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1. A Mobile Phone–Based Sexual and Reproductive Health Intervention for Female Sex Workers in Kenya: Development and Qualitative Study

Author

Ampt, Frances H, L'Engle, Kelly, Lim, Megan S C, Plourde, Kate F, Mangone, Emily, Mukanya, Collins Mudogo, Gichangi, Peter, Manguro, Griffins, Hellard, Margaret, Stoové, Mark, Chersich, Matthew F, Jaoko, Walter, Agius, Paul A, Temmerman, Marleen, Wangari, Winnie, and Luchters, Stanley

Subjects
Information technology, T58.5-58.64, Public aspects of medicine, RA1-1270
Abstract

BackgroundFemale sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and sexually transmitted infection (STI) prevention and management, alcohol awareness, gender-based violence and rights, and health care utilization. The Women’s Health Intervention using SMS for Preventing Pregnancy (WHISPER) mobile phone intervention uses a participatory development approach and behavior change theory to address these high-priority concerns of FSWs in Mombasa, Kenya. ObjectiveThis paper aimed to (1) describe the process of development of the WHISPER intervention, its theoretical framework, key content domains and strategies and (2) explore workshop participants’ responses to the proposed intervention, particularly with regard to message content, behavior change constructs, and feasibility and acceptability. MethodsThe research team worked closely with FSWs in two phases of intervention development. First, we drafted content for three different types of messages based on a review of the literature and behavior change theories. Second, we piloted the intervention by conducting six workshops with 42 FSWs to test and refine message content and 12 interviews to assess the technical performance of the intervention. Workshop data were thematically analyzed using a mixed deductive and inductive approach. ResultsThe intervention framework specified six SRHR domains that were viewed as highly relevant by FSWs. Reactions to intervention content revealed that social cognitive strategies to improve knowledge, outcome expectations, skills, and self-efficacy resonated well with workshop participants. Participants found the content empowering, and most said they would share the messages with others. The refined intervention was a 12-month SMS program consisting of informational and motivational messages, role model stories portraying behavior change among FSWs, and on-demand contraceptive information. ConclusionsOur results highlight the need for health promotion interventions that incorporate broader components of SRHR, not only HIV prevention. Using a theory-based, participatory approach, we developed a digital health intervention that reflects the complex reality of FSWs’ lives and provides a feasible, acceptable approach for addressing SRHR concerns and needs. FSWs may benefit from health promotion interventions that provide relevant, actionable, and engaging content to support behavior change.

Published
2020
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3. ENhancinG vAGinal dElivery in Greece through educational and behavioral interventions among maternity care providers regarding labor management: the ENGAGE stepped-wedge randomized prospective trial protocol

Author

Vrachnis, Nikolaos, Antonakopoulos, Nikolaos, von Dadelszen, Peter, Vidler, Marianne, Maroudias, Georgios, Bone, Jeffrey, Sandhu, Ash, Loukas, Nikolaos, Magee, Laura, Roussos, Nikolaos, Kassaris, Stefania, Fotiou, Alexandros, Zygouris, Dimitrios, Adonakis, Georgios, Akrivis, Christodoulos, Antsaklis, Aris, Athanasiadis, Apostolos, Bontis, Nikolaos, Daniilidis, Angelos, Daponte, Alexandros, Daskalakis, Georgios, Deligeoroglou, Efthimios, Dinas, Konstantinos, Drakakis, Peter, Gerede, Angeliki, Grimbizis, Grigorios, Iacovidou, Nicoletta, Kambas, Nikolaos, Katasos, Theodoros, Katsetos, Christos, Katsikis, Ilias, Makrigiannakis, Antonios, Matalliotakis, Michail, Messini, Christina, Mikos, Themis, Nikolettos, Nikolaos, Pados, Georgios, Paschopoulos, Minas, Patsouras, Konstantinos, Siahanidou, Soultana, Sioulas, Vasileios, Skentou, Chara, Stavros, Sofoklis, Temmerman, Marleen, Tsikouras, Panagiotis, Tsitsis, Vasilios, Vlahos, Nikolaos, Rodolakis, Alexandros, Papageorghiou, Aris, and Loutradis, Dimitrios

Published
2024
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7. Generalisability of fetal ultrasound deep learning models to low-resource imaging settings in five African countries

Author

Sendra-Balcells, Carla, Campello, Víctor M., Torrents-Barrena, Jordina, Ahmed, Yahya Ali, Elattar, Mustafa, Botwe, Benard Ohene, Nyangulu, Pempho, Stones, William, Ammar, Mohammed, Benamer, Lamya Nawal, Kisembo, Harriet Nalubega, Sereke, Senai Goitom, Wanyonyi, Sikolia Z., Temmerman, Marleen, Gratacós, Eduard, Bonet, Elisenda, Eixarch, Elisenda, Mikolaj, Kamil, Tolsgaard, Martin Grønnebæk, and Lekadir, Karim

Subjects
Electrical Engineering and Systems Science - Image and Video Processing, Computer Science - Computer Vision and Pattern Recognition
Abstract

Most artificial intelligence (AI) research have concentrated in high-income countries, where imaging data, IT infrastructures and clinical expertise are plentiful. However, slower progress has been made in limited-resource environments where medical imaging is needed. For example, in Sub-Saharan Africa the rate of perinatal mortality is very high due to limited access to antenatal screening. In these countries, AI models could be implemented to help clinicians acquire fetal ultrasound planes for diagnosis of fetal abnormalities. So far, deep learning models have been proposed to identify standard fetal planes, but there is no evidence of their ability to generalise in centres with limited access to high-end ultrasound equipment and data. This work investigates different strategies to reduce the domain-shift effect for a fetal plane classification model trained on a high-resource clinical centre and transferred to a new low-resource centre. To that end, a classifier trained with 1,792 patients from Spain is first evaluated on a new centre in Denmark in optimal conditions with 1,008 patients and is later optimised to reach the same performance in five African centres (Egypt, Algeria, Uganda, Ghana and Malawi) with 25 patients each. The results show that a transfer learning approach can be a solution to integrate small-size African samples with existing large-scale databases in developed countries. In particular, the model can be re-aligned and optimised to boost the performance on African populations by increasing the recall to $0.92\pm0.04$ and at the same time maintaining a high precision across centres. This framework shows promise for building new AI models generalisable across clinical centres with limited data acquired in challenging and heterogeneous conditions and calls for further research to develop new solutions for usability of AI in countries with less resources., Comment: 14 pages, 6 figures, accepted for publication in Scientific Reports

