Search

Background: Institutional delivery is one of the key and proven strategies to reduce maternal deaths. Since the 1990s, the government of India has made substantial investment on maternal care to reduce the huge burden of maternal deaths in the country. However, despite the effort access to institutional delivery in India remains below the global average. In addition, even in places where health investments have been comparable, inter- and intra-state difference in access to maternal care services remain wide and substantial. This raises a fundamental question on whether the sub-national units themselves differ in terms of the efficiency with which they use available resources, and if so, why? Methods: Data obtained from round 3 of the country's District Level Health and Facility Survey was analyzed to measure the level and determinants of inefficiency of institutional delivery in the country. Analysis was conducted using spatial stochastic frontier models that correct for heterogeneity and spatial interactions between sub-national units. Results: Inefficiency differences in maternal care services between and within states are substantial. The top one third of districts in the country has a mean efficiency score of 90 per cent or more, while the bottom 10 per cent of districts exhibit mean inefficiency score of as high as over 75 per cent or more. Overall mean inefficiency is about 30 per cent. The result also reveals the existence of both heterogeneity and spatial correlation in institutional delivery in the country. Conclusions: Given the high level of inefficiency in the system, further progress in improving coverage of institutional delivery in the country should focus both on improving the efficiency of resource utilization--especially where inefficiency levels are extremely high--and on bringing new resources in to the system. The additional investment should specifically focus on those parts of the country where coverage rates are still low but efficiency levels are already at a high level. In addition, given that inefficiency was also associated inversely with literacy and urbanization and positively related with proportion of households belonging to poor households, investment in these areas can also improve coverage of institutional delivery in the country. [ABSTRACT FROM AUTHOR]

Background: Gaps in coverage, equity and quality of health services hinder the achievement of the Millennium Development Goals 4 and 5 in most countries of sub-Saharan Africa as well as in other high-burden countries, yet few studies attempt to assess all these dimensions as part of the situation analysis. We present the base-line data of a project aimed at simultaneously addressing coverage, equity and quality issues in maternal and neonatal health care in five districts belonging to three African countries. Methods: Data were collected in cross-sectional studies with three types of tools. Coverage was assessed in three hospitals and 19 health centres (HCs) utilising emergency obstetric and newborn care needs assessment tools developed by the Averting Maternal Death and Disability program. Emergency obstetrics care (EmOC) indicators were calculated. Equity was assessed in three hospitals and 13 HCs by means of proxy wealth indices and women delivering in health facilities were compared with those in the general population to identify inequities. Quality was assessed in three hospitals using the World Health Organization’s maternal and neonatal quality of hospital care assessment tool which evaluates the whole range of aspects of obstetric and neonatal care and produces an average score for each main area of care. Results: All the three hospitals qualified as comprehensive EmOC facilities but none of the HCs qualified for basic EmOC. None of the districts met the minimum requisites for EmOC indicators. In two out of three hospitals, there were major quality gaps which were generally greater in neonatal care, management of emergency and complicated cases and monitoring. Higher access to care was coupled by low quality and good quality by very low access. Stark inequities in utilisation of institutional delivery care were present in all districts and across all health facilities, especially at hospital level. Conclusion: Our findings confirm the existence of serious issues regarding coverage, equity and quality of health care for mothers and newborns in all study districts. Gaps in one dimension hinder the potential gains in health outcomes deriving from good performances in other dimensions, thus confirm the need for a three-dimensional profiling of health care provision as a basis for data-driven planning. [ABSTRACT FROM AUTHOR]

Background: Despite efforts to reduce under-5 mortality rates worldwide, an estimated 6.6 million under-5 children die every year. Community mobilisation through participatory women’s groups has been shown to improve maternal and newborn health in rural settings, but little is known about the potential of this approach to improve care and health in children after the newborn period. Methods: Following on from a cluster-randomised controlled trial to assess the effect of participatory women’s groups on maternal and neonatal health outcomes in rural Bangladesh, 162 women’s groups continued to meet between April 2010 and December 2011 to identify, prioritise and address issues that affect the health of children under 5 years. A controlled before-and-after study design and difference-in-difference analysis was used to assess morbidity outcomes and changes in knowledge and practices related to child feeding, hygiene and care-seeking behaviour. Findings: Significant improvements were measured in mothers’ knowledge of disease prevention and management, danger signs and hand washing at critical times. Significant increases were seen in exclusive breast feeding for at least 6 months (15.3% (4.2% to 26.5%)), and mean duration of breast feeding (37.9 days (17.4 to 58.3)). Maternal reports of under-5 morbidities fell in intervention compared with control areas, including reports of fever (−10.5% (−15.1% to −6.0%)) and acute respiratory infections (−12.2% (−15.6% to −8.8%)). No differences were observed in dietary diversity scores or immunisation uptake. Conclusions: Community mobilisation through participatory women’s groups can be successfully adapted to address health knowledge and practice in relation to child’s health, leading to improvements in a number of child health indicators and behaviours. [ABSTRACT FROM AUTHOR]

