Maternal and Child Health Commons^™

Accuracy Of Rn Visual Quantification Of Emesis Volumes In The Neonatal Intensive Care Unit, Stephen Stoever

Seton Hall University DNP Final Projects

An important component of nursing assessment of feeding tolerance in the neonatal intensive care unit (NICU) for both low-risk and high-risk babies, is the quantification of emesis volumes. While some nurses attempt to weigh the items saturated in emesis in order to quantify volume loss (QEV), there is no or limited consistency in this practice across nurses in this unit. Rather, volumes are “best-guessed” or estimated (EEV) and reported to the practitioner for decision-making. Often feed advances are paused or limited due to perceived feeding intolerance connected to emesis events in neonates.

For this project, 158 NICU nurses at a …

Evaluating Implementation Of "Management Of Possible Serious Bacterial Infection (Psbi) When Referral Is Not Feasible" In Primary Health Care Facilities In Sindh Province, Pakistan, Maria Asif Bhura, Shabina Ariff, Shamim Ahmad Qazi, Zaitoon Qazi, Imran Ahmed, Yasir Bin Nisar, Zamir Suhag, Abdul Wahab Soomro, Sajid Bashir Soofi

Woman and Child Health

Background: The World Health Organization (WHO) launched a guideline in 2015 for managing Possible Serious Bacterial Infection (PSBI) when referral is not feasible in young infants aged 0-59 days. This guideline was implemented across 303 Basic Health Unit (BHU) Plus primary health care (PHC) facilities in peri-urban and rural settings of Sindh, Pakistan. We evaluated the implementation of PSBI guideline, and the quality of care provided to sick young infants at these facilities.
Methods: Thirty (10%) out of 303 BHU Plus facilities were randomly selected for evaluation. A survey team visited each facility for one day, assessed the health system …

Weight Status Of Children Aged 2-5 Years Old, Attending A Paediatric Outpatient Clinic And Its Association With Parental Feeding Style And Parental Perceptions Of Weight Status, Aisling Lee, Helen Callaghan, Dara Gallagher Dr, Annette Lalor, Louise Rattigan, Hilary Greaney, Laura Keaver

SURE Journal: Science Undergraduate Research Experience Journal

Background: A child’s weight status can allow health care professionals to assess their developmental growth. A child having a low or high weight for height could be due to an imbalance in nutrient intake occurring. It is important to balance dietary intake and physical activity to maintain a healthy weight status. Excessive consumption of food can lead to an overweight/obese weight status which is linked to non-communicable diseases. Parental feeding style can directly impact a child’s set of eating behaviours. Therefore, parents have a strong influence over a child’s growth pattern. In addition, parental awareness of childhood obesity is reported …

Chronic Inflammation Was A Major Predictor And Determinant Factor Of Anemia In Lactating Women In Sidama Zone Southern Ethiopia: A Cross-Sectional Study, Tafere Gebreegziabher Belay, Taylor Roice, Barbara J. Stoecker

All Faculty Scholarship for the College of the Sciences

Anemia in women of reproductive age is highly prevalent globally and remains a public health problem. In Ethiopia, despite efforts to minimize the burden of anemia, it is still a moderate public health problem. Anemia has various etiologies including nutritional deficiency, parasitic infection, and inflammation. The aim of this study was to examine contributing factors to anemia in lactating women. Following ethical approval, and six months after delivery, all lactating women (n = 150) were recruited to participate in this study from eight randomly selected rural villages. Anthropometric and socio-economic factors were assessed. From each, a blood sample was collected …

Cesarean Delivery And Infant Cortisol Regulation, Leticia D. Martinez, Laura M. Glynn, Curt A. Sandman, Deborah A. Wing, Elysia Poggi Davis

