Preterm Birth Rates – Ghana
Rank: 14 –Rate: 14.5% Estimated # of preterm births per 100 live births (USA – 12%)
Ghana, officially the Republic of Ghana, is a country located along the Gulf of Guinea and Atlantic Ocean, in the subregion of West Africa. Spanning a land mass of 238,535 km2 (92,099 sq mi), Ghana is bordered by the Ivory Coast in the west, Burkina Faso in the north, Togo in the east and the Gulf of Guinea and Atlantic Ocean in the south. Ghana means “Warrior King” in the Soninke language.
Ghana’s population of approximately 30 million spans a variety of ethnic, linguistic and religious groups.
Ghana is a unitary constitutional democracy led by a president who is both head of state and head of the government. Ghana’s growing economic prosperity and democratic political system have made it a regional power in West Africa. It is a member of the Non-Aligned Movement, the African Union, the Economic Community of West African States (ECOWAS), Group of 24 (G24) and the Commonwealth of Nations.
Ghana has a universal health care system strictly designated for Ghanaian nationals, National Health Insurance Scheme (NHIS). Health care is very variable throughout Ghana and in 2012, over 12 million Ghanaian nationals were covered by the National Health Insurance Scheme (Ghana) (NHIS). Urban centres are well served, and contain most of the hospitals, clinics, and pharmacies in Ghana. There are over 200 hospitals in Ghana and Ghana is a destination for medical tourism. In 2010, there were 0.1 physicians per 1,000 people and as of 2011[update], 0.9 hospital beds per 1,000 people.
The unsung hero in breast-milk
Date: Jan 16 , 2020 BY: Matilda Twumasi & Dr Freda Intiful
Breastfeeding a child after birth can be considered exciting, fascinating, interesting and tiring for mothers who have just given birth.Human breast milk is considered the best food and the gold standard for newborns and infants. It has been well documented that breastfed infants are better protected from infectious agents than formula-fed infants.This can be attributed to various factors present in milk. Oligosaccharides are one of the important factors.
Milk oligosaccharides (HMOs) are complex sugars which form part of the functional ingredients of human breast milk.
They are the third most important solid component of breast milk (with the first and second being lactose and lipids respectively) which has positive short-and long-term effects on infants.
HMOs levels appear to be higher in first milk (colostrum, the yellowish creamy milk) after child birth and decrease as breastfeeding continues.
They have many benefits which put breastfed children at an advantage as compared to formula-fed infants.
The first of its benefits is its function on the gastrointestinal tract (GIT).
HMOs act as feed for digestive micro-organisms. HMOs have long been thought to stimulate the colonisation of beneficial microbes in the gastrointestinal tract of the infant.
Generally, breast-fed infants seem to have a less complex, more stable microbial community than formula-fed infants.
It is now well established that HMOs can serve as substrate for intestinal microbes.
The second of its benefits is its ability to protect against infections. Studies have shown that breast-fed infants have lower incidences of infectious diseases of the intestinal, urinary and respiratory tract.
Many pathogens first need to adhere to mucosal surfaces to invade the host to cause disease or initiate infection but some HMOs inhibit adhesion and enhance pathogen clearance which reduces infection.
Thirdly, HMOs are also considered nutrients for brain development.
Studies have shown that breastfed preterm infants have superior developmental scores at 18 months of age and higher intelligence quotients at the age of seven.
Human milk is a rich source of sialic acid, and post-mortem analysis on human neonates showed that sialic acid concentrations are significantly higher in the brains of breastfed infants than infants fed with formula that contained lower amounts of sialic acid.
This shows that sialylated HMOs contribute to the majority of sialic acid in human milk that provides the developing brain with this seemingly essential nutrient and contribute to good developmental scores and intelligence quotients in breastfed infants.
HMOs represent the next frontier in neonatal nutrition as they constitute a major component of the immune-protection conferred by breast milk upon vulnerable infants.
The addition of HMOs to infant formula is currently not feasible due to the limited availability.
Cattle-milk-based infant formula contains very low levels of complex oligosaccharides, which make it difficult to be used as a substitute for that which comes from humans.
In an attempt to compensate for this deficiency, infant formula manufacturers are presently fortifying their products with enzymatically produced or plant-based, non-human oligosaccharides, including galactooligosaccharides (GOS) and fructooligosaccharides (FOS).
The effects of formula oligosaccharides on intestinal epithelium and barrier functions are controversial.
