Maternal and Neonatal Outcomes of COVID-19 Infection in Pregnancy.

BACKGROUND: Limited data is available on the full spectrum of maternal COVID-19 infection in terms of pregnancy outcomes. The present study aimed to compare the maternal and neonatal outcomes of COVID-19 in infected and non-infected pregnant women. METHODS: A dual-site retrospective cohort study was conducted in two tertiary hospitals in Isfahan, Iran. The sample included 104 infected and 210 non-infected hospitalized pregnant women. Odds ratios (OR) were estimated using multivariate logistic regression. RESULTS: There were significant differences between COVID-19-infected and non-infected pregnant women regarding preterm labor (PTL) (odds ratio [OR]: 11.34, 95% confidence interval [CI]: 1.19-48.54, P=0.035); hospitalization days (OR: 7.21, 95% CI: 4.05-12.85, P≤0.001); cesarean section (CS) (OR: 4.76, 95% CI: 1.78-12.45, P=0.002); neonatal admission to neonatal intensive care unit (NICU) (OR: 1.28, 95% CI: 1.12-1.67, P=0.004); and neonatal respiratory distress (OR: 2.37, 95% CI: 1.02- 5.47, P=0.044). No significant association was found between COVID-19 infection and abortion (OR: 0.06, 95% CI: 0.01-1.45, P=0.084); stillbirth (OR: 1.84, 95% CI: 0.05-39.68, P=0.743); Apgar score (1 minute) (OR: 0.91, 95% CI: 0.74-1.13, P=0.382); Apgar score (5 minutes) (OR: 0.97, 95% CI: 0.81-1.18, P=0.765); and low birth weight (LBW) (OR: 4.76, 95% CI: 1.78-12.45, P=0.002). CONCLUSION: PTL, CS, neonatal admission in NICU, neonatal respiratory distress, and hospitalization days were significantly higher in pregnant women with COVID-19 compared to those without infection.

Women empowerment in reproductive health: a systematic review of measurement properties.

INTRODUCTION: There is a considerable dearth of official metrics for women empowerment, which is pivotal to observe universal progress towards Sustainable Development Goals 5, targeting "achieve gender equality and empower all women and girls." This study aimed to introduce, critically appraise, and summarize the measurement properties of women empowerment scales in sexual and reproductive health. METHODS: A comprehensive systematic literature search through several international electronic databases, including PubMed, Scopus, Embase, ProQuest, and Science Direct was performed on September 2020, without a time limit. All studies aimed to develop and validate a measurement of women empowerment in sexual and reproductive health were included. The quality assessment was performed through a rating scale addressing the six criteria, including: a priori explicit theoretical framework, evaluating content validity, internal consistency, and factor analysis to assess structural validity. RESULTS: Of 5234 identified studies, fifteen were included. The majority of the studies were conducted in the United States. All studies but one used a standardized measure. Total items of each scale ranged from 8 to 23. The most common domains investigated were decision-making, freedom of coercion, and communication with the partner. Four studies did not use any conceptual framework. The individual agency followed by immediate relational agency were the main focus of included studies. Of the included studies, seven applied either literature review, expert panels, or empirical methods to develop the item pool. Cronbach's alpha coefficient reported in nine studies ranged from α = 0.56 to 0.87. Most of the studies but three lack reporting test-retest reliability ranging r = 0.69-0.87. Nine studies proved content validity. Six criteria were applied to scoring the scales, by which nine of fifteen articles were rated as medium quality, two rated as poor quality, and four rated as high quality. CONCLUSION: Most scales assessed various types of validity and Internal consistency for the reliability. Applying a theoretical framework, more rigorous validation of scales, and assessing the various dimensions of women empowerment in diverse contexts and different levels, namely structural agency, are needed to develop effective and representing scales.

Impact of COVID-19 Infection on Neonatal Birth Outcomes.

