Case-control study of the association of use of health services by children with behavioural and developmental disorders with prenatal alcohol exposure

Includes bibliographical references.Background Prenatal alcohol exposure can result in a range of permanent birth defects known as Fetal Alcohol Spectrum Disorders (FASD). Fetal Alcohol Syndrome (FAS), which detrimentally affects the neurodevelopmental, physical, and social capabilities of children, is the most severe diagnosis on this scale of disorders. Research suggests that FASD rates exceed FAS in various populations. South Africaâs Western Cape region has one of the highest rates of FAS in the world. Hypothesis In populations where the prevalence of full-blown FAS is already known to be high, such as the Western Cape, other, less severe childhood developmental and behavioural disorders may be due to prenatal alcohol exposure. Objectives The aim of this research was to determine the odds of maternal alcohol use in children with behavioural and/or developmental disorders (BDD) in comparison to children free from behavioural disorders. This project also examined the average utilisation of health services by children with BDD as an arm of a larger study on the economic burden of FAS in South Africa. Methods Opportunistic sampling was employed to select parents or caretakers of 110 children aged 4 to 12 for interviews at a tertiary childrenâs public hospital in Cape Town. Health service utilization and maternal alcohol consumption habits were compared between 55 cases, children with BDD and 55 controls, children free from such disorders. Univariate analyses and logistic regression methods were used to determine these associations. Ethics The University of Cape Town Research Ethics Committee approved this study. Dr. T. Blake, Senior Medical Superintendent of Red Cross War Memorial Childrenâs Hospital granted access to Red Cross Hospital. Before each study interview was conducted, informed consent, which emphasized confidentiality of responses and the right to refuse to answer a question or withdraw from the interview, was taken from the adult respondent. We also explained to participants that they would remain anonymous and that their answers would not affect their childâs treatment in the clinics. Results BDD were significantly associated with current maternal alcohol consumption, maternal binge drinking in the last six months, and maternal alcohol use six months before pregnancy, but not significantly with reported maternal gestational drinking. The median number of visits to a clinic in the last six months was significantly higher for cases than for controls. Conclusions Childhood BDD among our study participants were not attributed to prenatal alcohol exposure. Current maternal alcohol consumption has a significant impact on BDD in children, possibly serving as a proxy for unstable home environments. The competing environmental factors that influence childhood BDD warrants further research

Childhood behavioural and developmental disorders - association with maternal alcohol consumption in Cape Town, South Africa

Current maternal alcohol consumption, especially binge drinking, is strongly associated with childhood behavioural and/or developmental disorders (BDDs) in a population attending tertiary hospital ambulatory services. BDDs were also associated with maternal alcohol use 6 months before pregnancy. An association with BDDs could not be conclusively demonstrated for drinking during pregnancy, but this may have been influenced by under-reporting and reduced study power due to misclassification of exposure. We cannot rule out the a priori suspicion that some mild BDDs in children in the Western Cape could be undiagnosed fetal alcohol spectrum disorder. Nonetheless, the study highlighted the important impact of current maternal alcohol use on behaviour and development of children. Future research on the impact of maternal alcohol use on childhood development should include examination of environmental and social factors contributing to this increased risk. Upstream interventions aimed at reducing alcohol-related harms may also contribute to reducing the burden of BDDs

Use of routine health information systems to monitor disruptions of coverage of maternal, newborn, and child health services during COVID-19: A scoping review.

BACKGROUND: The COVID-19 pandemic is a unique global health challenge which disrupted essential health services (EHS). Most early data related to EHS during the COVID-19 pandemic came from country and regional "pulse" surveys conducted by the World Health Organization (WHO) and United Nations Children's Fund (UNICEEF), which relied on respondent perceptions and not necessarily routine health information system (RHIS) data. By conducting a scoping review, we aimed to describe the use of RHIS data for monitoring changes in EHS coverage for maternal, newborn, and child health (MNCH) during the COVID-19 pandemic. METHODS: We performed a scoping review using Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping Review (PRISMA-SCR) guidelines. We included descriptive or analytic reports on the availability and use of RHIS data published in peer-reviewed, pre-publication, or gray literature on MNCH essential health services coverage during the COVID-19 pandemic. The following databases were searched for studies published between January 2020 and May 2022: PubMed/MEDLINE, Google Scholar, Google, MedRXiv (pre-publication), Embase, CINAHL, Cochrane, Campbell, and OpenGrey. A single reviewer screened the titles, abstracts, and full texts of the retrieved publications, while a second reviewer screened 20% of the total sample. Publications were tabulated by WHO Region, World Bank income group, country, data sources, study topic, and period. We used content analysis to qualitatively describe the trends and use of data for policy or programming in the studies. RESULTS: We included 264 publications after the full-text review. The publications came from 81 countries, covering all WHO regions and World Bank income groups. The most common data sources were hospital information systems (27%) and primary health care management information systems (26%). Most studies examined data trends before COVID-19 compared to periods during COVID-19. Most publications reported a decrease in MNCH services (45%). Reports with follow-up beyond August 2020 (first six months of pandemic) were significantly more likely to report recovery of service coverage (8% vs 30%, P < 0.001). Low- and middle-income countries reported significantly higher morbidity and/or mortality in COVID-19 periods than high-income countries (54% vs 30%, P < 0.001). Less than 10% of reports described RHIS data quality specifically during the COVID-19 period and only 22% reported program mitigation strategies to address reductions noted from routine data. CONCLUSION: Results suggest awareness and usefulness of RHIS to monitor MNCH service disruptions during the COVID-19 pandemic. However, with only 22% of reports including descriptions of policy or program adaptations, use of RHIS data to monitor MNCH service disruptions was not necessarily followed by data-informed policies or program adaptations. RHIS data on MNCH services should be strengthened to enable its use by program managers and policymakers to respond to direct and indirect effects of future public health emergencies. REGISTRATION: Open Science Framework (available at: https://osf.io/usqp3/?view_only=94731785fcba4377adfa1bdf5754998d)

