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Modern availability of rich geospatial datasets and analysis tools can provide insight germane to the design of field experiments. Design of field experiments, and in particular the choice of sampling strategy, requires careful consideration of its consequences on the external representativity and interference (SUTVA violations) of the experimental sample. This paper presents a methodology for a) modeling the geospatial and social interaction factors that drive interference in rural field experiments; and b) eliciting a set of nondominated sample options that approximate the Pareto-optimal tradeoff between interference and external representativity, as functions of sample choice. The study develops and tests the methodology in the context of a large-scale health experiment in rural Mexico, involving more than 3,000 pregnant women and 600 health clinics across 5 states. Relevant for the practitioner, the methodology is computationally tractable and can be implemented leveraging open sourced geo-spatial data and software tools.

Background Cell-free DNA (cfDNA) in blood, urine, and other biofluids provides a unique window into human health. A proportion of cfDNA is derived from bacteria and viruses, creating opportunities for the diagnosis of infection via metagenomic sequencing. The total biomass of microbial-derived cfDNA in clinical isolates is low, which makes metagenomic cfDNA sequencing susceptible to contamination and alignment noise. Results Here, we report low biomass background correction (LBBC), a bioinformatics noise filtering tool informed by the uniformity of the coverage of microbial genomes and the batch variation in the absolute abundance of microbial cfDNA. We demonstrate that LBBC leads to a dramatic reduction in false positive rate while minimally affecting the true positive rate for a cfDNA test to screen for urinary tract infection. We next performed high-throughput sequencing of cfDNA in amniotic fluid collected from term uncomplicated pregnancies or those complicated with clinical chorioamnionitis with and without intra-amniotic infection. Conclusions The data provide unique insight into the properties of fetal and maternal cfDNA in amniotic fluid, demonstrate the utility of cfDNA to screen for intra-amniotic infection, support the view that the amniotic fluid is sterile during normal pregnancy, and reveal cases of intra-amniotic inflammation without infection at term.

An estimated 40 percent of the world's garbage is burned in open-air fires, which are responsible for as much as half of the global emissions of some pollutants. However, there is little evidence on the health consequences of open-air waste burning. In this paper, we estimate the effect of in utero exposure to open-air waste burning on birth outcomes. We do so by examining the consequences of the Lebanese garbage crisis of 2015, which led to an abrupt, unanticipated increase in waste burning in residential neighborhoods in Beirut and Mount Lebanon. To identify effects, we exploit variation in exposure across neighborhoods before and after the crisis. Results indicate exposure had large impacts on birth outcomes; in utero exposure to at least one open-air waste burn increased premature births by 4 percentage points (50%) and low birth weight by 5 to 8 percentage points (80 - 120%). Given previous research documenting the long-run effects of prenatal shocks on adult health, human capital, and labor market outcomes, this suggests open-air waste burning imposes significant costs on populations worldwide.

No abstract available. published

Guatemala has the sixth worst stunting rate with 48% of children under five years of age classified as stunted according to World Health Organization standards. This study utilizes two different yet complimentary system-analysis approaches to analyze correlations among environmental and demographic variables, environmental enteric dysfunction (EED), and child height-for-age (stunting metric) in Guatemala. Two descriptive models constructed around applicable environmental and demographic factors on child height-for-age and EED were analyzed using Network Analysis (NA) and Structural Equation Modeling (SEM). Data from two populations of children between the age of three months and five years were used. The first population (n = 2103) was drawn from the Food for Peace Baseline Survey conducted by the US Agency for International Development (USAID) in 2012, and the second population (n = 372) was drawn from an independent survey conducted by the San Vicente Health Center in 2016. The results from the NA of the height-for-age model confirmed pathogen exposure, nutrition, and prenatal health as important, and the results from the NA of the EED model confirmed water source, water treatment, and type of sanitation as important. The results from the SEM of the height-for-age model confirmed a statistically significant correlation among child height-for-age and child-mother interaction (−0.092, p = 0.076) while the SEM of the EED model confirmed the statistically significant correlation among EED and type of water treatment (−0.115, p = 0.013). Our approach supports important efforts to understand the complex set of factors associated with child stunting among communities sharing similarities with San Vicente.

1997년 IMF 이후 사회경제적 지위에 상관없이 여성들의 결혼과 출산 시기는 모두 늦어지기 시작하면서, 미숙아 및 저체중아 출산에 있어 여성들의 사회 경제적･행동적 및 심리적 특성보다는 이들의 연령과 생물학적 특성이 더 중요한 위험요인으로 주목받고 있다. 이에 본 연구는 한국 여성들의 미숙아 및 저체중아 출산에 대한 사회경제적 격차가...

Background Use of tobacco, especially smokeless tobacco have characterised as highly prevalent among women, and also the mode of using smokeless tobacco varies based on geographic location, ingredient availability, cultural/societal norms, and personal preferences. Therefore, this study examines the prevalence and social determinants of use of smokeless tobacco among women in NE India. Further, it also identifies the cluster and district hotspots of smokeless tobacco prevalence. Methods We analysed a nationally representative data of NFHS-4, covering 93,409 eligible women aged 15–49 years from a survey of representative households from NE states, India. Descriptive statistics, chi-square, binary logistic and log-binomial regression were employed to analyse the data by using STATA software 13.1. Spatial clustering analysis and hotspot analysis were carried out using R-library. Findings The prevalence of SLT use among women in NE states, India is 23%. Mizoram (47.8 ± 1.2) shows the highest prevalence of SLT use, followed by Manipur (46.1 ± 0.7). It increases concomitantly with age among women. Social determinants like marital status (divorced/widowed), low educational level and residence (urban) were observed to be associated with smokeless tobacco use. Out of the 4032 clusters used in the analysis, 949 clusters were showed as hotspots. Conclusion The existing implementation of tobacco control programs and policies in the NE states needs to be evaluated. Owing to the geographical barriers and cultural differences, there is a need to explore the influences unique to these regions, which can further strengthen tobacco control measures. Targeted and tailored intervention within the identified hotspots can be beneficial.

