Caesarean birth by maternal request: a poorly understood phenomenon in low- and middle-income countries

Abstract Background While trends in caesarean birth by maternal request in low- and middle-income countries are unclear, age, education, multiple gestation and hypertensive disease appear associated with the indication when compared with caesarean birth performed for medical indications. Methods We performed a secondary analysis of a prospectively collected population-based study of home and facility births using descriptive statistics, bivariate comparisons and multilevel mixed-effects logistic regression. Results Of 28 751 patients who underwent caesarean birth and had a documented primary indication for the surgery, 655 (2%) were attributed to caesarean birth by maternal request. The remaining 98% were attributed to maternal and foetal indications and prior caesarean birth. In a multilevel mixed effects logistic regression adjusted for site and cluster of birth, when compared with caesareans performed for medical indications, caesarean birth performed for maternal request had a higher odds of being performed among women ≥35 y of age, with a university or higher level of education, with multiple gestations and with pregnancies complicated by hypertension (P < 0.01). Caesarean birth by maternal request was associated with a two-times increased odds of breastfeeding within 1 h of delivery, but no adverse outcomes (when compared with women who underwent caesarean birth for medical indications; P < 0.01). Conclusion Caesarean performed by maternal request is more common in older and more educated women and those with multifoetal gestation or hypertensive disease. It is also associated with higher rates of breastfeeding within 1 h of delivery.

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Impact of Essential Medicine Stock Outs on Cancer Therapy Delivery in a Resource-Limited Setting

Journal of Global Oncology ◽

10.1200/jgo.18.00230 ◽

2019 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

Yehoda M. Martei ◽

Surbhi Grover ◽

Warren B. Bilker ◽

Barati Monare ◽

Dipho I. Setlhako ◽

...

Keyword(s):

Logistic Regression ◽

Cancer Therapy ◽

Mixed Effects ◽

Middle Income ◽

Middle Income Countries ◽

Increased Risk ◽

Cancer Medicine ◽

The Impact ◽

Therapy Delivery ◽

Low And Middle Income

PURPOSE Essential cancer medicine stock outs are occurring at an increasing frequency worldwide and represent a potential barrier to delivery of standard therapy in patients with cancer in low- and middle-income countries. The objective of this study was to measure the impact of cancer medicine stock outs on delivery of optimal therapy in Botswana. METHODS We conducted a retrospective analysis of patients with common solid tumor malignancies who received systemic cancer therapy in 2016 at Princess Marina Hospital, Gaborone, Botswana. Primary exposure was the duration of cancer medicine stock out during a treatment cycle interval, when the cancer therapy was intended to be administered. Mixed-effects univariable and multivariable logistic regression analyses were used to calculate the association of the primary exposure, with the primary outcome, suboptimal therapy delivery, defined as any dose reduction, dose delay, missed cycle, or switch in intended therapy. RESULTS A total of 378 patients met diagnostic criteria and received systemic chemotherapy in 2016. Of these, 76% received standard regimens consisting of 1,452 cycle intervals and were included in this analysis. Paclitaxel stock out affected the highest proportion of patients. In multivariable mixed-effects logistic regression, each week of any medicine stock out (odds ratio, 1.9; 95% CI, 1.7 to 2.13; P < .001) was independently associated with an increased risk of a suboptimal therapy delivery event. CONCLUSION Each week of cancer therapy stock out poses a substantial barrier to receipt of high-quality cancer therapy in low- and middle-income countries. A concerted effort between policymakers and cancer specialists is needed to design implementation strategies to build sustainable systems promoting a reliable supply of cancer medicines.

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Exposure to air pollution and tobacco smoking and their combined effects on depression in six low- and middle-income countries

The British Journal of Psychiatry ◽

10.1192/bjp.bp.117.202325 ◽

2017 ◽

Vol 211 (3) ◽

pp. 157-162 ◽

Cited By ~ 26

Author(s):

Hualiang Lin ◽

Yanfei Guo ◽

Paul Kowal ◽

Collins O. Airhihenbuwa ◽

Qian Di ◽

...

