Association between father involvement and attitudes in early child-rearing and depressive symptoms in the pre-adolescent period in a UK birth cohort.

BACKGROUND: Much of the research on parenting and its influence on child development has emphasised the mother's role. However, increasing evidence highlights the important role of fathers in the development, health and well-being of their children. We sought to explore the association between paternal involvement in early child-rearing and depressive symptoms in 9 and 11 year-old children. METHODS: We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort recruited in the southwest of England. The outcome was depressive symptoms measured using the short Moods and Feelings Questionnaire (sMFQ) score. The main exposure was father involvement measured through factor analysis of fathers' responses on their participation in, understanding of, and feelings about their child's early upbringing. Scores on factor 1 measured fathers' emotional response to the child; scores on factor 2 measured the frequency of father involvement in domestic and childcare activities; scores on factor 3 measured fathers' feelings of security in their role as parent and partner. RESULTS: Children of fathers with high scores on factors 1 and 3 had 13% (OR 0.87, 95%CI 0.77-0.98, p = 0.024) and 9% (OR 0.91, 95%CI 0.80-1.03, p = 0.129) respectively lower adjusted odds of depressive symptoms at 9 and 11 years. For factor 2, there was weak evidence of a 17% increase in odds of depressive symptoms associated with 1 unit higher factor scores at both ages (OR 1.17, 95%CI 1.00-1.37, p = 0.050). LIMITATIONS: In these observational data, the possibility of residual confounding in the association between the exposure and the outcome cannot be ruled out. CONCLUSION: Positive psychological and emotional aspects of father involvement in children's early upbringing, but not the quantity of direct involvement in childcare, may protect children against developing symptoms of depression in their pre-teen years

Occupational risk factors of Low Back Pain among tea pickers and non-tea pickers in James Finlay (K) Ltd, Kericho County, Kenya

Low back pain (LBP) is a major public health problem in the world. It is estimated that 60% of all employees experience LBP at some point in their life during their employment career. It is also the most prevalent musculo-skeletal condition in rural communities in Kenya and it is estimated that 64% of the tea pickers are suffering from LBP in Kenya, of these, 29% had a history of back pain before they started picking tea. The study aimed at determining the prevalence and assessing the occupational risk factors of LBP among tea pickers and non-tea pickers in James Finlay (K) Limited tea estates in Kericho County. Data were collected using structured questionnaires. Bivariate, multivariate analysis and Pearson’s chi square (χ2) test was used to measure the associations. This study was a cross-sectional comparative study that sampled 454 adults (335 tea pickers and 119 non-tea pickers). The prevalence of LBP was found to be 45.4% (125/335) and 39.5% (47/119) among tea pickers and non-tea pickers respectively. The following characteristics were significant at bivariate level including age, parity and duration of work were found to be related to LBP among tea pickers and non-tea pickers (χ2=8.643; P=0.034 and χ2=6.013; p=0.049) respectively. However, the number of hours worked per day was significantly associated with LBP among tea pickers only (χ2=17.192; p=0.000).  Further, the number of kilograms of tea leaves picked and the number of kgs carried per day was also significantly associated with LBP (χ2=16.882; p=0.000 and χ2=15.978; p=0.001) respectively. There was also a significant association of LBP with carrying of heavy load and how one sharpened farm tools among the non tea pickers who reported to have suffered LBP (χ2=13.129; p=0.000 and χ2=4.125; p=0.042) respectively. However, age (p=0.0022; 95% CI -9.4-7); absenteeism from work (P=0.010; 95% CI 2.7-19.5), work duration per day (P=0.000; 95% CI 23.1-38.5), type of occupation (P=0.000; 95% CI 62.2-79.3) and the no. of Kgs (P=0.011; 95% CI -17.8-2.3) carried were found to contribute independently to LBP among tea pickers whereas absenteeism from work (P=0.000; 95% CI 11.9-29.1), work duration per day (P=0.000; 95% CI 69.8-86.8), alcohol uptake (P=0.008; 95% CI 3.2-20.7), heavy load carried (P=0.018; 95% CI 1.8-18.2) and work duration (P=0.002; 95% CI -14.3-3.2) among non-tea pickers were also found to contribute independently to LBP. The prevalence of LBP was found to be high among both tea and non-tea pickers. We recommend that there is need to consider reviewing tea picking policies for instance introduction of tea picking devices in order to alleviate occupational health hazards associated with tea picking. Key words: Low Back Pain, tea pickers, non-tea pickers.

