Dissertations / Theses on the topic 'Maternal health'
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1
CANTARUTTI, ANNA. "Maternal and Child Health." Doctoral thesis, Università degli Studi di Milano-Bicocca, 2017. http://hdl.handle.net/10281/158179.
Abstract:
Secondo l'Organizzazione Mondiale della Sanità (OMS), ogni giorno, in tutto il mondo, circa 1.000 donne muoiono per cause legate alla gravidanza o al parto e, ogni anno, più di otto milioni di bambini nei paesi a basso e medio reddito muoiono prima di raggiungere i cinque anni di vita. L'OMS è stata chiara: la salute materno-infantile è un tema di enorme importanza sanitaria e richiede investimenti, progetti, energie e impegno, rappresentando una componente fondamentale della salute pubblica delle popolazioni umane.
Migliorando l'approccio e l'accesso alle cure sanitarie, rendendo più disponibili assistenza qualificata, trattamenti farmacologici e la formazione degli operatori, ma anche semplici interventi preventivi durante la gravidanza, nel corso della gravidanza, del parto e dei primi anni di vita del bambino è possibile, infatti, prevenire le morti evitabili.
A fronte della complessità dell’insieme dei temi e delle problematiche relative al percorso nascita e alla salute materno-infantile, ho ritenuto di suddividere in più fasi il mio progetto sviluppando diversi profili, come quello socio-economico, farmacologico, e clinico.
Sono state utilizzate diverse metodologie statistiche a seconda dell’obiettivo dello studio. Le associazioni tra le diverse esposizioni della madre, prima e/o durante la gravidanza, e gli esiti neonatali selezionati, sono state valutate attraverso modelli di regressione logistica. In alcuni studi c’è stata la necessità di imputare i dati mancanti. Vista la natura di questi ultimi, arbitrary missing data pattern, è stato utilizzato il modello “fully conditional specification (FCS)”, ipotizzando l'esistenza di una distribuzione congiunta per le variabili mancanti. Per rendere le stime più robuste, a seguito della presenza di confondenti non misurati, è stato utilizzato l'approccio rule-out descritto da Schneeweiss. Per valutare il ruolo che gli eventi avversi neonatali alla nascita svolgono nel rapporto tra l’esposizione della madre durante la gravidanza e gli esiti neonatali in questione, ho utilizzato la “mediation analysis” descritta da VanderWeele e Vansteelandt. Infine, a seguito dell’utilizzo di dati osservazionali, le caratteristiche basali di esposti e non esposti potrebbero essere sbilanciate. Ho quindi utilizzato la tecnica del “propensity score startification” che permette di creare gruppi di pazienti con simile probabilità di ricevere il trattamento. Il propensity score è stato stimato sia attraverso il metodo classico della regressione logistica, sia utilizzando l’algoritmo “high-dimensionale propensity score” per valutare le centinaia di diagnosi, procedure, e prescrizioni più significative.
Lo scopo della mia tesi è quello di identificare i possibili fattori per sviluppare e migliorare la salute materno-infantile da un aspetto socio-demograficho, farmacologico, e clinico.
Ho strutturato la mia tesi in diverse sezioni. Procederò in prima istanza, dando una panoramica dei metodi utilizzati nei vari studi effettuati durante il mio dottorato, procedendo con una descrizione dettagliata di questi ultimi.According to the World Health Organization (WHO), every day, worldwide, about 1,000 women die due to causes related to pregnancy or childbirth and, every year, more than eight million children in low and middle income countries die before reaching five years of age. The WHO was clear: maternal and child health is a topic of enormous medical importance and requires investments, projects, energy and commitment; it is an essential part of the public health of human populations. Improving the approach and access to health care, making qualified assistance, drug treatment and training of the operators more available, but also elementary preventive interventions during pregnancy, childbirth and the early years of a child's life, can prevent avoidable deaths and reduce several neonatal outcomes. Given the complexity of all the issues and problems concerning births and maternal and child health, through this thesis I propose a path divided into several stages which covers various topics starting from the socio-economic profile of the mother, moving to the pharmacological profile of pregnancy, up to the prevention of stillbirths. Several statistical methods were implemented to answer the different questions depending on the aim of each study. Log-binomial regression was used for estimating the association between the mother’s exposure during pregnancy and the selected neonatal outcomes. The fully conditional specification (FCS) model was performed to generate appropriate values of missing data for those women with missing covariates. The rule-out approach described by Schneeweiss was implemented to make our estimates, which might be affected by unmeasured confounder, more robust. The mediation analysis described by VanderWeele and Vansteelandt was used to assess the role that some adverse neonatal events at presentation (mediator) play in the relationship between the mother’s exposure during pregnancy (exposure) and adverse neonatal events later in life (outcome). Lastly, the Propensity Score Stratification derived from the predicted probability of treatment estimated in a logistic-regression model, as well as the high-dimensional propensity score algorithm to evaluate hundreds of inpatient diagnosis, procedures, and pharmacy claims, were completed to account for all potential confounders. The aim of my thesis is to identify factors to develop and improve the health care related to maternal- fetal and maternal-child world (before and after birth, respectively) from a sociodemographic, farmacoepidemiology, and clinical point of view. The layout of the thesis has been divided into different sections. I will proceed in the first instance by giving an overview of the methods used in the various studies carried out during my PhD, proceeding with a detailed description of the latter.
2
Webb, Rebecca. "Maternal mental health, processing of emotion and maternal sensitivity." Thesis, City, University of London, 2017. http://openaccess.city.ac.uk/21219/.
Abstract:
Background: Research suggests that postnatal affective disorders such as anxiety, depression and post-traumatic stress disorder (PTSD) are associated with lower levels of maternal sensitivity. Understanding the mechanisms through which maternal affective disorders influence maternal sensitivity is important as it could lead to more tailored effective interventions to improve outcomes for women and their infants. One mechanism that is yet to be explored is the way in which mothers' process infant-related information. This thesis therefore developed a cognitive model that aimed to examine this mechanism. Aim: The aim of this thesis was to test this cognitive model of maternal sensitivity using a range of experimental, observational and questionnaire studies. The model proposed that maternal affective symptoms would be associated with maternal processing of infant-related information, which in turn would be associated with maternal sensitivity. Methods & Results: The aims were addressed through a systematic review and a study of women with (n = 23) and without (n = 47) affective symptoms and their infants (aged 2-8 months) after birth. The systematic review found that mothers with perinatal affective disorders are faster to disengage from sad infant faces and are more accurate at identifying sadness in infant faces (Article 1). To assess how mothers process infant-related information, validated pictures of infants' emotional faces were needed. Therefore, a validated set of infant emotional expressions was created and validated on student midwives and nurses and members of the general public. The images were found to have high criterion validity and good test-retest reliability (Article 2). Mothers processing of infant-related information and its relationship with maternal sensitivity was tested using a series of questionnaires, computerised and observational tasks. Results are reported in Articles 3, 4 and 5. Conclusion: Overall, the cognitive model of maternal sensitivity was only partly supported, in that maternal affective symptoms explained more of the variance of maternal sensitivity than maternal processing of infant-related information. Despite this, the work in this thesis provides a novel contribution to the literature by developing and testing a model based on previous research and by using robust measures such as eye-tracking technology and observational measures of mother-infant interaction. However, interpretation of the data is hindered due to methodological issues such as small sample sizes, homogeneous sample and demand characteristics. Therefore, more research is needed to test this model on a larger, more heterogenous sample.
3
McLendon, Pamela Ann. "Opening Doors for Excellent Maternal Health Services: Perceptions Regarding Maternal Health in Rural Tanzania." Thesis, University of North Texas, 2014. https://digital.library.unt.edu/ark:/67531/metadc500156/.
Abstract:
The worldwide maternal mortality rate is excessive. Developing countries such as Tanzania experience the highest maternal mortality rates. The continued exploration of issues to create ease of access for women to quality maternal health care is a significant concern. A central strategy for reducing maternal mortality is that every birth be attended by a skilled birth attendant, therefore special attention was placed on motivations and factors that might lead to an increased utilization of health facilities. This qualitative study assessed the perceptions of local population concerning maternal health services and their recommendations for improved quality of care. The study was conducted in the Karatu District of Tanzania and gathered data through 66 in-depth interviews with participants from 20 villages. The following components were identified as essential for perceived quality care: medical professionals that demonstrate a caring attitude and share information about procedures; a supportive and nurturing environment during labor and delivery; meaningful and informative maternal health education for the entire community; promotion of men’s involvement as an essential part of the system of maternal health; knowledgeable, skilled medical staff with supplies and equipment needed for a safe delivery. By providing these elements, the community will gain trust in health facilities and staff. The alignment the maternal health services offered to the perceived expectation of quality care will create an environment for increased attendance at health facilities by the local population.
4
Aihara, Yoko Sirikul Isaranurug. "Effect of maternal and child health handbook on maternal and child health promoting belief and action /." Abstract, 2005. http://mulinet3.li.mahidol.ac.th/thesis/2548/cd375/4737949.pdf.
5
Hohnen, Bettina. "Maternal attributions for premature labour and their relationship to maternal mental health and maternal bonding." Thesis, Open University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.369032.
6
Chung, Sangbun. "The effect of maternal blood phenylalanine level on mouse maternal phenylketonuria offspring." Diss., The University of Arizona, 1999. http://hdl.handle.net/10150/289025.
Abstract:
Maternal phenylketonuria is a disease process caused by the adverse effects of high maternal blood phenylalanine (PHE) on the fetus. Unless treated, maternal PKU results in teratogenic effects on the fetus that can lead to mental retardation, microcephaly, intrauterine growth retardation, congenital cardiovascular defects, low birth weight, spontaneous abortion and fetal death. Although PKU has been recognized as a major challenge for many years, surprisingly little is known about the pathophysiologic mechanism(s) of PHE toward the fetus. To more thoroughly investigate the pathogenesis of this heritable disease and to explore potential therapeutic actions, the genetic mouse model Pahenu2 was used. The overall goals of this project were to use the Pah enu2 mouse to examine the effect of maternal blood PHE level on: (1) The pregnancy outcome of maternal PKU offspring as measured by the incidence of spontaneous abortion and certain key measures of development at birth (i.e., head circumference, weight, and crown-rump length of offspring); and (2) The fetal nutritional status of maternal PKU offspring as assessed by the levels of PHE, tyrosine (TYR), and other essential amino acids (EAA) at birth. In this study, we clearly observed that elevated maternal blood PHE levels, whether they were caused by the maternal diet or maternal genotype, were responsible for the fetal abnormalities in maternal PKU. With regard to fetal developmental outcomes, significant reductions in birth weight, crown-rump length, and head circumference were seen in offspring gestated under high maternal blood PHE conditions. The incidence of fetal loss was significantly different between treatment and control groups. Reductions in the levels of alanine, glutamine, and glutamic acid were observed in fetal blood among offspring born to mutant mothers with high blood PHE levels. None of the branched chain amino acids were reduced in maternal PKU offspring. These findings strongly suggest that there are important maternal genotype and dietary components but no fetal genotype component to this maternal PKU model. Given that these maternal factors also appear to be the most important components of human maternal PKU, this model seems certain to provide a valid animal model to overcome the difficulties of human studies.
