Lenka Benova

Vertical Transmission of Hepatitis C Virus: Systematic Review and Meta-analysis

Updated pooled estimates of vertical hepatitis C (HCV) infection risk to children of HCV RNA–positive mothers ranges between 5.8% and 10.8%, depending on maternal HIV coinfection. Additional risk factors need to be captured and reported by future studies.

A mediation approach to understanding socio-economic inequalities in maternal health-seeking behaviours in Egypt

BackgroundThe levels and origins of socio-economic inequalities in health-seeking behaviours in Egypt are poorly understood. This paper assesses the levels of health-seeking behaviours related to maternal care (antenatal care [ANC] and facility delivery) and their accumulation during pregnancy and childbirth. Secondly, it explores the mechanisms underlying the association between socio-economic position (SEP) and maternal health-seeking behaviours. Thirdly, it examines the effectiveness of targeting of free public ANC and delivery care.MethodsData from the 2008 Demographic and Health Survey were used to capture two latent constructs of SEP: individual socio-cultural capital and household-level economic capital. These variables were entered into an adjusted mediation model, predicting twelve dimensions of maternal health-seeking; including any ANC, private ANC, first ANC visit in first trimester, regular ANC (four or more visits during pregnancy), facility delivery, and private delivery. ANC and delivery care costs were examined separately by provider type (public or private).ResultsWhile 74.2% of women with a birth in the 5-year recall period obtained any ANC and 72.4% delivered in a facility, only 48.8% obtained the complete maternal care package (timely and regular facility-based ANC as well as facility delivery) for their most recent live birth. Both socio-cultural capital and economic capital were independently positively associated with receiving any ANC and delivering in a facility. The strongest direct effect of socio-cultural capital was seen in models predicting private provider use of both ANC and delivery. Despite substantial proportions of women using public providers reporting receipt of free care (ANC: 38%, delivery: 24%), this free-of-charge public care was not effectively targeted to women with lowest economic resources.ConclusionsSocio-cultural capital is the primary mechanism leading to inequalities in maternal health-seeking in Egypt. Future studies should therefore examine the objective and perceived quality of care from different types of providers. Improvements in the targeting of free public care could help reduce the existing SEP-based inequalities in maternal care coverage in the short term.

Vertical transmission of hepatitis C: Systematic review and meta-analysis

Updated pooled estimates of vertical hepatitis C (HCV) infection risk to children of HCV RNA–positive mothers ranges between 5.8% and 10.8%, depending on maternal HIV coinfection. Additional risk factors need to be captured and reported by future studies.

Systematic review and meta-analysis: association between water and sanitation environment and maternal mortality

To assess whether the lack of water or the lack of sanitation facilities in either the home or in health facilities is associated with an increased risk of maternal mortality and to quantify the effect sizes.

Estimation of hepatitis C virus infections resulting from vertical transmission in Egypt

Despite having the highest hepatitis C virus (HCV) prevalence in the world, the ongoing level of HCV incidence in Egypt and its drivers are poorly understood. Whereas HCV mother‐to‐child infection is a well‐established transmission route, there are no estimates of HCV infections resulting from vertical transmission for any country, including Egypt. The aim of this study was to estimate the absolute number of new HCV infections resulting from vertical transmission in Egypt. We developed a conceptual framework of HCV vertical transmission, expressed in terms of a mathematical model and based on maternal HCV antibody and viremia. The mathematical model estimated the number of HCV vertical infections nationally and for six subnational areas. Applying two vertical transmission risk estimates to the 2008 Egyptian birth cohort, we estimated that between 3,080 and 5,167 HCV infections resulted from vertical transmission among children born in 2008. HCV vertical transmission may account for half of incident cases in the <5‐year age group. Disproportionately higher proportions of vertical infections were estimated in Lower Rural and Upper Rural subnational areas. This geographical clustering was a result of higher‐area‐level HCV prevalence among women and higher fertility rates. Conclusion: Vertical transmission is one of the primary HCV infection routes among children <5 years in Egypt. The absolute number of vertical transmissions and the young age at infection highlight a public health concern. These findings also emphasize the need to quantify the relative contributions of other transmission routes to HCV incidence in Egypt. (Hepatology 2015;61:834–842)

Using multi‐country household surveys to understand who provides reproductive and maternal health services in low‐ and middle‐income countries: a critical appraisal of the Demographic and Health Surveys

The Demographic and Health Surveys (DHS) are a vital data resource for cross‐country comparative analyses. This study is part of a set of analyses assessing the types of providers being used for reproductive and maternal health care across 57 countries. Here, we examine some of the challenges encountered using DHS data for this purpose, present the provider classification we used, and provide recommendations to enable more detailed and accurate cross‐country comparisons of healthcare provision.

The role of the private sector in the provision of antenatal care: a study of Demographic and Health Surveys from 46 low- and middle-income countries

To examine the role of the private sector in the provision of antenatal care (ANC) across low‐ and middle‐income countries.

Lifelong Socio Economic Position and biomarkers of later life health: testing the contribution of competing hypotheses

The relative contribution of early or later life Socio Economic Position (SEP) to later life health is not fully understood and there are alternative hypotheses about the pathways through which they may influence health. We used data from the English Longitudinal Study of Ageing with a formal approach for the identification of mediating factors in order to investigate alternative hypotheses about life course influences on biomarkers of later life health. We found that early life SEP predicts physical health at least 65 years later. However, a more complicated pattern of associations than that implied by previous findings was also observed. Age group specific effects emerged, with current SEP dominating the effect on later life physical health and fibrinogen levels in participants under 65, while early life SEP had a more prominent role in explaining inequalities in physical health for men and women over 75. We extend previous findings on mid adulthood and early old age, to old age and the beginnings of late old age. The complexity of our findings highlights the need for further research on the mechanisms that underlie the association between SEP and later life health.

Getting the basic rights - the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework.

To explore linkages between water, sanitation and hygiene (WASH) and maternal and perinatal health via a conceptual approach and a scoping review.

A Fresh Look at the Level of Unmet Need for Family Planning in the Postpartum Period, Its Causes And Program Implications

One central rationale for the promotion of family planning is the potential benefit to the health of mothers and children. The achievement of adequate spacing between pregnancies is a major pathway through which contraceptive practice can render benefits. Pregnancies conceived less than 20 months following a prior birth are at considerably higher risk of prematurity low birth weight fetal death and early neonatal death.1 The importance of this link is underscored by the facts that neonatal deaths account for 44% of all childhood deaths and that prematurity is the most common cause.2 In addition to the 2.9 million neonatal deaths that occur each year 99% in low- and middle-income countries an almost equal number of stillbirths occur.3 An analysis of Demographic and Health Survey (DHS) data from 52 countries showed that the adverse effects of inadequate spacing extend beyond the neonatal period.4 Expressed in terms of interbirth intervals children born within 24 months of an elder sibling have a 60% increased risk of dying before their first birthday and those born 2-3 years after an elder sibling have a 10% increased risk compared with those born after an interval of 3-5 years. For children between the ages of one and five years the balance of evidence suggests that intervals of less than two years are associated with a 40% increased risk of dying. A systematic review confirmed that the health of mothers is also affected by inadequate spacing.5 Specifically short intervals are associated with uterine rupture and uteroplacental bleeding disorders. Despite the steep rise in contraceptive use in developing countries interbirth intervals have increased in length only slightly over the past 25 years; according to recent surveys 25% of second and higher-order children are born within two years of a sibling compared with about 29% a decade earlier.6.