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Introduction: This study assessed prevalence and time trends of pre‐pregnancy obesity in immigrant and non‐immigrant women in Norway and explored the impact of immigrants' length of residence on pre‐pregnancy obesity prevalence. Material and Methods: Observational data from the Medical Birth Registry of Norway and Statistics Norway for the years 2016–2021 were analyzed. Immigrants were categorized by their country of birth and further grouped into seven super regions defined by the Global Burden of Disease study. Pre‐pregnancy obesity was defined as a body mass index ≥30.0 kg/m2, with exceptions for certain Asian subgroups (≥27.5 kg/m2). Statistical analysis involved linear regressions for trend analyses and log‐binomial regressions for prevalence ratios (PRs). Results: Among 275 609 pregnancies, 29.6% (N = 81 715) were to immigrant women. Overall, 13.6% were classified with pre‐pregnancy obesity: 11.7% among immigrants and 14.4% among non‐immigrants. Obesity prevalence increased in both immigrants and non‐immigrants during the study period, with an average yearly increase of 0.62% (95% confidence interval [CI]: 0.55, 0.70). Obesity prevalence was especially high in women from Pakistan, Chile, Somalia, Congo, Nigeria, Ghana, Sri Lanka, and India (20.3%–26.9%). Immigrant women from "Sub‐Saharan Africa" showed a strong association between longer residence length and higher obesity prevalence (≥11 years (23.1%) vs. <1 year (7.2%); adjusted PR = 2.40; 95% CI: 1.65–3.48), particularly in women from Kenya, Eritrea, and Congo. Conclusions: Prevalence of maternal pre‐pregnancy obesity increased in both immigrant and non‐immigrant women from 2016 to 2021. Several immigrant subgroups displayed a considerably elevated obesity prevalence, placing them at high risk for adverse obesity‐related pregnancy outcomes. Particular attention should be directed towards women from "Sub‐Saharan Africa", as their obesity prevalence more than doubled with longer residence. [ABSTRACT FROM AUTHOR]

Introduction: Birth asphyxia is a leading cause of neonatal mortality in sub‐Saharan Africa. The relationship to grand multiparity (GM), a controversial pregnancy risk factor, remains largely unexplored, especially in the context of large multinational studies. We investigated birth asphyxia and its association with GM and referral in Benin, Malawi, Tanzania and Uganda. Material and methods: This was a prospective cross‐sectional study. Data were collected using a perinatal e‐Registry in 16 hospitals (four per country). The study population consisted of 80 663 babies (>1000 g, >28 weeks' gestational age) delivered between July 2021 and December 2022. The primary outcome was birth asphyxia, defined by 5‐minute appearance, pulse, grimace, activity and respiration score <7. A multilevel and stratified multivariate logistic regression was performed with GM (parity ≥5) as exposure, and birth asphyxia as outcome. An interaction between referral (none, prepartum, intrapartum) and GM was also evaluated as a secondary outcome. All models were adjusted for confounders. Clinical Trial: Pan African Clinical Trial Registry 202006793783148. Results: Birth asphyxia was present in 7.0% (n = 5612) of babies. More babies with birth asphyxia were born to grand multiparous women (11.9%) than to other parity groups (≤7.6%). Among the 76 850 cases included in the analysis, grand multiparous women had a 1.34 times higher odds of birth asphyxia (95% confidence interval [CI] 1.17–1.54) vs para one to two. Grand multiparous women referred intrapartum had the highest probability of asphyxiation (13.02%, 95% CI 9.34–16.69). GM increased odds of birth asphyxia in Benin (odds ratio [OR] 1.37, 95% CI 1.13–1.68) and Uganda (OR 1.29, 95% CI 1.02–1.64), but was non‐significant in Tanzania (OR 1.44, 95% CI 0.81–2.56) and Malawi (OR 0.98, 95% CI 0.67–1.44). Conclusions: There is some evidence of an increased risk of birth asphyxia for grand multiparous women having babies at hospitals, especially following intrapartum referral. Antenatal counseling should recognize grand multiparity as higher risk and advise appropriate childbirth facilities. Findings in Malawi suggest an advantage of health systems configuration requiring further exploration. [ABSTRACT FROM AUTHOR]

Background: Studies have shown that caregivers of children with cancer experience challenges when caring for their children. To date, no studies have examined the experience of caregivers of children with cancer in Malawi, a low‐income country in sub‐Saharan Africa. Hence, this study aimed to explore the experiences of caregivers of Malawian children receiving cancer treatment. Methods: This explorative qualitative study used semi‐structured interviews to collect data from 22 caregivers of children receiving cancer treatment. The data were analysed using qualitative content analysis. Results: Five themes emerged from the QCA. The caregivers perceived their children's cancer as a burden, a form of psychological torture and a disruptor of family routines and social lifestyles. They also reported self‐isolation due to the stigma that they faced in the course of caring for their children and a need for informational, psychosocial, spiritual and financial support. Conclusion: Caregivers of Malawian children with cancer experience physical and psychosocial challenges as they are caring for their children with cancer. Developing appropriate interventions would enable nurses to offer optimal support to these caregivers in dealing with these challenges and meeting their needs effectively. [ABSTRACT FROM AUTHOR]

