82 research outputs found
Obstetrical interventions during labour and birth: an examination of effects on breastfeeding, neonatal mortality and children’s educational outcomes
No full textBackground
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
Factors associated with acceptance of provider-initiated HIV testing and counseling among pregnant women in Ethiopia
No full textKetema Bizuwork Gebremedhin,1 Bingjie Tian,2 Chulei Tang,3 Xiaoxia Zhang,3 Engida Yisma,1,4 Honghong Wang3 1Department of Nursing and Midwifery, School of Allied Health Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Department of General Surgery, Affiliated Huashan Hospital of Fudan University, Shanghai, China; 3Department of Fundamental Nursing, Xiangya School of Nursing, Central South University, Changsha, China; 4School of Medicine, Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia Introduction: The global human immunodeficiency virus (HIV) epidemic disproportionately affects sub-Saharan African countries, including Ethiopia. Provider-initiated HIV testing and counseling (PITC) is a tool to identify HIV-positive pregnant women and an effective treatment and prevention strategy. However, its success depends upon the willingness of pregnant women to accept HIV testing.Objectives: To describe the level of acceptance of PITC and associated factors among pregnant women attending 8 antenatal care clinics in Adama, Ethiopia.Methods: Trained nursing students and employees from an HIV clinic conducted face-to-face structured interviews in private offices at the clinics from August to September, 2016.Results: Among the 441 respondents, 309 (70.1%) accepted PITC. Women with more antenatal care visits (odds ratio [OR] =2.59, 95% CI: 1.01–6.63), reported better quality of the PITC service (OR =1.91, 95% CI: 1.19–3.08), and higher level of knowledge on mother-to-child transmission (OR =1.82, 95% CI: 1.03–3.20), were more likely to accept PITC, while women who were older in age (OR =0.37, 95% CI: 0.19–0.74) and perceived negative attitudes from their partners toward HIV-positive results (OR =0.31, 95% CI: 0.10–0.94) were less likely to accept the PITC service.Conclusion: About one-third of pregnant women are not willing to accept PITC. When designing intervention program to improve the acceptance of PITC, we should take into consideration the personal factors, HIV-related knowledge, and attitude of women as well as institutional factors. Keywords: pregnant woman, HIV, provider initiated HIV testing and counseling (PITC), Ethiopi
Menopause: A Contextualized Experience Across Social Structures
No full textMenopause is a phenomenon experienced by women as they approach middle age, marking the end of menstruation and reproduction. Throughout history, menopause has been classified in negative terms as a malady and decay of femininity necessitating a cure, which led to the controversial development of hormone replacement therapy. Feminists and activists challenged existing stereotypes and emphasized menopause as a natural transition. There is still little consensus on universal menopause symptoms since wide variations are reported across geographic regions and cultures. These differences can be better examined via individual menopausal experiences, which are unique and shaped by attitudes and expectations. Macro-level structures often place psychosocial constraints on individual women imposing roles after menopause or creating expectations of common symptoms. This chapter applies three theoretical frameworks to the menopausal experience. The biomedical model portrays menopause as a result of biological pathways with clear diagnoses of menopausal stages and is widely used by physicians. The life course perspective views menopause as a lifelong process that is shaped by the current time period with early life advantages or disadvantages that affect women as they enter their menopausal years. The biopsychosocial model integrates women's experiences of menopause into a hierarchy of structures. Each woman is shaped by microlevel factors like genetics and body functions while also influenced by macro-level structures within her family or society. As the number of women experiencing menopause rises with emerging demographic shifts, special consideration to individual and global experiences of menopause should be integrated to advance well-being
Subchronic oral administration of crude khat extract (Catha edulis forsk) induces schizophernic-like symptoms in mice
No full textSubchronic oral administration of crude khat extract (Catha edulis forsk) induces schizophernic-like symptoms in mice
No full textInitiation of breastfeeding within one hour of birth among mothers with infants younger than or equal to 6 months of age attending public health institutions in Addis Ababa, Ethiopia
