Assessing the Relationship between Short Birth-to-Pregnancy Interval and the Maternal and Perinatal Outcomes among Multiparous Women in Northern Ghana

Introduction: The World Health Organization (WHO) recommends an optimal Birth-to-Pregnancy Interval (BPI) of 24-59 months, or a 33-month interval between two successive births, to reduce the risk of untoward maternal and newborn outcomes. Short Birth to Pregnancy Interval (SBPI) and unmet need for Family Planning (FP) are the major contributors to rapid population growth and increased maternal and newborn mortalities. The purpose of this study was to assess the adverse perinatal and maternal outcomes associated with SBPI among multiparous women in three municipalities of the Upper East Region (UER) of Ghana. Materials and Methods: We employed a cross-sectional design conducted among 904 women aged 15-49 attending Antenatal Care (ANC) clinics in three municipalities in the UER who had at least two successive live births prior to data collection. A multistage cluster sampling technique was employed to recruit respondents for this study. This was conducted in four steps. Out of the 46 health facilities, we randomly selected 25 respondents using the systematic random selection method. Data was collected using a structured questionnaire, incorporated into the electronic data collection tool (Kobo collect), and administered by trained research assistants. Birth interval was categorized according to the WHO’s classification: <24 months as SBPI, 24-≥59 months as Optimal Birth to Pregnancy Interval (OBPI), and >59 months as Long Birth to Pregnancy Interval (LBPI). Results: Of the 904 respondents, the majority (56.2%) had an OBPI, while 36.9% had a SBPI. Factors that influenced SBPI were parity, mode of delivery, and the educational status of woman’s partner. Participants with a higher parity (≥5 children) had 0.67 times the potential of spacing their births (AOR 0.67; 95% CI 0.46-0.98; p = 0.040). Women who experienced a Caesarean Section (CS) delivery were 3.28 times more likely to have LBPI (AOR 3.28; 95% CI 1.02–10.62; p=0.047). Respondents whose partners had secondary education had a 1.87 chance (AOR 2.07; 95% CI 1.09–3.96; p=0.027) of spacing their births. The birth complications reported were retained products of conception (41.9%), pregnancy-induced hypertension (27.9%), postpartum hemorrhage (11.6%), obstructed labor (10.5%), sepsis (38.1%), neonatal jaundice (23.8%), low birth weight (19%), and preterm birth (14.3%). Conclusion: A significant proportion of the participants in this study reported having a short duration between the birth of one child and the conception of the next. This was associated with various adverse maternal and perinatal outcomes, such as birth complications and mortalities. The study emphasizes the need for health professionals to address challenges in contraceptive uptake, especially among multiparous women, and promote optimal birth spacing to improve maternal and perinatal outcomes

Assessing the Relationship between Short Birth-to-Pregnancy Interval and the Maternal and Perinatal Outcomes among Multiparous Women in Northern Ghana