Prevalence of perinatal post-traumatic stress disorder (PTSD) in low-income and middle-income countries: a systematic review and meta-analysis

Objectives: To systematically synthesise the evidence on prevalence of perinatal post-traumatic stress disorder (PTSD) in low-income and middle-income countries (LMICs). Design: Systematic review and meta-analysis. Data sources: MEDLINE, Embase, PsycINFO, Scopus, Web of Science, Global Health, Global Index Medicus and the grey literature were searched with no language or date restrictions. The final search was carried out on 3 May 2022. Eligibility criteria: Cross-sectional, cohort or case–control studies that assessed the prevalence of PTSD in pregnant or postpartum women in LMICs were included. Data extraction and synthesis: Screening, data extraction and quality assessment were conducted independently by two reviewers. Pooled prevalence estimates were calculated with 95% CIs and prediction intervals (PI) using random-effects meta-analyses. Subgroup analyses and meta-regression were conducted to explore possible sources of statistical heterogeneity. Results: 39 studies were included in the systematic review of which 38 were included in meta-analysis. The pooled prevalence of clinically diagnosed perinatal PTSD was 4.2% (95% CI 2.2% to 6.8%; 95% PI 0–18%; 15 studies). The pooled prevalence of self-reported perinatal PTSD symptoms was 11.0% (95% CI 7.6% to 15.0%; 95% PI 0–36%; 23 studies). There was no evidence of differences in prevalence according to perinatal stage (antenatal versus postnatal), geographical region, type of setting or study quality. Conclusions: Findings of this review suggest 1 in 10 perinatal women experiences symptoms of PTSD and 1 in 20 experiences clinically diagnosed PTSD. Statistical heterogeneity between studies persisted in subgroup analyses and results should be interpreted with caution. More research from low-income countries is needed to improve understanding of the burden of perinatal PTSD in these settings. PROSPERO registration number: CRD42022325072

Risk factors for maternal mortality among 1.9 million women in nine empowered action group states in India: secondary analysis of Annual Health Survey data.

OBJECTIVE: To examine the risk factors for pregnancy-related death in India's nine Empowered Action Group (EAG) states. DESIGN: Secondary data analysis of the Indian Annual Health Survey (2010-2013). SETTING: Nine states: Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand. PARTICIPANTS: 1 989 396 pregnant women. METHODS: Maternal mortality ratio (MMR), overall and for each state, with 95% CI was calculated. Stepwise multivariable logistic regression was used to investigate the association of risk factors with maternal mortality. Area under the receiver-operating characteristic (AUROC) curve was used to assess the prediction of the model. OUTCOME MEASURES: MMR adjusted for survey design, adjusted OR (aOR)with 95% CI and C-statistic with 95% CI. RESULTS: MMR calculated for the nine states was 383/100 000 live births (95% CI 346 to 423 per 100 000). Age exhibited a U-shaped association with maternal mortality. Not having a health scheme and belonging to a scheduled caste or scheduled tribe group were significant risk factors for maternal death with aOR of 2.72 (95% CI 2.41 to 3.07), 1.10 (95% CI 1.02 to 1.18) and 1.43 (95% CI 1.31 to 1.56), respectively. Socioeconomic status and rural residence were not associated with maternal mortality after adjusting for access to a healthcare facility. Complications of pregnancy and medical comorbidities were the strongest risk factors for maternal death (aOR 50.2, 95% CI 44.5 to 56.6). Together, the risk factors identified accounted for 89% (95% CI 0.887 to 0.894) of the AUROC. CONCLUSIONS: Maternal mortality in India's EAG states greatly exceeds the national average. The identified risk factors demonstrate the importance of improving the quality of pregnancy care. Notably, the study showed that the risk conferred by poor socioeconomic status could be mitigated by universal access to healthcare during pregnancy and childbirth

Postpartum haemorrhage and risk of cardiovascular disease in later life: A population‐based record linkage cohort study

