Medicine and Health Sciences Commons^™

Modifiers Of The Effect Of Maternal Multiple Micronutrient Supplementation On Stillbirth, Birth Outcomes, And Infant Mortality: A Meta-Analysis Of Individual Patient Data From 17 Randomised Trials In Low-Income And Middle-Income Countries, Emily R. Smith, Anuraj H. Shankar, Lee S-F Wu, Said Aboud, Seth Adu Afarwuah, Hasmot Ali, Rina Agustina, Shams Arifeen, Per Ashorn, Arjumand Rizvi

Department of Paediatrics and Child Health

Background: Micronutrient deficiencies are common among women in low-income and middle-income countries. Data from randomised trials suggest that maternal multiple micronutrient supplementation decreases the risk of low birthweight and potentially improves other infant health outcomes. However, heterogeneity across studies suggests influence from effect modifiers. We aimed to identify individual-level modifiers of the effect of multiple micronutrient supplements on stillbirth, birth outcomes, and infant mortality in low-income and middle-income countries.
Methods: This two-stage meta-analysis of individual patient included data from 17 randomised controlled trials done in 14 low-income and middle-income countries, which compared multiple micronutrient supplements containing iron-folic acid versus iron-folic …

Measuring Home Environments Across Cultures: Invariance Of The Home Scale Across Eight International Sites From The Mal-Ed Study, Paul C. Jones, Laura L. Pendergast, Barbara A. Schaefer, Muneera Rasheed, Erling Svensen, Rebecca Scharf, Rita Shrestha, Angelina Maphula, Reeba Roshan, Zeba Rasmussen

Department of Paediatrics and Child Health

The home environment provides the context for much of a child's early development. Examples of important aspects of the home environment include safety, cleanliness, and opportunities for cognitive stimulation. This study sought to examine the psychometric properties of an adapted form of the Home Observation for the Measurement of the Environment (HOME; Caldwell & Bradley, 1984, 2003) across the eight international sites of the MAL-ED project (Dhaka, Bangladesh; Vellore, India; Bhakatapur, Nepal; Naushahro Feroze, Pakistan; Fortaleza, Brazil; Loreto, Peru; Venda, South Africa; Haydom, Tanzania), to identify a factor structure that fit the data at all sites, and to derive a …

Cost-Effectiveness Of A Family Planning Voucher Program In Rural Pakistan, Edward Ivor Broughton, Waqas Hameed, Xaher Gul, Shabnum Sarfraz, Imam Yar Baig, Monica Villanueva

Community Health Sciences

Introduction: This study reports on the effectiveness and efficiency from the program funder's perspective of the Suraj Social Franchise (SSF) voucher program in which private health-care providers in remote rural areas were identified, trained, upgraded, and certified to deliver family planning services to underserved women of reproductive age in 29 districts of Sindh and 3 districts of Punjab province, Pakistan between October 2013 and June 2016.
Method: A decision tree compared the cost of implementing SSF to the program funder and its effects of providing additional couple years of protection (CYPs) to targeted women, compared to business-as-usual. Costs included vouchers …

Progress And Priorities For Reproductive, Maternal, Newborn, And Child Health In Kenya: A Countdown To 2015 Country Case Study, Emily C. Keats, Anthony Ngugi, William Macharia, Nadia Akseer, Emma Nelima Khaemba, Zaid Ahmad Bhatti, Arjumand Rizvi, John Tole, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Progress in reproductive, maternal, newborn, and child health (RMNCH) in Kenya has been inconsistent over the past two decades, despite the global push to foster accountability, reduce child mortality, and improve maternal health in an equitable manner. Although several cross-sectional assessments have been done, a systematic analysis of RMNCH in Kenya was needed to better understand the push and pull factors that govern intervention coverage and influence mortality trends. As such, we aimed to determine coverage and impact of key RMNCH interventions between 1990 and 2015.
Methods: We did a comprehensive, systematic assessment of RMNCH in Kenya from 1990 …