ABSTRACT The current study examined a temporal cascade linking mothers' history of abuse with their children's internalizing difficulties through proximal processes such as maternal postnatal depressive symptoms and responsive parenting. Participants consisted of 490 mother-child dyads assessed at three time points when children were, on average, 2 months old at Time 1 (T1), 18 months at Time 2 (T2), and 36 months at Time 3 (T3). Maternal abuse history and depressive symptoms were assessed via questionnaires at T1. Observations of responsive parenting were collected at T2 and were coded using a validated coding scheme. Children's internalizing difficulties were assessed in the preschool period using averaged parental reports. Path analysis revealed that maternal physical abuse was associated with depressive symptoms postnatally, which were in turn associated with children's internalizing behavior at 36 months of age. We also found that the association between physical abuse history and responsive parenting operated indirectly through maternal depressive symptoms. These findings remained after controlling for covariates including socioeconomic status, child gender, and age. After accounting for physical abuse history, sexual abuse history was not associated with child internalizing problems either directly or indirectly through maternal depressive symptoms and/or parenting behavior. Thus, mothers' physical abuse history is a risk factor for relatively poor mental health, which is itself predictive of both later parenting behavior and children's internalizing problems. [ABSTRACT FROM AUTHOR]

Maternal psychosocial stress during pregnancy is associated with risks to maternal health and birth outcomes, as well as adverse health and behavioral outcomes in offspring. Maternal immune dysregulation, particularly disruption of inflammatory processes, is also implicated in adverse perinatal health outcomes, with the greatest evidence in relation to preterm birth. Increasingly, the extent to which psychosocial stress induces dysregulation of inflammatory processes during pregnancy is being considered. In this article, I describe studies linking stress to immune function during pregnancy, with an emphasis on studies from my research group on inflammation. As reviewed here, research utilizing psychoneuroimmunology models in pregnancy is a rapidly developing area with abundant opportunities to address questions of clinical relevance for both maternal and child health. [ABSTRACT FROM PUBLISHER]

The article evaluates the use of mobile health care services in Malawi and explores the impact of mobile technology in maternal, newborn, and child health care in Malawi.

The article discusses the need to develop better technology to reduce barriers to access maternal and infant health care service and presents an introduction in which the editor discusses various reports within the issue on topics including mobile health service and maternal health service.

Background Cardiopulmonary arrest in pregnancy has a very high maternal and fetal mortality rate. We report a case of successful maternal and neonatal survival in association with emergency cesarean section of a schizophrenic pregnant patient. To our knowledge, this is the first reported case of cardiopulmonary arrest in a pregnant woman with schizophrenia. Case presentation The parents were Japanese. The mother was 39 years old and had no history of prior pregnancy. Her admission to our hospital at 36 weeks and 4 days of pregnancy was due to deterioration of schizophrenia. On the first day of hospitalization, she collapsed after a seizure and vomiting, and an emergency resuscitation team was called immediately. The team identified apparent aspiration and successfully resuscitated the patient after 11 minutes of cardiopulmonary arrest. An emergency cesarean section was performed in the operating room. The newborn male infant received bag and mask ventilation at birth, and his Apgar scores were 5 at 1 minute and 8 at 5 minutes. He had a myoclonic seizure on the 2nd day of life: however, he experienced no further seizures on anticonvulsant medication after that episode. On the 18th day of life, magnetic resonance imaging of his brain revealed bilateral small hyperintensities on T1-weighted images in the basal ganglia. The mother and her newborn were discharged from our hospital without neurological disorders. Conclusion We speculate that the cause of cardiopulmonary arrest was aspiration due to seizure, and it is possible that a neurological response was evoked by administration of antipsychotic drugs and/or by eclampsia. Medical staff must be aware of the possibility of cardiopulmonary arrest in pregnant women with schizophrenia. [ABSTRACT FROM AUTHOR]

Background: Maternal health behaviors during pregnancy/infancy can have a significant impact on maternal and child health. Many women engage in health risk behaviors during pregnancy. Multiple health behavior change (MHBC) interventions provide support to change health behaviors, but further information is needed on potential targets for such an intervention, as well as on the feasibility of technology use and e-health with this population. Materials and Methods: Two studies were completed as part of this project. First, a survey to examine views regarding health behaviors, desires to change health behaviors, and use of technology was completed by 68 pregnant women presenting for routine care. Based on survey findings, a brief MHBC e-health educational intervention related to breastfeeding, healthy nutrition/lifestyle, and stress management, using iPad® (Apple, Cupertino, CA) and text-messaging media, was then developed and piloted in the home with five pregnant women. Results: In the survey, the majority of participants reported interest in receiving help to improve health behaviors, including losing weight or eating a healthier diet, breastfeeding, smoking cessation, and help with depression. The majority of women reported access to a computer with Internet, a phone, and frequent use of text messaging. In the second phase, results suggest that the home-based intervention was feasible and that the technology was convenient and user-friendly. Conclusions: Pregnant women are interested in improving health behaviors and found a brief technology-based e-health intervention feasible, convenient, and user-friendly. In-home technology appears to be a feasible and convenient approach to addressing the multiple health behavior change needs of pregnant women. [ABSTRACT FROM AUTHOR]

Child support compliance continues to be a thorny policy issue. In Australia, major changes to the Child Support Scheme were introduced between 2006 and 2008, featuring a markedly different and purportedly 'fairer' system for the calculation of child support. Extra resources were also provided to the Child Support Agency (CSA) to ensure that child support is paid in full and on time. Did these initiatives lead to greater compliance by payers with their child support obligations? This article explores this question by examining child support compliance among several national random samples of CSA clients just prior to, 1 year after, and 3 years after, the introduction of a new child support formula on 1 July 2008. The new formula and strengthened enforcement regime appear to have had very little impact on compliance behaviour in Australia. [ABSTRACT FROM AUTHOR]

