Risk Of Infant Mortality Research Articles

Neutrophil trafficking to the site of infection requires Cpt1a-dependent fatty acid β-oxidation

Cellular metabolism influences immune cell function, with mitochondrial fatty acid β-oxidation and oxidative phosphorylation required for multiple immune cell phenotypes. Carnitine palmitoyltransferase 1a (Cpt1a) is considered the rate-limiting enzyme for mitochondrial metabolism of long-chain fatty acids, and Cpt1a deficiency is associated with infant mortality and infection risk. This study was undertaken to test the hypothesis that impairment in Cpt1a-dependent fatty acid oxidation results in increased susceptibility to infection. Screening the Cpt1a gene for common variants predicted to affect protein function revealed allele rs2229738_T, which was associated with pneumonia risk in a targeted human phenome association study. Pharmacologic inhibition of Cpt1a increases mortality and impairs control of the infection in a murine model of bacterial pneumonia. Susceptibility to pneumonia is associated with blunted neutrophilic responses in mice and humans that result from impaired neutrophil trafficking to the site of infection. Chemotaxis responsible for neutrophil trafficking requires Cpt1a-dependent mitochondrial fatty acid oxidation for amplification of chemoattractant signals. These findings identify Cpt1a as a potential host determinant of infection susceptibility and demonstrate a requirement for mitochondrial fatty acid oxidation in neutrophil biology.

Effect of wealth inequality on child and infant mortality in Togo

At birth, individual has a health capital that depends on family, environmental and personal characteristics which depreciates over time requiring investment. It's in this sense that this article aims to analyze the effect of wealth inequality on infant and child mortality in Togo. This effect is accessed by a semi-parametric proportional hazard duration model of Cox. According to the model estimation which is based on data from the Multiple Indicator Cluster Survey (MICS) carried out in Togo in 2017, the results obtained show in one hand that coming from a less wealthy household increases the risk of death for children. On other hand, the results show that the possession of a source of drinking water, the possession of health insurance by the mother, and the mastery of the use of new information technologies and communication reduce the risk of infant and child mortality. In view of these results, policies to reduce wealth inequalities could help reduce the risk of infant and child mortality in proportions ranging from 0.075 to 0.264.

THE ASSOCIATION BETWEEN HB LEVELS AND PLACENTA PREVIA IN GRAVIDA PATIENTS

A placenta previa develops in the lower part of the uterus, covering the internal uterine ostium entirely or partially. The risk of maternal and infant mortality and morbidity rises as the placenta's inadequate vascularization expands to cover the entire birth canal. Hemoglobin (Hb) level is a biochemical indicator to determine the nutritional status of pregnant women, and reduced blood supply to the placenta can be caused by a lack of Hb levels in pregnant women. The purpose of this study was to determine the association between Hb level in gravida patients and the incidence of placenta previa at Sultan Agung Islamic Hospital, Semarang. This research was an observational analytic study with a cross-sectional design, which was conducted on 97 respondents who met the inclusion and exclusion criteria. The data was taken from the patient's medical record document from January 2017 - January 2018 at Sultan Agung Islamic Hospital. Analysis of the research data using the Chi-Square test. The findings revealed a significant correlation between Hb level and placenta previa incidence, low Hb levels (<11 g/dl) could significantly increase the risk of placenta previa in gravida patients.

Maternal Anemia in Third Trimester and Low Birth Weight (LBW): Systematic Review

Background: Low Birth Weight (LBW) babies have an increased risk of infant mortality and morbidity. LBW is defined as babies weighing fewer than 2,500 grams at birth. Maternal anemia or hemoglobin levels less than 11 g/dL is a significant risk factor associated with LBW. Objective: This study systematically analyzed the association between maternal anemia in the third trimester and low birth weight. Methods: This systematic review was conducted using the primary databases (PubMed, Science Direct, and Google Scholar), literature in Indonesian and English, and literature using cohort, cross-sectional, and case-control for the study researcher. Results: 5 cohorts, 2 cross-sectional, and 1 case-control study were included in this systematic review after a total of 2171 articles were retrieved from a database and systematically examined with PRISMA. Conclusion: Maternal anemia in the third trimester is associated with low birth weight because third-trimester hemoglobin is a crucial factor in determining birth weight.

