Factors associated with short birth interval in low- And middle-income countries: A systematic review

Background: There is ample evidence of associations between short birth interval and adverse maternal and child health outcomes, including infant and maternal mortality. Short birth interval is more common among women in low- and middle-income countries. Identifying actionable aspects of short birth interval is necessary to address the problem. To our knowledge, this is the first systematic review to systematize evidence on risk factors for short birth interval in low- and middle-income countries. Methods: A systematic mixed studies review searched PubMed, Embase, LILACS, and Popline databases for empirical studies on the topic. We included documents in English, Spanish, French, Italian, and Portuguese, without date restriction. Two independent reviewers screened the articles and extracted the data. We used the Mixed Methods Appraisal Tool to conduct a quality appraisal of the included studies. To accommodate variable definition of factors and outcomes, we present only a narrative synthesis of the findings. Results: Forty-three of an initial 2802 documents met inclusion criteria, 30 of them observational studies and 14 published after 2010. Twenty-one studies came from Africa, 18 from Asia, and four from Latin America. Thirty-two reported quantitative studies (16 studies reported odds ratio or relative risk, 16 studies reported hazard ratio), 10 qualitative studies, and one a mixed-methods study. Studies most commonly explored education and age of the mother, previous pregnancy outcome, breastfeeding, contraception, socioeconomic level, parity, and sex of the preceding child. For most factors, studies reported both positive and negative associations with short birth interval. Shorter breastfeeding and female sex of the previous child were the only factors consistently associated with short birth interval. The quantitative and qualitative studies reported largely non-overlapping results. Conclusions: Promotion of breastfeeding could help to reduce short birth interval and has many other benefits. Addressing the preference for a male child is complex and a longer-term challenge. Future quantitative research could examine associations between birth interval and factors reported in qualitative studies, use longitudinal and experimental designs, ensure consistency in outcome and exposure definitions, and include Latin American countries. Trial registration: Prospectively registered on PROSPERO (International Prospective Register for Systematic Reviews) under registration number CRD42018117654. © 2020 The Author(s)

Impact of home visits to pregnant women and their spouses on gender norms and dynamics in Bauchi state, Nigeria : narratives from visited men and women

A trial program involving universal home visits to pregnant women and their spouses, with the intention to increase male involvement in pregnancy and childbirth, showed improvements in actionable risk factors and in maternal morbidity rates. This analysis report indicates that the visits improved men’s support for antenatal care, immunization, and seeking help for danger signs; increased spousal communication; led to changes in perceptions about gender violence and promoted non-violent gender relationships. However, the men’s stories described a continuing paternalistic, male-dominant position in decision-making.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR

“Kunika women are always sick” : views from community focus groups on short birth interval (kunika) in Bauchi state, northern Nigeria

The word kunika in the Hausa language describes a woman becoming pregnant before weaning her last child (pregnant while breast feeding). In support of culturally safe child spacing in Bauchi State, North East Nigeria, the study explores local perspectives about kunika and its consequences. Family size in this area is large, and polygamy is common. Some 57% of women in Bauchi have no education, compared with 36% nationally. Use of contraception is minimal. In the Bauchi context men continue to dominate decision-making about reproductive health (and ill-health) and sexual activity.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR

Causes of short birth interval (kunika) in Bauchi State, Nigeria : systematizing local knowledge with fuzzy cognitive mapping

In Bauchi State (northern Nigeria), “kunika” describes a short interval between successive births, understood as becoming pregnant again before the previous child is weaned. Participants of the study mapped common causes of kunika: frequent sex; not using modern or traditional contraception; and family dynamics. Women indicated forced sex as an important cause, but men focused on lack of awareness about contraception and fear of side effects. Promoting contraception is unlikely to be enough on its own to reduce kunika. The summary maps can help local stakeholders to co-design culturally safe ways of reducing kunika

The impact of universal home visits with pregnant women and their spouses on maternal outcomes: a cluster randomised controlled trial in Bauchi State, Nigeria

In Bauchi State (Nigeria) maternal morbidity is associated with domestic violence, heavy work in pregnancy, ignorance of danger signs, and lack of spousal communication. This cluster randomized controlled trial tested the impact of universal home visits where risk factors were discussed with pregnant women and their spouses, to precipitate household actions that protect pregnant women. Universal home visits which share evidence and provoke discussion between pregnant women and their husbands can reduce maternal morbidity without an increased load on facilities for antenatal and delivery care

Male responsibility and maternal morbidity: a cross-sectional study in two Nigerian states

<p>Abstract</p> <p>Background</p> <p>Nigeria continues to have high rates of maternal morbidity and mortality. This is partly associated with lack of adequate obstetric care, partly with high risks in pregnancy, including heavy work. We examined actionable risk factors and underlying determinants at community level in Bauchi and Cross River States of Nigeria, including several related to male responsibility in pregnancy.</p> <p>Method</p> <p>In 2009, field teams visited a stratified (urban/rural) last stage random sample of 180 enumeration areas drawn from the most recent censuses in each of Bauchi and Cross River states. A structured questionnaire administered in face-to-face interviews with women aged 15-49 years documented education, income, recent birth history, knowledge and attitudes related to safe birth, and deliveries in the last three years. Closed questions covered female genital mutilation, intimate partner violence (IPV) in the last year, IPV during the last pregnancy, work during the last pregnancy, and support during pregnancy. The outcome was complications in pregnancy and delivery (eclampsia, sepsis, bleeding) among survivors of childbirth in the last three years. We adjusted bivariate and multivariate analysis for clustering.</p> <p>Findings</p> <p>The most consistent and prominent of 28 candidate risk factors and underlying determinants for non-fatal maternal morbidity was intimate partner violence (IPV) during pregnancy (ORa 2.15, 95%CIca 1.43-3.24 in Bauchi and ORa 1.5, 95%CI 1.20-2.03 in Cross River). Other spouse-related factors in the multivariate model included not discussing pregnancy with the spouse and, independently, IPV in the last year. Shortage of food in the last week was a factor in both Bauchi (ORa 1.66, 95%CIca 1.22-2.26) and Cross River (ORa 1.32, 95%CIca 1.15-1.53). Female genital mutilation was a factor among less well to do Bauchi women (ORa 2.1, 95%CIca 1.39-3.17) and all Cross River women (ORa 1.23, 95%CIca 1.1-1.5).</p> <p>Interpretation</p> <p>Enhancing clinical protocols and skills can only benefit women in Nigeria and elsewhere. But the violence women experience throughout their lives – genital mutilation, domestic violence, and steep power gradients – is accentuated through pregnancy and childbirth, when women are most vulnerable. IPV especially in pregnancy, women's fear of husbands or partners and not discussing pregnancy are all within men's capacity to change.</p

One size does not fit all: local determinants of measles vaccination in four districts of Pakistan

Common factors are associated with vaccination. However, despite common factors the pattern of variables related to measles vaccination differs between and within districts. In this study children were more likely to receive measles vaccination if their mother had any formal education, if she knew at least one vaccine preventable disease, and if she had not heard of any bad effects of vaccination. In rural areas, living within 5 km of a vaccination facility or in a community visited by a vaccination team were factors associated with vaccination, as was the mother receiving information about vaccinations