A hospital policy change toward delayed cord clamping is effective in improving hemoglobin levels and anemia status of 8-month-old Peruvian infants.

OBJECTIVE: To assess the effectiveness of a hospital policy change toward delayed cord clamping on infant hemoglobin (Hb) levels and anemia status at 4 and 8 months of age. METHODS: A cohort of Peruvian mothers and infants, originating from a pre/post study investigating a change in hospital policy from early to delayed cord clamping, was followed until 8 months postpartum. Infant hemoglobin levels and anemia status were measured at 4 and 8 months postpartum. RESULTS: Following the hospital policy change, adjusted mean infant Hb levels improved by 0.89 gdl(-1) [95% confidence interval (95% CI) 0.57-1.22] and anemia was significantly reduced (aOR = 0.38; 95% CI 0.19-0.78) at 8 months postpartum. CONCLUSIONS: A hospital policy change toward delayed cord clamping is effective in improving Hb levels and the anemia status of 8-month-old infants. Prior to scaling-up this intervention, issues related to training, monitoring, safety, additional long-term benefits and specific local conditions should be investigated.

A review of the flightless genus Nanotermitodius Howden, 2003 (Coleoptera: Scarabaeidae: Aphodiinae: Rhyparini).

The genus Nanotermitodius Howden, 2003 (Coleoptera: Scarabaeidae: Aphodiinae: Rhyparini) is reviewed and a new species described. Only two species are presently known in the genus, Nanotermitodius andersoni Skelley, Smith, & Mora-Aguilar, new species, and Nanotermitodius peckorum Howden, 2003, which both occur in Oaxaca, Mexico. A key and distribution map for the species are presented.

A comparison of low birth weight among newborns of early adolescents, late adolescents, and adult mothers in the Peruvian Amazon.

To compare low birth weight (LBW: <2,500 g) between infants born to adolescent and adult mothers in Iquitos, Peru. A random sample of 4,467 records of women who delivered at the Hospital Apoyo Iquitos between 2005 and 2007 was collected from hospital birth registries. Multivariate logistic and linear regression analyses were performed to compare LBW in newborns of adolescents (10-14, 15-19 years) and adults (≥20 years) and then for primiparous mothers with a normal gestational age, adjusting for newborn sex, antenatal care, and location of the mother's residence. A total of 4,384 mothers had had a singleton live birth and 1,501 were primiparous with a normal gestational age. Early and late adolescents had significantly greater odds of having a LBW infant than adults (OR = 2.28, 95%CI: 1.09, 4.78; OR = 1.67, 95%CI: 1.30, 2.14, respectively). For primiparous mothers with a normal gestational age, the same was true only for early adolescents (OR = 3.07, 95%CI: 1.09, 8.61). There were significant differences in mean birth weight between adults (3178.7 g) and both adolescent age groups overall (10-14 years: 2848.9 g; 15-19 years: 2998.3 g) and for primiparous mothers with a normal gestational age (10-14 years: 2900.8 g; 15-19 years: 3059.2 g; ≥20 years: 3151.8 g). Results suggest there is an important difference between adolescent and adult mothers in terms of newborn birth weight, especially among early adolescents. Future research on LBW and possibly other adverse birth outcomes should consider early adolescents as a separate sub-group of higher risk.

Effect of a two-component intervention to change hospital practice from early to delayed umbilical cord clamping in the Peruvian Amazon.

OBJECTIVE: To investigate the effect of a two-component intervention to change hospital practice with regard to the timing of umbilical cord clamping. METHODS: A pre-/post-study design was used to measure the effect of a two-component intervention on mean time to clamp the umbilical cord. The study took place at Hospital Iquitos "César Garayar García" in Iquitos, Peru. A total of 224 women were recruited from the hospital labor room: 112 pre-intervention, from 18 May-3 June 2009, and 112 post-intervention, from 6-20 July 2009. The intervention consisted of 1) a "best practice" three-day training workshop on birthing, and 2) a hospital directive. All deliveries were observed and the time between delivery of the first shoulder and clamping of the umbilical cord was measured with a digital stopwatch. RESULTS: The mean time between delivery and cord clamping before the intervention was 56.8 seconds (95% confidence interval [CI]: 51.0, 62.7). This increased to 169.8 seconds (95% CI: 153.8, 185.8) following the intervention. The difference in mean time to clamp remained significant in multivariate analyses (ß adjusted = 113.2 seconds, 95% CI: 96.6, 129.9). CONCLUSIONS: Hospital policy and practice can be successfully changed from early to delayed umbilical cord clamping using a simple, two-component intervention.

A new Mexican species of Onthophagus Latreille (Coleoptera: Scarabaeidae: Scarabaeinae), with a revised key to the species of the O. dicranius species complex.

