Delivery Practices of Traditional Birth Attendants in Dhaka Slums, Bangladesh

This paper describes associations among delivery-location, training of birth attendants, birthing practices, and early postpartum morbidity in women in slum areas of Dhaka, Bangladesh. During November 1993–May 1995, data on delivery-location, training of birth attendants, birthing practices, delivery-related complications, and postpartum morbidity were collected through interviews with 1,506 women, 489 home-based birth attendants, and audits in 20 facilities where the women from this study gave birth. Associations among maternal characteristics, birth practices, delivery-location, and early postpartum morbidity were specifically explored. Self-reported postpartum morbidity was associated with maternal characteristics, delivery-related complications, and some birthing practices. Dais with more experience were more likely to use potentially-harmful birthing practices which increased the risk of postpartum morbidity among women with births at home. Postpartum morbidity did not differ by birth-location. Safe motherhood programmes must develop effective strategies to discourage potentially-harmful home-based delivery practices demonstrated to contribute to morbidity

Delivery Practices of Traditional Birth Attendants in Dhaka Slums, Bangladesh

This paper describes associations among delivery-location, training of birth attendants, birthing practices, and early postpartum morbidity in women in slum areas of Dhaka, Bangladesh. During November 1993-May 1995, data on delivery-location, training of birth attendants, birthing practices, delivery-related complications, and postpartum morbidity were collected through interviews with 1,506 women, 489 home-based birth attendants, and audits in 20 facilities where the women from this study gave birth. Associations among maternal characteristics, birth practices, delivery-location, and early postpartum morbidity were specifically explored. Self-reported postpartum morbidity was associated with maternal characteristics, delivery-related complications, and some birthing practices. Dais with more experience were more likely to use potentially-harmful birthing practices which increased the risk of postpartum morbidity among women with births at home. Postpartum morbidity did not differ by birth-location. Safe motherhood programmes must develop effective strategies to discourage potentially-harmful home-based delivery practices demonstrated to contribute to morbidity

Associations of Suboptimal Growth with All-Cause and Cause-Specific Mortality in Children under Five Years: A Pooled Analysis of Ten Prospective Studies

Background: Child undernutrition affects millions of children globally. We investigated associations between suboptimal growth and mortality by pooling large studies. Methods: Pooled analysis involving children 1 week to 59 months old in 10 prospective studies in Africa, Asia and South America. Utilizing most recent measurements, we calculated weight-for-age, height/length-for-age and weight-for-height/length Z scores, applying 2006 WHO Standards and the 1977 NCHS/WHO Reference. We estimated all-cause and cause-specific mortality hazard ratios (HR) using proportional hazards models comparing children with mild (-2≤Z<-1), moderate (-3≤Z<-2), or severe (Z<-3) anthropometric deficits with the reference category (Z≥-1). Results: 53809 children were eligible for this re-analysis and contributed a total of 55 359 person-years, during which 1315 deaths were observed. All degrees of underweight, stunting and wasting were associated with significantly higher mortality. The strength of association increased monotonically as Z scores decreased. Pooled mortality HR was 1.52 (95% Confidence Interval 1.28, 1.81) for mild underweight; 2.63 (2.20, 3.14) for moderate underweight; and 9.40 (8.02, 11.03) for severe underweight. Wasting was a stronger determinant of mortality than stunting or underweight. Mortality HR for severe wasting was 11.63 (9.84, 13.76) compared with 5.48 (4.62, 6.50) for severe stunting. Using older NCHS standards resulted in larger HRs compared with WHO standards. In cause-specific analyses, all degrees of anthropometric deficits increased the hazards of dying from respiratory tract infections and diarrheal diseases. The study had insufficient power to precisely estimate effects of undernutrition on malaria mortality. Conclusions: All degrees of anthropometric deficits are associated with increased risk of under-five mortality using the 2006 WHO Standards. Even mild deficits substantially increase mortality, especially from infectious diseases

Distribution of Major Health Risks: Findings from the Global Burden of Disease Study

BACKGROUND: Most analyses of risks to health focus on the total burden of their aggregate effects. The distribution of risk-factor-attributable disease burden, for example by age or exposure level, can inform the selection and targeting of specific interventions and programs, and increase cost-effectiveness. METHODS AND FINDINGS: For 26 selected risk factors, expert working groups conducted comprehensive reviews of data on risk-factor exposure and hazard for 14 epidemiological subregions of the world, by age and sex. Age-sex-subregion-population attributable fractions were estimated and applied to the mortality and burden of disease estimates from the World Health Organization Global Burden of Disease database. Where possible, exposure levels were assessed as continuous measures, or as multiple categories. The proportion of risk-factor-attributable burden in different population subgroups, defined by age, sex, and exposure level, was estimated. For major cardiovascular risk factors (blood pressure, cholesterol, tobacco use, fruit and vegetable intake, body mass index, and physical inactivity) 43%–61% of attributable disease burden occurred between the ages of 15 and 59 y, and 87% of alcohol-attributable burden occurred in this age group. Most of the disease burden for continuous risks occurred in those with only moderately raised levels, not among those with levels above commonly used cut-points, such as those with hypertension or obesity. Of all disease burden attributable to being underweight during childhood, 55% occurred among children 1–3 standard deviations below the reference population median, and the remainder occurred among severely malnourished children, who were three or more standard deviations below median. CONCLUSIONS: Many major global risks are widely spread in a population, rather than restricted to a minority. Population-based strategies that seek to shift the whole distribution of risk factors often have the potential to produce substantial reductions in disease burden

