Impact of Antimicrobial Stewardship Programs on Antibiotic Use and Drug Resistance:Analysis of Data from Maternal and Child Health Care Hospitals in Hubei Province,China

ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).

Determining Optimal Strategies to Reduce Maternal and Child Mortality in Rural Areas in Western China: an Assessment Using the Lives Saved Tool

China, as a whole, is about to meet the Millennium Development Goals for reducing the maternal mortality ratio (MMR) and infant mortality rate (IMR), but the disparities between rural area and urban area still exists. This study estimated the potential effectiveness of expanding coverage with high impact interventions using the Lives Saved Tool (LiST). It was found that gestational hypertension, antepartum and postpartum hemorrhage, preterm birth, neonatal asphyxia, and neonatal childhood pneumonia and diarrhea are still the major killers of mothers and children in rural area in China. It was estimated that 30% of deaths among 0-59 month old children and 25% of maternal deaths in 2008 could be prevented in 2015 if primary health care intervention coverage expanded to a feasible level. The LiST death cause framework, compared to data from the Maternal and Child Mortality Surveillance System, represents 60%-80% of neonatal deaths, 40%-50% of deaths in 1-59 month old children and 40%-60% of maternal deaths in rural areas of western China.

Marked Improvement in China's Maternal and Child Health

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Evidence on result-based financing in maternal and child health in low-and middle-income countries:a systematic review

Introduction:Result-Based Financing(RBF)is an umbrella term for financial mechanisms that link incentives to outputs or outcomes.International development agencies are promoting RBF as a viable financing approach for the realization of universal health coverage,with numerous pilot trials,particularly in low-and middle-income countries(LMICs).There is limited synthesized evidence on the performance of these mechanisms and the reasons for the lack of RBF institutionalization.This study aims to review the evidence of RBF schemes that have been scaled or institutionalized at a national level,focusing on maternal,newborn,and child health(MNCH)programming in LMICs.Methods:A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.The authors identified and reviewed country-level RBF evaluation reports for the period between January 2000 and June 2019.Data were extracted from both published and gray literature on RBF application in MNCH using a predesigned matrix.The matrix headers included country of application;program setting;coverage and duration;evaluation design and methods;outcome measures;and key findings.A content thematic analysis approach was used to synthesize the evidence and emerging issues.Results:The review identified 13 reports from 11 countries,predominantly from Sub-Saharan Africa.Performancebased financing was the most common form of RBF initiatives.The majority of evaluation designs were randomized trials.The evaluations focused on outputs,such as coverage and service utilization,rather than outcomes.RBF schemes in all 11 countries expanded their scope,either geographically or accordingly in terms of performance indicators.Furthermore,only three studies conducted a cost-effectiveness analysis,and only two included a discussion on RBF’s sustainability.Only three countries have institutionalized RBF into their national policy.On the basis of the experience of these three countries,the common enabling factors for institutionalization seem to be political will,domestic fund mobilization,and the incorporation of demand-side RBF tools.Conclusion:RBF evidence is still growing,partial,and inconclusive.This limited evidence may be one of the reasons why many countries are reluctant to institutionalize RBF.Additional research is needed,particularly regarding costeffectiveness,affordability,and sustainability of RBF programs.

The direct and indirect impact of COVID-19 pandemic on maternal and child health services in Africa:a scoping review

Introduction:The novel coronavirus disease 2019(COVID-19)continues to disrupt the availability and utilization of routine and emergency health care services,with differing impacts in jurisdictions across the world.In this scoping review,we set out to synthesize documentation of the direct and indirect effect of the pandemic,and national responses to it,on maternal,newborn and child health(MNCH)in Africa.Methods:A scoping review was conducted to provide an overview of the most significant impacts identified up to March 15,2022.We searched MEDLINE,Embase,HealthSTAR,Web of Science,PubMed,and Scopus electronic databases.We included peer reviewed literature that discussed maternal and child health in Africa during the COVID-19 pandemic,published from January 2020 to March 2022,and written in English.Papers that did not focus on the African region or an African country were excluded.A data-charting form was developed by the two reviewers to determine which themes to extract,and narrative descriptions were written about the extracted thematic areas.Results:Four-hundred and seventy-eight articles were identified through our literature search and 27 were deemed appropriate for analysis.We identified three overarching themes:delayed or decreased care,disruption in service provision and utilization and mitigation strategies or recommendations.Our results show that minor consideration was given to preserving and promoting health service access and utilization for mothers and children,especially in historically underserved areas in Africa.Conclusions:Reviewed literature illuminates the need for continued prioritization of maternity services,immunization,and reproductive health services.This prioritization was not given the much-needed attention during the COVID-19 pandemic yet is necessary to shield the continent’s most vulnerable population segments from the shocks of current and future global health emergencies.

