Stillbirth outcome capture and classification in population-based surveys: EN-INDEPTH study

Abstract Background Household surveys remain important sources of stillbirth data, but omission and misclassification are common. Classifying adverse pregnancy outcomes as stillbirths requires accurate reporting of vital status at birth and gestational age or birthweight for every pregnancy. Further categorisation, e.g. by sex, or timing (intrapartum/antepartum) improves data to understand and prevent stillbirth. Methods We undertook a cross-sectional population-based survey of women of reproductive age in five health and demographic surveillance system sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017–2018). All women answered a full birth history with pregnancy loss questions (FBH+) or a full pregnancy history (FPH). A sub-sample across both groups were asked additional stillbirth questions. Questions were evaluated using descriptive measures. Using an interpretative paradigm and phenomenology methodology, focus group discussions with women exploring barriers to reporting birthweight for stillbirths were conducted. Thematic analysis was guided by an a priori codebook. Results Overall 69,176 women reported 98,483 livebirths (FBH+) and 102,873 pregnancies (FPH). Additional questions were asked for 1453 stillbirths, 1528 neonatal deaths and 12,620 surviving children born in the 5 years prior to the survey. Completeness was high (> 99%) for existing FBH+/FPH questions on signs of life at birth and gestational age (months). Discordant responses in signs of life at birth between different questions were common; nearly one-quarter classified as stillbirths on FBH+/FPH were reported born alive on additional questions. Availability of information on gestational age (weeks) (58.1%) and birthweight (13.2%) was low amongst stillbirths, and heaping was common. Most women (93.9%) were able to report the sex of their stillborn baby. Response completeness for stillbirth timing (18.3–95.1%) and estimated proportion intrapartum (15.6–90.0%) varied by question and site. Congenital malformations were reported in 3.1% stillbirths. Perceived value in weighing a stillborn baby varied and barriers to weighing at birth a nd knowing birthweight were common. Conclusions Improving stillbirth data in surveys will require investment in improving the measurement of vital status, gestational age and birthweight by healthcare providers, communication of these with women, and overcoming reporting barriers. Given the large burden and effect on families, improved data must be made available to end preventable stillbirths.

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The association between serum alanine aminotransferase and hypertension: A national based cross-sectional analysis among over 21 million Chinese adults

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01948-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jiajing Jia ◽

Ying Yang ◽

Fangchao Liu ◽

Minjin Zhang ◽

Qin Xu ◽

...

Keyword(s):

Alanine Aminotransferase ◽

Elevated Serum ◽

Population Based ◽

Reproductive Age ◽

Chinese Adults ◽

Cross Sectional ◽

Serum Alanine Aminotransferase ◽

Cross Sectional Analysis ◽

Registration Data ◽

Sectional Analysis

Abstract Background Inconsistent results were found in the association between serum alanine aminotransferase (ALT) and hypertension among population-based studies. This study evaluated the association between ALT and hypertension among Chinese reproductive-age population by utilizing registration data from National Free Pre-pregnancy Checkups Project in 2016–2017. Methods The 21,103,790 registered participants were eligible for analysis, including women who were 20–49 years old and men who were 20–59 years old with available data for ALT and blood pressure (BP). Logistic regression was conducted to estimate odds ratio (OR) for the association between ALT and hypertension as a binary outcome. Linear regression was used to examine the association between ALT and BP as a continuous outcome. Results In total, 4.21% of the participants were hypertensive, and 11.67% had elevated ALT (> 40 U/L). Hypertension prevalence was 3.63% and 8.56% among participants with normal and elevated ALT levels. A strong linear relationship was found between serum ALT levels and the odds of hypertension after adjustment for potential confounders. The multivariable-adjusted ORs for hypertension were 1, 1.22 (1.21, 1.22), 1.67 (1.65 1.68), 1.78 (1.76, 1.80), and 1.92 (1.90, 1.94) in participants with ALT levels of ≤ 20, 20.01–40, 40.01–60, 60.01–80, and > 80 U/L, respectively. Systolic and diastolic BPs rose by 1.83 and 1.20 mmHg on average, for each 20 U/L increase in ALT (P for trend < 0.001). The association was consistent among subgroups and tended to be stronger among populations who are overweight (body mass index ≥ 24 kg/m2) (χ2 = 52,228, P < 0.001), alcohol drinking (χ2 = 100,730, P < 0.001) and cigarette smoking (χ2 = 105,347, P < 0.001). Conclusions Our cross-sectional analysis suggested a linear association between serum ALT and hypertension or BP, which indicated that abnormal liver metabolism marked by elevated serum ALT could play a role in hypertension or elevated BP condition.