This study examines the socioeconomic impact of Special Economic Zones (SEZs) in Cambodia--a prominent place-based policy established in 2005. The paper employs a database on existing and future SEZs in Cambodia with matched household surveys at the district level and documents stylized facts on SEZs in a low-income country setting. To identify the causal effects of the SEZ program, the paper (i) constructs an alternative control group including future SEZ program participants and districts adjacent to SEZ hosts; and (ii) employs a propensity score weighting technique. The study finds that entry of SEZs increases employment and leads to a decline in income inequality at a district level. Gains in female employment is the key channel explaining rising employment rates. The paper also finds that school drop-out rates are higher in districts with clusters of multiple SEZs. [ABSTRACT FROM AUTHOR]

Objective: To determine the success rate of trial of labor after two cesarean sections (TOLA2C) in the low‐resource setting of the Democratic Republic of Congo (DRC) and to describe factors associated with success and related complications. Methods: A prospective cohort study was conducted from 2015 to 2020 in a teaching hospital. Patients who underwent TOLA2C were followed across prenatal visits, onset of spontaneous labor, and delivery. Demographics and clinical characteristics were documented. Pearson and Fisher χ2 tests were used. Predictors of successful vaginal delivery were determined by logistic regression (P ˂ 0.05). Results: Among 532 patients, the success rate of TOLA2C was 405 (76.1%). Factors associated with success included birth spacing ≥24 months (adjOR: 2.02 ; 95% CI 1.14–3.56; P = 0.015), previous vaginal delivery (adjOR: 5.02; 95% CI 2.71–9.31; P ˂ 0.001), intercalated vaginal delivery (adjOR: 5.15; 95% CI 2.28–11.65; P ˂ 0.001), cervical dilation >6 cm (adjOR: 2.37; 95% CI 1.92–6.05; P = 0.031) and/or complete dilation on arrival in the delivery room (adjOR: 1.96; 95% CI 1.33–11.45; P = 0.047) and oxytocin stimulation (adjOR: 4.24; 95% CI 1.82–9.91; P ˂ 0.001). No association with hemorrhage, uterine rupture, transfer to neonatology, or maternal–neonatal deaths was observed. Conclusions: TOLA2C is possible in a low‐resource setting with a high success rate and low rates of complications. Patient selection and obstetrical team competency are required. [ABSTRACT FROM AUTHOR]

Nicaragua is one of the lowest income countries in Latin America, where there is a shortage of data on women living homeless. This paper analyses the types, timing and perceived causality of stressful life events (SLE) suffered both during childhood and adolescence and throughout life by women living homeless (n = 30). A structured interview was used to collect the data. Findings showed that women living homeless in Nicaragua suffered a very high number of SLEs, and that these were extremely severe and from very early ages. Most of the SLEs took place before the women became homeless. The SLEs suffered by the women interviewed in Nicaragua were largely similar to those seen in women living homeless in other cultural contexts with higher incomes, although it should be noted that those interviewed in Nicaragua had suffered a higher number of SLE during their childhood and adolescence. The women interviewed mainly attributed finding themselves homeless to having suffered SLEs in the family environment. The suffering of multiple and severe SLEs, largely leading to living in socioeconomically disadvantaged situations, seem to present a significant vulnerability factor both for becoming homeless and remaining homeless over time. [ABSTRACT FROM AUTHOR]

Background: Safe and timely access to cesarean section (CS) in low‐ and middle‐income countries (LMIC) remains a significant challenge. Objectives: To compare maternal and perinatal outcomes of CS by non‐physician clinicians (NPCs) versus physicians in LMIC. Search strategy and Selection criteria: A systematic search of Ovid MEDLINE, EMBASE, Cochrane Library (including CENTRAL), Web of Science, and LILACS was performed from inception to January 2022. Data collection and analysis: Data were extracted by two independent reviewers and meta‐analysis was performed when possible. Main results: Ten studies from seven African countries were included. There was no significant difference in maternal mortality for CS performed by NPCs versus physicians (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.56–2.14, P = 0.8, I2 = 70%, P < 0.05, eight studies, n = 20 711) or in perinatal mortality (OR 1.18, 95% CI 0.86–1.61, P = 0.3, I2 = 88%, n = 19 716). Despite heterogeneous clinical settings between providers, there was no difference in the rates of wound infection or re‐operation, although there was a higher rate of wound complications (such as dehiscence) in the NPC group (OR 1.89, 95% CI 1.21–2.95, P = 0.005, n = 6507). Conclusions: NPCs have comparable maternal and neonatal outcomes for CS compared with standard providers, albeit with increased odds of wound complication. PROSPERO Registration: CRD42020217966. Synopsis: Task‐shifting cesarean sections are frequently performed in some sub‐Saharan countries with comparable maternal/perinatal outcomes to standard providers. [ABSTRACT FROM AUTHOR]

