Maternal and Child Health Commons^™

Exploring The Prevalence And Determinants Of Self-Medication During Pregnancy Among Women From South Punjab, Pakistan, Madiha Madiha, Sehar Jabbar, Imran Masood

Makara Journal of Health Research

Background: For developing countries with high neonatal and maternal mortality rates, any practice that may threaten the maternal-fetal health must be gauged. This study evaluated the prevalence and contributing factors of self-medication during pregnancy among women opting for antenatal or postnatal care in South Punjab, Pakistan.

Methods: A cross-sectional study design was used. Data was collected from 424 women, selected through multi-stage sampling, who visited health care facilities located in six randomly selected cities of South Punjab. Outcomes reported by descriptive and inferential statistics (p < 0.05). Binary logistic regression analysis was performed to determine the association of self-medication with different factors.

Results: Most of the women were involved in self-medication practice (38.9%) …

Standardizing The Use Of The Sinc Screening Tool In A Rural Clinic, Madison Foss

DNP Projects

Unmet contraceptive need represents a persistent quality gap in rural primary care, where reproductive health discussions are often inconsistently addressed. A rural primary care clinic in Shelbyville, Tennessee lacked a standardized, evidence-based process for screening women of childbearing age (15–44 years) for contraceptive needs. This quality improvement project evaluated the feasibility and effectiveness of implementing the Self-Identified Need for Contraception (SINC) screening tool to support routine, patient-centered care. The SINC tool consists of a single validated question designed to identify patients who wish to discuss contraception or pregnancy prevention during clinical visits. Plan–Do–Study–Act cycles were used to integrate the tool …

Matrescence: An Emerging Concept For Birth Worker Practice, Kelsey B. Green

DNP Qualifying Manuscripts

The maternal mental health (MMH) crisis, affecting up to 25% of birthing individuals, is exacerbated by significant gaps in perinatal support. While birth workers are uniquely positioned to provide care, they often lack specialized training beyond basic screening checklists to address the complex transition to motherhood, defined as matrescence. This clinical innovation proposal outlines a matrescence-informed educational curriculum, guided by the Comprehensive Model of Mental Health during the Perinatal Period. The intervention is designed to build tangible, implementable skills, training birth workers to: (1) operationalize matrescence as a psychoeducational tool to normalize distress; (2) use clinical differentiation to distinguish the …

Analisis Perbedaan Biaya Satuan Sectio Caesarea Tanpa Penyulit Dengan Tarif Ina-Cbgs Di Rumah Sakit Swasta Tipe D (X) Di Ternate Tahun 2022, Ummu Hani Mars, Prastuti Soewondo

Jurnal Ekonomi Kesehatan Indonesia

Cesarean section unit cost is an important component for hospital’s management to implement strategic efficiency steps in the future, especially for Rumah Sakit X which 90% of patients are Jaminan Kesehatan Nasional’s participant. Geographically, this hospital is one of hospitals which serve delivery and labor services in Ternate Island that can accommodate references from nearby islands. This resulting in high caesarean section rate, 55 % of all deliveries. The low JKN rate for caesarean section forced management to know the detailed cost component, so the efficiency strategies and the continuity of hospital services could be more increased. This research through …

Power, Interests, And Maternal Health Care: A Political Economy Analysis Of Service Delivery Redesign In Kenya, Jacinta Nzinga, Easter Olwanda, Kennedy Opondo, Hillary Kimutai, Jan Cooper, Brian Arwah, Benjamin Tsofa, Edwine Barasa, Kevin Croke

Institute for Human Development, East Africa

The maternal and newborn health (MNH) service delivery redesign (SDR) in Kakamega County, Kenya, represents the country's first system-level reorganization of MNH services. The reform aimed to improve care quality and reduce mortality by centralizing delivery services at designated hubs. Using a political economy lens, we examined how ideology, political dynamics, and institutional structures shaped the agenda-setting, adoption, implementation, and sustainability of SDR. We drew on data from document reviews, stakeholder analysis, semi-structured interviews, and non-participant observation to assess the structural, contextual, and institutional factors influencing the reform. Ambiguity around SDR's purpose contributed to the community's uncertain engagement characterized by …

Across The Pond, Across The Waistline: A Comparative Look At The Childhood Obesity Crisis In The United States And United Kingdom, Samantha N. Eales

Honors College Theses

Childhood obesity is no longer just a local concern; it’s a global epidemic shaping the health of future generations. This paper compares how two similar nations with drastically different healthcare systems, the United States and the United Kingdom, tackle this growing crisis. Although both countries struggle with fast food culture, sedentary lifestyles, and targeted marketing, their health policy strategies differ dramatically. The U.S. leans on community programs and education, while the U.K. enforces stronger national regulations and advertising restrictions. By examining nutrition, physical activity, and policy, this thesis explores what each country does well and where they fall short. It …

Acceptability Of Corticosteroid Use In The Treatment Of Infant Bronchiolitis: Utilizing The Theoretical Framework Of Acceptability To Design Research Instruments, Caroline R. Smetanka

Capstone Experience: Master of Public Health

Bronchiolitis is the leading cause of hospitalization among infants under six months, yet treatment remains largely supportive due to clinical guidelines that discourage pharmacologic intervention. Recent research suggests that bronchiolitis is not a uniform condition, and a subgroup of infants (those classified within “Profile A”) may benefit from targeted corticosteroid therapy. However, these treatments remain outside current clinical guidelines, and their successful adoption depends on stakeholder acceptability. This Capstone project developed and refined four data collection instruments- two questionnaires and two interview guides- designed to assess how healthcare providers and caregivers perceive the acceptability of corticosteroid treatment for Profile A …

Identifying Barriers For Community Pharmacies As Vaccines For Children (Vfc) Providers In Rural Alabama: Opportunities For Solutions, Myra Bajwa

Honors Theses

Significant Human papillomavirus (HPV) vaccination disparities exist between rural and urban areas in the US. A primary contributor is low access to preventive care in rural areas. Among the most promising strategies to overcome this is increasing access through offering HPV vaccination in non-traditional, convenient health settings such as pharmacies. In rural areas, community pharmacies are trusted, convenient pillars of the community. In Alabama, community pharmacies are eligible for enrollment in the Vaccines for Children (VFC) Program, a federally-funded program that provides free vaccines to children and adolescents under 18 years old who are uninsured, underinsured, American Indian, or Alaska …

Determinants Of Utilization Of Skilled Birth Attendant Among Women Of Reproductive Age In Habeswein Ward, Wajir County, Kenya, Suada Hassan

MSc in Advanced Practice Midwifery

Background: Maternal care provided by a skilled birth attendant (SBA) during pregnancy, at delivery, childbirth, and the postpartum period is vital for reducing maternal and neonatal mortality. In sub-Saharan Africa, the overall prevalence of usage of SBA in a 2021 study was 63%. Tanzania recorded the lowest rate at 13.8%, while Kenya registered 89.3% in 2023. However, disparities exist within Kenyan counties, for instance, in Wajir County only 57% of births were assisted by skilled health providers, a disparity that could be due to socio-cultural differences.

Aim: This study aimed to determine the factors influencing the utilization of skilled …

Assessing The Impact Of Maternal Oral Health On The Risk Of Adverse Birth Outcomes, May Amr Salama

Health Services Research Dissertations

Preterm birth (PTB) and low birth weight (LBW) are leading causes of neonatal morbidity and mortality. Maternal periodontal disease (PD) has been increasingly linked to these adverse birth outcomes (ABOs), yet questions about causality and treatment effectiveness persist due to study design heterogeneity and potential unmeasured confounding. These gaps hinder the development of clear clinical and public health guidelines. This dissertation addresses these gaps through three interconnected studies assessing the relationship between maternal oral health and ABOs.

The first study employed a meta-epidemiological analysis of 62 original studies from nine systematic reviews to evaluate the impact of unmeasured confounding on …

Evaluating Parent Workshops To Reduce Sexual Health Misinformation, Marshall Farrior

Capstone Projects and Master's Theses

This capstone project addressed the problem of sexual health misinformation among youth in Santa Cruz County, which stems from cultural factors, limited parental communication, and inadequate comprehensive sexual health education. Implemented through the Santa Cruz County Public Health Department’s Teen Health Outreach (THO) program, the project evaluated the effectiveness of parent workshops designed to build the capacity of adults’ knowledge and confidence to discuss sexual and reproductive health topics with youth. Serving primarily Hispanic/Latino communities in Watsonville and Freedom, THO collaborates with local schools and organizations to deliver workshops. The intervention aimed to reduce misinformation by empowering parents as trusted …

Assessing Post-Pandemic Engagement In The Supplemental Nutrition Program For Women, Infants, And Children (Wic) In Northeast Tennessee, Christen Minnick

Electronic Theses and Dissertations

Since 1974, the federal Supplemental Nutrition Program for Women, Infants, and Children (WIC) has provided healthy food resources, nutrition education, and provider referrals for families at risk for poor nutrition. Public health professionals have consistently presented evidence that WIC engagement reduces premature births and infant mortality, improves child health and development, and increases specialized care access for participants. While average monthly participation in WIC has increased since the program’s inception, trends indicate that only around half of eligible families have consistently engaged with the program since 2011. Research has linked declining WIC participation to administrative burden, citing learning, psychological, compliance, …

