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Women's development group leaders are volunteer community health workers in Ethiopia who, among other duties, promote health and prevention of diseases. They link and extend essential health services from health posts to households. To assess the characteristics, knowledge, and practice of women's development group leaders in the field of maternal, neonatal, and child health care. This study used a cluster-sampled cross-sectional survey conducted from December 2016 to February 2017 in four regions of Ethiopia: Oromia, Amhara, Tigray and Southern Nations, Nationalities and Peoples. One of the volunteers, who was available at the time of the survey, was included from each cluster. A total of 187 women's development group leaders participated in this quantitative study. Close to half of the women's development group leaders were illiterate. The leaders had a wide variation in the number of women in their groups. Two-thirds had received some training during the last year, covering a broad range of health topics. Their knowledge of maternal, newborn, and child health was relatively low. Two-thirds had monthly contact with health extension workers. Around half had interacted with other local stakeholders on maternal and child health matters during the last three months. Two-thirds had visited pregnant women, and half had made home visits after delivery in the previous quarter. Activities regarding sick newborns and under-five children were less frequent. The women leaders were given a wide range of tasks, despite having a low educational level and receiving training through brief orientations. They also showed limited knowledge but had a relatively high level of activities related to maternal health, while less so on neonatal and child health. [ABSTRACT FROM AUTHOR]

Aim: A previous maternal and infant nutrition intervention in rural Matlab, Bangladesh, showed that prenatal nutrient supplements improved child survival, but had no effect on size at birth. This secondary analysis examined whether prenatal multiple micronutrient supplements (MMS), on their own or combined with an early invitation to receive prenatal food supplements, affected child morbidity.Methods: This randomised trial enrolled 4436 pregnant women from November 2001 to October 2003 and allocated them to early or standard invitations to food supplements, in the ninth and 20th weeks of pregnancy, respectively, and supplements of either the standard 60 mg iron with 400 μg folic acid, 30 mg iron with 400 μg folic acid or MMS. Quasi-Poisson regression was used to analyse morbidity.Results: There were 3560 single live births and 3516 had morbidity data. The incidence rates of fever, diarrhoea and acute lower respiratory tract infection were 15.3, 3.6 and 2.3 episodes per person-year, respectively. The separate or combined interventions had no effect on morbidity up to 24 months.Conclusion: Early invitations to prenatal food supplements or prenatal MMS had no effect on common infections in rural Bangladesh, suggesting that earlier findings on improved child survival were not mediated by an effect on child morbidity. [ABSTRACT FROM AUTHOR]

Background: To operationalize the post-MDG agenda, there is a need to evaluate the effects of health interventions on equity. The aim of this study is to evaluate the effect on equity in neonatal survival of the NeoKIP trial (ISRCTN44599712), a population-based, cluster-randomized intervention trial with facilitated local stakeholder groups for improved neonatal survival in Quang Ninh province in northern Vietnam. Methods: Semi-structured interviews were conducted with all mothers experiencing neonatal mortality and a random sample of 6% of all mothers with a live birth in the study area during the study period (July 2008-June 2011). Multilevel regression analyses were performed, stratifying mothers according to household wealth, maternal education and mother’s ethnicity in order to assess impact on equity in neonatal survival. Findings: In the last year of study the risk of neonatal death was reduced by 69% among poor mothers in the intervention area as compared to poor mothers in the control area (OR 0.31, 95% CI 0.15–0.66). This pattern was not evident among mothers from non-poor households. Mothers with higher education had a 50% lower risk of neonatal mortality if living in the intervention area during the same time period (OR 0.50, 95% CI 0.28–0.90), whereas no significant effect was detected among mothers with low education. Interpretation: The NeoKIP intervention promoted equity in neonatal survival based on wealth but increased inequity based on maternal education. [ABSTRACT FROM AUTHOR]

Knowledge about the impact of maternal food and micronutrient supplementation on infant micronutrient status is limited. We examined the effect of maternal food and micronutrient supplementation on infant micronutrient status in the Maternal and Infant Nutrition Interventions in Matlab Trial. Pregnant women (n = 4436) were randomized to Early or Usual promotion of enrollment in a food supplementation program. In addition, they were randomly allocated to 1 of the following 3 types of daily micronutrient supplements provided from wk 14 of gestation to 3 mo postpartum: 1) folic acid and 30 mg iron (Fe30Fol); 2) folic acid and 60 mg iron; or 3) a multiple micronutrient including folic acid and 30 mg iron (MMS). At 6 mo, infant blood samples (n = 1066) were collected and analyzed for hemoglobin and plasma ferritin, zinc, retinol, vitamin B-12, and folate. The vitamin B-12 concentration differed between the micronutrient supplementation groups (P =0.049). The prevalence of vitamin B-12 deficiency was lower in the MMS group (26. 1%) than in the Fe3OFol group 136.5%) (P = 0.003). The prevalence of zinc deficiency was lower in the Usual food supplementation group 154.1 %) than in the Early group (60.2%) (P = 0.046). There were no other differential effects according to food or micronutrient supplementation groups. We conclude that maternal multiple micronutrient supplementation may have a beneficial effect on vitamin B-12 status in infancy. [ABSTRACT FROM AUTHOR]

