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  • 1
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    Preterm Nutrition and Clinical Outcomes
    SAGE Publications ; 2020
    In:  Global Pediatric Health Vol. 7 ( 2020-01), p. 2333794X2093785-
    Details
    In: Global Pediatric Health, SAGE Publications, Vol. 7 ( 2020-01), p. 2333794X2093785-
    Abstract: Background. In low-income countries, preterm nutrition is often inadequately addressed. The aim of the study was to assess the patterns of feeding and associated clinical outcomes of preterm neonates admitted to neonatal intensive care units in Ethiopia. Method. This was a multicenter, prospective study. Infants’ clinical characteristics at birth, daily monitoring of feeding history, and weight measurements were collected. An outcome assessment was completed at 28 days. Result. For this analysis, 2560 infants (53% male) were eligible. The mean (SD) gestational age was 33.1 (2.2) weeks. During the hospital stay the proportion of infants on breast milk only, preterm formula, term formula, and mixed feeding was 58%, 27.4%, 1.6%, and 34.1%, respectively. Delay in enteral feeding was associated with increased risk of death (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.33-2.78; P 〈 .001) and (OR = 5.06, 95% CI = 3.23-7.87; P 〈 .001) for 1 to 3 and 4 to 6 days of delay in enteral feeding, respectively, after adjusting for possible confounders. The length of delay in enteral feeding was associated with increased risk of hypoglycemia (OR = 1.2, 95% CI = 1.1-1.2; P = .005). The mortality rate was lower in hospitals providing preterm formula more often ( P = .04). Half of the infants continued losing weight at the time of discharge. Conclusion. Delayed enteral feeding significantly increases the risk of mortality before discharge and hypoglycemia in preterm infants in resource-limited settings. Ensuring adequate nutritional support of preterm infants is highly needed.
    Type of Medium: Online Resource
    ISSN: 2333-794X , 2333-794X
    URL: Article
    DOI: 10.1177/2333794X20937851
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2785531-4
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  • 2
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    Antenatal Steroid Utilization in Ethiopia
    SAGE Publications ; 2021
    In:  Global Pediatric Health Vol. 8 ( 2021-01), p. 2333794X2199034-
    Details
    In: Global Pediatric Health, SAGE Publications, Vol. 8 ( 2021-01), p. 2333794X2199034-
    Abstract: Background. Administration of antenatal corticosteroids to pregnant mothers is one of the most effective interventions to decrease preterm neonatal mortality. In this study we assessed antenatal steroid utilization by the mother and its effect on preterm babies. Method. Two years prospective, multicenter, observational study was conducted in selected hospitals of Ethiopia. Significance of the study outcomes was tested by chi-square and binary logistic regression. Result. Out of 4919 participants, 1575 preterm babies whose gestational ages were below 35 weeks were included in the study. Use of antenatal dexamethasone was 37.5% among study participants. The risk of early onset neonatal sepsis 235 (40.4%) was higher in preterm babies whose mother took antenatal dexamethasone ( P-value .002) than those who did not. Conclusion. Antenatal dexamethasone use in our study was comparable with other low and middle-income countries. Risk of early onset neonatal sepsis was higher among infants whose mother took antenatal dexamethasone.
    Type of Medium: Online Resource
    ISSN: 2333-794X , 2333-794X
    URL: Article
    DOI: 10.1177/2333794X21990344
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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  • 3
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    Prevalence of Anxiety, Depression and Associated Factors Among Pregnant Women of Hyderabad, Pakistan
    SAGE Publications ; 2009
    In:  International Journal of Social Psychiatry Vol. 55, No. 5 ( 2009-09), p. 414-424
    Details
    In: International Journal of Social Psychiatry, SAGE Publications, Vol. 55, No. 5 ( 2009-09), p. 414-424
    Abstract: Background: Few studies have examined the relationship between antenatal depression, anxiety and domestic violence in pregnant women in developing countries, despite the World Health Organization’s estimates that depressive disorders will be the second leading cause of the global disease burden by 2020. There is a paucity of research on mood disorders, their predictors and sequelae among pregnant women in Pakistan. Aims: To determine the prevalence of anxiety and depression and evaluate associated factors, including domestic violence, among pregnant women in an urban community in Pakistan. Methods: All pregnant women living in identified areas of Hyderabad, Pakistan were screened by government health workers for an observational study on maternal characteristics and pregnancy outcomes. Of these, 1,368 (76%) of eligible women were administered the validated Aga Khan University Anxiety Depression Scale at 20—26 weeks of gestation. Results: Eighteen per cent of the women were anxious and/or depressed. Psychological distress was associated with husband unemployment ( p = 0.032), lower household wealth ( p = 0.027), having 10 or more years of formal education ( p = 0.002), a first ( p = 0.002) and an unwanted pregnancy ( p 〈 0.001). The strongest factors associated with depression/anxiety were physical/sexual and verbal abuse; 42% of women who were physically and/or sexually abused and 23% of those with verbal abuse had depression/anxiety compared to 8% of those who were not abused. Conclusions: Anxiety and depression commonly occur during pregnancy in Pakistani women; rates are highest in women experiencing sexual/physical as well as verbal abuse, but they are also increased among women with unemployed spouses and those with lower household wealth. These results suggest that developing a screening and treatment programme for domestic violence and depression/anxiety during pregnancy may improve the mental health status of pregnant Pakistani women.
    Type of Medium: Online Resource
    ISSN: 0020-7640 , 1741-2854
    URL: Article
    DOI: 10.1177/0020764008094645
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2066492-8
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  • 4
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    Minimally Invasive Tissue Sampling in Preterm Deaths: A Validation Study
    SAGE Publications ; 2020
    In:  Global Pediatric Health Vol. 7 ( 2020-01), p. 2333794X2095326-
    Details
    In: Global Pediatric Health, SAGE Publications, Vol. 7 ( 2020-01), p. 2333794X2095326-
    Abstract: Uncertainty about the causes of neonatal deaths impedes achieving global health targets to reduce mortality. Complete diagnostic autopsy (CDA) is the gold standard to determine cause of death. However, it is often difficult to perform in high-burden, low-income settings. Validations of more feasible methods to determine cause of death are needed. This prospective, multi-center study in Ethiopia assessed the validity of the minimally invasive tissue sampling (MITS) approach to contribute to causes of death in preterm neonates compared to CDA. The MITS and CDA of 105 cases were reviewed. The MITS sampling success for lungs and liver was 100% and 84%, respectively. The kidney and brain had sampling successes of 58% each. MITS showed good agreement with CDA for the diagnosis of hyaline membrane disease (kappa = 0.78), and moderate to substantial agreement for pneumonia and pulmonary hemorrhage (kappa = 0.59 and 0.68, respectively). Even though CDA is the gold standard in identifying the cause of death, we believe that the MITS method can be a useful alternative method in supporting determination of cause of death in low-resource settings.
    Type of Medium: Online Resource
    ISSN: 2333-794X , 2333-794X
    URL: Article
    DOI: 10.1177/2333794X20953263
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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  • 5
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    Hematologic Profiles of Ethiopian Preterm Infants With Clinical Diagnoses of Early-Onset Sepsis, Perinatal Asphyxia, and Respiratory Distress Syndrome
    SAGE Publications ; 2020
    In:  Global Pediatric Health Vol. 7 ( 2020-01), p. 2333794X2096026-
    Details
    In: Global Pediatric Health, SAGE Publications, Vol. 7 ( 2020-01), p. 2333794X2096026-
    Abstract: Objective. To determine the hematologic profile of preterm infants with regard to different diseases. Methods. A prospective, cross-sectional, observational study, conducted in 5 hospitals in Ethiopia from July 2016 to May 2018. Preterm babies 〈 7 days of age were included and investigated with complete blood counts (CBC) and other investigations, accordingly. Results. Out of 4919 preterms, 3852 (78.3%) were admitted to a newborn intensive care unit, and of these, 68.3% had a CBC performed. The mean values of hemoglobin, white blood cell (WBC) and platelet counts were 17.9 mg/dL; 12 685 cells/mm 3 , and 159 340 cells/mm 3 , respectively. Early onset neonatal sepsis (EONS) 1433 (37%), asphyxia 266 (6.9%), and respiratory distress syndrome (RDS) 1738 (45.3%) were common reasons for admission. The WBC count was 〈 5000 cells/mm 3 for 8.8%, 9.0%, and 11.1% of neonates with EONS, asphyxia and RDS, respectively. The hemoglobin value was 〈 7 mg/dL for 0.6%, 1.7%, and 0.4% of preterm infants with EONS, asphyxia, and RDS, respectively. The platelet count was 〈 50 000 cells/mm 3 for 16.8%, 17.7%, and 19.8% of preterms admitted with a diagnosis of EONS, asphyxia, and RDS, respectively. Conclusion. WBC and platelet counts were the most common to be associated with EONS, asphyxia, and RDS. Further study is recommended to determine the effect of abnormal hematologic profile on the outcome of preterm babies.