Because non-pharmacological methods of pain relief have no side effects on the mother and fetus and are easy to use, they are applicable in the labor process of labor. The present study was conducted to determine the effect of Quran sound on the intensity of pain and other parameters influencing the first stage of labor, as well as the nulliparous women, admitted to Ghamar-Bani Hashem Hospital in Khoi city, Iran. This was a quasi-experimental study conducted on 60 nulliparous women, selected and randomly divided into two groups. Immediately after entry to the delivery room, vital signs were recorded and the intensity of baseline pain was monitored and recorded using Visual Analog Scale. Then, only for the trial group, during the active phase of first stage of delivery, Quran sound (recited by Abdolbaset) was played alternately through headphones for half an hour; then, the intensity of pain and vital signs were measured and recorded. The statistical t-test was used for analysis of data, and the significance level was considered less than 0.05. The majority of subjects were 20-24 years old. The intensity of pain during the active phase of delivery showed a significant differences in the two control and trial groups. It is recommended that the Quran sound be used as a non-pharmacological method for pain relief, shortening the duration of the first stage delivery, improving the vital signs, and increasing the infant's Apgar score. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of two mechanical devices for cervical ripening: double versus single balloon catheters, both with extra-amniotic saline infusion (EASI). Methods: Women at term with a singleton pregnancy presenting for labor induction were assigned to receive the double balloon catheter (with EASI) or the single balloon catheter (with EASI). Outcomes included time from device insertion to delivery, rates of successful vaginal delivery and occurrence of adverse events. Results: One hundred and eighty-six women completed the study. Ripening success was comparable between the double and single balloon arms (96.4% versus 92.7%, p = 0.55, respectively). Balloon insertion to delivery interval was significantly shorter, and cesarean section rate was significantly lower in the double balloon arm compared with the single balloon arm (14.3 versus 15.8 h, p = 0.04 and 8.3% versus 20%, p = 0.05, respectively). There were no significant differences in maternal characteristics, satisfaction or adverse outcomes. Conclusions: This study is the first documented assessment of the double balloon catheter combined with EASI. Our findings suggest that the double balloon catheter results in reduced time to delivery and higher vaginal delivery rates, compared with the single balloon catheter with EASI, without compromising maternal or fetal safety. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of two mechanical devices for cervical ripening: double versus single balloon catheters, both with extra-amniotic saline infusion (EASI). Methods: Women at term with a singleton pregnancy presenting for labor induction were assigned to receive the double balloon catheter (with EASI) or the single balloon catheter (with EASI). Outcomes included time from device insertion to delivery, rates of successful vaginal delivery and occurrence of adverse events. Results: One hundred and eighty-six women completed the study. Ripening success was comparable between the double and single balloon arms (96.4% versus 92.7%, p = 0.55, respectively). Balloon insertion to delivery interval was significantly shorter, and cesarean section rate was significantly lower in the double balloon arm compared with the single balloon arm (14.3 versus 15.8 h, p = 0.04 and 8.3% versus 20%, p = 0.05, respectively). There were no significant differences in maternal characteristics, satisfaction or adverse outcomes. Conclusions: This study is the first documented assessment of the double balloon catheter combined with EASI. Our findings suggest that the double balloon catheter results in reduced time to delivery and higher vaginal delivery rates, compared with the single balloon catheter with EASI, without compromising maternal or fetal safety. [ABSTRACT FROM AUTHOR]

Introducing evidence-based accountability mechanisms at national and subnational levels into maternal newborn health programs can accelerate reductions in maternal and newborn mortality. Clearly packaged evidence has the potential to catalyze change, if it is communicated not only to the public but also to key policymakers. Evidence for Action (E4A) is a DFID-funded program that contributes to global efforts toward improving accountability in maternal and neonatal health. It uses evidence to drive action and accountability to improve maternal and newborn survival in six African countries: Ethiopia, Ghana, Malawi, Nigeria, Sierra Leone, and Tanzania. This paper introduces the E4A program, the rationale that underpins the program design, and presents initial findings on how information and data currently feed into accountability and implementation across the six E4A countries. [ABSTRACT FROM AUTHOR]

Since the 2010 launch of the UN Secretary-General’s Global Strategy for Women’s and Children’s Health, worldwide political energy coalesced around improving the health of women and children. Nigeria acted on a key recommendation emerging from the Global Strategy and became one of the first countries to establish an independent group known as the Nigeria Independent Accountability Mechanism (NIAM). NIAM aims to track efforts on progress related to Nigeria’s roadmap for the health of women and children. It includes eminent people from outside government to ensure independence, and is recognized within government to analyze and report on progress. The concept of NIAM received approval at various national and international forums, as well as from the Nigeria Federal Ministry of Health. This experience provides an example of connecting expertise and groups with the government to influence and accelerate progress in maternal, newborn, and child health. Engagement between government and civil society should become the norm rather than the exception to achieve national goals. [ABSTRACT FROM AUTHOR]

The article explores what counts today as an "emergency" in maternal healthcare in rural Guatemala. It argues that the creation and circulation of Planes de Emergencia (Emergency Plans) for birthing shape the possibilities for biomedical maternity care in this context. Drawing on fieldwork carried out in Santiago Atitlán, Guatemala, and on recent feminist scholarship on "emergency thinking," the article suggests that Emergency Plans, and the forms of care of which they are a part, generate their own forms of knowledge and ignorance. In so doing, these planning systems reconfigure both the sociality and temporality of biomedical maternity care in Guatemala today. This "technology of emergency" shifts moral responsibilities among care providers and mothers, engenders new intimate relationships while obviating other forms of collective security, and positions biomedical birth as the only possible outcome of moral action. Considering how this technology of emergency works as a mode of "reproductive governance" points to the ways in which reproduction is understood and managed in contexts beyond Guatemala. [ABSTRACT FROM AUTHOR]

