276 research outputs found
Quantifying primaquine effectiveness and improving adherence: a round table discussion of the APMEN Vivax Working Group
The goal to eliminate malaria from the Asia-Pacific by 2030
will require the safe and widespread delivery of effective
radical cure of malaria. In October 2017, the Asia Pacific
Malaria Elimination Network Vivax Working Group met to discuss
the impediments to primaquine (PQ) radical cure, how these can
be overcome and the methodological difficulties in assessing
clinical effectiveness of radical cure. The salient discussions
of this meeting which involved 110 representatives from 18
partner countries and 21 institutional partner organizations are
reported. Context specific strategies to improve adherence are
needed to increase understanding and awareness of PQ within
affected communities; these must include education and health
promotion programs. Lessons learned from other disease programs
highlight that a package of approaches has the greatest
potential to change patient and prescriber habits, however
optimizing the components of this approach and quantifying their
effectiveness is challenging. In a trial setting, the reactivity
of participants results in patients altering their behaviour and
creates inherent bias. Although bias can be reduced by
integrating data collection into the routine health care and
surveillance systems, this comes at a cost of decreasing the
detection of clinical outcomes. Measuring adherence and the
factors that relate to it, also requires an in-depth
understanding of the context and the underlying sociocultural
logic that supports it. Reaching the elimination goal will
require innovative approaches to improve radical cure for vivax
malaria, as well as the methods to evaluate its effectiveness
Maternal immunization: A call to accelerate progress
Maternal immunization provides an excellent
evidence-based strategy for preventing severe disease and
decreasing neonatal and infant mortality. A substantial
proportion of these deaths are due to infectious diseases, most
of them vaccine-preventable, then, there is a real opportunity
for intervention. Maternal immunization has been an
underexploited area for many years, with the exception of
neonatal tetanus. There are now programs for influenza and
acellular pertussis vaccination in many countries and two
maternal vaccine targets under development are focused on
decreasing the burden of infant respiratory syncytial virus
(RSV) and Group B Streptococcus (GBS). Bodies like the Strategic
Advisory Group of Experts (SAGE) on Immunization established by
the WHO, the Global Vaccine Action Plan (GVAP) and Gavi, The
Vaccine Alliance, have recognized the relevance of maternal
immunization on several occasions. However, why is the field not
moving faster, as one might expect? Major initiatives and
programs should consider spelling out more clearly the role and
benefits of this intervention and calling for specific actions,
including future strategic approaches for the post 2020
immunization strategy following the GVAP; and single out the
area as one of its priorities as a key component of immunization
across the life course. While waiting for the new vaccines like
RSV and GBS and optimizing the use of influenza and pertussis
there is momentum now to coordinate efforts, address the missing
information and action gaps, and call to accelerate progress
Malaria in pregnancy: challenges for control and the need for urgent action
Malaria in pregnancy has a devastating effect on the health of mothers and their babies, and is an important cause of maternal and infant mortality and morbidity.1 The greatest effect of malaria in pregnancy is concentrated in sub-Saharan Africa and is associated with Plasmodium falciparum infection. However, pregnant women are also at risk of Plasmodium vivax malaria. Although its burden seems to be lower than that of P falciparum, P vivax malaria is still associated with harmful consequences for maternal and infant health
Determinants of institutional delivery among young married women in Nepal: Evidence from the Nepal Demographic and Health Survey, 2011
OBJECTIVES: To identify the determinants of institutional
delivery among young married women in Nepal. DESIGN: Nepal
Demographic and Health Survey (NDHS) data sets 2011 were
analysed. Bivariate and multivariate logistic regression
analyses were performed using a subset of 1662 ever-married
young women (aged 15-24 years). OUTCOME MEASURE: Place of
delivery. RESULTS: The rate of institutional delivery among
young married women was 46%, which is higher than the national
average (35%) among all women of reproductive age. Young women
who had more than four antenatal care (ANC) visits were three
times more likely to deliver in a health institution compared
with women who had no antenatal care visit (OR: 3.05; 95% CI:
2.40 to 3.87). The probability of delivering in an institution
was 69% higher among young urban women than among young women
who lived in rural areas. Young women who had secondary or above
secondary level education were 1.63 times more likely to choose
institutional delivery than young women who had no formal
education (OR: 1.626; 95% CI: 1.171 to 2.258). Lower use of a
health institution for delivery was also observed among poor
young women. Results showed that wealthy young women were 2.12
times more likely to deliver their child in an institution
compared with poor young women (OR: 2.107; 95% CI: 1.53 to
2.898). Other factors such as the age of the young woman,
religion, ethnicity, and ecological zone were also associated
with institutional delivery. CONCLUSIONS: Maternal health
programs should be designed to encourage young women to receive
adequate ANC (at least four visits). Moreover, health programs
should target poor, less educated, rural, young women who live
in mountain regions, are of Janajati ethnicity and have at least
one child as such women are less likely to choose institutional
delivery in Nepal
Multistakeholder Perspectives on Maternal Text Messaging Intervention in Uganda: Qualitative Study
Background: Despite continued interest in the use of mobile health for improving maternal health outcomes, there have been limited attempts to identify relevant program theories.
