Search

Objective. To assess changes in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in Haiti from August 2018 to September 2021, before and during the COVID-19 pandemic. Methods. A retrospective study using surveillance data from the Haitian Unique Health Information System, examining two periods: pre- and peri-COVID-19 pandemic. Health indicators at the national level in the two periods were compared using two-sample t-tests for proportions, and average absolute monthly changes were calculated using variance-weighted regression. Results. There was a statistically significant decline in the proportion of most of the indicators assessed from the pre- to the peri-COVID-19 pandemic period. However, the most affected indicators were the proportions of pregnant women with four antenatal care visits, with five antenatal care visits or more, and those who received a second dose of tetanus vaccine, which decreased by over 4 percentage points during the two periods. Likewise, the proportions of children who received diphtheria, tetanus, and pertussis (DTaP), BCG, polio, pentavalent, and rotavirus vaccines also all declined by over 8 percentage points. In contrast, pneumococcal conjugate vaccine increased by over 4 percentage points. A statistically significant decrease was also observed in the average absolute monthly changes of several reproductive and child health indicators assessed. Conclusions. The COVID-19 pandemic may have contributed to the decline observed in several RMNCAH indicators in Haiti. However, the role played by the sociopolitical crisis and control exercised by armed groups over the population in the last three years cannot be ruled out.

Abstract Objective To assess the prevalence and factors associated with early initiation of breastfeeding at Georgetown Public Hospital Corporation (GPHC). Methods This study used data from an institution‐based cross‐sectional study conducted at GPHC from July to September 2022. A structured pretested questionnaire was used to collect the data. A total of 1276 mothers were interviewed and provided data on early initiation of breastfeeding. Early initiation of breastfeeding was defined as mothers who breastfed their babies within the first hour after birth. We performed descriptive analyses for both the outcome and the independent variables. Logistic regression and backward selection procedure were used to assess factors associated with early initiation of breastfeeding. Results The prevalence of early breastfeeding at GPHC was 27.8% (95%CI: 25.4–30.3). Mothers who were primigravida (AOR: 0.52; 95%CI: 0.36–0.75), who had urinary tract infections during pregnancy (AOR: 0.72; 95%CI: 0.52–0.99), and who delivered by caesarean section (AOR: 0.06; 95%CI: 0.03–0.11) were less likely to breastfeed their babies in the first hour after birth. Likewise, babies who were diagnosed with any health problems after birth (AOR: 0.34; 95%CI: 0.21–0.54) had a lesser chance to receive breastfeeding in the first hour after birth, compared with their counterparts. Conclusion Less than one‐third of mothers who delivered at GPHC breastfed their babies within the first hour after birth. Targeted intervention focuses on promoting early initiation of breastfeeding, immediate skin‐to‐skin contact between mothers and babies, timely diagnosis and treatment of urinary tract infections during pregnancy are essential to improve the prevalence of early initiation of breastfeeding at GPHC.

Objective: To estimate the relative risk of COVID-19 in-hospital mortality rates among patients according to residing in the two largest cities of each state or residing in any smaller city, and to describe different patterns across states and macro-regions of Brazil. Method: The sample included all hospitalizations confirmed for COVID-19 that occurred in Brazil with a recorded outcome of the hospitalization by the end of December 2021. The exposure assessed was patients residing in the two largest cities of the state or any smaller cities. The outcome was in-hospital mortality rates caused by COVID-19. Multilevel Poisson regression was used to estimate adjusted relative risks for each state and macro-region of Brazil. Result: The analytic sample was composed of 1,658,934 hospitalized COVID-19 cases. For the whole country, living in the two largest cities of each state was associated with a lower risk of in-hospital mortality rate. Nevertheless, in two states of the North region (Amazonas and Pará), individuals living in the largest cities presented greater in-hospital fatality rates than those living in smaller cities. Conclusion: At the two biggest states of the Brazilian North region, the pattern of association between living in the largest cities and in-hospital fatality was inverse, and higher proportions of deaths without access to a hospital bed were identified, indicating singular vulnerability. The findings highlight the need for a more equitable distribution of health care services and qualified professionals in the vast territory of Brazil.