Objective: To identify and describe research tools used to evaluate bonding between mother and child up to one year of age, as well as to provide information on reliability and validity measures related to these tools. Data source: Research studies available on PUBMED, LILACS, ScienceDirect, PsycINFO and CINAHL databases with the following descriptors: mother-child relations and mother infant relationship, as well as the expressions validity, reliability and scale. Data synthesis: 23 research studies were selected and fully analyzed. Thirteen evaluation research tools were identified concerning mother and child attachment: seven scales, three questionnaires, two inventories and one observation method. From all tools analyzed, the Prenatal Attachment Inventory presented the higher validity and reliability measures to assess mother and fetus relation during pregnancy. Concerning the puerperal period, better consistency coefficients were found for Maternal Attachment Inventory and Postpartum Bonding Questionnaire. Besides, the last one revealed a higher sensibility to identify amenable and severe disorders in the affective relations between mother and child. Conclusions: The majority of research tools are reliable to study the phenomenon presented, although there are some limitations regarding the construct and criterion related to validity. In addition to this, only two of them are translated into Portuguese and adapted to women and children populations in Brazil, being a decisive gap to scientific production in this area. [ABSTRACT FROM AUTHOR]

SUMMARY Objective To analyse anti-D quantification levels and frequency of intrauterine transfusion (IUT), per maternal ABO blood group. Background Maternally derived red cell allo-antibodies can target fetal red cell antigens in utero leading to haemolytic disease and fetal anaemia. When a clinically significant allo-antibody is formed the priority is ascertaining the risk to the fetus and maternal ABO blood groups are not considered relevant. Materials and methods This was a 10-year retrospective, observational study carried out on women referred for anti-D quantification ( n = 1106), and women whose fetuses required an IUT to treat fetal anaemia ( n = 62) due to anti-D, in the Republic of Ireland. Results Relative to the overall incidence of RhD allo-immunisation by blood group, women of blood group A were more likely to require IUT compared with those who were blood group O ( P = 0·002). Conclusion It is known that ABO feto-maternal compatibility can influence the incidence and level of red cell allo-antibodies in pregnancy; however, it does not account for the significantly high rate of severe haemolytic disease requiring IUT seen in blood group A women. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Public Health is the property of Turkish Journal of Public Health and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Following scientific advancements in the prevention of mother-to-child transmission (PMTCT) of HIV, a global plan is being implemented to virtually eliminate new pediatric HIV infections. However, despite revisions to guidelines for providing antiretroviral medications, including the availability of more effective drug regimens over the past decade, and the recent rapid scale-up of PMTCT services, sizeable challenges persist in achieving this goal. This paper provides a summary of recent approaches to the provision of antiretroviral medicines to pregnant women and the resulting implications. Emerging programmatic and service delivery considerations, aiming to increase the effectiveness of PMTCT programs to overcome barriers faced by women in accessing PMTCT services are also discussed. Worldwide elimination of pediatric HIV is now a possibility due to the increasing similarity of PMTCT guidelines in developing countries to those in developed countries. However the resulting practical challenges of implementation will require resources and support at local, national, and international levels. As developing countries strive to adopt and implement more efficacious drug regimens, the effectiveness of PMTCT programs will be determined by coverage of services and the recruitment and retention of pregnant women in the cascade. To expand services and provide an effective, comprehensive approach in under resourced settings, harmonized efforts to address barriers whilst considering contextual factors will be needed. [ABSTRACT FROM AUTHOR]

IMPORTANCE: There is accumulating evidence relating maternal smoking during pregnancy to attention-deficit/hyperactivity disorder (ADHD) without elucidating specific mechanisms. Research investigating the neurobiological underpinnings of this disorder has implicated deficits during response inhibition. Attempts to uncover the effect of prenatal exposure to nicotine on inhibitory control may thus be of high clinical importance. OBJECTIVE: To clarify the influence of maternal smoking during pregnancy (hereafter referred to as prenatal smoking) on the neural circuitry of response inhibition and its association with related behavioral phenotypes such as ADHD and novelty seeking in the mother's offspring. DESIGN, SETTING, AND PARTICIPANTS: Functional magnetic resonance imaging was performed for the offspring at 25 years of age during a modified Eriksen flanker/NoGo task, and voxel-based morphometry was performed to study brain volume differences of the offspring. Prenatal smoking (1-5 cigarettes per day [14 mothers] or >5 cigarettes per day [24 mothers]) and lifetime ADHD symptoms were determined using standardized parent interviews at the offspring's age of 3 months and over a period of 13 years (from 2 to 15 years of age), respectively. Novelty seeking was assessed at 19 years of age. Analyses were adjusted for sex, parental postnatal smoking, psychosocial and obstetric adversity, maternal prenatal stress, and lifetime substance abuse. A total of 178 young adults (73 males) without current psychopathology from a community sample followed since birth (Mannheim, Germany) participated in the study. MAIN OUTCOMES AND MEASURES: Functional magnetic resonance imaging response, morphometric data, lifetime ADHD symptoms, and novelty seeking. RESULTS: Participants prenatally exposed to nicotine exhibited a weaker response in the anterior cingulate cortex (t168 = 4.46; peak Montreal Neurological Institute [MNI] coordinates x = -2, y = 20, z = 30; familywise error [FWE]-corrected P = .003), the right inferior frontal gyrus (t168 = 3.65; peak MNI coordinates x = 44, y = 38, z = 12; FWE-corrected P = .04), the left inferior frontal gyrus (t168 = 4.09; peak MNI coordinates x = -38, y = 36, z = 8; FWE-corrected P = .009), and the supramarginal gyrus (t168 = 5.03; peak MNI coordinates x = 64, y = -28, z = 22; FWE-corrected P = .02) during the processing of the NoGo compared to neutral stimuli, while presenting a decreased volume in the right inferior frontal gyrus. These findings were obtained irrespective of the adjustment of confounders, ADHD symptoms, and novelty seeking. There was an inverse relationship between inferior frontal gyrus activity and ADHD symptoms and between anterior cingulate cortex activity and novelty seeking. CONCLUSIONS AND RELEVANCE: These findings point to a functional involvement of prenatal exposure to tobacco smoke in neural alterations similar to ADHD, which underlines the importance of smoking prevention treatments. [ABSTRACT FROM AUTHOR]