Anthropometric Indices For Non-Pregnant Women Of Childbearing Age Differ Widely Among Four Low-Middle Income Populations, K Michael Hambidge, Nancy F. Krebs, Ana Garcés, Jamie E. Westcott, Lester Figueroa, Shivaprasad S. Goudar, Sangappa Dhaded, Omrana Pasha, Sumera Aziz Ali, Antoinette Tshefu

Community Health Sciences

Background: Maternal stature and body mass indices (BMI) of non-pregnant women (NPW) of child bearing age are relevant to maternal and offspring health. The objective was to compare anthropometric indices of NPW in four rural communities in low- to low-middle income countries (LMIC).
Methods: Anthropometry and maternal characteristics/household wealth questionnaires were obtained for NPW enrolled in the Women First Preconception Maternal Nutrition Trial. Body mass index (BMI, kg/m²) was calculated. Z-scores were determined using WHO reference data.
Results: A total of 7268 NPW participated in Equateur, DRC (n = 1741); Chimaltenango, Guatemala (n = 1695); North …

Rsv Associated Hospitalizations In Children In Karachi, Pakistan: Implications For Vaccine Prevention Strategies, Syed Asad Ali, Mohammad Tahir Yousafzai, Rabbia Waris, Fatima Jafri, Fatima Aziz, Imran Naeem Abbasi, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Major progress is being made in vaccines against Respiratory Syncytial Virus (RSV), with multiple vaccine candidates currently in the clinical phase of development. Making an investment case for public sector financing of RSV vaccine will require estimation of burden, cost-effectiveness, and impact. The aim of this study is to determine the proportion, age distribution and clinical spectrum of RSV associated hospitalizations in children in Karachi, Pakistan. A three years prospective study was conducted at the Aga Khan University Hospital in Karachi, a city of 20 million in south Pakistan, from August 2009 to June 2012. Children less than five years …

Determinants And Impact Of Giardia Infection In The First 2 Years Of Life In The Mal-Ed Birth Cohort, Elizabeth T. Rogawski, Luther A. Bartelt, James A. Platts-Mills, Jessica C. Seidman, Amidou Samie, Alexandre Havt, Sudhir Babji, Shahida Qureshi, Sadia Shakoor, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Giardia are among the most common enteropathogens detected in children in low-resource settings. We describe here the epidemiology of infection with Giardia in the first 2 years of life in the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED), a multisite birth-cohort study.
Methods: From 2089 children, 34916 stool samples collected during monthly surveillance and episodes of diarrhea were tested for Giardia using an enzyme immunoassay. We quantified the risk of Giardia detection, identified risk factors, and assessed the associations with micronutrients, markers of gut inflammation and …

Setting Health Research Priorities Using The Chnri Method: Vii. A Review Of The First 50 Applications Of The Chnri Method, Igor Rudan, Sachiyo Yoshida, Kit Yee Chan, Devi Sridhar, Kerri Wazny, Harish Nair, Aziz Sheikh, Mark Tomlinson, Joy E. Lawn, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Several recent reviews of the methods used to set research priorities have identified the CHNRI method (acronym derived from the "Child Health and Nutrition Research Initiative") as an approach that clearly became popular and widely used over the past decade. In this paper we review the first 50 examples of application of the CHNRI method, published between 2007 and 2016, and summarize the most important messages that emerged from those experiences.
Methods: We conducted a literature review to identify the first 50 examples of application of the CHNRI method in chronological order. We searched Google Scholar, PubMed and so-called …

Comprehensive Review Of The Evidence Regarding The Effectiveness Of Community-Based Primary Health Care In Improving Maternal, Neonatal And Child Health: 8. Summary And Recommendations Of The Expert Panel, Robert E. Black, Carl E. Taylor, Shobha Arole, Abhay Bang, Zulfiqar Ahmed Bhutta, A Mushtaque R. Chowdhury, Betty R. Kirkwood, Nazo Kureshy, Claudio F. Lanata, James F. Phillips

Department of Paediatrics and Child Health

Background: The contributions that community-based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health-related Millennium Development Goals by 2015. This article provides a summary of a series of articles about the effectiveness of CBPHC in improving MNCH and offers recommendations from an Expert Panel for strengthening CBPHC that were formulated in 2008 and have been updated on the basis of more recent evidence.
Methods: …