Background The excess of manganese (Mn) causes severe deleterious effects in the central nervous system, and the developing brain is especially sensitive to Mn overload. However, results of prospective studies regarding Mn neurodevelopmental effects remain inconclusive. The present study aims at studying the association of prenatal Mn exposure and neurodevelopment at 4–5 years of age. Methods: Mn serum concentration was measured in 1465 pregnant women from the INMA (INfancia y MedioAmbiente, Environment and Childhood) Project. Neurodevelopment was assessed using a standardized version of the McCarthy Scales of Children's Abilities (MSCA). Multivariate regression models were used for data analysis. Results: No association was found between Mn levels in serum and any of the McCarthy scales. However, the stratification by sex showed a positive and beneficial association of prenatal Mn levels and the verbal, quantitative and general-cognitive scales in girls (β (95%CI): 4 (0.03, 7.96), 4.5 (0.43, 8.57) and 4.32 (0.6, 8.05), respectively). Conclusions: A beneficial association was found for the first time between prenatal Mn levels measured in serum and neurodevelopment of female offspring at 4 years of age, which could have implications on public health policies, specifically on the establishment of policies promoting prenatal health related to dietary deficits of micronutrients such as Mn.

Pregnancy and childbirth complications are leading causes of death and disability among women of reproductive age, especially in developing countries, with Nigeria experiencing 576 deaths in every 100,000 births. This is particularly worrisome when most of these deaths could be prevented if pregnant women seek prenatal health care services. It is in the light of the foregoing that this research investigates the level of access and factors that influence use of prenatal health care services in Isiekenesi. Secondary and primary data were used for this study. The study adopted questionnaire, IDI, and FGD as data collection instruments. The data was analyzed at univariate and bivariate levels. The high cost of prenatal health care services was identified as a major factor that influences a woman’s decision not to use prenatal health care services. Finally, while all stakeholders should intensify awareness of the importance of using prenatal health care services, concerted effort should be channeled toward reduction of cost or outright free services at least in government-owned health centers in rural areas.

This study examines how a policy that sharply increased alcohol availability during 8.5 months affected the labor productivity of those exposed to it in utero. Compared to the surrounding cohorts, the prenatally exposed children have substantially worse labor market and educational outcomes and lower cognitive and noncognitive ability. Effects on earnings are found throughout the distribution but are largest below the median. Males are more affected than females, consistent with growing evidence that boys are less resilient to early environmental insults. The long-term effects seem primarily driven by changes in prenatal health rather than changes in the childhood environment.

Objective The rs10229583 polymorphism near paired box gene 4 ( PAX4) is associated with insulin resistance and type 2 diabetes. Mutations in the PAX4 gene may be associated with impaired differentiation/development of pancreatic islet beta cells during fetal development and, consequently, a compromised insulin response to high blood glucose. To ascertain whether this polymorphism plays a role in gestational diabetes mellitus (GDM), we investigated the genotypic and allele frequency differences between GDM and normal pregnancies. Methods A total of 310 GDM and 440 normal pregnancies were evaluated. Allele and genotype frequencies of rs10229583 were determined for all participants with Sanger sequencing and SNaPshot. Association of the allele and genotypes of the single nucleotide polymorphism with the disease was analyzed using Pearson’s χ2 test and OR (odds ratio). Results The G allele was more frequent in patients with GDM compared with controls (OR = 1.47, 95% confidence interval (CI): 1.12–1.939). The GG genotype frequency of rs10229583 was significantly different between subjects with GDM and normal controls (OR = 1.411, 95% CI: 1.032–1.928). The OR of the GA + GG genotype was 3.182 (95% CI: 1.294–7.826) for patients with GDM compared with controls. Conclusion The present study suggests that rs10229583 is associated with GDM.

Recent research in environmental epidemiology has attempted to estimate the effects of exposure to nature, often operationalized as vegetation, on health. Although many analyses have focused on vegetation or greenness with regard to physical activity and weight status, an incipient area of interest concerns maternal health and birth outcomes. This paper reviews 14 studies that examined the association between greenness and maternal or infant health. Most studies were cross-sectional and conducted in birth cohorts. Several studies found evidence for positive associations between greenness and birth weight and maternal peripartum depression. Few studies found evidence for an association between greenness and gestational age or other birth outcomes, or between greenness and preeclampsia or gestational diabetes. Several assessed effect modification by individual or area-level socioeconomic status and found that effects were stronger among those of lower socioeconomic status. Few studies conducted mediation analyses of any kind. Future research should include more diverse birth outcomes and focus on maternal health (especially mental health) and capitalize on richer exposure information during pregnancy rather than cross-sectional assessment at birth.

Objective The aim of this study was to investigate the effects of group supportive counseling (SC) on pregnancy-specific stress, general stress, and healthy behavior of pregnant women. Methods This randomized controlled trial study was conducted on 80 pregnant women in two groups; SC for six sessions, once a week for two hours (n = 40), and antenatal usual care (AUC) (n = 40). All Participants completed questionnaires measuring pregnancy-specific stress, state anxiety, prenatal health behaviors, perceived stress, and provided a saliva sample for measurement of cortisol at pre-intervention and 6-week post-intervention. Results The post-intervention results indicated that the outcome scores decreased more significantly in group SC than in the AUC for total NuPDQ, for state-anxiety, for PSS-14, and for unhealthy behaviors with a large effect size. Also, healthy behaviors were promoted more significantly in SC group than in AUC. However, salivary cortisol levels did not differ between group SC and AUC groups. Conclusion Group supportive counselling can promote pregnancy stress and healthy behaviors. Practice Implications Addition of supportive counseling to prenatal usual care may be suggested for pregnant women with any gestational age who seek methods for improving pregnancy stress and healthy behaviors.

