Injury-related infant mortality in West Virginia, 2010-2014

Background and objective Infant mortality in United States is high relative to other more developed nations. Therefore, there is a need to curb this trend, especially in states with high infant mortality rates. Hence, this research investigated and examined characteristics associated with injury-related infant death in West Virginia. The objective of this retrospective study was to 1) investigate maternal and infant characteristics associated with injury-related infant deaths in West Virginia, 2) examine the relationship between unintentional-injury-related infant death and rurality in West Virginia, holding other variables in the model constant, and 3) compare differences in the unintentional-injury related infant mortality rate between West Virginia and the United States as a whole, stratified by race/ethnicity. Methods De-identified linked birth-infant death data for the period 2010-2014 were sourced from the West Virginia Bureau for Public Health, Charleston WV and the United States linked birth-death vital records from the Centers for Disease Control website. Additionally, 2013 Urban Influence Codes used for urban/rural classification were sourced from the United States Department of Agriculture Economic Research Service. A generalized linear model with binomial distribution was used to determine characteristics associated with injury-related infant death, and a generalized linear mixed model with binomial distribution was used to determine the relationship between unintentional injury-injury related infant death and rurality, holding other variables in the model constant. A non-model-based method, which follows a simple Poisson distribution, was used to calculate the infant mortality rate in West Virginia and the United States, stratified by race. Results Maternal characteristics associated with injury-related infant mortality in West Virginia were race/ethnicity ( = 7.48, p = .03) and smoking during pregnancy ( , p \u3c .00). Risk of a Non-Hispanic Black infant for an injury-related death was 4.0 (95% CI: 1.7 - 9.3) times that of infants of other race/ethnicities. Unintentional injury-relate infant death was significantly associated with rurality, race/ethnicity and a rurality-smoking during pregnancy interaction (p=0.02, p=0.3, and p=0.05 respectively). The relative risk for unintentional injury-related infant death in rural versus urban counties was 1.7 (95% CI: 0.7- 3.8), whereas the unintentional injury-related infant mortality rate for West Virginia and the United States Non-Hispanic Black population was 83.2 (95% CI: 26.8 - 258.0) deaths per 100,000 live births and 57.5 (95% CI: 54.8 - 60.3) deaths per 100,000 live births, respectively. Conclusion Injury-related infant mortality is associated with race/ethnicity and smoking during pregnancy. Smoking during pregnancy and living in rural counties was related to higher risk of unintentional injury-related infant death than living in urban counties, whether or not the mother smoked during pregnancy. In general, the unintentional injury-related infant mortality rate in West Virginia and the nation are similar. Findings should be interpreted with caution due to the small number of cases. Nevertheless, this study provides important information to public health stakeholders, at both the state and local levels, for designing interventions for reduction or prevention of injury-related infant mortality in West Virginia

Maternal Characteristics Associated with Injury-related Infant Death in West Virginia, 2010-2014

Although injury-related deaths have been documented among children and adult populations, insufficient attention has been directed towards injury-related infant deaths. The objective of this retrospective study was to investigate maternal and infant characteristics associated with injury-related infant deaths in West Virginia. Birth and infant mortality data for 2010–2014 were sourced from the West Virginia Bureau for Public Health, Charleston. Relative risk was calculated using log-binomial regression utilizing generalized estimating equations. Maternal characteristics associated with injury-related infant mortality in West Virginia were race/ethnicity ( = 7.48, p = .03), and smoking during pregnancy (, p \u3c .00). Risk of a Black Non-Hispanic infant suffering an injury-related death was 4.0 (95% CL 1.7, 9.3) times that of infants of other races/ethnicities. Risk of an infant dying from an injury-related cause, if the mother smoked during pregnancy, was 2.9 (95% CL 1.6, 5.0) times the risk of such a death if maternal smoking status during pregnancy is unknown or no smoking, controlling for race/ethnicity. This study provides important information to public health stakeholders at both the state and local levels in designing interventions for partial reduction or prevention of injury-related infant mortality in West Virginia

A Policy Brief on Adopting the Somali Camel for Enhanced Profitability and Pastoral Resilience in Northern Kenya