Keyword(s):

Air Pollution ◽

Logistic Regression ◽

Tobacco Smoking ◽

Smoking Status ◽

Fine Particulate Matter ◽

Additive Model ◽

Interactive Effects ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

BackgroundLittle is known about the joint mental health effects of air pollution and tobacco smoking in low- and middle-income countries.AimsTo investigate the effects of exposure to ambient fine particulate matter pollution (PM2.5) and smoking and their combined (interactive) effects on depression.MethodMultilevel logistic regression analysis of baseline data of a prospective cohort study (n=41785). The 3-year average concentrations of PM2.5 were estimated using US National Aeronautics and Space Administration satellite data, and depression was diagnosed using a standardised questionnaire. Three-level logistic regression models were applied to examine the associations with depression.ResultsThe odds ratio (OR) for depression was 1.09 (95% CI 1.01–1.17) per 10 μg/m3 increase in ambient PM2.5, and the association remained after adjusting for potential confounding factors (adjusted OR = 1.10, 95% CI 1.02–1.19). Tobacco smoking (smoking status, frequency, duration and amount) was also significantly associated with depression. There appeared to be a synergistic interaction between ambient PM2.5 and smoking on depression in the additive model, but the interaction was not statistically significant in the multiplicative model.ConclusionsOur study suggests that exposure to ambient PM2.5 may increase the risk of depression, and smoking may enhance this effect.

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Determining Prevalence of Anemia and Its Associated Factors in Cameroon: A Multilevel Analysis

BioMed Research International ◽

10.1155/2021/9912549 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Betregiorgis Zegeye ◽

Bight Opoku Ahinkorah ◽

Edward Kwabena Ameyaw ◽

Abdul-Aziz Seidu ◽

Mpho Keetile ◽

...

Keyword(s):

Logistic Regression ◽

Perinatal Mortality ◽

Community Level ◽

Health Concern ◽

Multilevel Logistic Regression ◽

Middle Income ◽

Factors Associated ◽

Middle Income Countries ◽

Prevalence Of Anemia ◽

Low And Middle Income

Background. Anemia constitutes a major public health concern, which is associated with maternal and perinatal mortality. In low- and middle-income countries, the burden of anemia is profoundly high. Cameroon, as one of the low- and middle-income countries, has a disproportionate anemia burden. Factors associated with anemia prevalence are largely unknown in Cameroon. Hence, we determined the prevalence of anemia and its individual/household and community-level factors among adult women in Cameroon. Methods. We derived data from the 2018 Cameroon Demographic and Health Survey for analysis in this study. Using the Stata version 14 software, univariate multilevel logistic regression analysis was used to select variables that had significant association with anemia at p < 0.05 . Statistically significant variables were included in a multivariable multilevel logistic regression modelling to examine their associations with anemia. Results were reported using adjusted odds ratios (AOR) with their respective 95% confidence interval (CI). Results. A total of 6,809 women aged 15-49 years were involved in this study with a mean age 30 ± 11.87 years. Approximately two-fifths of women were anemic. Of them, 0.8% were severely anemic, while 17.4% and 21.5% were moderately and mildly anemic, respectively. Current employment status (yes AOR = 0.77 , 95% CI; 0.61-0.96) and parity (1-2 children AOR = 0.61 , 95% CI; 0.44-0.86) were the main individual level factors associated with anemia, whereas region (Douala region AOR = 2.65 , 95% CI; 1.61-4.36, North-West region AOR = 0.53 , 95% CI; 0.28-0.99) was the community-level factor associated with anaemia. Conclusion. Empowerment of women through employment opportunities as well as focusing special attention in region where high prevalence of anemia could be crucial to decrease the burden of anemia and related maternal and perinatal mortality in the country.

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