Children in immigrant families are twice as likely to be uninsured as their counterparts, and states may influence these inequities by facilitating or restricting immigrant families’ access to coverage. Our objective was to measure differences in insurance by mother’s documentation status among a nationally representative sample of US-born children in immigrant families and to examine the role of state-level immigrant health care policy—namely, state-level immigrant access to prenatal coverage. Compared with US-born children in immigrant families with citizen mothers, children with undocumented immigrant mothers had a 17.0 percentage point ( P < .001) higher uninsurance rate (8.8 percentage points higher in adjusted models, P < .05). However, in states with nonrestrictive prenatal coverage for immigrants, there were no differences in children’s insurance by mother’s documentation status, while large inequities were observed within states with restrictive policies. Our findings demonstrate the potential for state-level immigrant health care policy to mitigate or exacerbate inequities in children’s insurance.

This article aimed to identify the scientific evidence about the educational strategies used to promote prenatal health. This is a systematic meta-synthesis. Analysis of published studies revealed the emergence of two central thematic categories: methodological strategies for the educational activities and; educational tools to promote prenatal health. The most used strategy was health education with pregnant women or couples, using conversation circles and focus groups as methods to target the public. The strategies and educational tools used to promote maternal health in prenatal care seek to anchor the expanded concept of health and to contribute to the construction of varied models of health education.

Early life, including prenatal development and childhood, is a period of sensitivity, with potential for developmental programming under conditions of adversity. The intergenerational effects of early adversity have received attention, most often studied in relation to fetal development according to maternal exposures. Less often considered but critically important is the effect of early adversity on future prenatal risk (e.g., risk for preeclampsia, preterm birth), which threatens the health of mother and infant. The body's ability to turn collections of genes "on" or "off" across a range of tissues via receptor-driven transcription factors and epigenetic mechanisms (i.e., chemical modifications to the genome) in response to the perceived environment may help to explain such associations. This review aims to summarize discoveries surrounding the effects of early adversity on gene expression, emphasizing prenatal populations. First, we review findings from gene expression studies examining the effects of early adversity on various tissues known to contribute to prenatal health in adulthood. Next, we review several gene regulatory mechanisms thought to underlie differences in gene expression. Finally, we discuss potential implications for prenatal risk among early adversity-exposed mothers according to our current understanding of the biology that contributes to the development of prenatal syndromes.

Incarcerated pregnant women experience psychosocial conditions that put them at risk of adverse perinatal outcomes. To examine perinatal outcomes including maternal mental health well-being, birth weight, and preterm birth, an integrated search of the literature was conducted. Findings indicate that time in prison, especially during the first trimester, results in improved birth weight and longer gestation. Findings related to maternal mental health well-being were inconclusive but suggest significant risk to maternal role development when mother and infant are separated. Limited findings demonstrate that prenatal care, a safe environment, and food stability, along with reduced or eliminated substance abuse and violence, can positively influence perinatal outcomes. Rigorous, systematic research is vital for developing policies related to incarcerated women and perinatal outcomes.

Objectives Use the Consolidated Framework for Implementation Research to describe the context in which a gestational weight gain (GWG) intervention, embedded within Parents as Teachers (PAT), will be implemented at PAT sites nationwide. Methods Ten site leaders and six parent educators from ten PAT sites in eight states participated in semi-structured interviews and a survey. Audio-recordings and systematic notes were used in a deductive analysis. Scales were descriptively analyzed. Results Surveys demonstrated positive perspectives of PAT+GWG. In interviews, participants described PAT+GWG filling a need for prenatal health education and confidence delivering this content, valued integration of PAT+GWG within the PAT curriculum, and recommended materials to meet their clients' needs. Conclusions Contextual information can help maximize PAT+GWG's impact.

Introduction: Depression and anxiety during pregnancy have a negative impact on prenatal health and reduces mother’s child care capability. Up to 20% of the pregnant women experience mood disorders...

A large body of research examines determinants of infant health outcomes but little examines geographic variation generated by exogenous economic shocks. Linking birth data from the CDC Natality files to counties building new facilities from 1995-2002, we find that sports facility construction projects generate local negative externalities. Infants born during facility construction periods have lower birth weights than infants born in comparable counties where no new facility opened. Maternal prenatal health visits also fall in the post-facility-opening period. Mechanisms for this impact include local airborne particulate matter and reduced provision of government services affecting prenatal health.

Recent epidemiological studies suggest that prenatal exposure to acetaminophen (APAP) is associated with increased risk of Autism Spectrum Disorder (ASD), a neurodevelopmental disorder affecting 1 in 59 children in the US. Maternal and prenatal exposure to pesticides from food and environmental sources have also been implicated to affect fetal neurodevelopment. However, the underlying mechanisms for ASD are so far unknown, likely with complex and multifactorial etiology. The aim of this study was to explore the potential effects of APAP and pesticide exposure on development with regards to the etiology of ASD by highlighting common genes and biological pathways. Genes associated with APAP, pesticides, and ASD through human research were retrieved from molecular and biomedical literature databases. The interaction network of overlapping genetic associations was subjected to network topology analysis and functional annotation of the resulting clusters. These genes were over-represented in pathways and biological processes (FDR p < 0.05) related to apoptosis, metabolism of reactive oxygen species (ROS), and carbohydrate metabolism. Since these three biological processes are frequently implicated in ASD, our findings support the hypothesis that cell death processes and specific metabolic pathways, both of which appear to be targeted by APAP and pesticide exposure, may be involved in the etiology of ASD. This novel exposures-gene-disease database mining might inspire future work on understanding the biological underpinnings of various ASD risk factors.

