Maternal and Child Health Commons^™

Findings From Post-Intervention Analysis Of Pre-Eclampsia/Eclampsia In Kogi State, Salisu Mohammed Ishaku

Reproductive Health

Maternal and newborn deaths due to pre-eclampsia and eclampsia (PE/E) are preventable, yet in Nigeria this is the most significant direct cause of maternal mortality. Following a landscape analysis to better understand the enormity of this problem across seven states in Nigeria, a cross-cutting intervention was implemented in Cross River, Ebonyi, and Kogi states. Researchers worked with primary healthcare (PHC) providers, policymakers, women’s groups, and community members to increase uptake of underutilized interventions and commodities for the prevention and treatment of PE/E in rural Nigeria. This brief presents study findings from Kogi state on post-intervention landscape changes in: programmatic and …

Reducing Barriers To Accessing Fistula Repair: Implementation Research In Ebonyi, Pooja Sripad, Emmanuel Nwala, Vandana Tripathi

Reproductive Health

Female genital fistula is preventable and surgically treatable, but women who lack access to quality health care often live with fistula for many years. For every 1,000 births, an estimated 2.11 women develop fistula in Nigeria and despite the establishment of internationally accredited national fistula centers across the country, the majority of women live with unrepaired fistula. The Population Council, in collaboration with EngenderHealth and the Fistula Care Plus project, conducted implementation research to understand whether a comprehensive information, screening, and referral intervention reduces transportation, communication, and financial barriers to accessing preventive care, detection, and treatment of fistula in Ebonyi …

Reducing Barriers To Accessing Fistula Repair: Implementation Research In Katsina, Pooja Sripad, Emmanuel Nwala, Vandana Tripathi

Reproductive Health

Female genital fistula is preventable and surgically treatable, but women who lack access to quality health care often live with fistula for many years. For every 1,000 births, an estimated 2.11 women develop fistula in Nigeria and despite the establishment of internationally accredited national fistula centers across the country, the majority of women live with unrepaired fistula. The Population Council, in collaboration with EngenderHealth and the Fistula Care Plus project, conducted implementation research to understand whether a comprehensive information, screening, and referral intervention reduces transportation, communication, and financial barriers to accessing preventive care, detection, and treatment of fistula in Katsina …

Retrospective Cohort Study: Clinical Presentation And Outcomes Of Pre-Eclampsia And Eclampsia At Kenyatta National Hospital, Nairobi, Kenya, Charity Ndwiga, Alfred Osoti, Pooja Sripad, George Odwe, Omondi Ogutu, Charlotte E. Warren

Reproductive Health

Pre-eclampsia has two distinct subtypes: early onset pre-eclampsia, which occurs before 34 weeks of gestation, and late onset pre-eclampsia, which occurs after 34 weeks. Few studies examine and compare early and late onset pre-eclampsia in a low- and middle-income country setting. This study’s goal was to establish a profile of patients with hypertensive disorders in pregnancy, especially pre-eclampsia and eclampsia, over a two-year period. At Kenya’s national referral hospital, clinical presentation at admission was examined, as was management of complications, along with maternal and newborn health outcomes in the hospital’s maternity unit, to ascertain any differences in health outcomes for …

Three Essays On Maternal And Child Health, Mandar V. Bodas

Theses and Dissertations

This dissertation is a collection of three separate essays on the health of women and children. In the first essay, I along with my co-authors, analyzed the impact of two large, national-level health policies (the Janani Suraksha Yojana (JSY) and the National Rural Health Mission (NRHM)) on maternal health outcomes (proportion of institutional deliveries) in India. We used data from the India Human Development Survey (IHDS) and found that the JSY and the NRHM had a greater impact on institutional deliveries in high-focus states. We also found that the conditions of the public health facilities, did not change after the …

Factors Associated With Iron-Folic Acid Supplement Use Among Pregnant Women In Karu, Nasarawa State, Nigeria - A Cross Sectional Study Using Theory Of Planned Behavior, Toyin O. Akomolafe

