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Background: Both interpregnancy intervals (IPI) and environmental factors might contribute to low birth weight (LBW). However, the extent to which air pollution influences the effect of IPIs on LBW remains unclear. We aimed to investigate whether IPI and air pollution jointly affect LBW. Methods: A retrospective cohort study was designed in this study. The data of birth records was collected from the Jiangsu Maternal Child Information System, covering January 2020 to June 2021 in Nantong city, China. IPI was defined as the duration between the delivery date for last live birth and date of LMP for the subsequent birth. The maternal exposure to ambient air pollutants during pregnancy—including particulate matter (PM) with an aerodynamic diameter of ≤ 2.5 μm (PM2.5), PM10, ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2) and carbon monoxide (CO)—was estimated using a hybrid kriging-LUR-RF model. A novel air pollution score was proposed, assessing combined exposure to five pollutants (excluding CO) by summing their concentrations, weighted by LBW regression coefficients. Multivariate logistic regression models were used to estimate the effects of IPI, air pollution and their interactions on LBW. Relative excess risk due to interaction (RERI), attributable proportion of interaction (AP) and synergy index (S) were utilized to assess the additive interaction. Results: Among 10, 512 singleton live births, the LBW rate was 3.7%. The IPI-LBW risk curve exhibited an L-shaped pattern. The odds ratios (ORs) for LBW for each interquartile range increase in PM2.5, PM10, O3 and the air pollution score were 1.16 (95% CI: 1.01–1.32), 1.30 (1.06–1.59), 1.22 (1.06–1.41), and 1.32 (1.10–1.60) during the entire pregnancy, respectively. An additive interaction between IPI and PM2.5 was noted during the first trimester. Compared to records with normal IPI and low PM2.5 exposure, those with short IPI and high PM2.5 exposure had the highest risk of LBW (relative risk = 3.53, 95% CI: 1.85–6.49, first trimester). Conclusion: The study demonstrates a synergistic effect of interpregnancy interval and air pollution on LBW, indicating that rational birth spacing and air pollution control can jointly improve LBW outcomes. [ABSTRACT FROM AUTHOR]

Among those with a severe maternal morbidity (SMM) event and a subsequent birth, we examined how the risk of a second SMM event varied by patient characteristics and intrapartum hospital utilization. We used a Massachusetts population-based dataset that longitudinally linked in-state births, hospital discharge records, prior and subsequent births, and non–birth-related hospital utilizations for birthing individuals and their children from January 1, 1999, to December 31, 2018, representing 1,460,514 births by 907,530 birthing people. We restricted our study sample to 2,814 people who had their first SMM event associated with a singleton birth and gave birth a second time within the study period. Our outcome measure was recurrence of SMM in the second birth. We calculated the prevalence of SMM at second birth, compared SMM conditions between births, and estimated the adjusted risk ratios and 95% confidence intervals for having an SMM event at second birth among those who had an SMM at the first birth. We also examined overall hospital utilization including inpatient admissions, emergency room visits, and observational stays, and hospital utilization by interpregnancy intervals (IPIs) between the first and second birth. There were 2,814 birthing people with at least one birth after the first SMM singleton birth. Among those, 198 (7.0%) had a subsequent SMM. The percentage of people with a second SMM event varied by age, race/ethnicity, insurance, IPI, and history of hypertension at first case of SMM (all p <.05). Between births, people with a second SMM event had significantly higher proportions of inpatient admissions (60.1% vs. 33.2.0%; p <.001), emergency room visits (71.7% vs. 57.7%; p <.001), and observational stays (35.4% vs. 19.5%; p <.001) compared with those who did not experience a second SMM event. Hospital utilization after a birth with SMM might indicate an elevated risk of a second SMM event. Providers should counsel their patients about prevention and warning signs. [ABSTRACT FROM AUTHOR]

Background: Our study aimed to investigate the value of inflammatory indices in predicting the latency period until birth in patients with preterm premature rupture of membranes (PPROM). Methods: This retrospective study was conducted on PPROM cases between 24 and 34 weeks of gestation at Ankara Etlik City Hospital Perinatology Department from October 2023 to April 2024. A total of 146 participants were divided into two groups: Group 1 included 73 patients who gave birth within 72 hours (h) of PPROM diagnosis, and Group 2 included 73 patients who gave birth after 72 h. Results: This study evaluated the prognostic significance of various inflammatory markers neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), systemic immune inflammation index (SII), systemic inflammatory response index (SIRI), pan-immune inflammation value (PIV), immature granulocytes (IG), multi-inflammatory index (MII)-1, MII-2, and MII-3 in predicting the latency period in patients with PPROM. Only MII-1, MII-2, and MII-3 reliably predicted labor within 72 h. The cut-off value for MII-1 was > 48.3, with a sensitivity of 57.7% and specificity of 57.3% (AUC: 0.598, 95% CI: 0.503–0.692, p = 0.042). For MII-2, the cut-off was > 1037.6, with a sensitivity of 57.7% and specificity of 57.3% (AUC: 0.611, 95% CI: 0.516–0.705, p = 0.021). MII-3 had a cut-off of > 10919.9, with a sensitivity of 53.5% and specificity of 52% (AUC: 0.595, 95% CI: 0.501–0.690, p = 0.046). Conclusion: Our findings show that, among NLR, PLR, MLR, SII, SIRI, PIV, IG, MII-1, MII-2, and MII-3, only MII-1, MII-2, and MII-3 levels are statistically significant in predicting birth timing. [ABSTRACT FROM AUTHOR]

Predators impose top‐down forces on prey populations, with the strength of those effects often varying over space and time and among demographic groups. In ungulates, predation risk is typically greatest for neonatal offspring, with some suggesting that predators can key in on adult activity to locate hidden neonates. However, few field studies to date have been able to directly assess the influence of maternal care on ungulate neonate survival. Using a population of white‐tailed deer under heavy coyote predation pressure, we tested the maternal dispersion hypothesis, which suggests the dispersion of maternal activity temporally and spatially attenuates risk of predation for ungulate neonates during this vulnerable altricial phase. We compared support for this hypothesis with more commonly tested hypotheses regarding the influence of habitat conditions and intrinsic factors on neonatal survival. Fawn survival to 16 weeks was 27.7%, with coyotes accounting for 59% of fawn mortalities. In support of our maternal temporal diffusion hypothesis, we found that neonatal survival decreased as more maternal visits (proportionally) occurred at night. The only other significant (p <.1) predictor of fawn survival was birth timing, with fawn survival decreasing as the season progressed. Given that fawn survival declined as the proportion of nighttime visits increased, and that wild pig presence and human disturbance can push doe and fawn activity toward nocturnal hours, additional research is needed to determine whether managing pig and human disturbance can decrease fawn mortality. More broadly, given the importance of recruitment in ungulate population dynamics, our finding opens a potentially important new line of inquiry on how maternal behaviors influence predation risk in large animal predator–prey ecology. [ABSTRACT FROM AUTHOR]

The collapse of communism led to highly skewed sex ratios in Albania, which had a long patriarchal tradition before the advent of communism. While the use of sex-selective abortions in the region is well-known, little is known about other forms taken by revealed son preference, such as differential stopping behaviour and birth spacing. Pooling data from the Demographic Health Surveys in 2008–2009 and 2017–2018, we find evidence of a higher proportion of boys being born at the last birth, indicating that parents practice differential stopping behaviour. Using a logit model, we also show that in sonless households parents shorten the birth intervals significantly, endangering mothers' and children's health. We conclude that differential stopping behaviour and short birth spacing are prevalent in all regions and across the socio-economic spectrum. [ABSTRACT FROM AUTHOR]