INTRODUCTION: There is limited data on newborns born to mothers with COVID-19 infection. This multicenter cohort study aimed to investigate the clinical characteristics and outcomes of neonates born to mothers with and without COVID-19 infection to fill a gap in the literature review. METHODS: The medical records of all neonates in Isfahan, Iran, between October 2020 and March 2021, were retrospectively reviewed. RESULTS: Among the 600 neonates in this study, 255 (42.5%) were in the infected group and 345 (57.5%) were assigned to the control group as they were born to non-infected mothers. In the infected group, sepsis, fever and pneumothorax were detected in 3 (1.2%), 3 (1.2%) and 4 (1.6%) neonates, respectively, compared with no case in the control group. In the infected group, neonatal respiratory distress (NRDS) (32, 12.5%) was significantly higher than the control group (27, 10.6%). Asphyxia in the infected group was 22(6.4%), compared with 19 (5.5%), in the control group. Preterm labor (PTL) (55, 21.65%), premature rupture of membranes (PROMs) (24, 9.4%) and intra-uterine growth retardation (IUGR) (15, 5.9%) were significantly higher in women with COVID-19 (45, 13.0%, 4, 1.2% and 7, 2.0%, respectively). Low birth weight (LBW) accounted for 42 (16.5%) neonates in the infected group and 25 (7.2%) in the control group (p < 0.05). Of the 255 neonates born to infected mothers, 38 (14.9%) were admitted to the Neonatal Intensive Care Unit (NICU), compared with 31 out of 345 (9.0%) in the control group (p < 0.05). RT-PCR test results were positive in two newborns (0.8%), one of whom died of necrotizing enterocolitis. CONCLUSION: As a result of maternal COVID-19 infections, neonates experienced higher rates of sepsis, fever, pneumothorax, asphyxia and NRDS in addition to PTL, PROMs, IUGR, and LBW.

Contradictory results have been reported on the impact of COVID-19 infection on neonatal outcomes. We conducted a review of 600 cases of neonates, with 255 (42.5%) in the COVID-19 infected and 345 (57.5%) in the control group. The results indicated that neonates born to women with COVID-19 showed higher rates of sepsis, fever, pneumothorax, asphyxia and neonatal respiratory distress in addition to preterm labor, premature rupture of membranes, intra-uterin growth retardation and low birth weight.

Characteristics and outcomes of COVID-19 pneumonia in pregnancy compared with infected nonpregnant women.

OBJECTIVE: To compare the clinical and paraclinical features and outcomes of pregnant and nonpregnant women with COVID-19. METHODS: A multicenter retrospective cohort study of pregnant and nonpregnant women of reproductive age hospitalized between March and October 2020 in Tehran, Iran. Medical records were reviewed and women who tested positive for SARS-CoV-2 on RT-PCR were included. Extracted data were compared and logistic regression performed. RESULTS: A total of 110 pregnant and 234 nonpregnant COVID-19-positive women were included. Frequency of severe disease was higher in nonpregnant women than pregnant women (29% vs 11.8%; P < 0.001). Symptoms including cough, dyspnea, chill, fatigue, and headache were more frequent in nonpregnant women (P < 0.05). Pregnant women had higher oxygen saturation levels and lower lymphocyte count (P = 0.001). Six (5.5%) pregnant and 12 (5.1%) nonpregnant women died (P = 0.80). No significant differences between the groups were found for ICU admission and end organ failure. Significantly more nonpregnant women had acute respiratory distress syndrome (ARDS, 9.4% vs 0%; P = 0.001). Univariate regression indicated association between hypertension and death; oxygen saturation and ARDS; and body mass index and ICU admission. No association was found between pregnancy and death, ICU admission, or ARDS. CONCLUSION: Pregnant women with COVID-19 are not at higher risk of adverse outcomes compared with nonpregnant women.

The mental health of healthcare workers in the COVID-19 pandemic: A systematic review.

Purpose: The novel coronavirus 2019 (COVID-19) is widely spreading all over the world, causing mental health problems for most people. The medical staff is also under considerable psychological pressure. This study aimed to review all research carried out on the mental health status of health care workers (HCWs) to bring policymakers and managers' attention. Methods: A literature search conducted through e-databases, including PubMed, EMBASE, Scopus, and Web of Science (WoS) from December 2019 up to April 12th 2020. All cross- sectional studies published in English which assessed the health workers' psychological well-being during the SARS-CoV-2 pandemic included. Study quality was analyzed using NHLBI Study Quality assessment tools. Results: One hundred relevant articles were identified through systematic search; of which eleven studies were eligible for this review. Their quality score was acceptable. The lowest reported prevalence of anxiety, depression, and stress among HCWs was 24.1%, 12.1%, and 29.8%, respectively. In addition, the highest reported values for the aforementioned parameters were 67.55%, 55.89%, and 62.99%, respectively. Nurses, female workers, front-line health care workers, younger medical staff, and workers in areas with higher infection rates reported more severe degrees of all psychological symptoms than other health care workers. Moreover, vicarious traumatization in non-front-line nurses and the general public was higher than that of the front-line nurses. Conclusion: During SARS-CoV-2 outbreak, the health care workers face aggravated psychological pressure and even mental illness. It would be recommended to the policymakers and managers to adopt the supportive, encouragement & motivational, protective, and training & educational interventions, especially through information and communication platform.

Climate-Related Displacement and Antenatal Care Service Utilization in Rural Bangladesh.

CONTEXT: Extreme weather events cause large-scale population displacement in Bangladesh. It is important to know how household displacement due to such events might affect women's antenatal care (ANC) service utilization. METHODS: In 2017, a cross-sectional household survey was conducted in 25 rural villages in either displacement prone or non-displacement prone areas of Bangladesh. Data were collected from 611 respondents (a woman or her husband) who reported having had a live birth in the past three years; of those, 289 had experienced household displacement due to an extreme weather event. Logistic regression analyses were conducted to examine the relationship between experience of household displacement and women's ANC service utilization during their last pregnancy resulting in a live birth. RESULTS: Eighty-three percent of women had received at least one ANC visit during their last pregnancy resulting in a live birth; of those, 31% received at least four visits with a trained provider. Women from households that had been displaced three or more times were less likely than those from nondisplaced households to have received an ANC visit and at least four visits with a trained provider (odds ratios, 0.3 and 0.4, respectively). Receiving at least four visits with a trained provider was also associated with having previous children (0.3-0.4), age at pregnancy (2.5-3.9), husband's occupation (2.2 for "other") and joint parental decision-making about ANC visits (1.8). CONCLUSIONS: Strengthening family planning services and extending eligibility for Bangladesh's Maternity Allowance benefits in the areas prone to floods and riverbank erosion are recommended to improve ANC service utilization.

RESUMEN Contexto: Los eventos climáticos extremos causan desplazamientos de población a gran escala en Bangladesh. Es importante conocer cómo el desplazamiento de hogares debido a tales eventos podría afectar la utilización que las mujeres hacen de los servicios de atención prenatal (APN). Métodos: En 2017, se condujo una encuesta transversal de hogares en 25 pueblos rurales de Bangladesh tanto en áreas propensas al desplazamiento como en áreas no propensas al mismo. Se recolectaron datos de 611 personas entrevistadas (mujeres o sus cónyuges) que reportaron haber tenido un nacido vivo en los tres años previos; de ellas, 289 habían experimentado desplazamiento del hogar debido a un evento climático extremo. Se llevaron a cabo análisis de regresión logística para examinar la relación entre la experiencia del desplazamiento del hogar y la utilización de servicios de APN por las mujeres durante su último embarazo que resultó en un nacido vivo. Resultados: Ochenta y tres por ciento de las mujeres habían tenido al menos una visita de APN durante su último embarazo que resultó en un nacido vivo; de ellas, 31% tuvo al menos cuatro visitas con un proveedor de servicios capacitado. Las mujeres de hogares que habían sido desplazados tres o más veces tuvieron menos probabilidad que las mujeres de hogares no desplazados de haber tenido una visita de APN y al menos cuatro visitas con un proveedor de servicios capacitado (razón de probabilidades, 0.3 y 0.4, respectivamente). Tener hijos previamente (0.3­0.4), edad al embarazo (2.5­3.9), ocupación del cónyuge (2.2 para "otro") y toma de decisiones parentales conjunta sobre visitas de APN (1.8) también estuvieron asociados con el hecho de tener al menos cuatro visitas con un proveedor de servicios capacitado. Conclusiones: Se recomienda fortalecer los servicios de planificación familiar y extender la elegibilidad para los beneficios de la Prestación por Maternidad del Gobierno de Bangladesh en las áreas propensas a inundaciones y erosión de las riberas de los ríos para mejorar la utilización de servicios de APN.

RÉSUMÉ Contexte: Les phénomènes météorologiques extrêmes sont la cause de déplacements de population à grande échelle au Bangladesh. Il importe de documenter l'effet éventuel de ce déplacement des ménages sur le recours des femmes aux prestations de soins prénatals (SPN). Méthodes: En 2017, une enquête transversale auprès des ménages a été menée dans 25 villages bangladais situés dans des zones sujettes ou non au déplacement. Les données ont été collectées auprès de 611 répondants (les femmes ou leur mari) ayant déclaré avoir eu une naissance vivante au cours des trois dernières années. Parmi ces répondants, 289 avaient connu un déplacement du ménage dû à un phénomène météorologique extrême. La relation entre le vécu de ce déplacement et le recours des femmes aux prestations SPN durant leur dernière grossesse ayant abouti sur une naissance vivante a été examinée par analyses de régression logistique. Résultats: Quatre-vingt-trois pour cent des femmes avaient obtenu au moins une consultation SPN durant leur dernière grossesse ayant abouti sur une naissance vivante; parmi elles, 31% en avaient obtenu au moins quatre avec un prestataire qualifé. Les femmes des ménages déplacés trois fois ou davantage étaient moins susceptibles que celles des ménages non déplacés d'avoir obtenu une consultation SPN et au moins quatre consultations avec un prestataire qualifié (RC, 0,3 et 0,4, respectivement). L'expérience antérieure de la maternité (0,3­0,4), l'âge au moment de la grossesse (2,5­3,9), l'activité professionnelle du mari (2,2 pour « autre ¼) et la prise de décision parentale conjointe concernant les consultations SPN (1,8) se sont aussi avérés associés à l'obtention d'au moins quatre consultations avec un prestataire qualifié. Conclusions: Le renforcement des services de planification familiale et l'admissibilité accrue aux prestations de maternité du gouvernement bangladais dans les zones vulnérables aux inondations et à l'érosion des rives sont recommandés pour améliorer le recours aux prestations SPN.

Analysis of Maternal Coronavirus Infections and Neonates Born to Mothers with 2019-nCoV; a Systematic Review.

INTRODUCTION: The emergence and fast spread of 2019 novel coronavirus (2019-nCoV) threatens the world as a new public health crisis. This study aimed to clarify the impact of novel coronavirus disease (COVID-19) on pregnant patients and maternal and neonatal outcomes. METHODS: A comprehensive literature search was conducted in databases including PubMed, Scopus, Embase, ProQuest, and Science Direct. All studies including original data; case reports, case series, descriptive and observational studies, and randomized controlled trials were searched from December 2019 until 19 March 2020. RESULTS: The search identified 1472 results and 939 abstracts were screened. 928 articles were excluded because studies did not include pregnant women. Full texts of eleven relevant studies were reviewed and finally nine studies were included in this study. The characteristics of 89 pregnant women and their neonates were studied. Results revealed that low-grade fever and cough were the principal symptoms in all patients. The main reported laboratory findings were lymphopenia, elevated C-Reactive Protein (CRP), Amino alanine transferase (ALT), and Aspartate amino transferase (AST). In all symptomatic cases, chest Computerized Tomography (CT) scans were abnormal. Fetal distress, premature rupture of membranes and preterm labor were the main prenatal complications. Two women needed intensive care unit admission and mechanical ventilation, one of whom developed multi-organ dysfunction and was on Extracorporeal Membrane Oxygenation (ECMO). No case of maternal death was reported up to the time the studies were published. 79 mothers delivered their babies by cesarean section and five women had a vaginal delivery. No fetal infection through intrauterine vertical transmission was reported. CONCLUSIONS: Available data showed that pregnant patients in late pregnancy had clinical manifestations similar to non-pregnant adults. It appears that the risk of fetal distress, preterm delivery and prelabor rupture of membranes (PROM) rises with the onset of COVID-19 in the third trimester of pregnancy. There is also no evidence of intrauterine and transplacental transmission of COVID-19 to the fetus in the third trimester of pregnancies.

