Health system-related barriers to prenatal care management in low- and middle-income countries: a systematic review of the qualitative literature.

BACKGROUND: Appropriate prenatal care (PNC) is essential for improving maternal and infant health; nevertheless, millions of women in low- and middle-income countries (LMICs) do not receive it properly. The objective of this review is to identify and summarize the qualitative studies that report on health system-related barriers in PNC management in LMICs. METHODS: This systematic review was conducted in 2022. A range of electronic databases including PubMed, Web of Knowledge, CINHAL, SCOPUS, Embase, and Science Direct were searched for qualitative studies conducted in LMICs. The reference lists of eligible studies also were hand searched. The studies that reported health system-related barrier of PNC management from the perspectives of PNC stakeholders were considered for inclusion. Study quality assessment was performed applying the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed. RESULTS: Of the 32 included studies, 25 (78%) were published either in or after 2013. The total population sample included 1677 participants including 629 pregnant women, 122 mothers, 240 healthcare providers, 54 key informed, 164 women of childbearing age, 380 community members, and 88 participants from other groups (such as male partners and relatives). Of 32 studies meeting inclusion criteria, four major themes emerged: (1) healthcare provider-related issues; (2) service delivery issues; (3) inaccessible PNC; and (4) poor PNC infrastructure. CONCLUSION: This systematic review provided essential findings regarding PNC barriers in LMICs to help inform the development of effective PNC strategies and public policy programs.

Comparative Efficacy of Different Classes of Antiemetic Medications for the Prevention of Nausea and Vomiting in Cesarean Section: A Network Meta-Analysis.

Background: Antiemetic medications have been associated with the prevention of nausea and vomiting in cesarean section, although less is known about the comparative efficacy of different medication classes. Methods: We conducted a systematic review with network meta-analyses to compare and rank antiemetic medication classes (5-HT3 receptor antagonists, dopamine receptor antagonists, corticosteroids, antihistamines, anticholinergic agents, sedatives, and opioid antagonists or partial agonists) in terms of preventing intra- and postoperative nausea and vomiting among patients undergoing cesarean section. We included all randomized controlled trials (RCTs) that evaluated any antiemetic medication classes' treatment for target outcomes. Network meta-analysis was conducted with a frequentist approach using the R netmeta package. A total of 58 trials were included (6,665 women undergoing cesarean section; mean age, 28.1 years). Results: Compared with placebo, all interventions reduced the odds of intraoperative nausea (except antihistamines), intraoperative vomiting (except antihistamines), postoperative nausea (except anticholinergic agents and opioid antagonists), and postoperative vomiting (except opioid antagonists). In terms of intraoperative nausea and both intra- and postoperative vomiting, sedatives ranked first among other medication classes. Conclusions: The relative effect sizes for various classes of antiemetic medication in preventing nausea and vomiting in the cesarean section were modeled using the principles of network meta-analysis which may facilitate informed clinical decision-making.

A Systematic Review and Meta-Analysis of the Prevalence of Malnutrition Among 6-14-Year-Old Children in Iran.

Background: Malnutrition is a major public health issue worldwide. It has significant consequences, including weakened immune systems, which may lead to increased incidences of infectious disease and higher mortality, particularly in children. A systematic review and meta-analysis were conducted to estimate the overall prevalence of malnutrition (wasting, underweight, and stunting) among children of 6-14 years of age in Iran. Methods: Data were collected in 2018 based on searches of the PubMed, Science Direct, Scopus, Google Scholar, Science Information Database (SID), Magiran, Irandoc, and Iranmedex databases using the following keywords: childhood, childhood malnutrition, children, nutrition, malnutrition, wasting, underweight, stunting, child, student, boy, girl, cause, prevalence, and Iran, in order to identify studies eligible for inclusion in the review. Comprehensive Meta-Analysis, version 2 (CMA: 2) was used to estimate the overall prevalence of malnutrition. Results: Nine out of 328 articles were included in our analyses. The overall of wasting among children of 6-14 years of age in Iran based on the random-effects model (according to nine studies and 18,296 participants) was 12.5% (95% Confidence Interval, 7.1-21.2). The overall prevalence of underweight based on the random-effects model (according to 10 studies and 19,185 participants) was 19% (95% CI, 8.1-38.6). Also, the overall prevalence of stunting based on the random-effects model (according to 10 studies and 19,185 participants) was 20% (95% CI, 9.4-37.8). Conclusions: The results of this study show that the prevalence of malnutrition among 6-14-year-old children in Iran is similar to the global average. We need solutions that can be used for both prevention and reduction of malnutrition, especially in areas with middle or low socioeconomic status. It is necessary to identify factors associated with malnutrition in various geographic regions in order to implement appropriate programs based on factors with the highest impact in each region.

Differential effect of polyvinylpyrrolidone-coated superparamagnetic iron oxide nanoparticles on BT-474 human breast cancer cell viability.

