Public Health Commons^™

A Web-Based Dietary Intervention In Early Pregnancy And Neonatal Outcomes: A Randomized Controlled Trial, Rachel Ak Kennedy, C.M.E. Reynolds, Shona Cawley, E. O'Malley, D.M. Mccartney, M.J. Turner

Articles

Background Maternal nutrition is a determinant of pregnancy outcomes. Few studies have evaluated the potential of online nutrition resources to modify behaviour. This randomized controlled trial aimed to determine whether access to a customized evidence-based nutrition website in pregnancy improved neonatal outcomes.

Methods Women < 18 weeks gestation were recruited at their convenience. The control group received standard care. In addition to standard care, the intervention group received access to an evidence-based nutrition website, customized to the preferences of pregnant women.

Results Of the 250 women, there were no differences in characteristics between the two groups. Of the women, 91.0% reported they make a conscious effort currently to eat a healthy diet. However, only 19.6% met dietary requirements for calcium, 13.2% for iron, 2.7% for folate and 2.3% for iodine. The most popular website section was pregnancy …

Development Of A Novel Periconceptual Nutrition Score (Pens) To Examine The Relationship Between Maternal Dietary Quality And Fetal Growth, Rachel Ak Kennedy, Michael J. Turner

Articles

Background Maternal nutrition may influence intrauterine fetal development. To date, the relationship between contemporary European dietary guidelines and fetal growth has not been examined.

Aims To develop a novel Periconceptual Nutrition Score (PENS) to assess maternal dietary quality in early pregnancy and examine its relationship with fetal growth.

Study design Women were recruited conveniently at their first clinic visit and completed a supervised four day retrospective diet history. The PENS was developed using European Food Safety Authority recommended dietary intakes for pregnancy. The relationship between PENS and fetal growth was examined.

Subjects Women with a singleton pregnancy.

Outcome measures Birthweight, …

Accelerating Action To End Child Marriage In Bangladesh—Project Brief, Population Council

Poverty, Gender, and Youth

Bangladesh ranks among the five countries with the highest rate of child marriage in the world. Community norms and values are among the underlying factors that support the practice of child marriage in Bangladesh. The Population Council is partnering with the Ministry of Women and Children Affairs to delay marriage as part of the UNFPA-UNICEF Global Program to Accelerate Action to End Child Marriage. This program is being implemented to generate evidence on reduction of child marriage through an adolescent skills-building program. The project works to empower girls with life-skills and livelihood and gender-awareness trainings, as well as engaging communities …

Antihypertensive Drugs, Population Council

Reproductive Health

Pre-eclampsia (PE) is a condition in pregnant women marked by an increase in blood pressure and protein in the urine after 20 weeks gestation. Eclampsia is a life-threatening condition characterized by convulsions in women with PE. PE/E and other hypertensive disorders in pregnancy increase risk of preterm births. Providing high-quality and regular antenatal care improves the prevention and early detection of PE and can prevent its progression to eclampsia. Prescribing low-dose aspirin and calcium to at-risk women can prevent PE and eclampsia. PE and eclampsia can be managed by administering antihypertensive drugs and magnesium sulphate (MgSO4). MgSO4 is the safest …

Autonomy, Intimate Partner Violence, And Maternal Health-Seeking Behavior: Findings From Mixed-Methods Analysis In Bangladesh, Pooja Sripad, Sharif M.I. Hossain, Charity Ndwiga, Charlotte E. Warren

Reproductive Health

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically subordinate women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care (ANC) use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. …

Autonomy, Intimate Partner Violence, And Maternal Health-Seeking Behavior: Findings From Mixed-Methods Analysis In Ethiopia, Charlotte E. Warren, Pooja Sripad, Charity Ndwiga

Reproductive Health

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically disadvantage women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care (ANC) use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. …

Assessing The Effect Of A Primary Health Care Intervention For Improving Pre-Eclampsia And Eclampsia Knowledge And Practice In Bangladesh, Sharif M.I. Hossain, Shongkour Roy, Kanij Sultana, Charlotte E. Warren

Reproductive Health

In resource-poor countries such as Bangladesh, proven life-saving commodities for pregnant women have not been optimally examined, such as magnesium sulphate (MgSO4) to manage severe pre-eclampsia/eclampsia, use of anti-hypertensives to manage high blood pressure during pregnancy, aspirin prophylaxis for pregnant women at high risk of PE/E, as well as task shifting to lower health-worker cadres, and community involvement. There has been no systematic review of research and programming on PE/E prevention, early detection, and treatment in Bangladesh. With support from USAID, the Ending Eclampsia project has been expanding access to proven, underutilized interventions and commodities for PE/E prevention, early detection, …