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

How much does your baby cry? Expectations, patterns and perceptions of infant crying in Mexico

Background: A limited number of studies have examined infant crying patterns in less affluent societies, but none of them have been longitudinal in nature. The aim of this study was to describe reported infant crying patterns in a cohort of Mexican infants and examine how these are associated with crying-related maternal expectations, general perceptions and help-seeking behavior. Methods: Observational cohort study, 204 primiparous mothers and their infants, recruited at birth and visited in their homes at nine different time points from 1 to 24 weeks of infant age. Results: Mothers reported that their infants cried less than infants in other more affluent societies, although not less frequently. A previously reported evening clustering of crying was present, with a subtle 24-h crying peak emerging around 2 to 4 weeks. Having an expectation of an infant who will be difficult to soothe and/or an increased report of crying frequency were associated with perceptions of maternal anguish, which was associated with maternal concern and help-seeking behaviors related to crying. Conclusions: Similarities and differences were found in the crying patterns reported by mothers of Mexican infants and others previously studied. Expectations and reports of crying behavior were associated with maternal perceptions, which may have a role in reducing crying-related anguish and demand on health services

Perfil nutricional de recém-nascidos de mães adolescentes suplementadas com ferro, em diferentes concentrações, zinco e ácido fólico Nutritional profile of newborns of adolescent mothers supplemented with iron, in different concentrations, zinc and pholic acid

O objetivo deste estudo foi avaliar o estado nutricional de recém-nascidos de mães adolescentes com até 18 anos de idade, de baixa renda, suplementadas durante a gravidez com ferro, em diferentes concentrações, zinco e ácido fólico. Estas mães fizeram pré-natal no Instituto de Perinatologia Social do Piauí, Maternidade Dona Evangelina Rosa, no município de Teresina, Piauí, Nordeste do Brasil. As adolescentes foram aleatoriamente distribuídas em cinco grupos: grupos I e II receberam quantidades constantes de ácido fólico (250 µg) e diferentes concentrações de ferro, na forma de sulfato ferroso (120 e 80 mg, respectivamente); grupos III e IV receberam quantidades constantes de ácido fólico (250 µg) associado ao sulfato de zinco (5 mg) e ferro nas concentrações de 120 e 80 mg, respectivamente; e grupo V, considerado controle, recebeu apenas ferro (120 mg) (rotina da Instituição). A avaliação do estado nutricional de 74 recém-nascidos foi feita através de dados referentes à idade, peso, comprimento e perímetro cefálico, por ocasião do nascimento. De acordo com os resultados, as médias de peso (3000 ± 418 g), comprimento (48,07 ± 2,15 cm) e perímetro cefálico (33,53 ± 1,50 cm) encontradas para os filhos de mães do grupo V (rotina local) não diferem dos grupos de intervenção. Conclui-se que os recém-nascidos de adolescentes suplementadas com ferro em diferentes concentrações (120 e 80 mg), zinco e ácido fólico apresentaram um bom perfil nutricional. No entanto, não se observou, entre os grupos de intervenção e o controle, diferenças significativas na duração da gravidez ou no estado nutricional dos bebês.<br>The objective of this study was to evaluate the nutritional status of newborn infants of low income adolescent mothers, aged up to 18 years old, supplemented during pregnancy with iron, in different concentrations, zinc and folic acid. These mothers received prenatal care supervision in the Institute of Social Perinatology of Piauí, Dona Evangelina Rosa Maternity, located in the city of Teresina, Piauí, Northeast of Brazil. The adolescents were distributed at random into five groups: groups I and II received constant quantities of folicc acid (250 µg) and different iron concentrations, in the form of iron sulfate (120 and 80 mg, respectively); groups III and IV received constant quantities of folic acid (250 µg) associated to zinc sulfate (5 µg) and iron in the concentrations of 120 and 80 mg, respectively; and group V, considered control, received only 120 mg of iron (Institution routine). The evaluation of the nutritional status of 74 newborn infants was done through data referring to their age, weight, height and cephalic perimeter, on the occasion of their birth. According to the results, the averages of weight (3000 ± 418g), height ( 48.07 ± 2,15 cm) and cephalic perimeter (33.53 ± 1,50 cm) found in children of group V mothers (local routine) did not present significant differences in relation to the intervention groups. The newborn infants of adolescents supplemented with iron in different concentrations (120 and 80 mg), zinc and folic acid, presented a good nutritional profile. However, it was not observed, between the intervention groups and the control, significant differences in the pregnancy duration or in the nutritional status of the babies