Death Inequality During the First Year of Life in Morocco: A Macro Level Analysis

Disparities in child mortality are a reality in Morocco. These disparities coexist with inequalities in: (i) the availability of primary health care (PHCs); (ii) the socioeconomic status of the population as reflected by the prevalence of various forms of poverty; as well as (iii) fertility levels (TFRs) and the status of women in literacy and employment rates. Despite its limitations, this research provides a macro-level understanding of the link between infant mortality and a range of aggregates (political, economic, social and demographic).The metadata collected in the 2014 census (RGPH-2014) RGPH-2014 was used to construct a provincial proxy indicator of infant mortality by area of residence.This is considered as a dependent variable that we have tried to explain by the above-mentioned indicators. This is considered as a dependent variable that we have tried to explain by the above-mentioned indicators. The latter indicators reflect the socio-economic conditions prevailing in each of the provinces by area of residence. In addition, they give information on the availability of basic health services and on the woman's status. A key finding is that the level of current fertility as measured by the TFR negatively affects child survival. With a statistically significant regression coefficient of 2.912 (Pvalue =0.000), it can be argued that high fertility increases the risk of infant mortality. In turn, the prevalence of overall poverty also has a statistically significant effect on infant survival (β= -0.213 with a pvalue =0.029).

Factors Associated with Low Birthweight in Low-and-Middle Income Countries in South Asia.

Child with Low Birth Weight (LBW) has a higher risk of infant mortality, learning difficulties in childhood due to stunted growth and impaired neurodevelopment, is more likely to develop heart diseases and diabetes in adulthood. This study aimed to evaluate the latest demographic and health surveys (DHSs) across multiple countries in South Asia to determine the factors associated with LBW among these countries. Latest available DHS data across Afghanistan (2015, n = 29,461), Bangladesh (2018, n = 20,127), Nepal (2016, n = 12,862), and Pakistan (2018, n = 15,068) were analysed. Complex survey adjusted generalized linear models were fitted to investigate the association of birth weight with sociodemographic and decision-making factors. Pakistan had the highest proportion of LBW at 18% followed by Afghanistan and Bangladesh at around 14% and Nepal had the lowest (13%). Children born in Pakistan were more likely to have LBW children than Afghanistan (AOR = 2.17, 95% CI = 1.49-3.14). Mothers living in rural areas (AOR = 0.77, 95% CI = 0.61-0.97), with highly educated partners and belonging to richer families were less susceptible to having child with LBW. To reduce 30% LBW in-line with the World Health Organisation's 2025 goal, policymakers in SA should focus on women in urban areas with low-educated partners belonging to poor households to ease LBW burden.

Implementation of a 24-hour empiric antibiotic duration for negative early-onset sepsis evaluations to reduce early antibiotic exposure in premature infants.

Antibiotic exposure increases the risk of morbidity and mortality in premature infants. Many centers use at least 48 hours of antibiotics in the evaluation of early-onset sepsis (EOS, <72 hours after birth), yet most important pathogens grow within 24 hours. We investigated the safety and efficacy of reducing empiric antibiotic duration to 24 hours. Quality improvement study. A tertiary-care neonatal intensive care unit. Inborn infants <35 weeks gestational age at birth (ie, preterm) admitted January 2019 through December 2020. In December 2019, we changed the recommended duration of empiric antibiotics for negative EOS evaluations from 48 hours to 24 hours. Patient characteristics before and after the intervention were similar. After the intervention, 71 preterm infants (57%) with negative EOS evaluations received ≤24 hours of antibiotics, an increase from 15 (10%) before the intervention. These 71 infants comprised 77% of infants with negative EOS blood cultures after excluding those treated as clinical sepsis (≥5 days of antibiotics). For all negative EOS blood cultures, the mean treatment duration decreased by 0.5 days from 3.9 days to 3.4 days. This finding equated to 2.4 fewer antibiotic days per 100 patient days for negative EOS blood cultures but similar antibiotic days per 30 patient days (7.2 days vs 7.5 days). This measure did not change over time. Subsequent sepsis evaluations <7 days after a negative EOS blood culture did not increase. Excluding contaminants, the median time to positivity was 13.2 hours (range, 8-23) in 8 positive blood cultures. Implementation of a 24-hour antibiotic course for negative EOS evaluations safely reduced antibiotic exposure in 77% of infants <35 weeks gestational age at birth in whom EOS was ruled out. All clinically significant pathogens grew within 24 hours.