Ethnopharmacological relevance In West Africa, women utilize wild plant species to maintain and enhance their health throughout the duration of pregnancy. These plants are a culturally resilient and financially accessible form of nourishment for pregnant women in the region, many of whom are malnourished, yet studies that identify both the nutritional and medicinal properties of these plants are limited. Aim of the study The objective of this study was to analyze women's knowledge of plants consumed in pregnancy in the southern regions of Ghana and Benin from a food-medicine continuum perspective. Materials and methods We gathered data in two fieldwork periods in West Africa (Ghana 2010 and Benin 2011) through herbal market surveys and 56 questionnaires with women and then conducted a literature review on known properties of the plants. Results Ghanaian women reported consuming wild greens such as iron-rich Nephrolepis biserrata and tree barks such as protein-rich Ricinodendron heudelotii in a soup based on the African oil palm fruit (Elaeis guineensis), a source of fatty acids. In Benin, participants frequently reported ingesting plants during pregnancy in the form of herbal teas. Commonly cited species included Securidaca longipedunculata, Dichapetalum madagascariense, and Schwenckia americana. Several of the plants demonstrated antioxidant, anti-malarial and anti-inflammatory activity in pharmacological studies, yet the majority has incomplete nutritional and pharmacological profiles. In total, informants cited 105 species that were consumed during pregnancy. Although Ghanaian and Beninese women mentioned different species and different forms of consumption, in both countries women cited "strengthening" as the most common motivation to consume wild plants during pregnancy. Strengthening is a concept that resonates within the food-medicine continuum, bridging the local diet and herbal pharmacopoeia of women's plant use during pregnancy. Conclusions Ethnobotanical studies of this nature highlight the multidimensional use of plants and can improve health and nutritional programs in the region.

Pregnancy and Childbirth are physiological. But normal pregnancy and childbirth can turn into pathology. One of the ways to prevent delays in handling is through the readiness of childbirth by means of health education using media and video media. Analyzing the differences in the effectiveness of Prenatal health education using Booklet and Video media in reducing anxiety and increasing maternity readiness. This type of research is Quasy Experiment with one group pretest posttest design research design. The population in this study were all pregnant women in the working area of the South Klaten Puskesmas in the February to September 2019 period with a sampling quota of 60 pregnant women, namely 30 booklet groups and 30 video groups. Data analysis uses paired t-test, Wilcoxon and Mann Whitney. Prenatal health education using the Media Booklet is effective in reducing anxiety and increasing readiness to face labor with a p value

Background: Pregnancy outcomes in the United States rank among the worst of countries with a developed health care system. Although traditional prenatal health primarily focuses on women, promising findings have emerged in international research that suggest the potential of including men in prenatal health interventions in the United States. eHealth apps present a promising avenue to reach new and expectant fathers with crucial parenting knowledge and healthy, supportive behaviors. Objective: The aim was to explore the perceived role of men in prenatal health, acceptability of eHealth to positively engage men during pregnancy, and participant-suggested ways of improving a prenatal health app designed for new and expectant fathers. Methods: A nationally representative sample of adult males (N=962) was recruited through an online survey panel. A third-party market research and digital data collection agency managed the recruitment. The sample had a mean age of 30.2 (SD 6.3) years and included both fathers (413/962, 42.9%) and non-fathers (549/962, 57.1%). Nearly 12.0% (115/962) of participants had a partner who was pregnant at the time of the survey. Results: Despite perceived barriers, such as time constraints, financial burdens, and an unclear role, men believe it is important to be involved in pregnancy health. The majority of participants (770/944, 81.6%) found the site to contain useful and interesting information. Most substantially, more than three-quarters (738/962, 76.7%) of the sample said they would share the site with others who would benefit from the information. Participants recommended the addition of interactive modules, such as a financial planning tool and videos, to make the site stronger. Conclusions: We explored the use of targeted eHealth to introduce men to prenatal education. Results indicate men are favorable to this intervention. Additional refinement should include interactive tools to further engage men in this important issue. Reaching men at the prenatal phase is an early “teachable moment”—where new/expectant fathers are open to information on how to help their partners have a healthy pregnancy and promote the health of their unborn children. Findings will further inform best practices for engaging men in pregnancy, which is crucial for improving maternal and child health outcomes in the United States.

Prenatal health programs and public health promotion provide strategies to mitigate modifiable risks to pregnancy. Women marginalized by race/ethnicity, disability, sexual identity, socioeconomic status, immigration, Francophone and Indigenous status experience barriers to prenatal service access. Multijurisdictional program evaluations were conducted to review prenatal health promotion, design, implementation and evaluation strategies for Canadian government-hosted websites, prenatal e-classes and international prenatal guidance documents. Gaps were noted in prenatal content targeted to non-Anglophone, immigrant, Indigenous and disabled women and LGBTQ communities. I recommend that prenatal program best practices consist of evidence-based, theoretical foundations which recognize the diverse interacting determinants of health across the lifespan. Intersectoral collaborations and integration of public health into primary care facilitates delivery of accessible, inclusive, woman-centred services. These best practices are anticipated to help harmonize prenatal programs across communities, which optimize maternal-child health and children’s long-term health outcomes.

