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Background: Fertility is one of the three main components which determines the size, structure, and composition of a population, and fertility preferences are important measures for forecasting fertility levels of a population. Therefore, this study aims to assess the impacts of the inequalities in the utilization of key maternal health services on fertility preference among high parity women in four selected regions (i.e., Afar, Beninshangul-Gumuz, Gambella and Somali) of Ethiopia. Methods: The study used data collected for the 2016 Ethiopian Demographic and Health Surveys (EDHS) survey. It includes a total of 977 high parity women (104 urban and 873 rural) residing in the four regions of the study. Bivariate logistic regression was used to select the potential variables by using a cut off p-value < 0.2 and then the multivariable logistic regression analyses were performed to assess the association between the selected explanatory variables (i.e., control and exposure variables) and the outcome variable (i.e. fertility preference). Further, the study employed a Population Attributable Fractions (PAFs) to examine the population level impacts of the inequalities in maternal and child health service variables on fertility preference. Results: The results showed that religion, household wealth index, place of delivery and contraceptive use were significantly associated with fertility preference. The results of the PAFs analysis indicated that contraceptive use had the biggest impact (80%), meaning that non-use of contraceptive increased fertility preference among women in the four regions. Similarly, out of health facility delivery increased fertility preference by 37%. Conclusion: The study findings underscore the critical factors influencing women's fertility preferences in the studied regions. Low utilization of maternal health services had an impact on fertility preference, accounting for more than half of the observed variations in fertility preferences. To address this issue, targeted interventions are recommended: enhancing access to maternal health services, strengthening fertility control programs, promoting the benefits of using these services, and actively addressing inequalities. [ABSTRACT FROM AUTHOR]

Background: Pregnancy-Induced Hypertensive Disorders (PIHD) include conditions like Pre-Eclampsia, Eclampsia, and Gestational Hypertension, impacting 5–10% of pregnancies globally. These disorders are responsible for 16% of maternal deaths in Sub-Saharan Africa and account for 16.9% of maternal mortality in Ethiopia, representing 10% of the country's total maternal deaths. Objective: To identify predictors of PIHD among pregnant and delivery women in public hospitals and primary health care units (health centers) in Sidama, Ethiopia. Methods: A multi-center unmatched case–control study was conducted on women in antenatal care and obstetrics/gynecology departments at 12 randomly selected public health institutions, including one specialized teaching hospital, two general hospitals, three primary hospitals, and six health centers. The study involved 920 women (230 cases and 690 controls) selected from December 2023 to February 2024. Cases included pregnant or delivery women at 20 + weeks gestation with PIHD such as pre-eclampsia, eclampsia, gestational hypertension, and chronic hypertension with superimposed preeclampsia. Controls were normotensive pregnant women or delivering mothers without PIHD after 20 weeks gestation. Data was manually verified, entered, and validated using Epidata software, followed by analysis with SPSS 22. Univariate analysis assessed predictors of PIHD, while binary logistic regression evaluated the relationships between factors. Model fitness was checked using collinearity assessments and the Hosmer–Lemeshow test, with variables having a P value < 0.05 deemed independent predictors. Results: Out of 920 planned participants, 686 were included, resulting in a response rate of 94.35%. Factors associated with PIHD in women included age at first conception (AOR = 1.26), mid (AOR = 6.05) and high (AOR = 5.01) wealth index levels, multigravidity (AOR = 4.34), pregnancy age ≥ 42 weeks (AOR = 3.65), maternal mid-upper arm circumference (MUAC) (AOR = 1.29), hemoglobin levels of 6.5–10.9 g/dL (AOR = 5.59), pre-pregnancy Body Mass Index (BMI) ≥ 25 kg/M2 (AOR = 0.81), preexisting hypertension (AOR = 8.97), family history of diabetes mellitus (AOR = 20.02), former alcohol consumption (AOR = 0.27), and total physical activity during pregnancy (AOR = 0.54). Conclusions: The study identifies key predictors of PIHD in women, including age at conception, wealth index, multigravidity, gestational age, and pre-pregnancy BMI. It underscores the link between socioeconomic status and maternal health, highlighting that financial resources alone don't ensure better outcomes without educational access. The research advocates for a health intervention strategy focusing on socioeconomic factors and public health initiatives to reduce maternal health disparities while exploring the role of partner stability and psychosocial aspects. [ABSTRACT FROM AUTHOR]

Non-Hodgkin's Lymphoma (NHL) is the most common subtype of lymphoma. The incidence of venous thromboembolism (VTE) in aggressive NHL was estimated recently to be 11%. Several risk assessment scores and factors are available to help identify cancer patients at risk for developing VTE. Patients with a pathologically confirmed diagnosis of NHL were identified at the Oncology Center of Mansoura University. The study included 777 patients: 719 with DLBCL-NOS, 26 with Anaplastic-B-cell, and 32 with T-cell-rich-NHL. Data were retrospectively collected from electronic medical records, including clinical, radiological, and laboratory information related to VTE and NHL. The median age at NHL diagnosis was 53 years, (range: 18–98). There was a male predominance, 51.4% of the cases. At initial lymphoma diagnosis, VTE was identified in 46 (5.9%) patients, and 61 (7.9%) patients experienced VTE while undergoing chemotherapy. According to logistic regression analysis, a PS (performance status) ≥ 2, bulky lesions, and mediastinal masses were significant predictors of VTE at presentation, with P-values of 0.022, 0.002, and < 0.001, respectively. Meanwhile, NHL patients who developed VTE during chemotherapy had significantly poorer PS, higher absolute neutrophilic counts (ANC), neutrophil/lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lactate dehydrogenase (LDH) levels than lymphoma patients without VTE, with P-values of 0.003, 0.034, 0.049, 0.01 and 0.007, respectively, as determined by multivariate analysis. The ROC curve identified the cut-off values of 4.875 × 109/L for ANC, 2.985 for NLR, 144.85 for PLR, and 417.5 U/L for LDH as potential markers for predicting VTE in NHL patients. Patients with a PS ≥ 2 and values exceeding these cut-offs for ANC, NLR, and PLR experienced significantly higher incidences of VTE than other groups, with P-values of 0.003, < 0.001, < 0.001, and < 0.001, respectively. At the end of the follow-up, the overall survival was significantly shortened by VTE occurring during chemotherapy, hypoalbuminemia, intermediate-high and high international prognostic index (IPI) scores (intermediate-high and high), responses other than CR and relapse, all with P-values < 0.05. ECOG PS and Inflammatory markers such as NLR, PLR, and neutrophilic count could serve as predictors of the development of thrombotic events in patients with NHL-DLBCL. Additionally, the occurrence of VTE during chemotherapy is an independent poor prognostic marker for overall survival (OS). [ABSTRACT FROM AUTHOR]

Balanced energy protein (BEP) supplementation is an efficacious intervention in pregnancy for improving birthweight and is recommended by World Health Organization (WHO) in countries with high maternal undernutrition. Few countries have implemented BEP programmes due in part to high cost, lack of data on acceptability and feasibility, and complexity of delivery. We sought to address implementation gaps in BEP interventions through a formative study designed to understand implementation outcomes. We conducted 52 in‐depth interviews and 8 focus‐group discussions with married women of reproductive age, family members, health care providers and pharmacists in three unions of the Gaibandha district in rural Bangladesh. Interviews were translated and transcribed in English and analysed using an analytic framework for implementation science in nutrition. BEP was viewed as an acceptable and appropriate intervention to combat undernutrition in this setting. There was a lack of clarity on who should or could be responsible for providing/distributing BEP in a way convenient to mothers. Many participants preferred door‐to‐door delivery and thought this approach could address social and gender inequities, but providers mentioned already being overworked and worried about adding new tasks. Participants were concerned about the affordability of BEP and opportunity costs associated with travel to proposed distribution sites such as ANC or pharmacies. Women in these communities do not always have the agency to travel without supervision or make purchasing decisions. BEP supplementation is a complex intervention; future trials seek to assess ways to overcome these implementation challenges and inform a long‐term systems‐owned BEP intervention. Key messages: Balanced energy protein (BEP) supplementation is an efficacious intervention in pregnancy for improving birthweight but its implementation through ANC, as recommended by WHO, is complex.Decisions about who bears the cost of the product should consider the feasibility of scaling solutions to different groups. Targeting the most in need and with government supported programmes should be considered.Door‐to‐door distribution emerged as the preferred delivery modality, though the feasibility of this mechanism at scale is a concern, particularly given the documented lack of human resources in health.Given the positive community perceptions around BEP supplements, delivery through ANC could increase ANC participation. [ABSTRACT FROM AUTHOR]

