bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of awareness campaigns on Acute Encephalitis Syndrome in Northern India
Authors: Singh A , Jain P , Singh N , Singh S , Bajpai P , Kharya P
Published: October 2020

Introduction

Acute encephalitis syndrome (AES), is a major public health problem in northern India. To meet with the growing concerns of death and disability outcomes of the disease, the Government launched an ambitious awareness campaign in collaboration with the UNICEF. The campaign known as “dastak” comprised of intersectoral convergence for coordinated preventive activities along with widespread door to door awareness programme and envisaged reducing the morbidity and mortality associated with the disease.

Methods

This is a record based retrospective study conducted in the state of Uttar Pradesh, India. Line list of patients suffering from AES, from the year 2016 to 2019, was used to determine number of cases, deaths, case fatality rate, and age group affected. In addition, the time lag between onset of symptoms and hospital admission as well as duration of hospital stay was also calculated. The data were analysed using Statistical Package for Social Sciences (SPSS) version 24.0.

Results

Analysis of data revealed that, in the year 2016 and 2017, there were 8635 reported cases of AES out of which 1296 patients died of the disease. During this period average CFR was 15%. However, after launch of intersectoral preventive and awareness campaign the total number of AES cases dropped to 5262 (3077 cases in 2018 and 2185 cases in 2019) with 374 deaths and an overall CFR of 7.11% during this period. Children are more commonly affected than adults with average age of AES patients being 10.29 and the most commonly affected age group being 1 to 5 years. After introduction of the campaign there was a decrease in mean (± SD) duration between onset of symptoms and hospital admission from 2.20 (± 1.64) to 1.02 (± 0.41) days. Similarly mean (± SD) duration of hospital stay decreased from 7.64 (± 10.83) to 5.6 (± 6.9) days.

Conclusions

Since the introduction of preventive and awareness campaign there has been a significant reduction in morbidity and mortality associated with AES.

Key messages

Impact assessment of preventive activities and awareness campaign on disease helps in making policy decisions and future plan of action for fight against the Acute encephalitis syndrome. Acute encephalitis syndrome is a major public health problem in northern India and early recognition and treatment significantly affects its outcome.
Pilot Study on non-tuberculous mycobacteria infections in Italy
Authors: Fattorini L , Iacobino A , Giannoni F ,   SMI-NTM
Published: October 2020

Background

The rise in non-tuberculous mycobacteria (NTM) diseases has been reported worldwide, but no major information is known for Italy. The purpose of this pilot study is to release nationwide data on distribution of NTM in our country.

Methods

In 2016, the Istituto Superiore di Sanità (National Institute of Health) began to collect microbiological, clinical and minimum inhibitory concentration (MIC) data on NTM infections, in collaboration with hospital laboratories located in 15 out of 20 regions (Studio Multicentrico Italiano NTM, SMI-NTM), which routinely isolate and characterize NTM by commercial identification (Genotype) and MIC (Sensititre) assays.

Results

In 2016-2018, 32 labs reported data on 4169 NTM strains, including 644 rapid growers (15%) and 3525 slow growers (85%). The most frequent species were Mycobacterium avium (MA) (29.2%), M. intracellulare (MI) (21.5%), M. xenopi (MX) (10.6%), M. gordonae (10.6%), M. abscessus (5.9%), M. chimaera (MC) (5.1%). Overall, 88% NTM strains were isolated from pulmonary sites, 84% from Italians, 51% from men. NTM infections in Italians occurred in 75-84 years old patients, while in foreign-born people were observed in 15-44 years old patients. Strains from cystic fibrosis were 11.9%. The MICs of clarithromycin (CLA) for MA or MI peaked at 2 µg/ml, while for amikacin (AK) peaked at 16 µg/ml. When MICs were interpreted according to the 2018 Clinical and Laboratory Institute Standards (CLSI) breakpoints, MA or MI resistances for CLA were 2.6% and 2.6% respectively, while for AK they were 7.2% and 4.5%, respectively. Higher resistance rates for MA and MI were observed for moxifloxacin and linezolid. MICs of MC, MX, M. kansasii, M. marinum and rapid grower NTM were also determined and interpreted on the basis of CLSI breakpoints.

Conclusions

This 3-years pilot study is the basis for a future multiannual national strategic plan for surveillance of NTM infections in Italy (collection of 2019 data is in progress).

Key messages

This 3-years pilot study is the basis for a future multiannual national strategic plan for surveillance of NTM infections in Italy. The purpose of this pilot study is to release nationwide data on distribution of NTM in our country.
Tuberculosis latent infection in health care workers: oxidative stress and Quantiferon-TB Plus
Authors: Santoro A , Petrillo S , Nijhawan P , Gallo M G , Brugaletta R , Gilardi F , Mastroianni C , Piemonte F , Zaffina S
Published: October 2020

Background

This study moves from recent evidences highlighting: 1) the high sensitivity of Mycobacterium tuberculosis (MT) to perturbation of redox homeostasis induced by oxidative stress; 2) the improvement of Tuberculosis (TB) diagnosis following the introduction of Quantiferon-TB Plus (QFT-Plus) assay.