Objective: To investigate the association between postpartum haemorrhage (PPH) and subsequent cardiovascular disease. Design: Population‐based retrospective cohort study, using record linkage between Aberdeen Maternity and Neonatal Databank (AMND) and Scottish healthcare data sets. Setting: Grampian region, Scotland. Population: A cohort of 70 904 women who gave birth after 24 weeks of gestation in the period 1986–2016. Methods: We used extended Cox regression models to investigate the association between having had one or more occurrences of PPH in any (first or subsequent) births (exposure) and subsequent cardiovascular disease, adjusted for sociodemographic, medical, and pregnancy and birth‐related factors. Main Outcome Measures: Cardiovascular disease identified from the prescription of selected cardiovascular medications, hospital discharge records or death from cardiovascular disease. Results: In our cohort of 70 904 women (with 124 795 birth records), 25 177 women (36%) had at least one PPH. Compared with not having a PPH, having at least one PPH was associated with an increased risk of developing cardiovascular disease, as defined above, in the first year after birth (adjusted hazard ratio, aHR 1.96; 95% confidence interval, 95% CI 1.51–2.53; p < 0.001). The association was attenuated over time, but strong evidence of increased risk remained at 2–5 years (aHR 1.19, 95% CI 1.11–1.30, P < 0.001) and at 6–15 years after giving birth (aHR 1.17, 95% CI 1.05–1.30, p = 0.005). Conclusions: Compared with women who have never had a PPH, women who have had at least one episode of PPH are twice as likely to develop cardiovascular disease in the first year after birth, and some increased risk persists for up to 15 years

Trends in birth attendants in Sudan using three consecutive household surveys (from 2006 to 2014)

Introduction: Improving maternal health and survival remains a public health priority for Sudan. Significant investments were made to expand access to maternal health services, such as through the training and deployment of providers with varying skills and competencies to work across the country. This study investigates trends in the coverage of different birth attendants and their relationship with the maternal mortality ratio (MMR). Methods: Trend analyses were conducted using data from the 2006, 2010, and 2014 Sudan Household surveys. Three categories of birth attendants were identified: (1) skilled birth attendants (SBA) such as doctors, nurse-midwives, and health visitors, (2) locally certified midwives, and (3) traditional birth attendants (TBA). Multivariable logistic regression models were used to examine trends in SBAs (vs. locally certified midwives and TBAs), locally certified midwives (vs SBAs and TBAs), and SBAs and locally certified midwives by place of birth (health facility and home). The analyses were adjusted for potential confounders. An ecological analysis was conducted to assess the relationship between birth attendants by place of birth and MMR at the state level. Results: Births by 15,848 women were analysed. Locally certified midwives attended most births in each survey year, with their contribution increasing from 36.3% in 2006 to 55.5% in 2014. The contributions of SBAs and TBAs decreased over the same period. In 2014 compared with 2006, births were more likely to be attended by a locally certified midwife (aOR: 2.19; 95%CI: 1.82–2.63) but less likely to be attended by a SBA (aOR: 0.46; 95%CI: 0.37–0.56). The decrease in SBA was more substantial for births taking place at home (aOR: 0.17; 95%CI: 0.12–0.23) than for health facility births (aOR: 0.45; 95%CI: 0.31–0.65). In the ecological analysis 2014–2016, the proportion of births attended by SBA in health facilities correlated negatively with MMR at state level (rho −0.55; p: 0.02). Conclusion: This analysis suggests that although an improved coverage of maternal health with locally certified midwives has been observed, it has not provided the skill level reached by SBA. SBAs working in facility settings were a key correlating factor to reduced maternal mortality. Urgent action is needed to improve access to SBAs in health facilities, thereby accelerating progress in reducing maternal mortality

Variations in neonatal mortality, infant mortality, preterm birth and birth weight in England and Wales according to ethnicity and maternal country or region of birth: an analysis of linked national data from 2006 to 2012.