Prioritizing Research For Integrated Implementation Of Early Childhood Development And Maternal, Newborn, Child And Adolescent Health And Nutrition Platforms, Renee Sharma, Michelle F. Gaffey, Harold Alderman, Diego G. Bassani, Kimber Bogard, Gary L. Darmstadt, Jai K. Das, Joseph E De Graft–Johnson, Jena D. Hamadani, Susan Horton

Department of Paediatrics and Child Health

Background: Existing health and nutrition services present potential platforms for scaling up delivery of early childhood development (ECD) interventions within sensitive windows across the life course, especially in the first 1000 days from conception to age 2 years. However, there is insufficient knowledge on how to optimize implementation for such strategies in an integrated manner. In light of this knowledge gap, we aimed to systematically identify a set of integrated implementation research priorities for health, nutrition and early child development within the 2015 to 2030 timeframe of the Sustainable Development Goals (SDGs).
Methods: We applied the Child Health and Nutrition …

Unintended Pregnancies Among Married Women In Sindh Pakistan: Role Of Lady Health Workers, Sumera Aziz Ali, Unaib Rabbani

Community Health Sciences

Background: Unintended pregnancies, which pose substantial risks to both mothers and children, account for 24% of all pregnancies in Pakistan. Door to door visits and service provision by lady health workers (LHWs) may be related to the reduction of such pregnancies, particularly in rural areas. This study aimed to determine the association of knowledge about Lady Health Visitors (LHWs) and door to door visits by LHWs with unintended pregnancies among rural women.
Methods: We conducted a community-based, nested case-control study of 800 pregnant women, identified from the database of an active surveillance mechanism, which registers and follows all pregnant women …

Predictors Of Modern Contraceptive Usage Among Women In Rural Pakistan: Physical Access To Services Stills A Major Barrier, Sumera Aziz Ali, Zafar Fatmi

Community Health Sciences

Background: The predictors of contraceptive use may vary in urban and rural areas. Studies have largely focused on the factors predicting contraceptive usage in urban areas. We studied the predictors of contraceptives in one of the rural districts of Pakistan.
Methods: A nested case-control design was used on The Global Network’s Maternal Newborn Health Registry (MNHR) in district Thatta Pakistan between June 2011 to July 2012. Pregnant women before their index pregnancy, who did not use (n = 200 cases) and those used any modern contraceptive method (n = 600 controls), were compared. Logistic regression was used to as certain …

Implementation Of Warning Tool To Improve Maternal Newborn Health Outcomes In A Developing Country, Sana Sheikh, Rahat Qureshi, Sidrah Nausheen, Rozina Sikandar Sultanali

Department of Obstetrics & Gynaecology

Objective: To improve health outcomes through the implementation of national early warning sign tool for babies delivered through emergency caesarean section in off-work hours.

Methods: This comparative clinical study was conducted at the Aga Khan Hospital for Women and Children, Karachi, from April to August 2014, and comprised women who had an emergency caesarean section. Maternal and perinatal outcomes were compared of patients in Group A and Group B which represented individuals before and after the implementation of the national early warning score respectively.

Results: Of the 200 participants, there were 100(50%) in each group. The overall mean age was …

Maternal And Fetal Outcome In Renal Transplant Recipients, Wajeeha Syed, Lumaan Sheikh

Department of Obstetrics & Gynaecology

Objective: To determine maternal and fetal outcome in renal transplant recipients.
Methodology: Retrospective analysis of the antenatal patients with renal transplant
was done between January 1st 2005 till December 31st 2015 and maternal
and fetal outcomes were determined. Data was entered and analyzed in SPSS
version 20.
Results: 08 pregnancies in 07 women who had undergone renal transplant
were included in this study. The mean age at the time of transplantation was
25.29 ±5.5 years (16-32 years). 25% cases had gestational diabetes mellitus,
75% had anemia and 50% had urinary tract infection. The mean birth weight
of babies was 2210 …