Obstetrics and Gynecology Commons^™

Couple Based Family Planning Education: Changes In Male Involvement And Contraceptive Use Among Married Couples In Jimma Zone, Ethiopia, Tizta Tilahun, Gily Coene, Marleen Temmerman, Olivier Degomme

Obstetrics and Gynaecology, East Africa

Background: Family planning contributes substantially in achieving the Millennium Development Goals. Recently,male involvement has gained considerable attention in family planning programs but the implementation thereof remains a challenge. In that context, our study aimed at measuring the effect of a six-month-long family planning education program on male involvement in family planning, as well as on couples’ contraceptive practice.

Methods: We conducted a quasi-experimental research among 811 married couples in Jimma Zone, southwest Ethiopia. Our study consisted of an intervention and a control group for comparative purpose; and surveyed before and after the implementation of the intervention. The intervention consisted of …

A Cross Sectional Comparison Of Postnatal Care Quality In Facilities Participating In A Maternal Health Voucher Program Versus Non-Voucher Facilities In Kenya, Charlotte E. Warren, Timothy Abuya, Lucy Kanya, Francis Obare, Rebecca Njuki, Marleen Temmerman, Ben Bellows

Obstetrics and Gynaecology, East Africa

Background: Health service fees constitute substantial barriers for women seeking childbirth and postnatal care. In an effort to reduce health inequities, the government of Kenya in 2006 introduced the output-based approach (OBA), or voucher programme, to increase poor women’s access to quality Safe Motherhood services including postnatal care. To help improve service quality, OBA programmes purchase services on behalf of the poor and marginalised, with provider reimbursements for verified services. Kenya’s programme accredited health facilities in three districts as well as in two informal Nairobi settlements.

Methods: Postnatal care quality in voucher health facilities (n = 21) accredited in 2006 …

Induced Abortion In 30 Chinese Provinces In 2013: A Cross-Sectional Survey, Shangchun Wu, Marleen Temmerman, Kun Wang, Shuchen Wang, Jiong Li, Wei-Hong Zhang

Obstetrics and Gynaecology, East Africa

Background: Galloping economic growth and reform in China in the past 30 years has led to dramatic social changes. Attitudes towards sex and sexual behaviour have changed, and premarital sex has become more acceptable. The methods of contraception have changed, and the use of highly effective or long-acting contraceptive methods tends to be decreasing, especially in urban areas. Abortion is commonly used to end unintended pregnancy. The aim of this study was to survey the current situation of induced abortions in selected hospitals in 30 provinces in China.

Methods: This cross-sectional study was conducted in 295 randomly selected hospitals in …

Quality At The Centre Of Universal Health Coverage, Howard L. Sobel, Dale Huntington, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

The last decade of the MDG era witnessed substantial focus on reaching the bottom economic quintiles in low and middle income countries. However, the inordinate focus on reducing financial risk burden and increasing coverage without sufficient focus on expanding quality of services may account for slow progress of the MDGs in many countries. Human Resources for Health underlie quality and service delivery improvements, yet remains under-addressed in many national strategies to achieve Universal Health Coverage. Without adequate investments in improving and expanding health professional education, making and sustaining gains will be unlikely. The transition from the Millennium Development Goals (MDG) …

Determinants Of Method Switching Among Social Franchise Clients Who Discontinued The Use Of Intrauterine Contraceptive Device, Waqas Hameed, Syed Khurram Azmat, Moazzam Ali, Wajahat Hussain, Ghulam Mustafa, Muhammad Ishaque, Safdar Ali, Aftab Ahmed, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Introduction: Women who do not switch to alternatemethods after contraceptive discontinuation, for reasons other than the desire to get pregnant or not needing it, are at obvious risk for unplanned pregnancies or unwanted births. This paper examines the factors that influence women to switch from Intrauterine Contraceptive Device (IUCD) to other methods instead of terminating contraceptive usage altogether.

