Cohort Profile: The Alliance for Maternal and Newborn Health Improvement (AMANHI) biobanking study.
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ABSTRACT:
SUBMITTER: Aftab F
PROVIDER: S-EPMC8743110 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:We aimed to evaluate and improve the accuracy of the ultrasound scan in estimating gestational age in late pregnancy (ie, after 24 weeks' gestation) in low-income and middle-income countries (LMICs), where access to ultrasound in the first half of pregnancy is rare and where intrauterine growth restriction is prevalent. METHODS:This prospective, population-based, cohort study was done in three LMICs (Bangladesh, Pakistan, and Tanzania) participating in the WHO Alliance for Maternal and Newborn Health Improvement study. Women carrying a live singleton fetus dated by crown-rump length (CRL) measurements between 8+0-14+6 weeks of gestation, who were willing to return for two additional ultrasound scans, and who planned on delivering in the study area were enrolled in the study. Participants underwent ultrasonography at 24+0-29+6 weeks and at 30+0-36+6 weeks' gestation. Birthweights were measured within 72 h of birth, and the proportions of infants who had a small-for-gestational-age birthweight (ie, a birthweight <10% of the standard birthweight for the infant's gestational age and sex according to the INTERGROWTH-21st project newborn baby reference standards) and appropriate-for-gestational-age birthweights were ascertained. Estimation of gestational age by standard fetal biometry measurements in addition to transcerebellar diameter (TCD) measurements was compared with gold-standard CRL measurements by use of Bland-Altman plots to calculate the mean difference and 95% limits of agreement. Statistical modelling was done to develop new gestational age prediction formulas for third trimester ultrasonography in LMICs. FINDINGS:Between Feb 7, 2015, and Jan 9, 2017, 1947 women were enrolled in the study. 1387 pregnant women had an ultrasound scan at 24+0-29+6 weeks of gestation and 1403 had an ultrasound scan between 30+0-36+6 weeks of gestation. Of the 1379 unique infants whose birthweights were available, 981 (71·1%) infants were born with an appropriate-for-gestational-age birthweight and 398 (28·9%) infants were born with a small-for-gestational-age birthweight. The accuracy of late pregnancy ultrasound biometry using existing formulas to estimate gestational age in LMICs was similar to that in high-income settings. With standard dating formulas, late pregnancy ultrasound at 24+0-29+6 weeks' gestation was accurate to within approximately plus or minus 2 weeks of the gold-standard CRL measurement of gestational age, and late pregnancy ultrasound was accurate to within ±3 weeks of the CRL measurement at 30+0-36+6 weeks' gestation. In infants who were ultimately born small for gestational age, individual parameters systematically underestimated gestational age, apart from TCD, which showed minimal bias. By use of a novel parsimonious model formula that combined TCD with femur length, gestational age at the 24+0 -29+6-week ultrasound scan was estimated to within ±10·5 days of the CRL measurement and estimated to within ±15·1 days of the CRL measurement at the 30+0-36+6-week ultrasound scan. Similar results were observed in infants who were small-for-gestational-age. INTERPRETATION:Incorporation of TCD and the use of new formulas in late pregnancy ultrasound scans could improve the accuracy of gestational age estimation in both appropriate-for-gestational-age and small-for-gestational-age infants in LMICs. Given the high rates of small-for-gestational-age infants in LMICs, these results might be especially relevant. Validation of this new formula in other LMIC populations is needed to establish whether the accuracy of the late pregnancy ultrasound can be narrowed to within approximately 2 weeks. FUNDING:Bill & Melinda Gates Foundation.
