Search results for: maternal effects

Authors: Yiqi Zhu, Jean Francois Trani, Rameez Ulhassan

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Extreme weather phenomena increased by 46% between 2007 and 2017 and have become more intense with the rise in global average temperatures. This increased intensity of climate variations often induces humanitarian crises and particularly affects vulnerable populations in low- and middle-income countries (LMICs). Expectant and lactating mothers are among the most vulnerable groups. Pakistan ranks 10th among the most affected countries by climate disasters. In 2022, monsoon floods submerged a third of the country, causing the loss of 1,500 lives. Approximately 650,000 expectant and lactating mothers faced systematic stress from climatic disasters. Our study used participatory methods to investigate the systematic impact of climatic disasters on maternal health. In March 2023, we conducted six Group Model Building (GMB) workshops with healthcare workers, fathers, and mothers separately in two of the most affected areas in Pakistan. This study was approved by the Islamic Relief Research Review Board. GMB workshops consist of three sessions. In the first session, participants discussed the factors that impact maternal health. After identifying the factors, they discussed the connections among them and explored the system structures that collectively impact maternal health. Based on the discussion, a causal loop diagram (CLD) was created. Finally, participants discussed action ideas that could improve the system to enhance maternal health. Based on our discussions and the causal loop diagram, we identified interconnected factors at the family, community, and policy levels. Mothers and children are directly impacted by three interrelated factors: food insecurity, unstable housing, and lack of income. These factors create a reinforcing cycle that negatively affects both mothers and newborns. After the flood, many mothers were unable to produce sufficient breastmilk due to their health status. Without breastmilk and sufficient food for complementary feeding, babies tend to get sick in damp and unhygienic environments resulting from temporary or unstable housing. When parents take care of sick children, they miss out on income-generating opportunities. At the community level, the lack of access to clean water and sanitation (WASH) and maternal healthcare further worsens the situation. Structural failures such as a lack of safety nets and programs associated with flood preparedness make families increasingly vulnerable with each disaster. Several families reported that they had not fully recovered from a flood that occurred ten years ago, and this latest disaster destroyed their lives again. Although over twenty non-profit organizations are working in these villages, few of them provide sustainable support. Therefore, participants called for systemic changes in response to the increasing frequency of climate disasters. The study reveals the systematic vulnerabilities of mothers and children after climatic disasters. The most vulnerable populations are often affected the most by climate change. Collaborative efforts are required to improve water and forest management, strengthen public infrastructure, increase access to WASH, and gradually build climate-resilient communities. Governments, non-governmental organizations, and the community should work together to develop and implement effective strategies to prevent, mitigate, and adapt to climate change and its impacts.

Keywords: climatic disasters, maternal health, Pakistan, systematic impact, flood, disaster relief.

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Authors: Mochache Vernon, Mwakusema Omar, Lakhani Amyn, El Busaidy Hajara, Temmerman Marleen, Gichangi Peter

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Background: Utilization of contraceptive methods has been associated with improved maternal and child health (MCH) outcomes. Unfortunately, there has been sub-optimal uptake of contraceptive services in the developing world despite significant resources being dedicated accordingly. It is imperative to granulate factors that could influence uptake and utilization of contraception. Methodology: Between March and December 2015, we conducted a mixed-methods cross-sectional study among women of reproductive age (18-45 years) from a pre-dominantly rural coastal Kenyan community. Qualitative approaches involved focus group discussions as well as a series of key-informant interviews. We also administered a sexual and reproductive health survey questionnaire at the household level. Results: We interviewed 745 women from 15 villages in Kwale County. The median (interquartile range, IQR) age was 29 (23-37) while 76% reported being currently in a marital union. Eighty-seven percent and 85% of respondents reported ever attending school and ever giving birth, respectively. Respondents who had ever attended school were more than twice as likely to be using contraceptive methods [Odds Ratio, OR = 2.1, 95% confidence interval, CI: 1.4-3.4, P = 0.001] while those who had ever given birth were five times as likely to be using these methods [OR = 5.0, 95% CI: 1.7-15.0, P = 0.004]. The odds were similarly high among women who reported attending antenatal care (ANC) [OR = 4.0, 95% CI: 1.1-14.8, P = 0.04] as well as those who expressly stated that they did not want any more children or wanted to wait longer before getting another child [OR = 6.7, 95% CI: 3.3-13.8, P<0.0001]. Interviewees reported deferring to the ‘wisdom’ of an older maternal figure in the decision-making process. Conclusions: Uptake and utilization of contraceptive methods among Digo women from Kwale, Kenya is positively associated with demand-side factors including educational attainment, previous birth experience, ANC attendance and a negative future fertility desire. Interventions to improve contraceptive services should focus on engaging dominant maternal figures in the community.

Keywords: unmet need, utilization of contraceptive methods, women, Digo community

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Authors: Eliza Torrigue, Efrelyn Iellamo

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Maternal death is one of the rising health issues in the Philippines. It is alarming to know that in every hour of each day, a mother gives birth to a child who may not live to see the next day. Statistics shows that intrapartum period and third stage of labor are the very crucial periods for the expectant mother, as well as the first six hours of life for the newborn. To address the issue, The Essential Intrapartum Newborn Care (EINC) was developed. Through this, Obstetric Delivery Room (OB-DR) Nurses shall be updated with the evidence-based maternal and newborn care to ensure patient safety, thus, reducing maternal and child mortality. This study aims to describe the compliance of hospitals, especially of OB-DR nurses, to the EINC Protocols. The researcher aims to link the profile variables of the respondents in terms of age, length of service and formal training to their compliance on the EINC Protocols. The outcome of the study is geared towards the development of appropriate training program for OB-DR Nurses assigned in the delivery room of the hospitals based on the study’s results to sustain the EINC standards. A descriptive correlational method was used. The sample consists of 75 Obstetric Delivery Room (OB-DR) Nurses from three government hospitals in the City of Manila namely, Ospital ng Maynila Medical Center, Tondo Medical Center, and Gat Andres Bonifacio Memorial Medical Center. Data were collected using an evaluative checklist. Ranking, weighted mean, Chi-square and Pearson’s R were used to analyze data. The level of compliance to the EINC Protocols by the respondents was evaluated with an overall mean score of 4.768 implying that OB-DR Nurses have a high regard in complying with the step by step procedure of the EINC. Furthermore, data shows that formal training on EINC have a significant relationship with OB-DR Nurses’ level of compliance during cord care, AMTSL, and immediate newborn care until the first ninety minutes to six hours of life. However, the respondents’ age and length of service do not have a significant relationship with the compliance of OB-DR Nurses on EINC Protocols. In the pursuit of decreasing the maternal mortality in the Philippines, EINC Protocols have been widely implemented in the country especially in the government hospitals where most of the deliveries happen. In this study, it was found out that OB-DR Nurses adhere and are highly compliant to the standards in order to assure that optimum level of care is delivered to the mother and newborn. Formal training on EINC, on the other hand, create the most impact on the compliance of nurses. It is therefore recommended that there must be a structured enhancement training program to plan, implement and evaluate the EINC protocols in these government hospitals.