Some studies have reported that FOS supplementation in neonatal rats increased bacterial translocation without affecting barrier integrity.
Whether or not this is a potential health concern to the human infant remains to be clarified.
In conclusion, HMOs seem to have a wide spectrum of benefits for the breast-fed infant that go beyond the prebiotic aspects.
Adding “the real” HMOs to infant formula in similar complexity as found in breast milk will, at least for now, remain technically unfeasible.
However, with recent advances in glycan synthesis, one or more “authentic” HMOs might soon become available for clinical studies with infant health outcomes, but also to address basic measures such as HMO metabolism, bioavailability and kinetics.
Until then, breast milk still remains the most perfect food for the baby and mothers are encouraged to choose breastmilk over formula.
Israeli gov’t provides support GHS in Neonatal care
By Florence Afriyie Mensah, GNA – Wednesday 10th July, 2019
Kumasi, July 10, GNA – The government of Israel as part of efforts to deepen relationship with the Ghana Health Service (GHS), has inaugurated two neonatal units in two health facilities in the Kumasi Metropolis.
The beneficiary hospitals are the Kumasi South and the Suntreso Government Hospitals.
Each of the 16 bed capacity for newborns, would provide essential services such as; Kangaroo Mother Care (KMC), clinical training for medical and physician assistants, while also serving as maternal and child health research hubs.
Ms. Shani Cooper, Israeli Ambassador to Ghana, who inaugurated the facilities at separate ceremonies in Kumasi on Wednesday, said the aim was to improve performance, reduce neonatal and maternal deaths in the Mother and Baby Units (MBU).
The units were created by an Israeli Physician, Dr. Miki Karplus in 2009 for the two hospitals, under the joint MASHAV and Soroka initiative.
So far, the two units have been able to register significant achievement with the introduction of new methodologies, computerized data collection system and a sharp decrease in maternal and neonatal mortality rate.
Additionally, the units have ensured permanent distant medical consultations between the Israeli team of doctors and their counterparts in the two facilities.
Ms. Cooper said the Israeli government had also helped to install at the facilities, bubble CPAP, infusion pumps, radiant warmers, oxihoods and phototherapy equipment, all being aids that promote effective delivery of neonatal services at the facilities.
She mentioned that a delegation from the Ghana health Service was already in Israel attending a conference on health technologies, adding that, her government remained committed to partner the Ghana government to speed up socio-economic development.
Dr. Ashura Bakari, Head of the MBU of the Sunterso Government Hospital, said the Hospital had an annual admission of more than 900 babies between ages of zero to two months.
He said neonatal deaths decreased from 23 in 2017 to 16 in 2018 at the facility and commended the Israeli government for the continued support to improve neonatal services at the two facilities.
HEALTH CARE PARTNERS
esStudy provid data-based answer for preterm baby’s discharge from the NICU
Reviewed by James Ives, M.Psych. (Editor)Jan 16 2020
“When is my baby going home?” is one of the first questions asked by families of infants admitted to the neonatal intensive care unit (NICU). Now clinicians have a data-based answer. Moderate to late preterm babies (born at gestational age of 32 to 36 weeks) who have no significant medical problems on admission are likely to be discharged at 36 weeks of postmenstrual age (gestational age plus age since birth), according to a study published in the American Journal of Perinatology. Small for gestational age infants and those with specific diagnoses may stay longer.
For the first time, practitioners have tangible data on length of stay to counsel parents at the time of their preterm baby’s admission. Our results may decrease parent stress and help families prepare for their baby’s arrival home.”
Previously, length of stay predictors were signs of the infant’s physiological maturity, which were only available near the end of the hospital stay. Infants born at less than 37 weeks of completed gestation comprise almost 10 percent of births in the United States. Most preterm infants are born between 32 and 36 weeks of gestation.
To establish a reliable length of stay estimate at the time of a preterm baby’s admission, Dr. Higgins Joyce and colleagues from Lurie Children’s conducted a retrospective chart review over six years, encompassing 3,240 moderate to late preterm infants born in a large, urban NICU. They found that the mean length of stay for these infants was 17 days, ranging from 30 days for infants born at 32 weeks of gestation to about a week for infants born at 36 weeks.
“While these results come from just our hospital, we hope other centers can confirm that many parents of premature infants can anticipate having their babies home with them earlier than previously expected,” says senior author Patrick Myers, MD, neonatologist at Lurie Children’s and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine.