Engaging Community Women’S Groups To Improve Maternal Health Care Delivery In Cross River: Implementation Research Report, Pooja Sripad, Emmanuel Nwala, Tracy Mcclair, Salisu Mohammed Ishaku, Charlotte E. Warren

Reproductive Health

Ending Eclampsia’s main objective is to improve access to underutilized interventions and commodities by training community health extension workers in preventing, detecting (screening), and managing pre-eclampsia and eclampsia. While the broader project emphasizes primary health care interventions, this implementation research (IR) study focused on a community intervention in one state, in areas where the facility interventions were active. This final research report describes IR testing the feasibility and utility of employing women’s groups as community platforms to increase women’s access to quality antenatal service utilization, using pre-eclampsia screening as the entry point. The study was conducted in 48 communities in …

Feasibility And Acceptability Of Community Health Extension Workers To Identify And Treat Hypertension Associated With Pregnancy: Implementation Research Report, Emmanuel Nwala, Udochisom Anaba, Pooja Sripad, Salisu Mohammed Ishaku, Charlotte E. Warren

Reproductive Health

Hypertensive disorders in pregnancy, experienced by 10 percent of women globally, are major contributors to maternal and newborn mortality, morbidity, and disability. Task shifting essential health services to mitigate insufficient human resources is recommended to strengthen and expand the health workforce and rapidly increase access to quality services. Nigeria’s task-shifting policy recommends that community health extension workers administer a loading dose of magnesium sulphate for severe pre-eclampsia or eclampsia prior to referral to a higher-level facility. This study tested the feasibility and acceptability of community health extension workers at primary health care facilities in Ebonyi state in detecting and managing …

Implementing Components Of The Primary Health Care Pre-Eclampsia/Eclampsia Model In Bangladesh: A Cost Analysis, Sharif M.I. Hossain, Pooja Sripad, Sara Chace Dwyer

Reproductive Health

Between 2016 and 2018, the Population Council, in collaboration with the Directorate General of Family Planning and Obstetrical and Gynecological Society of Bangladesh, implemented an intervention to confront pre-eclampsia/eclampsia (PE/E). This was part of the Ending Eclampsia project, a five-year USAID investment that implemented aspects of the Primary Health Care (PHC) PE/E Model in Bangladesh, Nigeria, and Pakistan. The intervention in Bangladesh comprised two components of the PHC for PE/E Model: 1) Task sharing to detect and manage PE/E (MgSO4 and referral) with PHC providers (Family Welfare Visitors, Sub-Assistant Community Medical Officers, and Nurse-Midwives), and 2) Introducing antihypertensive drug provision …

Implementing Components Of The Phc For Pe/E Model In Nigeria: A Cost Analysis, Pooja Sripad, Sara Chace Dwyer, Gloria Adoyi

Reproductive Health

Between 2016 and 2018, the Population Council, in partnership with the Nigerian Federal and State Ministries of Health, implemented an intervention to confront pre-eclampsia/eclampsia (PE/E) in three states—Cross River, Ebonyi, and Kogi. This was part of the Ending Eclampsia project, a five-year USAID investment that implemented aspects of the Primary Health Care (PHC) PE/E Model in Bangladesh, Nigeria, and Pakistan. The intervention in Nigeria was comprised of five components of the PHC for PE/E Model: 1) Task sharing to detect and manage PE/E (MgSO4 and referral) with PHC providers; 2) Introducing antihypertensive drug provision at the PHC level; 3) Engaging …

Fgm/C And Ecm: Drawing Lessons From Research, Jacinta Muteshi-Strachan

Reproductive Health

No abstract provided.

"No To Circumcision": The Road To Effective Social Marketing Campaigns In Egypt, Salma Abou Hussein, Sarah Ghattass

Reproductive Health

To inform the design and scale up of initiatives that can drive a change in attitudes and behaviors toward FGM/C abandonment, there is a rising need to understand the perspectives of individuals who are exposed to social marketing campaigns (SMCs), which are a key intervention to promote the abandonment of the practice. This working paper presents the findings of a study that sought to understand how, where, and why SMCs for FGM/C abandonment are working, and with what impact, to inform design and scale-up of campaigns that can foster new perspectives, expectations, and behaviors.