These cases are not intended to provide clinical guidance for the delivery of psychosocial oncological care in Ghana or SSA but to provide psychosocial oncology clinicians who are not familiar with the region a description of the lived experience of providing psychosocial oncology care in SSA. Cancer, case Series, Ghana, mental health, palliative care, psycho-oncology, low-income country, psychosocial wellbeing, sub-Saharan Africa, supportive oncology METHODS To provide an overview of the nature of psychosocial oncology services in SSA, we conducted a scoping review of the literature describing psychosocial oncology services in SSA countries including Ghana. [Extracted from the article]

Objective: To describe the incidence and causes of severe maternal outcomes and the unmet need for life‐saving obstetric interventions among women admitted for delivery in a referral hospital in Somaliland. Methods: A prospective cross‐sectional study was conducted from April 15, 2019 to March 31, 2020, with women admitted during pregnancy or childbirth or within 42 days after delivery. Data were collected using the World Health Organization (WHO) and sub‐Saharan Africa (SSA) maternal near‐miss (MNM) tools. Descriptive analysis was performed by computing frequencies, proportions, and ratios. Results: The MNM ratios were 56 (SSA criteria) and 13 (WHO criteria) per 1000 live births. The mortality index was highest among women with medical complications (63%), followed by obstetric hemorrhage (13%), pregnancy‐related infection (10%), and hypertensive disorders (7.9%) according to the SSA MNM criteria. Most women giving birth received prophylactic oxytocin for postpartum hemorrhage prevention (97%), and most laparotomies (60%) for ruptured uterus were conducted after 3 h. Conclusion: There is a need to improve the quality of maternal health services through implementation of evidence‐based obstetric interventions and continuous in‐service training for healthcare providers. Using the SSA MNM criteria could facilitate such preventive measures in this setting as well as similar low‐resource contexts. [ABSTRACT FROM AUTHOR]

Background: In developing countries, mental health literacy (MHL) still needs to be improved due to the high prevalence of mental disorders. It is widely recognized that MHL can improve health outcomes for both individuals and populations. Healthcare professionals' development in MHL is crucial to the prevention of mental disorders. The aim of this study was to assess MHL of primary healthcare (PHC) workers in South Africa (SA) and Zambia and determinants thereof. Limited evidence is available on the levels of MHL among PHC workers in the sub‐Saharan Africa region, which faces a large burden of mental disorders. Methods: The study population for this cross‐sectional survey comprised PHC workers (n = 250) in five provinces of SA and Zambia. MHL was measured with the Mental Health Literacy Scale (MHLS). We conducted a multivariate analysis to explore determinants of MHL. Results: Results showed moderate MHL among PHC professionals, but with a wide range from low to high MHL. Knowledge‐related items had a greater dispersion than other attributes of MHL. PHC workers with more education showed a greater ability to recognize mental health‐related disorders. Those who had experience in the use of mental health‐related assessment scales or screening tools reported a higher total MHL. The results confirmed strong internal consistency for the MHLS. Conclusion: The results highlighted varying mental health perceptions and knowledge in PHC. Implementation of specifically developed formal training programs and interventions to improve MHL in PHC workers to strengthen their competence may help bridge the treatment gap. [ABSTRACT FROM AUTHOR]

Introduction: One in four women giving birth in Sweden is foreign‐born. Immigrant status has been suggested as a risk factor for adverse perinatal outcomes. It is not known if infants to foreign‐born women have an increased risk of severe birth asphyxia, or which factors might mediate such association. Material and methods: A population‐based cohort study of 726 730 live births at 36 weeks of gestation or more in Sweden in 2009–2015. The exposure was maternal country of birth, grouped according to the World Bank country classification: low‐, lower‐middle, upper‐middle, and high‐income economies. The main outcome was neonatal hypoxic ischemic encephalopathy (HIE). The outcome was estimated by severity and classified as non‐hypothermia‐treated HIE, representing mainly mild cases, and hypothermia‐treated HIE, representing moderate to severe cases. A secondary outcome was low Apgar score at 5 minutes, defined as <7 or <4. Odds ratios with 95% CI were calculated, using Swedish‐born women as the reference. Structural equation modeling was used to investigate potential mediation of known antepartum risk factors. Results: A total of 854 infants were diagnosed with HIE and 398 received therapeutic hypothermia. Offspring of mothers born in low‐income countries had the highest incidences of HIE and low Apgar score, with an incidence of therapeutic hypothermia of 1.1 per 1000. Compared with offspring of Swedish‐born mothers, these neonates had an almost two‐fold increased risk of HIE, with or without hypothermia treatment (odds ratio 1.7; 95% CI 1.2–2.7 and odds ratio 1.7; 95% CI 1.2–2.6, respectively), and a 2‐ to 3‐fold increased risk of low Apgar score. The structural equation model analysis indicated an exclusive direct effect of country of birth on HIE. Factors reflecting socio‐economic status mediated a small proportion of the risk of Apgar score <7 at 5 minutes. Conclusions: Offspring of women born in low‐income countries had associations with severe birth asphyxia, with increased risk of both HIE and low Apgar score at 5 minutes. The associations seemed only to be marginally mediated by other antepartum factors. The associations are complex and further studies are needed to find explanatory and potentially preventable factors. [ABSTRACT FROM AUTHOR]