The present study investigated factors associated with the incidence of stillbirth in young hyper‐prolific sows within free farrowing systems in tropical environments. A total of 714 live‐born and 54 stillborn piglets from 57 Landrace × Yorkshire sows, with an average parity of 2.7 ± 1.0 (range: 1 – 4), were comprehensively investigated. Reproductive variables of the sows, including gestation length, farrowing duration, the total number of piglets born per litter, and the birth order and status of each piglet, were recorded. Differences in the physiological characteristics of live‐born and stillborn piglets, such as birth interval, cumulative birth interval, body weight at birth, crown‐rump length, body mass index (BMI), ponderal index (PI), meconium staining score, and the percentage of piglets with a broken umbilical cord, were analysed. Piglets were divided into four groups based on the quartiles of birth order (Q1–Q4). On average, the duration of farrowing was 173.3 ± 85.9 min, and the total number of piglets born and number of piglets born alive‐per litter were 14.1 ± 3.8 and 12.5 ± 3.5, respectively. The incidence of stillbirth was 6.7% (54/801 piglets). The higher percentages of stillbirths were detected in sows with large litter sizes (≥17 piglets, 10.9%) compared to those with small (≤13 piglets, 6.1%) and moderate (14 – 16 piglets, 2.8%) litter sizes (p <.001). The incidences of stillbirth in Q3 and Q4 of the litters were higher than in Q1 and Q2 (p <.001). Compared to live‐born piglets, stillborn piglets had higher cumulative birth interval (103.0 ± 3.71 vs. 142.4 ± 9.35 min, p <.001), BMI (17.1 ± 0.15 vs. 18.4 ± 0.39 kg/m2, p =.002), PI (63.7 ± 0.59 vs. 70.8 ± 1.59 kg/m3, p <.001), meconium staining scores (1.78 ± 0.04 vs. 2.04 ± 0.10, p =.021), and the percentage of piglets born with a ruptured umbilical cord (45.2% vs. 66.0%, p =.004). An increase in the incidence of stillbirth was detected at 60, 120, 150, 180, and ≥ 210 min after the first piglet was born, compared to those born within the first 30 min of farrowing (p <.05). In conclusion, the study found that stillbirths in young, hyper‐prolific sows were linked to several factors: large litter sizes (≥17 piglets per litter), prolonged cumulative birth intervals (142.4 min), elevated BMI of 18.4 kg/m2, high PI values of 70.8 kg/m3, increased meconium staining scores, and a higher occurrence of ruptured umbilical cords. To reduce the risk of stillbirth, particularly among piglets with high body indices born later in the birthing process, it is recommended to enhance farrowing supervision for young sows, starting at a cumulative birth interval of 60 min. [ABSTRACT FROM AUTHOR]

Background: Short inter-pregnancy or birth interval is associated with an increased risk of adverse perinatal outcomes. However, some emerging evidence questions this association and there are also inconsistencies among the existing findings. This study aimed to systematically review the evidence regarding the effect of short inter-pregnancy or birth intervals on adverse perinatal outcomes in the Asia-Pacific region. Methods: A comprehensive search of five databases was conducted targeting studies published between 2000 to 2023. Studies that reported on short inter-pregnancy or birth interval and examined adverse perinatal outcomes, such as low birthweight (LBW) preterm birth (PTB), small for gestational age (SGA), and neonatal mortality were included and appraised for methodological quality using the Joanna Briggs Institute critical appraisal tools. Three reviewers independently screened the studies and performed data extraction. Narrative synthesis and meta-analyses were conducted to summarise the key findings. Results: A total of 41 studies that fulfilled the inclusion criteria were included. A short-interpregnancy interval was associated with an increased risk of low birthweight (odds ratio [OR] = 1.65; 95%CI:1.39, 1.95), preterm birth (OR = 1.50; 95%CI: 1.35, 1.66), and small for gestational age (OR = 1.24; 95%CI:1.09, 1.41). We also found elevated odds of early neonatal mortality (OR = 1.91; 95%CI: 1.11, 3.29) and neonatal mortality (OR = 1.78; 95%CI: 1.25, 2.55) among women with short birth intervals. Conclusion: This review indicates that both short inter-pregnancy and birth interval increased the risk of adverse perinatal outcomes. This underscores the importance of advocating for and implementing strategies to promote optimal pregnancy and birth spacing to reduce the occurrence of adverse perinatal outcomes. Reproductive health policies and programs need to be further strengthened and promote access to comprehensive family planning services and increase awareness about the importance of optimal pregnancy and birth spacing. [ABSTRACT FROM AUTHOR]

Most studies on the impact of birth intentions on children's well‐being do not separate risks of infant mortality associated with pregnancy intention status from the risks that are associated with sociodemographic characteristics. There is a lack of studies taking a multicountry comparative perspective. We analyzed 60 Demographic and Health Surveys in Asia, the Americas, and Africa to examine the association between birth intentions and infant mortality using sibling fixed‐effects linear probability models accounting for confounding due to time‐invariant maternal characteristics. Compared to wanted births, the probability of infant mortality was higher after an unwanted or mistimed birth, or both, in 41 countries. Particularly in West Africa, mostly mistimed pregnancies were associated with infant mortality, whereas in the Americas unwanted pregnancies mattered more. These differences could be partly due to contextual variation in the concept of birth intentions and in the importance of birth spacing and limiting. We show that the risk of infant mortality after an unwanted/mistimed pregnancy was higher in countries with low human development index and high overall infant mortality rate, highlighting the importance of taking context into account rather than pooling data. To the best of our knowledge, this is the first large‐scale, cross‐regional, and cross‐country comparative study to analyze the association between birth intentions and infant mortality using a fixed‐effects approach. [ABSTRACT FROM AUTHOR]

Background: Short birth interval (SBI) has profound implications for the health of both mothers and children, yet there remains a notable dearth of studies addressing wealth-based inequality in SBI and its associated factors in India. This study aims to address this gap by investigating wealth-based disparities in SBI and identifying the underlying factors associated with SBI in India. Methods: We used information on 109,439 women of reproductive age (15–49 years) from the fifth round of the National Family Health Survey (2019-21). We assessed wealth-based inequality in SBI for India and its states using the Erreygers Normalised Concentration Index (ECI). Additionally, we used a multilevel binary logistic regression to assess the factors associated with SBI in India. Results: In India, the prevalence of SBI was 47.8% [95% CI: 47.4, 48.3] during 2019-21, with significant variation across states. Bihar reported the highest prevalence of SBI at 61.2%, while Sikkim the lowest at 18.1%. SBI prevalence was higher among poorer mothers compared to richer ones (Richest: 33.8% vs. Poorest: 52.9%). This wealth-based inequality was visible in the ECI as well (ECI= -0.13, p < 0.001). However, ECI varied considerably across the states. Gujarat, Punjab, and Manipur exhibited the highest levels of wealth-based inequality (ECI= -0.28, p < 0.001), whereas Kerala showed minimal wealth-based inequality (ECI= -0.01, p = 0.643). Multilevel logistic regression analysis identified several factors associated with SBI. Mothers aged 15–24 (OR: 12.01, p < 0.001) and 25–34 (2.92, < 0.001) were more likely to experience SBI. Women who married after age 25 (3.17, < 0.001) and those belonging to Scheduled Caste (1.18, < 0.001), Scheduled Tribes (1.14, < 0.001), and Other Backward Classes (1.12, < 0.001) also had higher odds of SBI. Additionally, the odds of SBI were higher among mothers in the poorest (1.97, < 0.001), poorer (1.73, < 0.001), middle (1.62, < 0.001), and richer (1.39, < 0.001) quintiles compared to the richest quintile. Women whose last child had passed away were also significantly more likely to have SBI (2.35, < 0.001). Furthermore, mothers from communities with lower average schooling levels (1.18, < 0.001) were more likely to have SBI. Geographically, mothers from eastern (0.67, < 0.001) and northeastern (0.44, < 0.001) regions of India were less likely to have SBI. Conclusion: The significant wealth-based inequality in SBI in India highlights the need for targeted interventions focusing on economically disadvantaged women, particularly in states with high SBI prevalence. Special attention should be given to younger mothers and those from socially disadvantaged groups to enhance maternal and child health outcomes across the country. [ABSTRACT FROM AUTHOR]

Objectives: Women experiencing homelessness have higher rates of unintended pregnancy than stably housed women and may benefit from reproductive interconception care. How reproductive interconception care differs between women who did and did not experience perinatal homelessness is not known. We estimated prevalence ratios of reproductive interconception behaviors among US women experiencing homelessness during the perinatal period. Methods: We used data from the 2016-2019 Pregnancy Risk Assessment Monitoring System to calculate the prevalence of 5 reproductive interconception care outcomes: attending a maternal postpartum checkup, participating in a conversation with a health care provider about birth intervals, receiving family planning counseling, obtaining a prescription for short-acting contraception, and having a long-acting reversible contraceptive inserted. We used complex survey weights, stratified by perinatal homelessness, and converted adjusted logistic regression odds ratios between housing status and outcome variables to adjusted prevalence ratios (aPRs) and 95% CIs. Results: Among participants, approximately 2.4% (weighted percentage; unweighted 2953 of 100 706) experienced homelessness sometime in the 12 months before their children were born; the majority were non-Hispanic (83.2%) and White (69.4%), were not married (82.2%), and had public health insurance (56.8%). Perinatal homelessness was significantly associated with a lower prevalence of attending a postpartum maternal visit (aPR = 0.90; 95% CI, 0.87-0.94) and a higher prevalence of having a conversation about birth intervals with their health care providers (aPR = 1.13; 95% CI, 1.03-1.21). Conclusions: Findings suggest that improving attendance at postpartum visits and evaluating birth interval conversations may strengthen interconception care practices while contextualizing social determinants such as housing stability. Improving uptake of postpartum visits may reduce unintended pregnancy, short birth intervals, and adverse birth outcomes in future pregnancies among women experiencing homelessness. [ABSTRACT FROM AUTHOR]