Background: Coronavirus Disease 2019 (COVID–19) has been associated with adverse effects and death among people with low immunity, including pregnant women. Despite introducing the vaccine as the proper means to curb the spread of the pandemic, vaccine uptake is still low. This study assessed the influence of perception, attitude, and trust toward COVID-19 vaccine uptake among pregnant women attending Antenatal Care Clinics. Methods: A cross-sectional study design was used, utilizing a quantitative approach with a cross-sectional analytical design conducted in Mbeya urban, distribution of sample size during data collection based on client's volume at three government health facilities (one tertiary health facility, one secondary health facility, and one primary health facility) in Mbeya Urban, Tanzania. Data were collected from 333 pregnant women who attended ANC during the data collection period using a questionnaire with closed-ended questions administered to respondents face-to-face. Data cleaning and analysis were done using Excel and Stata/SE 14.1 software for bivariate and multivariate data; Pearson's chi-squire and Fisher's test were used to analyze the independent determinants of COVID-19 vaccine uptake. Results: The proportion of pregnant women vaccinated with the COVID-19 vaccine was 27%. There was a statistically significant association between the respondents' vaccine uptake with primary education and < 5 work experience to vaccine uptake P = 0.015 (AOR = 6.58; 95% CI; 1.45–29.85), and P = 0.046 (AOR = 2.45; 95% CI; 1.02–5.89) respectively. The association of attitude influence to COVID-19 vaccine uptake was statistically significant (acceptance of vaccine due to its availability, vaccine acceptance for protection against COVID-19 pandemic to respondent and her baby, experience from other vaccines) was statistically significant at P = 0.011 (AOR = 4.43; 95% CI; 1.41–13.93), P = 0.001 (AOR = 45.83; 95% CI; 18.6-112.89) respectively. The level of trust in the COVID-19 vaccine influenced respondents' association with vaccine uptake in the 2nd and 3rd trimesters of pregnancy (P = 0.633 (AOR = 1.23; 95% CI; 0.53–2.48), respectively. Conclusion: Pregnant women's positive attitude and trust in the COVID-19 vaccine influenced them to uptake it; our conclusion supports the WHO guidelines that the COVID-19 vaccine should be administered to pregnant women since it is a safer means to curb COVID-19 pregnancy-related complications. [ABSTRACT FROM AUTHOR]

Abstract Background Pregnancy-Induced Hypertensive Disorders (PIHD) include conditions like Pre-Eclampsia, Eclampsia, and Gestational Hypertension, impacting 5–10% of pregnancies globally. These disorders are responsible for 16% of maternal deaths in Sub-Saharan Africa and account for 16.9% of maternal mortality in Ethiopia, representing 10% of the country's total maternal deaths. Objective To identify predictors of PIHD among pregnant and delivery women in public hospitals and primary health care units (health centers) in Sidama, Ethiopia. Methods A multi-center unmatched case–control study was conducted on women in antenatal care and obstetrics/gynecology departments at 12 randomly selected public health institutions, including one specialized teaching hospital, two general hospitals, three primary hospitals, and six health centers. The study involved 920 women (230 cases and 690 controls) selected from December 2023 to February 2024. Cases included pregnant or delivery women at 20 + weeks gestation with PIHD such as pre-eclampsia, eclampsia, gestational hypertension, and chronic hypertension with superimposed preeclampsia. Controls were normotensive pregnant women or delivering mothers without PIHD after 20 weeks gestation. Data was manually verified, entered, and validated using Epidata software, followed by analysis with SPSS 22. Univariate analysis assessed predictors of PIHD, while binary logistic regression evaluated the relationships between factors. Model fitness was checked using collinearity assessments and the Hosmer–Lemeshow test, with variables having a P value

Abstract Background Coronavirus Disease 2019 (COVID–19) has been associated with adverse effects and death among people with low immunity, including pregnant women. Despite introducing the vaccine as the proper means to curb the spread of the pandemic, vaccine uptake is still low. This study assessed the influence of perception, attitude, and trust toward COVID-19 vaccine uptake among pregnant women attending Antenatal Care Clinics. Methods A cross-sectional study design was used, utilizing a quantitative approach with a cross-sectional analytical design conducted in Mbeya urban, distribution of sample size during data collection based on client’s volume at three government health facilities (one tertiary health facility, one secondary health facility, and one primary health facility) in Mbeya Urban, Tanzania. Data were collected from 333 pregnant women who attended ANC during the data collection period using a questionnaire with closed-ended questions administered to respondents face-to-face. Data cleaning and analysis were done using Excel and Stata/SE 14.1 software for bivariate and multivariate data; Pearson’s chi-squire and Fisher’s test were used to analyze the independent determinants of COVID-19 vaccine uptake. Results The proportion of pregnant women vaccinated with the COVID-19 vaccine was 27%. There was a statistically significant association between the respondents’ vaccine uptake with primary education and

Abstract Background Globally, infant mortality is one of the major public health threats, especially in low-income countries. The infant mortality rate of Somalia stands at 73 deaths per 1000 live births, which is one of the highest infant death rates in the region as well as in the world. Therefore, the aim of this study was to ascertain the risk factors of infant mortality in Somalia using national representative data. Method In this study, data from the Somali Health and Demographic Survey (SHDS), conducted for the first time in Somalia in 2018/2019 and released in 2020, were utilized. The analysis of the data involved employing the Chi-square test as a bivariate analysis. Furthermore, a multivariate Cox proportional hazard model was applied to accommodate potential confounders that act as risk factors for infant death. Results The study found that infant mortality was highest among male babies, multiple births, and those babies who live in rural areas, respectively, as compared to their counterparts. Those mothers who delivered babies with small birth size and belonged to a poor wealth index experienced higher infant mortality than those mothers who delivered babies with average size and belonged to a middle or rich wealth index. Survival analysis indicated that mothers who did use ANC services (HR = 0.740; 95% CI = 0.618–0.832), sex of the baby (HR = 0.661; 95% CI = 0.484–0.965), duration of pregnancy (HR = 0.770; 95% CI = 0.469–0.944), multiple births (HR = 1.369; 1.142–1.910) and place of residence (HR = 1.650; 95% CI = 1.451–2.150) were found to be statistically significantly related to infant death. Conclusion The study investigated the risk factors associated with infant mortality by analyzing data from the first Somali Health and Demographic Survey (SHDS), which included a representative sample of the country’s population. Place of residence, gestational duration, infant’s gender, antenatal care visits, and multiple births were identified as determinants of infant mortality. Given that infant mortality poses a significant public health concern, particularly in crisis-affected countries like Somalia, intervention programs should prioritize the provision of antenatal care services, particularly for first-time mothers. Moreover, these programs should place greater emphasis on educating women about the importance of receiving antenatal care and family planning services, in order to enhance their awareness of these vital health services and their positive impact on infant survival rates.

Abstract Background The world health organization’s global health observatory defines maternal mortality as annual number of female deaths, regardless of the period or location of the pregnancy, from any cause related to or caused by pregnancy or its management (aside from accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy and an estimated 287 000 women worldwide passed away from maternal causes between 2016 and 2020, that works out to be about 800 deaths per day or about one every two minutes. Method The most recent 2018–2023 DHS data set of 14 SSA countries was used a total of 89,489 weighted mothers who gave at list one live birth 3 years preceding the survey were included, a multilevel analysis was conducted. In the bi-variable analysis variables with p-value ≤ 0.20 were included in the multivariable analysis, and in the multivariable analysis, variables with p-value less than ≤ 0.05 were considered to be significant factors associated with having eight and more ANC visits. Result The magnitude of having eight and more ANC visits in 14 sub-Saharan African countries was 8.9% (95% CI: 8.76–9.13) ranging from 3.66% (95% CI: 3.54–3.79) in Gabon to 18.92% (95% CI: 18.67–19.17) in Nigeria. The multilevel analysis shows that maternal age (40–44, AOR;2.09, 95%CI: 1.75–2.53), maternal occupational status (AOR;1.14, 95%CI; 1.07–1.22), maternal educational level (secondary and above, AOR;1.26, 95%CI; 1.16–1.38), wealth status(AOR;1.65, 95%CI; 1.50–1.82), media exposure (AOR;1.20, 95%CI; 1.11–1.31), pregnancy intention (AOR;1.12, 95%CI; 1.05–1.20), ever had terminated pregnancy (AOR;1.16 95%CI; 1.07–1.25), timely initiation of first ANC visit (AOR;4.79, 95%CI; 4.49–5.10), empowerment on respondents health care (AOR;1.43, 95%CI; 1.30–1.56), urban place of residence (AOR;1.33, 95%CI; 1.22–1.44) were factors highly influencing the utilization of AN. On the other hand higher birth order (AOR;0.54, 95%CI; 0.53–0.66), not using contraceptive (AOR;0.80, 95%CI; 0.75–0.86) and survey year (AOR;0.47, 95%CI; 0.34–0.65) were factors negatively associated with having eight and more ANC visits. Conclusion In the 14 SSA included in this study, there is low adherence to WHO guidelines of eight and more ANC visits. Being educated, having jobs, getting access to media being from rural residence and rich wealth group contribute to having eight and more ANC visits, so we highly recommend policy implementers to advocate this practices.

