Barriers Faced by the Health Workers to Deliver Maternal Care Services and Their Perceptions of the Factors Preventing Their Clients from Receiving the Services: A Qualitative Study in South Sudan

Objective The study objective was to explore challenges and barriers confronted by maternal and child healthcare providers to deliver adequate quality health services to women during antenatal care visits, facility delivery and post-delivery care. Methods We conducted 18 in-depth-interviews with maternal and child health professionals including midwives/nurses, trained traditional birth attendants (TBAs), gynecologists, and pediatricians in three public health facilities in Juba, South Sudan. We purposively selected these health professionals to obtain insights into service delivery processes. We analyzed the data using thematic analysis. Results Limited support from the heath system, such as poor management and coordination of staff, lack of medical equipment and supplies and lack of utilities such as electricity and water supply were major barriers to provision of health services. In addition, lack of supervision and training opportunity, low salary and absence of other forms of non-financial incentives were major elements of health workers’ de-motivation and low performance. Furthermore, security instability as a result of political and armed conflicts further impact services delivery. Conclusions for Practice This study highlighted the urgent need for improving maternal and child healthcare services such as availability of medical supplies, equipment and utilities. The necessity of equal training opportunities for maternal and child healthcare workers at different levels were also stressed. Assurance of safety of health workers, especially at night, is essential for providing of delivery services.     

Evaluation of a real-time fluorescent PCR assay for rapid detection of Group B Streptococci in neonatal blood

Streptococcus agalactiae (Group B Streptococcus: GBS) is the major causative agent of neonatal sepsis. Neonates at risk for GBS infections are empirically administered broad-spectrum antibiotics for at least 48 h pending blood culture results. A rapid assay to expedite detection of GBS would facilitate initiation of specific antibiotic therapy. Conversely, expeditious proof of absence of infection will avoid unnecessary antibiotic use. Using the LightCycler, we evaluated a hybridization probe polymerase chain reaction (PCR) assay to detect GBS-specific cfb gene target DNA sequence in blood specimens. Both sensitivity and specificity of the real-time PCR assay was 100%. The assay demonstrated 100% specificity when tested against 26 non-GBS bacteria. This method is capable of detecting as few as approximately 100 copies or 10 pg of GBS genomic DNA. This real-time PCR method is rapid, sensitive, and specific for the detection of GBS in neonatal blood samples and holds great promise in its utility in the diagnostic laboratory.     

Zinc and copper supplementation are not cost-effective interventions in the treatment of acute diarrhea

BackgroundDiarrhea is one of the principal causes of morbidity and mortality among children in the developing world. Cumulative costs of treating diarrhea would be high and would further increase if zinc was used as an adjunct to treatment of acute diarrhea.ObjectiveTo determine the impact of zinc supplementation on the mean predicted costs of treating acute diarrhea and the incremental cost-effectiveness (CE) as compared with placebo, from the provider's (government) and patient's perspective.Study Design and SettingIn a randomized, double-blind, placebo-controlled clinical trial, 808 children aged 6–59 months with acute diarrhea were individually randomized to placebo (Pl), zinc (Zn) only, and zinc and copper (Zn + Cu) together with standard treatment of acute diarrhea. The actual resource utilization and cost data were collected for all participants. The incremental CE ratio and its 95% confidence interval (95% CI) were assessed.ResultsThe relative CE for treating acute diarrhea was 1.5 (95% CI: 1.50, 1.52) times more when supplemented with zinc and 1.7 (95% CI: 1.69, 1.71) times more when supplemented with Zn + Cu with no additional beneficial effect.ConclusionThis study showed that zinc or zinc with copper supplementation were not cost-effective in the treatment of acute diarrhea in this study population.     

Effect of nutrition counselling with a digital job aid on child dietary diversity: Analysis of secondary outcomes from a cluster randomised controlled trial in rural Bangladesh

