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Background: Over one-third of the global stillbirth burden occurs in countries affected by conflict or a humanitarian crisis, including Afghanistan. Stillbirth rates in Afghanistan remained high in 2021 at over 26 per 1000 births. Stillbirths have devastating physical, psycho-social and economic impacts on women, families and healthcare providers. Data on the risks and causes of stillbirths are critical to target prevention measures and are currently lacking. This study aimed to use routine health facility data to examine the socio-demographic, maternal, fetal, and obstetric characteristics associated with stillbirth. Methods: This was a hospital-based case-control study of births at the maternity units of the three tertiary care referral hospitals in Kabul, Afghanistan between March-September 2021. Cases were defined as stillbirths that occurred at 22 weeks or later in pregnancy while live births occurring after each case were selected as controls. Multivariable logistic regression was used to explore factors associated with stillbirth after performing multiple imputation to impute missing data for independent variables. Results: A total of 497 cases (stillbirths) and 1069 controls (live births) were included in the analysis. Factors independently associated with stillbirth while adjusting for maternal age and baby's sex were: being referred from another facility which increased the odds of stillbirth by over three times (aOR 3.24; 95% CI 1.17, 8.85) compared to those who were not referred; being born extremely preterm (< 28 weeks) (aOR 13.98; 95% CI 7.44, 26.27), very preterm (28–31 weeks) (aOR 3.91; 95% CI 2.73, 5.62), and moderate to late preterm (32–36 weeks) (aOR 2.32; 95% CI 1.60, 3.37) compared to term babies; and being small-for-gestational age (aOR 1.70; 95% CI 1.10, 2.64) compared to those that were average size for gestational age. Placental abruption also increased the odds of stillbirth by two times (aOR 2.07; 95% CI 1.37–3.11). Conclusions: Improving the detection and management of preterm births, and small-for-gestational age babies through improvements in antenatal care attendance and quality will be important for future stillbirth prevention in Afghanistan. More research is needed to understand referral delays and contributing factors to increased risk among referrals. Strengthening routine data quality for stillbirths is imperative for improved understanding and prevention of stillbirths. Plain English summary: A stillbirth refers to the death of a baby before or during childbirth, at or after 22 weeks of pregnancy. Stillbirth can have devastating mental, social, and economic impacts on women and families yet many of these deaths can be prevented. Understanding stillbirth and its risk factors is important to design public health interventions to prevent these deaths in the future. There is currently very little publicly available information to understand stillbirth risk factors in Afghanistan. We used routine hospital data to examine factors associated with having a stillbirth among women that gave birth in three health facilities in urban Kabul, Afghanistan between March- September 2021. We compared the characteristics of stillborn babies (497 cases) to live born babies (1069 controls) to identify the factors that increased the odds of having a stillbirth. Our findings showed that being referred from another health facility; being born extremely preterm, very preterm, and moderate to late preterm, being small for gestational age and placental abruption increased the likelihood of stillbirth. In Afghanistan, more research is needed to understand referral and what is contributing to increased stillbirths among women who are referred. It will also be important to improve the quality of antenatal care to ensure appropriate management of preterm and small babies. Further, strengthening the quality of data recorded at health facilities will be critical for more accurate understanding of why these deaths occur. [ABSTRACT FROM AUTHOR]

Babies born from 28 weeks gestation onward have a considerable chance of survival. The World Health Organization defines the death of a fetus beyond this gestational age and before birth [...]