Keywords: compliance, intrapartum, newborn care, nurses

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Authors: Lisnawati Hutagalung

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Background: Low birth weight (LBW) is one cause of newborn death. Babies with low birth weight tend to have slower cognitive development, growth retardation, more at risk of infectious disease event at risk of death. Objective: Identifying risk factors and dominant factors that influence the incidence of LBW in Indonesia. Method: This research used some database of public health such as Google Scholar, UGM journals, UI journals and UNAND journals in 2012-2015. Data were filtered using keywords ‘Risk Factors’ AND ‘Cause LBW’ with amounts 2757 study. The filtrate obtained 5 public health research that meets the criteria. Results: Risk factors associated with LBW, among other environment factors (exposure to cigarette smoke and residence), social demographics (age and socio-economic) and maternal factors (anemia, placental abnormal, nutritional status of mothers, examinations antenatal, preeclampsia, parity, and complications in pregnancy). Anemia and nutritional status become the dominant factor affecting LBW. Conclusions: The risk factors that affect LBW, most commonly found in the maternal factors. The dominant factors are a big effect on LBW is anemia and nutritional status of the mother during pregnancy.

Keywords: low birth weight, anemia, nutritional status, the dominant factor

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Authors: Eveline Muika Kabongo, Peter Delobelle, Ferdinand Mukumbang, Edward Nicol

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Introduction: Studies have been conducted to establish the effect of the MomConnect program in South Africa, but these studies did not focus on the stakeholders' and implementers' perspectives and the underlying program theory of the MomConnect initiative program. We strived to obtain stakeholders’ perspectives and assumptions on the MomConnect program and develop an initial program theory (IPT) of how the MomConnect initiative was expected to work. Methods: A realist-informed explanatory design used. The interviewer was performed with 10 key informants selected purposively among MomConnect key informants at the a national level of NDoH South Africa. The interview was done via zoom and lasted for 30 to 60 minutes. Introduction and abduction inferencing approaches were applied. The deductive and inductive approaches were performed during the analysis. ICAMO hereustic framework was used to analysed the data in order to get key informants expectations on how the MomConnect will work or not. Results: We developed three folk’s theories illustrating how the key informants’ expected the MomConnect to work. These theories showed that the MomConnect intended to provide users with health information and education that will empower and motivate them with knowledge which will allow the improvement of health services delivery among HCPs and improvement of the uptake of MCH services among pregnant women and mothers and decrease the rate of maternal and child mortality in the country. The lack of an updated mechanism to link women to the outcome was an issue. Another problem enlightened was the introduction of the WhatsApp program instead of SMS messaging, which was free of charge to women. Conclusion: The Folk’s theory developed from this study provided an insight into how the MomConnect was expected to work and what did not work. The folk’s theory will be merged with information from candidate theories on synthesis review and document review to develop our initial program theory of the MomConnect initiative.

Keywords: mHealth, MomConnect program, realist evaluation, maternal and child health, maternal and child health services, introduction, theory-driven

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Authors: Ebenezer Kwesi Armah-Ansah, Kenneth Fosu Oteng, Esther Selasi Avinu, Eugene Budu, Edward Kwabena Ameyaw

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Background: Maternal mortality, particularly in Benin, is a major public health concern in Sub-Saharan Africa. To provide a positive pregnancy experience and reduce maternal morbidities, all pregnant women must get appropriate and timely prenatal support. However, many pregnant women in developing countries, including Benin, begin antenatal care late. There is a paucity of empirical literature on the prevalence and predictors of early antenatal care visits in Benin. As a result, the purpose of this study is to investigate the prevalence and predictors of early antenatal care visits among women of productive age in Benin. Methods: This is a secondary analysis of the 2017/2018 Benin Demographic and Health Survey (BDHS) data. The study involved 6,919 eligible women. Data analysis was conducted using Stata version 14.2 for Mac OS. We adopted a multilevel logistic regression to examine the predictors of early ANC visits in Benin. The results were presented as odds ratios (ORs) associated with 95% confidence intervals (CIs) and p-value <0.05 to determine the significant associations. Results: The prevalence of early ANC visits among pregnant women in Benin was 57.03% [95% CI: 55.41-58.64]. In the final multilevel logistic regression, early ANC visit was higher among women aged 30-34 [aOR=1.60, 95% CI=1.17-2.18] compared to those aged 15-19, women with primary education [aOR=1.22, 95% CI=1.06-142] compared to the non-educated women, women who were covered by health insurance [aOR=3.03, 95% CI=1.35-6.76], women without a big problem in getting the money needed for treatment [aOR=1.31, 95% CI=1.16-1.49], distance to the health facility, not a big problem [aOR=1.23, 95% CI=1.08-1.41], and women whose partners had secondary/higher education [aOR=1.35, 95% CI=1.15-1.57] compared with those who were not covered by health insurance, had big problem in getting money needed for treatment, distance to health facility is a big problem and whose partners had no education respectively. However, women who had four or more births [aOR=0.60, 95% CI=0.48-0.74] and those in Atacora Region [aOR=0.50, 95% CI=0.37-0.68] had lower odds of early ANC visit. Conclusion: This study revealed a relatively high prevalence of early ANC visits among women of reproductive age in Benin. Women's age, educational status of women and their partners, parity, health insurance coverage, distance to health facilities, and region were all associated with early ANC visits among women of reproductive in Benin. These factors ought to be taken into account when developing ANC policies and strategies in order to boost early ANC visits among women in Benin. This will significantly reduce maternal and newborn mortality and help achieve the World Health Organization’s recommendation that all pregnant women should initiate early ANC visits within the first three months of pregnancy.