Reducing risks for infant mortality in the Midlands, UK: a qualitative study identifying areas for improvement in the delivery of key public health messages in the perinatal period

Background:The Midlands has amongst the highest rates of neonatal and infant mortality in the UK. A public health parent education and empowerment programme, aimed at reducing key risks associated with this mortality was established and evaluated in the region. This was undertaken in an attempt to identify areas for optimal delivery of the public health messages around reducing risks for neonatal and infant mortality.Method:Qualitatively assessment, using the software package Dedoose®, was undertaken. This involved analysis of reflections by the programme trainers, after the delivery of their training sessions to parents, families and carers, between 01 January and 31 December 2021. These were intended to capture insights from the trainers on parent, family, carer and staff perspectives, perceptions/misperceptions around reducing risks for infant mortality. Potential areas for improvement in delivery of the programme were identified from this analysis.Results:A total of 323 programmes, comprising 524 parents, family members and carers were offered the programme. Analysis of 167 reflections around these interactions and those of staff (n = 29) are reported. The programme was positively received across parents, families, carers and staff. Four overall themes were identified: (a) reach and inclusion, (b) knowledge, (c) practical and emotional support and (d) challenges for delivery of the programme. Recommendations for improved delivery of the programme were identified, based on qualitative analysis.Conclusion:This novel approach to empowerment and education around neonatal public health messaging is a valuable tool for parents, families, carers and staff in the Midlands. Key practical recommendations for enhancing delivery of these critical public health messages were identified from this qualitative research. These are likely to be of value in other parts of the UK and globally.

Community and individual level determinants of infant mortality in rural Ethiopia using data from 2016 Ethiopian demographic and health survey

The infant mortality rate remains unacceptably high in sub-Saharan African countries. Ethiopia has one of the highest rates of infant death. This study aimed to identify individual-and community-level factors associated with infant death in the rural part of Ethiopia. The data for the study was obtained from the 2016 Ethiopian Demographic and Health Survey. A total of 8667 newborn children were included in the analysis. The multilevel logistic regression model was considered to identify the individual and community-level factors associated with new born mortality. The random effect model found that 87.68% of the variation in infant mortality was accounted for by individual and community level variables. Multiple births (AOR = 4.35; 95%CI: 2.18, 8.69), small birth size (AOR = 1.29; 95%CI: 1.10, 1.52), unvaccinated infants (AOR = 2.03; 95%CI: 1.75, 2.37), unprotected source of water (AOR = 1.40; 95%CI: 1.09, 1.80), and non-latrine facilities (AOR = 1.62; 95%CI: 1.20) were associated with a higher risk of infant mortality. While delivery in a health facility (AOR = 0.25; 95%CI: 0.19, 0.32), maternal age 35–49 years (AOR = 0.65; 95%CI: 0.49, 0.86), mothers receiving four or more TT injections during pregnancy (AOR = 0.043, 95% CI: 0.026, 0.071), and current breast feeders (AOR = 0.33; 95% CI: 0.26, 0.42) were associated with a lower risk of infant mortality. Furthermore, Infant mortality rates were also higher in Afar, Amhara, Oromia, Somalia, and Harari than in Tigray. Infant mortality in rural Ethiopia is higher than the national average. The government and other concerned bodies should mainly focus on multiple births, unimproved breastfeeding culture, and the spacing between the orders of birth to reduce infant mortality. Furthermore, community-based outreach activities and public health interventions focused on improving the latrine facility and source of drinking water as well as the importance of health facility delivery and received TT injections during the pregnancy.