Persistent drought and high temperatures in Isiolo and Marsabit counties of northern Kenya repeatedly devastate livestock herds particularly cattle making the pastoralists less resilient, more vulnerable to climate change and poor. To address this challenge, an IGAD funded project promoted adoption of Somali camel breed, trained farmers on improved management and also estimated potential profitability of rearing the camel. Through the project, trainers were trained and facilitated to train 240 peri-urban Somali camel producers in Isiolo and Marsabit on breeding, health, routine husbandry and marketing. Impact study documenting positive stories of change was conducted at the end. Producers who hitherto made zero money from their camels were making KES. 42,000 a month from sale of 20 litres of milk daily from only 5 milking camels; producers had adopted a new grazing management strategy that ensured daily access of the camel milk market and conservation of grazing areas around settlements; motor bikes had been adopted as means delivering milk to collection centers thus creating jobs for the youth; the beneficiary producers were spending more money on production inputs. In terms of policy, the county governments of Isiolo and Marsabit need to appreciate the huge business potential in Somali camel rearing and the magnitude of positive change that can be brought about by capacity training of producers on improved camel management technologies and agree to allocate more funds in support of livestock production extension services

Continuous Invasion by Respiratory Viruses Observed in Rural Households During a Respiratory Syncytial Virus Seasonal Outbreak in Coastal Kenya.

BACKGROUND: Households are high-intensity close-contact environments favorable for transmission of respiratory viruses, yet little is known for low-income settings. METHODS: Active surveillance was completed on 47 households in rural coastal Kenya over 6 months during a respiratory syncytial virus (RSV) season. Nasopharyngeal swabs (NPSs) were taken from 483 household members twice weekly irrespective of symptoms. Using molecular diagnostics, NPSs from 6 households were screened for 15 respiratory viruses and the remainder of households only for the most frequent viruses observed: rhinovirus (RV), human coronavirus (HCoV; comprising strains 229E, OC43, and NL63), adenovirus (AdV), and RSV (A and B). RESULTS: Of 16928 NPSs tested for the common viruses, 4259 (25.2%) were positive for ≥1 target; 596 (13.8%) had coinfections. Detection frequencies were 10.5% RV (1780), 7.5% HCoV (1274), 7.3% AdV (1232), and 3.2% RSV (537). On average, each household and individual had 6 and 3 different viruses detected over the study period, respectively. Rhinovirus and HCoV were detected in all the 47 households while AdV and RSV were detected in 45 (95.7%) and 40 (85.1%) households, respectively. The individual risk of infection over the 6-month period was 93.4%, 80.1%, 71.6%, 61.5%, and 37.1% for any virus, RV, HCoV, AdV, and RSV, respectively. NPSs collected during symptomatic days and from younger age groups had higher prevalence of virus detection relative to respective counterparts. RSV was underrepresented in households relative to hospital admission data. CONCLUSIONS: In this household setting, respiratory virus infections and associated illness are ubiquitous. Future studies should address the health and economic implications of these observations

"You cannot know if it's a baby or not a baby": uptake, provision and perceptions of antenatal care and routine antenatal ultrasound scanning in rural Kenya.

BACKGROUND: Antenatal care early in pregnancy enables service providers to identify and manage risks to mother and fetus. In the global north, ultrasound scans are routinely offered in pregnancy to provide an accurate estimate of gestational age and identify potential problems. In sub-Saharan Africa, such services are rarely available and women often delay initiating antenatal care. This study describes the uptake and provision of antenatal care in a rural Kenyan hospital and explores how pregnant women and healthcare providers perceived the provision of ultrasound scanning, following its introduction in an international foetal growth study. METHODS: A descriptive study, using qualitative and quantitative methods, was conducted in Kilifi District Hospital, Kenya, between June 2011 and April 2012. In-depth interviews were conducted with 10 nurses working in the antenatal clinic (ANC) and 59 pregnant women attending ANC. Structured observations of 357 ANC consultations and 30 ultrasound scans were made. RESULTS: Women sought antenatal care for information about the health of their baby and the protection provided by the ANC services. Uncertainty about pregnancy status contributed to delay in ANC attendance; more than 78 % of women were over 20 weeks' gestation at their first visit. Healthcare workers found it difficult to detect pregnancies below 16 weeks gestation and, accurate assessment of gestational age below 20 weeks' gestation could be problematic. Provision of services depended on the pregnancy being detected and gestational age assessed. The "seeing", made possible through ultrasound scanning was perceived by pregnant women and healthcare workers to be beneficial: confirming the pregnancy, and providing reassurance about the fetus' condition. Few participants raised concerns about ultrasound scanning. CONCLUSIONS: Uncertainty about pregnancy status and gestational age for women and healthcare providers is a key factor influencing timing of ANC attendance, contributing to delays and restricting early provision of ANC services. Ultrasound scanning was perceived to enhance antenatal care through confirmation of pregnancy status and enabling more accurate estimation of gestational age and the health status of the fetus. There is a need to make available more affordable means of pregnancy testing as a strategy towards encouraging early attendance, and delivery of antenatal care

