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Background Maternal morbidity is common in Bangladesh, where the maternal mortality rate has plateaued over the last 6 years. Maternal undernutrition and micronutrient deficiencies contribute to morbidity, but few interventions have measured maternal outcomes. We compared reported prevalence of antepartum, intrapartum, and postpartum complications among recently delivered women between maternal nutrition intervention and control areas in Bangladesh. Methods and findings We conducted a cross-sectional assessment nested within a population-based cluster-randomized trial comparing a nutrition counseling and micronutrient supplement intervention integrated within a structured home-based maternal, newborn, and child health (MNCH) program to the MNCH program alone in 10 sub-districts each across 4 Bangladesh districts. Eligible consenting women, delivering within 42-60 days of enrollment and identified by community-level health workers, completed an interviewer-administered questionnaire detailing the index pregnancy and delivery and allowed review of their home-based care register. We compared pooled and specific reported antepartum, intrapartum, and postpartum complications between study groups using hierarchical logistic regression. There were 594 women in the intervention group and 506 in the control group; overall, mean age was 24 years, 31% were primiparas, and 39% reported facility-based delivery, with no significant difference by study group. There were no significant differences between the intervention and control groups in household-level characteristics, including reported mean monthly income (intervention, 6,552 taka, versus control, 6,017 taka; p = 0.48), having electricity (69.6% versus 71.4%, p = 0.84), and television ownership (41.1% versus 38.7%, p = 0.81). Women in the intervention group had higher recorded iron and folic acid and calcium supplement consumption and mean dietary diversity scores, but reported anemia rates were similar between the 2 groups (5.7%, intervention; 6.5%, control; p = 0.83). Reported antepartum (69.4%, intervention; 79.2%, control; p = 0.12) and intrapartum (41.4%, intervention; 48.5%, control; p = 0.18) complication rates were high and not significantly different between groups. Reported postpartum complications were significantly lower among women in the intervention group than the control group (33.5% versus 48.2%, p = 0.02), and this difference persisted in adjusted analysis (adjusted odds ratio [AOR] = 0.51, 95% CI 0.32-0.82; p < 0.001). For specific conditions, odds of retained placenta (AOR = 0.35, 95% CI 0.19-0.67; p = 0.001), postpartum bleeding (AOR = 0.37, 95% CI 0.15-0.92; p = 0.033), and postpartum fever/infection (AOR = 0.27, 95% CI 0.11-0.65; p = 0.001) were significantly lower in the intervention group in adjusted analysis. There were no significant differences in reported hospitalization for antepartum (49.8% versus 45.1%, p = 0.37), intrapartum (69.9% versus 59.8%, p = 0.18), or postpartum (36.1% versus 29.9%, p = 0.49) complications between the intervention and control groups. The main limitations of this study are outcome measures based on participant report, non-probabilistic selection of community-level workers' catchment areas for sampling, some missing data for variables derived from secondary sources (e.g., dietary diversity score), and possible recall bias for reported dietary intake and supplement use. Conclusions Reported overall postpartum and specific intrapartum and postpartum complications were significantly lower for women in intervention areas than control areas, despite similar rates of facility-based delivery and hospitalization for reported complications, in this exploratory analysis. Maternal nutrition interventions providing intensive counseling and micronutrient supplements may reduce some pregnancy complications or impact women's ability to accurately recognize complications, but more rigorous evaluation is needed for these outcomes., Author(s): Catherine S. Todd 1,*, Zakaria Chowdhury 2, Zeba Mahmud 2, Nazia Islam 3, Sadia Shabnam 3, Musarrat Parvin 2, Alissa Bernholc 1, Andres Martinez 1, Bachera Aktar 4, Kaosar [...]

Results from a longitudinal study of the implementation of the Reading Recovery (RR) program in the Wake County Public School System (North Carolina) for 1990 through 1994 show achievement gains for RR students, although these gains lessen in recent years. Reasons for inconsistent benefits after the first year are discussed. (SLD)

Achieving the 95-95-95 UNAIDS targets requires meeting the needs of adolescents, however we lack evidenced-based approaches to improving adolescent adherence to antiretroviral therapy (ART), increasing viral suppression, and supporting general wellbeing. We developed Family Connections as a group intervention for adolescents and their adult caregivers and conducted a randomized controlled trial in Ndola, Zambia to test feasibility and acceptability. Fifty pairs (n = 100) of adolescents (15–19 years and on ART ≥ 6 months) and their caregivers were randomly assigned either to the intervention consisting of 10 group sessions over 6 months, or to a comparison group, which received the usual care. Each pair completed baseline and endline surveys, with adolescents also undergoing viral load testing. Of the 24-intervention adolescent/caregiver pairs, 88% attended at least eight group sessions. Most adolescents (96%) and all caregivers would recommend Family Connections to peers. Adolescent viral failure decreased but did not significantly differ by study group. Adolescents in the intervention group showed a greater reduction in HIV-related feelings of worthlessness and shame than the comparison group. The feasibility, acceptability, and the positive trend toward significantly reducing internalized stigma, generated by this Family Connections pilot study, contributes valuable data to support adolescent/caregiver approaches that use peer groups. [ABSTRACT FROM AUTHOR]

Uganda's Obulamu? campaign delivered messages relevant to life stage to address evolving health needs of audiences at times they were likely to change behaviors. We estimated Obulamu?'s effects on HIV/AIDS, family planning, maternal and child health, tuberculosis, malaria, and nutrition behavioral outcomes. We conducted repeated cross-sectional household surveys with women, men, and children's caregivers in 2015 and 2017 in 16 districts using multi-stage probability sampling weighted by population. Eleven pre-specified outcomes were evaluated in multivariable weighted regression models. Survey 1 included 2,377 households with 4,012 individuals and survey 2 included 2,398 households with 3,563 individuals. After controlling for time and potentially confounding factors, we observed notable increases among people exposed to topic-specific messages in condom use with at least one non-marital, non-cohabiting partner in the last six months; recent male circumcision; seeking tuberculosis screening/testing for self; seeking tuberculosis screening/testing for child; delivery of baby in a facility; and caregiver seeking advice or treatment for child under five years with fever. Exposure did not appear to influence knowledge of antiretroviral therapy, delay sexual debut, breastfeeding infants and all of the household's pregnant women/children less than five years sleeping under a net the night before the survey. Exposure to topic-specific messages was associated with improvements in six of the eleven outcomes. Across the health priority areas, we observed improvements in select HIV/AIDS, tuberculosis, and maternal and child health outcomes. We did not observe effects of exposure on select outcomes in the areas of family planning, malaria, or nutrition. [ABSTRACT FROM AUTHOR]

The article explores the factors associated with short pregnancy intervals among young women in Uganda. Data on 626 married or cohabiting women aged 15-22 with one or two previous pregnancies showed that 71% and 37% had experienced a rapid repeat pregnancy within 24 months and 12 months respectively. Variables associated with short pregnancy interval include urban-rural residence, region, age at first union and marriage-to-birth interval.