Continuum of maternity care in Zambia: a national representative survey

Abstract Background Globally, over half of maternal deaths are related to pregnancy-related complications. Provision of a continuum of care during pregnancy, childbirth and the postnatal period results in reduced maternal and neonatal morbidity and mortality. Hence this study determined the prevalence of the continuum of care and its determinants among women in Zambia. Methods We used weighted data from the Zambian Demographic and Health Survey (ZDHS) of 2018 for 7325 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants. Complete continuum of care was considered when a woman had; at least four antenatal care (ANC) contacts, utilized a health facility for childbirth and had at least one postnatal check-up within six weeks. We conducted multivariable logistic regression to explore continuum of care in Zambia. All our analyses were done using SPSS version 25. Results Of the 7,325 women, 38.0% (2787/7325) (95% confidence interval (CI): 36.9-39.1) had complete continuum of maternal healthcare. Women who had attained tertiary level of education (adjusted odds ratio (AOR): 1.93, 95% CI: 1.09-3.42) and whose partners had also attained tertiary level of education (AOR: 2.58, 95% CI: 1.54-4.32) were more likely to utilize the whole continuum of care compared to those who had no education. Women who initiated ANC after the first trimester (AOR: 0.46, 95% CI: 0.39-0.53) were less likely to utilize the whole continuum of care compared to those who initiated in the first semester. Women with exposure to radio (AOR: 1.58, 95% CI: 1.27-1.96) were more likely to utilize the whole continuum of care compared to those who were not exposed to radio. Women residing in the Western province were less likely to utilize the entire continuum of care compared to those in the other nine provinces. Conclusion Level of education of the women and of their partners, early timing of ANC initiation, residing in other provinces other than the Western province, and exposure to information through radio were positively associated with utilization of the entire continuum of care. Improving literacy levels and promoting maternity services through radio may improve the level of utilization of maternity services.

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Continuum of Maternity Care in Zambia: a National Representative Survey

10.21203/rs.3.rs-257870/v1 ◽

2021 ◽

Author(s):

Quraish Sserwanja ◽

Milton W. Musaba ◽

Linet M. Mutisya ◽

Emmanuel Olal ◽

David Mukunya

Keyword(s):

Antenatal Care ◽

Neonatal Morbidity ◽

First Trimester ◽

Continuum Of Care ◽

Postnatal Period ◽

Tertiary Level ◽

Level Of Education ◽

Maternity Services ◽

First Semester ◽

Western Province

Abstract BackgroundGlobally, over half of maternal deaths are related to pregnancy-related complications. Provision of a continuum of care during pregnancy, childbirth and the postnatal period results in reduced maternal and neonatal morbidity and mortality. Hence this study determined the prevalence of the continuum of care and its determinants among women in Zambia.MethodsWe used weighted data from the Zambian Demographic and Health Survey (ZDHS) of 2018 for 7325 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants. We conducted multivariable logistic regression to explore continuum of care in Zambia. All our analyses were done using SPSS version 25. ResultsOf the 7,325 women, 38.0% (2787/7325) (95% CI: 36.9-39.1) had complete continuum of maternal healthcare (four and more antenatal care contacts, childbirth at a health facility and postnatal care). Women who had attained tertiary level of education (AOR: 1.84, 95% CI: 1.01-3.35) and whose partners had also attained tertiary level of education (AOR: 2.54, 95% CI: 1.52-4.27) were more likely to utilize the whole continuum of care compared to those who had no education. Women who initiated antenatal care (ANC) after the first trimester (AOR: 0.46, 95% CI: 0.39-0.53) were less likely to utilize the whole continuum of care compared to those who initiated in the first semester. Women with exposure to radio (AOR: 1.58, 95% CI: 1.28-1.96) were more likely to utilize the whole continuum of care compared to those who were not exposed to radio. Women residing in the Western province were less likely to utilize the entire continuum of care compared to those in the other nine provinces.ConclusionLevel of education of the women and of their partners, early timing of ANC initiation, residing in other provinces other than the Western province, and exposure to information through radio were positively associated with utilization of the entire continuum of care. Improving literacy levels and promoting maternity services through radio may improve the level of utilization of maternity services.

