Geographically remote areas in lower-middle-income countries like Bangladesh experienced significant Maternal and Child Health (MCH) care shortages during the COVID-19 pandemic. These shortages were exacerbated by preexisting inadequate public health infrastructure and using existing health resources for pandemic management. The objective of this study was to assess the status of access to and utilization of maternal and child healthcare services among rural people during the outbreak of COVID-19. A community-based descriptive, exploratory, cross-sectional study was carried out from May to August 2020 among the rural people of the four districts of northern Bangladesh. A total of 639 women were included in the study with a sample random sampling technique, and multistage random sampling techniques were applied to select the study area. A pretested semi-structured questionnaire was used for data collection. SPSS Version 22 was used for the statistical analysis. The mean age of the respondents was 34.3 years with an SD ± 10 years. 37.7% of respondents belonged to the 21-30 year age group followed by the 31-40 years age group (34.9 %). Of the total 639 respondents, 59.5% were female. There were significant associations and moderate positive correlations between educational qualification, occupational status, and age group of the respondents (p=0.001). Most of the respondents (67.6%) indicated that they experienced health problems during COVID-19 with 70.6% of them specifically mentioning MCH-related problems. Out of them, only 33.1% mentioned they could access and utilize MCH services, whereas 66.9% of them could not access MCH Services. Major barriers to utilizing MCH services were the COVID-19 lockdown, lack of transport facilities, fear of being infected, shutdown of healthcare facilities, and unavailability of healthcare professionals. The differences in health facility usage before and during COVID-19 are statistically significant with p = < 0.001. During the COVID-19 pandemic, access to and utilization of MCH services was significantly hampered, particularly in Bangladesh's remote and rural regions during the strict lockdown times. The identified barriers were the COVID-19 lockdown, lack of transport facilities, fear of being infected, shutdown of healthcare facilities, and unavailability of healthcare professionals. Building strengthened health systems, capacity building of informal healthcare providers, backup plans, and alternate service delivery models are necessary to ensure access to maternity and child health. For future pandemics and natural disaster situations, the 'concerned officials should strategically have backup plans and alternative service delivery models to strengthen the health system. And, there should be collaborative efforts among the countries to support each other to address the crisis situations.
The burden of maternal mortality attributable to postpartum hemorrhage (PPH) remains high in Nigeria. Currently, oxytocin, and misoprostol, which are largely of suboptimal quality, are used for PPH prevention and treatment. Heat-stable carbetocin (HSC) is a viable uterotonic option for PPH prevention in a setting like Nigeria where compromised supply and cold chain systems result in the preponderance of poor-quality oxytocin and suboptimal PPH management. It is crucial to understand how healthcare providers (HCPs) accept and use HSC for PPH prevention, and what factors encourage correct uterotonic usage in health facilities, given PPH's ongoing public health challenge. This study aims to elucidate the current prophylactic use of HSC, oxytocin, and misoprostol in secondary and tertiary public health facilities while assessing HSC acceptability to clinicians and establishing factors that enable the appropriate use of uterotonics in health facilities. Descriptive analysis conducted on quantitative data from patient chart reviews, HCP interviews and assessment, and facility assessment using Stata 15 and Microsoft Excel are presented as counts and percentages, while qualitative data from key informant interviews and in-depth interviews are coded and analyzed using NVivo. The findings from 18 publicly owned secondary and tertiary healthcare facilities across Kano, Lagos, and Niger states in Nigeria were interpreted according to thematic areas. Health facilities selection criteria were high volume of deliveries (≥30 deliveries per month), accessible location, availability of trained HCPs (specifically doctors, nurses, and midwives), and willingness to participate in the study. HSC was administered prophylactically in 10,284 (56%) of 18,364 deliveries, with a total of 148 (0.8%) women developing PPH. Approximately 76% of HCPs preferred HSC for PPH prevention compared to other available uterotonics, with clinical guidance from senior HCPs (76%), in-service training (76%), mentoring (84%), and supportive supervision (75%) contributing significantly to the choice and practice of uterotonics use by HCPs. HSC, a thermostable analog of oxytocin, holds the potential to prevent PPH without the added cost of administering additional uterotonics and interventions. The introduction of HSC requires concerted procurement and capacity-building efforts to create an enabling environment for scale-up. HSC is non-inferior to oxytocin in preventing PPH, has few side effects compared to misoprostol or oxytocin-misoprostol combination, and more cost-effective when compared with the other three uterotonics. Although the geographical scope of our study is only three states in Nigeria, the preponderance of suboptimal uterotonics across the country makes our findings applicable to the whole country and other low- and middle-income countries with similar challenges.
