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Aim: Women's clothing during pregnancy may influence perinatal outcomes. A preliminary study suggested that midwives' advice to avoid wearing tight clothing during pregnancy may reduce the risk of preterm delivery. We examined the effects of such advice to pregnant women on the risk of preterm birth and health status during pregnancy. Methods: An open‐label evaluator‐blinded randomized controlled trial was conducted at the National Centre for Child Health and Development in Tokyo, Japan. Normal pregnant women were randomly assigned to receive constrictive clothing elimination care or standard care at 20 weeks gestation. The control group was issued leaflets concerning anemia prevention at entry and skin care at 30 weeks' gestation, along with a brief explanation and answers to questions by midwives as standard care. The intervention group received advice from midwives concerning avoiding constrictive clothing in addition to standard care. The primary outcome was the incidence of preterm birth (<37 weeks). The secondary outcomes were 12 indicators related to preterm delivery or health status. Results: Among 624 randomly assigned women, 599 (intervention group, n = 306; control group, n = 293) completed the study between February 2015 and August 2016. The incidence of preterm birth in the intervention and control groups was 4.2% (13/306) and 5.1% (15/293), respectively (p = 0.614). There were no significant differences regarding any secondary outcomes, including obstetric outcomes and physical/mental indicators, during pregnancy. Conclusions: Advice from midwives to avoid constrictive clothing during pregnancy did not influence the incidence of preterm birth or maternal health status. Trial registration: UMIN000016853 (March 30, 2015). [ABSTRACT FROM AUTHOR]

OBJECTIVES: Physical inactivity is an important health concern worldwide. In this study, we examined the effects of an exercise intervention on children's academic achievement, cognitive function, physical fitness, and other health-related outcomes. METHODS: We conducted a population-based cluster randomized controlled trial among 2301 fourth-grade students from 10 of 11 public primary schools in 1 district of Ulaanbaatar between February and December 2018. Schools were allocated to an intervention or control group with 5 schools each by using urban and mixed residential area stratified block randomization. The intervention group received a 3-minute high-intensity interval exercise program that included jumps, squats, and various steps implemented twice weekly over 10 weeks for 10 to 25 minutes per session. The control group received the usual physical education class. The primary outcome was academic achievement assessed by scores on the national examination. A linear mixed-effects model was applied. The difference between preintervention and post intervention was compared by least-squares means, estimated on the basis of the interaction of group, measurement time point, and school location. Only 1 statistician, responsible for the analysis, was blinded. RESULTS: Of 2301 students, 2101 (1069 intervention; 1032 control) were included in the analysis. Intervention group members in an urban area showed an 8.36-point improvement (95% confidence interval: 6.06 to 10.66) in academic scores when compared with the control group, whereas those in a mixed residential area showed a 9.55-point improvement (95% confidence interval: 6.58 to 12.51). No intervention-associated injuries were observed. CONCLUSIONS: The exercise program significantly improved children's academic achievement. [ABSTRACT FROM AUTHOR]

Background: The early life period provides a critical foundation for child health and development, and mothers exert great influence as primary caregivers. Previous studies have shown that single-motherhood is associated with negative child outcomes. In Japan, few studies have addressed the situation faced by single-mothers with young children, such as living conditions and mental health issues.Methods: We utilized nationwide data from the Comprehensive Survey of Living Conditions (2016), collected by the Japanese Ministry of Health, Labour and Welfare and compared mothers from single-mother households with those from two-parent households, with further subdivision by intergenerational cohabitation. Socio-demographic characteristics, lifestyle habits, psychological distress, subjective health status, and stress were examined.Results: We observed that single-mothers without intergenerational cohabitation seemed to experience harsh living conditions compared to other types of households. Severe psychological distress was observed in 11% of single-mothers without cohabitation compared with 6% among single-mothers with cohabitation and 4% among mothers of two-parent households. Multivariate analysis adjusting for demographic variables showed about a two-fold increased risk of severe psychological distress (OR=2.34, 95% CI: 1.71-3.22) associated with single-mothers without intergenerational cohabitation compared to mothers from two-parent household without cohabitation. Single-mothers without cohabitation tended to smoke and drink alcohol frequently and seemed sleep-deprived.Limitations: Due to the cross-sectional design, we could not make inference on causality.Conclusions: Our study highlighted needs for targeted support for single-mothers without intergenerational cohabitation. Efforts in public health and other related fields may present opportunities to reduce negative intergenerational impacts of adversities among socially vulnerable families. [ABSTRACT FROM AUTHOR]

Mental health assessments of both members of a couple are important when considering the child-rearing environment. The prevalence and factors associated with both parents' psychological distress have not been fully investigated. A nationally representative sample from the 2016 Comprehensive Survey of Living Conditions in Japan was used to examine the prevalence of moderate and severe psychological distress in parents in the first year after childbirth. In total, 3,514 two-parent households raising children under one year old met the study criteria. The Japanese version of Kessler 6 was used to assess moderate and severe psychological distress. The prevalence of either or both parents experiencing psychological distress in the first year after birth were 15.1% and 3.4%, respectively. A multivariate logistic regression analysis showed factors of fathers who worked ≥ 55 h a week, reduced duration of sleep in mothers, age in months of the youngest child, and high household expenditures were significantly associated with both parents simultaneously having moderate or severe psychological distress. This study implied the importance of prevention and early detection of parental psychological distress in both parents. Assessing parents' psychological distress and work-style reform in the childcare period is an urgent issue to improve their mental health conditions. [ABSTRACT FROM AUTHOR]

Background: This study aimed to describe the prevalence trends of pre- and postnatal depression, via measures of the Edinburgh Postnatal Depression Scale (EPDS) total and factor scores, from 20 weeks' gestation to 3 months postpartum, stratified by parity, in a Japanese female population.Methods: A longitudinal, population-based study was conducted among perinatal women giving birth at maternity facilities in Setagaya area of Tokyo, Japan. Of the 1775 women who participated, 1311 women met the inclusion criteria of this analysis. All data, including EPDS, were collected via self-administrated questionnaires at 20 weeks' gestation and at 5 time points postpartum, from the first few days to 3 months postpartum. We divided EPDS items into three factors: "anxiety," "anhedonia," and "depression," according to factor analysis.Results: The prevalence of individuals exhibiting depressive symptoms, EPDS total score, and each factor score peaked at two weeks postpartum in primiparas (EPDS total = 5.58, anhedonia = 0.47, anxiety = 2.64, and depression = 1.23). In contrast, the EPDS total score and factor scores for "anxiety" and "depression" gradually decreased for multiparas, from the prenatal to postpartum period (EPDS total 3.33, 3.03, 3.03, 2.72, 2.76, and 2.37).Limitations: Each factor score was not weighted; instead, we simply added up the item scores ranging from 0 to 3 for each question. Additionally, the population representativeness of Japanese women was not high, although the sample was population-based and had a high follow-up rate.Conclusions: This study shows that the trends of EPDS total and factor scores differ by parity throughout the pre- and postnatal periods among a Japanese female population. [ABSTRACT FROM AUTHOR]

