Preconception care: promoting reproductive planning

INTRODUCTION: Preconception care recognizes that many adolescent girls and young women will be thrust into motherhood without the knowledge, skills or support they need. Sixty million adolescents give birth each year worldwide, even though pregnancy in adolescence has mortality rates at least twice as high as pregnancy in women aged 20-29 years. Reproductive planning and contraceptive use can prevent unintended pregnancies, unsafe abortions and sexually-transmitted infections in adolescent girls and women. Smaller families also mean better nutrition and development opportunities, yet 222 million couples continue to lack access to modern contraception. METHOD: A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on MNCH outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture. RESULTS: Comprehensive interventions can prevent first pregnancy in adolescence by 15% and repeat adolescent pregnancy by 37%. Such interventions should address underlying social and community factors, include sexual and reproductive health services, contraceptive provision; personal development programs and emphasizes completion of education. Appropriate birth spacing (18-24 months from birth to next pregnancy compared to short intervals <6 months) can significantly lower maternal mortality, preterm births, stillbirths, low birth weight and early neonatal deaths. CONCLUSION: Improving adolescent health and preventing adolescent pregnancy; and promotion of birth spacing through increasing correct and consistent use of effective contraception are fundamental to preconception care. Promoting reproductive planning on a wider scale is closely interlinked with the reliable provision of effective contraception, however, innovative strategies will need to be devised, or existing strategies such as community-based health workers and peer educators may be expanded, to encourage girls and women to plan their families

Preventive zinc supplementation for children, and the effect of additional iron: a systematic review and meta-analysis

Objective: Zinc deficiency is widespread, and preventive supplementation may have benefits in young children. Effects for children over 5 years of age, and effects when coadministered with other micronutrients are uncertain. These are obstacles to scale-up. This review seeks to determine if preventive supplementation reduces mortality and morbidity for children aged 6 months to 12 years. Design: Systematic review conducted with the Cochrane Developmental, Psychosocial and Learning Problems Group. Two reviewers independently assessed studies. Meta-analyses were performed for mortality, illness and side effects. Data sources We searched multiple databases, including CENTRAL and MEDLINE in January 2013. Authors were contacted for missing information. Eligibility criteria for selecting studies Randomised trials of preventive zinc supplementation. Hospitalised children and children with chronic diseases were excluded. Results: 80 randomised trials with 205 401 participants were included. There was a small but non-significant effect on all-cause mortality (risk ratio (RR) 0.95 (95% CI 0.86 to 1.05)). Supplementation may reduce incidence of all-cause diarrhoea (RR 0.87 (0.85 to 0.89)), but there was evidence of reporting bias. There was no evidence of an effect of incidence or prevalence of respiratory infections or malaria. There was moderate quality evidence of a very small effect on linear growth (standardised mean difference 0.09 (0.06 to 0.13)) and an increase in vomiting (RR 1.29 (1.14 to 1.46)). There was no evidence of an effect on iron status. Comparing zinc with and without iron cosupplementation and direct comparisons of zinc plus iron versus zinc administered alone favoured cointervention for some outcomes and zinc alone for other outcomes. Effects may be larger for children over 1 year of age, but most differences were not significant. Conclusions: Benefits of preventive zinc supplementation may outweigh any potentially adverse effects in areas where risk of zinc deficiency is high. Further research should determine optimal intervention characteristics and delivery strategies

The constant threat of terrorism: stress levels and coping strategies amongst university students of Karachi