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Knowledge and attitude of pregnant women towards preeclampsia and its associated factors in South Gondar Zone, Northwest Ethiopia: a multi‐center facility‐based cross‐sectional study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03647-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maru Mekie ◽

Dagne Addisu ◽

Minale Bezie ◽

Abenezer Melkie ◽

Dejen Getaneh ◽

...

Keyword(s):

Associated Factors ◽

First Trimester ◽

Cross Sectional Study ◽

Northwest Ethiopia ◽

Sectional Study ◽

Cross Sectional ◽

Level Of Knowledge ◽

Knowledge And Attitude ◽

Study Participants ◽

South Gondar

Abstract Background Preeclampsia has the greatest impact on maternal mortality which complicates nearly a tenth of pregnancies worldwide. It is one of the top five maternal mortality causes and responsible for 16 % of direct maternal death in Ethiopia. Little is known about the level of knowledge and attitude towards preeclampsia in Ethiopia. This study was designed to assess the knowledge and attitude towards preeclampsia and its associated factors in South Gondar, Northwest Ethiopia. Methods A multicenter facility-based cross-sectional study was implemented in four selected hospitals of South Gondar Zone among 423 pregnant women. Multistage random sampling and systematic random sampling techniques were used to select the study sites and the study participants respectively. Data were entered in EpiData version 3.1 while cleaned and analyzed by Statistical Package for Social Sciences (SPSS) version 23. Descriptive and inferential statistics were performed. Adjusted odds ratio with 95 % confidence interval were used to identify the significance of the association between the level of knowledge on preeclampsia and its predictors. Results In this study, 118 (28.8 %), 120 (29.3 %) of the study participants had good knowledge and a positive attitude towards preeclampsia respectively. The likelihood of having good knowledge on preeclampsia was found to be low among women with no education (AOR = 0.22, 95 % CI (0.06, 0.85)), one antenatal care visit (ANC) (AOR = 0.13, 95 % CI (0.03, 0.59)). Whereas, those who booked for ANC in the first trimester (AOR = 6.59, 95 % CI (1.43, 30.33)), gave the last birth at a health facility (AOR = 2.61, 955 CI (1.03, 6.61)), and experienced a complication during previous births (AOR = 3.67, 95 % CI (1.78, 7.57)) were more likely to be knowledgeable on preeclampsia. Conclusions No formal education and not attending four ANC visits were associated with poor knowledge of preeclampsia. While participants who visited health facilities during the first trimester, who gave birth at health facilities, and those who experienced a complication in previous births were more likely to be knowledgeable on preeclampsia. Improving the numbers of ANC visits and encouraging facility delivery are important measures to improve women’s knowledge on preeclampsia. Health education regarding preeclampsia risk factors, symptoms, and complications shall be emphasized.

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Migrant Voices in the Polish Classroom: Canadian Literature on the Tertiary Level of Education

Zeitschrift für Anglistik und Amerikanistik ◽

10.1515/zaa-2019-0030 ◽

2019 ◽

Vol 67 (4) ◽

pp. 411-427

Author(s):

Dagmara Drewniak

Keyword(s):

Present Article ◽

English Language ◽

Tertiary Level ◽

Mutual Understanding ◽

Teaching English ◽

Level Of Education ◽

Canadian Literature ◽

Cultural Heterogeneity ◽

English Language Literature ◽

Language Literature

Abstract This paper explores the possibilities of introducing contemporary Canadian texts into a Polish university classroom. It contextualizes teaching English language literature in Poland as well as seeks options for promoting values such as openness and tolerance while facilitating global reading and raising students’ awareness on global conflicts and their meaning in the contemporaneous world. The paper aims at demonstrating that Canadian literature courses composed of texts concerned with immigration and multiculturalism turn out to have an enormous potential in creating valuable debates on the problem of embracing otherness, seeking bridges in mutual understanding, and promoting openness towards different identities. On the basis of close readings of three texts, M. Ondaatje’s The English Patient, A.J. Borkowski’s Copernicus Avenue, and E. Stachniak’s Necessary Lies, the present article also demonstrates how Canadian literature enriches and rescales students’ perception of cultural heterogeneity and responsibility of reading, thus offering new perspectives on the rapidly changing world.