Child malnutrition remains a significant concern in the Asia‐Pacific region, with short birth intervals recognised as a potential risk factor. However, evidence of this association is inconclusive. This study aimed to systematically review the existing evidence and assess the summary effects of short birth interval on child malnutrition in the Asia‐Pacific region. Five electronic databases were searched in May 2023 to identify relevant studies reporting the association between short birth interval and child malnutrition, including stunting, wasting, underweight, anaemia and overall malnutrition, in Asia‐Pacific region between September 2000 and May 2023. Fixed‐effects or random‐effects meta‐analysis was performed to estimate the summary effects of short birth interval on child malnutrition. Out of 56 studies meeting the inclusion criteria, 48 were included in quantitative synthesis through meta‐analysis. We found a slightly higher likelihood of stunting (n = 25, odds ratio [OR] = 1.13; 95% confidence interval [CI]: 0.97–1.32) and overall malnutrition (n = 3, OR = 2.42; 95% CI: 0.88–6.65) among children born in short birth intervals compared to those with nonshort intervals, although the effect was not statistically significant. However, caution is warranted due to identified heterogeneity across studies. Subgroup analysis demonstrated significant effects of short birth intervals on child malnutrition in national‐level studies and studies with larger sample sizes. These findings underscore short birth intervals as a significant contributor to child malnutrition in the Asia‐Pacific region. Implementing effective policies and programs is vital to alleviate this burden, ultimately reducing child malnutrition and associated adverse outcomes, including child mortality. Key messages: Short interval pregnancies pose a persistent public health threat in the South Asian region.While a potential link with child malnutrition exists, reported associations often conflict.Our findings suggest that short interval births slightly increase the risk of child malnutrition.Addressing short interval pregnancies is crucial to mitigate the ongoing nutritional burden in South Asian countries. [ABSTRACT FROM AUTHOR]

Background: A healthy child can make way for a healthy adult. Some of the factors that can be used to determine the health of a young child are nutritional status of the child, the developmental milestones achieved, and frequency of illness. Objectives: The health status of children and associated factors are determined. Methods: This is a community-based cross-sectional study with 271 participants. The height and weight of the child were measured; questions were asked regarding developmental milestones achieved and frequent illnesses. An interview schedule was used to enquire about the determinants of health status. Descriptive statistics were done; Chi-square test and regression were used to determine association between the health status of children and determinants. Results: A total of 127 (46.86%) were found to have a good health status. Family type (Chi square value 9.568; P value = 0.002), birth spacing (Chi square 20.540; P value < 0.001), term or pre-term birth (Chi square 4.598; P value = 0.032), chronic medical problem in the child (Chi square 11.074; P value = 0.001), and immunization status of the child (Chi square 5.666; P value = 0.017) were found to have significant association with the health status of the child. By logistic regression, pre-term child birth and family type were found to have higher odds. Conclusion: For better health of the child, specific focus on birth spacing, term birth of baby, better care of the ill, and complete immunization play vital roles. [ABSTRACT FROM AUTHOR]

Background Anemia during pregnancy is a public health problem and is related to negative birth outcomes, especially in developing countries. The main aim of this study was to assess predictors of anemia among pregnant women attending antenatal clinics at Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia. Methods Unmatched case-control study design was employed among 352 individuals. A face-to-face interview was used to gather data, and each pregnant woman's antenatal care follow-up record cards were reviewed in addition to the interview. EpiData version 3.1 and IBM SPSS version 26 was used for data entry and analysis, respectively. Bivariable and multivariable analyses were conducted to identify predictors of anemia, a p-value of <0.05 was considered a statistically significant association. Result The common determinants for anemia in pregnant mothers were: rural residency (AOR = 2.25, 95% CI: 1.14–4.8), no formal education (AOR = 4.4, 95% CI: 1.94–9.9), inter-pregnancy interval (AOR = 2.7, 95% CI: 1.24–5.8), and mid-upper arm circumference (AOR = 5.0, 95% CI: 2.0–12.7). Conclusion In this study, the identified determinant factors for anemia were: rural residency, maternal educational status, inter-pregnancy-interval, and mid-upper arm circumference. Therefore, providing health education and promotion for pregnant women regarding anemia by focusing on rural residents and counseling to lengthen their birth spacing is an important task. Moreover, counseling on taking iron supplementation as suggested and consuming a diet rich in iron during antenatal care will be recommended. [ABSTRACT FROM AUTHOR]

Background: Anemia in pregnancy is considered a significant public health problem. It has an essential role in disabled life and death of pregnant women and their future children, mainly in developing countries. Pregnant women in Yemen in internally displaced camps remain at most exposed to anemia. The aim of this study is to determine the prevalence and associated factors related to anemia among pregnant women in Marib, Yemen. Methods: A cross-sectional study was conducted among 402 pregnant women attending General hospitals from October 2023 to January 2024. The data were collected through structured pretested questionnaire, and via an interview. Laboratory investigations were done. Data Analysis: the data were statistically analyzed through SPSS program (version 21) using descriptive statistics, Chi square test for investigating the association between anemia and the independent factors. Results: The overall prevalence of anemia among study participants was 56.7%. The moderate anemia were the most prevalence among pregnant women (65.8%). Risk factors associated with anemia among pregnant women were displacement, level education, low family income, gestational age, space interval of birth, lack of iron supplementation during pregnancy, and one /zero consumption of monthly meat, liver and vegetables during pregnancy, habits such as taking tea immediately after meal and chewing of khat during pregnancy. Conclusion: prevalence of anemia in this study was public health problem. Several factors were found to be associated with anemia during pregnancy. Measures have to be taken to solve the problem by mass iron supplementation, family planning and health education towards risk factors that were associated with anemia to avoid them. [ABSTRACT FROM AUTHOR]

Sucrose reinforcement increases operant wheel running, but it is not certain that the increase is due to a reinforcement rather than a schedule-induction effect. To address this issue, eight female Long Evans rats were exposed to a fixed-interval (FI) 60-s schedule with wheel running as the operant. Across three conditions, water, sucrose, and water were delivered as outcomes. In addition, rats also ran freely for 20 min prior to, and subsequent to, exposure to the FI 60-s schedule. Results showed that operant wheel running on the FI 60-s schedule increased when sucrose was delivered. At the level of revolutions, over the reinforcement interval more rats showed increased revolutions in the sucrose condition in the latter half of the interval, consistent with a reinforcement effect, than an inverted U-shaped pattern in the initial half of the interval. Running during the pre- and postoperant running period was not substantially affected by the removal of sucrose reinforcement on the FI 60-s schedule. Sucrose reinforcement, but not water, increased running relative to the pre/post running periods. Results suggest that although both schedule-induction and reinforcement effects occur, the effect that dominates appears to be a function of the duration of the reinforcement interval with a reinforcement effect more prevalent with shorter intervals. [ABSTRACT FROM AUTHOR]

Objectives: Underweight remains the primary public health concern among under-five-year-old children in Ethiopia, despite numerous government-implemented nutrition-specific and sensitive interventions. Therefore, this study aimed to assess underweight and associated factors among children in South Ethiopia. Methods: Between March and April 2021, 717 children in the South Ari district who were between the ages of 6 and 59 months participated in a cross-sectional study. To choose a sample of households containing a minimum of one child between the ages of 6 and 59 months, a multi-stage sampling procedure was used. Data were collected by interviewer-administered structured questionnaires from the mothers of the children. To determine the factors associated with being underweight, a binary logistic regression analysis was built. All variables with a p-value <0.25 in the bivariable analysis were entered into a multivariable logistic regression analysis. To assess the strength of the association, an adjusted odds ratio (AOR) with a 95% confidence interval was used. With a p-value below 0.05, statistical significance was declared. Results: The prevalence of underweight was determined to be 29.7% (95% CI: 26.5%, 33.2%). Child age 6–23 months [adjusted odds ratio (AOR) = 0.28; 95% confidence interval (CI): 0.18, 0.44], food insecurity (AOR = 1.48; 95% CI: 1.04, 2.10), sub-optimal child dietary diversity (AOR = 1.44; 95% CI: 1.01, 2.03), birth interval <24 months (AOR = 2.49; 95% CI: 1.75, 3.54), and common childhood illness (AOR = 2.21; 95% CI: 1.52, 3.21) were associated with being underweight. Conclusion: Underweight among children is predicted by household food insecurity, suboptimal dietary diversity, and common childhood illnesses, necessitating further efforts to improve food security and manage common illnesses. [ABSTRACT FROM AUTHOR]