We investigated the association of paternal depression in the prenatal and early postnatal period with child maltreatment tendency at two months postpartum among Japanese fathers. This population-based longitudinal study recruited Japanese perinatal women and their partners living in Nishio City, Aichi, Japan. Of the 270 fathers who participated, 196 were included in the analysis. All data were collected via self-administrated questionnaires at four time points: 20 weeks’ gestation and in the first few days, one month, and two months postpartum. Paternal depression was assessed using the Edinburgh Postnatal Depression Scale. Three definitions of paternal depression were coded based on participants’ scores on this measure: prenatal, prior, and current. Child maltreatment tendency was evaluated using the Child Maltreatment Scale at two months postpartum. The associations of the three definitions of paternal depression and child maltreatment tendency were separately analyzed using logistic regression analysis. The prevalence of prenatal, prior, and current paternal depression was 9.7%, 10.2%, and 8.8%, respectively. According to the multivariate analysis, current paternal depression was significantly associated with child maltreatment tendency at two months postpartum (adjusted odds ratio: 7.77, 95% CI: 1.83–33.02). The other two types of depression, however, were not related to child maltreatment tendency. Thus, current paternal depression increased the risk of child maltreatment tendency in the postnatal period, suggesting that early detection and treatment of paternal depression might be useful for the prevention of child maltreatment. [ABSTRACT FROM AUTHOR]

Background: Partner education during pregnancy may be able to prevent postnatal mental health problems, and support expectant fathers in their transition to parenthood. The aim of this systematic review is to investigate the effects of prenatal childbirth education among partners of pregnant women, particularly regarding paternal postnatal mental health and couple relationship.Methods: We searched Medline, CINAHL, EMBASE, PsycINFO, ERIC, and CENTRAL using terms such as "partners of pregnant women," "education," and "prenatal support." Searches were limited to randomized trials.Results: We included 11 trials out of 13 reports that addressed the following topics: childbirth preparation, couple relationship, infants and parenting, postpartum psychosocial issues, and housework sharing. Overall risk of bias was low or unclear. Study outcomes, including parents' mental health (e.g., anxiety, depression, distress), couple relationship, parents' transition adjustment and parenting stress, and parents' satisfaction with their experience of childbirth and prenatal childbirth education programs were reported.Limitations: The studies included in this review were very diverse regarding intervention intensity and content, outcome types, measurement tools, and outcome timing. This impeded evaluation of the interventions' effectiveness.Conclusion: No sufficient evidence was identified that prenatal childbirth education for partners of pregnant women protects against paternal postnatal depression and couple relationship; however, paternal postnatal mental health is important to maternal and perinatal healthcare. The results of this review suggest that further research and intervention are required to provide partners of pregnant women with evidence-based information and support whole families during the perinatal period. [ABSTRACT FROM AUTHOR]

Objectives In recent years Mongolia has made great advances towards Millennium Development Goals to reduce maternal and child mortality, however few studies have investigated maternal and child health status several years after childbirth. Our study aims to describe priority health issues in maternal and child health in Mongolia 3 years after childbirth, and key areas requiring further health policy development. Methods We conducted a population-based cross-sectional study in Bulgan province, Mongolia. Participants were women who gave birth in 2010 and lived in Bulgan in 2013, and their children who were almost 3 years of age. Data was collected using structured interviews, self-administered questionnaires, transcribed records from the Maternal and Child Health Handbook, anthropometric measurements, and a developmental assessment tool. Results Data was obtained from 1,019 women and 1,013 children (recovery rate: 94.1 %). Among women, 171 (17.2 %) were obese and had an average body mass index (BMI) of 25.7, 40 (4.4 %) experienced intimate partner violence (IPV) and 356 (36.2 %) reported urinary incontinence in the past month. Among children, 110 (10.8 %) were assessed as at risk of developmental delay, 131 (13.1 %) were overweight or obese, burns accounted for the highest number of serious accidents at 173 (17.0 %) while lower respiratory tract infections (LRTIs) were the most frequent cause of pediatric hospitalization. Conclusions for Practice Further development in health policy is required in Mongolia to target the significant health challenges of obesity, IPV, and urinary incontinence in women, and obesity, development delay, burns, and LRTIs in children. [ABSTRACT FROM AUTHOR]

Aim In developing countries, around 200 million children with poor development cannot excel academically. Detecting children with developmental delay is fundamental in targeting early interventions. As the lack of a convenient screening tool in Mongolia remains a significant barrier, we aimed to produce an easy-to-administer developmental screening tool in Mongolia and to validate it against an internationally recognised instrument, the Bayley Scales of Infant and Toddler Development Third Edition (Bayley- III). Methods We developed the Mongolian Rapid Baby Scale consisting of 161 items arranged under seven developmental domains for children aged from zero months 16 days to 42 months 15 days. We recruited 150 children in Ulaanbaatar, Mongolia. After conducting face and content validity of the tool, we evaluated concurrent validity. Results Concurrent validity ranged from high correlation (r = 0.86) to very high (r = 0.97) for each of the corresponding domains between the two tests. Summary statistics showed good sensitivity (81.8%) and moderate specificity (52.3%). Conclusion Our newly developed tool takes only 15 min to complete and is easy to administer. It demonstrated good concurrent validity and sensitivity for the screening of developmental status in young children. This innovative tool will be useful to identify children who may benefit from early interventions in Mongolia. [ABSTRACT FROM AUTHOR]

