Maternal and Child Health Commons^™

Impact Of Local Terminology On The Design Of A Community-Based Diagnostic And Management Algorithm For Postpartum Sepsis: Findings Of Formative Research, Shabina Ariff, Fatima Mir, Wafa Aftab, Farrukh Raza, Shujaat Zaidi, Sheraz Memon, Amnesty Lefevre, Linda A. Bartlett, Peter Winch, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Postpartum sepsis is one of the leading causes of maternal mortality and morbidity in developing countries. This formative research elicits local terms used for postpartum illnesses and symptoms of postpartum sepsis with the aim of improving postpartum diagnosis and management in Pakistan.
Methods: We conducted 34 in-depth interviews with recently delivered women (RDW), traditional birth attendants (TBAs), healthcare providers and family members of RDW from rural Sindh to explore local Sindhi terms used to describe postpartum sepsis and related symptoms. During interviews, all participants were asked to orally free list common symptoms of postpartum illnesses; those who were aware …

Improved First Trimester Maternal Iodine Status With Preconception Supplementation: The Women First Trial, Amy E. Young, Jennifer F. Kemp, Charis Uhlson, Jamie L. Westcott, Sumera Aziz Ali, Sarah Saleem, Ana Garcès, Lester Figueroa, Manjunath S. Somannavar, Shivaprasad S. Goudar

Community Health Sciences

Maternal iodine (I) status is critical in embryonic and foetal development. We examined the effect of preconception iodine supplementation on maternal iodine status and on birth outcomes. Non-pregnant women in Guatemala, India and Pakistan (n ~ 100 per arm per site) were randomized ≥ 3 months prior to conception to one of three intervention arms: a multimicronutrient-fortified lipid-based nutrient supplement containing 250-μg I per day started immediately after randomization (Arm 1), the same supplement started at ~12 weeks gestation (Arm 2) and no intervention supplement (Arm 3). Urinary I (μg/L) to creatinine (mg/dl) ratios (I/Cr) were determined at 12 weeks …

Review Of Fetal Alcohol Spectrum Disorder (Fasd) Among Aboriginal And Torres Strait Islander People, Sharynne Hamilton, Michael Doyle, Carol Bower

Australian Indigenous HealthBulletin

Fetal Alcohol Spectrum Disorder (FASD) is a preventable, lifelong disability that disproportionately affects Aboriginal and Torres Strait Islander people. This review provides a comprehensive synthesis of the available information on FASD among Aboriginal and Torres Strait Islander people, with reference to the limitations on population-based data and evaluated programs. The review outlines; the harms of alcohol use in the context of colonisation, cultural perspectives on assessment and diagnosis, effective prevention programs and a summary of state and national policies. Health impacts, educational outcomes and the effects of FASD on vulnerable populations such as children in protection and young people in …

Mindfulness-Based Interventions For Prenatal Stress, Anxiety, And Depression, Fiona Kate Rice

Expressive Therapies Capstone Theses

Pregnant people in the United States (US) face myriad barriers to resource accessibility when seeking support, including financial gatekeeping, discrimination, and cis-gendering of the process. Commodification of prenatal support is exhaustive and contributes to a growing exclusivity of traditionally accessible interventions designed to reduce stress, anxiety, and depression, and to promote positive fetal outcomes and parent-child bond. Mindfulness-based interventions are particularly appropriate for reducing stress, anxiety, and depression in pregnancy. Mindfulness-based interventions are intersectional, accessible means of pregnancy and childbirth support with evidence-based outcomes of positive birth experiences and results. Mindfulness is defined as nonjudgmental awareness of the present moment. …

Cost Estimation Alongside A Multi-Regional, Multi-Country Randomized Trial Of Antenatal Ultrasound In Five Low-And-Middle-Income Countries, B W. Bresnahan, E Vodicka, J B. Babigumira, Ashar Muhammad Malik, F Yego, A Lokangaka, B M. Chitah, Z Bauer, H Chavez, Sarah Saleem

Community Health Sciences

Background: Improving maternal health has been a primary goal of international health agencies for many years, with the aim of reducing maternal and child deaths and improving access to antenatal care (ANC) services, particularly in low-and-middle-income countries (LMICs). Health interventions with these aims have received more attention from a clinical effectiveness perspective than for cost impact and economic efficiency.
Methods: We collected data on resource use and costs as part of a large, multi-country study assessing the use of routine antenatal screening ultrasound (US) with the aim of considering the implications for economic efficiency. We assessed typical antenatal outpatient and …

Stress, Alcohol Use, And Punitive Parenting During The Covid-19 Pandemic, Jennifer Price Wolf, Bridget Freisthler, Caileigh Chadwick