Background: spousal violence against women (SVAW) is a common form of violence that occurs within the family context, with spouses being the main perpetrators. Afghanistan has one of the highest rates of SVAW in the world, and its impact on reproductive health and fertility is not well understood. This study aims to investigate the extent to which SVAW influences the total fertility rate (TFR) of Afghan women. Methods: In this study, a regression model of discrete-time survival models was used to calculate the total fertility rate (TFR), parity progression ratio (PPRs), and average closed birth intervals (CBI) between two children. The method used in this study has its roots in the works of Griffin Finney (1983) and was further developed by Redford et al. (2010). The study population utilized the 2015 Afghanistan Demographic and Health Survey, and sample weights were used to ensure accurate estimates for the population of Afghanistan as a whole. Results: The study found that women in Afghanistan who have experienced SV are more likely to progress to the next parity, start childbearing faster, and continue to do so. Women who have not experienced SV tend to progress to higher parities at a slower pace during their initial reproductive years. The study also suggests that women with spousal violence (SV) experience may have slightly higher fertility rates and shorter birth intervals for certain birth orders, although the differences between the two groups are generally small. Specifically, the total fertility rate (TFR) for women who experienced SV was 6.9, while the TFR for women who did not experience SV was 6.2. Conclusions: These results provide valuable information for policymakers and public health professionals in developing effective policies and programs to address SVAW and improve maternal and child health outcomes in Afghanistan. [ABSTRACT FROM AUTHOR]

Background: Postpartum contraception is essential to sexual and reproductive health (SRH) care because it encourages healthy spacing between births, helps women avoid unwanted pregnancies, and lessens the risks of health problems for mothers and babies. Sub-Saharan African immigrant and refugee populations are rapidly increasing in the United States, and they come from a wide range of cultural, linguistic, religious, and social origins, which may pose challenges in timely access to culturally acceptable SRH care, for preventing mistimed or unwanted childbearing. The objective of this scoping review is to assess the extent of the available literature on postpartum contraception among sub-Saharan African immigrant and refugee women living in the United States. Methods: We developed preliminary search terms with the help of an expert librarian, consisting of keywords including birth intervals, birth spacing, contraception, postpartum contraception or family planning, and USA or America, and sub-Saharan African immigrants, or emigrants. The study will include the following electronic databases: PubMed/MEDLINE, PsycINFO, CINAHL, EMBASE, and the Global Health Database. The sources will include studies on postpartum care and contraceptive access and utilization among sub-Saharan African immigrants living in the US. Citations, abstracts, and full texts will be independently screened by two reviewers. We will use narrative synthesis to analyze the data using quantitative and qualitative methods. Factors associated with postpartum contraception will be organized using the domains and constructs of the PEN-3 Model as a guiding framework. Conclusion: This scoping review will map the research on postpartum contraception among sub-Saharan African immigrant and refugee women living in the US. We expect to identify knowledge gaps, and barriers and facilitators of postpartum contraception in this population. Based on the findings of the review, recommendations will be made for advocacy and program and policy development toward optimizing interpregnancy intervals in sub-Saharan African immigrants living in the US. Trial registration: Review registration Open Science Framework: https://osf.io/s385j. [ABSTRACT FROM AUTHOR]

Existing literature documents connections between short birth spacing (birth‐to‐conception interval of under 18 months) and the risk of child maltreatment, but explanations for this relation are understudied. We hypothesise that short birth spacing predicts child maltreatment, and it mediates the association between maternal history of childhood maltreatment and their child's risk of abuse and neglect. We use data for second and higher parity children from the Prospective Study of Infant Development (n = 335) and fit logistic regression models with relevant covariates to examine the association between maternal history of childhood maltreatment, her offspring's short birth spacing and her offspring's child maltreatment (CM) as measured by Child Protective Services (CPS) assessments. Findings demonstrate that children of mothers who reported experiencing any abuse or neglect during childhood have a higher likelihood of being born shortly spaced and a higher likelihood of CM. Additionally, short birth spacing is associated with increased likelihood of CM. No evidence for mediation from maternal history of maltreatment to CM operating through short birth spacing was detected. We conclude that maternal history of childhood maltreatment and short birth spacing are independent, additive factors for CM risk. Key Practitioner Messages: Maternal history of childhood maltreatment is a strong predictor of her children's birth spacing and her children's abuse and neglect risk.Maternal history of childhood maltreatment and birth spacing between her children serve as independent predictors of her children's abuse and neglect risk.Child maltreatment risk assessment models should incorporate historical information about parental childhood trauma, as well as prenatal indicators of wellbeing such as birth spacing.Child maltreatment prevention programmes should address parental childhood trauma as well as family planning to minimise risk. [ABSTRACT FROM AUTHOR]

Background: Access to safe drinking water, sanitation, and hygiene (WASH) facilities is crucial for health and human rights, impacting nutrition and weight. Methods: Multiple Indicators Cluster Survey (MICS) 2017– 18 has been used in this study to examine the association between WASH and underweight, alongside other factors. Analysis included descriptive statistics, association tests, logistic regression, and population-attributable fractions (PAF). Results: According to results child were 1.8, 1.1 and 1.04 times less likely to be underweight if they had access to improved source of drinking water, improved sanitation and hygiene facilities respectively. The likelihood of child being underweight reduces by 1.4, 1.89, 2.01 and 2.55 times if the household wealth status increases from poorest to second, middle, fourth and richest wealth quintiles, respectively. As the mothers' education level increases from no schooling to primary, middle, secondary, and higher level, the possibility of child being underweight reduces by 1.22, 1.24, 1.60 and 2.01 times, respectively. Moreover, the likelihood of a child being underweight decreases as the education level of the household head improves. If maternal age is less than 20 or more than 35 years the likelihood of the child being underweight is increased by 1.074 and 1.121 times, respectively. A child is 1.1 times more likely to be underweight if birth spacing is less than 2 years. A child's risk of being underweight decreases by 1.1 times if they have not experienced diarrhea. A child who has never been breastfed has 1.3 times higher risk of being underweight. The results of Population Attributable Fraction (PAF) indicate that holding the other factors constant, approximately 36.46% burden of underweight was preventable by access to improved drinking water, sanitation, and hygiene practices. Conclusion: Comprehensive strategy is needed that focuses on improving access to safe drinking water, sanitation infrastructure, and hygiene behaviors. [ABSTRACT FROM AUTHOR]

Background: With the rapid increase in the number of women in their later reproductive years (aged 35 and above) in the present decade, the concern surrounding their contraceptive considerations has reached a critical point of importance. This study aims to examine the trends and determinants of modern contraceptive uptake among later reproductive-aged women in Bangladesh. Methods: A total of 17,736 women aged 35 and above were included in the analysis, utilizing data from three consecutives Bangladesh Demographic and Health Surveys conducted in 2011, 2014, and 2017–18. The outcome variable was the uptake of modern contraceptive methods (yes or no). The explanatory variables encompassed survey years, individual characteristics of the women, as well as characteristics of their partners and the community. Multilevel logistic regression model was used to explore the association of the outcome variable with explanatory variables. Results: We found that approximately 54% of women aged 35 and more do not use modern contraceptive methods, and there have been no significant shifts in their usage observed over the survey years. Compared to women aged 35–39, women aged 40–45 (aOR = 0.53, 95% CI: 0.49–0.57) and 45–49 (aOR = 0.24, 0.22–0.26) reported lower likelihoods of modern contraceptive method uptake. Higher education correlated with increased uptake of modern contraceptive methods (112%-142%), while partner's education showed a negative association. Later reproductive-aged women in richer (aOR = 0.83, 95% CI: 0.74–0.94) and richest (aOR = 0.76, 95% CI: 0.66–0.88) quintiles reported lower uptake of modern contraceptive methods compared to their counterparts in the poorest quintile. Later reproductive-aged women in Dhaka (aOR = 1.22, 95% CI: 1.07–1.38) and Rajshahi (aOR = 1.37, 95% CI: 1.19–1.59) regions had higher uptake of modern contraception than those residing in the Barishal division. Modern contraceptive methods uptake was 1.22 times higher among women who reported exposure to mass media and 1.19 times higher among women who reported engagement in paid work compared to among women who reported no exposure to mass media and participation in no formal work, respectively. Modern contraceptive methods uptake was 43% higher (aOR = 1.43, 95% CI: 1.32–1.55) in women with more than 2 children compared to those with ≤2 children. Conclusion: The study highlights no significant change in modern contraception uptake among later reproductive-aged women in Bangladesh. This raises concerns about the elevated risk of unintended pregnancies and shorter birth intervals, emphasizing the need for targeted interventions to address the specific needs and preferences of this demographic. [ABSTRACT FROM AUTHOR]

Mothers with multiple-partner fertility have longer interbirth intervals (IBIs) than mothers with single-partner fertility, suggesting that partner change hinders achieving the preferred IBI. Previous studies have, however, overlooked possible differences in preferred IBI between these two groups. Using data from 724 Finnish mothers, we investigated how partner change between the first and second child moderated the association between actual and preferred IBI. Mothers with multiple-partner fertility had 54 months longer IBIs than mothers with single-partner fertility. The association between actual and preferred IBI was weaker in mothers with multiple-partner fertility. Our results further indicated that this difference could partly be explained by the mothers' deliberate actions, such as contraceptive use and abortions among mothers with multi-partner fertility. Family planning support could gain from mapping out the reasons among women with a partner change for postponing otherwise desired pregnancies and offering increased support in these areas. [ABSTRACT FROM AUTHOR]