Published
2022

8. Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis

Author

Smith, Emily R, Oakley, Erin, Grandner, Gargi Wable, Ferguson, Kacey, Farooq, Fouzia, Afshar, Yalda, Ahlberg, Mia, Ahmadzia, Homa, Akelo, Victor, Aldrovandi, Grace, Barr, Beth A Tippett, Bevilacqua, Elisa, Brandt, Justin S, Broutet, Nathalie, Buhigas, Irene Fernández, Carrillo, Jorge, Clifton, Rebecca, Conry, Jeanne, Cosmi, Erich, Crispi, Fatima, Crovetto, Francesca, Delgado-López, Camille, Divakar, Hema, Driscoll, Amanda J, Favre, Guillaume, Flaherman, Valerie J, Gale, Chris, Gil, Maria M, Gottlieb, Sami L, Gratacós, Eduard, Hernandez, Olivia, Jones, Stephanie, Kalafat, Erkan, Khagayi, Sammy, Knight, Marian, Kotloff, Karen, Lanzone, Antonio, Le Doare, Kirsty, Lees, Christoph, Litman, Ethan, Lokken, Erica M, Longo, Valentina Laurita, Madhi, Shabir A, Magee, Laura A, Martinez-Portilla, Raigam Jafet, McClure, Elizabeth M, Metz, Tori D, Miller, Emily S, Money, Deborah, Moungmaithong, Sakita, Mullins, Edward, Nachega, Jean B, Nunes, Marta C, Onyango, Dickens, Panchaud, Alice, Poon, Liona C, Raiten, Daniel, Regan, Lesley, Rukundo, Gordon, Sahota, Daljit, Sakowicz, Allie, Sanin-Blair, Jose, Söderling, Jonas, Stephansson, Olof, Temmerman, Marleen, Thorson, Anna, Tolosa, Jorge E, Townson, Julia, Valencia-Prado, Miguel, Visentin, Silvia, von Dadelszen, Peter, Waldorf, Kristina Adams, Whitehead, Clare, Yassa, Murat, Tielsch, Jim M, Langenegger, Eduard, Sam-Agudu, Nadia A, Gachuno, Onesmus W, Sekikubo, Musa, Mukwege, Denis M, Omore, Richard, Ouma, Gregory, Onyango, Clayton, Otieno, Kephas, Were, Zacchaeus Abaja, Were, Joyce, İlter, Pinar Birol, Mboizi, Robert, Hookham, Lauren, Meli, Federica, Bonanni, Giulia, Romanzi, Federica, Torcia, Eleonora, di Ilio, Chiara, Ananth, Cande V, Hill, Jennifer, Reddy, Ajay, Patrick, Haylea Sweat, Baba, Vuyelwa, and Adam, Mary

Subjects
Biodefense, Pneumonia, Lung, Infant Mortality, Vaccine Related, Emerging Infectious Diseases, Clinical Trials and Supportive Activities, Clinical Research, Pediatric, Perinatal Period - Conditions Originating in Perinatal Period, Preterm, Low Birth Weight and Health of the Newborn, Infectious Diseases, Prevention, Pneumonia & Influenza, Infection, Reproductive health and childbirth, Good Health and Well Being, Infant, Newborn, Pregnancy, Female, Humans, Pregnant Women, Prospective Studies, COVID-19, SARS-CoV-2, Maternal health, Epidemiology, Perinatal COVID PMA Study Collaborators
Abstract

IntroductionDespite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies.MethodsWe screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale.ResultsWe screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection-as compared with uninfected pregnant women-were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias.ConclusionsThis analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol.

Published
2023

10. Author Correction: Generalisability of fetal ultrasound deep learning models to low-resource imaging settings in five African countries

Author

Sendra-Balcells, Carla, Campello, Víctor M., Torrents-Barrena, Jordina, Ahmed, Yahya Ali, Elattar, Mustafa, Ohene-Botwe, Benard, Nyangulu, Pempho, Stones, William, Ammar, Mohammed, Benamer, Lamya Nawal, Kisembo, Harriet Nalubega, Sereke, Senai Goitom, Wanyonyi, Sikolia Z., Temmerman, Marleen, Gratacós, Eduard, Bonet, Elisenda, Eixarch, Elisenda, Mikolaj, Kamil, Tolsgaard, Martin Grønnebæk, and Lekadir, Karim

Published
2023
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11. Generalisability of fetal ultrasound deep learning models to low-resource imaging settings in five African countries

Author

Sendra-Balcells, Carla, Campello, Víctor M., Torrents-Barrena, Jordina, Ahmed, Yahya Ali, Elattar, Mustafa, Ohene-Botwe, Benard, Nyangulu, Pempho, Stones, William, Ammar, Mohammed, Benamer, Lamya Nawal, Kisembo, Harriet Nalubega, Sereke, Senai Goitom, Wanyonyi, Sikolia Z., Temmerman, Marleen, Gratacós, Eduard, Bonet, Elisenda, Eixarch, Elisenda, Mikolaj, Kamil, Tolsgaard, Martin Grønnebæk, and Lekadir, Karim

Published
2023
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15. Obstetric risk in pregnancy interacts with hair cortisone levels to reduce gestational length

Author

Musana, Joseph, Cohen, Craig R, Kuppermann, Miriam, Gerona, Roy, Wanyoro, Anthony, Aguilar, David, Santos, Nicole, Temmerman, Marleen, and Weiss, Sandra J

Subjects
Reproductive Medicine, Midwifery, Biomedical and Clinical Sciences, Health Sciences, Clinical Research, Infant Mortality, Mental Health, Pediatric, Preterm, Low Birth Weight and Health of the Newborn, Behavioral and Social Science, Basic Behavioral and Social Science, Conditions Affecting the Embryonic and Fetal Periods, Perinatal Period - Conditions Originating in Perinatal Period, Aetiology, 2.2 Factors relating to the physical environment, Reproductive health and childbirth, Good Health and Well Being, perceived stress, cortisol, cortisone, gestational length, obstetric medical risk, fetal sex, Biomedical and clinical sciences, Health sciences, Psychology
Abstract

