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Intl. J. of MCH and AIDS     Open Access  
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International Journal of MCH and AIDS
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ISSN (Print) 2161-8674 - ISSN (Online) 2161-864X
Published by Global Health and Education Projects Homepage  [1 journal]
  • Contributions of Socioeconomic, Demographic, and Behavioral Risk Factors
           to All-Cause Mortality Disparities by Psychological Distress in the United
           States: A Blinder-Oaxaca Decomposition Analysis of Longitudinal Data

    • Authors: Hyunjung Lee, Gopal Singh
      Abstract: Background: Previous research has shown a significant association between psychological distress (PD) and all-cause mortality. However, there is a dearth of studies quantifying the contributions of sociodemographic and behavioral characteristics to group differences in mortality. In this study, we identify factors of mortality differences by PD. Methods: The Blinder-Oaxaca decomposition analysis was used to quantify the contributions of individual sociodemographic and behavioral characteristics to the observed mortality differences between United States (US) adults with no PD and those with serious psychological distress (SPD), using the pooled data from the 1997-2014 National Health Interview Survey prospectively linked to the 1997-2015 National Death Index (N = 263,825). Results: Low educational level, low household income, and high proportions of current smokers, renters, former drinkers, and adults experiencing marital dissolution contributed to high all-cause mortality among adults with SPD. The relative percentage of all-cause mortality disparity explained by socioeconomic and demographic factors was 38.86%. Approximately 47% of the mortality disparity was attributed to both sociodemographic and behavioral risk factors. Lower educational level (21.13%) was the top contributor to higher all-cause mortality among adults with SPD, followed by smoking status (13.51%), poverty status (11.77%), housing tenure (5.11%), alcohol consumption (4.82%), marital status (3.61%), and nativity/immigrant status (1.95%). Age, sex, and body mass index alleviated all-cause mortality risk among adults with SPD. Conclusions and Global Health Implications: Improved education and higher income levels, and reduced smoking among US adults with SPD might eliminate around half of the all-cause mortality disparity by SPD. Such a policy strategy might lead to reductions in mental health disparities and adverse health impacts both in the US and globally. Copyright © 2022 Lee et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.
      PubDate: 2022-04-05
      DOI: 10.21106/ijma.533
      Issue No: Vol. 11, No. 1 (2022)
  • National Trends in Hospitalization, Surgical Resection, and Comorbidities
           in Pediatric Inflammatory Bowel Disease in the United States, 2002-2015

    • Authors: Faith D. Ihekweazu, Deepa Dongarwar, Hamisu M. Salihu, Richard Kellermeyer
      Abstract: Background and Objective: Therapeutic options for pediatric inflammatory bowel disease (PIBD) have dramatically changed over the last 20 years. However, the impact of modern medical management on PIBD outcomes remains unclear. We aimed to fill this gap in the literature by using a large, validated, national database, to study the change in hospitalization rates, surgical rates, and postoperative complications in PIBD over the last decade. Methods: The National Inpatient Sample (NIS) Database and ICD-9-CM codes were utilized to identify inpatient admissions with a primary or secondary diagnosis of pediatric Crohn’s disease (CD) or ulcerative colitis (UC) from 2002-2015. Trends in hospitalizations, comorbidities (including malnutrition and weight loss), surgical procedures, and postoperative complications were examined using joinpoint regression analysis, a statistical modeling approach to evaluate the extent to which the rate of a condition changes over time. Results: There were 119,282 admissions for PIBD during the study period. The annual incidence of hospitalization increased significantly over time for both CD (average annual percent change [AAPC] 6.0%) and UC (AAPC 7.2%). The rate of intestinal resection decreased in CD patients (AAPC -6.4%) while postoperative complications remained unchanged. However, comorbidities increased significantly in CD patients (AAPC 6.8%). For pediatric UC patients, postoperative complications (AAPC 6.7%), and comorbidities (AAPC 10.2%) increased significantly over time while intestinal resection rates remained stable. Intestinal resection rate in pediatric CD has decreased over time, but not in pediatric UC. Conclusion and Global Health Implications: Annual incidence of hospitalization and comorbidities continue to increase in PIBD. Intestinal resection rate in pediatric CD has decreased over time, but not in pediatric UC. Our findings emphasize the critical need for prevention and novel therapeutic options for this vulnerable patient population. Copyright © 2021 Ihekweazu et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.
