Commentary on Prevention of Low Birthweight in Low-Income Societies

2013 ◽  
pp. 74-78
Keyword(s):  
Low Income ◽  
Low Birthweight

scholarly journals Evidence-based interventions to reduce mortality among preterm and low-birthweight neonates in low-income and middle-income countries: a systematic review and meta-analysis

2021 ◽  
Vol 6 (2) ◽  
pp. e003618
Author(s):  
Mirjam Y Kleinhout ◽  
Merel M Stevens ◽  
Kwabena Aqyapong Osman ◽  
Kwame Adu-Bonsaffoh ◽  
Floris Groenendaal ◽  
...  
Keyword(s):  
Low Income ◽  
Low Birthweight ◽  
Meta Analysis ◽  
Neonatal Resuscitation ◽  
Newborn Care ◽  
Evidence Based ◽  
Antenatal Corticosteroids ◽  
Essential Newborn Care ◽  
Middle Income ◽  
Middle Income Countries

BackgroundPreterm birth is the leading cause of under-five-mortality worldwide, with the highest burden in low-income and middle-income countries (LMICs). The aim of this study was to synthesise evidence-based interventions for preterm and low birthweight (LBW) neonates in LMICs, their associated neonatal mortality rate (NMR), and barriers and facilitators to their implementation. This study updates all existing evidence on this topic and reviews evidence on interventions that have not been previously considered in current WHO recommendations.MethodsSix electronic databases were searched until 3 March 2020 for randomised controlled trials reporting NMR of preterm and/or LBW newborns following any intervention in LMICs. Risk ratios for mortality outcomes were pooled where appropriate using a random effects model (PROSPERO registration number: CRD42019139267).Results1236 studies were identified, of which 49 were narratively synthesised and 9 contributed to the meta-analysis. The studies included 39 interventions in 21 countries with 46 993 participants. High-quality evidence suggested significant reduction of NMR following antenatal corticosteroids (Pakistan risk ratio (RR) 0.89; 95% CI 0.80 to 0.99|Guatemala 0.74; 0.68 to 0.81), single cord (0.65; 0.50 to 0.86) and skin cleansing with chlorhexidine (0.72; 0.55 to 0.95), early BCG vaccine (0.64; 0.48 to 0.86; I2 0%), community kangaroo mother care (OR 0.73; 0.55 to 0.97; I2 0%) and home-based newborn care (preterm 0.25; 0.14 to 0.48|LBW 0.42; 0.27 to 0.65). No effects on perinatal (essential newborn care 1.02; 0.91 to 1.14|neonatal resuscitation 0.95; 0.84 to 1.07) or 7-day NMR (essential newborn care 1.03; 0.83 to 1.27|neonatal resuscitation 0.92; 0.77 to 1.09) were observed after training birth attendants.ConclusionThe findings of this study encourage the implementation of additional, evidence-based interventions in the current (WHO) guidelines and to be selective in usage of antenatal corticosteroids, to reduce mortality among preterm and LBW neonates in LMICs. Given the global commitment to end all preventable neonatal deaths by 2030, continuous evaluation and improvement of the current guidelines should be a priority on the agenda.

scholarly journals Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Joshua P. Mersky ◽  
ChienTi Plummer Lee
Keyword(s):  
Preterm Birth ◽  
Birth Outcomes ◽  
Low Income ◽  
Adverse Childhood Experiences ◽  
Pregnancy Loss ◽  
Low Birthweight ◽  
Childhood Adversity ◽  
Risk Models ◽  
Childhood Experiences ◽  
Adverse Childhood

Abstract Background Adverse childhood experiences (ACE) are associated with an array of health consequences in later life, but few studies have examined the effects of ACEs on women’s birth outcomes. Methods We analyzed data gathered from a sample of 1848 low-income women who received services from home visiting programs in Wisconsin. Archival program records from a public health database were used to create three birth outcomes reflecting each participant’s reproductive health history: any pregnancy loss; any preterm birth; any low birthweight. Multivariate logistic regressions were performed to test the linear and non-linear effects of ACEs on birth outcomes, controlling for age, race/ethnicity, and education. Results Descriptive analyses showed that 84.4% of women had at least one ACE, and that 68.2% reported multiple ACEs. Multivariate logistic regression analyses showed that cumulative ACE scores were associated with an increased likelihood of pregnancy loss (OR = 1.12; 95% CI = 1.08–1.17), preterm birth (OR = 1.07; 95% CI = 1.01–1.12), and low birthweight (OR = 1.08; 95% CI = 1.03–1.15). Additional analyses revealed that the ACE-birthweight association deviated from a linear, dose-response pattern. Conclusions Findings confirmed that high levels of childhood adversity are associated with poor birth outcomes. Alongside additive risk models, future ACE research should test interactive risk models and causal mechanisms through which childhood adversity compromises reproductive health.

