1087Ethnic inequalities in reproductive health in Latin America

Abstract Background African descendants continue to be affected by discrimination in the Americas. We assessed ethnic inequalities in sexual/reproductive health (SRH) in Latin American countries. Methods Using data from national surveys we analyzed SRH in nine countries. Absolute differences in coverage for Afro women and the country-specific reference group (usually full or mixed European ancestry) were estimated for contraception with modern methods (CPmo), family planning needs satisfied with modern methods (FPSmo), 4+ antenatal care visits (ANC4), and antenatal care start in the first trimester (ANC1st). The slope index of inequality (SII) was used to assess wealth-based inequalities. Results Afrodescendants represented from 2.4% of the sample (Costa Rica) to 56.4% (Brazil) and SRH coverage was lower for Afros compared to the reference. Average difference was of 4 percent points (pp) for CPmo and 6pp for FPSmo, and respectively 7pp and 11pp in the poorest group. The lower average difference (0.64) was found for ANC4, however Colombia had a gap of 7pp. For ANC1st, ethnic differences were >5pp in Brazil, Colombia, Ecuador and Suriname. Suriname had systematically lower coverage among Afros. In Honduras Afros presented similar/higher coverage than the reference. Positive SII revealed coverage concentrated in the richest group for all indicators, however the wealth-based inequalities were much greater among Afros, especially for ANC1st (mean SII = 23pp). Conclusion Lower coverage for Afro women is pervasive and worse for the poorest ones. Key messages Such evidence can help overcome ethnic long-term disadvantage in the Americas.

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Male participation in antenatal care and its influence on their pregnant partners’ reproductive health care utilization: insight from the 2015 Afghanistan Demographic and Health Survey

Journal of Biosocial Science ◽

10.1017/s0021932020000292 ◽

2020 ◽

pp. 1-23

Author(s):

Sharifullah Alemi ◽

Keiko Nakamura ◽

Mosiur Rahman ◽

Kaoruko Seino

Keyword(s):

Health Care ◽

Reproductive Health ◽

Health Care Utilization ◽

Antenatal Care ◽

Pregnancy Rate ◽

First Trimester ◽

Care Utilization ◽

Male Partners ◽

Reproductive Health Care ◽

Male Participation

Abstract Afghanistan has made remarkable progress in reducing maternal mortality over the past few decades, and male participation in their pregnant partner’s reproductive health care is crucial for further improvement. This study aimed to examine whether male attendance at antenatal care (ANC) with their pregnant partners might be beneficially associated with the degree of utilization of reproductive health care by the pregnant partners. Data for 2660 couples (women aged 16–49 years) were taken from the 2015 Afghanistan Demographic and Health Survey (AfDHS). Bivariate and multivariate logistic regression models were employed to explore the association between male attendance at ANC with their pregnant partners and reproductive health care utilization outcomes, including adequate utilization (four or more visits) of ANC services, ANC visits during the first trimester (up to 12 weeks) of pregnancy, rate of blood and urine testing during pregnancy, rate of institutional delivery and utilization of postnatal check-up services. The results indicated that the rate of male attendance at ANC with their pregnant partners was 69.4%. After controlling for covariates, pregnant partners who were accompanied to ANC by their male partners were more likely to adequately utilize ANC services (AOR=1.42; 95% CI: 1.18–1.71), commence ANC visits even during the first trimester (AOR=1.21; 95% CI: 1.03–1.42), give birth at a health facility (AOR=1.23; 95% CI: 1.03–1.47) and present themselves for postnatal check-ups (AOR=1.24; 95% CI: 1.04–1.47) than those who were not accompanied by them. The study demonstrated that participation of male partners in ANC was positively associated with their pregnant partners’ utilization of reproductive health care services in Afghanistan. The findings suggest that, to improve maternal and child health outcomes in the country, it would be worthwhile implementing interventions to encourage male partners to become more engaged in the ANC of their pregnant partners.

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Taking Part, Joining in, and Being Heard?