Background: Globally, infant mortality is one of the major public health threats, especially in low-income countries. The infant mortality rate of Somalia stands at 73 deaths per 1000 live births, which is one of the highest infant death rates in the region as well as in the world. Therefore, the aim of this study was to ascertain the risk factors of infant mortality in Somalia using national representative data. Method: In this study, data from the Somali Health and Demographic Survey (SHDS), conducted for the first time in Somalia in 2018/2019 and released in 2020, were utilized. The analysis of the data involved employing the Chi-square test as a bivariate analysis. Furthermore, a multivariate Cox proportional hazard model was applied to accommodate potential confounders that act as risk factors for infant death. Results: The study found that infant mortality was highest among male babies, multiple births, and those babies who live in rural areas, respectively, as compared to their counterparts. Those mothers who delivered babies with small birth size and belonged to a poor wealth index experienced higher infant mortality than those mothers who delivered babies with average size and belonged to a middle or rich wealth index. Survival analysis indicated that mothers who did use ANC services (HR = 0.740; 95% CI = 0.618–0.832), sex of the baby (HR = 0.661; 95% CI = 0.484–0.965), duration of pregnancy (HR = 0.770; 95% CI = 0.469–0.944), multiple births (HR = 1.369; 1.142–1.910) and place of residence (HR = 1.650; 95% CI = 1.451–2.150) were found to be statistically significantly related to infant death. Conclusion: The study investigated the risk factors associated with infant mortality by analyzing data from the first Somali Health and Demographic Survey (SHDS), which included a representative sample of the country's population. Place of residence, gestational duration, infant's gender, antenatal care visits, and multiple births were identified as determinants of infant mortality. Given that infant mortality poses a significant public health concern, particularly in crisis-affected countries like Somalia, intervention programs should prioritize the provision of antenatal care services, particularly for first-time mothers. Moreover, these programs should place greater emphasis on educating women about the importance of receiving antenatal care and family planning services, in order to enhance their awareness of these vital health services and their positive impact on infant survival rates. [ABSTRACT FROM AUTHOR]

Background: The world health organization's global health observatory defines maternal mortality as annual number of female deaths, regardless of the period or location of the pregnancy, from any cause related to or caused by pregnancy or its management (aside from accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy and an estimated 287 000 women worldwide passed away from maternal causes between 2016 and 2020, that works out to be about 800 deaths per day or about one every two minutes. Method: The most recent 2018–2023 DHS data set of 14 SSA countries was used a total of 89,489 weighted mothers who gave at list one live birth 3 years preceding the survey were included, a multilevel analysis was conducted. In the bi-variable analysis variables with p-value ≤ 0.20 were included in the multivariable analysis, and in the multivariable analysis, variables with p-value less than ≤ 0.05 were considered to be significant factors associated with having eight and more ANC visits. Result: The magnitude of having eight and more ANC visits in 14 sub-Saharan African countries was 8.9% (95% CI: 8.76–9.13) ranging from 3.66% (95% CI: 3.54–3.79) in Gabon to 18.92% (95% CI: 18.67–19.17) in Nigeria. The multilevel analysis shows that maternal age (40–44, AOR;2.09, 95%CI: 1.75–2.53), maternal occupational status (AOR;1.14, 95%CI; 1.07–1.22), maternal educational level (secondary and above, AOR;1.26, 95%CI; 1.16–1.38), wealth status(AOR;1.65, 95%CI; 1.50–1.82), media exposure (AOR;1.20, 95%CI; 1.11–1.31), pregnancy intention (AOR;1.12, 95%CI; 1.05–1.20), ever had terminated pregnancy (AOR;1.16 95%CI; 1.07–1.25), timely initiation of first ANC visit (AOR;4.79, 95%CI; 4.49–5.10), empowerment on respondents health care (AOR;1.43, 95%CI; 1.30–1.56), urban place of residence (AOR;1.33, 95%CI; 1.22–1.44) were factors highly influencing the utilization of AN. On the other hand higher birth order (AOR;0.54, 95%CI; 0.53–0.66), not using contraceptive (AOR;0.80, 95%CI; 0.75–0.86) and survey year (AOR;0.47, 95%CI; 0.34–0.65) were factors negatively associated with having eight and more ANC visits. Conclusion: In the 14 SSA included in this study, there is low adherence to WHO guidelines of eight and more ANC visits. Being educated, having jobs, getting access to media being from rural residence and rich wealth group contribute to having eight and more ANC visits, so we highly recommend policy implementers to advocate this practices. [ABSTRACT FROM AUTHOR]

Background: Southern African countries have the largest global burden of HIV and syphilis, with a high prevalence among women of reproductive age. Although antenatal screening is standard of care, syphilis screening has generally lagged behind HIV screening. We aimed to evaluate the performance and operational characteristics of two commercial dual HIV/syphilis point-of-care tests (POCTs) for simultaneous maternal HIV/syphilis screening. Methods: A clinic-based evaluation of dual HIV/syphilis POCTs (SD Bioline and Chembio) was conducted at five primary healthcare centres (PHCs) in South Africa and Zambia. POCT results using capillary fingerprick blood were compared to reference laboratory syphilis and HIV serological assays. Results: Three thousand four hundred twelve consenting pregnant women aged ≥ 18 years were enrolled. The prevalence of treponemal antibody seropositivity and HIV infection ranged from 3.7 to 9.9% (n = 253) and 17.8 to 21.3% (n = 643), respectively. Pooled sensitivity for syphilis compared to the reference assay was 66.0% (95%CI 57.7–73.4) with SD Bioline and 67.9% (95%CI 58.2–76.3) with Chembio. Pooled specificity for syphilis was above 98% with both POCTs. The sensitivities of SD Bioline and Chembio assays were 78.0% (95%CI 68.6–85.7) and 81.0% (95%CI 71.9–88.2), respectively compared to an active syphilis case definition of treponemal test positive with a rapid plasma reagin titre of ≥ 8. The negative predictive values (NPVs) based on various prevalence estimates for syphilis with both assays ranged from 97 to 99%. The pooled sensitivity for HIV was 92.1% (95%CI 89.4–94.2) with SD Bioline; and 91.5% (95%CI 88.2–93.9) with Chembio. The pooled specificities for HIV were 97.2% (95%CI 94.8–98.5) with SD Bioline and 96.7% (95%CI 95.1–97.8) with Chembio. The NPV based on various prevalence estimates for HIV with both assays was approximately 98%. Most participating women (91%) preferred dual POCTs over two single POCTs for HIV and syphilis, and healthcare providers gave favourable feedback on the utility of both assays at PHC level. Conclusions: Based on the need to improve antenatal screening coverage for syphilis, dual HIV/syphilis POCTs could be effectively incorporated into antenatal testing algorithms to enhance efforts towards elimination of mother-to-child transmission of these infections. [ABSTRACT FROM AUTHOR]

Abstract Balanced energy protein (BEP) supplementation is an efficacious intervention in pregnancy for improving birthweight and is recommended by World Health Organization (WHO) in countries with high maternal undernutrition. Few countries have implemented BEP programmes due in part to high cost, lack of data on acceptability and feasibility, and complexity of delivery. We sought to address implementation gaps in BEP interventions through a formative study designed to understand implementation outcomes. We conducted 52 in‐depth interviews and 8 focus‐group discussions with married women of reproductive age, family members, health care providers and pharmacists in three unions of the Gaibandha district in rural Bangladesh. Interviews were translated and transcribed in English and analysed using an analytic framework for implementation science in nutrition. BEP was viewed as an acceptable and appropriate intervention to combat undernutrition in this setting. There was a lack of clarity on who should or could be responsible for providing/distributing BEP in a way convenient to mothers. Many participants preferred door‐to‐door delivery and thought this approach could address social and gender inequities, but providers mentioned already being overworked and worried about adding new tasks. Participants were concerned about the affordability of BEP and opportunity costs associated with travel to proposed distribution sites such as ANC or pharmacies. Women in these communities do not always have the agency to travel without supervision or make purchasing decisions. BEP supplementation is a complex intervention; future trials seek to assess ways to overcome these implementation challenges and inform a long‐term systems‐owned BEP intervention.

