Search Results (110)

Background: Maternal and newborn health disparities remain a challenge in Puerto Rico, especially in underserved communities. Comienzo Saludable Puerto Rico, sponsored by the U.S. Department of Health and Human Services’ Healthy Start Initiative (HRSA), addresses these gaps through an integrated Networks of Care model known as Cuidado Compartido. Comienzo Saludable Puerto Rico is a maternal, paternal, and child health program aimed at improving the health and well-being of pregnant women, mothers, fathers, newborns, and children in Puerto Rico, particularly those from disadvantaged communities. Methods: This paper presents the Comienzo Saludable Puerto Rico program’s Cuidado Compartido model to integrate a network of healthcare providers and services across hospitals, community organizations, and families. This model aims to improve maternal and newborn/child health outcomes by focusing on the importance of integrated, hospital-community-based care networks. Results: Participants experienced significant improvements in key birth outcomes: low birth weight prevalence declined by 27.2% compared to the community baseline, premature birth rates decreased by 30.9%, and infant mortality dropped by 75%, reaching 0% by 2021 and remaining there through 2023. These results were complemented by increases in maternal mental health screening, paternal involvement, and breastfeeding practices. Conclusions: The Cuidado Compartido model demonstrates a scalable, culturally responsive strategy to improve maternal, newborn, and child health outcomes. It offers critical insights for implementation in other high-need contexts. Full article

Background: Prematurity and low birth weight (LBW) drive infant morbidity and mortality, requiring nutritional interventions, especially in food-insecure settings. In Indonesia, regional disparities in food security hinder adequate nutrition for premature and LBW infants, exacerbating health challenges. The aim of study is to investigate and determine factors associated with prematurity and LBW in children from food-insecure and food-secure households. Methods: This research employed a cross-sectional study with 657 mothers of children aged 36–59 months, conducted using random sampling. Data was collected via standardized questionnaires and analyzed using Chi-square tests and logistic regression. Results: The adjusted model showed that children of food-insecure households had a higher risk of LBW (AOR = 0.54; 95% CI: 0.29–0.99; p < 0.05). LBWs were found to significantly less occur in food-insecure households. Low maternal education was associated with an increased risk of preterm birth (AOR = 3.23; 95% CI:1.78–5.84; p < 0.001). Furthermore, prematurity correlated with house ownership (p < 0.01), indicating the household’s wealth condition. Maternal education and house ownership were linked to prematurity, indicating the risk to child health outcomes. In summary, maternal education, employment status, and household income were linked to food insecurity, indicating the risk to child health outcomes. Conclusion: Strategies to improve child health outcomes are essential, including enhancing maternal nutrition knowledge to improve child feeding practices, promoting gender equality in career development, and reducing food insecurity in households. Full article

Background: Gestational diabetes mellitus (GDM) affects 7–9% of pregnancies worldwide and is associated with adverse maternal and neonatal outcomes. Nutritional therapy is a key component of GDM management. However, inconsistencies exist across international and national guidelines regarding macronutrient distribution, glycemic targets, and micronutrient supplementation. This systematic review aims to compare updated nutritional recommendations for GDM across major health organizations and identify areas of consensus, divergence, and evidence gaps. Methods: This systematic review was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251026194). A comprehensive literature search was performed in PubMed, Scopus, and Google Scholar (concluding March 2025), along with manual searches of official websites of professional health organizations (e.g., ADA, WHO, NICE, IDF). Guidelines published within the last 10 years (or the most relevant national guideline if slightly older), available in English or with access to translation, and including explicit nutritional recommendations for GDM were included. Data were extracted on macronutrient composition, glycemic targets, and micronutrient supplementation, with evaluation of the supporting evidence and regional context, incorporating findings from recent key guideline updates. Results: In total, 12 guidelines met the inclusion criteria. While all guidelines emphasized carbohydrate moderation and adequate fiber intake, significant discrepancies were found in carbohydrate quality recommendations (e.g., low-glycemic index focus vs. total carbohydrate restriction), postprandial glucose targets (e.g., 1-h vs. 2-h measurements and varying thresholds like <120 vs. <140 mg/dL), and the use of non-routine micronutrients such as chromium, selenium, and omega-3 fatty acids (generally lacking endorsement). Recent updates from key bodies like ADA, Diabetes Canada, and KDA largely maintain these core stances but show increasing emphasis on dietary patterns and acknowledgement of CGM technology, without resolving key discrepancies. Cultural adaptability and behavioral counselling strategies were minimally addressed across most guidelines. Conclusions: Despite general agreement on the principal recommendations of nutritional management in GDM, substantial variation persists in specific recommendations, even considering recent updates. Consistent, evidence-based, and culturally adaptable guidelines incorporating implementation strategies are needed to optimize care and reduce disparities in GDM management across regions. Full article