      PubDate: 2022-03-06
      DOI: 10.21106/ijma.522
      Issue No: Vol. 11, No. 1 (2022)
  • Fourth Annual Summer Research Summit on Health Equity Organized by the
           Center of Excellence in Health Equity, Training and Research, Baylor
           College of Medicine, Houston, Texas 77030, USA on May 20, 2021

    • Authors: Aanand Naik, Abbhirami Rajagopal, Adam Floyd, Adriana Gil, Aisha Tepede, Aisha Koroma, Aisha Deslandes, Akua Graf, Alejandra Ruiz-Velasco, Alexa Reyna-Carrillo, Alexandra Alvarenga, Alexia Awoseyi, Alexis Hernandez, Alexis Lawrence, Alexis Hernandez, Ali Asghar-Ali, Ali Asghar-Ali, Allyssa Abacan, Alyce Adams, Alyna Khan, Alyson McGregor, Alyssa Hansen, Amari Johnson, Andrea Coj , Andrea Vick, Andria Tatem, Anjali Aggarwal, Anjali Deendyal, Ann Blake, Annabella Awazi, Anne VanHorn, Anuj Marathe, Anusha Jayaram, April Adams, Arabella Hall, Ariana Heredia, Ariana Chavarria, Asha Morrow, Ashley Butler, Asia Hodges, Aura Mejia, Avani Patel, Ayleen Hernandez, Benjamin Akande, Blessing Felix-Okoroji, Brisa Garcia, Buckleitner Jenna, Callie Fischer, Camden Hallmark, Cara Coren, Carlos Ramos, Cecilia Gambala, Charleta Guillory, Chelsea Livingston, Chioma Onyejiaka, Chishinga Callender, Christina Aldrich, Christopher Largaespada , Claire Bocchini, Craig Cochran, Danielle Sherman, Danielle Gonzales, David Venzon, David Wittkower, Debbe Thompson, Deborah Thompson, Debra Eseonu, Deepa Dongarwar, Delia Rospigliosi, Denise Smart, Denisse Velazquez, Derek Lockett , Eberechi Nwogu-Onyemkpa, Elizabeth Byrne, Elyse Lopez, Eric Dybbro, Eric Storch, Erica Onwuegbuchu, Erica Valdes, Erin Donovan, Eunique Williams, Evan Keil, Faith Ihekweazu, Felicia Rosiji, Gabriela Espinoza-Candelaria, Gabriella Chmaitelli, Gabriella Tavera , Gail Oneal, Gal Barbut, Gauvain Tonpouwo, George Carrum, Gina DeFelice, Hamisu Salihu, Heather Haq, Helen Heslop , Houston Lester, Ifeoma Ezenwabachili, Ila Gautham, Jacquelin Powell, Jaime Alleyn, Jasmine King, Jaydira Rivero, Jayer Chung, Jayna Dave, Jean Raphael, Jen Bryan, Jendi Haug, Jennifer Bryan, Jenny Blau, Jerry Bellamy, Jessica Medrano, Jessica Ramirez, Jocelyn Greely, Jonnae Atkinson, Jorge Miranda, Jose Dominguez, Jose Roca, Joseph Mills, Joshua Hamer, Joshua Muñiz, Julliet Ogu, Karen Gibbs, Karen Johnson , Karen Riggins , Karla Fredricks, Keila Lopez, Kellie Williams, Keyishi Peters, Kil Hyein, LaQuisa Hill, Lee Weinstein, Lena Shay, Lentz Lefevre, Lindy Ross, Lisa Noll, Lois Akpati, Lorin Crear, Lucy Puryear, Maame Coleman, Madhuri Vasudevan, Malachi Miller, Maria Vigil-Mallette, Maria Jaramillo, Maria Vigil-Mallette, Mariam Chacko, Mariana Baroni, Mariana Murillo, Maricarmen Marroquin, Marina Masciale, Marlene McNeese, Martinez Austin, Matthew Koller, Maya Lee, Maziar Nourian, Megan Abadom, Meghna Sebastian, Meheret Adera, Mei-Lei Laracuente, Michelle Lopez, Michelle Wright, Miguel Montero-Baker, Monica Gonzalez, Morrow Adelene, Mosope Adeyeye, Muzaffar Qazilbash, Namrata Walia, Nancy Shenoi, Natalia Rodriguez, Naya Mukdadi, Neeraj Saini, Norma Olvera, Ololade Chris-Rotimi, Paige Hoyer, Parisa Fallah, Peggy Smith, Premal Lulla, Priscilla Ehieze, Priyanka Murali, Rachel Head, Rachel Nwaneri , Rachelle Wanser, Racquel Lyn, Rammurti Kamble, Ramyar Gilani, Raquel Martinez, Rathi