Determinants of institutional delivery among young married women in Nepal: Evidence from the Nepal Demographic and Health Survey, 2011

OBJECTIVES: To identify the determinants of institutional delivery among young married women in Nepal. DESIGN: Nepal Demographic and Health Survey (NDHS) data sets 2011 were analysed. Bivariate and multivariate logistic regression analyses were performed using a subset of 1662 ever-married young women (aged 15-24 years). OUTCOME MEASURE: Place of delivery. RESULTS: The rate of institutional delivery among young married women was 46%, which is higher than the national average (35%) among all women of reproductive age. Young women who had more than four antenatal care (ANC) visits were three times more likely to deliver in a health institution compared with women who had no antenatal care visit (OR: 3.05; 95% CI: 2.40 to 3.87). The probability of delivering in an institution was 69% higher among young urban women than among young women who lived in rural areas. Young women who had secondary or above secondary level education were 1.63 times more likely to choose institutional delivery than young women who had no formal education (OR: 1.626; 95% CI: 1.171 to 2.258). Lower use of a health institution for delivery was also observed among poor young women. Results showed that wealthy young women were 2.12 times more likely to deliver their child in an institution compared with poor young women (OR: 2.107; 95% CI: 1.53 to 2.898). Other factors such as the age of the young woman, religion, ethnicity, and ecological zone were also associated with institutional delivery. CONCLUSIONS: Maternal health programs should be designed to encourage young women to receive adequate ANC (at least four visits). Moreover, health programs should target poor, less educated, rural, young women who live in mountain regions, are of Janajati ethnicity and have at least one child as such women are less likely to choose institutional delivery in Nepal

Patients' costs, socio-economic and health system aspects associated with malaria in pregnancy in an endemic area of Colombia.

Malaria in pregnancy threatens birth outcomes and the health of women and their newborns. This is also the case in low transmission areas, such as Colombia, where Plasmodium vivax is the dominant parasite species. Within the Colombian health system, which underwent major reforms in the 90s, malaria treatment is provided free of charge to patients. However, patients still incur costs, such as transportation and value of time lost due to the disease. We estimated such costs among 40 pregnant women with clinical malaria (30% Plasmodium falciparum, 70% Plasmodium vivax) in the municipality of Tierralta, Northern Colombia. In a cross-sectional study, women were interviewed after an outpatient or inpatient laboratory confirmed malaria episode. Women were asked to report all types of cost incurred before (including prevention), during and immediately after the contact with the health facility. Median total cost was over 16US$for an outpatient visit, rising to nearly 30US$ if other treatments were sought before reaching the health facility. Median total inpatient cost was 26US$or 54US$ depending on whether costs incurred prior to admission were excluded or included. For both outpatients and inpatients, direct costs were largely due to transportation and indirect costs constituted the largest share of total costs. Estimated costs are likely to represent only one of the constraints that women face when seeking treatment in an area characterized, at the time of the study, by armed conflict, displacement, and high vulnerability of indigenous women, the group at highest risk of malaria. Importantly, the Colombian peace process, which culminated with the cease-fire in August 2016, may have a positive impact on achieving universal access to healthcare in conflict areas. The current study can inform malaria elimination initiatives in Colombia

What Influences Adolescent Girls' Decision-Making Regarding Contraceptive Methods Use and Childbearing? A Qualitative Exploratory Study in Rangpur District, Bangladesh

BACKGROUND: Bangladesh has the highest rate of adolescent pregnancy in South Asia. Child marriage is one of the leading causes of pregnancies among adolescent girls. Although the country's contraceptive prevalence rate is quite satisfactory, only 52% of married adolescent girls use contraceptive methods. This qualitative study is aimed at exploring the factors that influence adolescent girls' decision-making process in relation to contraceptive methods use and childbearing. METHODS AND RESULTS: We collected qualitative data from study participants living in Rangpur district, Bangladesh. We conducted 35 in-depth interviews with married adolescent girls, 4 key informant interviews, and one focus group discussion with community health workers. Adolescent girls showed very low decision-making autonomy towards contraceptive methods use and childbearing. Decisions were mainly made by either their husbands or mothers-in-law. When husbands were unemployed and financially dependent on their parents, then the mothers-in-law played most important role for contraceptive use and childbearing decisions. Lack of reproductive health knowledge, lack of negotiation and communication ability with husbands and family members, and mistrust towards contraceptive methods also appeared as influential factors against using contraception resulting in early childbearing among married adolescent girls. CONCLUSIONS: Husbands and mothers-in-law of newly married adolescent girls need to be actively involved in health interventions so that they make more informed decisions regarding contraceptive use to delay pregnancies until 20 years of age. Misunderstanding and distrust regarding contraceptives can be diminished by engaging the wider societal actors in health intervention including neighbours, and other family members

Alterations and diagnostic performance of capillary ketonemia in pediatric acute appendicitis: a pilot study