7
Price, Robin Owen. "Maternal health and fetal brain development : altered fetal neurogenesis following maternal inflammation /." May be available electronically:, 2009. http://proquest.umi.com/login?COPT=REJTPTU1MTUmSU5UPTAmVkVSPTI=&clientId=12498.
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Carreon-Bailey, Rebecca Socorro. "Influences of maternal parenting behaviors: Maternal mental health, attachment history and eduction." CSUSB ScholarWorks, 2006. https://scholarworks.lib.csusb.edu/etd-project/2989.
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Studies have found that the type of parenting a child receives affects his or her subsequent development. This study investigates the relative influence of maternal parenting behavior and the impact of multiple variables influencing the quality of mothers' parenting behaviors. This knowledge will help to understand how early attachment experiences impact future parenting behavior.
9
Smith, Emily Rose. "Maternal and Child Health, Nutrition, and Hiv." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:32644541.
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Reducing maternal and child mortality was established as a global priority with the signing of the Millennium Declaration in September 2000. Neonatal vitamin A supplementation and very early breastfeeding initiation are scalable interventions which may improve infant survival. Although breastfeeding has proven benefits for infant health, the potential health consequences of breastfeeding for HIV-infected women are not well studied.
In paper one, “The effect of neonatal vitamin A supplementation on morbidity and mortality at 12 months: A randomized trial”, we assessed the efficacy of neonatal vitamin A supplementation (NVAS) in reducing infant morbidity and mortality. Using data from an individually randomized clinical trial of 31,999 infants in Tanzania, we found that NVAS did not affect the risk of death or the incidence of morbidities. However, we noted that postpartum maternal vitamin A supplementation modified the effect of neonatal vitamin A supplementation on infant mortality.
In paper two, “Effect of delayed breastfeeding initiation on infant survival: a systematic review and meta-analysis”, our objective was to synthesize the evidence regarding the association between breastfeeding initiation time and infant morbidity and mortality. We pooled five studies, including 136,047 infants. We found a clear dose-response relationship; the risk of neonatal mortality increased with increased delay in breastfeeding initiation. We found a similar pattern when the analysis was restricted to exclusively breastfed infants or low birthweight infants. There was limited evidence regarding the association between breastfeeding initiation time and infant morbidity and growth. We concluded that health policy frameworks and models to estimate newborn and infant survival should consider the independent survival benefit associated with early initiation of breastfeeding.
In paper three, “Breastfeeding and Maternal Health among HIV-infected Women in Tanzania”, our objective was to assess the relationship between infant feeding practices and the incidence of maternal mortality, morbidity, and indicators of poor nutritional status from six weeks to two years postpartum in a prospective cohort of Tanzanian women living with HIV. We concluded that breastfeeding may be associated with mixed health outcomes. Additional research should investigate whether HIV-infected women require nutritional support, in addition to antiretroviral therapy, during and after lactation.
10
Russell, Lynda. "Maternal mental health in the perinatal period." Thesis, University of Birmingham, 2011. http://etheses.bham.ac.uk//id/eprint/3153/.
Abstract:
Volume 1: Research component There are three papers contained in this volume, all concerned with maternal mental health problems in the perinatal period. The first is a review that examines the existing literature on eating disorders in the perinatal period. It examines prevalence, symptomatology levels across the perinatal period and factors associated with development and remission from eating disorders in the perinatal period. The second paper is a report of research, carried out by the author, investigating obsessive compulsive disorder, bonding and meta-cognitions in new mothers. It specifically examines whether bonding is impaired in new mothers with OCD when compared with mothers who have no symptoms of OCD, a subject that has not been investigated in previous research. Both papers have been prepared for submission to Archives of Women‟s Mental Health. The final paper is a public domain paper describing the literature review and empirical papers and has been used to disseminate the findings of the research amongst participants, mother and baby organisations and mental health professionals. The appendices contain information regarding ethical approval, measures used and instructions to authors from the Archives of Women‟s Mental Health. Volume 2: Clinical component This volume contains five clinical practice reports (CPR) submitted during the doctorate course. These reports reflect the training of the course and the work completed over the three years of the course. CPR 1 and 2 were conducted during a child and adolescent placement. CPR 1 describes a doctor phobia in a five year old girl, formulated from a behavioural and a systemic perspective. CPR 2 reports a single case experimental design study on a narrative intervention for sleep difficulties in a nine year old boy. CPR 3 describes a qualitative service evaluation of a waiting list initiative and changes to the referral system to a Psychological Therapies Service within an adult mental health service. CPR 4 is a case study of a CBT intervention for a client with OCD in a specialist adult service. The abstract of CPR 5, a presentation on a CBT and narrative intervention for anger in a woman with a learning disability in an inpatient setting. The names and identifying details have been changed or removed from these reports to protect anonymity.
11
Bodas, Mandar V. "Three Essays on Maternal and Child Health." VCU Scholars Compass, 2018. https://scholarscompass.vcu.edu/etd/5543.
Abstract:
This dissertation is a collection of three separate essays on the health of women and children. In the first essay, I along with my co-authors, analyzed the impact of two large, national-level health policies (the Janani Suraksha Yojana (JSY) and the National Rural Health Mission (NRHM)) on maternal health outcomes (proportion of institutional deliveries) in India. We used data from the India Human Development Survey (IHDS) and found that the JSY and the NRHM had a greater impact on institutional deliveries in high-focus states. We also found that the conditions of the public health facilities, did not change after the implementation of the JSY and the NRHM. Finally, we found that adequacy of health facilities was not associated with the likelihood of mothers in high-focus states having an institutional delivery. In the second essay, I examined whether a key social determinant of health in South Asia- gender inequality, is associated with physical health outcomes among Indian women. I found that the gender inequality expressed as the gendered household practice of seclusion was negatively associated with body weight of Indian women. Further, I found that participation in all household decisions by women of the household was generally not associated with body weight outcomes. The association between gendered household practices and women’s body weight outcomes was generally similar among rural and urban Indian women. In the final essay, I examined whether perinatal food environments (FE), maternal gestational weight gain (GWG) and early childhood weight (ECW) outcomes are associated. I used data on mother-children dyads from the Early Childhood Longitudinal Study – Birth cohort (ECLS-B), Area Resource Files (ARF) and Current Business Practices (CBP). I found that maternal GWG was associated with ECW outcomes. I also found that measures of food environment were associated with ECW outcomes. Specifically, I found that having an additional full-service restaurant per one thousand population in the maternal perinatal county of residence was associated with lower Body Mass Index (BMI) among children at age two years. Finally, I found that GWG did not mediate the association between food environment and ECW outcomes.
12
Nyberg, White Maria. "Preventing maternal mortality : - Nurses’ and midwives’ experiences from Tanzanian maternal health care services." Thesis, Linköpings universitet, Avdelningen för omvårdnad, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-116479.
Abstract:
Background: Half a million women died during pregnancy or childbirth in 2005. Bleeding, infections, high blood pressure, obstructed labor, unsafe abortions, malaria and HIV/Aids were the main causes. Tanzania is a highly affected country with 460 maternal deaths per 100 000 live births. Nurses and midwives play an important role in preventing maternal mortality. Purpose: The aim of this study was to explore and analyze nurses’ and midwives’ experiences of maternal mortality prevention on the Tanzanian island of Unguja. Method: Interviews with nine nurses and midwifes from four different hospitals and health care facilities were conducted with the assistance of an interpreter. A structural analysis designed by Ricoeur was undertaken. Results: The findings suggest that family planning, a more accessible health care, referral of severe cases, medical interventions, health education, community resource persons and involving fathers in maternal health care are preventive strategies that can reduce maternal mortality. Conclusion: To further improve the quality of maternal mortality prevention further knowledge aboutindividual differences in learning from health education is needed. Involvement of all fathers in maternal health care should also be considered. Training of unskilled personnel is believed to improve early identification of life-threatening complications and thereby reduce maternal mortality.Bakgrund: En halv miljon kvinnor i världen dog under graviditet eller förlossning under 2005. Huvudorsaker var blödningar, infektioner, högt blodtryck, långdragna förlossningar, osäkra aborter, malaria samt HIV/Aids. Tanzania är ett drabbat land med 460 fall av mödradödlighet per 100 000 levande födda barn. Sjuksköterskor och barnmorskor spelar en viktig roll i det preventiva arbetet mot mödradödlighet. Syfte: Syftet med studien var att utforska och analysera sjuksköterskors och barnmorskors upplevelser och erfarenhet av arbetet mot mödradödlighet på ön Unguja, Tanzania. Metod: Intervjuer med nio sjuksköterskor och barnmorskor från fyra olika sjukhus/hälsocentraler genomfördes med hjälp av en tolk. En strukturanalys utformad av Ricoeur genomfördes. Resultat: Resultatet visar att familjeplanering, en mer tillgänglig hälso- och sjukvård, remitterande av patienter med allvarliga komplikationer, medicinska interventioner, hälsoutbildning, resurspersoner i samhället och att involvera pappor i mödrahälsovården var preventiva strategier som kan minska mödradödlighet. Slutsats: För att ytterligare förbättra arbetet mot mödradödlighet tycks mer kunskap om individers förmåga att ta till sig hälsoutbildning behövas. Att i ännu större utsträckning även välkomna alla blivande pappor till mödrahälsovården föreslås också kunna fungera preventivt. Utbildning för outbildade kvinnor som hjälper till vid förlossningar (Traditional Birth Attendants) tros kunna förbättra tidig identifikation av livshotande komplikationer och därmed kunna minska mödradödligheten.
13
Leiferman, Jennifer Ann. "The effect of maternal depressive symptomatology on maternal behaviors associated with child health /." Digital version accessible at:, 2000. http://wwwlib.umi.com/cr/utexas/main.
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Minden, Maureen Marguerite. "Discrepancy between maternal health policy and practice : The case of maternal child health workers at sub-health posts in a rural district in Nepal." Thesis, University of London, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.536773.
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Connell, Sarah Elizabeth. "Maternal Mortality in Cambodia: Efforts to Meet the Millennium Development Goal for Maternal Health." Digital Archive @ GSU, 2011. http://digitalarchive.gsu.edu/iph_theses/198.