Psychology Faculty Articles and Research

Background:
Cesarean delivery reduces the risk of infant and maternal morbidity and mortality when medically indicated, however, the cesarean delivery rate is estimated to be two to three times higher than medically necessary. The World Health Organization and American College of Obstetricians and Gynecologists have expressed concern over the high rates of cesarean delivery, citing evidence that cesarean delivery has negative short- and long-term consequences for the health of the infant, mother, and for future pregnancies. Infants delivered by cesarean are at an increased risk of metabolic disease and immune dysfunction throughout the lifespan. Preliminary research suggests that the …

Contraceptive Methods In The United States: The Question Of Abortive Mechanisms, Tara Ferenczy

Senior Honors Theses

This thesis reviews the many methods of contraception available in the United States. Although society’s understanding of women’s health has become a major topic, there is still a significant deficit of information regarding how the accessible methods affect women’s bodies, specifically reproductive tissue. The thesis analyzes numerous contraceptive options focusing specifically on the mechanisms of action to determine whether options have abortifacient properties so that readers may develop educated opinions regarding medical and ethical uses. Information involving strengths and limitations of each technique and the effects on both the female body and the reproductive material assist in understanding the process …

High Impact Practices—Detecting And Managing Hypertension In The Extended Postnatal Period: Preventing Postnatal Pre-Eclampsia And Eclampsia, Charlotte E. Warren

Reproductive Health

The Population Council developed High Impact Practice (HIP) briefs for three strategies that show promise for improving prevention, detection, and management of Hypertensive Disorders in Pregnancy (HDPs). This brief focuses on one of those strategies: detecting and managing hypertension in the extended postnatal period. Key points presented are: the extended postnatal period provides an opportunity to monitor a woman’s blood pressure (BP) and check for persistent hypertension; if BP is measured routinely at any contact with the health system during the extended postnatal period, hypertension is more likely to be detected and managed appropriately; women with pre-eclampsia have a 3.7-fold …

Overview Of High Impact Practices For Improved Prevention, Detection, And Management Of Hypertensive Disorders In Pregnancy, Population Council

Reproductive Health

As part of the Ending Eclampsia Project and supported by the Pre-eclampsia Technical Working Group, the Population Council developed High Impact Practice (HIP) briefs for three strategies that show promise for improving the prevention, detection, and management of Hypertensive Disorders in Pregnancy (HDPs). HDPs affect 10 percent of women globally and are major contributors to maternal and newborn mortality, morbidity, and disability. Providing essential services and health education for women at all levels of the health system is necessary to improve survival rates and quality of life for those who experience HDPs and their newborns. Inspired by Family Planning HIPs, …

High Impact Practices—Task Sharing For Hypertensive Disorders In Pregnancy: Improving Early Detection And Management Of Hypertensive Disorders In Pregnancy, Karen Kirk

Reproductive Health

The Population Council developed High Impact Practice (HIP) briefs for three strategies that show promise for improving prevention, detection, and management of Hypertensive Disorders in Pregnancy (HDPs). This brief focuses on one of those strategies: task sharing, which is the expansion of the levels of health providers who can appropriately deliver health services. Key points presented in this brief are: optimizing available human resources through task sharing can be an effective strategy to increase access to health services; task sharing key services for the prevention, detection, and management of hypertensive disorders in pregnancy can help prevent maternal and newborn morbidity …

High Impact Practices—Encouraging Empowerment And Self-Care Through Participatory Women’S Groups And Group Antenatal Care: Supporting Women To Be At The Center Of Their Own Care As Active Participants, Tracy Mcclair

Reproductive Health

The Population Council developed High Impact Practice (HIP) briefs for three strategies that show promise for improving prevention, detection, and management of Hypertensive Disorders in Pregnancy (HDPs). This brief focuses on one of those strategies: encouraging empowerment and self-care through participatory women’s groups and group antenatal care. Key points presented are: highly participatory, group-based interventions—such as community-based women’s groups and group antenatal and postnatal care (ANC/PNC)—provide opportunities for women to share their experiences and knowledge with others, discuss the local context for challenges and how to address them, and promote empowerment and agency; participation in these groups is associated with …

Perinatal Anxiety And Depression During The Covid 19 Pandemic, Helen Xumin Chen, Nancy Selix, Marcianna Nosek