New World species of the genus Onthophagus Latreille (Coleoptera: Scarabaeidae: Scarabaeinae) have been classified in different ways, all of them without a phylogenetic framework. For instance, Boucomont (1932) separated them in 13 groups of species, but Zunino Halffter (1988; 1997) only recognize five species groups. Howden Gill (1993) add the O. dicranius Bates and O. mirabilis Bates species groups, and Kohlmann Solís (2001) added the O. gazellinus Bates species group. Also, over the years, groups, complexes, and sets of species have been defined using different criteria not even comparable each other. Two of these groupings are the O. dicranius and O. mirabilis species groups, which were firstly separated from the O. clypeatus Blanchard species group (sensu Zunino Halffter 1981, 1997) by Howden Gill (1993). After, Kohlmann Solís (2001) later merged both groups under the O. dicranius species group. Finally, Génier (2017) gives a conceptual framework for species groups and complexes, thus assigning the status of species complex to the two previous species groups, and integrating them in the O. dicranius species group. Herein, we describe a new species of the O. dicranius species complex, update the species list of this complex, and present a revised key to separate these species.

A new Mexican species of Rhyparus Westwood (Coleoptera: Scarabaeidae: Aphodiinae), with new records and a key to the Mexican and Guatemalan species.

In this paper we describe Rhyparus chimalapensis new species (Coleoptera: Scarabaeidae: Aphodiinae: Rhyparini), from the region of Chimalapas, Oaxaca, Mexico. New records are given for three species of Rhyparus Westwood from Mexico and Guatemala. A key to the Mexican and Guatemalan species of this genus is included.

A new Mexican species of Chrysina Kirby (Coleoptera: Scarabaeidae: Rutelinae), with nomenclatural changes, new records, and a key to the C. quiche species group.

Chrysina chimalapensis new species (Coleoptera: Scarabaeidae: Rutelinae: Rutelini), from the region of Chimalapas, Oaxaca, Mexico is described and illustrated. A key to the species of the C. quiche species group is included. Plusiotis neotenochca Morón Nogueira is placed as a new junior synonym of Chrysina paulseni Hawks, and C. aenigmatica (Morón) as a new junior synonym of C. modesta Sturm. Chrysina benesi from Guatemala, and C. quetzalcoatli from Nicaragua are recorded as new country records. Chrysina quetzalcoatli Morón and C. triumphalis Morón are also recorded for the first time for the state of Oaxaca, Mexico, and C. victorina (Hope) for the state of Veracruz, Mexico.

A Double-Blind Randomized Controlled Trial of Maternal Postpartum Deworming to Improve Infant Weight Gain in the Peruvian Amazon.

BACKGROUND: Nutritional interventions targeting the critical growth and development period before two years of age can have the greatest impact on health trajectories over the life course. Compelling evidence has demonstrated that interventions investing in maternal health in the first 1000 days of life are beneficial for both mothers and their children. One such potential intervention is deworming integrated into maternal postpartum care in areas where soil-transmitted helminth (STH) infections are endemic. METHODOLOGY/PRINCIPAL FINDINGS: From February to August 2014, 1010 mother-infant pairs were recruited into a trial aimed at assessing the effectiveness of maternal postpartum deworming on infant and maternal health outcomes. Following delivery, mothers were randomly assigned to receive either single-dose 400 mg albendazole or placebo. Participants were followed-up at 1 and 6 months postpartum. There was no statistically significant difference in mean weight gain between infants in the experimental and control groups (mean difference: -0.02; 95% CI: -0.1, 0.08) at 6 months of age. Further, deworming had no effect on measured infant morbidity indicators. However, ad hoc analyses restricted to mothers who tested positive for STHs at baseline suggest that infants of mothers in the experimental group had greater mean length gain in cm (mean difference: 0.8; 95% CI: 0.1, 1.4) and length-for-age z-score (mean difference: 0.5; 95% CI: 0.2, 0.8) at 6 months of age. CONCLUSIONS/SIGNIFICANCE: In a study population composed of both STH-infected and uninfected mothers, maternal postpartum deworming was insufficient to impact infant growth and morbidity indicators up to 6 months postpartum. Among STH-infected mothers, however, important improvements in infant length gain and length-for-age were observed. The benefits of maternal postpartum deworming should be further investigated in study populations having higher overall prevalences and intensities of STH infections and, in particular, where whipworm and hookworm infections are of public health concern. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01748929).

Timing of umbilical cord-clamping and infant anaemia: the role of maternal anaemia.

BACKGROUND: Evidence from randomized controlled trials has shown that delayed cord-clamping is beneficial to infant iron status. The role of maternal anaemia in this relationship, however, has not been established. OBJECTIVE: To determine the effect of maternal anaemia at delivery on the association between timing of umbilical cord-clamping and infant anaemia at 4 and 8 months of age. METHODS: A cohort of pregnant women admitted to the labour room of Hospital Iquitos (Iquitos, Peru) and their newborns were recruited into the study during two time periods (18 May to 3 June and 6-20 July 2009). Between the two recruitment periods, the hospital's policy changed from early to delayed umbilical cord-clamping. Maternal haemoglobin levels were measured before delivery, and the time between delivery and cord-clamping was recorded at delivery for the entire cohort. Mother-infant pairs were followed-up at 4 (n = 207) and 8 months (n = 184) post partum. Infant haemoglobin levels were measured at follow-up visits. Data were analysed using logistic regression models. RESULTS: The prevalence of maternal anaemia (Hb <11.0 g/dl) at delivery was 22%. Infant haemoglobin levels at 4 and 8 months of age were 10.4 g/dl and 10.3 g/dl, respectively. Infant haemoglobin levels did not differ significantly between infants born to anaemic mothers and those born to non-anaemic mothers at either 4 or 8 months of age. However, the association between the timing of cord-clamping and infant anaemia was modified by the mother's anaemia status. Significant benefits of delayed cord-clamping in preventing anaemia were found in infants born to anaemic mothers at both 4 months (aOR = 0.59, 95% CI 0.36-0.99) and 8 months (aOR = 0.38, 95% CI 0.19-0.76) of age. CONCLUSION: The study contributes additional evidence in support of delayed cord-clamping. This intervention is likely to have most public health impact in areas with a high prevalence of anaemia during pregnancy.