Pandemics, like COVID-19, disrupt healthcare, potentially reversing progress in various disease areas. The impact on maternal and child health (MCH) services in Kenya during the pandemic is yet to be determined. Recognizing this impact is crucial for formulating policies and programs that minimize disruptions in reproductive health services during future health crises. The purpose of this study was to determine the effect of COVID-19 on the uptake of MCH services at Thika Level V Hospital, a regional referral hospital in Kenya. In this cross-sectional mixed methods study, we reviewed antenatal clinic (ANC), MCH, and family planning (FP) registers for data on the uptake of the various services during the COVID-19 pandemic (July to October 2020) compared to a year before the COVID-19 pandemic (July to October 2019). MCH clients (N = 60) and healthcare workers (N = 19) were interviewed about the impact of the pandemic on MCH services at the hospital. Differences in clinic attendance before and during the pandemic were compared using the student t-test. Thematic analysis was conducted on the interview responses. The number of MCH/FP clients dropped from 12,915 pre-pandemic to 7,429 during the pandemic. Significant differences were noted in ANC revisits (p = 0.026) and those completing the World Health Organization recommended minimum of four ANC visits (p<0.001) during the COVID-19 pandemic. The number of revisits at the child welfare clinic was also significantly lower (p = 0.004) during the COVID-19 lockdown period. MCH clients stated that the decline in the uptake of MCH services was attributable to the fear of contracting disease, financial difficulties, and strain on the healthcare workforce. This study found a decline in access to MCH/FP services during the COVID-19 crisis with the potential to reverse gains made in securing the safety of the pregnant mother and unborn baby.
Tuberculosis (TB) has continued to be one of the global threats, affecting millions of individuals globally, including the maternal and child health (MCH) populations and individuals with HIV/AIDS. TB infected 10.8 million individuals, leading to 1.25 million deaths across the globe annually, leaving 4 million missing cases contributing to the global TB burden. This study aims to unveil innovative approaches to TB diagnosis, challenges, and the future direction of this field. A comprehensive literature search was conducted to retrieve studies published between 2019 and 2024 from PubMed, Google Scholar, and Web of Science. The studies were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and screened using the Rayyan tool. The quality and risk of bias of the included studies were assessed using Quality Assessment of Diagnostic Accuracy Studies 2 for diagnostic accuracy studies and Strengthening the Reporting of Observational Studies in Epidemiology for observational studies. A random effects model was employed to calculate the pooled sensitivity and specificity, while Egger's test and funnel plots were utilized to evaluate publication bias. R and MetaDTA software were used for all the statistical analyses. The review included 25 studies with sample sizes ranging from 100 to 6,520 participants and assessed various innovative approaches for diagnosing TB, including molecular methods, biomarker-based techniques, and artificial intelligence (AI) applications. The most common approach was molecular testing, specifically cartridge-based tests. The overall sensitivity of these methods was 0.79 (95% confidence interval [CI]: 0.70-0.86), with a heterogeneity index (I²) of 92.9% and a p < 0.0001. The specificity was recorded at 0.93 (95% CI: 0.87-0.96), with an I2 of 94.8% and a p < 0.0001. This review reinforces the promise of innovative diagnostic methods, especially cartridge-based molecular tests, for improving TB detection. However, moderate sensitivity and high heterogeneity emphasize the need for cautious implementation and further validation of new tools such as the AI-based and biomarker-based. Strategic investment in research and contextual deployment is critical for closing the TB diagnosis gap globally.
Suspected cases of tuberculosis (TB) are identified for confirmation by bacteriological tests through clinical screening for TB in people living with human immunodeficiency virus (HIV) during routine visits or when antiretrovirals (ARVs) are dispensed. Our aim is to determine the prevalence and describe the epidemiological and clinical characteristics of HIV-TB coinfected patients in the coronavirus disease 2019 (COVID-19) setting in health facilities in the East Region of Cameroon. This study addresses knowledge gaps on HIV-TB coinfection during COVID-19, aiming to provide insights into the interaction and impact of HIV, TB, and COVID-19 on individuals' health. This was an observational study. It involved two retrospective cohorts of HIV-TB coinfected patients before and after the COVID-19 pandemic. We conducted manual reviews of the medical records and antiretroviral therapy (ART) and TB registers of 262 patients. These patients were coinfected with HIV and TB during the period from April 2019 to April 2021 in 11 health facilities in the East Cameroon health region. The sociodemographic and clinical characteristics of the cases were extracted from the consultation registers and entered into the KoBo Collect application, then analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 25. In this study of 262 HIV-TB coinfection cases, 60.3% occurred before COVID-19, and 39.7% during the pandemic. HIV-TB coinfection prevalence among HIV patients was 1%. Patients averaged 39.3 years in age, with a significant shift in sex ratios from 0.65 to 1.33 between pre-COVID-19 and COVID-19 cohorts. Education varied, with 45.8% having secondary education, 44.8% with primary, 2.4% having higher education, and 7.1% having none. Most (78.9%) had professional occupations, and 53.7% lived in rural areas. The majority were newly diagnosed (96.3% before COVID-19; 93.3% during COVID-19), with 3.7% relapses and 4.2% discontinuing treatment. Most had pulmonary TB (84.9%) and were aware of treatment duration (94.6%). About 65.4% experienced treatment-related adverse events. Regarding family support, 69.3% received help with medication. However, the concern was 80.6% did not adhere to anti-COVID-19 measures. Gender was significantly associated with compliance. Most patients were on treatment, but a small percentage had discontinued it. Patients need to be made aware of the importance of complying with anti-COVID-19 barrier measures to prevent a potential worsening of the health situation. Moreover, clinical and biological monitoring needs to be stepped up throughout the course of anti-TB treatment.