Keywords: antenatal care, Benin, maternal health, pregnancy, DHS, public health

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Authors: Zaman Jawahar, Anne Rouve-Khiev, Elizabeth Hoban, Joanne Williams

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Ensuring access to timely obstetric care is essential to prevent maternal deaths. Geographical barriers pose significant challenges for women accessing quality reproductive and maternal health services in rural Cambodia. This policy brief affirms the need to address the issue of transportation and cost (direct and indirect) as critical barriers to accessing reproductive and maternal health (RMH) services in four provinces in Northeast Cambodia (Kratie, Ratanak Kiri, Mondul Kiri, Stung Treng). A systemic search of the literature identified 1,116 articles, and only ten articles from low-and-middle-income countries met the inclusion criteria. The ten articles reported on transportation and cost related to accessing RMH services. In addition, research findings from Partnering to Save Lives (PSL) studies in the four provinces were included in the analysis. Thematic data analysis using the information in the ten articles and PSL research findings was conducted, and the findings are presented in this paper. The key findings are the critical barriers to accessing RMH services in the four provinces because women experience: 1) difficulties finding affordable transportation; 2) lack of available and accessible transportation; 3) greater distance and traveling time to services; 4) poor geographical terrain and; 5) higher opportunity costs. Distance and poverty pose a double burden for the women accessing RMH services making a facility-based delivery less feasible compared to home delivery. Furthermore, indirect and hidden costs associated with institutional delivery may have an impact on women’s decision to seek RMH care. Existing health financing schemes in Cambodia such as the Health Equity Fund (HEF) and the Voucher Scheme contributed to the solution but have also shown some limitations. These schemes contribute to improving access to RMH services for the poorest group, but the barrier of transportation costs remains. In conclusion, initiatives that are proven to be effective in the Cambodian context should continue or be expanded in conjunction with the HEF, and special consideration should be given to communities living in geographically remote regions and difficult to access areas. The following strategies are recommended: 1) maintain and further strengthen transportation support in the HEF scheme; 2) expand community-based initiatives such as Community Managed Health Equity Funds and Village Saving Loans Associations; 3) establish maternity waiting homes; and 4) include antenatal and postnatal care in the provision of integrated outreach services. This policy brief can be used to inform key policymakers and provide evidence that can assist them to develop strategies to increase poor women’s access to RMH services in low-income settings, taking into consideration the geographic distance and other indirect costs associated with a facility-based delivery.

Keywords: access, barriers, northeast Cambodia, reproductive and maternal health service, transportation and cost

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Authors: Jevonte Abioye, Dylan Savary

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The aim of this research is to present a disaggregated geostatistical analysis of the subnational provincial trends of child mortality variation in Zimbabwe from a child health policy perspective. Soon after gaining independence in 1980, the government embarked on efforts towards promoting equitable health care, namely through the provision of primary health care. Government intervention programmes brought hope and promise, but achieving equity in primary health care coverage was hindered by previous existing disparities in maternal health care disproportionately concentrated in urban settings to the detriment of rural communities. The article highlights policies and programs adopted by the government during the millennium development goals period between 1990-2015 as a response to the inequities that characterised the country’s maternal health care. A longitudinal comparative method for a spatial variation on child mortality rates across provinces is developed based on geostatistical analysis. Cross-sectional and time-series data was extracted from the World Health Organisation (WHO) global health observatory data repository, demographic health survey reports, and previous academic and technical publications. Results suggest that although health care policy was uniform across provinces, not all provinces received the same antenatal and perinatal services. Accordingly, provincial rates of child mortality growth between 1994 and 2015 varied significantly. Evidence on the trends of child mortality rates and maternal health policies in Zimbabwe can be valuable for public child health policy planning and public service delivery design both in Zimbabwe and across developing countries pursuing the sustainable development agenda.

Keywords: antenatal care, perinatal care, infant mortality rate, neonatal mortality rate, under-five mortality rate, millennium development goals, sustainable development agenda

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Authors: Michael Campbell, Malaz Elsaddig, Kevin Jones

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Background: Despite encouraging progress, global maternal mortality has remained stubbornly high since the declaration of the Millennium development goals. Sub-Saharan Africa accounts for well over half of maternal deaths with Post-Partum Haemorrhage (PPH) being the lead cause. ‘In house’ simulation training delivered by local doctors may be a sustainable approach for improving emergency obstetric care. The aim of this study was to evaluate the use of a Train-the-Trainer (TtT) model in a rural Ugandan hospital to ascertain whether it can feasibly improve practitioners’ management of PPH. Methods: Three Ugandan doctors underwent a training course to enable them to design and deliver simulation training. These doctors used MamaNatalie® models to simulate PPH scenarios for midwives, nurses and medical students. The main outcome was improvement in participants’ knowledge and confidence, assessed using self-reported scores on a 10-point scale. Results: The TtT model produced significant improvements in the confidence and knowledge scores of the ten participants. The mean confidence score rose significantly (p=0.0005) from 6.4 to 8.6 following the simulation training. There was also a significant increase in the mean knowledge score from 7.2 to 9.0 (p=0.04). Medical students demonstrated the greatest overall increase in confidence scores whilst increases in knowledge scores were largest amongst nurses. Conclusions: This study demonstrates that a TtT model can be used in a low resource setting to improve healthcare professionals’ confidence and knowledge in managing obstetric emergencies. This Train-the-Trainer model represents a sustainable approach to addressing skill deficits in low resource settings. We believe that its expansion across healthcare institutions in Sub-Saharan Africa will help to reduce the region’s high maternal mortality rate and step closer to achieving the ambitions of the Millennium development goals.

Keywords: low resource setting, post-partum haemorrhage, simulation training, train the trainer

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Authors: Benrithung Murry

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This paper highlights the biosocial determinants of health-seeking behavior in tribal population groups of northeast India, focusing on maternal and child health. The northeastern region of India is a conglomeration of several ethnic groups, most of which are scheduled as tribal groups. A total of 750 ever-married women in reproductive ages (15-49 years) were interviewed from three tribal groups of Nagaland, India using pre-tested and modified maternal health schedule. Data pertaining to reproductive performance of the mothers and their children health status were collected from 12 villages of Dimapur district, Nagaland, India. The sample for study comprises 212 Angami women, 267 Ao women, and 271 Sumi women, all of which belonging to tribal populations of Northeast India. Sex ratios of 15-49 years in these three populations are 1018.18, 1086.69, and 1106.92, respectively. 90% of the populations in the study are nuclear families, with about 10% of households falling below the poverty line as per the cutoffs for India. Female literacy level in these population groups is higher than the national average of 65.46%; however, about 30% of all married women are not engaged in any sort of earnings. Total fertility rates of these populations are alarming (Total Fertility Rate ≥ 6) and far from replacement fertility level, while infant mortality rates are found to be much lower than the national average of 34 per 1000. The perception and practice of maternal health in this region is unimpressive despite the availability of medical amenities. Only 3 % of mothers in the study have reported 4 times antenatal checkups during last two pregnancies. Other mothers have reported 1 to 3 times of antenatal checkups, but about 25% of them never visited a doctor during the entire pregnancy period. About 15% of mothers never took tetanus injection, while 40% of mothers never took iron folic supplements during pregnancy. Almost half of all women and their husbands do not use birth control measures even for the spacing of children, which has an immense impact on prenatal mortality mainly due to deliberate abortions: the percentage of prenatal mortality among Angami, Ao and Sumi populations is 44.88, 31.88 and 54.98, respectively per 1000 live births. The steep decline in fertility levels in most countries is a consequence of the increasing use of modern methods of contraception. However, among users of birth control measures in these populations, it is seen that most couples use it only after they have the desired number of children, thus its use having no substantial influence in reducing fertility. It is also seen that the majority of the children were only partially vaccinated. With many child deliveries being done at home, many newborns are not administered with polio at birth. Two-third of all children do not have complete basic immunization against polio, diphtheria, tetanus, pertussis, bacillus, and hepatitis besides others. Certain adherence to traditional beliefs and customs apart from the socio-economic factors is believed to have been operating in these populations, which determines their health-seeking behavior. While a more in-depth study combining biological, socio-cultural, economic, and genetic factors is suggested, there is an urgent need for intervention in these populations to combat with the poor maternal and child health status.

