8 Depressing/Uplifting Things We Learned About Women This Year

Via:   http://goo.gl/QuVg5q 

TB-HIV Co-Infection among Pregnant Women in Karnataka, South India: A Case Series

Tuberculosis (TB) is a significant contributor to mortality in HIV-infected patients. Concurrent TB infection is also a significant contributing factor to maternal mortality in human immunodeficiency virus (HIV)-infected pregnant women. Studies addressing the outcomes of TB and HIV co-infection among pregnant women are generally infrequent. 

Although limited, the records maintained by the Revised National Tuberculosis Control Programme (RNTCP) and the National AIDS Control Programme (NACP) in Karnataka State, Southern India provide information about the numbers of pregnant women who are co-infected with TB and HIV and their pregnancy outcomes. We reviewed the data and conducted this study to understand how TB-HIV co-infection influences the outcomes of pregnancy in this setting. We sought to determine the incidence and treatment and delivery outcomes of TB-HIV co-infected pregnant women in programmatic settings in Karnataka State in southern India. 

The study participants were all the HIV-infected pregnant women who were screened for tuberculosis under the NACP from 2008 to 2012. For the purposes of this study, the program staff in the field gathered the data regarding on treatment and delivery outcomes of pregnant women. A total of seventeen pregnant women with TB-HIV co-infection were identified among 3,165,729 pregnant women (for an incidence of 5.4 per million pregnancies). 

The median age of these pregnant women was 24 years, and majority were primiparous women with WHO HIV stage III disease and were on a stavudine-based ART regimen. The maternal mortality rates were 18% before delivery and 24% after delivery. The abortion rate was 24%, and the neonatal mortality rate was 10%. The anti-tuberculosis treatment and anti-retroviral treatment outcome mortality rates were 30% and 53%, respectively. 

Although the incidence of TB among the HIV-infected pregnant women was marginally less than that among the non-HIV-infected women, the delivery outcomes were relatively poorer. 

The current strategy for the management of TB among the HIV-positive pregnant women needs urgent review.

Purchase full article at:   http://goo.gl/o4LGRn

By:   Suresh S1, Sharath BN2, Anita S3, Lalitha R4, Jaya Prasad T5, Rewari BB6.

• 1State Tuberculosis Office, Bangalore, India.
• 2ESIC Medical College and PGIMSR, Bangalore, India. Electronic address: sharathbn@yahoo.com.
• 3St. John's Medical College Hospital, Bangalore, India.
• 4Karnataka State AIDS Prevention Society, Bangalore, India.
• 5School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
• 6National AIDS Control Organization, New Delhi, India. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Effects of Intimate Partner Physical Violence on Newborns’ Birth Outcomes among Jordanian Birthing Women

Intimate partner physical violence against women (VAW) during pregnancy is a common experience all over the world. In Jordan, the number is double the reported international average. Data on effect of violence on birth outcomes are important for planning, implementing, and evaluating maternal health programs. 

The research question was, “Does intimate partner physical VAW during pregnancy increase the risk of negative birth outcomes for newborns among birthing women in Jordan?” Natural experiment design was used for this study. A consecutive sampling technique was used for selecting the victims of physical violence (n = 79) and a simple random sampling for selecting non-victims (n = 79). Intimate partner physical violence was measured by using the Arabic version of World Health Organization’s (WHO) domestic violence questionnaire, which has an accepted interrater validity. Analysis of covariance (ANCOVA) and chi-square were used to detect the differences in birth outcomes between the victims and non-victims of physical violence. 

The results showed that there is a significant difference in newborn’s birth weight between the victims of violence and non-victims with a small effect size. However, there were no significant differences between the two groups in preterm birth and assisted newborn ventilation. The non-significant effect of violence on the incidence of preterm birth contradicts the published literature. Intimate partner violence (IPV) is rooted in Jordanian culture and widely accepted among married Jordanian women. 

Midwives, doctors, educators, and policy makers should work together to eradicate violence and detect victims of it, to improve birth outcomes and decrease newborn morbidity and mortality rates.

Purchase full article at:  http://goo.gl/8uBPy3

By:   Sanaa Abujilban, PhD1, Lina Mrayan, PhD1, Hanan Al-Modallal, PhD1, Esra’a Isaa, BSc1

1. ¹Hashemite University College of Nursing, Zarqa, Jordan

1. Sanaa Abujilban, Faculty of Nursing, Department of Maternal, Child, and Family Health Nursing, Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan. Email:abujelban@yahoo.co.uk

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

The Triple Threat of Pregnancy, HIV Infection & Malaria: Reported Causes of Maternal Mortality in Two Nationwide Health Facility Assessments in Mozambique, 2007 & 2012

The paper’s primary purpose is to determine changes in magnitude and causes of institutional maternal mortality in Mozambique. We also describe shifts in the location of institutional deaths and changes in availability of prevention and treatment measures for malaria and HIV infection.

Two national cross-sectional assessments of health facilities with childbirth services were conducted in 2007 and 2012. Each collected retrospective data on deliveries and maternal deaths and their causes. In 2007, 2,199 cases of maternal deaths were documented over a 12 month period; in 2012, 459 cases were identified over a three month period. In 2007, data collection also included reviews of maternal deaths when records were available (n = 712).

Institutional maternal mortality declined from 541 to 284/100,000 births from 2007 to 2012. The rate of decline among women dying of direct causes was 66 % compared to 26 % among women dying of indirect causes. Cause-specific mortality ratios fell for all direct causes. Patterns among indirect causes were less conclusive given differences in cause-of-death recording. In absolute numbers, the combination of antepartum and postpartum hemorrhage was the leading direct cause of death each year and HIV and malaria the main non-obstetric causes. Based on maternal death reviews, evidence of HIV infection, malaria or anemia was found in more than 40 % of maternal deaths due to abortion, ectopic pregnancy and sepsis. Almost half (49 %) of all institutional maternal deaths took place in the largest hospitals in 2007 while in 2012, only 24 % occurred in these hospitals. The availability of antiretrovirals and antimalarials increased in all types of facilities, but increases were most dramatic in health centers.

The rate at which women died of direct causes in Mozambique’s health facilities appears to have declined significantly. Despite a clear improvement in access to antiretrovirals and antimalarials, especially at lower levels of health care, malaria, HIV, and anemia continue to exact a heavy toll on child-bearing women. Going forward, efforts to end preventable maternal and newborn deaths must maximize the use of antenatal care that includes integrated preventive/treatment options for HIV infection, malaria and anemia.

Below:  Map of maternal death reviews, with HIV implicated, 2007

Below:  Map of maternal death reviews, with malaria implicated, 2007

Full article at: http://goo.gl/RDaJx9

By: Patricia E. Bailey^12*, Emily Keyes¹², Allisyn C. Moran³, Kavita Singh⁴⁵, Leonardo Chavane⁶ and Baltazar Chilundo⁷

¹RMNCH Unit, Global Health Programs, FHI 360 359 Blackwell Street, Durham 27701, NC, USA

²Averting Maternal Death & Disability, Mailman School of Public Health, Columbia University, New York, NY, USA

³Global Health Fellows Program II, United States Agency for International Development (USAID), Washington, DC, USA

⁴MEASURE Evaluation/Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

⁵Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

⁶MCSP/Jhpiego, Maputo, Mozambique

⁷Departamento de Saúde da Comunidade, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

A Geographical Perspective on Access to Sexual & Reproductive Health Care for Women in Rural Africa

Utilization of sexual and reproductive health (SRH) services can significantly impact health outcomes, such as pregnancy and birth, prenatal and neonatal mortality, maternal morbidity and mortality, and vertical transmission of infectious diseases like HIV/AIDS. 

It has long been recognized that access to SRH services is essential to positive health outcomes, especially in rural areas of developing countries, where long distances as well as poor transportation conditions, can be potential barriers to health care acquisition. Improving accessibility of health services for target populations is therefore critical for specialized healthcare programs. Thus, understanding and evaluation of current access to health care is crucial. 

Combining spatial information using geographical information system (GIS) with population survey data, this study details a gravity model-based method to measure and evaluate access to SRH services in rural Mozambique, and analyzes potential geographic access to such services, using family planning as an example. Access is found to be a significant factor in reported behavior, superior to traditional distance-based indicators. Spatial disparities in geographic access among different population groups also appear to exist, likely affecting overall program success.

Below:  Study area and data

Below:  Health service quality of clinics

Below:  Potential geographic access of communities

Below:  Spatial variation of potential geographic access

Full article at: http://goo.gl/bQ4oR9

By: Jing Yao,a,* Alan T. Murray,b and Victor Agadjanianc

^a Centre for GeoInformatics, School of Geography and Geosciences, University of St Andrews, St Andrews, Fife, KY16 9AL, Scotland, UK

^b GeoDa Center for Geospatial Analysis and Computation, School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ 85287, USA

^c Center for Population Dynamics, T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ 85287, USA

^* Corresponding author. School of Geography & Geosciences, Irvine Building, University of St Andrews, North Street, St Andrews, KY16 9AL, Fife, Scotland, UK. Tel.: +44 01334 464026; fax: +44 01334 463949. Email: ku.ca.swerdna-ts@oay.gnij, Email: moc.liamg@usaoayj (J. Yao).

   

More at:  https://twitter.com/hiv_insight

Exceptionally Deadly: Death from Childbirth Is Unusually Common in America

Read at: http://ht.ly/Q6nbU Via @TheEconomist 

The Color of Risk: U.S. Maternal Mortality Rate

Read at http://ht.ly/Q6nbU Via @TheEconomist