Symptoms of maternal psychological distress during pregnancy: sex-specific effects for neonatal morbidity

Objectives: Maternal psychological distress during pregnancy has been associated with preterm birth. However, little is known about the relationship of a woman’s psychological symptoms during pregnancy to the infant’s morbidity at birth or any differential effects of these symptoms on female vs. male fetuses. Our research aims addressed these gaps. Methods: A total of 186 women were enrolled between 24 and 34 weeks gestation when demographic information was acquired and they completed the Brief Symptom Inventory to measure psychological distress. Data on gestational age at birth, fetal sex, and neonatal morbidity was extracted from the medical record. To control for their effects, obstetric complications were also identified. Multiple linear regressions were computed to examine the aims, including interaction terms to measure moderating effects of fetal sex. Results: Symptoms of maternal psychological distress were a significant predictor of neonatal morbidity but were not associated with gestational age. The interaction between symptom distress and fetal/infant sex was also significant for neonatal morbidity but not for gestational age. For boys, high levels of maternal symptom distress during pregnancy were associated with neonatal resuscitation, ventilatory assistance, and infection. Maternal distress was not associated with neonatal morbidity for girls. Conclusions: The male fetus may be more sensitive to effects of mothers’ psychological symptoms than the female fetus. Further research is needed to confirm our findings and identify potential biological mechanisms that may be responsible for these sex differences. Findings suggest the importance of symptom screening and early intervention to reduce maternal distress and risk of neonatal morbidity

Psychobiobehavioral model for preterm birth in pregnant women in low- and middle-income countries

Preterm birth (PTB) is a final common outcome resulting from many interrelated etiological pathways; of particular interest is antenatal psychosocial distress (i.e., stress, anxiety, and depression). In LMI countries, both exposure to severe life stressors and rate of PTB are on average greater when compared with high-income countries. In LMI countries women are exposed to some of the most extreme psychosocial stress worldwide (e.g., absolute poverty, limited social resources). High prevalence of antenatal stress and depression have been observed in some studies from LMI countries. We propose a psychosocial, biological, and behavioral model for investigating the complex multisystem interactions in stress responses leading to PTB and explain the basis of this approach. We discuss ethical considerations for a psychosocial, biological, and behavioral screening tool to predict PTB from a LMI country perspective

Conceptualizing pathways linking women's empowerment and prematurity in developing countries.

BackgroundGlobally, prematurity is the leading cause of death in children under the age of 5. Many efforts have focused on clinical approaches to improve the survival of premature babies. There is a need, however, to explore psychosocial, sociocultural, economic, and other factors as potential mechanisms to reduce the burden of prematurity. Women's empowerment may be a catalyst for moving the needle in this direction. The goal of this paper is to examine links between women's empowerment and prematurity in developing settings. We propose a conceptual model that shows pathways by which women's empowerment can affect prematurity and review and summarize the literature supporting the relationships we posit. We also suggest future directions for research on women's empowerment and prematurity.MethodsThe key words we used for empowerment in the search were "empowerment," "women's status," "autonomy," and "decision-making," and for prematurity we used "preterm," "premature," and "prematurity." We did not use date, language, and regional restrictions. The search was done in PubMed, Population Information Online (POPLINE), and Web of Science. We selected intervening factors-factors that could potentially mediate the relationship between empowerment and prematurity-based on reviews of the risk factors and interventions to address prematurity and the determinants of those factors.ResultsThere is limited evidence supporting a direct link between women's empowerment and prematurity. However, there is evidence linking several dimensions of empowerment to factors known to be associated with prematurity and outcomes for premature babies. Our review of the literature shows that women's empowerment may reduce prematurity by (1) preventing early marriage and promoting family planning, which will delay age at first pregnancy and increase interpregnancy intervals; (2) improving women's nutritional status; (3) reducing domestic violence and other stressors to improve psychological health; and (4) improving access to and receipt of recommended health services during pregnancy and delivery to help prevent prematurity and improve survival of premature babies.ConclusionsWomen's empowerment is an important distal factor that affects prematurity through several intervening factors. Improving women's empowerment will help prevent prematurity and improve survival of preterm babies. Research to empirically show the links between women's empowerment and prematurity is however needed

Bringing Climate Smart Agriculture to Scale: Experiences from the Water Productivity Project in East and Central Africa

Since 2010, six research organizations in the region have implemented a regional project that sought to combat food insecurity, poverty and climate change by up-scaling Climate-Smart Agriculture (CSA) technologies across farms and landscapes using the Climate Smart Landscape (CSL) approach. Several CSA technologies were evaluated and promoted across landscapes using this approach with remarkable success. Maize yields in Kenya rose from 0.5 to 3.2 t ha-1, resulting in over 90% of the watershed communities being food secure. In Madagascar, rice yields increased from 2 to 4 t ha-1 whilst onion yields increased from 10 to 25 t ha-1, resulting in watershed communities being 60% food-secure. In Eritrea, sorghum yields increased from 0.6 to 2 t ha-1. Farmers in Ethiopia earned US$10,749 from the sale of pasture whilst in Madagascar, watershed communities earned additional income of about US$2500/ha/year from the sale of onions and potatoes during off-season. Adoption levels of various CSA technologies rose from less than 30% to over 100% across the participating countries, resulting in rehabilitation of huge tracts of degraded land. In a nutshell, the potential for CSL in the region is huge and if exploited could significantly improve our economies, lives and environment