Polyvinylpyrrolidone superparamagnetic iron oxide nanoparticles (PVP-SPIONs) have unique properties. Due to these characteristics, PVP-SPIONs have been used in several medical applications such as magnetic resonance imaging (MRI) contrast agent or drug delivery system. However, a more comprehensive understanding of the environmental safety of PVP-SPIONs is vital for consumption of these nanomaterials. In this study, we describe the effects of PVP-SPIONs on cell viability of the BT-474 human breast cancer cells. Cell viability of the BT-474 cells treated with PVP-SPIONs (10-800 µg/ml) was assessed by MTT assay. MRC-5 cell line was used as a control. Quantitative real-time PCR was performed to investigate the mRNA expression levels of apoptotic (caspase 3) and anti-apoptotic (BCL2) genes Confluent BT-474 monolayers exposed to PVP-SPIONs showed biphasic effects on cell proliferation. PVP-SPIONs at 10-100 µg /ml promote proliferation of BT-474 cells but not the MRC-5 cells. At higher dosage, PVP-SPIONs have toxicity on BT-474 cells. The results of real-time PCR was in line with MTT assay. The increase of cell proliferation at low PVP-SPIONs concentrations is different from what would be expected for these nanoparticles. Our results suggest that more attentions are needed to ensure the safer use of SPION in nanomedicine.

Tolerance to heavy metals in filamentous fungi isolated from contaminated mining soils in the Zanjan Province, Iran.

In the present study the population of fungi inhabiting metal contaminated soil samples from lead-zinc mining area was investigated, and their tolerance and biosorption capacity towards Cd, Pb, Zn and Cu were evaluated. Fungal species, including Acremonium persicinum, Penicillium simplicissimum, Seimatosporium pistaciae, Trichoderma harzianum, Alternaria chlamydosporigena and Fusarium verticillioides were isolated. Fungal tolerance was determined by measuring of the "Minimum Inhibitory Concentration", after exposure to increasing concentrations of heavy metal chlorides. Among the test fungi, Trichoderma harzianum was the most tolerant against Cd, Pb and Cu. The Heavy metal content in the fungal biomass was quantified after combustion. The calculated total sorption of heavy metals showed that Acremonium persicinum and Penicillium simplicissimum had the highest accumulation of Zn and Cu, respectively. The data presented in this study should help to use the accumulation potential of some of those fungal species examined for bioremediation of contaminated soils.

Diversity of culturable fungi inhabiting petroleum-contaminated soils in Southern Iran.

The present study was aimed at characterising species diversity of fungi inhabiting petroleum-contaminated soils of oil fields in a southern region of Iran. Two different techniques were used for fungal isolation including enrichment on atmospheres of phenolic hydrocarbons and crude oil as substrate. Phylogenetic analysis of the internal transcribed spacer of ribosomal DNA was used for taxonomic identification with additional information from the ß-tubulin gene for selected taxa. Overall, 183 strains from 14 genera and five orders were obtained: Pleosporales (Alternaria, Curvularia, Stemphylium, Ulocladium), Chaetothyriales (Exophiala), Eurotiales (Aspergillus), Hypocreales (Acremonium, Emericellopsis, Sarocladium, Stachybotrys, Fusarium, Trichoderma, Beauveria), and Capnodiales (Cladosporium). The most frequently isolated strains belonged to the genera Alternaria, Exophiala and Aspergillus. The crude oil substrate was the most successful isolation method, and among the four hydrocarbon enrichments, toluene substrate yielded the highest number of strains. Enrichment on xylene and benzene also yielded herpotrichiellaceous and other filamentous fungi.

Health-Related Quality of Life and its Predictive Factors among Infertile Women.

INTRODUCTION: The present study aimed to determine health-related quality of life (HRQOL) and its predictive factors among infertile women. METHODS: This cross-sectional study was conducted on infertile women referring to Majidi Infertility Center (Tabriz, Iran). The data was collected through self-administered questionnaires including clinical and demographic characteristics and the Persian version of 36-item short form health survey (SF-36). One-sample t-test, independent t-test, one-way analysis of variance (ANOVA), and logistic regression were used for data analysis. RESULTS: Overall, 1012 infertile women were studied. The quality of life scores of infertile women in all eight subscales were significantly lower than normative data for Iranian women. Low physical component summary was more frequent in younger [adjusted odds ratio (AOR):1.45; 95% CI: 1.07-1.96], less educated (AOR: 1.75; 95% CI: 1.27-2.41), and low income (AOR: 1.52; 95% CI: 1.06-2.16) participants. It was less frequent in individuals whose infertility duration was 3-9 years (AOR: 0.65; 95% CI: 0.48-0.86), had male (AOR: 0.58; 95% CI: 0.43-0.78) or female and male factors infertility (AOR: 0.48; 95% CI: 0.30-0.78), or had a history of 1-2 in vitro fertilization (IVF), intrauterine insemination (IUI), or intracytoplasmic sperm injection (ICSI). Low mental component summary was associated with low income (AOR: 1.56; 95% CI: 1.11-2.18) and unexplained cause of infertility (AOR: 0.52; 95% CI: 0.32-0.56). CONCLUSION: The findings of this study indicated low quality of life among infertile women. The findings suggested the need for providing this group, especially those at higher risk such as low educated or low income females, with necessary support.