Background A valuable addition to the mobile health (mHealth) space is an exploration of the context of minorities in developed countries. The transition period postmigration, culture, and socioeconomic uniqueness of migratory groups can shed light on the problems with existing prenatal mHealth apps. Objective The objectives of this study were to (1) use the theoretical concept of pregnancy ecology to understand the emotional, physical, information, and social challenges affecting low-income Caribbean immigrant women's prenatal well-being practices and (2) develop a deep understanding of challenges worthy of consideration in mHealth design for these women. Methods This qualitative interpretive approach using analytical induction presents the findings of 3 focus group sessions with 12 Caribbean immigrant women living in South Florida in the United States. The study took place from April to September 2015. Results The participants revealed problematic tiers and support needs within the pregnancy ecology including emotional stressors caused by family separation, physical challenges, information gaps, and longing for social support. Conclusions mHealth interventions for low-income Caribbean immigrant women must be designed beyond the conventional way of focusing on the events surrounding the unborn child. It can be tailored to the needs of the expecting mother. Pregnancy information should be customized on the basis of the variability of lifestyle, cultural practices, socioeconomic status, and social ties while still being able to deliver appropriate guidelines and clear cultural misconceptions.

Physically demanding work carried out during long workdays affects women’s health. In rural and agrarian societies, women perform a variety of domestic and productive tasks, often from dawn to dusk, with little or no leisure time. This paper presents the results of a survey of indigenous women in six rural communities in the Ecuadorian highlands. It was conducted to measure the amount of time women spend on physically demanding work in the context of food security, parity outcomes, and access to prenatal health care. The findings demonstrate that these women work very long workdays and also experience food insecurity and poor access to prenatal health care.