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Congenital malformations in neonates: analysis of morbidity and associated factors

International Archives of Medicine ◽

10.3823/2465 ◽

2017 ◽

Vol 10 ◽

Author(s):

Rosana Alves de Melo ◽

Flávia Emília Cavalcante Valença Fernandes ◽

Ana Kariny Costa Araújo ◽

Nadja Maria dos Santos ◽

Maria Elda Alves de Lacerda Campos ◽

...

Keyword(s):

Congenital Malformations ◽

Neonatal Morbidity ◽

Normal Weight ◽

Central Tendency ◽

Chi Square ◽

Level Of Education ◽

The Mean ◽

Upper Level ◽

The City ◽

Prenatal Visits

Objective: To evaluate the neonatal morbidity due to congenital malformations in the city of Petrolina-PE, from 2008 to 2013. Methods: A descriptive study with data from the Information System on Live Births (Sinasc). The analyzes were carried out through frequency distribution and measures of central tendency and dispersion. The associations were tested by the Pearson and Kruskal Wallis chi-square tests. Significance was set at 5% and 95% confidence. Results: 436 cases of congenital malformations were recorded in the study period, with 2011 being the highest occurrence year. The mothers of the newborns were young (25.2 years old), single, upper level of education and household. In general multiparous, with single gestation, vaginal delivery and performed up to six prenatal visits. The newborns were males, at 39 weeks or more of gestation and with normal weight (> = 2500g). The malformations of the musculoskeletal system were the most frequent followed by the genitourinary system. Congenital malformations were especially associated with neonatal characteristics such as gender and weight. In all causes the mean weight was greater than 2500g (p <0.05). The causes of malformation of greater occurrence in both sexes were osteomuscular (p <0.05). The aspects of the mother did not present significant differences in the present study (p> 0.05). Conclusion: The present study evidenced relevant aspects in the occurrence of morbidities due to congenital malformations, directing to a greater attention the occurrence of these diseases especially in relation to the newborn.

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P–384 First trimester pregnancy outcomes after confirmed SARS-CoV–2 infection in the community; a nationwide prospective longitudinal study of 10,000 pregnant women from the COVID–19 pandemic

Human Reproduction ◽

10.1093/humrep/deab130.383 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

N Balachandren ◽

M Davies ◽

J Hall ◽

D Mavrelos ◽

E Yasmin

Keyword(s):