Asaithambi, Reginald Hatter, Rhanna Wilson, Ria Brown, Robert Shulman, Robert Mbilinyi, Robert Levine, Roe Avery, Romil Patel, Roslyn Aduhene-Opoku, Ruth Mizu, Saad Usmani, Sadia Usmani, Saeed Ahmed, Samantha Moore, Samer Hadidi, Sana Erabti, Sana Javed, Sana Younus, Sanders Mar’Quenda, Sandy Samaan, Sara Alam, Sara Welty, Sergio Navarro, Shad Deering, Shaine Morris, Shana Alford, Shangir Siddique, Shantyka Walton, Shayan Bhathena, Shelease O’Bryant, Shital Patel, Sindhu Idicula, Sophia Banu, Sophie Albert, Sophie McCullum, Sophie Lin, Star Okolie, Sunita Agarwal, Susan Gillespie , Syed Hussaini, Sylvia Hysong, Tammy Kang, Tara Everett, Tara Everett, Taylor Ottesen, Tiana DiMasi, Tien Nguyen, Toi Harris, Tzu-An Chen, Vicki Mercado, Victoria Michael, Victoria Xie, William Simonds, Yesenya Gonzalez, Yicenia Aviles, Ynhi Thomas, Zachary Pallister
      Pages: 54
      Abstract: The fourth annual summer research summit organized by the Center of Excellence (COE) in Health Equity, Training and Research, Baylor College of Medicine (BCM) was held on May 20, 2021. The theme of this year’s summit was ‘Strengthening Our Commitment to Racial and Social Justice to Improve Public Health.’ Given the ongoing pandemic, the summit was conducted virtually through digital platforms. This program was intended for both BCM and external audiences interested in advancing health equity, diversity and inclusion in healthcare among healthcare providers and trainees, biomedical scientists, social workers, nurses, individuals involved in talent acquisition and development such as hiring managers (HR professionals), supervisors, college and hospital affiliate leadership and administrators, as well as diversity and inclusion excellence practitioners. We had attendees from all regions of the United States, India, Pakistan and the Demographic Republic of the Congo. The content in this Book of s encapsulates a summary of the research efforts by the BCM COE scholars (which includes post-baccalaureate students, medical students, clinical fellows and junior faculty from BCM) as well as the external summit participants. The range of topics in this year’s summit was quite diverse encompassing disparities in relation to maternal and child health (MCH), immigrant heath, cancers, vaccination uptakes and COVID-19 infections. Various solutions were ardently presented to address these disparities including community engagement and partnerships, improvement in health literacy and development of novel technologies and therapeutics. With this summit, BCM continues to build on its long history of educational outreach initiatives to promote diversity in medicine by focusing on programs aimed at increasing the number of diverse and highly qualified medical professionals ready to introduce effective and innovative approaches to reduce or eliminate health disparities. These programs will improve information resources, clinical education, curricula, research and cultural competence as they relate to minority health issues and social determinants of health. The summit received very positive response in terms of zealous participation and outstanding evaluations; and overall, it was a great success. Copyright © 2021 Dongarwar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.
