Search results for: preterm infants

Authors: Rashed Shah, Jeanne Koepsell, Dixmer Rivera, Eric Swedberg, David Marsh

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Success of primary health care goals of health promotion and disease prevention may well be determined by community based health workers’ overall job satisfaction. It is also important to understand the ways community health workers perceive their jobs and the importance they give to the various factors influencing their job satisfaction, which is critical before making a decision for task-shifting and for expanding their scope of work. Although brigadistas are unpaid volunteers, they are formally recognized and receive support and supervision from the Ministry of Health in Nicaragua. Brigadistas are responsible for classifying and diagnosing illnesses, administering treatment, counseling mothers and care givers within the community, encouraging referral in case of serious illness and making follow-up visits at home. Some brigadistas provide more technically advanced services, including treatment for pneumonia, diarrhea, malaria and tuberculosis and/or distribution of contraceptives. Expanding brigadistas’ duties could threaten their heretofore ‘job satisfaction’. This study primarily aims to report on job satisfaction of brigadistas in Nicaragua before expanding the scope of their work by adding more responsibilities. The study was guided by the following research questions: 1) What aspects of their job made the brigadistas satisfied or dissatisfied? 2) What is the job satisfaction level of brigadistas in Nicaragua? This cross-sectional study was conducted during March – July 2014, to assess brigadistas’ job satisfaction, prior to deciding on inclusion of care for sick newborns and young infants (<2 months of age) to brigadistas’ existing service package of community case management for children of 2-59 months of age. Following stratified random sampling strategy, 15 brigadistas were randomly selected from each of the following four strata: [(1) females under 25 years of age, (2) females over 30 years of age, (3) males under 25 years of age, and (4) males over 30 years of age. Out of 45 completed in-person interview with eligible and available brigadistas, 20 (44.4%) were with female and 25 (55.6%) were with male respondents; the mean age (±sd) was found as 32.0 (±3.2) years. About 53% (24/45) brigadista mentioned “Training” as the most helpful for performing their job. Another 31% (14/45) mentioned that “feeling of doing good, supporting community, women and children” was helpful to perform their job well. When asked about difficulty, about 35.5% (16/45) brigadistas mentioned about “Lack of time” due to their responsibilities in family, farm, other work places, study and such time constraint made their job performance difficult. Measured on a 0-5 scale, estimated average job satisfaction was 4.2. Current trends in task-shifting and integrated program delivery require community health workers (like the brigadistas) to deliver several essential services, including maternal, newborn and child health, and family planning, and thereby increasing their responsibilities. Given the reported level of job satisfaction among brigadistas (4.2 out of 5), and the mentioned difficulty in performing their current job (as ‘Lack of Time’) in this study results, the policy makers and program managers in MOH should be cautious enough before making a decision to expand current scope of work for brigadistas in Nicaragua.

Keywords: Brigadisata, job satisfaction, Nicaragua, task-shifting

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Authors: Allison Herlene Du Plessis, Dalena (R.M.) Van Rooyen, Wilma Ten Ham-Baloyi, Sihaam Jardien-Baboo

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Introduction: Women die in pregnancy and childbirth for five main reasons—severe bleeding, infections, unsafe abortions, hypertensive disorders (pre-eclampsia and eclampsia), and medical complications including cardiac disease, diabetes, or HIV/AIDS complicated by pregnancy. In 2015, WHO classified sepsis as the third highest cause for maternal mortalities in the world. Chorioamnionitis is a clinical syndrome of intrauterine infection during any stage of the pregnancy and it refers to ascending bacteria from the vaginal canal up into the uterus, causing infection. While the incidence rates for chorioamnionitis are not well documented, complications related to chorioamnionitis are well documented and midwives still struggle to identify this condition in time due to its complex nature. Few diagnostic methods are available in public health services, due to escalated laboratory costs. Often the affordable biomarkers, such as C-reactive protein CRP, full blood count (FBC) and WBC, have low significance in diagnosing chorioamnionitis. A lack of screening impacts on effective and timeous management of chorioamnionitis, and early identification and management of risks could help to prevent neonatal complications and reduce the subsequent series of morbidities and healthcare costs of infants who are health foci of perinatal infections. Objective: This integrative literature review provides an overview of current best research evidence on the screening of women at risk for chorioamnionitis. Design: An integrative literature review was conducted using a systematic electronic literature search through EBSCOhost, Cochrane Online, Wiley Online, PubMed, Scopus and Google. Guidelines, research studies, and reports in English related to chorioamnionitis from 2008 up until 2020 were included in the study. Findings: After critical appraisal, 31 articles were included. More than one third (67%) of the literature included ranked on the three highest levels of evidence (Level I, II and III). Data extracted regarding screening for chorioamnionitis was synthesized into four themes, namely: screening by clinical signs and symptoms, screening by causative factors of chorioamnionitis, screening of obstetric history, and essential biomarkers to diagnose chorioamnionitis. Key conclusions: There are factors that can be used by midwives to identify women at risk for chorioamnionitis. However, there are a paucity of established sociological, epidemiological and behavioral factors to screen this population. Several biomarkers are available to diagnose chorioamnionitis. Increased Interleukin-6 in amniotic fluid is the better indicator and strongest predictor of histological chorioamnionitis, whereas the available rapid matrix-metalloproteinase-8 test requires further testing. Maternal white blood cells count (WBC) has shown poor selectivity and sensitivity, and C-reactive protein (CRP) thresholds varied among studies and are not ideal for conclusive diagnosis of subclinical chorioamnionitis. Implications for practice: Screening of women at risk for chorioamnionitis by health care providers providing care for pregnant women, including midwives, is important for diagnosis and management before complications arise, particularly in resource-constraint settings.