College of Graduate Studies: Theses & Dissertations

Introduction: Iron-folic acid supplementation is one of the key interventions provided during antenatal care (ANC) services to reduce iron deficiency, maternal anemia, low birthweight and other pregnancy-related complications responsible for maternal and neonatal mortality. However, use of iron-folic acid supplements and adherence with recommended dosage in Nigeria is low. The purpose of this cross-sectional study was to examine factors associated with iron-folic acid supplements use among pregnant women in Karu local government area (LGA), Nasarawa, Nigeria. Methods: Questionnaires were administered in face-to-face interviews with 64 pregnant women (18 – 49 years old) and 19 healthcare providers in selected …

Insights And Evidence Gaps In Girl-Centered Programming: A Systematic Review, Nicole Haberland, Katharine Mccarthy, Martha Brady

Poverty, Gender, and Youth

Increased attention to the needs of adolescent girls has led to a growing number of programs in low- and middle-income countries. Questions remain, however, about what aspects of program design are most effective. This hinders efforts to effectively allocate resources, scale up programs, and replicate results across settings. This review looks at how the number of program components, involvement of supporting actors who influence the lives of girls, supplemental “booster” activities, intervention exposure level, and community saturation level influenced outcomes for girls. While findings suggest the importance of multicomponent programs and longer program exposure, each area requires further rigorous research …

Worldwide Trends In Body-Mass Index, Underweight, Overweight, And Obesity From 1975 To 2016: A Pooled Analysis Of 2416 Population-Based Measurement Studies In 128·9 Million Children, Adolescents, And Adults, James Bentham, Mariachiara Di Cesare, Ver Bilano, Honor Bixby, Bin Zhou, Gretchen A. Stevens, Leanne M. Riley, Cristina Taddei, Kaveh Hajifathalian, Yuan Lu, Con Burns, Tara Coppinger, Janette Walton, Stefan Savin, Melanie J. Cowan, Christopher J. Paciorek, Adela Chirita-Emandi, Alison J. Hayes, Joanne Katz, Roya Kelishadi, Andre Pascal Kengne, Young Ho Khang, Avula Laxmaiah, Yanping Li, Jun Ma, J. Jaime Miranda, Aya Mostafa, Martin Neovius, Cristina Padez, Lekhraj Rampal, Aubrianna Zhu, James E. Bennett, Goodarz Danaei, Zulfiqar A. Bhutta, Majid Ezzati

Publications

Background Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. Methods We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5–19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI …

Nutritional Status Of Infants At Six Months Of Age Following Maternal Influenza Immunization: A Randomized Placebo-Controlled Trial In Rural Nepal., Joanne Katz, Janet A Englund, Mark C Steinhoff, Subarna K Khatry, Laxman Shrestha, Jane Kuypers, Luke C Mullany, Helen Y Chu, Steven C Leclerq, Naoko Kozuki, James M Tielsch

Global Health Faculty Publications

Background

Maternal influenza vaccination has increased birth weight in two randomized trials in South Asia but the impact on infant growth is unknown.

Methods

A randomized placebo-controlled trial of year round maternal influenza immunization was conducted in two annual cohorts in Sarlahi District, southern plains of Nepal, from April 2011 through April 2014. Infants born to women enrolled in the trial had weight, length, and head circumference measured at birth and 6 months of age. The study was powered for the 3 primary trial outcomes but not for stunting and wasting at 6 months of age.

Results

3693 women received …

Pertussis Seroepidemiology In Women And Their Infants In Sarlahi District, Nepal., Michelle M Hughes, Janet A Englund, Kathryn Edwards, Sandra Yoder, James M Tielsch, Mark Steinhoff, Subarna K Khatry, Steven C Leclerq, Joanne Katz

Global Health Faculty Publications

Background

Infants are at greatest risk for pertussis morbidity and mortality. Maternal vaccination during pregnancy has been shown to prevent pertussis in young infants in high- and middle-income countries. However, data on the levels of maternal pertussis antibodies and the efficiency of transplacental transfer in low-income South Asian settings are limited.