| S-EPMC7091029 | biostudies-literature
Project description:BackgroundMaternal and newborn deaths and ill health are relatively common in low income countries, but can adequately be addressed through locally, collaboratively designed, and responsive research. This has the potential to enable the affected women, their families and health workers themselves to explore 'why maternal and newborn adverse outcomes continue to occur. The objectives of the study include; To work with seldom heard groups of mothers, their families, and health workers to identify unanswered research questions for maternal and newborn health in villages and health facilities in rural UgandaTo establish locally responsive research questions for maternal and newborn health that could be prioritised together with the public in UgandaTo support the case for locally responsive research in maternal and newborn health by the ministry of health, academic researchers and funding bodies in Uganda.MethodsThe present study will follow the James Lind Alliance (JLA) Priority Setting Partnership (PSP) methodology. The project was initiated by an academic research group and will be managed by a research team at the Sanyu Africa Research Institute on a day to day basis. A steering group with a separate lay mothers' group and partners' group (individuals or organisations with interest in maternal and newborn health) will be recruited. The PSP will be initiated by launch meetings, then a face-to-face initial survey for the collection of raw unanswered questions; followed by data collation. A face-to-face interim prioritisation survey will then be performed to choose questions before the three separate final prioritisation workshops.The PSP will involve many participants from an illiterate, non-internet population in rural eastern Uganda, but all with an interest in strategies to avert maternal and newborn deaths or morbidities in rural eastern Uganda. This includes local rural women, their families, health and social workers, and relevant local groups or organisations.We will generate a top 10 list of maternal and newborn health research priorities from a group with no prior experience in setting a research agenda in rural eastern Uganda.DiscussionThe current protocol elaborates the JLA methods for application with a new topic and in a new setting translating the JLA principles not just into the local language, but into a rural, vulnerable, illiterate, and non-internet population in Uganda. The face-to-face human interaction is powerful in eliciting what exactly matters to individuals in this particular context as opposed to online surveys.This will be the first time that mothers and lay public with current or previous experience of maternal or neonatal adverse outcomes will have the opportunity to identify and prioritise research questions that matter to them in Uganda. We will be able to compare how the public would prioritise maternal health research questions over newborn health in this setting.
| S-EPMC7506205 | biostudies-literature
Project description:PURPOSE:Maternal and Child Health and Nutrition in Acre, Brazil (MINA-Brazil) is a longitudinal, prospective population-based birth cohort, set-up to understand the effects of early environmental exposures and maternal lifestyle choices on growth and development of the Amazonian children. PARTICIPANTS:Mother-baby pairs (n=1246) were enrolled at delivery from July 2015 to June 2016 in Cruzeiro do Sul, Acre, Brazil. Mothers of 43.7% of the cohort were recruited in the study during pregnancy from February 2015 to January 2016. Study visits took place during pregnancy, delivery, at 1?month, 6 months, 1?year and 2 years after delivery. In addition to clinical and epidemiological data, samples collected by the MINA-Brazil study include plasma, serum and extracted DNA from blood and faeces, which are stored in a biobank. FINDINGS TO DATE:Key baseline reports found a high prevalence of gestational night blindness (11.5%; 95% CI 9.97% to 13.25%) and maternal anaemia (39.4%; 95% CI 36.84% to 41.95%) at delivery. Antenatal malaria episodes (74.6% of Plasmodium vivax) were diagnosed in 8.0% of the women and were associated with an average reduction in birth weight z-scores of 0.35 (95% CI 0.14 to 0.57) and in birth length z-scores of 0.31 (95% CI 0.08 to 0.54), compared with malaria-free pregnancies. At 2-year follow-up, data collection strategies combined telephone calls, WhatsApp, social media community and home visits to minimise losses of follow-up (retention rate of 79.5%). FUTURE PLANS:A 5-year follow-up visit is planned in 2021 with similar interviews and biospecimens collection. The findings from this prospective cohort will provide novel insights into the roles of prenatal and postnatal factors in determining early childhood development in an Amazonian population.
| S-EPMC7045011 | biostudies-literature
Project description:BackgroundAdolescent girls between 15 and 19 years give birth to around 16 million babies each year, around 11% of births worldwide. We sought to determine whether adolescent mothers are at higher risk of maternal and perinatal adverse outcomes compared with mothers aged 20-24 years in a prospective, population-based observational study of newborn outcomes in low resource settings.MethodsWe undertook a prospective, population-based multi-country research study of all pregnant women in defined geographic areas across 7 sites in six low-middle income countries (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). The study population for this analysis was restricted to women aged 24 years or less, who gave birth to infants of at least 20 weeks' gestation and 500g or more. We compared adverse pregnancy maternal and perinatal outcomes among pregnant adolescents 15-19 years, <15 years, and adults 20-24 years.ResultsA total of 269,273 women were enrolled from January 2010 to December 2013. Of all pregnancies 11.9% (32,097/269,273) were in adolescents 15-19 years, while 0.14% (370/269,273) occurred among girls <15 years. Pregnancy among adolescents 15-19 years ranged from 2% in Pakistan to 26% in Argentina, and adolescent pregnancies <15 year were only observed in sub-Saharan Africa and Latin America. Compared to adults, adolescents did not show increased risk of maternal adverse outcomes. Risks of preterm birth and LBW were significantly higher among both early and older adolescents, with the highest risks observed in the <15 years group. Neonatal and perinatal mortality followed a similar trend in sub-Saharan Africa and Latin America, with the highest risk in early adolescents, although the differences in this age group were not significant. However, in South Asia the risks of neonatal and perinatal death were not different among adolescents 15-19 years compared to adults.ConclusionsThis study suggests that pregnancy among adolescents is not associated with worse maternal outcomes, but is associated with worse perinatal outcomes, particularly in younger adolescents. However, this may not be the case in regions like South Asia where there are decreasing rates of adolescent pregnancies, concentrated among older adolescents. The increased risks observed among adolescents seems more likely to be associated with biological immaturity, than with socio-economic factors, inadequate antenatal or delivery care.Trial registration numberNCT01073475.