IntroductionAnemia is one of the most serious health problems impacting people worldwide. The disease is quiet, moving slowly and producing only a few physical symptoms. Anemia during pregnancy raises the risk of premature birth, low birth weight, and fetal anomalies, and it can have a substantial financial impact on society and families. However, there was a paucity of studies on the magnitude and associated factors of anemia among pregnant women in southern Ethiopia.ObjectiveThis study aimed to assess the magnitude and associated factors of anemia among pregnant women attending antenatal care in the Hawella Tula Sub-city of Hawassa City in 2021.MethodsInstitution-based cross-sectional study was done on 341 randomly selected pregnant women attending antenatal care clinics. Data were obtained using a standardized semi-structured questionnaire. To identify the associated factors for the magnitude of anemia logistic regression model was used with an adjusted odds ratio (AOR) with 95% confidence intervals (CI) was calculated.ResultsThe prevalence of anemia among pregnant women attending antenatal care in health facilities of Hawella Tula Sub-city was 113 (33.7%) with a 95% confidence interval (CI) (28.8, 38.9). Male-headed household (AOR = 2.217, 95% CI: 1.146, 4.286), rural resident (AOR = 3.805, 95% CI: 2.118, 6.838), early marriage below 18 years (AOR = 2.137, 95% CI: 1.193, 3.830), and recurrent of illness during pregnancy (AOR = 3.189, 95% CI: 1.405, 7.241) were associated factors for anemia.ConclusionAnemia prevalence among pregnant women was 113 (33.7%). Anemia among pregnant women was associated with rural residents, early marriage age below 18 years, and repeated illnesses during pregnancy.

This paper investigates the construction of the concepts of empowerment and transformation as they manifest through the discourse of Black Economic Empowerment (BEE) in South Africa. Using critical discourse analysis, the paper argues that key BEE documents such as the BEE Commission Report, the DTI BEE Strategy and the BBBEE Acts reduce the discourses of empowerment and transformation to the ahistorical and apolitical concepts of economic inclusion and participation. Previous studies have ignored the analysis of these fundamental discourses while framing BEE as a radically transformative policy that has only failed. Drawing upon Nancy Fraser and Marion Young’s concepts of justice, the paper finds that BEE policy documents appropriate and compound anti-colonial and anti-apartheid discourses to construct BEE as radically transformative without being transformative in conception and discourse. Thus, these policy documents are ideologically oriented towards the allocation of surplus resources among Black people rather than addressing the more central question of radically transforming social rules and unequal power relations of racial capitalism that determine economic relations. The outcome of these discursive practices directly contributes to the maintenance of these relations that continue to underpin the oppression of black people while giving the impression that something radically has been done about this oppression.

Objectives: The purpose of this study was to determine the maternal mortality ratio at a tertiary care hospital of rural Assam, analyze the epidemiological factors and causes of maternal death, and to suggest recommendations for improvement. Method: This was a 10 year retrospective study from January, 2011 to December, 2020. Total 275 no of maternal deaths were taken for this study. Demographic and other data are collected from bed head tickets, case records, maternal death register and maternal death review register from office of O&G and MRD of Jorhat Medical College And Hospital. The maternal mortality ratio, epidemiological parameters, and causes of maternal mortality were evaluated. Results: In our study, total 275 no of maternal death were found in 69,685 no of live birth with a maternal mortality ratio(MMR) of 394.63 per 1,00,000 live birth. Out of total maternal death most are occurred in below 25 years of age which is 60% (165). Maximum maternal death 132(48%) out of 275 were primigravida. 211(76.7%) cases were found as unbooked. Most women died within 12 hours of admission 191, (69.4%) which suggest that majority of patients arrived at the hospital quite late. Maximum maternal deaths 141(51.2%) occurred in the postpartum period. Leading cause of maternal death in our study is found as eclampsia which is 78 no (28.4%). Conclusion: The majority of maternal deaths may have been avoided with good and proper antenatal care at primary level, early diagnosis and referral, better transportation facilities and better-equipped tertiary care centre. [ABSTRACT FROM AUTHOR]

Background: HIV/AIDS is one of the top global public health threats that causes significant cases, deaths, and socioeconomic impact. Even though both HIV testing and counseling are identified as essential HIV interventions during pregnancy, large population-representative data shows that service coverage and determinants are limited. Therefore, this study aimed to assess the coverage and determinants of HIV testing and counseling services among pregnant mothers attending antenatal care services in sub-Saharan African countries using different nationwide data. Methods: This study was conducted on large national-representative data from the Demographic Health Survey (DHS) using multilevel analysis. Data extraction, cleaning, coding, and statistical analysis were performed using STATA version 17. Weighting was used to ensure the representativeness of the sample and to obtain reliable estimates and standard errors. The multivariable multilevel logistic regression model was used to identify the determinants of HIV testing and counseling during the antenatal care visit. Adjusted odds ratios with 95% confidence intervals were used to measure statistical significance. Results: A total of 83,584 women attending antenatal care were included in this study. HIV testing and counseling coverage in sub-Saharan Africa was found to be 62.87% with a 95% CI of 62.54–63.19%. The HIV testing and counseling determinants included being in the age group of 35–49 (AOR = 1.64; 95% CI: 1.46–1.83), secondary and above education levels (AOR = 1.50; 95% CI: 1.39–1.60), having at least four ANC visits (AOR = 1.85; 95% CI: 1.68–2.02), living in an urban area (AOR = 1.40; 95% CI: 1.30–1.52), and living in countries such as Rwanda (AOR = 6.19; 95% CI: 5.19–7.38) and Mauritania (AOR = 0.02; 95% CI: 0.01–0.03). Conclusion: This study revealed that HIV testing and counseling coverage was 62.87% in sub-Saharan Africa. Factors affecting the HIV testing and counseling coverage were age, education, frequency of antenatal care visits, residence area, and living in Rwanda and Mauritania. Therefore, to increase HIV testing and counseling coverage in sub-Saharan Africa, policymakers on maternal health and other stakeholders should work with an integrated approach with other sectors and give prior attention to modifiable factors such as promoting women's education and the comprehensiveness of antenatal care follow-up services during the follow-up. [ABSTRACT FROM AUTHOR]