Objectives: This study had two aims: first, to explicate the assumptions of program designers, which we call the program theory and second, to contrast this program theory with empirical data to gain a better understanding of mechanisms, facilitators, and barriers related to the program outcomes.
Methods: To achieve the aforementioned objectives, we conducted a retrospective qualitative study of a text messaging (short message service) platform geared at improving individual maternal health outcomes in Uganda. Through interviews with program designers (n=3), we elicited 3 main designers’ assumptions and explored these against data from qualitative interviews with primary beneficiaries (n=26; 15 women and 11 men) and health service providers (n=6), as well as 6 focus group discussions with village health team members (n=50) who were all involved in the program.
Results: Our study results highlighted that while the program designers’ assumptions were appropriate, additional mechanisms and contextual factors, such as the importance of incentives for village health team members, mobile phone ownership, and health system factors should have been considered.
Conclusions: Our results indicate that text messages could be an effective part of a more comprehensive maternal health program when context and system barriers are identified and addressed in the program theories
Targeting strategies of mHealth interventions for maternal health in low and middle-income countries: a systematic review protocol
INTRODUCTION: Recently, there has been a steady increase in
mobile health (mHealth) interventions aimed at improving
maternal health of women in low-income and middle-income
countries. While there is evidence indicating that these
interventions contribute to improvements in maternal health
outcomes, other studies indicate inconclusive results. This
uncertainty has raised additional questions, one of which
pertains to the role of targeting strategies in implementing
mHealth interventions and the focus on pregnant women and health
workers as target groups. This review aims to assess who is
targeted in different mHealth interventions and the importance
of targeting strategies in maternal mHealth interventions.
METHODS AND ANALYSIS: We will search for peer-reviewed,
English-language literature published between 1999 and July 2017
in PubMed, Web of Knowledge (Science Direct, EMBASE) and
Cochrane Central Registers of Controlled Trials. The study scope
is defined by the Population, Intervention, Comparison and
Outcomes framework: P, community members with maternal or
reproductive needs; I, electronic health or mHealth programmes
geared at improving maternal or reproductive health; C, other
non-electronic health or mHealth-based interventions; O,
maternal health measures including family planning, antenatal
care attendance, health facility delivery and postnatal care
attendance. ETHICS AND DISSEMINATION: This study is a review of
already published or publicly available data and needs no
ethical approval. Review results will be published in a
peer-reviewed journal and presented at international
conferences. PROSPERO REGISTRATION NUMBER: CRD42017072280
Uncertainties, Fear and Stigma: Perceptions of Zika Virus among Pregnant Women in Spain.
Similar to other epidemics, knowledge about Zika virus
(ZIKV) relies upon information often coming from outside the
health system. This study aimed to explore views, perceptions
and attitudes towards ZIKV among migrant women from Central and
South America, diagnosed with ZIKV infection during pregnancy,
and to comprehend healthcare professionals' perceptions of ZIKV.
An exploratory qualitative study, based on phenomenology and
grounded theory, was conducted in Barcelona, Spain. Data were
collected through in-depth and paired interviews with women
diagnosed with ZIKV infection during pregnancy, and
semi-structured interviews with healthcare professionals. Women
showed good level of awareness of ZIKV, despite some knowledge
gaps. The most consulted source of information about ZIKV was
the Internet. Women expressed they suffered from anxiety and
depression due to potential effects of ZIKV on their babies.
They conveyed their sources of support came primarily from their
partners and relatives, as well as healthcare professionals.
