Maternal and Child Health Commons^™

Intergrowth-21st Project International Inter-Nda Standards For Child Development At 2 Years Of Age: An International Prospective Population-Based Study, Michelle Fernandes, José Villar, Alan Stein, Eleonora Staines Urias, Cutberto Garza, Cesar G. Victora, Fernando C. Barros, Enrico Bertino, Manorama Purwar, Maria Carvalho, Zulfiqar Ahmed Bhutta

Woman and Child Health

Objectives: To describe the construction of the international INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) standards for child development at 2 years by reporting the cognitive, language, motor and behaviour outcomes in optimally healthy and nourished children in the INTERGROWTH-21st Project.
Design: Population-based cohort study, the INTERGROWTH-21st Project.
Setting: Brazil, India, Italy, Kenya and the UK.
Participants: 1181 children prospectively recruited from early fetal life according to the prescriptive WHO approach, and confirmed to be at low risk of adverse perinatal and postnatal outcomes.
Primary measures: Scaled INTER-NDA domain scores for cognition, language, fine and gross motor skills and behaviour; vision outcomes measured …

C'Est Vraiment Compliqué: A Case Study On The Delivery Of Maternal And Child Health And Nutrition Interventions In The Conflict-Affected Regions Of Mali, Anushka Ataullahjan, Michelle F. Gaffey, Moctar Tounkara, Samba Diarra, Seydou Doumbia, Zulfiqar Ahmed Bhutta, Diego G. Bassani

Woman and Child Health

Background: Mali is currently in the midst of ongoing conflicts which involve jihadist groups, rebels, and the state. This conflict has primarily centered in the North of the country. Humanitarian actors delivering services in these geographies must navigate the complex environment created by conflict. This study aimed to understand how humanitarian actors make decisions around health service delivery within this context.
Methods: The current case-study utilized a mixed methods approach and focused on Mopti, Mali's fifth administrative region and fourth largest in population. Latent content analysis was used to analyze interview transcripts guided by our research objectives and new concepts …

Understanding The Factors Affecting The Humanitarian Health And Nutrition Response For Women And Children In Somalia Since 2000: A Case Study, Zahra Ahmed, Anushka Ataullahjan, Michelle F. Gaffey, Mohamed Osman, Chantal Umutoni, Zulfiqar Ahmed Bhutta, Abdirisak A. Dalmar

Woman and Child Health

Background: Somalia has been ravaged by more than two decades of armed conflict causing immense damage to the country's infrastructure and mass displacement and suffering among its people. An influx of humanitarian actors has sought to provide basic services, including health services for women and children, throughout the conflict. This study aimed to better understand the humanitarian health response for women and children in Somalia since 2000.
Methods: The study utilized a mixed-methods design. We collated intervention coverage data from publically available large-scale household surveys and we conducted 32 interviews with representatives from government, UN agencies, NGOs, and health facility …

Impact Of Conflict On Maternal And Child Health Service Delivery - How And How Not: A Country Case Study Of Conflict Affected Areas Of Pakistan, Jai K. Das, Zahra Ali Padhani, Sultana Jabeen, Arjumand Rizvi, Uzair Ansari, Malika Fatima, Ghulam Akbar, Wardah Ahmed, Zulfiqar Ahmed Bhutta

Woman and Child Health

Introduction: In conflict affected countries, healthcare delivery remains a huge concern. Pakistan is one country engulfed with conflict spanning various areas and time spans. We aimed to explore the effect of conflict on provision of reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH&N) services and describe the contextual factors influencing the prioritization and implementation in conflict affected areas of Pakistan (Balochistan and FATA).
Method: We conducted a secondary quantitative and a primary qualitative analysis. For the quantitative analysis, we stratified the various districts/agencies of Balochistan and FATA into the conflict categories of minimal-, moderate- and severe based on …

Investigating The Delivery Of Health And Nutrition Interventions For Women And Children In Conflict Settings: A Collection Of Case Studies From The Branch Consortium, Anushka Ataullahjan, Michelle F. Gaffey, Samira Sami, Neha S. Singh, Hannah Tappis, Robert E. Black, Karl Blanchet, Ties Boerma, Ana Langer, Paul B. Spiegel, Ronald J. Waldman, Paul H. Wise, Zulfiqar Ahmed Bhutta