It is commonly observed that poor access to food, especially during maternity and lactation, leads to under-nutrition and increases the probability of premature birth, anaemia amongst mothers and childhood stunting. This study investigates the correlation and aims to determine the relationship between childhood stunting and maternal underweight in specific rural and urban zones within the North 24 Parganas district of West Bengal. Primary data was collected through in-person interviews with checked and approved questionnaires during April- August 2023. A child aged one to fifty-nine months was selected randomly from each family to take part in the study. The Binary logistic regression model was used to investigate the impact of maternal body mass index (BMI) on rural-urban child stunting, long term nutritional deficit. A total of 860 children from both urban (430) and rural (430) backgrounds participated in the study. This study found a slight difference in the rate of stunting. The prevalence of stunting remains high at 9 percent in the urban zone and 11percent in the rural region. The study infers that addressing maternal malnutrition and educating and empowering women will improve access to family planning while reducing childhood stunting. Therefore, implementation of dietary, counselling, delivery transportation, and child spacing is essential. [ABSTRACT FROM AUTHOR]

Reproductive interconception care provided at maternal postpartum visits may help reduce unintended pregnancies and elongate birth intervals for women experiencing homelessness. To improve interconception care uptake, this qualitative study aimed to identify barriers and facilitators to reproductive interconception care from the perspectives of women who were recently pregnant and homeless. A semi-structured interview guide and demographic survey were developed based on epidemiological findings, Information-Motivation-Behavioral Skill framework components, and a review by community health workers for content validity. After conducting 12 interviews with women recently pregnant and homeless in a local continuum of care in 2022, audio-recorded interviews were transcribed, iteratively coded using a priori and emerging codes, and thematically analyzed. Key themes were identified to determine implications and next steps to improving reproductive interconception care uptake. Interrelated themes focused on information (e.g., knowledge and misconceptions about pregnancy, birth intervals, contraception), motivation (e.g., attitudes about interconception care experiences, perinatal social influences), behavioral skills (e.g., objective ability to obtain interconception care and perceived self-efficacy related to attending maternal postpartum visits and increasing birth intervals), and macro-level factors (e.g., obtaining housing, contextualizing socioeconomic factors, navigating COVID-19). The findings suggest the need for flexible, streamlined, and personalized interconception care delivery that acknowledges pressing housing and relationship considerations and supports women's autonomy. Improvements to reproductive interconception care may reduce future unintended pregnancies, increase birth intervals, and improve birth outcomes among women experiencing homelessness. [ABSTRACT FROM AUTHOR]

An extensive literature has examined the relationship between birth spacing and subsequent health outcomes for parents, particularly for mothers. However, this research has drawn almost exclusively on observational research designs, and almost all studies have been limited to adjusting for observable factors that could confound the relationship between birth spacing and health outcomes. In this study, we use Norwegian register data to examine the relationship between birth spacing and the number of general practitioner consultations for mothers' and fathers' physical and mental health concerns immediately after childbirth (1–5 and 6–11 months after childbirth), in the medium term (5–6 years after childbearing), and in the long term (10–11 years after childbearing). To examine short-term health outcomes, we estimate individual fixed-effects models: we hold constant factors that could influence parents' birth spacing behavior and their health, comparing health outcomes after different births to the same parent. We apply sibling fixed effects in our analysis of medium- and long-term outcomes, holding constant mothers' and fathers' family backgrounds. The results from our analyses that do not apply individual or sibling fixed effects are consistent with much of the previous literature: shorter and longer birth intervals are associated with worse health outcomes than birth intervals of approximately 2–3 years. Estimates from individual fixed-effects models suggest that particularly short intervals have a modest negative effect on maternal mental health in the short term, with more ambiguous evidence that particularly short or long intervals might modestly influence short-, medium-, and long-term physical health outcomes. Overall, these results are consistent with small to negligible effects of birth spacing behavior on (non-pregnancy-related) parental health outcomes. [ABSTRACT FROM AUTHOR]

IntroductionShort interpregnancy interval (IPI) is a well-known risk factor for preterm births and low birth weights. However, research on the association between interpregnancy interval (IPI) and health outcomes in children under age 5 is limited in India. We examined the associations between IPI and five child health outcomes in India.MethodsWe used nationally representative cross-sectional data from three rounds of National Family Health Survey (NFHS) conducted in India during 2005-06, 2015-16 and 2019-21 to examine the associations between IPI [categorized as

Abstract Background This study aimed to explore the association of the second birth delivery mode and interval with maternal pelvic floor changes. Methods This prospective cohort study included women who had a first delivery and were in weeks 36–41 of a subsequent pregnancy at Panzhihua Central Hospital between July 2017 and June 2018. The primary outcomes of the study were the hiatus area at 6 months postpartum and bladder neck (mm) at rest and during a maximum Valsalva maneuver. Results There were 112 women with vaginal delivery and 182 with Cesarean section. The hiatus area and hiatus circumference decreased at all time points (all P

Background: This study aimed to explore the association of the second birth delivery mode and interval with maternal pelvic floor changes. Methods: This prospective cohort study included women who had a first delivery and were in weeks 36–41 of a subsequent pregnancy at Panzhihua Central Hospital between July 2017 and June 2018. The primary outcomes of the study were the hiatus area at 6 months postpartum and bladder neck (mm) at rest and during a maximum Valsalva maneuver. Results: There were 112 women with vaginal delivery and 182 with Cesarean section. The hiatus area and hiatus circumference decreased at all time points (all P < 0.001). The women with Cesarean section had a smaller hiatus area and circumference (P < 0.001 and P < 0.001). The hiatus diameters decreased with time in both groups (all P < 0.001) and were smaller after Cesarean section (both P < 0.001). The bladder neck at maximum Valsalva increased with time (all P < 0.001) without significant differences between the two groups. Finally, the proportion of patients with POP-Q stage 0/I increased with time in both groups (all P < 0.001), with the proportions being higher in the Cesarean group (P = 0.002). The birth interval was negatively correlated with the hiatus area (B=-0.17, 95%CI: -0.25, -0.08, P < 0.001) and positively correlated with the bladder neck at rest (B = 0.22, 95%CI: 0.08, 0.35, P = 0.001) and at maximum Valsalva (B = 0.85, 95%CI: 0.65, 1.05, P < 0.001). Conclusions: In conclusion, the mode of delivery at the second birth could influence the hiatus area and circumference and bladder neck size. The birth interval was negatively correlated with the hiatus area and positively correlated with the bladder neck at rest and at maximum Valsalva. [ABSTRACT FROM AUTHOR]

Objective: Heart murmurs in childhood are the most common reason for pediatric cardiology consultations worldwide. The aim of this study is to investigate the frequency and etiology of congenital heart disease (CHD) in two different centers possessing significant differences in factors such as geography, climate, and sociocultural conditions. Methods: The study involves patients who’d been referred to the pediatric cardiology outpatient clinic due to heart murmurs between November 2022-October 2023. All patients were evaluated by echocardiograph to investigate the causes of the murmur. Results: The study includes 2,127 patients (1,452 from Şırnak and 675 from Giresun; median age = 1.95 years). The gender distributions were similar in both regions. Pathological heart murmurs were more prevalent in Şırnak (21.6%) compared to Giresun (7.7%), while Giresun had a higher percentage of innocent murmurs (92.3%). Cyanotic conditions were rare. Surgery was required for 3.7% of patients overall (4.5% in Şırnak; 1.9% in Giresun). Normal echocardiograms were found in 46% of the total population, with variations being 41% in Şırnak and 56% in Giresun. Pathological murmurs were more common in females. Patients with pathological murmurs were more likely to require surgery. Şırnak had more pathological echocardiography results and a higher need for surgery. Neonates were the age group most frequently requiring surgery in both centers. Conclusions: Educating society and fostering awareness are imperative steps for preventing consanguineous marriages and encouraging appropriate birth intervals. Swift public education is particularly crucial in developing nations marked by elevated consanguinity rates and limited financial resources, highlighting the potential detrimental consequences of inbreeding. [ABSTRACT FROM AUTHOR]

BACKGROUND: The fertility behavior of women is characterized by maternal age, birth spacing and order, and it impacts the health of women and children. Evidence on the factors associated with maternal high-risk fertility behavior is scant in Ethiopia. Thus, the aim of this study was to identify the factors associated with maternal high-risk fertility behavior in Hadiya Zone, Southern Ethiopia. METHODS: A facility-based cross-sectional study was conducted. Three hundred women of reproductive age admissions to public hospitals in the Hadiya Zone who gave birth in the five years preceding this study were selected using systematic random sampling. Face-to-face interviews were held to gather data using interviewer-administered questionnaires. Descriptive statistics and binary logistic regression models were used to analyze data. Statistical significance was assessed using odds ratios and 95% confidence intervals and declared at a p-value of less than 0.05. RESULTS: The overall proportion of maternal high-risk fertility behavior was 60.3%. Mother, who lived in rural areas (AOR = 4.85; 95%CI: 2.56, 9.19), had early marriage (AOR = 3.39; 95%CI: 1.87, 6.14) and had unplanned last pregnancy (AOR = 2.62; 95%CI: 1.28, 5.39) were more likely engaged in high-risk fertility patterns. CONCLUSIONS: In the study area, there was a high overall proportion of married women engaging in high-risk fertility behavior. Mothers with early marriages, unplanned pregnancies, and rural residence were more likely engaged in high-risk fertility behaviors. Plans for interventions aimed at preventing maternal high-risk fertility behavior should center on expanding access to family planning services and ending the practice of early marriage by giving rural women extra care and attention. [ABSTRACT FROM AUTHOR]

