Maternal and Neonatal Health

Purpose This comprehensive scoping review aims to systematically synthesize and critically evaluate the existing literature on the feasibility, effectiveness, and multifaceted impact of various digital health technologies in addressing the persistent challenge of maternal, neonatal, and child health (MNCH) deaths across the diverse landscape of Sub-Saharan Africa. With a specific and in-depth focus on Kenya as a compelling case study, the primary objective is to identify and appraise the evidence regarding how these innovative technologies, ranging from basic mobile health (mHealth) applications to advanced telemedicine and sophisticated digital data management systems, can strategically enhance access to quality care, significantly improve the capacity and performance of frontline health workers, strengthen fragmented health information systems, and ultimately contribute to a substantial reduction in preventable MNCH mortality rates. By doing so, this review seeks to illuminate how digital health can effectively bridge critical gaps in healthcare delivery, particularly in the most underserved and resource-limited settings within the region. Findings The synthesized literature consistently indicates that digital health technologies demonstrate significant and growing promise in improving MNCH outcomes across Sub-Saharan Africa, with numerous impactful examples emanating from Kenya. Specifically, studies highlight how mHealth interventions, encompassing targeted SMS messaging, interactive voice response (IVR) systems, and dedicated mobile applications, effectively enhance health education for expectant mothers and caregivers, improve adherence to crucial antenatal and postnatal appointments, and facilitate seamless, real-time communication between patients and healthcare providers. Telemedicine applications are shown to dramatically expand access to specialized medical consultations and expert support for health workers in remote and geographically isolated areas. Concurrently, digital training tools and e-learning platforms demonstrably improve the knowledge, clinical skills, and confidence of frontline health workers, including community health volunteers and midwives. Furthermore, the adoption of robust digital data management systems contributes profoundly to more accurate and timely disease surveillance, optimized resource allocation, and enhanced program monitoring and evaluation. While inherent challenges related to infrastructure, digital literacy, and sustainability persist, the cumulative evidence suggests that these technologies enable more timely and appropriate interventions, significantly improve health literacy among populations, and fundamentally strengthen fragile health systems, collectively contributing to a measurable reduction in preventable MNCH deaths.

Background: Maternal health refers to the health of women during pregnancy, delivery, and the postpartum period,  and the services include promotive,  preventive,  therapeutic,  and rehabilitative health services for mothers and children provided by health facilities. Maternal and child health services are a priority program for community health. The main objective of this study was to assess the utilization of maternal health services among married women of reproductive age (MWARA).

Methods: A quantitative descriptive cross-sectional study design was adopted to assess the utilization of maternal health services. The  157 MWARA aged between 19 and 45 years were employed for this study from June to July 2024 at Tamankhola Rural Municipality, Baglung District, Gandaki Province, Nepal. The study employed a simple random sampling technique to select the wards, and a purposive sampling technique was used to get respondents. A  face-to-face interview with a semi-structured questionnaire among MWARS who had at least one child under two years was applied. The data were gathered, and univariate analysis was done by using IBM SPSS version 27 to disseminate the study's findings.

Results: Out of 157 respondents, nearly half (42.8%) belongedin nuclear families, while a little bit more than half  (58.59%) belongedin joint families.  Most respondents  (63.69%) married before the age of 20, and similarly (61.15%) had their first pregnancy at this young age. The majority of women (91.72%) had visited a health facility by walking on their feet. The utilization of antenatal care (ANC) services at least four or more times was found to be 97.45%, where a significant number (2.55%) of women didn’t utilize recommended ANC services as per protocol. Likewise, 66.88% were counseled on delivery preparation, 76.43% on breastfeeding, and 61.15% on recognizing pregnancy danger signs. Similarly, all the women (100%)  received the  Tetanus  Diphtheria  (TD)  vaccine,  and all mothers gave birth in a healthcare facility and found that all the mothers received recommended postnatal care (PNC), viz. most of them (96.2%) had three PNC visits, while few of them (3.8%) received only two PNC services.
Conclusion and Recommendation: The study found that most women utilized ANC, delivery and neonatal care, and PNC services, with fully institutional delivery, and there were no home deliveries,  which led to low pregnancy complications and mostly normal deliveries. All women received PNC services, and most of the newborns were bathed after an hour of birth.  Likewise,  a significant number of women received vitamin  A  and  IFA supplements after delivery. The investigators recommended that the policymaker reform the policy that incorporates the provision of maternal health services planning, implementation, and evaluation primarily by the local government with data-driven decision-making practice since maternal health is a concurrent responsibility of three tiers of government.
Keywords: ANC, Gynecology, MCH, MNH, PNC, Safe motherhood

This book centers on negotiations around cultural, governmental, and individual constructions of COVID-19. It considers how the coronavirus pandemic has been negotiated in different cultures and countries, with the final part of the volume focusing on South Asia and Pakistan in particular. The chapters include autoethnographic accounts and ethnographic explorations that reflect upon experiences of living with the pandemic and its implications for all areas of life. The book explicates people's dealings with COVID-19 at various levels, situates the spread of rumors, conspiracy theories, and new social rituals within micro-and/ or macro-contexts, and describes the interplay between the virus and various institutionalized forms of inequalities and structural vulnerabilities. Bringing together a variety of perspectives, the volume relates to the past, describes the Covidian present, and offers futuristic implications. It enlists distinct imaginaries based on current understandings of an extraordinary challenge that holds significant importance for our human future.

Key messages: 1. The welfare of midwives is essential both for personal wellbeing and for the provision of quality care. 3. Significant levels of stress, burnout and PTSD are common in health care workers' responses to pandemics, with possible long-term consequences. 4. Staff want to continue providing high quality care but will also be very concerned about their own personal/family safety and wellbeing. Fear, uncertainty and moral distress are common. 5. Midwives' individual demographic characteristics and personal circumstances must be acknowledged, especially as some may increase vulnerability to Covid-19. 6. Trusting, open and non-judgemental relationships between managers and staff are essential for responding effectively to staff concerns, during and after the pandemic. 7. Optimise wellbeing through ensuring that midwives have access to: adequate PPE, drinks and regular breaks, appropriate working hours, psychological support. 8. Provide opportunities for positive experiences e.g. team get-togethers, whether socially distanced or virtual.