Woman and Child Health

Globally, the number of people affected by conflict is the highest in history, and continues to steadily increase. There is currently a pressing need to better understand how to deliver critical health interventions to women and children affected by conflict. The compendium of articles presented in this Conflict and Health Collection brings together a range of case studies recently undertaken by the BRANCH Consortium (Bridging Research & Action in Conflict Settings for the Health of Women and Children). These case studies describe how humanitarian actors navigate and negotiate the multiple obstacles and forces that challenge the delivery of health and …

Substantial And Sustained Reduction In Under-5 Mortality, Diarrhea, And Pneumonia In Oshikhandass, Pakistan: Evidence From Two Longitudinal Cohort Studies 15 Years Apart, C L. Hansen, B J J. Mccormick, Iqbal Azam Syed, K Ahmed, J M. Baker, E Hussain, A Jahan, A F. Jamison, N Samji, Oshikhandass Diarrhea And Pneumonia Project, Anita K. M. Zaidi, Ahmed Jan

Community Health Sciences

Background: Oshikhandass is a rural village in northern Pakistan where a 1989-1991 verbal autopsy study showed that diarrhea and pneumonia were the top causes of under-5 mortality. Intensive surveillance, active community health education and child health interventions were delivered in 1989-1996; here we assess improvements in under-5 mortality, diarrhea, and pneumonia over this period and 15 years later.
Methods: Two prospective open-cohort studies in Oshikhandass from 1989 to 1996 (Study 1) and 2011-2014 (Study 2) enrolled all children under age 60 months. Study staff trained using WHO guidelines, conducted weekly household surveillance and promoted knowledge on causes and management of …

Risk Factors For Postpartum Sepsis: A Nested Case-Control Study, Samina Bakhtawar, Sana Sheikh, Rahat Qureshi, Zahra Hoodbhoy, Beth Payne, Iqbal Azam Syed, Peter Von Dadelszen, Laura Magee

Community Health Sciences

Background: The Majority (99%) of maternal deaths occur in low and middle-income countries. The three most important causes of maternal deaths in these regions are postpartum hemorrhage, pre-eclampsia and puerperal sepsis. There are several diagnostic criteria used to identify sepsis and one of the commonly used criteria is systematic inflammatory response syndrome (SIRS). However, these criteria require laboratory investigations that may not be feasible in resource-constrained settings. Therefore, this study aimed to develop a model based on risk factors and clinical signs and symptoms that can identify sepsis early among postpartum women.
Methods: A case-control study was nested in an …

Polycystic Ovary Syndrome, Subfertility And Vitamin D Deficiency, Arfa Azhar, Fatima Abid, Rehana Rehman

Department of Biological & Biomedical Sciences

Polycystic ovarian syndrome (PCOS) is the most common endocrine female disorder, affecting 4-18% women of reproductive age. The prevalence of PCOS in South Asian women, especially in Pakistani women, is much higher (52%) as compared to white population (20 - 25% in UK). In Pakistan, vitamin D status displays 31.2% vitamin D insufficiency, 53.5% vitamin D deficiency, and 15.3% normal vitamin D values. Vitamin D deficiency, though very common in the general population, is even more prevalent in PCOS patients, seen in approximately 67-85%, which further correlates to their related comorbidities. A lot of researches have to be directed to …

Chloroquine Administration In Breastfeeding Mothers Associates With Increased Hiv-1 Plasma Viral Loads, William A. Paxton, Marloes A. Naarding, Ferdinand Wnm Wnm Wit, Nienke J. Veldhuijzen, Matthew F. Chersich, Brigitte Kankindi Kankindi, Rene Douma A. Douma, Samuel Tuyizere, Suzanne Jurriaans, Stanley Luchters

Population Health, East Africa

Chloroquine (CQ) and Hydroxychloroquine (HCQ) have been proposed to be effective at treating COVID-19 patients. We, and others, have previously reported on the capacity of CQ to reduce HIV-1 replication in vitro. We tested CQ administration in post-partum mothers on influencing HIV-1 viral loads in human milk as a means of lowering mother to child transmission. A Phase I/II, randomized, placebo-controlled study to evaluate chloroquine administration to reduce HIV-1 RNA levels in human milk: the CHARGE study. Thirty HIV-1 positive pregnant Rwandese women (CQ n = 20; placebo n = 10) were enrolled in a 16-week study, with the treatment …

Do Recipients Of Cash Transfer Scheme Make The Right Decisions On Household Food Expenditure? A Study From A Rural District In Pakistan, Aminah Jahangir, Shehla Zaidi, Jai K. Das, Shifa Habib