| S-EPMC4464033 | biostudies-literature
Project description:BackgroundQuality improvement (QI) methods are effective in improving healthcare delivery using sustainable, collaborative, and cost-effective approaches. Systems-integrated interventions offer promise in terms of producing sustainable impacts on service quality and coverage, but can also improve important data quality and information systems at scale.MethodsThis study assesses the preliminary impacts of a first phase, quasi-experimental, QI health systems intervention on maternal and neonatal health outcomes in four pilot districts in Ethiopia. The intervention identified, trained, and coached QI teams to develop and test change ideas to improve service delivery. We use an interrupted time-series approach to evaluate intervention effects over 32-months. Facility-level outcome indicators included: proportion of mothers receiving four antenatal care visits, skilled delivery, syphilis testing, early postnatal care, proportion of low birth weight infants, and measures of quality delivery of childbirth services.ResultsFollowing the QI health systems intervention, we found a significant increase in the rate of syphilis testing (ß?=?2.41, 95% CI?=?0.09,4.73). There were also large positive impacts on health worker adherence to safe child birth practices just after birth (ß?=?8.22, 95% CI?=?5.15, 11.29). However, there were limited detectable impacts on other facility-usage indicators. Findings indicate early promise of systems-integrated QI on the delivery of maternal health services, and increased some service coverage.ConclusionsThis study preliminarily demonstrates the feasibility of complex, low-cost, health-worker driven improvement interventions that can be adapted in similar settings around the world, though extended follow up time may be required to detect impacts on service coverage. Policy makers and health system workers should carefully consider what these findings mean for scaling QI approaches in Ethiopia and other similar settings.
| S-EPMC7282234 | biostudies-literature
Project description:BackgroundDespite reports of universal access to and modest utilization of maternal and newborn health services in Ethiopia, mothers and newborns continue to die from preventable causes. Studies indicate this could be due to poor quality of care provided in health systems. Evidences show that high quality health care prevents more than half of all maternal deaths. In Ethiopia, there is limited knowledge surrounding the status of the quality of maternal and newborn health care in health facilities. This study aims to assess the quality of maternal and neonatal health care provision at the health facility level in four regions in Ethiopia.MethodologyThis study employed a facility-based cross-sectional study design. It included 32 health facilities which were part of the facilities for prototyping maternal and neonatal health quality improvement interventions. Data was collected using a structured questionnaire, key informant interviews and record reviews. Data was entered in Microsoft Excel and exported to STATA for analysis. Descriptive analysis results are presented in texts, tables and graphs. Quality of maternal and neonatal health care was measured by input, process and outputs components. The components were developed by computing scores using standards used to measure the three components of the quality of maternal and neonatal health care.ResultThe study was done in a total of 32 health facilities: 5 hospitals and 27 health centers in four regions. The study revealed that the average value of the quality of the maternal and neonatal health care input component among health facilities was 62%, while the quality of the process component was 43%. The quality of the maternal and neonatal health output component was 48%. According to the standard cut-off point for MNH quality of care, only 5 (15.6%), 3 (9.3%) and 3 (10.7%) of health facilities met the expected input, process and output maternal and neonatal health care quality standards, respectively.ConclusionThis study revealed that the majority of health facilities did not meet the national MNH quality of care standards. Focus should be directed towards improving the input, process and output standards of the maternal and neonatal health care quality, with the strongest focus on process improvement.