    Type of Medium: Online Resource
    ISSN: 2333-794X , 2333-794X
    URL: Article
    DOI: 10.1177/2333794X20960264
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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  • 6
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    Disparity in Birth Size of Ethiopian Preterm Infants in Comparison to International INTERGROWTH-21st Data
    SAGE Publications ; 2020
    In:  Global Pediatric Health Vol. 7 ( 2020-01), p. 2333794X2097348-
    Details
    In: Global Pediatric Health, SAGE Publications, Vol. 7 ( 2020-01), p. 2333794X2097348-
    Abstract: Background. Patterns of fetal growth are largely influenced by environmental, nutritional, and socioeconomic factors more than differences in populations. The aim of this study was to assess anthropometric measurements of Ethiopian preterm infants at birth and compare the results with the international INTERGROWTH-21st data. Patients and methods. We analyzed anthropometric data on live-born singleton preterm infants enrolled in a hospital-based multicenter study of illness in preterm infants (SIP). Eligible newborns with gestational age of 28-36 weeks were included. Gestational age (GA) and sex-specific mean and standard deviations (SD), 10th, 50th, 90th, centile values for birth weight, length and head circumference (HC) were calculated and compared with INTERGROWTH-21st data. Result. A total of 2763 preterm infants were included in the study, 54% were male. The prevalence of small for GA (SGA) ( 〈 10th percentile) and large for GA (LGA) ( 〉 90th percentile) were 10.8% and 9.9%, respectively. In all 3 parameters, the mean values of boys were higher than of girls. Birth weight centiles were comparable to international averages at lower GA, then after GA of 32 weeks the 10th, 50th, and 90th centile values were 100-500 g less than the international averages. The head circumference centiles were mostly comparable, and the 90th centile values were greater than the international averages across the GA and in both sexes. Conclusion. The infants’ birth weights were smaller at higher GA, which may indicate maternal undernutrition in the third trimester of pregnancy. Strengthening antenatal nutrition counseling and providing nutrition supplementation might improve the birth weight.
    Type of Medium: Online Resource
    ISSN: 2333-794X , 2333-794X
    URL: Article
    DOI: 10.1177/2333794X20973484
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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  • 7
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    Hypothermia in Preterm Newborns: Impact on Survival
    SAGE Publications ; 2020
    In:  Global Pediatric Health Vol. 7 ( 2020-01), p. 2333794X2095765-
    Details
    In: Global Pediatric Health, SAGE Publications, Vol. 7 ( 2020-01), p. 2333794X2095765-
    Abstract: Background. Globally, prematurity is the leading cause of neonatal mortality, and hypothermia is one of its contributing factors. The goal of this study was to determine the association between hypothermia and mortality. Methods. A prospective, multi-center, descriptive clinical study was conducted in 5 hospitals in Ethiopia. Axillary temperatures were taken at the time of admission to the newborn intensive care units (NICU) and followed during the NICU stay. Results. A total of 3852 premature neonates ( 〈 37 weeks) were admitted to the NICUs from July 2016 to May 2018. Of these infants, 1109 (28.8%) died and 2991 (79.6%) had hypothermia. Hypothermia was associated with perinatal asphyxia (89.5%), RDS (86.2%), and resuscitation at birth (82.7%). Admission temperatures in preterm newborns were inversely associated with mortality and morbidity. Conclusion. Hypothermia at admission is associated with neonatal mortality in premature neonates in Ethiopia. RDS and perinatal asphyxia were the main factors associated with hypothermia. The very high prevalence and association with mortality warrants quality improvement interventions.
    Type of Medium: Online Resource
    ISSN: 2333-794X , 2333-794X
    URL: Article
    DOI: 10.1177/2333794X20957655
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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  • 8
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    Bacterial Isolates and Resistance Patterns in Preterm Infants with Sepsis in Selected Hospitals in Ethiopia: A Longitudinal Observational Study
    SAGE Publications ; 2020
    In:  Global Pediatric Health Vol. 7 ( 2020-01), p. 2333794X2095331-
    Details
    In: Global Pediatric Health, SAGE Publications, Vol. 7 ( 2020-01), p. 2333794X2095331-
    Abstract: Background: Neonatal sepsis is the third leading cause of neonatal mortality, behind prematurity and intrapartum-related complications. The main objectives of this study are to assess the proportion of sepsis in preterm newborns and identify the etiologic agents and their antibiotic sensitivity patterns. Methods: A longitudinal observational study was done from July 2016 to May 2018. Whenever clinical diagnosis of sepsis was made, blood cultures and antibiotic susceptibility tests were done. Result: We did 690 blood cultures, 255 (36.9%) showing bacterial growth. The most commonly isolated bacteria were Klebsiella species 78 (36.6%), Coagulase negative Staphylococcus 42 (19.7%) and Staphylococcus aureus 39 (18.3%). Gram-positive bacteria showed high resistance to penicillin (98.9%) and ceftriaxone (91.3%) whereas Gram-negative bacteria were highly resistant to gentamicin (83.2%) and ceftriaxone (83.2%). Conclusion: Resistance to the more commonly used antibiotics such as ampicillin and gentamycin was very high, necessitating reconsideration of the empiric use of these antibiotics.