Community Health Sciences

Objective: To assess spending by beneficiaries of Benazir Income Support Programme on monthly food commodities, and contribution of the cash grant programme on purchase of nutritious foods.
Methods: The descriptive cross-sectional survey of households enrolled in the Benazir Income Support Programme was conducted during July and August, 2013, in Matiari district of the Sindh province of Pakistan. Monthly household food expenditure on food commodities and use of the cash grant on type of food purchased was assessed through structured interviews of the beneficiaries. Results were computed in 2013 Pak rupees and converted to 2018 United States dollar. Women beneficiaries were …

Delivering Infectious Disease Interventions To Women And Children In Conflict Settings: A Systematic Review, Sarah Meteke, Marianne Stefopulos, Daina Als, Michelle Gaffey, Mahdis Kamali, Fahad J. Siddiqui, Mariella Munyuzangabo, Reena P. Jain, Shailja Shah, Amruta Radhakrishnan, Anushka Ataullahjan, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: Conflict has played a role in the large-scale deterioration of health systems in low-income and middle-income countries (LMICs) and increased risk of infections and outbreaks. This systematic review aimed to synthesise the literature on mechanisms of delivery for a range of infectious disease-related interventions provided to conflict-affected women, children and adolescents.
Methods: We searched Medline, Embase, CINAHL and PsychINFO databases for literature published in English from January 1990 to March 2018. Eligible publications reported on conflict-affected neonates, children, adolescents or women in LMICs who received an infectious disease intervention. We extracted and synthesised information on delivery characteristics, including delivery …

Delivering Non-Communicable Disease Interventions To Women And Children In Conflict Settings: A Systematic Review, Shailja Shah, Mariella Munyuzangabo, Michelle F. Gaffey, Mahdis Kamali, Reena P. Jain, Daina Als, Sarah Meteke, Amruta Radhakrishnan, Fahad J. Siddiqui, Anushka Ataullahjan, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: Non-communicable diseases (NCDs) are the leading cause of death worldwide. In the context of conflict settings, population displacement, disrupted treatment, infrastructure damage and other factors impose serious NCD intervention delivery challenges, but relatively little attention has been paid to addressing these challenges. Here we synthesise the available indexed and grey literature reporting on the delivery of NCD interventions to conflict-affected women and children in low- and middle-income countries (LMICs).
Methods: A systematic search in MEDLINE, Embase, CINAHL and PsycINFO databases for indexed articles published between 1 January 1990 and 31 March 2018 was conducted, and publications reporting on NCD …

Adolescent Food Insecurity In Rural Sindh, Pakistan: A Cross-Sectional Survey, Sana Sheikh, Romaina Iqbal, Rahat Qureshi, Iqbal Azam Syed, Rubina Barolia

Department of Obstetrics & Gynaecology

Background: Food insecurity (FI) is alarmingly high in developing countries including Pakistan. A quarter of Pakistan's population consists of adolescents yet there is no information on their experience of FI. FI at adolescent age have long term effect on mental and physical health hence we aimed to determine the prevalence of food insecurity (FI) among adolescents and compare it with household FI, and assess social determinants of adolescent FI.
Methods: A cross-sectional survey on 799 households with unmarried adolescents was conducted from September 2015 to June 2016 in three union councils of Hyderabad, Pakistan. Unmarried 10-19 years old girls and …

Assessing Physical Activity In People With Mental Illness: 23-Country Reliability And Validity Of The Simple Physical Activity Questionnaire (Simpaq), S Rosenbaum, R Morell, A Abdel-Baki, M Ahmadpanah, T V. Anilkumar, L Baie, A Bauman, S Bender, Zahra Hoodbhoy, Romaina Iqbal, Ayesha Mian

Department of Paediatrics and Child Health

Background: Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness. Increases in physical activity are associated with improvements in symptoms of mental illness and reduction in cardiometabolic risk. Reliable and valid clinical tools that assess physical activity would improve evaluation of intervention studies that aim to increase physical activity and reduce sedentary behaviour in people living with mental illness.
Methods: The five-item Simple Physical Activity Questionnaire (SIMPAQ) was developed by a multidisciplinary, international working group as a clinical tool to assess physical activity and sedentary behaviour in …

A Descriptive Study Of Double Burden Of Malnutrition In Mothers Of Children With Severe Acute Malnutrition Admitted In Children Hospital And Institute Of Child Health, Multan, Saadia Khan, Umme Ammara, Reema Arshad, Farah Naz, Kamran Ishfaq