During the Suez crisis, the written media served as the primary method which provided the British populace with information. Strong anti-Egyptian sentiment permeated the British press. It was constantly fuelled by the Government's propaganda strategy. In the USA the crisis was also covered by the news media, particularly in the light of the fact that it was President Eisenhower's greatest foreign policy challenge at the time and the crisis reached its zenith a few days before his re-election. Nasser utilised the Egyptian press and radio to accomplish his goals against Britain and France and to promote his nationalist image inside and outside of Egypt. When a permanent member's veto prevented the Security Council from fulfilling its primary responsibility of maintaining international peace and security, the General Assembly could consider the matter and make recommendations to member states to restore international peace and security. In November 1956, the "Uniting for Peace" resolution, which stipulates this procedure, went into effect. Prior to the crisis, two-thirds of Europe's crude oil was transported via the Suez Canal. Due to the strategic significance of Suez, the canal zone was always vigilantly guarded by Britain. After the crisis, oil emerged as the new deterrent in international affairs, and the crisis was the primary impetus for the establishment of the Organisation of Petroleum Exporting Countries (OPEC) in 1961. When the crisis broke out and the canal was closed, the strategic significance of the sea route around the Cape regained prominence, and in subsequent months, port traffic in South Africa increased. South Africa and the United Kingdom were already negotiating the status of the naval base at Simonstown, which was subsequently transferred to South Africa. In order to receive training from the Algerian National Liberation Army ( Front de Libération Nationale -- FLN) in preparation for the South African revolution, Nelson Mandela joined the revolutionary forces of Algeria in 1961. He visited FLN training camps where he established Umkhonto weSizwe (Spear of the Nation) or MK of the African National Congress (ANC). According to Mandela, his visits to Egypt were educational, whereas his encounters in Algeria served a different purpose. He received training in revolutionary strategy and tactics, as well as military instruction. All of these were crucial elements for him in shaping the ANC into a liberation movement. During a visit to Algeria following his release from prison, he declared that he deemed Algeria to be his home and that he regarded himself to be an Algerian. Algeria provided a great deal of military and diplomatic instruction to liberation movements. The Third World won a decisive diplomatic victory at Suez. The geopolitical implications of the crisis were thus widespread and significant. Several changes took place with regard to the policies of the nations involved and the climate of global affairs changed. The crisis resulted in significant geopolitical ramifications and had profound effects for the nations involved. Furthermore, within a wider regional framework, significant transformations occurred in the political structure of multiple nations. The crisis necessitated political decision modifications and the implementation of new policy ideas by the key stakeholders involved, including Egypt, Britain, France, and the USA. The crisis also had an influence on other countries, including South Africa. Undoubtedly, this particular juncture in history can be seen as being of significant consequence. Nasser emerged as a central figure in this crisis, garnering increased recognition both domestically and internationally. One notable accomplishment of his was his adeptness in retaining his position as the political leader of Egypt for a duration of 18 years, even in the face of significant opposition. He is generally recognised as an important political figure in modern Egyptian history and is highly respected as an emblematic figure in the Arab world. This is mostly due to his significant contributions to social justice, Arab unity, and unwavering resistance against colonialism and imperialism. [ABSTRACT FROM AUTHOR]

Globally, there is welter of evidence demonstrating that cooperative government is likely achievable where the same political party in charge of the national government is also a power holder at subgovernments level. This has been the experience of the South Africa's African National Congress (ANC) which has been in charge of the national government and the majority of provinces for 30 years, except in few instances where opposition parties are in control. Since the ANC lost Western Cape (WC) province to the Democratic Alliance in 2004, cooperative government has been a difficult practice due in part to party ideological differences. The contradictions often play out at executive levels but the silence of legislation, in as far as ensuring that cooperative government is achievable for common goal, necessitates attention. This non-empirical article refers to numerous cases of intergovernmental tensions, with the intention being to debate the discursive issues under the Constitution of the Republic of South Africa, 1996 (hereafter referred to as 1996 Constitution). Following comprehensive reflection, the article concluded that the extent to which national government is showing inherent inertia to work with WC and other areas where the DA is governing has been perpetuated by the lacuna in the current legal framework, but most of the conflicts have much to do with party ideology and politics of the 'left' where parties just oppose executive decisions and programmes not on substance but because they are official opposition. As a result, the continuation of these actions stands to bedevil the national and provincial executive relations in a decentralised South Africa. [ABSTRACT FROM AUTHOR]

Die Ära der absoluten Mehrheiten im demokratischen Südafrika ist vorbei. Nachdem der African National Congress sechs aufeinanderfolgende Wahlen über einen Zeitraum von 30 Jahren mit absoluter Mehrheit gewonnen hatte, erhielt die Partei am 29. Mai 2024 zum ersten Mal weniger als 50% der Stimmen. Der ANC bleibt stärkste Partei. Am Abend des 14. Juni wählte die südafrikanische Nationalversammlung den ANC-Parteichef Cyril Ramaphosa in seine zweite Amtszeit als Präsident des Landes. Doch Politik und Verfassungsstaatlichkeit in Südafrika haben sich fundamental geändert.

The dominant party era in democratic South Africa is over. After winning absolute majorities in six consecutive national elections spanning thirty years, on 29 May 2024 the African National Congress (ANC) fell below 50% of the vote for the first time. The ANC remains the largest party. On the evening of 14 June, the National Assembly elected ANC leader Cyril Ramaphosa for a second term as the country’s president. But South Africa politics, and its constitutionalism, have changed fundamentally.

Background: The presence of peripheral inflammatory cells has been linked to the prognosis of cancer. This study aims to investigate the distinct roles of absolute neutrophil count (ANC) and absolute monocyte count (AMC) in differentiating renal cell carcinoma (RCC) from renal angiomyolipoma (RAML), as well as their prognostic significance in RCC. Methods: We conducted a comprehensive analysis of peripheral immune cell data, clinicopathological data, and tumor characteristics in patients diagnosed with RCC or RAML from January 2015 to December 2021. Receiver operating characteristic (ROC) curves, as well as univariate and multivariate analyses, were employed to assess the diagnostic utility of AMC and ANC in differentiating between RCC and RAML. Kaplan-Meier curve analysis was used to study the survival of RCC patients with different AMC and ANC. The prognostic value of AMC and ANC in RCC was investigated using COX univariate and multivariate analysis. The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases were used for bioinformatic correlation analysis. Results: A total of 1120 eligible patients were included in the study. The mean preoperative AMC and ANC in patients with RCC were found to be significantly higher compared to those in patients with RAML (P = 0.001 and P 3.205 *10^9/L was identified to be independently associated with the presence of RCC (HR = 1.618, P = 0.008). High AMC and ANC were significantly associated with reduced OS and PFS (P

Abstract Background Mental health problems are the most common morbidities of women during the prenatal period. In LMICs mobile phones have been identified as a good vehicle for monitoring individuals with a high risk of mental health conditions. However, evidence is scarce and the purpose of this study was to assess the intention to use a mobile phone to receive mental health support and its predicting factors among women attending antenatal care at public health facilities in Ambo town, Ethiopia 2022. Methods and materials An institutional-based cross-sectional study design was conducted from May 20th to June 20th, 2022. A total of 715 prenatal women were included and a systematic random sampling technique was employed. An interviewer-administered structured questionnaire was used. Collected data was exported to SPSS version 25 for the descriptive part, and AMOS 26 structural equation modeling was also used to describe and assess the degree and significance of relationships between variables. Results A total of 699 (97.8% response rate) responded to complete all the questionnaires. About 530 (77.3%) 95% CI (74%-80.3%) of women intended to use a mobile phone to receive mental health support. The perceived usefulness has a positive effect on attitude (β = 0.391, p

Objective: COVID-19 disrupted health service delivery and weakened global and national health systems. The objective of this study was to describe the changes in health service utilization in three local government areas (LGAs) in Nigeria and examine factors involved. Methods: A cross-sectional mixed-methods approach was used. A total of 315 pregnant women seen for antenatal care in 80 health facilities in three LGAs between October 1 and November 30, 2020, participated in exit interviews; 93 women participated in focus group discussions (FGDs). Descriptive analyses and a multivariable logistic analysis were conducted to examine associations between characteristics and decreased service utilization. Content analysis was used to identify the emerging themes related to health service utilization during the pandemic. Results: One quarter of women reported that they reduced or ceased health service. The biggest reported changes were in immunization (47 to 30%, p < 0.001) and a small but statistically significant decline in antenatal care (98.7 to 93.8%, p < 0.001) was observed. Qualitative findings show that lockdowns, transportation issues, increased costs and fear of contracting COVID-19 or being labeled as COVID-positive were the most common reasons for not seeking care during this period of the pandemic. Conclusions: The pandemic negatively impacted health service utilization amongst pregnant women in Nigeria. A better understanding of differences in state response could help inform future actions. The findings highlight the need for health systems to consider how to facilitate service utilization during a pandemic, such as providing safe transport or increasing outreach, and to minimize stigma for those seeking care. Significance: What is already known on this subject? The COVID-19 pandemic has disrupted health systems worldwide and service utilization decreased as a result, including the utilization of maternal and child health services. What this study adds? This study shows that there were significant declines in service utilization and provides insight into why pregnant woman did or did not alter their care-seeking for antenatal care and immunizations services. The qualitative results indicate that pregnant women responded to or interpreted State and facility-level responses differently, which resulted in increased or decreased utilization. These insights can inform future emergency responses and policies to build more resilient health systems and communities. [ABSTRACT FROM AUTHOR]