Childbearing women and newborn infants continue to require care during the current COVID-19 pandemic. When staff and services are under extreme stress there is a real risk of increasing avoidable harm, including an increased risk of infection and reductions in the overall quality of care. Safety, quality, and avoiding harm must be key priorities in decisionmaking. Review questions Three related review questions were addressed. All considered safety, quality and minimising avoidable harm in the provision of midwifery services: 1. What is the evidence on the impact of community care vs centralisation of care during pandemics, for childbearing women, newborn infants, families, staff, and resources? 2. How to optimise availability of midwifery expertise when staffing becomes heavily affected by the midwifery workforce being off sick, self-isolating, fear of pandemic or other major unavoidable events? 3. What is the evidence on viral load of SARS-COV-2 in domestic settings and hospitals, relevant to informing the safety of community and hospital settings for health professionals? Principles for equitable, safe, effective, quality maternal and newborn care in a pandemic were developed to inform this review, derived from evidence and key resources: o Continue to provide evidence-based, equitable, safe, compassionate and respectful care for physical and mental health, wherever and whenever care takes place, by remote access if necessary o Protect the human rights of women and newborn infants, unless and only unless the public health imperative makes this impossible o Ensure strict hygiene measures and social distancing when possible o Ensure birth companionship o Prevent unnecessary interventions o Do not separate mother and newborn infant unless absolutely necessary o Promote and support breastfeeding o Protect and support staff, including their mental health needs Key findings and recommendations on each review question are briefly presented, including strategies for maintaining essential components of quality care in a pandemic situation. Detailed information on all sources identified is then presented. NB. This is a very fast-moving situation and new information will emerge on an ongoing basis; regular updates to this review will be needed. Rapid analytical review v4: 8 April 2020 RCM Professorial Advisory Group 4 o Ensure strict hygiene measures and social distancing when possible o Ensure birth companionship o Prevent unnecessary interventions o Do not separate mother and newborn infant unless absolutely necessary o Promote and support breastfeeding o Protect and support staff, including their mental health needs Methods This was a rapid analytic scoping review. Timing precluded a full systematic approach, but a structured approach was used and is summarised in the Appendix.

Introduction: Pre-conception nutrition is a key determinant of the pregnancy outcome and the health of a newborn. Nutrition knowledge and attitude are known to influence dietary practices. However, in Kenya, pre-conception nutrition information is scanty and there is concern that women put little consideration into their pre-conception nutrition status. This study aimed to establish the pre-conception nutrition knowledge and attitudesamong female undergraduate students at Kenyatta University, Kenya Methods: The study adopted a cross-sectional analytical design involving sample of 422 female undergraduate students randomly selected from Kenyatta University. A semistructured questionnaire was used to collect respondents’ information. Pre-conception nutrition knowledge was determined based on nutrition knowledge scores while attitude were measured using a five point likert scale. Data was analyzed using SPSS version 22. Results: The study results showed that close to half (45.9%) of th...

Introduction: Congenital malformations comprise 8% of the perinatal mortality in India. They rank fifth as a cause of perinatal mortality, after asphyxia, respiratory problems, infections and cerebral trauma. However, the pattern is changing rapidly with improvement in health care and living standards.

Material & Method: In the present study, authors have tried to study the cases of congenital malformations specially related to Central nervous system and Gastro-intestinal system. 5240 cases of newborn babies were studied and results were analyzed and classified in to various categories.

Findings: The results show that malformations are more common in still birth, more in female babies and more in central nervous system In live born babies the percentage of malformation is0.63 % whereas in still born baby it is6.53 %.

Conclusions: Chances of having malformations increases as the age advances. Parity of mother also influences the incidence. Exposure to radiation & drugs also influences malformations. Incidence of congenital malformation is highest in central nervous system.

Diagnoses of depression, anxiety, or other mental illness capture just one aspect of the psychosocial elements of the perinatal period. Perinatal loss; trauma; unstable, unsafe, or inhumane work environments; structural racism and gendered oppression in health care and society; and the lack of a social safety net threaten the overall wellbeing of birthing people, their families, and communities. Developing relevant policies for perinatal mental health thus requires attending to the intersecting effects of racism, poverty, lack of child care, inadequate postpartum support, and other structural violence on health. To fully understand and address this issue, we use a human rights framework to articulate how and why policy makers must take progressive action toward this goal. This commentary, written by an interdisciplinary and intergenerational team, employs personal and professional expertise to disrupt underlying assumptions about psychosocial aspects of the perinatal experience and reimagines a new way forward to facilitate wellbeing in the perinatal period.

COVID-19 has spread rapidly in Kenya and has not spared pregnant women. Evidence from Kenya shows that during the COVID-19 pandemic, health systems have been either stressed to their maximum capacity or are becoming overwhelmed. However, the population is advised not to attend hospital unless strictly necessary, and this advice seems to apply to all, including expectant mothers. There is a dearth of information on how poor expectant mothers with low bargaining power cope during COVID-19 in Kenya, which this study addresses for those in Kilifi County. This rapid qualitative study draws data from an extensive literature review and from interviews with 12 purposively selected mothers who were either expectant or had newborn babies during the pandemic in Kilifi County. Five matrons-in-charge of maternal health services and four traditional birth attendants were also interviewed via mobile phone. Data were analyzed thematically and are presented in a textual description. It emerged that ...