Risk of morbidity and mortality in preterm infants born to advanced maternal age pregnancies

Background: Little is known about the effect of advanced maternal age on preterm morbidity and mortality. This study aimed to evaluate the possible relationship between maternal age and morbidity and mortality in premature infants born at a gestational age ≤32 weeks.Methods: Premature infants born at ≤32 weeks of gestation and admitted to the neonatal intensive care unit were divided into three groups by maternal age: &amp;lt;35, 35-39, and ≥40 years. Infant and maternal demographic and clinical characteristics, and preterm morbidity and mortality were compared between the groups.Results: A total of 827 preterm infants were included. Their distribution by maternal age was as follows: 659 infants in the &amp;lt;35 years group, 120 in the 35-39 years group, and 48 in the ≥40 years age group. Older maternal age was associated with higher gravidity, frequency of assisted reproductive technology use, preeclampsia, gestational diabetes mellitus, and caesarean delivery (P=0.004, P&amp;lt;0.001, P=0.007, P=0.004, and P&amp;lt;0.001, respectively). Respiratory distress syndrome, patent ductus arteriosus, and necrotising enterocolitis were significantly more frequent in preterm infants aged ≥35 years (P=0.014, P=0.029, and P&amp;lt;0.001, respectively).Conclusions: In addition to the maternal risks associated with pregnancy at older ages, some prematurity morbidities may also increase in frequency. Although this novel study presents important results, further studies are needed to evaluate the relationship between advanced maternal age and preterm morbidity.

Education to Prevent Anemia in Pregnancy

Anemia in pregnant women can increase the risk of maternal and infant mortality. Pregnant women really need tablets to increase blood (iron) to avoid anemia. Prevention of anemia in pregnancy starts from adolescence and when it is declared pregnant by consuming iron and folic acid supplements. People who have the potential to experience anemia are women. Educational activities for the prevention of pregnancy anemia were held on Sunday, July 17, 2022 at the RT Kembangan Regency Gresik hall which was attended by cadres, local residents, and pregnant women. The method used is providing counseling, handouts, picture and video slides and questions and answers about anemia. After this counseling, it is hoped that all pregnant women will understand about preventing anemia in pregnancy and how to prevent it.

Neutrophil extracellular traps in the pathogenesis of obstetric complications in COVID-19 (brief review)

Introduction. In the pathogenesis of the new coronavirus infection (COVID-19), innate cellular elements of the immune system are of great importance, among which special attention is paid to neutrophils and the mechanisms of their death – netosis, which leads to the formation of extracellular DNA traps. Neutrophil extracellular traps play an important role in the development of endothelial dysfunction and thrombotic disorders, which not only complicates the course of COVID-19 infection, but also causes severe obstetric complications that increase the risk of maternal and infant mortality. This review describes possible mechanisms for the formation of neutrophil extracellular traps, as well as their role in the pathogenesis of COVID-19.Materials and methods. An analysis of Russian (eLibrary) and foreign (PubMed) literature was carried out with a search depth of 2010-2021.Results. The pathogenesis of COVID-19 is directly related to the uncontrolled progression of systemic inflammation, which changes the innate immune response in the form of functional maladaptation and premature death of neutrophils with the formation of neutrophil extracellular traps. The neutrophils that were transformed by netosis play a key role in the development of thrombotic disorders of the microvasculature, which leads to the development of life-threatening complications such as acute respiratory distress syndrome and multiple organ failure, which increases the mortality of patients with COVID-19 infection. During pregnancy, increased formation of neutrophilic extracellular traps is the cause of hemodynamic disturbances of the fetoplacental complex, placental disorders and endothelial dysfunction, concomitant with the development of preterm labor and preeclampsia, which increases the risk of postpartum hemorrhage, maternal morbidity and mortality. Therefore, new data on neutrophil extracellular traps and mechanisms of formation may lead to a reconsideration of the pathogenesis of thrombotic disorders in pregnant women with COVID-19 infection, which is important for further management of pregnancy.

