scholarly journals Increasing uptake of maternal, newborn, and child health interventions through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya

2019 ◽  
Author(s):  
Lauren Yu-Lien Maldonado ◽  
Julia J. Songok ◽  
John W. Snelgrove ◽  
Christian B. Ochieng ◽  
Sheilah Chelagat ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Education ◽  
Child Health ◽  
Pregnant Women ◽  
Matched Cohort ◽  
Western Kenya ◽  
Newborn And Child Health ◽  
Matched Cohort Study ◽  
Significant Difference ◽  
And Child Health

Abstract Background We launched Chamas for Change (Chamas), a group-based health education and microfinance program for pregnant women and their infants, to address inequities contributing to high rates of maternal and neonatal mortality in western Kenya. In this prospective matched cohort study, we evaluated Chamas’ impact on improving uptake of evidence-based maternal, newborn and child health (MNCH) interventions. Methods We prospectively compared MNCH intervention uptake between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October-December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women in Busia county attending their first antenatal care (ANC) visit to participate in Chamas and enroll in this study. Upon joining, women agreed to attend bi-monthly group health education and optional microfinance sessions for 12 months. We selected controls among non-Chamas participants who attended the same ANC clinics. We collected baseline sociodemographic and reproductive health data at study enrollment. We used descriptive analyses and adjusted multivariable logistic regression models to compare outcomes across cohorts at 6-12 months postpartum, with α set to 0.05. Results Compared to controls (n=115), a significantly higher proportion of Chamas participants (n=211) delivered in a facility with a skilled birth attendant (84.4% vs. 50.4%, p<0.001), attended at least four ANC visits (64.0% vs. 37.4%, p<0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p<0·001), and received a CHV home visit within 48 hours postpartum (75.8% vs. 38.3%, p<0·001). In our adjusted models, Chamas participants were nearly five times as likely as controls to deliver in a health facility (OR 5.07, 95% CI 2.74-9.36, p<0.001). Though not statistically significant, Chamas participants experienced fewer stillbirths than non-participants (n=2 vs. n=6, p=0.083). Our sensitivity analyses revealed no significant difference in the odds of facility delivery based on microfinance participation. Conclusions Chamas participation was associated with increased uptake of MNCH interventions among pregnant women in western Kenya. Our findings demonstrate this program’s potential to achieve population-level maternal and infant health benefits; however, a larger study is needed to validate this observed effect.

scholarly journals Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya

2020 ◽  
Author(s):  
Lauren Yu-Lien Maldonado ◽  
Julia J. Songok ◽  
John W. Snelgrove ◽  
Christian B. Ochieng ◽  
Sheilah Chelagat ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Education ◽  
Child Health ◽  
Health Behaviors ◽  
Pregnant Women ◽  
Evidence Based ◽  
Matched Cohort ◽  
Western Kenya ◽  
Newborn And Child Health ◽  
And Child Health

Abstract Background: We launched Chamas for Change (Chamas), a group-based health education and microfinance program for pregnant women and their infants, to address inequities contributing to high rates of maternal and neonatal mortality in western Kenya. In this prospective matched cohort study, we evaluated the association between Chamas participation and uptake of evidence-based, maternal, newborn and child health (MNCH) behaviors. Methods: We prospectively compared the uptake of MNCH behaviors between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October-December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women attending their first antenatal care (ANC) visits at health facilities in Busia County to participate in Chamas . Women enrolled in Chamas agreed to attend bi-monthly group health education and optional microfinance sessions for 12 months. We collected baseline sociodemographic data at study enrollment for each cohort. We used descriptive analyses and adjusted multivariable logistic regression models to compare outcomes across cohorts at 6-12 months postpartum, with α set to 0.05. Results: Compared to controls (n=115), a significantly higher proportion of Chamas participants (n=211) delivered in a facility with a skilled birth attendant (84.4% vs. 50.4%, p<0.001), attended at least four ANC visits (64.0% vs. 37.4%, p<0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p<0·001), and received a CHV home visit within 48 hours postpartum (75.8% vs. 38.3%, p<0·001). In our adjusted models, Chamas participants were nearly five times as likely as controls to deliver in a health facility (OR 5.07, 95% CI 2.74-9.36, p<0.001). Though not statistically significant, Chamas participants experienced a lower proportion of stillbirths (0.9% vs. 5.2%), miscarriages (5.2% vs. 7.8%), infant deaths (2.8% vs. 3.4%), and maternal deaths (0.9% vs. 1.7%) compared to controls. Our sensitivity analyses revealed no significant difference in the odds of facility delivery based on microfinance participation. Conclusions: Chamas participation was associated with increased practice of evidence-based MNCH health behaviors among pregnant women in western Kenya. Our findings demonstrate this program’s potential to achieve population-level MNCH benefits; however, a larger study is needed to validate this observed effect.