While social determinants of health have been perennially linked to child survival in resource-limited countries, the precise and tested pathways to effect are not clearly understood. The objective of this study was therefore to identify the critical pathways as posited a priori in a model through which social factors (at maternal, household, and community levels) determine neonatal, infant, and under-five mortalities in Nigeria. Using a novel analytic approach (hierarchical path modelling for predicting accelerated failure time) to estimate (in)direct and total effects of social determinants of child survival, we analysed 30,960 live births (weighted data for representativeness), obtained from the 2016/2017 Nigeria Multiple Indicator Cluster Survey. There were three outcome variables: time until occurrence of neonatal, infant, and under-five mortalities. The independent variables were layered factors related to child, maternal, household and community. Geographical region, rurality of residence, infrastructural development, maternal education, contraceptive use, marital status, and maternal age at birth were found to operate more indirectly on neonatal, infant, and under-five survival. Child survival is due to direct effects of child's sex (female), gestational type (singleton), birth spacing (children whose mothers delivered at least two years apart), and maternal age at delivery (20–34 years). According to the path coefficients, the indirect effects of geographical regions are the most influential determinants of child survival, accounting for 30% (neonatal), 37.1% (infant) and 39.9% (under-five) of the total effects. This study offers comprehensive set of factors, and linked pathways, at the maternal, household, and community levels that are associated with child survival in Nigeria. To accelerate progress towards Sustainable Development Goal targets for child survival and reduce geographical inequities, stakeholders should implement more impactful policies that promote maternal education, contraceptive use and improve living conditions of women (especially in rural areas of northern Nigeria). Future research should focus on identifying the most effective interventions for addressing these social determinants of child survival in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Anemia in pregnancy is a pervasive health issue, particularly in developing countries. Aims and Objectives: This study aims to assess various socio-demographic factors, nutritional intake, and other risk factors contributing to anemia among pregnant women attending a tertiary care hospital in Prakasam District, Andhra Pradesh, India. Materials and Methods: A crosssectional study was conducted involving 160 pregnant women. Data were collected on sociodemographic factors (family type, religion, caste, residence, education, socio-economic status, age, occupation), anemia prevalence, antenatal care, birth spacing, nutritional intake (caloric, protein, and iron), and gravida status. Chi-square tests were used for statistical analysis to determine associations between anemia and various risk factors. Results: The study revealed a high prevalence of moderate anemia (74.4%) among the participants. Most women were from nuclear families (75%), lived in rural areas (89.4%), and were predominantly homemakers (83.1%) in the age group of 21–30 years. Nutritional analysis showed 74.6% of women had a calorie intake below 2000 K. Cal/day, 64.7% had a protein intake below 50 g/day, and 87.5% had an iron intake below 20 mg/day. A significant association was found between anemia and factors such as caloric intake (χ²=10.6654, P=0.001092), gravidity (χ²=7.0278, P=0.008025), and iron intake (χ²=27.277, P<0.00001), but not with protein intake (χ²=3.7547, P=0.052658). Conclusion: The study highlights a high prevalence of anemia among pregnant women in the Prakasam District, primarily associated with inadequate caloric and iron intake and increased gravidity. These findings emphasize the need for enhanced nutritional counseling and healthcare interventions focusing on diet and family planning for pregnant women in this region. [ABSTRACT FROM AUTHOR]

Arbitrary age-cutoff dates used for eligibility in schooling and organized sports create differential opportunities for children that can have long-term consequences. These opportunities, in turn, provide incentives for birth-date targeting. I study a setting in which being born just after the cutoff date is highly advantageous relative to being born late in the eligibility year. Using an exogenous change in the cutoff date, I obtain causal evidence showing how birth timing at conception responds to memory-based salient incentives: certain parents target birth dates to ensure that their children are among the oldest in the eligibility year. [ABSTRACT FROM AUTHOR]

Research from the medical and social science literature has found that spacing births closely together leads to adverse health and socioeconomic outcomes for the younger child. More recent evidence using inter-family comparisons is challenging the validity of those results. However, while inter-family comparisons allow for time-invariant unobservable heterogeneity across families, they cannot fully control for changes in families that occur over time and may affect both decisions about birth intervals as well as child outcomes. To our knowledge, this paper provides the first examination of the effects of birth spacing on later childhood cognitive outcomes that accounts for both time-invariant and time-varying heterogeneity in the same models. Instrumental variables estimations on data from Indonesia indicate that younger siblings perform significantly better on maths assessment exams when they are spaced farther apart from their immediately older sibling. This effect appears to be concentrated among the poorest and least educated households. The data thus suggest that close spacing may be detrimental to the socioeconomic outcomes of the younger sibling. [ABSTRACT FROM AUTHOR]

Background: Latent inhibition occurs when exposure to a stimulus prior its direct associative conditioning impairs learning. Results from naturalistic studies suggest that latent inhibition disrupts the learning of dental fear from aversive associative conditioning and thereby reduces the development of dental phobia. Although theory suggests latent inhibition occurs because pre-exposure changes the expected relevance and attention directed to the pre-exposed stimulus, evidence supporting these mechanisms in humans is limited. The aim of this study is to determine if two variables, pre-exposure session spacing and multiple context pre-exposure, potentiate the hypothesized mechanisms of expected relevance and attention and, in turn, increase latent inhibition of dental fear. Methods: In a virtual reality simulation, child and adult community members (ages 6 to 35) will take part in pre-exposure and conditioning trials, followed by short- and long-term tests of learning. A 100ms puff of 60 psi air to a maxillary anterior tooth will serve as the unconditioned stimulus. Pre-exposure session spacing (no spacing vs. sessions spaced) and multiple context pre-exposure (single context vs. multiple contexts) will be between-subject factors. Stimulus type (pre-exposed to-be conditioned stimulus, a non-pre-exposed conditioned stimulus, and an unpaired control stimulus) and trial will serve as within-subject factors. Baseline pain sensitivity will also be measured as a potential moderator. Discussion: It is hypothesized that spaced pre-exposure and pre-exposure in multiple contexts will increase the engagement of the mechanisms of expected relevance and attention and increase the latent inhibition of dental fear. It is expected that the findings will add to theory on fear learning and provide information to aid the design of future interventions that leverage latent inhibition to reduce dental phobia. [ABSTRACT FROM AUTHOR]

Background: Child mortality is a crucial indicator reflecting a country's health and socioeconomic status. Despite significant global improvements in reducing early childhood deaths, Southern Asia and sub-Saharan Africa still bear the highest burden of newborn mortality. Ethiopia is one of five countries that account for half of new-born deaths worldwide. Methods: This study examined the relationship between specific reproductive factors and under-five mortality in Ethiopia. A discrete-time survival model was applied to analyze data collected from four Ethiopian Demographic and Health Surveys (EDHS) conducted between 2000 and 2016. The study focused on investigating the individual and combined effects of three factors: preceding birth interval, maternal age at childbirth, and birth order, on child mortality. Results: The study found that lengthening the preceding birth interval to 18–23, 24–35, 36–47, or 48+ months reduced the risk of under-five deaths by 30%, 46%, 56%, and 60% respectively, compared to very short birth intervals (less than 18 months). Giving birth between the ages 20–34 and 35+ reduced the risk by 34% and 8% respectively, compared to giving birth below the age of 20. The risk of under-five death was higher for a 7th-born child by 17% compared to a 2nd or 3rd-born child. The combined effect analysis showed that higher birth order at a young maternal age increased the risk. In comparison, lower birth order in older maternal age groups was associated with higher risk. Lastly, very short birth intervals posed a greater risk for children with higher birth orders. Conclusion: Not only does one reproductive health variable negatively affect child survival, but their combination has the strongest effect. It is therefore recommended that policies in Ethiopia should address short birth intervals, young age of childbearing, and order of birth through an integrated strategy. [ABSTRACT FROM AUTHOR]