Fatalities due to road crashes are rising globally, with the situation being particularly severe in low‐income countries. Traditional investigation methods have reached a ceiling in terms of reducing road traffic fatalities, hence safety researchers have begun to explore systems‐based approaches. In this study, two bus‐pedestrian collisions occurring in Bangladesh and separated by a time span of 13 years have been analyzed using the Accimap methodology. Building on and going further than the Accimaps of the two collisions, the recommendations that have been proposed to reduce the recurrence of such collision types have been graphically represented in a combined Preventimap. This graphically displays the inter‐connectedness of the countermeasures. Further, the countermeasures have been mapped against six road safety E's, namely engineering, education, enforcement, economics, emergency response, and enablement. Comparing the countermeasures arising from each of the two collisions showed that some preventive strategies are unique to one collision while others are common to both collisions. With a significant proportion of the proposed recommendations being of similar types, we discuss the idea that had prompt and appropriate intervention measures been implemented at different levels of the system after the first collision, the probability of the occurrence of the second collision would have been significantly less. The same would apply to similar collisions in the future. We also discuss the benefits of the Preventimap representation and its potential uses in road safety policy and practice. [ABSTRACT FROM AUTHOR]

Objective: To establish the storage conditions of oxytocin in a health facility in a low‐income country with a tropical climate, as suboptimal storage may lead to ineffectiveness of drugs essential to prevent and treat postpartum hemorrhage. Methods: At Mulago National Referral Hospital (28 000–33 000 deliveries/year) in Kampala, Uganda, temperature logging Safe‐Rx cards were placed in boxes of oxytocin and in every known storage location. The route of the boxes through the hospital was tracked for 54 days, and storage conditions were observed. Results: Oxytocin was stored within the recommended temperature range (2°C–8°C) 24% of the time. The average temperature measured within the oxytocin boxes was 18.2°C, with a minimum of –2.3°C and maximum of 30.4°C. Six out of twelve known storage places had a refrigerator, but not one location stored medication at the recommended temperature constantly. The average temperature in the storage places ranged from 9.5°C to 27.6°C, with a minimum temperature of 2.3°C and maximum of 30.9°C. Conclusion: Oxytocin is not stored in the recommended temperature range for the majority of time. The presence of refrigerators does not ensure adherence to advised temperature storage conditions. Synopsis: The presence of refrigerators does not ensure adherence to advised temperature storage conditions for oxytocin in a tropical climate low‐income country. [ABSTRACT FROM AUTHOR]

Objectives: To describe patients' activity and participation levels and to compare these levels across different groups of stroke survivors according to their walking speed (WS). Methods: In this cross‐sectional study, 67 stroke survivors (43 men, mean age: 58.4 ± 12.9 years old) were assessed using the stroke impairment assessment set (SIAS), ACTIVLIM‐Stroke, 10‐m walk test (10MWT), 6‐min walk test (6MWT) and Reintegration to Normal Living Index (RNLI). The sample was afterwards split into three WS sub‐groups (<0.4 m/s, 0.4–0.8 m/s and >0.8 m/s) based on 10MWT scores. Results: ACTIVLIM‐Stroke, 10MWT and 6MWT mean scores (±SD) were, respectively, 69.4 ± 20.2%, 0.9 ± 0.6 m/s and 282.1 ± 182 m. RNLI median score (range) was 5 (0–20). Sub‐group analyses indicated that 26.9% (n = 18) obtained WS < 0.4 m/s, 13.4% (n = 9) WS between 0.4 and 0.8 m/s, and 59.7% (n = 40) WS > 0.8 m/s. Significant differences (p <.001) were found between WS sub‐groups for both activity and participation. Conclusion: Stroke survivors in Kinshasa presented a good performance for basic‐activities of daily life (basic‐ADLs). However, some of them still had difficulties with some community activities. Differences in WS seemed to discriminate well stroke survivors in terms of activity and participation, since the higher WS, the more they performed in basic‐ADLs, walking distance and participation, and inversely. [ABSTRACT FROM AUTHOR]