Department of Paediatrics and Child Health

Objective: To assess the nutritional status of mothers of severely malnourished children, and to evaluate the factors associated with inadequate caloric intake of children with severe acute malnutrition versus sufficient caloric intake by mothers.
Methods: The cross-sectional descriptive study was conducted from January to June 2016 at Children Hospital and Institute of Child Health, Multan, Pakistan, and comprised mothers of severely malnourished children admitted for treatment. Data was collected using a questionnaire administered through interviews. Elements noted included body mass index, 24-hour recall, dietary restriction during pregnancy, lactation and complimentary feeding patterns of the children. The mothers were also examined …

Mainstreaming Nutrition Services: Stabilization Centers And Outpatient Therapeutic Program Centers, Ashar Muhammad Malik

Community Health Sciences

No abstract provided.

A Novel Histological Index For Evaluation Of Environmental Enteric Dysfunction Identifies Geographic-Specific Features Of Enteropathy Among Children With Suboptimal Growth, Ta-Chiang Liu, Kelley Vanbuskirk, Syed Asad Ali, M. Paul Kelly, Lori R. Holtz, Omer H. Yilmaz, Kamran Sadiq, Najeeha Talat Iqbal, Beatrice Amadi, Sana Syed

Department of Paediatrics and Child Health

Background: A major limitation to understanding the etiopathogenesis of environmental enteric dysfunction (EED) is the lack of a comprehensive, reproducible histologic framework for characterizing the small bowel lesions. We hypothesized that the development of such a system will identify unique histology features for EED, and that some features might correlate with clinical severity.
Methods: Duodenal endoscopic biopsies from two cohorts where EED is prevalent (Pakistan, Zambia) and North American children with and without gluten sensitive enteropathy (GSE) were processed for routine hematoxylin & eosin (H&E) staining, and scanned to produce whole slide images (WSIs) which we shared among study pathologists …

Neonatal Jaundice And Developmental Impairment Among Infants In Kilifi, Kenya, Dorcas N. Magai, Michael Mwaniki, Amina Abubakar, Shebe Mohammed, Anne L. Gordon, Raphael Kalu, Paul Mwangi, Hans M. Koot, Charles R. Newton

Institute for Human Development, East Africa

Background: Neonatal jaundice (NNJ) is common in sub‐Saharan Africa (SSA), and it is associated with sepsis. Despite the high incidence, little has been documented about developmental impairments associated with NNJ in SSA. In particular, it is not clear if sepsis is associated with greater impairment following NNJ.

Methods: We followed up 169 participants aged 12 months (57 cases and 112 controls) within the Kilifi Health Demographic Surveillance System. The diagnosis of NNJ was based on clinical laboratory measurement of total serum bilirubin on admission, whereas the developmental outcomes were assessed using the Developmental Milestones Checklist and Kilifi Development …

Postpartum Endometritis And Infection Following Incomplete Or Complete Abortion: Case Definition & Guidelines For Data Collection, Analysis, And Presentation Of Maternal Immunization Safety Data, C E. Rouse, L O. Eckert, F M. Muñoz, J S A. Stringer, S Kochhar, L Bartlett, M Sanicas, D J. Dudley, D M. Harper, Fyezah Jehan

Department of Paediatrics and Child Health

Abstract are not provided by the author/publisher

Colostrum And Mature Breast Milk Analysis Of Serum Irisin And Sterol Regulatory Element-Binding Proteins-1c In Gestational Diabetes Mellitus, Syeda Sadia Fatima, Erum Khalid, Asma Akbar Ladak, Syed Adnan Ali

Department of Biological & Biomedical Sciences

Background: We aimed to evaluate irisin and SREBP-1c levels in serum, colostrum and mature breast milk in women with and without gestational diabetes (GDM); and to relate them with maternal glucose, lipid profile and weight status of babies.
Methods: GDM positive women (n = 33) and normal glucose tolerant women (NGT) (n = 33) were recruited. Maternal blood samples were collected at 28th week of gestation and later at 6-week post-partum while breast milk samples of the lactating mothers were collected within 72 hours of birth (colostrum) and at 6 weeks post-partum (mature milk). Irisin and SREBP-1c levels were analyzed …