The Oxford Handbook of Children's Rights Law ◽

10.1093/oxfordhb/9780190097608.013.24 ◽

2020 ◽

pp. 475-494

Author(s):

Perpetua Kirby ◽

Rebecca Webb

Keyword(s):

Primary Schools ◽

Specific Reference ◽

School Life ◽

Children’S Participation ◽

Using Data ◽

Children's Participation ◽

The Voice

This chapter explores how Article 12 and the voice of the child are implemented. The chapter does so by making specific reference to ways in which children express themselves within two different English primary schools. The chapter introduces Article 12 as a commitment to giving due attention to children’s experiences. Using data vignettes, the chapter illustrates the value of paying attention to children by focusing on the micro moments of everyday school life. The chapter argues that children’s participation is necessarily political, suggesting that participation must be read as such and demonstrating how it is often subsumed within powerful dominant schooling discourses of conformity within different governmental climates that are regarded as beyond politics. The chapter identifies limited possibilities for transformation in the study’s research sites, discussed in terms of children achieving agency and enacting their own subjectivities. This is apparent even within the less coercive ethos of a school participating in the Rights Respecting Schools Initiative (UNICEF). The chapter argues that in order to open up possible transformational participatory spaces, adults in schools need to require opportunities to reflect together on the tensions within their own educational contexts and between supporting children’s participation and their conformity to wider schooling discourses. The chapter suggests that the provision of such opportunities will help to keep a focus on listening to children in line with the ambitions of Article 12.

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EXPRESS: Method dependent variation in TSH and FT4 reference intervals in pregnancy: a systematic review

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/00045632211026955 ◽

2021 ◽

pp. 000456322110269

Author(s):

O E Okosieme ◽

Medha Agrawal ◽

Danyal Usman ◽

Carol Evans

Keyword(s):

Systematic Review ◽

Reference Interval ◽

First Trimester ◽

Reference Intervals ◽

Assay Method ◽

Specific Reference ◽

Upper Limits ◽

Wide Range ◽

Assay Methods ◽

In Pregnancy

Background: Gestational TSH and FT4 reference intervals may differ according to assay method but the extent of variation is unclear and has not been systematically evaluated. We conducted a systematic review of published studies on TSH and FT4 reference intervals in pregnancy. Our aim was to quantify method-related differences in gestation reference intervals, across four commonly used assay methods, Abbott, Beckman, Roche, and Siemens. Methods: We searched the literature for relevant studies, published between January 2000 and December 2020, in healthy pregnant women without thyroid antibodies or disease. For each study, we extracted trimester-specific reference intervals (2.5â97.5 percentiles) for TSH and FT4 as well as the manufacturer provided reference interval for the corresponding non-pregnant population. Results: TSH reference intervals showed a wide range of study-to-study differences with upper limits ranging from 2.33 to 8.30 mU/L. FT4 lower limits ranged from 4.40â13.93 pmol/L, with consistently lower reference intervals observed with the Beckman method. Differences between non-pregnant and first trimester reference intervals were highly variable, and for most studies the TSH upper limit in the first trimester could not be predicted or extrapolated from non-pregnant values. Conclusions: Our study confirms significant intra and inter-method disparities in gestational thyroid hormone reference intervals. The relationship between pregnant and non-pregnant values is inconsistent and does not support the existing practice in some laboratories of extrapolating gestation references from non-pregnant values. Laboratories should invest in deriving method-specific gestation reference intervals for their population.

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Congenital Toxoplasmosis: Missed Opportunities for Diagnosis and Prevention

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmaa069 ◽

2020 ◽

Author(s):

Raquel Aitken Soares Mueller ◽

Ana Cristina Cisne Frota ◽

Daniela Durão Menna Barreto ◽

Daniela Pires Ferreira Vivacqua ◽

Gabriela Bueno Loria ◽

...

Keyword(s):

Antenatal Care ◽

Congenital Toxoplasmosis ◽

First Trimester ◽

University Hospital ◽

Serological Testing ◽

Missed Opportunities ◽

Clinic Appointment ◽

History Of ◽

Acute Toxoplasmosis ◽

Made In

Abstract Objectives Identify missed opportunities for the prevention and early diagnosis of congenital toxoplasmosis (CT) in infants followed up in a reference center for pediatric infectious diseases (PID) in Rio de Janeiro between January 2007 and December 2016. Methods Descriptive study including infants with CT, diagnosis established based on Brazil’s Ministry of Health’s criteria. All data regarding the infants and their mother’s prenatal care were collected from the medical records of the Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG)—a tertiary public pediatric university hospital. The study enrolled infants aged between 0 and 12 months followed up in the PID department of IPPMG and with confirmed infection by Toxoplasma gondii in the period between January 2007 and December 2016. All patients with diagnosis of CT registered in the PID database of the IPPMG and admitted in the above-mentioned period were included in the study. Patients whose records were not available, or who went to just one clinic appointment were excluded. Results The obstetric history of all 44 women, whose infants (45) were diagnosed with CT, was analyzed. Their median age was 22 years. None had undergone preconception serological testing for toxoplasmosis. Only 20 (45%) of them started antenatal care during the first trimester of gestation, a total of 24 (55%) had more than six antenatal care visits, and 16% of those did not undergo serological testing for toxoplasmosis. None were adequately informed of preventive measures. The diagnosis of acute toxoplasmosis was made in 50% of these pregnancies but 32% of the women were not treated. Only 10 children of these mothers were adequately screened and treated at birth. Conclusion Despite the existence of national recommendations, several opportunities were missed to prevent CT during the antenatal period and to diagnose and treat this condition in the neonatal period.