Introduction: The diagnostic performance of capillary ketonemia (CK) has been previously evaluated in context of pediatric acute gastroenteritis. To our knowledge, there is no literature on its performance in the setting of pediatric acute appendicitis (PAA). Materials and methods: In this study, 151 patients were prospectively included and divided into two groups: (1) patients with non-surgical abdominal pain in whom the diagnosis of PAA was excluded (n : 53) and (2) patients with a confirmed diagnosis of PAA (n : 98). In 80 patients (Group 1, n : 23 and group 2, n : 57) a CK was measured at the time of diagnosis. The PAA group was further classified into complicated (n : 18) and uncomplicated PAA (n : 39). Quantitative variables were compared between groups using the Mann-Whitney U test. Diagnostic performance of CK was evaluated with ROC curves. Results: CK values were 0.3 [0.1-0.9] mmol/L in group 1 and 0.7 [0.4-1.4] mmol/L in group 2 (p = 0.01). Regarding the type of PAA, CK values were 0.6 [0.4-0.9] mmol/L in uncomplicated PAA and 1.2 [0.8-1.4] mmol/L in complicated PAA (p : 0.02). The AUC for the discrimination between groups 1 and 2 was 0.68 (95/100 IC 0.53-0.82) (p : 0.24) and the AUC for the discrimination between uncomplicated PAA and complicated PAA was 0.69 (95/100 IC 0.54-0.85) (p : 0.04). The best cut-off point (group 1 vs group 2) resulted in 0.4 mmol/L, with a sensitivity of 80.7/100 and a specificity of 52.2/100. The best cut-off point (non-complicated vs complicated PAA) resulted in 1.1 mmol/L, with a sensitivity of 61.1/100 and a specificity of 76.9/100. Conclusions: This study found significantly higher levels of CK in patients with PAA than in those with NSAP. Similarly, significantly higher levels were observed in patients with complicated than in those with uncomplicated PAA. Nevertheless, the diagnostic performance of CK was only moderate in the two settings analyzed. The potential usefulness of CK determination as a tool to guide the preoperative rehydration regimen of patients with PAA to prevent postoperative hyporexia and vomiting is a promising line of research and should be evaluated in future studies

Determinants and trends in health facility-based deliveries and caesarean sections among married adolescent girls in Bangladesh

OBJECTIVE: To identify the determinants and measure the trends in health facility-based deliveries and caesarean sections among married adolescent girls in Bangladesh. METHODS: In order to measure the trends in health facility-based deliveries and caesarean sections, Bangladesh Demographic Health Survey (BDHS) data sets were analysed (BDHS; 1993-1994, 1996-1997, 1999-2000, 2004, 2007, 2011). The BDHS 2011 data sets were analysed to identify the determinants of health facility-based deliveries and caesarean sections. A total of 2813 adolescent girls (aged 10-19 years) were included for analysis. Bivariate and multivariate analyses were performed. RESULTS: Health facility-based deliveries have continuously increased among adolescents in Bangladesh over the past two decades from 3% in 1993-1994 to 24.5% in 2011. Rates of population-based and facility-based caesarean sections have increased linearly among all age groups of women including adolescents. Although the country's overall (population-based) caesarean section rate among adolescents was within acceptable range (11.6%), a rate of nearly 50% health facility level caesarean sections among adolescent girls is alarming. Among adolescent girls, use of antenatal care (ANC) appeared to be the most important predictor of health facility-based delivery (OR: 4.04; 95% CI 2.73 to 5.99), whereas the wealth index appeared as the most important predictor of caesarean sections (OR: 5.7; 95% CI 2.74 to 12.1). CONCLUSIONS: Maternal health-related interventions should be more targeted towards adolescent girls in order to encourage them to access ANC and promote health facility-based delivery. Rising trends of caesarean sections require further investigation on indication and provider-client-related determinants of these interventions among adolescent girls in Bangladesh

Paleogeografía sísmica de zonas costeras en la Península Ibérica: su impacto en el análisis de terremotos antiguos e históricos en España