Adequate dietary diversity among infants is often suboptimal in developing countries. We assessed the impact of nutrition counselling using a digital job aid on dietary diversity of children aged 6–23 months using data from a cluster randomised controlled trial in Bangladesh. The trial had five arms, each with 25 clusters. The four intervention arms provided counselling using a digital job aid and different prenatal and post-natal combinations of lipid-based supplements and the comparison arm with usual practice. We enrolled 1500 pregnant women and followed them until the children reached their second birthday. We developed a tablet-based system for intervention delivery, data collection and project supervision. We combined the four intervention arms (n = 855), in which community health workers (CHWs) provided age-appropriate complementary feeding counselling, to compare against the comparison arm (n = 403). We calculated the outcome indicators from the children's 24-h dietary recalls. Overall, the intervention increased the mean dietary diversity score by 0.09 (95% confidence interval [CI]: 0.2–0.16) and odds of minimum dietary diversity by 18% (95% CI: 0.99–1.40). However, there was a significant interaction on the effect of the intervention on dietary diversity by age. The mean dietary diversity score was 0.24 (95% CI: 0.11–0.37) higher in the intervention than in the comparison arm at 9 months and 0.14 (95% CI: 0.01–27) at 12 months of age. The intervention effect was non-significant at an older age. Overall, consumption of flesh food was 1.32 times higher in the intervention arm (odds ratio [OR] 1.32, 95% CI: 1.11–1.57) in 6–23 months of age. The intervention significantly improved child dietary diversity score in households with mild and moderate food insecurity by 0.27 (95% CI: 0.06–0.49) and 0.16 (0.05–27), respectively, but not with food-secure and severely food-insecure households. Although the study did not evaluate the impact of digital job aid alone, the findings indicate the utility of nutrition counselling by CHWs using a digital job aid to improve child feeding practices in broader programmes.     

Interpretation of Z-score anthropometric indicators derived from the international growth reference

The WHO international growth reference was reviewed to identify characteristics that might affect the interpretation of anthropometric indicators derived from it. Discontinuities were found at the junction point of the two distinct data sets from which the reference curves are derived. Also, the Z-score derived percentile curves for weight-for-age and weight-for-height did not join due to differences in the variances of the two portions of the reference. Empirically an examination of data from international nutrition surveys revealed an artifactual drop in the prevalence of low height-for-age, low weight-for-height, and high weight-for-height at age 2 y, which is due substantially to these discontinuities rather than to intrinsic changes in nutritional status with age. Strategies are discussed for the interpretation of anthropometric indicators in light of these characteristics of the international reference.     

Measuring Social Support in Pregnancy: Can It Be Simple and Meaningful?

Background: It is important to determine the level of a woman's social support at the booking‐in interview for prenatal care, but measurement tends to be ad hoc and nonquantifiable. The purpose of this study was to describe the Maternity Social Support Scale and the relationship between support scale ratings and the Edinburgh Postnatal Depression Scale and other health and service use outcomes. Methods: Women (n= 901) who attended the antenatal clinic at the Royal Women's Hospital in Brisbane, Australia, were asked to complete a support scale as part of their booking‐in interview. Participants were contacted at 16 weeks postpartum and invited to complete a follow‐up questionnaire. Relationships between the scale and study outcomes were explored using analysis of variance and chi‐square tests. Results: Women with low social support in pregnancy were more likely than well‐supported women to report poorer health during pregnancy (p= 0.006) and postnatally (p < 0.001), to book later for prenatal care (p= 0.000), to seek medical help more frequently (p= 0.004), and to be more depressed postnatally(p= 0.0001). Conclusion: Social support during pregnancy can be measured in a meaningful and simple way through the use of a short questionnaire administered at the prenatal booking‐in visit.     

Obesity increase among low SES Australian schoolchildren between 2000 and 2006: time for preventive interventions to target children from low income schools?

Objectives  

To examine change from 2000 to 2006 in obesity and overweight by gender, school year and school socioeconomic status (SES) in a national sample of students from Australia.     

Prevalence of obesity,overweight and thinness in Australian children and adolescents by socioeconomic status and ethnic/cultural group in 2006 and 2012

Objectives

To study the prevalence of obesity, overweight and thinness, by sex, SES and ethnic background in 2006 and 2012.

Methods

Large national surveys of school students were conducted. Height/weight was measured. The outcomes were height, weight, BMI, thinness, overweight and obesity (IOTF), SES and ethnicity.

Results

Obesity in 2006 and 2012 in boys and girls was 7.5 and 7.1 %, and 5.8 and 5.6 %; being overweight was 17.7 and 18.5 %, and 18.9 and 18.7 %; thinness was 3.8 and 4.6 %, and 5.0 and 6.0 %. Independent predictors of obesity in 2006 and 2012 were being Pacific Islander (OR 5.03, 5.66), Middle Eastern (OR 3.64, 1.50), aboriginal (OR 2.43 in 2012 only), African (OR 1.99 2012 only), Southern European (OR 1.75, 1.72), low SES (OR 2.22, 2.20), middle SES (OR 1.52, 1.60), female (OR 0.77, 0.82) and adolescent (OR 1.08, 2012 only). Predictors of thinness in 2006 and 2012 were ethnicity: Indian (OR 5.29, 1.96), African (OR 2.71, 2006 only), Asian (OR 1.69, 1.57) and female (OR 1.30, 1.27).

Conclusions

The predictors of obesity and thinness were ethnically based, suggesting culturally appropriate interventions in socially and economically disadvantaged communities.