COVID-19 Pandemic: Marked Global Disparities in Fatalities According to Geographic Location and Universal Health Care

Since its outbreak, COVID-19 pandemic has been the biggest global concern with exponentially increasing number of cases and associated deaths across all habitable continents. Various countries around the world with their diverse health care systems, have responded to the pandemic in very distinctive ways. In this paper, we: compared COVID-19 mortality rates across global geographic regions; and assessed differences in COVID-19-related case fatality rate (CFR) based on presence or absence of Universal Health Coverage (UHC). We found that as of May 6, 2020, Europe had experienced the highest CFR globally of 9.6%, followed by 5.9% in North America. Although the pandemic originated in Asia, the continent ranked second to the last in terms of CFR (3.5%). Countries with UHC had lower number of cases of 37.6%, but the CFR of countries with UHC was twice that of countries without UHC (10.5% versus 4.9%). In conclusion, UHC does not appear to protect against mortality in a pandemic environment such as with COVID-19. Key words: • COVID-19 • Global disparity • Universal Health Coverage • Case fatality rate

Risk of Stillbirth after Infertility Treatment in the United States: 2014-2017

To estimate the risk of stillbirth following infertility treatment in the United States (US), we analyzed data from the US Natality and Fetal Death files from 2014 to 2017. We built Cox proportional regression models to generate adjusted hazard ratios (HR) for the risk of stillbirth among women who utilized various modalities of infertility treatment within the study period. Women who used any infertility treatment and, specifically, assisted reproductive technology (ART), had an elevated risk of stillbirth (HR: 1.21, 95% CI:1.09 -1.33) compared to women who did not use ART. We concluded that in this population, the risk of stillbirth was elevated among women using infertility treatment. Key words: • ART • Infertility treatment • Fertility enhancing drugs • Stillbirth in US   Copyright © 2020 Dongarwar and Salihu. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Place of Residence and Inequities in Adverse Pregnancy and Birth Outcomes in India

Background and Objectives: India, the second most populous country in the world, has two-thirds of its population living in rural areas. Rural women in developing countries like India have worse access to healthcare compared to their urban counterparts. We examined the association between place of residence and various pregnancy and birth outcomes among Indian women. Methods: We analyzed data from the 2015-2016 India Demographic and Health Survey (DHS). Sociodemographic and reproductive health-related information were obtained from Indian women of reproductive age. We calculated the prevalence of selected pregnancy and birth outcomes among the study participants. We conducted adjusted survey log binomial regression to determine the level of association between place of residence and various pregnancy and birth outcomes. Results: About 66.4% of the survey responders resided in villages. When adjusted for covariates, rural women had increased likelihood of experiencing miscarriage, stillbirth, early neonatal, late neonatal and infant mortality as compared to urban women. Urban women had 22% higher likelihood (PR = 1.22, 95% CI=1.10-1.35) of having an abortion as compared to rural dwellers. Conclusion and Global Health Implications: Despite India’s extensive efforts to improve maternal and reproductive health, wide geographical disparities exist between its urban and rural population. Interventions at various socio-ecologic and cultural levels, along with improved health literacy, access to improved health care and sanitation need attention when formulating and implementing policies and programs for equitable progress towards improved maternal and reproductive health. Key words: • India • Maternal and reproductive health • Pregnancy outcomes • Birth outcomes • Miscarriage • Stillbirth • Neonatal mortality • Infant mortality • Abortion • Health equity   Copyright © 2020 Dongarwar and Salihu. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Trends in Stillbirths and Stillbirth Phenotypes in the United States: An Analysis of 131.5 Million Births

