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Obstetrical interventions during labour and birth: an examination of effects on breastfeeding, neonatal mortality and children’s educational outcomes
Get PDFBackground
Obstetrical interventions during labour and birth are essential for perinatal care as part of any contemporary obstetric practice. Various underlying biological mechanisms have been proposed in linking obstetrical interventions during labour and birth with breastfeeding, infant’s health and children’s neurodevelopmental outcomes at later life. These mechanisms include changes in the gut microbiota composition, exposure to different levels of physical stress and stress hormone surges during labour and delivery, as well as epigenetic alteration of gene expression. The available evidence regarding the effect of obstetrical interventions during labour and birth on short-and long-term outcomes is limited. For instance, much of the available evidence was generated from high-income countries. Moreover, many of the previous studies were hampered by non-longitudinal study designs, small sample sizes and inconsistent findings, which may be due to suboptimal control of confounders and other biases. This thesis addresses these issues and utilises data from low-, middle- and high-income country settings.
Aims
The overarching aim of this thesis is to examine the effect of obstetrical interventions during labour and birth on breastfeeding indicators (early initiation of breastfeeding, exclusive breastfeeding under 6 months, and children ever breastfed), neonatal mortality and children’s educational outcomes at eight years of age.
Specifically, the aims include:
-To estimate the prevalence and examine sociodemographic factors associated with caesarean section in Ethiopia.
-To examine the changing temporal association between caesarean birth and neonatal death in Ethiopia from 2000 to 2016 as well as to provide an interpretation of the associations using the ‘Three Delays Model’ in the context of Ethiopia.
-To investigate the effect of caesarean section on breastfeeding indicators—early initiation of breastfeeding (within 1 hour), exclusive breastfeeding under 6 months and children ever breastfed (at least once)—in each of the 33 countries in sub-Saharan Africa, as well as to summarise the magnitude of these within-country effects in an overall estimate using random-effects meta-analyses.
-To examine the effect of Apgar scores of 0-5, 6, 7, 8 and 9 (compared with 10) on children’s educational outcomes at eight years of age.
-To estimate the effect of elective induction of labour at 39 weeks of gestation as compared with expectant management on children’s educational outcomes at eight years of age. Methods
Data for this thesis were drawn from the Demographic and Health Surveys (DHS) and the South Australian Early Childhood Data Project (SAECDP). The DHS are widely available high-quality data sources from low- and middle-income countries. The SAECDP is an established project that encompasses high-quality whole-of-population linked administrative data from state and federal sources in South Australia. The DHS data from 33 low- and middle-income countries in sub-Saharan Africa were used for the first three studies while the SAECDP data from South Australia were used for the final two studies in this thesis. The use of these two different data sources allowed this thesis to capture the effects of obstetrical interventions during labour and birth on women’s breastfeeding practices, neonatal health and children’s educational outcomes across diverse health system resource settings. For each study, the potential confounding was identified based on a priori subject matter and expert knowledge as well as through the use of the Directed Acyclic Graphs (DAGs). The analytic approaches to answer the aims of this thesis included the modified Poisson regression (Log-Poisson regression), augmented inverse probability weighed (AIPW) estimator, negative control outcome (a tool for detecting confounding and bias), random-effects meta-analysis as well as an application of the ‘Three Delays Model’.
Results
In the first study, the national caesarean section rate increased from 0.7% in 2000 to 1.9% in 2016, with increases across 7 of the 11 administrative regions in Ethiopia. In the adjusted analysis, women who gave birth in a private health facility had a 78.0% higher risk of caesarean section (adjusted prevalence ratio (aPR) (95% CI) 1.78 (1.22 to 2.58) when compared to women who gave birth in public health facility. Having four or more births was associated with a lower risk of caesarean section compared to first births (aPR (95% CI) 0.36 (0.16 to 0.79)). In the second study, in Ethiopia, the adjusted prevalence ratios (aPR) for neonatal death among neonates born via caesarean section versus vaginal birth increased over time, from 0.95 (95% CI, 0.29 to 3.19) in 2000 to 2.81 (95% CI, 1.11 to 7.13) in 2016. The association between caesarean birth and neonatal death was stronger among rural women (aPR (95% CI) 3.43 (1.22 to 9.67)) and among women from the lowest quintile of household wealth (aPR (95% CI) 7.01 (0.92 to 53.36)) in 2016. On the other hand, the aggregate-level analysis revealed that increased caesarean section rates were correlated with a decreased proportion of neonatal deaths.