Methods: The data used for this study comes from a larger cross-sectional survey conducted in nine

(9) randomly selected districts of Sindh and Punjab provinces of Pakistan, during January 2011. Using Stata 11.2, we analyzed data on 333 women, who …

The Perceptions Of The Preparedness Of Medical Graduates To Take On Internship Responsibilities In Low Resource Hospitals In Kenya, Patricia Muthaura, Tashmin Khamis

Obstetrics and Gynaecology, East Africa

The Aga Khan University is developing an Undergraduate Medical Education (UGME) curriculum for implementation in East Africa in 2016, which aims to serve the health needs of the populations there. Pilot focus group discussions of recent interns were conducted at the Aga Khan University Hospital, Nairobi to find out: (1) If Kenyan medical students are adequately prepared for their roles as interns in low resource hospitals upon graduation from medical schools; (2) The likely clinical conditions that interns will face in low resource hospitals in Kenya; and (3) How might the UGME curriculum best prepare interns for their roles in …

Perceptions Of The Preparedness Of Medical Graduates For Internship Responsibilities In District Hospitals In Kenya: A Qualitative Study, Patricia Muthaura, Tashmin Khamis, Mushtaq Ahmed, Syeda Ra’Ana Hussain

Obstetrics and Gynaecology, East Africa

Background: Aga Khan University is developing its undergraduate medical education curriculum for East Africa. In Kenya, a 1 year internship is mandatory for medical graduates’ registration as practitioners. The majority of approved internship training sites are at district hospitals. The purposes of this study were to determine: (1) whether recent Kenyan medical graduates are prepared for their roles as interns in district hospitals upon graduation from medical school; (2) what working and training conditions and social support interns are likely to face in district hospital; and (3) what aspects of the undergraduate curriculum need to be addressed to overcome perceived …

The Fertility Problem Inventory And Infertility-Related Stress: A Case Study, Staci Leigh Born

All Graduate Theses, Dissertations, and Other Capstone Projects

More than seven million people of childbearing age in the United States experience infertility. For women, the experience of infertility is stressful. The Fertility Problem Inventory (FPI) has been used to quantitatively measure women's experience of infertility-related stress. However, the construct of infertility-related stress is poorly described in existing literature. The purpose of this case study was understand how women experience the FPI as a measure of infertility-related stress. To address this issue, women who are undergoing infertility treatment completed the FPI and participated in unstructured interviews. Archival documents were also retrieved to corroborate findings and satisfy saturation. Results indicate …

Centering Pregnancy Implementation And Its Effect On Preterm Birth And Low Birthweight, Carole Ann Moleti

Walden Dissertations and Doctoral Studies

Preterm birth (PTB) and low birthweight (LBW) babies are the source of a large burden of infant, neonatal, and childhood morbidity. The purpose of this project was to expand the use of the CenteringPregnancy^TM Group Prenatal Care Model as an evidence-based intervention for management of both medical and psychosocial risk in low-income, ethnic and racial minorities in New York City. The standardized model developed by Schindler Rising decreases the incidence of preterm birth and low birthweight and increases the rate of breastfeeding. A CenteringPregnancy^TM program implementation plan, customized to meet the needs of a multisite urban hospital system, …

Increasing Initiation And Exclusivity Of Breastfeeding In The Hospitalized Postpartum Dyad, Candace L. Rouse

Walden Dissertations and Doctoral Studies

The purpose of this project was to highlight an intervention to increase breastfeeding initiation and exclusive breastfeeding during the birth hospitalization in a coastal mid-Atlantic inner city hospital. Although researchers and national standards promote early initiation and exclusive breastfeeding, there continues to be a significant number of women who do not breastfeed and/or supplement with formula. The advantages of breastfeeding for mother and infant are substantial and include protecting babies from allergens to reducing maternal breast and ovarian cancer. Breastfeeding rates of initiation and exclusivity at the project hospital were below benchmarks set by international, national, and state agencies. The …