DNP Qualifying Manuscripts

Abstract

The novel coronavirus disease 2019 (COVID-19) outbreak places perinatal women at higher risk of developing anxiety and depression. Uncertainty, fear, and confusion in medical, social, economic, occupational and political aspects of life in the US add to existing stressors that perinatal women experience. To optimize the quality of perinatal care during the pandemic, appropriate mental health interventions must be implemented to prevent and alleviate perinatal anxiety and depression and improve maternal and infant outcomes. Measures include increased screening, non-pharmacologic and/or pharmacologic interventions and the use of telehealth for care delivery.

Keywords: perinatal anxiety, perinatal depression, COVID-19, SARS CoV-2, maternal …

Operability, Usefulness, And Task-Technology Fit Of An Mhealth App For Delivering Primary Health Care Services By Community Health Workers In Underserved Areas Of Pakistan And Afghanistan: Qualitative Study, Shehla Zaidi, Abdul Momin Kazi, Atif Riaz, Ammarah Ali, Rabia Najmi Taha, Rawshan Jabeen, Umerdad Khudadad, Saleem Sayani

Community Health Sciences

Background: The recent proliferation of digital health technology in low- and middle-income countries has made it possible for community health workers (CHWs) to use mobile health (mHealth) to perform tasks such as data collection and training. Although most studies focus on the prospect of digital apps to motivate and connect CHW, only a few have captured end-user experiences with mobile-based apps. We examined the experience of frontline health workers with a move towards digitalized real-time data to record maternal and childcare services in remote areas of Afghanistan and Pakistan.
Objective: Our study aimed to explore CHW perceptions on the operability …

Fertility Awareness And Parenting Intentions Among Mexican Undergraduate And Graduate University Students, J. M. Place, Brennan D. Peterson, B. Horton, M. Sanchez

Marriage and Family Therapy Faculty Articles and Research

An online, cross-sectional survey was carried out between November 2017 and January 2018 to assess fertility awareness among students attending the National Autonomous University of Mexico (UNAM) in Mexico City. A total of 371 students participated in the survey (n = 228 females, 143 males). 75% of females and 74% of males believed a woman’s fertility begins to decline markedly after age 40. Over 75% of all participants overestimated the probability of couples having a live birth after undergoing one cycle of IVF. With regard to parenting intentions, only 48% of females wished to have children compared to 59% …

Neonatal Lead (Pb) Exposure And Dna Methylation Profiles In Dried Bloodspots, Luke Montrose

Public and Population Health Faculty Publications and Presentations

Lead (Pb) exposure remains a major concern in the United States (US) and around the world, even following the removal of Pb from gasoline and other products. Environmental Pb exposures from aging infrastructure and housing stock are of particular concern to pregnant women, children, and other vulnerable populations. Exposures during sensitive periods of development are known to influence epigenetic modifications which are thought to be one mechanism of the Developmental Origins of Health and Disease (DOHaD) paradigm. To gain insights into early life Pb exposure-induced health risks, we leveraged neonatal dried bloodspots in a cohort of children from Michigan, US …

A Case Study Of Ovc Case Management Through The Zambia Family (Zamfam) Project—Brief, Population Council

HIV and AIDS

The ZAMFAM program aims to improve the care and resilience of orphans and vulnerable children (OVC) as well as young people living with HIV in Zambia by providing support and protection and by strengthening the capacity of children, families, and the community to better manage the socioeconomic shocks of the HIV/AIDS epidemic. A case study approach was employed to understand actors and perceptions, and to document best practices by the program. This brief summarizes the case study findings. The ZAMFAM program utilized several approaches to improving the well-being of OVC. Services or referrals were provided to beneficiaries through home visitation …

A Case-Study Of Ovc Case Management Through The Zambia Family (Zamfam) Project, Lyson Phiri, Drosin Mulenga, Nancy Choka, Caila Brander, Nachela Chelwa, Nkomba Kayeyi