Methods

The QFT-Plus diagnostic performance and the blood antioxidant capacity, expressed as ratio between oxidized (GSSG) and reduced (GSH) forms of glutathione, were determined on three selected populations (40 Health care workers (HCWs) controls, 63 latent TB HCWs, 8 active TB patients). Quantitative Real Time PCR analysis on leukocytes of active TB patients was also performed, in order to identify “redox profiles” of genes mainly involved in the antioxidant response.

Results

1) The glutathione homeostasis was shifted towards an oxidative status in active TB patients respect to controls, as evidenced by the significant decrease of the ratio between free and total GSH, an indirect index of oxidative stress. More reducing conditions were observed in latent TB subjects. 2) The expression profiles of antioxidant genes confirmed the major susceptibility of active TB patients to oxidative stress compared to controls, and highlighted a great individual variability. 3) The diagnostic performance of QFT-Plus test present a moderate concordance with QFT-GIT one, in this preliminary phase.

Conclusions

Glutathione has anti-mycobacterial effects in its reduced form GSH, thus the quantification of Free/Total GSH ratio may represent a systemic marker of TB infection and be useful in developing combined therapies. Moreover, the identification of personalized redox profiles will additionally provide an individual antioxidant response to the infection.

This project was funded by the Ministry of Health (RF 2016)

Key messages

LTBI management represents an objective of primary importance in the field of occupational medicine in order to define a personalized prevention in HCW. A new approach that combines biochemical determinations of redox biomarkers and gene expression in blood will be a novel biomarkers of tuberculosis.
Tuberculosis and HIV’s management: A health seeking behaviour Analysis of Incarcerated Patients
Authors: Ralaizara B , Andriamandrimbisoa A , Chevallier E , Mattern C
Published: October 2020

Madagascar has about 23.000 prisoners detained in 44 prisons. In prisons, tuberculosis (TB) prevalence is eight times higher than in the general population due to different conditions that make them vulnerable like overcrowded conditions. HIV prevalence may also be higher than in the general population due to risky practices that may expose prisoners to HIV infection, but no precise data are available. Though the national strategic plans for TB, HIV or TB-HIV co-infection' management mention prisoners as one of their target populations, any specific care are provided for these incarcerated patients. They then face many difficulties in their care specifically HIV carriers.

An anthropological study dealing with the care pathway of TB and HIV patients in prison is on-going. The aim of our study is to analyse and understand the care seeking pathway of prisoners with TB and/or HIV'. Interviews are conducted at the main prisons of Antananarivo, Mahajanga and Manakara. A total of sixty interviews will be conducted with prisoners (with TB and/or HIV) and other persons such as nurses, reference doctors, prison officers. Focus groups were also conducted with prisoners in order to understand the care seeking pathway in prison and also detainees' perception of TB and HIV.

Data collection is on-going and will be finished in May 2020. These preliminary findings revealed that there is an informal hierarchy to be respected for access to care. The power relations between detainees give unequal access to care. It is also conditioned by others circumstances like coinage or social status. It was also revealed that the level of detainees' knowledge of diseases TB and HIV remains limited to the modes of transmission. Interviews revealed any stigmatization of patients with TB or HIV.

Data are being collected and recommendations will follow. Yet, we can already claim that the prevention of both TB and HIV needs to be strengthened.

Key messages

Our study will provide a better understanding of the detainees’ issues the management of TB and/or HIV. Our analysis would propose concrete recommendations to improve health care and cure in prisons.
Knowledge, attitudes, and susceptibility on HIV/AIDS in university students
Authors: Hernández Blanco K , Jiménez Triana A , Caporal Taffoya C , Romero Montero C , Márquez Celedonio F G , Villegas Domínguez J E
Published: October 2020

Background

Veracruz is Mexico's second state with the highest number of HIV / AIDS cases. Identifying the factors that facilitate greater knowledge, a better attitude, self-efficacy and susceptibility could improve the way HIV/AIDS prevention and training activities are planned and executed. Research question: What are the characteristics that mark differences in knowledge, attitudes, self-efficacy and susceptibility on HIV in university students?

Methods

An observational, prospective, cross-sectional and analytical study was conducted in Veracruz, Mexico between June and December 2019. University students from public and private schools in Veracruz-Boca del Río were included, excluding those who did not agree to participate, selecting participants through non-probabilistic sampling. Through the application of surveys, in which students were requested the VIH/ SIDA-65 test was applied to assess attitudes, self-efficacy and susceptibility. The surveys were conducted through Google Forms® and were answered on that same platform. The results were collected and analyzed with the SPSS Statistic® program.