| S-EPMC8272353 | biostudies-literature
Project description:ObjectivesReduction in maternal and newborn mortality requires that women deliver in high quality health facilities. However, many facilities provide sub-optimal quality of care, which may be a reason for less than universal facility utilisation. We assessed the impact of a quality improvement project on facility utilisation for childbirth.MethodsIn this cluster-randomised experiment in four rural districts in Tanzania, 12 primary care clinics and their catchment areas received a quality improvement intervention consisting of in-service training, mentoring and supportive supervision, infrastructure support, and peer outreach, while 12 facilities and their catchment areas functioned as controls. We conducted a census of all deliveries within the catchment area and used difference-in-differences analysis to determine the intervention's effect on facility utilisation for childbirth. We conducted a secondary analysis of utilisation among women whose prior delivery was at home. We further investigated mechanisms for increased facility utilisation.ResultsThe intervention led to an increase in facility births of 6.7 percentage points from a baseline of 72% (95% Confidence Interval: 0.6, 12.8). The intervention increased facility delivery among women with past home deliveries by 18.3 percentage points (95% CI: 10.1, 26.6). Antenatal quality increased in intervention facilities with providers performing an additional 0.5 actions across the full population and 0.8 actions for the home delivery subgroup.ConclusionsWe attribute the increased use of facilities to better antenatal quality. This increased utilisation would lead to lower maternal mortality only in the presence of improvement in care quality.
| S-EPMC6499631 | biostudies-literature
Project description:BackgroundChamas 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.MethodsWe 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.ResultsCompared 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 h 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.ConclusionsChamas 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 registrationClinicalTrials.gov, NCT03188250 (retrospectively registered 31 May 2017).
| S-EPMC7216653 | biostudies-literature
Project description:OBJECTIVE:To implement a vital statistics registry system to register pregnant women and document birth outcomes in the Global Network for Women's and Children's Health Research sites in Asia, Africa, and Latin America. METHODS:The Global Network sites began a prospective population-based pregnancy registry to identify all pregnant women and record pregnancy outcomes up to 42 days post-delivery in more than 100 defined low-resource geographic areas (clusters). Pregnant women were registered during pregnancy, with 42-day maternal and neonatal follow-up recorded-including care received during the pregnancy and postpartum periods. Recorded outcomes included stillbirth, neonatal mortality, and maternal mortality rates. RESULTS:In 2010, 72848 pregnant women were enrolled and 6-week follow-up was obtained for 97.8%. Across sites, 40.7%, 24.8%, and 34.5% of births occurred in a hospital, health center, and home setting, respectively. The mean neonatal mortality rate was 23 per 1000 live births, ranging from 8.2 to 48.5 per 1000 live births. The mean stillbirth rate ranged from 13.7 to 54.4 per 1000 births. CONCLUSION:The registry is an ongoing study to assess the impact of interventions and trends regarding pregnancy outcomes and measures of care to inform public health. ClinicalTrial.gov TRIAL REGISTRATION:NCT01073475.
| S-EPMC3417109 | biostudies-literature
Project description:ObjectiveTo investigate the repercussion of periodontal disease (PD) in the pregnant woman health and the complications during pregnancy and delivery, as well as negative outcomes for the newborn (as infections, prematurity, low birth weight and fetal growth restriction).MethodRetrospective cohort study, based on medical records of 142 pregnant women assisted at a prenatal service of usual risk between 2012-2014, with a dental evaluation for PD. Maternal variables, along with labor and newborn variables, were analyzed. The newborns were stratified into two groups: offspring of mothers with PD (subdivided into Severe Periodontal Disease-SPD) and offspring of mothers without PD. Each outcome was adjusted by a multiple logistic regression model, with significance for p-value <0.05, considering all potential confounding factors.ResultsAmong women diagnosed with SPD, the odds ratio for vulvovaginitis was 3.45 times greater (OR = 3.45, p-value = 0.050) and 5.59 times higher for premature rupture of membranes (OR = 5.59; p-value = 0.017). For neonates, the chance of fetal growth restriction was 11.53 times higher for pregnant women with SPD (OR = 11.53, p = 0.041).ConclusionThe periodontal disease increased the chance of neonatal and maternal negative outcomes, being the fetal growth restriction, vulvovaginitis and premature rupture of the membrane (PROM) the main results driven by the presence of Severe Periodontal Disease.
| S-EPMC6874354 | biostudies-literature