Objective. To study the neuroendocrine release of cortisol in response to perceived stress among pregnant women exposed to partner violence and how this affects the duration of pregnancy and the intrauterine growth of the infant. Design. Cross-sectional community-based study. Setting. Health and Demographic Surveillance System of Leon, Nicaragua. Population. One-hundred and forty-seven pregnant women. Methods. Standardized scales to measure intimate partner violence, social resources, perceived stress, and socio-economic conditions were applied. Two salivary samples for cortisol were collected in the morning and afternoon on the same day. Linear regression and path analysis were used. Main outcome measures. Cortisol levels, gestational age, and weight at delivery. Results. Partner violence during the pregnancy, low social resources, and perceived maternal stress were associated with high level of salivary cortisol. Pregnant women with high cortisol levels were significantly more likely to give birth to small-for-gestational age babies, but not to deliver preterm. A substantial decrease of birthweight, 121-186 g, was associated with an increase in cortisol in association with violence exposure. Conclusion. Partner violence during pregnancy is a stressor that provokes high levels of cortisol, which is associated with reduction of birthweight. [ABSTRACT FROM AUTHOR]

BACKGROUND: The interindividual variation in metabolism of inorganic arsenic (iAs), involving methylation via one-carbon metabolism, has been well documented, but the reasons remain unclear. OBJECTIVES: In this population-based study we aimed to elucidate the effect of nutrition on As methylation among women in Matlab, Bangladesh, where people are chronically exposed to iAs via drinking water. METHODS: We studied effects of macronutrient status using body mass index (BMI) among 442 women in early pregnancy (gestational week 8), and effects of micronutrient status (plasma folate, vitamin B12, zinc, ferritin, and selenium) among 753 women at gestational week 14. Arsenic metabolites in urine were measured by HPLC combined with hydride generation inductively coupled plasma mass spectrometry. RESULTS: The median concentration of As in urine was 97 μg/L (range, 5-1,216 μg/L, adjusted by specific gravity). The average proportions of iAs, monomethylarsonic acid, and dimethylarsinic acid in urine in gestational week 8 were 15%, 11%, and 74%, respectively. Thus, the women had efficient As methylation in spite of being poorly nourished (one-third had BMIs < 18.5 kg/m2) and having elevated As exposure, both of which are known to decrease As methylation. The metabolism of iAs was only marginally influenced by micronutrient status, probably because women, especially in pregnancy and with low folate intake, have an efficient betaine-mediated remethylation of homocysteine, which is essential for an efficient As methylation. CONCLUSIONS: In spite of the high As exposure and prevalent malnutrition, overall As methylation in women in early pregnancy was remarkably efficient. The As exposure level had the greatest impact on As methylation among the studied factors. [ABSTRACT FROM AUTHOR]

This study aims to estimate the prevalence and characteristics of partner abuse during pregnancy as well as to investigate associated social factors in León, Nicaragua. Cross-sectional community-based study. All pregnant women from 50 randomly selected geographical clusters out of 208 in the municipality of León, Nicaragua. A total of 478 pregnant women were included; only one woman refused to participate. The domestic violence questionnaire from the WHO-co-ordinated Multi-Country Study on Women's Health and Life Events was used with each participant being interviewed twice during pregnancy. Prevalence and characteristics of partner violence during pregnancy. The prevalence of emotional, physical and sexual abuse during pregnancy was 32.4%, 13.4% and 6.7%, respectively. Seventeen percent reported experience of all three forms of violence. Two-thirds of the victims reported repeated abuse. Half of the abused women had experienced punches and kicks directed towards the abdomen and 93% had been injured. Most women had not sought health care in relation to the abuse, but those who did were usually hospitalised. Factors such as women's age below 20 years, poor access to social resources and high levels of emotional distress were independently associated with violence during pregnancy. Violence against pregnant women in Nicaragua is common and often repeated. Although these women have poor access to social resources and high levels of emotional distress, they are rarely assisted by the health services. Innovative strategies are needed to provide support and counselling. [ABSTRACT FROM AUTHOR]

Background: Anaemia and iron-deficiency anaemia in women are global problems that are prevalent throughout the reproductive cycle. Data are scarce on whether iron supplementation in pregnancy and puerperium has a sustained effect on haemoglobin concentration. Objective: To assess whether there is a dose effect of iron supplementation in pregnancy and puerperium on haemoglobin 6 weeks after delivery, and compare the effectiveness of daily and weekly dose regimens at 6 weeks postpartum. Design: 50 antenatal centres were assigned randomly to 1×60 mg iron daily or 2×60 mg once weekly. Data are reported for 146 women (daily, n =67; weekly, n =79): haemoglobin, serum ferritin (sFt) and serum transferrin receptors (sTfR) at baseline and at 6 weeks postpartum. Tablet intake was monitored using pill-bottles equipped with electronic counting devices. Results: There was a dose effect of iron supplementation on haemoglobin concentration at 6 weeks postpartum. Endpoint attained haemoglobin, sFt and sTfR did not differ between daily and weekly groups, although a larger increment of sFt was found in the daily group ( p =0.03). Conclusions: Effects of iron supplementation in pregnancy and puerperium were observed at 6 weeks after delivery. The size of the effect was dependent on the number of tablets, not on daily or weekly regimen. It is not known whether the effects of iron supplementation in pregnancy are sustained into the next pregnancy. [ABSTRACT FROM AUTHOR]