Background and aim: The death of a woman while pregnant or within 42 days of delivery, regardless of the cause of death, or even up to one year after the end of the pregnancy, due to causes related to or aggravated by pregnancy remains a critical public health problem globally and in Colombia. While the country shows a general decreasing trend (preliminary Maternal Mortality Ratio 38.6/100,000 live births in 2023), significant regional disparities persist. Understanding precise underlying causes, especially in high-complexity referral centers, is vital. This study describes the sociodemographic and anatomopathological characteristics associated with autopsy-verified maternal mortality cases at a Level-4 hospital in southwestern Colombia (2000–2023). Methodology: A descriptive observational retrospective study analyzed 42 maternal mortality cases verified by clinical autopsy (2000–2023) at the Pathology Department of Universidad del Valle, a Level-4 referral center in Cali, Colombia. Cases met the WHO definition. Data on sociodemographic, clinical, and pathological characteristics were retrospectively extracted from clinical records and autopsy reports. Results: The analysis of 42 autopsies (2000–2023) showed that 85.7% were early maternal deaths. Indirect causes predominated (57.1%, n = 24) over direct (42.9%, n = 18). Septic shock was the main indirect cause (65.2% of indirect), often from endemic infections. Hypovolemic shock due to PPH was the main direct cause (50% of direct). A high proportion were from subsidized/uninsured schemes (65.7%) and had a migratory history (20%). Discussion and conclusions: This study highlights the value of autopsy in revealing maternal mortality etiologies, showing a predominance of indirect/infectious causes and endemic diseases often missed clinically, despite PPH remaining the main direct cause. Findings reaffirm the strong link between maternal death and social/economic inequity, access barriers, and regional/migratory vulnerabilities. Effectively reducing maternal mortality necessitates rigorous clinical management, regionalized public health strategies addressing inequities, and integrating pathological data for targeted surveillance. Full article

This article describes a case study of the partnership between Healthy Birth Initiatives, a community-based organization (CBO) and Black-led public health nurse home visiting program, and the maternal health division of the Providence Health System located in the Pacific Northwest. This study’s purpose was to explore the formation, significance, and impact of this partnership from the perspectives of staff and leadership members from both organizations. We conducted a case study through qualitative interviews with staff, participant observation, and debrief of leadership meetings. We completed a hybrid deductive–inductive thematic analysis of the data, followed by member checking with study participants and other key interest holders. Key facilitators of the CBO–health system partnership included the vital role of leaders in prioritizing the partnership; health system willingness to incorporate new information from the CBO to improve care; and health system utilization of resources to institutionalize changes that emerged from this partnership. Challenges to the CBO–health system partnership included CBO resource limitations; fragmented referral processes and information sharing; and the persistence required to nurture the relationship without formalized roles. This study contributes to the literature by offering staff perspectives on how a CBO–health system partnership formed, successes, early lessons learned, and practical suggestions for how to develop stronger alignment to provide culturally responsive patient-centered care to Black families. Full article