This paper argues that Tom Lodge's Red Road to Freedom is a milestone in South African history and a model of historical writing. The author reconstructs the history of an underground revolutionary movement in all its complexity mobilizing a huge array of sources. He details the role the protagonists played, provides a wealth of information, and delves into local politics without ever losing sight of the bigger picture. Lodge demonstrates that the South African Communist Party (SACP) made "national democracy" and the alliance with ANC its cause and rallying cry effectively taking ownership of post-Stalinist Soviet political theory. Thus, he compels historians to delve into the actual materialization of international ideological currents in the global South. [ABSTRACT FROM AUTHOR]

Background: Peripartum cardiomyopathy/cardiomyopathy in pregnancy is seen with no other cause of heart failure, heart chamber may or may not be dilated. Due to greater knowledge and attention towards the disease increasing incidence and prevalence has been noted. Objectives: 1. To estimate prevalence of cardiomyopathy in third trimester antenatal women attending antenatal care at Kamla Raja Hospital, Gwalior. 2. Identify independent predictors of cardiomyopathy. 3. Study ECG and ECHO changes in third trimester antenatal women with cardiomyopathy. 4. Study maternal outcome in terms of morbidity, mortality and ICU attendance. Methodology: A cross sectional study on 184 antenatal women was conducted at Department of Obstetrics and Gynaecology, Kamla Raja Hospital, Gwalior. Study population included antenatal women attending antenatal care during third trimester. Study was conducted for a period of one year from October 2021 to September 2022. Results: Out of 184 antenatal women in third trimester, prevalence of cardiomyopathy was found to be 1.09% and in those patients moderate LV dysfunction was seen. All the patients were multipara and low BMI and anaemia was associated. Conclusion: Routine cardiomyopathy screening of antenatal women in third trimester will optimize maternal care during antenatal period. [ABSTRACT FROM AUTHOR]

Objective: To study effect of supplementing G-CSF to septic neonates with ANC<5000/cmm in terms of 1. Increase in Absolute Neutrophi Count (ANC) 2. Effect of increase ANC count on outcome especially mortality Material And Method: Prospective observational study in division of neonatology of pediatrics Department, Pacific Medical College and Hospital, Udaipur from September 2022 to September 2023. Inclusion Criteria: 1. Septic neonate 2. ANC <5000/cmm 3. Evidence of sepsis i.e., at least one positive blood culture in neonatal period Methodology: Written consent from guardians of neonates were taken. Ethical clearance was taken, Necessary laboratory investigations were done and blood culture was taken by proper method. Antibiotic and appropriate treatment was initiated as per NICU unit protocol. Standard hematological techniques were employed for estimation of hematological parameters. Result: The study was carried out in 40 septic neutropenic preterm neonates with ANC<5000/cmm. They were randomly assigned to treatment group(n=20) and control group (n=20). There was male preponderance with 60% of babies were male. Age of neonate at study entry was comparable between G-CSF and control group [6.5 ± 2.98 days Vs 6.0 ± 5.38 days (p>0.05)]. With administration of G-CSF, ANC rose to significantly higher level with G-CSF group as compared to control group on day 3 (4786±1089/cmm Vs 4212±754/cmm, p<0.05). The rise was sustained till day 5 (5008±1028/cmm Vs 4055±522/cmm, p<0.01). However by day 7, ANC was comparable between two groups. (5077±657/cmm Vs 4652±779/cmm. p>0.05). ANC reached peak value on day 7 in G-CSF group. Mortality was significantly higher in control group compared G-CSF group (35% Vs 15%, p<0.05). Stepwise regression analysis revealed no significant correlation between G-CSF use and mortality. Only predictable factor affecting mortality significantly was ANC not recovering to >5000/cmm by day 7. Other factors like birth weight, IVH, meningitis, ANC recovering to >5000/cmm by day 7 and blood culture sterility by day 6 were not found to correlate significantly with mortality. Clinical symptoms of sepsis like gastrointestinal symptoms and hypoglycemia were resolved earlier in G-CSF group as compared to control group (4.71±2.3 Vs 8.0±4.2 days, p<0.05) and (4.0±1.0 Vs 7.0±1.78 days, p<0.01 respectively). Conclusion: G-CSF use in preterm septic neonates with Birth weight (900-1900 gm, mean 1345±289 gm) and Gestational age (28-36 weeks, mean 31.5±2.68 weeks) increased absolute neutrophil count and resulted in decrease in mortality. Mortality was more in patients in whom ANC did not rise >5000/cmm by D7. However, studies with large number of patients are warranted before use of G-CSF can be recommended as standard therapy for preterm neutropenic septic neonates. [ABSTRACT FROM AUTHOR]

Background: The WHO recommends Exclusive Breastfeeding (EBF) for a period of 6 months for optimal health and development of the child. In India, only 56% of Mothers match this standard. Individual factors such as the Education of the mother and the Number of ANC visits have been identified as potentially modifiable short- and long-term factors implicated in a woman's ability to successfully exclusively breastfeed, however there is very limited research examining these factors specifically for exclusive breastfeeding to 6 months duration. A positive association between the factors and the duration of Exclusive Breastfeeding could guide the legislative efforts in targeting the Infant and Under-5 Mortality rates and Maternal health. Aim: This study is aimed at investigating breastfeeding practices among mothers of Chitradurga town and identifying the factors associated with Exclusive Breastfeeding (EBF) among Mothers of Chitradurga town. Objectives: The objectives of this study were to identify the factors that favour the early cessation of Exclusive Breastfeeding (EBF) among Mothers of Chitradurga town and to establish the association between the practice of Exclusive Breastfeeding and the Number of ANC visits and also the Education of the Mother. Methodology: A cross-sectional study was conducted for a duration of 2 months, among 200 randomly selected mothers visiting the Paediatric OPD in Basaveshwara Medical College and Hospital, Chitradurga. An informed consent was obtained from all the participants. A pre-designed, pretested and self-administered proforma was used to collect the data regarding the participants’ work-related, health services-related and socio-demographic factors by face-to-face interview. The data thus obtained was analyzed using the IBM Statistical Package for the Social Services (SPSSS) software. Results: The majority of the Mothers (30%) were educated till the SSLC level. 63 Mothers (31.5%) exercised EBF for a period of at least 6 months and most of the Mothers (38.5%) exercised it for a period of 5 months. 58 Mothers (29%) each had completed at least 5 or 6 ANC visits. Upon using the Chi-Square Test of Significance, Education of the Mother and Number of ANC visits were found to be significant factors in influencing the period of Exclusive Breastfeeding (EBF). Conclusion: Our efforts to establish the probable factors that favour early cessation of Exclusive Breastfeeding have borne the conclusion that Education of the Mother and Number of ANC visits made bear a significant Positive relationship with the number of months of EBF. This is an essential finding in understanding the reasons for insufficient breastfeeding practices and could prove to be the basis of health legislature targeting lower Infant and Under-5 mortality rates. [ABSTRACT FROM AUTHOR]

Background: Mental health problems are the most common morbidities of women during the prenatal period. In LMICs mobile phones have been identified as a good vehicle for monitoring individuals with a high risk of mental health conditions. However, evidence is scarce and the purpose of this study was to assess the intention to use a mobile phone to receive mental health support and its predicting factors among women attending antenatal care at public health facilities in Ambo town, Ethiopia 2022. Methods and materials: An institutional-based cross-sectional study design was conducted from May 20th to June 20th, 2022. A total of 715 prenatal women were included and a systematic random sampling technique was employed. An interviewer-administered structured questionnaire was used. Collected data was exported to SPSS version 25 for the descriptive part, and AMOS 26 structural equation modeling was also used to describe and assess the degree and significance of relationships between variables. Results: A total of 699 (97.8% response rate) responded to complete all the questionnaires. About 530 (77.3%) 95% CI (74%-80.3%) of women intended to use a mobile phone to receive mental health support. The perceived usefulness has a positive effect on attitude (β = 0.391, p < 0.001) and intention to use (β = 0.253, p < 0.001). The perceived ease of use influences perceived usefulness (β = 0.253, p < 0.001) and attitude β = 0.579, p < 0.001). The intention to use is positively affected by attitude (β = 0.662, p < 0.001).Trust has a positive effect on perceived usefulness (β = 0.580, p < 0.001) and intention to use (β = 0.113, p = 0.005). Subjective norm has a direct positive effect on perceived usefulness (β = 0.248, p < 0.001). Attitude serves as a partial mediator between perceived usefulness and intention to use and a complete mediating role between perceived ease of use and intention to use. Conclusion: The level of intention to use a mobile phone among prenatal women is relatively high and attitude, perceived usefulness, and trust had direct positive effects on intention to use a mobile phone. Therefore, hospitals and healthcare providers should take proactive measures to implement the strategies and policies for providing mobile phone-based mental health support to prenatal women in remote areas. [ABSTRACT FROM AUTHOR]

