The effectiveness of adolescent-specific prenatal interventions on improving attendance and reducing harm during and after birth: A systematic review

Abstract Background: Adolescent pregnancy has been associated with poor pregnancy outcomes including pre-term birth (PTB), low birth weight (LBW) and perinatal death. Objective: To systematically review the effect of adolescent-specific interventions on reducing PTB, LBW, and perinatal death and increasing prenatal care attendance. Search strategy: Possible studies for inclusion were identified by a comprehensive search of OvidSP MEDLINE (limits: humans, 1990–present), EMBASE (limits: humans, 1990–2015), Popline and Global Health Database from the World Health Organisation (WHO) and PubMed International scientific databases, and references of identified articles were searched from 1990 to present. Selection criteria: All types of controlled studies of prenatal interventions were exclusive to adolescents and at least one of the outcomes of interest. Data collection and analysis: Investigators identified relevant studies and entered the data in a pro forma. Data were summarised as forest plots and narrative synthesis. Main results: Twenty-two studies (three randomised controlled trials (RCTs), four prospective cohort studies, nine retrospective cohort studies, five case controls and one natural experiment) were included with all but one study being carried out in higher-income countries. Seven of the 16 studies reporting on PTB found a statistically significant reduction in PTB rates between adolescent-specific prenatal care (intervention) and non-age specific prenatal care odds ratio (OR) and 95% confidence intervals (CIs) ranged from OR: 0.15 (95% CI: 0.03–0.83) to OR: 0.59 (95% CI: 0.45–0.78). Nine of the 12 studies reported statistically significant higher mean prenatal attendance rates among the intervention group compared to controls (ranging from a mean number of visits of 14.3 vs. 10.7 p&lt;0.001 to 10.8 vs. 7.6 visits p&lt;0.001). The type and construct of the interventions, their implementation and local population differed sufficiently that a statistical synthesis was deemed inappropriate. Conclusion: There is some evidence that adolescent-specific programs can increase prenatal attendance and reduce the risk of PTB and low birth rate but their effect on perinatal death is uncertain. There is a distinct lack of evidence of the effectiveness of these interventions for adolescents living in low-middle income countries, despite having the majority of adolescent pregnancies, and associated risk of harm. No high-quality intervention studies were identified. Robust, cluster-based RCTs are an urgent necessity to quantify the impact of these interventions and to identify factors contributing to their success.</jats:sec

Mothers\u27 perception of childhood injuries, child supervision and care practices for children 0-5 years in a peri-urban area in Central Uganda; Implications for prevention of childhood injuries

© 2019 The Author(s). Background: Injuries are a major concern in childhood. They are especially associated with high morbidity, disability and death in low-income countries. This study aimed at describing mothers\u27 perceptions, child supervision and care practices for children 0-5 years old and how these influence prevention of childhood injuries among children in peri-urban areas of Wakiso district, Uganda. Methods: In this qualitative study, 10 in-depth interviews and 4 focus group discussions were held with mothers of children aged 0-5 years living in peri-urban areas of Wakiso district, Uganda. The interviews were audio recorded in the local language (Luganda). The audios were transcribed verbatim and later translated into English. We conducted thematic analysis for transcripts from the focus group discussions and in-depth interviews. Results: Most respondents considered injuries as inevitable events among children, although, they acknowledged the impact of injuries on children\u27s health. Close child supervision was highlighted as key in preventing injuries. Hostile situations that place children at increased risk of injuries in this setting include: lack of adult supervision, harsh punishments and lack of safe play areas. Conclusion: Our study highlights the different aspects of child care in low resource settings which put children at an increased risk of injuries. Injury prevention programs for children living in low resource settings should thus be aimed towards improving caregivers\u27 perceptions towards injuries, child supervision, care practices and the children play environment

Incidence, patterns and risk factors for injuries among Ugandan children

© 2017 Informa UK Limited, trading as Taylor & Francis Group. There is limited epidemiological data on childhood injuries in developing countries. This study assessed the incidence, patterns and risk factors for injuries among children aged 0–5 years in Wakiso District, Uganda. To determine differences, chi-square and Wilcoxon rank sum tests were used. Risk factors were assessed using Poisson regression. Overall, information from 359 children of mean age 32 months (SD: 18.4) was collected. Annual incidence of injuries was 69.8 per 1000 children/year (95% CI 58.8–80.8). One fatal injury due to burns was reported. Incidence of injuries was less associated with being female (IRR: 0.56, 95% CI 0.34–0.90) and increasing age of the caretaker (IRR: 0.96, 95% CI 0.92–0.99). The high incidence of childhood injuries necessitates the need for interventions to reduce injuries among children