A Study Protocol For An Mhealth, Multi-Centre Randomized Control Trial To Promote Use Of Postpartum Contraception Amongst Rural Women In Punjab, Pakistan, Xaher Gul, Waqas Hameed, Sharmeen Hussain, Ishaque Sheikh, Junaid-Ur-Rehman Siddiqui

Community Health Sciences

Background: Provision of family planning services during the immediate post-partum phase is considered effective and cost-efficient for promoting healthy timing and spacing of pregnancies. This research aims to test the effectiveness of mobile phone-based interventions in promoting use of postpartum contraception. Moreover, it will also test the non-inferiority of text and voice messages compared to interactive phone-based counselling.
Methods: A three-arm, 10-month, multicentre, randomized controlled trial will be conducted at 15 social franchise (SF) health facilities in Punjab province of Pakistan. Pregnant women aged 15-44 years who are in their first or second trimester and have a mobile phone for …

Polyhydramnios Among Women In A Cluster-Randomized Trial Of Ultrasound During Prenatal Care Within Five Low And Low-Middle Income Countries: A Secondary Analysis Of The First Look Study, Melissa Bauserman, Robert Nathan, Adrien Lokangaka, Elizabeth M. Mcclure, Janet Moore, Daniel Ishoso, Antoinette Tshefu, Lester Figueroa, Sarah Saleem, Waseem Mirza

Community Health Sciences

Background: In many low and low-middle income countries, the incidence of polyhydramnios is unknown, in part because ultrasound technology is not routinely used. Our objective was to report the incidence of polyhydramnios in five low and low-middle income countries, to determine maternal characteristics associated with polyhydramnios, and report pregnancy and neonatal outcomes.
Methods: We performed a secondary analysis of the First Look Study, a multi-national, cluster-randomized trial of ultrasound during prenatal care. We evaluated all women enrolled from Guatemala, Pakistan, Zambia, Kenya and the Democratic Republic of Congo (DRC) who received an examination by prenatal ultrasound. We used pairwise site …

Pregnant Women In Four Low-Middle Income Countries Have A High Prevalence Of Inadequate Dietary Intakes That Are Improved By Dietary Diversity, Rebecca L. Lander, K Michael Hambidge, Jamie E. Westcott, Gabriela Tejeda, Tshilenge S. Diba, Shivanand C. Mastiholi, Umber S. Khan, Ana Garcés, Sumera Aziz Ali, Sarah Saleem, On Behalf Of The Women First Preconception Nutrition Trial Group

Community Health Sciences

Background: Up-to-date dietary data are required to understand the diverse nutritional challenges of pregnant women living in low-middle income countries (LMIC). To that end, dietary data were collected from 1st trimester pregnant women in rural areas of Guatemala, India, Pakistan, and Democratic Republic of the Congo (DRC) participating in a maternal lipid-based nutrient supplement (LNS) Randomized Controlled Trial to examine dietary diversity (DD), usual group energy and nutrient intakes, and prevalence of inadequate dietary intakes.
Methods: Two 24-h dietary recalls were conducted in ~240 pregnant women/site (total n = 966) prior to 12-week gestation. Adequate DD was assessed, i.e., ≥5 …

Challenges Of Implementing An Individual Randomized Controlled Trial (Women First: Preconception Maternal Nutrition Study) In A Rural Study Site: A Case Study From Pakistan, Sumera Aziz Ali, Umber S. Khan, Farina Abrejo, Sarah Saleem, Michael K. Hambidge, Nancy F. Krebs, Jamie E. Westcott, Robert L. Goldenberg, Elizabeth M. Mcclure, Omrana Pasha

Community Health Sciences

Persistent global disparities in maternal and neonatal outcomes associated with poor maternal nutrition provided the genesis of the Women First (WF) study, an individually randomized controlled trial on preconceptional maternal nutrition. This article describes the challenges that arose in implementing this trial related to nutrition or diet of the mother, in District Thatta-Pakistan. During different phases of the study, we encountered problems in identifying the eligible participants, taking consent from couples, randomizing participants in different arms, conducting biweekly follow-up visits on time, ensuring compliance to the intervention, and measuring the primary outcome within the 24 hours of birth. Each challenge …

Improving Identification And Child-Focused Collaborative Care For Children Of Parents With A Mental Illness In Tyrol, Austria, Hanna Christiansen, Annette Bauer, Batool Fatima, Melinda Goodyear, Ingunn Olea Lund, Ingrid Zechmeister-Koss, Jean Lillian Paul