scholarly journals Development and Validation of a Risk Score to Predict Low Birthweight Using Characteristics of the Mother: Analysis from BUNMAP Cohort in Ethiopia

2020 ◽  
Vol 9 (5) ◽  
pp. 1587
Author(s):  
Hamid Y. Hassen ◽  
Seifu H. Gebreyesus ◽  
Bilal S. Endris ◽  
Meselech A. Roro ◽  
Jean-Pierre Van Geertruyden
Keyword(s):  
Prediction Model ◽  
Pregnant Women ◽  
Risk Score ◽  
Low Income ◽  
Low Birthweight ◽  
Multivariable Analysis ◽  
Curve Analysis ◽  
Decision Curve Analysis ◽  
Maternal Characteristics ◽  
Trained Manpower

At least one ultrasound is recommended to predict fetal growth restriction and low birthweight earlier in pregnancy. However, in low-income countries, imaging equipment and trained manpower are scarce. Hence, we developed and validated a model and risk score to predict low birthweight using maternal characteristics during pregnancy, for use in resource limited settings. We developed the model using a prospective cohort of 379 pregnant women in South Ethiopia. A stepwise multivariable analysis was done to develop the prediction model. To improve the clinical utility, we developed a simplified risk score to classify pregnant women at high- or low-risk of low birthweight. The accuracy of the model was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration plot. All accuracy measures were internally validated using the bootstrapping technique. We evaluated the clinical impact of the model using a decision curve analysis across various threshold probabilities. Age at pregnancy, underweight, anemia, height, gravidity, and presence of comorbidity remained in the final multivariable prediction model. The AUC of the model was 0.83 (95% confidence interval: 0.78 to 0.88). The decision curve analysis indicated the model provides a higher net benefit across ranges of threshold probabilities. In general, this study showed the possibility of predicting low birthweight using maternal characteristics during pregnancy. The model could help to identify pregnant women at higher risk of having a low birthweight baby. This feasible prediction model would offer an opportunity to reduce obstetric-related complications, thus improving the overall maternal and child healthcare in low- and middle-income countries.

scholarly journals Extending the Reach of Human Milk Banking

2017 ◽  
Vol 8 (2) ◽  
pp. 232 ◽  
Author(s):  
George Kent
Keyword(s):  
Human Milk ◽  
Critically Ill ◽  
Low Income ◽  
Low Birthweight ◽  
Low Income Countries ◽  
Human Milk Banking ◽  
Milk Banking ◽  
Milk Banks

The banking of human milk is expanding rapidly in both high- and low-income countries. Most milk banks serve critically ill infants, including those who are born prematurely or have low birthweight. This commentary explores the potential for extending the reach of milk banking so that it also serves many infants who are not critically ill, but would benefit from human milk from women other than their own mothers.

scholarly journals Feasibility of using an Early Warning Score for preterm or low birthweight infants in a low-resource setting: results of a mixed-methods study at a national referral hospital in Kenya

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039061
Author(s):  
Eleanor J Mitchell ◽  
Zahida P Qureshi ◽  
Fredrick Were ◽  
Jane Daniels ◽  
George Gwako ◽  
...  
Keyword(s):  
Low Income ◽  
Early Warning ◽  
Low Birthweight ◽  
Clinical Signs ◽  
Vital Signs ◽  
Referral Hospital ◽  
Sub Saharan Africa ◽  
Early Warning Score ◽  
Resource Setting ◽  
National Referral Hospital

IntroductionFifteen million babies are born prematurely, before 37 weeks gestational age, globally. More than 80% of these are in sub-Saharan Africa and Asia. 35% of all deaths in the first month of life are due to prematurity and the neonatal mortality rate is eight times higher in low-income and middle-income countries (LMICs) than in Europe. Early Warning Scores (EWS) are a way of recording vital signs using standardised charts to easily identify adverse clinical signs and escalate care appropriately. A range of EWS have been developed for neonates, though none in LMICs. This paper reports the findings of early work to examine if the use of EWS is feasible in LMICs.MethodsWe conducted an observational study to understand current practices for monitoring of preterm infants at a large national referral hospital in Nairobi, Kenya. Using hospital records, data were collected over an 8-week period in 2019 on all live born infants born at <37 weeks and/or <2500 g (n=294, 255 mothers) in the first week of life. Using a chart adopted from the EWS developed by the British Association of Perinatal Medicine, we plotted infants’ vital signs. In addition, we held group discussions with stakeholders in Kenya to examine opinions on use of EWS.ResultsRecording of vital signs was variable; only 63% of infants had at least one temperature recorded and 53% had at least one heart rate and respiratory rate recorded. Stakeholders liked the traffic-light system and simplicity of the chart, though recognised challenges, such as staffing levels and ability to print in colour, to its adoption.ConclusionEWS may standardise documentation and identify infants who are at higher risk of an adverse outcome. However, human and non-human resource issues would need to be explored further before development of an EWS for LMICs.

Stillbirth and Neonatal mortality in Jordan: Findings from Jordan Stillbirths and Neonatal Deaths Surveillance System (Preprint)

2021 ◽  
Author(s):  
Yousef Khader ◽  
Nihaya Al-Sheyab ◽  
Mohammad Alyahya ◽  
Ziad El-Khatib ◽  
Khulood Shattnawi ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Low Income ◽  
Surveillance System ◽  
Death Rate ◽  
Congenital Malformations ◽  
Low Birthweight ◽  
Chromosomal Abnormalities ◽  
Mortality Rates ◽  
Low Income Countries ◽  
Neonatal Deaths

BACKGROUND Stillbirth and neonatal mortality declined significantly in high- and some middle- income countries because of the significant improvements in obstetric and neonatal care. Yet, stillbirth and neonatal mortality rates remain high in low-income countries. The main reason for low progress in reducing such stillbirths and neonatal deaths in Jordan is the scarcity of data on causes and contributing factors leading to these deaths. OBJECTIVE This study aimed to determine the rates, causes and risk factors of stillbirth and neonatal mortality in Jordan. METHODS An electronic stillbirth and neonatal deaths surveillance system was established in five large hospitals in Jordan. Data on all births, stillbirths and neonatal deaths and their causes during the period May 2019 – December 2020 were exported from the system and analyzed. RESULTS A total of 29,592 women gave birth to 31,106 babies during a period of 20 months in the selected hospitals. The stillbirth rate was 10.5 per 1,000 total births, the neonatal death rate was 14.2 per 1,000 live births, and the perinatal death rate was 21.4 per 1,000 total births. Of all neonatal deaths, 29.4% died within the first day of life and 77.8% died during the first week of life. For neonatal deaths occurred pre-discharge, the leading causes of death were respiratory and cardiovascular disorders (35.0%), low birth weight and prematurity (32.7%), and congenital malformations, deformations and chromosomal abnormalities (19.5%). Almost one third of stillbirths had unspecified cause of death (33.3% of antepartum stillbirths and 28.9% of intrapartum stillbirths). Acute antepartum event was responsible of 27.4% of antepartum stillbirths and acute intrapartum event was responsible for 13.2% of intrapartum stillbirths. Congenital malformations, deformations and chromosomal abnormalities contributed to 18.1% of antepartum stillbirths and 34.2% of intrapartum stillbirths. CONCLUSIONS There is a relative stability of stillbirth and neonatal mortality rates in Jordan. Several identified maternal and/or fetal conditions that contributed to stillbirths and/or neonatal deaths in Jordan are preventable. Focused care needs to be directed high-risk pregnant women and to neonates with low birthweight and respiratory problems.