This paper presents three examples of ancient earthquakes occurring in coastal areas of the S and SE of the Iberian Peninsula (218 BC, AD 40-60 and AD 1048) with the aim of illustrating the use of geological and archaeological data in their macroseismic characterization. Historical information for ancient earthquakes that occurred in Spain prior to the 10th century is scarce or non-existent. This paper shows that the current state of knowledge on palaeoseismology and archaeoseismology on these ancient events clearly exceeds the existing historical information allowing the increase of macroseismic information points by using the ESI-07 scale (Environmental Seismic Intensity). Consequently, the geologic analyses of ancient earthquakes contribute to their understanding and parametric evaluations, and improve further advances in seismic hazard assessments. The most significant issue outlined in the present paper is the analysis of the ancient palaeogeography of the affected areas. The studied examples analysed were located in open estuarine areas that have been filled by fluvial sediments or anthropogenic fills over time. The effects of the 218 BC earthquake-tsunami event in the Gulf of Cadiz are analysed in estuarine areas, and especially in the ancient Roman Lagus Ligustinus (Guadalquivir Depression marshes); the effects of the earthquake in AD 40-60 is analysed in the old Roman city of Baelo Claudia located in the Bolonia Bay (Strait of Gibraltar); and the effects of the earthquake of AD 1048on the ancient Sinus Ilicitanus (Bajo Segura Depression) during Muslim times. Descriptions from Roman and Arabic geographers are cross-checked with existing palaeogeographic models based on geological data. This type of analysis results in ancient macroseismic scenarios for the interpretation of theoretical distributions of intensities and environmental effects supporting the concept of “seismic palaeogeography” proposed in this paperEl presente trabajo recoge tres ejemplos de terremotos antiguos (218 AC, 40-60 AD y 1048 AD) ocurridos en zonas litorales del S y SO de la Península Ibérica con la intención de ilustrar el uso de datos geológicos y ar¬queológicos en la caracterización macrosísmica de los mismos. En la mayor parte de los sísmos ocurridos con anterioridad al siglo X d.C. la información documental histórica que se posee es muy escasa o inexistente. El presente trabajo muestra que el actual estado de conocimiento en paleosismología y arqueosismologia sobre este tipo de terremotos sobrepasa con creces la información documental histórica, permitiendo la multiplica¬ción de los puntos de información macrosísmica mediante el uso de la escala ESI-07 (Environmental Seismic Intensity). Consecuentemente, el análisis geológico de los terremotos antiguos mejora su conocimiento y análisis paramétrico, permitiendo avanzar la evaluación de la peligrosidad sísmica de las zonas afectadas. El aspecto que se pone de especial relieve en este trabajo es el análisis de la paleogeografía existente en la antigüedad, ya que todas las zonas (afectadas) analizadas en este trabajo corresponden a zonas estuarinas abiertas que se han ido rellenado por aportes fluviales o de forma artificial con el tiempo. Se analizan los efectos del terremoto de 218 AC en las zonas estuarinas del Golfo de Cádiz y muy especialmente en el antiguo Lacus Ligustinus (marismas del Guadalquivir) durante época romana; los efectos del terremoto de 40-60 AD en la antigua Bahía de Baelo Claudia (Estrecho de Gibraltar); y los efectos del terremoto de 1048 AD en el antiguo Sinus ilicitanus (Depresión del Bajo Segura) durante época musulmana. Se han cotejado descripciones de geógrafos romanos y árabes con modelos basados en datos geológicos. Este tipo de análisis ha permitido generar antiguos escenarios macrosísmicos basados en la paleogeografía y reinterpretar las distribuciones teóricas de intensidades y los efectos ambientales de los terremotos estudiados que es a lo que se refiere el concepto de “paleogeografía sísmica” propuesto en este trabajoThis work has been funded by the Spanish-FEDER research projects CGL2012-37281 C02.01 (QTECTBETICA-USAL), CGL2012-33430 (CSIC) and CGL2013-42847-R (UNED

Influence of Malignant Pleural Fluid from Lung Adenocarcinoma Patients on Neutrophil Response

Malignant pleural effusion (MPE) is a common severe complication of advanced lung adenocarcinoma (LAC). Neutrophils, an essential component of tumor infiltrates, contribute to tumor progression and their counts in MPE have been associated with worse outcome in LAC. This study aimed to evaluate phenotypical and functional changes of neutrophils induced by MPE to determine the influence of MPE immunomodulatory factors in neutrophil response and to find a possible association between neutrophil functions and clinical outcomes. Pleural fluid samples were collected from 47 LAC and 25 heart failure (HF) patients. We measured neutrophil degranulation products by ELISA, oxidative burst capacity and apoptosis by flow cytometry, and NETosis by fluorescence. The concentration of degranulation products was higher in MPE-LAC than in PE-HF. Functionally, neutrophils cultured with MPE-LAC had enhanced survival and neutrophil extracellular trap (NET) formation but had reduced oxidative burst capacity. In MPE, NETosis was positively associated with MMP-9, P-selectin, and sPD-L1 and clinically related to a worse outcome. This is the first study associating NETs with a worse outcome in MPE. Neutrophils likely contribute to tumor progression through the release of NETs, suggesting that they are a potential therapeutic target in LAC

Malaria in rural Mozambique. Part II: children admitted to hospital

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Low birth weight: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data

Need for developing case definitions and guidelines for data collection, analysis, and presentation for low birth weight as an adverse event following maternal immunization The birth weight of an infant is the first weight recorded after birth, ideally measured within the first hours after birth, before significant postnatal weight loss has occurred. Low birth weight (LBW) is defined as a birth weight of less than 2500 g (up to and including 2499 g), as per the World Health Organization (WHO) [1]. This definition of LBW has been in existence for many decades. In 1976, the 29th World Health Assembly agreed on the currently used definition. Prior to this, the definition of LBW was ‘2500 g or less’. Low birth weight is further categorized into very low birth weight (VLBW, <1500 g) and extremely low birth weight (ELBW, <1000 g) [1]. Low birth weight is a result of preterm birth (PTB, short gestation <37 completed weeks), intrauterine growth restriction (IUGR, also known as fetal growth restriction), or both. The term low birth weight refers to an absolute weight of <2500 g regardless of gestational age. Small for gestational age (SGA) refers to newborns whose birth weight is less than the 10th percentile for gestational age. This report will focus specifically on birth weight <2500 g. Further details related to case definitions for PTB [2], IUGR and SGA are included in separate GAIA reports