To analyse factors affecting variations in the observed quality of antenatal and sick-child care in primary-care facilities in seven African countries.We pooled nationally representative data from service provision assessment surveys of health facilities in Kenya, Malawi, Namibia, Rwanda, Senegal, Uganda and the United Republic of Tanzania (survey year range: 2006-2014). Based on World Health Organization protocols, we created indices of process quality for antenatal care (first visits) and for sick-child visits. We assessed national, facility, provider and patient factors that might explain variations in quality of care, using separate multilevel regression models of quality for each service.Data were available for 2594 and 11 402 observations of clinical consultations for antenatal care and sick children, respectively. Overall, health-care providers performed a mean of 62.2% (interquartile range, IQR: 50.0 to 75.0) of eight recommended antenatal care actions and 54.5% (IQR: 33.3 to 66.7) of nine sick-child care actions at observed visits. Quality of antenatal care was higher in better-staffed and -equipped facilities and lower for physicians and clinical officers than nurses. Experienced providers and those in better-managed facilities provided higher quality sick-child care, with no differences between physicians and nurses or between better- and less-equipped clinics. Private facilities outperformed public facilities. Country differences were more influential in explaining variance in quality than all other factors combined.The quality of two essential primary-care services for women and children was weak and varied across and within the countries. Analysis of reasons for variations in quality could identify strategies for improving care.Analyser les facteurs qui affectent les variations de qualité observées concernant les soins prénatals et aux enfants malades dans des établissements de soins primaires de sept pays africains.Nous avons rassemblé des données représentatives à l'échelle nationale provenant d'enquêtes évaluant la qualité des services fournis par des établissements de santé situés au Kenya, au Malawi, en Namibie, en Ouganda, en République-Unie de Tanzanie, au Rwanda et au Sénégal (années couvertes par les enquêtes: 2006-2014). Nous avons créé des indices de qualité du processus pour les soins prénatals (premières visites) et les visites aux enfants malades en nous appuyant sur les protocoles de l'Organisation mondiale de la Santé. À l'aide de différents modèles de régression multiniveaux de qualité pour chaque service, nous avons évalué des facteurs liés aux pays, aux établissements, aux prestataires et aux patients susceptibles d'expliquer les variations qualitatives des soins.Nous avons disposé de données tirées de 2594 observations de consultations cliniques pour des soins prénatals et de 11 402 observations de consultations cliniques pour des enfants malades. Dans l'ensemble, les prestataires de soins de santé ont réalisé en moyenne 62,2% (intervalle interquartile, IQR: de 50,0 à 75,0) des huit actions de soins prénatals recommandées et 54,5% (IQR: de 33,3 à 66,7) des neuf actions de soins aux enfants malades lors des visites observées. Les soins prénatals étaient de meilleure qualité dans les établissements mieux dotés en personnel et mieux équipés et ceux fournis par les médecins et les cliniciens se sont révélés de moins bonne qualité que ceux des infirmiers. Les prestataires expérimentés ainsi que ceux qui exerçaient dans des établissements mieux gérés ont fourni des soins de meilleure qualité aux enfants malades, aucune différence n'ayant été observée entre les médecins ou les infirmiers ou entre les centres de consultation mieux équipés et ceux moins bien équipés. Les établissements privés ont obtenu de meilleurs résultats que les établissements publics. Les différences entre les pays ont davantage permis d'expliquer les variations de qualité que tous les autres facteurs combinés.Deux services de soins primaires essentiels pour les femmes et les enfants se sont révélés de qualité médiocre, celle-ci variant selon les pays et au sein des pays. Une analyse des raisons des variations qualitatives permettrait de définir des stratégies afin d'améliorer les soins.Analizar los factores que afectan a las variaciones de la calidad observada en la atención prenatal y a niños enfermos en centros de atención primaria de siete países africanos.Se recopilaron datos representativos a nivel nacional de encuestas de evaluación sobre prestación de servicios de centros sanitarios de Kenya, Malawi, Namibia, la República Unida de Tanzanía, Rwanda, Senegal y Uganda (rango anual de encuestas: 2006–2014). En base a los protocolos de la Organización Mundial de la Salud, se crearon índices de calidad de procesos para la atención prenatal (primeras consultas) y para las consultas a niños enfermos. Se evaluaron los factores nacionales, de centros, de proveedores y de pacientes que pudieran explicar las variaciones en la calidad de la atención mediante el uso de distintos modelos de regresión en múltiples niveles de calidad para cada servicio.Se disponía de los resultados para 2 594 y 11 402 observaciones de consultas médicas de atención prenatal y atención a niños enfermos, respectivamente. En general, los profesionales sanitarios realizaron una media de 62,2% (rango intercuartílico, ICR: 50,0 a 75,0) de ocho acciones de atención prenatal recomendadas y de 54,5% (ICR: 33,3 a 66,7) de nueve acciones de atención a niños enfermos en las visitas observadas. La calidad de la atención prenatal fue mejor en los centros con mejor personal y mejores equipos e inferior para los médicos y asistentes clínicos que para los enfermeros. Los proveedores con experiencia y aquellos en centros con una mejor gestión ofrecieron una atención a niños enfermos de mejor calidad, sin diferencias entre médicos y enfermeros o entre centros mejor o peor equipados. Los centros privados superaron la calidad de los públicos. Las diferencias entre países tuvieron un papel más influyente a la hora de explicar la varianza en la calidad que el resto de factores juntos.La calidad de dos servicios de atención primaria básicos para mujeres y niños era escasa y diversa entre países y dentro de ellos. El análisis de las razones de las variaciones en la calidad podría identificar estrategias para mejorar la atención.الغرض تحليل العوامل المؤثرة على التباين فيما يخضع للملاحظة من جودة الرعاية المقدمة في مرحلة ما قبل الولادة والرعاية المقدمة للمرضى من الأطفال داخل منشآت الرعاية الأولية في سبع دول أفريقية. الطريقة جمعنا بيانات تمثيلية على المستوى الوطني مستمدة من مسوح تقييمية للمنشآت الصحية من حيث توفير الخدمة في أوغندا وجمهورية تنزانيا المتحدة ورواندا والسنغال وكينيا وملاوي وناميبيا (المدى الزمني لسنوات المسح: 2006-2014). ووفقًا لبروتوكولات منظمة الصحة العالمية، أنشأنا مؤشرات لجودة تدابير الرعاية المقدمة في مرحلة ما قبل الولادة (الزيارات الأولى) والزيارات الخاصة بالمرضى من الأطفال. وقيَّمنا العوامل الوطنية والعوامل المرتبطة بالمنشأة والمرضى والجهات الموفرة للخدمة والتي قد تفسر التباين في مستوى جودة الرعاية المقدمة، حيث استخدمنا نماذج تحوّف منفصلة متعددة المستويات فيما يتعلق بمستوى الجودة لكل نوع من أنواع الخدمات. النتائج كانت البيانات متاحةً بشأن 2594 و11402 من عمليات ملاحظة الاستشارات العلاجية فيما يتعلق بالرعاية المقدمة في مرحلة ما قبل الولادة والمقدمة للمرضى من الأطفال، على التوالي. وإجمالاً، بلغ متوسط تنفيذ جهات توفير الرعاية الصحية للإجراءات الموصى بها 62.2‏% (المدى الربيعي: من 50.0 إلى 75.0) وذلك من إجمالي ثمانية إجراءات موصى بها لتقديم الرعاية في مرحلة ما قبل الولادة، و54.5‏% (المدى الربيعي: من 33.3 إلى 66.7) من إجمالي تسع إجراءات للرعاية في الزيارات التي خضعت للملاحظة. وارتفع مستوى جودة الرعاية المقدمة في مرحلة ما قبل الولادة لدى المنشآت التي تحظى بتجهيزات وفريق عمل أكثر كفاءة، بينما انخفض مستوى الجودة لدى الأطباء والمساعدين الإكلينيكيين مقارنةً بالممرضات. وتولى مقدمو الخدمات الصحية من ذوي الخبرة والعاملون في المنشآت التي تحظى بمستوى أفضل من الإدارة تقديم مستوى أعلى من جودة الرعاية المقدمة للمرضى من الأطفال، دون أي اختلاف بين الأطباء والممرضات أو بين العيادات التي يرتفع فيها مستوى التجهيزات وتلك التي يقل فيها مستوى التجهيزات. وتفوقت المنشآت الخاصة في أدائها على المنشآت الحكومية. ولعبت الاختلافات بين الدول دورًا أكثر فعالية في تفسير التباين في مستوى الجودة مقارنةً بالعوامل الأخرى مجتمعةً. الاستنتاج إن جودة اثنين من أنواع الخدمات الأساسية للرعاية الصحية الأولية المقدمة للنساء والأطفال كانت ضعيفة المستوى ومتباينة فيما بين الدول وفيما بين المناطق داخل الدول. ويمكن أن يؤدي تحليل أسباب التباين في مستوى الجودة إلى تحديد استراتيجيات لتحسين الرعاية المقدمة.旨在分析影响七个非洲国家初级医疗机构中所观测的产前及患儿护理质量的变化的因素。.我们通过肯尼亚、卢旺达、马拉维、纳米比亚、塞内加尔、坦桑尼亚联合共和国和乌干达的卫生设施服务提供评估调查收集了具有全国代表性的数据(调查年份: 2006–2014)。 根据世界卫生组织协议,我们创建了产前护理(初诊)及患儿就诊流程的质量指标。 我们通过各服务质量的独立多级回归模型对可阐明护理质量变化的全国性、设施、提供者及患者因素进行了评估。.数据分别适用于 2594 及 11 402 份产前护理及患儿临床咨询的观测报告。 总体来说,在所观测的就诊期间,八项推荐产前护理行为中,62.2% (四分差,IQR: 50.0 至 75.0)由医疗护理提供者开展;九项患儿护理行为中,54.5% (IQR: 33.3 至 66.7)由医疗护理提供者开展。 人员及设施配备更为齐全出色的机构产前护理质量会更高一些,且医生及临床助理医师提供的产前护理质量低于护士提供的产前护理质量。经验丰富的提供者以及管理良好的机构中的提供者能够提供更高质量的患儿护理,且护理质量在医生及护士之间或设施配备多与少的诊所之间并无差别。 私营机构表现优于公共机构。 国家差异较所有其它因素而言,在阐明质量差异方面更具影响力。.各国妇女及儿童的两项基本初级医疗服务的质量较为薄弱且在国家之间以及国家内部存在差异。 可通过分析质量变化的原因制定改善护理的策略。.Проанализировать факторы, обуславливающие различия в качестве дородового наблюдения и ухода за больными детьми в учреждениях первичной медико-санитарной помощи в семи африканских странах.Авторы объединили репрезентативные на национальном уровне данные обзорных исследований по оценке предоставления услуг в медицинских учреждениях в Кении, Малави, Намибии, Объединенной Республике Танзания, Руанде, Сенегале и Уганде (учитывались обследования, проводимые в 2006–2014 гг.). На основании протоколов Всемирной организации здравоохранения были разработаны показатели качества для дородового наблюдения (первых визитов) и для ухода за больными детьми. Авторы провели оценку национальных факторов, а также факторов, связанных с медицинским центром, поставщиком медицинских услуг и пациентом, которые могли бы объяснить различия в качестве медицинской помощи, используя отдельные многоуровневые регрессионные модели качества для каждой услуги.Были доступны данные для 2594 и 11 402 обзорных исследований клинических консультаций по дородовому уходу и уходу за больными детьми соответственно. Медицинские работники провели в среднем 62,2% (межквартильный размах, МКР: от 50,0 до 75,0) из восьми рекомендуемых мероприятий по дородовому уходу и 54,5% (МКР: от 33,3 до 66,7) из девяти мероприятий по уходу за больными детьми во время посещений, совершенных под наблюдением исследователей. Качество дородового ухода было выше в медицинских учреждениях, которые были лучше укомплектованы персоналом и оборудованием, и ниже у врачей, чем у медсестер. Опытные поставщики медицинских услуг в медицинских учреждениях с лучшей системой управления обеспечивали уход за больными детьми более высокого качества без каких-либо различий между врачами и медсестрами или между клиниками с лучшим и худшим оснащением. Частные медицинские учреждения превзошли общественные медицинские учреждения. Страновые особенности были более значимы при объяснении различий в качестве, чем все остальные факторы, вместе взятые.Качество двух основных услуг первичной медико-санитарной помощи для женщин и детей было низким и варьировалось как между странами, так и внутри отдельной страны. Анализ причин различий в качестве позволил бы определить стратегии для усовершенствования медико-санитарной помощи.