BackgroundMaternal psychological stress has been linked to preterm birth. However, the differential contribution of psychological stress versus stress hormones is not clear. Studies focus primarily on perceived stress and cortisol, with few assessing its inter-convertible hormone cortisone. Furthermore, little is known about the potential moderating roles of obstetric risk and fetal sex in the relationship between maternal stress and gestational length. This gap in knowledge is particularly evident for rural women who typically experience chronic multiple stressors during pregnancy. We explored the relationship of hormonal and psychological stress to gestational length and the effects of obstetric risks and fetal sex on this relationship among Kenyan pregnant women.MethodsThe sample included 130 women recruited between 22 to 28 weeks gestation. They completed a clinical and sociodemographic questionnaire together with the Perceived Stress Scale and provided a hair sample for cortisol and cortisone assay. Women underwent an ultrasound to assess weeks of gestation. At delivery, their pregnancy-related health problems were identified using information extracted from medical records to compile each woman's number of pregnancy risks on the Obstetric Medical Risk Index (OMRI).ResultsPerceived stress and hair cortisol were not significant predictors of gestational length. However, a greater number of obstetric risks on the OMRI was associated with shorter gestational length. This effect was further explained by the interaction between obstetric risk and hair cortisone (B = 0.709, p = 0.02). Hair cortisone levels of mothers who had a shorter gestation were significantly higher in mothers with 2 or more risks on the OMRI but not among mothers with only one or no risks (t = 2.39, p = 0.02). Fetal sex had no relationship to gestational length and also had no moderating effect on the relationship between any stress-related metric and gestational length.ConclusionCortisone levels may increase in anticipation of shorter gestation as a compensatory response to increased obstetric risk. Elevated cortisone may be a more sensitive marker of risk for early delivery than cortisol or psychological stress, with salience for both the male and female fetus.

Published
2022

16. Protocol for a sequential, prospective meta-analysis to describe coronavirus disease 2019 (COVID-19) in the pregnancy and postpartum periods

Author

Smith, Emily R, Oakley, Erin, He, Siran, Zavala, Rebecca, Ferguson, Kacey, Miller, Lior, Grandner, Gargi Wable, Abejirinde, Ibukun-Oluwa Omolade, Afshar, Yalda, Ahmadzia, Homa, Aldrovandi, Grace, Akelo, Victor, Barr, Beth A Tippett, Bevilacqua, Elisa, Brandt, Justin S, Broutet, Natalie, Buhigas, Irene Fernández, Carrillo, Jorge, Clifton, Rebecca, Conry, Jeanne, Cosmi, Erich, Delgado-López, Camille, Divakar, Hema, Driscoll, Amanda J, Favre, Guillaume, Flaherman, Valerie, Gale, Christopher, Gil, Maria M, Godwin, Christine, Gottlieb, Sami, Bellolio, Olivia Hernandez, Kara, Edna, Khagayi, Sammy, Kim, Caron Rahn, Knight, Marian, Kotloff, Karen, Lanzone, Antonio, Le Doare, Kirsty, Lees, Christoph, Litman, Ethan, Lokken, Erica M, Longo, Valentina Laurita, Magee, Laura A, Martinez-Portilla, Raigam Jafet, McClure, Elizabeth, Metz, Torri D, Money, Deborah, Mullins, Edward, Nachega, Jean B, Panchaud, Alice, Playle, Rebecca, Poon, Liona C, Raiten, Daniel, Regan, Lesley, Rukundo, Gordon, Sanin-Blair, Jose, Temmerman, Marleen, Thorson, Anna, Thwin, Soe, Tolosa, Jorge E, Townson, Julia, Valencia-Prado, Miguel, Visentin, Silvia, von Dadelszen, Peter, Waldorf, Kristina Adams, Whitehead, Clare, Yang, Huixia, Thorlund, Kristian, and Tielsch, James M

Subjects
Reproductive Medicine, Biomedical and Clinical Sciences, Health Sciences, Clinical Research, Emerging Infectious Diseases, Pediatric, Prevention, Reproductive health and childbirth, Good Health and Well Being, Adolescent, COVID-19, Child, Female, Humans, Infant, Newborn, Meta-Analysis as Topic, Postpartum Period, Pregnancy, Prospective Studies, Retrospective Studies, SARS-CoV-2, General Science & Technology
Abstract

We urgently need answers to basic epidemiological questions regarding SARS-CoV-2 infection in pregnant and postpartum women and its effect on their newborns. While many national registries, health facilities, and research groups are collecting relevant data, we need a collaborative and methodologically rigorous approach to better combine these data and address knowledge gaps, especially those related to rare outcomes. We propose that using a sequential, prospective meta-analysis (PMA) is the best approach to generate data for policy- and practice-oriented guidelines. As the pandemic evolves, additional studies identified retrospectively by the steering committee or through living systematic reviews will be invited to participate in this PMA. Investigators can contribute to the PMA by either submitting individual patient data or running standardized code to generate aggregate data estimates. For the primary analysis, we will pool data using two-stage meta-analysis methods. The meta-analyses will be updated as additional data accrue in each contributing study and as additional studies meet study-specific time or data accrual thresholds for sharing. At the time of publication, investigators of 25 studies, including more than 76,000 pregnancies, in 41 countries had agreed to share data for this analysis. Among the included studies, 12 have a contemporaneous comparison group of pregnancies without COVID-19, and four studies include a comparison group of non-pregnant women of reproductive age with COVID-19. Protocols and updates will be maintained publicly. Results will be shared with key stakeholders, including the World Health Organization (WHO) Maternal, Newborn, Child, and Adolescent Health (MNCAH) Research Working Group. Data contributors will share results with local stakeholders. Scientific publications will be published in open-access journals on an ongoing basis.