Abstract:
Recent estimates of global maternal mortality indicate that for the first time since the Safe Motherhood Initiative of 1987, deaths due to pregnancy-related causes are on the decline. Defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, maternal mortality is one of the strongest health statistics showing the disparity between poor and rich countries. Although a global decline is documented, challenges to reducing maternal mortality, and meeting Millennium Development Goals (MDGs) for maternal health remain, particularly in many Sub-Saharan African and Southeast Asian countries.
This study presents an assessment of Cambodia’s progress towards reaching the Millennium Development Goal of reducing maternal deaths by ¾ by 2015. The report examines issues related to the improvement of maternal health, outlining the magnitude, determinants, and prevention methods of maternal mortality globally and in Cambodia.
Cambodia’s health policies and contextual factors impacting the maternal mortality ratio such as dramatic increases of skilled health personnel for delivery, delivery in health facility, and use of antenatal care are identified as key contributors to MMR reduction.
Continued progress in reducing maternal mortality in Cambodia requires improvements to midwifery skill, competencies around normal and emergency birthing care, and salaries of midwives as well as an incentive for new graduates to work in the public sector. An increase in the cooperation between government health centers and hospitals are crucial to ensure obstetric referrals, supervision of health center staff, and an improvement in maternal death data collection. Finally a national priority to increase the use of family planning and safe abortion will significantly contribute to the continued reduction of MMR.
16
Moonesar, Immanuel Azaad. "The Role of UAE Health Professionals in Maternal and Child Health Policy." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1649.
Abstract:
Maternal and child health (MCH) mortality is a formidable challenge for health systems around the world according to the World Health Organization. Health professionals and practitioners within the United Arab Emirates were studied to determine the extent they were involved in the policy-making process, and the potential impact that analysis may have on new or revised MCH policies. Research on MCH policy-making and development processes are limited. The Andersen model of healthcare services utilization provides an appropriate framework for this research, enabling the analysis that influences the policy-making process in the area of MCH. Independent variables included nationality, education, work experience, and organizational support, and the dependent variable included policy-making process. The quantitative methodology included the data collection from a sample of 380 health professionals and practitioners. The results of the study revealed statistical correlations where the most significant predictor of policy-making was organizational support, which explained the 42% variation in policy-making. This predictor was followed by nationality and education. The research adds value for decision-makers when considering and evaluating the extent of MCH policy, laws and regulations, current challenges, and strategies. The research findings could positively influence decision makers' action plan in formulating new guidelines, public policies, and strategies for the development of maternal and child health across the UAE region. Future research should aim to include other factors that may have an influence on the policy-making process.
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Kanu, Alhassan Fouard. "Health System Access to Maternal and Child Health Services in Sierra Leone." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7394.
Abstract:
The robustness and responsiveness of a country's health system predict access to a range of health services, including maternal and child health (MCH) services. The purpose of this cross-sectional study was to examine the influence of 5 health system characteristics on access to MCH services in Sierra Leone. This study was guided by Bryce, Victora, Boerma, Peters, and Black's framework for evaluating the scaleup to millennium development goals for maternal and child survival. The study was a secondary analysis of the Sierra Leone 2017 Service Availability and Readiness Assessment dataset, which comprised 100% (1, 284) of the country's health facilities. Data analysis included bivariate and multivariate logistic regressions. In the bivariate analysis, all the independent variables showed statistically significant association with access to MCH services and achieved a p-value < .001. In the multivariate analysis; however, only 3 predictors explained 38% of the variance (R� = .380, F (5, 1263) = 154.667, p <.001). The type of health provider significantly predicted access to MCH services (β =.549, p <.001), as did the availability of essential medicines (β= .255, p <.001) and the availability of basic equipment (β= .258, p <.001). According to the study findings, the availability of the right mix of health providers, essential medicines, and basic equipment significantly influenced access to MCH services, regardless of the level and type of health facility. The findings of this study might contribute to positive social change by helping the authorities of the Sierra Leone health sector to identify critical health system considerations for increased access to MCH services and improved maternal and child health outcomes.
18
Urassa, David Paradiso. "Quality Aspects of Maternal Health Care in Tanzania." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distrubutör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4221.
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Hagan, Teresa. "Under-utilisation of maternal and child health care." Thesis, Sheffield Hallam University, 1988. http://shura.shu.ac.uk/3084/.
Abstract:
The central aim of this study is to identify and describe the experiences of first time mothers who are underusers of child care clinics. An attempt is made to counterbalance the tendency of researchers in this area to be judgmental of underusers who "neglect" their children, and their own health care needs, -by reporting the mothers' views of the child health services in their own terms. Underusers within a certain Health Authority area were identified using a purposely developed Index of Uptake. The achieved sample of predominantly working class mothers constituted a group of people who are particularly difficult to research. It is believed that success in locating and eliciting evidence from this group was in itself an important contribution to the research literature. In depth interviews were undertaken, and the data analysed in two ways; (1) A Subsample, made up of those having made least use of the services available to them, was analysed interpretively to provide detailed material of an idiographic kind on the lifeworld of the person and the place of medical care within it; (2) All interviews were subjected to content analysis to provide a more general picture of mothers' experiences of health care provision. The main findings include the following; (1) The particular population studied had a generally low level of visage as assessed by the index, but use of specifically medical provision was greater. A process of rational decision making is implicated. (2) Accounts of underusers' experiences highlight as a central theme the mothers' vulnerability to personal undermining by many aspects of health care provision. The thesis concludes with a discussion of the approach which health care providers adopt towards'underusers, and argues that there must be an explicit recognition of the point of view of the clients if the services are to reach this deprived segment of the community. Such recognition is rarely found in research or comment on the problem of underusage. In fact apparently irrational and blameworthy behaviour by underusers can be. rendered explicable when considered in the light of the individuals' perceptions and experiences, and this leads to a serious questioning of the utility and appropriateness of the negative judgements made of them.
20
Miller, Karissa G. "Impact of health behaviors on prenatal maternal stress." Thesis, California State University, Long Beach, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1526933.
Abstract:
Previous studies find prenatal stress to relate to negative health in mothers and their children. Health behaviors such as exercise, proper nutrition, and relaxation have been found to reduce stress in non-pregnant populations, yet few studies have investigated the effect of these behaviors on prenatal stress. The current study examined the impact of exercise, nutrition, and relaxation on perceived stress, anxiety, and cortisol reactivity to a stress task in pregnant women. We hypothesized that women who exercised, had better eating habits, and engaged in relaxation would have reduced perceived stress, anxiety and more adaptive cortisol responses. Our results suggest an adaptive effect of exercise, and maladaptive effect of fat consumption on prenatal cortisol responses, but no association between health behaviors and perceived stress or anxiety. These findings contribute to our understanding of the relationship between health behaviors and stress during pregnancy, and may be useful for prenatal health interventions.
21
Halpin, Lisa. "Foetal congenital anomaly diagnoses and maternal mental health." Thesis, University of Liverpool, 2017. http://livrepository.liverpool.ac.uk/3009541/.
Abstract:
Pregnancy is a time of physiological and psychosocial change for women, and can be a stressful life event (Hodgkinson, Smith & Wittkowski, 2014). Therefore, for some women, pregnancy can exacerbate existing psychological distress (e.g. depression, anxiety and/or stress), or contribute to its development (Biaggi, Conroy, Pawlby & Pariante, 2016). Although there are many reasons why some women experience psychological distress during pregnancy (e.g. lack of social support; Biaggi et al., 2016), this thesis is concerned with the impact of foetal congenital anomaly diagnosis on maternal mental health. Specifically, congenital heart disease (CHD) and cleft lip and/or palate (CL/P). The original focus of the thesis was planned to be exclusively on prenatal CL/P diagnosis, however it was deemed unfeasible to conduct a systematic review in this area due to a lack of relevant quantitative research. CHD was therefore chosen as it is a commonly diagnosed congenital anomaly with sufficient literature available to conduct a systematic review. Chapter one of this thesis therefore aims to critically review, and synthesise the available literature to gain an understanding of whether prenatal CHD diagnosis is associated with maternal mental health difficulties. Clinical implications and directions for future research are considered. The empirical paper presented in chapter two of this thesis focusses on the impact of prenatal CL/P diagnosis on maternal mental health and its associations with antenatal attachment (AA), mindfulness and self-compassion (SC). AA was selected as a variable of interest due to associations between psychological distress in pregnancy and reduced maternal-foetal attachment (Alhusen, 2008; Rubertsson, Pallant, Sydsjo, Haines & Hildingsson, 2015). Furthermore, identifying factors that might contribute to the promotion of increased AA and optimal mental health in pregnancy is therefore important. Mindfulness and SC are two such factors which are increasingly demonstrating their efficacy as concepts related to reducing psychological distress and enhancing AA in pregnant women (Dunn, Hanich, Roberts & Powrie, 2012; Matvienko-Silkar, Lee, Murphy & Murphy, 2016; Mohamadirizi & Kordi, 2016). The empirical paper provides an overview of relevant research, a description of the methods used to address the research question, followed by a discussion of the results. Implications for antenatal services and directions for future research are provided.
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Iyanda, Ayodeji Emmanuel. "The Geography of Maternal Health Indicators in Ghana." Thesis, University of North Texas, 2017. https://digital.library.unt.edu/ark:/67531/metadc984208/.
Abstract:
Ghana is identified among the developing countries with high maternal mortality ratio in Africa. This study unpacked the Demographic and Health Survey data by examining the maternal health indicators at the district level using GIS methods. Understanding the geographic patterns of antenatal care, place of delivery, and skilled birth attendants at the small scale will help to formulate and plan for location-specific health interventions that can improve maternal health care behavior among Ghanaian women. Districts with high rates and low rates were identified. Place of residence, Gini-Coefficient, wealth status, internet access, and religious affiliation were used to explore the underlying factors associated with the observed patterns. Economic inequality was positively associated with increased use of maternal health care services. The ongoing free maternal health policy serves as a cushion effect for the economic inequality among the districts in the Northern areas. Home delivery is common among the rural districts and is more prominent mostly in the western part of Northern Region and southwest of Upper West. Educating women about the free maternal health policy remains the most viable strategy for positive maternal health outcomes and in reducing MMR in Ghana.
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Manthalu, Gerald Herbert. "The impact of user fee exemption on maternal health care utilisation and health outcomes at mission health care facilities in Malawi." Thesis, University of Aberdeen, 2014. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=214843.