Introduction: The World Health Organization (WHO) recommends an optimal Birth-to-Pregnancy Interval (BPI) of 24-59 months, or a 33-month interval between two successive births to reduce the risk of untoward maternal and newborn outcomes. Short Birth to Pregnancy Interval (SBPI), and unmet need for Family Planning (FP) are the major contributors to rapid population growth and increased maternal and newborn mortalities. The purpose of this study was to assess the adverse perinatal and maternal outcomes associated with SBPI among multiparous women in three municipalities of the Upper East Region (UER) of Ghana.  Materials and Methods:The study employed the Cross-sectional Design conducted among 904 women aged 15-49 years attending Antenatal Care (ANC) clinics in three municipalities in the UER who had at least two successive live births prior to data collection. Data was collected using structured questionnaire, incorporated into the electronic data collection tool, Kobo collect and administered by trained research assistants. Birth interval was categorized according to the WHO’s classification, <24 months as SBPI, 24-≥59 months as Optimal Birth to Pregnancy Interval (OBPI) and >59 months as Long Birth to Pregnancy Interval (LBPI). Results: Of the 904 respondents, the majority (56.2%) had an OBPI, while 36.9% had a SBPI. Factors that influenced SBPI were parity, mode of delivery, and the educational status of women’s partner. Participants with a higher parity (≥5 children) had 0.67 times the potential of spacing their births (AOR 0.67; 95% CI 0.46-0.98; p = 0.040). Women who experienced a Caesarean Section (CS) delivery were 3.28 times more likely to have LBPI (AOR 3.28; 95% CI 1.02-10.62; p=0.047). Respondents whose partners had secondary education had a 1.87 chance (AOR 2.07; 95% CI 1.09-3.96; p=0.027) of spacing their births. The birth complications reported were retained products of conception (41.9%), pregnancy-induced hypertension (27.9%), postpartum hemorrhage (11.6%), obstructed labor (10.5%), sepsis (38.1%), neonatal jaundice (23.8%), low-birth-weight (19%), and preterm birth (14.3%). Conclusion and Global Health Implications: The study recommends health professionals in direct contact with maternal, reproductive, and child health to be proactive in FP counseling, and to support women decision making

Testing of crop Models for Accurate Predictions of Evapotranspiration and crop Water Use

All crop models, whether site-specific or global-gridded and regardless of crop, simulate daily crop transpiration and soil evaporation during the crop life cycle, resulting in seasonal crop water use. Modelers use several methods for predicting daily potential evapotranspiration (ET), including FAO-56, Penman-Monteith, Priestley-Taylor, Hargreaves, full energy balance, and transpiration water efficiency. They use extinction equations to partition energy to soil evaporation or transpiration, depending on leaf area index. Most models simulate soil water balance and soil-root water supply for transpiration, and limit transpiration if water uptake is insufficient, and thereafter reduce dry matter production. Comparisons among multiple crop and global gridded models in the Agricultural Model Intercomparison and Improvement Project (AgMIP) show surprisingly large differences in simulated ET and crop water use for the same climatic conditions. Model intercomparisons alone are not enough to know which approaches are correct. There is an urgent need to test these models against field-observed data on ET and crop water use. It is important to test various ET modules/equations in a model platform where other aspects such as soil water balance and rooting are held constant, to avoid compensation caused by other parts of models. The CSM-CROPGRO model in DSSAT already has ET equations for Priestley-Taylor, Penman-FAO-24, Penman-Monteith-FAO-56, and an hourly energy balance approach. In this work, we added transpiration-efficiency modules to DSSAT and AgMaize models and tested the various ET equations against available data on ET, soil water balance, and season-long crop water use of soybean, fababean, maize, and other crops where runoff and deep percolation were known or zero. The different ET modules created considerable differences in predicted ET, growth, and yield

Decision support tools for site-specific fertilizer recommendations and agricultural planning in selected countries in sub-Sahara Africa

Peer Revie

Modelling varietal differences in response to phosphorus in West African sorghum

International audienceIn West Africa’s highly weathered soils, plant-available soil-P levels determine sorghum performance and yield to a far greater extent than projected variability in climate. Despite local landrace varieties having excellent adaptation to the environment and a relatively stable yield, sorghum grain yield remains quite low, averaging less than 1 t ha−1. Low P availability in West African soils has significant effects on crop development and growth with potential grain yield losses of more than 50%. Use of mechanistic models, which integrate physiological processes, could assist with understanding the differences in P-uptake among varieties and guide effective P management. Yet only few crop models include a soil-plant P model for simulating crop yield response to P management. A generic soil-plant P module was developed for crop models in the Cropping System Model (CSM) of the Decision Support System for Agrotechnology Transfer (DSSAT) but the module was adapted and tested only on two crops, groundnut and maize. The aim of the study was to adapt the soil-plant P module for sorghum and perform initial testing on highly weathered soils in West Africa. Data used in adapting and testing the soil-plant P model for sorghum consisted of in-season P concentrations and dry weights of stems, leaves and grain from four sorghum varieties covering a range of maturities and photoperiod sensitivities and grown in high-P and P-deficient soils at ICRISAT-Mali. Results showed that the coupled CERES-Sorghum − P module reasonably reproduced the vegetative and grain yield reductions experienced in the field experiments with an average RMSE of 1561 and 909 kg ha−1 under high P conditions and 1168 and 466 kg ha−1 under low P conditions, respectively. The simulations are in most cases within the observation error. We also confirmed that contrasting variety types differ in their P-uptake dynamics relative to above-ground growth change over time, and hence respond differently to available P