Results

565 students were included, 62.8% were male, 98.6% cisgender and, 88.3% as heterosexual. Being a man, marks differences in neutral attitude (32.2 ± 18.0 vs. 29.0 ± 15.8) and susceptibility (48.95 ± 20.3 vs. 43.2 ± 18.2), non-heterosexual sexual orientation in positive attitude (4.5 ± 0.7 vs. 4.2 ± 1.1), active sex life in neutral attitude (32.0 ± 17.4 vs. 24.1 ± 12.1) and self-efficacy (89.1 ± 19.5 vs. 83.5 ± 22.0) all with values of p < 0.05 while gender identity, place of origin, socioeconomic level, religion, and pre-university sex education showed values of p > 0.5

Conclusions

Among the university students, being a man, being non-heterosexual and having active sex life are factors that make a difference in attitude, self-efficacy and susceptibility to HIV / AIDS.

Key messages

We must improve pre-university reproductive health education, since it does not make a difference in knowledge and attitudes for HIV / AIDS. We consider it convenient to propose a reproductive health module to promote HIV-focused health in university students.
Maternal health care provision for refugee women
Authors: Kasper A
Published: October 2020

Background

In the recent past, the number of forcibly displaced people increased worldwide. About 1/3 of the persons seeking asylum in Germany are female. The majority of all refugee women who are coming to Germany are currently of childbearing age. Refugee women are considered a highly vulnerable refugee subgroup, as they frequently experience physical strains and psychological burdens while fleeing their home countries and being pregnant at the same time. Moreover, pregnancy and the following period require specialized care and support in order to allow a transition to maternity without complications.

The aim of this project is to analyze maternal health care services for refugee women on the level of interaction with maternal health care professionals in Germany.

Methods

Maternal health care professionals in outpatient and clinical settings with experiences of caring for refugee women were recruited. Semi-structured interviews were conducted. The interviews were analyzed following the standards of qualitative thematic analysis.

Results

Maternal health care professionals face challenges in implementing and providing maternal health care concerning their professional practices and interventions. Due to a lack of resources (e.g. translators, time) and other conditions, gynaecologists and midwives are forced to find new solutions that maintain (medical care), adapt (vaginal examination) or miss out on (informed consent) ordinary professional practices.

Key messages

Maternal health care professionals face different barriers when providing maternal health care to migrant/refugee such as communication barriers and problems in relationship building. The identification of challenges and opportunities for professionals in maternal health care provision may contribute to improve maternal health (care) for refugee women.
Public private strategy for elimination of congenital transmission of infectious diseases - Argentina
Authors: Castelli J M , Costa A , Wolovich T , Fontana S , Ávila M , Abril M , Gold S , Silvestrini Viola C , Monteverde M , Pereiro A C
Published: October 2020

Problem

Mother-to-child transmission of HIV, Syphilis, Chagas and Hepatitis B constitutes a significant public health issue in Latin America, mostly because of the great morbidity and mortality of these diseases, the social impact of their consequences and the opportunity to eliminate the transmission with timely diagnosis and treatment. Useful strategies to face this mayor problem may be beneficial for the region.

Description of the Problem

The number of newborns with congenital syphilis has been growing all over the region. Moreover, Argentina is the country with the largest affected population with Chagas Disease and, although treatment is very effective during infancy, less than 1% of the infected population accesses the drug. The recurring economic crisis raised the percentage of poverty from 4.6 % in 1974 up to 35.4 % in 2019, thus worsening health determinants and adding new challenges to the healthcare sector. The Framework for Elimination of Mother-to-Child Transmission of HIV, Syphilis, Hepatitis B and Chagas (EMTCT Plus) proposed by the Pan American Health Organization in 2017 was approved by Argentina and is of low complexity. Under this context, the non-governmental organization Mundo Sano Foundation together with the Municipality of Almirante Brown elaborated an intervention model to implement EMTCT Plus in a municipality of Buenos Aires Province.

Results

After two years, 3561 pregnant women were evaluated as well as their babies: 317 were positive for syphilis, 27 were positive for HIV, 25 for Chagas and 3 for Hepatitis B. At the moment, all the newborns were free of the four diseases. The social profitability evaluation was very high.

Lessons

Public-private associations could be an innovative way to deal with some major public health issues. EMTCT Plus is a useful framework for Latin American countries. The social profitability of investments in the elimination of mother to child transmission is very high.

Key messages

Elimination of Mother-to-Child Transmission of HIV, Syphilis, Chagas and Hepatitis B is a useful framework for Latin American countries. The social profitability evaluation was very high. Public-private associations could be an innovative way to deal with some major public health issues.
Determinants related to the risk of using ED among paediatric patients receiving home care services
Authors: Scattaglia M , Campagna S , Politano G , Dalmasso M , Dimonte V , Gianino M
Published: October 2020

Introduction

Pediatric home care services (PHC) are recommended to avoid hospital visits or readmission in children with chronic or complex conditions and to reduce the use of emergency departments. It would be useful to know the association of sociodemographic, clinical and health supply factors with Emergency Department (ED) access by patients receiving PHC.