The effects of household's climate-related displacement on delivery and postnatal care service utilization in rural Bangladesh.

Exposure to extreme climate events causes population displacement and adversely affects the health of mothers and children in multiple ways. This paper investigates the effects of displacement on whether a child is delivered at a health center, as opposed to at home, and on postnatal care service utilization in Bangladesh. Using cross-sectional survey data from 599 mothers who gave birth in the three years prior to the date of interview, including 278 from households which had previously been displaced and 231 from households which had not been displaced, we use multivariate logistic regression to identify the factors associated with maternal healthcare service utilization. The results show that displaced households' mothers are only about a quarter as likely to deliver at a health center as mothers from non-displaced households. The use of health center-based delivery decreases as the numbers of past displacements increases. Higher number of previous children, lower use of antenatal care during pregnancy, lower household income, and lack of access to radio/television also significantly reduce a mother's likelihood of delivery at a health center. Displaced mothers are also substantially less likely to use postnatal care services for their neonates, especially those supplied by trained providers. Use of health facilities for delivery, use of antenatal care services, and previous number of children are other important predictors of postnatal care service utilization for neonates. In light of these findings, relocation of local health facilities with basic and emergency care provisions to areas in which the displaced have resettled, reinforcement of Family Planning services, and extension of coverage of the Maternity Allowance benefits in the displacement-prone mainland riverine areas are recommended policy responses.

Parents' healthcare-seeking behavior for their children among the climate-related displaced population of rural Bangladesh.

In Bangladesh climate change has contributed to a massive displacement of people. This study examines the effects of climate-related displacement, socioeconomic status, availability of healthcare providers and disease-related attributes on the healthcare-seeking behaviors of parents for their children. Using cross-sectional survey data from the parents of 1003 children aged under 15 who were ill in the four weeks prior to the interview, collected from 600 randomly-selected households in climate displacement-susceptible areas and 600 households in non-climate-displacement-susceptible areas in Bangladesh, we use multivariate logistic regression to identify the factors associated with parental healthcare-seeking behaviors. The results show that 15.5% of the children who had been ill receive either no care or curative care at home. Of those receiving care outside the home, only 22.1% are treated by trained providers. Climate-related displaced parents are significantly less likely to seek care or to use provider-prescribed care to manage children's illnesses. Areas lacking local healthcare providers, poorer households, females, child age and mild illness are also associated with a child being significantly less likely to be treated outside the home. The children of climate-related displaced parents are around half as likely as those of non-displaced parents to be treated by a trained provider. The local availability of medical doctors, cost of reaching a healthcare center, household income, type and severity of illness, child's age, and joint parental decision-making about care providers are also important predictors of the selection of trained healthcare providers for children. Thus, climate-related displacement affects the healthcare-seeking behaviors of parents for their children. Policy aimed at improving child health should address the socioeconomic disadvantage and access to healthcare of the displaced, the training of local untrained providers about Primary Health Care service provision, and the numbers of medical doctors in the displacement-prone areas.

LOCAL GOVERNMENT AND COMMUNITY LEADERS' PERSPECTIVES ON CHILD HEALTH AND MORTALITY AND INEQUITY ISSUES IN RURAL EASTERN INDONESIA.

Since 2001 a decentralization policy has increased the responsibility placed on local government for improving child health in Indonesia. This paper explores local government and community leaders' perspectives on child health in a rural district in Indonesia, using a qualitative approach. Focus group discussions were held in May 2013. The issues probed relate to health personnel skills and motivation, service availability, the influence of traditional beliefs, and health care and gender inequity. The participants identify weak leadership, inefficient health management and inadequate child health budgets as important issues. The lack of health staff in rural areas is seen as the reason for promoting the use of traditional birth attendants. Midwifery graduates and village midwives are perceived as lacking motivation to work in rural areas. Some local traditions are seen as detrimental to child health. Husbands provide little support to their wives. These results highlight the need for a harmonization and alignment of the efforts of local government agencies and local community leaders to address child health care and gender inequity issues.