Background: Infant anemia has a significant impact on physical and cognitive development, not only in infancy but also throughout their life. Objective: The study aimed to estimate the prevalence, types, and risk factors of anemia in infancy. Patients and Methods: A cross-sectional study was conducted on 498 infants aged 6-23 months who attended five primary healthcare centers in Kafr-el Sheikh governorate, Egypt, for vaccination and follow-up. Results: The prevalence of anemia among the study infants was 44%, with the highest in those aged 6-12 months. Maternal anemia in pregnancy, low birth weight infant, and lack of adherence to iron supplementation were the significant risk factors for anemia. Conclusion: Infant anemia in Egypt resembles a complicated multifactorial severe health issue with a long-run burden. Health policy interventions such as early screening at 6 months old, more adherence to iron supplements for infants, maternal nutrition education, family planning, and birth spacing between siblings should be accessed to overcome and manage this health problem. [ABSTRACT FROM AUTHOR]

Sexual autonomy is an inalienable human right to protect and maintain an informed decision over one's body, sexuality, and sexual experience. With the increased attention to women's empowerment and gender equality all over the world, it is surprising that previous research has overlooked the relationship between women's sexual autonomy and short birth intervals. This study examined the association between women's sexual autonomy and short birth intervals in sub-Saharan Africa (SSA). Data were sourced from the Demographic and Health Surveys of 29 sub-Saharan African countries conducted from 2010 to 2019. A total of 222,940 women were included in this study. Multilevel logistic regression analysis was conducted to examine the association between sexual autonomy and short birth interval. The results were presented as adjusted odds ratios (aOR) and significance level was set at p <.05. The overall proportions of sexual autonomy and short birth interval among women in SSA were 75.1% and 13.3%, respectively. Women who reported having sexual autonomy had lower odds of short birth interval [aOR = 0.94; CI = 0.91, 0.96]. The likelihood of short birth interval among women increased with increasing maternal and partner's age but reduced with increasing level of education and wealth index. Given that short birth intervals could have negative maternal and child health outcomes, public health authorities in sub-Saharan African countries should endeavor to promote health interventions and social programs to empower women with low sexual autonomy. [ABSTRACT FROM AUTHOR]

Early childhood care and education providers provide instruction to diverse learners, including children with developmental delays, but often lack training in the use of evidence-based instructional strategies to support children's meaningful learning engagement. This preliminary study examined effects of the Early Achievements for Child Care Providers professional development program with and without generalization training on center-based child care providers (N = 12). Outcomes assessed included providers' implementation fidelity, knowledge, and self-efficacy as well as children's (N = 43) social-communication skills and engagement in shared book reading. Results demonstrated that providers trained in a generalization context made larger gains in implementation fidelity in a generalization context; no other significant between-group differences were found for providers. Children in both groups made comparable, significant gains. Findings suggest that explicit generalization training is needed for providers to achieve fidelity when transferring newly learned evidence-based practices to additional classroom instructional contexts, but a brief interval of implementation likely is insufficient to differentially benefit child outcomes. Researchers should elicit providers' perceptions when designing professional development programs to maximize feasibility of investing additional time and resources for generalization training. [ABSTRACT FROM AUTHOR]

Our aim was to investigate if structural and relational characteristics of sibling relationships moderated the association between known injury risk factors and child injuries. Prior to the pandemic, 80 Canadian parents of two school‐aged biological siblings completed standardized questionnaires concerning child risk‐taking behaviours and injury frequency; they also reported on sibling caregiving. Children reported on sibling warmth. Wider age spacing amplified injury risk for younger siblings who engaged in more risk‐taking, while warmer sibling relationships lessened injury risk for younger siblings cared for by older siblings. The importance of incorporating sibling characteristics into family‐centred injury prevention programs was discussed. [ABSTRACT FROM AUTHOR]

Anemia is more prevalent in low- and middle-income countries including India. Anemia in pregnancy is associated with increased risk of maternal health problems and adverse birth outcomes. This study estimates the prevalence and associated risk factors of anemia among pregnant women in India. This cross-sectional study is based on secondary data from the India National Family Health Survey-V (NFHS-5) conducted during 2019–2021. We extracted data of 27,317 currently pregnant women to estimate the prevalence and contributory factors associated with anemia using descriptive statistics and logistic regression analysis. The prevalence of anemia among pregnant women in India was 52.2%. Anemia was higher among adolescent women (61.5%), those with no education (59.2%), those belonging to poorest wealth index (61.9%), scheduled tribes (59.3%), and those from the eastern region of India (62.1%). Further, it was more prevalent among women with a habit of smoking, tobacco, or alcohol (63.0%), and women with shorter birth intervals (59.7%). Among Indian states, anemia prevalence was higher in the state of Bihar (63.1%) and the union territory of Ladakh (71.4%). Logistic regression models show that women with no education (aOR = 1.41, 95% CI = 1.27–1.57), belonging to a poorest wealth quintile (aOR = 1.69, 95% CI = 1.51–1.90), and those with a habit of smoking, tobacco, or alcohol (aOR = 1.39, 95% CI = 1.18–1.63) were more anemic than their counterparts. Additionally, women with no education showed a four-times higher risk of severe anemia (aOR = 4.79, 95% CI = 2.75–8.36) than their highly educated counterparts. Anemia affects half of all pregnant women in India. Anemia prevalence is higher among adolescents, illiterate, poor, and tribal communities. Social norm-based interventions and strengthening the community health facilitators should be implemented to reduce the high burden of anemia in India. Anemia in pregnancy increases the risk of maternal and new-born health problems that lead to unfavorable pregnancy outcomes. This study aimed to find the current proportion and factors influencing anemia among currently pregnant Indian women. This study analyzed the data of 27,317 currently pregnant women reported with hemoglobin levels to find the prevalence and contributing factors of anemia. The study revealed that about 52.2% of pregnant women suffer from anemia inclusive of 1.4% with severe anemia. The anemia proportion was higher in women living in the eastern region of India, the poorest households, teenage pregnant women, and women with no formal education. Severity was higher in women belonging to the poorest households, tribal groups, and those with a habit of smoking, tobacco, or alcohol. Further, women with no formal education were four-times more likely to have a risk of severe anemia during their pregnancy. Maternal anemia hampers the growth and development of the newborns. Thereby, anemia adds a huge burden to the nation's economy and health system. High rates of anemia among pregnant women could be a probable factor linked to the higher rate of maternal and child health illness and death in the eastern region, poorest strata, and other vulnerable populations in India. Special attention needs to be focused to ensure that these populations have easy access to healthy nutrition and the best public health systems. [ABSTRACT FROM AUTHOR]

One of the most prevalent serious health issues is anaemia. It is a high-risk condition since it has negative pregnancy-related effects on both the mother and the fetus. The most vulnerable population to anaemia is pregnant women. This research was done in Aljouf, Saudi Arabia, to find out the negative effects of anaemia on maternal and fetal outcomes during pregnancy. Retrospective research was conducted on pregnant patients treated at the Maternity and Children Hospital (MCH), Sakaka, Aljouf, Saudi Arabia, over a 12-month period. All 480 pregnant women provided the necessary information, which included demographics like age, education, socioeconomic status, parity, birth intervals, trimester of pregnancy, BMI, history of fever, neonatal information, and investigative data. Participants with anaemia during pregnancy totaled 485; mild anaemia made up 18.7%, moderate anaemia 77.9%, and severe anaemia 3.2%. The age group of 30-34 years had the highest prevalence of anaemia (32.5%), multiparity (51.7%), and secondary education (51.7%). While 73.6% anaemia found in first trimester,63% in overweight women and 73.6% less than 2 years of birth intervals. Out of 485, 145 had abortions, and the remaining 340 expectant mothers had fetal distress at a rate of 14.4%, IUGR at a rate of 6.7%, LBWB at a rate of 10.8%, a cardiac anomaly at a rate of 0.2%, and 6.7% were admitted to the NICU. All anemic pregnant women have their blood hematocrit levels examined as well. For associated risk factors including fever, parity, and social classes, use multivariate analysis. Our study's pregnant participants were severely anemic, which had negative impacts on the developing fetus and newborn. The linked factors that contributed to the development of anaemia during pregnancy must be improved. [ABSTRACT FROM AUTHOR]

In the present study, the farrowing kinetics of primiparous and multiparous sows belongs to Landly and Landrace breed was observed. The total number of 28 sows were studied comprising of 23 Landly (10 primiparous and 13 multiparous) and 5 Landrace (2 primiparous and 3 multiparous) sows. The farrowing kinetics of sows such a farrowing duration, placental expulsion and birth interval were recorded. During the study period, observed farrowing kinetics was in the normal range and there was no effect of parity and breed on farrowing duration, placental expulsion and birth intervals. Furthermore, Litter size at birth was positively correlated with farrowing duration (0.728), placental expulsion (0.566) and negatively correlated to birth interval (r = -0.493). Placental expulsion was positively correlated (r = 0.432) to farrowing duration. Hence, it was concluded that the parity and breed did not have any effect on farrowing kinetics but affected by the litter size. [ABSTRACT FROM AUTHOR]