Methods

A cross sectional retrospective cohort study was held from 2012 to 2017 in Pediatric home care services in Italy. Participants are children aged 0-18 years receiving pediatric home care services. Collected data are: sociodemographic variables (sex, age, presence or absence of an unfamiliar caregiver); distance from the ED in minutes; clinical variables (mortality rate at home, mortality rate in the ED, pathology responsible for the PHC activation and pathology determining the ED access); health supply variables (PHC proposed duration as stated by the proponent, subjects directing the patient to the ED, place of discharge after ED access, and arrival time to the ED).

Results

A total of 1236 PHC events contributed to 769 ED accesses. Receiving PHC services after hospital discharge (RR:1.26) and longer duration of charge-taking significantly increased the risk of experiencing ED access. The RR significantly decreased among children >5 years-of-age (RR:0.84; RR:0.62; RR;0.57; in 5-9; 10-14; 15-18 years respectively) and among children with neoplastic (RR:0.7), respiratory (RR:0.69), trauma (RR:0.4) or musculoskeletal diseases (RR:0.31) at first evaluation.

Conclusions

Confirming that ED accesses are issue present among children receiving home care services, this study has the main strength of demonstrating which risk factors are associated with ED accesses by children using home care services. Knowledge of them is necessary in order to implement adequate prevention strategies on both management and quality of care.

Key messages

Determinants associated with the risk of using emergency departments among paediatric patients receiving integrated paediatric home care services. ED visit is shown to be an issue among children receiving PHC and some determinants emerged as associated with ED visits by children in PHC.
Sexual dating violence victimization and adolescent psychological distress in Rio de Janeiro, Brazil
Authors: Faus D , de Moraes C L , Castro M C , Keefe-Oates B , Reichenheim M E , Taquette S
Published: October 2020

Background

Studies from high income countries showed physical and psychological dating violence associated with poor mental health (MH) outcomes, including depressive symptoms and suicide attempts. However, sexual dating violence (SDV) has received less attention, especially in low middle-income countries like Brazil. This study investigated the prevalence and the effect of SDV victimization on MH in adolescent students from Rio de Janeiro, Brazil.

Methods

This is a school-based study comprising 550 students enrolled in 13 high schools. Only adolescents reporting at least one romantic relationship in the prior twelve months were eligible. SDV and MH were measured using the Conflict in Adolescent Dating Relationships Inventory (CADRI) and General Health Questionnaire (GHQ-12), respectively. Frequency of SDV was assessed in the aggregate and by specific sociodemographic subgroups. Multivariate logistic models were employed to study the relationship between SDV victimization and MH status. Direct Acyclic Graphs steared the covariates selection process: skin color, maternal education, history of child sexual abuse, and sex.

Results

The prevalence of SDV victimization experienced over the last 12 months was 16.5%. SDV victimization was a significant risk factor for MH problems (OR = 2.04; 95%CI: 1.01 - 4.15).

Conclusions

The high prevalence of SDV among students in the sample was striking. Its relationship with psychological suffering highlights the importance of involving schools and health services in actions aimed at reducing all forms of SDV and at mitigating its consequences. The findings also indicate that mental health professionals should regurlarly investigate SDV victimization among adolescents reporting MH symptoms.

Key messages

Rio de Janeiro schools and health services need to join efforts to develop and implement actions aimed at the prevention of sexual dating violence. Health professionals might investigate if adolescents with psychological distress are also victims of sexual dating violence.
Intersectoral collaboration to promote child development: mapping the relationships
Authors: Chiari A P G , Soares A R S , Cury G C , Alves C R L , Senna M I B , Ferreira R C
Published: October 2020

Integrated and intersectoral interventions early in life have the greatest potential to address social inequities, ensuring better opportunities for access to child development support services. The “Projeto Nascente” (Universidade Federal de Minas Gerais and Ministry of Health, Brazil) sought to qualify health and other sectors professionals in actions to promote and monitor early child development, in primary health care. One of its focuses was to stimulate the intersectoral actions to promote child development. The research analyzed the intersectoral network in 31 municipalities in the State of Minas Gerais, Brazil, participating in the 'Projeto Nascente'.

A case study with a qualitative approach was developed using document research on the professionals' perception regarding intersectoral networking. The material was ecomaps elaborated by professionals during the training of the “Projeto Nascente”. The ecomaps represented the local intersectoral networks.

Initially, 29 ecomaps from eleven municipalities were analyzed. Social Protection, Education, Sports, Culture, churches and non-governmental organizations were cited. Other health services were also included. All ecomaps were represented with the family health team in a central position with the other services around them. In municipalities with more than one ecomap, there was no uniformity neither in the services nor in the quality of the relationships represented.