Abstract: The electronic structure of S-doped TiO2 with an optimized anatase structure was calculated within the framework of the density functional theory (DFT). For the calculation we built four kinds of supercells; type-A and B supercells consist of 12 and 48 atoms and a centered Ti atom is substituted for an S atom, while type-C and D supercells consist of 12 and 48 atoms and a centered O atom is substituted for an S atom. The supercells (type-B and D) were employed to adjust the S-concentration in TiO2 to an experimental value of a few %. The changes of the lattice parameters are not significant in the type-A and B supercells. The phase transition from the tetragonal to the orthorhombic occurs in the type-C and D supercells. In the small supercell (type-A), S-related states are located in the range of −1.6 to 0eV, and the S-states are band-like. In contrast, in the large supercell (type-B), S-related states appeared at about 0.9eV above the top of the valence band, and the S-states are atomic-like. The localization of the S-related states is remarkable in the type-B supercell. In the type-D supercell, the S-related states were merged with the top of the valence band, and as a result the band-gap energy is narrowed by 0.7eV. Despite a low S-concentration (3%) in the type-D supercell, the S-related states are somewhat band-like. [Copyright &y& Elsevier]

Aim: For women, being underweight increases their susceptibility to osteoporosis, anemia, and other conditions and affects the weight of their infants and the well‐being of future generations. This study examined the association between low pre‐pregnancy body mass index (BMI) and low birthweight using health insurance claims data and health checkup data, including weight measurements. Methods: We used health insurance claims data and health checkup data (JMDC, Tokyo, Japan) of women and their newborns in Japan between 2006 and 2020. We used checkup data, which included more accurate weight measurements and blood test‐based diagnoses of anemia and hyperlipidemia compared to self‐reported data. Maternal pre‐pregnancy BMI was compared across three groups: underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5–24.9 kg/m2), and overweight (BMI ≥25.0 kg/m2). The primary outcome was low birthweight (<2500 g), and secondary outcome was preterm childbirth. Logistic regression analyses were conducted to compare outcomes in the three groups by BMI. The underweight BMI group was considered as the reference group. A subgroup analysis was performed by maternal age. Results: In total, 16 363 mothers (underweight, 3418 [21%], normal weight, 11 493 [70%], and overweight, 1452 [8.9%]) were included. The risk of primary outcome (low birthweight) was significantly lower in the normal weight group than in the underweight group (4.6% vs. 5.7%; adjusted odds ratio 0.78 [95% confidence interval: 0.65–0.96]). In the subgroup analyses, no significant differences were noted in the incidences of low birthweight and preterm childbirth between maternal age groups. Conclusions: Pre‐pregnancy BMI was associated with an increased risk of delivering low‐birthweight infant. Awareness about the importance of women's pre‐pregnancy health and appropriate BMI may reduce the incidence of low birthweight. [ABSTRACT FROM AUTHOR]

Background: The use of cardiotocography (CTG) to improve neonatal outcomes is controversial. The medical settings, subjects, utilizations, and interpretation guidelines of CTG are unclear for low‐ and middle‐income countries (LMICs). Objectives: To assess and review CTG use for studies identified in LMICs and provide insights on the potential for effective use of CTG to improve maternal and neonatal outcomes. Search Strategy: The databases Medline, CINAHL, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for published and unpublished literature through September 2023. Selection Criteria: Publications were identified which were conducted in LMICs, based on the World Bank list of economies for 2019; targeting pregnant women in childbirth; and focusing on the utilization of CTG and neonatal outcomes. Data Collection and Analysis: Publications were screened, and duplicates were removed. A scoping review was conducted using PRISMA‐ScR guidelines. Results: The searches generated 1157 hits, of which 67 studies were included in the review. In the studies there was considerable variation and ambiguity regarding the study settings, target populations, utilizations, timing, frequency, and duration of CTG. While cesarean section rates were extensively investigated as an outcome of studies of CTG itself and the effect of additional techniques on CTG, other clinically significant outcomes, including neonatal mortality, were not well reported. Conclusions: Variations and ambiguities were found in the use of CTG in LMICs. Due to the limited amount of evidence, studies are needed to examine CTG availability in the context of LMICs. Synopsis: Cardiotocography (CTG) use in low‐ and middle‐income countries (LMICs) lacks consistency and clarity, with limited evidence on outcomes. [ABSTRACT FROM AUTHOR]

Background: Many studies have demonstrated positive effects of physical activity on children's health such as improved cardiorespiratory function and decreased obesity. Physical activity has also been found to have positive effects on academic achievement and cognitive function. However, there are few high quality RCT studies on this topic at present and the findings remain controversial.Methods: This protocol describes cluster randomized controlled trials assessing the impact of school-based exercise intervention among children in Mongolia. The intervention consists of 3-min sessions of high intensity interval training combined with music implemented two times a week at school during study periods. The participants are children in the fourth grade in public elementary schools in the Sukhbaatar district in Ulaanbaatar, Mongolia. The participants are cluster randomized by school and allocated either to the intervention or control group. The primary outcome is academic achievement. Secondary outcomes are obesity/overweight, physical fitness function, lifestyle, mental health, and cognitive function.Discussion: This cluster-RCT is designed and implemented to assess the effectiveness of exercise intervention on academic achievement, cognitive function, and physical and mental health among school-age children in Mongolia. This study will provide evidence to promote physical activities among children in low- and middle- income countries.Trial Registration: UMIN: UMIN000031062 . Registered on 1st February 2018. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to estimate the total numbers of obstetric diseases diagnosed, total amounts of medical expenses claimed for obstetric diseases, their averages per livebirth, and yearly trends in Japan. Methods: This is a secondary analysis of the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) (data from 2015 to 2019). The target population was women of reproductive age (15–49 years old) with diseases in pregnancy, childbirth, and the puerperium, defined by having O codes according to the International Classification of Diseases 10th Revision. We calculated the numbers of obstetric diseases diagnosed, amounts of medical expenses claimed for obstetric diseases marked with the "main injury/disease decision flag," and the totals divided by the annual numbers of livebirths, by year and women's age group. Results: From 2015 to 2019, both the numbers of obstetric diseases diagnosed and amounts of medical expenses claimed for obstetric diseases per livebirth were on an upward trend, whereas the total numbers of obstetric diseases diagnosed were decreased. Women in advanced age groups had a higher number of diagnoses and a higher amount of medical expenses for obstetric diseases per livebirth. "Preterm labour without delivery" had the highest amounts of medical expenses claimed for and the second highest numbers of diagnoses throughout the study period. Conclusions: This study suggests that pregnant women in Japan would have an increasing number of obstetric complications and necessary medical expenses year by year. Further study is warranted to elucidate these trends and identify possible mitigation measures. [ABSTRACT FROM AUTHOR]

