Maternal and Child Health Commons^™

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 …

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 …

High-Risk Advanced Maternal Age And High Parity Pregnancy: Tackling A Neglected Need Through Formative Research And Action., Khadidiatou Ndiaye, Erin Portillo, Dieneba Ouedraogo, Allison Mobley, Stella Babalola

Global Health Faculty Publications

Pregnancy among women of advanced maternal age (those 35 years or older) or among women of high parity (those having had 5 or more births) is linked to maternal and infant mortality. Yet little is known about the drivers of these pregnancies as they are often neglected in existing family planning and reproductive health programs. To better understand the context in which advanced maternal age and high parity pregnancies occur and the acceptability of discussing associated pregnancy risks, the Health Communication Capacity Collaborative (HC3) conducted formative qualitative research between January and March 2015 on the perception and determinants of such …

Perceptions, Careseeking, And Experiences Pertaining To Non-Cephalic Births In Rural Sarlahi District, Nepal: A Qualitative Study., Naoko Kozuki, Luke C Mullany, Subarna K Khatry, James M Tielsch, Steven C Leclerq, Caitlin E Kennedy, Joanne Katz

Global Health Faculty Publications

BACKGROUND: In low-resource settings, a significant proportion of fetal, neonatal, and maternal deaths can be attributed to intrapartum-related complications. Certain risk factors, such as non-cephalic presentation, have a particularly high risk of complications. This qualitative study describes experiences around non-cephalic births and highlights existing perceptions and care-seeking behavior specific to non-cephalic presentation in rural Sarlahi District, Nepal.

METHODS: We conducted in-depth interviews with 34 individuals, including women who recently gave birth to a non-cephalic infant and female decision-makers in their households. We also conducted two focus groups with mothers (have two or more children, with at least one child under …

Addressing Extreme Vulnerability: Remaining Barriers To Neonatal Healthcare Delivery In Conflict Areas, Olivia Palmer

Independent Study Project (ISP) Collection

Global statistics show that world-wide neonatal mortality rates are not yet within the target range set by Sustainable Development Goals and reflect persistent violations of the fundamental right to health for newborns around the world. While there is a wide base of knowledge on the main causes of death and minimum standards of care for neonatal health in stable and low-resource settings, there is a significant gap in knowledge regarding the unique circumstances of neonatal healthcare situated in conflict settings. The main objectives of this research are to elaborate on the current state of neonatal healthcare in conflict areas and …

(Video) Outreach Services To Treat Women Living With Obstetric Fistula: A Systematic Review, Pauline Pamela Pratt, Rashida Muhammad

GW Research Days 2016 - 2020

Background: Obstetric fistula is a condition experienced by women who because of prolonged labor become incontinent forming one or more holes in between the rectum and the vagina or the vagina and the bladder (Heller, A., 2017). The hole causes uncontrollable stool and urine to leak from the woman. For most women with obstetric fistula, the duration of the labor leading to fistula varied between 5 hours and 9 days, averaging 3.0 days long (Heller, A., 2017). Women who suffer from this from this condition are do not have access to quality medical care. While prevention is the priority and …

Etiology And Management Of Hospitalized And Outpatient Diarrhea Among Children Less Than 5 Years Of Age In Lambaréné, Gabon, Christina Pugliese, Natalie Byrne, Frederique Nguema, Kafui Vodounou, Mirabeau Mbong Ngwese, Gedeon Manouana, Jean Edoa, Bayode Adegbite, Jeannot Zinsou, Ayola Adegnika, Martin Grobusch, David Diemert

GW Research Days 2016 - 2020

Objectives: Diarrhea remains a significant cause of global under-5 mortality, particularly in SubSaharan Africa (SSA). To reduce morbidity and mortality, the World Health Organization (WHO) recommends oral rehydration salts (ORS), zinc supplementation, and continued feeding or breastfeeding for all children with diarrhea to prevent dehydration and malnutrition; antibiotics only for bloody diarrhea (i.e. probable shigellosis), suspected cholera, or severe non-intestinal infections (e.g. pneumonia or sepsis); and avoidance of antidiarrheals and antiemetics owing to lack of benefit and potential for harm in young children. Gabon is an upper-middle income country in SSA for which there is a lack of recent, high …

