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An individual-based modelling study estimating the impact of maternity service delivery on health in Malawi
Get PDFMaternal and perinatal morbidity and mortality remain high in Malawi, partially due to gaps in the coverage and quality of health services. We developed an individual-based model of maternal and perinatal health and healthcare in Malawi, situated in a ‘whole-health system, all-disease’ framework (Thanzi La Onse). We modelled sixteen scenarios estimating the impact of current and improved coverage and quality of antenatal, intrapartum, and postnatal services from 2023 to 2030. Whilst current service delivery is inferred to avert morbidity and mortality, the largest reductions in the stillbirth, maternal and neonatal mortality rates were observed when the use and quality of all services was maximised concurrently (a 10%, 52% and 57% reduction respectively). When services were considered in isolation, generally, increased coverage without quality improvement did not impact mortality or DALYs. In only three scenarios was a sufficient reduction in neonatal mortality observed to achieve target 3.2 of the United Nation’s Sustainable Development Goals (SDG), and in no scenarios was a reduction in maternal mortality sufficient to achieve SDG target 3.1 observed, reaffirming that system wide investments are essential to achieve these goals.</p
Pregnant women’s sleep quality and its associated factors among antenatal care attendants in Bahir Dar City, Northwest Ethiopia
Get PDFGood sleep quality is crucial for health and body equilibrium, particularly during pregnancy, where changes in sleep are influenced by mechanical and hormonal factors. Poor sleep can hinder daily activities and lead to adverse pregnancy outcomes. Data on sleep quality are scarce in low and middle-income countries such as Ethiopia. Hence, this study aimed to determine the magnitude of sleep quality and its associated factors among pregnant mothers in Bahir Dar City, northwest Ethiopia. A facility-based cross-sectional study was conducted with 367 randomly selected pregnant women. All pregnant women who attended public health facilities in Bahir Dar City from November 1st to December 30, 2022 were included except who were critically ill and aged less than 18 years. The data were collected through face-to-face interviews. Sleep quality was assessed by using the Pittsburgh Sleep Quality Index (PSQI). Stata v14 was used for data analysis. A binary logistic regression model was used to identify factors associated with poor sleep quality. Statistical significance was set at p < 0.05. The prevalence of poor sleep quality was 55.04%. In the multivariable analysis, older maternal age (AOR = 3.62), third trimester (AOR = 2.83), multigravidas (AOR = 2.55), low hemoglobin (AOR = 1.92), and coffee consumption (AOR = 2.19) were associated with poor sleep quality. More than half of pregnant women had poor sleep quality. Women aged ≥ 30 years, 3rd trimester, multigravidas, anemic women, and coffee consumption during pregnancy were factors associated with poor sleep quality. The concerned body should pay attention to improving Hgb level and iron/folate supplementation and reduce coffee intake in pregnant women to improve maternal sleep quality during pregnancy
How Can We Accelerate Maternal Vaccination Globally?
No full textNew maternal vaccines could reduce infant deaths at and after birth, especially in low- and middle-income countries. Work is underway to prepare for new maternal vaccines globally, and the Maternal Immunization Readiness Network for Africa and Asia will support in-country preparation in several low- and middle-income countries. However, the impact of new maternal vaccines will only be realized with supportive policy recommendations and sufficient financing for the development of maternal immunization platforms
The constellations of child fostering in Kenya: Considering location and distance: Considering location and distance
Get PDFBACKGROUND While studies provide context on why mothers foster-out children, there is little discussion about where children reside, transitions in children’s living arrangements over time, distance between fostered children and their mothers, and how such distance might influence mothers’ relationships with children. OBJECTIVES We aimed to: (1) examine the geographical location of fostered children and distance from mothers, (2) establish who fosters children and the mothers’ relationships with caregivers, (3) determine transitions in children’s fostering arrangements, including mobility within kin networks, and (4) explore mothers’ perceptions of distance, location, and barriers to contact with fostered children. METHODS We used innovative kinship-network data and in-depth interviews with mothers who have fostered-out children in Kenya. We mapped locations of fostered-out children using geo-coded data, determining’ hot spots’ while exploring distance from mothers, and analyzed qualitative and quantitative data to examine mothers’ perceptions of distance as a barrier to maternal- relationships. RESULTS Fostered children live primarily in rural Kenya, and there is substantial fluidity in children’s living arrangements. Mothers’ relationships and contact with children are impacted by location and distance. CONTRIBUTION Our study highlights kinship linkages and child fostering over time and space. It suggests vital areas in future research on fostering and kinship more broadly and demonstrates the possibility of narrowing the focus to collect more insightful data. It provides evidence on fostering experiences while accurately capturing children’s transitions over time and within kin networks. The study paints a more complete picture of child fostering complexities and how they rely on the constellations of available kin