Tailoring IPM plans to fight a cloaked pest: helping smallholder farmers combat the sweetpotato weevil in sub-Saharan Africa

Africa accounts for a significant portion of the world’s sweetpotato production where it is widely grown as a staple crop. In sub-Saharan Africa (SSA), sweetpotato serves as an important year-round source of calories and nutrition, a form of income for smallholder and pre-commercial farmers, and is increasingly used as silage for animal feed. However, yield per hectare is considerably lower in SSA than from other regions primarily due to sweetpotato weevils (SPW, Cylas spp., Coleoptera: Brentidae). Weevil feeding causes physical damage to the root and can induce chemical responses that give the storage root a bitter taste, both of which make them unmarketable. Commercial growers in many developed countries rely on frequent chemical treatments and strict quarantine regulations to control SPW, however, this approach is currently not practical for many areas of SSA. In this paper we, (1) outline factors that contribute to SPW infestation; (2) review available strategies and ongoing research for control of SPW, including chemical pesticides, biological control (macro-organismal as well as microbial control), cultural practices, selective breeding, and biotechnology; and (3) discuss the potential for implementing an integrated pest management (IPM) approach that leverages a combination of techniques. We rationalize that a multifaceted strategy for SPW control will improve both the quantity and quality of sweetpotato production in Africa

Feasibility and acceptability of undertaking postmortem studies for tuberculosis medical research in a low income country

IntroductionIf we are to break new ground in difficult-to-treat or difficult-to-vaccinate diseases (such as HIV, malaria, or tuberculosis), we must have a better understanding of the immune system at the site of infection in humans. For tuberculosis (TB), the initial site of infection is the lungs, but obtaining lung tissues from subjects suffering from TB has been limited to bronchoalveolar lavage (BAL) or sputum sampling, or surgical resection of diseased lung tissue.MethodsWe examined the feasibility of undertaking a postmortem study for human tuberculosis research at Mulago National Referral Hospital in Kampala, Uganda.ResultsPostmortem studies give us an opportunity to compare TB-involved and -uninvolved sites, for both diseased and non-diseased individuals. We report good acceptability of the next-of-kin to consent for their relative’s tissue to be used for medical research; that postmortem and tissue processing can be undertaken within 8 hours following death; and that immune cells remain viable and functional up to 14 hours after death.DiscussionPostmortem procedures remain a valuable and essential tool both to establish cause of death, and to advance our medical and scientific understanding of infectious diseases

Symptoms of maternal psychological distress during pregnancy: sex-specific effects for neonatal morbidity

Abstract Objectives Maternal psychological distress during pregnancy has been associated with preterm birth. However, little is known about the relationship of a woman’s psychological symptoms during pregnancy to the infant’s morbidity at birth or any differential effects of these symptoms on female vs. male fetuses. Our research aims addressed these gaps. Methods A total of 186 women were enrolled between 24 and 34 weeks gestation when demographic information was acquired and they completed the Brief Symptom Inventory to measure psychological distress. Data on gestational age at birth, fetal sex, and neonatal morbidity was extracted from the medical record. To control for their effects, obstetric complications were also identified. Multiple linear regressions were computed to examine the aims, including interaction terms to measure moderating effects of fetal sex. Results Symptoms of maternal psychological distress were a significant predictor of neonatal morbidity but were not associated with gestational age. The interaction between symptom distress and fetal/infant sex was also significant for neonatal morbidity but not for gestational age. For boys, high levels of maternal symptom distress during pregnancy were associated with neonatal resuscitation, ventilatory assistance, and infection. Maternal distress was not associated with neonatal morbidity for girls. Conclusions The male fetus may be more sensitive to effects of mothers’ psychological symptoms than the female fetus. Further research is needed to confirm our findings and identify potential biological mechanisms that may be responsible for these sex differences. Findings suggest the importance of symptom screening and early intervention to reduce maternal distress and risk of neonatal morbidity. </jats:sec

Maternal sociodemographic factors and antenatal stress

Antenatal stress has been associated with adverse birth outcomes such as fetal growth restriction, low birth weight, and preterm birth. Understanding key determinants of stress in a vulnerable pregnant population has the potential of informing development of targeted cost-effective interventions to mitigate against these adverse birth outcomes. We conducted a secondary analysis of data from 150 pregnant women attending antenatal care services at a rural referral hospital in Kenya. The participants completed a sociodemographic and clinical questionnaire, the Cohen’s Perceived Stress Scale (PSS) and gave a hair sample for cortisol and cortisone analysis. The association between selected sociodemographic predictors (age, parity, marital status, maternal education, household income, polygyny, and intimate partner violence) and outcomes (hair cortisol, hair cortisone, and PSS score) was examined using univariate, bivariate and multivariate models. We found a negative association between PSS scores and household income (β = −2.40, p = 0.016, 95% CI = −4.36, −0.45). There was a positive association of the ratio of hair cortisone to cortisol with Adolescent age group (β = 0.64, p = 0.031, 95% CI = 0.06, 1.22), and a negative association with Cohabitation (β = −1.21, p = 0.009, 95% CI = −2.11, −0.31). We conclude that household income influenced psychological stress in pregnancy. Adolescence and cohabitation may have an influence on biological stress, but the nature of this effect is unclear