Utilization Of Anc And Pnc Services In Nepal : A Multivariate Analysis Based On Nepal Demographic Health Survey 2001 And 2006, Gehendra Mahara, Collins Asweto, Kai Cao, Ali M. Alzain, Andrea Sebastian, Jill Barr, Xiuhua Guo, Wei Wang

Research outputs 2014 to 2021

Background: Maternal Mortality is a public health problem in Nepal, which was highest in 1990 among the South Asian countries. Associated factors of maternal mortality are various; among them maternal health sevices such as antenatal (ANC) and postnatal care (PNC) services are the main. Methods: A multivariate secondary data analysis out based on Nepal Demographic Health Surveys 2001 and 2006. Logistic regression models was performed to compare the utilization of the ANC and PNC services, with background characteristics of women aged between 15 to 49 years old. Results: A total of 8913 reproductive aged groups (15-49) women were taken f …

The Characterization Of A Putative Virulence Factor Expressed By Sneathia Amnii, Amy Sanford

Theses and Dissertations

Preterm birth, defined at birth before 37 weeks gestation, affects millions of newborns worldwide every year. Preterm birth is a leading cause of infant morbidity and mortality. One major cause of preterm birth is preterm premature rupture of membranes (PPROM), which can be triggered by bacterial infection and inflammation. A bacterial species that has been implicated in preterm birth and other obstetric complications is Sneathia amnii. The goals of this study were to observe cytopathogenic effects caused by S. amnii strain Sn35 and identify putative virulence factors causing those effects. Sn35 was able to adhere to, invade, and damage/kill …

Psychosocial Determinants Of Elective Cesarean Section Deliveries In Selected Obstetric Facilities In Nairobi, Kenya, Tom Joseph Oguta

Walden Dissertations and Doctoral Studies

Cesarean section (CS) rates have generally increased across the world in the past decade. Reducing elective cesarean section (ECS) rates is imperative as many countries aim to maintain threshold CS rates at or below 15%, the level recommended by the United States' National Institutes of Health. Women are believed to consider ECS for various interconnected psychosocial reasons, but few quantitative studies have investigated these factors. This prospective cohort study was based on the social ecological model (SEM) and the theory of planned behavior (TPB) models, and identified the psychosocial predictors of ECS among 1,268 expectant women in 2 hospitals in …

The Association Of Maternal Health Literacy Levels And Preterm Birth, Aimee Moynihan

Walden Dissertations and Doctoral Studies

According to the CDC, each year approximately 0.06 % of the world's population dies in infancy. The March of Dimes indicated that the leading causes of infant mortality include birth defects, preterm birth, low birth weight, sudden infant death syndrome, maternal complications of pregnancy, and respiratory distress syndrome, most of which are considered preventable with access to adequate prenatal care by mothers. The goal of this study was to examine the association between maternal health literacy levels and preterm birth. This research was based on the theoretical framework of the Interaction Model of Client Health Behavior. The hypothesis for this …

Preventative Strategies To Improve Birth Outcomes Among African American Women In Rhode Island, Yvonne Michele Heredia

Walden Dissertations and Doctoral Studies

Despite increased access to prenatal care, birth outcomes continue to be a major source of disparity among women in the United States. The focus on lifestyle choices and negative behaviors prior to a pregnancy to reduce adverse birth outcomes has become a well-documented strategy. The purpose of this study was to determine if preparing for a pregnancy in advance improves birth outcomes for African American women of childbearing age between the ages of 12 and 45 years in the State of Rhode Island (RI). The theoretical foundation for this study was based on Prochaska's model of change, which is also …

Maternal Fish Oil Supplementation In Pregnancy: A 12 Year Follow-Up Of A Randomised Controlled Test, Suzanne Meldrum, Janet A. Dunstan, Jonathon K. Foster, Karen Simmer, Susan L. Prescott