      PubDate: 2021-10-20
      DOI: 10.21106/ijma.540
      Issue No: Vol. 10, No. 2 (2021)
  • Pregnancy and Birth Outcomes Among Women on Antiretroviral Therapy: A
           Long-term Retrospective Analysis of Data from a Major Tertiary Hospital in
           North Central Nigeria

    • Authors: Maxwell Dapar, Benjamin Joseph, Rotkangmwa Okunola, Josiah Mutihir, Moses Chingle, Mathilda Banwat
      Pages: 183 - 190
      Abstract: Background and Objective: Antiretroviral therapy (ART) has transformed human immune deficiency virus (HIV) infection from a death sentence to a chronic syndrome, allowing infected individuals to lead near-normal lives, including achieving pregnancy and bearing children. Notwithstanding, concerns remain about the effects of ART in pregnancy. Previous studies suggested contradictory associations between ART and pregnancy. This study determined birth outcomes in pregnant women who accessed ART between 2004 and 2017 at a major tertiary hospital in North Central Nigeria. Methods: This was a retrospective study of 5,080 participants. Ethical clearance was obtained from the Institutional Review Board of the Harvard T. H. Chan School of Public Health Boston. A pro forma for data abstraction was designed and used to collect data. ed data were sorted and managed using SPSS® version 22. The Chi-square test was used to calculate the proportions of pregnancy outcomes. One-way analysis of variance was used to test the effect of antiretroviral drug regimens on mean birth weight and gestational age at delivery. All levels of significance were set at p 0.05. Results: Pregnancy outcomes were recorded as live birth (99.8%), stillbirth (0.2%), preterm delivery (6.6%), and low birth weight (23%). There was a statistically significant association between ART in pregnancy and low birth weight {χ2[(5, n = 3439) = 11.99, p = 0.04]}. The highest mean birth weights were recorded in participants who received drug combinations with protease inhibitors or efavirenz, in contrast to participants who received Nevirapine, stavudine and Emtricitabine/Tenofovirbased regimens. However, there was no significant difference in the gestational age of babies at birth for the six ART regimens in the study. Conclusion and Global Health Implications: Findings support the benefits of ART in pregnancy, which is in line with the testing and treatment policies of the 90-90-90 targets for ending HIV by the year 2030. Copyright © 2021 Dapar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.
      PubDate: 2021-10-28
      DOI: 10.21106/ijma.511
      Issue No: Vol. 10, No. 2 (2021)
  • An Analysis of Levels and Trends in HIV Prevalence Among Pregnant Women
           Attending Antenatal Clinics in Karnataka, South India, 2003-2019

    • Authors: Arumugam Elangovan, Joseph K David, Santhakumar Aridoss, Nagaraj Jaganathasamy , Malathi Mathiyazhakan, Balasubramanian Ganesh , Manikandan Natesan , Padmapriya VM, Kirubakaran BK, Sanjay Patil, Pradeep Kumar, Shobini Rajan
      Pages: 198 - 209
      Abstract: Background and Objective: Periodic tracking of the trends and the levels of HIV prevalence at regional and district levels helps to strengthen a state’s HIV/AIDS response. HIV prevalence among pregnant women is crucial for the HIV prevalence estimation of the general population. Karnataka is one of the high HIV prevalence states in India. Probing regional and district levels and trends of HIV prevalence provides critical insights into district-level epidemic patterns. This paper analyzes the region- and district-wise levels and trends of HIV prevalence among pregnant women attending the antenatal clinics (ANC) from 2003 to 2019 in Karnataka, South India. Methods: HIV prevalence data collected from pregnant women in Karnataka during HIV Sentinel Surveillance (HSS) between 2003 and 2019 was used for trend analysis. The consistent sites were grouped into four zones (Bangalore, Belgaum, Gulbarga and Mysore regions), totaling 