HIV and AIDS

Zambia’s HIV prevalence is estimated at 11% among adults aged 15–49 years and 1% among children younger than 15 years. An estimated 10% of Zambia’s population is at high risk of being orphaned or vulnerable due to the HIV epidemic. The Zambia Family (ZAMFAM) project aims to improve the care and resilience of vulnerable populations while supporting HIV epidemic control. ZAMFAM used a case management approach that tracks beneficiaries from identification to graduation. The Population Council conducted a qualitative case study to understand actors and perceptions, and document best practices. Program beneficiaries viewed the ZAMFAM program as having made a …

Frequency And Outcome Of Meconium Aspiration Syndrome In Babies Born With Meconium-Stained Liquor At Secondary Care Hospital In Pakistan: A Case Series Study, Abdul Moeed, Heeramani Lohana, Sarwat Urooj, Sheraz Ahmed, Khalil Ahmed, Khadija N Humayun

Department of Paediatrics and Child Health

Background: Meconium aspiration syndrome (MAS) in the newborn is characterized by hypoxia, hypercapnia, and acidosis. MAS is a leading cause of morbidity and mortality in neonates. The primary objective of this study was to estimate the frequency of meconium aspiration syndrome (MAP) in babies born with meconium-stained liquor. The secondary outcome was to estimate the meconium aspiration syndrome; in terms of hospital stay, complications, and mortality.
Methods: The study was done at Aga Khan Maternal and Child Care Centre, Hyderabad, Pakistan. Study design was case series and the duration of the study was of 6 months. All patients who fulfilled …

Determinants Of Health Care Seeking Behaviors In Puerperal Sepsis In Rural Sindh, Pakistan: A Qualitative Study, Shabina Ariff, Fatima Mir, Farhana Tabassum, Farrukh Raza, Atif Habib, Ali Turab, Amnesty Lefevre, Linda A. Bartlett, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Puerperal sepsis (PS) is one of the major causes of maternal death, contributing to 26,000 deaths per year in developing countries. Early recognition and treatment are essential to managing PS, but numerous social, cultural and technical barriers prevent or delay access to care and necessary medical attention. Through this qualitative study, we identified barriers to care seeking for puerperal sepsis among recently delivered women in Matiari, Pakistan.
Methods: We conducted 20 in-depth interviews among recently delivered women with and without sepsis and their family members in September 2012. Key informant interviews were conducted with 14 healthcare providers and traditional …

Non-Obstetric Vulvar/Paravaginal Hematoma In An Adolescent Female With Scleroderma: An Opportunity For Intimate Partner Violence Intervention, Amanda Burnham, Jo Cooke-Barber, Stephen Thacker, Donna Evans, David Carney, William Boswell

HCA Healthcare Journal of Medicine

A 15-year-old female presented to the emergency department with swelling and pain in her left labial region as well as urinary retention after intercourse. This was the patient’s first time having sexual intercourse and the patient stated that her boyfriend “kneed” her in the labia. A CT scan of the pelvis revealed a large vulvar/external hematoma measuring 6 x 10 x 7 cm which extended into the vaginal vault. This case is the first of a vulvar hematoma reported in a pediatric patient with scleroderma. This case was complicated by the fact that our patient claimed her boyfriend intentionally “kneed” …

Drivers Of Stunting Reduction In Peru: A Country Case Study, Luis Huicho, Elisa Vidal-Cárdenas, Nadia Akseer, Samanpreet Brar, Kaitlin Conway, Muhammad Islam, Elisa Juarez, Aviva Rappaport, Hana Tasic, Tyler Vaivada, Jannah Wigle, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: Peru reduced its under-5 child stunting prevalence notably from 31.3% in 2000 to 13.1% in 2016.
Objectives: We aimed to study factors and key enablers of child stunting reduction in Peru from 2000-2016.
Methods: Demographic and Health Surveys were used to conduct descriptive analyses [height-for-age z scores (HAZ) means and distributions, equity analysis, predicted child growth curves through polynomial regressions] and advanced regression analyses. An ecological (at department level) multilevel regression analysis was conducted to identify the major predictors of stunting decline from 2000 to 2016, and Oaxaca-Blinder decomposition was conducted to identify the relative contribution of each factor …