The determinants of maternal and child health have been the recurrent topics of study in developing countries. Using the Demographic and Health Survey (2010) of Colombia, this study aimed to identify the determinants for professional antenatal care and institutional delivery, taking into account the interdependence of these two decisions, which we consider using a bivariate probit model. This study found that when certain factors affecting both the decision to seek prenatal care and giving birth in a hospital are neglected, the results of the estimates are inefficient. Estimates show that the effects of education, parity, regional location and economic status on institutional delivery tend to be underestimated in a univariate probit model. The results indicate that economic status, level of education, parity and medical-insurance affiliation influenced the joint likelihood of accessing professional antenatal care and delivering in a health facility. An important finding is that mothers with a higher level of education are 9 percentage points more likely to access these two health services compared with mothers who are illiterate. Another observed finding is the regional disparities. The evidence indicates that mothers in the Pacific Region, the poorest region of Colombia, are 6 percentage points less likely to access such services. Thus, the results indicate that the Colombian health policy should emphasize increasing the level of schooling of mothers and establish health facilities in the poorest regions of the country to ensure that women in need are provided with social health insurance. [ABSTRACT FROM PUBLISHER]

Introduction: Satisfaction with medical care is defined as the patient's level of acceptance of healthcare, taking into account his or her needs and expectations. Purpose: Determining the level of satisfaction with care in the early postnatal period. Identification of factors affecting the level of satisfaction with care in the early postnatal period. Materials and methods: The study covered 100 women aged 15-45, patients of the Obstetrics and Gynecology Department. The study employed the diagnostic survey method, using a custom-designed questionnaire. Results: 68% of hospitalized patients rated the conditions in the unit as good and very good. According to 42% of them, both the doctors and the midwives provided the patients with exhaustive information and expressed empathy. 54% of the surveyed women had not been acquainted with the floor plan of the unit, and 75% of the personnel had not revealed their names or functions to the patients. Conclusions: More than a half of the respondents assessed the level of care as good or very good. Assessing the early postnatal care they received, they mostly considered the conditions ensured by the hospital, the level of care from the personnel, both with respect to the women and newborns, and the general atmosphere in the unit. [ABSTRACT FROM AUTHOR]

Information about the "Women Deliver Conference" on maternal health and safe birth that was held in Kuala Lumpur, Malaysia in May 2013 is presented. Topics discussed include sexual and reproductive health and rights, midwifery presence and family planning, and need for investments in education for empowerment of girls and women. The conference featured several experts including Kavita N. Ramdas, Debra Pascali Bonaro, and Robbie Davis-Floyd.

Abstract: Background: Poor vitamin D status (i.e. low serum 25-hydroxyvitamin D (25(OH)D)) has been associated with adverse clinical outcomes during pregnancy and childhood. However, the interpretation of serum 25(OH)D levels may be complicated by the presence of the C3-epimer of 25(OH)D. We aimed to quantify C3-epi-25(OH)D3 in pregnant women and fetuses, to explore the relationship of the C3-epimer between maternal and cord samples, and to establish whether infant C3-epimer abundance is explained by prenatal formation. Methods: In a sub-study of a randomized trial of prenatal vitamin D3, 25(OH)D3 and C3-epi-25(OH)D3 were quantified by LC–MS/MS in 71 sets of mother–fetus–infant serum samples, including maternal delivery specimens, cord blood, and infant specimens acquired at 3–28weeks of age. Results: Without supplementation, median concentrations of C3-epi-25(OH)D3 were higher in infants (6.80nmol/L) than mothers (0.45nmol/L) and cord blood (0nmol/L). However, there was substantial variation such that C3-epi-25(OH)D3 accounted for up to 11% (maternal), 14% (cord), and 25% (infant) of the total 25(OH)D3. Supplemental vitamin D3 significantly increased maternal–fetal C3-epi-25(OH)D3, and was a preferential source of C3-epi-25(OH)D3 compared to basal vitamin D, possibly due to C3-epi-cholecalciferol in the supplement. Multivariate regression did not suggest transplacental transfer of C3-epi-25(OH)D3, but rather indicated its generation within the fetal–placental unit from maternally-derived 25(OH)D3. Neither maternal nor fetal C3-epi-25(OH)D3 is accounted for the relatively high concentrations of infant C3-epi-25(OH)D3, suggesting rapid postnatal generation. Conclusions: C3-epi-25(OH)D3 is present in some pregnant women and fetuses, but does not appear to be efficiently transferred transplacentally. High C3-epimer concentrations in infancy are probably due to postnatal formation rather than fetal stores. [Copyright &y& Elsevier]