Background: Congenital Anomalies (Birth defects) are functional, metabolic and even structural deficiencies that are present before or at birth. They are a major contributor to perinatal and infant morbidity and mortality. In Kenya, there is little empirical data on congenital anomalies. Study objective: The objective of this study was to determine the prevalence and pattern of congenital anomalies; and to describe the associated risk factors. Methodology: This was a hospital based descriptive, cross-sectional study design. 52 respondents were recruited for this study using the Fischer’s formula. A researcher-administered questionnaire was used to collect data. Data from structured questionnaires was entered, checked, cleaned and analyzed. Descriptive analysis using means, frequency and proportions was computed. Results: Analysis of the data showed that among the 315 neonates admitted in Newborn Unit, Kenyatta National Hospital, the prevalence of Congenital Anomalies was 19.4% (61)....

What are the experiences of birthing partners from traumatic childbirth? Aim: Exploring the traumatic childbirth experienced of birthing partners. Objectives: 1. To explore the existing literature on traumatic experiences of birthing partners.

Networks of Care (NOCs) can improve quality of care, continuity of care, and maternal and newborn outcomes. They focus on relational elements that are key to health system functioning and are context specific. n NOCs focus on creating intentional connections between people and services and strengthening the functional aspects of health systems while incorporating and emphasizing core relational aspects. They can also be used to strengthen referral systems, thus promoting continuity of care. n With momentum and interest gathering around the NOC approach, it could be an essential tool for meeting the Sustainable Development Goals for maternal and newborn health.

Objective: Racial and ethnic inequities in perinatal health outcomes are pervasive. Doula support is an evidencebased practice for improving maternal outcomes. However, women in lower-income populations often do not have access to doulas. This study explored community perspectives on doula care to inform the development of a hospital-based doula program to serve primarily low-income women of color. Methods: Four focus groups and four individual interviews were conducted with: (1) women who were pregnant or parenting a child under age 2 (n = 20); (2) people who had provided support during a birth in the previous 2 years (n = 5); and (3) women who had received doula training (n = 4). Results: Participants had generally positive perceptions of doula services. Many aspects of doula support desired by participants are core to birth doula services. Participants identified ways that doulas could potentially address critical gaps in health care services known to impact outcomes (e.g., continuity of care and advocacy), and provide much-needed support in the postpartum period. Responses also suggested that doula training and hospital-based doula programs may need to be adapted to address population-specific needs (e.g., women with substance use disorder and younger mothers). Novel program suggestions included ''on call'' informational doulas. Conclusions: Findings suggested that women in racial/ethnic minority and lower income groups may be likely to utilize a hospital-based doula program and identified adaptations to traditional doula care that may be required to best meet the needs of women in groups with higher risk of poor maternal health and birth outcomes.

Background COVID-19 exposes major gaps in the MCH safety net and illuminates the disproportionate consequences borne by people living in low resource communities where systemic racism, community disinvestment, and social marginalization creates a perfect storm of vulnerability. Methods We draw eight lessons from the first 8 months of the pandemic, describing how COVID-19 has intensified preexisting gaps in the MCH support network and created new problems. For each lesson identified, we present supporting evidence and a call for specific actions that can be taken by MCH practitioners, researchers and advocates. Results LESSON #1: COVID-19 hits communities of color hardest, exposing and exacerbating health inequities caused by systemic racism. LESSON #2: Women experience the most devastating social, economic and mental health tolls during COVID-19. LESSON #3: Virulent pathogens find and exacerbate cracks in our public health and health care systems. LESSON #4: COVID-19 has become a pretext to limit access to sexual and reproductive health care. LESSON #5: COVID-19 has exposed and deepened fault lines in maternity care: over-medicalization, discrimination, lack of workforce diversity, underutilization of collaborative team approaches, and lack of post-delivery follow-up. LESSON #6: The pandemic adds impetus to much-needed Medicaid policy reforms that can have a lasting positive effect on maternal health. LESSON #7: Social and health policy changes, heretofore deemed infeasible, ARE possible under pandemic threat. LESSON #8: Finally, an overarching COVID-19 lesson: We are all inextricably connected. Conclusion COVID-19 is a loud wake up call for renewed action by MCH epidemiologists, policy-makers, and advocates.

Ethiopia is one of the sub-Saharan African countries contributing to the highest number of maternal and neonatal deaths. Coverage of maternal and neonatal health (MNH) interventions has remained very low in Ethiopia. We examined the cost-effectiveness of selected MNH interventions in an Ethiopian setting. We analysed 13 case management and preventive MNH interventions. For all interventions, we used an ingredients-based approach for cost estimation. We employed a static life table model to estimate the health impact of a 20% increase in intervention coverage relative to the baseline. We used disability-adjusted life years (DALYs) as the health outcome measure while costs were expressed in 2018 US$. Analyses were based on local epidemiological, demographic and cost data when available. Our finding shows that 12 out of the 13 interventions included in our analysis were highly cost-effective. Interventions targeting newborns such as neonatal resuscitation (institutional), kangaroo moth...

Background: Congenital Anomalies (Birth defects) are functional, metabolic and even structural deficiencies that are present before or at birth. They are a major contributor to perinatal and infant morbidity and mortality. In Kenya, there is little empirical data on congenital anomalies. Study objective: The objective of this study was to determine the prevalence and pattern of congenital anomalies; and to describe the associated risk factors. Methodology: This was a hospital based descriptive, cross-sectional study design. 52 respondents were recruited for this study using the Fischer's formula. A researcher-administered questionnaire was used to collect data. Data from structured questionnaires was entered, checked, cleaned and analyzed. Descriptive analysis using means, frequency and proportions was computed. Results: Analysis of the data showed that among the 315 neonates admitted in Newborn Unit, Kenyatta National Hospital, the prevalence of Congenital Anomalies was 19.4% (61). The Musculoskeletal system was the most affected (38.5%). 88.4% of the mothers were below 35years of age and 61.5% were not working. The prevalence of Congenital Anomalies was more among neonates born vaginally. Conclusion: The prevalence of Congenital Anomalies was high compared to the global prevalence of 3-7%. Congenital anomalies were more likely to be associated with younger maternal age, being of low socioeconomic class, vaginal delivery and the neonate being a first born.