A closer relationship between Education and Social Protection was noticed. However, the quality of the relationships often seemed stressful. Health professionals reported that they invest more energy in relationships than other sectors. Sport and Culture, although less mentioned, seem to be potential partners for new collaborations. The emergence of other health services seems to reflect the fragmentation of the health sector, as well as evidence of the conceptual confusion surrounding intersectoral collaboration.

Key messages

The identification and mapping of the services networking aimed at promoting child development are essential steps in the process of stimulating and reflecting on intersectoral collaboration. The centrality and self-perceived protagonism of the health professionals may not be the best way to involve and count on the participation of other sectors in intersectoral collaboration.
An assessment of the Armenian national midwifery curriculum as per international standards
Authors: Aslanyan L , Sahakyan S , Petrosyan V
Published: October 2020

Background

Literature suggests increasing evidence that incompetent midwifery education results in poor quality of care. The study compared and evaluated the level of compliance of the Armenian national criterion on midwifery with the global competency standards and developed recommendations for improvement.

Methods

The study team conducted a document review using a standardized checklist, which was adapted from the International Confederation of Midwives (ICM) core assessment tools. The document review explored if the main knowledge and skills/ability related elements of each ICM competency were separately covered by different modules of the national criterion using a scoring system with categories: not met, partially met, fully met and unspecified.

Results

Although the national criterion did not have specifically defined competencies, most of the elements required by the ICM were present as specific learning outcomes under different modules of the criterion. Midwifery program curriculum was described as intensive with unnecessarily heavy workload. Additionally, the document review reviled that most of the learning outcome defined in modules of the national criterion focused more on theoretical knowledge rather than practical skills and abilities. Overall, the ICM required competency in provision of care during pregnancy was the most comprehensively covered one in the national criterion, while the competency in facilitation of abortion related care was the lowest covered. National criterion did not highlight the importance of topics such as women's rights and health, principles of epidemiology, statistical methods of research, cultural, local and ethical beliefs.

Conclusions

The systematic comparison of the national criterion with internationally recognized essential competencies demonstrates significant gaps. The study team recommends revisions to the national criterion to make it competency based.

Key messages

Midwifery education criteria in Armenia did not reflect internationally accepted midwifery competency’s fundamental philosophy and values. Given the shortcomings of the current national midwifery education criterion, a comprehensive revision of the competencies of midwives in Armenia should be considered.
Predicting postpartum mothers' intention for vaccinating their infants
Authors: Bord S , Satran C , Schor A , Offer M , Ohana N , Sagi S
Published: October 2020

Background

Vaccines are administered for free in Israel. Yet, despite experts' agreement that vaccinations are important, some parents choose not to vaccinate their children - in part due to lack of trust in the health system. This study examines factors that predict mothers' intention to vaccinate their infants as per recommendations of the Israeli Ministry of Health.

Methods

The study included 344 women in a maternity ward of a hospital in northern Israel. After receiving approval from the Helsinki Commission, and with the mothers' consent, data were collected through a self-administrated questionnaire, from June to September 2019.

Results

Participants were aged 19-47 (M = 30.77), 96% were married, and 70% had 1-2 children. About 78% reported that their children had been vaccinated for hepatitis B upon birth and had received vitamin K by injection. About 20% did not know if their newborns had received the injection and vaccination, meaning that they probably did as part of the hospital routine. Only 1.5-3% of the mothers said they would vaccinate their child later or not at all. Overall, the mothers' intention to vaccinate their infants was high (4.33 on a 1-5 scale). A hierarchical linear regression model for predicting mothers' intentions to vaccinate their infants was significant, explaining 36% of the variance. Factors that predict mothers' intentions to vaccinate their infants as recommended include mothers' adherence to the pertussis vaccination administration during their pregnancy (P = 0.037), lower trust in non-medical factors (P < 0.001), and positive attitudes (P < 0.001), and subjective norms (P < 0.001) regarding vaccinating their infants.

Conclusions

Mothers' adherence to vaccinations during pregnancy could help identify at-risk populations. Interventions for encouraging vaccinations should focus on information sources and levels of trust, as trust in authoritative sources could assist in shaping attitudes and create a supportive environment for vaccinations.

Key messages

Mothers' adherence to vaccinations during pregnancy could help identify at-risk populations. Lower trust in non-medical factors, positive attitudes, and subjective norms are important predictors of mothers' intention for vaccinating their newborns.
Triage in Preventive Child Healthcare: A novel triage protocol to identify health problems
Authors: Theunissen M
Published: October 2020

Background

A triage approach to routine health assessments was introduced to improve the efficiency of Preventive Child Healthcare (PCH): PCH assistants carry out pre-assessments of all children and send the children with suspected health problems to follow-up assessments conducted by a physician or nurse. Each PCH service use their own protocol (with health themes such as visuals disorders, sleeping- and psychosocial problems) to determine whether a follow-up assessment is needed. In this study a novel standardized triage protocol was developed. The aim was to improve the quality of detection of health problems in primary school children by PCH by investigating the quality of detection of health problems and satisfaction of this novel triage protocol.