Introduction: There is a great deal of controversy regarding the effect of gestational magnesium (Mg) deficiency on fetal growth and the incidence of low birth weight (LBW) in infants. Therefore, this study aimed to delineate the possible relationship between maternal Mg level and infant LBW. Methods: This case-control study was conducted on 180 mothers in Shiraz, Iran. Fasting blood samples were obtained for magnesium after delivery. Maternal and neonatal demographic data were recorded, and the mothers were divided into two groups: the control group including mothers with normal-weight infants (≥2500 g), and the case group consisting of mothers with LBW infants (<2500 g). Results: Out of 90 samples obtained in each group, there was neither a statistical association between the mean maternal magnesium level and neonatal sex (P=0.43) or gestational age (P=0.56), nor a correlation between serum magnesium level and maternal parity (P=0.52), education (P=0.75), or occupation (P=0.59) in the groups. In addition, no significant relationship was observed between maternal serum magnesium level and birth weight in each group (P=0.79). Conclusion: Due to lack of a statistically significant relationship between magnesium level and birth weight, and considering the contribution of various factors for LBW, more studies are required to investigate the role of other nutrients in infant LBW. [ABSTRACT FROM AUTHOR]

As early as 1985, Rosenfield and Maine began to look at what is called the maternal child field (MCH). More than two decades later, maternal and infant mortality is still among the worst performing health indicator in resource-poor countries and regions, and it has barely changed since 1990. Although three of the eight United Nations Millennium Development Goals aim at reducing child mortality, maternal mortality, and promoting gender equality, most literature in the field is either clinical or exclusively deals with women's health problems. In this study, I proposed an empirical model that tests the impact of gender equality, women's human rights, and maternity care on MCH with economic and political development as background factors. The proposed model was tested by using structural equation analysis. Data were obtained from 137 developing countries. The proposed model is partially supported by the data. Empirical findings demonstrate that gender equality has a pivotal role to play in the promotion of MCH. The relationship between MCH and maternity care is found to be strong and statistically significant. This finding may permit a probable verification given the current social conditions in some developing countries, particularly the neglect of many of women's health needs and the assignment of their primary responsibilities in childrearing. The women's human rights hypothesis is not supported by the data. It is perhaps that human rights instruments provide a legal discourse for political functions and social welfare issues, but that the legal approach alone does not necessarily provide a moral and social foundation to ensure the implementation of social welfare and human well-being, particularly maternal and child health in developing countries. The findings also indicate the importance of economic development in predicting maternity care. Finally, a positive and statistically significant relationship is found between economic development and gender equality. Implications and limitations of the study are discussed. [ABSTRACT FROM AUTHOR]

Background: To determine the adequacy of resources (human and material) for provision of maternal health services at the primary health care (PHC) level in Nnewi, Nigeria. Materials and Methods: A cross-sectional study of women utilising maternal health services in four public PHC facilities in Nnewi selected using multistage sampling technique was done. Data was collected using a mix of quantitative and qualitative methods. Quantitative data was analysed using statistical package for social sciences (SPSS) version 16, while qualitative data was reported verbatim, analysed thematically and necessary quotes presented. Results: Two hundred and eighty women were studied. The mean age of respondents was 29.2 ± 5.9 years, while 231 (82.5%) were married. Most of them (82.5%) and 184 (66.1%), had their blood pressure and body weight respectively measured, while 196 (70.0%) had tetanus toxoid vaccination. Less than half of the respondents (41.4%) had urine test for sugar, and protein, while 94 (33.8%) had blood test for anaemia. The four facilities studied had most of the equipment and drugs available but in insufficient quantities. In three out of the four facilities, the physical structures were mostly good. None of them is equipped to provide an essential obstetric care (EOC) services, while one medical doctor covered all the facilities studied. Conclusions: This study showed that none of the health facilities is equipped with the minimum equipment package, essential drugs nor staff complement required to enable them offer quality maternal health services. With advocacy, technical support and funding, strategies could be implemented to provide quality maternal health services. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Dans le cadre du réseau de périnatalité ville–hôpital ELENA Loire–Nord-Ardèche, les liaisons postnatales entre les services de maternités et les services de protection maternelle et infantile (PMI) sont coordonnées par le conseil général de la Loire. Méthode: Nous avons évalué l’efficience de l’outil fiche de liaison (FDL) dans la transmission des informations, à partir de l’analyse de 819 FDL implémentées en 2011 par les services de maternité et de néonatologie du CHU de Saint-Étienne. Résultats: Le taux de remplissage des items ű obligatoires Ƈ de la FDL est supérieur à 90 % alors que le signalement aux familles des informations transmises à la PMI n’est pas optimal (63,4 %). Le secteur de PMI réalise un retour dans 91,1 % des cas. Parmi les items ű facultatifs Ƈ, les commentaires libres existent dans 82,5 % des FDL. Discussion: Une amélioration de l’information de l’usager sur la transmission d’information vers le secteur est nécessaire. Notre étude a montré que si le fond de la fiche de liaison est pertinent, la forme est perfectible ; nous proposons une version ű optimisée Ƈ de la FDL. Une informatisation et une implémentation optimales du logiciel interne du conseil général permettraient également de réduire les délais de transfert d’information. Conclusion: La coordination entre les acteurs hospitaliers et les services de protection maternelle et infantile du réseau de périnatalité Loire–Nord-Ardèche ELENA est perfectible. L’informatisation des liaisons entre les services hospitaliers et le conseil général est le seul garant d’une efficience de l’organisation humaine déjà mise en place. [ABSTRACT FROM AUTHOR]

An essay is presented on the infant welfare movement in Croydon, London, England, during the early 20th century. Particular focus is given to women volunteers involved in the movement and their motivations. Details on the organization known as the Croydon Mothers and Infants Welfare Association (CMIWA) are presented. According to the author, organizations such as the CMIWA allowed women to assume public responsibilities and engage in societal debates about motherhood ideals.