Published
2022

18. Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries

Author

Calvert, Clara, Brockway, Meredith (Merilee), Zoega, Helga, Miller, Jessica E., Been, Jasper V., Amegah, Adeladza Kofi, Racine-Poon, Amy, Oskoui, Solmaz Eradat, Abok, Ishaya I., Aghaeepour, Nima, Akwaowo, Christie D., Alshaikh, Belal N., Ayede, Adejumoke I., Bacchini, Fabiana, Barekatain, Behzad, Barnes, Rodrigo, Bebak, Karolina, Berard, Anick, Bhutta, Zulfiqar A., Brook, Jeffrey R., Bryan, Lenroy R., Cajachagua-Torres, Kim N., Campbell-Yeo, Marsha, Chu, Dinh-Toi, Connor, Kristin L., Cornette, Luc, Cortés, Sandra, Daly, Mandy, Debauche, Christian, Dedeke, Iyabode Olabisi F., Einarsdóttir, Kristjana, Engjom, Hilde, Estrada-Gutierrez, Guadalupe, Fantasia, Ilaria, Fiorentino, Nicole M., Franklin, Meredith, Fraser, Abigail, Gachuno, Onesmus W., Gallo, Linda A., Gissler, Mika, Håberg, Siri E., Habibelahi, Abbas, Häggström, Jonas, Hookham, Lauren, Hui, Lisa, Huicho, Luis, Hunter, Karen J., Huq, Sayeeda, KC, Ashish, Kadambari, Seilesh, Kelishadi, Roya, Khalili, Narjes, Kippen, Joanna, Le Doare, Kirsty, Llorca, Javier, Magee, Laura A., Magnus, Maria C., Man, Kenneth K. C., Mburugu, Patrick M., Mediratta, Rishi P., Morris, Andrew D., Muhajarine, Nazeem, Mulholland, Rachel H., Bonnard, Livia Nagy, Nakibuuka, Victoria, Nassar, Natasha, Nyadanu, Sylvester D., Oakley, Laura, Oladokun, Adesina, Olayemi, Oladapo O., Olutekunbi, Olanike A., Oluwafemi, Rosena O., Ogunkunle, Taofik O., Orton, Chris, Örtqvist, Anne K., Ouma, Joseph, Oyapero, Oyejoke, Palmer, Kirsten R., Pedersen, Lars H., Pereira, Gavin, Pereyra, Isabel, Philip, Roy K., Pruski, Dominik, Przybylski, Marcin, Quezada-Pinedo, Hugo G., Regan, Annette K., Rhoda, Natasha R., Rihs, Tonia A., Riley, Taylor, Rocha, Thiago Augusto Hernandes, Rolnik, Daniel L., Saner, Christoph, Schneuer, Francisco J., Souter, Vivienne L., Stephansson, Olof, Sun, Shengzhi, Swift, Emma M., Szabó, Miklós, Temmerman, Marleen, Tooke, Lloyd, Urquia, Marcelo L., von Dadelszen, Peter, Wellenius, Gregory A., Whitehead, Clare, Wong, Ian C. K., Wood, Rachael, Wróblewska-Seniuk, Katarzyna, Yeboah-Antwi, Kojo, Yilgwan, Christopher S., Zawiejska, Agnieszka, Sheikh, Aziz, Rodriguez, Natalie, Burgner, David, Stock, Sarah J., and Azad, Meghan B.

Published
2023
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19. Protocol for intervention development to improve adolescent perinatal mental health in Kenya and Mozambique: The INSPIRE project

Author

Lamahewa, Kethakie, Griffin, Sally, Seward, Nadine, Temmerman, Marleen, West, Jonathan, de Melo, Málica, Raby, Elizabeth, Alonso, Aline, Burnside, Bethan, Chissale, Fernando, Gheerawo, Rama, Lang'at, Evaline Chepchichir, Mandlate, Flavio, Mahangue, Domingos, Mohiddin, Abdu, Neagu, Ela, and Taylor Salisbury, Tatiana

Published
2023
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20. Psychological and physiological stress and burnout among maternity providers in a rural county in Kenya: individual and situational predictors.

Author

Afulani, Patience A, Ongeri, Linnet, Kinyua, Joyceline, Temmerman, Marleen, Mendes, Wendy Berry, and Weiss, Sandra J

Subjects
Autonomic Nervous System, Humans, Hydrocortisone, Stress, Psychological, Burnout, Professional, Pregnancy, Adult, Kenya, Female, Male, Stress, Physiological, Burnout, Cortisol, Heat rate variability, Maternity providers, Kenya, Stress, Maternity providers, Clinical Research, Neurosciences, Behavioral and Social Science, Mental Health, Public Health, Public Health and Health Services
Abstract

BackgroundStress and burnout among healthcare workers has been recognized as a global crisis needing urgent attention. Yet few studies have examined stress and burnout among healthcare providers in sub-Saharan Africa, and even fewer among maternity providers who work under very stressful conditions. To address these gaps, we examined self-reported stress and burnout levels as well as stress-related physiologic measures of these providers, along with their potential predictors.MethodsParticipants included 101 maternity providers (62 nurses/midwives, 16 clinical officers/doctors, and 23 support staff) in western Kenya. Respondents completed Cohen's Perceived Stress Scale, the Shirom-Melamed Burnout scale, and other sociodemographic, health, and work-related items. We also collected data on heart rate variability (HRV) and hair cortisol levels to assess stress-related physiologic responses to acute and chronic stress respectively. Multilevel linear regression models were computed to examine individual and work-related factors associated with stress, burnout, HRV, and cortisol level.Results85% of providers reported moderate stress and 11.5% high stress. 65% experienced low burnout and 19.6% high burnout. Average HRV (measured as the root mean square of differences in intervals between successive heart beats: RMSSD) was 60.5 (SD = 33.0) and mean cortisol was mean cortisol was 44.2 pg/mg (SD = 60.88). Greater satisfaction with life accomplishments was associated with reduced stress (β = - 2.83; CI = -5.47; - 0.18), while motivation to work excessively (over commitment) was associated with both increased stress (β = 0.61 CI: 0.19, 1.03) and burnout (β = 2.05, CI = 0.91, 3.19). Female providers had higher burnout scores compared to male providers. Support staff had higher HRV than other providers and providers under 30 years of age had higher HRV than those 30 and above. Although no association between cortisol and any predictor was statistically significant, the direction of associations was consistent with those found for stress and burnout.ConclusionsMost providers experienced moderate to high levels of stress and burnout. Individuals who were more driven to work excessively were particularly at risk for higher stress and burnout. Higher HRV of support staff and providers under age 30 suggest their more adaptive autonomic nervous system response to stress. Given its impact on provider wellbeing and quality of care, interventions to help providers manage stress are critical.

Published
2021

21. What more can be done? Prioritizing the most promising antenatal interventions to improve birth weight

Author

Awoyemi, Toluwalase, Ayede, Adejumoke I., Bastola, Kalpana, Bhutta, Zulfiqar A., Blencowe, Hannah, Christian, Parul, David, Anna, Hunter, Patricia, Isojärvi, Jaana, Katz, Joanne, De Costa, Ayesha, Erchick, Daniel J., Gibson, Sarah, Goncalves, Bronner P., Gravett, Michael G., Hadji, Maryam, Hazel, Elizabeth, Hofmeyr, G Justus, Kozuki, Naoko, Lee, Anne CC., Magge, Hema, Manasyan, Albert, Mohiddin, Abdulrahman, Morrison, Melissa, Muthiani, Yvonne, Nabwera, Helen, Nakimuli, Annettee, Okong, Pius, Prendergast, Andrew J., Simon, Jonathon, Temmerman, Marleen, Yan, Jian, Koivu, Annariina M., Haapaniemi, Tiia, Askari, Sufia, Bhandari, Nita, Black, Robert E., Chico, R. Matthew, Dewey, Kathryn G., Duggan, Christopher P., Klein, Nigel, Kumar, Somesh, Lawn, Joy E., Manji, Karim, Näsänen-Gilmore, Pieta K., Salasibew, Mihretab, Semrau, Katherine E.A., Ashorn, Ulla, and Ashorn, Per