scholarly journals Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya

2020 ◽  
Author(s):  
Lauren Y. Maldonado ◽  
Julia J. Songok ◽  
John W. Snelgrove ◽  
Christian B. Ochieng ◽  
Sheilah Chelagat ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Education ◽  
Child Health ◽  
Health Facility ◽  
Standard Of Care ◽  
Matched Cohort ◽  
Western Kenya ◽  
Newborn And Child Health ◽  
Matched Cohort Study ◽  
And Child Health

Abstract Background: Chamas for Change (Chamas) is a group-based health education and microfinance program for pregnant and postpartum women that aims to address inequities contributing to high rates of maternal and infant mortality in rural western Kenya. In this prospective matched cohort study, we evaluated the association between Chamas participation and facility-based delivery. We additionally explored the effect of participation on promoting other positive maternal, newborn and child health (MNCH) behaviors. Methods: We prospectively compared outcomes between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October-December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women attending their first antenatal care (ANC) visits at rural health facilities in Busia County to participate in Chamas. Women enrolled in Chamas agreed to attend group-based health education and microfinance sessions for one year; controls received the standard of care. We used descriptive analyses, multivariable logistic regression models, and random effect models to compare outcomes across cohorts 12 months following enrollment, with α set to 0.05. Results: Compared to controls (n=115), a significantly higher proportion of Chamas participants (n=211) delivered in a health facility (84.4% vs. 50.4%, p<0.001), attended at least four ANC visits (64.0% vs. 37.4%, p<0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p<0·001), and received a CHV home visit within 48 hours postpartum (75.8% vs. 38.3%, p<0·001). In multivariable models, Chamas participants were over five times as likely as controls to deliver in a health facility (OR 5.49, 95% CI 3.12-9.64, p<0.001). Though not significant, Chamas participants experienced a lower proportion of stillbirths (0.9% vs. 5.2%), miscarriages (5.2% vs. 7.8%), infant deaths (2.8% vs. 3.4%), and maternal deaths (0.9% vs. 1.7%) compared to controls. Conclusions: Chamas participation was associated with increased odds of facility-based delivery compared to the standard of care in rural western Kenya. Larger proportions of program participants also practiced other positive MNCH behaviors. Our findings demonstrate Chamas’ potential to achieve population-level MNCH benefits; however, a larger study is needed to validate this observed effect. Trial Registration: ClinicalTrials.gov, NCT03188250 (retrospectively registered 31 May 2017)

scholarly journals Global Disease Outbreaks and Effects on Maternal, Newborn & Child Health in Global South, a Systematic Review

2020 ◽  
pp. 47-58
Author(s):  
O. Orjingene ◽  
N. L. Akondeng ◽  
A. Kone-Coulibaly ◽  
T. Ogojah ◽  
M. Ganama
Keyword(s):  
Health Care ◽  
Child Health ◽  
Pregnant Women ◽  
Low Income ◽  
Hospital Admissions ◽  
Disease Outbreaks ◽  
Global South ◽  
Hiv Positive ◽  
Newborn And Child Health ◽  
And Child Health