Purpose: to investigate the children writing and the relationship with the level of maternal education. Methods: the children's mothers were interviewed with a view to ascertaining their level of education, and other cultural aspects. Then, writing the children were assessed according to the Observation Guide for Spelling Zorzi (1998), composed of dictated words, sentences and texts, as well as textual productions, using the narrative genre, from pre-established themes . We evaluated 30 children, all enrolled in third grade of elementary education at a public school in Recife. The data were tabulated in a spreadsheet statistical analysis software SPSS. Result: it was observed that 20% of children have not yet reached the level of development of alphabetic writing, which is an important aspect, considering that in the third grade, kids should be consolidating functional reading and writing. Significant correlations were found between maternal education and the acquisition of the narrative scheme of stories, as well as between maternal education and reading habits of mothers. An analysis of spelling errors revealed that children were committing the same types of errors have already been observed in other populations, only with a higher frequency. Children who produced more structured narratives that were made more errors in spelling, which proves that the spelling error is inherent in the acquisition process of writing and does not preclude the production of texts. Conclusion: the learning of writing is influenced by social factors such as maternal education. These aspects need to be considered in the evaluation and diagnosis of speech therapy, as well as in educational practices offered by the school. [ABSTRACT FROM AUTHOR]

Background Maternity health care available in Canada is based on the needs of women born in Canada and often lacks the flexibility to meet the needs of immigrant women. The purpose of this study was to explore immigrant Chinese women's experiences in accessing maternity care, the utilization of maternity health services, and the obstacles they perceived in Canada. Methods This descriptive phenomenology study used in-depth unstructured interviews to examine immigrant Chinese women's experiences. Fifteen participants were recruited from the Chinese community in Toronto, Canada by using snowballing sampling. The interviews were digitally recorded and transcribed verbatim into written Chinese. The transcripts were analyzed using Colaizzi's (1978) phenomenological method. Results Six themes were extracted from the interviews: (1) preference for linguistically and culturally competent healthcare providers, with obstetricians over midwives, (2) strategies to deal with the inconvenience of the Canadian healthcare system (3) multiple resources to obtain pregnancy information, (4) the merits of the Canadian healthcare system, (5) the need for culturally sensitive care, and (6) the emergence of alternative supports and the use of private services. Conclusions The findings provide new knowledge and understanding of immigrant Chinese women's experiences in accessing maternity health services within a large metropolitan Canadian city. Participants described two unique experiences within the themes: preference for linguistically and culturally competent healthcare providers, with obstetricians over midwives, and the emergence of alternative supports and the use of private services. Few studies of immigrant maternity service access have identified these experiences which may be linked to cultural difference. Further investigation with women from different cultural backgrounds is needed to develop a comprehensive understanding of immigrant women's experiences with maternity care. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of congenital defects and to investigate their maternal and perinatal associated aspects by reviewing Birth Certificates. Methods: Among all born alive infants from January 2003 to December 2007 in Maternidade da Santa Casa de Misericórdia of São Carlos, Southeast Brazil (12,199 infants), cases were identified as the newborns whose Birth Certificates registered any congenital defect. The same sex neonate born immediately after the case was chosen as a control. In total, 13 variables were analyzed: six were maternal related, three represented labor and delivery conditions and four were linked to fetal status. The chi-square and Fisher's exact tests were used to compare the variables, being significant p<0.05. Results: The prevalence of congenital defects was 0.38% and the association of two or more defects represented 32% of all cases. The number of mothers whose education level was equal or less than eight years was significantly higher among the group with birth defects (p=0.047). A higher frequency of prematurity (p<0.001) and cesarean delivery (p=0.004) was observed among children with birth defects. This group also showed lower birth weight and Apgar scores in the 1st and the 5th minute (p<0.001). Conclusions: The prevalence of congenital defect of 0.38% is possibly due to underreporting. The defects notified in the Birth Certificates were only the most visible ones, regardless of their severity. There is a need of adequate epidemiological monitoring of birth defects in order to create and expand prevention and treatment programs. [ABSTRACT FROM AUTHOR]