Source: Alanna Higgins Joyce, MD, MPH, lead author, hospitalist at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine
Journal reference: Joyce, A. H., et al. (2020) When is My Baby Going Home? Moderate to Late Preterm Infants are Discharged at 36 Weeks Based on Admission Data. American Journal of Perinatology. doi.org/10.1055/s-0039-3401850.
Tackling Physician Burnout and Moral Injury
January 8, 2020 Health Policy and Management, Psychology Katie Brind’Amour, PhD, MS, CHES
Across the United States, burnout and suicide rates for physicians have reached record highs, claiming the life of a doctor a day. What can be done to protect and improve the wellbeing of the people who care for everyone else?
Most doctors enter their profession knowing that it is demanding, but believing that it is also rewarding and meaningful work. “Demanding” may be putting it mildly, however. Health care providers sleep less than people in any other profession. Physician stress, depression and anxiety levels are on the rise, with more than half of clinicians reporting symptoms that qualify as emotional, physical and mental burnout. And sadly, between 300 and 400 physicians per year are lost to suicide.
But why do some physicians develop burnout, moral injury and long-term mental health conditions, while others don’t? Why is America losing a doctor every day to suicide? And what can be done about it?
Seeing the Problem
The health care system surrounding today’s clinicians encompasses much more than just providing care. Clinical work is part of a much larger picture that often includes electronic medical record management, office and insurance paperwork, highly complex regulatory requirements, satisfaction reviews, quality improvement and cost reduction responsibilities, continuing education, and multidisciplinary collaboration for complex patients. Clinicians are asked to accomplish more and more, often with no extra time or resources provided.
“Clinicians are increasingly torn by competing priorities, and they report they are constantly making trade-off decisions: having to choose between getting their administrative duties completed and providing more or better patient care,” says Brandon Kozar, PsyD, MBA, director of leadership coaching and development at Nationwide Children’s Hospital. “These are individuals who are in medicine because they want to help people, so this constant battle is demoralizing, guilt-inducing and makes them feel they aren’t in control of their professional lives. They lose the joy of practicing medicine.”
Resourcefulness and hard work cannot solve this dilemma, and their resiliency plummets. Over time, clinicians who feel that these forced trade-offs infringe on their ethical duties — that they are unable to uphold their entrenched moral desire to put patients’ wellbeing first — experience “moral injury,” a significant predictor of other serious mental health concerns, such as clinical depression, substance abuse, anxiety and suicidal ideation.
Burnout — a more common phenomenon, where emotional and physical exhaustion result from constant exposure to stressors and a decreased ability to cope with daily duties — and moral injury have important implications beyond the wellbeing of the affected individual clinicians. These problems may negatively impact patient care and outcomes. When doctors are exhausted mentally, emotionally and physically, they cannot provide optimal care. They become more likely to make mistakes. Substance abuse, sleep deprivation, anger control issues, relationship troubles and other problems arise, further increasing the risk to physicians and their patients.
Unfortunately, physicians and other health care workers often feel they have nowhere to turn for relief.
Understanding the Problem
Historically, clinicians have been known for a dogged commitment to their patients and their work, often at their own expense. Acknowledging emotions and troubles, admitting to being overwhelmed, and seeking help have been tantamount to inadequacy or unprofessionalism, and thus have carried a stigma.
Even in recent years, clinicians with depression or substance use disorders have faced loss of licensure, increased supervision, restriction of hospital privileges, and loss of privacy — making admission of difficulties a potential threat to their livelihood and status. And in part because of the profession’s reticence on the idea of mental health concerns affecting their own, suicide among physicians is believed to be underreported by pathologists trying to protect their deceased colleagues’ reputations.
To further complicate matters, many hospital program and department leaders are clinicians themselves, rather than business experts trained in human resource management and administrative processes. Running a business unit with significant fiduciary, regulatory and supervisory responsibilities may come naturally to some clinical directors, but others struggle to create environments that both support morale and enable engaged productivity. Emotional intelligence — the ability to recognize and empathetically respond to the emotions of the people around you — is perhaps under-appreciated in the selection of leadership, and clinicians and other staff pay the price.
“Some departments have greater rates of burnout and poor mental health than others, and the differences are not best predicted by workload,” says Dr. Kozar, referencing literature on emotional intelligence and clinical staff performance. “Instead, just the perception of being socially supported by peers, superiors or the organization dramatically influences how health care providers cope. Positive and supportive work environments that foster a sense of support and collegiality result in more productive work, more accurate differential diagnoses and less burnout.”