Methods

We included 459 primary school children undergoing routine health assessments in 2 PCH services across the Netherlands. We used parent-reported child problems and PCH registry data. After each assessment PCH professionals reported whether they had identified any problems and carried out any additional actions (e.g., additional assessments, referral). The validity of the protocol is assessed, with problems identified by PCH professionals and performing additional actions as criteria.

Results

Results showed that the psychometric properties of the novel triage protocol were moderate to good. Sensitivity (true positives) and specificity (true negatives) for the novel triage protocol were 0.73 and 0.62, respectively for the identification of any problems, and were 0.91 and 0.41, respectively, for additional PCH actions.

Conclusions

The novel triage protocol is a valid tool for the detection of health problem in primary school children by PCH. Few children with health problems were missed. Professionals and parents were very satisfied with the novel protocol. Professionals made specific recommendations about adaptations of the protocol to improve efficiency and facilitate implementation in daily PCH practice.

Key messages

The novel triage protocol is a valid tool for the detection of health problem in primary school children. For optimal implementation in preventive child healthcare the novel triage protocol needs some minor adaptations.
Planned teenage pregnancy: a sociocultural health problem that lead to a local intervention
Authors: Carmona A , Paixão M , Silva A
Published: October 2020

According to data from the National Statistics Institute (2018), Portugal was the country with the second highest birth rate in the European Union in mothers between 15 and 19 years old. This number of births may be influenced by ethnic-cultural issues, such as acceptance and encouragement of marriage and early motherhood, especially in some African ethnic-cultural groups. Our public health unit is located in Amadora, a suburban area of the Portuguese capital with a high percentage of migrants, a high rate of teenage pregnancies and economically deprived areas.

The aim of our research was to understand beliefs and values in both native and migrant girls regarding motherhood in order to better tailor interventions aiming to prevent teenage pregnancy.

We interviewed fifteen participants, seven migrants and eight natives, who were or had been teenage mothers. The participants were selected through non-probabilistic snowball sampling. Afterwards, we performed a qualitative content analysis.

Overall, we found no difference between the 2 groups of participants with most, 12, having wished for their pregnancies. The social and religious framing of fertility as a gift was often stated. The housing context was also mentioned given several participants lived in overcrowded houses with poor conditions and believed pregnancy could have provided a way out of their living situation. Low education and poor job prospects were also mentioned as pregnancy was framed as a “life project” in the absence of a career prospect.

We found evidence of a “social and cultural pregnancy” not related to certain migrant cultures but associated with a “neighbourhood” culture associated with economic deprivation. As such, we are now implementing a pilot study within the community, by creating regular group sessions to discuss the meaning and impact of motherhood to try to capacitate girls to find a different life project other than choosing pregnancy during teenage years.

Key messages

Teenage pregnancy can be planned who use it to try to find a life project, be accepted within their community and escape their daily conditions. Public health interventions aiming to prevent teenage pregnancies should acknowledge social and cultural factors that encourage these pregnancies.
Do primary healthcare providers have the competency of providing adolescent-friendly health services?
Authors: Grigoryan Z , Hayrumyan V , Sargsyan Z , Petrosyan V
Published: October 2020

Background

Investment in adolescents' health is one of the most rewarding efforts for meeting the Sustainable Development Goals. The national standard on state assured free-of-charge services defines the minimum requirements of adolescent-friendly healthcare services (AFHS) in primary healthcare facilities (PHCFs); however, services for adolescents are highly inconsistent in terms of quality and coordination. We aimed to assess the PHC providers' (PHPs) capacity to provide AFHS in PHC facilities in Armenia.

Methods

A qualitative cross-sectional study through in-depth interviews and focus-group discussions was conducted in two biggest cities of Armenia. Overall, six focus group discussions and 16 in-depth interviews were conducted with adolescents (18 and 19 years old), PHPs, managers of PHCFs, and experts in adolescent health. Eight PHC facilities were chosen for conducting observations. The WHO Global standards for quality health-care services for adolescents guided the deductive content analysis.

Results

PHPs' capacity to provide AFHS in assessed PHCFs was not satisfactory. PHPs did not know the specific age range of adolescence and the content of AFHS in the national standard. PHPs perceived friendliness of services as welcoming and good attitude. Facility managers and most PHPs did not participate in professional education activities to advance their expertise in adolescent health. Experts concluded that services provided to adolescents were not “friendly” and PHPs did not have appropriate competencies. However, PHPs' had the opposite opinion - they were confident in their knowledge and skills to work with adolescents. Adolescents complained that PHPs did not provide explanations for provided services and lacked appropriate communication skills.

Conclusions

The PHCFs have formal grounds to provide AFHS, however lack of appropriate competencies among PHPs and managers of PHCs hinder advancement of AFHS.