Advocate program for healthy traditional houses, Ume Kbubu, in a Timor community: preserving traditional behavior and promoting improved health outcomes.

Families in the Timor society of Indonesia have customarily used traditional houses, called Ume Kbubu, for confinement practices of a newborn baby and the mother during the first 40 days after birth. The practice, known as Sei (smoke) tradition, involves retaining heat, which is believed to foster healing, inside the house by continuously burning a wood burning stove. Exacerbated by inadequate ventilation in the traditional house, this practice results in poor indoor air quality and negatively affects the health of the mother and baby. Preliminary findings from a baseline study conducted in 2009 identified high levels of indoor air pollution in Ume Kbubu where mothers practiced the Sei tradition. Many respondents expressed that they suffered from respiratory health problems during the practice. On the basis of those results, a follow-up study was conducted in 2011 to develop and test a communication-focused behavior change intervention that would foster conversion of traditional houses into healthy Ume Kbubu and promote changes to traditional practices for better health outcomes. The study suggests that redesigning an Ume Kbubu house could promote better air quality inside the house and involving the community in the health intervention program led to positive changes in the Sei practice (i.e., decreasing the Sei period's length from 40 days to 4 days on average and attempting to reduce household air pollution). The study resulted in several recommendations in relation to sustained transformation to improve health behaviors.

INEQUITY ISSUES AND MOTHERS' PREGNANCY, DELIVERY AND EARLY-AGE SURVIVAL EXPERIENCES IN ENDE DISTRICT, INDONESIA.

Indonesia's infant mortality rates are among the highest in South-East Asia, and there are substantial variations between its sub-national regions. This qualitative study aims to explore early mortality-related health service provision and gender inequity issues based on mothers' pregnancy, delivery and early-age survival experience in Ende district, Nusa Tenggara Timur province. Thirty-two mothers aged 18-45 years with at least one birth in the previous five years were interviewed in depth in May 2013. The results show most mothers have little knowledge about the danger signs for a child's illness. Mothers with early-age deaths generally did not know the cause of death. Very few mothers had received adequate information on maternal and child health during their antenatal and postnatal visits to the health facility. Some mothers expressed a preference for using a traditional birth attendant, because of their ready availability and the more extensive range of support services they provide, compared with local midwives. Unprofessional attitudes displayed by midwives were reported by several mothers. As elsewhere in Indonesia, the power of health decision-making lies with the husband. Policies aimed at elevating mothers' roles in health care decision-making are discussed as measures that would help to improve early-age survival outcomes. Widening the public health insurance distribution, especially among poorer mothers, and equalizing the geographical distribution of midwives and health facilities are recommended to tackle geographical inequities and to increase early-age survival in Ende district.

Urbanization and fertility: an event-history analysis of coastal Ghana.

In this article, we undertake an event-history analysis of fertility in Ghana. We exploit detailed life history calendar data to conduct a more refined and definitive analysis of the relationship among personal traits, urban residence, and fertility. Although urbanization is generally associated with lower fertility in developing countries, inferences in most studies have been hampered by a lack of information about the timing of residence in relationship to childbearing. We find that the effect of urbanization itself is strong, evident, and complex, and persists after we control for the effects of age, cohort, union status, and education. Our discrete-time event-history analysis shows that urban women exhibit fertility rates that are, on average, 11% lower than those of rural women, but the effects vary by parity. Differences in urban population traits would augment the effects of urban adaptation itself Extensions of the analysis point to the operation of a selection effect in rural-to-urban mobility but provide limited evidence for disruption effects. The possibility of further selection of urbanward migrants on unmeasured traits remains. The analysis also demonstrates the utility of an annual life history calendar for collecting such data in the field.