Addressing Hydrocephaly In Viet Nam: A Plausible Prevention And Intervention Medical Support Program Proposal, Chelle Mcintyre-Brewer

UNO Student Research and Creative Activity Fair

Families affected by hydrocephalus in Viet Nam have few options for sustainable treatment for a myriad of reasons, primarily centering on barriers to care prevalent to minority, underserved, and economically disadvantaged populations. High morbidity and abandonment rates often result from these circumstances. An interdisciplinary examination of the factors contributing to causal concerns reveals unique cultural considerations, language and literacy barriers, ethnic and geographic differences, as well as economic and governmental issues greatly impacting patient outcome for this condition. The author contends that a program that addresses sociological concerns, along with the medical treatment of the patient, proffers the opportunity for …

Stigma Gets In My Way: Factors Affecting Client-Provider Communication Regarding Childbearing Among People Living With Hiv In Uganda., Jolly Beyeza-Kashesya, Rhoda K. Wanyenze, Kathy Goggin, Sarah Finocchario-Kessler, Mahlet Atakilt Woldetsadik, Deborah Mindry, Josephine Birungi, Glenn J. Wagner

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Many HIV-affected couples living in sub-Saharan Africa desire to have children, but few quantitative studies have examined support for their childbearing needs. Our study explored client-provider communication about childbearing and safer conception among HIV clients in Uganda.

METHODS: 400 Ugandan HIV clients in committed relationships and with intentions to conceive were surveyed. Knowledge, attitudes and practices related to childbearing, and use of safer conception methods were assessed, including communication with providers about childbearing needs, the correlates of which were examined with bivariate statistics and logistic multivariate analysis.

RESULTS: 75% of the sample was female; 61% were on antiretroviral therapy; …

Infant Mortality: Sub-Saharan Africa, Danielle Rae Steffen

Global Issues in Public Health

Like much of the third world, the countries found in Sub-Saharan Africa have a distressingly high infant mortality rate compared to those recorded in places such as the United States and Europe. While there are many factors that play a role in the increased number of infant deaths in this region, lack of access to adequate healthcare for infants and their families is one of the main overarching causes. Although infant mortality rates remain high, there has been significant improvement in infant survival over the last several years which is largely due to the implementation of the Millennium Development Goals …

Engaging Male Partners Of Adolescent Girls And Young Women In Hiv Services In Malawi: Findings From Dreams Implementation Science Research, Project Soar

HIV and AIDS

Important contributors to adolescent girls' and young women's (AGYWs') vulnerability to HIV are the power differentials in their sexual relationships with male partners. Therefore, engaging male partners of AGYWs is important in reducing HIV incidence among these women. Project SOAR, in collaboration with the Center of Reproductive Health at the University of Malawi College of Medicine, conducted qualitative research in the districts of Zomba and Machinga in Malawi to: 1) identify and locate the types of men who have sexual relationships with AGYW; 2) understand the challenges to and facilitators of accessing HIV services among AGYWs’ male partners; and 3) …

Microcephaly, Christianne E. Albers

Global Issues in Public Health

Microcephaly is a noncommunicable condition causing the head of an infant to be smaller than what is typical. Microcephaly can cause delays in developmental milestones and/or can cause other conditions such as epilepsy, cerebral palsy, learning disabilities, hearing loss and vision problems. Microcephaly is found more frequently in certain populations of the world than others, specifically those with an increased number of cases with Zika virus. Women need to take preventative measures to ensure their unborn child is safe from the Zika virus. The Zika virus is not the only way microcephaly can occur. Many other causes like exposure to …