Harnessing Participatory Formative Research to Inform Women's Preferences on Multiple Micronutrient Supplement (MMS) Design Considerations Across Four Country Contexts

Objectives To determine universally acceptable MMS box design inputs including preferred color scheme, logo, and slogan options to include in demonstration projects across four countries. Methods Design: This multi-phased, formative study was conducted between Oct. 2020 - Feb. 2021 in Burkina Faso, Bangladesh, Tanzania, and Madagascar. It was designed using a social marketing framework and employed Rapid Assessment Procedures (RAP). Data collection methods and sampling: Qualitative methods were used to inform MMS product design and promotional strategies, including 40 participatory workshops and 32 focus group discussions with pregnant women across four countries. In Burkina Faso, a survey was administered to pregnant women (n = 30) for further triangulation. During data collection, several mock MMS box designs, with design options based on local contexts, were used as stimulus prompts for discussion and voting on preferred MMS design color schemes, logos, and slogans. Analysis: Data across methods were synthesized to identify the most preferred MMS characteristics. Results Color scheme: Overall, a white/pink MMS box color scheme was the most preferred, universal packaging color across countries. Participants explained that white was “clean”, and in Burkina Faso, it reminded participants of a local paracetamol package “which has no side effects.” The pink was described as “soft and attractive.” In Madagascar, there was a stronger preference for an orange/green color scheme, with pink as a second choice. Box logo: Across countries, participants suggested an image of a pregnant woman on the box design to ensure it is recognizable for its intended purpose. In Burkina Faso, participants voted for a ‘healthy pregnant woman smiling, holding the supplement’ and in Madagascar, participants preferred a ‘healthy, pregnant woman taking the supplement.’ Promotional slogans: While there was variation in specific slogan recommendations to promote MMS by country, shared themes related to good health, strength, happiness, and God. The MMS box design was thus tailored to reflect a combination of preferences. Conclusions Engaging pregnant women who will be end-users of MMS through participatory methods in four countries aided to inform programming that may improve supplement acceptability and compliance across contexts. Funding Sources Bill and Melinda Gates Foundation.

Hemoperitoneum during Pregnancy: A Rare Case of Spontaneous Rupture of the Uterine Artery

Spontaneous rupture of the uterine artery is a rare cause of hemoperitoneum during pregnancy. This is a life-threatening condition associated with maternal and fetal mortality. We describe a case of spontaneous rupture of the left uterine artery in a 32-year-old healthy pregnant woman with an uneventful pregnancy.

Spontaneous Ovarian Hyperstimulation Syndrome in Second Pregnancy of a Healthy Pregnant Woman

pontaneous ovarian hyperstimulation syndrome (OHSS) is an uncommon type of OHSS that is characterized by gastrointestinal symptoms and complications of accommodation of body fluids in third spaces in the absence of medical ovarian stimulations. This syndrome is mostly seen in multiple or molar pregnancies with an underlying medical condition such as hypothyroidism. Treatment of spontaneous OHSS depends on the patient’s clinical condition. Appropriate management will warrant a successful pregnancy. The aim of this report is to introduce a case of spontaneous ovarian hyperstimulation syndrome in second pregnancy of a healthy pregnant woman. The patient was a 8 weeks pregnant female who referred to gynecology and obstetrics clinic because of gradual abdominal distension, abdominal pain and nausea from one month ago. The patient didn't have any history of the specific predisposing factors of OHSS such as thyroid gland dysfunction or multiple pregnancies. Abdominal sonography showed enlarged ovaries with prominent follecules as well as free fluid in the entire abdomen. Elevated levels of HCG (312850 mlU/ml) and carcinoembryonic antigen (106 U/ml) were the remarkable laboratory findings. We successfully controlled the patient by conservative management and the size of ovaries returned back to normal by 17th weeks of gestation. On sonographic follow-ups, untill delivery, the patient was symptom-free and a healthy infant was born. While spontaneous OHSS is a rare and life-threatening condition, conservative management including albumin and anticoagulant administration as well as paracentesis of body third space fluids, will be a promising approach in the stable patients.

Sunburn as a Cause of Unexpected Neutrophilia in a Healthy Pregnant Woman

Background. Neutrophilia has a broad differential diagnosis and represents a systemic response to an infection or other inflammatory pathologies. Case. A 31-year-old woman, Gravida 3, Para 2 at 28 weeks of gestation, presented to the day assessment unit following routine blood tests that showed an unexpected marked neutrophilia. The underlying cause of the neutrophilia was sunburn. The sunburn recovered and her neutrophil count spontaneously normalised. Conclusion. Clinicians can add sunburn to the broad differential diagnosis of neutrophilia.

Adrenal infarction in a healthy pregnant woman

Adrenal infarction is a very rare event but occasionally seen in hypercoagulable states. We present a case of a 31-year-old woman at 38 weeks of gestation who developed a severe upper abdominal pain and unilateral adrenal infarction due to thrombosis of the adrenal vein. The only thrombogenic factor found was pregnancy. The case highlights that adrenal infarction may complicate a normal pregnancy and should be included in the differential diagnosis of the acute abdomen in pregnancy.