This study investigated the association between maternal and child health service utilization patterns and postpartum depression (PPD). This study analyzed a dataset of women who participated in a randomized controlled trial to examine the effectiveness of the Maternal and Child Health Handbook in Angola. We defined probable PPD as an Edinburgh Postpartum Depression Scale (EPDS) score ≥ 10. The EPDS was administered at approximately 6 months postpartum. Service utilization patterns were defined using numbers of antenatal care (ANC), facility delivery, and vaccination visits by 6 months postpartum. The association between service utilization patterns and PPD was examined using logistic regression analyses adjusting for socioeconomic factors and parity. The continuum of care (CoC) complete pattern (four ANC/facility delivery/four vaccination) was used as a reference. The data of 7087 participants whose children were alive and aged 6 months or older at the endline survey were analyzed. Prevalence of PPD was 17.9 % in urban and 43.2 % in rural municipalities. In urban municipalities, dropouts from the CoC at delivery and after delivery had significantly higher odds of PPD (AOR = 1.45, 95 % CI = 1.00–2.10; AOR = 1.57, 95 % CI = 1.24–1.99). In rural municipalities, dropouts from the CoC after delivery (AOR = 1.60, 95 % CI = 1.12–2.28) had significantly higher odds of PPD. The onset of depressive symptoms was not assessed. The EPDS was validated in some Portuguese speaking countries but not in Angola. PPD was associated with irregular service utilization patterns such as dropouts from the CoC. Therefore, CoC and mental health must be promoted simultaneously. • Majority of women with postpartum depression (PPD) receive no treatment in developing countries. • Maternal and child health services are potential intervention sites for PPD. • The association between service utilization patterns and PPD among Angolan mothers was analyzed. • Dropouts from the continuum of care (CoC) at and after delivery were associated with PPD. • The CoC and mental health must be addressed together to achieve better maternal and child health. [ABSTRACT FROM AUTHOR]

Some studies conducted in the United Kingdom have shown long-term associations between paternal involvement in childcare and adolescents' mental health issues. However, findings were inconsistent, and similar epidemiologic studies have not been conducted in other countries in Europe or Asia. Thus, we aimed to examine this association using Japanese population-based cohort study data. The Japanese Longitudinal Survey of Newborns in the 21st Century commenced in 2001. Data from 18,568 16-year-olds enrolled in the survey were analyzed. Poor psychological well-being was assessed using the WHO-5 Well-being Index. Paternal involvement in childcare—in tasks such as changing diapers—was assessed at the children's 6 months of age. We created four groups from least involvement to most active involvement based on the frequency of fathers' performing the tasks. The risk of poor psychological well-being was lower among more active involvement groups compared with the least involvement group, after adjusting for potential confounders (risk ratios = 0.90 [95 % confidence intervals: 0.85, 0.95] for the most active group). Due to 16 years of follow-up, loss to follow-up may have caused a selection bias. Our study is the first in Asian countries to show that fathers' active involvement in childcare is associated with poor psychological well-being in adolescence. Encouraging fathers' involvement in childcare may ameliorate prevalent issues of school refusals and withdrawals in the long term in Japan. • Fathers' childcare involvement is associated with adolescents' mental well-being. • Active childcare involvement is protective against poor psychological well-being. • Active childcare involvement may ameliorate children's mental health issues. [ABSTRACT FROM AUTHOR]

Objective: To explore the association between obstetric factors or outcomes and fetal heart rate (FHR) abnormalities after combined spinal‐epidural analgesia (CSEA). Methods: Women with singleton term deliveries who received CSEA at our institution between January 1 and December 31, 2017, were analyzed using medical records. We performed a logistic regression analysis to compare factors and outcomes between cases with and without new FHR abnormalities within 1 h after CSEA. Results: Of the 393 women, 163 showed the new occurrence of FHR abnormality after CSEA. Rupture of the membrane (odds ratio [OR] 2.49; 95% confidence interval [CI] 1.52–4.09; P < 0.01) and dilatation of the cervix (OR 1.24; 95% CI 1.07–1.44; P < 0.01) were significantly associated with FHR abnormalities. There were significant differences in FHR abnormality rates between women with cervical dilatation of 2 cm or less and 3 cm or more (OR 2.20; 95% CI 1.01–4.81; P = 0.047) and 6 cm or less and 7 cm or more (OR 2.46; 95% CI 1.01–6.01; P = 0.048). FHR abnormalities were not significantly associated with cesarean delivery during labor, instrumental delivery, APGAR score below 7 at 1 or 5 min, or umbilical arterial blood gas pH less than 7.2. Conclusion: Rupture of the membrane and an advanced dilated cervix were risk factors for FHR abnormality when CSEA was initiated. Synopsis: Rupture of the membrane and extended dilated cervix are associated with fetal heart rate abnormality after the introduction of combined spinal‐epidural labor analgesia. [ABSTRACT FROM AUTHOR]

Background: The number of children with medical complexity (CMC) is increasing worldwide. For these children and their families, various forms of support are legislated; among them, short‐stay respite care has a great unmet need. We examined such children's parents' preferences for respite care and their willingness to pay. Methods: We used discrete choice experiments (DCEs) to estimate the parents' preferences and willingness to pay. Parents whose children used overnight short‐stay respite services answered a questionnaire to compare two hypothetical facilities of respite care having seven attributes and three levels. The DCE data was analyzed using the conditional logit model. The willingness to pay was calculated based on DCE estimates. Results: A total of 70 parents participated in this study and mean age of their children was 7.8 years (standard deviation [SD] 4.3). Among those children, 67 (96%) had the severest certification of disability, and 27 (38%) used a ventilator at home. We found that the parents' highest preferences was the best level of medical care level that can manage ventilators (coefficient 1.61, 95% confidence interval [CI]: 1.32–1.90). The better and best level of medical care, daily care, education/nursing, and emergency care were preferred over basic quality services. Willingness to pay for the best level of medical care was approximately 75,367 JPY per night. Conclusion: This study shows a need for respite care that can deliver high‐level medical care, especially for the management of ventilators, to CMC. This finding can serve as a basis for promoting respite care services. [ABSTRACT FROM AUTHOR]