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Current status of antenatal care of pregnant women—8 provinces in China, 2018

BMC Public Health ◽

10.1186/s12889-021-11154-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wenling Hu ◽

Huanqing Hu ◽

Wei Zhao ◽

Aiqun Huang ◽

Qi Yang ◽

...

Keyword(s):

Health Services ◽

Antenatal Care ◽

Pregnant Women ◽

Community Health ◽

First Trimester ◽

Community Health Services ◽

Current Status ◽

Categorical Variables ◽

Chi Square ◽

Prenatal Care Visit

Abstract Background Antenatal care (ANC) played a crucial role in ensuring maternal and child safety and reducing the risk of complications, disability, and death in mothers and their infants. The objective of this study was to evaluate the current status of ANC emphasizing the number, timing, and content of examinations on a national scale. Methods The data was collected from maternal and newborn’s health monitoring system at 8 provinces in China. After ethical approval, all pregnant women registered in the system at their first prenatal care visit, we included 49,084 pregnant women who had delivered between January 1, 2018 and December 31, 2018. Descriptive statistics of all study variables were calculated proportions and chi-square for categorical variables. Results Of the 49,084 women included in this study, the mean number of ANC visits was 6.95 ± 3.45. By percentage, 78.79% women received ANC examinations at least five times, 39.93% of the women received ANC examinations at least eight times and 16.66% of the women received ANC examinations at least 11 times. The proportion of first ANC examination in first trimester was 61.87%. The percentage of normative ANC examinations and the percentage of qualified ANC examinations were 30.98 and 8.03% respectively. Only 49.40% of the total women received all six kinds of examination items in first ANC examination: 91.47% received a blood test, 91.62% received a urine test, 81.56% received a liver function examination, 80.52% received a renal function examination, 79.07% received a blood glucose test, and 86.66% received a HIV/HBV/syphilis tests. 50.85% women received the first ANC examination in maternal and child health care (MCH) institutions, 14.07% in a general hospital, 18.83% in a township hospital, 13.15% in a community health services center, and 3.08% in an unspecified place. The proportion of women who received each of the ANC examination items in community health services center was the highest, but that in the MCH institutions was the lowest. Conclusions There is a big difference between the results of this study and the data in official reports, this study found the current status of antenatal care is not optimal in China, findings from this study suggest that the systematization, continuity and quality of ANC examinations need to be improved.

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Evaluation of Thyroid Function in Pregnant Women Using Automated Immunoassays

Clinical Chemistry ◽

10.1093/clinchem/hvab009 ◽

2021 ◽

Author(s):

K Aaron Geno ◽

Matthew S Reed ◽

Mark A Cervinski ◽

Robert D Nerenz

Keyword(s):

Pregnant Women ◽

Equilibrium Dialysis ◽

Reference Interval ◽

First Trimester ◽

Reference Intervals ◽

Free Thyroxine ◽

Specific Reference ◽

Childbearing Age ◽

Thyroid Autoantibody ◽

The Impact

Abstract Introduction Automated free thyroxine (FT4) immunoassays are widely available, but professional guidelines discourage their use in pregnant women due to theoretical under-recoveries attributed to increased thyroid hormone binding capacity and instead advocate the use of total T4 (TT4) or free thyroxine index (FTI). The impact of this recommendation on the classification of thyroid status in apparently euthyroid pregnant patients was evaluated. Methods After excluding specimens with thyroid autoantibody concentrations above reference limits, thyroid-stimulating hormone (TSH), FT4, TT4, and T-uptake were measured on the Roche Cobas® platform in remnant clinical specimens from at least 147 nonpregnant women of childbearing age and pregnant women at each trimester. Split-sample comparisons of FT4 as measured by the Cobas and equilibrium dialysis were performed. Results FT4 decreased with advancing gestational age by both immunoassay and equilibrium dialysis. TSH declined during the first trimester, remained constant in the second, and increased throughout the third, peaking just before delivery. Interpretation of TT4 concentrations using 1.5-times the nonpregnant reference interval classified 13.6% of first trimester specimens below the lower reference limit despite TSH concentrations within trimester-specific reference intervals. Five FTI results from 480 pregnant individuals (about 1.0%) fell outside the manufacturer’s reference interval. Conclusions Indirect FT4 immunoassay results interpreted in the context of trimester-specific reference intervals provide a practical and viable alternative to TT4 or FTI. Declining FT4 and increasing TSH concentrations near term suggest that declining FT4 is not an analytical artifact but represents a true physiological change in preparation for labor and delivery.