Understanding The U.S. Maternal Healthcare System At The Intersection Of Asian American Birth Outcomes And The Model Minority Stereotype: A Literature Review, Sophia Hevel

University Honors Theses

This thesis aims to explore the maternal healthcare system in the United States as it pertains to Asian American birthing people, the ways in which their racial, ethnic, and cultural identities are interacted with within the U.S. Healthcare system, and subsequently the detrimental effects of the medical system's devaluation of culturally specific birthing and postpartum practices have on Asian American birthing experiences. This will be accomplished through an exploration of the United States' maternal healthcare system, or rather, its crisis; how Asian Americans navigate a system that has not been structured to support their specific needs; and lastly, a discussion …

Parentcoach: Designing An Mhealth Parenting App To Enhance Parental Involvement In Adhd Support, Franceli L. Cibrian, Nancy Herrera, Jesus A. Beltran, Lucas M. Silva, Mikaela Pulse, Kayla Anderson, Cassie Zeiler, Luc Rieffel, Daniel I. Lee, Sabrina E. B. Schuck, Kimberley D. Lakes

Engineering Faculty Articles and Research

Introduction: Parents play a vital role in supporting self-regulation and managing behaviors in children with Attention-Deficit/Hyperactivity Disorder (ADHD). However, many face barriers to accessing consistent, evidence-based support. Mobile health (mHealth) technologies offer a promising way to deliver flexible, low-burden guidance for parents on best practices and strategies to support their children's self-regulation. However, designing them is non-trivial.

Objective: This paper introduces ParentCoach, a mobile application designed to support parents of children with ADHD through brief daily lessons, reflection prompts, and skill-building activities.

Methods: ParentCoach was developed in two phases: (1) secondary analysis of qualitative data from over 30 families …

Nirsevimab Effectiveness Against Intensive Care Unit Admission For Respiratory Syncytial Virus In Infants - 24 States, December 2024-April 2025, Laura D. Zambrano, Regina M. Simeone, Margaret M. Newhams, Amanda B. Payne, Natasha B. Halasa, Amber O. Orzel-Lockwood, Jemima M. Calixte, Satoshi Kamidani, Hillary Crandall, Melissa A. Cameron, Jennifer E. Schuster, Aline B. Maddux, Kathleen Chiotos, Katherine Irby, Steven L. Shein, Mary Allen Staat, Lora M. Martin, Samina S. Bhumbra, Ryan A. Nofziger, Jigar C. Chauhan, Danielle M. Zerr, Shira J. Gertz, Judith A. Guzman-Cottrill, Michele Kong, Janet R. Hume, Bria M. Coates, Kelly N. Michelson, Tamara T. Bradford, Et Al

School of Medicine Faculty Publications

Respiratory syncytial virus (RSV) is a leading cause of intensive care unit (ICU) admission and respiratory failure among infants (children aged < year) in the United States. In August 2023, CDC’s Advisory Committee on Immunization Practices recommended nirsevimab, a long-acting monoclonal antibody, to protect against RSV-associated lower respiratory tract infection among all infants aged < 8 months born during or entering their first RSV season. Following licensure, nirsevimab effectiveness has been demonstrated against RSV-associated infant hospitalization, but evidence regarding effectiveness against RSV-associated critical illness is limited. In a 27-hospital case-control investigation, nirsevimab effectiveness against both RSV-associated infant ICU admission and acute respiratory failure (illness requiring continuous positive airway pressure, bilevel positive airway pressure, or invasive mechanical ventilation) after hospital admission was evaluated during December 1, 2024-April 15, 2025. Among 457 case-patients who received a positive RSV test result and 302 control patients who received a negative RSV test result admitted to an ICU with respiratory symptoms, 14% and 45%, respectively, had received nirsevimab ≥ 7 days before symptom onset. Nirsevimab was 80% effective (95% CI = 70%-86%) against RSV-associated ICU admission and 83% effective (95% CI = 74%-90%) against acute respiratory failure when received a median of 52 days (IQR = 32-89 days) and 50 days (IQR = 32-86 days) before onset for each respective endpoint. These estimates support the recommendation for use of nirsevimab as a prevention strategy to protect infants against severe outcomes from RSV infection.