Faculty Research, Scholarly, and Creative Activity

Background
Emerging research suggests that parents are experiencing heightened stress during the COVID-19 pandemic. Parental stress is a risk factor for harsh or punitive parenting, and this association may be exacerbated by the use of alcohol.
Objective
We examine whether parental stress is associated with use of punitive parenting, as well as whether this association is modified by drinking pattern.
Participants & setting
We used advertisements and word-of-mouth to recruit 342 parents living in Central Ohio during the initial stay-at-home order for COVID-19.
Methods
We used geographic ecological momentary assessment (gEMA) to measure parental stress and punitive parenting during three …

The Prevalence Of Postpartum Depression In Black And Hispanic Women In New Jersey, Courtney Chineme, Rachel Shmuts, Chris Canlas

Rowan-Virtua Research Day

Postpartum depression (PPD) is defined as symptoms of major depressive disorder (MDD) within one month of giving birth with the prevalence in the United States being 10-15%. There are well documented instances of racial differences and their effects on maternal outcomes including infant, maternal mortality and postpartum mood disorders. In New Jersey, there are monitoring systems that explore the relationships between maternal characteristics such as race, age, education level, insurance status, and racial bias and how they may correlate with higher incidences of Postpartum Depression (PPD) in these communities of women. The purpose of this comparative study is to analyze …

The Role Of Primary Care Physicians In Post-Partum Depression (Ppd), Elizabeth Bowman

Rowan-Virtua Research Day

Background

• Symptoms of depression lasting longer than 2 weeks following birth
• 10-15% of new mothers affected yet 50% of cases go undiagnosed
• Long-lasting consequences for the mother, baby, and father
• Multi-factorial condition

Conclusion

• Primary care providers are the first-line defense against PPD
• Many providers are resistant to PPD screenings
• Interventions from primary care providers are effective

The Impact Of Exercise On Pregnant Women Aged 18-40 And Fetal Development, Jinisha Patwa

Rowan-Virtua Research Day

68% of those who performed minimum level exercise prior to pregnancy stopped completely during early pregnancy.

Women stop exercising during pregnancy due to worries about the impact it may have on the development of the fetus.

Starting moderate-intensity, weight-bearing exercise early in pregnancy increases placental growth rate and volume.

Exercise reduces the risks of excess gestational weight gain and high maternal body weight before pregnancy.

Physical exercise reduces the risk of gestational diabetes mellitus.

Breastfeeding Education Support Tool For Baby (Best4baby): Feasibility, Acceptability, And Preliminary Impact Of An Mhealth Supported Breastfeeding Peer Counselor Intervention In Rural India, Parth D. Lalakia, Vanessa L. Short, Roopa M. Bellad, Patricia J. Kelly, Yukiko Washio, Tony Ma, Katie Chang, Niranjana Majantashetti, Umesh S. Charantimath, Frances J. Jaeger, Shivaprasad S. Goudar, Richard J. Derman

Rowan-Virtua Research Day

Objective: To evaluate the feasibility of an mHealth-supported breastfeeding peer counselor intervention implemented in rural India and the preliminary impact of the intervention on maternal breastfeeding behaviors, including exclusive breastfeeding (EBF).

Methods: In this quasi-experimental pilot study, participants received either the intervention plus usual care (n = 110) or usual care alone (n = 112). The intervention group received nine in-home visits during and after pregnancy from peer counselors who provided education about and support for EBF and other optimal infant feeding practices and were aided with an mHealth tool. The control group received routine prenatal and postnatal health education. …

Ethnic Differences In Maternal Cytokines And Adipokines And Their Association With Spontaneous Preterm Delivery, Yelizavet D. Lomakova, Xinhua Chen

Rowan-Virtua Research Day

Spontaneous preterm delivery (SPTD, birth at <37 weeks’ gestation) is a leading cause of infant mortality in the United States [1]. Infants born prematurely are more likely to suffer from both short and long-term complications including neurodevelopmental delay, visual and hearing impairment, and chronic diseases such as heart disease, hypertension and diabetes in later life [2-4]. African American women have a 2-fold increased risk of preterm delivery compared to Caucasian women [5].The reasons for this disparity are poorly understood. This limits the ability to predict and prevent preterm delivery in the most high-risk populations.