Abstract:
The Government of Malawi has entered into agreements with Christian health association of Malawi (CHAM) health care facilities in order to exempt their catchment populations from paying user fees. These agreements are called service level agreements (SLAs). Government in turn reimburses the CHAM health care facilities for the health services that they provide. The agreements started in 2006 with 28 out of 166 CHAM health care facilities and increased to 68 in 2010. The aim of the exemption policy is to guarantee universal access to a basic package of health care services. Although the agreements were designed to cover every health service in the basic health care package, only maternal and neonatal health services are included due to limited resources. The main objective of this thesis was to evaluate the impact of the health care financing change on health care utilisation and health. The specific objectives were as follows: first, to examine whether health care facility visits for maternal health care changed due to user fee exemption; second, to evaluate whether user fee exemption affected the choice of the health care provider where women living in the catchment areas of CHAM health care facilities with user fee exemption sought maternal health care; third, to analyse the effect of user fee exemption on birth weight and; fourth, to explore and apply novel methods in the evaluation of user fee exemption. The gradual uptake of service level agreements by CHAM health care facilities provided a natural experiment with treated and control health care facilities. An additional control group comprised of other demographic groups apart from pregnant women and neonates at CHAM health care facilities with service level agreements. In household survey data, individuals were assigned to treatment and control groups based on their proximity to either a CHAM health care facility with SLA or a CHAM health care facility without SLA. This proffered the unique opportunity to estimate the effect of a single treatment on multiple outcomes. The difference-in-differences (DiD) approach was used to obtain causal effects of user fee exemption. It was implemented in the context of fixed effects, switching regression and multinomial logit models across different chapters. Health care facility level panel data for utmost 146 health care facilities for a maximum of 8 years, 2003-2010, were used. The data were obtained from the Malawi health management xiii information system (HMIS). Linked survey data were also used. Malawi demographic and survey data for 2004 and 2010 were linked to health care facility data and then merged. Analyses that utilised health care facility data showed that user fee exemption had led to increases in first antenatal care visits in the first trimester, first antenatal care visits in any trimester, average antenatal care visits and deliveries at CHAM health care facilities with SLAs. Results from survey data showed that the probability of using a CHAM health care facility with user fee exemption for antenatal care increased, the probability of using home antenatal care declined and the probability of not using antenatal care also declined due to user fee exemption. The probability of delivering at a CHAM health care facility with SLA also increased while the probability of delivering at home declined. User fee exemption did not affect the choice of where to go for postpartum care. Results of the effect of user fee exemption on birth weight were not reported because of potential endogeneity bias arising from lack of instrumental variables for antenatal care. The key policy messages from this thesis are that the user fee exemption policy is an important intervention for increasing the utilisation of maternal health care and needs to be extended to as many CHAM health care facilities as necessary. User fee exemption is not enough, however. Other factors such as education of the woman and her husband/partner, wealth status and cultural factors are also important. This thesis has contributed to the body of knowledge in the following ways. First, it has generated evidence on the impact of user fee exemption on maternal health care utilisation and birth weight in Malawi. Second, with respect to maternal health care utilisation, the thesis has looked at variables that capture the whole maternal health care process from early pregnancy to postpartum care and in a policy relevant way. Third, the thesis has evaluated the effect of user fee exemption on a variable that have not been looked at before, first antenatal care visits in the first trimester. Fourth, the thesis has examined the effect of a single treatment on multiple outcomes in a methodologically unique way. Treatment effects, which were the changes in the probabilities of using different alternatives summed up to zero, thus showing where any increase in the probability of using the outcome of interest came from. Fifth, this thesis is first to use disequilibrium theory of demand and supply in health economics. Application of this theory entailed using switching regression models with unknown sample separation, a seldom used estimation method in health economics. This was an important contribution to the methods xiv of analysing aggregate health care utilisation. Sixth, the STATA program that was written for the estimation of the disequilibrium models was itself a very important contribution to the methods for estimating aggregate supply and demand.
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Kachimanga, Chiyembekezo. "Improving utilisation of maternal health related services: the impact of a community health worker pilot programme in Neno Malawi." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29196.
Abstract:
Malawi has one of the highest maternal mortality ratio (MMR) in sub-Saharan Africa (SSA). Despite investments in family planning and emergency obstetric care (EmOC), Malawi’s Millennium Development Goal (MDG) target of reducing maternal deaths to 155 deaths per 100,000 live births was not met by the end of 2015. Between 2010 and 2015, Malawi was only able to reduce the MMR from 675 to 439 per 100,000 live births. Inadequate utilisation of perinatal services is the contributing factor to the MMR target not being achieved. One approach for improving the utilisation of perinatal services is to invest in community health workers (CHWs). CHWs can be trained to: identify women of child bearing age (WCBA) who need perinatal services; provide community education; encourage timely referral of clients to the nearest health facility; and undertake community follow up for WCBA who are pregnant and/or have recently given birth. We evaluated changes in utilisation of antenatal care (ANC), facility based births, and postnatal care (PNC) after CHW deployment to conduct monthly home visits to WCBA for pregnancy identification and escorting women to ANC, labour and facility birth and PNC clinics in Neno district, Malawi. The CHW programme was implemented in two catchment areas from March 2015 to June 2016. Methodology: We employed a retrospective quasi-experimental study design to evaluate the impact of CHWs on changes in the utilisation of ANC, facility based births, and PNC in Neno district, Malawi between March 2014 and June 2016 (pre-intervention period: March 2014 to February 2015, and post-intervention period: March 2015 to June 2016). Monthly outcomes were compared between a combined CHW intervention area and its synthetic control area using the synthetic control method. The synthetic control area (or synthetic counterfactual of the CHW) 14 was the control area that was created from multiple available control sites where the CHW programme was not implemented to allow the comparison of outcomes between the sites where CHWs were implemented and the sites where CHWs was not implemented. Two hundred and eleven CHWs (128 existing CHWs plus 83 new CHWs from the community) were trained in maternal health and deployed to cover an estimated 5,132 WCBA living in a catchment area of about 20,530 people. The primary focus of the CHWs was to conduct monthly household visits to identify pregnant women, and then escort pregnant women to their initial and subsequent ANC appointments, facility births, and to PNC check-ups. As part of package of care, community mobilisation and improvements in services to achieve a minimum package of services at the local health centres were also added. Using the synthetic control method, as developed by Abadie and Gardeazabal (2003) and Abadie, Diamond and Hainmueller (2010) and a Bayesian approach of synthetic control developed by Brodersen (2015), a synthetic counterfactual of the CHW intervention was created based on six available public control facilities. The synthetic counterfactual trend was created to have similar pre-intervention characteristics as the CHW intervention trend. The impact of the CHW intervention was the difference between the CHW intervention site and its synthetic counterfactual Results: CHWs in the intervention areas visited an average of 3,147 (range 3,036 – 3,218) of WCBA monthly, covering 61.0% of WCBA. During these visit 3.6% (97 women per month) of WCBA were suspected to be pregnant every month. Of those women suspected to be pregnant, 67.8% (66 women per month) were escorted to health facilities immediately every month. CHWs 15 visited an average of 254 pregnant women enrolled in ANC and 64 women in postpartum period monthly. ANC and facility births utilisation in the CHW intervention site increased in comparison to the control site. Firstly, the number of new pregnant women enrolled in ANC per month increased by 18.0 % (95% Credible Interval (CrI) 8.0%, 28.0%), from 83 to 98 per pregnant women. Secondly, the proportion of women starting ANC in first trimester increased by 200.0% (95% CrI 162.0%, 234.0%), from 9.5% to 29.0% per month. Thirdly, the number of women attending four or more ANC visits increased by 37.0% (95% CrI 31.0%, 43.0%), from to 28.0% to 39.0%. Lastly, the number of facility births increases by 20% (CrI 13.0%, 28.0%), from 85 women to 102 per month. However, there was no net difference on PNC visits between the CHW intervention site and its counterfactual unit (-37.0%, 95% CrI -224.0%, 170.0%). Conclusions: CHW intervention significantly increased the utilisation of ANC and facility based births in Neno, Malawi. However, CHWs had no net difference on PNC utilisation.
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Webster, Barbara Anne. "Maternal fatigue during the postpartum period." Thesis, McGill University, 1994. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=22528.
Abstract:
The purpose of this study was to describe maternal fatigue during the first six weeks postpartum. Forty-eight healthy, primiparous mothers who experienced uncomplicated vaginal births in a large urban hospital were asked to complete the Maternal Piper Fatigue Scale during their hospital stay, and at two and six weeks postpartum. Fatigue intensity was relatively high at two days and two weeks, but had significantly declined to a relatively "normal" level by six weeks postpartum. However, 25% of the mothers were still reporting "severe" fatigue at six weeks. The contributing factors most frequently identified by the mothers were labour and delivery issues (2 days), sleep pattern disturbances, and infant care issues (2 & 6 weeks). Rest, sleep, and instrumental support were consistently identified by mothers as helping alleviate their fatigue during the first six weeks postpartum.
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Figueirêdo, Rudgy Pinto de. "O estudo da morbidade materna e do concepto em uma maternidade pública de João Pessoa, Paraíba." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/6/6132/tde-13032014-083803/.