Married adolescents face significant obstacles in making informed reproductive health decisions and accessing sexual and reproductive health (SRH) services. It is important to identify barriers hindering these adolescents from accessing SRH services. The aim of this study was to identify factors associated with the utilization of SRH services among married adolescent girls in northern Nigeria. We used a cross-sectional study design. The study population comprised of married female adolescents aged 14-19 years who were residents in the study areas for at least six months. The outcome measure was SRH service utilization, defined as the use of any of the conventional SRH services (ante/postnatal care, human immunodeficiency virus (HIV) testing and counseling, sexually transmitted infections (STI) treatment, family planning, and post-abortion care). Predictor variables included the sociodemographic, obstetric, and gynecological characteristics of the respondents. An adapted, pretested, interviewer-administered, and semi-structured questionnaire was employed for data collection. Multivariable logistic regression was used to explore the independent association between selected variables and utilization of SRH services. A total of 200 respondents were surveyed (100 each from an urban and a rural community in Kano, Nigeria), survey response rate: 94.5%. The age of respondents ranged from 14 to 19 years, with mean age (± standard deviation) of 18.5 (±1.1) years and 17.5 (±1.3) years for urban and rural respondents, respectively. All respondents were aware of the available SRH facilities and preferred public facilities (92.6% urban respondents and 67.0% rural respondents). Ever-use of SRH services was higher among urban than rural respondents (86% vs. 56%, respectively). Geographic proximity was a key factor for urban respondents (64.2%), while affordability was considered important by rural respondents (47.9%). Respondent's age and partner's occupation were independently associated with utilization of SRH services. Urban respondents whose husbands were businessmen were seven times more likely to use SRH services than those whose partners were civil servants (adjusted odds ratio [aOR] = 6.80, 95% confidence interval [CI]: 1.29-35.84, P = 0.02). Rural respondents 18 years of age and older were approximately six times more likely to utilize SRH services than those <18 years (aOR = 5.71, 95% CI: 1.56-12.78, P = 0.01). Awareness of available SRH services was high in the study population, and service utilization was influenced by the respondent's age and partner's occupation. Findings from this study can help inform the development of age-appropriate and accessible SRH services tailored to married adolescents in similar settings.
While coronavirus disease-2019 (COVID-19) stressors on women's mental health have been studied in the United States (US), very few have focused on pregnant and postnatal women in Georgia, US. This study sought to identify the sources of the COVID-19 stressors on the mental health of pregnant and postnatal women in Georgia during the pandemic, the effects of COVID-19 stressors on their mental health, and to provide recommendations for protecting the mental health of this population during a future pandemic or health emergency. Although the global health emergency caused by the COVID-19 pandemic officially ended in 2023, and while its devastating effects have been largely overcome, its presence has left an indelible impression on populations worldwide. A mixed-methods cross-sectional design was used to collect data from 66 study participants across eight domains using Qualtrics. Quantitative data were analyzed using the Statistical Package for the Social Sciences version 28 and the Statistical Analysis Software version 9. Qualitative data were manually analyzed using a thematic approach. Before the pandemic, anxiety was experienced by 21.2% of the study participants, depression by 12.1%, and post-traumatic stress disorder (PTSD) by 6.1%. These statistics almost doubled for anxiety (39.4%), more than doubled for depression (27.3%), and increased for PTSD (9.1%) during the pandemic. The fear of getting COVID-19 was the most prevalent stressor for both pregnant and postnatal women (39.4%), as well as the possibility of their babies or they themselves becoming sick. The most widespread effects of stressors caused by the pandemic were worry (50.0%), sadness (42.4%), and loneliness (36.4%). Very few of the study participants who experienced mental health conditions (25.6%) sought care from a mental health professional during the pandemic. Those who did not seek care (74.4%) said they coped by utilizing self-management strategies (cited 14 times), depended on family, partners, and friends for support (cited 11 times), or exercised (cited 7 times). The pandemic had a considerable impact on the mental health of pregnant and postnatal women in Georgia. It is essential for the local government and healthcare providers in Georgia and different parts of the world to be proactive and put in place mechanisms that will help to maintain the mental health of this population during a future pandemic or health emergency.