Research outputs 2014 to 2021

A number of trials have been undertaken to assess whether the intake of omega-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) during pregnancy can influence the neurological development of the offspring, yet no consensus from these trials has been reached. We aimed to investigate the long-term effects (12 years) of fish oil supplementation in pregnancy on neurodevelopment, including cognition, language and fine motor skills. In a follow up of a previously published randomised controlled trial of 98 pregnant women, their children were assessed at 12 years of age using a battery of neurodevelopmental assessments. Fifty participants were assessed at 12 years, …

Women's Perspectives On Adequacy Of Screening And Treatment For Postpartum Depression, Gloria Marcia Watson

Walden Dissertations and Doctoral Studies

Postpartum depression affects some 10% to 20% of mothers. Its impact on the health and well-being of mothers and their infants is well documented. If not identified and addressed early, it can result in emotional burden, costly hospitalization and treatment, and, at worst, suicide and or infanticide. Empowerment theory was the conceptual framework for this hermeneutic phenomenological study. The purpose was to understand the lived experiences of the screening and treatment processes of 10 women from New York City experiencing postpartum depression and their perceived adequacy of the treatment received. In-depth interviews were used to investigate participants' lived experiences of …

Pelvic Pain, Pelvic Organ Prolapse, Urinary And Colorectal Distress Incidence And Relationship To Quality Of Life And Birth Mode, Lori Maria Walton, Christine Abreu, Eliena Jeffus, Amy Trautwein, Shenya Xavier

Faculty Publications

Abstract Purpose: To determine the incidence and impact of pelvic pain, pelvic organ prolapse, urinary and colorectal distress and quality of life by birth mode for women in the chronic postpartum period. Study design: Cross-sectional correlational design utilizing purposive sampling of (n=21) female postpartum subjects ages 18-45. Background: Caesarean Section (CS) incidence is reported at 32% nationwide, well above the recommended safe rate of 10% (WHO). Literature is not clear regarding role of birth mode in postpartum symptoms including: pelvic pain, colorectal distress, pelvic organ prolapse, and quality of life. Methods: Data collection took place after IRB approval from Andrews …

A Critical Analysis Of Infant Mortality In Kalamazoo County, Audrey Jensen

Honors Theses

The following is a review of the state of infant and fetal health in Kalamazoo County in the 21st century. Since infant health is a marker for the effectiveness of health care, this review will analyze the leading causes of infant mortality in Kalamazoo County. Statistical indicators show that Kalamazoo County falls below both state and national IMR averages. The leading causes of infant mortality in Kalamazoo are considered preventable infant deaths. Therefore, this review will make recommendations for the reduction of IMR through the improvement of preventative prenatal healthcare practices.

Challenges And Considerations In Optimizing Ovarian Stimulation Protocols In Oncofertility Patients, Kathryn Coyne, Mackenzie Purdy, Kathleen O'Leary, Jerome L. Yaklic, Steven R. Lindheim, Leslie A. Appiah

Obstetrics and Gynecology Faculty Publications

The scope of cancer treatment in women of childbearing age has changed in the last decade. Fertility preservation is no longer an afterthought but central to multi-disciplinary cancer treatment planning and should be addressed due to the cytotoxic effects of cancer therapy. However, oncology patients present as a unique treatment challenge as the physician must balance the urgency of fertility preservation with the risks of delaying cancer therapy. Controlled ovarian stimulation (COS) is routinely applied in assisted reproductive technology but can be contraindicated in women with estrogen-receptor-positive tumors. This paper reviews some of the challenges to consider when using COS …

La Cesárea Y El Parto Natural: Las Opiniones De Profesionales De La Salud En La Provincia De Buenos Aires / Cesarean Section And Natural Birth: The Opinions Of Health Provinces In The Province Of Buenos Aires, Jacqueline Chipkin