Published
2023
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22. Small babies, big risks: global estimates of prevalence and mortality for vulnerable newborns to accelerate change and improve counting

Author

Ashorn, Per, Black, Robert E, Lawn, Joy E, Ashorn, Ulla, Klein, Nigel, Hofmeyr, G Justus, Temmerman, Marleen, Askari, Sufia, Ohuma, Eric O, Moller, Ann-Beth, Bradley, Ellen, Chakwera, Samuel, Hussain-Alkhateeb, Laith, Lewin, Alexandra, Okwaraji, Yemisrach B, Retno Mahanani, Wahyu, White Johansson, Emily, Lavin, Tina, Estevez Fernandez, Diana, Gatica Domínguez, Giovanna, de Costa, Ayesha, Cresswell, Jenny A, Krasevec, Julia, Blencowe, Hannah, Requejo, Jennifer, Moran, Allisyn C, Pingray, Veronica, Cormick, Gabriela, Gibbons, Luz, Belizan, José, Guevel, Carlos, Warrilow, Kara, Gordon, Adrienne, Flenady, Vicki, Sexton, Jessica, Lawford, Harriet, Paixao, Enny S., Rocha Falcão, Ila, Lima Barreto, Mauricio, Lisonkova, Sarka, Wen, Qi, Mardones, Francisco, Caulier-Cisterna, Raúl, Acuña, José, Velebil, Petr, Jirova, Jitka, Horváth-Puhó, Erzsébet, Sørensen, Henrik Toft, Sakkeus, Luule, Abuladze, Liili, Gissler, Mika, Moradi-Lakeh, Maziar, Heidarzadeh, Mohammad, Khalili, Narjes, A. Yunis, Khalid, Al Bizri, Ayah, Nakad, Pascale, Devi Karalasingam, Shamala, R Jeganathan, J Ravichandran, binti Baharum, Nurakman, Suárez-Idueta, Lorena, Barranco Flores, Arturo, Gonzalez Roldan, Jesus F, Lopez Alvarez, Sonia, van Dijk, Aimée E., Broeders, Lisa, Huicho, Luis, Quezada Pinedo, Hugo G, Cajachagua-Torres, Kim N, Carrillo-Larco, Rodrigo M, Tarazona Meza, Carla Estefania, Guzman-Vilca, Wilmer Cristobal, Olukade, Tawa O., Ali, Hamdy A., Alyafei, Fawziya, AlQubaisi, Mai, Alturk, Mohamad R, Kim, Ho Yeon, Cho, Geum Joon, Razaz, Neda, Söderling, Jonas, Smith, Lucy K, Kurinczuk, Jennifer J, Matthews, Ruth J, Manktelow, Bradley N, Draper, Elizabeth S, Fenton, Alan C, Lowry, Estelle, Rowland, Neil, Wood, Rachael, Monteath, Kirsten, Pereyra, Isabel, Pravia, Gabriella, Davis, Celina, Clarke, Samantha, Wu, Lee S.F., Yoshida, Sachiyo, Bahl, Rajiv, Grandi, Carlos, Labrique, Alain B, Rashid, Mabhubur, Ahmed, Salahuddin, Roy, Arunangshu D., Haque, Rezwanul, Shaikh, Saijuddin, Baqui, Abdullah H., Saha, Samir K., Khanam, Rasheda, Rahman, Sayedur, Shapiro, Roger, Zash, Rebecca, Silveira, Mariângela F., Buffarini, Romina, Kolsteren, Patrick, Lachat, Carl, Huybregts, Lieven, Roberfroid, Dominique, Zeng, Lingxia, Zhu, Zhonghai, He, Jianrong, Qui, Xiu, Gebreyesus, Seifu H., Tesfamariam, Kokeb, Bekele, Delayehu, Chan, Grace, Baye, Estifanos, Workneh, Firehiwot, Asante, Kwaku P., Boanmah-Kaali, Ellen, Adu-Afarwuah, Seth, Dewey, Kathryn G., Gyaase, Stephaney, Wylie, Blair J., Kirkwood, Betty R., Manu, Alexander, Thulasiraj, Ravilla D, Tielsch, James, Chowdhury, Ranadip, Taneja, Sunita, Babu, Giridhara R, Shriyan, Prafulla, Maleta, Kenneth, Mangani, Charles, Acevedo-Gallegos, Sandra, Rodriguez-Sibaja, Maria J., Khatry, Subarna K., LeClerq, Steven C., Mullany, Luke C., Jehan, Fyezah, Ilyas, Muhammad, Rogerson, Stephen J., Unger, Holger W., Ghosh, Rakesh, Musange, Sabine, Ramokolo, Vundli, Zembe-Mkabile, Wanga, Lazzerini, Marzia, Mohamed, Rishard, Wang, Dongqing, Fawzi, Wafaie W., Minja, Daniel T.R., Schmiegelow, Christentze, Masanja, Honorati, Smith, Emily, Lusingu, John P.A., Msemo, Omari A., Kabole, Fathma M., Slim, Salim N., Keentupthai, Paniya, Mongkolchati, Aroonsri, Kajubi, Richard, Kakuru, Abel, Waiswa, Peter, Walker, Dilys, Hamer, Davidson H., Semrau, Katherine E.A., Chaponda, Enesia B., Chico, R. Matthew, Banda, Bowen, Musokotwane, Kebby, Manasyan, Albert, Pry, Jake M., Chasekwa, Bernard, Humphrey, Jean, Shamim, Abu Ahmed, Christian, Parul, Ali, Hasmot, Klemm, Rolf D.W., Massie, Alan B., Mitra, Maithili, Mehra, Sucheta, Schulze, Kerry J., Shamim, Abu Amed, Sommer, Alfred, Ullah, Barkat, West, Keith P., Jr, Begum, Nazma, Chowdhury, Nabidul Haque, Islam, Shafiqul, Mitra, Dipak Kumar, Quaiyum, Abdul, Diseko, Modiegi, Makhema, Joseph, Cheng, Yue, Guo, Yixin, Yuan, Shanshan, Roro, Meselech, Shikur, Bilal, Goddard, Frederick, Haneuse, Sebastien, Hunegnaw, Bezawit, Berhane, Yemane, Worku, Alemayehu, Kaali, Seyram, Arnold, Charles D., Jack, Darby, Amenga-Etego, Seeba, Hurt, Lisa, Shannon, Caitlin, Soremekun, Seyi, Bhandari, Nita, Martines, Jose, Mazumder, Sarmila, Ana, Yamuna, R, Deepa, Hallamaa, Lotta, Pyykkö, Juha, Lumbreras-Marquez, Mario I., Mendoza-Carrera, Claudia E., Hussain, Atiya, Karim, Muhammad, Kausar, Farzana, Mehmood, Usma, Nadeem, Naila, Nisar, Muhammad Imran, Sajid, Muhammad, Mueller, Ivo, Ome-Kaius, Maria, Butrick, Elizabeth, Sayinzoga, Felix, Mariani, Ilaria, Urassa, Willy, Theander, Thor, Deloron, Phillippe, Nielsen, Birgitte Bruun, Muhihi, Alfa, Noor, Ramadhani Abdallah, Bygbjerg, Ib, Moeller, Sofie Lykke, Aftab, Fahad, Ali, Said M., Dhingra, Pratibha, Dhingra, Usha, Dutta, Arup, Sazawal, Sunil, Suleiman, Atifa, Mohammed, Mohammed, Deb, Saikat, Kamya, Moses R., Nakalembe, Miriam, Mulowooz, Jude, Santos, Nicole, Biemba, Godfrey, Herlihy, Julie M., Mbewe, Reuben K., Mweena, Fern, Yeboah-Antwi, Kojo, Bruce, Jane, Chandramohan, Daniel, Prendergast, Andrew, Idueta, Lorena Suárez, Hazel, Elizabeth, Erchick, Daniel J, Yargawa, Judith, Katz, Joanne, Lee, Anne C C, Diaz, Mike, Salasibew, Mihretab, Hayashi, Chika, and Borghi, Elaine