How do social norms influence the sexual and reproductive health of very young adolescents in sub-Saharan Africa? A scoping review protocol
Get PDFIntroductionYounger adolescents (aged 10–14 years) in sub-Saharan Africa (SSA) have disproportionate sexual and reproductive health (SRH) outcomes due to structural, behavioural, socioeconomic and other factors. Social and gender norms have important consequences for the SRH and wellbeing of younger adolescents both now and over their life course. SRH programming often focuses on older adolescents (aged 15–19 years), overlooking younger ones. This scoping review sets out to explore how gender and social norms influence younger adolescents’ SRH in SSA, to inform tailored interventions.MethodsThe Arksey and O'Malley strategy will be used to review the available literature. Online databases (PubMed/MEDLINE, CINHAL, EMBASE, PsycINFO, Cochrane Library, and African Index Medicus) will be searched for original studies published between 1 January 2000 and 30 September 2024. Further, a manual search to include relevant grey literature will be performed. The steps in the review are: 1) defining the research question, 2) identifying relevant studies, 3) selecting studies, 4) charting the data, and 5) collating, summarising, and reporting the results.ResultsFindings will be reported in accordance with the guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement.DiscussionThe review will generate the most up-to-date evidence and identify gaps in literature in addition to informing future research on how gender and social norms influence younger adolescents’ SRH in SSA. Findings will inform and influence future interventions and evaluations in this area.</p
UK guidelines for the investigation and management of eosinophilia in returning travellers and migrants
Get PDFEosinophilia is a common finding in returning travellers, migrants and other travelling groups. In this setting it often indicates an underlying helminth infection. Infections associated with eosinophilia are frequently either asymptomatic or associated with non-specific symptoms but some can cause severe disease. Here the British Infection Association guidelines group has comprehensively reviewed and updated the UK recommendations for the investigation and management of eosinophilia in returning travellers, migrants and other relevant groups, first published in 2010.1 Literature reviews have been undertaken to update the evidence on the prevalence and causes of eosinophilia in these groups and on the treatment of relevant pathogens and clinical conditions. Diagnostic tests available to UK-based clinicians are summarised.Changes made to the updated guidelines include in sections on the investigation and empirical treatment of asymptomatic eosinophilia and on the treatment of trichuriasis, lymphatic filariasis, onchocerciasis, hookworm, fascioliasis, taeniasis. Pathogens which are rarely encountered in UK practice have been removed from the guidelines and others added, including an expanded section on fungal infection. A section on off-license and rarely used drugs has been included.</p
Epidemiology and impact of travellers’ diarrhoea differs during UK military training exercises in Kenya and Oman
Get PDFBackground. Gastrointestinal illnesses are common during military training and operational deployments. We compared the incidence and burden of travellers’ diarrhoea (TD) reported by British service personnel (SP) during recent training exercises in Kenya and Oman.Methods. SP completed a validated anonymous questionnaire regarding clinical features of any diarrhoeal illness, associated risk factors and impact on work capability after 6-week training exercises in 2018 in Kenya and 2018–2019 in Oman. Responses were tabulated for descriptive comparisons.Results. Questionnaires were received from 388 (32%) SP in Kenya and 627 (52%) in Oman. The cumulative incidence of reported diarrhoea over 6-weeks was 14.2% (95% CI 8.02% to 22.61%) in Kenya compared with 3.9% (95% CI 1.10% to 9.91%) in Oman (OR 3.56, 95% CI 2.18 to 5.8; p<0.0001). Attack rates were 9.45 SP/100 exposure-months in Kenya and 2.66/100 in Oman. The number of workdays lost was greater in Kenya (6.26 per 1000 days) compared with Oman (4.13 per 1000 days) (p<0.01). In Kenya, 52.3% of those experiencing diarrhoea became ill during the first 14 days of deployment, but in Oman, 50% were ill in the last deployment week. The strongest risk factor associated with TD at both locations was contact with a colleague experiencing diarrhoea, followed in Kenya by eating locally sourced food and swimming in local water, which had weaker protective associations in Oman.Conclusions. The epidemiology, risk factors and burden of TD in Kenya were similar to previous descriptions, where overall incidence continues to decline. Incidence and burden were significantly lower in Oman, where both were much lower than historical descriptions. Peak timing of illness and associated risk factors differed between Kenya and Oman. Continued documentation and review of TD during training exercises at different geographical locations is essential to inform the chain of command about risks to operational effectiveness.</p
Vertical transmission of hepatitis B virus in the WHO African region: a systematic review and meta-analysis.