Meta-Analysis of Enteral Lactoferrin Supplementation for Reducing the Risk of Preterm Infants Sepsis

Introduction: Severe COVID-19 in pregnancy is strongly associated with preterm infant late-onset sepsis (LOS), which is a major cause of morbidity and mortality in infants. Recently, Lactoferrin, an iron-binding protein significantly discovered in human colostrum, shows potential effect on reducing the risk of preterm infant LOS and mortality by its immunomodulatory properties. Therefore, this study aimed to evaluate the effect of Lactoferrin on reducing the risk of preterm LOS, necrotizing enterocolitis (NEC), and mortality in preterm infants. &#x0D; Methods: This study followed the guidelines provided by PRISMA. A literature search was conducted with PubMed, Cochrane Library, Google Scholar, and ScienceDirect. The combined effect of LOS, NEC and mortality incidence were presented as risk ratios (RR) with a 95% confidence interval (CI) using a random-effects model (REM) or fixed-effects model (FEM) forest plot. Furthermore, the heterogeneity level was checked by I2 and the p-value of the chi2 test.&#x0D; Results: The incidence of LOS was significantly higher in the control than lactoferrin supplementation group [RR=0.65, 95% CI (0.56,0.77), p&lt;0.00001, I2=56%]. However, there were no significant differences in NEC [RR=0.80, 95% CI (0.63,1.02), p=0.10, I2=39%] and mortality [RR=0.94, 95% CI (0.77,1.13), p=0.49, I2=39%], despite the trends are higher in the control group.&#x0D; Conclusion: This meta-analysis showed that enteral lactoferrin supplementation in preterm infants was associated with a significant reduction in LOS, but not NEC stage II or III and all-cause mortality.&#x0D; Registered Protocol: The protocol of this review was already registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42021279189.

Determinants of neonatal near-miss among neonates delivered in public hospitals of Ilu Abba Bor Zone, Southwest Ethiopia: An unmatched case-control study during the COVID-19 pandemic.

BackgroundThe neonatal period is the time with the highest risk of neonatal and infant mortality. The COVID-19 pandemic diverted resources from routine maternal health services, which raises the possibility of neonatal near misses (NNMs). To implement prompt treatments that could improve the standard of infant care and lower neonatal mortality, it has been theorized that pinpointing the determinants of NNM during this outbreak is crucial. In light of this, the current study identified the determinants of NNM in neonates delivered in public hospitals of Ilu Abba Bor Zone, South West Ethiopia.MethodsAn institution-based unmatched case–control study was conducted among randomly selected 303 (101 cases and 202 controls) neonates admitted to Mettu Karl Comprehensive Specialized Hospital (MKCSH) and Darimu Primary Hospital (DPH) from 1 November to 28 December 2020. Data were collected using interviewer-administered structured questionnaire and checklist. The collected data were coded and entered into Epi-Data version 4.6 and then exported to SPSS version 20 for analysis. Adjusted odds ratios (AOR) along with a 95% confidence interval was used to assess the strength of the association, and a p-value < 0.05 was considered to declare the statistical significance in the multivariable logistic regression analysis.ResultA total of 303 (101 cases and 202 controls) neonates admitted to MKCSH and DPH were included in the study making a 97.4% response rate. In the multivariable logistic regression analysis, no formal maternal education [AOR = 3.534, 95% CI: (1.194–10.455)], Breech presentation during birth [AOR = 3.088, 95% CI: (1.029–9.268)], < 4 antenatal care (ANC) visits [AOR = 1.920, 95% CI: (1.065–3.461], cesarean section delivery [AOR = 4.347, 95% CI: (1.718–10.996)], antepartum hemorrhage (APH) [AOR = 3.37, 95% CI: (1.23–9.24)], and hypertensive disorders of pregnancy (HDP) [AOR = 4.05, 95% CI: (2.36–11.05)] were independent determinants of NNM.ConclusionThe study's result revealed that factors such as education level, birth presentation, ANC visit, mode of delivery, APH, and HDP continued to be important determinants of the NNM in Ethiopia during this pandemic. Therefore, much work is needed to improve neonatal health by providing adequate ANC services and other identified potential determinant factors that predispose the newborn to life-threatening (near-miss) conditions especially during this pandemic.

