Marianne E. Zotti

Factors associated with health care access for Mississippi children with special health care needs

Objectives: This purpose of the study was to examine the factors associated with access to routine care and to specialty care for Mississippi children with special health care needs (CSHCN). Methods: We analyzed data for Mississippi CSHCN from the 2001 National Survey of Children with Special Health Care Needs. Using a modified version of Andersen and Aday’s Behavioral Model of Health Services Use, we explored the relationship of independent variables (e.g., demographics, insurance, severity of illness) to dependent variables (did not obtain routine care, did not obtain specialty care). We conducted bivariate and logistic regression analyses using SAS and SUDAAN. Results: Based on self-reported data, with a 61% response rate, 66% of Mississippi CSHCN needed routine health care, and 52.8% needed specialty care. Of these children, 6.5% did not receive routine care and 9.3% did not receive specialty care. In a fully adjusted model, discontinuous insurance coverage was an important factor associated with not having obtained routine care (OR = 7.8; CI = 1.7–35.9) and specialty care (OR = 8.6; CI = 2.0–36.8). Children with a high illness severity rank were more likely to have not obtained routine care than children with a low rank (OR 1.4; CI = 1.1–1.9). Conclusions: It may be important to establish a health insurance safety net for families who lack insurance continuity since it appears that a lapse in insurance coverage impedes health care access. Further research is needed to understand the relationship between illness severity and lack of health care access, especially for children with special health care needs.

Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women

Clinical recommendations for the prevention and treatment of anthrax among pregnant women are updated.

Anthrax cases in pregnant and postpartum women: a systematic review.

OBJECTIVE: To describe the worldwide experience of Bacillus anthracis infection reported in pregnant, postpartum, and lactating women. DATA SOURCES: Studies were identified through MEDLINE, Web of Science, Embase, and Global Health databases from inception until May 2012. The key words ([“anthrax” or “anthracis”] and [“pregna*” or “matern*” or “postpartum” or “puerperal” or “lact*” or “breastfed*” or “breastfeed*” or “fetal” or “fetus” or “neonate” or “newborn” or “abort*” or “uterus”]) were used. Additionally, all references from selected articles were reviewed, hand searches were conducted, and relevant authors were contacted. METHODS OF STUDY SELECTION: The inclusion criteria were: published articles referring to women diagnosed with an infection due to exposure to B anthracis during pregnancy, the postpartum period, or during lactation; any article type reporting patient-specific data; articles in any language; and nonduplicate cases. Non-English articles were professionally translated. Duplicate reports, unpublished reports, and review articles depicting previously identified cases were excluded. TABULATION, INTEGRATION, AND RESULTS: Two authors independently reviewed articles for inclusion. The primary search of the four databases yielded 1,340 articles, and the secondary crossreference search revealed 146 articles. Fourteen articles met the inclusion criteria. In total, 20 cases of B anthracis infection were found, 17 in pregnant women, two in postpartum women, and one case in a lactating woman. Among these reports, 16 women died and 12 fetal or neonatal losses were reported. Of these fatal cases, most predated the advent of antibiotics. CONCLUSIONS: Based on these case reports, B anthracis infection in pregnant and postpartum women is associated with high rates of maternal and fetal death. Evidence of possible maternal-fetal transmission of B anthracis infection was identified in early case reports.

Contraceptive Availability During an Emergency Response in the United States

This article provides the evidence for contraceptive need to prevent unintended pregnancy during an emergency response, discusses the most appropriate types of contraceptives for disaster situations, and details the current provisions in place to provide contraceptives during an emergency response.

Reproductive Health Assessment After Disaster: Introduction to the RHAD Toolkit

This article reviews associations between disaster and the reproductive health of women, describes how Hurricane Katrina influenced our understanding about postdisaster reproductive health needs, and introduces a new toolkit that can help health departments assess postdisaster health needs among women of reproductive age.

Cluster Sampling with Referral to Improve the Efficiency of Estimating Unmet Needs among Pregnant and Postpartum Women after Disasters

INTRODUCTION AND BACKGROUND Women of reproductive age, in particular women who are pregnant or fewer than 6 months postpartum, are uniquely vulnerable to the effects of natural disasters, which may create stressors for caregivers, limit access to prenatal/postpartum care, or interrupt contraception. Traditional approaches (e.g., newborn records, community surveys) to survey women of reproductive age about unmet needs may not be practical after disasters. Finding pregnant or postpartum women is especially challenging because fewer than 5% of women of reproductive age are pregnant or postpartum at any time. METHODS From 2009 to 2011, we conducted three pilots of a sampling strategy that aimed to increase the proportion of pregnant and postpartum women of reproductive age who were included in postdisaster reproductive health assessments in Johnston County, North Carolina, after tornadoes, Cobb/Douglas Counties, Georgia, after flooding, and Bertie County, North Carolina, after hurricane-related flooding. RESULTS Using this method, the percentage of pregnant and postpartum women interviewed in each pilot increased from 0.06% to 21%, 8% to 19%, and 9% to 17%, respectively. CONCLUSION AND DISCUSSION Two-stage cluster sampling with referral can be used to increase the proportion of pregnant and postpartum women included in a postdisaster assessment. This strategy may be a promising way to assess unmet needs of pregnant and postpartum women in disaster-affected communities.

Conflict, Displacement, and IPV Findings From Two Congolese Refugee Camps in Rwanda

This study describes the prevalence and correlates of past-year intimate partner violence (IPV) among displaced women. We used bivariate and multivariate analyses to assess the relationships between IPV and select variables of interest. Multivariate logistic regression modeling revealed that women who had experienced outsider violence were 11 times as likely (adjusted odds ratio [AOR] = 11.21; confidence interval, CI [5.25, 23.96]) to have reported IPV than women who had not experienced outsider violence. IPV in conflict-affected settings is a major public health concern that requires effective interventions; our results suggest that women who had experienced outsider violence are at greater risk of IPV.

Evaluation of Maternal Death Surveillance: A Community Process

The Mississippi State Department of Health found that the Centers for Disease Control and Prevention guidelines for evaluating surveillance systems could be used as a community approach in changing a maternal mortality surveillance system. This experience caused us to think more broadly about maternal mortality, challenge the guideline process, and ultimately embark on a new surveillance system. System changes included ensuring dissemination of findings, increasing number and type of stakeholders, including nonmedical factors, heightening awareness of maternal mortality, promoting timely reviews, reviewing our regulatory authority, adding field staff notification about maternal deaths, expanding the definition of maternal death, and combining surveillance systems—all of which leads to improved maternal mortality surveillance in Mississippi.