Keywords: case study, health behavior, mother and child, northeast india

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Authors: Joseph L. Mathew, Shourjendra N. Banerjee, R. K. Ratho, Sourabh Dutta, Vanita Suri

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Background: In India and many other developing countries, a single dose of measles vaccine is administered to infants at 9 months of age. This is based on the assumption that maternal transplacentally transferred antibodies will protect infants until that age. However, our previous data showed that most infants lose maternal anti-measles antibodies before 6 months of age, making them susceptible to measles before vaccination at 9 months. Objective: This prospective study was designed to compare susceptibility in pre-term vs term infants, at different time points. Material and Methods: Following Institutional Ethics Committee approval and a formal informed consent process, venous blood was drawn from a cohort of 45 consecutive term infants and 45 consecutive pre-term infants (both groups delivered by the vaginal route); at birth, 3 months, 6 months and 9 months (prior to measles vaccination). Serum was separated and anti-measles IgG antibody levels were measured by quantitative ELISA kits (with sensitivity and specificity > 95%). Susceptibility to measles was defined as antibody titre < 200mIU/ml. The mean antibody levels were compared between the two groups at the four time points. Results: The mean gestation of term babies was 38.5±1.2 weeks; and pre-term babies 34.7±2.8 weeks. The respective mean birth weights were 2655±215g and 1985±175g. Reliable maternal vaccination record was available in only 7 of the 90 mothers. Mean anti-measles IgG antibody (±SD) in terms babies was 3165±533 IU/ml at birth, 1074±272 IU/ml at 3 months, 314±153 IU/ml at 6 months, and 68±21 IU/ml at 9 months. The corresponding levels in pre-term babies were 2875±612 IU/ml, 948±377 IU/ml, 265±98 IU/ml, and 72±33 IU/ml at 9 months (p > 0.05 for all inter-group comparisons). The proportion of susceptible term infants at birth, 3months, 6months and 9months was 0%, 16%, 67% and 96%. The corresponding proportions in the pre-term infants were 0%, 29%, 82%, and 100% (p > 0.05 for all inter-group comparisons). Conclusion: Majority of infants are susceptible to measles before 9 months of age suggesting the need to anticipate measles vaccination, but there was no statistically significant difference between the proportion of susceptible term and pre-term infants, at any of the four-time points. A larger study is required to confirm these findings and compare sero-protection if vaccination is anticipated to be administered between 6 and 9 months.

Keywords: measles, preterm, susceptibility, term infant

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Authors: Hae Jeong Park, Joo-Ho Chung

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In this study, the effect of essential oil from Chamaecyparis obtuse (EOCO) on early life stress using maternal separation (MS) rats was investigated. Anxiety-related behaviors were examined in MS rats using the elevated plus-maze (EPM) test. The changes of gene expressions by EOCO in the hippocampus of MS rats were analyzed using a microarray method. Rats in the MS groups were separated from their respective mothers from postnatal day (pnd) 14 to 28. Rats in the EOCO-treated groups were exposed to EOCO for 1 h or 2 h by inhalation from pnd 21 to 28. The EOCO-treated MS rats showed decreased anxiety-related behaviors compared to the MS rats in the EPM test. In the microarray analysis, EOCO downregulated the expressions of cytokine genes such as Ccl2, Il6, Cxcl10, Ccl19, and Il1rl in the hippocampus of MS rats, and it was also confirmed through RT-PCR. In particular, the expressions of Ccl2 and Il6 were predominantly decreased by EOCO in the hippocampus of MS rats. Interestingly, their protein expressions were also reduced by EOCO in MS rats. These results indicate that EOCO decreases MS-induced anxiety-related behaviors, and modulate cytokines, particularly Ccl2 and Il6, in the hippocampus of MS rats.

Keywords: anxiety-related behavior, Chamaecyparis obtuse, cytokine gene, early-life stress, maternal separation

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Authors: Sergey Kuznetsov, Yuri Urman

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We present an approach to investigate non-linear dynamical effects occurring in the noncontact superconducting and diamagnetic suspensions, when levitated body has finite size. This approach is based on the calculation of interaction energy between spherical finite size superconducting or diamagnetic body with external magnetic field. Effects of small deviations from spherical shape may be also taken into account by introducing small corrections to the energy. This model allows investigating dynamical effects important for practical applications, such as nonlinear resonances, change of vibration plane, coupling of rotational and translational motions etc. We also show how the geometry of suspension affects various dynamical effects and how an inverse problem may be formulated to enforce or diminish various dynamical effects.

Keywords: levitation, non-linear dynamics, superconducting, diamagnetic stability

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Authors: Silpa Mariyam John, S. Baburaj, Prajit Geevarghese

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Diabetes accelerates pregnancy and can cause adverse effects on the fetus. Studies have shown that fetal abdominal circumference measured in ultrasound is an early parameter for the assessment of macrosomia. The objective of the study is to compare the fetal abdominal circumferences between diabetes and non-diabetic mothers. It was a comparative cross-sectional study conducted in a tertiary care hospital in Trivandrum, Kerala, with a sample size calculated as 95 for each group. All mothers taking antenatal care and delivering at the hospital were included after obtaining consent. The mothers and their newborns were divided into 2 groups (diabetic and non-diabetic). Relevant fetal biometry values were collected from medical records, and birth weight was measured by a calibrated electronic weighing machine after birth. The data were entered in MS EXCEL and analyzed. It was found that there is a significant relationship between the fetal abdominal circumference and birthweight in diabetic mothers during the first and third trimesters.