BackgroundTo assess the attitudes of women towards intimate partner violence (IPV) in Guyana.MethodsWe used national data from the publicly available Multiple Indicator Cluster Survey (MICS) conducted in Guyana in 2019 for women aged 15 to 49 years. The prevalence of women who agreed that a husband is justified in beating his wife was analyzed. Respondent reasons included if she: "goes out without telling him", "neglects the children", "argues with him", "refuses sex with him", "burns the food", "has another partner", "stays out late/partying", "refuses to cook or clean", "overspends", and/or "he doesn't have access to her cellphone". Descriptive analyses were carried for all the variables. Logistic regression was used to identify factors associated with these 10 respondent reasons, separately and in combination.ResultsThe overall prevalence of women's attitudes justifying IPV against women if there was a 'yes' response to any of the 10 reasons was 17.9% (95%CI: 16.6-19.3%), and varied from 2.7% if she "goes out without telling him", "burns the food", or "overspends" to 10.0% if she "has another partner". This prevalence ranged from 10.2% in urban areas to 19.3% in rural areas (pConclusionOver one-sixth of the respondents agreed that a husband was justified in committing IPV against women in Guyana. Public health programs focusing on geographic locations, ethnicity, and economic status must be implemented to change attitudes justifying IPV and reduce this significant public health challenge.

# Background Guyana is among the countries committed to achieving the sustainable development goals. This research assessed the patterns of change in reproductive, maternal, newborn, and child health (RMNCH) in Guyana. # Methods Four nationally representative surveys conducted from 2009 to 2019 were assessed. Temporal trends in RMNCH indicators were assessed at the national level, by place of residence, and by wealth index. The slope index and concentration index of inequality were calculated to assess trends in inequalities over time. The average absolute annual change (AAAC) of the indicators was calculated using a weighted variance regression. # Results From 2006 to 2019, we observed an increase in the coverage of institutional delivery (from 82.6% to 97.7%), and exclusive breastfeeding (from 21.4% to 31.0%), among others. Likewise, antenatal care with four or more visits increased from 77.4% in 2009 to 84.7% in 2019. The opposite was observed for coverage of current contraceptive use (modern methods) (from 32.7% to 28.2%), family planning needed satisfied (from 49.6% to 43.8%), tetanus toxoid in pregnancy (from 31.7% to 8.2%) and full vaccination coverage (from 82.0% to 63.4%). Under-five stunting prevalence decreased from 18.0% to 9.2% and the under-five mortality rate from 40.4 to 29.3 per 1,000 live births. The gap between the poorest and richest women tended to decrease for seven out of the 16 intervention indicators, as well as for under-five stunting prevalence and under-five mortality rate. Institutional delivery was the best performer in increasing coverage and decreasing inequality over time, while immunization with measles was the worst performer. # Conclusions Guyana has made great progress in improving its RMNCH indicators. However, the observed decline in the coverage of several RMNCH indicators can be seen as a warning sign to redouble efforts to achieve sustainable development goals, SDGs 1 and 2, by 2030 and to reduce inequalities by lagging no one behind.

Abstract Background Having high-quality data available by 2020, disaggregated by income, is one of the Sustainable Development Goals (SGD). We explored how well coverage with skilled birth attendance (SBA) is predicted by asset-based wealth quintiles and by absolute income. Methods We used data from 293 national surveys conducted in 100 low and middle-income countries (LMICs) from 1991 to 2014. Data on household income were computed using national income levels and income inequality data available from the World Bank and the Standardized World Income Inequality Database. Multivariate regression was used to explore the predictive capacity of absolute income compared to the traditional measure of quintiles of wealth index. Results The mean SBA coverage was 68.9% (SD: 24.2), compared to 64.7% (SD: 26.6) for institutional delivery coverage. Median daily family income in the same period was US$ 6.4 (IQR: 3.5–14.0). In cross-country analyses, log absolute income predicts 51.5% of the variability in SBA coverage compared to 22.0% predicted by the wealth index. For within-country analysis, use of absolute income improved the understanding of the gap in SBA coverage among the richest and poorest families. Information on income allowed identification of countries – such as Burkina Faso, Cambodia, Egypt, Nepal and Rwanda – which were well above what would be expected solely from changes in income. Conclusion Absolute income is a better predictor of SBA and institutional delivery coverage than the relative measure of quintiles of wealth index and may help identify countries where increased coverage is likely due to interventions other than increased income.