Pregnant Women ◽

Pregnancy Outcomes ◽

First Trimester ◽

Severe Illness ◽

Healthy Controls ◽

Household Contacts ◽

Increased Risk ◽

Early Miscarriage ◽

Study Participants ◽

Prospective Longitudinal

Abstract Study question Are pregnant women in the community with confirmed diagnosis of SARS-CoV–2 infection, at increased risk of an early miscarriage? Summary answer Women diagnosed with COVID–19 in their first trimester were not at increased risk of an early miscarriage. What is known already: In the earliest stages of the pandemic, the Human Fertilisation and Embryology Authority and the European Society of Human Reproduction and Embryology, independently advised against starting assisted reproductive treatments. At the time of this recommendation, among other reasons, there were concerns about the complications of SARS-CoV–2 during pregnancy and the potential for vertical transmission. We now having growing evidence that pregnant women are at an increased risk of severe illness along with higher rates of preterm births in those with severe acute respiratory syndrome. However, data on the impact of community infections of SARS-CoV–2 in early pregnancy has been sparse. Study design, size, duration This is an online survey study undertaken in the UK between May and November 2020. Pregnant women at any stage in their pregnancy were invited to participate in the study. Study participants were asked to complete online surveys at the end of each trimester. 10, 430 women were recruited to take part in the study. Participants/materials, setting, methods: We analysed pregnancy outcomes from women who were under 13 weeks gestation at the time of registration. We compared miscarriage rates among women with a confirmed diagnosis of SARS-CoV–2 infection to healthy controls. Those in the control group had not been diagnosed with or had symptoms of SARS-CoV–2 infection nor did they have any household contacts that were diagnosed with or had symptoms of SARS-CoV–2 infection. Main results and the role of chance 10, 430 pregnant women were recruited to participate in the study. 2934 were under 13 weeks gestation at the time of registration. The median age was 32.6 [IQR 29.8–35.6]. The median gestational age at registration was 8 weeks [IQR [6–10]. 246 women reported a miscarriage before 13 weeks of gestation. The overall miscarriage rate before 13 weeks of gestation was 8.4% (95% CI 7.3%–9.4%). 68 women reported a confirmed diagnosis of SARS-CoV–2 infection in their first trimester. The overall rate of confirmed SARS-CoV–2 infections in the first trimester was 2.3% (95% CI 1.8–2.9%). 3/68 (4.4%) were asymptomatic. Among those reporting symptoms, the commonest symptoms were fatigue (82%), headache (69%) and loss of smell/taste (69%). Only 38% of those with a confirmed diagnosis reported a fever. None of the 68 women with confirmed diagnosis of SARS-CoV–2 infection were hospitalised. The rate of miscarriage before 13 weeks of gestation in women who were diagnosed with SARS-CoV–2 infections was not significantly higher compared to healthy controls (11.8% versus 9.3%, p = 0.35). A further 35 women had household contacts with confirmed SARS-CoV–2 infection although they themselves had not been diagnosed. No miscarriages were reported in this group. Limitations, reasons for caution None of the 68 patients diagnosed with SARS-CoV–2 were hospitalised. We do not know whether the rate of miscarriage among hospitalised women with SARS-CoV–2 infection is the same as those with community infections. Wider implications of the findings: The overall rate of miscarriage during the pandemic was not higher than rates occurring outside of the pandemic. The rate of miscarriage among women diagnosed with SARS-CoV–2 infection was not significantly higher compared to healthy controls. This data can be used to counsel women planning a pregnancy during this pandemic Trial registration number Not applicable

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Exploring the Difficulties Encountered by the Non-English Department Students in Learning the English Language: A Study on the Tertiary Level of Education in Bangladesh

Global Journal of Human-Social Science ◽

10.34257/gjhssgvol21is4pg47 ◽

2021 ◽

pp. 47-55

Author(s):

Md. Musrifur Jelane

Keyword(s):

Language Learning ◽

Quantitative Research ◽

English Language ◽

Tertiary Level ◽

English Department ◽

Research Approach ◽

Structured Interviews ◽

Public And Private ◽

Level Of Education ◽

English Departments

Most of the non-English departments at the tertiary level of education in Bangladesh conduct the English language course for the development of English language skills of the non-English department students. However, the non-English department students at the tertiary level of education in Bangladesh face many troubles in learning the English language efficiently. The purpose of this study was to explore the difficulties encountered by the non-English department students at the tertiary level of education in Bangladesh in learning the English language. This study followed a quantitative research approach. Data collected from 100 non-English department students both from public and private universities of Bangladesh through survey questionnaires and semi-structured interviews. The findings of this study disclosed that the non-English department students face the most difficulty in productive skills (speaking and writing). Moreover, duration of the class and semester, syllabus design, needs analysis, classroom techniques, and methods are the significant factors that affect the English language learning of the non-English department students.

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Neonatal Sepsis: A Review of the Literature

Journal of Pediatrics & Child Health Care ◽

10.26420/jpediatrchildhealthcare.2021.1042 ◽

2021 ◽

Vol 6 (2) ◽

Author(s):

Nyenga AM ◽

◽

Mukuku O ◽

Wembonyama SO ◽

◽

...