Stunting In Childhood: An Overview Of Global Burden, Trends, Determinants, And Drivers Of Decline, Tyler Vaivada, Nadia Akseer, Selai Akseer, Ahalya Somaskandan, Marianne Stefopulos, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: Progress has been made worldwide in reducing chronic undernutrition and rates of linear growth stunting in children under 5 y of age, although rates still remain high in many regions. Policies, programs, and interventions supporting maternal and child health and nutrition have the potential to improve child growth and development.
Objective: This article synthesizes the available global evidence on the drivers of national declines in stunting prevalence and compares the relative effect of major drivers of stunting decline between countries.
Methods: We conducted a systematic review of published peer-reviewed and gray literature analyzing the relation between changes in key …

The Intertwined Relationship Between Malnutrition And Poverty, Faareha Siddiqui, Rehana Salam, Zohra S. Lassi, Jai K. Das

Woman and Child Health

Despite social and economic development, the burden of malnutrition across the globe remains unacceptably high. A vital relationship exists between nutritional status, human capital, and economic standing. Malnutrition adversely affects the physiological and mental capacity of individuals; which in turn hampers productivity levels, making them and their respective countries more susceptible to poverty. A two-way link exists between malnutrition and poverty, creating a vicious cycle with each fueling the other. Malnutrition produces conditions of poverty by reducing the economic potential of the population and likewise, poverty reinforces malnutrition by increasing the risk of food insecurity. The aim of the paper …

The Community-Level Interventions For Pre-Eclampsia (Clip) Cluster Randomised Trials In Mozambique, Pakistan, And India: An Individual Participant-Level Meta-Analysis, Peter Von Dadelszen, Zulfiqar Ahmed Bhutta, Sumedha Sharma, Jeffrey Bone, Joel Singer, Hubert Wong, Mrutyunjaya B. Bellad, Shivaprasad S. Goudar, Tang Lee, Rahat Qureshi, Clip Trials Working Group

Woman and Child Health

Background: To overcome the three delays in triage, transport and treatment that underlie adverse pregnancy outcomes, we aimed to reduce all-cause adverse outcomes with community-level interventions targeting women with pregnancy hypertension in three low-income countries.
Methods: In this individual participant-level meta-analysis, we de-identified and pooled data from the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised controlled trials in Mozambique, Pakistan, and India, which were run in 2014-17. Consenting pregnant women, aged 12-49 years, were recruited in their homes. Clusters, defined by local administrative units, were randomly assigned (1:1) to intervention or control groups. The control groups continued local standard of …

Effect Of Lipid-Based Nutrient Supplement-Medium Quantity On Reduction Of Stunting In Children 6-23 Months Of Age In Sindh, Pakistan: A Cluster Randomized Controlled Trial, Gul Nawaz Khan, Sumra Kureishy, Shabina Ariff, Arjumand Rizvi, Muhammad Sajid, Cecilia Garzon, Ali Ahmad Khan, Saskia De Pee, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Chronic childhood malnutrition, or stunting, remains a persistent barrier to achieve optimal cognitive development, child growth and ability to reach full potential. Almost half of children under-five years of age are stunted in the province of Sindh, Pakistan.
Objective: The primary objective of this study was to test the hypothesis that the provision of lipid-based nutrient supplement-medium-quantity (LNS-MQ) known as Wawamum will result in a 10% reduction in risk of being stunted at the age of 24 months in the intervention group compared with the control group.
Design: A cluster randomized controlled trial was conducted in Thatta and Sujawal …

A Comparison Of Mits Counseling And Informed Consent Processes In Pakistan, India, Bangladesh, Kenya, And Ethiopia, Anam Shahil Feroz, Christina Paganelli, Milka Bunei, Beza Eshetu, Shahana Parveen, Sayyeda Reza, Chaitali Sanji, Shiyam Sunder Tikmani, Shivaprasad S. Goudar, Sarah Saleem