Objective

To estimate the prevalence of maternal pertussis antibodies and the efficiency of transplacental transfer in rural southern Nepal.

Design/methods

Paired maternal-infant blood samples were collected from a subsample of participants in a randomized, controlled trial of maternal influenza immunization (n = 291 pairs). Sera were tested by enzyme-linked …

Impact Of Maternal Vaccination Timing And Influenza Virus Circulation On Birth Outcomes In Rural Nepal., Naoko Kozuki, Joanne Katz, Janet A Englund, Mark C Steinhoff, Subarna K Khatry, Laxman Shrestha, Jane Kuypers, Luke C Mullany, Helen Y Chu, Steven C Leclerq, James M Tielsch

Global Health Faculty Publications

Objective

To describe the effect of maternal vaccination on birth outcomes in rural Nepal, modified by timing of vaccination in pregnancy and influenza virus activity.

Methods

A secondary analysis was conducted using data from two annual cohorts of a randomized controlled trial. A total of 3693 pregnant women from Sarlahi District were enrolled between April 25, 2011, and September 9, 2013. All participants were aged 15–40 years and received a trivalent inactivated influenza vaccine or placebo. The outcome measures included birth weight, pregnancy length, low birth weight (<2500 g), preterm birth, and small‐for‐gestational‐age birth.

Results

Data were available on birth weight for 2741 births and on …

Essential Newborn Care During Humanitarian Crises: Integration Of Low-Cost Interventions, Athena Wong

Independent Study Project (ISP) Collection

Newborn healthcare has long been neglected on the international agenda despite neonatal death making up 44% of all under-five deaths. Neonates are newborns under 28 days of age and are the most vulnerable population with the highest risk of mortality during humanitarian emergencies. The common misconception that neonatal healthcare is very expensive and requires delivery from highly skilled healthcare professionals must be dismissed. There are many low-cost interventions that are highly effective at saving lives, the most notable ones being kangaroo mother care, bag and mask resuscitation, and basic immunizations. The leading causes of neonatal death are prematurity, intrapartum complications, …

Programming Maternal And Child Overweight And Obesity In The Context Of Undernutrition: Current Evidence And Key Considerations For Low- And Middle-Income Countries., Lindsay M Jaacks, Justine Kavle, Abigail Perry, Albertha Nyaku

Prevention and Community Health Faculty Publications

The goals of the present targeted review on maternal and child overweight and obesity were to: (i) understand the current situation in low- and middle-income countries (LMIC) with regard to recent trends and context-specific risk factors; and (ii) building off this, identify entry points for leveraging existing undernutrition programmes to address overweight and obesity in LMIC. Trends reveal that overweight and obesity are a growing problem among women and children in LMIC; as in Ghana, Kenya, Niger, Sierra Leone, Tanzania and Zimbabwe, where the prevalence among urban women is approaching 50 %. Four promising entry points were identified: (i) the …

Equity And Community-Based Health Insurance: How Does Insurance Coverage Affect Health Seeking Behavior Among Disadvantaged Groups In India?, Hazel Hering

Independent Study Project (ISP) Collection

The objective of this study is to examine how Community-Based Health Insurance (CBHI) can promote equity by improving health seeking behavior across gender and geography. Using a CBHI scheme from the Self-Employed Women’s Association (SEWA) as a case study, trends in claims filed between October 2016 and March 2017 are compared to the distribution of memberships in order to investigate whether health insurance coverage positively impacts health seeking behavior among disadvantaged groups, and what barriers to access exist when the burden of medical costs are reduced. This study concludes that the number of male and female claims in the sample …

Improving Health Outcomes In Trafficking Survivors Through Core Skills Development In The Workplace: Experience From The Philippines, Melinda A. Gill