Abstract:
Introdução - O estudo da morbidade materna contribui para um melhor entendimento do quadro da saúde materna, no Brasil, e para o conhecimento dos problemas obstétricos que podem levar (ou não) ao internamento das gestantes. Os dados de morbidade materna são vitais para os gestores de políticas públicas de saúde, os quais precisam saber quantas mulheres necessitam de cuidados obstétricos básicos para tornar a gestação e o parto mais seguros. Objetivos - Estudar a morbidade materna e os conceptos de puérperas numa maternidade da rede pública de João Pessoa, Paraíba, e identificar mulheres com diagnósticos considerados potencialmente graves e sugestivos de morbidade materna near miss. Método - Trata-se de um estudo transversal que fez parte de uma pesquisa maior sobre a morbimortalidade materna. Foi selecionada uma amostra de 414 puérperas por um processo de amostragem aleatória sistemático, cujos dados foram coletados, prospectivamente, de setembro a novembro de 2011, a partir dos prontuários clínicos e entrevistas complementares, numa maternidade pública de referência e acentuada demanda no município. Resultados - Foram estudadas 383 gestações que terminaram em parto e 391 conceptos. Entre as puérperas, predominou a faixa etária dos 20 aos 34 anos, cor parda, baixa escolaridade, baixa renda e sem ocupação formal no mercado de trabalho. Metade delas tiveram parto cesariano e 17 por cento dos recém-nascidos apresentaram problemas de saúde. Foram identificadas as seguintes intercorrências no parto: lacerações do períneo, hematomas, traumatismos, hemorragias e hipertensões. No puerpério, destacaram-se os transtornos hipertensivos, as hemorragias do pós-parto e as infecções. Entre os 64 diagnósticos sugestivos de near miss, estão as síndromes hipertensivas (58 por cento ) e as síndromes hemorrágicas (32,8 por cento ). Na análise comparativa entre os grupos de puérperas com morbidades sugestivas e não sugestivas de near miss, as seguintes variáveis apresentaram diferenças estatisticamente significantes (p<0,001): problemas de saúde na gestação anterior e atual, hipertensão, gestação de risco e uso de anti-hipertensivos. Não foram encontradas diferenças estatísticas entre as características dos neonatos e a morbidade materna, sugestiva ou não de near miss. Conclusão - O estudo permitiu conhecer as características maternas e a prevalência (15,5 por cento ) de morbidades sugestivas de near miss que ocorrem, seja no parto seja no puerpério. Ampliar o conhecimento sobre os aspectos que envolvem a morbidade materna torna-se crucial para o adequado enfrentamento de complicações no ciclo gravídico-puerperal, além de apoiar o Plano de Ação para acelerar a redução da mortalidade materna e morbidade materna grave.Introduction The study of maternal morbidity contributes to a better understanding of the maternal health scene in Brazil and to the fuller knowledge of obstetric problems that may lead (or not) to the hospitalization of pregnant women. Maternal morbidity data are vital for the administrators of public health policies, who need to know how many women are expected to need basic obstetric care so as to make pregnancy and delivery safer. Objectives To study maternal morbidity and the conceptuses of puerperae in a public maternity hospital in João Pessoa, Paraíba, and identify women with a diagnosis considered potentially threatening and suggestive of being possible near misses. Method - This is a transverse study that is part of a larger project on maternal morbimortality. A sample of 414 puerperae was selected by a process of systematic random sampling, the data on whom were collected, prospectively, from September to November 2011, on the basis of clinical case notes and complementary interviews, at a public maternity hospital of reference in great demand in the municipality. Results - A total of 383 pregnancies which were carried through to delivery and 391 conceptuses were studied. There predominated, among the puerperas: the 20 - 34 year age-group, of brown skin color, low level of schooling, low income and no formal professional occupation. Half of them underwent caesarian section and 17 per cent of the new-born presented health problems. The following incidents were identified during labour: lacerations of the perineum, haematomas, traumatisms, haemorrhages and hypertensions. During the puerperium, hypertensive disorders, post-partum hemorrhage and other puerperal infections were noteworthy. The most frequent mention in the case notes of maternal causes was of hypertensive disturbances of pregnancy. Among the 64 diagnoses suggestive of near-miss, are the hypertensive (58 per cent ) and the haemorrhagic syndromes (32.8 per cent ). In the comparative analysis of the groups of puerperae with morbidities suggestive of near-miss, the following variables presented statistically significant differences (p<0.001): health problems during the previous and present pregnancy, hypertension, risk pregnancy and use of hypertensive medications. No statistical differences between the characteristics of the newborn and those of maternal morbidity (whether suggestive of near miss or not) were found. Conclusion - The study allowed the identification of maternal characteristics and the prevalence (15.5 per cent ) of the morbidities suggestive of maternal near-miss which occur either during labour or puerperium. It is crucial that our knowledge of the aspects of maternal mortality should be expanded so that the complications of the pregnancy-puerperal cycle may be adequately treated and to provide support for the Action Plan to speed up the reduction of maternal mortality and severe maternal morbidity.
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Shaw, Amanda K. "Maternal use of medication and childhood leukemia." Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=31537.
Abstract:
This thesis explored the association between maternal use of medication during pregnancy and risk of childhood acute lymphocytic leukemia (ALL); specifically, whether use of antibiotics, analgesics, anti-nauseas and/or illicit drugs were associated with an increased risk of ALL in the offspring. All cases of ALL, aged 0--14, diagnosed in Quebec during the period 1994--1997 were identified and matched to population-based controls by age and sex. With an overall response rate of 87%, this resulted in nearly 160 case-control pairs. Information was obtained from parents via telephone interviews, and analyzed using conditional logistic regression. Overall use of medication did not increase risk of childhood ALL (OR = 1.15, 95% CI = 0.66--1.99). Increased risks were observed for illicit drug use in the year prior to birth (OR = 2.44, 95% CI = 0.66--9.00), and for the offspring of women who used pain medication during delivery (OR = 1.88, 95% CI = 1.05--3.31); however, the latter increase was seen for male children only (OR = 3.43, 95% CI = 1.45--8.10).
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O'Keefe, Maree Frances. "Maternal perspectives of child health consultations by medical students." Title page, contents and abstract only, 2002. http://web4.library.adelaide.edu.au/theses/09PH/09pho4121.pdf.
Abstract:
"June 2002" Errata inside back cover. Bibliography: leaves 244-256. The first aim of this thesis was to determine the relationship between medical student clinical competence and patient-centredness, and maternal satisfaction and subsequent recall of information in child health consultations. The second aim was to test the application of this knowledge in medical student teaching programmes. The study demonstrated the ability of mothers to assess the clinical competence and patient-centredness of medical students in videotaped consultations. Applications in medical student learning were also developed and evaluated.
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Carter, Lindsay G. "Offspring and Maternal Health Benefits of Exercise during Pregnancy." UKnowledge, 2013. http://uknowledge.uky.edu/nutrisci_etds/6.
Abstract:
Maternal lifestyle and nutrient intake during pregnancy can have long-lasting effects on the health of offspring as well as the mother. This dissertation focuses on the impact of maternal exercise during pregnancy on offspring insulin sensitivity and glucose uptake and the maternal effects of exercise during pregnancy.
The first aim of this dissertation was to investigate if exercise prior to and during pregnancy and nursing would improve glucose uptake and insulin sensitivity in mice and rats. In both mice and rats, it was concluded that maternal exercise could enhance whole-body insulin sensitivity and increase glucose uptake into skeletal muscle and adipose tissue in adult offspring compared with offspring from sedentary dams. Maternal exercise also positively influenced male but not female adult offspring body composition; male offspring from exercised dams had significantly decreased fat mass and increased lean mass compared with offspring from sedentary dams.
The second aim of this dissertation was to test whether exercise during pregnancy would improve glucose disposal in mouse dams with diet-induced obesity. Maternal running was effective in reducing fat mass accumulation and glucose intolerance associated with high fat feeding during pregnancy. In high fat diet mice, exercise was also able to improve insulin sensitivity in adipose tissue compared to tissue from sedentary high fat diet mice.
The findings in this dissertation provide new insight into the long-term effects exercise during pregnancy can have on offspring health. Women may be encouraged to start an exercise regimen before and during their pregnancy if they are aware of the life-long benefits it can have for their children. The findings from the second aim present new insight into how exercise can affect pregnancies complicated by maternal obesity and glucose intolerance, and the animal model can be used in the future studies to investigate the offspring effects of maternal exercise during a diabetic pregnancy.
30
Krizova, Katarina. "ADHD CHILDREN AND MENTAL HEALTH SERVICE USE: MATERNAL DETERMINANTS." UKnowledge, 2015. http://uknowledge.uky.edu/hes_etds/28.
Abstract:
The current study investigated maternal determinants of mental health service use, namely, individual child therapy, among preadolescent children diagnosed with ADHD. The Behavioral Model of Health Care Utilization (Andersen, 2008) was used as a theoretical framework for the study. Data from the last three rounds of ECLS-K dataset were employed to test a longitudinal model using Bayesian analysis. Socio-demographic variables and maternal mental health were tested as exogenous variables and mother-child relationship variables, discipline variables, and perceived maternal concern about child’s overall behavior and child’s emotional symptoms were tested as intervening variables. Results showed that only maternal mental health remained in the model as an exogenous variable. The effect of mental health on child therapy was mediated by maternal aggravation and maternal concern about overall behavior in one path and by maternal concern about emotional symptoms in another path, suggesting that maternal mental health needs to be considered when attempting to understand help-seeking determinants. Both concern variables were found to have large direct effects on child therapy. The results of the current study showed the importance of maternal mental health and the importance of determinants related to mother-child relationship in a mother’s decision to seek therapy for a child.
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Turton, Mervyn Sydney. "The effect of maternal oral health on pregnancy outcomes." University of the Western Cape, 2014. http://hdl.handle.net/11394/4360.
Abstract:
Philosophiae Doctor - PhDAdverse pregnancy outcomes such as preterm birth and low birth weight are major causes of maternal and neonatal morbidity and mortality. Increasing evidence points to an association between periodontal disease and adverse pregnancy outcomes and thus a better understanding of the nature of this association will assist in treatment planning to reduce adverse pregnancy outcomes. Among the Gram-negative anaerobic bacteria frequently associated with periodontal disease are Treponema denticola, Tannerella forsythia and Porphyromonas gingivalis which may be detected in plaque using the BANA test (N-benzoyl-DL-arginine-2-naphthylamide). The aim of this study was to investigate the effect of periodontal disease on pregnancy outcomes and evaluate the use of BANA as a screening test for the risk of adverse pregnancy outcomes. This study complied with the Declaration of Helsinki (2013) and included 443 pregnant women attending ante-natal clinics in KwaZulu Natal. At first visit, maternal oral health status was assessed by the measurement of periodontal indices and BANA testing of dental plaque from the same teeth. Patient demography and medical history were obtained by means of a questionnaire and all data compared with pregnancy outcomes. While controlling for other factors, significant differences were found between the distributions of periodontal disease at BANA-negative and BANA-positive sites and between infant birth weight and maternal periodontal index scores such as plaque index and gingival index. The birth weight and gestational age at delivery of infants born of BANA-positive periodontally diseased mothers were significantly lower than those born of BANA-negative mothers with no periodontal disease. We may conclude that the presence of periodontal disease during pregnancy has a significant association with negative pregnancy outcomes and suggest that the risk for adverse pregnancy outcomes may be reduced by monitoring the oral health status of women during pregnancy.
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King, Janet. "Midwives, infant and maternal health in Monmouthshire, 1900-1938." Thesis, University of South Wales, 1999. https://pure.southwales.ac.uk/en/studentthesis/midwives-infant-and-maternal-health-in-monmouthshire-19001938(0b0e1ce6-6dba-48bd-851a-75728e3ead82).html.
Abstract:
The purpose of this study is to extend knowledge concerning the health of expectant and nursing mothers and infants in working-class districts of Wales, particularly mothers and infants residing in the county of Monmouthshire during the 1920s and 1930s. The thesis covers the period 1900-1938 and considers the implementation of various Acts of Parliament and the effects of the legislation on the lives of women and infants. The main Acts covered are the Midwives Act 1902 and 1936, the Notification of Births Act 1907 and 1915, the Maternity and Child Welfare Act 1918 and the 'Special Areas' Act of 1934. Through the use of mainly primary sources and oral testimony, it will be argued that these social policies did extend the welfare system and bring benefits to mothers and infants. However, at the same time, the implementation of the policies exerted control over the realm of motherhood to such an extent that pregnancy, child-birth and infant care were irrevocably transported from the natural and familiar domestic sphere, into the unnatural and unfamiliar sphere of the public, male-dominated medical world. Furthermore, the policies which were initially introduced to improve the health of both mothers and infants were limited, discriminatory and did little to address the poverty, which was a reality of life for mothers in the working-class districts of Wales.
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Miranda, Veronica. "REPRODUCING CHILDBIRTH: NEGOTIATED MATERNAL HEALTH PRACTICES IN RURAL YUCATAN." UKnowledge, 2017. http://uknowledge.uky.edu/anthro_etds/25.
Abstract:
This ethnographically informed dissertation focuses on the ways rural Yucatec Maya women, midwives and state health care workers participate in the production of childbirth and maternal health care practices. It further addresses how state health programs influence the relationships and interactions between these groups. Although childbirth practices in Yucatan have always been characterized by contestation, negotiation and change, their intensity and speed have significantly increased over the last decade. Drastic changes in the maternal health of rural indigenous communities in Mexico and throughout the world are directly connected to intensified state interventions that favor biomedicine over traditional health systems. In rural Yucatan, state health programs such as Oportunidades and Seguro Popular support a biomedical approach to birth by distributing medical resources to government clinics/hospitals and encouraging program participation of poor women through conditional cash incentives.
This dissertation seeks to interrogate changing childbirth practices in a rural indigenous community in Quintana Roo, MX to gain a deeper understanding of the complex politics that shape local understandings and approaches to childbirth. It further explores how shifting social relations and political alliances are created within the context of reproductive health. This ethnography highlights how Yucatec Maya women envision a productive, yet negotiated, relationship with the state that allows them control of their prenatal and maternal health while engaging with state health programs. Focusing on the cultural production of childbirth in a rural community in southwestern Quintana Roo, this research seeks to explore the dynamic ways in which indigenous communities are reproduced over time through moments of engagement and contestation with the state. The Maya women in this dissertation exist at the margins of the Mexican government’s concerns, policies, and resources. Yet, even at the margins the influence and power of state ideology and policies intimately affect the lives of rural indigenous women. The core argument of this dissertation is that these women, who rely on traditional and historical experience, create strategies for survival and social reproduction despite their marginalized position within the Mexican state.
This research draws from over a decade of fieldwork. Predissertation fieldwork took place during the summer months of 2002, 2003, 2004, 2007, 2008, and 2010. I completed my dissertation fieldwork from January to October of 2013. During that time, I conducted 60 formal and informal interviews and a small survey. Additionally, a large portion of my research took place with a local family that consisted of female healers and health educators, whom I extensively interviewed and conducted hundreds of hours of participant observation. The family was the locus of authoritative knowledge in the community and they provided vital insights into community life and local understandings and approaches to reproductive health. This dissertation follows the Latin American tradition of using testimonios to articulate—and reflexively examine—the layered meanings and intersecting politics that shape changing childbirth practices in rural Yucatan.
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Shrestha, Nirajan. "Role of High Maternal Linoleic Acid on Offspring Health." Thesis, Griffith University, 2021. http://hdl.handle.net/10072/403638.
Abstract:
Maternal nutrition during pregnancy plays a critical role in the adult-onset of disease in a mother’s children. The first 1000 days, spanning from conception to two years of life, are an important period when appropriate nutritional needs must be ensured for long-term health. Studies have shown that inadequate nutritional condition in utero and early life increases the risk of developing chronic conditions later in life. In recent years, the intake of linoleic acid (LA) has increased gradually in human populations, due to changes in a dietary pattern that have resulted in increased consumption of vegetable oils and foods processed in vegetable oils. LA is an omega-6 polyunsaturated fatty acid (n-6 PUFA), which is an essential fatty acid required in the human diet. LA plays a vital role in fetal growth and development. Even though LA is essential in our diet, studies have raised concern over its beneficial effect, as excess LA is shown to have pro-inflammatory characteristics. In addition, the n-6/n-3 PUFA ratio should be balanced in the diet however, increased consumption of n-6 PUFA and limited consumption of n-3 PUFA perturb the optimal balance of n-6 and n-3 PUFA in the Westernized diet. There are conflicting findings on the effect of increased LA in human health. Further, as women of reproductive age have increased their consumption of LA, the effect of increased maternal LA on offspring risk of developing metabolic diseases is yet to be determined. This thesis aimed to investigate the effect of a maternal diet high in LA on maternal physiology, fetal growth, placental function, and offspring metabolic outcomes.
Wistar Kyoto female rats were fed with either low LA diet (LLA; 1.44% of energy from LA) or a high LA diet (HLA; 6.21% of energy from LA) for 10 weeks before pregnancy. The total fat and n-3 PUFA content were matched in the experimental diet. Respective diets were fed during pregnancy and pregnant females were sacrificed at gestation day 20 (E20). For the animal model to study the effect on offspring, they were weaned at postnatal day (PN) 25 and exposed to either LLA or HLA postnatal diet until sacrifice. Offspring were sacrificed at PN40 to study the effect of maternal HLA during adolescence, and at PN180 to study its effect during adulthood. To investigate the effect of LA in a human placental cell line, LA was treated in the Swan71 cells for 24 hours.
The major finding of the thesis was that maternal HLA diet decreased total n-3 PUFA and alpha-linolenic acid (ALA) in the plasma of dams and her offspring, during embryonic development, adolescence and adulthood. Postnatal HLA diet had a greater impact on fatty acid composition rather than maternal diet in adult offspring. Maternal HLA diet decreased the circulating concentration of leptin in the dams and had a sex-specific effect on the plasma leptin in the offspring. The decreased concentration of plasma leptin in the dams was accompanied by downregulation of mRNA expression of the leptin gene in the maternal white adipose tissue. Furthermore, maternal HLA diet increased prostaglandin E metabolite in the maternal circulation and altered the inflammatory mediators in the maternal liver. Interestingly, maternal HLA diet decreased the proportion of male fetuses. Furthermore, maternal HLA diet decreased blood total cholesterol and high-density lipoprotein (HDL)-cholesterol in the dams and adolescent female offspring. Postnatal HLA diet decreased blood total cholesterol and HDLcholesterol in male offspring. Also, maternal and postnatal HLA diet altered the cardiac function in the adolescent offspring and expression of genes related to hepatic lipid metabolism in adult offspring in a sex-specific manner.
In conclusion, the findings presented in this thesis suggested that the maternal diet high in LA during pregnancy alters the parameters related to metabolic function in the offspring. These findings further support the previous research about the controversial role of LA in inflammatory responses and lipids. The data obtained from this thesis expanded our knowledge on the role of a maternal and postnatal diet high in LA on offspring lipid metabolism. The change in the circulating leptin concentrations in both the mother and offspring without a change in body weight and fat mass suggests the role of leptin in developmental programming is independent of adiposity. Future studies are needed to identify the molecular mechanism underlying the relation between LA and leptin in developmental programming.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Medical Science
Griffith Health
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Chama-Chiliba, Chitalu Miriam. "An economic analysis of maternal health care in Zambia." Thesis, University of Pretoria, 2013. http://hdl.handle.net/2263/40259.
Abstract:
This thesis investigates the utilisation of maternal health care in Zambia, where despite being a signatory to the Safe Motherhood Initiative and Millennium Development Goals, which are aimed at improving maternal health, indicators of maternal health continue to perform poorly. The need to understand crucial factors in improving maternal health motivated the current research, especially since there is a dearth of literature in this area in Zambia. The thesis focuses on two aspects of maternal health care: antenatal care (ANC) and facility-based deliveries, to answer two broad questions. Firstly, what factors determine the use of ANC in Zambia? Secondly, to what extent has the abolition of user fees affected facility-based deliveries?
An assessment of the factors, which explain the utilisation of ANC in Zambia, using three sets of comparable datasets reveals that, while there are differences in the factors explaining the decision to use ANC and the frequency of visits over time, the decision to seek ANC and the frequency of use is low among the poor and less educated, and there are marked regional differences in utilisation. The most appropriate econometric specification for antenatal visits, according to different performance indicators, was the two-part model, which differs from recent research favouring more complex methodologies.
The analysis is further extended through the inclusion of supply-side factors and the examination of individual and community level factors associated with inadequate and non-use of ANC, following the adoption of the focused ANC approach in Zambia. To incorporate the supply side factors, the 2007 Zambia Demographic and Health Survey was linked to administrative and health facility census data using geo-referenced data. To assess the factors associated with (1) the inadequate use of ANC (defined as three or less visits), and (2) the non-use of ANC in the first trimester of pregnancy, we specify two multilevel logistic models. At the individual level, the woman’s employment status, quality of ANC received and the husband’s educational attainment are negatively associated, while parity, the household childcare burden and wealth are positively associated with inadequate utilisation of ANC. Both individual and community level characteristics influence inadequate use and non-use of ANC in the first trimester; however, community level factors are relatively stronger in rural areas.
Although ANC is an important facet of maternal care, it occurs before delivery, but does not necessarily provide much information with respect to delivery decisions. Therefore, the thesis investigates delivery decisions, as well, in particular, the effect of user fee removal in rural areas of Zambia on facility-based deliveries. To account for regional differences, we employ a Seemingly Unrelated Regression model incorporating an Interrupted Time Series design. The analysis uses quarterly longitudinal data covering 2003q1-2008q4. When unobserved heterogeneity, spatial dependence and quantitative supply-side factors are controlled for, user fee removal is found to immediately increase aggregate facility-based deliveries, although the national trend was unaffected. Drug availability and the presence of traditional birth attendants also influence facility-based deliveries at the national level, such that, in the short-term, strengthening and improving community-based interventions could increase facility-based deliveries. However, there is significant variation and spatial dependence masked in the aggregate analysis. The results highlight the importance of service quality in promoting facility-based deliveries, and also suggest that social and cultural factors, especially in rural areas, influence the use of health facilities for delivery. These factors are not easily addressed, through an adjustment to the cost of delivery in health facilities.
Additionally, we analyse the effect of user fee abolition on the location of childbirth, focussing on deliveries that occur in public health facilities using household survey data. To elicit the causal relationship, we exploit the relative change in fees across health districts within a difference-in-differences framework. Surprisingly, although reductions in home deliveries were observed, as expected, reductions in public health facility-based deliveries were also uncovered, along with increases in deliveries at private health facilities. However, these findings were statistically insignificant; suggesting that the abolition of user fees had little, if any, impact on the choice of location for childbirth. The statistically insignificant, but unexpected, causal effects further suggest that the removal of user fees have unintended consequences, possibly the transference of facility costs to the client, which would deter the utilisation of delivery services. Therefore, abolishing user fees, alone, may not be sufficient to affect changes in outcomes; instead, other efforts, such as improving service quality, could have a greater impact.Thesis (PhD)--University of Pretoria, 2013.
gm2014
Economics
unrestricted
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Parel, Alpi Jain. "Health, education and maternal labour supply in developing countries." Thesis, University of Bristol, 2016. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.738516.