Keywords: chorioamnionitis, guidelines, best evidence, screening, diagnosis, pregnant women

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Authors: Massimiliano Biagini, Marco Spinsanti, Gabriella De Angelis, Sara Tomei, Ilaria Ferlenghi, Maria Scarselli, Alessia Biolchi, Alessandro Muzzi, Brunella Brunelli, Silvana Savino, Marzia M. Giuliani, Isabel Delany, Paolo Costantino, Rino Rappuoli, Vega Masignani, Nathalie Norais

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The gram-negative bacterium Neisseria meningitidis serogroup B (MenB) is an exclusively human pathogen representing the major cause of meningitides and severe sepsis in infants and children but also in young adults. This pathogen is usually present in the 30% of healthy population that act as a reservoir, spreading it through saliva and respiratory fluids during coughing, sneezing, kissing. Among surface-exposed protein components of this diplococcus, factor H binding protein is a lipoprotein proved to be a protective antigen used as a component of the recently licensed Bexsero vaccine. fHbp is a highly variable meningococcal protein: to reflect its remarkable sequence variability, it has been classified in three variants (or two subfamilies), and with poor cross-protection among the different variants. Furthermore, the level of fHbp expression varies significantly among strains, and this has also been considered an important factor for predicting MenB strain susceptibility to anti-fHbp antisera. Different methods have been used to assess fHbp expression on meningococcal strains, however, all these methods use anti-fHbp antibodies, and for this reason, the results are affected by the different affinity that antibodies can have to different antigenic variants. To overcome the limitations of an antibody-based quantification, we developed a quantitative Mass Spectrometry (MS) approach. Selected Reaction Monitoring (SRM) recently emerged as a powerful MS tool for detecting and quantifying proteins in complex mixtures. SRM is based on the targeted detection of ProteoTypicPeptides (PTPs), which are unique signatures of a protein that can be easily detected and quantified by MS. This approach, proven to be highly sensitive, quantitatively accurate and highly reproducible, was used to quantify the absolute amount of fHbp antigen in total extracts derived from 105 clinical isolates, evenly distributed among the three main variant groups and selected to be representative of the fHbp circulating subvariants around the world. We extended the study at the genetic level investigating the correlation between the differential level of expression and polymorphisms present within the genes and their promoter sequences. The implications of fHbp expression on the susceptibility of the strain to killing by anti-fHbp antisera are also presented. To date this is the first comprehensive fHbp expression profiling in a large panel of Neisseria meningitidis clinical isolates driven by an antibody-independent MS-based methodology, opening the door to new applications in vaccine coverage prediction and reinforcing the molecular understanding of released vaccines.

Keywords: quantitative mass spectrometry, Neisseria meningitidis, vaccines, bexsero, molecular epidemiology

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Authors: Manjula Kola, K. Chandralekha