Published
2023
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24. Small vulnerable newborns—big potential for impact

Author

Okwaraji, Yemisrach, Krasevec, Julia, Bradley, Ellen, Conkle, Joel, Stevens, Gretchen, Gatica, Giovanna, Ohuma, Eric O., Coffey, Chris, Estevez Dominguez, Diana, Blencowe, Hannah, Kimathi, Ben, Moller, Ann Beth, Lewin, Alexandra, Hussain-Alkhateeb, Laith, Dalmiya, Nita, Lawn, Joy E., Borghi, Elaine, Hayashi, Chika, Ashorn, Per, Ashorn, Ulla, Muthiani, Yvonne, Aboubaker, Samira, Askari, Sufia, Bahl, Rajiv, Black, Robert E, Duggan, Christopher P, Hofmeyr, G Justus, Kennedy, Stephen H, Klein, Nigel, Lawn, Joy E, Shiffman, Jeremy, Simon, Jonathon, and Temmerman, Marleen

Published
2023
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27. Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis

Author

Smith, Emily R., Oakley, Erin, Grandner, Gargi Wable, Rukundo, Gordon, Farooq, Fouzia, Ferguson, Kacey, Baumann, Sasha, Adams Waldorf, Kristina Maria, Afshar, Yalda, Ahlberg, Mia, Ahmadzia, Homa, Akelo, Victor, Aldrovandi, Grace, Bevilacqua, Elisa, Bracero, Nabal, Brandt, Justin S., Broutet, Natalie, Carrillo, Jorge, Conry, Jeanne, Cosmi, Erich, Crispi, Fatima, Crovetto, Francesca, del Mar Gil, Maria, Delgado-López, Camille, Divakar, Hema, Driscoll, Amanda J., Favre, Guillaume, Fernandez Buhigas, Irene, Flaherman, Valerie, Gale, Christopher, Godwin, Christine L., Gottlieb, Sami, Gratacós, Eduard, He, Siran, Hernandez, Olivia, Jones, Stephanie, Joshi, Sheetal, Kalafat, Erkan, Khagayi, Sammy, Knight, Marian, Kotloff, Karen L., Lanzone, Antonio, Laurita Longo, Valentina, Le Doare, Kirsty, Lees, Christoph, Litman, Ethan, Lokken, Erica M., Madhi, Shabir A., Magee, Laura A., Martinez-Portilla, Raigam Jafet, Metz, Torri D., Miller, Emily S., Money, Deborah, Moungmaithong, Sakita, Mullins, Edward, Nachega, Jean B., Nunes, Marta C., Onyango, Dickens, Panchaud, Alice, Poon, Liona C., Raiten, Daniel, Regan, Lesley, Sahota, Daljit, Sakowicz, Allie, Sanin-Blair, Jose, Stephansson, Olof, Temmerman, Marleen, Thorson, Anna, Thwin, Soe Soe, Tippett Barr, Beth A., Tolosa, Jorge E., Tug, Niyazi, Valencia-Prado, Miguel, Visentin, Silvia, von Dadelszen, Peter, Whitehead, Clare, Wood, Mollie, Yang, Huixia, Zavala, Rebecca, and Tielsch, James M.

Published
2023
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31. The COVID-19 pandemic and disruptions to essential health services in Kenya: a retrospective time-series analysis

Author

Cosmas, Leonard, Gatheca, Gladwell, Kiarie, James, Soe, Khaing, Munyao, Oliver, Gathiti, Zipporah, Maina, Lucy, Godana, Adano, Muthee, Rose, Onyango, Brian, Langat, Chirchir, Wangari, Claudine, Sadia, Christine, Onyango, Joyce, Kimanga, Davies, Nyangasi, Mary, Otieno, David, Kamau, Peter, Cheburet, Samuel, Kibet, Sergon, Gitau, Shikoh, Kiarie, Helen, Temmerman, Marleen, Nyamai, Mutono, Liku, Nzisa, Thuo, Wangari, Oramisi, Violet, Nyaga, Lilly, Karimi, Janette, Wamalwa, Phidelis, Mwenda, Valerian, Ombajo, Loice Achieng, and Thumbi, S M

Published
2022
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32. The impact of training on self-reported performance in reproductive, maternal, and newborn health service delivery among healthcare workers in Tanzania: a baseline- and endline-survey

Author

Mwansisya, Tumbwene, Mbekenga, Columba, Isangula, Kahabi, Mwasha, Loveluck, Mbelwa, Stewart, Lyimo, Mary, Kisaka, Lucy, Mathias, Victor, Pallangyo, Eunice, Edwards, Grace, Mantel, Michaela, Konteh, Sisawo, Rutachunzibwa, Thomas, Mrema, Secilia, Kidanto, Hussein, and Temmerman, Marleen

Published
2022
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39. Effect of male partners' involvement and support on reproductive, maternal and child health and well‐being in East Africa: A scoping review.