Keywords: newborn, diabetes, abdominal circumference, ultrasound

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Authors: Vanita Singh

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In developing countries, there are conflicting political agendas; policy makers have to prioritize issues from a list of issues competing for the limited resources. Thus, it is imperative to understand how some issues gain attention, and others lose in the policy circles. Multiple-Streams Theory of Kingdon (1984) is among the influential theories that help to understand the public policy process and is utilitarian for health policy makers to understand how certain health issues emerge on the policy agendas. The issue of maternal mortality was long standing in India and was linked with high birth rate thus the focus of maternal health policy was on family planning since India’s independence. However, a paradigm shift was noted in the maternal health policy in the year 1992 with the launch of Safe Motherhood Programme and then in the year 2005, when the agenda of maternal health policy became universalizing institutional deliveries and phasing-out of Traditional Birth Attendants (TBAs) from the health system. There were many solutions proposed by policy communities other than universalizing of institutional deliveries, including training of TBAs and improving socio-economic conditions of pregnant women. However, Government of India favored medical community, which was advocating for the policy of universalizing institutional delivery, and neglected the solutions proposed by other policy communities. It took almost 15 years for the advocates of institutional delivery to transform their proposed solution into a program - the Janani Suraksha Yojana (JSY), a safe-motherhood program promoting institutional delivery through cash incentives to pregnant women. Thus, the case of safe motherhood policy in India is worth studying to understand how certain issues/problems gain political attention and how advocacy work in policy circles. This paper attempts to understand the factors that favored the agenda of safe-motherhood in the policy circle in India, using John Kingdon’s Multiple-Stream model of agenda-setting. Through document analysis and literature review, the paper traces the evolution of safe motherhood program and maternal health policy. The study has used open source documents available on the website of Ministry of Health and Family Welfare, media reports (Times of India Archive) and related research papers. The documents analyzed include National health policy-1983, National Health Policy-2002, written reports of Ministry of Health and Family Welfare Department, National Rural Health Mission (NRHM) document, documents related to Janani Suraksha Yojana and research articles related to maternal health programme in India. The study finds that focusing events and credible indicators coupled with media attention has the potential to recognize a problem. The political elites favor clearly defined and well-accepted solutions. The trans-national organizations affect the agenda-setting process in a country through conditional resource provision. The closely-knit policy communities and political entrepreneurship are required for advocating solutions high on agendas. The study has implications for health policy makers in identifying factors that have the potential to affect the agenda-setting process for a desired policy agenda and identify the challenges in generating political priorities.

Keywords: agenda-setting, focusing events, Kingdon’s model, safe motherhood program India

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Authors: Cangir Uyarlar, E. Eren Gultepe, I. Sadi Cetingul, Ismail Bayram

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This study was conducted to investigate the effect of humic acid (Potassium Humate) at different levels on rations on the effects of both maternal and offspring health, metabolic parameters and immunity levels in transition dairy cows. For this purpose, 50 Holstein dairy cows divided 5 trial groups. Experimental groups were designed as follows: A) Control (0% Humas); B) 0.5 Humas (0,5% in concentrated diet); C) 1 Humas (1% in concentrated diet), D) 1,5 Humas (1,5% in concentrated diet), E) 2 Humas (2% in concentrated diet), respectively. The study lasted from the first day of the dry period to postpartum 30th day. Diets were prepared as isocaloric and isonitrogenic. In the experiment, the day on which the animals gave birth was accepted as ‘0 (zero)’ and blood was taken from tail vein (v. coccygea) at -60, -53, -46, -39, -32, -25, -18, -11, -4, 0, ; Colostrum samples were taken on days 0, 1 and 2; Blood samples were taken on days 0, 1, 2, 15 and 30 from the juguler vein (v. jugularis) of the new born calves. Total blood leukocyte, Lymphocyte, Monocyte, granulocytes, Hemoglobin, Hematocrit, MCV, MCH, MWC, RDW, PLT, MPV, PDW, PCT, NEFA, BHBA, Glucose, Total Cholesterol , Triglyceride, LDL, HDL, VLDL, ALT, AST, ALP, GGT and Total IgG levels and colostrum IgG levels were determined in this experiment. The results suggest that although the supplementation of humic acid at 2% level adversely affected to production parameters, the addition of humic acid (potassium humate) to the concentrate mix during the dry period (particularly 0.5 and 1% levels) may provide an increasing on mother and the offspring immunity, some improving on serum metabolism parameters and enhancing the milk production.

Keywords: humic acid, dairy cow, calf, immunity

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Authors: K. M. Damodara Gowda

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Background: Maternal health and nutrition are considered as the predominant factors influencing brain functional development. If the mother is free of illness and genetic defects, maternal nutrition would be one of the most critical factors affecting the brain development. Calorie restrictions cause significant impairment in spatial learning ability and the levels of Brain Derived Neurotrophic Factor (BDNF) in rats. But, the mechanism by which the prenatal under-nutrition leads to impairment in brain learning and memory function is still unclear. In the present study, prenatal Astaxanthin supplementation on BDNF level, spatial learning and memory performance in the offspring’s of normal, calorie restricted and Astaxanthin supplemented rats was investigated. Methodology: The rats were administered with 6mg and 12 mg of astaxanthin /kg bw for 21 days following which acquisition and retention of spatial memory was tested in a partially-baited eight arm radial maze. The BDNF level in different regions of the brain (cerebral cortex, hippocampus and cerebellum) was estimated by ELISA method. Results: Calorie restricted animals treated with astaxanthin made significantly more correct choices (P < 0.05), and fewer reference memory errors (P < 0.05) on the tenth day of training compared to offsprings of calorie restricted animals. Calorie restricted animals treated with astaxanthin also made significantly higher correct choices (P < 0.001) than untreated calorie restricted animals in a retention test 10 days after the training period. The mean BDNF level in cerebral cortex, Hippocampus and cerebellum in Calorie restricted animals treated with astaxanthin didnot show significant variation from that of control animals. Conclusion: Findings of the study indicated that memory and learning was impaired in the offspring’s of calorie restricted rats which was effectively modulated by astaxanthin at the dosage of 12 mg/kg body weight. In the same way the BDNF level at cerebral cortex, Hippocampus and Cerebellum was also declined in the offspring’s of calorie restricted animals, which was also found to be effectively normalized by astaxanthin.

Keywords: calorie restiction, learning, Memory, Cerebral cortex, Hippocampus, Cerebellum, BDNF, Astaxanthin

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Authors: Ankush Kalra, Mirza Masroor, Usha Manaktala, B. C. Koner, T. K. Mishra

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Introduction: Pre-eclampsia affects 3-5% of pregnancies worldwide and increases maternal-fetal morbidity and mortality. Reduced placental perfusion induces the release of biomolecules by the placenta into maternal circulation causing endothelial dysfunction. Zinc dependent matrix metalloproteinase-2 (MMP-2) may be up-regulated and interact with circulating factors of oxidative stress and inflammation to produce endothelial dysfunction in pre-eclampsia. Aim: To study the functional genetic polymorphism of MMP-2 gene (g-1306 C>T) in pre-eclampsia and its effect on serum MMP-2 levels in these patients. Method: Hundred pre-eclampsia patients and hundred age and gestation period matched healthy pregnant women with their consent were recruited in the study. Serum MMP-2 levels in all subjects were estimated using standard ELISA kits. MMP-2 gene (g.- 1306 C>T) SNPs were genotyped using whole blood by ASO-PCR. Result: The pre-eclampsia patients had higher serum levels of MMP-2 compared to the healthy pregnant (p < 0.05). Also the MMP-2 genotype was associated with significant alteration in the serum MMP-2 concentration in these patients (p < 0.05). Conclusion: This study results suggest an association of MMP-2 genetic polymorphism and serum levels of MMP-2 to the path physiology of hypertensive disorder of pregnancy.