Abstract Background Indigenous Australians are significantly less likely to participate in colorectal cancer (CRC) screening compared to non-Indigenous people. This study aimed to identify important factors influencing the decision to undertake screening using Faecal Occult Blood Testing (FOBT) among Indigenous Australians. Very little evidence exists to guide interventions and programmatic approaches for facilitating screening uptake in this population in order to reduce the disparity in colorectal cancer outcomes. Methods Interviewer-administered surveys were carried out with a convenience sample (n = 93) of Indigenous Western Australians between November 2009-March 2010 to assess knowledge, awareness, attitudes and behavioural intent in regard to CRC and CRC screening. Results Awareness and knowledge of CRC and screening were low, although both were significantly associated with exposure to media advertising (p = 0.008; p Conclusions Improving CRC related knowledge and confidence to carry out the FOBT self-screening test through education and greater promotion of screening has the potential to enhance Indigenous participation in CRC screening. These findings should guide the development of interventions to encourage screening uptake and reduce bowel cancer related deaths among Indigenous Australians.

Abstract Background Despite a lower incidence of bowel cancer overall, Indigenous Australians are more likely to be diagnosed at an advanced stage when prognosis is poor. Bowel cancer screening is an effective means of reducing incidence and mortality from bowel cancer through early identification and prompt treatment. In 2006, Australia began rolling out a population-based National Bowel Cancer Screening Program (NBCSP) using the Faecal Occult Blood Test. Initial evaluation of the program revealed substantial disparities in bowel cancer screening uptake with Indigenous Australians significantly less likely to participate in screening than the non-Indigenous population. This paper critically reviews characteristics of the program which may contribute to the discrepancy in screening uptake, and includes an analysis of organisational, structural, and socio-cultural barriers that play a part in the poorer participation of Indigenous and other disadvantaged and minority groups. Methods A search was undertaken of peer-reviewed journal articles, government reports, and other grey literature using electronic databases and citation snowballing. Articles were critically evaluated for relevance to themes that addressed the research questions. Results The NBCSP is not reaching many Indigenous Australians in the target group, with factors contributing to sub-optimal participation including how participants are selected, the way the screening kit is distributed, the nature of the test and comprehensiveness of its contents, cultural perceptions of cancer and prevailing low levels of knowledge and awareness of bowel cancer and the importance of screening. Conclusions Our findings suggest that the population-based approach to implementing bowel cancer screening to the Australian population unintentionally excludes vulnerable minorities, particularly Indigenous and other culturally and linguistically diverse groups. This potentially contributes to exacerbating the already widening disparities in cancer outcomes that exist among Indigenous Australians. Modifications to the program are recommended to facilitate access and participation by Indigenous and other minority populations. Further research is also needed to understand the needs and social and cultural sensitivities of these groups around cancer screening and inform alternative approaches to bowel cancer screening.

Background & Aims: Aberrant DNA methylation is a common early event in neoplasia, but it is unclear how this relates to dysregulation of DNA (cytosine-5) methyltransferases (Dnmts). Here we use knock-in transgenic mice to investigate the consequences of intestinal epithelium-specific overexpression of de novo Dnmt3a. Methods: A novel gene targeting strategy, based on the intestinal epithelium-specific, uniform expression of the A33 glycoprotein, is employed to restrict Dnmt3a overexpression in homozygous A33 Dnmt3a mutant mice. Results: A33 Dnmt3a mice infrequently develop spontaneous intestinal polyps. However, when genetically challenged, tumor multiplicity in A33 Dnmt3a;Apc Min compound mice is 3-fold higher than in Apc Min mice. Although we observe a requirement for spontaneous loss of heterozygosity of the adenomatous polyposis coli (Apc) gene to trigger tumorigenesis in Apc Min mice, lesions in A33 Dnmt3a;Apc Min mice frequently retain the wild-type Apc allele. However, epithelia from normal mucosa and polyps of A33 Dnmt3a;Apc Min mice show hypermethylation-mediated transcriptional silencing of the Wnt antagonists Sfrp5, and to a lesser extent, Sfrp1 and increased nuclear β-catenin alongside activation of the Wnt-target gene Axin2/Conductin. Conversely, enforced Sfrp5 expression suppresses canonical Wnt-signaling more effectively in wild-type than in Apc Min cells. Conclusions: Aberrant activation of the canonical Wnt pathway, either by mono-allelic Apc loss or transcriptional silencing of Sfrp5 is largely insufficient to promote polyposis, but epistatic interactions between these genetic and epigenetic events enables initiation and promotion of disease. This mechanism is likely to play a role in human colorectal cancer, because we also show that elevated DNMT3A expression coincides with repressed SFRP5 and enhanced AXIN2/CONDUCTIN expression in paired patient biopsies. [Copyright &y& Elsevier]

