Uptake of intermittent preventive treatment and pregnancy outcomes: health facilities and community surveys in Chókwè district, southern Mozambique

Malaria in pregnancy leads to serious adverse effects on the mother and the child and accounts for 75,000-200,000 infant deaths every year. Currently, the World Health Organization recommends intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) at each scheduled antenatal care (ANC) visit. This study aimed to assess IPTp-SP coverage in mothers delivering in health facilities and at the community. In addition, factors associated with low IPTp-SP uptake and malaria adverse outcomes in pregnancy were investigated. Methods: A community and a health facility-based surveys were conducted in mothers delivering in Chókwè district, southern Mozambique. Social-demographic data, malaria prevention practices and obstetric history were recorded through self-report and antenatal records. For women delivering at health facilities, a clinical examination of mother and child was performed, and malaria infection at delivery was determined by rapid diagnostic test, microscopy, quantitative PCR and placental histology. Results: Of 1141 participants, 46.6, 30.2, 13.5 and 9.6% reported taking ≥ 3, two, one and none SP doses, respectively. Low IPTp uptake (< 3 doses) was associated with non-institutional deliveries (AOR = 2.9, P < 0.001), first ANC visit after week 28 (AOR = 5.4, P < 0.001), low awareness of IPTp-SP (AOR = 1.6, P < 0.002) and having no or only primary education (AOR = 1.3, P = 0.041). The overall prevalence of maternal malaria (peripheral and/or placental) was 16.8% and was higher among women from rural areas compared to those from urban areas (AOR = 1.9, P < 0.001). Younger age (< 20 years; AOR = 1.6, P = 0.042) and living in rural areas (AOR = 1.9, P < 0.001) were predictors of maternal malaria at delivery. Being primigravidae (AOR = 2.2, P = 0.023) and preterm delivery (AOR = 2.6, P < 0.001) predicted low birth weight while younger age was also associated with premature delivery (AOR = 1.4, P = 0.031). Conclusion: The coverage for two and ≥ 3 doses of IPTp-SP is moderately higher than estimates from routine health facility records in Gaza province in 2015. However, this is still far below the national target of 80% for ≥ 3 doses. Ongoing campaigns aiming to increase the use of malaria prevention strategies during pregnancy should particularly target rural populations, increasing IPTp-SP knowledge, stimulate early visits to ANC, improve access to health services and the quality of the service provided.

La estimulación eléctrica nerviosa transcutánea (TENS). El manejo del dolor durante el proceso de parto / Transcutaneous electrical nerve stimulation (TENS) for pain management during labor

En la actualidad, la analgesia epidural se perfila como el método farmacológico más empleado en obstetricia para el manejo del dolor durante el parto, pero esta técnica no está exenta de riesgos. Existen métodos no farmacológicos que se pueden utilizar alternativamente o en sinergia con la analgesia epidural, que no presentan efectos adversos sobre los resultados materno-fetales y que pueden ayudar a paliar el dolor. Entre estos métodos se encuentra la estimulación eléctrica nerviosa transcutánea (TENS). La TENS es una técnica fisioterapéutica especialmente indicada durante el periodo de dilatación, en el inicio del trabajo del parto, y mientras la mujer no percibe un dolor muy intenso. Su uso en el parto es relativamente reciente y controvertido. A pesar de ser bien recibido por mujeres y matronas, su eficacia no está demostrada claramente. Así pues, organismos como la Sociedad Española de Ginecología y Obstetricia o el Ministerio de Sanidad, Servicios Sociales e Igualdad, consideran esta terapia como un mecanismo de alivio del dolor no farmacológico de ineficacia demostrada en la fase activa del parto. Las mujeres deben tener la opción de elegir los métodos de alivio de dolor que quieren emplear en cualquier etapa de su parto. Los profesionales sanitarios son los responsables de conocer, investigar y trabajar con los diferentes métodos, ofreciendo a la gestante información adecuada y basada en evidencia científica sobre ellos (AU)

Currently, epidural analgesia is considered the most used method for pain management during labor, but this technique could have side effects. There are non-pharmacological methods that can be used alternatively or in synergy with epidural analgesia, without adverse effects on maternal and fetal outcomes. These methods include transcutaneous electrical nerve stimulation (TENS). TENS is a physiotherapy technique particularly suitable for the dilation period, during the first state of labor, and while women does not perceive a very intense pain. The use in childbirth is recent and controversial. Despite being well received by women and midwives, their effectiveness has not been clearly demonstrated. Organizations such as the Spanish Society of Gynaecology and Obstetrics and the Department of Health, consider this therapy an inefficient non-pharmacological mechanism for pain relief in the active stage of labor. Women should have the option to choose any pain relief mathod in any stage of their process. Health professionals are the responsible to know, investigate and work with these different methods, offering to pregnant women, adequate information, which must be based on scientific evidence (AU)

[Pregnancy and labor in women in the region of the accident at the Chernobyl Atomic Electric Power Station]. / Beremennost' i rody u zhenshchin v regione avarii na Chernobyl'skoi AES.

