from cervical cancer [1], with 91% of these deaths occurring in low- and middle-income countries (LMICs) [2]. While screening programs have led to a dramatic reduction in cervical cancer rates in high-income countries, their implementation in LMICs has faced many challenges [3]. Screen-and-treat programs, […]

A community-based participatory approach to engaging Congolese migrants in intervention co-design

Abstract Issue The World Health Organization has called for tailored, community-based interventions to address disparities in vaccination uptake affecting migrant and minoritised populations, however few exist. This study directly responds to global calls for community-centred and participatory approaches to engaging migrants in routine and COVID-19 vaccination. Problem description Black and African migrants are known to be at risk of under-immunisation and have lower COVID-19 vaccine uptake rates in high-income countries. This UK study will use community-based participatory approaches to engage Congolese migrants in co-developing a tailored intervention to increase vaccine uptake. A community-academic coalition will lead the study. Community members will be trained as peer researchers and financially compensated. The final output will be an intervention strategy tailored to and embedded within the Congolese migrant community. Preliminary results The coalition held 20 hours of planning meetings and peer researcher training in 2021 and co-developed a phased study involving 1) community days with poster walls and qualitative in-depth interviews with Congolese migrants, 2) interviews and workshops with local stakeholders, and 3) co-design workshops with Congolese migrants. Following outreach and pre-engagement, approximately 80 migrants attended the community days, with more than 50 interviews and 100% left positive feedback (including: felt valued, welcomed, Congolese language recognised). Lessons Community-academic partnerships are resource-intensive but can be an effective means to build and maintain trust required to deliver a community-based research study. Academic partners should support community partners in understanding the research process to help manage expectations and provide financial compensation for their time and effort. This study offers an innovative engagement model and study design that can be adapted to other underserved populations. Key messages • Global policy-setting organisations have called urgently for participatory research that engages migrants in the co-production of tailored initiatives to address vaccination inequalities. • This study uses a novel, theory-driven, participatory approach to engage with and identify barriers to vaccination in Congolese migrants and co-design a tailored strategy to increase uptake.

A Systematic Review of Severe Maternal Morbidity in High-Income Countries.

With declining maternal mortality rates in high-income countries (HICs), severe maternal morbidity (SMM) is becoming an important quality measure of maternal care. However, there is no international consensus on the definition and types of SMM. This study aims to critically analyze published literature on SMM in HICs. The objectives are to compare definitions and criteria used to identify SMMand identify the main causes and risk factors contributing to SMM in HICs. PubMed, Cumulative IndextoNursing and Allied Health Literature(CINAHL), and Scopus databases were searched for articles published between 2010 and 2022, results were filtered, and 10 studieswere critically appraised. Six of the articles discussed SMM identification criteria and proposed definition modifications. Longer hospital stays and admission to the intensive care unit (ICU) were suggested as additional criteria. Disease-based criteria were shown to be superior to organ dysfunction criteria. Seven articles detailed common types of SMM as severe hemorrhage, hypertensive disorders, and preeclampsia/eclampsia. Six articles described SMM risk factors, of which advanced maternal age and cesarean delivery were the most common. This literature review identified disease-based criteria and Canadian study criteria as promising measures of SMM. It also identified several causes and risk factors of SMM common between HICs. These findings can help physicians identify women at risk of SMM. The study is however limited to eight HICs and 10 studies. Further research should aim to investigate how these criteria compare with previous sources of criteria and discern the association of weight and race risk factors with SMM.

Catastrophe squared: COVID-19 vaccine inequity in humanitarian crises

The COVID-19 pandemic has caused physical, social, and economic devastation all around the world. While more manageable case numbers and immunisation efforts seem to indicate that the world has come a long way in controlling the virus, there is great inequity in vaccination numbers around the world. Low-income countries have only received 14 doses per 100 people—13-fold lower than the 182 doses per 100 people in upper-middle income and high-income countries. This paper highlights the disparity of COVID-19 vaccination rates in high-income countries versus those afflicted with crises and raises the need for linking pandemic response with humanitarian assistance.

Epidemiology of inflammatory bowel diseases in the state of Rio Grande do Sul, Brazil.