Fetal and infant death associated with short-term ozone exposure

Background: Air pollution is linked to adverse pregnancy outcomes such as preterm births, but few studies evaluated its acute impact on fetal and infant mortality. We evaluated short-term impacts of warm-season ozone and cold-season fine particulate matter &amp;#x3c;2.5 microns (PM2.5) exposures on the risk of fetal death (&amp;#x3e;20 weeks) and infant mortality (live birth to one year). Methods: This time-stratified case-crossover analysis includes 1,880 singleton fetal deaths (2007-2011) and 3,229 singleton infant deaths (2007-2015) from the San Joaquin Valley (SJV), California. Daily ozone and PM2.5 were estimated by the SJV Air Pollution Control District and geospatially linked to maternal zip code at birth. Critical exposure windows of interest included the day of death (lag 0) up to 14 days before (lag 14). Conditional logistic regression models estimated the odds ratio (OR) and 95% confidence intervals (CI) for each 5 units increase in pollutant. Results: In warm season (May-October), a 5-ppb increase in ozone was associated with a 7% (95% CI: 2%-13%) increased risk of fetal death and 6% (95% CI: 2%-10%) increased risk of infant death within two weeks. The estimates were generally consistent from lag 0 to lag 14 for both mortality outcomes, with evidence of slightly stronger estimates for fetal death compared to infant death during certain lags. During lag 7, a 5-ppb increase in ozone was associated with a 9% increased risk in fetal death (95% CI: 5%-14%) and a 4% (95% CI: 1%-7%) increased risk in infant death. No associations were observed for cold-season PM2.5. Conclusions: Ozone exposure is positively associated with short-term risk of fetal and infant mortality in the warm season. Given the ubiquitous nature of air pollution, these associations merit further investigation. Meanwhile, efforts to minimize exposures among pregnant women may be warranted. Keywords: pollution, infant mortality, fetal death, stillbirth, pregnancy, mortality, ozone

Incidence of infant mortality and its predictors in East Africa using Gompertz gamma shared frailty model

BackgroundGlobally, infant mortality is a major public health concern and a sensitive indicator of countries' socio-economic and health status. Despite the substantial reduction of under-five mortality in sub-Saharan African countries specifically in East Africa, the infant mortality rate remains highest and too far below to achieve the WHO target. As to our search of the literature is concerned, there is a dearth of evidence on the incidence and predictors of infant mortality in East Africa. Therefore, this study investigated the incidence of infant mortality and its predictors in East Africa.MethodsThe present study has utilized 138,803 weighted samples from Demographic and Health Surveys (DHSs) of 12 East African countries. Considering the hierarchical nature of DHS data shared frailty parametric survival models were fitted and compared based on deviance (-2LLR), AIC, and BIC. Gompertz gamma shared frailty model was the best-fitted model for the data since it had the lowest deviance, AIC, and BIC values. Variables with a p-value < 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable Gompertz gamma shared analysis, the Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to declare the significant predictors of infant mortality.ResultsThe infant mortality rate in East Africa was 41.41 per 1000 live births. Mothers aged 25–34 years, wanted birth, health facility delivery, 1–3 ANC visit, being 2nd- 4th birth order, 5th and above, the birth interval of 24–48 months, and birth interval of 49 months and above were significantly associated with lower risk of infant mortality. Whereas women who didn’t have formal education, women who didn't participate in making health care decisions making, being male children, cesarean delivery, small size at birth, and large size at birth were significantly associated with a higher risk of infant mortality.ConclusionDespite the substantial progress in improving maternal and child health, this study showed that infant mortality is still a major public health concern in East Africa. Maternal age, place of delivery, maternal education, birth size, sex of the child, mode of delivery, women's autonomy, birth order, birth interval, and ANC visit were found to be significant predictors of infant mortality. Therefore, public health interventions enhancing health facility delivery, ANC visit, maternal education, birth spacing, and empowering women are crucial for reducing the incidence of infant mortality in East Africa.