Objective: To improve asthma care in a complex, low resource, developing country setting. This observational study was carried out in a challenging low‐income real‐life setting in the ED at Modilon Hospital, Papua New Guinea. The only government hospital in Madang Province, with 258 beds, it provides medical care to a population of nearly 700 000 people of whom 40% live on less than US$1.25/day. Methods: An asthma management analysis questionnaire followed by action research, with a four‐step programme change model (exposure, adoption, implementation and practice), were used to develop and implement new department asthma guidelines. Staff perceptions were gathered via discussion groups and questionnaire. Results: Asthma management initially involved frequent antibiotics, intravenous steroids, multiple short acting bronchodilators (oral, inhaled and nebulised) and limited oral steroids. No spacers, preventative inhaled steroid therapy or asthma action plans were used. On review after new guideline implementation staff felt antibiotic dispensing and concurrent use of multiple short acting oral bronchodilators decreased and spacer, preventer therapy and action plan use increased. Conclusion: This project highlights the difficulties experienced with change management, both in general and in a limited resource setting. Lack of data limits conclusions about asthma management improvement. However, positive trends were apparent and make this approach reasonable for those considering change management strategies in a similar setting. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this review is to determine the factors associated with the outcomes of community health programs with particular focus on low‐ to middle‐income countries. In addition, this review aims to suggest how these factors can affect the creation of a Sickle Cell Anemia health program in sub‐Saharan Africa. Design and Sample: A literature review spanning the last decade (March 2007 to February 2017) was conducted using the Whittemore and Knafl integrative review framework. Results: Community ownership, networking, and resource allocation were identified as themes that affect community health program outcomes. Attempts to use a guiding principle or process to implement community health programs were also apparent in the literature. Conclusion: More rigorous scientific investigation is needed to ensure that these community health programs are effective and have measurable outcomes. Nursing is well positioned, considering the metaparadigm concepts that guide practice, to forge this research. Nursing scientists could fill the gap in knowledge related to community health program outcomes in low‐ to middle‐income countries while achieving global objectives focused on decreasing noncommunicable disease burden. [ABSTRACT FROM AUTHOR]

Aim: We explored the diagnostic accuracy of the clinical dehydration scale (CDS), the World Health Organization (WHO) scale and the Gorelick scale for assessing dehydration in children admitted to a Tanzanian referral hospital.Methods: This was a prospective, observational study, carried out from April 2015 to January 2017 on children aged one month to five years admitted to the hospital with acute diarrhoea lasting less than five days. Before rehydration therapy, each patient's weight was recorded and the degree of dehydration was assessed based on the three scales. The reference standard was the percentage weight change between admission and discharge. The main outcomes were the sensitivity, specificity and positive and negative likelihood ratios (LRs) of the scales.Results: Data from 124 eligible patients were available. The CDS showed limited value for ruling in cases with some dehydration (LR 1.9, 95% confidence interval 1.1-2.8), but was of no value in assessing no and moderate to severe dehydration. The WHO and Gorelick scales were of no value in evaluating any degree of dehydration.Conclusion: The WHO and Gorelick dehydration scales were no use for assessing dehydration in small children, and the CDS was of limited use for predicting cases with some dehydration. [ABSTRACT FROM AUTHOR]

The Association of Anaesthetists of Great Britain and Ireland and the then Uganda Society of Anaesthesia established the Uganda Fellowship Scheme in 2006, to provide scholarships to encourage doctors to train in anaesthesia in Uganda. We conducted an evaluation of this programme using online questionnaires and face-to-face semi-structured interviews with trainees who received scholarships, as well as with senior surgeons and anaesthetists. Focus group discussions were held to assess changes in attitudes towards anaesthesia over the last 10 years. Interviews were recorded, transcribed and analysed using the constant comparative method. A total of 54 Ugandan doctors have received anaesthesia scholarships since 2006 (median funding per trainee (IQR [range]) £5520 (£5520-£6750 [£765-£9000]). There has been a four-fold increase in the number of physician anaesthetists in Uganda during this time. All those who received funding remain in the region. The speciality of anaesthesia is undergoing a dramatic transformation led by this group of motivated young anaesthetists. There is increased access to intensive care, and this has allowed surgical specialities to develop. There is greater understanding and visibility of anaesthesia, and the quality of education in anaesthesia throughout the country has improved. The Uganda Fellowship Scheme provided a relatively small financial incentive to encourage doctors to train as anaesthetists. Evaluation of the project shows a wide-ranging impact that extends beyond the initial goal of simply improving human resource capacity. Financial incentives combined with strong 'north-south' links between professional organisations can play an important role in tackling the shortage of anaesthesia providers in a low-income country and in improving access to safe surgery and anaesthesia. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the acceptability, feasibility, and outcomes of pessary fitting in rural Nepali communities.Methods: A 1-year prospective cohort study was conducted in the Ramechhap district of Nepal in January 2013-January 2014 among women attending a free gynecology health camp. All women with symptomatic pelvic organ prolapse (POP) were offered ring pessaries. Demographic information was collected and questionnaires on POP were completed. A urogynecologic examination was performed. At the 1-year follow-up, women were questioned on pessary use and underwent an examination. Logistic regression was used to identify associations.Results: In total, 411 women attended the health camps, of whom 142 presented with symptomatic POP. Initial fitting was accomplished for 134 (94.4%) of the women. At the 1-year follow-up, 130 (97.0%) women in the cohort were evaluated, and 72 (55.4%) were still using the pessary. The primary reason for discontinuation was the pessary falling out (35/58, 60.3%). The most common complication was vaginal erosion (18/130, 13.8%), observed exclusively among postmenopausal women. Postmenopausal status was a predictor of continued use (odds ratio 3.12, 95% confidence interval 1.45-6.72; P=0.004).Conclusion: Pessaries were found to be an acceptable and feasible option with minimal complications for treating POP in rural Nepal. [ABSTRACT FROM AUTHOR]

The political economy models of targeting postulate that going universal is a win-win situation, for the poor and the middle class, as well as those who are in power. This article critically discusses the assumptions behind the political economy arguments of targeting and tests whether a universal mechanism is bound to politically excel in a low-income country context. On the basis of attitudinal surveys with the urban, rural and student population in Zambia, we do not find any support for the predictions of the political economy models. We discuss the assumptions of the political economy models in the light of these findings and consider potentially decisive parameters that the models currently do not incorporate. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the knowledge, attitudes, and extent of involvement of men in family planning in Nigeria, and to evaluate spousal communication regarding family planning.Methods: A community-based, mixed-methods study enrolled participants in Gwagwalada, Abuja, Nigeria between January 11 and June 30, 2012. Quantitative surveys including semi-structured interviews were used to collect information from married men regarding their knowledge and attitudes to modern family planning. The qualitative components constituted focus group discussion sessions and in-depth interviews that included married men, married women, religious leaders, community leaders, and family-planning providers.Results: Quantitative surveys were completed by 152 men; 99 (65.1%) reported that they would accompany their wives to family-planning clinics in the future, 116 (76.3%) reported approving of the use of modern contraception by their wives, and 132 (86.8%) reported wanting to know more about family planning. Both quantitative and qualitative aspects of the study indicated that husbands were the major decision makers regarding family size, choice of contraceptive, and pregnancy timing.Conclusion: In terms of fertility goals and family planning, men were the primary decision makers; consequently, obtaining their support and commitment to family planning is of crucial importance in Nigeria. [ABSTRACT FROM AUTHOR]

Objective: To compare provider assessment of fetal maceration with death-to-delivery interval to evaluate the reliability of appearance as a proxy for time of death.Methods: Cohort chart abstraction was performed for all stillbirth deliveries at or above 28 weeks of gestation during a 1-year period in a teaching hospital in Ghana.Results: Of 470 stillborn infants, 337 had adequate data for analysis. Of 47 fetuses alive on admission with death-to-delivery intervals estimated to be less than 8 hours (expected to be reported as fresh), 14 (30%) were actually reported as macerated. Of 94 cases in which the fetus was deceased on admission with death-to-delivery interval of more than 8 hours (expected to be macerated), 17 (18%) were described as fresh.Conclusion: Provider description of fetal appearance may be an unreliable indicator for time since fetal death. The findings have significant implications for stillbirth prevention and assessment. [ABSTRACT FROM AUTHOR]

Background Previous reviews found that the H1N1 pandemic was associated with a large proportion of hospitalizations, severe illness, workplace absenteeism, and high costs. However, the burden among socially disadvantaged groups of the population is unclear. This is a summary of a previously published systematic review commissioned by the World Health Organization on the burden of H1N1 pandemic (influenza A/Mexico/2009 (H1N1)) among socially disadvantaged populations. Methods MEDLINE and EMBASE were searched to identify studies reporting hospitalization, severe illness, and mortality attributable to the 2009 H1N1 pandemic among socially disadvantaged populations, including ethnic minorities and low-income or lower-middle-income economy countries ( LIC/ LMIC). SAS and Review Manager were used to conduct random effects meta-analysis. Results Forty-eight cohort studies and 14 companion reports including 44 777 patients were included after screening 787 citations and 164 full-text articles. Twelve of the included studies provided data on LIC/ LMIC, including one study from Guatemala, two from Morocco, one from Pakistan, and eight from India, plus four companion reports. The rest provided data on ethnic minorities living in high-income economy countries (HIC). Significantly more hospitalizations were observed among ethnic minorities versus nonethnic minorities in two North American studies [1313 patients, odds ratio ( OR) 2·26 (95% confidence interval: 1·53-3·32)]. Among hospitalized patients in HIC, statistically significant differences in intensive care unit admissions ( n = 8 studies, 15 352 patients, OR 0·84 [0·69-1·02]) and deaths ( n = 6 studies, 14 757 patients, OR 0·85 [95% CI: 0·73-1·01]) were not observed. Conclusion We found significantly more hospitalizations among ethnic minorities versus nonethnic minorities in North America, yet no differences in intensive care unit admissions or deaths among H1N1-infected hospitalized patients were observed in North America and Australia. Our results suggest a similar burden of H1N1 between ethnic minorities and nonethnic minorities living in HIC. [ABSTRACT FROM AUTHOR]