Community Health Sciences

Globally, more than 5 million stillbirths and neonatal deaths occur annually. For many, the cause of death (CoD) is unknown. Minimally invasive tissue sampling (MITS) has been increasingly used in postmortem examinations for ascertaining the CoD in stillbirths and neonates. Our study compared the counseling and consent methods used in MITS projects in five countries in Africa and south Asia. Key informant interviews were conducted with researchers to describe the characteristics and backgrounds of counselors, the environment and timing of consent and perceived facilitators and barriers encountered during the consent process. Counselors at all sites had backgrounds in social science, …

Management Practices For West Syndrome In South Asia: A Survey Study And Meta-Analysis, Priyanka Madaan, Prem Chand, Kyaw Linn, Jithangi Wanigasinghe, Mimi Lhamu Mynak, Prakash Poudel, Raili Riikonen, Amit Kumar, Pooja Dhir, Sandeep Negi, Jitendra Kumar Sahu

Department of Paediatrics and Child Health

Objectives: Considering the dearth of literature on West syndrome (WS) from South Asian countries, this study aimed to evaluate the management practices in South Asia by an online survey and meta-analysis.
Methods: An online questionnaire was sent to 223 pediatric neurologists/pediatricians in India, Pakistan, Myanmar, Sri Lanka, Bhutan, Nepal, and Bangladesh. Their responses were evaluated and supplemented by a meta-analysis.
Results: Of 125 responses received (response rate: 56%), around 60% of responders observed male preponderance and an approximate lead-time-to-treatment (LTTT) of 4-12 weeks. The commonest etiology observed was a static structural insult (88.6% of responders). Most commonly used first-line drug …

The Spectrum Of Primary Immunodeficiencies At A Tertiary Care Hospital In Pakistan, Sonia Qureshi, Fatima Mir, Samina Junejo, Khalid Saleem, Samreen Zaidi, Abdullah B. Naveed, Khalil Ahmad, Farah Naz Qamar

Department of Paediatrics and Child Health

Background: Primary Immunodeficiency Disorders (PIDs) are well-known disorders in the West. but the recognition and diagnosis of these disorders is challenging in developing countries. We present the spectrum of PIDs seen at a tertiary care center in Pakistan, identified using clinical case definitions and molecular methods.
Methods: A retrospective chart review of children suspected to have PID was conducted at the Aga Khan University Hospital (AKUH) Karachi, Pakistan from 2010 to 2016. Data on demographics, clinical features, family history of consanguinity, sibling death, details of laboratory workup done for PID and molecular tests targeted panel next generation sequencing (NGS) or …

Examining Provider Perceptions And Roles Associated To Breastfeeding Support And Medical Management In Primary Care, Meghan Ganio Molinari

Graduate Theses

Background: Human milk is recommended as the exclusive source of nutrition for all infants in the first six months of life. Current rates of exclusive breastfeeding at six months are well below the public health recommendations (24.9% as of 2015). New mothers may experience many challenges which impact both breastfeeding initiation and duration rates in the postpartum period. Studies indicate that breastfeeding rates improve when women receive a combination of prenatal education coupled with postnatal support. Primary care practitioners in outpatient settings have a unique opportunity to provide lactation education, support, and medical management for their patients to improve …

Changing Prevalence Of Gestational Diabetes Mellitus During Pregnancy Over More Than A Decade, Aisha Sheikh, Lumaan Sheikh

Section of Diabetes, Endocrinology and Metabolism

No abstract provided.

Mapping Geographical Inequalities In Oral Rehydration Therapy Coverage In Low-Income And Middle-Income Countries, 2000–17, Kirsten E. Wiens, Robert C. Reiner Jr, Arianna Maever L. Amit, Veincent Christian F. Pepito, Local Burden Of Disease Diarrhoea Collaborators, 702 Co-Authors

Ateneo School of Medicine and Public Health Publications

Background

Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative …