Tracing shadows: How gendered power relations shape the impacts of maternal death on living children in Sub-Saharan Africa

Driven by the need to better understand the full and intergenerational toll of maternal mortality (MM), a mixed-methods study was conducted in four countries in sub-Saharan Africa to investigate the impacts of maternal death on families and children. The present analysis identifies gender as a fundamental driver not only of maternal, but also child health, through manifestations of gender inequity in house- hold decision making, labor and caregiving, and social norms dictating the status of women. Focus group discussions were conducted with community members, and in depth qualitative interviews with key- informants and stakeholders, in Tanzania, Ethiopia, Malawi, and South Africa between April 2012 and October 2013. Findings highlight that socially constructed gender roles, which define mothers as care- givers and fathers as wage earners, and which limit women's agency regarding childcare decisions, among other things, create considerable gaps when it comes to meeting child nutrition, education, and health care needs following a maternal death. Additionally, our findings show that maternal deaths have differential effects on boy and girl children, and exacerbate specific risks for girl children, including early marriage, early pregnancy, and school drop-out. To combat both MM, and to mitigate impacts on children, investment in health services interventions should be complemented by broader interventions regarding social protection, as well as aimed at shifting social norms and opportunity structures regarding gendered divisions of labor and power at household, community, and society levels.Web of Scienc

Investigating the feasibility of child mortality surveillance with postmortem tissue sampling: generating constructs and variables to strengthen validity and reliability in qualitative research

The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to generate reliable data on the causes of death among children aged <5 years using all available information, including minimally invasive tissue sampling (MITS). The sensitive nature of MITS inevitably evokes religious, cultural, and ethical questions influencing the feasibility and sustainability of CHAMPS.Due to limited behavioral studies related to child MITS, we developed an innovative qualitative methodology to determine the barriers, facilitators, and other factors that affect the implementation and sustainability of CHAMPS surveillance across 7 diverse locations in sub-Saharan Africa and South Asia. We employed a multimethod grounded theory approach and analytical structure based on culturally specific conceptual frameworks. The methodology guided data interpretation and collective analyses confirming how to define dimensions of CHAMPS feasibility within the cultural context of each site while reducing subjectivity and bias in the process of interpretation and reporting.Findings showed that the approach to gain consent to conduct the MITS procedure involves religious factors associated with timing of burial, use of certain terminology, and methods of transporting the body. Community misperceptions and uncertainties resulted in rumor surveillance and consistency in information sharing. Religious pronouncements, recognition of health priorities, attention to pregnancy, and advancement of child health facilitated community acceptability. These findings helped formulate program priorities, guided site-specific adaptations in surveillance procedures, and verified inferences drawn from CHAMPS epidemiological and formative research data. Results informed appropriate community sensitization and engagement activities for introducing and sustaining mortality surveillance, including MITS

Prediction of preterm delivery in symptomatic women using PAMG‐1, fetal fibronectin and phIGFBP‐1 tests: systematic review and meta‐analysis

Objective To assess the accuracy of placental alpha microglobulin‐1 (PAMG‐1), fetal fibronectin (fFN) and phosphorylated insulin‐like growth factor‐binding protein‐1 (phIGFBP‐1) tests in predicting spontaneous preterm birth (sPTB) within 7 days of testing in women with symptoms of preterm labor, through a systematic review and meta‐analysis of the literature. The test performance of each biomarker was also assessed according to pretest probability of sPTB ≤ 7 days. Methods The Cochrane, MEDLINE, PubMed and ResearchGate bibliographic databases were searched from inception until October 2017. Cohort studies that reported on the predictive accuracy of PAMG‐1, fFN and phIGFBP‐1 for the prediction of sPTB within 7 days of testing in women with symptoms of preterm labor were included. Summary receiver–operating characteristics (ROC) curves and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and positive (LR+) and negative (LR–) likelihood ratios were generated using indirect methods for the calculation of pooled effect sizes with a bivariate linear mixed model for the logit of sensitivity and specificity, with each diagnostic test as a covariate, as described by the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Results Bivariate mixed model pooled sensitivity of PAMG‐1, fFN and phIGFBP‐1 for the prediction of sPTB ≤ 7 days was 76% (95% CI, 57–89%), 58% (95% CI, 47–68%) and 93% (95% CI, 88–96%), respectively; pooled specificity was 97% (95% CI, 95–98%), 84% (95% CI, 81–87%) and 76% (95% CI, 70–80%) respectively; pooled PPV was 76.3% (95% CI, 69–84%) (P < 0.05), 34.1% (95% CI, 29–39%) and 35.2% (95% CI, 31–40%), respectively; pooled NPV was 96.6% (95% CI, 94–99%), 93.3% (95% CI, 92–95%) and 98.7% (95% CI, 98–99%), respectively; pooled LR+ was 22.51 (95% CI, 15.09–33.60) (P < 0.05), 3.63 (95% CI, 2.93–4.50) and 3.80 (95% CI, 3.11–4.66), respectively; and pooled LR– was 0.24 (95% CI, 0.12–0.48) (P < 0.05), 0.50 (95% CI, 0.39–0.64) and 0.09 (95% CI, 0.05–0.16), respectively. The areas under the ROC curves for PAMG‐1, fFN and phIGFBP‐1 for sPTB ≤ 7 days were 0.961, 0.874 and 0.801, respectively. Conclusions In the prediction of sPTB within 7 days of testing in women with signs and symptoms of PTL, the PPV of PAMG‐1 was significantly higher than that of phIGFBP‐1 or fFN. Other diagnostic accuracy measures did not differ between the three biomarker tests. As prevalence affects the predictive performance of a diagnostic test, use of a highly specific assay for a lower‐prevalence syndrome such as sPTB may optimize management

Impact of mothers’ socio-demographic factors and antenatal clinic attendance on neonatal mortality in Nigeria

Neonatal death is often referred to maternal complications during pregnancy, and other exogenous factors that exist around the time of birth or shortly after birth. The United Nations Sustainable Development Goals (UNSDG)-Goal 3, Targets 3.2 aimed at ending preventable deaths of newborns by demanding that all countries should reduce neonatal mortality to 12 per 1000 live births by 2030. The objective of the study was to examine the relationship between mothers’ socioeconomic and demographic factors on neonatal deaths in Nigeria. The study used quantitative data from the 2013 Nigeria Demographic and Health Surveys (NDHS). The data analyzed consisted of 26,826 women aged 15–49 years who had a live or dead birth within the 5 years preceding the survey. STATA 12 computer software was used to carry out data analyses. Data analyses were at univariate (frequency distribution), bivariate (chi-square) and due to the dichotomous nature of the outcome variable (i.e., whether a child was born alive or dead during the delivery; coded as (1, 0), a binary logistic regression was carried out to examine the relationships between various socio-demographic factors, antenatal clinic attendance and neonatal mortality in Nigeria. The results, among others, revealed that background factors of the women such as age, region, residence, education, and wealth status have a significant association with neonatal mortality (P < 0.05). The study also found that adequate antenatal clinic attendance helps to reduce neonatal deaths. The study recommended that women should be encouraged to observe regular antenatal clinic visits during pregnancy and also go for institutional delivery for possible reduction of neonates and infant deaths in Nigeria

Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative

Extent: 10p.BACKGROUND: Australia's Aboriginal and Torres Strait Islander (Indigenous) populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities. METHODS: We undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4) were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems. RESULTS: The proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician. CONCLUSION: Participating services had both strengths and weaknesses in the delivery of maternal health care. Increasing access to evidence-based screening and health information (most notably around smoking cessation) were consistently identified as opportunities for improvement across services.Alice R. Rumbold, Ross S. Bailie, Damin Si, Michelle C. Dowden, Catherine M. Kennedy, Rhonda J. Cox, Lynette O’Donoghue, Helen E. Liddle, Ru K. Kwedza, Sandra C. Thompson, Hugh P. Burke, Alex D. H. Brown, Tarun Weeramanthri and Christine M. Connor