Environmental, socio-demographic and behavioural determinants of malaria risk in the western Kenyan highlands: a case–control study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73660/1/j.1365-3156.2009.02370.x.pd

The PRECISE (PREgnancy Care Integrating translational Science, Everywhere) database: open-access data collection in maternal and newborn health

In less-resourced settings, adverse pregnancy outcome rates are unacceptably high. To effect improvement, we need accurate epidemiological data about rates of death and morbidity, as well as social determinants of health and processes of care, and from each country (or region) to contextualise strategies. The PRECISE database is a unique core infrastructure of a generic, unified data collection platform. It is built on previous work in data harmonisation, outcome and data field standardisation, open-access software (District Health Information System 2 and the Baobab Laboratory Information Management System), and clinical research networks. The database contains globally-recommended indicators included in Health Management Information System recording and reporting forms. It comprises key outcomes (maternal and perinatal death), life-saving interventions (Human Immunodeficiency Virus testing, blood pressure measurement, iron therapy, uterotonic use after delivery, postpartum maternal assessment within 48 h of birth, and newborn resuscitation, immediate skin-to-skin contact, and immediate drying), and an additional 17 core administrative variables for the mother and babies. In addition, the database has a suite of additional modules for ‘deep phenotyping’ based on established tools. These include social determinants of health (including socioeconomic status, nutrition and the environment), maternal comorbidities, mental health, violence against women and health systems. The database has the potential to enable future high-quality epidemiological research integrated with clinical care and discovery bioscience

Harnessing the PRECISE network as a platform to strengthen global capacity for maternal and child health research in sub-Saharan Africa

It is widely acknowledged across the global health sector that research programmes need to be designed and implemented in a way that maximise opportunities for strengthening local capacity. This paper examines how the United Kingdom Research and Innovation (UKRI) Grand Challenges Research Fund (GCRF) funded PRECISE (PREgnancy Care Integrating translational Science, Everywhere) Network has been established as a platform to strengthen global capacity for research focused on the improvement of maternal, fetal and newborn health in subSaharan Africa. Best practice principles outlined in an ESSENCE on Health Research report have been considered in relation to the PRECISE Network capacity-building activities described in this paper. These activities are described at the individual, programmatic and institutional levels, and successes, challenges and recommendations for future work are outlined. The paper concludes that the PRECISE leadership have an opportunity to review and refresh activity plans for capacity building at this stage in the project to build on achievements to date

Interactions between the Physical and Social Environments with Adverse Pregnancy Events Related to Placental Disorders—A Scoping Review

Background: Due to different social and physical environments across Africa, understanding how these environments differ in interacting with placental disorders will play an important role in developing effective interventions. Methods: A scoping review was conducted, to identify current knowledge on interactions between the physical and social environment and the incidence of placental disease in Africa. Results: Heavy metals were said to be harmful when environmental concentrations are beyond critical limits. Education level, maternal age, attendance of antenatal care and parity were the most investigated social determinants. Conclusions: More evidence is needed to determine the relationships between the environment and placental function in Africa. The results show that understanding the nature of the relationship between social determinants of health (SDH) and placental health outcomes plays a pivotal role in understanding the risk in the heterogenous communities in Africa