Background: Neonatal deaths remain a serious public health concern in Ethiopia; being one of the top five countries contributing to half of the neonatal deaths worldwide. Although antenatal care (ANC) is assumed as one of the viable options that contribute to neonatal survival, findings from original studies indicated disparities in the effect of ANC on neonatal mortality. Thus, this review aimed to determine the pooled effect of ANC on neonatal mortality in Ethiopia. Methods: Databases such as PubMed, EMBASE, CINAHL, HINARI, and Cochrane Central Library were searched for articles using keywords. Selection of eligible articles and data extraction were conducted by an independent author. The risk of a bias assessment tool for non-randomized studies was used to assess the quality of the articles. Comprehensive meta-analysis version 2 software was used for meta-analysis. Heterogeneity and publication bias of included studies were assessed using I2 test statistic and Egger test, respectively. The random-effect model was employed; an outcome is reported using a risk ratio with a 95% confidence interval. Results: Of 28 included studies, 20 showed receiving at least one ANC visit had a significant association with neonatal mortality. Accordingly, the estimated pooled risk ratio for neonatal mortality was 0.59 (95% CI 0.45, 0.77) among infants born to women who had at least one ANC visit compared to infants born to women who had no ANC visits. Conclusion: This finding indicated that neonatal mortality was decreased among infants born to women who had at least one ANC visit compared to infants born to women who had no ANC visit. Therefore, promoting and strengthening ANC service utilization during pregnancy would accelerate the reduction of neonatal mortality in Ethiopia. Significance: In some studies, providing ANC services reduces the risk of neonatal mortality, in others, the ANC visits did not significantly decrease neonatal mortality in Ethiopia, which represents a dismal picture of neonatal mortality (NM) in sub-Saharan Africa (SSA) region. Therefore, evidence emanated from comprehensive searches of review performed with several studies represented from various regions of the country which determine the effect of ANC on NM is essential to reinforce strategies that could help for newborn survival and wellbeing of neonates in Ethiopia. Hence, this study aimed to systematically examine the effect of ANC on NM by combining a wide range of reviews, to provide concrete evidence for policymakers. [ABSTRACT FROM AUTHOR]

BackgroundAntithyroid drugs, such as methimazole (MMI), are standard therapies for the medical management of thyrotoxicosis. Agranulocytosis is a rare but lethal adverse effect of antithyroid medications. We have reported 2 cases of MMI-induced agranulocytosis with similar risk factors that likely predisposed them to this adverse reaction.Case reportCase 1 involved a 71-year-old woman, with a history of Graves disease, who presented with an altered mental status. She was recently discharged on 40 mg of MMI twice daily, and she continued this dose for 2 months. She was readmitted and found to have neutropenic fever in the setting of MMI-induced agranulocytosis. MMI was discontinued, and she was started on filgrastim. Her cell counts gradually improved, and she was subsequently discharged.Case 2 involved a 68-year-old woman, with a history of Graves disease, who presented with severe back pain, nausea, and vomiting. She was recently discharged on 10 mg of MMI twice daily, which was increased to 10 mg 3 times a day. She was readmitted to the hospital because of a septic shock in the setting of pneumonia, colitis, bacteremia, and MMI-induced agranulocytosis. A bone marrow biopsy showed a polyclonal infiltrate with up to 85% plasma cells. Despite treatment with antibiotics, filgrastim, and continuous renal replacement therapy, she ultimately passed away.DiscussionAlthough these cases had differing outcomes, they shared similar features and risk factors, including older age, female sex, and relatively higher doses of MMI.ConclusionClose follow up and awareness of risk factors, such as age, female sex, and higher doses of MMI, may decrease the risk of MMI-induced agranulocytosis and fatal outcomes.

Access to and utilisation of antenatal care (ANC) is important for optimising health and nutrition during pregnancy. This study aimed to assess adherence to and factors associated with ANC and antenatal supplement use among Laotian women, and consider culturally appropriate strategies to increase micronutrient intakes. Mother-child (aged 21 d to

Abstract Background Continuous distribution channels are effective methods to deliver malaria interventions such as insecticide treated nets (ITNs) to pregnant women attending antenatal care clinics and children under five attending immunization visits. Facility-based and provider-based checklists were used during supportive supervision visits to measure the quality of facility-based services and interventions. This study looks at ITN distributions at health facilities in Ghana, with the aim of providing insights on how quality can be measured and monitored. Methods Various quality improvement approaches for malaria services occur in Ghana. Selected indicators were analysed to highlight the similarities and differences of how the approaches measured how well the channel was doing. Generally, the approaches assessed (1) service data management, (2) logistics data management, and (3) observation of service provision (ITN issuance, malaria education, ITN use and care education). Two approaches used a binary (Yes/No) scale, and one used a Likert scale. Results Results showed that most data reported to the national HMIS is accurate. Logistics data management remained an issue at health facilities, as results showed scores below average across facility stores, antenatal care, and immunization. Though the supervision approaches differed, overall results indicated that almost all eligible clients received ITNs, data were recorded accurately and reported on-time, and logistics was the largest challenge to optimal distribution through health facilities. Conclusion The supervision approaches provided valuable insights into the quality of facility-based ITN distribution. Ghana should continue to implement supportive supervision in their malaria agenda, with additional steps needed to improve reporting of collected data and increase the number of facilities visited for supportive supervision and the frequency. There were various supervision approaches used with no clear guidance on how to measure quality of facility-based ITN distribution, so there is also need for the global community to agree on standardized indicators and approaches to measuring quality of facility-based ITN distribution. Additionally, future studies can review the effect of multiple rounds of supervision visits on the quality of ITN distribution as well as understand the facilitators and barriers to scaling up supervision of facility-based ITN distribution.

Abstract Background Global efforts to reduce malaria burden include distribution of insecticide-treated mosquito nets through mass campaigns and routine channels. Ghana’s National Malaria Elimination Programme (NMEP) distributes insecticide-treated bed nets (ITNs) through various channels, including to pregnant women at antenatal care (ANC) visits and children at vaccination visits through child welfare clinics (CWC). This study assessed historical ITN distribution throughout ANCs and CWCs across Ghana and the characteristics of high performing facilities. Methods Monthly data on routine ITN distribution was provided from Ghana’s national health information management system for the years 2016–2021. Analyses were conducted to assess the performance of ITN distribution at ANC and CWC across time, ecological zone, regions, districts, facility ownership, and facility type. Univariate and multivariate logistic regressions were performed to predict the odds of ANC and CWC issuing rates greater or equal to 80% for a given facility type or ownership. Results In 2021, 93% of women who attended their first antenatal care visit and 92% of children under five who received their second dose of the measles-rubella vaccine (MR2) had received an ITN. At the regional level, 94% of regions (n = 15/16) maintained the NSP target issuing rate of 80% throughout 2020 and 2021. While there were no clear differences in issuing rates between ecological zones, district-level differences were present across the six years. All health facility types performed at or above 80% in 2021 for both ANC and CWC. Odds ratios demonstrated differences in the likelihood of meeting the 80% issuing rate goal among different facility types as well as private versus public ownership when comparing ANC and CWC. Conclusion By 2021, Ghana had improved its ITN issuing rates since the initial year of analysis, surpassing the 80% target by issuing nets to over 90% of pregnant women and young children attending ANC and CWC. Future work can explore the reasons for national and subnational differences in issuing rates as well as help understand additional characteristics of high performing facilities. Additionally, it is necessary to identify and expand on the drivers for improved performance over the time period.