BACKGROUND: Outcomes for relapsed childhood acute lymphoblastic leukemia (ALL) have not been documented in resource-limited settings. This study examined survival after relapse for children with ALL in Central America. METHODS: A retrospective cohort study was performed and included children with first relapse of ALL in Guatemala, Honduras, or El Salvador between 1990 and 2011. Predictors of subsequent event-free survival (EFS) and overall survival (OS) were examined. RESULTS: There were 755 children identified with relapsed disease. The median time from diagnosis to relapse was 1.7 years (interquartile range, 0.8-3.1 years). Most relapses occurred during (53.9%) or following (24.9%) maintenance chemotherapy, and the majority occurred in the bone marrow (63.1%). Following the initial relapse, subsequent 3-year EFS (± standard error) and OS were 22.0% ± 1.7%, and 28.2% ± 1.9%, respectively. In multivariable analysis, worse postrelapse survival was associated with age ≥ 10 years, white blood cell count ≥ 50 × 109/L, and positive central nervous system status at the original ALL diagnosis, relapse that was not isolated central nervous system or testicular, and relapse < 36 months following diagnosis. Site and time to relapse were used to identify a favorable risk group whose 3-year EFS and OS were 50.0% ± 8.9% and 68.0% ± 8.1%, respectively. CONCLUSIONS: Prognosis after relapsed ALL in Central America is poor, but a substantial number of those with favorable risk features have prolonged survival, despite lack of access to stem cell transplantation. Stratification by risk factors can guide therapeutic decision-making. Cancer 2013. © 2012 American Cancer Society. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess the use of fetal foot length for predicting gestational age in stillborn fetuses in Vietnam and the ability of this measurement to differentiate early from late fetal deaths. Methods: In a prospective case series, gestational age was determined from either certain first day of last menstrual period or early ultrasound scan. Foot length was measured, with a non-elastic tape measure, from the heel to the tip of the longest toe. Agreement of observed and predicted foot length for gestational age was tested, as well as the influence of fetal characteristics. Results: Accurate gestational age and foot length were available for 52 of 107 participants. Strong agreement was demonstrated between observed and predicted values of foot length across gestations (95% confidence interval, –4.7 to 4.3weeks). Accuracy of fetal foot length in predicting gestational age was affected by growth restriction but not fetal gender, maceration, or congenital anomalies. Fetal foot length of 55mm or greater demonstrated a sensitivity and specificity of 88% in identifying late fetal deaths. Conclusion: Foot length is a good differentiator of early and late fetal death, which is important for the global recording of the number of stillbirths. [Copyright &y& Elsevier]

Objective: To assess stillbirth rates and antepartum risk factors in rural Nepal.Methods: Data were collected prospectively during a cluster-randomized, community-based trial in Sarlahi, Nepal, from 2002 to 2006. Multivariate regression modeling was performed to calculate adjusted relative risk estimates.Results: Among 24531 births, the stillbirth rate was 35.4 per 1000 births (term stillbirth rate 21.2 per 1000 births). Most births occurred at home without a skilled birth attendant. The majority (69%) of intrapartum maternal deaths resulted in stillbirth. The adjusted RR (aRR) of stillbirth was 2.74 among nulliparas and 1.47 among mothers with history of a child death. Mothers above the age of 30 years carried a 1.59-fold higher risk for stillbirth than mothers who were 20-24 years old. The stillbirth risk was lower among households where the father had any formal education (aRR 0.70). Land ownership (aRR 0.85) and Pahadi ethnicity (aRR 0.67; reference: Madhesi ethnicity) were associated with significantly lower risks of stillbirth.Conclusion: Stillbirth rates were high in rural Nepal, with the majority of stillbirths occurring at full-term gestation. Nulliparity, history of prior child loss, maternal age above 30 years, Madhesi ethnicity, and socioeconomic disadvantage were significant risk factors for stillbirth. Clinicaltrials.govNCT00 109616. [ABSTRACT FROM AUTHOR]

Objective: To identify delivery methods and associated adverse neonatal outcomes after previous cesarean delivery.Methods: A retrospective cross-sectional study in an inner-city maternity hospital in Lagos, Nigeria, in which outcomes associated with delivery methods were determined by multinomial logistic regression.Results: Of 435 eligible singleton deliveries, 171 (39.3%) occurred via elective cesarean, 249 (57.2%) via emergency cesarean, and 15 (3.4%) after successful trial of labor. Emergency cesarean delivery was associated with low 1-minute Apgar scores compared with successful trial of labor. It was also associated with low 5-minute Apgar scores compared with elective cesarean delivery, in addition to hyperbilirubinemia and admission to the special care baby unit. Successful trial of labor was less likely to be associated with low 1-minute Apgar scores than was elective cesarean delivery. The delivery methods were not associated with risk of sensorineural hearing loss.Conclusion: Trial of labor is common in this tertiary hospital among women with previous cesarean delivery and is associated with high failure rates and adverse neonatal outcomes with potential developmental risks. [ABSTRACT FROM AUTHOR]