Dignity: A Journal of Analysis of Exploitation and Violence

Whilst an emerging body of research documents the adverse physical and mental health outcomes of victims of trafficking following rescue, there is little research or guidance regarding interventions which improve these outcomes. In this article, I describe my experience as physician involved in a computer-based social enterprise for survivors of trafficking and slavery in the Philippines, and outline my evolving understanding of the requirements for health behavior change and improved outcomes. I conclude that while meaningful vocational skills, economic security, and adequate health-related knowledge are foundational, it is necessary to develop core skills to achieve improved health outcomes and that …

Trinidad & Tobago : Hiv Epidemic, Madison Caldwell

Global Public Health

Trinidad and Tobago are twin islands located in the Caribbean off the coast of Venezuela. In the recent years since about 1990, citizens of this country have been greatly affected by the HIV epidemic. HIV stands for human immunodeficiency virus and is spread through infected seman, blood, or vaginal fluids usually through sexual intercourse. As this virus continues to progress in the body, it will eventually turn into AIDS, which stands for acquired immunodeficiency syndrome. Once HIV progresses to AIDS, the outcome is ultimately fatal, hence why there is a dire need to promote awareness and methods of intervention to …

Transition Into Adult Care: Factors Associated With Level Of Preparedness Among Adolescents Living With Hiv In Cambodia, Siyan Yi, Chanrith Ngin, Khuondyla Pal, Vohith Khol, Sovannary Tuot, Sokunmealiny Sau, Penhsun Ly

Background: Preparing adolescents for transition into adult care and supporting their acquisition of self-health care management skills is a critical determinant of their post-transition HIV care outcomes. However, there is a scarcity of research on effective transition strategies. This study explores factors associated with adolescent preparedness for transition into adult care in Cambodia.

Methods: In August 2016, a cross-sectional study was conducted among 223 adolescents living with HIV aged 15–17, randomly selected from 11 antiretroviral therapy clinics, utilizing a structured questionnaire. The level of preparedness was determined using a pre-existing scale, and adolescents were categorized as having a …

The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study Of Ultrasound Biometric Measurements And Estimated Fetal Weight., Torvid Kiserud, Gilda Piaggio, Guillermo Carroli, Mariana Widmer, José Carvalho, Lisa Neerup Jensen, Sameera A Talegawkar, +Several Additional Authors

Exercise and Nutrition Sciences Faculty Publications

BACKGROUND: Perinatal mortality and morbidity continue to be major global health challenges strongly associated with prematurity and reduced fetal growth, an issue of further interest given the mounting evidence that fetal growth in general is linked to degrees of risk of common noncommunicable diseases in adulthood. Against this background, WHO made it a high priority to provide the present fetal growth charts for estimated fetal weight (EFW) and common ultrasound biometric measurements intended for worldwide use.

METHODS AND FINDINGS: We conducted a multinational prospective observational longitudinal study of fetal growth in low-risk singleton pregnancies of women of high or middle …

Risk And Burden Of Adverse Intrapartum-Related Outcomes Associated With Non-Cephalic And Multiple Birth In Rural Nepal: A Prospective Cohort Study, Naoko Kozuki, Joanne Katz, Subarna Khatry, James M. Tielsch, Steven Leclerq, Luke C. Mullany

Global Health Faculty Publications

Objectives Intrapartum-related complications are the second leading cause of neonatal death worldwide. We estimate the community-level risk and burden of intrapartum-related fetal/neonatal mortality and morbidity associated with non-cephalic and multiple birth in rural Sarlahi District, Nepal.

Design Community-based prospective cohort study.

Setting Rural Sarlahi District, Nepal.

Participants Pregnant women residing in the study area.