Objective: Utilizing the Health Care Access Barriers (HCAB) Theoretical Framework, this study examined latent profiles of barriers to prenatal care among pregnant women in Alabama and whether these profiles mediate or moderate the relationship between pregnancy intentionality and early prenatal care initiation. Methods: An explanatory mixed-method design was employed, integrating quantitative analysis of Alabama Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 data (2016–2021) with qualitative insights from expert interviews. Latent class analysis (LCA) identified subgroups based on reported barriers. Multivariable logistic regression assessed the association between pregnancy intentionality and early prenatal care initiation, controlling for covariates. A Firth-penalized multivariable logistic regression model tested interaction effects. Results: Planned pregnancy was associated with higher odds of early prenatal care initiation (OR = 0.78, 95% CI [0.49, 1.23], p = 0.286), though this association was not statistically significant. Barrier profiles did not significantly moderate or mediate the relationship. The interaction term was nonsignificant (OR = 5.19, 95% CI [0.22, 828.94], p = 0.309), and the mediation pathway was also not supported (indirect effect = 0.012, p = 0.518). Expert interviews emphasized ongoing systemic and cognitive barriers that hinder timely access. Conclusions: Although pregnancy intentionality was not a statistically significant predictor of early prenatal care initiation, qualitative findings highlighted persistent barriers that continue to constrain access. These results underscore the need for multilevel strategies to address informational and logistical challenges. Future research should evaluate additional pathways that influence care-seeking behaviors. Full article

Background: Adherence to iron supplementation is influenced by systemic barriers, including poor healthcare infrastructure, shortage of healthcare providers, and limited access to antenatal care (ANC) services. These challenges are more pronounced in rural areas. However, evidence on urban–rural disparities in non-adherence to iron supplementation remains limited, particularly in sub-Saharan Africa. This study examined these regional differences, stratified by income levels and national contexts. Method: This analysis utilised Demographic Health Survey (DHS) data conducted between 2015 and 2023 from 26 sub-Saharan African countries, including 287,642 women from urban (n = 91,566) and rural areas (n = 196,076). The outcome of this study was non-adherence to iron supplementation, defined as taking iron supplementation for less than 90 days during pregnancy. This study examines urban–rural differences in non-adherence stratified by country income levels based on World Bank 2022 income classifications and national context. A chi-square test was used to assess urban–rural differences, with a p-value of <0.05 considered statistically significant. Results: Non-adherence was significantly higher in rural areas (68.42%) than in urban areas (51.32%) (p < 0.001), with the disparity more pronounced in low-income countries (LICs). Ethiopia, Madagascar, Uganda, and Burundi were among the countries with the highest rural non-adherence, reflecting severe poverty and limited access to ANC. In contrast, Zimbabwe showed an inverse trend, where rural adherence was higher than urban. Conclusions: Rural sub-Saharan Africa has significantly higher non-adherence to iron supplementation, particularly in LICs, likely driven by systemic barriers such as poor infrastructure and limited access to healthcare. This non-adherence in rural areas undermines efforts to improve pregnancy and birth outcomes across the region. Targeted interventions, like those in Zimbabwe, can help address these inequities and improve maternal health outcomes. Full article

Objective: To examine trends in perinatal smoking across rural and urban areas and investigate whether structural and intermediary health factors explain rural-urban disparities. Methods: This cross-sectional study used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) collected between 2009 and 2021 in the United States. Perinatal smoking patterns were based on self-reported smoking before, during, and after pregnancy. Weighted prevalence estimates with 95% confidence intervals (CIs) were calculated for persistent smoking and cessation, stratified by rural–urban residence. Temporal trends were analyzed using logistic regression. Multivariable weighted logistic regression was performed on Phase 8 data (2016–2021) to examine associations between rural–urban status and perinatal smoking patterns, adjusting for maternal age, year of delivery, region, and structural (e.g., education, Tobacco 21 policy) and intermediary (e.g., perinatal stressors) health determinants. All analyses accounted for the complex survey design. Results: Although perinatal smoking declined over time, prevalence remained consistently higher among rural mothers. From 2009 to 2021, persistent smoking decreased significantly in both rural and urban areas (p < 0.001). Smoking cessation rates remained stable (p = 0.087), with no significant difference by rural–urban status (p = 0.475). After adjustment, rural women were 45% more likely to smoke persistently than urban women (OR = 1.45, 95% CI: 1.35–1.56) and 26% less likely to quit smoking. Conclusions: While perinatal smoking declined overall, rural mothers remained more likely to smoke throughout pregnancy. Structural and intermediary determinants partially explained this persistent rural–urban disparity. Full article

