- Browse by Subject
Browsing by Subject "Maternal health"
Now showing 1 - 9 of 9
Results Per Page
Sort Options
Item Association between aspirin use during pregnancy and cardiovascular risk factors 2-7 years after delivery: The nuMoM2b Heart Health Study(Elsevier, 2022) Theilen, Lauren H.; Greenland, Philip; Varagic, Jasmina; Catov, Janet; Shanks, Anthony L.; Thorsten, Vanessa; Parker, Corette B.; McNeil, Rebecca; Mercer, Brian; Hoffman, Matthew; Wapner, Ronald; Haas, David; Simhan, Hyagriv; Grobman, William; Chung, Judith H.; Levine, Lisa D.; Barnes, Shannon; Merz, Noel Bairey; Saade, George; Silver, Robert M.; Obstetrics and Gynecology, School of MedicineObjectives: To evaluate the association between aspirin use during first pregnancy and later maternal cardiovascular risk. Study design: In this secondary analysis of a prospective cohort, we included participants who carried their first pregnancy to 20 + weeks, had data regarding aspirin use, and attended a study visit 2-7 years following delivery. The exposure was aspirin use during the first pregnancy. We calculated aspirin use propensity scores from logistic regression models including baseline variables associated with aspirin use in pregnancy and cardiovascular risk. Outcomes of interest were incident cardiovascular-related diagnoses 2-7 years following delivery. Robust Poisson regression calculated the risk of outcomes by aspirin exposure, adjusting for the aspirin use propensity score. Main outcome measures: The primary outcome was a composite of incident cardiovascular diagnoses at the time of the study visit: cardiovascular events, chronic hypertension, metabolic syndrome, prediabetes or type 2 diabetes, dyslipidemia, and chronic kidney disease. Results: Of 4,480 women included, 84 (1.9%) reported taking aspirin during their first pregnancy. 52.6% of participants in the aspirin-exposed group and 43.0% in the unexposed group had the primary outcome. After adjusting for the aspirin use propensity scores, aspirin use during the first pregnancy was not associated with any of the outcomes. Conclusion: We did not detect an association between aspirin use during the first pregnancy and cardiovascular-related diagnoses 2-7 years later. Our study was only powered to detect a large difference in relative risk, so we cannot rule out a smaller difference that may be clinically meaningful.Item Common Traditions, Practices, and Beliefs Related to Safe Motherhood and Newborn Health in Morocco(MDPI, 2023-03-06) Moujahid, Chaimae; Turman, Jack E., Jr.; Amahdar, Loubna; Social and Behavioral Sciences, School of Public HealthThe cultural context influences women's antenatal care and postpartum knowledge. This study aims to determine the traditional practices related to maternal health in Morocco. We conducted in-depth qualitative interviews with 37 women from three different Moroccan regions on the first postpartum day. We used thematic content to analyze data, and an a priori coding framework was created utilizing the pertinent literature. Beliefs regarding pregnancy and postpartum positively affect maternal health, such as family support, prolonged rest for health recovery, and specific dietary precautions according to the mode of delivery of the new mother. However, some practices may negatively affect maternal health, such as cold postpartum treatment through traditional medicine and not seeking prenatal care after the first pregnancy experience. Such practices include painting newborns with henna, using kohl and oil to hasten the umbilical cord's descent, and producing solutions based on chicken throat to cure respiratory ailments in newborns that might harm their health.Item Consumer Perspectives on Maternal and Infant Health Apps: Qualitative Content Analysis(JMIR Publications, 2021-09) Biviji, Rizwana; Williams, Karmen S.; Vest, Joshua R.; Dixon, Brian E.; Cullen, Theresa; Harle, Christopher A.; Health Policy and Management, School of Public HealthBackground: Despite the popularity of maternal and infant health mobile apps, ongoing consumer engagement and sustained app use remain barriers. Few studies have examined user experiences or perceived benefits of maternal and infant health app use from consumer perspectives. Objective: This study aims to assess users' self-reported experiences with maternal and infant health apps, perceived benefits, and general feedback by analyzing publicly available user reviews on two popular app stores-Apple App Store and Google Play Store. Methods: We conducted a qualitative assessment of publicly available user reviews (N=2422) sampled from 75 maternal and infant health apps designed to provide health education or decision-making support to pregnant women or parents and