Keywords: allele specific oligonucleotide polymerase chain reaction (ASO-PCR), enzyme linked immunosorbent assay (ELISA), matrix metalloproteinase-2 (MMP-2), pre-eclampsia

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Authors: Rafael Carlos C. Aniceto, Bryce Abraham M. Anos, Don Christian A. Cornel, Marjerie Brianna S. Go, Samantha Nicole U. Roque, Earl Christian C. Te

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Indigenous peoples (IPs) in the Philippines are a vulnerable, marginalized group in terms of health and overall well-being due to social inequities and cultural differences. National standards regarding maternal healthcare are geared towards facility-based delivery with modern medicine, health services, and skilled birth attendants. Standards and procedures of care for pregnant mothers do not take into account cultural differences between indigenous people and the majority of the population. There do exist, however, numerous other factors that cause relatively poorer health outcomes among indigenous peoples (IPs). This analytic cross-sectional study sought to determine the association between social determinants of health (SDH), focusing on status as indigenous peoples, and maternal health-related knowledge and attitudes (KA), and health behavior of the Dumagat-Agta indigenous people of Barangay Catablingan and Barangay San Marcelino, General Nakar, Quezon Province, and their utilization of health facilities for antenatal care, facility-based delivery and postpartum care, which would affect their health outcomes (that were not within the scope of this study). To quantitatively measure the primary/secondary exposures and outcomes, a total of 90 face-to-face interviews with IP and non-IP mothers were done. For qualitative information, participant observation among 6 communities (5 IP and 1 non-IP), 11 key informant interviews (traditional and modern health providers) and 4 focused group discussions among IP mothers were conducted. Primary quantitative analyses included chi-squared, T-test and binary logistic regression, while secondary qualitative analyses involved thematic analysis and triangulation. The researchers spent a total of 15 days in the community to learn the culture and participate in the practices of the Dumagat-Agta more intensively and deeply. Overall, utilization of all MNCHN services measured in the study was lower for IP mothers compared to their non-IP counterparts. After controlling for confounders measured in the study, IP status (primary exposure) was found to be significantly correlated with utilization of and adherence to two MNCHN-prescribed services: number of antenatal care check-ups and place of delivery (secondary outcomes). Findings show that being an indigenous mother leads to unfavorable social determinants of health, and if compounded by a difference in knowledge and attitudes, would then lead to poor levels of utilization of MNCHN-prescribed services. Key themes from qualitative analyses show that factors that affected utilization were: culture, land alienation, social discrimination, socioeconomic status, and relations between IPs and non-IPs, specifically with non-IP healthcare providers. The findings of this study aim to be used to help and guide in policy-making, to provide healthcare that is not only adequate and of quality, but more importantly, that addresses inequities stemming from various social determinants, and which is socio-culturally acceptable to indigenous communities. To address the root causes of health problems of IPs, there must be full recognition and exercise of their collective rights to communal assets, specifically land, and self-determination. This would improve maternal and child health outcomes to one of the most vulnerable and neglected sectors in society today.

Keywords: child health, indigenous people, knowledge-attitudes-practices, maternal health, social determinants of health

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Authors: Dejene Ermias Mekango, Mussie Alemayehu, Gebremedhin Berhe Gebregergs, Araya Abrha Medhanye, Gelila Goba

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Background: Maternal near miss (MNM) can be used as a proxy indicator of maternal mortality ratio. There is a huge gap in life time risk between Sub-Saharan Africa and developed countries. In Ethiopia, a significant number of women die each year from complications during pregnancy, childbirth and the post-partum period. Besides, a few studies have been performed on MNM, and little is known regarding determinant factors. This study aims to identify determinants of MNM among women in Tigray region, Northern Ethiopia. Methods: a case-control study in hospital found in Tigray region, Ethiopia was conducted from January 30 - March 30, 2016. The sample included 103 cases and 205 controls recruited from women seeking obstetric care at six public hospitals. Clients having a life-threatening obstetric complication including haemorrhage, hypertensive diseases of pregnancy, dystocia, infections, and anemia or clinical signs of severe anemia in women without haemorrhage were taken as cases and those with normal obstetric outcomes were considered as controls. Cases were selected based on proportional to size allocation while systematic sampling was employed for controls. Data were analyzed using SPSS version 20.0. Binary and multiple variable logistic regression (odds ratio) analyses were calculated with 95% CI. Results: The largest proportion of cases and controls was among the ages of20–29 years, accounting for37.9 %( 39) of cases and 31.7 %( 65) of controls. Roughly 90% of cases and controls were married. About two-thirds of controls and 45.6 %( 47) of cases had gestational age between 37-41 weeks. History of chronic medical conditions was reported in 55.3 %(57) of cases and 33.2%(68) of controls. Women with no formal education [AOR=3.2;95%CI:1.24, 8.12],being less than 16 years old at first pregnancy [AOR=2.5; 95%CI:1.12,5.63],induced labor[AOR=3; 95%CI:1.44, 6.17], history of Cesarean section (C-section) [AOR=4.6; 95%CI: 1.98, 7.61] or chronic medical disorder[AOR=3.5;95%CI:1.78, 6.93], and women who traveled more than 60 minutes before reaching their final place of care[AOR=2.8;95% CI: 1.19,6.35] all had higher odds of experiencing MNM. Conclusions: The Government of Ethiopia should continue its effort to address the lack of road and health facility access as well as education, which will help reduce MNM. Work should also be continued to educate women and providers about common predictors of MNM like the history of C-section, chronic illness, and teenage pregnancy. These efforts should be carried out at the facility, community, and individual levels. The targeted follow-up to women with a history of chronic disease and C-section could also be a practical way to reduce MNM.

Keywords: maternal near miss, severe obstetric hemorrhage, hypertensive disorder, c-section, Tigray, Ethiopia

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Authors: Sadia Munir

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Preeclampsia is the contributor to the worldwide maternal mortality of approximately 100,000 deaths a year. It complicates about 10% of all pregnancies and is the first cause of maternal admission to intensive care units. Predicting preeclampsia is a major challenge in obstetrics. More importantly, no major progress has been achieved in the treatment of preeclampsia. As placenta is the main cause of the disease, the only way to treat the disease is to extract placental and deliver the baby. In developed countries, the cost of an average case of preeclampsia is estimated at £9000. Interestingly, preeclampsia may have an impact on the health of mother or infant, beyond the pregnancy. We performed a systematic search of PubMed including the combination of terms such as preeclampsia, biomarkers, treatment, hypoxia, inflammation, oxidative stress, vascular endothelial growth factor A, activin A, inhibin A, placental growth factor, transforming growth factor β-1, Nodal, placenta, trophoblast cells, microRNAs. In this review, we have summarized current knowledge on the identification of potential biomarkers for the diagnosis of preeclampsia. Although these studies show promising data in early diagnosis of preeclampsia, the current value of these factors as biomarkers, for the precise prediction of preeclampsia, has its limitation. Therefore, future studies need to be done to support some of the very promising and interesting data to develop affordable and widely available tests for early detection and treatment of preeclampsia.