This goes beyond creating a feel-good culture to fostering an environment that systematically embraces a genuine concern for clinicians and other employees both in the adoption of workplace expectations and in the everyday manner of interpersonal interactions.
and administrative processes. Running a business unit with significant fiduciary, regulatory and supervisory responsibilities may come naturally to some clinical directors, but others struggle to create environments that both support morale and enable engaged productivity. Emotional intelligence — the ability to recognize and empathetically respond to the emotions of the people around you — is perhaps under-appreciated in the selection of leadership, and clinicians and other staff pay the price.
Some departments have greater rates of burnout and poor mental health than others, and the differences are not best predicted by workload,” says Dr. Kozar, referencing literature on emotional intelligence and clinical staff performance. “Instead, just the perception of being socially supported by peers, superiors or the organization dramatically influences how health care providers cope. Positive and supportive work environments that foster a sense of support and collegiality result in more productive work, more accurate differential diagnoses and less burnout.”
This goes beyond creating a feel-good culture to fostering an environment that systematically embraces a genuine concern for clinicians and other employees both in the adoption of workplace expectations and in the everyday manner of interpersonal interactions.
Fixing the Problem
There is no cut-and-dry solution to the problem of overwhelmed and under-supported physicians. But that has not stopped many institutions from trying to take an active step toward identifying burnout and distress, helping physicians in need, and preventing the problem in the first place.
At Nationwide Children’s, for instance, Dr. Kozar’s existence on staff is a primary example of the hospital’s intentional decision to protect its people. His role was created partly in response to the hospital’s Zero Hero program, designed to eliminate preventable harm, such as overtired staff and emotionally depleted clinicians. In addition, it was an attempt to formalize programs and a cultural shift toward de-stigmatizing mental health concerns, supporting employees and equipping them with resources and outlets to address their needs.
Dr. Kozar directs the hospital’s YOU Matter program, which offers emotional and mental health support to both clinical and non-clinical staff faced with work-related and potentially traumatic stressors, such as a patient death. The program has several components, including a peer support initiative, a critical response team, on-site Master’s-level clinical counselors exclusively for staff (focused in high-acuity settings such as the emergency department and intensive care units), and hospital rounds focused on discussing psychosocial impacts of participants’ work. In addition, hospital employees are eligible for confidential counseling sessions at no cost
(focused in high-acuity settings such as the emergency department and intensive care units), and hospital rounds focused on discussing psychosocial impacts of participants’ work. In addition, hospital employees are eligible for confidential counseling sessions at no cost.
“It might be due to the increasing visibility of mental health needs in society at large, but I think clinicians are becoming more accepting of the need to speak up and speak out about salient issues of burnout,” says Dr. Kozar. “The trick is to avoid framing all stress as evil. Stress actually can have many benefits both professionally and personally, and it isn’t realistic to totally eliminate it. Distress, however, is overwhelming and negative and needs to be reduced.”
Further efforts at Nationwide Children’s have included the implementation of business coaching for clinical department leaders to help them run better-organized programs and alleviate burnout. Stress management training for staff — in which the distinction between good and bad stress is emphasized — also reinforces the hospital’s culture of confronting the issue and treating each other with compassion. Staff trained as peer support personnel are taught to pay attention to the work experiences of their colleagues and to reach out to others on a regular basis.
“Human beings are social creatures — we do better when we work and operate in an environment where we are cared for,” says Dr. Kozar. “Instead of an environment where there’s nothing but a time crunched, task-oriented day where clinicians are drawn in every direction with no time to look out for each other, we’re focusing on building deliberate and strategic social support systems that can cultivate resiliency”.
How to Protect Clinician Well-being
The widespread problems of burnout and moral injury will not disappear overnight, but Dr. Kozar is confident that personal and institutional steps to counteract these problems can equip clinicians with the support and competencies they need in order to maintain resilience and protect their psyches.
“These are high-performing individuals,” Dr. Kozar says. “When you teach them to do something, they can implement it very effectively. You just have to make sure that you’re not training them to quash problems in one area only for them to pop up in another. The approach has to be comprehensive, which means it’s oriented at the institution’s programs and personal resiliency, not just workload.”
As many as a dozen hospitals per year come to Nationwide Children’s to learn about and implement programs similar to those managed by Dr. Kozar.