No full textAbstract Background Breast milk is comprised of the essential nutrients that an infant needs in the first six months of life. Timely initiation of breastfeeding guarantees that infants receive the colostrum, ‘the first breastmilk’, which contains antibodies that protect the newborn against diseases. Breastfeeding within the first hour of life prevents newborn death due to sepsis, pneumonia, diarrhea and hypothermia. Although breastfeeding is a common practice in sub-Saharan Africa, evidence show that early initiation of breastfeeding is low. Methods We conducted a cross-sectional study of 583 mothers with infants younger than or equal to 6 months of age attending Maternal and Child Health (MCH) clinics of public health institutions in Addis Ababa, Ethiopia from April to May 2012. A simple random sampling design was used to select the institutions included in this study. Data from mothers of infants were collected using interviewer-administered questionnaire. We analyzed the data to examine factors associated with initiation of breastfeeding within one hour of birth using logistic regression models. Results Of 564 (96.7%, 564/583) mothers who breastfed their infants, 58.3% (329/564) initiated breastfeeding within one hour of birth. In the adjusted analysis, mothers who had three or more infants had about twice higher odds of timely initiation of breastfeeding within one hour of birth (Adjusted Odds Ratio [aOR] 2.10; 95% Confidence Interval [CI]1.04, 4.30) compared with mothers who had one infant. Furthermore, women who started antenatal care at their fourth month of pregnancy or later had a 49.0% higher odds of initiation of breastfeeding within one hour of birth (aOR 1.49; 95% CI 1.01, 2.19) compared to mothers who started antenatal care before their fourth month of pregnancy. Conclusions Initiation of breastfeeding within one hour of birth was low. Initiation of breastfeeding within one hour of birth was highest among multiparous women, mothers aged 30–34 years, and women who began antenatal care at their fourth month of pregnancy or later. Public health officials and health care providers should consider interventions to promote and support early initiation of breastfeeding
Associations between Apgar scores and children’s educational outcomes at eight years of age
No full textFirst published: 24 August 2020BACKGROUND: Low Apgar scores are associated with neonatal morbidity and mortality, but effects of Apgar scores of 0-5, 6, 7, 8 and 9 (compared with 10) on longer-term neurodevelopmental outcomes are less clear. AIM: To examine the associations between Apgar scores of 0-5, 6, 7, 8 and 9 (compared with 10) and children's educational outcomes as measured by the Australian National Assessment Program-Literacy and Numeracy (NAPLAN) tests at age eight. MATERIALS AND METHODS: We merged perinatal data including all children born in South Australia from 1999 to 2008 with school assessment data (NAPLAN). School assessments included five learning areas (domains)-reading, writing, spelling, grammar and numeracy. Each domain was categorised according to performing at or below National Minimum Standards (≤NMS). Effects were estimated using Augmented Inverse Probability Weighting (AIPW) accounting for a range of maternal, perinatal and sociodemographic characteristics. RESULTS: Risk differences comparing five-minute Apgar scores of 0-5 with Apgar scores of 10 for children performing ≤NMS 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 ≤NMS were also evident when Apgar score of 6 was compared with Apgar score of 10. CONCLUSIONS: Children with five-minute Apgar scores of 0-5 and 6, compared with Apgar score of 10, are at higher risk of scoring at/below the NMS on the NAPLAN assessments at eight years.Engida Yisma, Ben W. Mol, John W. Lynch, Murthy N. Mittinty, Lisa G. Smither
Knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia
No full textPrevalence and severity of menopause symptoms among perimenopausal and postmenopausal women aged 30-49 years in Gulele sub-city of Addis Ababa, Ethiopia
No full textKnowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia
No full textAbstract Background Globally, there was an estimated number of 287,000 maternal deaths in 2010. Eighty five percent (245,000) of these deaths occurred in Sub-Saharan Africa and Southern Asia. Among the causes of these deaths were obstructed and prolonged labour which could be prevented by cost effective and affordable health interventions like the use of the partograph. The Use of the partograph is a well-known best practice for quality monitoring of labour and subsequent prevention of obstructed and prolonged labour. However, a number of cases of obstructed labour do happen in health facilities due to poor quality of intrapartum care. Methods A cross-sectional quantitative study assessed knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia using a structured interviewer administered questionnaire. The collected data was analyzed using SPSS version 16.0. Logistic regression analysis was used to identify factors associated with knowledge and use of partograph among obstetric care givers. Results Knowledge about the partograph was fair: 189 (96.6%) of all the respondents correctly mentioned at least one component of the partograph, 104 (53.3%) correctly explained the function of alert line and 161 (82.6%) correctly explained the function of action line. The study showed that 112 (57.3%) of the obstetric care givers at public health institutions reportedly utilized partograph to monitor mothers in labour. The utilization of the partograph was significantly higher among obstetric care givers working in health centres (67.9%) compared to those working in hospitals (34.4%) [Adjusted OR = 3.63(95%CI: 1.81, 7.28)]. Conclusions A significant percentage of obstetric care givers had fair knowledge of the partograph and why it is necessary to use it in the management of labour and over half of obstetric care givers reported use of the partograph to monitor mothers in labour. Pre-service and on-job training of obstetric care givers on the use of the partograph should be given emphasis. Mandatory health facility policy is also recommended to ensure safety of women in labour in public health facilities in Addis Ababa, Ethiopia.</p
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