60 sites, including 30 urban and 30 rural sites. Regional and district-level HIV prevalence was calculated; trend analysis using Chi-square trend test and spatial analysis using QGIS software was done. For the last three HSS rounds, HIV prevalence based on sociodemographic variables was calculated to understand the factors contributing to HIV positivity in each region. Results: In total, 254,563 pregnant women were recruited. HIV prevalence in Karnataka was 0.22 (OR: 0.15 95% CI: 0.16 - 0.28) in 2019. The prevalence was 0.24, 0.32, 0.17 and 0.14 in Bangalore, Belgaum, Gulbarga, and Mysore regions, respectively. HIV prevalence had significantly (P< 0.05) declined in 26 districts. Conclusion and Global Health Implications: HIV prevalence among pregnant women was comparatively higher in Bangalore and Belgaum regions. Analysis of contextual factors associated with the transmission risk and evidence-based targeted interventions will strengthen HIV management in Karnataka. Regionalized, disaggregated, sub-national analyses will help identify emerging pockets of infections, concentrated epidemic zones and contextual factors driving the disease transmission. Copyright © 2021. Arumugam et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.
      PubDate: 2021-11-01
      DOI: 10.21106/ijma.520
      Issue No: Vol. 10, No. 2 (2021)
  • Associations of Sociodemographic and Clinical Factors with Late
           Presentation for Early Infant HIV Diagnosis (EID) Services in Kenya

    • Authors: Agnes Langat, Tegan Callahan, Isabella Yonga, Boniface Ochanda, Anthony Waruru, Lucy Ng'anga, Abraham Katana, Brian Onyango, Benson Singa, Stephen Oyule, George Githuka, Lennah Omoto, Jane Muli, Thorkild Tylleskar, Surbhi Modi
      Pages: 210 - 220
      Abstract: Background: Understanding the missed opportunities in early infant HIV testing within the PMTCT program is essential to address any gaps. The study set out to describe the clinical and sociodemographic characteristics of the infants presenting late for early infant diagnosis in Kenya. Methods: We abstracted routinely collected clinical and sociodemographic characteristics, in a cross-sectional study, on all HIV-infected infants with a positive polymerase chain reaction (PCR) test from 1,346 President’s Emergency Plan for AIDS Relief (PEPFAR) supported health facilities for the period October 2016 to September 2018. We used multivariate logistic regression to examine the association of sociodemographic and clinical characteristics with late (>2 months after birth) presentation for infant HIV testing. Results: Of the 4,011 HIV-infected infants identified, the median infant age at HIV diagnosis was 3 months [interquartile range (IQR), 1-16 months], and two-thirds [2,669 (66.5%)] presented late for infant HIV testing. Factors that were associated with late presentation for infant testing were: maternal ANC non-attendance, adjusted odds ratio (aOR) 1.41 (95% confidence interval (CI) 1.18 -1.69); new maternal HIV diagnosis, aOR 1.45, (95%CI 1.24 -1.7); and lack of maternal antiretroviral therapy(ART), aOR 1.94, (95% CI 1.64 - 2.30). There was a high likelihood of identifying HIV-infected infants among infants who presented for medical services in the outpatient setting (aOR 18.9; 95% CI 10.2 - 34.9) and inpatient setting (aOR 12.2; 95% CI 6.23-23.9) compared to the infants who presented late in maternity. Conclusion and Global Health Implications: Gaps in early infant HIV testing suggest the need to increase maternal pre-pregnancy HIV diagnosis, timely antenatal care, early infant diagnosis services, early identification of mothers who seroconvert during pregnancy or breastfeeding and improved HIV screening in outpatient and inpatient settings. Early referral from the community and access to health facilities should be strengthened by the implementation of national PMTCT guidelines. Copyright © 2021 Langat et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.
      PubDate: 2021-12-13
      DOI: 10.21106/ijma.537
      Issue No: Vol. 10, No. 2 (2021)
  • Determinants of HIV Testing Uptake among Women (aged 15-49 years) in the
           Philippines, Myanmar, and Cambodia

    • Authors: Wah Myint, David Washburn, Brian Colwell, Jay Maddock
      Pages: 221 - 230
      Abstract: Background: Many countries have been trying to eliminate Mother-to-Child transmission of the Human Immunodeficiency Virus (HIV) and achieve the 90-90-90 target goals. The targets mean that 90% of People Living with HIV (PLWHIV) know their HIV status, 90% of those who are infected receive Antiretroviral treatment (ART), and 90% of those achieve viral suppression. Despite some progress, the goals have not been met in the Philippines, Myanmar, and Cambodia, countries with relatively high or growing HIV prevalence. This study identifies the sociodemographic determinants of testing among women in these countries so that better health education and stigma reduction strategies can be developed. Methods: Descriptive and multivariable analyses were conducted using Demographic and Health Survey data conducted in the Philippines (2017), Myanmar (2015/2016), and Cambodia (2014). The outcome variable was having ever been tested for HIV. Independent variables included knowledge and attitudes about HIV and social determinants of health. Results: A significant difference in testing rates among women was observed (the Philippines: 5%, Myanmar: 19%, Cambodia: 42%). In Myanmar and Cambodia, women who had more HIV knowledge and less stigma towards PLWHIV were more likely to get tested for HIV than those who did not. Marital status, education, wealth were strong predictors for HIV testing among women. Younger women aged 15-19 and those who live in the rural areas were less likely to get HIV tested than older and those living in urban areas. Employed women were less likely to seek an HIV test than the unemployed in Myanmar and Cambodia, whereas, in the Philippines, the opposite relationship was found. Conclusion and Global Health Implications: Women with less education and those less familiar with HIV should be targeted for HIV testing interventions. Stigma reduction and different testing strategies could facilitate early screening leading to improved HIV testing among women. Copyright © 2021 Myint et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.
      PubDate: 2021-12-02
      DOI: 10.21106/ijma.525
      Issue No: Vol. 10, No. 2 (2021)
  • Genital Chlamydia Trachomatis Infection: Prevalence, Risk Factors and
           Adverse Pregnancy and Birth Outcomes in Children and Women in sub-Saharan

    • Authors: Elizabeth Afibah Armstrong-Mensah, David-Praise Ebiringa, Kaleb Whitfield, Jake Coldiron
      Pages: 251 - 257
      Abstract: Genital Chlamydia trachomatis (CT) has adverse health outcomes for women and children. In pregnant women, the infection causes adverse obstetric outcomes including pelvic inflammation, ectopic pregnancy, and miscarriage. In children, it causes adverse birth outcomes such as skin rash, lesions, limb abnormalities, conjunctivitis, neurological damage, and even death. This article discusses genital CT prevalence, risk factors, and adverse pregnancy and birth outcomes among women and children in sub-Saharan Africa as well as challenges associated with the mitigation of the disease. A comprehensive search of databases including PubMed, ResearchGate, and Google Scholar was conducted using keywords such as genital chlamydia trachomatis, adverse pregnancy outcomes, adverse birth outcomes, and sub-Saharan African. We found that genital CT prevalence rates in some sub-Saharan Africa countries were higher than others and that risk factors such as the lack of condom use, having multiple sexual partners, and low educational levels contribute to the transmission of the infection. We also found that negative cultural practices, illiteracy among women, and the lack of access to screening services during pregnancy are some of the challenges associated with CT mitigation in sub-Saharan Africa. To reduce genital CT transmission in sub-Saharan Africa, efforts must be made by country governments to eliminate negative cultural practices, promote female literacy, and provide access to screening services for pregnant women. Copyright © 2021 Armstrong-Mensah et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.
