scholarly journals Time trends and sociodemographic determinants of preterm births in pregnancy cohorts in Matlab, Bangladesh, 1990–2014

2019 ◽  
Vol 4 (4) ◽  
pp. e001462 ◽  
Author(s):  
Anisur Rahman ◽  
Monjur Rahman ◽  
Jesmin Pervin ◽  
Abdur Razzaque ◽  
Shaki Aktar ◽  
...  
Keyword(s):  
Seasonal Variation ◽  
Preterm Birth ◽  
Low Income ◽  
Time Trends ◽  
Maternal Education ◽  
Preterm Births ◽  
Population Based ◽  
Low Income Countries ◽  
Sociodemographic Determinants ◽  
Gestational Age At Birth

IntroductionPreterm birth is the major cause of under-five mortality. Population-based data on determinants and proportions of children born preterm are limited, especially from low-income countries. This study aimed at assessing time trends and social, reproductive and environmental determinants of preterm births based on a population-based pregnancy cohort over 25 years in rural Bangladesh.MethodsIn this cohort study in Matlab, a rural area in Bangladesh, we used data from the Health and Demographic Surveillance System from 1990 to 2014. Gestational age at birth was based on the reported last menstrual period and verified by ultrasound assessments. Preterm birth proportions were assessed within strata of social and reproductive characteristics, and time series analysis was performed with decomposition for trend and seasonality. We also determined the prevented fractions of preterm birth reduction associated with social and demographic changes during the follow-up period.ResultsAnalyses were based on 63 063 live births. Preterm birth decreased from 29% (95% CI 28.6 to 30.1) in 1990–1994 to 11% (95% CI 10.5 to 11.6) in 2010–2014. Low education, older age and multi-parity were associated with higher proportions of preterm births across the study period. Preterm births had a marked seasonal variation. A rapid increase in women’s educational level and decrease in parity were associated with the decline in preterm births, and 27% of the reduction observed from 1990 to 2014 could be attributed to these educational and reproductive changes.ConclusionThe reduction in preterm birth was to a large extent associated with the sociodemographic transition, especially changes in maternal education and parity. The persistent seasonal variation in the proportion of preterm birth may reflect the environmental stressors for pregnant women across the study period. Continued investments in girls’ education and family planning programmes may contribute to further reduction of preterm births in Bangladesh.

scholarly journals Determinants of preterm birth: Pelotas, Rio Grande do Sul State, Brazil, 2004 birth cohort

2010 ◽  
Vol 26 (1) ◽  
pp. 185-194 ◽  
Author(s):  
Mariângela F. Silveira ◽  
Cesar G. Victora ◽  
Aluísio J. D. Barros ◽  
Iná S. Santos ◽  
Alicia Matijasevich ◽  
...  
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
Birth Cohort ◽  
Low Income ◽  
Family Income ◽  
Preterm Births ◽  
Rio Grande ◽  
Low Income Countries ◽  
Rio Grande Do Sul ◽  
Vaginal Deliveries

Prematurity is a leading cause of neonatal mortality and a global health problem that affects high, middle and low-income countries. Several factors may increase the risk of preterm birth. In this article, we test the hypothesis that different risk factors determine preterm birth in different income groups by investigating whether risk factors for preterm deliveries in the 2004 Pelotas (Rio Grande do Sul State, Brazil) birth cohort vary among those groups. A total of 4,142 women were included in the analysis. Preterm births were equally common among women who had spontaneous vaginal deliveries as for those with induced or operative births. In the multivariate analysis the factors that remained significantly associated with preterm birth were black skin color, low education, poverty, young maternal age, primiparity, previous preterm birth, inadequacy of prenatal care and reported hypertension. In the analyses repeated after stratification by family income terciles, there was no evidence of effect modification by income and no clear difference between the socioeconomic groups. No association between cesarean section and preterm delivery was found. Further studies are required to understand the causes of the epidemic of preterm births in Brazil.

scholarly journals Low birthweight and preterm birth: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015

2018 ◽  
Vol 48 (Supplement_1) ◽  
pp. i46-i53 ◽  
Author(s):  
Mariangela F Silveira ◽  
Cesar G Victora ◽  
Bernardo L Horta ◽  
Bruna G C da Silva ◽  
Alicia Matijasevich ◽  
...  
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
Low Income ◽  
Low Birthweight ◽  
Family Income ◽  
Preterm Births ◽  
Population Based ◽  
Skin Colour ◽  
Birth Cohorts ◽  
Maternal Risk