Author

Fletcher, Richard, Forbes, Faye, Dadi, Abel Fekadu, Kassa, Getachew Mullu, Regan, Casey, Galle, Anna, Beyene, Addisu, Liackman, Rebecca, and Temmerman, Marleen

Subjects
WELL-being, CHILDREN'S health, MATERNAL health, MALE reproductive health, INTIMATE partner violence, ABUSED women, MALE athletes
Abstract

Background and Aims: East African countries have high rates of maternal and child mortality and morbidity. Studies have shown that the involvement of male partners in reproductive health can benefit maternal and child health (MCH). This scoping review aims to provide an overview of the evidence across East Africa that describes male partner involvement and its effect on maternal, reproductive, and child well‐being. Methods: Ten databases were searched to identify quantitative data on male's involvement in East Africa. Studies reporting qualitative data, "intention to use" data or only reporting on male partner's education or economic status were excluded. Studies were organized into five a priori categories: antenatal care (ANC), human immunodeficiency virus, breastfeeding, family planning, and intimate partner violence with further categories developed based on studies included. Results: A total of 2787 records were identified; 644 full texts were reviewed, and 96 studies were included in this review. Data were reported on 118,967 mothers/pregnant women and 15,361 male partners. Most of the studies (n = 83) were reported from four countries Ethiopia (n = 49), Kenya (n = 14), Tanzania (n = 12) and Uganda (n = 10). The evidence indicates that male partner involvement and support is associated with improved reproductive, MCH across a wide range of outcomes. However, the studies were heterogeneous, using diverse exposure and outcome measures. Also, male partners' lack of practical and emotional support, and engagement in violent behaviors towards partners, were associated with profound negative impacts on MCH and well‐being. Conclusions: The body of evidence, although heterogeneous, provides compelling support for male involvement in reproductive health programs designed to support MCH. To advance research in this field, an agreement is needed on a measure of male partner "involvement." To optimize benefits of male partners' involvement, developing core outcome sets and regional coordination are recommended. [ABSTRACT FROM AUTHOR]

Published
2024
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41. Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition.

Author

Jamison, Dean T, Alwan, Ala, Mock, Charles N, Nugent, Rachel, Watkins, David, Adeyi, Olusoji, Anand, Shuchi, Atun, Rifat, Bertozzi, Stefano, Bhutta, Zulfiqar, Binagwaho, Agnes, Black, Robert, Blecher, Mark, Bloom, Barry R, Brouwer, Elizabeth, Bundy, Donald AP, Chisholm, Dan, Cieza, Alarcos, Cullen, Mark, Danforth, Kristen, de Silva, Nilanthi, Debas, Haile T, Donkor, Peter, Dua, Tarun, Fleming, Kenneth A, Gallivan, Mark, Garcia, Patricia J, Gawande, Atul, Gaziano, Thomas, Gelband, Hellen, Glass, Roger, Glassman, Amanda, Gray, Glenda, Habte, Demissie, Holmes, King K, Horton, Susan, Hutton, Guy, Jha, Prabhat, Knaul, Felicia M, Kobusingye, Olive, Krakauer, Eric L, Kruk, Margaret E, Lachmann, Peter, Laxminarayan, Ramanan, Levin, Carol, Looi, Lai Meng, Madhav, Nita, Mahmoud, Adel, Mbanya, Jean Claude, Measham, Anthony, Medina-Mora, María Elena, Medlin, Carol, Mills, Anne, Mills, Jody-Anne, Montoya, Jaime, Norheim, Ole, Olson, Zachary, Omokhodion, Folashade, Oppenheim, Ben, Ord, Toby, Patel, Vikram, Patton, George C, Peabody, John, Prabhakaran, Dorairaj, Qi, Jinyuan, Reynolds, Teri, Ruacan, Sevket, Sankaranarayanan, Rengaswamy, Sepúlveda, Jaime, Skolnik, Richard, Smith, Kirk R, Temmerman, Marleen, Tollman, Stephen, Verguet, Stéphane, Walker, Damian G, Walker, Neff, Wu, Yangfeng, and Zhao, Kun

Subjects
Humans, Health Priorities, Delivery of Health Care, Global Health, Universal Health Insurance, Behavioral and Social Science, Prevention, Generic health relevance, Good Health and Well Being, Medical and Health Sciences, General & Internal Medicine
Abstract

The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to be a model starting point for analyses at the country level, but country-specific cost structures, epidemiological needs, and national priorities will generally lead to definitions of EUHC that differ from country to country and from the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies increasingly on greater domestic finance, with global developmental assistance in health focusing more on global public goods. In addition to assessing effects on mortality, DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year metric and related cost-effectiveness analyses. The other objectives included financial protection (potentially better provided upstream by keeping people out of the hospital rather than downstream by paying their hospital bills for them), stillbirths averted, palliative care, contraception, and child physical and intellectual growth. The first 1000 days after conception are highly important for child development, but the next 7000 days are likewise important and often neglected.

Published
2018

43. Women in Health and their Economic, Equity and Livelihood statuses during Emergency Preparedness and Response (WHEELER) protocol: a mixed methods study in Kenya

Author

Langat, Evaline Chepchichir, primary, Mazoya, Bilali Yusuf, additional, Oginga, Pauline, additional, Okwaro, Ferdinand, additional, Matheka, Norah, additional, Kibara, Irene, additional, Otieno, Rhoda, additional, Mantel, Michaela, additional, Lorway, Robert, additional, du Plessis, Elsabe, additional, Temmerman, Marleen, additional, and Avery, Lisa, additional

Published
2024
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45. Pregnancy-related mortality up to 1 year postpartum in sub-Saharan Africa : an analysis of verbal autopsy data from six countries

Author

Gazeley, Ursula, Reniers, Georges, Romero-Prieto, Julio E., Calvert, Clara, Jasseh, Momodou, Herbst, Kobus, Khagayi, Sammy, Obor, David, Kwaro, Daniel, Dube, Albert, Dheresa, Merga, Kabudula, Chodziwadziwa W., Kahn, Kathleen, Urassa, Mark, Nyaguara, Amek, Temmerman, Marleen, Magee, Laura A., von Dadelszen, Peter, Filippi, Veronique, Gazeley, Ursula, Reniers, Georges, Romero-Prieto, Julio E., Calvert, Clara, Jasseh, Momodou, Herbst, Kobus, Khagayi, Sammy, Obor, David, Kwaro, Daniel, Dube, Albert, Dheresa, Merga, Kabudula, Chodziwadziwa W., Kahn, Kathleen, Urassa, Mark, Nyaguara, Amek, Temmerman, Marleen, Magee, Laura A., von Dadelszen, Peter, and Filippi, Veronique