The UN Commission on Life Saving Commodities 3 years on: global progress update and results of a multicountry assessment

Background In September, 2012, the UN Commission on Life Saving Commodities (UNCoLSC) outlined a plan to expand availability and access to 13 life saving commodities. We profi le global and country progress against these recommendations between 2012 and 2015. Methods For 12 countries in sub-Saharan Africa that were off -track to achieve the Millennium Development Goals for maternal and child survival, we reviewed key documents and reference data, and conducted interviews with ministry staff and partners to assess the status of the UNCoLSC recommendations. The RMNCH fund provided short-term catalytic fi nancing to support country plans to advance the commodity agenda, with activities coded by UNCoLSC recommendation. Our network of technical resource teams identifi ed, addressed, and monitored progress against cross-cutting commodity-related challenges that needed coordinated global action. Findings In 2014 and 2015, child and maternal health commodities had fewer bottlenecks than reproductive and neonatal commodities. Common bottlenecks included regulatory challenges (ten of 12 countries); poor quality assurance (11 of 12 countries); insuffi cient staff training (more than half of facilities on average); and weak supply chains systems (11 of 12 countries), with stock-outs of priority commodities in about 40% of facilities on average. The RMNCH fund committed US$175·7 million to 19 countries to support strategies addressing crucial gaps.$68·2 million (39·0%) of the funds supported systems-strengthening interventions with the remainder split across reproductive, maternal, newborn, and child health. Health worker training ($88·6 million, 50·4 ($53·3 million, 30·0%), and demand generation ($21·1 million, 12·0%) were the major topics of focus. All priority commodities are now listed in the WHO Essential Medicines List; appropriate price reductions were secured; quality manufacturing was improved; a fast-track registration mechanism for prequalifi ed products was established; and methods were developed for advocacy, quantifi cation, demand generation, supply chain, and provider training. Slower progress was evident around regulatory harmonisation and quality assurance. Interpretation Much work is needed to achieve full implementation of the UNCoLSC recommendations. Coordinated eff orts to secure price reductions beyond the 13 commodities and improve regulatory effi ciency, quality, and supply chains are still needed alongside broader dissemination of work products

Childhood behavioral and developmental disorders : association with maternal alcohol consumption and use of health services in Cape Town, South Africa

Includes bibliographical references.[Background] Prenatal alcohol exposure can result in a range of permanent birth defects known as Fetal Alcohol Spectrum Disorders (FASD). Fetal Alcohol Syndrome (FAS), which detrimentally affects the neurodevelopmental, physical, and social capabilities of children, is the most severe diagnosis on this scale of disorders. Research suggests that FASD rates exceed FAS in various populations. South Africa’s Western Cape region has one of the highest rates of FAS in the world. [Hypothesis] In populations where the prevalence of full-blown FAS is already known to be high, such as the Western Cape, other, less severe childhood developmental and behavioural disorders may be due to prenatal alcohol exposure. Objectives The aim of this research was to determine the odds of maternal alcohol use in children with behavioural and/or developmental disorders (BDD) in comparison to children free from behavioural disorders. This project also examined the average utilisation of health services by children with BDD as an arm of a larger study on the economic burden of FAS in South Africa. [Methods] Opportunistic sampling was employed to select parents or caretakers of 110 children aged 4 to 12 for interviews at a tertiary children’s public hospital in Cape Town. Health service utilization and maternal alcohol consumption habits were compared between 55 cases, children with BDD and 55 controls, children free from such disorders. Univariate analyses and logistic regression methods were used to determine these associations. [Ethics] The University of Cape Town Research Ethics Committee approved this study. Dr. T. Blake, Senior Medical Superintendent of Red Cross War Memorial Children’s Hospital granted access to Red Cross Hospital. Before each study interview was conducted, informed consent, which emphasized confidentiality of responses and the right to refuse to answer a question or withdraw from the interview, was taken from the adult respondent. We also explained to participants that they would remain anonymous and that their answers would not affect their child’s treatment in the clinics. [Results] BDD were significantly associated with current maternal alcohol consumption, maternal binge drinking in the last six months, and maternal alcohol use six months before pregnancy, but not significantly with reported maternal gestational drinking. The median number of visits to a clinic in the last six months was significantly higher for cases than for controls. [Conclusions] Childhood BDD among our study participants were not attributed to prenatal alcohol exposure. Current maternal alcohol consumption has a significant impact on BDD in children, possibly serving as a proxy for unstable home environments. The competing environmental factors that influence childhood BDD warrants further research