His recommended steps for physicians to take to prevent and address burnout and moral injury include:
- Recognize as early as possible the signs of compassion fatigue (the “empathy well” has run dry), moral injury (value conflicts between what you are doing and what you believe is the right thing to do), and burnout (loss of pleasure, increasing cynicism, mental/emotional exhaustion).
- Seek help early: Use your employee assistance program and/or seek counsel from a trusted colleague or supervisor.
- Focus on what you can control (“I can’t change the medical health system, but I can control and improve this…”).
- Promote and engage in social support (this is the single greatest protective factor against burnout and a primary source of life satisfaction).
- Continue to cultivate resilience by focusing on your interpretation or framing of events and not just the events themselves. Remember: A + B = C (Activating event + Belief about that event = Consequence: How I feel and therefore behave).
Dr. Kozar also suggests some opportunities for institutions to protect their employees from the potentially devastating problems of burnout and moral injury:
- Recognize that burnout and the need to support and care for staff is a critical investment for their wellbeing as well as that of patients.
- Assign a senior executive sponsor to support, fund and advocate for staff support programs –these initiatives deserve more than just staff-driven “culture club”-level support.
- Train chiefs of medicine and other leaders on the 3Rs: How to Recognize, Respond and Refer physicians struggling with socioemotional issues.
- Promote the purpose and joy of medicine: Have regular events in which physicians are exposed to past patients and families whom they have helped. Allow them the experience of someone expressing their gratitude and appreciation for what they did.
- Remember to “Acknowledge the pain yet promote the gain.”
- Teach leaders how to promote and support intrinsic motivation in staff: Autonomy, Mastery, and Purpose.
- Hire leaders with above-average emotional intelligence. Poor or ineffective leadership is one of the main drivers of work-related burnout and dissatisfaction. As the saying goes, “Most people don’t leave their jobs, they leave their bosses” — so make sure the “bosses” are good not just at medicine, but at personnel management.
A Randomized Trial of Erythropoietin for Neuroprotection in Preterm Infants
January 16, 2020 By: Sandra E. Juul, M.D., Ph.D., Bryan A. Comstock, M.S., Rajan Wadhawan, M.D., Dennis E. Mayock, M.D., Sherry E. Courtney, M.D., Tonya Robinson, M.D., Kaashif A. Ahmad, M.D., Ellen Bendel-Stenzel, M.D., Mariana Baserga, M.D., Edmund F. LaGamma, M.D., L. Corbin Downey, M.D., Raghavendra Rao, M.D., for the PENUT Trial Consortium*
High-dose erythropoietin has been shown to have a neuroprotective effect in preclinical models of neonatal brain injury, and phase 2 trials have suggested possible efficacy; however, the benefits and safety of this therapy in extremely preterm infants have not been established.
In this multicenter, randomized, double-blind trial of high-dose erythropoietin, we assigned 941 infants who were born at 24 weeks 0 days to 27 weeks 6 days of gestation to receive erythropoietin or placebo within 24 hours after birth. Erythropoietin was administered intravenously at a dose of 1000 U per kilogram of body weight every 48 hours for a total of six doses, followed by a maintenance dose of 400 U per kilogram three times per week by subcutaneous injection through 32 completed weeks of postmenstrual age. Placebo was administered as intravenous saline followed by sham injections. The primary outcome was death or severe neurodevelopmental impairment at 22 to 26 months of postmenstrual age. Severe neurodevelopmental impairment was defined as severe cerebral palsy or a composite motor or composite cognitive score of less than 70 (which corresponds to 2 SD below the mean, with higher scores indicating better performance) on the Bayley Scales of Infant and Toddler Development, third edition.
A total of 741 infants were included in the per-protocol efficacy analysis: 376 received erythropoietin and 365 received placebo. There was no significant difference between the erythropoietin group and the placebo group in the incidence of death or severe neurodevelopmental impairment at 2 years of age (97 children [26%] vs. 94 children [26%]; relative risk, 1.03; 95% confidence interval, 0.81 to 1.32; P=0.80). There were no significant differences between the groups in the rates of retinopathy of prematurity, intracranial hemorrhage, sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, or death or in the frequency of serious adverse events.
High-dose erythropoietin treatment administered to extremely preterm infants from 24 hours after birth through 32 weeks of postmenstrual age did not result in a lower risk of severe neurodevelopmental impairment or death at 2 years of age. (Funded by the National Institute of Neurological Disorders and Stroke; PENUT ClinicalTrials.gov number, NCT01378273. opens in new tab.)