Keyword(s):

Risk Factors ◽

Neonatal Sepsis ◽

Neonatal Morbidity ◽

Essential Elements ◽

Postnatal Period ◽

Therapeutic Interventions ◽

Hospital Environment ◽

Definitive Treatment ◽

Microbial Culture ◽

Transmitted Infection

Neonatal sepsis contributes significantly to neonatal morbidity and mortality and is a major public health challenge around the world. Depending on the mode of occurrence, a distinction is made between maternal-transmitted infection and that acquired in the postnatal period. Although the etiologies maternally transmitted diseases are well understood, those of postnatal acquired infections are variable depending on the epidemiology of each hospital environment. On the one hand, risk factors for maternal-transmitted infections are maternal sepsis, prolonged premature rupture of membranes, chorioamnionitis, and bacteriuria in the mother during pregnancy. On the other hand, risk factors for postnatal acquired infections are prematurity, low birth weight, lack of hygiene, and invasive therapeutic interventions. The diagnosis is based on a series of anamnestic, clinical and biological features. Although the positive diagnosis is based on the isolation of the germ by culture on a body sample (blood, cerebrospinal fluid, urine, etc.); its low sensitivity leads to the use of markers of the acute phase of inflammation such as C-reactive protein, procalcitonin and interleukins. New molecular biology techniques are promising and offer precise diagnosis with rapid results. Empirical management is a function of microbial ecology while definitive treatment is guided by the results of microbial culture. This article presents the essential elements for understanding neonatal sepsis and discusses new diagnosis and therapeutic management. It offers a thorough reading based on the issue of infections in newborns.

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They yelled me Coronavirus: A Content Analysis of Racism towards Chinese amid Coronavirus Outbreak. An Exploratory and Descriptive Study using Twitter. (Preprint)

10.2196/preprints.29183 ◽

2021 ◽

Author(s):

Amanda Lloret-Pineda ◽

Yuelu He ◽

Josep Maria Haro ◽

Paula Cristóbal Narvaez

Keyword(s):

Content Analysis ◽

Community Support ◽

First Trimester ◽

Verbal Aggression ◽

Food Sharing ◽

Community Art ◽

First Semester ◽

P Content ◽

Twitter Users ◽

Prejudice And Discrimination

BACKGROUND As the first COVID-19 cases were noticed in China, many racist comments on Chinese individuals spread. As there is a huge need to better comprehend why all these targeted comments and opinions developed specifically then, this paper emerged to carefully examine racism and advocacy efforts on Twitter in the first trimester of 2020 (from January 15th to March 3rd, 2020). OBJECTIVE The first question aimed to understand which type of racism was displayed on Twitter during the first semester of 2020. The second question was to inquire about Twitter users' behaviors regarding advocacy and activism. METHODS Content analysis was utilized. Using the NCapture browser link and the NVivo software, Tweets in English and Spanish from the Twitter data stream were pulled from January 15th to March 3rd, 2020. A total of 19,150 Tweets were captured using the advanced Twitter search engine with the keywords and hashtags #nosoyunvirus, #imNotAVirus, #ChineseDon’tComeToJapan, #racism, “No soy un virus” and,” Racismo Coronavirus.”After cleaning data, a total of 402 Tweets were codified and analyzed by the research team. RESULTS Data confirms racism during the first months of the Coronavirus outbreak towards Chinese Individuals. Physical and verbal aggression were highly denounced as well as some forms of rejection. Advocacy efforts were huge inside and outside the Chinese community; an allyship sentiment was foster by some White members and an identification with the oppression experienced by Chinese in the Black and Muslim worldwide community. Art, Asian food sharing, and community support activities were the main forms of activism showed on Twitter during the first semester of 2020. CONCLUSIONS Tweets displayed individual, cultural, and institutional racism against Chinese individuals. Individual racism was the most reported form of racism—specifically, physical and verbal aggression. As a form of resistance against racism, Twitter users created spaces for advocacy and activism. The hashtag “I am not a virus” helped break stereotypes, prejudice, and discrimination on Twitter. White, Black, and Muslim allyship relationships were also present to support Chinese individuals. Activism through social media manifested through art, food sharing, and community support.