Timing of first bath in term healthy newborns: A systematic review.

BackgroundThis systematic review of intervention trials and observational studies assessed the effect of delaying the first bath for at least 24 hours after birth, compared to conducting it within the first 24 hours, in term healthy newborns.MethodsWe searched MEDLINE via PubMed, Cochrane CENTRAL, Embase, CINAHL (updated till November 2021), and clinical trials databases and reference lists of retrieved articles. Key outcomes were neonatal mortality, systemic infections, hypothermia, hypoglycaemia, and exclusive breastfeeding (EBF) rates. Two authors separately evaluated the risk of bias, extracted data, and synthesized effect estimates using relative risk (RR) or odds ratio (OR). The GRADE approach was used to assess the certainty of evidence.ResultsWe included 16 studies (two trials and 14 observational studies) involving 39 020 term or near-term healthy newborns. Delayed and early baths were defined variably in the studies, most commonly as >24 hours (six studies) and as ≤6 hours (12 studies), respectively. We performed a post-hoc analysis for studies that defined early bath as ≤6 hours. Low certainty evidence suggested that bathing the newborn 24 hours after birth might reduce the risk of infant mortality (OR = 0.46, 95% confidence interval (CI) = 0.28 to 0.77; one study, 789 participants) and neonatal hypothermia (OR = 0.50, 95% CI = 0.28-0.88; one study, 660 newborns), compared to bathing within first 24 hours. The evidence on the effect on EBF at discharge was very uncertain. Delayed bath beyond 6 hours (at or after nine, 12, or 24 hours) after birth compared to that within 6 hours might reduce the risk of hypothermia (OR = 0.47, 95% CI = 0.36-0.61; four studies, 2711 newborns) and hypoglycaemia (OR = 0.39, 95% CI = 0.23-0.66; three studies, 2775 newborns) and improve the incidence of EBF at discharge (OR = 1.12, 95% CI = 1.08-1.34; six studies, 6768 newborns); the evidence of the effect on neonatal mortality was very uncertain.ConclusionDelayed first bath for at least 24 hours may reduce infant mortality and hypothermia. Delayed bath for at least 6 hours may prevent hypothermia and hypoglycaemia and improve EBF rates at discharge. However, most of these conclusions are limited by low certainty evidence.RegistrationPROSPERO 2020 CRD42020177430.

P-053: SICKLE CELL MANAGEMENT AND INTERNATIONAL COOPERATION

Purpose: Introduction: Sickle cell disease management is a public health problem in developing countries. According to the World Health Organization (WHO), more than 300,000 of the 500,000 annual births with sickle cell gene, in the world live in Africa, particulary in the sub-Saharan region. The risk of infant mortality is 50% to 80% in the lack of quick and appropriate care. In Senegal, the gene frequency is estimated at 10%, with 0.5% of annual births of major forms, (1700 newborns per year). In order to improve the management of this disease, Senegal State and Monaco Principality have co-financed a dedicated structure: Ambulatory Care Unit for Children and Adolescents with Sickle Cell Disease (USAD), in the National Children Hospital Albert Royer in Dakar, as part of a project with a partnership agreement. The main missions are care, training and research. Materials and methods: Methods: In order to share the results of the first four years, we used data from the project’s activity reports and the Hospital’s Medical Information Service. Results: Results: between 2017 and 2020, 14899 consultations were carried out, on average: 3700/year, including 4604 Emergencies, on average 1151/year and 1062 new cases, on average: 265/year. During the same period, 743 long-term hospitalizations were carried out, an average of 186/year. The number of daily hospitalizations was 2686, an average of 672/year. In 2020, according to SIM statistics, the management of sickle cell disease occupied the 1st place in specialized consultations at the hospital, and was the 1st reason for hospitalization in the two main general pediatrics Units (Unit M and Unit K). About the laboratory, 4099 complete blood counts were performed with 3063 Hb electrophoresis and 797 thick drops. Concerning the training of human resources, 8 paediatricians were certified in the management of sickle cell disease. In addition, 64 doctors and 82 nurses received capacity building. Advanced training courses were organized for 6 nurses and a laboratory technician. Associative activities made it possible to organize 28 talks with 2,831 people made aware of sickle cell disease. Three communications plan development workshops were organized with 60 people as well as training in social communication for 90 members of the association with the production of 1,800 awareness leaflets on sickle cell disease. Conclusion: Discussion and Conclusion: Sickle cell disease is a neglected disease that can be functionally or life-threatening. Its management requires a national and international commitment. The State of Senegal and the Monegasque Cooperation have contributed to improving the diagnosis and supported. However, the main challenges remain the sustainability and the implementation of neonatal screening, as part of a national program to fight against sickle cell disease. Keywords: sickle cell disease, management, cooperation. The authors do not declare any conflict of interest