Abstract Background Despite positive changes in most maternal risk factors in Brazil, previous studies did not show reductions in preterm birth and low birthweight. We analysed trends and inequalities in these outcomes over a 33-year period in a Brazilian city. Methods Four population-based birth cohort studies were carried out in the city of Pelotas in 1982, 1993, 2004 and 2015, with samples ranging from 4231 to 5914 liveborn children. Low birthweight (LBW) was defined as <2500 g, and preterm birth as less than 37 weeks of gestation. Information was collected on family income, maternal skin colour and other risk factors for low birthweight. Multivariable linear regression was used to estimate the contribution of risk factors to time trends in birthweight. Results Preterm births increased from 5.8% (1982) to 13.8% (2015), and LBW prevalence increased from 9.0% to 10.1%, being higher for boys and for children born to mothers with low income and brown or black skin colour. Mean birthweight remained stable, around 3200 g, but increased from 3058 to 3146 g in the poorest quintile and decreased from 3307 to 3227 g in the richest quintile. After adjustment for risk factors for LBW, mean birthweight was estimated to have declined by 160 g over 1982–2015 (reductions of 103 g in the poorest and 213 g in the richest quintiles). Conclusions Data from four birth cohorts show that preterm births increased markedly. Mean birthweights remained stable over a 33-year period. Increased prevalence of preterm and early term births, associated with high levels of obstetric interventions, has offset the expected improvements due to reduction in risk factors for low birthweight.

scholarly journals Quantifying the under-estimation of cervical Cancer in remote regions of Tanzania

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mariah P. Gesink ◽  
Robert M. Chamberlain ◽  
Julius Mwaiselage ◽  
Crispin Kahesa ◽  
Kahima Jackson ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Low Income ◽  
Population Based ◽  
Capital City ◽  
Low Income Countries ◽  
Treatment Center ◽  
Large Country ◽  
Number Of Patients ◽  
Sub Saharan ◽  
Radiotherapy Treatment

Abstract Background Cervical cancer is the most common cancer among women in Sub-Saharan countries, including Tanzania. While early detection and diagnosis are available in some parts of this large country, radiotherapy has been only available at the Ocean Road Cancer Institute (ORCI), in the capital city of Dar es Salaam and is just starting in a few regions. Methods The objective of this study was to compare the observed incidence of cervical cancer for the two remote regions of Mwanza in western Tanzania and Mbeya in southern Tanzania, based on their patients treated at the ORCI from 2011 to 2014. Results: The number patients referred and treated at ORCI were (120 from Mwanza, and 171 from Mbeya, representing 24.6 and 32.8% of the patients histopathologically confirmed in the two sites, respectively. The results showed significant underestimation of cervical cancer in the two regions. The vast majority of patients who were histopathologically-confirmed in their local regions (73.92% from Mwanza and 65.1% from Mbeya), but did not receive the needed radiotherapy treatment at the ORCI. The estimated incidence for the two regions based on the number of patients treated at the ORCI were underestimated by 53.9% for Mwanza and 68.9% for Mbeya. Conclusions Local establishment of radiotherapy treatment facilities in remote regions in Tanzania and similar other low-income countries is essential for providing effective treatment and improving survival of diagnosed cervical cancer patients. Linkage between the records of local remote hospitals and the main cancer treatment center in the capital city can also help support the emerging the population-based cancer registry at ORCI.

scholarly journals Improving access to healthcare for women in Tanzania by addressing socioeconomic determinants and health insurance: a population-based cross-sectional survey

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e023013 ◽  
Author(s):  
Deogratius Bintabara ◽  
Keiko Nakamura ◽  
Kaoruko Seino
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Formal Education ◽  
Wealth Index ◽  
Population Based ◽  
Reproductive Age ◽  
Low Income Countries ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Low Income Country

ObjectiveThis study was performed to explore the factors associated with accumulation of multiple problems in accessing healthcare among women in Tanzania as an example of a low-income country.DesignPopulation-based cross-sectional survey.SettingNationwide representative data for women of reproductive age obtained from the 2015–2016 Tanzania Demographic and Health Survey were analysed.Primary outcome measuresA composite variable, ‘problems in accessing healthcare’, with five (1-5) categories was created based on the number of problems reported: obtaining permission to go to the doctor, obtaining money to pay for advice or treatment, distance to a health facility and not wanting to go alone. Respondents who reported fewer or more problems placed in lower and higher categories, respectively.ResultsA total of 13 266 women aged 15–49 years, with a median age (IQR) of 27 (20–36) years were interviewed and included in the analysis. About two-thirds (65.53%) of the respondents reported at least one of the four major problems in accessing healthcare. Furthermore, after controlling for other variables included in the final model, women without any type of health insurance, those belonging to the poorest class according to the wealth index, those who had not attended any type of formal education, those who were not employed for cash, each year of increasing age and those who were divorced, separated or widowed were associated with greater problems in accessing healthcare.ConclusionThis study indicated the additive effects of barriers to healthcare in low-income countries such as Tanzania. Based on these results, improving uptake of health insurance and addressing social determinants of health are the first steps towards reducing women’s problems associated with accessing healthcare.