Female Genital Mutilation And Its Effects Among Women Of Reproductive Age In Kenya: Insights From Kenya Demographic And Health Survey 2022, Jovinary Adam, Joyce Jebet

School of Nursing & Midwifery, East Africa

Introduction Female genital mutilation (FGM) is a significant public health issue rooted in cultural traditions, affecting millions of women and girls. In Kenya, the practice is prevalent in various ethnic groups and is often associated with social and economic pressures.

Objective To determine the prevalence of FGM, the factors associated with FGM, and its effects among women of reproductive age in Kenya.

Methods This study used secondary data of a total 16,716 weighted women of reproductive age drawn from the 2022 Kenya Demographic and Health Survey. The study used the “svy” command in Stata to assign the sample weight. Multivariable …

Kenya’S Path To Universal Health Coverage: Insights From Policy And Practice, Evaline Chepchirchir Langat, Paul Ward, Hailay Gesesew, Lillian Mwanri

Centre of Excellence in Women and Child Health

Background Universal health coverage (UHC) is a globally endorsed commitment aimed at ensuring equitable access to affordable healthcare services. Kenya's journey toward UHC has been marked by significant reforms, including the 2018 pilot phase and ongoing implementation phase (2020–2030). Using qualitative insights from policymakers and practitioners, this study explored Kenya’s progress, challenges, and opportunities to achieve UHC.

Methods Key informant interviews were conducted with 44 stakeholders across seven counties in Kenya. Data were collected in English using a semi-structured interview guide, audio-recorded with consent, and transcribed verbatim. Thematic analysis, guided by the WHO health system framework, identified achievements, challenges, and …

Neonatal Unit Human Resources: Coverage For Six Cadres And Trends For Staff-To-Baby Ratios In 65 Neonatal Units Implementing With Nest360 In Kenya, Malawi, Nigeria, And Tanzania, Rebecca Penzias, Eric Ohuma, Opeyemi Odedere, Olabisi Dosunmu, George Okello, Hannah Mwaniki, Robert Tillya, Vincent Ochieng, Ekran Rashid, William Macharia

Paediatrics and Child Health, East Africa

Background Implementing small and sick newborn care (SSNC) requires skilled health workers; however, there is a shortage, adversely impacting patient outcomes and health worker well-being. There are limited data and no current World Health Organization (WHO) standards for staff-to-baby ratios in neonatal units in low- and middle-income countries (LMICs) to inform policy, planning, and investment.

Methods In 65 neonatal units (36 in Malawi, 13 in Kenya, 7 in Tanzania, and 9 in Nigeria), a health facility assessment (HFA) for SSNC and government-led quality improvement (QI) processes were implemented. Staffing data were collated from baseline HFA (Sept 2019–March 2021) and mid-2023 …

Food Insecurity Is Associated With Depressive And Anxiety Symptoms Among Caregivers Of Young Children In Arid And Semi-Arid Regions Of Kenya: A Cross-Sectional Study, Esther Chongwo, Daisy Chelangat, Eunice Njoroge, Barack Aoko, Martha Kaniala, Moses Wesala, Phillis Magoma, Joyce Marangu, Margaret Kabue, Daniel Rabok

Institute for Human Development, East Africa

Introduction: This study fills a critical gap by assessing the prevalence and association between food insecurity and depressive and anxiety symptoms among caregivers of young children in Kenya's arid and semi-arid lands (ASALs).

Methods: A cross-sectional design was used to collect data from caregivers of children aged 0–3 years from Lamu, Isiolo and Turkana Counties (N = 446). Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales were used to assess depressive and anxiety symptoms, respectively. We also administered the Household Food Insecurity Access Scale, alongside sociodemographic and health-related questionnaires.

Results: The mean caregiver age was 29.37 years …

Small For Gestational Age Subgroups Have Differential Morbidity, Growth, And Neurodevelopment At Age 2: The Interbio-21st Newborn Study, Aris T. Papageorghiou, María C. Restrepo-Ménde, Rose Mcgready, Fernando C. Barros, Francois Nosten, Shama Munim, Roseline Ochieng, Rachel Craik, Hellen C. Barsosio, Zulfiqar Ahmed Bhutta

Department of Obstetrics & Gynaecology

Background: Small for gestational age is a complex perinatal syndrome associated with increased neonatal morbidity, mortality, and impaired childhood growth and neurodevelopment. Current classifications rely primarily on birthweight, which does not capture the heterogeneity of the condition nor predict long-term health outcomes. Here we aim to identify and characterize distinct small for gestational age subgroups and assess their neonatal and early childhood health trajectories.
Objective: To refine the classification of small for gestational age by identifying subgroups based on maternal, fetal, and environmental factors and evaluating their associations with neonatal morbidity, growth, and neurodevelopment at age 2.
Study design: Prospective …