Hypertension is one of the most common medical complications during pregnancy and a leading cause of maternal mortality and morbidity. Severe preeclampsia is defined as blood pressure (BP) >160/110 mmHg with warning signs such as headache, blurring of vision, and epigastric pain. Nifedipine (C17H18N2O6), labetalol (C19H24N2O3), and hydralazine (C8H8N4) are commonly used drugs, and all are recommended as first-line agents. Hydralazine is associated with a higher incidence of adverse outcomes, so oral nifedipine has been proposed as a first-line alternative to intravenous labetalol. Consequently, this study aims to compare the efficacy and safety of oral nifedipine with that of intravenous labetalol. The objective is to compare the ability/effectiveness of oral nifedipine and intravenous labetalol to normalize acute hypertension in severe preeclampsia and to assess the birth outcome. Relations between different factors were established by appropriate statistical tests. The p-value <0.05 was considered statistically significant. The study was conducted on 120 antenatal women with blood pressure ≥160/110 mmHg admitted to our hospital, a tertiary care center, from January 1st, 2020 to June 30th, 2021. Patients were randomized by a single blinding method to receive intravenous labetalol and oral nifedipine. The primary outcome measures were the time taken to control the blood pressure and the number of doses of drugs required. The secondary outcome measures were the birth outcome like a method of delivery, side effect profile, and the number of admissions in the neonatal intensive care unit. A total of 120 patients were included with 60 patients in each group. The labetalol group took 48.67 ± 17.80 minutes and the nifedipine group took 64.33 ± 9.81 minutes to achieve a target BP of <=140/90 mmHg (p < 0.05). No side effects were seen in 70% of patients in the labetalol group and 71.67% in the nifedipine group (p > 0.05). Intravenous labetalol is faster in restoring blood pressure in pregnant women with preeclampsia than oral nifedipine and may be used as a first-line drug in the acute control of blood pressure in a hypertensive emergency during pregnancy. More studies are needed in order to evaluate the findings from this pilot study in a large sample of patients.
The introduction of digital health has been found to improve maternal health globally. However, the use and determinants of digitalized antenatal education (DAE) use among vulnerable populations are yet to be ascertained. Therefore, this study assessed the use and determinants of DAE use among pregnant women living with human immunodeficiency viruses (PWLHIV). The study adopted a descriptive design. Oyo state was randomly selected in Southwestern Nigeria, and 116 PWLHIV, who are receiving antiretroviral therapy, were recruited for the study. Of these, 93 returned completed data, which were included in the data analysis. A validated online questionnaire was used for data collection. Data analysis was done using STATA version 17. Descriptive statistics were used to assess the use, feasibility, and acceptability of DAE. Logistic regression was used to identify the determinants of DAE use. Most (78 [83.9%]) of the participants reported that they have never used DAE. Similarly, 72 (77.4%) reported that they were not familiar with DAE at all. However, 84 (90.3%) of the women believed that it would be highly effective. The feasibility of DAE use is high in 83 (89%) of the participants. Furthermore, the majority of the participants, 73 (78.5%), indicated that DAE addresses their specific needs, and 77 (82.8%) of them reported being very comfortable with using DAE. The level of acceptability of DAE use is high in 73 (78.5%) of the participants. Determinants of DAE use, using adjusted odds ratio (AOR), include internet access (AOR = 1.205 with 95% confidence intervals [CI] of 0.233-6.221 and p = 0.024) and digital literacy (AOR = 14.072 with 95% CI of 2.209-89.634, and p = 0.005). Despite the high feasibility and acceptability of DAE in Nigeria, its use is very low among PWLHIV. Strong determinants of use include digital literacy and internet access. Thus, for PWLHIV to meet the global standard in the use of digital health, interventions to improve digital literacy and internet access in low-resource settings are recommended.
Human immunodeficiency virus (HIV) infection attacks and gradually weakens the immune system by destroying CD4 cells, with the most advanced stage of the infection known as acquired immunodeficiency syndrome (AIDS). Mother-to-child transmission (MTCT) of HIV remains the primary method of infection among children. Understanding the factors contributing to MTCT and current transmission rates is crucial for developing effective prevention strategies during pregnancy, childbirth, and breastfeeding. This study aims to determine MTCT of HIV, assess maternal viral load, and identify transmission-associated factors in the Adamawa Region of Cameroon. Blood samples were collected from 119 mothers living with HIV and their children (mother-infant pair) in 15 different HIV/AIDS treatment units/facilities across the Adamawa Region and analyzed at the Ngaoundere Regional Hospital. Early infant diagnosis was performed using the GenXpert system, and viral load quantification was performed using the Cobas 5800 system. The findings showed that the MTCT rate of HIV was 1.7% (2/119), with an incidence rate of 33.6 cases/1000 person-years. Maternal viral load suppression rate was 96.6% (115/119). Among the participants, 47.1% (56/119) had undetectable viral loads (<20 copies/mL) and 49.6% (59/119) had suppressed viral loads of 20-<1000 copies/mL. Only 3.4% (4/119) had unsuppressed viral loads ≥1000 copies/mL. There was no statistically significant association between maternal age, duration of antiretroviral therapy (ART), type of ART, and number of antenatal visits. Significant associations were observed between MTCT and place of birth (p = 0.001) and maternal viral load (p < 0.001). The transmission rate of HIV infection in infants born to HIV-positive mothers was below the national target of 2%. There was high viral suppression in lactating mothers, which was associated with a high adherence rate to ART. Maternal viral load and delivery location were significant risk factors for transmission.
Digital health innovations are increasingly being deployed to improve maternal, newborn, and child health (MNCH) outcomes in Nigeria. However, their adoption and effectiveness are influenced not only by technological access and infrastructure but also by behavioral factors, gender norms, and cultural contexts that shape user engagement and health-seeking behaviors. A narrative review was conducted using PubMed, Web of Science, Scopus, and African Journals Online, covering studies published between 2015 and 2025. From an initial pool of records, 46 studies met the inclusion criteria following screening. This review synthesized empirical studies, program evaluations, and behavioral frameworks, such as the Fogg Behavior Model and Health Belief Model, to examine how gender dynamics, social hierarchies, and behavioral readiness shape digital MNCH adoption. The findings reveal that digital literacy gaps, gendered power relations, sociocultural beliefs, and intra-household decision-making processes significantly affect technology uptake. Interventions that incorporated voice-based content, local languages, and male-inclusive engagement strategies demonstrated higher levels of acceptance and retention in the target population. Behaviorally informed designs, culturally tailored messaging, and the involvement of trusted intermediaries, such as community health workers, were critical success factors. Effective digital health interventions must move beyond mere technical provision to integrate behavioral science and gender responsiveness into their design and delivery. Approaches that prioritize the lived realities of users, particularly women's agency within household decision-making, are more likely to achieve equitable and sustainable MNCH outcomes. Policy and program developers should prioritize human-centered, behaviorally intelligent, and gender-transformative digital health models, while future interventions must integrate cultural adaptability, motivational triggers, and inclusive engagement strategies to enhance digital MNCH impact.
In Kenya, the leading cause of maternal deaths is obstetric hemorrhage (39.5%), with postpartum hemorrhage (PPH) accounting for 50% with quality of uterotonics as one of the biggest challenges. The World Health Organization (WHO) in 2018 included heat-stable carbetocin (HSC) for the prevention of PPH in settings where the quality of oxytocin cannot be guaranteed. Maintenance of the cold chain for uterotonics is a challenge. HSC does not require refrigeration, reducing pressure on the fragile cold chain infrastructure. The main objective was to understand PPH prevention knowledge, experience, and perspectives, including uterotonic use, by policymakers and healthcare providers (HCPs) in the public health sector in ten counties in Kenya. HCP knowledge, perception, and experience were assessed after the HSC introduction. The mixed methods study was implemented in 39 secondary and tertiary public hospitals from ten counties. Quantitative interviews targeting 171 HCPs at baseline and end-line were collected using REDCap software (v5.26.4) and analyzed using Stata version 17. Qualitative data was collected from 19 policymakers at the national, county, sub county, and health facility levels and analyzed using NVIVO 12. At the end line, 98.8% had administered HSC for the prevention of PPH, while 96.5% of the HCPs were aware that their facilities had protocols/guidelines in place on the use of HSC. To enhance awareness of WHO recommendations on the use of HSC among HCPs, a top-down approach was used. Over 90% of HCPs agreed that HSC was easy to administer and distinguish from other uterotonics. Policymakers agreed that there was value in the HSC introduction in the public health sector that experiences cold chain challenges and recommended budgetary allocation. The findings demonstrate that HCP's knowledge, perception, and experience coupled with the policymaker's perspective is the key to the introduction of HSC in the public sector. Policymakers find value in introducing HSC as it alleviates challenges with the fragile cold chain systems. This study contributes to the global body of knowledge on the introduction of lifesaving commodities, which is anticipated to potentially improve PPH prevention and management, and hence reduce maternal mortality.