We examined the trends in stillbirth across gestational age in the United States (US).We conducted a trend analysis using the U.S. Natality and Fetal Death datasets covering 1982 and 2017. We compared the incidence and rates of stillbirth for term, all preterm, moderate-to-late preterm, very preterm, and extreme preterm phenotypes. The incidence of stillbirth decreased for the entire birth cohort over the 36-year period. The rates of overall, term, all preterm, very preterm and moderate-to-late preterm stillbirth decreased from 1982 to 2017; however, the rates for extreme preterm stillbirth increased by about 7.6% over the same study period. Key words: • Trends in stillbirth • Stillbirth phenotypes • Stillbirth in US   Copyright © 2020 Dongarwar et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Stillbirths among Advanced Maternal Age Women in the United States: 2003-2017

The aim of the study was to evaluate the association between fetal stillbirth and advanced maternal age in the United States (US). This was a population-based study using the Natality and Fetal Death datasets for the years 2003-2017. We built Cox proportional regression models to examine the likelihood of stillbirth among women aged ?40 years. Out of a total of 57,273,305 births, stillbirth was observed in 302,522, yielding a stillbirth rate of 5 per 1000. After adjusting for confounders, women of advanced age (?40 years) had a 40-50% greater risk of stillbirth compared to women 20-29 years of age. Keywords: • Advanced maternal age • Stillbirth • Cox proportional regression • United States   Copyright © 2020 Dongarwar et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Association between Intimate Partner Violence, Knowledge and Use of Contraception in Africa: Comparative Analysis across Five African Regions

Background Or Objectives: Intimate partner violence (IPV) against women is common globally, and is associated with several adverse consequences. This study provides a comparative analysis of potential regional differences in the association between IPV and knowledge and use of contraceptives within Africa. Methods: A multi-country cross-sectional study was conducted using data on women of reproductive age 15-49 years from the Demographic and Health Surveys covering five African regions. Exposure and outcome variables were IPV and reproductive literacy (comprising modern contraception knowledge and contraception usage) respectively. We used survey log-binomial regression models to generate prevalence ratios that estimated the association between IPV versus knowledge and usage of modern contraception. Results: Overall IPV prevalence in Africa was 30.8% with notable regional differences. Demographic, socioeconomic, and reproductive history markers of IPV were more pronounced in younger women, rural residents, women of low socioeconomic status and those with copious knowledge but poor usage of modern contraception. The level of knowledge of contraception was 84% greater among African women who were victims of IPV compared to their counterparts who were not victims of IPV (p < 0.0001). IPV was not associated with actual usage of modern contraception (p = 0.21). Conclusion And Global Health Implications: IPV against women in Africa may incentivize knowledge seeking of modern contraception as protective mechanisms. Regional variations notwithstanding, understanding the existing and new characteristics predictive of IPV may inform policy development, resource allocation and prevention of IPV globally. Key words: • Violence • Women • Contraception; • Knowledge • Usage • Africa • Intimate partner violence • Demographic and health surveys • Benin • Burundi • Egypt • Kenya • South Africa   Copyright © 2020 Yusuf et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Oral Health Problems among Children with Neurodevelopmental Disorders in the United States

Children with neurodevelopmental disabilities (NDD) suffer poor oral health problems (OHP) leading to adverse health outcomes. We examined the association between NDD and OHP among children in the United States (US) ages 3-17 years using data from the National Survey of Children’s Health (NSCH) 2016-17. The prevalence of OHP was 19.1%. Children with NDD had about 40% greater likelihood of poor oral health compared to their non-NDD counterparts (p <0.0001). Living at or above 200%-300% of the federal poverty level (FPL), private insurance coverage, and living with a least a college educated adult were found to be protective factors against poor oral health among children. Key words: • Neurodevelopmental disorder • Oral health problems • Children • United States   Copyright © 2020 Yusuf et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Social Determinants of Overweight and Obesity Among Children in the United States