Innovations in maternal and child health:case studies from Uganda

Background:Nearly 300 children and 20 mothers die from preventable causes daily,in Uganda.Communities often identify and introduce pragmatic and lasting solutions to such challenging health problems.However,little is known of these solutions beyond their immediate surroundings.If local and pragmatic innovations were scaled-up,they could contribute to better health outcomes for larger populations.In 2017 an open call was made for local examples of community-based solutions that contribute to improving maternal and child health in Uganda.In this article,we describe three top innovative community-based solutions and their contributions to maternal health.Main text:In this study,all innovations were implemented by non-government entities.Two case studies highlight the importance of bringing reproductive health and maternal delivery services closer to populations,through providing accessible shelters and maternity waiting homes in isolated areas.The third case study focuses on bringing obstetric imaging services to lower level rural health facilities,which usually do not provide this service,through task-shifting certain sonography services to midwives.Various health system and policy relevant lessons are highlighted.Conclusions:The described case studies show how delays in access to health care by pregnant women in rural communities can be systematically removed,to improve pregnancy and delivery outcomes.Emphasis should be put on identification,capacity building and research to support the scale up of these community-based health solutions.

Retrospective Analysis of Clinical Characteristics and Neonatal Outcomes of Pregnant Women with SARS-COV-2 Infection

This retrospective study aimed to investigate the clinical characteristics and neonatal outcomes of pregnant women with SARS-COV-2 in Wuhan Children's Hospital and further suggested a possible management strategy for infected pregnant women under epidemic situation.In this study,8 pregnant women with SARS-COV-2 who were admitted into Wuhan Children's Hospital,China from February 1,2020 to March 30,2020 and the clinical features,laboratory data,maternal and neonatal outcomes were analyzed.The mean age of the women at the time of admission was 30.6 years.The mean gestational age of the women was 37 weeks±4 days,and one woman presented with dichorionic diamniotic(DCDA)twin pregnancy.Except for one woman who was febrile,others had no typical clinical symptoms.For all pregnant women,the count of white blood cells and lymphocytes appeared normal,but 6 had a lower percentage of lymphocytes.C-reactive protein(CRP)levels were normal for all the women.One neonate was tested positive for the coronavirus IgG and IgM antibodies.The clinical symptoms of the pregnant women with SARS-COV-2 were mild,and the laboratory data showed similar characteristics to those of non-infected pregnant women.Since one neonate was tested positive for coronavirus,there is a possibility of vertical transmission of SARS-CoV-2.Prompt and efficient screening,triage,and isolation of pregnant women are ffective management strategies to reduce nosocomial infection during the SARS-COV-2 epidemic.

Study on the Lactation Volume and Related Factors of Mother’s Milk in Puerperal Women Separated from Infant

Objective: To investigate the lactation volume and milk secretion of mother’s milk in puerperal women separated from mother and infant, and to study the related influencing factors. Methods: Selected February 2015-February 2020 in Foshan women and children’s hospital 420 cases of maternal as the research object, using lactation related factors comprehensive questionnaire of maternal and infant separation of puerperal women for continuous determination of amount of lactation, and 1 - 7 days and 8 to 14 days postpartum lactation quantity and Pearson correlation analysis, using multiple linear regression analysis to affect maternal separation of puerperal women in lactation of breast volume related factors were analyzed. Results: The lactation volume of the puerperal women was on the rise within 14 days after delivery. 14 days mammary volume ware 545.13 - 243.18 ml, postpartum lactation II period start time was (67.48 + 26.57) h. The correlation coefficient between lactation volume on day 4 and lactation volume on day 14 was 0.04 (P < 0.05). Pregnancy-induced hypertension syndrome, lactation II period start time, birth gestational age, maternal age is affecting maternal separation of the main factors of puerperal women lactation milk. Conclusion: Early maternal separation of puerperal women breast milk lactation quantity is little, lactation II later period start time, delay rate is high: in clinical nursing work, should pay attention to produce age is bigger, smaller gestational age and birth with pregnancy-induced hypertension syndrome, maternal lactation stage II startup delay, should be timely intervention of maternal and infant separation maternal management effectively, promote successful lactation and increase the amount of lactation, for clinical guidance and provides some references for the separation of puerperal women breastfeeding.

