Association of Voluntary Legal Paternity and Breastfeeding Duration and Exclusivity in a Sample of Mothers in NewYork State, United States

Background and Objective: Globally, father engagement is deemed an important factor in mothers’ breastfeeding practices. In the U.S., the role of the father in breastfeeding is understudied. This study examines the association between voluntary legal paternity and maternal breastfeeding outcomes. Methods: Using data from a modified Pregnancy Risk Assessment Monitoring System survey (Monroe County, NY, 2015-2017) linked to New York State’s birth certificate data, we assessed breastfeeding outcomes (exclusivity and duration) by voluntary legal paternity (VLP) establishment. We examined breastfeeding duration (breastfeeding cessation at 13 weeks or less) and exclusive breastfeeding (at 13 weeks) among mothers whose infants had VLP (i.e., married, acknowledgment at birth), and those who had no-VLP (i.e., a court-mandated Paternity Affidavit or no legal paternity established). Univariate analyses were conducted, with additional variables (parental demographics, maternal social and clinical) included subsequently. The backward elimination method was used to determine the set of covariates to adjust in the model. Results: Of the 1,753 mothers initiating breastfeeding, 1,364 had VLP and 389 had no-VLP established. Mothers of infants with a no-VLP were more likely to be Black (29.49%), Hispanic (17.74%), have lower income (80.21%), have lower-education levels (44.73%) and were more likely to be <30 years old (61.7%), and had higher levels (14.4%) of reported traumatic stress before and during the most recent pregnancy. Among mothers initiating breastfeeding, those with no-VLP had a higher risk of breastfeeding cessation at 13 weeks (OR: 2.06; 95% CI, 1.25-3.42) after adjusting for maternal resilience, social support, hospital breastfeeding support, pre-pregnancy BMI, paternal age, and paternal education; and higher risk of breastfeeding cessation at 13 weeks (OR:1.46; 1.01-2.09). Conclusion and Implications for Translation: Voluntary legal establishment of paternity is associated with maternal breastfeeding outcomes. Screening of mothers may include legal paternity status as a further indication of the need for additional breastfeeding support, especially among socio-economically disadvantaged populations. Copyright © 2021 Alio et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Estimating Contributions of Social and Behavioral Factors to Cardiovascular Disease, Cancer, COPD, and Unintentional-Injury Mortality Disparities by Psychological Distress in the United States: A Blinder-Oaxaca Decomposition Analysis of the 1997-2014 NHIS-NDI Record Linkage Study

Background: Previous research has shown a significant association between psychological distress (PD) and cause-specific mortality, but contributions of sociodemographic and behavioral characteristics to mortality differences by PD are not fully explored. Methods: The Blinder-Oaxaca decomposition analysis was used to quantify the contributions of individual sociodemographic and behavioral characteristics to the observed cardiovascular disease (CVD), cancer, chronic obstructive pulmonary disease (COPD), and unintentional-injury mortality disparities between United States (US) adults with no PD and those with serious psychological distress (SPD), using the pooled 1997-2014 data from the National Health Interview Survey prospectively linked to the National Death Index (N=263,825). Results: Lower levels of education and household income, and higher proportions of current smokers, former drinkers, non-married adults, US-born, and renters contributed to higher mortality for adults with SPD. The relative percentage of mortality explained by sociodemographic and behavioral factors was highest for cancer mortality (71.25%) and lowest for unintentional-injury mortality (20.19%). Enhancing education level among adults with SPD would decrease approximately 30% of cancer or CVD mortality disparity, and around 10% of COPD and unintentional-injury mortality disparities. Half of the cancer mortality disparity (47.4%) could be attributed to a single factor, smoking. Increasing income level will decrease 7 to 13% of the disparity in cause-specific mortality. Higher proportions of renters explained higher CVD and COPD mortality among adults with SPD by 7% and 3%, respectively. Higher proportions of former drinkers explained higher CVD, cancer, and COPD mortality among adults with SPD by 6%, 7%, and 3%, respectively. Younger age, higher proportion of females, and higher BMI among adults with SPD mitigated the mortality disparities. Conclusions and Implications for Translational Research: Improved education and income levels, and reduced smoking among US adults with SPD would eliminate around 90% of the cancer mortality disparity by SPD, and half of the CVD mortality disparity. Copyright © 2021 Lee and Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

The Effect of Maternal Vitamin D Status on Fetal Growth and Stunting: A Systematic Review

Background and Objective: Impaired fetal growth and stunting remain immense public health problems involving maternal nutrition during pregnancy, as linear growth failure in children is the most common form of undernutrition across the world. Although both are preventable through adequate prenatal care and nutrition, impaired fetal growth and stunting continue to be implicated in multiple child health morbidities, physical, and psychological functioning. Recent knowledge and requirements for normal fetal and neonatal development are lacking. This systematic review investigates the effects of maternal vitamin D status on fetal growth and stunting. Methods: We reviewed three widely-used publications databases: the National Institutes of Health’s PubMed, Clarivate Analytics’ Web of Science, and Google Scholar using pre-established inclusion and exclusion criteria and keyword search strategy. Studies from 2010 to 2020 were included if they reported vitamin D levels on pregnant women, indicated growth outcomes and used quantitative measurements. We excluded non-English language studies, studies with ambiguous outcomes, studies that did not specify vitamin D intake, and studies that involved other maternal health complications. The search was implemented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Out of a total of 2,481 studies reviewed, we identified 8 studies on vitamin D and fetal growth and stunting. Published literature addressing maternal vitamin D status on fetal growth and stunting remains ambiguous. Five studies demonstrated improvements in fetal and humerus z-scores, which are known proxies for fetal growth, in groups with higher vitamin D status. Three studies found no statistical significance between vitamin D levels and fetal growth. Vitamin D status and ethnicity were correlated; vitamin D interacts with calcium levels in pregnant mothers to improve bone mineralization and fetal growth. Conclusion and Implications for Translation: Further studies are needed to understand the relationship between maternal vitamin D, ethnicity, and fetal growth and the long-term effects of maternal vitamin D levels on neonatal, early childhood, and adolescent growth. Copyright © 2021 Karmali et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

HIV Prevention in sub-Saharan Africa: Where Are Adolescents in the Continuum?

The human immunodeficiency virus (HIV) is the leading cause of death among adolescents in sub-Saharan Africa and the second leading cause of death among adolescents globally, yet this population is not expressly targeted in HIV prevention. Consequently, HIV prevalence among this population continues to rise. In 2014, McNairy and El-Sadr developed and proposed an HIV prevention continuum framework to ensure zero HIV infection among HIV uninfected people. While a step in the right direction, the continuum does not categorically focus on adolescents and thus, does not include mechanisms to offset the potential challenges this population experiences in HIV prevention. Intentionally involving adolescents in HIV prevention is crucial, as this population is considered integral to achieving the Sustainable Development Goal 3.3 target of eliminating HIV by 2030. This paper examines the challenges of adolescent participation in HIV prevention in sub-Saharan Africa using the McNairy and El-Sadar HIV prevention continuum framework as a backdrop. Copyright © 2021 Armstrong-Mensah et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Association Between Source of Treatment and Quality of Childhood Diarrhea Management Among Under-Five Children in Nigeria

Background and Objective: Despite the availability of low-cost and effective interventions, diarrhea remains one of the leading causes of under-five morbidity and mortality in Nigeria. We assessed the relationships between the source and quality of treatment for children with diarrhea in Nigeria. Methods: We analyzed cross-sectional data on 3,956 under-five children with a recent diarrheal episode, from the 2018 Nigeria Demographic and Health Survey. The outcome was quality of diarrhea management based on the administration of the following treatment recommendations: oral rehydration salt (ORS), zinc supplementation, increased oral fluids, and continued feeding. The exposure was the source of treatment (none; traditional/informal; public hospitals/health centers; private hospitals/clinics; and community-based services). Using adjusted, multivariable logistic regression, we estimated the odds ratio (OR) and 95% confidence intervals (CI) to predict the factors related to the quality of diarrhea management. Results: In all, only 1 in 5 children received all the four recommended diarrhea interventions. The odds of good quality diarrhea management were higher among children who received treatment in public hospitals/health centers, private hospitals/clinics, and community-based services compared to those of children who did not receive treatment (OR=2.52, 95% CI=1.89-3.34; OR=2.46, 95% CI=1.90-3.16; and OR=1.91, 95% CI=1.40-2.59, respectively). Compared to children whose parents did not seek treatment, the odds of receiving ORS ranged from 2.1 times (OR: 2.11, 95% CI=1.44-3.11) for seeking care in traditional/informal sources to 12.3 times (95% CI=8.81-17.15) in public hospitals/health centers. We observed similar trends for zinc supplementation. The odds of increased oral fluids were higher in public and private hospitals/clinics (OR=1.44, 95% CI=1.03-2.01 and OR=2.08, 95% CI=1.57-2.76, respectively). Across all settings, the odds of continued feeding were significantly lower among children who received treatment compared to children who did not receive treatment. Conclusion and Implications for Translation: Our findings indicate poor quality diarrhea management across various treatment settings. Policies and programs that encourage caregivers to seek treatment and improve the quality of care may contribute to reducing childhood diarrhea-related morbidity and mortality in Nigeria. Copyright © 2021 Olorunsaiye et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Barriers and Facilitators to Accessing Health Care Services among Married Women in Ethiopia: a Multi-level Analysis of the Ethiopia Demographic and Health Survey