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Years of potential life lost in pre-diabetes and diabetes mellitus: data from a 40-year follow-up of the Israel study on Glucose intolerance, Obesity and Hypertension

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001981 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001981

Author(s):

Micha Rapoport ◽

Angela Chetrit ◽

Dror Cantrell ◽

Ilya Novikov ◽

Jesse Roth ◽

...

Keyword(s):

Glucose Intolerance ◽

Lifestyle Modification ◽

Smoking Status ◽

Age Groups ◽

Tolerance Test ◽

High Risk Group ◽

Oral Glucose ◽

Average Difference ◽

Using Data

IntroductionWe examined years of potential life lost (YPLL) associated with pre-diabetes as compared with either normoglycemia or diabetes, using data of the Israel cohort of Glucose intolerance, Obesity and Hypertension 40-year follow-up.Research design and methodsMen and women (N=2844, mean age 52.0±8.2 years) who underwent oral glucose tolerance test and anthropometric measurements, during 1976–1982, were followed for mortality until May 2019. Multiple imputation procedures for missing mortality dates and multivariable regression mixed models were applied.ResultsAt baseline, 35.8%, 48.8% and 15.4% individuals were found with normoglycemia, pre-diabetes, and diabetes, respectively. The average difference in YPLL associated with pre-diabetes as compared with normoglycemia was 4.3 years (95% CI 3.3 to 5.2; p<0.001). YPLL were 1 year higher in women with pre-diabetes than in men with pre-diabetes. These differences persisted mainly in individuals younger than 60 years, and those with body mass index (BMI) <25 kg/m2, at baseline. Adjusting for age, sex, country of origin, smoking status, BMI, and blood pressure, the average difference in YPLL associated with pre-diabetes as compared with normoglycemia was 2.0 years (95% CI 1.2 to 2.8; p<0.001). Significant reductions of 5.9 years (95% CI 4.8 to 7.0) on average were observed for diabetes as compared with pre-diabetes and 7.9 years (95% CI 6.7 to 9.1) as compared with individuals with normoglycemia.ConclusionsThis study reveals that life expectancy of middle-aged individuals with pre-diabetes is shorter than of normoglycemic ones. These findings are especially relevant in view of the rising worldwide prevalence of pre-diabetes within younger age groups and underscore the crucial importance of interventions by either lifestyle modification or drug therapy capable of delaying progression from pre-diabetes to diabetes to reduce the YPLL in this high-risk group.

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The impact of antenatal care on under‐five mortality in Ethiopia: a difference‐in‐differences analysis

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03531-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Samuel Oduse ◽

Temesgen Zewotir ◽

Delia North

Keyword(s):

Antenatal Care ◽

Child Survival ◽

First Trimester ◽

Sub Saharan Africa ◽

P Value ◽

Difference In Differences ◽

Under Five ◽

Care Services ◽

Sub Saharan ◽

The Impact

Abstract Background Sub-Saharan Africa, as opposed to other regions, has the highest under-five mortality rates yet makes the least improvement in reducing under-five mortality. Despite the decline, Ethiopia is among the top ten countries contributing the most to global under-five mortalities. This article examines the impact of the number of antenatal care and the timing of first antenatal care on child health outcomes. We specifically investigated if the utilization of antenatal care services positively affects the reduction of under-five mortality. Methods We employ a difference-in-differences design with propensity score matching to identify direct causal effects of antenatal care on under-five mortality based on the Ethiopian Demographic Health Survey data of 2011 and 2016. Our sample includes 22 295 women between the ages of 14–49 who had antenatal care visits at different times before delivery. Results The study revealed 1 481 cases of reported under-five mortality. 99.0% of that under-five mortality cases are women who had less than eight antenatal care visits, while only 1% of that is by women who had eight or more antenatal care visits. Antenatal care visit decreases the likelihood of under-five mortality in Ethiopia by 45.2% (CI = 19.2–71.3%, P-value < 0.001) while the timing of first antenatal care within the first trimester decreases the likelihood of under-five mortality by 10% (CI = 5.7–15.6%, P-value < 0.001). Conclusions To achieve a significant reduction in the under-five mortality rate, Intervention programs that encourages more antenatal care visits should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets.