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Aguzie, Tessy Linda. "Influence of Maternal Psychosocial Health on Infant Feeding Practices." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5819.
Abstract:
Choice of nutrition has a great effect on the early development of human growth. Despite increased knowledge on the benefit of breastfeeding to both mother and child, some mothers still choose to formula feed. The purpose of this study is to explain how maternal health contributes to choices. The theory of maternal role attainment and the social cognitive theory are used to evaluate these feeding choices. This study tests for the association between maternal weight status and choice of infant feeding practices, the association between postpartum depression and choice of feeding and finally, if depression mediates the relationship between maternal weight gain and infant feeding choices. This retrospective cohort study employed a quantitative approach, utilizing secondary data with a sample size of 4902, retrieved from Infant Feeding Practices Study II. The data contained information on pregnant women in their third trimester until the first year of infants' life. Logistic regression was employed to answer these research questions. The result indicated that compared to those who are obese, mothers with normal weight are 29.6% more likely to breastfeed. Depressed mothers are 45.9% less likely to breastfeed. There is no possible mediation effect identified in this study. Further studies may need to collect mother's depression status prior to conception. Based on the outcome of this study, there is a need for caregivers to identify at-risk mothers prior to delivery while offering solutions that contribute to better feeding choices. For social change, mothers who are overweight or those experiencing depression prior to conception will make better feeding choices if they receive adequate support and counseling on the implication of their health condition on their infants.
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Mantha, Shannon. "Maternal confidence during the postpartum period." Thesis, University of Ottawa (Canada), 2005. http://hdl.handle.net/10393/26970.
Abstract:
Purpose. To determine the relationship between maternal confidence, maternal characteristics and experiences with nursing support during pregnancy, birth and the postpartum period. Additionally, to describe and compare the maternity experiences of women with low and high confidence levels.
Results. Multiparas were significantly more confident in the postpartum period than primiparas (p < 0.0001), although confidence increased over time for primiparas (p < 0.0001) and decreased over time for multiparas (p < 0.0005). Mothers who spoke a language other than English or French were significantly less confident caring for themselves at home (p < 0.0005) and caring for their baby at home (p < 0.0001). Mothers' rating of breastfeeding support in-hospital was significantly positively correlated with confidence breastfeeding upon discharge (p < 0.0001). Significant negative correlations were found between number of community services received or sought-out and all confidence measures (p ≤ 0.001). Women indicated that they would have liked more support from nurses for breastfeeding, infant and self-care. Women with low confidence commented more often on the need for teaching and education in the postpartum period when compared to women with high confidence. Both women with low and high confidence reported lack of nursing support for breastfeeding, although women with low confidence perceived the problem to be related to conflicting nursing advice, and women with high confidence perceived the problem to be related to pressure from nursing staff to breastfeed.
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Avella, García Claudia B. 1982. "Environmental influences on child health and development : The role of seafood, acetaminophen and maternal mental health." Doctoral thesis, Universitat Pompeu Fabra, 2016. http://hdl.handle.net/10803/458879.
Abstract:
The main aims of this thesis can be divided into three focuses. First: to review the literature on the effect of the intake of seafood during early life on neurodevelopment. Secondly: to evaluate the impact of maternal use of acetaminophen during pregnancy on the neuropsychological development of the offspring and to explore potential epigenetic mechanisms that could contribute to this effect. Third: to examine the relationship between the mental health of the mother and wheezing in the child.
Main results: 1) Seafood intake appears to be beneficial for neurodevelopment. 2) Prenatal acetaminophen exposure was associated with a greater number of autism spectrum symptoms in males and to hyperactivity/impulsivity behaviors and changes in attention function in all children. 4) Exposure to acetaminophen during pregnancy was associated with a significant difference in the DNA methylation of a CpG site that corresponds to the OTOP3 gene. 5) Maternal distress at child ages 1-1.5 or 4-5 years could increase the risk of wheezing in the child, especially for wheezing types associated with a greater risk of asthma.Los objetivos principales de esta tesis se pueden dividir en tres puntos. Primero: revisar la literatura sobre el efecto del consumo de comida de mar durante etapas tempranas de la vida sobre el neurodesarrollo. Segundo: evaluar el impacto del uso materno de paracetamol durante el embarazo sobre el desarrollo neuropsicológico de la progenie y explorar potenciales mecanismos epigenéticos que pudieran contribuir a este efecto. Tercero: examinar la relación entre la salud mental de la madre y las sibilancias en el niño. Resultados principales: 1) El consumo de comida de mar parece ser beneficioso para el neurodesarrollo. 2) La exposición prenatal a paracetamol estaba asociada con un mayor número de síntomas del espectro autista en varones y con conductas de hiperactividad/impulsividad y alteraciones de la función atencional de la progenie. 4) La exposición a paracetamol durante el embarazo estaba asociada a una diferencia significativa de la metilación del ADN a nivel de un sitio CpG correspondiente al gen OTOP3. 5) La presencia de distress materno a la edad de 1-1.5 o 4-5 años del niño puede incrementar el riesgo de sibilancias en el niño, especialmente para tipos de sibilancias que se han asociado a mayor riesgo de asma.
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Biswas, Animesh. "Maternal and Neonatal Death Review System to Improve Maternal and Neonatal Health Care Services in Bangladesh." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-46379.
Abstract:
Bangladesh has made encouraging progress in reducing maternal and neonatal mortality over the past two decades. However, deaths are much higher than in many other countries. The death reporting system to address maternal, neonatal deaths and stillbirths is still poor. Moreover, cause identification for each of the community and facility deaths is not functional. The overall objective of this thesis is to develop, implement and evaluate the Maternal and Neonatal Death Review (MNDR) system in Bangladesh. The study has been conducted in two districts of Bangladesh. A mixed method is used in studies I and II, whereas a qualitative method is used in studies III-V, and cost of MNDR is calculated in study VI. In-depth interviews, focus group discussions, group discussions, participant observations and document reviews are used as data collection techniques. Quantitative data are collected from the MNDR database. In study I, community death notification in the MNDR system was found to be achievable and acceptable at district level in the existing government health system. A simple death notification process is used to capture community-level maternal and neonatal deaths and stillbirths. It was useful for local-level planning by health managers. In study II, death-notification findings explored dense pocket areas in the district. The health system took local initiatives based on the findings. This resulted in visible and tangible changes in care-seeking and client satisfaction. Death numbers in 2012 were reduced in comparison with 2010 in the specific area. In study III, verbal autopsies at community level enabled the identification of medical and social causes of death, including community delays. Deceased family members cordially provided information on deaths to field-level government health workers. The health managers used the findings for a remedial action plan, which was implemented as per causal findings. In study IV, social autopsy highlights social errors in the community, and promotes discussion based on a maternal or neonatal death, or stillbirth. This was aneffective means to deliver some important messages and to sensitize the community. Importantly, the community itself plans and decides on what should be done in future to avert such deaths. In study V, facility death review of maternal and neonatal deaths was found to be possible and useful in upazila and district facilities. It not only identified medical causes of death, but also explored gaps and challenges in facilities that can be resolved. The findings of facility death reviews were helpful to local health mangers and planners in order to develop appropriate action plans and improve quality of care at facility level. Finally, in study VI, the initial piloting costs required for MNDR implementation were estimated, including large capacity development and other developmental costs. However, in the following year, costs were reduced. Unit cost per activity was 3070 BDT in 2010, but, in the following years, 1887 BDT and 2207 BDT, in 2011 and 2012 respectively.
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Männistö, T. (Tuija). "Maternal thyroid function during pregnancy:effects on pregnancy, peri- and neonatal outcome and on later maternal health." Doctoral thesis, Oulun yliopisto, 2011. http://urn.fi/urn:isbn:9789514294037.
Abstract:
Abstract Maternal thyroid dysfunction and/or antibodies are present in 5–10% of pregnancies and may be associated with increased risks of adverse pregnancy and perinatal outcomes. In the present study maternal thyroid function and antibody status in the Northern Finland Birth Cohort 1986 was analyzed using early pregnancy serum samples. The impact of long-term storage on the stability of thyroid hormones and antibodies was studied and while TSH and thyroid hormone levels were not affected by storage time the concentrations of thyroid antibodies appeared to be significantly increased after 10 years of storage. Normal maternal thyroid function was evaluated by calculating thyroid hormone reference intervals in the thyroid antibody-negative population using a biobank of stored serum samples. Thyrotropin, free thyroxine and triiodothyronine reference intervals in the first and second trimester were 0.07–3.1 mU/L and 0.10–3.5 mU/L, 11.4–22.4 pmol/L and 11–18.9 pmol/L; and 3.4–7.0 pmol/L and 3.5–7.3 pmol/L, respectively, in this population (Abbott Architect method). Compared with thyroid antibody-negative mothers, antibody-positive mothers had significantly higher TSH and lower fT4 concentrations and an increased risk of experiencing death of an infant in the perinatal period with odds ratios (ORs) of 3.1 (95% confidence interval 1.4–7.1) for thyroid-peroxidase and OR 2.6 (1.1–6.2) for thyroglobulin antibody positivity. These infants were more often born very preterm, which could possibly explain these increased risks. Positive thyroid antibody status was not associated with preterm birth in this study. No other major pregnancy or perinatal complications were observed among mothers or newborns of mothers with thyroid dysfunction/antibodies. Mothers, who had hypothyroidism or thyroid antibodies during pregnancy, had a very high risk of subsequent thyroid disease: hazard ratio (HR) 17.7 (7.8–40.6) for overt hypothyroidism, 4.2 (2.3–7.4) for thyroid-peroxidase and 3.3 (1.9–6.0) for thyroglobulin antibody positivity. Mothers with hypothyroidism during pregnancy had increased risk of subsequent diabetes, (HR 6.0 [2.2–16.4]). Women at risk of thyroid dysfunction should be recognized and their prepregnancy counseling, blood sampling and treatment is probably beneficial. Whether universal screening of all pregnant women is justified is still under debateTiivistelmä Kilpirauhasen toimintahäiriö tai ainoastaan kilpirauhasvasta-aineita (tyreoideaperoksidaasi- tai tyreoglobuliinivasta-aineita) esiintyy 5–10 % raskaana olevista naisista ja ne mahdollisesti lisäävät riskiä raskausajan ja vastasyntyneisyyskauden ongelmiin. Tässä väitöskirjatyössä tutkittiin Pohjois-Suomen syntymäkohorttia vuodelta 1985–1986. Äitien kilpirauhasen toimintaa tutkittiin alkuraskauden verinäytteiden avulla. Selvitimme pitkäaikaisen (20 vuotta) pakkassäilytyksen vaikutusta kilpirauhaslaboratoriokokeisiin. Tutkimuksessamme pakkassäilytyksellä ei ollut vaikutusta kilpirauhashormonien pitoisuuksiin, mutta kilpirauhasvasta-aineiden pitoisuudet olivat merkittävästi lähtötasoa korkeampia 10 säilytysvuoden jälkeen. Äitien normaali kilpirauhasen toiminta arvioitiin laskemalla aineistosta kilpirauhashormonien viitevälit kilpirauhasvasta-ainenegatiivisille naisille raskauden ensimmäiselle ja toiselle kolmannekselle käyttäen Abbott Architect metodia. Viitearvot olivat: tyreotropiinille 0.07–3.1 mU/l ja 0.10–3.5 mU/l, vapaalle tyroksiinille 11.4–22.4 ja 11–18.9 pmol/l sekä vapaalle trijodotyroniinille 3.4–7.0 ja 3.5–7.3 pmol/l. Äidin kilpirauhasen toimintahäiriöt eivät liittyneet vaikeisiin raskausajan tai vastasyntyneisyyskauden ongelmien, kuten ennenaikaisuuden ja kohtukuolemien esiintymiseen. Äidin kilpirauhasvasta-aineiden esiintyminen, mikä osoittaa kroonista autoimmuunityreoidiittia, lisäsi riskiä lapsen kohtukuolemaan ja ensimmäisen elinviikon kuolemaan; riski oli jopa kolminkertainen tyreoideaperoksidaasivasta-ainepositiivisten äitien vastasyntyneillä. Nämä vastasyntyneet olivat usein syntyneet hyvin ennenaikaisina (ennen 28. raskausviikkoa), mikä voi selittää tätä riskiä. Äidin kilpirauhasvasta-aineet eivät kuitenkaan lisänneet ennenaikaisten synnytysten riskiä tässä tutkimuksessa. Äideillä, joilla oli todettu kilpirauhasen vajaatoiminta tai kilpirauhasvasta-aineita, itsellään oli korkea, jopa 17-kertainen, riski sairastua myöhempiin kilpirauhasen sairauksiin, ja kilpirauhasen vajaatoiminta kuusinkertaisti sokeritautiin sairastumisriskin. Olisi tärkeää tunnistaa jo ennen raskautta ne naiset, joilla on riski sairastua kilpirauhasen vajaatoimintaan. Raskauden aikaisesta yleisestä seulonnasta ei vielä ole yksimielisyyttä
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Magadi, Monica Akinyi. "The determinants of poor maternal health care and adverse pregnancy outcomes in Kenya." Thesis, University of Southampton, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310540.