Innovative need-based low-cost kangaroo mother care (KMC) chair

2020 ◽  
Vol 6 (4) ◽  
pp. 220-224
Author(s):  
Ashish Jain ◽  
Jerin C Sekhar ◽  
Nisha Kumari ◽  
Nidhi Jain
Keyword(s):  
Low Income ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Low Cost ◽  
Kangaroo Mother Care ◽  
Low Income Countries ◽  
Mortality And Morbidity ◽  
Beneficial Effects ◽  
Level Of Satisfaction ◽  
Tertiary Teaching

ObjectivesLow birthweight neonates contribute substantially to mortality and morbidity. Their management in low-income countries is difficult due to shortage of skilled staff and limited resources. Kangaroo mother care (KMC) is an effective way of providing warmth, stimulation and protection against infection, thereby decreasing mortality. We intended to perform a need-based survey among mothers and to develop an economic and comfortable chair to facilitate and optimise KMC. We also evaluated the level of satisfaction among mothers using the developed chair.DesignIterative product development.SettingA tertiary teaching hospital having level 3 neonatal intensive care and KMC ward.MethodsAn initial design for KMC chair was developed based on the structured response of 40 mothers to a need-based questionnaire. The prototype was reviewed by experts, including nursing staff, and a comfortable chair with minimum logistics was developed. A formative assessment of satisfaction was done using a questionnaire after introducing it in clinical practice.Results67.5% of mothers were satisfied with the head rest, inclination and height, while 72.5% were satisfied with the in-built KMC cloth and platform for placing utensils. 86.6% of nurses found the chair helpful to mothers; 83.3% were satisfied with the length of in-built KMC cloth; and 80% expressed their overall satisfaction in the KMC chair. 70% of nurses found the chair to facilitate safe position for the baby and to improve breast feeding.ConclusionThis innovative and need-based KMC chair would help mothers of different builds perform KMC comfortably. This might prolong the duration of KMC, thereby having beneficial effects on the neonate.

scholarly journals Housing conditions as a social determinant of low birthweight and preterm low birthweight

2010 ◽  
Vol 44 (6) ◽  
pp. 1021-1031 ◽  
Author(s):  
Mario Vianna Vettore ◽  
Silvana Granado Nogueira da Gama ◽  
Gabriela de Almeida Lamarca ◽  
Arthur Orlando Corrêa Schilithz ◽  
Maria do Carmo Leal
Keyword(s):  
Prenatal Care ◽  
Low Income ◽  
Low Birthweight ◽  
Post Partum ◽  
Social Determinant ◽  
Normal Weight ◽  
Maternal Body Mass Index ◽  
Housing Conditions ◽  
Inadequate Prenatal Care ◽  
The Relationship

OBJECTIVE: To assess the relationship between housing conditions and low birthweight and preterm low birthweight among low-income women. METHODS: A case-control study was conducted with post-partum women living in the city of Rio de Janeiro, Southeast Brazil, in 2003-2005. Two groups of cases, low birthweight (n=96) and preterm low birthweight infants (n=68), were compared against normal weight term controls (n=393). Housing conditions were categorized into three levels: adequate, inadequate, and highly inadequate. Covariates included sociodemographic and anthropometric characteristics, risk behaviors, violence, anxiety, satisfaction during pregnancy, obstetric history and prenatal care. RESULTS: Poor housing conditions was independently associated with low birthweight (inadequate - OR 2.3 [1.1;4.6]; highly inadequate - OR 7.6 [2.1;27.6]) and preterm low birthweight (inadequate - OR 2.2 [1.1;4.3]; highly inadequate - OR 7.6 [2.4;23.9]) and factors associated with outcomes were inadequate prenatal care and previous preterm birth. Low income and low maternal body mass index remained associated with low birthweight. CONCLUSIONS: Poor housing conditions were associated with low birthweight and preterm low birthweight.

Relationship of Street Drug Use, Hospitalization, and Psychosocial Factors to Low Birthweight Among Low-Income Women

Birth ◽  
1988 ◽  
Vol 15 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Betty Lia-Hoagberg ◽  
Karen Knoll ◽  
Sheldon Swaney ◽  
Gertrude Carlson ◽  
Sara Mullett
Keyword(s):  
Drug Use ◽  
Psychosocial Factors ◽  
Low Income ◽  
Low Birthweight ◽  
Low Income Women ◽  
Relationship Of
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