Associations Between Fgm/C And Hiv In Ethiopia, The Gambia, Kenya, And Sierra Leone: A Limited Analysis Of Demographic And Health Survey Data, Yetunde A. Noah Pinheiro, Zhuzhi Moore, David Gathara

Reproductive Health

Studies investigating the association between male circumcision and HIV have demonstrated the protective effect of male circumcision. In some settings, FGM/C and male circumcision are considered “equivalent” procedures. This working paper presents findings of a study that investigates the effect of FGM/C on the likelihood of HIV infection for women in practicing communities in Ethiopia, Gambia, Kenya, and Sierra Leone.

Expanding Services To Detect, Manage, And Prevent Pre-Eclampsia And Eclampsia In Tando Allahyar District Of Sindh Province, Pakistan, Ali M. Mir, Irfan Masood, Mumraiz Khan, Sharif M.I. Hossain, Tracy Mcclair, Pooja Sripad, Charlotte E. Warren

Reproductive Health

This endline report documents a USAID-supported implementation research project carried out by the Population Council in one district in Sindh province, as part of the global—Bangladesh, Ethiopia, Kenya, Nigeria, Pakistan—Ending Eclampsia initiative. This project assessed community midwives’ (CMWs) abilities to screen and detect pre-eclampsia/severe pre-eclampsia/eclampsia (PE/SPE/E) in pregnant and postnatal women and provide a loading dose of magnesium sulfate (MgSO4) to clients suffering from SPE/E and referrals to facilities for further management. This study also explored opportunities to enhance collaboration between CMWs and lady health workers (LHWs), encouraging LHWs to refer pregnant women for group antenatal care (ANC) and postnatal …

Post-Intervention Analysis Of Pre-Eclampsia And Eclampsia In Three Nigerian States, Salisu Mohammed Ishaku, Emmanuel Nwala, Gloria Adoyi, Charles Nwigwe, Solomon Kongyamba, Udochisom Anaba, Caroline Johnson, Karen Kirk, Pooja Sripad, Charlotte E. Warren

Reproductive Health

In the last three decades, global maternal mortality has decreased by almost 45 percent, but approximately 830 women still die daily from largely preventable pregnancy complications. Since 2015, the Ending Eclampsia project, with support from USAID, has been working to expand proven, underutilized interventions and commodities for pre-eclampsia/eclampsia (PE/E) prevention, early detection, and treatment, and to strengthen global partnerships for care of hypertensive disorders in pregnancy (HDP), of which PE/E are the severest forms. A systematic review of the literature identifies a number of articles reporting PE/E burdens within set populations, common risk factors, adverse outcomes, and mortality rates, but …

Assessing Quality Of Care And Outcomes For Women And Their Infants In Nigeria After Pregnancies Complicated By Hypertensive Disorders, Salisu Mohammed Ishaku, Gloria Adoyi, Innocent Agbo, Karen Kirk, Pooja Sripad, Charlotte E. Warren

Reproductive Health

Hypertensive disorders in pregnancy (HDPs) are the leading cause of maternal mortality in Nigeria—now killing more women than postpartum hemorrhage. Various factors, including lack of capacity among lower-level health-care providers to detect, manage, and refer complications, have been indicated as reasons for most of these deaths. A landscape analysis of pre-eclampsia/eclampsia (PE/E) in Nigeria identified a lack of further information after delivery about the women who experienced HDPs. In this study, the Ending Eclampsia project recruited women with HDPs around the time of childbirth, and prospectively followed them for up to one year postpartum. The study evaluated the care these …

Hypertensive Disorders In Pregnancy: Assessing Postnatal Quality Of Care And Outcomes For Women And Their Infants In Bangladesh, Sharif M.I. Hossain, Kanij Sultana, Salma Rouf, Rabeya Akter, Shongkour Roy, Sumaiya Anwar, Karen Kirk, Charlotte E. Warren

Reproductive Health

Hypertensive disorders in pregnancy (HDPs) are the second leading cause of maternal mortality in Bangladesh, responsible for 24 percent of maternal deaths. Various factors, such as lack of health-care provider capacities for detecting, preventing, and managing pre-eclampsia and eclampsia (PE/E), late referrals, late (or lack of) antenatal care (ANC), and poor awareness of PE/E, are factors in most of these deaths. While some information was available on the prenatal and postnatal periods, an evidence gap existed in information after delivery through the first year postnatal, and beyond. In this prospective cohort study, the Ending Eclampsia project recruited married women ages …