scholarly journals The burden of serious health-related suffering among cancer decedents: Global projections study to 2060

2020 ◽  
pp. 026921632095756
Author(s):  
Katherine E Sleeman ◽  
Barbara Gomes ◽  
Maja de Brito ◽  
Omar Shamieh ◽  
Richard Harding
Keyword(s):  
Palliative Care ◽  
Low Income ◽  
Population Based ◽  
World Health ◽  
Low Income Countries ◽  
Cancer Type ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Related ◽  
Health Organization

Background: Palliative care improves outcomes for people with cancer, but in many countries access remains poor. Understanding future needs is essential for effective health system planning in response to global policy. Aim: To project the burden of serious health-related suffering associated with death from cancer to 2060 by age, gender, cancer type and World Bank income region. Design: Population-based projections study. Global projections of palliative care need were derived by combining World Health Organization cancer mortality projections (2016–2060) with estimates of serious health-related suffering among cancer decedents. Results: By 2060, serious health-related suffering will be experienced by 16.3 million people dying with cancer each year (compared to 7.8 million in 2016). Serious health-related suffering among cancer decedents will increase more quickly in low income countries (407% increase 2016–2060) compared to lower-middle, upper-middle and high income countries (168%, 96% and 39% increase 2016-2060, respectively). By 2060, 67% of people who die with cancer and experience serious health-related suffering will be over 70 years old, compared to 47% in 2016. In high and upper-middle income countries, lung cancer will be the single greatest contributor to the burden of serious health-related suffering among cancer decedents. In low and lower-middle income countries, breast cancer will be the single greatest contributor. Conclusions: Many people with cancer will die with unnecessary suffering unless there is expansion of palliative care integration into cancer programmes. Failure to do this will be damaging for the individuals affected and the health systems within which they are treated.

scholarly journals Nomogram to Early Screen Multiparous Women for Preterm Birth in a Cohort Study

2020 ◽  
Author(s):  
Mayssa Traboulsi ◽  
Zainab El Alaoui Talibi ◽  
Abdellatif Boussaid
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Preterm Birth ◽  
Regression Model ◽  
Low Income ◽  
Logistic Regression Model ◽  
Penalized Regression ◽  
Low Income Countries ◽  
Nulliparous Women ◽  
Multiparous Women

Abstract Background: Preterm Birth (PTB) can negatively affect the health of mothers as well as infants. Prediction of this gynecological complication remains difficult especially in Middle and Low-Income countries because of limited access to specific tests and data collection scarcity. Multiparous women in our study presented a higher PTB prevalence compared to nulliparous women. Methods: In a cohort study from Northern Lebanon of 1996 women, 922 were multiparous presenting a PTB prevalence of 8%. We analyzed the personal, demographic, and health indicators available for this group of women. We compared 4 modified logistic regression models (up-sampling, lasso penalized regression) to develop a nomogram that can screen for preterm in multi-parous women. The models were trained and validated on different data sets.Results: The best PTB prediction of the Logistic regression model reached around 88%. This was obtained using a Logistic Regression Model trained on up-sampled datasets and LASSO (Least Absolute Shrinkage and Selection Operator) penalized. The regression coefficients of the 6 selected variables (Pre-hemorrhage, Social status, Residence, Age, BMI, and Weight gain) were used to create a nomogram to screen multiparous women for PTB risk. Conclusions: The nomogram based on readily available indicators for multiparous women reasonably predicted most of the at PTB risk women. This tool will allow physicians to screen women that represent a high risk for spontaneous preterm birth and run furthermore adequate additional tests leading to better medical surveillance that can reduce PTB incidence.

scholarly journals Curtailing Covid-19 on a Dollar-a-Day in Malawi: Implications for the Ongoing Pandemic

2021 ◽  
Author(s):  
Iliana V. Kohler ◽  
Fabrice Kämpfen ◽  
Alberto Ciancio ◽  
James Mwera ◽  
Victor Mwapasa ◽  
...  
Keyword(s):  
Public Health ◽  
Low Income ◽  
Population Based ◽  
Community Leadership ◽  
Pivotal Role ◽  
Low Income Countries ◽  
Effective Response ◽  
Trust In Institutions ◽  
Primary Prevention Strategy ◽  
Sub Saharan