BACKGROUNDThis is the first study on the epidemiology of inflammatory bowel diseases (IBDs) in Rio Grande do Sul (RS), the southernmost state of Brazil with the country’s fifth largest population. Crohn’s disease (CD) and ulcerative colitis (UC) are collectively termed IBDs. They have high incidence and prevalence rates in high-income countries, although in recent years there has been a change in the classic geographical distribution of IBDs, with growing rates in traditionally low-incidence regions.AIMTo estimate the incidence and prevalence of IBDs in the RS state, Brazil, between 2014 and 2019.METHODSThis is a cross-sectional descriptive observational study. Patients with IBD who had initiated treatment and met the inclusion criteria of the RS state free drug distribution program were included. Data were obtained from registration or renewal records of the RS state specialty pharmacy. The male, female, and total populations were estimated according to mid-year data from the Brazilian Institute of Geography and Statistics, which served as a reference for calculating the incidence and prevalence rates of IBDs during the study period. Results were described using mean, standard deviation, and range.RESULTSWe included 1082 patients with IBD, of whom 57.5% were female and 42.5% were male. Patients with CD accounted for 72.45% of the sample, and those with UC accounted for 27.54%. IBD prevalence during the study period was 9.51 per 100000 population, of which 6.89 corresponded to people with CD and 2.62, to people with UC. Incidence rates per 100000 population/year were 2.54 in 2014, 2.61 in 2015, 1.91 in 2016, 0.80 in 2017, 0.83 in 2018, and 0.96 in 2019. The mean IBD incidence rate per 100000 population was 1.61, of which 1.17 corresponded to CD and 0.44, to UC. The mean age was 41 years, and patients were mostly aged 30-40 years. Prevalence by region was higher in the state capital metropolitan area: 12.69 per 100000 population.CONCLUSIONOur results demonstrated an IBD prevalence of 9.51% and incidence of 1.61 per 100000 population. The patients were predominantly female, and CD was more prevalent than UC.

Adding to the mantra: vaccines prevent illness and death, and preserve existing antibiotics

With rising incomes and the increased availability of antibiotics globally, per-capita consumption of antibiotics in middle-income countries is fast approaching the rates in high-income countries.1 Antimicrobial resistance has emerged as a major source of morbidity and mortality worldwide, and now is estimated to cause more deaths than malaria or HIV/AIDS.2 Existing and new vaccines could help avert a substantial proportion of current antibiotic use, and there is now considerable evidence linking vaccination with decreased use of antibiotics and averted cases of antimicrobial resistance.

Longer parental time and lower fertility rate

The fertility rates in high-income countries have been lower than the replacement level for decades. We argue that the rising parental time plays an essential role in the fertility rate decline. To this end, we construct an indicator named the parental time share, which links the time use survey data and the Barro–Becker modeling framework. We modify the model of de Silva and Tenreyro (2020) by introducing endogenous parental time share. The modified model analytically shows that the parental time share increases with the accumulation of human capital and depresses the fertility rate. The quantitative results fit the dynamics of fertility rates, human capital investments, and parental time shares in the high-income countries since 1965, confirming the importance of the parental time share in shaping the demographic changes. We also extend the basic model to account for countries at all income levels and present a demography opportunity set that describes all the combinations of fertility rates, human capital investments, and parental time shares.

Effects of the Human Development Index on COVID-19 Mortality Rates in High-Income Countries

The coronavirus disease (COVID-19) pandemic has caused a huge loss of life and impaired public health worldwide. The finding that countries with high human development indices (HDIs) is associated with higher death rates during COVID-19 reported in earlier research is confusing. To clarify this significant problem, we explored the correlations and associations between the COVID-19 mortality rate and HDI based on updated data (until April 1, 2022) in 41 high-income countries across the world. The outcomes demonstrate: (a) a strong negative correlation between COVID-19 mortality rate and HDI; and (b) a significant (p = 0.013) negative association between COVID-19 mortality rate and HDI after controlling for health heterogeneities including aging population, full vaccination rate, GDP per capita, UHC, out-of-pocket burden, and stringency index. This paper concludes that reductions in the COVID-19 mortality rate depend to a great extent on the enhancement of human development capacity. Therefore, to better protect global public health, improving human development capacity should be a vital priority for all countries, whether in the present or in the future.

Abstract 168: Population-based Epidemiology Of Heart Failure In A Low-income Country: The Haiti Cardiovascular Disease Study