Community Health Sciences

Background: Children of parents with a mental illness (COPMI) are more likely to experience negative long-term adversities. However, interventions to support their needs early can significantly enhance adjustment and reduce negative outcomes. Approximately one in four children currently lives with a parent with mental illness worldwide. The lifelong impact for individuals, governments, and broader society is likely to be substantial. There are significant workforce barriers to the early identification of COPMI and addressing their needs, particularly within the adult mental health care system. The current study aims to reduce such barriers and to improve identification of COPMI in the current …

Are Family Planning Vouchers Effective In Increasing Use, Improving Equity And Reaching The Underserved? An Evaluation Of A Voucher Program In Pakistan, Moazzam Ali, Syed Khurram Azmat, Hasan Bin Hamza, Md Mizanur Rahman, Waqas Hameed

Community Health Sciences

Background: Low modern contraceptive prevalence rate and high unmet need in Pakistan aggravates the vulnerabilities of unintended pregnancies and births contributing to maternal morbidity and mortality. This research aims to assess the effectiveness of a free, single-purpose voucher approach in increasing the uptake, use and better targeting of modern contraceptives among women from the lowest two wealth quintiles in rural and urban communities of Punjab province, Pakistan.
Methods: A quasi-interventional study with pre- and post-phases was implemented across an intervention (Chakwal) and a control district (Bhakkar) in Punjab province (August 2012-January 2015). To detect a 15% increase in modern contraceptive …

Factors Associated With Anemia Among Women Of The Reproductive Age Group In Thatta District: Study Protocol, Sumera Aziz Ali, Zahid Abbasi, Anam Feroz, K Michael Hambidge, Nancy F. Krebs, Jamie E. Westcott, Sarah Saleem

Community Health Sciences

Background: Maternal anemia is a leading public health issue placing pregnant women at higher risk of low birth weight, preterm birth, perinatal mortality, and neonatal mortality. Women in developing countries are at higher risk of anemia which could be either due to micronutrient deficiencies, hemoglobinopathies, infections or other socio-demographic factors. Thus, it is highly essential to explore the factors of anemia among women of the reproductive age group in order to design suitable interventions. The primary objective of this study is to assess the biological and socio-demographic factors that are associated with anemia among the women of the reproductive age …

Evaluating Quality Of Contraceptive Counseling: An Analysis Of The Method Information Index, Karen T. Chang, Mulenga Mukanu, Ben Bellows, Waqas Hameed, Amanda M. Kalamar, Karen A. Grépin, Xaher Gul, Nirali M. Chakraborty

Community Health Sciences

The Method Information Index (MII) is calculated from contraceptive users' responses to questions regarding counseling content-whether they were informed about methods other than the one they received, told about method-specific side effects, and advised what to do if they experienced side effects. The MII is increasingly reported in national surveys and used to track program performance, but little is known about its properties. Using additional questions, we assessed the consistency between responses and the method received in a prospective, multicountry study. We employed two definitions of consistency: (1) presence of any concordant response, and (2) absence of discordant responses. Consistency …

Health Care Seeking For Maternal And Newborn Illnesses In Low- And Middle-Income Countries: A Systematic Review Of Observational And Qualitative Studies, Zohra S. Lassi, Philippa Middleton, Zulfiqar Ahmed Bhutta, Caroline Crowther

Woman and Child Health

Background: In low- and middle-income countries, a large number of maternal and newborn deaths occur due to delays in health care seeking. These delays occur at three levels i.e. delay in making decision to seek care, delay in access to care, and delay in receiving care. Factors that cause delays are therefore need to be understand to prevent and avoid these delays to improve health and survival of mothers and babies.
Methods: A systematic review of observational and qualitative studies to identify factors and barriers associated with delays in health care seeking.
Results: A total of 159 observational and qualitative …

The Politics Of Abortion And Maternal Health: A Discussion Paper, Ihsan Ullah, Ayaz Ayub, Edwin Van Teijlingen

Journal of Asian Midwives (JAM)

Abortion should be legally allowed for women because it can save mothers from childbirth-related complications and death. Legal abortion is one of the safest methods to terminate a pregnancy when there is a risk to the mother’s health by childbirth or severe deformity of the fetus or it is unwanted. Unfortunately, approximately half of all abortions worldwide mostly in nations where abortion is severely restricted and are performed in dangerous settings. These risky abortions are a significant contributor to maternal morbidity and disability. Limiting a woman's access to an abortion does not stop abortion; rather, it just encourages more risky …