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The goal of the STAR Sexually Transmitted Infection Clinical Trial Group (STI CTG) Programmatic meeting on Sexually Transmitted Infections (STIs) in Pregnancy and Reproductive Health in April 2018 was to review the latest research and develop recommendations to improve prevention and management of STIs during pregnancy. Experts from academia, government, nonprofit, and industry discussed the burden of STIs during pregnancy; the impact of STIs on adverse pregnancy and birth outcomes; interventions that work to reduce STIs in pregnancy, and the evidence, policy, and technology needed to improve STI care during pregnancy. Key points of the meeting are as follows: (i) alternative treatments and therapies for use during pregnancy are needed; (ii) further research into the relationship between the vaginal microbiome and STIs during pregnancy should be supported; (iii) more research to determine whether STI tests function equally well in pregnant as nonpregnant women is needed; (iv) development of new lower cost, rapid point-of-care testing assays could allow for expanded STI screening globally; (v) policies should be implemented that create standard screening and treatment practices globally; (vi) federal funding should be increased for STI testing and treatment initiatives supported by the Centers for Disease Control and Prevention (CDC), the Centers of Excellence in STI Treatment, public STD clinics, and the President's Emergency Plan for AIDS Relief (PEPFAR).

ObjectiveTo determine the magnitude of relationships of early life factors with child development in low/middle-income countries (LMICs).DesignMeta-analyses of standardised mean differences (SMDs) estimated from published and unpublished data.Data sourcesWe searched Medline, bibliographies of key articles and reviews, and grey literature to identify studies from LMICs that collected data on early life exposures and child development. The most recent search was done on 4 November 2014. We then invited the first authors of the publications and investigators of unpublished studies to participate in the study.Eligibility criteria for selecting studiesStudies that assessed at least one domain of child development in at least 100 children under 7 years of age and collected at least one early life factor of interest were included in the study.AnalysesLinear regression models were used to assess SMDs in child development by parental and child factors within each study. We then produced pooled estimates across studies using random effects meta-analyses.ResultsWe retrieved data from 21 studies including 20 882 children across 13 LMICs, to assess the associations of exposure to 14 major risk factors with child development. Children of mothers with secondary schooling had 0.14 SD (95% CI 0.05 to 0.25) higher cognitive scores compared with children whose mothers had primary education. Preterm birth was associated with 0.14 SD (-0.24 to -0.05) and 0.23 SD (-0.42 to -0.03) reductions in cognitive and motor scores, respectively. Maternal short stature, anaemia in infancy and lack of access to clean water and sanitation had significant negative associations with cognitive and motor development with effects ranging from -0.18 to -0.10 SDs.ConclusionsDifferential parental, environmental and nutritional factors contribute to disparities in child development across LMICs. Targeting these factors from prepregnancy through childhood may improve health and development of children.

Inequities in birth outcomes are linked to experiential and environmental exposures. There have been expanding and intersecting wicked problems of inequity, racism, and quality gaps in childbearing care during the pandemic. We describe how an intentional transdisciplinary process led to development of a novel knowledge exchange vehicle that can improve health equity in perinatal services. We introduce the Quality Perinatal Services Hub, an open access digital platform to disseminate evidence based guidance, enhance health systems accountability, and provide a two-way flow of information between communities and health systems on rights-based perinatal services. The QPS-Hub responds to both community and decision-makers' needs for information on respectful maternity care. The QPS-Hub is well poised to facilitate collaboration between policy makers, healthcare providers and patients, with particular focus on the needs of childbearing families in underserved and historically excluded communities., Author(s): Saraswathi Vedam [sup.1] , Laurie Zephyrin [sup.2] , Pandora Hardtman [sup.3] , Indra Lusero [sup.4] , Rachel Olson [sup.5] , Sonia S. Hassan [sup.6] , Nynke van den Broek [...]

Background: Audit is a quality improvement approach used in maternal and newborn health. Our objective was to introduce the practice of standards-based audit at healthcare facility level, and to examine if this would improve quality of care assessed by compliance with standards developed and agreed with healthcare providers. Our focus was on emergency obstetric and newborn care (EmONC). Methods: A multidimensional incomplete stepped-wedge cluster randomised trial with 8 steps was conducted in 44 healthcare facilities in Malawi. A total of 25 standards of care were developed. At each healthcare facility one (health centres) or two (hospitals) standards were audited per cycle with two consecutive audit cycles conducted. Each cycle consisted of five steps: (i) select standard to be audited, (ii) measure compliance with standard (measurement 1), (iii) review findings and identify what changes are required to increase compliance (iv) implement changes, (v) re-measure compliance (measurement 2). Each compliance measurement assessed 25 women. Multilevel mixed effects logistic regression models were used to analyse data for all standards. Results: The crude overall compliance rate rose from 45% in the control phase (measurement 1) to 63% in the intervention phase (measurement 2) (from 51.6% to70.6% at Basic and from 34.5% to 50.8% at Comprehensive EmONC healthcare facilities. When adjusted for standard, facility type, month, and healthcare facility by month, the adjusted OR (95% CI) was 2.80 (1.65, 4.76). Actions taken to improve compliance with standards included improving staff performance of clinical duties and general conduct through re-orientation and staff meetings as well as improved supervision, and, ensuring basic equipment and consumables were available on site (thermometers, rapid diagnostic tests, partograph). Conclusion: The introduction of standards-based audit helped healthcare providers identify problems with service provision, which when addressed, resulted in a measurable and significant improvement in quality of care. Trial registration: ISRCTN registration number: 59931298. [ABSTRACT FROM AUTHOR]