Key messages

Qualitative findings suggest that visited PHCFs fail to appropriately implement AFHS as guided by the national standard. Provision of AFHS can be promoted in PHCFs through strengthening PHPs' competencies via continuous professional development activities.
Universal neonatal hearing screening in a public hospital in Brazil: parents participation
Authors: Gonçalves C , Crispin L , Luders D , Bellia C
Published: October 2020

Background

The National Policy for Hearing Health Care in Brazil proposes that all newborns in the country undergo hearing screening in the first month of life.The Universal Neonatal Hearing Screening Program being extremely important for the early intervention of deafness. However, many parents/guardians do not return to the auditory retest, interrupting the neonatal protocol and making early auditory diagnosis impossible. Objective:To analyze the reasons for the non-attendance to retest of the Hearing Screening of a hospital in Curitiba.

Methods

This study was carried out in a Public Hospital, with live births from August 2017-May 2018. All the born were considered for the variables gender, risk for hearing loss, age at birth, results of Hearing Screening. Failed babies were analyzed, including the active search of those who did not attend the retest, through contact with parents/guardians to collect the reasons for faults.

Results

2,531 infants were born, male had a prevalence of 1,275 (50.38%), term born 1,734(68.51%) and ICU stay as the most common risk indicator - 118(79.73%). 2,261(89.33%) infant passed on both ear; among those who failed only 94(40.0%) attended the retest. An active search was performed by phone, and 78(55.31%) could not establish contact, totaling 47(54.02%) mothers contacting. These motherś age was 19 to 24 years, 56.92% of whom had high school. The majority of those in charge are aware of the result of the test of the ear of their son (82.97%), was directed to test again (87.23%), were not able to answer the reason for not attending (27.65%) or had forgotten about this commitment (19.14%).

Conclusions

The data analyzed showed the lack of information that parents / guardians of the newborns give to the Hearing Screening, which compromises the integrality of health actions in newborns, making it necessary to seek other ways to ensure family adherence to the Program.

Key messages

Babies at risk of deafness need constant monitoring. Without parental participation, there is no success in health programs.
The effects of a local dairy food supplement on pregnancy outcomes in Indonesia: A feasibility trial
Authors: Soltani H , Fair F , Marvin-Dowle K , Lipoeto N I
Published: October 2020

Introduction

Approximately 20.1% of Indonesian pregnant women are underweight (BMI<18.5kg/m²) and over 50% of women have inadequate gestational weight gain (GWG) [1]. Maternal nutrition is a modifiable factor influencing child health. This project aims to assess the feasibility of a randomised controlled trial (RCT) using a traditional Indonesian yogurt from buffalo milk (Dadih), to improve outcomes for pregnant mothers and their babies.

Methods

This is a two armed feasibility RCT (1:1) in which 200 women with body mass index<27.5kg/m² (Asian BMI classifications) were planned to randomly be allocated to routine care or the intervention group, who will be supplemented with four weekly servings of Dadih.

Results

A total of 107 women were recruited to the trial in the first wave from Dec 2018-March 2019 (recruitment rate of ∼25/month). Of these 81 have been followed up to delivery and will be followed up to 6 months postpartum. Local Dadih production reached its full capacity in one region and recruitment had to be extended to other regions. Comparative trends on study outcomes including GWG, mode of birth, postpartum depression, postpartum haemorrhage, maternal nutritional status, anaemia, birthweight, gestational age, admission to neonatal care unit, breastfeeding, neonatal health status will be reported.

Conclusions

Early results show that the supplementation is acceptable to women and protocol implementation is feasible. In order for this feasibility project to be developed to a full scale RCT, improvements to the infrastructure of supply are required. Such projects may have positive economic impact and provide sustainable solutions to local maternal and neonatal health challenges.

Reference

1. Soltani H, Lipoeto NI, Fair FJ, Kilner K, Yusrawati Y. (2017) Pre-pregnancy body mass index and gestational weight gain and their effects on pregnancy and birth outcomes: a cohort study in West Sumatra, Indonesia. BMC Women's Health.

Key messages

Nutritional supplementation using a traditional Indonesian yogurt (Dadih) made from buffalo milk during pregnancy has been received positively by women. Depending on the observed comparative trends from the study outcomes, infrastructure investment is required to enable the feasibility study to be expanded to a full scale randomised controlled trial.
Development of an infant mortality risk score in Uruguay
Authors: Alegretti M , Leon I , Aleman A , Cavallieri F , Callero W
Published: October 2020

Background

The Ministry of Public Health of Uruguay incorporated a comprehensive home visit before 7 days of discharge to monitor children at risk of infant mortality. In this context, a precise risk stratification of newborns is needed to optimize the implementation of the home visit.

Objective

Implement a validated infant mortality risk score for Uruguay using the national electronic live birth certificate.