Objectives: The present study was undertaken 1. To know the incidence of congenital musculoskeletal malformations in neonates 2. To assess the relation of congenital musculoskeletal malformations with maternal age, parity and birth weight of the newborn 3. To compare the data obtained with other studies Materials and Method: The data for the study was collected from the

While the state plays important role in actively transforming the communities into a condition that they imagined as developed, some persistences are taking place at the micro level. Our short ethnographic observation among the Dawan at the village of Oinlasi, South Amanatun, East Nusa Tenggara revealed the dynamics of ume kbubu, the traditional house of the Timorese, that has experienced some changes as consequence of the introduction of healthful housing program commenced by the Ministry of Health some fifty years ago. We examined that this program, along with other development packages, have changed the traditional life of the communities there; however we also witnessed that communities were actually response to the changes. These traditional houses are in some cases built with modern materials, equipped with electricity, and used only as a kitchen while the family live in a modern-healthful housing nearby. It is our conclusion that the ume kbubu as we seen today is neither traditional or modern house but a hybrid configuration of knowledge that show friction in the process of development.

Objective To evaluate patient experience with a prenatal telemedicine visit and identify barriers to accessing telemedicine among rural pregnant people in northern New England during the beginning of the COVID-19 pandemic. Materials and Methods We conducted a postvisit electronic survey of pregnant people who successfully participated in a prenatal telemedicine visit at a rural academic medical center in Northern New England. Nineteen questions were included in 5 domains: (1) engagement with prenatal care; (2) barriers to telemedicine and in person healthcare; (3) experience of prenatal care; (4) remote pregnancy surveillance tools; and (5) sources of COVID-19 information. Results Responses were obtained from 164 pregnant people. Forty percent of participants had participated in an audio-only telemedicine visit, and 60% in a video telemedicine visit. The visit was easy or somewhat easy for 79% of respondents and somewhat difficult or difficult for 6.8%. The most common barrier to ac...

Background: Congenital anomalies contribute upto 11% of neonatal deaths globally. Neonates with multiple congenital malformations present a very difficult challenge to the treating physicians. This study was done to know the frequency, pattern of congenital anomalies and various presentations, which may help to develop strategies for patient counseling and management in our setting.Methods: Retrospective hospital based observational study from the period of June 2015 to June 2017. Neonates born in our hospital during the study period with documented congenital anomalies were included in the study and the data was classified as per European Surveillance of Congenital Anomalies and further analysed.Results: Total number of neonates with documented congenital anomalies was 40, of which 6 neonates (15%) had multiple anomalies. The anomalies in the study were divided into major and minor anomaly groups. 70% of the anomalies were classified as major anomalies while 30% were classified as ...

African American women have the lowest breastfeeding initiation rate (85.9%) of all ethnicities. Additionally, African American mothers are less likely to continue with breastfeeding beyond initiation. Reasons for low breastfeeding initiation and duration rates in African American mothers include societal stigma, culture, misconceptions, time and support. The lack of African American babies being breastfed is a public health concern for both mother-baby dyad. Coupled with the infant mortality rate for African American babies 12.5 per 1,000 is more than double that for Caucasian babies 5.7 per 1,000. Breastfeeding has been proved to decrease the incidence of several health concerns (i.e., asthma, diabetes, obesity and hypertension).

The phrase "Networks of Care" seems familiar but remains poorly defined. A health system that exemplifies effective Networks of Care (NOC) purposefully and effectively interconnects service delivery touch points within a catchment area to fill critical service gaps and create continuity in patient care. To more fully elaborate the concept of Networks of Care, we conducted a multimethod scoping study that included a literature review, stakeholder interviews, and descriptive case studies from five low-and middle-income countries. Our extended definition of a Network of Care features four overlapping and interdependent domains of activity at multiple levels of health systems, characterized by: 1) Agreement and Enabling Environment, 2) Operational Standards, 3) Quality, Efficiency and Responsibility, and 4) Learning and Adaptation. There are a series of key interrelated themes within each domain. Creating a common understanding of what characterizes and fosters an effective Network of Care can drive the evolution and strengthening of national health programs, especially those incorporating universal health coverage and promoting comprehensive care and integrated services. An understanding of the Networks of Care model can help guide efforts to move health service delivery toward goals that can benefit a diversity of stakeholders, including a variety of health system actors, such as health care workers, users of health systems, and the wider community at large. It can also contribute to improving poor health outcomes and reducing waste originating from fragmented services and lack of access.

Networks of Care (NOCs) can improve quality of care, continuity of care, and maternal and newborn outcomes. They focus on relational elements that are key to health system functioning and are context specific. n NOCs focus on creating intentional connections between people and services and strengthening the functional aspects of health systems while incorporating and emphasizing core relational aspects. They can also be used to strengthen referral systems, thus promoting continuity of care. n With momentum and interest gathering around the NOC approach, it could be an essential tool for meeting the Sustainable Development Goals for maternal and newborn health.

The phrase "Networks of Care" seems familiar but remains poorly defined. A health system that exemplifies effective Networks of Care (NOC) purposefully and effectively interconnects service delivery touch points within a catchment area to fill critical service gaps and create continuity in patient care. To more fully elaborate the concept of Networks of Care, we conducted a multimethod scoping study that included a literature review, stakeholder interviews, and descriptive case studies from five low-and middle-income countries. Our extended definition of a Network of Care features four overlapping and interdependent domains of activity at multiple levels of health systems, characterized by: 1) Agreement and Enabling Environment, 2) Operational Standards, 3) Quality, Efficiency and Responsibility, and 4) Learning and Adaptation. There are a series of key interrelated themes within each domain. Creating a common understanding of what characterizes and fosters an effective Network of Care can drive the evolution and strengthening of national health programs, especially those incorporating universal health coverage and promoting comprehensive care and integrated services. An understanding of the Networks of Care model can help guide efforts to move health service delivery toward goals that can benefit a diversity of stakeholders, including a variety of health system actors, such as health care workers, users of health systems, and the wider community at large. It can also contribute to improving poor health outcomes and reducing waste originating from fragmented services and lack of access.

Aim: To see the frequency of various types of congenital anomalies in infants and determine its contributing factors. Study design: Cross sectional study with retrospective study for etiological factors. Place and duration of study: Department of Pediatrics, Jinnah Hospital Lahore. from 1 November 2017 to 30 September,2018. Methods: All infants of both sexes presenting to the pediatric unit of Jinnah hospital Lahore for routine checkup or vaccination and having congenital anomalies were enrolled and data entered on prescribed performa and analyzed on SPSS v 22.0 Results: In our study 994 patients were enrolled in study, 232 patients (23.3%) had congenital anomalies in central nervous system. 94 children (9.5%) had gastro-intestinal system anomalies, 222 patients (22.3%) had congenital anomalies in musculo skeletal system, 84 (8.5%) had of cardio vascular system and remaining 362 patients (36.4%) had anomalies of genito-urinary system. Among five important contributing factors for co...

INTRODUCTION Babies come into the world heralding the good news that the human species with all its diversities and complexities is still going good. Though a newborn brings in its wake untold happiness to those around, there are some unfortunate babies whose birth is clouded with sadness and worry for the parents because of the birth defects 1 in them that are manifest either immediately after birth or after a while, depending on the nature of the congenital abnormality. Birth defects include abnormalities in the new born baby's structure, function or body metabolism) , which usually lead to physical and mental disabilities and can even be fatal sometimes. There are many causes for birth defects involving a wide range of factors-some due to hereditary abnormality, some caused by chromosomal disorders or genetic disorder and some others caused by environmental agents. There are commonly known birth defects like cleft lip, cleft palate, Down syndrome, autism, muscular dystrophy, neural tube defects, congenital heart disorders to rare birth defects such as cleft foot and hand, club foot, aglossia and albinism, to name a few. PREVALENCE AND INCIDENCE OF CONGENITAL ANOMALIES IN INDIA The birth prevalence of congenital anomalies in the developing world is underestimated by deficiencies in diagnostic capabilities and lack of reliability 2 of medical records and health statistics. As a result, recorded diagnoses in vital statistics focus on overt acute illnesses, rather than on pre-existing congenital conditions that increase vulnerability to infections and malnutrition (WHO, 1985). More reliable estimates of the prevalence at birth of congenital anomalies come from registries of congenital malformations in newborns which show that the prevalence of recognizable malformations

Objective: Although infant mortality because of birth defect has increased in both developed and developing countries, had not got attention like other health issues at national, regional, or local levels. Documenting the risk factors that influence the occurrence of birth defects and its seasonality will help to inform the community and to develop preventive strategies for the country. Results: Factors associated with higher likelihood of a major structural birth defects included maternal age; neonates born from women living in urban; and in Dega; history of fever during pregnancy; intake of herbal medicine; and drinking alcohol. Counselling for pregnancy preparation and folic acid supplementation was found protective for the likelihood of birth defect. Key words: Birth defect, maternal illness, maternal medication use, environmental exposure

Background: Congenital anomaly is one of the most common causes of perinatal death throughout the world. Consanguinity, nutritional deficiency, infection during pregnancy, malaria etc. are most prevalent in Bangladesh. The study was aimed to explore the prevalence and types of congenital malformations along with their immediate outcome. Materials and Methods: This observational study was conducted among all the admitted high risk pregnancies who were admitted with prenatally diagnosed congenital anomalies from January, 2015 to December, 2015. During this tenure 705 high risk patients were admitted among which 125 patients had prenatally diagnosed congenital anomalous fetus and included for the study to explore the prevalence and types of congenital malformations and their immediate outcome. For the study purpose, congenital anomalies were broadly classified into major and minor groups. Major anomalies were considered when the defects seemed to cause stillbirth or neonatal death or needed medical termination for lethal anomalies (anencephaly, multiple congenital anomalies) or severe anomalies that without medical intervention would cause handicap or death. Mild anomalies/defects were considered which might require medical intervention but compatible with life. Results: The mean of gestational age at the time of delivery was 31.77± 6.23(SD) wks. 125 (17.7%) women had congenital anomaly of their baby. Among these anomalies central nervous system anomalies was the most frequent (34.4%), followed by renal anomalies (22.4%) and others in order of frequency were gastro-intestinal, skeletal, non-immune hydrops, cardiac anomalies. The major anomalies were 81.6% and multiple congenital anomalies were in 28.8%. Among the congenital anomalous fetus, perinatal death was 43.2% and appeared to be the most common cause of death in new borne babies. Conclusion: In this study, Central nervous system (CNS) anomalies were found the commonest congenital anomalies and pointing to the risk of burden of these anomalies on the future handicapping condition and have their impact on social and economical consequences. So, emphasis is needed on prenatal diagnosis of congenital anomalies by routine scanning for anomalies by standard ultrasonograph, so that opportunity of secondary prevention can be considered in fatal cases and appropriate treatment can be ensured immediately after birth. Emphasis should also need in the use of fetal echocardiograph for prenatal detection of cardiac anomalies.

Background: Congenital anomalies contribute upto 11% of neonatal deaths globally. Neonates with multiple congenital malformations present a very difficult challenge to the treating physicians. This study was done to know the frequency, pattern of congenital anomalies and various presentations, which may help to develop strategies for patient counseling and management in our setting.Methods: Retrospective hospital based observational study from the period of June 2015 to June 2017. Neonates born in our hospital during the study period with documented congenital anomalies were included in the study and the data was classified as per European Surveillance of Congenital Anomalies and further analysed.Results: Total number of neonates with documented congenital anomalies was 40, of which 6 neonates (15%) had multiple anomalies. The anomalies in the study were divided into major and minor anomaly groups. 70% of the anomalies were classified as major anomalies while 30% were classified as ...