Background/Aim: The world has witnessed several disease outbreaks both in the past and in recent times. Apart from loss of lives as a result of such outbreaks, there are also disruptions in health care provision and utilization due to certain measures aimed at curtailing the spread of such outbreaks. This study aimed to seek evidence from existing literature on the effects of disease outbreaks on maternal, newborn and child health care in Global South. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used and 14 literatures met the inclusion criteria. Results: HIV/AIDS pandemic affected the Maternal Newborn and Child Health since increased cases of anaemia, hospital admissions, still births in HIV positive pregnant and cases of foetal anaemia reported in infants born from HIV positive pregnant women were reported. No COVID-19 pandemic related-effects on MNCH observed since no maternal deaths and transmission from infected pregnant women to their newborns reported. Indirect effects of pandemics on MNHC include reduced service delivery and demand/utilization as well as inaccessibility due to diverse reasons. Discussion: The Government should put in place palliative measures for low-income citizens; engage and sensitize women, pregnant women and their children on available health care services and mitigation measures in place to access with minimal or no risk of being infected in a secure environment.

Mortality Attributable to Hospital-Acquired Infections Among Surgical Patients

2008 ◽  
Vol 29 (12) ◽  
pp. 1167-1170 ◽  
Author(s):  
Christine Geffers ◽  
Dorit Sohr ◽  
Petra Gastmeier
Keyword(s):  
Cohort Study ◽  
Surgical Patients ◽  
Matched Cohort ◽  
Hospital Acquired Infection ◽  
Hospital Acquired Infections ◽  
Matched Cohort Study ◽  
Significant Difference ◽  
Hospital Acquired

We performed a multicenter prospective matched cohort study to evaluate the mortality attributable to hospital-acquired infections among 12,791 patients admitted to surgical departments. We were able to match 731 patients with 1 or more hospital-acquired infections (ie, case patients) with 731 patients without a hospital-acquired infection (ie, control patients) at a 1 : 1 ratio. Of the 731 case patients, 42 (5.7%) died; of the 731 control patients, 23 (3.1%) died—a significant difference of 2.6%.

scholarly journals 906. Surgical Site Infections in Children with Beta-Lactam Allergy: A Matched Cohort Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S487-S487
Author(s):  
Felicia Scaggs Huang ◽  
Colleen Mangeot ◽  
Heidi Sucharew ◽  
Katherine Simon ◽  
Joshua D Courter ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pediatric Patients ◽  
Significant Proportion ◽  
Surgical Site Infections ◽  
Matched Cohort ◽  
Antibiotic Regimen ◽  
Beta Lactam ◽  
Improvement Program ◽  
Matched Cohort Study ◽  
Significant Difference

Abstract Background Surgical site infections (SSIs) are a significant cause of morbidity and mortality. The administration of appropriate pre-operative antimicrobial prophylaxis (AMP) reduces SSI risk and beta-lactam antibiotics are considered the most effective agents. Studies in adult patients found increased SSI risk in patients with documented beta-lactam allergy (BLA) due to use of second line AMP agents. The SSI risk in BLA pediatric patients is not well-described. Methods We conducted a retrospective matched cohort study of patients (1-19 years-old) who underwent a surgical procedure at a quaternary pediatric hospital during 2010-2017. Patients with documented BLA at the time of surgery were matched 1:1 to patients with no BLA by age at surgery, National Surgical Quality Improvement Program (NSQIP) category, surgical calendar year, and presence of complex chronic conditions (CCC). AMP by BLA status was considered appropriate if recommended by the 2013 American Society of Health-System Pharmacists (ASHP) guidelines, antibiotic class appropriate, or recommended by an infectious disease physician. McNemar’s test was used to assess differences in SSI rates and antibiotic regimen appropriate for BLA status between BLA and no BLA groups. Results Of the 11878 surgical procedures among 9781 patients during the study period, 1021(9%) of patients had a reported BLA and we matched 972. SSI was rare in both groups and there was no significant difference in rates (18 (1.9%) in no BLA, 17 (1.8%) in BLA, p=1.0). BLA were more likely to receive an antibiotic regimen considered inappropriate for BLA status (22%) compared to no BLA (3%) with 89% receiving a beta-lactam-containing AMP regimen (p&lt; 0.01). Conclusion BLA was not associated with increased SSI risk in the pediatric patients studied. Interestingly, a significant proportion of children with a documented allergy received a beta-lactam for AMP. This suggests some providers recognize that allergy labels are inaccurate and may be comfortable administering beta-lactam AMP regardless of allergy status. Disclosures All Authors: No reported disclosures