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Efficacy of 7-Day and 14-Day Triple Therapy Regimens for the Eradication ofHelicobacter pylori: A Comparative Study in a Cohort of Romanian Patients

Gastroenterology Research and Practice ◽

10.1155/2016/5061640 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

Stefan Sorin Arama ◽

Catalin Tiliscan ◽

Cristina Negoita ◽

Alexandru Croitoru ◽

Victoria Arama ◽

...

Keyword(s):

Treatment Response ◽

Eradication Rate ◽

Urban Residents ◽

Tertiary Level ◽

Younger Patients ◽

Level Of Education ◽

Histological Features ◽

Duodenal Lesions ◽

Study Population ◽

Gastric Biopsies

Objective. This study compared the eradication rates of ofHelicobacter pylori(HP) infection by a 7-day and 14-day anti-HP regimen.Materials and Methods. An open, randomized, prospective study was performed to evaluate the response to anti-HP treatment in adult HP-positive patients following a 7-day course (Regimen A) of a proton pump inhibitor in association with clarithromycin and amoxicillin compared to a 14-day course (Regimen B). Gastric biopsies were performed at baseline and two months after anti-HP treatment.Results. Seventy-eight patients aged 18–64 years (28 males, 50 females) diagnosed with HP infection were included. Fifty-two (66.7%) patients received Regimen B and 26 (33.3%) Regimen A. The overall eradication rate was 70.5%. Better treatment response (p<0.01) was seen in Regimen B (44/52, 84.2% versus 11/26, 42.3%). Significant improvement in histological features was seen in regimen B. There has been significant overall reduction in endoscopic aspects of gastric and duodenal lesions in both regimens. Younger patients ≤35 years had a better response to Regimen B. Better treatment response was seen in women, urban residents, and those with tertiary level of education in both groups.Conclusion. 14-day anti-HP regimen offered a significant better overall eradication of HP in study population.

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Cost-effectiveness of conditional cash transfers to retain women in the continuum of care during pregnancy, birth and the postnatal period: protocol for an economic evaluation of the Afya trial in Kenya

BMJ Open ◽

10.1136/bmjopen-2019-032161 ◽

2019 ◽

Vol 9 (11) ◽

pp. e032161

Author(s):

Neha Batura ◽

Jolene Skordis ◽

Tom Palmer ◽

Aloyce Odiambo ◽

Andrew Copas ◽

...

Keyword(s):

Economic Evaluation ◽

Cost Effectiveness ◽

Care Facility ◽

Continuum Of Care ◽

Postnatal Period ◽

Cash Transfers ◽

Conditional Cash Transfers ◽

Sensitivity Analyses ◽

The Impact ◽

The Continuum

IntroductionA wealth of evidence from a range of country settings indicates that antenatal care, facility delivery and postnatal care can reduce maternal and child mortality and morbidity in high-burden settings. However, the utilisation of these services by pregnant women, particularly in low/middle-income country settings, is well below that recommended by the WHO. The Afya trial aims to assess the impact, cost-effectiveness and scalability of conditional cash transfers to promote increased utilisation of these services in rural Kenya and thus retain women in the continuum of care during pregnancy, birth and the postnatal period. This protocol describes the planned economic evaluation of the Afya trial.Methods and analysisThe economic evaluation will be conducted from the provider perspective as a within-trial analysis to evaluate the incremental costs and health outcomes of the cash transfer programme compared with the status quo. Incremental cost-effectiveness ratios will be presented along with a cost-consequence analysis where the incremental costs and all statistically significant outcomes will be listed separately. Sensitivity analyses will be undertaken to explore uncertainty and to ensure that results are robust. A fiscal space assessment will explore the affordability of the intervention. In addition, an analysis of equity impact of the intervention will be conducted.Ethics and disseminationThe study has received ethics approval from the Maseno University Ethics Review Committee, REF MSU/DRPI/MUERC/00294/16. The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference.Trial registration numberNCT03021070

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