BACKGROUND: Risks of adverse birth outcomes in England and Wales are relatively low but vary across ethnic groups. We aimed to explore the role of mother's country of birth on birth outcomes across ethnic groups using a large population-based linked data set. METHODS: We used a cohort of 4.6 million singleton live births in England and Wales to estimate relative risks of neonatal mortality, infant mortality and preterm birth, and differences in birth weight, comparing infants of UK-born mothers to infants whose mothers were born in their countries or regions of ethnic origin, or elsewhere. RESULTS: The crude neonatal and infant death risks were 2.1 and 3.2 per 1000, respectively, the crude preterm birth risk was 5.6% and the crude mean birth weight was 3.36 kg. Pooling across all ethnic groups, infants of mothers born in their countries or regions of ethnic origin had lower adjusted risks of death and preterm birth, and higher gestational age-adjusted mean birth weights than those of UK-born mothers. White British infants of non-UK-born mothers had slightly lower gestational age-adjusted mean birth weights than White British infants of UK-born mothers (mean difference -3 g, 95% CI -5 g to -0.3 g). Pakistani infants of Pakistan-born mothers had lower adjusted risks of neonatal death (adjusted risk ratio (aRR) 0.84, 95% CI 0.72 to 0.98), infant death (aRR 0.84, 95% CI 0.75 to 0.94) and preterm birth (aRR 0.85, 95% CI 0.82 to 0.88) than Pakistani infants of UK-born Pakistani mothers. Indian infants of India-born mothers had lower adjusted preterm birth risk (aRR 0.91, 95% CI 0.87 to 0.96) than Indian infants of UK-born Indian mothers. There was no evidence of a difference by mother's country of birth in risk of birth outcomes among Black infants, except Black Caribbean infants of mothers born in neither the UK nor their region of origin, who had higher neonatal death risks (aRR 1.71, 95% CI 1.06 to 2.76). CONCLUSION: This study highlights evidence of better birth outcomes among UK-born infants of non-UK-born minority ethnic group mothers, and could inform the design of future interventions to reduce the risks of adverse birth outcomes through improved targeting of at-risk groups

Acute malnutrition recovery energy requirements based on mid-upper arm circumference: Secondary analysis of feeding program data from 5 countries, Combined Protocol for Acute Malnutrition Study (ComPAS) Stage 1.

BACKGROUND: Severe and moderate acute malnutrition (SAM and MAM) are currently treated with different food products in separate treatment programs. The development of a unified and simplified treatment protocol using a single food product aims to increase treatment program efficiency and effectiveness. This study, the first stage of the ComPAS trial, sought to assess rate of growth and energy requirements among children recovering from acute malnutrition in order to design a simplified, MUAC-based dosage protocol. METHODS: We obtained secondary data from patient cards of children aged 6-59 months recovering from SAM in outpatient therapeutic feeding programs (TFPs) and from MAM in supplementary feeding programs (SFPs) in five countries in Africa and Asia. We used local polynomial smoothing to assess changes in MUAC and proportional weight gain between clinic visits and assessed their normalized differences for a non-zero linear trend. We estimated energy needs to meet or exceed the growth observed in 95% of visits. RESULTS: This analysis used data from 5518 patients representing 33942 visits. Growth trends in MUAC and proportional weight gain were not significantly different, each lower at higher MUAC values: MUAC growth averaged 2mm/week at lower MUACs (100 to <110mm) and 1mm/week at higher MUACs (120mm to <125mm); and proportional weight gain declined from 3.9g/kg/day to 2.4g/kg/day across the same MUAC values. In 95% of visits by children with a MUAC 100mm to <125mm who were successfully treated, energy needs could be met or exceeded with 1,000 kilocalories a day. CONCLUSION: Two 92g sachets of Ready-to-Use Therapeutic Food (RUTF) (1,000kcal total) is proposed to meet the estimated total energy requirements of children with a MUAC 100mm to <115mm, and one 92g sachet of RUTF (500kcal) is proposed to meet half the energy requirements of children with a MUAC of 115 to <125mm. A simplified, combined protocol may enable a more holistic continuum of care, potentially contributing to increased coverage for children suffering from acute malnutrition

Association of the Paediatric Admission Quality of Care score with mortality in Kenyan hospitals: a validation study.