Methods We collected data on maternal background characteristics, conditions during labour and delivery, fetal presentation and multiple birth during home visits. We ran log-binomial regression models to estimate the associations between non-cephalic/multiple births and fresh stillbirth, early neonatal mortality and signs of neonatal encephalopathy, respectively, and …

Preventing Pediatric Tuberculosis: A Randomized Trial Of Symptom-Based Screening Of South African Children Exposed To Tuberculosis, Population Council

HIV and AIDS

In South Africa, a country with one of the highest levels of HIV prevalence, HIV-positive adults are the source case for a large proportion of pediatric tuberculosis (TB) cases. Unfortunately, TB index cases are not consistently asked about their child contacts, not all child contacts present to the clinic for TB screening, and it remains unknown what proportion of child contacts receive isoniazid preventive therapy (IPT)—a highly effective treatment for preventing TB in these children, long recommended by the World Health Organization. Project SOAR is assessing whether a symptom-based screening approach by TB nurses in community health clinics is more …

Expanding Access To Integrated Family Planning Intervention Packages For Married Adolescent Girls In Urban Slums Of Dhaka, Bangladesh, Fauzia Akhter Huda, Hassan Rushekh Mahmood, Sadia Afrin, Anisuddin Ahmed, Nafis Al Haque, Bidhan Krishna Sarker

Reproductive Health

This research report describes an intervention study conducted among married adolescent girls aged 15–19 years in four urban slums of Dhaka, Bangladesh. Objectives of the study were to examine the acceptability and feasibility of forming married adolescent girls’ clubs, and involving community health volunteers (Shasthya Skebikas) and marriage registrars to increase access to family planning (FP) information and services, to promote the uptake of long-acting reversible contraceptive methods, and to provide FP information to newlywed couples at the time of marriage registration. The study findings revealed that a noteworthy number of married adolescent girls received FP-related information, mostly from the …

Global Health Experience In Swaziland, Anik Patel

Posters

Describes a global health learning experience at the Baylor Center of Excellence in Swaziland, where diagnosis and treatment of HIV/AIDS and TB, along with maternal health, women's health, and adolescent care are provided.

Health Aid In Africa: Placement, Service Utilization, And Benefit, Carrie Dolan

Theses and Dissertations

While the health sector has attracted significant foreign aid, evidence on the effectiveness of this support is mixed. This dissertation examines the allocation of health aid within the context of placement, service utilization, and benefit. The first paper examined the sub-national allocation of Chinese development aid projects across Africa. I determined how political preferencing of Chinese aid specifically, allocating aid to the birth region of the current political leader differs across sectors such as health, education, and transportation. I find some evidence that aid, more broadly defined, is subject to political preferencing in recipient countries, which could potentially limit its …

Effect Of A Family-Centered Model Of Hiv Care On Viral Suppression And Care Retention Among Hiv-Positive Children In Swaziland, Project Soar

HIV and AIDS

The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) has been supporting the Kingdom of Swaziland since 2003 to prevent mother-to-child transmission and to provide care and treatment services to HIV-positive children and adults. Project SOAR and the Swaziland Ministry of Health are leveraging EGPAF’s establishment of a family-centered care service delivery program (FAM-CARE) and a national rollout of viral load monitoring to assess their implementation and effect on viral suppression and retention in care among children living with HIV. This implementation science study is important because it will provide critical data to national and global policymakers about the model’s feasibility, acceptability, …

Evaluating Community-Facility Linkage Models To Promote Mother-Infant Retention Along The Hiv Care Continuum, Project Soar

HIV and AIDS

In Malawi, and other resourced-constrained, sub-Saharan African countries with a high HIV burden, several service delivery models have emerged to increase prevention of mother-to-child transmission care retention by strengthening connections between health facilities and their surrounding communities. Yet there has been little documentation of the unique characteristics of each model and their comparative impact on mother-infant pair (MIP) care retention and other health outcomes. This brief describes how Project SOAR is responding to these knowledge gaps by conducting research to identify components of community-based MIP support that are associated with maternal care retention and infant HIV-free survival. This research will …

Adolescent Health: Priorities And Opportunities For Rashtriya Kishor Swasthya Karyakram (Rksk) In Uttar Pradesh [Hindi], Sapna Desai

