"It is not by choice that I gave birth at home": the social determinants of home births during COVID-19 in peri-urban and urban Kenya, a qualitative study.

BACKGROUND: The COVID-19 pandemic significantly impacted the provision of global maternal health services, with an increase in home births. However, there are little data on women's decision-making and experiences leading up to home births during the pandemic. The objective of this study is to examine the economic, social, and health system factors associated with home births in Kenya. METHODS: Community health volunteers (CHVs) and village leaders helped identify potential participants for an in-depth, one-on-one, qualitative telephone interview in Nairobi and Kiambu County in Kenya. In total, the study interviewed 28 mothers who had home births. RESULTS: This study identified a number of economic, social, neighborhood, and health system factors that were associated with birthing at home during the COVID-19 pandemic. Only one woman had planned on birthing at home, while all other participants described various reasons they had to birth at home. Themes related to home births during the pandemic included: (1) unmet preferences related to location of birth; (2) burdens and fear of contracting COVID-19 leading to delayed or missed care; (3) lack of perceived community safety and fear of encounters with law enforcement; and (4) healthcare system changes and uncertainty that led to home births. CONCLUSION: Addressing and recognizing women's social determinants of health is critical to ensuring that preferences on location of birth are met.

Comment: silent burden no more: a global call to action to prioritize perinatal mental health.

Common perinatal mental disorders are the most frequent complications of pregnancy, childbirth and the postpartum period, and the prevalence among women in low- and middle-income countries is the highest at nearly 20%. Women are the cornerstone of a healthy and prosperous society and until their mental health is taken as seriously as their physical wellbeing, we will not improve maternal mortality, morbidity and the ability of women to thrive. On the heels of several international efforts to put perinatal mental health on the global agenda, we propose seven urgent actions that the international community, governments, health systems, academia, civil society, and individuals should take to ensure that women everywhere have access to high-quality, respectful care for both their physical and mental wellbeing. Addressing perinatal mental health promotion, prevention, early intervention and treatment of common perinatal mental disorders must be a global priority.

Principled Subpopulation Analysis of the BetterBirth Study and the Impact of WHO's Safe Childbirth Checklist Intervention.

The World Health Organization (WHO) developed the Safe Childbirth Checklist as an intervention to improve care and outcomes in maternal and newborn health. The original study reported that the intervention did not significantly improve the outcomes. In this work, we employ a principled data-driven analysis to identify subpopulations with divergent characteristics: 1) vulnerable subgroups with the highest risk of neonatal deaths and 2) subgroups in the intervention arm that benefited from the Checklist intervention with significantly reduced risks of deaths and complications. Results demonstrate that low birth weight represented the most vulnerable group, whereas mother-baby dyads described by normal gestational age at birth, known parity, and unknown number of abortions was found to benefit from the Checklist intervention (OR : 0.70, 95%CI : 0.62-0.79, p < 0.001). Generally, the flexibility of our approach helps to answer subgroup-based queries in the broader global health domain, which also provides further insights to domain experts.

Identifying Factors Associated with Neonatal Mortality in Sub-Saharan Africa using Machine Learning.

This study aimed at identifying the factors associated with neonatal mortality. We analyzed the Demographic and Health Survey (DHS) datasets from 10 Sub-Saharan countries. For each survey, we trained machine learning models to identify women who had experienced a neonatal death within the 5 years prior to the survey being administered. We then inspected the models by visualizing the features that were important for each model, and how, on average, changing the values of the features affected the risk of neonatal mortality. We confirmed the known positive correlation between birth frequency and neonatal mortality and identified an unexpected negative correlation between household size and neonatal mortality. We further established that mothers living in smaller households have a higher risk of neonatal mortality compared to mothers living in larger households; and that factors such as the age and gender of the head of the household may influence the association between household size and neonatal mortality.

Evaluating consistency of recall of maternal and newborn care complications and intervention coverage using PMA panel data in SNNPR, Ethiopia.

BACKGROUND: There is recognition that effective interventions are available to prevent neonatal and maternal deaths but providing reliable and valid coverage estimates remains a challenge. Household surveys rely on recall of self-reported events that may span up to 5 years, raising concerns of recall bias. OBJECTIVE: This study assessed the reliability of maternal recall of pregnancy, delivery, and postpartum events over a six-month period and identified relevant individual characteristics associated with inconsistent reporting. METHODOLOGY: A longitudinal household survey was conducted with 321 pregnant women in 44 enumeration areas in Southern Nationals, Nationalities and People's Region in Ethiopia. Women who were six or more months pregnant were enrolled and interviewed at seven days, six weeks, and six months post-partum using an identical set of questions regarding maternal and neonatal health and receipt of select neonatal care interventions. We compared responses given at 7 days to those reported at 6 weeks and 6 months and conducted sensitivity, specificity, area under receiving operative curve, and Kappa analyses of selected indicators. RESULTS: We find that reporting complications is higher at the first interview after birth than at either the six-week or six-month interview. The specificity of the majority of complications is high, however sensitivity is generally much lower. The sensitivity of reporting any complication during pregnancy, delivery, or post-partum ranged from 54.5% to 67.6% at the 6-week interview and from 39.2% to 63.2% at the 6-month interview. Though sensitivity of receipt of neonatal interventions was high, specificity and kappa demonstrate low consistency. CONCLUSION: As with childbirth, it may be that during the first seven days women note symptoms with higher scrutiny, but if these do not later develop into serious health issues, they may be forgotten over time. Maternal complications and care are likely to be under-reported by women if interviewed for distant events.