scholarly journals Association between Chinese Dietary Guidelines Compliance Index for Pregnant Women and Risks of Pregnancy Complications in the Tongji Maternal and Child Health Cohort

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 829
Author(s):  
Ye Ding ◽  
Fangping Xu ◽  
Chunrong Zhong ◽  
Lishu Tong ◽  
Fang Li ◽  
...  
Keyword(s):  
Cohort Study ◽  
Child Health ◽  
Pregnant Women ◽  
Pregnancy Complications ◽  
Gestational Hypertension ◽  
Maternal Diet ◽  
Dietary Guidelines ◽  
Dietary Quality ◽  
Second Trimester ◽  
And Child Health

Background: Compliance with dietary guidelines among pregnant women can positively influence not only their own health but also the health of their babies. Measuring the compliance requires professional skills in nutrition and dietary counseling. In China, few simple and effective techniques assess dietary quality among pregnant women, especially in rural areas. We aimed to establish a new simple and effective assessment technique, the “Chinese Dietary Guidelines Compliance Index for Pregnant Women (CDGCI-PW)” and assess the association between maternal dietary compliance and risks of pregnancy complications. Methods: The CDGCI-PW consists of 13 main components which were based on the 2016 edition of the Chinese dietary guidelines for pregnant women. Each component was assigned a different score range, and the overall score ranged from 0 to 100 points. The Tongji Maternal and Child Health Cohort study (from September 2013 to May 2016) was a prospective cohort study designed to examine maternal dietary and lifestyle effects on the health of pregnant women and their offspring. The maternal diet during the second trimester was compared with the corresponding recommended intake of the Chinese balanced dietary pagoda for pregnant women to verify their compliance with dietary guidelines. The association between maternal dietary quality and risks of pregnancy complications was estimated by regression analysis. Receiver operating characteristic (ROC) curves were constructed to identify the optimal cut-off values of CDGCI-PW for gestational hypertension and gestational diabetes mellitus (GDM). Results: Among the 2708 pregnant women, 1489 were eventually followed up. The mean CDGCI-PW score was 74.1 (standard deviation (SD) 7.5) in the second trimester. The majority of foods showed the following trend: the higher the CDGCI-PW score, the higher the proportion of pregnant women who reported food intake within the recommended range. Moreover, a higher maternal CDGCI-PW score was significantly associated with lower risks of gestational hypertension [odds ratio (OR) (95% confidence interval [(CI): 0.30 (0.20, 0.37)] and GDM [OR (95% CI): 0.38 (0.31, 0.48)]. The optimal CDGCI-PW cut-off value for gestational hypertension was ≥68.5 (sensitivity 82%; specificity: 61%; area under the ROC curve, AUC = 0.743), and the optimal CDGCI-PW cut-off score for GDM was ≥75.5 (sensitivity 43%; specificity: 81%; area under the ROC curve, AUC = 0.714). Conclusions: The CDGCI-PW is a simple and useful technique that assesses maternal diet quality during pregnancy, while adherence to the CDGCI-PW is associated with a lower risk of gestational hypertension and GDM.

scholarly journals Women’s Participation in Research to Improve Maternal, Newborn and Child Health Outcomes Through Evidence Base Data in West Africa