Keywords: activin, biomarkers, growth factors, miroRNA

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Authors: Utsamani Cintyamena, Sandra Frans Olivia, Shita Lisyadewi, Ariane Utomo

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Family planning is one of fundamental aspects in preventing maternal morbidity and mortality. However, the prevalence rate of Indonesia’s married women in choosing contraception is low. This study purpose to assess opportunities and challenges in family planning. Methodology: We conducted a qualitative study in Banyumas District which has huge reduction of maternal mortality rate from 2013 to 2015. Four focus group discussions and four small group discussions were conducted to assess knowledge and attitude of women in using contraceptive and their method of choice, as well as in-depth interview to four health workers and two family planning field officers as triangulation. Thematic content analysis was done manually. Results: Key themes emerge across interviews including (1) first choice of contraception is the one that they previously had, provided that they did not encountered problems with it, (2) rumor and fear of side effect affected their method of choice, (3) selection of contraceptive method was influenced by approval of husband, believes, and role model in community. Conclusion: Collaboration of health worker, family planning field officers, community, as well as support from stakeholder, must be increased to socializing family planning.

Keywords: attitude, challenge, chance, family planning, knowledge

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Authors: Sri Widati, Ira Nurmala

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The Se’i Tradition was considered to contribute highly to the high maternal mortality rate in South Amanuban, East Nusa Tenggara. This tradition is still preserved due to the social support that has influenced the decision to carry out the Se’i to pregnant women and post-partum women. The purpose of this study is to analyze this social support towards the Se’i Tradition on pregnant women in East Nusa Tenggara. This research was an explorative study with in-depth interviews, observations, and focus group discussions (FGD) in collecting the data. This study showed that emotional support towards Se’i was commonly given by families, specifically by the mother-in laws. Instrumental support was shown by the husbands and the traditional midwives who helped delivered the babies. Informational support was found on the pregnant women and their mother-in laws. Appraisal support was given by all the neighbors and relatives of the pregnant women by telling how comfortable it was to go through this tradition which eventually affected those women to carry it out themselves. The Se’i Tradition is still carried out and mostly supported by the relatives of the pregnant women. The first recommendation of this study is to suggest people to only follow the suggestions from the local health staff to give birth in the local health centers and not to do the tradition anymore. The second recommendation is to urge the government to give support in the form of transportation facilities for pregnant women to reach the local health staff.

Keywords: the Se’i tradition, social support, pregnant women, maternal mortality, post-partum women

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Authors: Renate Gericke, Carol Long

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Despite the robust empirical support of attachment, advancement in the description and conceptualization of attachment has been slow and has not significantly advanced beyond the identification of attachment security or type (namely, secure, avoidant, ambivalent and disorganized). This has continued despite papers arguing for theoretical refinement in the classification of attachment presentations. For thinking and practice to advance, it is critically important that these categories and their assessment be interrogated in different contexts and across developmental age. To achieve this, a quantitative design was used with descriptive and inferential statistics, and general linear models were employed to analyze the data. The Attachment Story Completion Test (ASCT) was administered to 105 children between the ages of eight and twelve from socio-economically deprived contexts with high exposure to trauma. A staggering 93% of the children had insecure attachments (specifically, avoidant 37%, disorganized 34% and ambivalent 22%) and attachment was more complex than currently conceptualized in the attachment literature. Primary attachment did not only present as one of four discreet categories, but 70% of the sample had a complex attachment with more than one type of maternal attachment style. Attachment intensity also varied along a continuum (between 1 and 5). The findings have implications for a) research that has not considered the potential complexity of attachment or attachment intensity, b) policy to more actively support mother-infant dyads, particularly in high-risk contexts and c) question the applicability of a western conceptualization of a primary maternal attachment figure in non-western collectivist societies.

Keywords: attachment, children at risk, middle childhood, non-western context

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Authors: Janine Just, Kerstin Meints

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The research aims to compare vocabulary size and grammatical development between US American English- and British English-speaking children at age 2;0. As there is evidence that precocious children with large vocabularies develop grammar skills earlier than their typically developing peers, it was investigated if this also holds true across varieties of English. Thus, if US American children start to produce words earlier than their British counterparts, this could mean that US children are also at an advantage in the early developmental stages of acquiring grammar. This research employs a British English adaptation of the MacArthur-Bates CDI Words and Sentences (Lincoln Toddler CDI) to compare vocabulary and also grammar scores with the updated US Toddler CDI norms. At first, the Lincoln TCDI was assessed for its concurrent validity with the Preschool Language Scale (PLS-5 UK). This showed high correlations for the vocabulary and grammar subscales between the tests. In addition, the frequency of the Toddler CDI’s words was also compared using American and British English corpora of adult spoken and written language. A paired-samples t-test found a significant difference in word frequency between the British and the American CDI demonstrating that the TCDI’s words were indeed of higher frequency in British English. We then compared language and grammar scores between US (N = 135) and British children (N = 96). A two-way between groups ANOVA examined if the two samples differed in terms of SES (i.e. maternal education) by investigating the impact of SES and country on vocabulary and sentence complexity. The two samples did not differ in terms of maternal education as the interaction effects between SES and country were not significant. In most cases, scores were not significantly different between US and British children, for example, for overall word production and most grammatical subscales (i.e. use of words, over- regularizations, complex sentences, word combinations). However, in-depth analysis showed that US children were significantly better than British children at using some noun categories (i.e. people, objects, places) and several categories marking early grammatical development (i.e. pronouns, prepositions, quantifiers, helping words). However, the effect sizes were small. Significant differences for grammar were found for irregular word forms and progressive tense suffixes. US children were more advanced in their use of these grammatical categories, but the effect sizes were small. In sum, while differences exist in terms of vocabulary and grammar ability, favouring US children, effect sizes were small. It can be concluded that most British children are ‘catching up’ with their US American peers at age 2;0. Implications of this research will be discussed.