Background: Father's closeness and playful behavior influence a child's emotional and cognitive development. In this study, we aimed to assess the long‐term association of paternal involvement in childcare at 1–3 years of life on subsequent behavioral outcomes at 8 years of age. Methods: Data were obtained from the 2010 cohort of the Longitudinal Survey of Newborns in the 21st century in Japan. We used group‐based trajectory modeling to predict the trajectory of total childcare scores in surveys 1, 2 and 3 to determine the overall involvement of fathers in childcare during early childhood. The level of fathers' involvement in childcare was categorized as "low", "medium" and "high". Responses from the eighth survey were used to assess child behavioral outcomes using five indicators when the child was 8 years old. Crude and adjusted logistic regression analysis was conducted to estimate the odds ratio (OR) separately for each of the behavioral outcomes of the child. Results: Among the 17,027 father‐child dyads included in this study, two‐thirds of the fathers were of the age group 30–39 years. Compared to low involvement, children of fathers with high involvement in childcare during the early childhood years were less likely to not want to go to school even after adjusting for covariates (adjusted OR, 0.46; 95% CI: 0.32–0.66). Conclusions: Children benefit from their fathers' involvement in early childcare activities. To improve a child's well‐being, fathers should be encouraged by providing them with a suitable working environment with flexible arrangements and the opportunity to involve in childcare. [ABSTRACT FROM AUTHOR]

Objective: This study was carried out to understand the disparities in mortality and survival without major morbidities among very premature and very low birth weight infants between participating Neonatal Intensive Care Units (NICUs) from the Brazilian Network on Neonatal Research (RBPN) and the Neonatal Research Network of Japan (NRNJ). Methods: Secondary data analysis of surveys by the RBPN and NRNJ was performed. The surveys were conducted in 2014 and 2015 and included 187 NICUs. Primary outcome was mortality or survival without any major morbidity. Logistic regression analysis adjustment for confounding factors was used. Results: The study population consisted of 6,406 infants from the NRNJ and 2,319 from the RBPN. Controlling for various confounders, infants from RBPN had 9.06 times higher adjusted odds of mortality (95%CI 7.30–11.29), and lower odds of survival without major morbidities (AOR 0.36; 95%CI 0.32–0.41) compared with those from the NRNJ. Factors associated with higher odds of mortality among Brazilian NICUs included: Air Leak Syndrome (AOR 4.73; 95%CI 1.26– 15.27), Necrotizing Enterocolitis (AOR 3.25; 95%CI 1.38–7.26), and Late Onset Sepsis (LOS) (AOR 4.86; 95%CI 2.25–10.97). Conclusions: Very premature and very low birth weight infants from Brazil had significantly higher odds for mortality and lower odds for survival without major morbidities in comparison to those from Japan. Additionally, we identified the factors that increased the odds of in-hospital neonatal death in Brazil, most of which was related to LOS. [ABSTRACT FROM AUTHOR]

Background: To further curb preventable child deaths, some countries have implemented Child Death Review (CDR). CDR is a comprehensive multidisciplinary process that investigates, reviews, and registers all child deaths to consider prevention strategies. This study deciphered the barriers, facilitators, and implementation strategies in Japan.Methods: This study used a three-round modified Delphi method. The expert panel consisted of local government officers and health professionals responsible for the CDR pilot project in Japan. As a modification, the initial list of barriers, facilitators, and implementation strategies to address each barrier and facilitator was prepared based on project reports and interviews with local government officers. Throughout the three rounds, the panel evaluated predefined barriers and facilitators, suggested and evaluated additional items, and appraised the potential effectiveness of the implementation strategies on barriers and facilitators which they were meant to address. The importance of barriers and facilitators, and the potential effectiveness of implementation strategies were evaluated using 5-point Likert scale. The priority of the combinations of barriers, facilitators, and implementation strategies were determined considering their importance and effectiveness.Results: A total of 31 experts participated in the panel. Response rates were 96.8%, 80.6%, and 90.3% for the first, second, and third rounds, respectively. A total of 13 barriers, eight facilitators, and 72 implementation strategies corresponding to the barriers and facilitators reached consensus. At the national government level, a barrier-strategy combination of "lack of legislation (barrier)" and "legislation for CDR (strategy)," and a facilitator-strategy combination of "good multi-agency collaboration (facilitator)" and "official notices from the national government (strategy)" were at the highest priority. At the local government level, combinations of "lack of legislation (barrier)" and "constant budget allocations (strategy)," "lack of legislation (barrier)" and "citizens' acceptance (strategy)," and "good multi-agency collaboration (facilitator)" and "appointment of a full-time staff (strategy)" were at the highest priority.Conclusion: This study demonstrated that legislation is the key to better implementation of CDR in Japan. Legislation can address various barriers such as personal information collection, multi-agency collaboration, high workload, and budget instability. Without legislation, careful strategies must be taken to solve difficulties caused by its absence.Trial Registrations: None. [ABSTRACT FROM AUTHOR]

In our study, we aimed to investigate the survival pattern in patients with trisomy 18 syndrome (T18) using vital statistics data in Japan, linking the Japanese vital statistics database with the ICD code for the primary cause of death to the death certificate data that contain more specific information including narrative description on multiple causes of death or contributory cause of death. Dear Editor, Thank you for the opportunity to reply to the Letter to the Editor by Dr. Takashima and Prof. Hitosugi [[1]]. References 1 Takashima K, Hitosugi M. Underestimation of trisomy 18 and 13 syndromes in vital statistics from inadequate death certificates. [Extracted from the article]