2021 ◽  
Author(s):  
Issiaka Sombié ◽  
Ermel Ameswue Kpogbe Johnson ◽  
Moukaïla Amadou ◽  
Virgil Lokossou ◽  
Aina Olabisi
Keyword(s):  
Decision Making ◽  
Child Health ◽  
West Africa ◽  
Evidence Base ◽  
Decision Makers ◽  
Newborn And Child Health ◽  
Participation Of Women ◽  
Significant Difference ◽  
Using Data ◽  
And Child Health

Abstract Background: Women participation in decision-making fora is key to ensure that their concerns are take into consideration, especially in maternal, newborn and child health issues. The objective of this study was to analyse the participation of stakeholders in the various meetings organized as part of the project "Moving for Maternal, Newborn and Child Evidence into Policy in West Africa".Methods: A gender analysis was conducted using data drawn from the attendance lists at the various meetings organized during the project implementation. Results: This analysis showed that women were under-represented in the various meetings organized by the project, but that their profile was not different from that of men. There was a higher proportion of women among the decision-makers during the engagement, dialogue workshops and at the international workshops without significant difference. Nevertheless, in the training workshops, there was a low proportion of women among the decision-makers with statistical significant difference. Conclusion: The women participating in the regional platform meeting have the same profile as men in terms of decision-making power. An inequitable participation of women in the health research meetings in West Africa noted in this analysis need to be addressed in the future by the application of some innovative approaches including women as part of the organizers or by the introduction of quotas.

Human Papillomavirus Detection in Pregnant Women: A Prospective Matched Cohort Study

2012 ◽  
Vol 21 (12) ◽  
pp. 1295-1301 ◽  
Author(s):  
Channa E. Schmeink ◽  
Willem J.G. Melchers ◽  
Johannes C.M. Hendriks ◽  
Wim G.V. Quint ◽  
Leon Fag Massuger ◽  
...  
Keyword(s):  
Cohort Study ◽  
Human Papillomavirus ◽  
Pregnant Women ◽  
Matched Cohort ◽  
Matched Cohort Study

scholarly journals “When I Eat Well, I Will Be Healthy, and the Child Will Also Be Healthy”: Maternal Nutrition among HIV-Infected Women Enrolled in a Livelihood Intervention in Western Kenya

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Annie McDonough ◽  
Sheri D Weiser ◽  
Afkera Daniel ◽  
Elly Weke ◽  
Pauline Wekesa ◽  
...  
Keyword(s):  
Child Health ◽  
Food Insecurity ◽  
Pregnant Women ◽  
Maternal And Child Health ◽  
Maternal Nutrition ◽  
Controlled Trial ◽  
Well Being ◽  
Western Kenya ◽  
Living With Hiv ◽  
And Child Health

ABSTRACT Background Food insecurity remains a major obstacle to achieving health and well-being for individuals living with HIV in western Kenya. Studies have shown that pregnant women are vulnerable to experiencing food insecurity worldwide, with significant consequences for both maternal and child health. The Shamba Maisha cluster randomized controlled trial in western Kenya (which means “farming for life” in Swahili) tested the effects of a multisectoral livelihood intervention consisting of agricultural and finance trainings, farm inputs, and a loan on health and food security among 746 farmers living with HIV in Kisumu, Homa Bay, and Migori Counties. Objectives We conducted a qualitative substudy within the Shamba Maisha trial to understand the experiences and perspectives of pregnant women living with HIV enrolled in the trial. Methods Thirty women who had experienced a pregnancy during the Shamba Maisha study period, comprising 20 women in the intervention arm and 10 women in the control arm, completed in-depth interviews using a semistructured interview guide. Results Intervention participants interviewed noted improvements in maternal nutrition compared with previous pregnancies, which they attributed to the livelihood intervention. Key identified pathways to improved nutrition included improved access to vegetables, increased variety of diet through vegetable sales, and improved nutritional awareness. Women in the intervention arm also perceived increased weight gain compared with prior pregnancies and increased strength and energy throughout pregnancy. Conclusions Livelihood interventions represent a promising solution to alleviate food insecurity for pregnant women in order to improve maternal and child health outcomes. This trial was registered at clinicaltrials.gov as NCT02815579.

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