Resumo O objetivo deste artigo é apresentar os principais métodos de mensuração e monitoramento das desigualdades sociais em saúde e ilustrar suas aplicações. Foram revisadas as medidas mais frequentemente empregadas na literatura. Dados de cobertura e qualidade do cuidado pré-natal no Brasil, provenientes da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS-2006) e da Pesquisa Nacional de Saúde (PNS-2013), foram utilizados para exemplificar as aplicações. Medidas de desigualdade absoluta e relativa foram apresentadas, destacando-se sua complementaridade. Apesar dos avanços evidenciados nos indicadores nacionais de pré-natal, importantes desigualdades foram identificadas entre subgrupos da população, sem que houvesse redução da magnitude dessas diferenças no período estudado. O Brasil apresenta importantes desigualdades sociais, que ainda se refletem em persistentes desigualdades em saúde. A descrição e monitoramento dessas desigualdades são fundamentais para o direcionamento de políticas de saúde, com foco em grupos mais vulneráveis que vêm sendo deixados para trás.

(1) Background: Reports suggest COVID-19-associated olfactory dysfunction (OD) may result in alterations in dietary behaviors and perceived weight change, but few studies using psychophysical evaluation of post-COVID-19-associated chemosensory dysfunction and body mass index (BMI) exist. The purpose of this study is to assess the impact of both quantitative and qualitative features of COVID-19-associated OD on BMI; (2) Methods: Recruitment of thirty-one participants with self-reported OD in the form of quantitative loss with and without qualitative features. Surveys with questions specific to qualitative olfactory function, Sniffin' Sticks tests, and BMI measures were completed at two visits, one year apart. Group differences were assessed with Wilcoxon signed-rank tests and the Holm–Bonferroni method; (3) Results: Individuals with persistent quantitative OD (n = 15) and self-reported parosmia (n = 19) showed statistically significant increases in BMI after 1 year (p = 0.004, adjusted α = 0.0125; p = 0.011, adjusted α = 0.0167). Controls with transient quantitative OD (n = 16) and participants without self-reported parosmia (n = 12) showed no statistically significant changes in BMI over the same time period (p = 0.079, adjusted α = 0.05; p = 0.028, adjusted α = 0.025); (4) Conclusions: This study shows an association between COVID-19-associated OD and BMI, suggesting olfaction may play a role in altering dietary habits and nutrition in this population. Larger study cohorts are needed to further evaluate this relationship. [ABSTRACT FROM AUTHOR]

Background: Nearly 40% of patients who experience smell loss during SARS-CoV-2 infection may develop qualitative olfactory dysfunction, most commonly parosmia. Our evidence-based review summarizes the evolving literature and offers recommendations for the clinician on the management of patients experiencing parosmia associated with COVID-19. Methods: We performed a systematic search using independent queries in PubMed, Embase, Ovid, and Cochrane databases, then categorized articles according to themes that emerged regarding epidemiology, effect on quality of life, disease progression, prognosis, pathophysiology, diagnosis, and treatment of parosmia. Results: We identified 123 unique references meeting eligibility and performed title and abstract review with 2 independent reviewers, with 74 articles undergoing full-text review. An inductive approach to thematic development provided 7 central themes regarding qualitative olfactory dysfunction following COVID-19. Conclusions: While other respiratory viruses are known to cause qualitative olfactory disturbances, the incidence of parosmia following COVID-19 is notable, and correlates negatively with age. The presence of parosmia predicts persistent quantitative olfactory dysfunction. Onset can occur months after infection, and symptoms may persist for well over 7 months. Affected patients report increased anxiety and decreased quality of life. Structured olfactory training with essential oils is the preferred treatment, where parosmia predicts recovery of aspects of quantitative smell loss when undergoing training. There is limited evidence that nasal corticosteroids may accelerate recovery of olfactory function. Patients should be prepared for the possibility that symptoms may persist for years, and providers should guide them to resources for coping with their psychosocial burden. [ABSTRACT FROM AUTHOR]