PREEMIE FAMILY PARTNERS
Buffalo NICU Nurse Writes Book for Preemies (wgrz.com)
Alyssa Veech Published on May 10, 2019
Sisters of Charity Hospital nurse, Alyssa Veech, wrote “Small But Mighty” to help parents on the emotional journey of having a preemie in the NICU.
Preterm children have similar temperament to children who were institutionally deprived
Date: November 12, 2019 Source: University of Warwick
A child’s temperament appears to be affected by the early stages of their life. Researchers have found children who were born very preterm (under 32 weeks gestation) or very low birthweight (under 1500g) had similar temperamental difficulties in controlling their impulses, to children who experienced institutional deprivation
The paper ‘A Comparison of the Effects of Preterm Birth and Institutional Deprivation on Child Temperament’, published today, 12 November in the journal Development and Psychopathology, highlights how different adverse experiences such as preterm birth and institutional deprivation affect children’s temperament in similar ways, resulting in greater risk for lower self-control.
The team of researchers, from the University of Warwick, University of Tennessee, University of Southampton and King’s College London looked at children who were born very preterm, or very low birth weight from the Bavarian Longitudinal study, and children who experienced at least six months of institutional deprivation — a lack of adequate, loving caregivers — in Romanian institutions from the English and Romanian Adoptees study, who were then compared to 311 healthy term born children and 52 non-deprived adoptees, respectively.
The researchers found that both groups of children had lower effortful control at 6 years.
This is the first study that directly compares the effects of severe preterm birth and extended institutional deprivation, and suggests that self-control interventions early in life may promote the development of children after both risk experiences.
Prof Dieter Wolke from the Department of Psychology at the University of Warwick comments: “Both, early care either in an incubator or deprivation and neglect in an orphanage lead to poor effortful control. We need to further determine how this early deprivation alters the brain.”
Lucia Miranda Reyes, from the Department of Child and Family Studies at the University of Tennessee comments: “These findings suggest that children’s poor effortful control may underlie long-term social problems associated with early adverse experiences; thus, improving their self-control may also help prevent these later problems.”
We are all in this together. This short video shares a powerful glimpse of our preterm birth journeys. The links below will provide families and caregivers with access to great support and the opportunity to give and give back. There are preterm birth support groups around the world. We are listing a few that we know are fully committed to supporting the Neonatal Womb/preterm birth community world-wide.
Preemie Graduation | Canadian Premature Babies Foundation
Canadian Premature Babies Foundation – Published on Nov 13, 2019
Help premature babies and their parents reach the most important graduation of all.
Hand to Hold: https://handtohold.org/
Graham’s Foundation: https://grahamsfoundation.org/
March of Dimes: https://www.marchofdimes.org/nicufamilysupport/index.aspx
Simple test predicts dangerous pregnancy disorder
Date: October 23, 2019 Source: Edith Cowan University
Summary: Researchers have developed a simple, low-cost way to predict preeclampsia, a potentially deadly condition that kills 76,000 mothers and 500,000 babies every year.
Australian researchers have developed a way to predict the onset of a deadly pregnancy condition that kills 76,000 women and half a million babies each year, mostly in developing countries.
Researchers from Edith Cowan University in Perth Western Australia have developed a simple, low-cost way to predict preeclampsia, one of the leading causes of maternal-fetal mortality worldwide.
Preeclampsia can cause devastating complications for women and babies, including brain and liver injury in mothers and premature birth.
Survey gives early warning
ECU researchers assessed the health status of 593 pregnant Ghanaian women using the Suboptimal Health Questionnaire.
The Suboptimal Health Questionnaire was developed in 2009 by Professor Wei Wang from ECU’s School of Health and Medical Sciences. Combining scores for fatigue, heart health, digestion, immunity and mental health, the questionnaire provides an overall ‘suboptimal health score’ that can help predict chronic diseases.
Professor Wang’s PhD candidate Enoch Anto found that 61 per cent of women who scored high on the questionnaire went on to develop preeclampsia, compared with just 17 per cent of women who scored low.
When these results were combined with blood tests that measured women’s calcium and magnesium levels, the researchers were able to accurately predict the development of preeclampsia in almost 80 per cent of cases.
Mr Anto said preeclampsia was very treatable once identified, so providing an early warning could save thousands of lives.
