Perinatal distress in women in low- and middle-income countries: Allostatic load as a framework to examine the effect of perinatal distress on preterm birth and infant health

In low- and middle-income countries (LMIC), determinants of women\u27s and children\u27s health are complex and differential vulnerability may exist to risk factors of perinatal distress and preterm birth. We examined the contribution of maternal perinatal distress on preterm birth and infant health in terms of infant survival and mother-infant interaction. A critical narrative and interpretive literature review was conducted. Peer-reviewed electronic databases (MEDLINE, Embase, Global Health, CINHAL), grey literature, and reference lists were searched, followed by a consultation exercise. The literature was predominantly from high-income countries. We identify determinants of perinatal distress and explicate changes in the hypothalamic-pituitary-adrenal axis, sympathetic, immune and cardiovascular systems, and behavioral responses resulting in pathophysiological effects. We suggest cultural-neutral composite measures of allostatic mediators (i.e., several biomarkers) of maternal perinatal distress as objective indicators of dysregulation in body systems in pregnant women in LMIC. Understanding causal links of maternal perinatal distress to preterm birth in women in LMIC should be a priority. The roles of allostasis and allostatic load are considered within the context of the health of pregnant women and fetuses/newborns in LMIC with emphasis on identifying objective indicators of the level of perinatal distress and protective factors or processes contributing to resilience while facing toxic stress. We propose a prospective study design with multiple measures across pregnancy and postpartum requiring complex statistical modeling. Building research capacity through partnering researchers in high-income countries and LMIC and reflecting on unique ethical challenges will be important to generating new knowledge in LMIC

Exploring Perinatal Global Health: A Reflective Commentary of a Nursing Student’s Experience Abroad in Uganda

Background: The first author undertook the Perinatal Global Health Internship from May to July 2016 in Kampala, Uganda as part of the Canadian Queen Elizabeth II Diamond Jubilee Scholarship Program funded by the Community Foundations of Canada. The internship was carried out in partnership with the University of Calgary, Faculty of Nursing and University of Calgary International, and the Aga Khan University – School of Nursing and Midwifery with technical support from Universities Canada.  Aim: In this paper, we explain the role of nursing in global health, explore the first author’s learning in the area of perinatal health, and invite other nursing students to engage in global health work. Discussion of Stories: A reflective commentary is used to describe the first author’s experience in a government hospital in Kampala as she learned to recognize the implications of perinatal distress, socio-ecological conditions, and resource-poor settings on the health of mothers and premature neonates. In the commentary, the first author also describes the development of an Early Childhood Development resource and the value of partnership in relation to this experience. Reflection: The first author reflects on the benefit of the internship in developing key competencies and attributes for global health work, the need for cultural competency, and barriers to creating effective change to address complex issues. Conclusion: The first author summarizes key learning from the practice, teaching, and research components of the internship. She describes growth, two-way learning, and recommendations for the internship

Children learn in diverse ways : the sangareddy experience

Devika and Bala are two among the 33 million children between 3-6 years of age attending about 1.3 million Anganwadi Centres (AWCs) run by Integrated Child Development Services (ICDS) Scheme of the Ministry of Women Development and Child Welfare to provide nutrition, health and early education services. The children learn through play and meaningful activities facilitated by the teacher. Most of the children attending AWCs come from disadvantaged families. Does the learning ability of these children depend on their socio-economic conditions? If they grow up failing to learn to read or write and dropout subsequently, is it due to their individual inadequacies influenced by factors such as poor habits, laziness or the lack of interest in education? Do poverty, caste, religion and other social differences account for their learning abilities

Stories of change : case study challenge 2019-2020

Modern India has a history of a vibrant and active social sector. Many local development organisations, community organizations, social movements and non-governmental organisations populate the space of social action. Such organisations imagine a different future and plan and implement social interventions at different scales, many of which have lasting impact on the lives of people and society. However, their efforts and, more importantly, the learning from these initiatives remains largely unknown not only in the public sphere but also in the worlds of ‘development practice’ and ‘development education’. This shortfall impedes the process of learning and growth across interventions, organizations and time

Exploration of in Vivo Efficacy of Artemether-Lumefantrine Against Uncomplicated Plasmodium Falciparum Malaria in Under Fives in Tabora Region, Tanzania.

Tanzania adopted artemether-lumefantrine (AL) as first-line drug for uncomplicated malaria in 2006. Recently, there was an anecdotal report on high malaria recurrence rate following AL treatment in in the (urban and peri-urban), western part of Tanzania. The current report is an exploratory study to carefully and systematically assess AL efficacy in the area. Between June and August 2011, a total of 1,126 patients were screened for malaria, 33 had malaria, of which 20 patients met inclusion criteria and were enrolled and treated with standard dose of AL as recommended in the WHO protocol. Treated patients were followed up for 28 days to assess treatment responses. Before treatment (Day 0) and post-treatment (Day 7) plasma lumefantrine levels were determined to assess prior AL use and ascertain parasites exposure to adequate plasma leveles of lumefantrine, respectively. The cure rate was 100%. All Day 0 plasma lumefantrine were below HPLC detectable level. The median Day 7 lumefantrine concentration was 404, (range, 189-894 ng/ml). Six out of 20 patients (30%) were gametocytaemic and all cleared gametocytes by Day 14. One patient showed an increase in gametocytes from four on Day 0 to 68, per 500 WBC on Day 2. Artemether lumefantrine is highly efficacious against uncomplicated Plasmodium falciparum malaria. The elevation of gametocytaemia despite AL treatment needs to be evaluated in a larger study

Low floor high ceiling tasks : Summing v

The Thinking Skills Pullout continues to be our favorite as it packs a lot of food for thought. It has already generated a series of two articles including a LFHC (Dotted Squares) and a TearOut. Here is another LFHC (which we have tried with a group of children from Class 3-4 in Pokhrama, Bihar, and with government school teachers from Telengana)