In the third study, the within-country analyses in sub-Saharan Africa showed, compared with vaginal birth, caesarean section was associated with aPR for early initiation of breastfeeding that ranged from 0.24 (95% CI, 0.17 to 0.33) in Tanzania to 0.89 (95% CI, 0.78 to 1.00) in South Africa. The aPR for exclusive breastfeeding under 6 months ranged from 0.58 (95% CI; 0.34 to 0.98) in Angola to 1.93 (95% CI; 0.46 to 8.10) in Cote d'Ivoire, while the aPR for children ever breastfed ranged from 0.91 (95% CI, 0.82 to 1.02) in Gabon to 1.02 (95% CI, 0.99 to 1.04) in Gambia. The meta-analysis combining effect estimates from 33 countries in sub-Saharan Africa showed caesarean section was associated with a 46% lower prevalence of early initiation of breastfeeding (pooled aPR, 0.54 (95% CI, 0.48 to 0.60)). However, the pooled effects indicated there was little association with exclusive breastfeeding under 6 months (pooled aPR, 0.94 (95% CI; 0.88 to 1.01) and children ever breastfed (pooled aPR, 0.98 (95% CI; 0.98 to 0.99) among caesarean versus vaginally born children.
In the fourth study, after adjusting for confounding, the risk differences comparing five-minute Apgar scores of 0-5 with Apgar score of 10 for children scoring at/below the national minimum standard (NMS) on the National Assessment Program—Literacy and Numeracy (NAPLAN) tests for each domain were: reading (0.07 (95% CI -0.16 to 0.29)), writing (0.27 (95% CI -0.14 to 0.68)), spelling (0.15 (95% CI -0.10 to 0.40)), grammar (0.04 (95% CI -0.21 to 0.29)) and numeracy (0.21 (95% CI -0.04 to 0.45)). Risk differences for children performing at/below the NMS were also evident when Apgar score of 6 were compared with Apgar score of 10.
In the fifth (last) study, after adjusting for confounding, the average treatment effects (ATEs) comparing elective induction of labour at 39 weeks of gestation with expectant management for children scoring at/below the NMS on each domain were: reading (0.01 (95% CI -0.02 to 0.03)), writing (0.02 (95% CI -0.00 to 0.04)), spelling (0.01 (95% CI -0.01 to 0.04)), grammar (0.02 (95% CI -0.01 to 0.04)) and numeracy (0.03 (95% CI 0.00 to 0.05)).
Conclusions
The findings from this thesis present a comprehensive analyses of the effect of obstetrical interventions during labour and birth on breastfeeding, neonatal mortality and children’s educational outcomes at eight years of age by utilising data from low-, middle-, and high-income countries. The findings of Study 1 highlighted that there were large disparities in caesarean section use in Ethiopia, demonstrating unequal access. The results from Studies 2, 3 and 4 suggest that obstetrical interventions during labour and birth (caesarean section and Apgar score) have an influence on neonatal mortality, breastfeeding and children’s educational outcomes at later age. However, the findings of Study 5 suggest that elective induction of labour at 39 weeks of gestation as compared with expectant management did not affect children’s educational outcomes at eight years of age.Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 202
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
Author Under Sail The Imagination of Jack London, 1893-1902
No full textIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Intro -- Title Page -- Copyright Page -- Dedication -- Contents -- Acknowledgments -- Introduction -- 1. Spirit Truth -- 2. From Absorption to Theatricality and Back Again -- 3. "I Will Build a New Present" -- 4. Sons as Authors -- 5. Fathers as Publishers -- 6. The Daughter as Author -- 7. Lovers as Authors -- 8. At Sea with the Family -- 9. Yellow News, Yellow Stories -- 10. The Return Home -- Notes -- Bibliography -- Index -- About Jay WilliamsIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Description based on publisher supplied metadata and other sources.Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, YYYY. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries
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