Background: Prevalence of postnatal depression (PND) is high (Western countries, 10–15%; Japan, 17%). PND can cause parenting impairment and affect family health (e.g. child behaviors, cognitive development and physical health). This study aimed to reveal the risk factors of PND during the pregnancy period in a Japanese sample, and to identify the psychosocial risk factors of PND that should be appended to existing obstetric interview sheets. A cohort study with a Japanese sample was conducted. Methods: All 14 obstetrics hospitals in the Setagaya ward, Tokyo, Japan, participated in this study. Pregnant women who booked their delivery between December 2012 and May 2013 were enrolled. Data used for this study were collected at 20 weeks gestation, a few days and one month postnatal. The questionnaires consisted of psychosocial factors and the Edinburgh Postnatal Depression Scale (EPDS). To identify PND risk factors, multivariate analyses were performed. Results: A total of 1,775 women participated in this study. Eventually, the data of 1,133 women were used for the multivariate analyses. The demonstrated significant risk factors include EPDS score, primipara, “a perceived lack of family cohesion”, “current physical illness treatment” and “current psychiatric illness treatment”. Conclusion: This study highlights the importance of mental health screening using psychological measures during the pregnancy period. In addition, family environment, parity, physical and psychiatric illness should be paid attention by professionals in maternal and child health. The results also suggest that mothers’ feelings of developing their families should be supported. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization recommends the Maternal and Child Health Handbook (MCH-HB) to promote health service utilization from pregnancy to early childhood. Although many countries have adopted it as a national health policy, there is a paucity of research in MCH-HB's implementation. Thus, this study aimed to evaluate the MCH-HB's implementation status based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), and identify facilitators of, and barriers to its implementation in Angola to understand effective implementation strategies.Methods: A cross-sectional survey was conducted targeting all health facilities which implemented MCH-HB, subsamples of health workers, and officers responsible for the MCH-HB at the municipality health office. Using the 14 indicators based on the RE-AIM framework, health facilities' overall implementation statuses were assessed. This categorized health facilities into optimal-implementation and suboptimal-implementation groups. To identify barriers to and facilitators of MCH-HB implementation, semi-structured interviews were conducted among health workers and municipality health officers responsible for MCH-HB. The data were analyzed via content analysis.Results: A total of 88 health facilities and 216 health workers were surveyed to evaluate the implementation status, and 155 interviews were conducted among health workers to assess the barriers to and facilitators of the implementation. The overall implementation target was achieved in 50 health facilities (56.8%). The target was achieved by more health facilities in urban than rural areas (urban 68.4%, rural 53.6%) and by more health facilities of higher facility types (hospital 83.3%, health center 59.3%, health post 52.7%). Through the interview data's analysis, facilitators of and barriers to MCH-HB were comprehensively demonstrated. MCH-HB's content advantage was the most widely recognized facilitator and inadequate training for health workers was the most widely recognized barrier.Conclusions: Strengthening education for health workers, supervision by municipality health officers, and community sensitization were potential implementation strategies. These strategies must be intensified in rural and lower-level health facilities. [ABSTRACT FROM AUTHOR]

Background: It is worthwhile to identify women at risk of developing postpartum depression during pregnancy. This study aimed to determine the optimal time and cutoff score for antenatal screening for prediction of postpartum depressive symptoms (PDS) using the Edinburgh Postnatal Depression Scale (EPDS) and to identify risk factors for PDS.Methods: The target population was healthy pregnant women receiving antenatal care at a university hospital in Tokyo, Japan. During the first, second, and third trimesters, 3-4 days postpartum, and one month postpartum, they were asked to take the Japanese version of the EPDS questionnaire. The primary outcome of the study was PDS, defined as an EPDS score ≥ 9 at one month postpartum. The area under the receiver operating characteristics curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of EPDS scores at each antenatal screening time were calculated.Results: From 139 pregnant women, 129 were successfully followed up throughout the study. The number of women with an EPDS score ≥ 9 during the first, second, and third trimesters, 3-4 days postpartum, and one month postpartum were 6/126 (4.8%), 9/124 (7.3%), 5/117 (4.3%), 17/123 (13.8%), and 15/123 (12.2%), respectively. Screening during the second trimester had the highest AUC to predict PDS (0.89) among antenatal screenings. The optimal EPDS cutoff score during the second trimester was 4/5 (sensitivity: 85.7%; specificity: 77.1%; PPV: 33.3%; NPV: 97.6%). An EPDS score ≥ 5 during the second trimester (adjusted odds ratio [aOR]: 15.9; 95% confidence interval [95%CI]: 3.2-78.1) and a family history of mental illness (aOR: 4.5; 95%CI: 1.2-17.5) were significantly associated with PDS.Conclusions: Our study suggests that the EPDS score at the second trimester with the cutoff value of 4/5 may be adequate for initial screening for prediction of PDS. Women with an EPDS score ≥ 5 at the second trimester require more elaborate follow-up. [ABSTRACT FROM AUTHOR]

Purpose: Lifestyle factors of children and adolescents' mental health problems are an emerging health issue in low- and middle-income countries (LMICs). However, there is a lack of studies on lifestyle factors in LMICs. This study examined the socioeconomic and lifestyle factors associated with mental health problems among school-age children in Mongolia. Methods: A population-based cross-sectional survey was conducted among 4th-year students at public elementary schools in one district in Ulaanbaatar. The Strengths and Difficulties Questionnaire (SDQ) and a self-administrated socioeconomic and lifestyle questionnaire were completed by participants' guardians. A multivariate logistic regression analysis was performed. Results: Of the 2301 children surveyed, 1694 without missing responses were included in the analysis. The multivariate logistic regression analysis showed that male gender [adjusted odds ratio (AOR) 1.64 (1.29–2.10)], low maternal education [AOR 1.89 (1.16–3.05)], short sleep [AOR 1.41 (1.10–1.80)], no physical activity [AOR 1.31 (1.03–1.67)], and long screen time (AOR 1.53 (1.20–1.94)) were associated with high risk of mental health problems. Low maternal education, low household income, no physical activity habit, and long screen time were associated with internalising problems. Meanwhile, male gender, low maternal education, and long screen time were associated with externalising problems. Conclusion: The results are consistent with previous studies in high-income countries, indicating that there are globally common socioeconomic and lifestyle risk factors. The findings of this study may help develop a targeted preventive intervention for high-risk groups, such as socioeconomically disadvantaged groups, as well as a universal preventive intervention to foster a healthy lifestyle in Mongolia. [ABSTRACT FROM AUTHOR]

Background: In low- and middle-income countries (LMICs), most parents of children with mental health problems receive limited support from social and health services while caring for their children. However, research on the quality of life (QOL) of these parents in LMICs is limited. This study aimed to investigate the association between maternal QOL and children's mental health problems, and other related factors in Mongolia. Methods: A cross-sectional analysis of children aged 4–17 years who lived in Ulaanbaatar and visited the National Mental Health Centre in Mongolia and their mothers was conducted. The mothers' QOL was assessed using the WHOQOL-BREF, and the severity of children's mental health problems was assessed using the Strengths and Difficulties Questionnaire (SDQ). Multivariate linear regression analyses were performed using the mothers' WHOQOL domain scores as dependent variables and the children's SDQ scores and demographic and socioeconomic factors as explanatory variables. Results: A total of 242 child-mother dyads were included in this study, and 231 dyads were included in the multivariate regression analyses. Children's SDQ internalising scores were negatively associated with all four maternal QOL domain scores, while their externalising scores were negatively associated with maternal physical and psychological domain scores. Non-cohabitation of fathers was negatively associated with physical, social, and environmental domain scores, and non-cohabitation of grandparents was associated with psychological and environmental domain scores. Conclusions: In Mongolia, maternal QOL is influenced by the severity of children's mental health problems and family member support. These findings highlight the importance of developing systems to support all families. [ABSTRACT FROM AUTHOR]