Predictors Of Iron Consumption For At Least 90 Days During Pregnancy: Findings From National Demographic Health Survey, Pakistan (2017-2018), Sumera Aziz Ali, Savera Aziz Ali, Shama Razzaq, Nayab Khowaja, Sarah Gutkind, Fazal Ur Rehman, Nadir Suhail

Section of Internal Medicine

Background: Iron supplementation is considered an imperative strategy for anemia prevention and control during pregnancy in Pakistan. Although there is some evidence on the predictors of iron deficiency anemia among Pakistani women, there is a very limited understanding of factors associated with iron consumption among Pakistani pregnant women. Thus, this study aimed to investigate the predictors of iron consumption for at least ≥90 days during pregnancy in Pakistan.
Methods: We analyzed dataset from the nationally representative Pakistan Demographic Health Survey 2017-2018. The primary outcome of the current study was the consumption of iron supplementation for ≥90 days during the pregnancy …

Randomised Trials At The Level Of The Individual, Jay J H. Park, Nathan Ford, Denis Xavier, Per Ashorn, Rebecca F. Grais, Zulfiqar Ahmed Bhutta, Herman Goossens, Kristian Thorlund, Maria Eugenia Socias, Edward J. Mills

Centre of Excellence in Women and Child Health

In global health research, short-term, small-scale clinical trials with fixed, two-arm trial designs that generally do not allow for major changes throughout the trial are the most common study design. Building on the introductory paper of this Series, this paper discusses data-driven approaches to clinical trial research across several adaptive trial designs, as well as the master protocol framework that can help to harmonise clinical trial research efforts in global health research. We provide a general framework for more efficient trial research, and we discuss the importance of considering different study designs in the planning stage with statistical simulations. We …

Fine Particulate Matter And Low Weight Births In Mexico City, Mexico, Kennedy Cohn

Honors Theses

Fine particulate matter (PM2.5) exposure has been associated with several negative health consequences, and recent studies suggest a potential relationship between PM2.5 exposure and adverse birth outcomes, including low birth weight (LBW). This thesis investigated a potential relationship between fine particulate matter concentration and low birth weight in Mexico City, Mexico between 2008-2016. Maternal pollution exposure was estimated at the city-wide level by averaging PM2.5 measurements from various monitoring stations. Birth weight was collected from the SINAC database. Logistic regression models were run for different temporal scales (by trimester, and 10-month periods); however, there were no significant relationships found between …

Tiny Tusks Internship: An Analysis Of Exclusive Breastfeeding In Low Income Women, Brittany Jones

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Due to the fact that formula feeding is often seen as the “easier” option for some women, this literature analysis was conducted to gain an understanding about factors which influence the perception of breastfeeding in low-income populations. This literature review analyzed the factors which influence reduced rates of breastfeeding in lower income populations and the importance of breastfeeding education to this population. A search through CINAHL and PubMed for journal articles dating from 2016 to 2021 was conducted. The search generated 46 studies, 40 from CINAHL and 6 from PubMed. Study eligibility was determined by looking for articles involving low …

Tiny Tusks Internship: Marketing Towards Breastfeeding: How Marketing Can Either Help Or Hinder How Breastfeeding Is Perceived, Hailey Tremmel

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Tiny Tusks Breastfeeding and Infant Support is a program run by faculty and students in the Eleanor Mann School of Nursing program that allows for breastfeeding mothers in attendance at the University of Arkansas sporting events to have a place to pump or provide care to their infant. How marketing towards breastfeeding is portrayed has a huge impact on helping breastfeeding mothers to feel properly educated and supported about the decision to breastfeed. The purpose of this literature review is to demonstrate how marketing tactics can affect the view of breastfeeding, whether that be positive or negative. The results found …

Diet Diversity Among Pregnant Women And Young Children—Insights For Improving Malaria, Family Planning, And Maternal And Child Health Outcomes In Northwestern Nigeria Through Social And Behavior Change Programming, Breakthrough Research

Reproductive Health

This research brief provides rigorous, evidence-based insights to policy-makers, implementers, and researchers of social and behavior change (SBC) programs on maternal and child nutrition during the 1,000-day period between a woman’s pregnancy and her child’s second birthday. It is one of a series of briefs presenting findings from a Breakthrough RESEARCH study that uniquely captures data on a wide range of psychosocial drivers of behavioral outcomes in family planning, malaria, and maternal, newborn and child health and nutrition (MNCH+N) in the three northwestern states of Nigeria.