Get PDFMore new infections with hepatitis B virus (HBV) occur annually in the WHO African region than in the rest of the world combined. We did a systematic review and meta-analysis to estimate the prevalence of hepatitis B surface antigen (HBsAg) in pregnant women and vertical transmission events in the region. In this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, Africa Index Medicus, and Africa Journals Online for publications between Jan 1, 1992, and Jan 7, 2024, with no language restrictions. HBsAg prevalence and vertical transmission (HBsAg positivity in children aged 6-12 months) were estimated with the use of binomial mixed models with logit links, stratified by infant vaccination status. We estimated HBsAg prevalence for subregions of Africa and for the WHO African region by weighting by estimated livebirths for each subregion. We estimated transmission events using WHO and UNICEF vaccine coverage data and UN population estimates. We included 113 studies reporting on HBsAg prevalence from 190 983 pregnant women and 11 studies reporting on vertical transmission. HBsAg prevalence in women receiving antenatal care in the WHO African region (based on 2014-23 data) was 6·2% (95% CI 5·3-7·2). No relationship between risk of bias and HBsAg prevalence was observed. In 2022, an estimated 172 000 vertical transmission events (95% CI 82 000-383 000) occurred (0·4% of livebirths), a fall from a peak of 339 000 (149 000-634 000; 1·2% of all livebirths) in 2001. Increasing birth dose vaccination coverage to the WHO target of 90% could reduce vertical transmission by 43·7% (95% CI 11·6-78·0) to 97 000 events per year (95% CI 58 000-160 000). Adding maternal antiviral prophylaxis with 90% coverage could reduce transmission by 86·3% (95% CI 78·4-94·6) to 24 000 events per year (95% CI 14 000-39 000; 0·06% of livebirths) and achieve WHO elimination targets. Vertical transmission is an important contributor to HBV transmission in the WHO African region. Scaling up of hepatitis B birth dose vaccination and antiviral prophylaxis is urgently needed, which could achieve elimination of vertical transmission.</p
Correction to: ‘Unravelling nicotinic receptor and ligand features underlying neonicotinoid knockdown actions on the malaria vector mosquito Anopheles gambiae ’ (2024), by Ito et al.
Get PDFAlthough the biological data we presented in the original paper are correct, there is an error in the calculated log P values for certain compounds, now corrected in this Corrigendum. One conclusion in the original paper as published, which states that log P and Imax are negatively correlated with log k, is incorrect and we clarify that in this Corrigendum. The corrected calculations still indicate that the Agα1/Agα2/Agα8/Agβ1 nAChR is the most important factor determining the rate constant, as described in the original paper. This has been corrected in the text below.</p
Exploring gender stereotypes and norms among peri-urban very young adolescents in Zimbabwe using participatory and qualitative approaches
Get PDFGender stereotypes and norms shape very young adolescents’ (VYAs, 10–14 years old) behaviours, including in relation to sexual and reproductive health (SRH). This formative study sought to determine and prioritise the stereotypes and norms to be targeted as part of work to co-develop a gender-transformative intervention for VYAs in Zimbabwe to promote positive masculinities and SRH. In 2023, we collected data from VYAs, using participatory workshops encompassing various activities. We also held focus group discussions with older adolescents and parents/guardians, and individual interviews with community influencers. We used interpretive thematic analysis to generate themes across data. We later presented research findings to diverse stakeholders to explore how the findings might influence the design of our gender-transformative intervention. Gender stereotypes emerged in relation to sexual behaviour and SRH norms. Both boys and girls seemed to condone boys’ multiple, concurrent relationships. Boys were deemed to be unable to control their sexual urges. Menstrual stigma, myths and misconceptions were pervasive. Stereotypes were also evident in beliefs and norms around resource and task allocation. For example, both boys and girls concurred that given limited resources, educating a boy child should be prioritised even when a girl sibling is performing better academically. Stereotypes relating to labour distribution were also evident. Daily activity charts suggested longer working hours for girls. Differential attitudes towards drug and substance use among boys and girls were driven by underlying masculine norms. Of note, adolescents disapproved of some of these norms, pointing to an opportunity to shift them. Stakeholders highlighted the need for our planned intervention to focus on the wider community, in addition to VYAs themselves. The formative research enabled us to identify key gender stereotypes and norms, information which is critical for informing the planned gender-transformative intervention. Although deeply seated, these stereotypes are not insurmountable, particularly among VYAs.</p