BACKGROUND: Universal prevention approaches that target the general population can be effective for promoting children's health. This overview aims to summarize evidence presented in existing reviews of school‐based interventions. METHODS: We present an overview of evidence sourced from Campbell and Cochrane systematic reviews. These reviews examined randomized controlled trials concerning school‐based health‐promotion programs for children (mostly aged 4‐18 years) in the general population. RESULTS: We identified 56 high‐quality reviews. The reviews focused on emotional and behavioral outcomes, infectious diseases, injury reduction, mental health, nutrition intake, oral health, physical and developmental changes, sense‐organ diseases, sexual‐health outcomes, and substance use/abuse. Positive evidence—such as vision screening plus provision of free spectacles for spectacle wear increase and a combination of social competence and social‐influence approaches for preventing illicit drug use—were considered high certainty. CONCLUSIONS: Of the various interventions implemented in school settings that involved people from various occupations, some positive effects were found. In most cases, evidence certainty was negatively affected by a high risk of bias within studies, inconsistencies within the estimates, and insufficient sample sizes. Further primary studies in these areas would be helpful for accumulating evidence to promote stronger cooperation between health and education stakeholders. [ABSTRACT FROM AUTHOR]

Background: Child and adolescent mental health problems are urgent health issues in low- and middle-income countries. To promote child and adolescent mental health services, simple validated screening tools are helpful. In Mongolia, the Strengths and Difficulties Questionnaire (SDQ), an internationally used child and adolescent mental health screening tool for children aged 4–17, was translated but not yet validated. To use the questionnaire appropriately, validation is necessary. Methods: Children at 4th year at elementary school (community sample) and children visited psychiatric outpatient service (clinical sample) were recruited and their parental version of the SDQ was compared. The discriminating ability of the parental version of the SDQ was examined using Receiver Operating Characteristics (ROC) analysis on the SDQ total difficulties score. The area under the ROC curve (AUC) was used as a measure. Cut-off score was determined by normative banding that categorizes children with the highest 10% score range as abnormal and the second highest 10% as borderline following the original method; this cut-off score was compared with the cut-off score candidates with good balance between sensitivity and specificity using ROC analysis. Results: We included 2301 children in the community sample, and 429 children in the clinical sample. Mean age was 9.7 years (SD 0.4, range 8.3–12.0) among the community sample and 10.4 years (SD 3.8, range 4.0–17.8) among the clinical sample. The mean total difficulties score was 12.9 (SD 4.8) among the community sample and 20.4 (SD 6.2) among the clinical sample. A total of 88.8% of the community sample and 98.8% of the clinical sample answered the SDQ. Using ROC analysis, the AUC was 0.82 (95% confident interval 0.80–0.85), which meant moderate discriminating ability. Using normative banding, the borderline cut-off score was 16/17 and abnormal cut-off score was 19/20. For cut-off scores of 16/17 and 19/20, sensitivity was 71.9 and 53.8% and specificity was 78.5 and 90.5%, respectively. The cut-off score candidates by ROC analysis were 16/17 and 17/18. Conclusions: The parental version of the SDQ had moderate discriminating ability among Mongolian school-age children. For the screening of mental health problems among community children, cut-off score of 16/17 is recommended. [ABSTRACT FROM AUTHOR]

The efficacy of antipyretics for preventing febrile seizure recurrence has been reported by a recent study, and the results might overturn previous evidence. We systematically reviewed the efficacy of antipyretics in the prevention of febrile seizure recurrence in children focused on the timing of its administration. We searched the Medline, Embase, and Cochrane Central Register of Controlled Trials databases for randomized and quasi-randomized trials and prospective non-randomized studies of aged up to 60 months, diagnosed with febrile seizure, who were treated with antipyretics. Data were extracted from eight studies. Only one study reported that antipyretics prevented the recurrence of febrile seizures within the same fever episode (9.1% in the acetaminophen group vs. 23.5% in the control group, p < 0.01). Four studies found no evidence for the efficacy of antipyretics in preventing febrile seizure recurrence in distant fever episodes (odds ratio, 0.92; 95% confidence interval, 0.57–1.48, for two randomized controlled studies). Conclusion: This review provides very limited support for the use of antipyretics in preventing febrile seizure recurrence within the same fever episode and no evidence for its use in distant fever episodes. New studies are required to evaluate this topic further and determine whether the effectiveness of antipyretics is based on intervention timing. What is Known: • Reviews of prophylactic drug management among febrile seizure children found that antipyretics had no significant benefits. • Recent data suggest that antipyretics are effective in preventing febrile seizures. What is New: • Weak evidence suggests a possible role in preventing febrile seizure recurrence within the same fever episode. • There is clearly no role for antipyretic prophylaxis in preventing febrile seizures during distant fever episodes. [ABSTRACT FROM AUTHOR]

Despite the potential efficacy of hospital-based multidisciplinary child protection team (CPTs), research analyzing Japanese CPT databases is scarce. We aimed to describe the characteristics of children and families reported to a CPT in Japan and investigate factors associated with the substantiation of maltreatment. This retrospective, cross-sectional study took place in a national children's hospital in Japan and included 350 children who were reported to CPTs between April 2014 and March 2018. Univariable and multivariable logistic regression analyses were conducted using the CPT database and medical records. Among 350 cases, 33.4 % were substantiated. Children of <6 years of age comprised 73.4 % of the cases. The majority (67.7 %) received an injury-related diagnosis and physical maltreatment was suspected in 68.3 % of cases. In the univariable analysis, older age, a primary diagnosis other than injury, reporting department, psychological maltreatment, witnessing intimate partner violence, maltreatment by relatives other than biological father or mother, developmental disability, emotional/behavioral difficulty or psychological disorder, maternal/paternal psychological difficulty, and maternal history of maltreatment were significantly associated with substantiation. When adjusted for demographic, child and familial factors, a diagnosis other than injury (AOR 2.02, 95 % CI = 1. 11–3.65) and parental psychological difficulties (AOR 2.49, 95 % CI = 1.37–4.55) were independently associated with substantiation. Most cases reported to our CPT were young children with an injury-related diagnosis. Substantiation was associated with a diagnosis other than injury and parental psychological difficulties. Further prospective and comprehensive studies are needed to establish universal guidelines for databases of hospital-based CPTs. [ABSTRACT FROM AUTHOR]