Abstract Background Little is known whether women’s knowledge of perceived severity of illness and sociodemographic characteristics of women influence healthcare seeking behavior for maternal health services in Afghanistan. The aim of this study was to address this knowledge gap. Methods Data were used from the Afghanistan Health Survey 2018. Women’s knowledge in terms of danger signs or symptoms during pregnancy was assessed. The signs or symptoms were bleeding, swelling of the body, headache, fever, or any other danger sign or symptom (e.g., high blood pressure). A categorical variable of knowledge score was created. The outcome variables were defined as ≥ 4 ANC vs. 0–3 ANC; ≥ 4 PNC vs. 0–3 PNC visits; institutional vs. non-institutional deliveries. A multivariable generalized linear model (GLM) was used. Results Data were used from 9,190 ever-married women, aged 13–49 years, who gave birth in the past two years. It was found that 56%, 22% and 2% of women sought healthcare for institutional delivery, ≥ 4 ANC, ≥ 4 PNC visits, respectively, and that women’s knowledge is a strong predictor of healthcare seeking [odds ratio (OR)1.77(1.54–2.05), 2.28(1.99–2.61), and 2.78 (2.34–3.32) on knowledge of 1, 2, and 3–5 signs or symptoms, respectively, in women with ≥ 4 ANC visits when compared with women who knew none of the signs or symptoms. In women with ≥ 4 PNC visits, it was 1.80(1.12–2.90), 2.22(1.42–3.48), and 3.33(2.00–5.54), respectively. In women with institutional deliveries, it was 1.49(1.32–1.68), 2.02(1.78–2.28), and 2.34(1.95–2.79), respectively. Other strong predictors were women’s education level, multiparity, residential areas (urban vs. rural), socioeconomic status, access to mass media (radio, TV, the internet), access of women to health workers for birth, and decision-making for women where to deliver. However, age of women was not a strong predictor. Conclusion Our findings suggest that pregnant women’s healthcare seeking behaviour is influenced by women’s knowledge of danger signs and symptoms during pregnancy, women’s education, socioeconomic status, access to media, husband’s, in-laws’ and relatives’ decisions, residential area, multiparity, and access to health workers. The findings have implications for promoting safe motherhood and childbirth practices through improving women’s knowledge, education, and social status.

Abstract Background The term premature rupture of the membranes is the rupture of the membranes before the onset of labor beyond 37 weeks of gestation. Several factors, including obstetric, gynecologic, socioeconomic, and medical, are identified as potential risk factors. This clinical event has detrimental maternal and neonatal complications. Objectives This study aimed to investigate the determinants of the term premature rupture of the membranes in Ethiopia. Methods This institution-based unmatched case-control study was conducted on 246 women admitted to Saint Paul’s hospital millennium medical college from October 2019 to January 2020 (82 cases and 164 controls). Data were collected using an interviewer-based questionnaire and data extraction tools, and data were entered using Epi data 3.1 and analyzed using SPSS 20. The association between independent variables and premature rupture of the membrane was estimated using an odds ratio with 95% confidence intervals and P-value

Irina-Maria Popescu,1 Madalin-Marius Margan,2 Mariana Anghel,1 Alexandra Mocanu,3 Sorina Maria Denisa Laitin,1 Roxana Margan,4 Ionut Dragos Capraru,1 Alexandra-Andreea Tene,5 Emanuela-Georgiana Gal-Nadasan,6 Daniela Cirnatu,5,7 Gratiana Nicoleta Chicin,5,8 Cristian Oancea,9 Andrei Anghel10 1Department of Infectious Diseases, Discipline of Epidemiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2Department of Functional Sciences, Discipline of Public Health, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 3Department of Infectious Diseases, Discipline of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 4Department of Functional Sciences, Discipline of Physiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 5Regional Center of Public Health Timisoara, Timisoara, Romania; 6Department of Balneology, Medical Rehabilitation and Rheumatology, Discipline of Medical Rehabilitation, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 7Department of Medicine, “Vasile Goldis” Western University, Faculty of Medicine, Arad, Romania; 8Department of Epidemiology, Infectious Diseases and Preventive Medicine, “Vasile Goldis” Western University, Faculty of Medicine, Arad, Romania; 9Center for Research and Innovation in Precision Medicine of Respiratory Disease, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 10Department of Biochemistry and Pharmacology, Discipline of Biochemistry, “Victor Babes” University of Medicine and Pharmacy, Timisoara, RomaniaCorrespondence: Madalin-Marius Margan, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, Timisoara, 300041, Romania, Tel +40 726 277 354, Email marganmm@gmail.comPurpose: Coronavirus disease is a global pandemic with millions of confirmed cases and hundreds of thousands of deaths worldwide that continues to create a significant burden on the healthcare systems. The aim of this study was to determine the patient clinical and paraclinical profiles that associate with COVID-19 unfavourable outcome and generate a prediction model that could separate between high-risk and low-risk groups.Patients and Methods: The present study is a multivariate observational retrospective study. A total of 483 patients, residents of the municipality of Timișoara, the biggest city in the Western Region of Romania, were included in the study group that was further divided into 3 sub-groups in accordance with the disease severity form.Results: Increased age (cOR=1.09, 95% CI: 1.06– 1.11, p< 0.001), cardiovascular diseases (cOR=3.37, 95% CI: 1.96– 6.08, p< 0.001), renal disease (cOR=4.26, 95% CI: 2.13– 8.52, p< 0.001), and neurological disorder (cOR=5.46, 95% CI: 2.71– 11.01, p< 0.001) were all independently significantly correlated with an unfavourable outcome in the study group. The severe form increases the risk of an unfavourable outcome 19.59 times (95% CI: 11.57– 34.10, p< 0.001), while older age remains an independent risk factor even when disease severity is included in the statistical model. An unfavourable outcome was positively associated with increased values for the following paraclinical parameters: white blood count (WBC; cOR=1.10, 95% CI: 1.05– 1.15, p< 0.001), absolute neutrophil count (ANC; cOR=1.15, 95% CI: 1.09– 1.21, p< 0.001) and C-reactive protein (CRP; cOR=1.007, 95% CI: 1.004– 1.009, p< 0.001). The best prediction model including age, ANC and CRP achieved a receiver operating characteristic (ROC) curve with the area under the curve (AUC) = 0.845 (95% CI: 0.813– 0.877, p< 0.001); cut-off value = 0.12; sensitivity = 72.3%; specificity = 83.9%.Conclusion: This model and risk profiling may contribute to a more precise allocation of limited healthcare resources in a clinical setup and can guide the development of strategies for disease management.Keywords: ANC, CRP, risk profiling, unfavourable outcome

This paper explores the application of network security technology within intelligent information terminals of the Internet of Things (IoT). It examines existing security issues and proposes a technical framework to address them. The technical framework starts from two aspects of data encryption and intrusion detection technology, in the data encryption technology, the CCA-ANC encryption algorithm is proposed to change the attacker in ANC from pure ciphertext attack to using the method of selective ciphertext attack. In intrusion detection technology, the DAGMM algorithm has been improved and optimized. The WEFS-DAGMM improved intrusion detection algorithm has been proposed, and an intrusion detection firewall has been constructed. In the performance test, the CCA-ANC encryption algorithm completes the encryption after inputting 1024MB of data in 13.6s, and the average speed of encryption reaches 71.54MB/s. The optimized WEFS-DAGMM algorithm achieves an accuracy of 0.952, which is 0.03 higher than the original DAGMM algorithm. The recall and F1 values are 0.03 higher than the original DAGMM algorithm, respectively. The algorithms have been improved by 0.03 and 0.037, respectively. Simulation experiments are conducted on the technical framework constructed in this paper. The success rate of malicious attack detection is greater than 90%, and the security protection rate reaches more than 99% in all of them.

Background: The paper aims to identify the factors for effective implementation and adherence to the behavioural intervention package by women experiencing domestic violence (DV) and attending ANC in a public hospital. Methods: A qualitative study was undertaken with 211 pregnant women experiencing DV and attending antenatal care (ANC) at the LN Hospital, New Delhi. The intervention was given to women recruited under the RCT study. The narratives were analysed under two broad themes, impeding and facilitating factors, with nine sub-themes. Findings: Impeding factors are external factors generated by the structural interaction of the participants, whereas facilitating factors are supplied internally in the trial to eliminate the influence of impeding factors and singulate the factors under study. Our results show that despite the plethora of impeding factors (nine), the overall sum impact of impeding factors falls short of the positive impact of facilitating factors (nine), which were minor adjustments but reinforce participation in the trial and adherence with 97% follow-up rates. Interpretation: Our study findings are expected to reset the treatment protocol, which entails converting impeding factors into facilitating factors for appropriate adherence and compliance and adequate access and utilization of public services. The sensitization of healthcare providers to the impact of the quality of human interaction on the patient and its impact on the uptake of healthcare services and adherence is needed, particularly in the public hospitals of India. Funding: Funds received for the research are from the Indian Council of Medical Research (ICMR), New Delhi, Government of India.