Assessing The Feasibility Of Primary Health Care Provider Prescription Of Anti-Hypertensive Medication To Pregnant Women In Bangladesh, Sharif M.I. Hossain, Kanij Sultana, Shongkour Roy, Pooja Sripad, Charlotte E. Warren

Reproductive Health

Hypertensive disorders of pregnancy (HDPs)—which are major contributors of maternal and newborn mortality, morbidity, and disability—are preventable. About 24 percent of maternal deaths in Bangladesh each year are due to pre-eclampsia and eclampsia (PE/E). A known cause of death in women with PE/E is cerebrovascular accident, which occurs due to rapidly increasing blood pressure (BP). Elevated BP associated with pregnancy should be detected and appropriately managed before onset of convulsions (eclampsia) and other life-threatening complications. For women presenting with severe PE/E, magnesium sulphate (MgSO4) is the recommended drug for convulsion management. Anti-hypertensive medicines are also recommended for control of high …

Mise En Œuvre Des Composantes Du Modèle Ssp Pour La Pe / E Au Nigéria : Une Analyse Des Coûts, Pooja Sripad, Sara Chace Dwyer, Gloria Adoyi

Reproductive Health

Entre 2016 et 2018, le Population Council, en partenariat avec les Ministères de la Santé fédéraux et des États du Nigéria, a mis en œuvre une intervention visant à lutter contre la pré-éclampsie/éclampsie (PE/E) dans trois États: Ebonyi, Cross River et Kogi. C’était dans le cadre du projet Ending Eclampsia, un investissement quinquennal de l'USAID qui a mis en œuvre des aspects du modèle de soins de santé primaires (SSP) pour le modèle PE/E au Bangladesh, au Nigéria et au Pakistan. L'intervention au Nigéria comprenait cinq composantes de SSP pour le modèle PE/E: 1) le partage des tâches avec des …

Prévention Du Mariage D’Enfants Dans La Région De L’Est, Burkina Faso, Gisele Kaboré, Julien Ouedraogo, Annabel Erulkar, Sara Chace Dwyer

Reproductive Health

En collaboration avec la Direction Provinciale de la Femme, de la Solidarité Nationale et de la Famille du Burkina Faso et des partenaires communautaires de la région orientale du Burkina Faso, le Projet Evidence a mis à l'échelle des approches éprouvées pour retarder le mariage des jeunes filles en sensibilisant aux effets négatifs du mariage précoce. Les approches étaient basées sur des preuves produites dans une étude menée par le Population Council de 2013 à 2016 dans la province de Léraba. Dans cette étude, le report de l'âge du mariage pour les filles de 15 à 17 ans et la …

Reducing Barriers To Accessing Fistula Repair: Implementation Research In Uganda, Justus Barageine, Charity Ndwiga, Hassan Kanakulya, Pooja Sripad

Reproductive Health

The Population Council, in collaboration with Fistula Care Plus and EngenderHealth, conducted implementation research to understand whether a comprehensive information, screening, and referral intervention reduces transportation, communication, and financial barriers to accessing fistula screening, diagnosis, and treatment in Uganda. Following a baseline assessment, researchers implemented a multi-pronged intervention utilizing a mobile hotline, transport voucher, and mass media tools to increase community awareness. This brief provides key messages and recommendations for overcoming barriers hindering access to fistula care services. Health systems and external stakeholder support are essential for sustaining trends.

Strengthening Bauchi State College Of Nursing And Midwifery By Updating Its Training Curricula, Procedure Manuals And Student Handbooks, Ekechi Okereke, Ibrahim Suleiman, Aisha Jibril

Reproductive Health

Many of Nigeria’s Nursing and Midwifery schools and colleges encounter challenges that include outdated training curricula, which can lead, in some cases, to loss of accreditation. In Bauchi state, a state College of Nursing and Midwifery was formally established in 2013. The Population Council engaged a curriculum expert who had worked with the Nursing and Midwifery Council of Nigeria (which stipulates minimum standards of compliance for accreditation) to assess the school’s training documents, including its training curriculum, procedure manual, and student handbook. The school is expected to secure full accreditation in 2019. The Population Council also supported the strengthening of …

Strengthening Cross River State Schools Of Nursing And Midwifery By Updating Their Training Curricula, Procedure Manuals And Student Handbooks, Ekechi Okereke, Godwin Unumeri, Aisha Jibril