Maternal depression has been widely studied but paternal depression is often overlooked. Depression in men is generally more difficult to detect as the symptoms are not apparent. Furthermore, Japanese couples tend to suppress their real emotions to avoid confrontation. We aimed to investigate the reliability and validity of the K6, K10 and PHQ-9 in assessing the mental health status of men when used by their pregnant partners, as well as the prevalence of paternal prenatal depression in a Japanese study sample. A total of 136 couples participated in this study. The prevalence of paternal prenatal depression reported by the men themselves was higher compared to that reported by their female partners (K6, 10.3 %; K10, 6.6 %; PHQ-9, 3.7 % vs. K6-FP, 2.2 %; K10-FP, 1.5 %; PHQ-9-FP, 0 %, respectively). Mental health issues in men may not be accurately rated by their female partners, suggesting the importance of self-rating and direct consultation. [ABSTRACT FROM AUTHOR]

Introduction: International norms and ethical standards have suggested that compensation for research-related injury should be provided to injured research volunteers. However, statistical data of incidence of compensation claims and the rate of awarding them have been rarely reported. Method: Questionnaire surveys were sent to pharmaceutical companies and medical institutions, focusing on industry-initiated clinical trials aiming at new drug applications (NDAs) on patient volunteers in Japan. Results: With the answers from pharmaceutical companies, the incidence of compensation was 0.8%, including 0.06% of monetary compensation. Of the cases of compensation claims, 99% were awarded. In turn, with the answers from medical institutions, the incidence of compensation was 0.6%, including 0.4% of serious but not death cases, and 0.04% of death cases. Furthermore, most claims for compensation were initiated by medical institutions, rather than by the patients. On the other hand, with the answers from clinical trial volunteers, 3% of respondents received compensations. These compensated cases were 25% of the injuries which cannot be ruled out from the scope of compensation. Conclusion: Our study results demonstrated that Japanese pharmaceutical companies have provided a high rate of compensation for clinical trial-related injuries despite the possibility of overestimation. In the era of global clinical development, our study indicates the importance of further surveys to find each country's compensation policy by determining how it is being implemented based on a survey of the actual status of compensation coming from statistical data. [ABSTRACT FROM AUTHOR]

A “drop-stamp method” has been developed for the design and fabrication of molecular interfaces. The amphiphilic protein HFBII, isolated from filamentous fungi, was employed as a genetically taggable molecular carrier for the formation of a structrally ordered layer of functional protein molecules on a solid surface. In this study, the interfacial behavior of maltose-binding protein tagged with HFBII (MBP-HFBII fusion protein) at both the air/water and water/solid interfaces was investigated. A rigid molecular layer of MBP-HFBII fusion protein was successfully formed through the drop-stamp procedure by employing an intermixed system, in which HFBII molecules are intermingled as nanospacers to prevent the intermolecular steric hindrance of the fusion protein. The results show that the drop-stamp method can be utilized in the high-throughput fabrication of structurally ordered molecular interfaces. [ABSTRACT FROM AUTHOR]

Background Postpartum paternal depression (PPPD) is under-acknowledged worldwide compared to maternal depression, despite PPPD prevalence being reported to be just as high. Although PPPD has clear health consequences, even on other family members, preventive methods have been under-studied. We investigated the association between an educational intervention and risk of PPPD. Methods We performed a parallel-group, randomized controlled trial in an obstetrics clinic in Japan that included expecting fathers and their pregnant partners at 28-32 weeks gestation. The intervention comprised an educational booklet created for fathers that was distributed during pregnancy. For the primary outcome, Edinburg Postnatal Depression Scale (EPDS) was administered at one and three months post-delivery, and EPDS of 8 or greater was considered at risk for depression. Results In total, the intervention and control groups comprised 286 and 282 couples, respectively. At follow-up, depressive symptoms were observed in 7.2% of fathers in the intervention group and 9.8% in the control group (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.36-1.36). Logistic regression in an adjusted analysis showed a reduced, but non-significant risk of PPPD (odds ratio=0.61, 95% confidence interval=0.31-1.20). Conclusions In the first PPPD intervention study of its kind in Japan, our study suggests that distributing the educational booklet to fathers may be helpful in general, but may not be enough to significantly influence the risk of a major condition like PPPD. Key messages A more personalized preventive approach beyond the simple administration of a booklet may be necessary to significantly impact PPPD occurrences. [ABSTRACT FROM AUTHOR]

Background: The Maternal and Child Health (MCH) handbook is an integrated home-based record (HBR) designed to record in a single document all the information regarding health services provided to a pregnant woman and her child. The MCH handbook has the potential to support continuity of care which is key to strengthening maternal, newborn and child health. However, there is a lack of an integrated system to manage the health of pregnant women and young children on an ongoing basis in Angola. Thus, the Angolan Ministry of Health is partnering with the Japan International Cooperation Agency to build the capacity of healthcare providers through trainings and implementation of the MCH handbook to improve service utilisation. In this study, we will estimate the impact of an intervention package including distribution of MCH handbook and its supplementary interventions to women, on the utilisation of services provided at healthcare facilities from pregnancy through the postnatal and early childhood period.Methods: This study is a cluster randomised controlled trial involving public healthcare facilities across all the municipalities located in Benguela Province, Angola. All women who go to participating healthcare facilities and with confirmed pregnancy around the beginning of the trial period will be included in the study. Women will be randomised according to the municipality where their primary maternity and/or childcare services are located. The intervention package will consist of MCH handbook distribution at all public healthcare facilities, MCH handbook utilisation training for healthcare providers and community mobilisation for women on the use of the MCH handbook. The intervention will be administered to all women in the intervention arm while those in the control arm will continue the traditional use of two stand-alone HBRs. The primary outcome measure for this study is to compare the proportion of women who achieve a complete continuum of care in both study arms.Discussion: The findings from the study are expected to form a basis for revising the current trial version of the Angola MCH handbook and provide a framework for policy guiding nationwide scale-up and distribution of the MCH handbook.Trial Registration: ISRCTN Registry ISRCTN20510127 . Registered on 4 June 2019. [ABSTRACT FROM AUTHOR]