Psychometrically sound self-report measures are important tools to advance research on health behaviors in pregnancy. The Prenatal Health Behavior Scale (PHBS) has been used in prior studies to quantify health behaviors and examine their associations with relevant variables, but its psychometric properties have not been carefully investigated.In a sample of low-risk women, we examined the factor structure, reliability, and validity of the PHBS at mid- (N = 138) and late (N = 102) pregnancy.In confirmatory factor analysis, items on the PHBS loaded onto a single reliable factor, but separating health-promoting and health-impairing behavior into two factors had better model fit. The scales defined by these two factors had good internal consistency in mid- and late pregnancy, were only moderately correlated, and were predicted by somewhat different sets of sociodemographic and psychological variables. Pregnancy-specific stress was a robust predictor of health-promoting and health-impairing behavior across time.Results bolster confidence in the reliability and validity of the PHBS and its appropriateness as a self-report tool for investigation of health behaviors among pregnant women. This study is one of the first investigations to examine patterns and predictors of health behavior practices at two time periods of pregnancy.

Learn how medical practitioners learned how to work with pregnant women with disabilities in this research summary.

This research was conducted to uncover women’s health behaviors during prenatal periods using a transcultural approach. The qualitative ethnonursing method was used, and the research was conducted at the family health center in Bornova District in Izmir. The data were collected between November 2007 and August 2008 using the purposive sampling method. Eighteen pregnant women were included in the study and in-depth face-to-face semi-structured interviews were recorded on an audio recording device. A thematic analysis revealed four main themes: family, social learning-tradition transfer, perceptions, and behavioral changes.

Low birth weight (LBW), defined as a live birth weighing

Birth outcomes of two groups of socially disadvantaged mothers at risk for adverse birth outcomes, one receiving prebirth assistance from a certified doula and the other representing a sample of birthing mothers who elected to not work with a doula, were compared. All of the mothers were participants in a prenatal health and childbirth education program. Expectant mothers matched with a doula had better birth outcomes. Doula-assisted mothers were four times less likely to have a low birth weight (LBW) baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding. Communication with and encouragement from a doula throughout the pregnancy may have increased the mother’s self-efficacy regarding her ability to impact her own pregnancy outcomes.

Objectives We analysed the extent of planned, mistimed and unwanted pregnancies and how they predict optimal use of prenatal (timing and number of antenatal) care services in 30 African countries. Methods We pooled data from Demographic and Health Surveys conducted in 30 African countries between 2006 and 2015. We described the extent of mistimed and unwanted pregnancies and further used mixed effects logistic and Poisson regression estimation techniques to examine the impacts of planned, mistimed and unwanted pregnancies on the use of prenatal health services. Results 73.65% of pregnancies in all countries were planned. Mistimed pregnancy ranged from 7.43% in Burkina Faso to 41.33% in Namibia. Unwanted pregnancies were most common in Swaziland (39.54%) and least common in Niger (0.74%). Timely (first trimester) initiation of ANC was 37% overall in all countries; the multi-country average number of ANC visits was, optimal [4.1; 95% CI 4.1-4.2] but with notable disparities between countries. Overall, mistimed and unwanted pregnancies were strongly associated with late ANC attendance and fewer visits women made in the pooled analysis. Conclusions Unintended pregnancies are critical risks to achieving improved maternal health in respect of early and optimal ANC coverage for women in Africa. Programmes targeted at advancing coverage of ANC in Africa need to critically deploy contextually appropriate mechanisms to prevent unintended pregnancies. This article is protected by copyright. All rights reserved.