caregivers of infants. The reviews were coded and analyzed using a general inductive qualitative content analysis approach. Results: The three major themes included the following: app functionality, where users discussed app features and functions; technical aspects, where users talked about technology-based aspects of an app; and app content, where users specifically focused on the app content and the information it provides. The six minor themes included the following: patterns of use, where users highlighted the frequency and type of use; social support, where users talked about receiving social support from friends, family and community of other users; app cost, where users talked about the cost of an app within the context of being cost-effective or a potential waste of money; app comparisons, where users compared one app with others available in app stores; assistance in health care, where users specifically highlighted the role of an app in offering clinical assistance; and customer care support, where users specifically talked about their interaction with the app customer care support team. Conclusions: Users generally tend to value apps that are of low cost and preferably free, with high-quality content, superior features, enhanced technical aspects, and user-friendly interfaces. Users also find app developer responsiveness to be integral, as it offers them an opportunity to engage in the app development and delivery process. These findings may be beneficial for app developers in designing better apps, as no best practice guidelines currently exist for the app environment.Item Improving maternal, newborn and child health outcomes through a community-based women's health education program: a cluster randomised controlled trial in western Kenya(BMJ, 2020-12) Maldonado, Lauren Y.; Bone, Jeffrey; Scanlon, Michael L.; Anusu, Gertrude; Chelagat, Sheilah; Jumah, Anjellah; Ikemeri, Justus; Songok, Julia J.; Christoffersen-Deb, Astrid; Ruhl, Laura J.; Medicine, School of MedicineIntroduction: Community-based women's health education groups may improve maternal, newborn and child health (MNCH); however, evidence from sub-Saharan Africa is lacking. Chamas for Change (Chamas) is a community health volunteer (CHV)-led, group-based health education programme for pregnant and postpartum women in western Kenya. We evaluated Chamas' effect on facility-based deliveries and other MNCH outcomes. Methods: We conducted a cluster randomised controlled trial involving 74 community health units in Trans Nzoia County. We included pregnant women who presented to health facilities for their first antenatal care visits by 32 weeks gestation. We randomised clusters 1:1 without stratification or matching; we masked data collectors, investigators and analysts to allocation. Intervention clusters were invited to bimonthly, group-based, CHV-led health lessons (Chamas); control clusters had monthly, individual CHV home visits (standard of care). The primary outcome was facility-based delivery at 12-month follow-up. We conducted an intention-to-treat approach with multilevel logistic regression models using individual-level data. Results: Between 27 November 2017 and 8 March 2018, we enrolled 1920 participants from 37 intervention and 37 control clusters. A total of 1550 (80.7%) participants completed the study with 822 (82.5%) and 728 (78.8%) in the intervention and control arms, respectively. Facility-based deliveries improved in the intervention arm (80.9% vs 73.0%; risk difference (RD) 7.4%, 95% CI 3.0 to 12.5, OR=1.58, 95% CI 0.97 to 2.55, p=0.057). Chamas participants also demonstrated higher rates of 48 hours postpartum visits (RD 15.3%, 95% CI 12.0 to 19.6), exclusive breastfeeding (RD 11.9%, 95% CI 7.2 to 16.9), contraceptive adoption (RD 7.2%, 95% CI 2.6 to 12.9) and infant immunisation completion (RD 15.6%, 95% CI 11.5 to 20.9). Conclusion: Chamas participation was associated with significantly improved MNCH outcomes compared with the standard of care. This trial contributes robust data from sub-Saharan Africa to support community-based, women's health education groups for MNCH in resource-limited settings.Trial registration numberNCT03187873.Item Maternal and child health after injuries: a two-year follow-up of a nationally representative sample(Elsevier, 2019-03) Alghnam, S.; Bell, T.M.; Cook, L.J.; Castillo, R.; Surgery, School of MedicineObjective: The objective of this study was to examine the association between childhood injury and health outcomes among survivors and their mothers using a national survey in the United States (US). Study design: This was a longitudinal analysis of a nationally representative sample. Methods: Secondary analysis of the 1997–2013 