The healthcare-seeking behavior of vulnerable groups, such as children under five, depends on a multitude of factors, including the caregiver's decision making. Approximately 60% of Indians seek care from private hospitals. Recent health policy in India has favored the establishment of multispecialty hospitals. However, it remains unclear to what extent this policy has changed the number of Indians seeking healthcare from these government-established multispecialty hospitals. The study aims to assess the health-seeking behavior of parents of children under five in the vicinity of a public multispecialty tertiary care hospital. This was a community-based cross-sectional survey with geospatial mapping conducted among the parents of children under five using a semi-structured questionnaire in Epi-collect mobile app. The study site was an urban slum in a catchment area [within five kilometers (km)] of a multispecialty tertiary care public hospital in the central Indian state of Chhattisgarh. The study was conducted for one year duration from February 2019 to January 2020. A questionnaire was administered to the parents of the children under five (N = 353) after their household confirmation from the nearby Anganwadi center, the community level service providing center under the Integrated Child Development Scheme by the Ministry of Women and Child Development (WCD). The questionnaire included sections for demographic characteristics, the illness pattern among their children, health-seeking decision-making, and more. Descriptive analysis was presented with numbers and percentages. Univariate analysis was used to assess the association between sociodemographic variables and health-seeking characteristics. Statistical significance was considered at p value less than 0.05. We used geospatial mapping using coordinates collected and compiled using the Microsoft Excel version 2021 and analyzed using QGIS (Quantum Geographic Information System) software. Among the parents interviewed patients (N = 353), maternal literacy rates were over 85%. Approximately 54% of the families were below poverty line. Among 95.2% of the families, mothers were part of decision-making regarding their children's health-seeking. Over 92% of the families opted for consultation in a nearby private hospital or dispensary. Geospatial mapping of private hospitals was a favored place for healthcare-seeking by mothers, irrespective of their socioeconomic status or education rather than multispecialty hospital. The majority of the parents in the vicinity of public multispecialty hospitals seek care from private clinics for ailments for children under five. The establishment of public multispecialty tertiary care hospitals, which are mandated for tertiary level of care and research, cannot replace primary-level healthcare institutions, showed that private hospitals were the favored places healthcare seeking by mothers. These primary-level institutions are critical for the management of common ailments for children under five near home and reducing the financial burden on the family, even in the vicinity of a multispecialty hospital.
Chronic diseases have progressively increased worldwide, impacting all areas and socioeconomic groups. Periodontal disease is an increasing global concern and contains risk factors similar to other chronic illnesses. The main risk factor for periodontitis is smoking. Smoking not only hastens periodontal disease but also complicates periodontal therapy. Serum glycosylated hemoglobin levels, which are derived from the average life span of an erythrocyte, are a good indicator of glycemic management during the preceding one to three months. This study was undertaken to assess the association between tobacco smoking and periodontal disease by evaluating plaque score, gingival score, extent and severity index (ESI), and glycemic status by estimating serum HbA1c in cigarette smoker patients compared to non-smokers. The study was conducted with 40 patients in the age range of 20-40 years. Patients were divided into two groups: non-smokers (Group I) and cigarette smokers (Group II). Periodontal clinical parameters such as the plaque index (PI), gingival index (GI), and ESI were recorded during the oral cavity examination. The biochemical marker, serum glycosylated hemoglobin, was measured in both groups. All parameters were measured at baseline and three months after periodontal therapy. The statistical tests used were the paired t-test, and Chi-square test for comparison between both groups. The mean difference of PI of non-smokers was 0.33 ± 0.30, and smokers were 0.52 ± 0.32, which was statistically significant. The mean difference of GI of non-smokers was 0.34 ± 0.19 and smokers 0.36 ± 0.303, which was statistically significant. The mean difference of extent in non-smokers was 5.33 ± 1.59, 5.52 ± 2.43, and smokers were 0.18 ± 0.17. The mean difference in severity in non-smokers was 0.18 ± 0.17, and smokers were 0.31 ± 0.25, which was statistically significant. The mean difference of HbA1c in non-smokers and smokers was 0.43 ± 0.277 and 0.415 ± 0.230, which shows a higher mean difference in non-smokers, which was statistically non-significant. This study concluded that each of Group I and Group II showed substantial improvements in all clinical periodontal variables, which include plaque index (PI), gingival index (GI), extent and severity index (ESI), and biochemical marker serum glycosylated hemoglobin. Controlling inflammation with SRP can improve insulin resistance, lower glucose levels, and prevent non-enzymatic glycation of hemoglobin.