Maryam Alimoradian , Hajiieh Bibi Razeghi Nasrabad * , Maliheh Alimondegari , Abbas Askari-Nodoushan Background and Objective: A basic factor in the reduction of fertility levels is delayed fertility. This research was carried out in Khorramabad, Lorestan Province, Iran. Methods: This descriptive-analytical study was conducted on 535 married women aged 15-49 years in Khorramabad. The data were collected face-to-face through a cross-sectional survey in 2020 using a researcher-made questionnaire between September and December 2019. This study used the Kaplan-Meier test to determine the childlessness survival time. A logistic parametric model with the gamma shared frailty distributions was employed to analyze its determinants. Results: The mean of childlessness survival time was 31.76 months, with a median of 24 months. Women in the age group of 15 to 30 years, women with university education, women who married at the age of less than 25 years, and women with a higher sense of socioeconomic insecurity had a longer childlessness survival time (P

IntroductionPrevious studies that used traditional multivariable and sibling matched analyses to investigate interpregnancy interval (IPI) and birth outcomes have reached mixed conclusions about a minimum recommended IPI, raising concerns about confounding. Our objective was to isolate the contribution of interpregnancy interval to the risk for adverse birth outcomes using propensity score matching.MethodsFor this retrospective cohort study, data were drawn from a California Department of Health Care Access and Information database with linked vital records and hospital discharge records (2007-2012). We compared short IPIs of

Background: Evidence suggests that women who give birth in a health facility have lower odds of experiencing pregnancy complications and significantly reduced risk of death from pregnancy-related causes compared to women who deliver at home. Establishing the association between high-risk fertility behaviour (HRFB) and health facility delivery is imperative to inform intervention to help reduce maternal mortality. This study examined the association between HRFB and health facility delivery in West Africa. Methods: Data for the study were extracted from the most recent Demographic and Health Surveys of twelve countries in West Africa conducted from 2010 to 2020. A total of 69,479 women of reproductive age (15–49 years) were included in the study. Place of delivery was the outcome variable in this study. Three parameters were used as indicators of HRFB based on previous studies. These were age at first birth, short birth interval, and high parity. Multivariable binary logistic regression analysis was performed to examine the association between HRFB and place of delivery and the results were presented using crude odds ratio (cOR) and adjusted odds ratio (aOR), with their respective 95% confidence interval (CI). Results: More than half (67.64%) of the women delivered in a health facility. Women who had their first birth after 34 years (aOR = 0.52; 95% CI = 0.46–0.59), those with short birth interval (aOR = 0.91; 95% CI = 0.87–0.96), and those with high parity (aOR = 0.58; 95% CI = 0.55–0.60) were less likely to deliver in a health compared to those whose age at first delivery was 18-34 years, those without short birth interval, and those with no history of high parity, respectively. The odds of health facility delivery was higher among women whose first birth occurred at an age less than 18 years compared to those whose age at first birth was 18-34 years (aOR = 1.17; 95% CI = 1.07–1.28). Conclusion: HRFB significantly predicts women's likelihood of delivering in a health facility in West Africa. Older age at first birth, shorter birth interval, and high parity lowered women's likelihood of delivering in a health facility. To promote health facility delivery among women in West Africa, it is imperative for policies and interventions on health facility delivery to target at risk sub-populations (i.e., multiparous women, those with shorter birth intervals and women whose first birth occurs at older maternal age). Contraceptive use and awareness creation on the importance of birth spacing should be encouraged among women of reproductive age in West Africa. [ABSTRACT FROM AUTHOR]

Introduction: The association between extreme birth spacing and adverse outcomes is controversial, and available evidence is fragmented into different classifications of birth spacing. Material and methods: We conducted a systematic review of observational studies to evaluate the association between birth spacing (i.e., interpregnancy interval and interoutcome interval) and adverse outcomes (i.e., pregnancy complications, adverse birth outcomes). Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using a random‐effects model, and the dose–response relationships were evaluated using generalized least squares trend estimation. Results: A total of 129 studies involving 46 874 843 pregnancies were included. In the general population, compared with an interpregnancy interval of 18–23 months, extreme intervals (<6 months and ≥ 60 months) were associated with an increased risk of adverse outcomes, including preterm birth, small for gestational age, low birthweight, fetal death, birth defects, early neonatal death, and premature rupture of fetal membranes (pooled OR range: 1.08–1.56; p < 0.05). The dose–response analyses further confirmed these J‐shaped relationships (pnon‐linear < 0.001–0.009). Long interpregnancy interval was only associated with an increased risk of preeclampsia and gestational diabetes (pnon‐linear < 0.005 and pnon‐linear < 0.001, respectively). Similar associations were observed between interoutcome interval and risk of low birthweight and preterm birth (pnon‐linear < 0.001). Moreover, interoutcome interval of ≥60 months was associated with an increased risk of cesarean delivery (pooled OR 1.72, 95% CI 1.04–2.83). For pregnancies following preterm births, an interpregnancy interval of 9 months was not associated with an increased risk of preterm birth, according to dose–response analyses (pnon‐linear = 0.008). Based on limited evidence, we did not observe significant associations between interpregnancy interval or interoutcome interval after pregnancy losses and risk of small for gestational age, fetal death, miscarriage, or preeclampsia (pooled OR range: 0.76–1.21; p > 0.05). Conclusions: Extreme birth spacing has extensive adverse effects on maternal and infant health. In the general population, interpregnancy interval of 18–23 months may be associated with potential benefits for both mothers and infants. For women with previous preterm birth, the optimal birth spacing may be 9 months. [ABSTRACT FROM AUTHOR]

Background: Adverse birth outcomes, such as preterm birth and low birth weight (LBW), are leading causes of neonatal morbidity and mortality. In this study, we aimed to estimate the association between inter‐pregnancy interval (IPI) and the risks of adverse birth outcomes in a subsequent pregnancy. Methods: We conducted a retrospective analysis involving 630 mothers who delivered a singleton live infant at a leading tertiary hospital in northern Jordan from March to August 2021. Outcome variables were preterm birth (<37 weeks of gestation) and LBW (<2.5 kg). Using multivariable logistic regression, the association between IPI and these two adverse birth outcomes was investigated. Results: The rates of preterm birth and LBW were 12.4% and 16.8%, respectively. Compared with an optimal IPI (24–36 months), a short IPI (<24 months) was positively associated with preterm birth (aOR: 4.09; 95% CI: 1.48–6.55) and LBW (aOR: 3.58; 95% CI: 1.57–5.15). Infants conceived after a long IPI (≥ 60 months) had increased odds of preterm birth (aOR: 3.78; 95% CI: 1.12–5.78) and LBW (aOR: 2.65; 95% CI: 1.67–4.03). Preterm delivery was also significantly associated with the mother's age (aOR: 1.10; 95% CI: 1.04–1.17), history of multiple cesarean births (aOR: 2.67; 95% CI: 1.14–4.29), prolonged rupture of membranes (aOR: 2.46; 95% CI: 1.10–5.52), and perinatal death (aOR: 3.42; 95% CI: 1.10–5.49). A mother's history of prior LBW (aOR: 4.39; 95% CI: 1.08–6.80), hypertensive disorders (aOR: 1.95; 95% CI: 1.03–3.89), and multiple cesarean births (aOR: 4.35; 95% CI: 2.10–6.99) was associated with LBW. Conclusions: Both short and long IPIs were related to preterm delivery and LBW. Optimal birth spacing is recommended to improve birth outcomes and must be considered when designing effective family planning programs. [ABSTRACT FROM AUTHOR]

Low uptake of family planning among women is predominantly attributed to low participation of men in postpartum family planning. In order to improve maternal health, strengthening male participation in family planning is an important public health initiative. This study aimed to assess factors associated with participation of men in postpartum care at Kiswa Health Centre III, Nakawa division, Kampala. An analytical cross-sectional study design involving collection of quantitative data was used. Systematic random sampling was used to select study participants. Data was collected using semi-structured questionnaires. Data entry and cleaning was performed using EpiData version 12 and analysed using Stata version 14. 80.0% of respondents participated in postpartum family planning. Approval of family planning use, knowledge on family planning and information source were significantly associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in family planning services as compared to those who didn't approve family planning. Conclusively, there was a generally high level of male involvement in postpartum family planning in comparison with the national levels. Approval of family planning at home increased the likelihood of men's participation in family planning. What is already known on this subject? Evidence has it that short birth intervals of less than 15 months have been found to be associated with adverse pregnancy outcomes including induced abortions, miscarriages, preterm births, neonatal and child mortalities, still births and maternal depletion syndrome. In Africa, generally, low family uptake among women is also attributed to low men participation in postpartum family planning. What do the results of this study add? Approval of family planning use, knowledge on family planning and information source were associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in postpartum family planning services as compared to those who didn't approve family planning. What are the implications of these findings for clinical practice and/or further research? In this study, the involvement of men was relatively high, but more studies are needed in other locations to compare with this finding. Otherwise, consolidation of such high involvement is highly needed, as this can be a starting point for further improvement. [ABSTRACT FROM AUTHOR]