BACKGROUND: Measuring the quality of hospital admission care is essential to ensure that standards of practice are met and continuously improved to reduce morbidity and mortality associated with the illnesses most responsible for inpatient deaths. The Paediatric Admission Quality of Care (PAQC) score is a tool for measuring adherence to guidelines for children admitted with acute illnesses in a low-income setting. We aimed to explore the external and criterion-related validity of the PAQC score by investigating its association with mortality using data drawn from a diverse sample of Kenyan hospitals. METHODS: We identified children admitted to Kenyan hospitals for treatment of malaria, pneumonia, diarrhoea, or dehydration from datasets from three sources: an observational study, a clinical trial, and a national cross-sectional survey. We extracted variables describing the process of care provided to patients at admission and their eventual outcomes from these data. We applied the PAQC scoring algorithm to the data to obtain a quality-of-care score for each child. We assessed external validity of the PAQC score by its systematic replication in datasets that had not been previously used to investigate properties of the PAQC score. We assessed criterion-related validity by using hierarchical logistic regression to estimate the association between PAQC score and the outcome of mortality, adjusting for other factors thought to be predictive of the outcome or responsible for heterogeneity in quality of care. FINDINGS: We found 19 065 eligible admissions in the three validation datasets that covered 27 hospitals, of which 12 969 (68%) were complete cases. Greater guideline adherence, corresponding to higher PAQC scores, was associated with a reduction in odds of death across the three datasets, ranging between 9% (odds ratio 0·91, 95% CI 0·84-0·99; p=0·031) and 30% (0·70, 0·63-0·78; p<0·0001) adjusted reduction per unit increase in the PAQC score, with a pooled estimate of 17% (0·83, 0·78-0·89; p<0·0001). These findings were consistent with a multiple imputation analysis that used information from all observations in the combined dataset. INTERPRETATION: The PAQC score, designed as an index of the technical quality of care for the three commonest causes of admission in children, is also associated with mortality. This finding suggests that it could be a meaningful summary measure of the quality of care for common inpatient conditions and supports a link between process quality and outcome. It might have potential for application in low-income countries with similar disease profiles and in which paediatric practice recommendations are based on WHO guidelines. FUNDING: The Wellcome Trust

Effects of community-based interventions for stillbirths in sub-Saharan Africa: a systematic review and meta-analysis

Background Sub-Saharan Africa (SSA) alone contributed to 42% of global stillbirths in 2019, and the rate of stillbirth reduction has remained slow. There has been an increased uptake of community-based interventions to combat stillbirth in the region, but the effects of these interventions have been poorly assessed. Our objectives were to examine the effect of community-based interventions on stillbirth in SSA. Methods In this systematic review and meta-analysis, we searched eight databases (MEDLINE [OvidSP], Embase [OvidSP], Cochrane Central Register of Controlled Trials, Global Health, Science Citation Index and Social Science Citation index [Web of Science Core Collection], CINAHL [EBSCOhost] and Global Index Medicus) and four grey literature sources from January 1, 2000 to July 7, 2023 for relevant studies from SSA. Community-based interventions targeting stillbirths solely or as part of complex interventions, with or without hospital interventions were included, while hospital-only interventions, microcredit schemes and maternity waiting home interventions were excluded. Study quality was assessed using the Cochrane risk of bias and National Heart, Lung and Blood Institute's tools. The study outcome was odds of stillbirth in intervention versus control communities. Pooled odds ratios (ORs) were estimated using random-effects models, and subgroup analyses were performed by intervention type and strategies. Publication bias was evaluated by funnel plot and Egger’s test. This study is registered with PROSPERO, CRD42021296623. Findings Of the 4223 records identified, seventeen studies from fifteen SSA countries were eligible for inclusion. One study had four arms (community only, hospital only, community and hospital, and control arms), so information was extracted from each arm. Analysis of 13 of the 17 studies which had community-only intervention showed that the odds of stillbirth did not vary significantly between community-based intervention and control groups (OR 0.96; 95% CI 0.78–1.17, I2 = 57%, p ≤ 0.01, n = 63,884). However, analysis of four (out of five) studies that included both community and health facility components found that in comparison with community only interventions, this combination strategy significantly reduced the odds of stillbirth by 17% (OR 0.83; 95% CI 0.79–0.87, I2 = 11%, p = 0.37, n = 244,868), after excluding a study with high risk of bias. The quality of the 17 studies were graded as poor (n = 2), fair (n = 9) and good (n = 6). Interpretation Community-based interventions alone, without strengthening the quality and capacity of health facilities, are unlikely to have a substantial effect on reducing stillbirths in SSA. Funding Nuffield Department of Population Health, Balliol College, the Clarendon Fund, Medical Research Council