Abstract

Objective: To compare the causes of death for women who died during pregnancy and within the first 42 days postpartum with those of women who died between >42 days and within 1 year postpartum. Design: Open population cohort (Health and Demographic Surveillance Systems). Setting: Ten Health and Demographic Surveillance Systems (HDSS) in The Gambia, Kenya, Malawi, Tanzania, Ethiopia and South Africa. Population: 2114 deaths which occurred within 1 year of the end of pregnancy where a verbal autopsy interview was conducted from 2000 to 2019. Methods: InterVA5 and InSilicoVA verbal autopsy algorithms were used to attribute the most likely underlying cause of death, which were grouped according to adapted International Classification of Diseases-Maternal Mortality categories. Multinomial regression was used to compare differences in causes of deaths within 42 days versus 43–365 days postpartum adjusting for HDSS and time period (2000–2009 and 2010–2019). Main outcome measures: Cause of death and the verbal autopsy Circumstances of Mortality Categories (COMCATs). Results: Of 2114 deaths, 1212 deaths occurred within 42 days postpartum and 902 between 43 and 365 days postpartum. Compared with deaths within 42 days, deaths from HIV and TB, other infectious diseases, and non-communicable diseases constituted a significantly larger proportion of late pregnancy-related deaths beyond 42 days postpartum, and health system failures were important in the circumstances of those deaths. The contribution of HIV and TB to deaths beyond 42 days postpartum was greatest in Southern Africa. The causes of pregnancy-related mortality within and beyond 42 days postpartum did not change significantly between 2000–2009 and 2010–2019. Conclusions: Cause of death data from the extended postpartum period are critical to inform prevention. The dominance of HIV and TB, other infectious and non-communicable diseases to (late) pregnancy-related mortality highlights the need for better integration

Published
2024
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47. Baseline assessment of cervical cancer screening and treatment capacity in 25 counties in Kenya, 2022.

Author

Mwenda, Valerian, Murage, David, Kilonzo, Catherine, Bor, Joan-Paula, Njiri, Patricia, Osiro, Lance, Nyangasi, Mary, Arbyn, Marc, Tummers, Philippe, and Temmerman, Marleen

Subjects
CERVICAL cancer, EARLY detection of cancer, MEDICAL personnel, CANCER treatment, CAPACITY (Law)
Abstract

Background: Cervical cancer is the leading cause of cancer deaths among women in Kenya. In the context of the Global strategy to accelerate the elimination of cervical cancer as a public health problem, Kenya is currently implementing screening and treatment scale-up. For effectively tracking the scale-up, a baseline assessment of cervical cancer screening and treatment service availability and readiness was conducted in 25 priority counties. We describe the findings of this assessment in the context of elimination efforts in Kenya. Methods: The survey was conducted from February 2021 to January 2022. All public hospitals in the target counties were included. We utilized healthcare workers trained in preparation for the scale-up as data collectors in each subcounty. Two electronic survey questionnaires (screening and treatment; and laboratory components) were used for data collection. All the health system building blocks were assessed. We used descriptive statistics to summarize the main service readiness indicators. Results: Of 3,150 hospitals surveyed, 47.6% (1,499) offered cervical cancer screening only, while 5.3% (166) offered both screening and treatment for precancer lesions. Visual inspection with acetic acid (VIA) was used in 96.0% (1,599/1,665) of the hospitals as primary screening modality and HPV testing was available in 31 (1.0%) hospitals. Among the 166 hospitals offering treatment for precancerous lesions, 79.5% (132/166) used cryotherapy, 18.7% (31/166) performed thermal ablation and 25.3% (42/166) performed large loop excision of the transformation zone (LLETZ). Pathology services were offered in only 7.1% (17/238) of the hospitals expected to have the service (level 4 and above). Only 10.8% (2,955/27,363) of healthcare workers were trained in cervical cancer screening and treatment; of these, 71.0% (2,097/2,955) were offering the services. Less than half of the hospitals had cervical cancer screening and treatment commodities at time of survey. The main health system strength was presence of multiple screening points at hospitals, but frequent commodity stock-outs was a key weakness. Conclusion: Training, commodities, and diagnostic services are major gaps in the cervical cancer program in Kenya. To meet the 2030 elimination targets, the national and county governments should ensure adequate financing, training, and service integration, especially at primary care level. [ABSTRACT FROM AUTHOR]

Published
2024
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48. ENhancinG vAGinal dElivery in Greece through educational and behavioral interventions among maternity care providers regarding labor management: the ENGAGE stepped-wedge randomized prospective trial protocol

Author

Vrachnis, Nikolaos, primary, Antonakopoulos, Nikolaos, additional, von Dadelszen, Peter, additional, Vidler, Marianne, additional, Maroudias, Georgios, additional, Bone, Jeffrey, additional, Sandhu, Ash, additional, Loukas, Nikolaos, additional, Magee, Laura, additional, Kassaris, Stefania, additional, Roussos, Nikolaos, additional, Fotiou, Alexandros, additional, Zygouris, Dimitrios, additional, Adonakis, Georgios, additional, Akrivis, Christodoulos, additional, Antsaklis, Aris, additional, Athanasiadis, Apostolos, additional, Bontis, Nikolaos, additional, Daniilidis, Angelos, additional, Daponte, Alexandros, additional, Daskalakis, Georgios, additional, Deligeoroglou, Efthimios, additional, Dinas, Konstantinos, additional, Drakakis, Peter, additional, Gerede, Angeliki, additional, Grimbizis, Grigorios, additional, Iacovidou, Nicoletta, additional, Kambas, Nikolaos, additional, Katasos, Theodoros, additional, Katsetos, Christos, additional, Katsikis, Ilias, additional, Makrigiannakis, Antonios, additional, Matalliotakis, Michail, additional, Messini, Christina, additional, Mikos, Themis, additional, Nikolettos, Nikolaos, additional, Pados, Georgios, additional, Paschopoulos, Minas, additional, Patsouras, Konstantinos, additional, Siahanidou, Soultana, additional, Sioulas, Vasileios, additional, Skentou, Chara, additional, Stavros, Sofoklis, additional, Temmerman, Marleen, additional, Tsikouras, Panagiotis, additional, Tsitsis, Vasilios, additional, Vlahos, Nikolaos, additional, Rodolakis, Alexandros, additional, Papageorghiou, Aris, additional, and Loutradis, Dimitrios, additional

Published
2024
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