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Men’s perceptions of sexual and reproductive health education within the context of pregnancy and HIV in Zambia: a descriptive qualitative analysis

BMC Public Health ◽

10.1186/s12889-021-11430-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tulani Francis L. Matenga ◽

Joseph Mumba Zulu ◽

Sharon Nkwemu ◽

Perfect Shankalala ◽

Karen Hampanda

Keyword(s):

Reproductive Health ◽

Antenatal Care ◽

Health Care Providers ◽

Sexual And Reproductive Health ◽

Decision Makers ◽

Care Providers ◽

Convenience Sample ◽

Essential Information ◽

Women Living With Hiv ◽

The Family

Abstract Background Although health care providers are beginning to focus on men’s roles as fathers and husbands, there is limited understanding of how men view their ability to promote sexual and reproductive health in families affected by HIV and their experiences with receiving education through antenatal care. This paper aims to explore men’s perceptions of the education they need regarding sexual and reproductive health within the family in the context of HIV. Methods We interviewed a convenience sample of 18 male partners of pregnant women living with HIV in Lusaka, Zambia. Atlas.ti was used to facilitate data management and content analysis. Results Men reported being the primary decision-makers regarding sexual and reproductive issues in the family; however, they admitted far-reaching unmet needs in terms of information on sexual and reproductive health in the context of HIV. Most men felt that antenatal care was not a conducive setting to fully educate men on sexual and reproductive health because it is a woman’s space where their health concerns were generally neglected. There was a strong desire for more education that was specific to men’s sexual and reproductive health, especially because all the couples were affected by HIV. Men especially requested education on sexual preparedness, safe sex, the use of condoms in sero-concordant and sero-discordant relationships and general health information. Although men stated they were the main decision-makers regarding sexual and reproductive issues such as pregnancy, most men were not confident in their ability to promote sexual and reproductive health in the family because of limited knowledge in this area. Conclusion There is need to change the environment and messaging of antenatal care, as well as offer relevant education opportunities outside health facility settings to empower men with essential information for meaningful involvement in sexual and reproductive health in the context of HIV.

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CONTROVERSIES IN ENDOCRINOLOGY: On the need for universal thyroid screening in pregnant women

Acta Endocrinologica ◽

10.1530/eje-13-0561 ◽

2014 ◽

Vol 170 (1) ◽

pp. R17-R30 ◽

Cited By ~ 27

Author(s):

Lluís Vila ◽

Inés Velasco ◽

Stella González ◽

Francisco Morales ◽

Emilia Sánchez ◽

...

Keyword(s):

Thyroid Function ◽

First Trimester ◽

Specific Reference ◽

Geographic Variations ◽

Scientific Societies ◽

Need For Treatment ◽

Positive Effects ◽

Thyroid Screening ◽

Iodine Supplementation ◽

Widespread Agreement

There is a well-known controversy among scientific societies regarding the recommendation to screen for thyroid dysfunction (TD) during pregnancy. Although several studies have shown an association between maternal subclinical hypothyroidism and/or hypothyroxinemia with obstetric problems and/or neurocognitive impairment in the offspring, there is only limited evidence on the possible positive effects of thyroxine (T4) treatment in such cases. Despite the scarcity of this evidence, there is a widespread agreement among clinicians on the need for treatment of clinical hypothyroidism during pregnancy and the risks that could arise due to therapeutic abstention. As maternal TD is a quite prevalent condition, easily diagnosed and for which an effective and safe treatment is available, some scientific societies have proposed to assess thyroid function during the first trimester of pregnancy and ideally before week 10 of gestational age. Given the physiologic changes of thyroid function during pregnancy, hormone assessment should be performed using trimester-specific reference values ideally based on locally generated data as geographic variations have been detected. Screening of TD should be based on an initial determination of TSH performed early during the first trimester and only if abnormal should it be followed by either a free or total T4measurement. Furthermore, adequate iodine supplementation during pregnancy is critical and if feasible it should be initiated before the woman attempts to conceive.

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