Poverty, Gender, and Youth

The Government of India in 2014 signaled its commitment to adolescent health through introduction of a national strategy, Rashtriya Kishor Swasthya Karyakram (RKSK). Targeting adolescents aged 10–14 and 15–19, the program aims to ensure universal coverage of health information and services for all adolescents—those in and out of school, married or unmarried, and in vulnerable groups. Envisaged as a paradigm shift to address adolescent health beyond sexual and reproductive health, RKSK spans six domains: nutrition, sexual and reproductive health, mental health, injuries and violence including gender-based violence, substance misuse, and non-communicable diseases. This policy brief presents evidence on adolescent health …

Executive Summary—Understanding The Lives Of Adolescents And Young Adults (Udaya) In Bihar, India, K.G. Santhya, Rajib Acharya, Neelanjana Pandey, Santosh Kumar Singh, Shilpi Rampal, A.J. Francis Zavier, Ashish Kumar Gupta

Poverty, Gender, and Youth

A program of research titled, “Understanding the lives of adolescents and young adults (UDAYA) in Bihar and Uttar Pradesh,” implemented by the Population Council, aimed to understand the factors that determine healthy transitions from childhood to adolescence and adulthood. The goal of UDAYA is to establish the levels, patterns, and trends in the situation of younger (10–14) and older (15–19) adolescents and assess factors that influence the quality of transitions they make. The specific objectives of UDAYA are: 1) to explore the situation of adolescents, with a focus on assessing the extent to which both younger and older adolescents have …

Executive Summary—Understanding The Lives Of Adolescents And Young Adults (Udaya) In Bihar, India [Hindi], K.G. Santhya, Rajib Acharya, Neelanjana Pandey, Santosh Kumar Singh, Shilpi Rampal, A.J. Francis Zavier, Ashish Kumar Gupta

Poverty, Gender, and Youth

A program of research titled, “Understanding the lives of adolescents and young adults (UDAYA) in Bihar and Uttar Pradesh,” implemented by the Population Council, aimed to understand the factors that determine healthy transitions from childhood to adolescence and adulthood. The goal of UDAYA is to establish the levels, patterns, and trends in the situation of younger (10–14) and older (15–19) adolescents and assess factors that influence the quality of transitions they make. The specific objectives of UDAYA are: 1) to explore the situation of adolescents, with a focus on assessing the extent to which both younger and older adolescents have …

More Than Brides Alliance (Mtba): Mariage N’Est Pas Un Jeu D’Enfat, Rapport De Référence Mali, Andrea J. Melnikas, Sajeda Amin, Sarah Engebretsen, Mouhamadou Gueye

Poverty, Gender, and Youth

L’Alliance « Plus qu’une épouse » vise à améliorer la vie des adolescentes et propose des interventions dans plusieurs domaines (la santé reproductive, l’éducation, les normes de genre et les moyens de subsistance, entre autres). Dans le cadre d’une évaluation des interventions visant à retarder l’âge du mariage, le Population Council a mené des enquêtes de référence sur les adolescentes dans les régions de Sikasso et Ségou au Mali. Les résultats suggèrent que des interventions sont nécessaires pour répondre aux vulnérabilités rencontrées par les filles qui vivent dans ces communautés. La collecte de données supplémentaires contribuera à examiner certains de …

More Than Brides Alliance (Mtba): Mariage N’Est Pas Un Jeu D’Enfat, Rapport De Référence Niger, Grace Saul, Andrea J. Melnikas, Sajeda Amin, Sarah Engebretsen, Aissa Diarra, Chaibou Saadou

Poverty, Gender, and Youth

L’Alliance « Plus qu’une épouse » vise à améliorer la vie des adolescentes et propose des interventions dans plusieurs domaines (la santé reproductive, l’éducation, les normes de genre et les moyens de subsistance, entre autres). Dans le cadre d’une évaluation des interventions visant à retarder l’âge du mariage, le Population Council a mené des enquêtes de référence sur les adolescentes dans des zones sélectionnées dans deux régions au Niger (Tillabéry et Maradi). Les objectifs de l’étude de référence étaient les suivants : 1) fournir un point de référence permettant de mesurer les changements découlant de l’intervention à mi-parcours et à …