Background: Health-seeking behaviour lies on the direct pathway between socio-economic position (SEP) and health outcomes. The objective of this systematic review is to identify and synthesise evidence of socio-economic gradients in health-seeking behaviours related to maternal and child health in Egypt. Methods: Four databases (Medline, Embase, Global Health and Web of Science) were searched in September 2013 for material published in English from 1992 to 2013 for a combination of terms describing health-seeking behaviours, indicators of socio-economic position and geographical limitation to Egypt. Findings of studies were described and synthesised in a narrative format as meta-analysis was not possible. Findings: Among the 786 references identified, 10 articles met the inclusion criteria. Six studies examined maternal and five studies child health-seeking behaviours (one study examined both). For maternal health, three dimensions of health-seeking behaviour (receipt of any care, type of care and intensity of care) were covered by studies of ante-natal and one dimension (type of care) by analyses of delivery care. For child health, two dimensions of preventive care (coverage of and intensity of immunisation) and three dimensions of curative care (receipt of any care, type and cost of care) were analysed. Conclusions: Based on two studies of time trends in nationally-representative surveys, socio-economic inequalities in seeking care for basic preventive and curative interventions in maternal and child health appear to have narrowed. Limited evidence of gradients in intensity of maternal preventive and provider selection in child curative care showed that inequalities may have widened. In studies of more geographically and socially homogeneous samples, fewer gradients were identified. Current body of evidence contains numerous limitations and gaps and is insufficient to draw a conclusive summary of such gradients. Improved understanding of SEP gradients is crucial in designing and prioritising interventions to equitably improve maternal and child health outcomes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the effects of dietary counseling on blood lipid concentrations during and after pregnancy. Methods: Partcipants (N = 256) were randomized into three study groups: dietary counseling with probiotics or placebo and a control group at first trimester of pregnancy. Diet quality was evaluated from food records by an index of healthy eating and total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides, apolipoproteins A-I and B, and lipoprotein (a) were measured at the first and third trimesters of pregnancy and 1, 6, and 12 mo postpartum. Results: During pregnancy, no differences in lipid values were noted among the groups, but postpartum TC and LDL-C were lower in both dietary counseling groups compared with controls (P = 0.027 and P = 0.012, respectively). Higher points on the healthy eating index, normal weight, and regular exercise were associated with a more favorable lipid profile at 12 mo after delivery. Conclusion: Maternal dietary counseling may lower maternal TC and LDL-C levels postpartum. A healthy lifestyle during pregnancy and postpartum may benefit women's cardiovascular health. [ABSTRACT FROM AUTHOR]

Background Postnatal care is essential to save the life of the mother and newborn. Knowledge on the determinants of postnatal care assists the policy makers to design, justify and implement appropriate interventions. The current study aimed to analyse the factors associated with utilisation of postnatal care services by mothers in Nepal based on the data from Nepal Demographic and Health Survey (NDHS) 2011. Methods This study utilised the data from NDHS 2011. The association between utilisation of at least one postnatal care visit (within 6 weeks of delivery) and immediate postnatal care (within 24 hours of delivery) with selected factors was examined by using Chi-square test (χ²), followed by multiple logistic regressions. Result Of the 4079 mothers, 43.2% reported attending postnatal care within the first six weeks of birth, while 40.9% reported attending immediate postnatal care. Mothers who were from urban areas, from rich families, who were educated, whose partners were educated, who delivered in a health facility, who had attended a four or more antenatal visits, and whose delivery was attended by a skilled attendant were more likely to report attending at least one postnatal care visit. On the other hand, mothers who reported agricultural occupation, and whose partners performed agricultural occupation were less likely to have attended at least one postnatal care visit. Similarly, mothers who were from the urban areas, from rich families, who were educated, whose partners were educated, who had attended four or more antenatal visits, who delivered in a health facility and had delivered in the presence of a skilled birth attendant were more likely to report attending immediate postnatal care. Mothers who reported agricultural occupation, and whose partners performed agricultural occupation were less likely to attend immediate postnatal care. Conclusion The majority of postnatal mothers in Nepal did not seek postnatal care. Increasing utilisation of the recommended four or more antenatal visits, delivery at health facility and increasing awareness and access to services through community-based programs especially for the rural, poor, and less educated mothers may increase postnatal care attendance in Nepal. [ABSTRACT FROM AUTHOR]

Objectives. In order to comprehensively examine the risks and resources associated with racial-ethnic disparities in adverse obstetric outcomes, the Los Angeles County Department of Public Health and the University of California, Los Angeles, joined efforts to design and implement the 2007 Los Angeles Mommy and Baby (LAMB) study. This paper aims to present the conceptual frameworks underlying the study's development, highlight the successful collaboration between a research institution and local health department, describe the distinguishing characteristics of its methodology, and discuss the study's implications for research, programs, and policies. Methods. The LAMB study utilized a multilevel, multistage cluster design with a mixed-mode methodology for data collection. Two samples were ultimately produced: the multilevel sample (n = 4,518) and the augmented final sample (n = 6,264). Results. The LAMB study allowed us to collect multilevel data on the risks and resources associated with racial-ethnic disparities in adverse obstetric outcomes. Both samples were more likely to be Hispanic, aged 20-34 years, completed at least 12 years of schooling, and spoke English. Conclusions. The LAMB study represents the successful collaboration between an academic institution and local health department and is a theoretically based research database and surveillance system that informs effective programmatic and policy interventions to improve outcomes among LAC's varied demographic groups. [ABSTRACT FROM AUTHOR]

Globalization is, in part, an economic force to bring about a closer integration of national economies. Globalization is also a biological, social and ideological process of change. Globalization results in powerful multinational corporations imposing their products on new markets. Food globalization brings about nutritional transitions, the most common being a shift from a locally-grown diet with minimally refined foods, to the modern diet of highly processed foods, high in saturated fat, animal products and sugar, and low in fiber. This paper will examine the influences of food globalization using the Maya of Mexico as a case study. The Maya people of Mexico are a poignant case. Maya health and culture has deteriorated as a result, with highly processed foods affecting physical growth and health of Maya children and their families. The case of the Maya is not isolated and we must come to terms with food globalization if we are to translate research into better child health and well-being [ABSTRACT FROM AUTHOR]

The article focuses on the Impacting Maternal and Prenatal Care Together (IMPACT) Collaborative program of Harris County, Texas. Topics discussed include how the birth outcome data in Harris Counry have driven the collaborative partnership to deal with the issues of preterm birth, infant mortality, and pregnancy-related mortality, how the members of IMPACT are working at various levels such as education and legislative policy, and the developmental process of IMPACT.