Medical Expenditure Panel Survey (MEPS) was performed. Children (aged 2–18 years) with or without injuries were followed up for two years. Injuries captured in the study were those associated with at least one hospitalization, emergency department visit, or office-based visit. Outcome measures were child and maternal general and mental health status. Multiple mixed-logistic regressions were used with suboptimal health defined as the response of poor or fair health versus good, very good, or excellent health. Results: Of the 63,422 children analyzed, 3251 (4.9%) were injured, representing 3.6 million US children. Injured children were more likely to be male, white, and older than those without injuries (P < 0.01). About a fifth of injured children suffered head injuries. Injuries were strongly associated with suboptimal general and mental health status in children (adjusted odds ratios [AORs], 1.35 and 1.36, respectively, P < 0.05). Mothers of children with injuries were also more likely to report suboptimal mental health (AOR, 1.30, P < 0.05). Conclusion: Injuries among children are associated with lasting adverse effects in general and mental health. To improve health outcomes of pediatric injuries, further follow-up care may be needed to ensure that they return to pre-injury health levels. These results highlight the importance of primary prevention and the long-term impact of injuries on the health of children and their mothers.Item Overcoming the Maternal Care Crisis: How Can Lessons Learnt in Global Health Informatics Address US Maternal Health Outcomes?(AMAI, 2018-04-16) Kasthurirathne, Suranga N.; Mamlin, Burke W.; Purkayastha, Saptarshi; Cullen, Theresa; BioHealth Informatics, School of Informatics and ComputingDespite unprecedented spending, US maternal outcomes have worsened drastically over the past decade. In comparison, maternal outcomes of many Low and Middle-Income Countries (LMIC) have improved. Lessons learnt by their success may be applicable to the US. We performed a literature review to identify innovations that had met with success across LMIC, and should be considered for adoption in the US. mHealth and patient facing alerts, Telehealth, patient controlled health records, inclusion of patient relationship data in health information systems and positioning empowered community health workers as catalysts of maternal care delivery were identified as innovations worthy of further evaluation. These innovations were categorized into several themes; knowledge, technology, patient/community empowerment, coordination and process change. Tools that place informed and empowered patients and community members at the center of maternal care has greatly improved maternal outcomes, and are suitable to be considered for the US healthcare system.Item Paediatric and obstetric outcomes at a faith-based hospital during the 100-day public sector physician strike in Kenya(BMJ Publishing Group, 2018-04-12) Adam, Mary Beth; Muma, Sarah; Modi, Jecinter Achieng; Steere, Mardi; Cook, Nate; Ellis, Wayne; Chen, Catherine T.; Shirk, Arianna; Muma Nyagetuba, John K.; Hansen, Erik N.; Pediatrics, School of MedicinePublished reviews of national physician strikes have shown a reduction in patient mortality. From 5 December 2016 until 14 March 2017, Kenyan physicians in the public sector went on strike leaving only private (not-for-profit and for-profit) hospitals able to offer physician care. We report on our experience at AIC-Kijabe Hospital, a not-for-profit, faith-based Kenyan hospital, before, during and after the 100-day strike was completed by examining patient admissions and deaths in the time periods before, during and after the strike. The volume of patients increased and exceeded the hospital's ability to respond to needs. There were substantial increases in sick newborn admissions during this time frame and an additional ward was opened to respond to this need. Increased need occurred across all services but staffing and space limited ability to respond to increased demand. There were increases in deaths during the strike period across the paediatric medical, newborn, paediatric surgical and obstetric units with an OR (95% CI) of death of 3.9 (95% CI 2.3 to 6.4), 4.1 (95% CI 2.4 to 7.1), 7.9 (95% CI 3.2 to 20) and 3.2 (95% CI 0.39 to 27), respectively. Increased mortality across paediatric and obstetrical services at AIC-Kijabe Hospital correlated with the crippling of healthcare delivery in the public sector during the national physicians' strike in Kenya.Item The utilization of maternal health services at primary healthcare setting in Southeast Asian Countries: A systematic review of the literature(Elsevier, 2022) Herwansyah, Herwansyah; Czabanowska, Katarzyna; Kalaitzi, Stavroula; Schröder-Bäck, Peter; Global Health, School of Public HealthThe reduction of Maternal Mortality Ratio (MMR) remains a global health issue. Although major progress has been achieved in the past 15 years, the ratio is still high, especially in Low Middle-Income Countries. In the Southeast Asian region, most of the countries have not reached the Sustainable Development Goals target yet. Although the countries have several similarities in many aspects, such as community characteristics, cultural context, health systems, and geographical proximity, the MMR in the region presents interesting variations. The scope of this systematic review is to explore published literature on the utilization of maternal health services at the community healthcare centre setting in Southeast Asian countries. The databases PubMed, Web of Science, and Google Scholar were searched systematically to identify quantitative, qualitative and mixed methods studies published in 2000–2020. A total of 1876 records were found, out of which 353 full text were screened. Finally, 27 studies on utilization of maternal health services met the inclusion criteria and were selected for analysis from seven Southeast Asian countries: Cambodia, Indonesia, Lao PDR, Myanmar, The Philippines, Timor Leste and Vietnam. Most of the articles focused on the utilization of maternal health services at primary health care setting. Several themes on maternal health services utilization in the countries emerged, including cultural and socioeconomic factors contributed to the utilization of maternal health services, factors associated with the low utilization of ANC, determinants affected place of delivery and delivery assistance choice. The utilization of maternal health services at primary healthcare setting in seven Southeast Asian countries was identified in a small number of studies. Sociocultural barriers and disparities of health services provision are the major factors associated with low utilization of the services. Further research on strengthening the role of primary healthcare in maternal health services provision is required.Item Understanding the Individual Narratives of Women Who Use Formula in Relation to the Master Narrative of "Breast is Best"(2022-05) Scott, Susanna Foxworthy; Bute, Jennifer J.; Brann, Maria; Head, Katharine; Turman, Jack E., Jr.Despite clinical recommendations, only 25.8% of infants in the United States are exclusively breastfed at 6 months of age. Breastfeeding policies and communication campaigns exist to support exclusive breastfeeding, and women who use formula report facing stigma and feeling like a failure. Narratives can be used to discern how individuals make sense of experiences related to health, and narrative theorizing in health communication provides a framework of problematics used to explain how individuals construct stories that reveal the tensions between continuity and disruption and creativity and constraint. Individual experiences are often influenced by master narratives such as “Breast is best,” which are phrases that shape our understanding of the world. Because of the negative impact of using formula on maternal well-being, the purpose of this research was to use a narrative framework to analyze the stories of women who used formula in relation to the master narrative of breast is best. Building off of pilot interviews with 22 mothers, semi-structured interviews were conducted with 20 women who had used formula within the first 6 months after giving birth and had an infant no older than 12 months at the time of the interview. Qualitative analysis revealed that women perceived formula as shameful and costly. Conversely, they viewed breastfeeding as biologically superior, better for bonding, and a way to enact good motherhood. Current messaging about breastfeeding, particularly for women who intend to breastfeed, may have unintended negative effects when women face a disruption to their breastfeeding journey. In addition, women viewed breastfeeding and formula feeding as in relation to and in opposition to one another, reducing the perceived acceptability of behaviors such as combination feeding. Despite constraints in the master narrative regarding acceptable infant feeding practices, women demonstrated creativity in their individual stories and found formula feeding enabled more equitable parenting and preserved mental health. Practical implications include that organizations promoting exclusive breastfeeding in the United States should move away from framing breastfeeding as an all-or-nothing choice and develop tailored and value-neutral messaging recognizing breastfeeding as a complex psychosocial and biological process.