Background: Maternal and child health (MCH) is a critical public health issue affecting individuals, families, and communities worldwide. Immigrant populations, including Brazilian mothers and children in the United States (U.S.), face unique challenges, such as language barriers, limited healthcare access, and socioeconomic disparities that exacerbate health risks. Despite their growing numbers, Brazilian immigrants in the U.S. are an understudied group in MCH research. Objective: This systematic review and qualitative meta-synthesis aims to identify, appraise, and synthesize qualitative and mixed-methods research focused on the MCH experiences of Brazilian immigrants in the U.S. Methods: This review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines and is registered with PROSPERO, an international prospective registry of systematic reviews. Qualitative and mixed-methods research published between 2004 and 2024 that explicitly report qualitative methodology, analysis, and findings related to MCH experiences among Brazilians in the U.S. will be eligible to be included. Studies will be identified through a comprehensive search of seven databases (CINAHL, MEDLINE, PubMed, PsycINFO, Web of Science, Scopus, SocINDEX), and selected according to predefined inclusion/exclusion criteria. Only studies available in English, Portuguese, or Spanish and reporting original qualitative data will be included. Data extraction will be conducted using the Joanna Briggs Institute (JBI) Data Extraction Tool for Qualitative Research. Findings will be synthesized using the JBI meta-aggregation approach in MAXQDA software and evaluated for confidence using the JBI Confidence in Qualitative Research (ConQual) tool. Conclusions: By synthesizing qualitative findings, this review aims to inform the development of culturally responsive healthcare policies, community-based interventions, and future research tailored to the unique needs and experiences of Brazilian immigrant mothers and children in the U.S. Full article

Background/Objectives: This study aimed to evaluate a novel, theory-informed multimedia learning intervention (an animation and a game) designed to target Black Women and Birthing People (BWBP) and their companions as catalysts for change in improving maternal health communication disparities. Methods: We used an explanatory sequential mixed-method design to examine the feasibility and acceptability of the intervention. A total of 135 BWBP completed a survey; 14 participated in follow-up interviews. Results: The participants reported high levels of feasibility, acceptability, and appropriateness of the intervention. The knowledge scores improved significantly after exposure to the animation and game; the intentions to use and share the intervention were also high. The participants scored moderately for agency and self-efficacy after exposure to the intervention, suggesting that there may still be a need for more messages to support BWBP. Conclusions: These promising results lay a foundation for elucidating the role of communication in addressing maternal health disparities and demonstrates the importance of a holistic approach to maternal health that intervenes at the community level (via the family care team) to impact the interaction with the institution level (the healthcare team). Full article

Maternal immunization is a key strategy for protecting pregnant individuals and newborns from infectious diseases. This review examines the mechanisms and benefits of maternal immunization, with a focus on transplacental IgG transfer and immune system interactions. We provide an overview of current recommendations and the safety and efficacy profiles of maternal vaccines, including influenza, tetanus–diphtheria–acellular pertussis (Tdap), respiratory syncytial virus (RSV), COVID-19, and hepatitis B. Additionally, we analyze the barriers to maternal immunization, such as misinformation, vaccine hesitancy, and disparities in healthcare access, while exploring potential strategies to overcome these challenges through targeted educational initiatives, improved provider communication, and policy-driven interventions aimed at increasing vaccine confidence and accessibility. Finally, this review highlights recent innovations and future directions in maternal immunization, including emerging vaccines for Group B Streptococcus and cytomegalovirus. Expanding immunization programs and advancing research on maternal–fetal immunity are essential to optimizing vaccination strategies, improving public health outcomes, and reducing the global burden of infectious diseases. Full article