Background and Objective: Access to health care services is a major challenge to women and children in many developing countries such as Ethiopia. In this study, we investigated the individual- and community-level factors associated with barriers to accessing health care services among married women in Ethiopia. Methods: Data from the 2016 Ethiopia demographic and health survey on 9,824 married women of reproductive age (15-49 years) were analyzed. Multilevel logistic regression models were used to assess individual- and community-level factors associated with barriers to access health care services. Regression analysis results revealed adjusted odds ratios at 95% confidence intervals. Results: Over two-thirds (71.8%) of married women in Ethiopia reported barriers to accessing health care services. Some of the individual-level factors that were associated with lower odds of reporting barriers to access health care services include: having secondary education (aOR=0.49, 95% CI: 0.32-0.77), being in the richest quintile (aOR=0.34, 95% CI: 0.22-0.54), and indicating wife-beating as unjustified (aOR=0.66, 95% CI:0.55-0.81). Among the community-level factors, high community-level literacy (aOR=0.56, 95% CI: 0.34-0.92) and moderate community socioeconomic status (aOR=0.62, 95% CI: 0.45-0.85) were significantly associated with lower odds of reporting barriers to access health care services. Conclusion and Implications for Translation: The findings revealed high barriers to access health care services, and both individual- and community-level factors were significant contributing predictors. Therefore, it is important to consider multidimensional strategies and interventions to facilitate access to health care services in Ethiopia. Copyright © Zegeye et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Racial/Ethnic Disparities in Temporal Trends of Myocardial Infarction Hospitalizations Among Pregnant Women in the United States: 2009-2018

There has been an increase in the incidence of Myocardial Infarction (MI) among pregnant women in the United States. There have been no studies examining the trends in the rates of gestational MI hospitalizations by race/ethnicity;and therefore, we undertook this study. No prior studies have examined the trends in the rates of gestational MI hospitalizations by race and ethnicity. In this study, we examined temporal trends of MI-related hospitalizations among pregnant women using the Nationwide Inpatient Sample (NIS) dataset from 2009 to 2018. We performed joinpoint regression analyses to assess trends in the rates of MI by race/ethnicity during the study period. Overall, there was an increase in the rates of MI among pregnant women during the study period (from 9.7 per 100,000 hospitalizations in 2009 to 18.1 per 100,000 hospitalizations in 2018) with an average annual percentage change (AAPC) of 7.2, (95% Confidence Interval (CI)=[4.0, 10.5]. The overall rate of MI was highest in non-Hispanic (NH)-Blacks and the greatest increments in rates of MI-related hospitalizations were noted in NH-Blacks during 2013-2018, and in Hispanics during the entire study period (2009-2018). NH-Blacks and Hispanics bear a disproportionately high burden of MI among pregnant women in the US. More worrisome is the first-ever reported finding in this study of a widening Black-White disparity in MI-related hospitalizations over the past decade. Copyright © Dongarwar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

COVID-19 Related Misconceptions and Prevention Practices Among the Public in a Southeastern City in Nigeria

Introduction: The COVID-19 pandemic brought several misconceptions that could hinder individuals from taking necessary measures to prevent infection, thus, undermining the public health containment efforts. We aimed to assess the prevalence of COVID-19 related misconceptions and their associations with demographic characteristics and prevention practices in Onitsha city in Anambra state, Nigeria. Methods: We analyzed data from a cross-sectional survey of 140 adult residents of Onitsha city in Anambra state, Nigeria, conducted in March 2020. Descriptive and inferential statistics were used to describe the study population and determine the associations between COVID-19 misconceptions, demographic characteristics, and implementation of COVID-19 prevention practices. Data management and statistical analyses were conducted using SAS JMP Statistical DiscoveryTM Software version 14.3 (SAS Institute, Cary, North Carolina, USA). Results: The participants’ average age was 34.5 (SD: ±10.9) years, and most were males (54.3%). Misconceptions about COVID-19 among the study population resulted in markedly reduced compliance with nearly all prevention practices. Some participants believed that COVID-19 would not spread in Nigeria (34.4%, p<0.0001), was not fatal (10.8%, p<0.0001), can be prevented and cured through spiritual means (48.2%, P <0.0001), use of herbs (13.6%, P <0.0001), use of antibiotics (11.4%, p<0.0001) and that COVID-19 vaccine was available (25.4%, p<0.01). Misconception about the possibility of COVID-19 spread was significantly associated with non-compliance to all prevention practices (P<0.05) except travel restrictions. Conclusions and Implications for Translation: Our study suggests the need for the government to tailor interventions targeting the common misconceptions in Onitsha in order to improve the public’s trust and compliance with recommended COVID-19 prevention practices. Misconception has become a significant public health challenge, primarily as its prioritization over scientific evidence and guidelines directly affects the pandemic preparedness and control efforts and may cause more people to be at risk of contracting COVID-19. Copyright © 2021 Iloanusi et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.