Objective To date, most investigations of mental health in pregnant women have focused on depression or substance use. This study aimed to (a) delineate the relationships between symptoms of attention-deficit/hyperactivity disorder (ADHD) and prenatal health behaviors and (b) explore whether the symptom clusters of ADHD differentially predict prenatal health behaviors (e.g., physical strain, healthy eating, prenatal vitamin use). Method A total of 198 pregnant women (mean age = 27.94 years) completed measures of ADHD symptoms, prenatal health behaviors, and depression. Results Inattention, hyperactivity, and impulsivity/emotional lability all evidenced significant relationships with the prenatal health behaviors, each differentially predicting different prenatal health behaviors. Conclusion As decreased engagement in adequate prenatal health behaviors puts both the mother and fetus at risk for negative birth outcomes, future research should work to develop a brief ADHD screen to be used in obstetric clinics and should investigate these relationships within a sample of women with a diagnosis of ADHD.

This dissertation presents the findings from three participatory focus group and co-design sessions with Caribbean transmigrant women in the United States. Informed by their focus group discussions regarding their pregnancy experiences in the United States, the participants produced design ideas that reflected on physical, emotional, informational and social gap themes. The purpose of this study was to understand the challenges affecting the women’s prenatal wellbeing practices, and to conceive a set of recommendations and opportunities for mHealth technology design to assist with prenatal preventative care and management. The study uses the theoretical concept of pregnancy ecology to identify gaps in prenatal health management, and understand participants’ reflection on these gaps through design. Then, the study identifies opportunities for mHealth and HCI research to consider designing tailored interventions to the realities of the expecting immigrant mother, including the role of transnational social support, and embracing the role of entertainment in mental health during pregnancy.

Efforts to achieve the new worldwide goals for maternal and child survival will also prevent stillbirth and improve health and developmental outcomes. However, the number of annual stillbirths remains unchanged since 2011 and is unacceptably high: an estimated 2·6 million in 2015. Failure to consistently include global targets or indicators for stillbirth in post-2015 initiatives shows that stillbirths are hidden in the worldwide agenda. This Series paper summarises findings from previous papers in this Series, presents new analyses, and proposes specific criteria for successful integration of stillbirths into post-2015 initiatives for women's and children's health. Five priority areas to change the stillbirth trend include intentional leadership; increased voice, especially of women; implementation of integrated interventions with commensurate investment; indicators to measure effect of interventions and especially to monitor progress; and investigation into crucial knowledge gaps. The post-2015 agenda represents opportunities for all stakeholders to act together to end all preventable deaths, including stillbirths. Fil: de Bernis, Luc. UN Population Fund; Suiza Fil: Kinney, Mary V.. Save the Children; Sudáfrica Fil: Stones, William. University of St. Andrews; Reino Unido. University of Malawi; Malaui. International Federation of Gynecology and Obstetrics; Reino Unido Fil: ten Hoope-Bender, Petra. Independent Consultant; Suiza Fil: Vivio, Donna. Agency for International Development; Estados Unidos Fil: Hopkins Leisher, Susannah. International Stillbirth Alliance; Estados Unidos. University of Queensland; Australia Fil: Bhutta, Zulfiqar A.. The Hospital for Sick Children; Canadá. The Aga Khan University, Karachi; Pakistán. World Health Organization; Suiza Fil: Gülmezoglu, Metin. World Health Organization; Suiza Fil: Mathai, Matthews. World Health Organization; Suiza Fil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Franco, Lynne. EnCompass LLC; Estados Unidos Fil: McDougall, Lori. Newborn and Child Health; Suiza Fil: Zeitlin, Jennifer. Paris Descartes University; Francia Fil: Malata, Address. Kamuzu College of Nursing University of Malawi; Malaui Fil: Dickson, Kim E.. UNICEF; Estados Unidos Fil: Lawn, Joy E.. London School of Hygiene & Tropical Medicine; Reino Unido. Save the Children; Estados Unidos

Though research suggests that women with physical disabilities are just as likely to be, pregnant as women without disabilities, there isn’t as much information for women with, physical disabilities about navigating pregnancy, childbirth, and motherhood. Women with, physical disabilities may face unique challenges when it comes to pregnancy care; they have, reported that their clinicians do not have all the information necessary to manage their, pregnancies, may be misinformed about their disabilities, and express harmful stereotypes, about disability and sexuality. Many clinicians do not have accessible offices and equipment, such as scales. Additionally, research has shown that women with physical disabilities may be, at higher risk for poor birth outcomes like low birthweight and premature birth. Our goal with, this study was to identify the unmet needs and barriers that women with physical disabilities, experience during pregnancy, childbirth and motherhood so that care can be improved at a, systemic level

Several economic studies have evaluated the effects of cigarette smoking and quitting on other health behaviors such as alcohol use and weight gain. However, there is little research that evaluates the effects of cigarette quitting during pregnancy on other health behaviors such as caloric intake, alcohol consumption, multivitamin use, and caffeine intake. In this paper, we evaluate these effects and employ a genetic variant that predicts cigarette quitting to aid in identification. We find some evidence that cigarette quitting during pregnancy may increase multivitamin use and caloric intake and reduce caffeine consumption.