Objective: To develop a prospective perinatal registry that characterizes all deliveries, differentiates between stillbirths and early neonatal deaths (ENDs), and determines the ratio of fresh to macerated stillbirths in the northwest Democratic Republic of Congo.Method: Birth outcomes were obtained from 4 rural health districts.Results: A total of 8230 women consented, END rate was 32 deaths per 1000 live births, and stillbirth rate was 33 deaths per 1000 deliveries. The majority (75%) of ENDs and stillbirths occurred in neonates weighing 1500 g or more. Odds of stillbirth and END increased in mothers who were single or who did not receive prenatal care, and among premature, low birth weight, or male infants. The ratio of fresh to macerated stillbirths was 4:1.Conclusion: Neonates weighing 1500 g or more at birth represent a group with a high likelihood of survival in remote areas, making them potentially amenable to targeted intervention packages. The ratio of fresh to macerated stillbirths was approximately 10-fold higher than expected, suggesting a more prominent role for improved intrapartum obstetric interventions. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy and efficiency of systematic, ultrasound-based risk adjustment using a published algorithm with that of a maternal age cutoff of 37 years for the prenatal detection of chromosomal abnormalities (especially autosomal trisomies).Methods: These approaches were compared in a retrospective study of 136 chromosomal abnormalities confirmed by karyotyping prenatally (n=46) or postnatally (n=90). There were 114 autosomal trisomies.Results: Maternal age was known for 103 fetuses with confirmed abnormalities. The ultrasound-based risk adjustment approach was more sensitive for autosomal trisomy (93.9% vs 44.1%), and karyotyping for younger women with abnormalities on ultrasound was more effective than routine karyotyping in older women (1 trisomy detected in 13.5 vs 42.8 samples, P<0.001). A lack of screening was the main reason for the postnatal diagnosis.Conclusion: Ultrasound-based risk adjustment was the more effective approach. [ABSTRACT FROM AUTHOR]

Background: There is a need to assess the cost-benefit of different models of antibiotic administration for the prevention of post cesarean infection, particularly in resource-scarce settings.Design: Randomized, nonblinded comparative study of a single combined preoperative dose of gentamicin and metronidazole vs. a post cesarean scheme for infection prophylaxis.Methods: Pregnant women (n = 288) with indication for emergency cesarean section were randomly allotted to two groups. Group 1 (n = 143) received the single, combined dose of prophylactic antibiotics and group 2 (n = 145) received, over 7 days, the postoperative standard scheme of antibiotics followed in the department. Both groups were followed up during 7 days for detection of signs of wound infection, endometritis, peritonitis and urinary tract infection.Main Outcome Measures: Prevalence of postoperative infection, mean hospital stay and costs of antibiotics used.Results: Women completing the study (n = 241) were distributed into group 1 (n = 116) and group 2 (n = 125). No significant difference was found neither in the prevalence of postoperative infection nor in the mean hospital stay. No death occurred. The cost of the single dose of prophylactic antibiotics was less than one-tenth of the cost of the standard postoperative scheme.Conclusion: In our setting, the administration of a single dose of 160 mg of gentamicin in combination with 500 mg of metronidazole before emergency cesarean section for prevention of infection is clinically equivalent to existing conventional week-long postoperative therapy, but at approximately one-tenth of the cost. [ABSTRACT FROM AUTHOR]

Objective. To describe and compare the frequency of antenatally identified maternal ‘risk’ characteristics, place of delivery and occurrence of delivery complications. Methods. A prospective cohort study of 780 pregnant women completing antenatal follow-up at a rural health center in Malawi. Results. Three-quarters of the subjects had at least one commonly accepted risk characteristic. Only 30% of these women, and 22% of those with no risk chracteristics, delivered in a modern health facility. Four women died, 127 experienced other delivery complications and there were 52 perinatal deaths. The ‘at-risk’ classification had over 80% sensitivity but less than 30% specificity to predict delivery complications or perinatal deaths. The positive predictive values were as low as 20% for delivery complications and 7% for perinatal mortality. Most individual ‘risk’ characteristics were not associated with adverse delivery outcomes, even when adjusted for the place of delivery. Conclusions. Antenatal risk identification failed to promote safe deliveries because of a poor predictive value of the ‘risk’ variables and the failure of the identified ‘at-risk’ individuals to deliver in modern health facilities. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Alcohol taxation policy in Thailand: implications for other low- to middle-income countries," by B. Sornpaisarn and colleagues in the August 2012 issue.

Objective: To identify the factors associated with non-medically indicated cesarean deliveries (NMIC) in Burkina Faso in centers where user fees for cesarean delivery were partially removed.Methods: We carried out a criteria-based audit in 22 referral hospitals, using data from a 6-month prospective observational study, to assess the proportion of NMIC. Multivariate logistic regression analyses were used to identify factors associated with NMIC.Results: The decision of cesarean delivery was not medically indicated in 24% of cases. The factors independently associated with NMIC were urban residence (adjusted OR 1.55; 95% CI, 1.12-2.12; P=0.006), spouse's occupation other than breeder or farmer (aOR varying from 1.77 [95% CI, 1.19-2.62] to 2.15 [95% CI, 1.38-3.32] according to the profession), and cesarean decided by a general practitioner (aOR 1.61; 95% CI, 1.13-2.30; P=0.009).Conclusion: The high percentage of unnecessary cesarean deliveries is in contrast to the unmet needs of women who still deliver outside health facilities. NMIC is associated with both socioeconomic determinants and medical factors. Hence, interventions are needed to improve the skills of healthcare professionals and awareness of women concerning the risks associated with unnecessary cesarean delivery. [ABSTRACT FROM AUTHOR]