Bangladesh has achieved remarkable progress in healthcare with a steady decline in maternal and under-5 child mortality rates in efforts to achieve Millennium Development Goals 4 and 5. However, the mortality rates are still very high compared with high-income countries. The quality of healthcare needs improve to reduce mortality rates further. It is essential to investigate the current quality of healthcare before implementing any interventions. The study was conducted to explore the perception of healthcare providers about the quality of maternal and neonatal health (MNH) care. The study also investigated patient satisfaction with the MNH care received from district and sub-district hospitals. Both qualitative and quantitative methods were used in the study. Two district and 12 sub-district hospitals in Thakurgaon and Jamalpur in Bangladesh were the study settings. Fourteen group discussions and 56 in-depth interviews were conducted among the healthcare providers. Client exit inte...

The non-governmental organization Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) developed a multi-facility maternal and neonatal Network of Care (NOC) among 22 government hospitals and catchment facilities operating across Dar es Salaam. While facility delivery rates were above 90% in the Dar es Salaam region, the quality of services was substandard, leading to an excess of preventable maternal and neonatal morbidity and mortality. In partnership with the Dar es Salaam regional health authorities CCBRT developed a plan to improve the quality of service delivery at childbirth by through a system strengthening approach, capacitating lower-level facilities to provide routine care during pregnancy and uncomplicated deliveries, as well as improving care at secondary level referral hospitals and developing an interconnected strengthened referral system. The Regional-CCBRT partnership implemented interventions across the continuum of care that included clinical training in basic and comprehensive emergency obstetric care, investments in infrastructure, and a rigorous maternal and perinatal death audit and follow-up program. Routine data generated were reflected upon at quarterly quality improvement meetings to follow up on problems identified. The government has initiated the replication of the model. This descriptive case study uses the four domains of the Networks of Care framework to document the wide-ranging efforts made to build and maintain the CCBRT Network of Care in order to solve for specific challenges in maternal and neonatal health service delivery in the urban context of the Dar es Salaam region.

Introduction: Congenital Anomalies (CA) are a significant cause of neonatal mortality both in developed and developing nations. Congenital abnormalities can have different patterns, prevalence rates, and risk factors across time and across different geographic regions. Aim: To find out the incidence of CA occurring among institutional live births and to study the associated maternal and perinatal risk factors in Northeast region of India. Materials and Methods: This retrospective observational study was carried out in the Neonatal Intensive Care Unit (NICU) at a Tertiary Care Hospital, Guwahati, Assam, India. The duration of the study was from January 2019 to December 2019. All newborns with CA during this period were included. Maternal and labour ward records were obtained. Data of maternal and antenatal factors such as age, parity, history of consanguinity, family history of congenital abnormality and mode of delivery were collected. The data were analysed using Microsoft Excel an...

Introduction: Neonatal congenital anomalies are the 17th leading cause of global disease burden. Congenital anomalies in low-income countries are high due to prevalence of nutritional deficiencies, intrauterine infections, teratogenic exposure and unsupervised self medication. This study aimed to find various antenatal risk factors for birth defects and the delays in health seeking behaviors in cases of still births with birth defects. Methods: In this retrospective study the records of mothers and neonates born with congenital anomalies during the period of 30 months were reviewed. Consanguinity, intrauterine infections, presence of anemia, and history of drug intake were noted. In cases of stillborns with anomalies, mode of delivery, labor complications and the three delays leading to morbidities were also noted. Results: There were 65 congenital anomalies during the study period with an incidence of 9.3 per 1000 births. Out of them, 43 were live births and 22 were still births. T...

Birth defects are a diverse group of disorders of prenatal origin that can be caused by single gene defects, chromosomal disorders, multifactorial inheritance, environmental teratogens and micronutrient deficiencies. Maternal infections such as rubella, maternal illnesses like diabetes mellitus (DM), iodine and folic acid deficiency, exposure to medicinal and recreational drugs including alcohol and tobacco, certain environmental chemicals, and doses of radiation are all other factors that cause birth defects. 1 Birth defects, Congenital malformations (CMs) and congenital anomalies (CAs) are interchangeable terms used to describe developmental defects that are present at birth. 2 Congenital anomalies represent defective morphogenesis during early fetal life. A broader definition includes metabolic or microscopic defects at a cellular level. Major anomalies have serious medical, surgical and cosmetic consequences. 3 Congenital anomalies affect approximately 1 in 33 infants leading to 6.6% deaths in infants and causing significant morbidity in children. 4 According to WHO Fact sheet, out of all causes of 2.761 million deaths worldwide during the neonatal period in 2013, congenital malformations contributed to 276000 deaths, preterm birth complications 965000, intra partum related complications (birth asphyxia) 662000, neonatal sepsis 421000 and other important causes 437000. 5 Community based study by Indian council of Medical Research ABSTRACT Background: Data on congenital malformations from developing countries like India are very few. However, it is important to have comprehensive and reliable data on the description and frequency of congenital malformations to allow surveillance and the implementation of appropriate public health strategies for prevention and management. In this study, we describe the pattern of congenital malformations seen in newborns delivered in tertiary care hospital of western Maharashtra. The objective was to study various newborn characteristics and to determine the frequency and pattern of congenital malformations at birth. Cross-sectional study conducted in Govt Medical College and Hospital Miraj, a tertiary care hospital in district of Maharashtra from June 2014 to November 2014 targeting all newborns delivered in hospital during study period. Methods: Data was collected by administering a semi structured questionnaire and a devised newborn screening clinical examination protocol. Results: Out of all 892 newborns (live births and still births), 24(2.69%) were having congenital malformations at birth and out of that, malformations involving circulatory system was highest i.e. 29.6% compared to other system. Conclusions: As compared to other studies circulatory disorders appear to be more common and by improvement in antenatal, postnatal diagnosis, early referral to tertiary hospital and early intervention most of these newborns can be saved.