    Type of Medium: Online Resource
    ISSN: 2333-794X , 2333-794X
    URL: Article
    DOI: 10.1177/2333794X20953318
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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  • 9
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    Women’s Perceptions and Experiences of Domestic Violence : An Observational Study From Hyderabad, Pakistan
    SAGE Publications ; 2017
    In:  Journal of Interpersonal Violence Vol. 32, No. 1 ( 2017-01), p. 76-100
    Details
    In: Journal of Interpersonal Violence, SAGE Publications, Vol. 32, No. 1 ( 2017-01), p. 76-100
    Abstract: This community-based observational study of 1,325 women seen for antenatal care examined how women in Pakistan define violence against women (VAW), with an emphasis on domestic violence, what an acceptable response to violence is, reasons for remaining silent, and whether participants are willing to disclose incidents of domestic violence to others. Nearly half of the study participants believed that physical violence was VAW. Verbal abuse, controlling behavior by the husband, conflict with in-laws, overburdening domestic work, and threatening to leave or remarry were also considered VAW. However, only five respondents (0.4%) considered sexual abuse to be VAW. Most women who screened positive for domestic violence responded by remaining silent or verbal fighting back. None sought professional help. Women who decided to remain silent feared that the abuse would escalate or that responding would not help them. Women cited social stigma and concerns about the impact of the violence on children as reasons for not disclosing violent incidents to others or seeking professional help. Women’s lack of autonomy further reduced their ability to take steps against violence. Although societal norms, particularly patriarchal beliefs and women’s subordination to men, likely explain women’s tolerance of abuse, their recognition of physical abuse as violence indicates that they do not necessarily believe it is always justified. Educational interventions to drive changes in the social norms around gender violence along with effective and enforceable legal measures are likely required to ensure women’s safety.
    Type of Medium: Online Resource
    ISSN: 0886-2605 , 1552-6518
    URL: Article
    DOI: 10.1177/0886260515585533
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2028900-5
    SSG: 2
    SSG: 2,1
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  • 10
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    Hyperbilirubinemia in Preterm Infants Admitted to Neonatal Intensive Care Units in Ethiopia
    SAGE Publications ; 2020
    In:  Global Pediatric Health Vol. 7 ( 2020-01), p. 2333794X2098580-
    Details
    In: Global Pediatric Health, SAGE Publications, Vol. 7 ( 2020-01), p. 2333794X2098580-
    Abstract: Background. Hyperbilirubinemia is prevalent and protracted in preterm infants. This study assessed the pattern of hyperbilirubinemia in preterm infants in Ethiopia. Methods. This study was part of multi-centered prospective, cross-sectional, observational study that determined causes of death among preterm infants. Jaundice was first identified based on clinical visual assessment. Venous blood was then sent for total and direct serum bilirubin level measurements. For this study, a total serum bilirubin level ≥5 mg/dL was taken as the cutoff point to diagnose hyperbilirubinemia. Based on the bilirubin level and clinical findings, the final diagnoses of hyperbilirubinemia and associated complications were made by the physician. Result. A total of 4919 preterm infants were enrolled into the overall study, and 3852 were admitted to one of the study’s newborn intensive care units. Of these, 1779 (46.2%) infants were diagnosed with hyperbilirubinemia. Ten of these (0.6%) developed acute bilirubin encephalopathy. The prevalence of hyperbilirubinemia was 66.7% among the infants who were less than 28 weeks of gestation who survived. Rh incompatibility ( P = .002), ABO incompatibility ( P = .0001), and sepsis ( P = .0001) were significantly associated with hyperbilirubinemia. Perinatal asphyxia ( P-value = 0.0001) was negatively associated with hyperbilirubinemia. Conclusion. The prevalence of hyperbilirubinemia in preterm babies admitted to neonatal care units in Ethiopia was high. The major risk factors associated with hyperbilirubinemia in preterm babies in this study were found to be ABO incompatibility, sepsis, and Rh isoimmunization.
    Type of Medium: Online Resource
    ISSN: 2333-794X , 2333-794X
    URL: Article
    DOI: 10.1177/2333794X20985809
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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