OBJECTIVES: To assess the levels of stress in the face of terrorism and the adopted coping strategies, amongst the student population of universities in Karachi . METHODS: A descriptive, cross sectional study was conducted on undergraduate students from four universities of Karachi. Self-administered questionnaires were filled out by 291 students. Pearson Chi-Square test was used to assess associations between stress levels and different variables at a level of significance of 0.05% . RESULTS: A total of 65.8% of the students had mild stress levels, 91.5% of university students were exposed to terrorism through television, while only 26.5% students reported personal exposure to terrorism. 67.4% students were forbidden by their parents to go out (p = 0.002). Most of those who had self exposure to an attack were the ones whose parents forbade them from going out (p = 0.00). Most commonly used coping strategy was increased faith in religion. Irritability was the most common stress symptom . CONCLUSION: A majority of students studying in universities of Karachi had mild stress levels due to the constant threat of terrorism whereas a minority had severe stress levels. Possible reasons for resilience and only mild stress levels could be the history of Karachi\u27s internal conflicts and its prolonged duration of being exposed to terrorism. These students who are positive for stress need to be targeted for counseling either through the media or through their universities. More extensive research is needed in this area

Importance of intervening in the preconception period to impact pregnancy outcomes

Preconception care that begins in adolescence and is provided before and between pregnancies has the potential to impact 136 million women who give birth each year and ensure that newborns receive the healthiest start possible. Providing simple interventions before pregnancy can prevent a significant proportion of maternal and neonatal mortality and morbidity. Interventions to promote adolescent health and prevent teenage pregnancies, encourage contraceptive use and appropriate birth spacing, optimize weight and micronutrient status, and screen for and manage chronic conditions have proven efficacy. These interventions must now be scaled up to maximize delivery. Women who receive preconception care are more likely to adopt healthy behaviors, and therefore have better pregnancy outcomes. Preconception care is particularly effective when men are involved and care is provided in the community setting. All healthcare providers can and should begin to provide preconception care to all adolescent girls, women and couples of reproductive age by asking them if they wish to become pregnant or are actively trying to prevent pregnancy

Setting research priorities for preconception care in low- and middle-income countries: aiming to reduce maternal and child mortality and morbidity

Preconception care means providing care before pregnancy is established. Women and couples of reproductive age are generally unaware of the effects that their own health conditions and health-related behaviors may have on the fetus during pregnancy. Although antenatal care is set in the maternal, newborn, and child health (MNCH) continuum [1], it neglects the most critical time of embryonic development, which often occurs before a woman even knows she is pregnant [2]. The evidence increasingly points to earlier care before pregnancy to improve women´s health, and better pregnancy outcomes for the mother and newborn.Fil: Dean, Sohni. Aga Khan Univer​sity; PakistánFil: Rudan, Igor. University of Edinburgh; Reino UnidoFil: Althabe, Fernando. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Webb Girard, Aimee. University of Emory; Estados UnidosFil: Howson, Christopher. March of Dimes Foundation; Estados UnidosFil: Langer, Ana. Harvard University. Harvard School of Public Health; Estados UnidosFil: Lawn, Joy. Saving Newborn Lives- Save The Children; SudáfricaFil: Reeve, Mary Elizabeth. March of Dimes Foundation; Estados UnidosFil: Teela, Katherine C.. Bill and Melinda Gates Foundation; Estados UnidosFil: Toledano, Mireille. Imperial College London; Reino UnidoFil: Venkjatraman, Chandra Mouli. World Health Organization; SuizaFil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Car, Josip. Imperial College London; Reino UnidoFil: Chan, Kit Yee. The University of Melbourne; AustraliaFil: Chatterjee, Subidita. Virtual Institute for Advancement of Women, Children and Young People; IndiaFil: Chitekwe, Stanley. United Nations Children's Fund; MalauiFil: Doherty, Tanya. University of the Western Cape; SudáfricaFil: Donnay, France. Bill and Melinda Gates Foundation; Estados UnidosFil: Ezzati, Majid. Imperial College London; Reino UnidoFil: Humayun, Khadija. Aga Khan Univer​sity; PakistánFil: Jack, Brian. Boston University; Estados UnidosFil: Lassi, Zohra S.. Aga Khan Univer​sity; PakistánFil: Martorelli, Reynaldo. University of Emory; Estados UnidosFil: Poortman, Ysbrand. International Genetic Alliance of parent and patient organizations and Preparing for Life; Países BajosFil: Bhutta, Zulfiqar A.. Aga Khan Univer​sity; Pakistá