Maternal mortality, largely due to postpartum hemorrhage (PPH), remains high in resource-limited and crisis-affected settings, where heat-stable carbetocin (HSC) and tranexamic acid (TXA) offer promise for PPH prevention and treatment but lack evidence. This study, implemented in basic maternity facilities within humanitarian settings, explores healthcare providers' perspectives on an HSC and TXA-inclusive PPH intervention package and related operational challenges and facilitators. Based on semi-structured interview guides and using thematic analysis, this qualitative research, through 13 focus group discussions and individual interviews, investigated the perspectives of 64 healthcare staff (mostly midwives) from eight basic emergency obstetric care facilities in South Sudanese and Ugandan settings hosting large numbers of forcibly displaced populations. The PPH intervention package comprised refresher training, an online provider community, PPH readiness kits, alarm bells, and displayed algorithms. Findings from both countries converged, highlighting providers' positive views on HSC and TXA. HSC effectiveness in preventing bleeding was acknowledged, bolstering staff's confidence in its use. TXA was perceived as effective although providers reported having less experience with it due to the limited number of PPH cases. Enabling factors included the ease of administration, practical training, endorsement by national and local authorities, and the absence of a cold chain requirement. Appreciation was given to the WhatsApp community of practice as it facilitated knowledge exchange, quality improvement projects that enhanced PPH diagnosis, and innovative tools like wall clocks to record the timing of clinical actions and bells to call for assistance. Challenges included confusion between new and existing medications and record systems that inadequately capture HSC, TXA, and other PPH indicators. HSC and TXA integrated into a PPH intervention package were overall positively valued by providers in humanitarian settings. Continued education and support are crucial. Addressing challenges like medication confusion underscores the need for ongoing education and clear guidelines for the use of HSC, TXA, oxytocin, and other drugs for PPH prevention and treatment. Our findings stress the importance of a comprehensive strategy to overcome health system barriers in PPH management, potentially improving maternal health outcomes in resource-limited and fragile contexts, with broader global implications.
Sickle cell disease is a neglected inherited condition that affects the hemoglobin in red blood cells and impacts at least 2% of the West African population. This hemoglobinopathy presents with high mobility and mortality as a result of infections and vaso-occlusive pain crises as a result of structural abnormality of the red blood, making it fragile and rigid. The objective of our study was to describe the oral health status of sickle cell patients in Yaoundé Central Hospital, Cameroon. A descriptive cross-sectional study was carried out in the hematology unit of the Yaoundé Central Hospital from June to October 2022. A total of 63 patients, made up of 41 (65%) males and 22 (35%) females, were recruited in the study. The majority, 60 (95%), consumed sugary foods, while 43 (68%) brushed their teeth before meals, and 27 (43%) brushed their teeth once a day. A third, 24 (38%), presented with pallor of the palatal mucosa, and 24 (74.6%) had dental caries. The mean decayed, missing, and filled teeth index of this population was 2.6 (moderate) and 11 (17.5%) periodontitis. Less than a third, 17 (26.9%) of the patients had been to a dentist, 26 (41.3%) did not see it necessary to consult a dentist, while 23 (37%) thought that oral conditions are not serious. Two-thirds, 38 (60.5%), did not receive any treatment for caries. Tooth extraction 18 (27.9%) was the most common treatment given, 5 (7%) conservative treatment, and no treatment was administered for periodontitis. There was a high prevalence of periodontal diseases, moderate levels of dental caries, and elevated prevalence of oral mucosal lesions like tonsillar hypertrophy, pallor of the palate, lingual mycosis inflammation, and mucositis among sickle cell patients. The poor oral health-seeking behavior of the patients and poor oral hygiene practices might be responsible for the high burden of carious and periodontal diseases.
Limited research exists on health inequities between American Indians and Alaska Natives (AIANs), tribal communities, and other population groups in the United States. To address this gap in research, we conducted time-trend analyses of social determinants of health and disease outcomes for AIANs as a whole and specific tribal communities and compared them with those from the other major racial/ethnic groups. We used data from the 1990-2022 National Vital Statistics System, 2015-2022 American Community Survey, and the 2018-2020 Behavioral Risk Factor Surveillance System to examine socioeconomic, health, disability, disease, and mortality patterns for AIANs. In 2021, life expectancy at birth was 70.6 years for AIANs, lower than that for Asian/Pacific Islanders (APIs) (84.1), Hispanics (78.8), and non-Hispanic Whites (76.3). All racial/ethnic groups experienced a decline in life expectancy between the pre-pandemic year of 2019 and the peak pandemic year of 2021. However, the impact of COVID-19 was the greatest for AIANs and Blacks whose life expectancy decreased by 6.3 and 5.8 years, respectively. The infant mortality rate for AIANs was 8.5 per 1,000 live births, 78% higher than the rate for non-Hispanic Whites. One in five AIANs assessed their physical and mental health as poor, at twice the rate of non-Hispanic Whites or the general population. COVID-19 was the leading cause of death among AIANs in 2021. Risks of mortality from alcohol-related problems, drug overdose, unintentional injuries, and homicide were higher among AIANs than the general population. AIANs had the highest overall disability, mental and ambulatory disability, health uninsurance, unemployment, and poverty rates, with differences in these indicators varying markedly across the AIAN tribes. AIANs remain a disadvantaged racial/ethnic group in the US in many health and socioeconomic indicators, with poverty rates in many Native American tribal groups and reservations exceeding 40%.