Independent Study Project (ISP) Collection

Introduction: The ways in which women of society give birth have the power to influence maternal-infant health and shape the economy of the healthcare system. Today, the rates of cesarean sections are increasing throughout the world. In Argentina, on average, more than 35% of pregnant women received cesarean sections in 2008, with large differences observed in the rates between the public and private health sectors. The World Health Organization (WHO) has established that healthcare systems should only employ a cesarean section if labor cannot progress safely. According to this standard, the organization estimates that cesarean sections should only be utilized …

Food Choices And Practices During Pregnancy Of Immigrant Women With High-Risk Pregnancies In Canada: A Pilot Study, Gina M A. Higginbottom, Helen Vallianatos, Joan Forgeron, Donna Gibbons, Fabiana Mamede, Rubina Barolia

School of Nursing & Midwifery

Background: Immigrant women may be regarded as a vulnerable population with respect to access and navigation of maternity care services. They may encounter difficulties when accessing culturally safe and appropriate maternity care, which may be further exacerbated by language difficulties and discriminatory practices or attitudes. The project aimed to understand ethnocultural food and health practices and how these intersect in a particular social context of cultural adaptation and adjustment in order to improve the care-giving capacities of health practitioners working in multicultural perinatal clinics.
Methods: This four-phase study employed a case study design allowing for multiple means of data collection …

A Study Protocol: Using Demand-Side Financing To Meet The Birth Spacing Needs Of The Underserved In Punjab Province In Pakistan, Syed Khurram Azmat, Moazzam Ali, Waqas Hameed, Ghulam Mustafa, Ghazanfer Abbas, Muhammad Ishaque, Mohsina Bilgrami, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women’s health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan.

Methods/Design: This study will use quasi-experimental design with control arm and be implemented in: six government …

Sexual Violence And Sub-Saharan Migrants In Morocco: A Community-Based Participatory Assessment Using Respondent Driven Sampling, Ines Keygnaert, Abdessamad Dialmy, Altay Manço, Jeroen Keygnaert, Nicole Vettenburg, Kristien Roelens, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: The European Union contracted Morocco to regulate migration from so-called “transit migrants” from Morocco to Europe via the European Neighbourhood Policy. Yet, international organisations signal that human, asylum and refugee rights are not upheld in Morocco and that many sub-Saharan migrants suffer from ill-health and violence. Hence, our study aimed at 1) investigating the nature of violence that sub-Saharan migrants experience around and in Morocco, 2) assessing which determinants they perceive as decisive and 3) formulating prevention recommendations.

Methods: Applying Community-Based Participatory Research, we trained twelve sub-Saharan migrants as Community Researchers to conduct in-depth interviews with peers, using Respondent …

Maternal And Perinatal Health Research Priorities Beyond 2015: An International Survey And Prioritization Exercise, Joao Paulo Souza, Mariana Widmer, Ahmet Metin Gülmezoglu, Theresa Anne Lawrie, Ebunoluwa Aderonke Adejuyigbe, Guillermo Carroli, Caroline Crowther, Sheena M. Currie, Therese Dowswell, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Maternal mortality has declined by nearly half since 1990, but over a quarter million women still die every year of causes related to pregnancy and childbirth. Maternal-health related targets are falling short of the2015 Millennium Development Goals and a post-2015 Development Agenda is emerging. In connection with this, setting global research priorities for the next decade is now required.