Background: Childhood obesity is one of the foremost threats to population health in the United States (U.S.) leading to the emergence of co-morbidities and increased healthcare cost. We explore the influence of selected social determinants of health (SDOH) on overweight and obesity among U.S. children. Methods: We utilized the National Survey of Children’s Health (NSCH) 2016-17 dataset for this analysis. Overweight was defined as Body Mass Index (BMI) ? 85th to<95th, while obesity was defined as BMI ? 95th percentile for age and sex. Based on the literature and pathway plausibility, we examined several SDOH variables as predictors of childhood overweight or obesity in the US. Survey log-binomial regression models were built to generate prevalence ratio (PR) estimates to capture the associations between SDOH and overweight or obesity. Results: About 30.6 million children were surveyed of which 9.5 million (31.0%) were either overweight or obese. The likelihood of obesity was elevated among non-Hispanic Black and Hispanic children (PR = 1.53; 95% CI = 1.01-2.31) and (PR = 1.50; 95% CI = 1.18-1.90) respectively. Overweight was more frequent in younger children, children of single parents, and children who lived in a neighborhood with no amenities. Parental attainment of college education, health insurance coverage, female gender, and language spoken in home other than Spanish were protective against overweight or obesity. Conclusions and Global Health Implications: SDOH represent markers of overweight or obesity in children. We recommend the development of innovative interventions using SDOH risk and protective pathways as guide to address the current epidemic of childhood overweight and obesity. Key words: • Social determinants • Obesity • Overweight • SDOH • Children • United States   Copyright © 2020 Yusuf et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Global Ranking of COVID-19-Related Mortality by Country using a Novel Pandemic Efficiency Index (PEI)

The world is currently witnessing a dramatic disruption of everyday life owing to the rapid progression of the coronavirus disease 2019 (COVID-19) pandemic. As the pandemic evolves, there is an urgent need to better understand its epidemiology, characterize its potential impact, and identify mitigatory strategies to avert pandemic-related mortality. There is a need for a tool or algorithm to evaluate the extent to which public health policy and/or economic preparedness measures are effectively averting COVID-19 related mortality. We present a simple and yet practical epidemiological tool, the Pandemic Efficiency Index (PEI), that can be utilized globally to test the relative efficiency of measures put in place to avert death resulting from COVID-19 infection. Using the PEI and current COVID-19-related mortality, we determined that so far Germany demonstrates the highest PEI (5.1) among countries with more than 5,000 recorded cases of the infection, indicating high quality measures instituted by the country to avert death during the pandemic. Italy and France currently have the lowest COVID-19-related PEIs. Epidemics and pandemics come and go, but local, national, and global abilities to determine the efficiency of their efforts in averting deaths is critical. Key words: • COVID-19 • Pandemic Efficiency Index • PEI • Coronavirus • Mortality • Pandemic • Epidemic • Global health   Copyright © 2020 Salihu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Healthcare Access as a Risk-Marker for Obstetric Vesicovaginal Fistula in Malawi

Objectives: To determine the association between access to health care among pregnant women in Malawi and occurrence of obstetric vesicovaginal fistula (VVF). Methods: This was a case-control study using data obtained from patients’ records documented by the ‘Fistula Care Center-Bwaila Hospital’ in Malawi. Socio-demographic characteristics of women with VVF (study arm, n=1046) and perineal tear (control arm, n=37) were examined. A composite variable called “Malawi Healthcare Access Index” (MHAI) was created through summation of scores related to three factors of access to care: (1) walking distance to closest health center; (2) presence of trained provider at delivery; and (3) receipt of antenatal care. Binomial logistic regression models were built to determine the association between the MHAI and presence of VVF. Results: Obstetric VVF was more common in women from rural areas, mothers delivering at extremes of age, those with less education, and patients with long labor (>12 hours). In adjusted models, women with “insufficient” health access based on the MHAI were at greater risk (OR = 2.64, 95%CI = 1.07 – 6.03) of obstetric VVF than women with “sufficient” score on the MHAI. Conclusion and Global Health Implications: Inadequate access to essential obstetric care increases the risk of VVF. Key words: • Health care index • Obstetric complications • Vesicovaginal fistula • Poverty • Malawi • Malawi Healthcare Access Index   Copyright © 2020 Rupley et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited