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Background Antenatal care (ANC) is an essential platform to improve maternal and newborn health (MNH). While several articles have described the content of ANC in low- and middle-income countries (LMICs), few have investigated the quality of detection and management of pregnancy risk factors during ANC. It remains unclear whether women with pregnancy risk factors receive targeted management and additional ANC. Methods and findings This observational study uses baseline data from the MNH eCohort study conducted in 8 sites in Ethiopia, India, Kenya, and South Africa from April 2023 to January 2024. A total of 4,068 pregnant women seeking ANC for the first time in their pregnancy were surveyed. We built country-specific ANC completeness indices that measured provision of 16 to 22 recommended clinical actions in 5 domains: physical examinations, diagnostic tests, history taking and screening, counselling, and treatment and prevention. We investigated whether women with pregnancy risks tended to receive higher quality care and we assessed the quality of detection and management of 7 concurrent illnesses and pregnancy risk factors (anemia, undernutrition, obesity, chronic illnesses, depression, prior obstetric complications, and danger signs). ANC completeness ranged from 43% in Ethiopia, 66% in Kenya, 73% in India, and 76% in South Africa, with large gaps in history taking, screening, and counselling. Most women in Ethiopia, Kenya, and South Africa initiated ANC in second or third trimesters. We used country-specific multivariable mixed-effects linear regression models to investigate factors associated with ANC completeness. Models included individual demographics, health status, presence of risk factors, health facility characteristics, and fixed effects for the study site. We found that some facility characteristics (staffing, patient volume, structural readiness) were associated with variation in ANC completeness. In contrast, pregnancy risk factors were only associated with a 1.7 percentage points increase in ANC completeness (95% confidence interval 0.3, 3.0, p-value 0.014) in Kenya only. Poor self-reported health was associated with higher ANC completeness in India and South Africa and with lower ANC completeness in Ethiopia. Some concurrent illnesses and risk factors were overlooked during the ANC visit. Between 0% and 6% of undernourished women were prescribed food supplementation and only 1% to 3% of women with depression were referred to a mental health provider or prescribed antidepressants. Only 36% to 73% of women who had previously experienced an obstetric complication (a miscarriage, preterm birth, stillbirth, or newborn death) discussed their obstetric history with the provider during the first ANC visit. Although we aimed to validate self-reported information on health status and content of care with data from health cards, our findings may be affected by recall or other information biases. Conclusions In this study, we observed gaps in adherence to ANC standards, particularly for women in need of specialized management. Strategies to maximize the potential health benefits of ANC should target women at risk of poor pregnancy outcomes and improve early initiation of ANC in the first trimester., Author(s): Catherine Arsenault 1,*, Nompumelelo Gloria Mfeka-Nkabinde 2, Monica Chaudhry 3, Prashant Jarhyan 3, Tefera Taddele 4, Irene Mugenya 5, Shalom Sabwa 6, Katherine Wright 6, Beatrice Amboko 5, Laura [...]

Distinguishing chemical mixtures in terms of the similarity vs. dissimilarity of their components' mechanisms or modes of action (MOAs) is perceived as a key issue in mixture risk assessment. However, [...]

Abstract As new vaccines against diseases that are prevalent in low- and middle-income countries gradually become available, national health authorities are presented with new regulatory and policy challenges. The use [...]

Objectives: More than one in ten adults--and about one in three young adults--report past year cannabis use in Canada. While cannabis use is associated with a variety of health risks, current policy prohibits all use, rather than adopting a public health approach focusing on interventions to address specific risks and harms as do policies for alcohol. The objective of this paper was to develop 'Lower Risk Cannabis Use Guidelines' (LRCUG) based on research evidence on the adverse health effects of cannabis and factors that appear to modify the risk of these harms. Methods: Relevant English-language peer-reviewed publications on health harms of cannabis use were reviewed and LRCUG were drafted by the authors on the basis of a consensus process. Synthesis: The review suggested that health harms related to cannabis use increase with intensity of use although the risk curve is not well characterized. These harms are associated with a number of potentially modifiable factors related to: frequency of use; early onset of use; driving after using cannabis; methods and practices of use and substance potency; and characteristics of specific populations. LRCUG recommending ways to reduce risks related to cannabis use on an individual and population level--analogous to 'Low Risk Drinking Guidelines' for alcohol--are presented. Conclusions: Given the prevalence and age distribution of cannabis use in Canada, a public health approach to cannabis use is overdue. LRCUG constitute a potentially valuable tool in facilitating a reduction of health harms from cannabis use on a population level. Key words: Canada; cannabis; epidemiology; morbidity; policy; public health Objectifs : Plus d'un adulte sur dix--et environ un jeune adulte sur trois --declare avoir consomme du cannabis au cours de la derniere annee au Canada. La consommation de cannabis est associee a divers risques pour la sante, mais contrairement aux politiques sur l'alcool, la politique actuelle sur le cannabis interdit toute consommation plutot que d'adopter une approche de sante publique avec des interventions faites pour aborder les risques et les mefaits particuliers de cette drogue. Nous avons voulu elaborer des << directives de consommation a moindre risque pour le cannabis >> (DCMRC) a la lumiere des donnees de recherche sur les effets defavorables du cannabis pour la sante et sur les facteurs qui semblent attenuer le risque de ces mefaits. Methode : Nous avons examine des publications a comite de lecture, de langue anglaise, portant sur les mefaits pour la sante de la consommation du cannabis, et redige des DCMRC selon un processus consensuel. Synthese : Notre examen a montre que les mefaits du cannabis pour la sante augmentent avec l'intensite de la consommation, mais que la courbe du risque n'est pas bien definie. Les mefaits du cannabis sont associes a des facteurs potentiellement modifiables lies a : la frequence de consommation; le debut precoce de la consommation; la conduite automobile apres la consommation; les methodes et les pratiques de consommation et la teneur de la substance; et les caracteristiques de certaines populations. Nous presentons nos DCMRC, qui recommandent des moyens de reduire les risques de la consommation de cannabis a l'echelle individuelle et populationnelle--un peu comme les << directives de consommation a faible risque >> pour l'alcool. Conclusion : Etant donne la prevalence et la structure par age de la consommation de cannabis au Canada, une politique publique sur le cannabis concue sous l'angle de la sante publique se fait attendre depuis longtemps. Nos DCMRC pourraient etre un precieux outil pour faciliter la reduction des mefaits pour la sante de la consommation de cannabis a l'echelle de la population. Mots cles : Canada; cannabis; epidemiologie; morbidite; politique; sante publique, More than 10% of the general adult population in Canada report use (largely recreational) of cannabis in the past year, the highest use rate of any illegal drug. (1) Use [...]

Objective: No studies have examined the relationship between caregiver beliefs about the risks of smoking to their own health and caregiver beliefs about the effect of their smoking on their child's health. In the current study, we investigated our proposed risk congruence hypothesis among caregivers who smoke. Specifically, we investigated whether caregivers' self-perceived risk of smoking is directly associated with their perception of the risks of smoking to their child. Method: The sample consisted of 271 regular smokers ([greater than or equal to] 3 cigarettes per day: [M.sub.age] = 32.9 years; 214 women) who were caregivers of children with asthma ([M.sub.age] = 4.9 years) who had a recent visit to the emergency room for their asthma. Three constructs of perceived risk were measured via self-report questionnaires assessing both caregiver perception of smoking risk to self and to child: Precaution Effectiveness, Optimistic Bias, and Perceived Vulnerability. Child asthma-related functional morbidity and home and child secondhand smoke exposure were also assessed. Results: Consistent with our risk congruence hypothesis, self-perceived risk of smoking was significantly associated with perceived risk to child, over and above the child's secondhand smoke exposure and caregiver report of child's asthma symptoms (i.e., asthma-related functional morbidity). Conclusions: These findings should be considered in the design of clinical interventions seeking to influence risk of caregiver behavior on child health. Keywords: risk perception, smoking, caregiver, asthma DOI: 10.1037/a0021094