Improvements to Female Autonomy and Household Decision-Making Power from an Intervention Targeting Improved Food Security: A Gender-Based Analysis of the Rajasthan Nutrition Project

In India, women and children continue to experience food insecurity. The purpose of this study is to evaluate whether the Rajasthan Nutrition Project (RNP) led to changes in 1) dietary habits and nutrition, and 2) indicators of gender equality, female autonomy, and empowerment. This study surveyed women belonging to self-help groups who were pregnant or who had young children. Over the course of the intervention, significant improvements were seen in the following indicators: breastfeeding within one hour of birth, exclusively breastfeeding for the first six months, food insecurity of children and mothers, household decision-making, communication, mobility, and domestic violence. These findings suggest that the RNP is a promising intervention for improving nutrition and female autonomy in Rajasthan, India. Additional research is needed to determine if the RNP would be equally as effective in other regions of India, or in populations outside of India.

The Zika epidemic and abortion in Latin America:a scoping review

Background:Latin America presently has the world’s highest burden of Zika virus,but there are unexplained differences in national rates of congenital malformations collectively referred to as Congenital Zika Syndrome(CZS)in the region.While Zika virulence and case detection likely contribute to these differences,policy-related factors,including access to abortion,may play important roles.Our goal was to assess perspectives on,and access to,abortion in Latin America in the context of the Zika epidemic.Methods:We conducted a scoping review of peer-reviewed and gray literature published between January 2015 and December 2016,written in English,Spanish,Portuguese,or French.We searched PubMed,Scielo,and Google Scholar for literature on Zika and/or CZS and abortion,and used automated and manual review methods to synthesize the existing information.Results:36 publications met our inclusion criteria,the majority of which were qualitative.Publications were generally in favor of increased access to safe abortion as a policy-level response for mitigating the impact of CZS,but issues with implementation were cited as the main challenge.Aside from the reform of abortion regulation in Colombia,we did not find evidence that the Zika epidemic had triggered shifts in abortion policy in other countries.Conclusion:Abortion policy in the region remained largely unchanged following the Zika epidemic.Further empirical research on abortion access and differential rates of CZS across Latin American countries is required.

我国母婴出生队列特色生物样本库的建设和管理

阐述我国母婴出生队列特色生物样本库的建设意义和现状,基于母婴出生队列“样本类型多样、样本来源关联、研究范围广泛”特点及法律规范,从管理体系、设施设备与人员、过程控制、样本利用等角度,结合自动化和信息化手段,探讨我国母婴出生队列特色生物样本库规范化建设及管理方法,助力妊娠期高血压、糖尿病、流产、早产、出生缺陷等发病机制研究,推动母婴特色资源合作与共享。

中非妇幼健康南南合作核心培训内容遴选

目的构建中非妇幼健康南南合作的培训内容。方法在查阅文献的基础上形成初始问卷,培训内容分为领导与治理、卫生筹资与保障、卫生人力、卫生信息、卫生产品和技术、卫生服务提供6个维度。用电子邮件进行2轮专家函询。结果2轮函询的有效问卷回收率均为100.0%,专家积极系数为100.0%。专家对37个条目达成了共识,包括领导与治理14个条目、卫生筹资与保障5个条目、卫生人力3个条目、卫生信息2个条目、卫生产品和技术5个条目、卫生服务提供8个条目。结论研究形成了关于中非妇幼健康南南合作培训内容的中方专家共识,结果可为进一步调查非洲学员的培训需求提供参考。

山东省基层妇幼保健机构资源效率的空间分布

目的 研究山东省县(区、市)级妇幼保健机构资源效率的空间分布特征及聚集性,为妇幼保健机构资源效率的提升提供科学依据。方法 用ArcGIS 10.5软件进行Moran’s Ⅰ空间自相关分析和Getis-Ord G~*热点分析。结果 目前,山东省还有13家(占9.42%)基层妇幼保健机构没有开展门诊服务,41家(占29.71%)未开展住院服务。山东省基层妇幼保健机构的日均住院工作负担和床位使用率呈空间正相关(Moran’s Ⅰ=0.194,P=0.001;Moran’s Ⅰ=0.223,P < 0.001)。Getis-Ord Gi~*热点分析显示,日均门急诊工作负担、日均住院工作负担和床位使用率均存在热点和冷点聚集区域。其中,热点区域主要分布在临沂、潍坊和烟台等市,冷点区域主要分布在济南市、青岛市、东营市和菏泽市。结论 山东省基层妇幼保健机构的资源使用效率指标具有空间异质性,应密切关注冷热点区域,分类指导、统筹规划,提高妇幼保健资源的利用效率。