Background: Congenital anomalies are a major cause of perinatal and neonatal deaths, both in low- and high-income countries. They are relatively common worldwide, affecting 3% to 5% of live births. Methods: A cross-sectional study was conducted from January 2014 to June 2014 at the Khyber teaching hospital in Peshawar. Specific patient information was obtained from patient records at the beginning of the study. Those individuals found to have at least one birth defect were approached and their attendants (mothers) were interviewed. Information regarding various risk factors was collected. Descriptive analyses were carried out. Results: Out of 1062 deliveries, 2.9% (31) of newborns had various congenital anomalies.b Hydrocephalus (22.6%), anencephaly (12.9%), and spina bifida (9.7%) were major anomalies. The maternal age ranged from 18 years to 46 years (mean: 30 ± 8). Most of the anomalies (35.5%) were present in the 26-30 years age group. Out of 31 babies, 6.4% had multiple anomali...

Background: Low Birth Weight (LBW) is considered an inescapable health hazard directly related to public health. It has already been well established by various scientific houses that less than 2.5 kg weight at the time of birth of a newborn is considered LBW. This research paper makes an attempt to depict the prevalence of LBW among tribal infants from all over India, based on published research articles. Methods: While searching for LBW-related articles by keywords, the researcher benefited from various well-known scientific websites like ResearchGate, Academia.edu, Science direct, PubMed/Medline, WHO (World Health Organization) database, and Google scholar. From 2000 to 2022 years published articles are involved in the present review analysis. Use descriptive statistics to understand the magnitude of the summarized data by using the Past Software 4.03 version. Results: A total of 17 articles were selected for the review analysis along with an investigation of 28746 infants, the prevalence of LBW in tribal infants of India was achieved at 39.89 % based on the study. The highest prevalence of LBW was in infants in Maharashtra at 87.50 % (95 % CI: 74.754 to 95.272), also the lowest LBW prevalence was found in children in Assam at 16.70 % (95 % CI: 16.100 to 16.820). Conclusion: LBW prevalence is quite high among tribal infants in India, health policymakers need to work on the intervention of anemia, along with the nutritional status of mothers and children to decrease the prevalence rate of low birth weight.

Background: Congenital anomaly is known for its multifactorial origin and trends among people across the world. Karachi is a hub of people belongs to different ethnic groups from all over Pakistan. Objective: The study was conducted to determine the frequency of congenital anomalies among antenatal patients. Study type, settings & duration: This descriptive cross sectional study was conducted in the outpatient Gynae department of Civil Hospital, Karachi from January 2017 to December 2018. Methodology: The antenatal patients both booked and un-booked, diagnosed antenatal with congenitally abnormal fetus or delivered congenitally abnormal neonate were included in the study. Results: During this tenure, a total of 8908 pregnant ladies were admitted in labor room and among those 198 were diagnosed with congenitally malformed babies. The most commonly identified abnormality was of central nervous system 60.1%, followed by renal 11.61%, gastrointestinal 4.54% and others 17.6%. Various risk factors like parental age, history of previous congenital anomaly and consanguinity showed association with these anomalies. Conclusion: Early detection of these anomalies and identification of the associated risk factor will help in reducing morbidity and mortality and creating awareness to solve the issue.

Maternal and neonatal death review (MNDR) introduced in Bangladesh and initially piloted in a district during 2010. MNDR is able to capture each of the maternal, neonatal deaths and stillbirths from the community and government facilities (hospitals). This study aimed to estimate the cost required to implement MNDR in a district of Bangladesh during 2010-2012. MNDR was implemented in Thakurgaon district in 2010 and later gradually extended until 2015. MNDR implementation framework, guidelines, tools and manual were developed at the national level with national level stakeholders including government health and family planning staff at different cadre for piloting at Thakurgaon. Programme implementation costs were calculated by year of costing and costing as per component of MNDR in 2013. The purchasing power parity conversion rate was 1 $INT = 24.46 BDT, as of 31(st) Dec 2012. Overall programme implementation costs required to run MNDR were 109,02,754 BDT (445,738 $INT $INT) in the ...

Objectives: To identify the effects of Maternal and Neonatal Death Review (MNDR) in terms of improving maternal and neonatal health at the community level in Bangladesh. Methods: Both quantitative and qualitative methods were undertaken for collecting data in Kashipur Union, Bangladesh. Death notifications from households, subsequent data collections from a focus-group discussion (FGD), a group discussion (GD) and in-depth interviews (IDIs) were obtained using structured tools and guidelines. Results: A total of four maternal deaths, 21 neonatal deaths and 15 still births were reported in the MNDR death notification system at Kashipur Union in 2010. Data were presented to local programme managers, who took various initiatives including awareness programmes, pregnancy registration, antenatal care, birth planning, and also the revitalization of a community clinic. The coverage of antenatal care, delivery in clinics, postnatal care and referral of complications increased through the active participation of the community. Community healthcare providers, care recipients and members of the community expressed satisfaction with the quality of maternal and neonatal services. In the preceding two years, maternal and neonatal deaths substantially reduced in Kashipur (in 2011 maternal death = 1, neonatal death = 20, still birth = 8; in 2012 maternal death = 1, neonatal death = 8, still birth = 13). Conclusions: The MNDR system successfully delivered notification of all maternal and neonatal deaths in the defined area and collected information for the formulation and implementation of specific interventions, which resulted in visible and tangible changes in care-seeking and client satisfaction.

Background The worldwide incidence of congenital anomalies (CAs) is estimated at 3-7%, but actual numbers vary widely among countries. Birth defects are the most common causes of infantile mortality, accounting for ~25% of all neonatal deaths. Aims To determine the prevalence of congenital anomalies in neonates in Fayoum Governorate; to classify malformations; and to clarify the association between congenital anomalies and possible risk factors. Methods A cross-sectional study was conducted on 1000 infants in the neonatal intensive care unit and outpatient clinics of Fayoum University Hospital and Fayoum General Hospital during August 2017 to April 2018. Detailed history, clinical examination and relevant investigations were performed. Results The prevalence of CAs was 7.4%. Major malformations accounted for 78.4% and minor malformations 21.6%. The most common CAs involved the cardiovascular system (32.4%), followed by musculoskeletal anomalies (18.9%), chromosomal anomalies (10.8%)...

Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach.  The  study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacity-building. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for...

Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach.  The  study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacity-building. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for...

This study aimed to describe the dealings of 20 biomedical doctors with coronavirus disease-19 (COVID-19) in the Sindh province of Pakistan. Focusing on physicians from three different hospitals, we describe their challenges, emotions, and views concerning the pandemic. Many regarded the virus from a biomedical standpoint. Yet some also perceived it as a “tool of a proxy war” and a “plot,” without giving agency to anyone for that “plot.” Furthermore, these care providers faced a great fear of infection and an even greater fear of transmitting the virus to their families and friends. A few also feared stigmatization as viral carriers. Whether they experienced fear or not, all of our physician interlocutors emphasized their sense of responsibility to “serve humanity,” yet some also expressed a strong belief in the inevitability of the will of Allah. Some were satisfied with the role of the government in containing the virus, while others expressed concerns and felt that the government...

Bangladesh has achieved remarkable progress in healthcare with a steady decline in maternal and under-5 child mortality rates in efforts to achieve Millennium Development Goals 4 and 5. However, the mortality rates are still very high compared with high-income countries. The quality of healthcare needs improve to reduce mortality rates further. It is essential to investigate the current quality of healthcare before implementing any interventions. The study was conducted to explore the perception of healthcare providers about the quality of maternal and neonatal health (MNH) care. The study also investigated patient satisfaction with the MNH care received from district and sub-district hospitals. Both qualitative and quantitative methods were used in the study. Two district and 12 sub-district hospitals in Thakurgaon and Jamalpur in Bangladesh were the study settings. Fourteen group discussions and 56 in-depth interviews were conducted among the healthcare providers. Client exit inte...

Introduction: All human worldwide had a risk infected by a severe acute respiratory syndrome–coronavirus-2 (SARS-CoV-2), including pregnant woman. Nowadays, SARS-CoV-2 transmission is still not fully understood. Thus, this situation created anxiety particularly for mothers that planned to breast-feed their baby and did their routine hospital visit. Thus this research aimed to evaluate the impact of COVID-19 pandemic with the routine visits and breastfeeding plan. Methods: This study was carried out with cross sectional observational study at Kasih Medika Hospital. The routine visits were conducted on the 5th-10th of August 2020. This study used a questionnaire instrument with samples of pregnant and postpartum mothers. The inclusion criteria of the sample were all pregnant women and post-partum that registered in Kasih Medika Hospital, complete questionnaire data filled in. The exclusion criteria were the patient agreed to be the research sample. All of the data was analyzed descrip...

Birth defects are a diverse group of disorders of prenatal origin that can be caused by single gene defects, chromosomal disorders, multifactorial inheritance, environmental teratogens and micronutrient deficiencies. Maternal infections such as rubella, maternal illnesses like diabetes mellitus (DM), iodine and folic acid deficiency, exposure to medicinal and recreational drugs including alcohol and tobacco, certain environmental chemicals, and doses of radiation are all other factors that cause birth defects. 1 Birth defects, Congenital malformations (CMs) and congenital anomalies (CAs) are interchangeable terms used to describe developmental defects that are present at birth. 2 Congenital anomalies represent defective morphogenesis during early fetal life. A broader definition includes metabolic or microscopic defects at a cellular level. Major anomalies have serious medical, surgical and cosmetic consequences. 3 Congenital anomalies affect approximately 1 in 33 infants leading to 6.6% deaths in infants and causing significant morbidity in children. 4 According to WHO Fact sheet, out of all causes of 2.761 million deaths worldwide during the neonatal period in 2013, congenital malformations contributed to 276000 deaths, preterm birth complications 965000, intra partum related complications (birth asphyxia) 662000, neonatal sepsis 421000 and other important causes 437000. 5 Community based study by Indian council of Medical Research ABSTRACT Background: Data on congenital malformations from developing countries like India are very few. However, it is important to have comprehensive and reliable data on the description and frequency of congenital malformations to allow surveillance and the implementation of appropriate public health strategies for prevention and management. In this study, we describe the pattern of congenital malformations seen in newborns delivered in tertiary care hospital of western Maharashtra. The objective was to study various newborn characteristics and to determine the frequency and pattern of congenital malformations at birth. Cross-sectional study conducted in Govt Medical College and Hospital Miraj, a tertiary care hospital in district of Maharashtra from June 2014 to November 2014 targeting all newborns delivered in hospital during study period. Methods: Data was collected by administering a semi structured questionnaire and a devised newborn screening clinical examination protocol. Results: Out of all 892 newborns (live births and still births), 24(2.69%) were having congenital malformations at birth and out of that, malformations involving circulatory system was highest i.e. 29.6% compared to other system. Conclusions: As compared to other studies circulatory disorders appear to be more common and by improvement in antenatal, postnatal diagnosis, early referral to tertiary hospital and early intervention most of these newborns can be saved.

Birth defects, encountered frequently by pediatricians, are important causes of childhood morbidity and mortality. Birth defects can be classified according to their severity, pathogenic mechanism, or whether they are involving a single system or multiple systems. This hospital-based prospective descriptive study highlights the prevalence of Congenital Anomalies (CAs) in one year among live born neonates delivered in Zagazig University Hospital (Egypt). All women giving birth to viable babies were included. Demographic details, associated risk factors and the type of CAs in all babies were recorded. Diagnosis of CAs was based on clinical evaluation, radiographic examination, ultrasonography, echocardiography and chromosomal analysis of the newborn whenever recommended. The overall incidence of CAs among live born neonates was 2.5%, as most of the cases were referred to Zagazig University Hospital (Egypt) for delivery. The musculoskeletal system (23%) was the most commonly involved f...