Systematic review of Integrated Disease Surveillance and Response (IDSR) implementation in the African region

Background: The WHO African region frequently experiences outbreaks and epidemics of infectious diseases often exacerbated by weak health systems and infrastructure, late detection, and ineffective outbreak response. To address this, the WHO Regional Office for Africa developed and began implementing the Integrated Disease Surveillance and Response strategy in 1998. Objectives: This systematic review aims to document the identified successes and challenges surrounding the implementation of IDSR in the region available in published literature to highlight areas for prioritization, further research, and to inform further strengthening of IDSR implementation. Methods: A systematic review of peer-reviewed literature published in English and French from 1 July 2012 to 13 November 2019 was conducted using PubMed and Web of Science. Included articles focused on the WHO African region and discussed the use of IDSR strategies and implementation, assessment of IDSR strategies, or surveillance of diseases covered in the IDSR framework. Data were analyzed descriptively using Microsoft Excel and Tableau Desktop 2019. Results: The number of peer-reviewed articles discussing IDSR remained low, with 47 included articles focused on 17 countries and regional level systems. Most commonly discussed topics were data reporting (n = 39) and challenges with IDSR implementation (n = 38). Barriers to effective implementation were identified across all IDSR core and support functions assessed in this review: priority disease detection; data reporting, management, and analysis; information dissemination; laboratory functionality; and staff training. Successful implementation was noted where existing surveillance systems and infrastructure were utilized and streamlined with efforts to increase access to healthcare. Conclusions and implications of findings: These findings highlighted areas where IDSR is performing well and where implementation remains weak. While challenges related to IDSR implementation since the first edition of the technical guidelines were released are not novel, adequately addressing them requires sustained investments in stronger national public health capabilities, infrastructure, and surveillance processes

Predicting maize phenology: intercomparison of functions for developmental response to temperature

Accurate prediction of phenological development in maize (Zea mays L.) is fundamental to determining crop adaptation and yield potential. A number of thermal functions are used in crop models, but their relative precision in predicting maize development has not been quantified. The objectives of this study were (i) to evaluate the precision of eight thermal functions, (ii) to assess the effects of source data on the ability to differentiate among thermal functions, and (iii) to attribute the precision of thermal functions to their response across various temperature ranges. Data sets used in this study represent >1000 distinct maize hybrids, >50 geographic locations, and multiple planting dates and years. Thermal functions and calendar days were evaluated and grouped based on their temperature response and derivation as empirical linear, empirical nonlinear, and process-based functions. Precision in predicting phase durations from planting to anthesis or silking and from silking to physiological maturity was evaluated. Large data sets enabled increased differentiation of thermal functions, even when smaller data sets contained orthogonal, multi-location and -year data. At the highest level of differentiation, precision of thermal functions was in the order calendar days < empirical linear < process based < empirical nonlinear. Precision was associated with relatively low temperature sensitivity across the 10 to 26 degrees C range. In contrast to other thermal functions, process-based functions were derived using supra-optimal temperatures, and consequently, they may better represent the developmental response of maize to supra-optimal temperatures. Supra-optimal temperatures could be more prevalent under future climate-change scenarios, but data sets in this study contained few data in that range