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The association between subclinical hypothyroidism and TPOAb positivity with infertility in a population-based study: Tehran thyroid study (TTS)

BMC Endocrine Disorders ◽

10.1186/s12902-021-00773-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Batul Birjandi ◽

Fahimeh Ramezani Tehrani ◽

Atieh Amouzegar ◽

Maryam Tohidi ◽

Razieh Bidhendi Yarandi ◽

...

Keyword(s):

Thyroid Autoimmunity ◽

Population Based ◽

Cross Sectional Study ◽

Cross Sectional ◽

Population Based Study ◽

History Of ◽

Autoimmune Condition ◽

Biochemical Measurements ◽

Adverse Pregnancy ◽

Adjusted Logistic Regression

Abstract Background Thyroid autoimmunity(TAI) is the most prevalent autoimmune condition in women of fertile age. There are increasing data regarding the association of thyroid dysfunction and thyroid autoimmunity with adverse pregnancy outcomes but there is no consensus regarding infertility and TPOAb positivity; thus we aimed to evaluate the association between thyroid TPOAb positivity and infertility in females and males in a population-based study (TTS). Methods Cross-sectional study of 3197 female and male participants in Tehran Thyroid Study (TTS) at the framework of the Tehran Lipid and Glucose Study (TLGS). Data included biochemical measurements and a self-administered questionnaire. Results A total of 12,823 cases in phase 4, 3719 cases (2108 female and 1611 male) were analyzed. The mean TSH of the infertile female and male was 2.52 ± 2.68 μIU/ml and 3.24 ± 10.26 μIU/ml respectively. The TPO median(IQR) of women with and without a history of infertility were 6.05 (3.30–13.96)and 6.04 (3.17–11.15);(P = 0.613), they were 5.08 (3.20–125.68) and 5.31 (3.93–125.68);(P = 0.490) in male participants, respectively. Results of crude and adjusted logistic regression analysis of the development of infertility by thyroid function and TPOAb, except for fT4 in male subjects, depicted no association between infertility and other variables in both crude and adjusted models. Conclusion Based on the result, thyroid autoimmunity was not associated with infertility in both females and males.

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Paradata analyses to inform population-based survey capture of pregnancy outcomes: EN-INDEPTH study

Population Health Metrics ◽

10.1186/s12963-020-00241-0 ◽

2021 ◽

Vol 19 (S1) ◽

Author(s):

Vladimir Sergeevich Gordeev ◽

◽

Joseph Akuze ◽

Angela Baschieri ◽

Sanne M. Thysen ◽

...

Keyword(s):

Pregnancy Outcomes ◽

Population Based ◽

Reproductive Age ◽

Maternal And Newborn Health ◽

Time Data ◽

Additional Time ◽

Electronic Data ◽

Cross Sectional ◽

Improve Measurement ◽

Population Based Survey

Abstract Background Paradata are (timestamped) records tracking the process of (electronic) data collection. We analysed paradata from a large household survey of questions capturing pregnancy outcomes to assess performance (timing and correction processes). We examined how paradata can be used to inform and improve questionnaire design and survey implementation in nationally representative household surveys, the major source for maternal and newborn health data worldwide. Methods The EN-INDEPTH cross-sectional population-based survey of women of reproductive age in five Health and Demographic Surveillance System sites (in Bangladesh, Guinea-Bissau, Ethiopia, Ghana, and Uganda) randomly compared two modules to capture pregnancy outcomes: full pregnancy history (FPH) and the standard DHS-7 full birth history (FBH+). We used paradata related to answers recorded on tablets using the Survey Solutions platform. We evaluated the difference in paradata entries between the two reproductive modules and assessed which question characteristics (type, nature, structure) affect answer correction rates, using regression analyses. We also proposed and tested a new classification of answer correction types. Results We analysed 3.6 million timestamped entries from 65,768 interviews. 83.7% of all interviews had at least one corrected answer to a question. Of 3.3 million analysed questions, 7.5% had at least one correction. Among corrected questions, the median number of corrections was one, regardless of question characteristics. We classified answer corrections into eight types (no correction, impulsive, flat (simple), zigzag, flat zigzag, missing after correction, missing after flat (zigzag) correction, missing/incomplete). 84.6% of all corrections were judged not to be problematic with a flat (simple) mistake correction. Question characteristics were important predictors of probability to make answer corrections, even after adjusting for respondent’s characteristics and location, with interviewer clustering accounted as a fixed effect. Answer correction patterns and types were similar between FPH and FBH+, as well as the overall response duration. Avoiding corrections has the potential to reduce interview duration and reproductive module completion by 0.4 min. Conclusions The use of questionnaire paradata has the potential to improve measurement and the resultant quality of electronic data. Identifying sections or specific questions with multiple corrections sheds light on typically hidden challenges in the survey’s content, process, and administration, allowing for earlier real-time intervention (e.g.,, questionnaire content revision or additional staff training). Given the size and complexity of paradata, additional time, data management, and programming skills are required to realise its potential.

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Knowledge, attitudes and intention regarding mHealth in generation Y: evidence from a population based cross sectional study in Chakaria, Bangladesh

BMJ Open ◽

10.1136/bmjopen-2017-016217 ◽

2017 ◽

Vol 7 (11) ◽

pp. e016217 ◽

Cited By ~ 4

Author(s):

M Shafiqur Rahman ◽

Syed Hanifi ◽

Fatema Khatun ◽

Mohammad Iqbal ◽

Sabrina Rasheed ◽

...

Keyword(s):

Young People ◽

Sex Education ◽

Mobile Phones ◽

Generation Y ◽

Healthcare Providers ◽

Age Groups ◽

Household Survey ◽

Population Based ◽

Cross Sectional ◽

Level Of Knowledge

Background and objectivesmHealth offers a new opportunity to ensure access to qualified healthcare providers. Therefore, to better understand its potential in Bangladesh, it is important to understand how young people use mobile phones for healthcare. Here we examine the knowledge, attitudes and intentions to use mHealth services among young population.DesignPopulation based cross sectional household survey.Setting and participantsA total of 4909 respondents, aged 18 years and above, under the Chakaria Health and Demographic Surveillance System (HDSS) area, were interviewed during the period November 2012 to April 2013.MethodsParticipants younger than 30 years of age were defined as young (or generation Y). To examine the level of knowledge about and intention towards mHealth services in generation Y compared with their older counterparts, the percentage of the respective outcome measure from a 2×2 contingency table and adjusted odds ratio (aOR), which controls for potential confounders such as mobile ownership, sex, education, occupation and socioeconomic status, were estimated. The aOR was estimated using both the Cochran–Mantel–Haenszel approach and multivariable logistic regression models controlling for confounders.ResultsGeneration Y had significantly greater access to mobile phones (50%vs40%) and better knowledge about its use for healthcare (37.8%vs27.5%;aOR 1.6 (95% CI1.3 to 2.0)). Furthermore, the level of knowledge about two existing mHealth services in generation Y was significantly higher compared with their older counterparts, with aOR values of 3.2 (95% CI 2.6 to 5.5) and 1.5 (95% CI 1.1 to 1.8), respectively. Similarly, generation Y showed significantly greater intention towards future use of mHealth services compared with their older counterparts (aOR 1.3 (95% CI 1.1 to 1.4)). The observed associations were not modified by sociodemographic factors.ConclusionThere is a greater potential for mHealth services in the future among young people compared with older age groups. However, given the low overall use of mHealth, appropriate policy measures need to be formulated to enhance availability, access, utilisation and effectiveness of mHealth services.

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Development of a health literacy scale for preconception care: a study of the reproductive age population in Japan

BMC Public Health ◽

10.1186/s12889-021-12081-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maiko Suto ◽

Haruhiko Mitsunaga ◽

Yuka Honda ◽

Eri Maeda ◽

Erika Ota ◽

...

Keyword(s):

Health Literacy ◽

Online Survey ◽

Preconception Care ◽

Population Based ◽

Living Environment ◽

Reproductive Age ◽

Self Report ◽

Healthy Weight ◽

Cross Sectional ◽

Behavioral Skills

Abstract Background Preconception care aims to improve both maternal and child health in the short as well as long term, along with providing health benefits to adolescents, women, and men, whether or not they plan to become parents. However, there is limited evidence regarding the effectiveness of interventions for improving preconception health in population-based settings. To accumulate evidence in this field, this study focused on the concept of health literacy, and aimed to develop a self-report health literacy scale in Japanese, focusing on preconception care. Methods We conducted a cross-sectional online survey. Participants were recruited from December 2019 to February 2020 from the registered members of a web-based research company. Participants were Japanese men and women aged 16–49 (n = 2000). A factor analysis was conducted to select both factors and items for health-related behavior and skills (33 initial items were generated), along with an item response theory analysis to examine how the 16 items were related to people’s knowledge of preconception care. Results We developed a 6-factor (including “appropriate medical examinations,” “appropriate diet,” “stress coping,” “healthy weight,” “safe living environment,” and “vaccinations”), 25-item behavior and skills scale, as well as a 13-item knowledge scale, to evaluate participants’ health literacy around preconception care. A shortened version, consisting of 17 items, was also prepared from the 25 items. The reliability coefficients of total scores and each factor of the behavior and skills scale were comparatively high, with weak-to-moderate correlation between behavior and skills and knowledge. Conclusions The new scale will, ideally, provide information on the current state of preconception care health literacy of the general population. In addition, this scale, which consists of both behavioral/skills and knowledge dimensions, should help support the effective implementation of risk assessment programs and interventions aimed at promoting behavioral changes using a population-based approach. Future studies using different question/administration formats for diverse populations, and considering respondents’ opinions on health literacy scales should be effective in improving this scale.

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Fetal foot length for assessment of gestational age: a cross sectional study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212972 ◽

2021 ◽

Vol 10 (8) ◽

pp. 3153

Author(s):

Vaibhav Sharma ◽

Ruchi Saxena ◽

Priyanka Gaur

Keyword(s):

Gestational Age ◽

Abdominal Ultrasound ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Maternal Characteristics ◽

Foot Length ◽

Adverse Pregnancy ◽

The Relationship ◽

Singleton Pregnancies

Background: Fetal age actually begins at conception and an equivalent term is conceptional age. Uncertain gestational age (GA) has been associated with adverse pregnancy outcomes independent of maternal characteristics. The objective was to evaluate the accuracy of fetal foot length (FFL) in estimation of gestational age.Methods: It was a cross sectional study. Trans abdominal ultrasound on 150 pregnant women with normal singleton pregnancies between 16 to 40 weeks was done to measure FFL. The relationship between GA and FFL was analysed by simple linear regression.Results: A linear relationship was demonstrated between FFL and GA. (GA (in weeks)=7.490+0.393×FFL (in mm)) with significant correlation (r=0.985, p<0.001).Conclusions: Ultrasonographic measurement of FFL is a reliable indicator of gestational age and can be a useful alternative to estimate GA when other routine biometric parameters are not conclusive.

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Parents’ Knowledge of Neonatal Danger Signs and Associated Factors at Health Centers in Kigali, Rwanda

Rwanda Journal of Medicine and Health Sciences ◽

10.4314/rjmhs.v3i2.4 ◽

2020 ◽

Vol 3 (2) ◽

pp. 128-138

Author(s):

Patricie Mujawimana ◽

Fauste Uwingabire ◽

Felicite Kankindi ◽

Ruth Dusabe ◽

Pamela Meharry

Keyword(s):

Associated Factors ◽

Neonatal Period ◽

Healthcare Providers ◽

Sampling Strategy ◽

Health Centers ◽

Cross Sectional ◽

Neonatal Deaths ◽

Danger Signs ◽

Parity Number ◽

Cross Sectional Design

Background Globally, nearly half of all under-five deaths occur during the neonatal period. About two million dies within the first week, of which 75% come from low-resource countries, such as Rwanda. Many neonatal deaths are preventable or avoidable if parents are knowledgeable of Neonatal Danger Signs (NDS), and do not delay seeking care at a health facility. Objective To assess the parents’ knowledge of NDS and associated factors within the neonatal period at four health centers in Kigali. Method This study was a descriptive cross-sectional design. A proportionate stratified probability sampling strategy was used to select 209 parents who attended selected health centers in Kigali. Data analysis used descriptive and inferential statistics. Results The findings showed that 67% of participants had some information on NDS. Logistic regression showed that educational level, parity, number of antenatal visits, and information from healthcare providers was significantly associated with parents' knowledge of NDS. Conclusion Our findings indicate the need to enhance education of parents’ knowledge of NDS in the study population. Educational efforts also should target NDS in health centers where most Rwandan women attend antenatal care. Rwanda J Med Health Sci 2020;3(2):128-138

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Is quality maternal healthcare all about successful childbirth? Views of mothers in the Wa Municipality, Ghana

PLoS ONE ◽

10.1371/journal.pone.0257401 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257401

Author(s):

Linus Baatiema ◽

Augustine Tanle ◽

Eugene Kofuor Maafo Darteh ◽

Edward Kwabena Ameyaw

Keyword(s):

Service Delivery ◽

Maternity Care ◽

Healthcare Providers ◽

Care Providers ◽

Maternal Healthcare ◽

Cross Sectional ◽

West Region ◽

Adverse Pregnancy ◽

Wa Municipality

Introduction In spite of the countless initiatives of the Ghana government to improve the quality of maternal healthcare, Upper West Region still records poor childbirth outcomes. This study, therefore, explored women’s perception of the quality of maternal healthcare they receive in the Wa Municipality of the Upper West Region of Ghana. Materials and methods This is a qualitative cross-sectional study of 62 women who accessed maternal healthcare in the Wa Municipality of Ghana. We analysed the transcripts using the analytic inductive technique. An inter-coding technique (testing for inter-coding agreement) was employed. The iterative coding process resulted in a coding scheme with four main themes. We used peer-debriefing technique in ensuring credibility and trustworthiness. Results Logistics and equipment; referral service; empathic service delivery; inadequacy of care providers; affordability of service; satisfaction with services received; as well as experience and service delivery were the parameters used by the women in assessing quality maternity care. A number of gaps were reported in the healthcare system including limited healthcare providers, limited beds and inefficient referral system. Conversely, some of them reported that some healthcare providers offered empathetic healthcare. Contrary views were expressed with respect to satisfaction with maternity care. Conclusion Government and all stakeholders seeking to enhance quality of maternal health and accelerate the attainment of the third Sustainable Development Goal need to reconsider the financing of service delivery at health institutions. Indeed, our findings have illustrated that routine workshops on empathetic healthcare are required in efforts to increase the rate of facility-based childbirth, and thereby subside maternal mortality and all adverse pregnancy outcomes.

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Trends and risk factors of stillbirths and neonatal deaths in Eastern Uganda (1982-2011): a cross-sectional, population-based study

Tropical Medicine & International Health ◽

10.1111/tmi.12807 ◽

2016 ◽

Vol 22 (1) ◽

pp. 63-73 ◽

Cited By ~ 12

Author(s):

Sanni Kujala ◽

Peter Waiswa ◽

Daniel Kadobera ◽

Joseph Akuze ◽

George Pariyo ◽

...

Keyword(s):

Risk Factors ◽

Population Based ◽

Cross Sectional ◽

Population Based Study ◽

Neonatal Deaths ◽

Eastern Uganda

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CONSANGUINITY AND MATERNAL AGE;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.04.1458 ◽

2017 ◽

Vol 24 (04) ◽

pp. 511-515

Author(s):

Nayyab Zehra ◽

Ahmed Hassaan Malik ◽

Zahabia Khalid ◽

Misha Sabir ◽

Simra Tanvir ◽

...

Keyword(s):

Family History ◽

Gestational Age ◽

Maternal Age ◽

Sampling Technique ◽

Reproductive Age ◽

Military Hospital ◽

Age Group ◽

Spontaneous Abortions ◽

Cross Sectional ◽

History Of

Objectives: To determine the frequency of risk factors i.e. consanguinity andmaternal age associated with spontaneous abortions in Pakistan and to propose ways toreduce them. Study design: Cross sectional descriptive study. Place of study: Gynecologydepartment of Military Hospital and Combined Military Hospital, Rawalpindi. Duration ofstudy: 6 months (September 2015 to February 2016). Sampling technique: Non probabilityconvenient sampling. Methodology: 150 married female patients in reproductive age group(15-49 years), who were confirmed cases of pregnancy and presented with abortions, wereinterviewed and responses were filled in a structured questionnaire after written consent.The collected data was then entered and analyzed by SPSS 20.0. Results: The major bulkof spontaneous abortions occurred in the maternal age group of 25-35 years (55.3%). A totalof 53.3% of abortions occurred in the gestational age of less than 12 weeks. Around 54.7% offemales had family history of spontaneous abortions and 65.3% had consanguineous marriage.Conclusion: Spontaneous abortions occur more frequently in the females of 25-35 yearsage group and among the fetuses with gestational age less than 12 weeks (1st trimester ofpregnancy). Family history of spontaneous abortions and consanguinity are associated withspontaneous abortions.

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