AbstractUtilizing population-based data from the Covid-19 phone survey (N = 2, 262) of the Malawi Longitudinal Study of Families and Health (MLSFH) collected during June 2nd–August 17th, 2020, we investigate behavioral, economic and social responses to Covid-19 and focus on the crucial role that community leadership and trust in institutions play towards shaping these responses. We argue that the effective response of Malawi to limit the spread of the virus was facilitated by the engagement of local leaders to mobilize communities to adapt and adhere to Covid-19 prevention strategies. Village heads (VHs) played pivotal role in shaping individual’s knowledge about the pandemic and the adaption of preventive health behaviors and were crucial for mitigating the negative economic and health consequences of the pandemic. We further show that trust in institutions is of particular importance in shaping individuals’ behavior during the pandemic, and these findings highlight the pivotal role of community leadership in fostering better compliance and adoption of public health measures essential to contain the virus. Overall, our findings point to distinctive patterns of pandemic response in a low-income sub-Saharan African rural population that emphasized local leadership as mediators of public health messages and policies. These lessons from the first pandemic wave remain relevant as in many low-income countries behavioral responses to Covid-19 will remain the primary prevention strategy for a foreseeable future.

scholarly journals Associations Between Socioeconomic Status and Adverse Pregnancy Outcomes: A Greater Magnitude of Perinatal Inequities in Montreal Than in Brussels

2021 ◽  
Author(s):  
Mouctar Sow ◽  
Marie-France Raynault ◽  
Myriam Spiegelaere
Keyword(s):  
Socioeconomic Status ◽  
Preterm Birth ◽  
Low Income ◽  
Pregnancy Outcomes ◽  
Maternal Education ◽  
Social Inequalities ◽  
Administrative Databases ◽  
Income Quintile ◽  
Adverse Pregnancy ◽  
The Impact

Abstract Objective This paper compares the associations between socioeconomic status (SES) and 1) low birth weight (LBW) and 2) preterm birth, in Brussels and Montreal, and discusses hypotheses that may explain the differences between these two regions. Methods This population-based study uses administrative databases from Belgian and Quebec birth records. The analysis is based on 97,844 and 214,620 singleton live births in Brussels and Montreal, respectively. Logistic regression models were developed for each region in order to estimate the relationship between SES (maternal education and income quintile) and pregnancy outcomes. The analyses were performed for all births according to the mother’s origin. Results SES is associated with LBW and preterm birth in both regions. This association varies according to the mother’s birth place; the impact of SES being greater for mothers born in Belgium or Canada than for those born abroad. The main difference between the two regions concerns the magnitude of perinatal inequalities, which is greater in Montreal than in Brussels, whether among the general population, native-born mothers, or immigrant mothers. Conclusion Significant differences in social inequalities in perinatal health are observed between Brussels and Montreal. The different characteristics of low-income and immigrant households between the two contexts help explain these results. In fact, the poor are relatively poorer in Quebec than in Belgium and live in a more unequal context.

scholarly journals Nomogram to Early Screen Multiparous Women for Preterm Birth in a Cohort Study

2021 ◽  
Vol 15 ◽  
pp. 135-141
Author(s):  
Mayssa A. Traboulsi ◽  
Zainab. El Alaoui Talibi ◽  
Abdellatif Boussaid
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Low Income ◽  
Health Indicators ◽  
Penalized Regression ◽  
Low Income Countries ◽  
Medical Surveillance ◽  
Spontaneous Preterm Birth ◽  
Multiparous Women ◽  
Low Prevalence

Preterm Birth (PTB) can negatively affect the health of mothers as well as infants. Prediction of this gynecological complication remains difficult especially in Middle and Low-Income countries because of limited access to specific tests and data collection scarcity. Machine learning methods have been used to predict PTB but the low prevalence of this pregnancy complication led to rather low prediction values. The objective of this study was to produce a nomogram based on improved prediction for low prevalence PTB using up sampling and lasso penalized regression. We used data from a cohort study in Northern Lebanon of 922 multiparous presenting a PTB prevalence of 8%. We analyzed the personal, demographic, and health indicators available for this group of women. The improved Positive Predictive Value for PTB reached around 88%. The regression coefficients of the 6 selected variables (Pre-hemorrhage, Social status, Residence, Age, BMI, and Weight gain) were used to create a nomogram to screen multiparous women for PTB risk. The nomogram based on readily available indicators for multiparous women reasonably predicted most of the at PTB risk women. The physicians can use this tool to screen for women at high risk for spontaneous preterm birth to improve medical surveillance that can reduce PTB incidence.

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