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Anaemia is one of the world’s most widespread health problems. Prevalence of anemia in south Asia is among the highest in the world. Iron deficiency anemia accounts for almost 85 percent of all types of anemia in India and affects more than half of the total population. Women of childbearing age particularly pregnant women, infants, preschool children and adolescents are at greatest risk of developing iron deficiency anemia. In India, 74 percent children between 6-35 months of age are anemic. Children between 1-6 years in major cities are found with a high prevalence rate of 64.8 percent. Iron deficiency anemia is not only a public health problem, but also a development problem. Its prevention and reduction must be viewed as investment in human capital that will enhance development and reduce poverty. Ending this hidden hunger in the form of iron deficiency is the most important achievable international health goal. Eliminating the underlying problem is essential to the sustained elimination of the iron deficiency anemia. The intervention programmes toward the sustained elimination need to be broadly based so that interventions become accepted community practices. Hence, intervention strategies need to go well beyond traditional health and nutrition systems and based upon empowering people and communities so that they will be capable of arranging for and sustaining an adequate intake of foods with respect to iron, independent of external support. Such strategies must necessarily be multisectoral and integrate interventions with social communications, evaluation and surveillance. The main objective of the study was to design a community based Nutrition intervention using theoretical framework of social marketing to sustain improvement of iron nutriture among preschool children. In order to carryout the study eight rural communities In Chittoor district of Andhra Pradesh, India were selected. A formative research was carryout for situational analysis and baseline data was generated with regard to demographic and socioeconomic status, dietary intakes, Knowledge, Attitude and Practices of the mothers of preschool children, clinical and hemoglobin status of the target group. Based on the formative research results, the research area was divides into four groups as experimental area I,II,III and control area. A community based, integrated and comprehensive social marketing intervention was designed based on various theories and models of nutrition education/ communication. In Experimental area I, Nutrition intervention using social marketing and a weekly iron folic acid supplementation was given to improve iron nutriture of preschool children. In experimental area II, Social marketing alone was implemented and in experimental area III Iron supplementation alone was given. No intervention was given in control area. The Impact evaluation revealed that among different interventions tested, the integrated social marketing intervention resulted best outcomes. The overall observations of the study state that social marketing, an integrated and functional strategy for nutrition communication to prevent and control iron deficiency. Various theoretical frame works / models for nutrition communication facilitate to design culturally appropriate interventions thus achieved improvements in the knowledge, attitude and practices there by resulting successful impact on nutritional status of the target groups.

Keywords: anemia, iron deficiency, social marketing, theoretical framework

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Authors: Petra Gergelova, Sofia Ioannidou, Davide Arcella, Alexandra Tard, Polly E. Boon, Oliver Lindtner, Christina Tlustos, Jean-Charles Leblanc

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Objectives: To assess chronic dietary exposure to food additives in different European countries and population groups. Method and Design: The European Food Safety Authority’s (EFSA) Panel on Food Additives and Nutrient Sources added to Food (ANS) estimates chronic dietary exposure to food additives with the purpose of re-evaluating food additives that were previously authorized in Europe. For this, EFSA uses concentration values (usage and/or analytical occurrence data) reported through regular public calls for data by food industry and European countries. These are combined, at individual level, with national food consumption data from the EFSA Comprehensive European Food Consumption Database including data from 33 dietary surveys from 19 European countries and considering six different population groups (infants, toddlers, children, adolescents, adults and the elderly). EFSA ANS Panel estimates dietary exposure for each individual in the EFSA Comprehensive Database by combining the occurrence levels per food group with their corresponding consumption amount per kg body weight. An individual average exposure per day is calculated, resulting in distributions of individual exposures per survey and population group. Based on these distributions, the average and 95th percentile of exposure is calculated per survey and per population group. Dietary exposure is assessed based on two different sets of data: (a) Maximum permitted levels (MPLs) of use set down in the EU legislation (defined as regulatory maximum level exposure assessment scenario) and (b) usage levels and/or analytical occurrence data (defined as refined exposure assessment scenario). The refined exposure assessment scenario is sub-divided into the brand-loyal consumer scenario and the non-brand-loyal consumer scenario. For the brand-loyal consumer scenario, the consumer is considered to be exposed on long-term basis to the highest reported usage/analytical level for one food group, and at the mean level for the remaining food groups. For the non-brand-loyal consumer scenario, the consumer is considered to be exposed on long-term basis to the mean reported usage/analytical level for all food groups. An additional exposure from sources other than direct addition of food additives (i.e. natural presence, contaminants, and carriers of food additives) is also estimated, as appropriate. Results: Since 2014, this methodology has been applied in about 30 food additive exposure assessments conducted as part of scientific opinions of the EFSA ANS Panel. For example, under the non-brand-loyal scenario, the highest 95th percentile of exposure to α-tocopherol (E 307) and ammonium phosphatides (E 442) was estimated in toddlers up to 5.9 and 8.7 mg/kg body weight/day, respectively. The same estimates under the brand-loyal scenario in toddlers resulted in exposures of 8.1 and 20.7 mg/kg body weight/day, respectively. For the regulatory maximum level exposure assessment scenario, the highest 95th percentile of exposure to α-tocopherol (E 307) and ammonium phosphatides (E 442) was estimated in toddlers up to 11.9 and 30.3 mg/kg body weight/day, respectively. Conclusions: Detailed and up-to-date information on food additive concentration values (usage and/or analytical occurrence data) and food consumption data enable the assessment of chronic dietary exposure to food additives to more realistic levels.

Keywords: α-tocopherol, ammonium phosphatides, dietary exposure assessment, European Food Safety Authority, food additives, food consumption data

Procedia PDF Downloads 319