Objective To describe tools used for the assessment of maternal and child health issues In humanitarian emergency settings. Methods We systematically searched MEDLINE, Web of Knowledge and POPLINE databases for studies published between January 2000 and June 2014. We also searched the websites of organizations active in humanitarian emergencies. We included studies reporting the development or use of data collection tools concerning the health of women and children In humanitarian emergencies. We used narrative N synthesis to summarize the studies. Findings We identified 100 studies: 80 reported on conflict situations and 20 followed natural disasters. Most studies (76/100) focused on the health status of the affected population while 24 focused on the availability and coverage of health services. Of 17 different data collection tools identified, 14 focused on sexual and reproductive health, nine concerned maternal, newborn and child health and four were used to collect information on sexual or gender-based violence. Sixty-nine studies were done for monitoring and evaluation purposes, 18 for advocacy, seven for operational research and six for needs assessment. Conclusion Practical and effective means of data collection are needed to inform life-saving actions in humanitarian emergencies. There are a wide variety of tools available, not all of which have been used In the field. A simplified, standardized tool should be developed for assessment of health issues in the early stages of humanitarian emergencies. A cluster approach is recommended, in partnership with operational researchers and humanitarian agencies, coordinated by the World Health Organization. Objectif Decrire les outils utlllses pour evaluer les problemes en matlere de sante maternelle et Infantile dans les situations d'urgence humanitaire. Methodes Nous avons recherche de facon systemique, dans les bases de donnees Medline, Web of Knowledge et Popline, les etudes publiees entre janvier 2000 et juin 2014. Nous avons egalement fait des recherches sur les sites Internet dbrganisations intervenant dans les situations d'urgence humanitaire. Nous avons inclus les etudes qui se rapportaient au developpement ou a l'utilisation d'outils de collecte de donnees concernant la sante des femmes et des enfants dans des situations d'urgence humanitaire. Nous avons resume ces etudes par unesynthese narrative. Resultats Nous avons retenu 100 etudes: 80 portaient surdes situations de conflit et 20 faisalent suite a des catastrophes naturelles. La plupart de ces etudes (76/100) s'interessaient a la situation sanltalre des populations affectees tandis que 24 d'entre elles s'interessaient a la disponibllite de services de sante et a leur couverture. Sur 17 outils de collecte de donnees identifies, 14 concernaient la sante sexuelle et genesique, neuf la sante de la mere, du nouveau-ne et de l'enfant, et quatre servalent a recueilllr des informations sur la violence sexuelle ou exercee a l'egard des femmes. Soixante-neuf etudes avaient ete reallsees a des fins de sulvi et devaluation, dlx-huit de sensibilisation, sept pour la recherche operationnelle et six pour evaluer les besoins. Conclusion Des moyens pratiques et efficaces de collecte de donnees sont necessalres pour orlenter les actions permettant de preserver des vies humaines dans les situations d'urgence humanitaire. II existe une grande variete d'outils disponibles, dont tous n'ont pas ete employes sur le terrain. II faudralt developper un outil simplifie et standardise pour evaluer les problemes sanitaires des les premieres phases des urgences humanitaires. II est recommande d'adopter une approche groupee, en partenariat avec les chercheurs operationnels et les agences humanitaires, sous la coordination de l'Organisation mondiale de la Sante. Objetivo Describir las herramientas utilizadas para evaluar los problemas de salud materna e infantil en entornos de emergencias humanitarias. Metodo Se realizaron busquedas sistematicas en las bases de datos de Medline, Web of Knowledge y Popline para encontrar estudios publicados entre enero de 2000 y junio de 2014. Tambien se realizaron busquedas en paginas web de organizaciones activas en emergencias humanitarias. Se incluyeron estudios que informaban sobre el desarrollo o el uso de herramientas de recopilacion de datos relacionadas con la salud de las mujeres y los ninos durante emergencias humanitarias. Se utilizo la sintesis narrativa para resumir los estudios. Resultados Se identificaron 100 estudios: 80 informaban sobre situaciones de conflicto y 20 sobre desastres naturales. La mayoria de los estudios (76/100) se centraban en el estado de la salud de la poblacion afectada, mientras que 24 lo hacian en la disponibilidad y cobertura de los servicios de salud. De las 17 herramientas de recopilacion de datos diferentes identificadas, 14 se centraban en la salud reproductiva y sexual, nueve trataban sobre salud maternal, neonatal e infantil y cuatro se utilizaban para recopilar informacion sobre violencia sexual o basada en el genero. 69 estudios se habian realizado con fines de supervision y evaluacion, 18 para promocion, siete para investigaciones operacionales y seis para la evaluacion de necesidades. Conclusion Se necesitan medios practicos y efectivos de recopilacion de datos para informar de acciones para salvar vidas en emergencias humanitarias. Existe una amplia variedad de herramientas disponibles, y no todas se han utilizado en este campo. Se deberia desarrollar una herramienta simplificada estandar para evaluar los problemas de salud en las primeras etapas de emergencias humanitarias. Se recomienda un enfoque por grupos en cooperacion con investigadores operacionales y agencias humanitarias, coordinados por la Organizacion Mundial de la Salud., Introduction Humanitarian emergencies are natural disasters, man-made events or a combination of both that represent critical threats to the health, safety, security or wellbeing of a community. (1) Humanitarian emergencies [...]