There is a global effort to eliminate new human immunodeficiency virus (HIV) infections among children. However, mother-to-child transmission (MTCT) of HIV, which accounts for nearly all pediatric infections, remains disproportionately high in Africa, including Ghana. This study aims to determine the prevalence and identify the key predictors of MTCT of HIV among HIV-exposed infants in the Ashanti Region of Ghana. A retrospective cohort analysis of routine follow-up records of HIV-infected mothers and their exposed infants was conducted between August 2023 and June 2024 in four hospitals. A convenient consecutive sampling technique was employed to include exposed infants who were at least 18 months old, had ceased breastfeeding, and had definite HIV test results. A structured form was used to collect sociodemographic, clinical, and treatment data of mother-infant pairs. The data were entered into an Excel sheet and exported to STATA version 17.0 for analysis. Bivariate and multivariate logistic regression models were used to determine key predictors of MTCT. Out of the 220 records reviewed, 24 infants tested positive for HIV, giving an overall prevalence of 10.9%. The prevalence was 17.5% (21/120) among participants living in rural communities, compared to 0.03% (3/100) in urbanized areas. Maternal viral load ≥1000 copies/mL (adjusted odds ratio [aOR]: 13.13; 95% confidence interval [CI]: 2.75-62.69), no antiretroviral (ARV) prophylaxis in infant (aOR: 11.05; 95% CI: 2.18-55.91), and mixed feeding during the first 6 months of life of the infant (aOR: 5.65; 95% CI: 1.34-23.87) were the main predictors of MTCT of HIV. The prevalence of MTCT of HIV is high, especially in rural settings. Eliminating MTCT will require effective maternal viral suppression through optimal ART adherence, ensuring prompt ARV prophylaxis for infants at birth and promoting safer feeding practices during the infant's first 6 months of life.
The optimal use of oxytocin for preventing postpartum hemorrhage (PPH) faces challenges in many low-middle income countries (LMICs) owing to its storage and transportation prerequisites. We demonstrated Heat-Stable Carbetocin (HSC) for PPH prevention through an innovative Public-Private Partnership (PPP) model in 15 public health facilities of the Dewas District of Madhya Pradesh (MP) state in India. This study evaluates the feasibility and appropriate utilization of HSC in public health settings. We analyzed facility-level data collected between August 2022 and July 2023 from selected 15 health facilities, where HSC was introduced. Prior to the introduction of HSC, all healthcare providers received training on Active Management of the Third Stage of Labor (AMTSL), use of HSC, and recording and reporting procedures. The supply of HSC in health facilities was ensured, and a robust mechanism was set up to monitor the progress. A total of 18,497 women were admitted for delivery in the 15 selected facilities. Uterotonic administration within one minute of delivery was almost universal (99.9%). No instance was recorded of using HSC either for induction of labor or management of PPH. In 636 cases (3.43%), HSC was not given for PPH prevention. Pearson's chi-square test was conducted to assess the relationship between HSC usage and the health facility's level. The HSC use was significantly higher in First Referral Unit (FRU) facilities compared to non-FRUs (p < 0.001). Moreover, the administration of HSC within one minute of delivery was also more prevalent in FRU facilities compared to non-FRUs (p < 0.001). The PPH incidence and case referral rates noted in this study were 0.7% and 16.7%, respectively, with no reported adverse drug events or deaths. Our study suggests the safe and appropriate use of HSC within India's public health system.
Although maternal mortality in India has declined significantly due to improved healthcare access and government initiatives, uterine rupture is re-emerging as a serious obstetric complication, largely driven by the rising incidence of cesarean deliveries. This study was conducted to evaluate the incidence, risk factors, and maternal and fetal outcomes of uterine rupture at a tertiary care center in Eastern Uttar Pradesh, India. An observational cross-sectional study was conducted over 12 months (October 2019-September 2020) in the gynecology inpatient department of a tertiary care center. All clinically diagnosed and laparotomy-confirmed cases of uterine rupture were included. Maternal demographics, antenatal and perinatal risk factors, intraoperative findings, and maternal and fetal outcomes were analyzed. The occurrence of uterine rupture during COVID and non-COVID periods was compared using a Z test for proportion. The incidence was calculated from the total number of hospital deliveries during the study. Of 3,552 deliveries, 31 cases of uterine rupture were reported, yielding an incidence of 8.7/1,000- markedly higher than the national average. The incidence during the COVID-19 period increased, but was not statistically significant. Previous cesarean section (CS) with unsupervised labor was the leading risk factor. Maternal mortality was 6.45%, and 83.87% of women recovered without major complications. Perinatal mortality was alarmingly high at 96.77%, with only one neonate surviving. Uterine rupture remains a significant contributor to maternal and perinatal mortality in rural India, particularly due to unsafe labor practices and poor antenatal care. There is an urgent need to strengthen health systems, referral networks, and community education to prevent uterine rupture and improve maternal-child health outcomes. In addition, focused efforts are required to reduce the rate of unnecessary CS through adherence to evidence-based guidelines and promoting safe vaginal births when appropriate.