      PubDate: 2021-12-02
      DOI: 10.21106/ijma.523
      Issue No: Vol. 10, No. 2 (2021)
  • Strengthening Maternal Death Surveillance Systems for Evidence-Based
           Decision Making in Sub-Saharan Africa: The Case of the Center Region in

    • Authors: Anastasia Bongajum Yenban, Pascal Foumane, Charlotte Moussi, Noel Vogue, Hycinth Banseka, Jujlius Nwobegahay, Martina Baye
      Pages: 258 - 268
      Abstract: Background: The article seeks to document the experience of implementing Maternal Death Surveillance and Response (MDSR) in the Center Region of Cameroon. The paper raises awareness on the need for implementing MDSR, shares progress and lessons learned and reflects on the implications for public health practice. Methods: A desk research involving the collection and analysis of secondary data using tables with specific themes in excel, following the review of existing resources at the Regional Delegation of Public Health-Center from the year 2016 to 2019. Results: The findings depict the existence of MDSR policies and sub-regional committees. Although, the number of regional maternal death notifications increased from 19 to 188 deaths between 2016 and 2019, the implementation of death review recommendations was only estimated at 10% in 2019. While 66% of deaths occurred in Yaoundé, 72% of these were deaths reported to have occurred in tertiary institutions out of which 75% were attributed to late referrals. Hemorrhage constituted 70/144 (48.6%) of the known direct causes of death. Maternal death related co-factors such as the use of partograph during labor had a high non-response rate (84%) and represents a weakness in the data set. Conclusion and Global Health Implications: Across the board, stakeholder engagement towards MDSR was increased through continuous awareness-raising, dissemination of surveillance tools, the institutionalization of the District Health Information Software (DHIS 2) and the “No Name No Blame” policy. However, the reporting and investigation of deaths for informed decisions remain a daunting challenge. For a resource-scarce setting with limited access to blood banks, the application of life-saving cost-effective interventions such as the use of partographs and the institution of a functional referral system among health units is likely to curb the occurrence of deaths from hemorrhage and other underlying causes. The success of these will require a robust strengthening of the health system. Copyright © 2021 Bongajum, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.
      PubDate: 2021-12-01
      DOI: 10.21106/ijma.517
      Issue No: Vol. 10, No. 2 (2021)
  • Geographic, Health Care Access, Racial Discrimination, and Socioeconomic
           Determinants of Maternal Mortality in Georgia, United States

    • Authors: Elizabeth Afibah Armstrong-Mensah, Damilola Dada, Amber Bowers, Aruba Muhammad, Chisom Nnoli
      Pages: 278 - 286
      Abstract: Over the past decade, the United States has been taking steps to reduce its rising maternal mortality rate. However, these steps have yet to produce positive results in the state of Georgia, which tops the list of all 50 states with the highest maternal mortality rate of 46.2 maternal deaths per 100,000 live births for all women, and a maternal mortality rate of 66.6 deaths per 100,000 live births for African American women. In Georgia, several social determinants of health such as the physical environment, economic stability, health care access, and the quality of maternal care contribute to the high maternal mortality rate. Addressing these determinants will help to reduce the state’s maternal mortality rate. This commentary discusses the relationship between social determinants of health and maternal mortality rates in Georgia. It also proposes strategies for reversing the trend.We conducted an ecological study of the relationship between social determinants of health and maternal mortality in Georgia. We searched PubMed and Google Scholar and reviewed 80 English articles published between 2005 and 2021. We identified five key social determinants associated with high maternal mortality rates in Georgia - geographic location of obstetric services, access to health care providers, socioeconomic status, racism, and discrimination. We found that expanding Medicaid coverage, reducing maternal health care disparities among the races, providing access to maternal care for women in rural areas, and training a culturally competent health workforce, will help to reduce Georgia’s high maternal mortality rate. Copyright © 2021 Armstrong-Mensah et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.
      PubDate: 2021-12-13
      DOI: 10.21106/ijma.524
      Issue No: Vol. 10, No. 2 (2021)
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