“In developing nations, preeclampsia is a leading cause of death for both mothers and babies. In Ghana, it’s responsible for 18 per cent of maternal deaths,” Mr Anto said.
“But it can be treated using medication that lowers blood pressure once diagnosed.
“Both blood tests for magnesium and calcium and the Suboptimal Health Questionnaire are inexpensive, making this ideally suited to the developing world where preeclampsia causes the most suffering.”
NICU Technology Predicts Care
Hurley Medical Center / Hurley Children’s Hospital
Hurley’s NICU has been performing miracles for decades. With our growing technology, we are now able to do even more. Our doctors and nurses can now predict symptoms or problems BEFORE your baby experiences them. That gives us a jump on treating your baby. #HurleyCares #NHITweek @HIMSS
Environmental Research Volume 176, September 2019,
Synergistic effects of prenatal exposure to fine particulate matter (PM2.5) and ozone (O3) on the risk of preterm birth:
A population-based cohort study
There is some evidence that prenatal exposure to low-level air pollution increases the risk of preterm birth (PTB), but little is known about synergistic effects of different pollutants.
We assessed the independent and joint effects of prenatal exposure to air pollution during the entire duration of pregnancy.
The study population consisted of the 2568 members of the Espoo Cohort Study, born between 1984 and 1990, and living in the City of Espoo, Finland. We assessed individual-level prenatal exposure to ambient air pollutants of interest at all the residential addresses from conception to birth. The pollutant concentrations were estimated both by using regional-to-city-scale dispersion modelling and land-use regression–based method. We applied Poisson regression analysis to estimate the adjusted risk ratios (RRs) with their 95% confidence intervals (CI) by comparing the risk of PTB among babies with the highest quartile (Q4) of exposure during the entire duration of pregnancy with those with the lower exposure quartiles (Q1-Q3). We adjusted for season of birth, maternal age, sex of the baby, family’s socioeconomic status, maternal smoking during pregnancy, maternal exposure to environmental tobacco smoke during pregnancy, single parenthood, and exposure to other air pollutants (only in multi-pollutant models) in the analysis.
In a multi-pollutant model estimating the effects of exposure during entire pregnancy, the adjusted RR was 1.37 (95% CI: 0.85, 2.23) for PM2.5 and 1.64 (95% CI: 1.15, 2.35) for O3. The joint effect of PM2.5 and O3 was substantially higher, an adjusted RR of 3.63 (95% CI: 2.16, 6.10), than what would have been expected from their independent effects (0.99 for PM2.5 and 1.34 for O3). The relative risk due to interaction (RERI) was 2.30 (95% CI: 0.95, 4.57).
Our results strengthen the evidence that exposure to fairly low-level air pollution during pregnancy increases the risk of PTB. We provide novel observations indicating that individual air pollutants such as PM2.5 and O3 may act synergistically potentiating each other’s adverse effects.
A Liftless Intervention to Prevent Preterm Birth and Low Birthweight Among Pregnant Ghanaian Women:
Protocol of a Stepped-Wedge Cluster Randomized Controlled Trial
JMIR Res Protoc 2018 Aug 23;7(8):e10095. Epub 2018 Aug 23. Institute of Public Health & Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland.
Preterm birth (PTB) is a leading cause of infant morbidity and mortality worldwide. Every year, 20 million babies are born with low birthweight (LBW), about 96% of which occur in low-income countries. Despite the associated dangers, in about 40%-50% of PTB and LBW cases, the causes remain unexplained. Existing evidence is inconclusive as to whether occupational physical activities such as heavy lifting are implicated. African women bear the transport burden of accessing basic needs for their families. Ghana’s PTB rate is 14.5%, whereas the global average is 9.6%. The proposed liftless intervention aims to decrease lifting exposure during pregnancy among Ghanaian women. We hypothesize that a reduction in heavy lifting among pregnant women in Ghana will increase gestational age and birthweight.
To investigate the effects of the liftless intervention on the incidence of PTB and LBW among pregnant Ghanaian women.