43
Källmark, Amanda. "Maternal health care in natural disasters : A study on the International Federation of the Red Cross’s maternal health care in flooding disaster relief." Thesis, Uppsala universitet, Statsvetenskapliga institutionen, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-439538.
Abstract:
This thesis aims to describe how the International Federation of Red Cross and Red Crescent Societies (IFRC) tends to maternal health care in floodings and whether it should be deemed sufficient. Floodings in Pakistan (2010), Bangladesh (2017) and Sudan (2013) are used as units of analysis when conducting a content analysis. The theoretical framework consists of critical success factors for disaster response based in the emergency management literature. A big part of the theoretical framework revolves around the importance of expertise and rationality in disaster response planning and implementation. The three floodings received relief efforts from IFRC which are presented in emergency appeal reports. Lists on essential maternal health care interventions in combination with the theoretical framework create analysis questions that are posed to the appeals. Results are presented in a table naming the prevalence of each intervention in each report. The findings show that maternal health care was seen to and deemed sufficient in only one of the three cases: Pakistan. The conclusion is that the discourse on maternal health care in natural disasters should be developed and that further research on the subject needs to be conducted.
44
Wood, David L. "New Models of Health and Social Determinants of Health." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5180.
45
Percy, Ray. "Maternal verbal communication and the treatment of children with anxiety disorders in the context of maternal anxiety disorder." Thesis, University of Southampton, 2014. https://eprints.soton.ac.uk/370404/.
46
Boundy, Ellen O'Neal. "Determinants of Global Maternal and Neonatal Morbidity and Mortality." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:16121139.
Abstract:
In 2013, approximately 289,000 women died from pregnancy-related causes and 2.8 million newborns died within the first 28 days of life. The vast majority of these deaths occur in resource-limited settings. This work examines risk and protective factors for the development of several perinatal complications that put mothers and their infants at risk for adverse health outcomes. We explored determinants of preeclampsia and gestational hypertension among women in Dar es Salaam, Tanzania. We also examined the effects of pregnancy spacing intervals on perinatal outcomes in that group of women. We used log binomial regression to obtain risk ratios and 95% confidence intervals for the development of the adverse pregnancy outcomes of interest. We also looked at the efficacy of an intervention aimed at improving neonatal outcomes by conducting a systematic review and meta-analysis of the effects of kangaroo mother care on neonatal morbidity and mortality.
We found that nulliparity, history of hypertension, urinary tract infection, low calcium intake, history of preeclampsia, and history of preterm birth were associated with an increased risk of developing preeclampsia among women in Dar es Salaam. Risk factors for gestational hypertension included a history of diabetes, elevated blood pressure at study enrollment, increased mid-upper arm circumference, high hematocrit, low mean corpuscular volume, a history of miscarriage or stillbirth, and older age at first pregnancy. Twin gestation and increased body mass index were risk factors for both types of hypertensive disorders of pregnancy among women in Tanzania. After a live birth, inter-pregnancy intervals less than six months were associated with an increased the risk of having a low birth weight baby in the next pregnancy; while after a stillbirth, short inter-pregnancy intervals were associated with increased risk of stillbirth and perinatal death. Providing kangaroo mother care to infants after birth was associated with decreased neonatal morbidity and mortality and increased likelihood of exclusive breastfeeding when compared to conventional care.
These findings can help identify women and infants at increased risk for developing pregnancy-related complications and contribute to informing development of evidence-based maternal, newborn, and family planning programs and policies.Epidemiology
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Moucheraud, Corrina. "Evaluation of Strategies and Outcomes in Maternal and Child Health." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:16121157.
Abstract:
Maternal and child mortality, particularly during the neonatal period, are among the most challenging global health issues of this era. This burden disproportionately affects the poorest populations, across and within countries. And although many of these deaths would be avertable, improvements in most countries have been slow. This dissertation explores three main research questions: (1) what is the effect of maternal health on infant outcomes?; (2) what survival gains could be attained through improved interventions, across the continuum of care?; and (3) how do health system characteristics affect the potential impact and cost-effectiveness of such interventions? The first paper uses decision modeling to evaluate how increased use of family planning and of improved intrapartum care could reduce maternal deaths in Nepal—as well as the cost-effectiveness of doing so, and of accompanying interventions to achieve these targets. The second paper estimates the potential impact of administering interventions from the Safe Childbirth Checklist at health facilities in India, and how “real world” implementation might see different results due to health system characteristics. Lastly, the third paper examines child survival outcomes following a maternal death in Ethiopia, using a long-term household-level longitudinal dataset. Together, these papers aim to provide new insights on approaches to reducing the high level of mortality among women and children.Global Health and Population
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Duhn, Lenora Jane. "The impact of a maternity cooperative care program on maternal and infant complications, maternal competence, social support, and stress." Thesis, McGill University, 1996. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=23999.
Abstract:
The purpose of this study was to assess the impact of a Maternity Cooperative Care Program (MCCP) on the prevalence of maternal and infant complications, maternal competence, social support, stress, and first-time-mothers' descriptions of their postpartum experience. Forty-one healthy, primiparous mothers who participated in a MCCP and forty-three healthy, primiparous mothers who received traditional maternity care were asked to complete the Perceived Competence Questionnaire, the Personal Resource Questionnaire, "The Help I Get" Questionnaire (spousal support), and three numerical rating scales relating to stress in general, as well as self- and infant-care stress 24-48 hours postpartum while in hospital and over the telephone at two weeks postpartum. Ten randomly selected mothers from each group also answered twelve open-ended questions during a home visit at 2-3 weeks postpartum. There were no statistically significant differences between the two groups for any of the outcome variables assessed. For both groups, competence with self- and infant-care increased over the two weeks postpartum, while support and stress remained stable. Interviews with the mothers revealed that the number of stressors increased once at home, while support continued to be of value in relieving stress and helping maternal adjustment and confidence. Results of a qualitative comparison between the groups suggests that the MCCP mothers felt more prepared to be discharged home, and identified their partner more often as an active participant during hospitalization.
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Carvalho, Natalie. "Health Impacts and Economic Evaluations of Maternal and Child Health Programs in Developing Countries." Thesis, Harvard University, 2012. http://dissertations.umi.com/gsas.harvard:10264.
Abstract:
This dissertation is motivated by two of the health-related Millennium Development Goals (MDGs): MDG 4, focused on reducing child mortality, and MDG 5, which aims to improve maternal health. My three papers evaluate the health and economic impact, and cost-effectiveness, of interventions to improve maternal and child health in three areas of the developing world using methods from decision sciences and statistics. In paper 1, I use a decision-analytic model that simulates the natural history of pregnancy and pregnancy-related complications to assess the expected health outcomes, costs, and cost-effectiveness of strategies to reduce maternal mortality in Afghanistan. Increasing family planning was found to be the most effective single intervention to reduce maternal mortality. Further findings suggest that a stepwise approach that couples increased family planning with incremental improvements in access to appropriate intrapartum care could prevent 3 out of 4 maternal deaths and would be cost-effective. Paper 2 explores the value of community-based disease management programs for reducing mortality from childhood pneumonia and malaria in 24 countries of sub-Saharan Africa. I use a model-based framework that combines symptom patterns, care-seeking behavior, and treatment coverage from an empirical assessment of household survey data with information on diagnostic algorithms and disease progression from the literature. Results indicate that a community health worker program modeled on currently-existing programs could avert over 100,000 under-five deaths combined across the 24 countries and would be regarded as cost-effective compared to the status quo under typical benchmarks for international cost-effectiveness analysis. My third paper evaluates the effect of Janani Suraksha Yojana (JSY), a conditional cash transfer program intended to promote the use of reproductive health services in India, on childhood immunizations and other reproductive and child health indicators. Using observational data from the most recent district-level household survey, I conduct a matching analysis with logistic regression to assess the associations of interest. Results show that receipt of financial assistance from JSY led to a significant increase in childhood immunizations rates, post-partum check-ups, and some healthy breastfeeding practices, but no impact was found on exclusive breastfeeding and care-seeking behaviors.
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Sosa-Rubi, Sandra Gabriela. "Maternal health care utilisation and the production function of the health of the newborn." Thesis, University of York, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.434158.