Reproductive Health

Many of Nigeria’s Nursing and Midwifery schools and colleges encounter challenges that include outdated training curricula, which can lead, in some cases, to loss of accreditation. In Cross River state, in 2014 only one health training institution was accredited—provisionally. Five other institutions had lost their accreditations from the Nursing and Midwifery Council of Nigeria (NMCN) which stipulates minimum standards of compliance for accreditation. An assessment team led by the Director of Nursing of Calabar’s Ministry of Health visited the Cross River schools to determine the best ways of addressing the gaps in the accreditation team’s report. Through the HRH project …

Autonomy, Intimate Partner Violence, And Maternal Health-Seeking Behavior: Findings From Mixed-Methods Analysis In Nigeria, Pooja Sripad, Charity Ndwiga, Charlotte E. Warren

Reproductive Health

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically subordinate women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. In …

Kangaroo Mother Care And Traditional Care, Arianna Smola, Kirsten Lawson

Williams Honors College, Honors Research Projects

Prematurity and low birth weight are leading causes of infant death. Throughout recent years care methods for this population have evolved from incubator care to Kangaroo Mother Care (KMC). The purpose of this systematic review was to answer the following PICO question: in the case of preterm and low birth weight (LBW) infants, how does the technique of Kangaroo Mother Care (KMC) compare to traditional incubator use, regarding long and short-term outcomes of preterm and LBW infant recovery. Methods of this study included the selection of twenty peer-reviewed articles that studied the effect of incubators and KMC on premature and …

The Role Of Prenatal Care And Systematic Hiv Testing In Preventing Perinatal Transmission In Tanzania, 2011-2012, Nkembi Lydie Bianda, Patrick A. Tschida, Vasileios Margaritis

Journal of Social, Behavioral, and Health Sciences

In 2012, the prevalence of HIV infection among Tanzanian women was 6.3%, and 18% of Tanzanian children were born infected with HIV. The purpose of this study was to determine the importance of prenatal care attendance on comprehensive knowledge of HIV mother-to-child transmission (MTCT), HIV testing and counseling, and awareness of HIV testing coverage services in Tanzania. The study population was Tanzanian women of childbearing. Guided by the health belief model, this cross-sectional survey design used secondary data from the 2011–2012 Tanzania Demographic Health Survey. Factors of interest were comprehensive knowledge of HIV MTCT, HIV testing and counseling, and awareness …

Determinants Of Physical Activity For Latino And White Middle School-Aged Children, Aileen Garcia, Shinya Takahashi, Mindy Anderson-Knott, Dipti Dev

Department of Child, Youth, and Family Studies: Faculty Publications

Background: Physical activity (PA) has long been acknowledged to contribute health benefits among children. However, research has consistently shown that PA declines as children grow older. Thus, this study examined the factors which are associated to children’s PA in order to identify potential barriers to PA.

Methods: Using data from the KidQuest Program, we conducted bivariate and multivariate analyses on survey data collected from fifth to seventh grade students in a small Midwestern city.

Results: We found that food knowledge, eating breakfast, and talking with family about eating healthy foods, are positively related to PA. On the

other hand, screen …

Delivering Results In Girls' Education: How To Evaluate What Works, What Doesn't, And What We Don't Know, Stephanie Psaki

Poverty, Gender, and Youth

Girls around the world face daunting challenges when it comes to enrolling in primary school, completing secondary school, and gaining the basic knowledge and skills they need to be empowered, healthy, and productive adults. Many governments and organizations have risen to meet that challenge through policies and programs designed to remove common barriers to girls’ education. But as the number of actors in this space grows, and resources to address these challenges remain scarce, it is essential to ensure that investments are targeted toward the most effective policies and programs. This brief lays out the basics of program evaluation. The …

Women's Empowerment And Its Impact On Reproductive Health Outcomes: Evidence From Nepal, Samyukta Ghimire

Masters Theses

The percentage of women utilizing maternal health care services in Nepal is relatively less than women in other South Asian countries. Moreover, large socio-economic and regional disparities have been the root causes for lower utilization of health care leading to increasing maternal mortality. Using a national representative sample of 9,475 women (2011) and 9,875 women (2016) from Nepal, I examine the impact of women empowerment in relation to prenatal care, place of delivery and postnatal care (3Ps) outcomes. A composite Women’s Empowerment Index (WEI) based upon responses is also constructed to include three empowerment domains namely, attitude toward violence, social …