Aims: Modeling estimates indicate that heart failure (HF) prevalence may be lowest in low-income (LICs). Conversely, HF has been shown to be the leading cause of hospital admission in hospitals in many LICs. This disconnect between estimates and hospital-based observations may be explained by the underlying data. Modeling studies may have selection bias reporting data on individuals presenting with symptomatic disease and may introduce ascertainment bias based on accessibility of care and other structural factors in these communities. Population-based studies are needed to identify the true clinical epidemiology of HF in order to improve HF-related health outcomes in these under-resourced settings where four billion persons live. Haiti is the poorest, most under-resourced country in the Western Hemisphere. We describe HF prevalence, survival, subtypes, risk factors, and one-year mortality in the population-based Haiti Cardiovascular Disease Study. Methods and Results: Multistage cluster-area random sampling identified 2,981 adults, who completed standardized history and exam, laboratory measures, and cardiac imaging. Kaplan-Meier and Cox proportional hazard regression assessed survival; logistic regression identified associated factors. Median follow-up was 15.4 months (IQR 9-22). Age-standardized HF prevalence was 3.2% (93/2,981 [CI:2.6-3.9]). One-year HF mortality was 6.6% versus 0.8% (HR: 7.7 [CI 2.9-20.6], p&lt;0.0001). The average age of participants with HF was 57 years (IQR 45-65). The first significant increase in HF prevalence occurred between 30-39 and 40-49-years (1.1% vs 3.7%, p=0.003). Age, hypertension, body-mass-index, poverty and renal dysfunction were associated with HF. 44.1% (41/93) of participants with HF were aware of their diagnosis. HFpEF was the most common HF subtype (71.0%). Conclusion: The age-standardized prevalence of HF in this low-income setting was alarmingly high at 3.2%--50% higher than rates in high-income countries and 5-fold higher than modeling estimates for LMICs. Adults with HF were two decades younger as compared to high-income settings and 7.7 times more likely to die at one year. These data serve as a warning sign and may have implications for policy makers and future HF interventions in LMICs.

Gastroschisis in Brazil within a Global Context

Introduction: global disparity in outcomes of gastroschisis is visible. Survival rates in high-income countries have improved since 1960, and are currently around 100%, due to progress in pediatric surgery and neonatal intensive care. However, in low- and middle-income countries mortality rates can reach all cases. Objective: this study aims to map the existing literature on gastroschisis in Brazil within a global context. Methods: scoping Review. PubMed, Scielo Brazil, Biblioteca Virtual em Saúde (BVS) and Google Scholar, were searched from January 2000 to May 2020. Results: eight studies met the inclusion criteria. The consolidated data of 912 patients were: Mean maternal age of 20.7 years, antenatal diagnosis rate of 80.2%, cesarean section rate of 77.7%. Mean of hospital stay of 40.8 days. Mean mortality rate of 25.3 %. Risk factors associated with death were: prematurity, low birth weight, low APGAR score, reinterventions, sepsis, birth-to-surgery interval greater than 4 hours, fewer prenatal visits, delayed prenatal diagnosis. Conclusion: studies on gastroschisis in Brazil were scarce, most of carried out in southeast of country. This study suggests that there are regional contrasts on gastroschisis outcomes in Brazil. The worst results are in regions with low economic resources, a similar situation found in international literature. This review should be validated with future studies to investigate the situation of pregnant women with fetuses with gastroschisis, especially in low-resource regions, in Brazil.

Social externalities, endogenous childcare costs, and fertility choice

We reconcile the steep decline in fertility rates during the demographic transition with the fertility rebound observed in recent decades in high-income countries. The micro-foundations of the optimal choice of agents in our expanded model include endogenous childcare costs and social externalities stemming from human capital, consumption, and fertility norms. Combining these factors with the quality-quantity trade-off in fertility choice explains the inverse J-shaped relationship between fertility and economic development. Moreover, the simulated average fertility rates based on the model are reasonably consistent with the observed pattern of the evolution of the cohort fertility rates in high-income countries. Sensitivity analyses show that the model fits historical cohort fertility rates only when it includes the effects of social externalities and endogenous childcare costs.

Women's mental health in Mozambique: is maternity a protective factor?

Globally, women have been shown to have high rates of common mental disorders (CMDs). In low and middle-income countries (LMICs), women face significant challenges related to maternity. However, no study has compared mental health problems among pregnant/post-partum women, childless women of childbearing age, and women with children in a low-income country. We sought to compare the frequency of CMD and suicide risk in a sample of women presenting or accompanying patients in primary care in two Mozambican semi-urban settings. We administered the MINI International Neuropsychiatric Interview to 853 women, of whom 220 (25.8%) were pregnant/post-partum, 177 (20.8%) were non-pregnant and childless, and 456 (53.5%) were non-pregnant and with children more than 1-year-old. Logistic regression models compared the likelihood of a psychiatric disorder across groups, adjusting for sociodemographic and chronic-illness covariates. We found a high frequency of CMD and suicide risk among all women in this low-income context sample. In adjusted models, no differences in rates of depression, anxiety, or panic disorder were observed among groups. However, suicide risk was higher in women without children than pregnant/post-partum women. The frequency of CMD among women of childbearing age in our study was higher than documented rates in high-income countries and other LMIC. Additionally, we found that motherhood was not protective and that pregnancy and the postpartum period were not stages of increased risk for most disorders. This highlights the need to expand mental health services not only for perinatal women but all women of childbearing age in this and possibly similar settings.