Methods

Electronic records of newborns from 2014 to 2017 were used to develop the score. The variables of the electronic live birth certificate were considered for the model and data of Infant mortality was obtained from the national mortality registry. A multivariate binary logistic regression model was estimated with a random sample of 80% of the cohort, the remaining 20% was the validation set. ROC curve analysis was performed. R software was used.

Results

The 2014-2017 birth cohort contains 187,388 records. 1307 children under one year died (IMR 6.97 per 1,000 births). The variables included in the final model were birth weight, APGAR score at 5 minutes, number of prenatal visits, maternal educational level and father living at home. The area under the curve (AUC) was 89%, CI 95% [87% - 91%]. Two cut-off points were defined: 0.4% and 2%. Less than 0.4% was considered low risk (IMR 1.4 per 1,000 births), between 0.4 and 2% was considered intermediate risk (IMR 7.1 per 1,000 births) and more than 2% was considered high risk (IMR 99.2 per 1,000 births).

Conclusions

The score identifies high-risk newborns at the time of entering the data in the electronic live birth certificate. This information could be used to plan and implement the home visit and other actions, according to the level of risk identified.

Key messages

In Uruguay, high-risk newborns can be identified using data collected routinely. The procedure could be applied in other countries with electronic birth certificate.
Assessment of the eating behaviour of adolescent girls from Varna, Bulgaria
Authors: Marinov D , Najdenova D , Dimitrova T
Published: October 2020

Background

Healthy eating behaviour of children determines their normal physical and neuropsychological status. Epidemiological data has revealed an increasing prevalence rate of disordered eating behaviour in the population for all ages and genders. It is most common in adolescent girls who often conduct extreme weight control practices, driven by a desire to achieve the “perfect” body shape.

Methods

A study was conducted among 240 adolescent girls from Varna aiming to estimate their eating behaviour. The data was collected via: • Anthropometric measurements for assessment of the nutritional status Bioelectrical impedance analysis of body composition assessmentQuestionnaires including: Food frequency questionnaire (FFQ); The Eating Attitudes Test - 26 (EAT- 26) to access the risk factors for the development of eating disorders (ED); Questionnaire for identification of risk factors contributing to early dieting.

Results

The analysis of the results shows that the eating behaviour of the female students aged from 14 to 19 years in Varna can be defined as risky. Findings demonstrate a significant percentage of subjects who are on a diet at the time of the survey. Over 36% of the participants show at least 1 symptom correlating with an increased risk for the development of ED and 22.7% are at very high risk of developing an ED in the future.

Conclusions

The findings suggest that adolescent girls tend to engage in unhealthy approaches trying to reach their “thin ideal”. Early detection of disordered eating behaviour is especially important to prevent the development of clinically expressed ED and the complications associated with them.

Key messages

The study has revealed that a significant percentage of adolescent girls are at high risk of developing an eating disorder. The data shows a need for an early detection program for risky eating behaviour in order to prevent the development of ED amongst adolescents.
Strategies of Health Surveillance in the construction of a support network for breastfeeding women
Authors: Garbin A , Yasuda N , Araujo D , Novaes C , Sartori L
Published: October 2020

In 2018 the Municipal Health Department of the city of Diadema, São Paulo, Brazil, started the implementation of strategies to promote, protect and support breastfeeding in health surveillance actions. Supervised compliance with the Brazilian Standards of Commercialization of Foods for Infants and Children of 1st Childhood, nipples, pacifiers and bottles and encouraged the installation of breast-feeding support rooms in public and private workplaces in the city, aiming to intervene in the infant mortality rates. According to the Global Strategy of the World Health Organization (WHO/UNICEF), for the Feeding of Infants and Children in the First Childhood, only 35% of children worldwide are breastfed exclusively during the first four months of life. What are the contributions of the surveillance area in encouraging the installation of breast-feeding facilities in the workplace? What are the responsibilities of the Health Surveillance to promote breastfeeding? The strategies implemented aimed to create a culture of respect and support for breastfeeding as a way to promote the health of the working woman and her baby, bringing direct benefits to society.The importance of women in promoting breastfeeding is evident, but it is essential to implement public policies. The surveillance began to integrate the municipal network of incentive to breastfeeding in search of the integrality of the attention aiming to contribute to increase the rates of breastfeeding in the city. Measures of a supervisory nature were implemented to comply with the rules that protect the practice of breastfeeding, in order to avoid early weaning and to reduce infant mortality. Intra and intersectoral strategies, permanent education and awareness-raising among professionals and the population were used. Isolated and fragmented initiatives do not contribute to structuring a breastfeeding support network in the workplace and many companies have not expressed an interest in promoting breastfeeding space.

Key messages

Dissemination of the pro-breastfeeding culture in which the workplace is a mainstay for a network of support for working women. Surveillance Area acted in the Network of Women’s and Children’s Health Care contributing to the reduction of maternal and infant mortality and healthy infant development.