This study stresses the dramatic health, social and emotional
burden that the epidemic imposed on migrant women infected with
ZIKV during pregnancy. These results may help guide psychosocial
support and health measures for pregnant women and their
children as part of the public health emergency response in
emergent epidemics
What Influences Adolescent Girls' Decision-Making Regarding Contraceptive Methods Use and Childbearing? A Qualitative Exploratory Study in Rangpur District, Bangladesh
BACKGROUND: Bangladesh has the highest rate of adolescent
pregnancy in South Asia. Child marriage is one of the leading
causes of pregnancies among adolescent girls. Although the
country's contraceptive prevalence rate is quite satisfactory,
only 52% of married adolescent girls use contraceptive methods.
This qualitative study is aimed at exploring the factors that
influence adolescent girls' decision-making process in relation
to contraceptive methods use and childbearing. METHODS AND
RESULTS: We collected qualitative data from study participants
living in Rangpur district, Bangladesh. We conducted 35 in-depth
interviews with married adolescent girls, 4 key informant
interviews, and one focus group discussion with community health
workers. Adolescent girls showed very low decision-making
autonomy towards contraceptive methods use and childbearing.
Decisions were mainly made by either their husbands or
mothers-in-law. When husbands were unemployed and financially
dependent on their parents, then the mothers-in-law played most
important role for contraceptive use and childbearing decisions.
Lack of reproductive health knowledge, lack of negotiation and
communication ability with husbands and family members, and
mistrust towards contraceptive methods also appeared as
influential factors against using contraception resulting in
early childbearing among married adolescent girls. CONCLUSIONS:
Husbands and mothers-in-law of newly married adolescent girls
need to be actively involved in health interventions so that
they make more informed decisions regarding contraceptive use to
delay pregnancies until 20 years of age. Misunderstanding and
distrust regarding contraceptives can be diminished by engaging
the wider societal actors in health intervention including
neighbours, and other family members
Malaria Prevention with IPTp during Pregnancy Reduces Neonatal Mortality
In the global context of a reduction of under-five mortality, neonatal mortality is an increasingly relevant component of this mortality. Malaria in pregnancy may affect neonatal survival, though no strong evidence exists to support this association.In the context of a randomised, placebo-controlled trial of intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine (SP) in 1030 Mozambican pregnant women, 997 newborns were followed up until 12 months of age. There were 500 live borns to women who received placebo and 497 to those who received SP.There were 58 infant deaths; 60.4% occurred in children born to women who received placebo and 39.6% to women who received IPTp (p = 0.136). There were 25 neonatal deaths; 72% occurred in the placebo group and 28% in the IPTp group (p = 0.041). Of the 20 deaths that occurred in the first week of life, 75% were babies born to women in the placebo group and 25% to those in the IPTp group (p = 0.039). IPTp reduced neonatal mortality by 61.3% (95% CI 7.4%, 83.8%); p = 0.024].Malaria prevention with SP in pregnancy can reduce neonatal mortality. Mechanisms associated with increased malaria infection at the end of pregnancy may explain the excess mortality in the malaria less protected group. Alternatively, SP may have reduced the risk of neonatal infections. These findings are of relevance to promote the implementation of IPTp with SP, and provide insights into the understanding of the pathophysiological mechanisms through which maternal malaria affects fetal and neonatal health.ClinicalTrials.gov NCT00209781
Factors associated with risk behavior in travelers to tropical and subtropical regions
BACKGROUND: Recent decades have seen a rise in population
movements and, therefore, the spread of tropical diseases and
changes in the epidemiology of global disease patterns. Only 50%
of travelers to tropical areas receive pre-travel advice and
most of them present risk behaviors for acquiring infections.
The aim of this study was to describe the clinical and
epidemiological characteristics of travelers and identify
factors associated with risk behaviors. METHODS: We made a
retrospective, descriptive and analytical study of 772 travelers
consulting a tropical medicine clinic in Barcelona in 2010. Data
on demographic and clinical variables, travel characteristics
and risk behaviors were collected. RESULTS: Among all travelers
studied, 65.8% (466/708) received pre-travel advice and 30.7%
(209/680) took malaria prophylaxis. At least one risk behavior
was reported by 82.6% (587/711) of travelers. People travelling
for 1-6 months had a 3-fold higher likelihood of experiencing
risk behaviors than people travelling for <1 month (95% CI
1.54-5.81, p=0.001), and those travelling for >6 months had a
13-fold higher likelihood (95% CI 3.11-56.14, p<0.001)
compared with the same group. Increasing age was associated with
presenting less risk behaviors. CONCLUSIONS: Younger travelers
and those making longer trips have a higher number of risk
behaviors. Strategies emphasizing advice on risk behavior should
focus on these groups
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