Syndromic surveillance has evolved into a vital public health tool, providing near real-time data to detect and respond to health threats. While states administer syndromic surveillance systems, Tribal Epidemiology Centers (TECs) serve American Indian and Alaska Native (AIAN) communities across multistate regions, often encountering significant barriers to data access and utilization. This manuscript explores how TECs access and use syndromic surveillance data to address health disparities in AIAN populations, highlighting successes, innovations, and ongoing challenges. The Alaska Native Epidemiology Center (ANEC), Great Plains Tribal Epidemiology Center (GPTEC), and Northwest Tribal Epidemiology Center (NWTEC) provide insights into their syndromic surveillance practices. This includes data access methods, the creation of dashboards and reports, technical assistance for Tribal Health Organizations (THOs), and strategies for overcoming jurisdictional and data-sharing barriers. TECs have successfully leveraged syndromic surveillance to monitor critical health issues, including respiratory illnesses, substance misuse, behavioral health, and maternal care. Collaborative efforts have addressed race misclassification and data gaps, enabling targeted interventions such as air purifier distribution and improving health care delivery for tribal veterans. However, TECs can face restrictive data use agreements, jurisdictional misalignments, and limited access to granular data, hindering their ability to serve AIAN communities comprehensively. Syndromic surveillance offers transformative potential for improving public health in AIAN communities. To fully realize this potential, systemic changes are needed to streamline data-sharing agreements and improve data accuracy. These efforts, along with strong collaborations between TECs and state health departments, are critical to advancing health equity, respecting tribal sovereignty, and ensuring timely, actionable insights for AIAN populations. Full article

Background/Objectives: Maternal mortality due to abortion in Brazil has shown a significant decline of 47.37% between 1996 and 2022. This study aims to analyze temporal trends in maternal mortality due to abortion across regions and sociodemographic groups, highlighting disparities and their implications for public health. Methods: Trends were assessed using Prais–Winsten regression models to estimate the annual percentage change (APC). Data were stratified by region and sociodemographic characteristics to identify vulnerable groups. Results: The findings reveal notable regional disparities, with some regions experiencing more pronounced declines than others. Vulnerable sociodemographic groups, including women with lower levels of education and younger age groups, exhibited persistently higher mortality rates. Conclusions: Despite a significant overall reduction in maternal mortality due to abortion, disparities remain among regions and sociodemographic groups. These findings underscore the need for targeted public health policies aimed at reducing inequalities and addressing the needs of the most affected populations. Full article

Background: Exclusive breastfeeding (EB), feeding an infant solely breast milk, has been recommended worldwide due to its health benefits for infants and mothers. However, EB rates remain low, due to several socio-demographic, occupational, and cultural factors. Objectives: Our aim was to investigate the factors associated with EB amongst Arab mothers living in Israel, i.e., age, education, religiosity, employment status, and the number of children which impact breastfeeding practices. Methods: Data were collected through surveys from Arab mothers of different religious and geographical backgrounds. Results: The findings revealed that older maternal age, higher levels of religiosity, and an increased number of children were positively associated with EB. Employment reduced EB. Muslim mothers were more likely to combine breastfeeding with formula; Christian and Druze mothers showed higher EB rates. Geographical disparities were also noted. Conclusions: This study highlights the complex interplay of socio-demographic and cultural factors that impact breastfeeding practices amongst Arab mothers in Israel, with significant implications for policy development and maternal support programs. We underscore the importance of incorporating religious and cultural considerations into breastfeeding promotion strategies. Public health initiatives should target support for working mothers by advocating extended maternity leave and breastfeeding-friendly workplace policies. Furthermore, community-based interventions should engage family members in supporting breastfeeding mothers. Full article

Background: Acute diarrheal disease remains a leading cause of childhood morbidity and mortality, particularly among children under five. Despite being preventable and treatable, cultural, socioeconomic, and familial factors influence home management. This study examined how these factors shape childhood diarrhea care in Ecuador. Objective: To analyze maternal, child, and household characteristics associated with diarrhea management in children under five years of age using data from the 2018 Ecuadorian National Health and Nutrition Survey (ENSANUT). Methods: This cross-sectional study applied logistic regression models to assess the influence of various factors on diarrhea management practices. Results: Maternal education, ethnicity, child’s age, household size, and urban or rural residence significantly influenced diarrhea management. Households with 4–6 persons (OR = 1.584, p < 0.05) and 7–9 persons (OR = 2.006, p < 0.05) had higher odds of receiving medical care. However, the child’s sex, birth order, maternal marital status, and socioeconomic status were not significant predictors. Conclusions: Although most children received some form of healthcare, disparities persisted, particularly in education level, ethnicity, and rural residence. These findings highlight the need for targeted maternal health literacy programs, culturally tailored interventions, and improved water-security initiatives to enhance diarrhea management and reduce inequities in care. Full article