Assessing the influence of digital technologies on antenatal care visits in Zimbabwe:insights from 2019 Zimbabwe Multiple Indicator Cluster Survey

Background and objective:To provide good health and well-being as established by the Sustainable Development Goal(SDG)3,access to digital technologies can act as conduits to achieve such progress in a population.As guided by the World Health Organization,antenatal care(ANC)attendance is one of the measures promoted to curtail the global health burden of maternal and infant mortality.ANC services are seldom utilized to their full potential in Zimbabwe.This study explores if any of the women's digital technology characteristics were associated with antenatal care visits.Methods:The study analyzed population-based cross-sectional data with a subsample of 1932 women aged 15-49 years from the 2019 Zimbabwe Multiple Indicator Cluster Survey.Test of associations with chi-square test,bivariate,and multivariate multinomial logistic regression analyses were used to examine the predictors of adequate(4-7)and optimal(≥8)ANC visits relative to undesirable(1-3)antenatal care visits among women who had given births 2 years before the survey.Results:The results indicate that 64.5%(1246/1932)of the women attained adequate ANC while about 9.8%(189/1932)attained optimal ANC.Reading a newspaper/magazine at least once a week(odds ratio[OR] 1.73,β'=0.551,t=2.030,P=0.043)and watching television at least once a week(OR 1.72,β=0.545,t=2.454,P=0.015),listening to the radio less than once a week(OR 1.28,β'=0.247,t=1.750,P=0.080),and owning a mobile phone(OR 1.48,β'=0.394,t=3.020,P=0.003)were positively associated with adequate ANC.Optimal ANC was significantly associated with women being able to read a newspaper at least once a week(OR 2.93,β'=1.074,t=3.120,P=0.002),listen to the radio less than 0nce a week(OR 2.07,p'=0.73,t=2.700,P=0.007)and have ownership of a mobile phone(OR 1.88,β'=0.631,t=2.620,P=0.009).Conclusion:Access to a newspaper,radio,television,and mobile phone were important predictors of a woman's ability to achieve her ANC attendance.Policies to improve the knowledge of ANC packages can be facilitated using digital technology to achieve adequate and preferably optimal ANC in Zimbabwe.It is important to improve digital infrastructure to support digital technologies in providing ANC services.

Maternity and Child Care in Yinan County

YINAN is a poor county in the Yimeng Mountain Area in Shandong Province. It has a population of 900,000, over 80 percent of whom live in rural areas and about 600,000 of whom are women and children. Protecting the health of women and children is not only important to reach the goal "Everyone Enjoys Health Protection by the year 2000" and the goals set out in the "Program for Chinese Children’s Development in the 1990s," but also has a crucial influence on

Trends in global health research among universities in China:a bibliometric analysis

Background There has been considerable progress in developing global health education and research in China.Nevertheless,evidence of the progress of Chinese universities’contributions to global health research is limited.More efforts are needed to depict the progress Chinese universities have collectively made in advancing the field of global health.This study aimed to examine Chinese universities’collective contributions to global health research by describing the longitudinal trends in global health research publications,uncovering research themes in global health,and exploring collaboration patterns.Methods A comprehensive bibliometric analysis was conducted for original research studies of the ten founding members of the China Consortium of Universities for Global Health,one of the largest networks of global health research and education in China.Results We found that(1)the number of research publications in the field of global health has steadily increased from 2014 to 2020,(2)non-communicable disease was the most popular research topic,accounting for over one-third of total publications,followed by maternal and child health and neurological and mental disorders and diseases,(3)less than one-fifth of papers involved primary data collection,with the majority of the study populations from low-income and lower-middle-income countries in Asia and Africa,and(4)a sizable collaboration network has been established with co-authors from over 200 oversea universities or organizations,with about one third from the US.Conclusions Despite a variety of challenges and barriers,Chinese universities have been playing an increasingly important role in global health research as assessed by peer-reviewed publications over the last decade.More concerted efforts by multiple stakeholders,including government,private sectors,funding agencies,academic institutions,and researchers,are needed to advance the development of global health research in China.