Methods: We adapted the methods of the Child Health and Nutrition Research Initiative (CHNRI) to identify and set global research priorities for maternal and perinatal health for the period 2015 to 2025. Priority research questions were received from various international …

Government Efforts And Personal Opinion Explain The Medicalization Of Pregnancy And Childbirth Through Time In Lower Mustang, Nepal, Ruth Baker

Independent Study Project (ISP) Collection

The way that women approach pregnancy and childbirth in rural Nepal has seen an amazing change in the past twenty to thirty years. The medicalization of this entire process, from pre-­‐ to post-­‐natal care, comes with government efforts for the increased education of women about family planning, nutrition, hygiene, and the proposed benefits of institutional versus in-­‐home delivery. In 9 villages of Lower Mustang, interviews conducted with Government Health Post workers, Female Health Volunteers, and women of different ages sought to discern personal experience and opinion about pregnancy and childbirth from the perspective of both local women and those with …

The Association Between Distances Traveled For Care And Treatment Choices For Pelvic Floor Disorders In A Rural Southwestern Population, Gena Dunivan, Pamela Fairchild, Sara Cichowski, Rebecca Rogers

Journal of Health Disparities Research and Practice

OBJECTIVES: To determine if distance traveled for care influenced patient choice for conservative vs. surgical treatment for pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI).

METHODS: Retrospective chart review of all new patients seen in the Urogynecology clinic at the University of New Mexico Hospital (UNMH) from January 2007 through September 2011. Data collected included medical history, Pelvic Organ Prolapse Quantification (POPQ) examination, and validated quality of life questionnaires.

RESULTS: 1384 women were identified with POP and/or SUI. Women traveled an average of 50 miles to receive care at UNMH. After multivariable analysis, greater distance traveled was associated with …

Longer Gestation Among Children Born Full Term Influences Cognitive And Motor Development, Emma V. Espel, Laura M. Glynn, Curt A. Sandman, Elyssia Poggi Davis

Psychology Faculty Articles and Research

Children born preterm show persisting impairments in cognitive functioning, school achievement, and brain development. Most research has focused on implications of birth prior to 37 gestational weeks; however, the fetal central nervous system continues to make fundamental changes throughout gestation. Longer gestation is associated with reduced morbidity and mortality even among infants born during the period clinically defined as full term (37–41 gestational weeks). The implications of shortened gestation among term infants for neurodevelopment are poorly understood. The present study prospectively evaluates 232 mothers and their full term infants (50.4% male infants) at three time points across the first postnatal …

Use Of Antenatal Corticosteroids And Tocolytic Drugs In Preterm Births In 29 Countries: An Analysis Of The Who Multicountry Survey On Maternal And Newborn Health, Joshua P. Vogel, João Paulo Souza, A Metin Gülmezoglu, Rintaro Mori, Pisake Lumbiganon, Zahida Qureshi, Guillermo Carroli, Malinee Laopaiboon, Bukola Fawole, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Despite the global burden of morbidity and mortality associated with preterm birth, little evidence is available for use of antenatal corticosteroids and tocolytic drugs in preterm births in low-income and middle-income countries. We analysed data from the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS) to assess coverage for these interventions in preterm deliveries.

Methods: WHOMCS is a facility-based, cross-sectional survey database of birth outcomes in 359 facilities in 29 countries, with data collected prospectively from May 1, 2010, to Dec 31, 2011. For this analysis, we included deliveries after 22 weeks’ gestation and we excluded births that …

One-Year Evaluation Of The Impact Of An Emergency Obstetric And Neonatal Care Training Program In Western Kenya, Rachel F. Spitzer, Sarah Jane Steele, David Caloia, Julie Thorne, Alan D. Bocking, Astrid Christoffersen-Deb, Aaron Yarmoshuk, Loise Maina, Johanna Sitters, Elkanah Omenge

Obstetrics and Gynaecology, East Africa

Objective: To determine the impact of introducing an emergency obstetric and neonatal care training program on maternal and perinatal morbidity and mortality at Moi Teaching and Referral Hospital, Eldoret, Kenya.

Methods: A prospective chart review was conducted of all deliveries during the 3-month period (November 2009 to January 2010) before the introduction of the Advances in Labor and Risk Management International Program (AIP), and in the 3-month period (August–November 2011) 1 year after the introduction of the AIP. All women who were admitted and delivered after 28 weeks of pregnancy were included. The primary outcome was the direct obstetric case …