A cohort stepped-wedge cluster randomized controlled trial in 10 antenatal clinics will be carried out in Ghana. A total of 1000 pregnant participants will be recruited for a 60-week period. To be eligible, the participant should have a singleton pregnancy between 12 and 16 weeks gestation, be attending any of the 10 antenatal clinics, and be exposed to heavy lifting. All participants will receive standard antenatal care within the control phase; by random allocation, two clusters will transit into the intervention phase. The midwife-led 3-component liftless intervention consists of health education, a take-home reminder card mimicking the colors of a traffic light, and a shopping voucher. The primary outcome are gestational ages of <28, 28-32, and 33-37 weeks. The secondary outcomes are LBW (preterm LBW, term but LBW, and postterm), compliance, prevalence of low back and pelvic pain, and premature uterine contractions. Study midwives and participants will not be blinded to the treatment allocation.
Permission to conduct the study at all 10 antenatal clinics has been granted by the Ghana Health Service. Application for funding to begin the trial is ongoing. Findings from the main trial are expected to be published by the end of 2019.
To the best of our knowledge, there has been no randomized trial of this nature in Ghana. Minimizing heavy lifting among pregnant African women can reduce the soaring rates of PTB and LBW. The findings will increase the knowledge of the prevention of PTB and LBW worldwide.
©Emma Kwegyir-Afful, Jos Verbeek, Lydia Aziato, Joseph D. Seffah, Kimmo Räsänen. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 23.08.2018.
Study investigates health, well-being of adults who were born preterm at very low birth weight
Reviewed by Kate Anderton, B.Sc. (Editor)Nov 18 2019
The Finnish Institute for Health and Welfare (THL) is investigating the health and well-being of adults who were born preterm at very low birth weight in a series of studies that are unique worldwide.
The study initiated 15 years ago, will be continued when the same individuals, now aged between 35 and 40, are invited to participate.
The information obtained from the study will help with the development of the care and monitoring of premature babies and the reduction of any related health risks for adults.
The study involves the participation of those who were treated at birth between 1978 and 1985 in the infant intensive care ward at the Helsinki University Hospital and who were born either preterm at very low birth weight or, as a control group, were born at full term.
The health and well-being of these individuals as adults has been studied since 2004-2005.
The follow-up study is done in cooperation with an international partner, the Department of Medical Science at the Norwegian University of Science and Technology (NTNU). In Norway, a similar study is simultaneously being carried out using the same methodology as the Finnish study. The researchers will work together to process the data collected in the Finnish and Norwegian studies, which will improve the reliability and precision of the results.
The research includes a detailed health check-up and several questionnaire forms. The individuals’ health will be assessed using different indicators such as their body fat percentage and the results of a glucose tolerance test and a pulmonary function test.
Also, their psychological well-being will be studied using different tasks and questionnaire forms. A new component of the study is a detailed eye check-up and study of their motor skills.
In addition to NTNU, this study involves cooperation with the Helsinki and Uusimaa Hospital District’s Department of Eye Diseases, the University of Helsinki’s Department of Psychology, and the University of Oulu’s Faculty of Medicine.
“We aim to make participation in the research as easy and rewarding as possible. The participants receive for themselves the results of the measurements and check-ups, and thus acquire a broad overall picture of their state of health. The adults who were born preterm at very low birth weight have participated actively in the earlier studies, and we hope that as many as possible will participate this time as well.” Maarit Kulmala, Medical Researcher and Eye Disease Specialist
Infants with a birth weight of 1.5kg or less are classified as having very low birth weight. The systematic intensive care of preterm infants at very low birth weight began in the 1970s.
The majority of those born preterm at very low birth weight consider themselves to be healthy and live a normal life. Slightly less than 10% have some kind of illness or disability which is related to being born preterm and which affects their daily life and capacity to work.
In earlier studies, it was observed that there were health differences at young adulthood between those born full term and those born preterm at very low birth weight. Those born preterm had, for example, a higher incidence of risk factors related to cardiovascular diseases, such as high blood pressure.
They also clearly engaged less in physical exercise than those born full term. Furthermore, they experienced slightly more learning difficulties, depression and anxiety disorders. On the other hand, they fared better than those born full term in some areas, showing lower levels of allergic reactions, behavioural disorders and excessive alcohol consumption.
“We previously studied those born preterm during their young adulthood, aged around 20 to 25, at which point the body’s operating capacity is at its peak. Now we will be studying how their health and operating capacity develop with age: do the differences observed between those born preterm at very low birth weight and those born full term increase over time or even out? This follow-up study for later adulthood, those aged between 35 and 40, is the first of its kind in the world,” explains Professor Eero Kajantie, who is in charge of the study and also heads up the Adults Born Preterm International Collaboration (APIC).
Article Research Source: Finnish Institute for Health and Welfare
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