Keywords: first language acquisition, grammar, parent report instrument, vocabulary

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Authors: Davod Ahmadigheidari, Isabel Alvarez, Kate Sinclair, Marnie Davidson, Patrick Cortbaoui, Hugo Melgar-Quiñonez

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The burden of collecting water tends to disproportionately fall on women and girls in low-income countries. Specifically, women spend between one to eight hours per day fetching water for domestic use in Sub-Saharan Africa. While there has been research done on the global time burden for collecting water, it has been mainly focused on water quality parameters; leaving the relationship between water fetching and health outcomes understudied. There is little available evidence regarding the relationship between water fetching and maternal child care practices. The main objective of this study was to help fill the aforementioned gap in the literature. Data from two surveys in Ethiopia and Malawi conducted by CARE Canada in 2016-2017 were used. Descriptive statistics indicate that women were predominantly responsible for collecting water in both Ethiopia (87%) and Malawi (99%) respectively, with the majority spending more than 30 minutes per day on water collection. With regards to child care practices, in both countries, breastfeeding was relatively high (77% and 82%, respectively); and treatment for malnutrition was low (15% and 8%, respectively). However, the same consistency was not found for weighing; in Ethiopia only 16% took their children for weighting in contrast to 94% in Malawi. These three practices were summed to create one variable for regressions analyses. Unadjusted logistic regression findings showed that only in Ethiopia was time fetching water significantly associated with child care practices. Once adjusted for covariates, this relationship was no longer found to be significant. Adjusted logistic regressions also showed that the factors that did influence child care practices differed slightly between the two countries. In Ethiopia, a lack of access to community water supply (OR= 0.668; P=0.010), poor attitudes towards gender equality (OR= 0.608; P=0.001), no access to land and (OR=0.603; P=0.000), significantly decreased a women’s odd of using positive childcare practices. Notably, being young women between 15-24 years (OR=2.308; P=0.017), and 25-29 (OR=2.065; P=0.028) increased probability of using positive childcare practices. Whereas in Malawi, higher maternal age, low decision-making power, significantly decreased a women’s odd of using positive childcare practices. In conclusion, this study found that even though amount of time spent by women fetching water makes a difference for childcare practices, it is not significantly related to women’s child care practices when controlling the covariates. Importantly, women’s age contributes to child care practices in Ethiopia and Malawi.

Keywords: time fetching water, community water supply, women’s child care practices, Ethiopia, Malawi

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Authors: Shan Jiang

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Child aggression represents a significant global issue, with its familial determinants being crucial. Family is a vital context for child development, but prior research on the impact of parental assortative mating on child aggression is limited. This study investigates the effects of assortative mating on child aggression, elucidating the mediating mechanisms involved and examining gender-specific responses, within a substantial sample of 10,570 parents and their children, grades 1-6, in Hangzhou City, Zhejiang Province, China. The findings indicate that children exhibit a significant increase in aggressive behaviors when maternal income surpasses paternal income, contrasted with families where the father's income is higher. The study identifies family communication, co-parenting quality, and parental problem-solving strategies as significant mediators in the relationship between parental income/education differences and child aggression. This research contributes to understanding the parental influence on child behavior within the family system and offers valuable implications for child protection policy and intervention strategies.

Keywords: assortative mating, aggression, children, family

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Authors: Rita SahaRay, Ganesh Dutta

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In this article, experimental situations are considered where a main effects plan is to be used to study m two-level factors using n runs which are partitioned into b blocks, not necessarily of same size. Assuming the block sizes to be even for all blocks, for the case n ≡ 2 (mod 4), optimal designs are obtained with respect to type 1 and type 2 optimality criteria in the class of designs providing estimation of all main effects orthogonal to the block effects. In practice, such orthogonal estimation of main effects is often a desirable condition. In the wider class of all available m two level even sized blocked main effects plans, where the factors do not occur at high and low levels equally often in each block, E-optimal designs are also characterized. Simple construction methods based on Hadamard matrices and Kronecker product for these optimal designs are presented.

Keywords: design matrix, Hadamard matrix, Kronecker product, type 1 criteria, type 2 criteria

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Authors: Chinwe Okpoko, Vivian Atasie

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One of the leading causes of death amongst women of child-bearing age in southeast Nigeria is pregnancy. Women in the reproductive age group die at a higher rate than men of the same age bracket. Furthermore, most maternal deaths occur among poor women who live in rural communities, and who generally fall within the low socio-economic group in society. Failure of policy makers and the media to create the strategic awareness and communication that conform with the sensibilities of this group account, in part, for the persistence of this malaise. Family planning (FP) is an essential component of safe motherhood, which is designed to ensure that women receive high-quality care to achieve an optimum level of health of mother and infant. The aim is to control the number of children a woman can give birth to and prevent maternal and child mortality and morbidity. This is what sustainable development goal (SDG) health target of World Health Organization (WHO) also strives to achieve. FP programmes reduce exposure to the risks of child-bearing. Indeed, most maternal deaths in the developing world can be prevented by fully investing simultaneously in FP and maternal and new-born care. Given the intrinsic value of communication in health care delivery, it is vital to adopt the most efficacious means of awareness creation and communication amongst rural women in FP. In a country where over 50% of her population resides in rural areas with attendant low-level profile standard of living, the need to communicate health information like FP through indigenous channels becomes pertinent. Interpersonal communication amongst family, friends, religious groups and other associations, is an efficacious means of communicating social issues in rural Africa. Communication in informal settings identifies with the values and social context of the recipients. This study therefore sought to determine the place of interpersonal communication on the knowledge of rural women on FP and how it influences uptake of FP. Descriptive survey design was used in the study, with interviewer administered questionnaire constituting the instrument for data collection. The questionnaire was administered on 385 women from rural communities in southeast Nigeria. The results show that majority (58.5%) of the respondents agreed that interpersonal communication helps women understand how to plan their family size. Many rural women (82%) prefer the short term natural method to the more effective modern contraceptive methods (38.1%). Husbands’ approval of FP, as indicated in the Mean response of 2.56, is a major factor that accounts for the adoption of FP messages among rural women. Socio-demographic data also reveal that educational attainment and/or exposure influenced women’s acceptance or otherwise of FP messages. The study, therefore, recommends amongst others, the targeting of husbands in subsequent FP communication interventions, since they play major role on contraceptive usage.

Keywords: family planning, interpersonal communication, interpersonal interaction, traditional communication

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Authors: Kristel Dame Bañez Sumagaysay, Marie Victoria Cruz-javier

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The current subject is a case of a 21 year-old woman at 29 1/7 weeks of gestation with Pre-B cell Acute Lymphoblastic Leukemia who was admitted to the coronary care unit (CCU) of the St. Luke’s Medical Center-Global City for Severe Acute Respiratory Distress Syndrome (ARDS) secondary to hospital-acquired pneumonia secondary to pneumocystis jiroveci; central line-associated bloodstream infection (E. aerogenes). She presented with chronic hypoxemia caused by Pulmonary edema, probably secondary to heart failure secondary to cardiomyopathy chemotherapy-induced. Due to worsening feto-maternal status, extracorporeal membrane oxygenation (ECMO) for respiratory support was instituted, and an elective cesarean section was done due to multiple maternal factors and deteriorating health status under total intravenous anesthesia assisted by veno-venous extracorporeal membrane oxygenation. She delivered a live preterm newborn male, APGAR Score: 1, 0, 0, birth weight 985 grams, birth length: 40.5cm, small for gestational age.

Keywords: extracorporeal membrane oxygenation, pre-b cell acute lymphoblastic leukemia, severe acute respiratory distress syndrome, ethical dilemmas

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