Economic And Cost-Effectiveness Analysis Of The Community-Level Interventions For Pre-Eclampsia (Clip) Trials In India, Pakistan And Mozambique, Jeffrey N. Bone, Asif R. Khowaja, Marianne Vidler, Beth A. Payne, Mrutyunjaya B. Bellad, Shivaprasad S. Goudar, Ashalata A. Mallapur, Khatia Munguambe, Rahat Qureshi, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: The Community-Level Interventions for Pre-eclampsia (CLIP) trials (NCT01911494) in India, Pakistan and Mozambique (February 2014-2017) involved community engagement and task sharing with community health workers for triage and initial treatment of pregnancy hypertension. Maternal and perinatal mortality was less frequent among women who received ≥8 CLIP contacts. The aim of this analysis was to assess the incremental costs and cost-effectiveness of the CLIP intervention overall in comparison to standard of care, and by PIERS (Pre-eclampsia Integrated Estimate of RiSk) On the Move (POM) mobile health application visit frequency.
Methods: Included were all women enrolled in the three …

Tiny Tusks Internship: The Importance Of Breastfeeding Education In The Workplace, Gianna Hogan

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Breastfeeding education in public, especially in the workplace, is a concept that has a multitude of different perspectives. Research has shown that breastfeeding has many positive effects on mother and baby, that can be lessened due to the lack of breastfeeding support in various organizations. In this literature review, barriers to breastfeeding in the workplace were analyzed in order to understand the effects these barriers have on breastfeeding duration. In addition, this review helped emphasize the need for policies to be enacted in the workplace to better support breastfeeding mothers, and the impact these policies have on employee retention rates …

Prenatal Dietary Education, Using The Midwifery Model, In Ireland Vs The United States, Allison Erby

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Prenatal dietary education is a very important component of care in healthy pregnancies, but more than that, dietary education can be an indicator of the value a healthcare provider places on holistic care or preventive medicine. The United States and Ireland are compared in this study because they represent high intervention vs. low intervention approaches, respectively, to obstetric care. Healthcare professionals from the United States and Ireland perceive the most important nutrients and method of receiving those differently. Maybe the most telling contrast, healthcare professionals in Ireland perceive food as the way pregnant women should receive vital nutrients, but healthcare …

Hpv Vaccine Hesitancy, Ellen Fountain

Health, Human Performance and Recreation Undergraduate Honors Theses

Human papillomavirus (HPV) is a virus spread through close contact, often sexual contact. Those infected will be at high risk of developing HPV-related cancers later in life. In 2006, the HPV vaccine was approved for use in the United States, but many were, and continue to be, hesitant to vaccinate their children. While other factors come into play, many times there are misconceptions contributing to hesitancy and ultimate refusal of the vaccine. The goal of this analysis is to review these factors and misconceptions and explore education-based interventions designed to minimize HPV vaccine hesitancy.

Chipatala Cha Pa Foni, Malawi's 'Health Center By Phone,' Improving Information Given About Pregnancy-Related Symptoms, Breakthrough Research, Villagereach

Reproductive Health

The Health Center by Phone, or "Chipatala cha pa Foni" (CCPF), was developed by Malawi’s Ministry of Health and VillageReach as a community-based hotline in the Balaka district of Malawi. CCPF was identified as an existing national health strategy with potential for providing Malawi’s women and their families important postpartum hemorrhage information. Because CCPF archives de-identified audio recordings of all calls, 28 telephone transcripts were qualitatively examined to assess whether women experiencing pregnancy-related complications such as postpartum bleeding call CCPF, and how hotline workers respond to them.

A Clinical Audit Of Management Of Third And Fourth Degree Perineal Tears, Saida Abrar, Raheela Mohsin Rizvi, Urooj Kashif

Department of Obstetrics & Gynaecology

Objective: To perform a clinical audit of the practices related to the management of third and fourth degree perineal tears.
Methods: The retrorspective study was conducted in 2019 at the Aga Khan University Hospital, Karachi, and comprised medical records from January 2008 to December 2018 of women having singleton term vaginal delivery and sustaining obstetric anal sphincter injuries. The change in practices regarding tear management was compared with a previous audit done at the same institution in 2008. Data was analysed using SPSS 20.
Results: Of the 25,370 deliveries, 142(0.56%) sustained obstetric anal sphincter injuries. There was a significant increase …

Adverse Childhood Experiences And Their Connection To Autoimmune Disease In Adulthood, Emma J. Molden

Honors Theses

Everyday in the United States, a child experiences a traumatic event. Autoimmune disease is one of the top two leading causes of death in the United States. Can these two horrifying events be connected? Autoimmune diseases currently affect millions of Americans and are considered an epidemic because of their prevalence within the adult population. Even with a high number of cases, this possible connection has been largely ignored and under researched for the history of modern medicine. However, two studies have begun to make the connection between adverse childhood experiences and how that affects the onset of autoimmune diseases in …

Are School Lunches Contributing To The Obesity Epidemic Among Children?, Luis Chavez