Skilled maternal healthcare and good essential newborn care practice in rural Bangladesh: A cross-sectional study.

Background and AimsEssential newborn care (ENC) practices play an important role in reducing the risk of infant mortality and morbidity. Therefore, more studies are needed on ENC practices. Skilled maternal healthcare can be a good strategy to increase the practice. Learn about the independent and joint effects of skilled maternal healthcare during pregnancy and childbirth on newborn care practices.MethodsThe study used a cross‐sectional data obtained from Bangladesh Multiple Indicator Cluster Survey, 2019. To investigate the association between maternal healthcare utilization and good ENC practice (cord care, delayed bathing, and immediate breast‐feeding), χ 2 test and t‐test in bivariate and binary logistic regression analysis, respectively have been performed after taking into account complex survey design.ResultsOnly about 24% (95% confidence interval [CI]: 22.95%–25.89%) women given birth at home in rural Bangladesh followed good newborn care practice. The results obtained from adjusted regression analysis showed that a woman was 24%, 49%, and 75% more likely of having good ENC practice if she received four or more skilled checkups during antenatal period only (adjusted odds ratios [AOR]: 1.24, 95% CI: 0.97, 1.60), received assistance from SBA during delivery only (AOR: 1.49, 95% CI 1.12, 1.97) and received skilled healthcare in both pregnancy and delivery (AOR: 1.75, 95% CI 1.13, 2.71), respectively compared to a woman who did not get an opportunity to receive skilled healthcare during pregnancy and delivery. Among the selected confounders, maternal age at birth, birth order, education of household heads and religion showed a significant association with good ENC practice.ConclusionThe study revealed that proper maternal healthcare during pregnancy and childbirth from skilled health personnel can improve the rate of ENC practices. For this, more training programs should be started, especially at the community level, and health promotion activities are needed to create awareness about efficient maternal healthcare practices.

Pandemic checkups: Mobile paediatric care and vaccination in disadvantaged areas.

In 2019, 10.1% of Canadians lived below the national poverty line (1). This percentage is greater among immigrants who arrived in Canada within the last 10 years (17.4%) (1). Poverty is a health issue: lower income is associated with poorer health outcomes, such as shorter life expectancy, mental health disorders, diabetes, and cardiovascular comorbidities (2). Children experiencing poverty are at higher risk of infant and child mortality and morbidity due to injury, asthma and developmental delay (2). In addition to having increased risk of adverse health outcomes, low-income, racially diverse populations face linguistic, structural, and psychological obstacles in accessing health care (2,3). These marginalized groups have also reported challenges in establishing trusting relationships with health care providers (4). COVID-19 has exacerbated these health inequities, as public health measures led to a reduction in health care appointments conducted in person. Reorganization of services led to a deprioritization of elective clinical activity, such as well-child visits (5). Furthermore, families were hesitant to seek care due to fear of contracting COVID-19 (6). To palliate these gaps in care, telemedicine has been widely adopted during the pandemic (7). Despite telemedicine improving health care access for some patients, vulnerable families have unequal access to virtual care (7).