Comparison of prenatal care coverage in early adolescents, late adolescents, and adult pregnant women in the Peruvian Amazon.

OBJECTIVE: To compare prenatal care coverage between adolescent (early and late) and adult pregnant women in Iquitos, Peru. METHODS: A random sample of 4467 birth records was collected. Multivariate analyses were performed to compare prenatal care coverage in all adolescent (10-14 years, 15-19 years) and adult (>or=20 years) age groups and then for primiparous women only. RESULTS: The mean number of visits was 5.0 for adolescents aged 10-14 years, 6.1 for adolescents aged 15-19 years, and 6.2 for women aged 20 years or older. For primiparous women, the means were 5.1, 6.2, and 6.8, for the respective age groups. Both the proportion attending and the number of prenatal visits were significantly lower in primiparous adolescents aged 10-14 years than in primiparous women aged 20 years or older (aOR 0.25; 95% CI, 0.10-0.62 and aRR 0.83; 95% CI, 0.74-0.94, respectively). CONCLUSION: All women attended prenatal care more frequently than the WHO's recommended 4 visits; however, early adolescents attended significantly less often than late adolescents or adult women. Further study of this inequality is warranted to adequately inform local health services.

Effect of a two-component intervention to change hospital practice from early to delayed umbilical cord clamping in the Peruvian Amazon / Efecto de una intervención de dos componentes para modificar la práctica hospitalaria de pinzamiento del cordón umbilical de precoz a tardío en la Amazonia peruana

OBJECTIVE: To investigate the effect of a two-component intervention to change hospital practice with regard to the timing of umbilical cord clamping. METHODS: A pre-/post-study design was used to measure the effect of a two-component intervention on mean time to clamp the umbilical cord. The study took place at Hospital Iquitos "César Garayar García" in Iquitos, Peru. A total of 224 women were recruited from the hospital labor room: 112 pre-intervention, from 18 May-3 June 2009, and 112 post-intervention, from 6-20 July 2009. The intervention consisted of 1) a "best practice" three-day training workshop on birthing, and 2) a hospital directive. All deliveries were observed and the time between delivery of the first shoulder and clamping of the umbilical cord was measured with a digital stopwatch. RESULTS: The mean time between delivery and cord clamping before the intervention was 56.8 seconds (95 percent confidence interval [CI]: 51.0, 62.7). This increased to 169.8 seconds (95 percent CI: 153.8, 185.8) following the intervention. The difference in mean time to clamp remained significant in multivariate analyses (βadjusted = 113.2 seconds, 95 percent CI: 96.6, 129.9). CONCLUSIONS: Hospital policy and practice can be successfully changed from early to delayed umbilical cord clamping using a simple, two-component intervention.

OBJETIVO: Investigar el efecto de una intervención de dos componentes para modificar la práctica hospitalaria respecto del momento en que se practica el pinzamiento del cordón umbilical. MÉTODOS: Se empleó un estudio con diseño antes-después para medir el efecto de una intervención de dos componentes sobre el tiempo medio de pinzamiento del cordón umbilical. El estudio se llevó a cabo en el Hospital Iquitos "César Garayar Gar-cía" en Iquitos (Perú). Se incluyeron en total 224 mujeres atendidas en la sala de trabajo de parto del hospital: 112 antes de la intervención, entre el 18 de mayo y el 3 de junio del 2009, y 112 después de la intervención, entre el 6 y el 20 de julio del 2009. La intervención consistió en: 1) un taller de capacitación sobre las "mejores prácticas" en la atención del parto, de 3 días de duración y 2) una directiva del hospital. Se observaron todos los partos y se midió el tiempo entre la salida del hombro anterior y el pinzamiento del cordón umbilical con un cronómetro digital. RESULTADOS: El tiempo medio entre el parto y el pinzamiento del cordón antes de la intervención fue de 56,8 segundos (intervalo de confianza [IC] de 95 por cento: 51,0-62,7), y aumentó a 169,8 segundos (IC 95 por cento: 153,8-185,8) después de la intervención. La diferencia en el tiempo medio hasta el pinzamiento siguió siendo significativa en los análisis multivariados (βajustado = 113,2 segundos, IC 95 por cento: 96,6-129,9). CONCLUSIONES: Es posible cambiar las normas y las prácticas hospitalarias de pinzamiento del cordón umbilical de precoz a tardío mediante una intervención sencilla de dos componentes.