Introduction: Mother-to-child transmission (MTCT) of HIV accounts for over 90% of annual HIV infections among children under the age of 15. Despite the introduction of the Option B+ strategy in Ethiopia in 2013, the rate of MTCT of HIV at 18 months was 15% in 2020. This study aimed to identify determinants of HIV infection among HIV-exposed infants (HEIs) in the context of prevention of MTCT (PMTCT) care in southern Ethiopia., Methods: We conducted a retrospective facility-based study of 299 mother-baby pairs (HIV-infected women and their HEIs up to 18 months) enrolled in PMTCT care at three health facilities in Wolaita Sodo town, southern Ethiopia, from September 2015 to October 2021. Data was collected from medical charts and PMTCT registers. Logistic regression was used to identify determinants of HIV infection among HEIs., Results: At enrolment into PMTCT care, most women were already on ART (75.3%) and in clinical stage I (89.6%) according to the World Health Organization's algorithm. Overall, 13 (4.3%, 95% CI: 2.5%-7.4%) HEIs were HIV-infected; the level was higher among HEIs born at home (17.9% (95% CI: 7.6%-36.5%). Being born to HIV-positive women with late WHO clinical stage (III and IV) of HIV (AOR = 9.1, 95%CI: 2.4, 34.5), being born at home (AOR = 4.8, 95%CI: 1.1-20.7), being born to women newly diagnosed with HIV (AOR = 4.8, 95%CI: 1.3-17.4), and low infant adherence to cotrimoxazole prophylaxis (AOR = 5.4, 95%CI: 1.4-20.4) increased the odds of MTCT., Conclusion: HIV infection levels among breastfeeding HEIs in PMTCT care was <5%, meeting the WHO transmission rate targets. Strengthening PMTCT care to expand community-based PMTCT interventions such as improving women's and communities' awareness of HIV, PMTCT and promoting male involvement would reduce reduce HIV infection among children to reach the 95-95-95 targets to end HIV in Ethiopia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Israel, Astatkie, Taye, Christou, Lejore and Asefa.)

Local perceptions and understanding of the causes of ill health and death can influence health-seeking behaviour and practices in pregnancy. We aimed to understand individual explanatory models for stillbirth in Afghanistan to inform future stillbirth prevention. This was an exploratory qualitative study of 42 semi-structured interviews with women and men whose child was stillborn, community elders, and healthcare providers in Kabul province, Afghanistan between October-November 2017. We used thematic data analysis framing the findings around Kleinman's explanatory framework. Perceived causes of stillbirth were broadly classified into four categories-biomedical, spiritual and supernatural, extrinsic factors, and mental wellbeing. Most respondents attributed stillbirths to multiple categories, and many believed that stillbirths could be prevented. Prevention practices in pregnancy aligned with perceived causes and included engaging self-care, religious rituals, superstitious practices and imposing social restrictions. Symptoms preceding the stillbirth included both physical and non-physical symptoms or no symptoms at all. The impacts of stillbirth concerned psychological effects and grief, the physical effect on women's health, and social implications for women and how their communities perceive them. Our findings show that local explanations for stillbirth vary and need to be taken into consideration when developing health education messages for stillbirth prevention. The overarching belief that stillbirth was preventable is encouraging and offers opportunities for health education. Such messages should emphasise the importance of care-seeking for problems and should be delivered at all levels in the community. Community engagement will be important to dispel misinformation around pregnancy loss and reduce social stigma., Competing Interests: The authors have declared that no competing interest exist., (Copyright: © 2023 Christou et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)