Availability of priority maternal and newborn health indicators: Cross-sectional analysis of pregnancy, childbirth and postnatal care registers from 21 countries.

Data from national health information systems are essential for routinely tracking progress, programmatic decision-making and to improve quality of services. Understanding the data elements captured in patient registers which are building blocks of national HMIS indicators, enables us to standardize data collection and measurement of key indicators for tracking progress towards achieving maternal and newborn health goals. This analysis was done through a review of antenatal care (ANC), childbirth and postnatal care (PNC) registers from 21 countries across five geographic regions. Between July and October 2020, country-based maternal and newborn experts, implementing agencies, program managers, and ministry of health personnel were asked to share the registers in use. Both paper-based and electronic registers were obtained. Twenty ANC registers, eighteen childbirth and thirteen PNC were available and analyzed. Both longitudinal and cross-sectional ANC and PNC registers were obtained, while the childbirth registers included in the analysis were all cross-sectional. Fifty-five percent (11/20) ANC registers and 54% (7/13) PNC registers were longitudinal. In four countries, the registers were electronic, while the rest were paper-based (17 countries). Sub-analysis of registers from four countries (Ghana, Kenya, Nigeria, and Zambia) where the 2017/2018 and 2019/2020 registers were available showed that the latest versions included 21/27 (78%) of data elements that are critical in the computation of key maternal and newborn care indicators. This analysis highlights some areas in where there are data gaps in data on pregnancy and childbirth. Program managers and health workers should use data gathered routinely to monitor the performance of their national health system and to guide the continuous improvement of health care services for women and newborns. The findings can help to inform the standardization of pregnancy and childbirth registers, and provide information for other countries seeking to introduce indicators in their health systems

The UN Commission on Life Saving Commodities 3 years on: global progress update and results of a multicountry assessment

Background: In September, 2012, the UN Commission on Life Saving Commodities (UNCoLSC) outlined a plan to expand availability and access to 13 life saving commodities. We profile global and country progress against these recommendations between 2012 and 2015. Methods: For 12 countries in sub-Saharan Africa that were off-track to achieve the Millennium Development Goals for maternal and child survival, we reviewed key documents and reference data, and conducted interviews with ministry staff and partners to assess the status of the UNCoLSC recommendations. The RMNCH fund provided short-term catalytic financing to support country plans to advance the commodity agenda, with activities coded by UNCoLSC recommendation. Our network of technical resource teams identified, addressed, and monitored progress against cross-cutting commodity-related challenges that needed coordinated global action. Findings: In 2014 and 2015, child and maternal health commodities had fewer bottlenecks than reproductive and neonatal commodities. Common bottlenecks included regulatory challenges (ten of 12 countries); poor quality assurance (11 of 12 countries); insufficient staff training (more than half of facilities on average); and weak supply chains systems (11 of 12 countries), with stock-outs of priority commodities in about 40% of facilities on average. The RMNCH fund committed US$175·7 million to 19 countries to support strategies addressing crucial gaps.$68·2 million (39·0%) of the funds supported systems-strengthening interventions with the remainder split across reproductive, maternal, newborn, and child health. Health worker training ($88·6 million, 50·4$53·3 million, 30·0%), and demand generation ($21·1 million, 12·0%) were the major topics of focus. All priority commodities are now listed in the WHO Essential Medicines List; appropriate price reductions were secured; quality manufacturing was improved; a fast-track registration mechanism for prequalified products was established; and methods were developed for advocacy, quantification, demand generation, supply chain, and provider training. Slower progress was evident around regulatory harmonisation and quality assurance. Interpretation: Much work is needed to achieve full implementation of the UNCoLSC recommendations. Coordinated efforts to secure price reductions beyond the 13 commodities and improve regulatory efficiency, quality, and supply chains are still needed alongside broader dissemination of work products. Funding: Governments of Norway (NORAD) and the UK (DFID)