The authors analyze the tentative results of a multiprofile study, including a review of labor histories, examinations of pregnant women and parturients, measurements of fetoplacental hormones, study of the immunity status and microbiocenosis of the mothers and newborns, living in the first (up to 15 Ci/km2) and second (15 to 40 Ci/km2) zones of radioactive contamination. The detected shifts of a compensatory nature were found mostly in women living in the first zone. The disorders found in the women living in the second zone evidenced a decrease of the defense potential of the body, this necessitating nonspecific and correcting therapy during pregnancy, in labor and the postpartum period.

Influence of photoperiod on the time of birth in the rat. IV. Effects of an imposed feeding rhythm.

In order to study the respective effects of photoperiod and feeding rhythm on the time of birth in rats, the onset of fetus expulsion was determined in six experimental groups. Under the standard light regime (14L-10D; lights-on at 6 a.m.), rats caged alone or in threes and fed ad libitum (groups C and 3C) gave birth over two preferential periods, the first during the late light phase of day 22 of gestation and the second during the early light phase of day 23. Under the same conditions, rats fed during a restricted period (from 9 a.m. to 11 a.m.) from day 8 of gestation (groups PF and 3PF) gave birth during a single period, starting just before and spreading over the first half of the night separating the last two days of gestation. The number of rats per cage affected birth distribution slightly, but an inverse effect was observed between the feeding regime and the social group constituted by mating (group 3C vs 3PF). Most births occurred after lights-on at day 23 of gestation when the rats were caged alone, fed ad libitum and submitted to a progressive shift in the light phase (group BC). This shift was realized by daily advancing dawn and dusk every day by 15 min from day 8 of gestation. Under these conditions, food restriction from 9 a.m. to 11 a.m. (group BC-PF) resulted in an intermediate distribution between groups BC and PF. The data show that time of birth in rats can be modulated by two different biological entrainers, photoperiod and feeding rhythm and that time of birth, in a given case, is determined by the interactions between these two factors.

Influence of light-dark cycle on antepartum serum relaxin and progesterone immunoactivity levels and on birth in the rat.

Relaxin and progesterone are produced by the corpora lutea in the pregnant rat. Relaxin immunoactivity levels are elevated in peripheral sera during the last 12 days of pregnancy. In rats maintained under a conventional photoperiod of 14 h of light (0600-2000 h) and 10 h of darkness (2000-0600 h), there is an antepartum elevation in serum relaxin to maximal levels coincident with the rapid decline in serum progesterone to basal levels during the light phase of the photoperiod 1 day before birth. Therefore, we postulated that this maximal elevation in serum relaxin levels may be temporally associated with functional luteolysis and linked to the photoperiod. In the present study the photoperiod was advanced near midpregnancy in order to examine further the relationship of the antepartum elevation in serum relaxin levels with both functional luteolysis and the photoperiod. Three groups of rats were maintained under a conventional photoperiod of 14 h of light (0500-1900 h) and 10 h of darkness until days 7 and 8 of pregnancy when the photoperiod was advanced 8 h in group 2 (G2) and advanced 18 h in G3 relative to the conventional photoperiod that was maintained in G1. Serum relaxin and progesterone levels were determined in blood samples obtained at 4-h intervals from 2000 h on day 19 of pregnancy until birth. The times of occurrence of birth, maximal relaxin levels, and decline of progesterone to basal levels in G2 and G3 were generaly advanced 50-60% of the advancement of the photoperiod. There was a close temporal association between the attainment of maximal relaxin levels and basal progesterone levels; they both occurred during the light phase of the photoperiod, approximately 24 h before birth in all three groups. We conclude that the antepartum elevation of serum relaxin to maximal levels may be associated with functional luteolysis and that its time of occurrence is influenced by the photoperiod. This study also provides evidence that the antepartum elevation of relaxin levels consists of two phases which occur at a 24-h interval. It is proposed that these two phases in the elevation of relaxin levels may be indicative of an increasingly effective endogenous circadian luteolytic process whose time of occurrence is influenced by the light-dark schedule.

Influence of photoperiod on the time of parturition in the rat. II. Demonstration of a photoinducible phase and determination of some of its characteristics.

Parturition time has been chosen to investigate whether a photoinducible phase exists during the light-dark cycle in the rat. A 1-hr light stimulation was given during the dark phase at various times after the beginning of the principal photoperiod or conventional dawn. The rats kept under 8 hrs of light and 16 hrs of darkness from mating (day 1 of pregnancy) gave birth to most of their pups on the afternoon of day 22 of pregnancy when the light pulse was applied 9 to 18 hrs or 22 to 23 hrs after dawn. Parturition was delayed till day 23 when the light pulse was given 18 to 22 hrs after dawn. In the same manner, under 16 hrs of light and 8 of darkness, most of the parturitions occurred on day 23 of pregnancy when a light pulse was given 22 hrs after dawn; they extended over two preferential periods--one on day 22 (about 50 p. 100) and the other on day 23 when the light pulse was given 16 to 17 hrs or 18 to 19 hrs after dawn. Thus, the stimulation of the photoinducible phase, found at the end of the dark period, resulted in retarded parturition. That delay was also observed when the light pulse was only given during the final days of pregnancy. Most parturitions occurred on day 22 of pregnancy under a short photoperiod to which 5 hrs of light were added during the dark phase at a time not coinciding with the photoinducible phase. This suggested that the effect of the principal light regime and the stimulation of the photoinducible phase could be dissociated.