Electronic Theses, Projects, and Dissertations

Background: Childhood obesity is a major public health issue in the United States (U.S.) and recent data have shown that the incidence and prevalence have been increasing over the past 20 years. Poor dietary habits are often attributed to these increasing rates. The National School Lunch Program (NSLP) provides meals and snacks to over 30 million students. Therefore, determining whether an association exists between student participation in the NSLP, and their respective body mass index (BMI) is critical. Few studies have examined a family’s economic stability and the child’s race as potential moderating variables. This study aimed to investigate …

Polycystic Ovarian Syndrome And Insulin Resistance: An Evaluation Of Treatment Modalities And Complication Prevention, Sarah Mann

Senior Honors Theses

Polycystic ovarian syndrome (PCOS) is a reproductive and endocrine disorder in women of childbearing age. This disorder includes multiple clinical manifestations, namely insulin resistance (IR) and infertility related to hormonal imbalances and anovulation. Despite being a common condition, its etiology and treatment modalities remain poorly defined. Without proper understanding and management of the condition, women may suffer numerous complications besides infertility such as diabetes mellitus type II (DMII), endometrial cancer, and cardiovascular disease. Therefore, further research is critical. This integrative review will create a comprehensive understanding of PCOS' pathophysiology, potential complications, treatment methods, and nursing considerations to promote the health …

How Covid-19 Has Fundamentally Changed Clinical Research In Global Health, Jay J H. Park, Robin Mogg, Gerald E. Smith, Etheldreda Nakimuli-Mpungu, Fyezah Jehan, Craig R. Rayner, Jeanine Condo, Eric H. Decloedt, Jean B. Nachega, Gilmar Reis, Edward J. Mills

Department of Paediatrics and Child Health

COVID-19 has had negative repercussions on the entire global population. Despite there being a common goal that should have unified resources and efforts, there have been an overwhelmingly large number of clinical trials that have been registered that are of questionable methodological quality. As the final paper of this Series, we discuss how the medical research community has responded to COVID-19. We recognise the incredible pressure that this pandemic has put on researchers, regulators, and policy makers, all of whom were doing their best to move quickly but safely in a time of tremendous uncertainty. However, the research community's response …

Urgently Seeking Efficiency And Sustainability Of Clinical Trials In Global Health, Jay J H. Park, Rebecca F. Grais, Monica Taljaard, Etheldreda Nakimuli-Mpungu, Fyezah Jehan, Jean B. Nachega, Nathan Ford, Denis Xavier, Andre P. Kengne, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

This paper shows the scale of global health research and the context in which we frame the subsequent papers in the Series. In this Series paper, we provide a historical perspective on clinical trial research by revisiting the 1948 streptomycin trial for pulmonary tuberculosis, which was the first documented randomised clinical trial in the English language, and we discuss its close connection with global health. We describe the current state of clinical trial research globally by providing an overview of clinical trials that have been registered in the WHO International Clinical Trial Registry since 2010. We discuss challenges with current …

Workforce Assessment: Measuring The Impacts Of Covid-19 On The Maternal And Child Health Workforce, Ashleigh M. Sutphen

Capstone Experience: Master of Public Health

Workforce assessments provide an opportunity to assess, evaluate, and identify the needs of a particular workforce. The use of workforce assessments in the field of maternal and child health (MCH) has been an ongoing and a strongly supported effort by the Health Resources & Services Administration: Maternal and Child Health Bureau (MCHB). The maternal and child health workforce is responsible for providing essential public health services to some of the most vulnerable populations such as mothers, children, and people living with disabilities. Thus, the continuation of providing these essential public health services is critical – even in the midst of …

Determinants Of Short Birth Intervals Among Married Women: A Cross-Sectional Study In Karachi, Pakistan, Sidrah Nausheen, Maria Asif Bhura, Kristy Hackett, Imtiaz Hussain, Zainab Shaikh, Arjumand Rizvi, Uzair Ansari, David Canning, Iqbal Shah, Sajid Bashir Soofi

Department of Obstetrics & Gynaecology

Introduction: Birth spacing is a critical pathway to improving reproductive health. WHO recommends a minimum of 33-month interval between two consecutive births to reduce maternal, perinatal, infant morbidity and mortality. Our study evaluated factors associated with short birth intervals (SBIs) of less than 33 months between two consecutive births, in Karachi, Pakistan.
Methods: We used data from a cross-sectional study among married women of reproductive age (MWRA) who had at least one live birth in the 6 years preceding the survey (N=2394). Information regarding their sociodemographic characteristics, reproductive history, fertility preferences, family planning history and a 6-year reproductive calendar were …