PSU Knowledge Bank Community:
http://kb.psu.ac.th:80/psukb/handle/2553/922
2024-03-28T13:15:06ZEffect of exposure to goats and raw goat products on adverse pregnancy outcomes and perceptions of healthcare providers in Songkhla province, southern Thailand
http://kb.psu.ac.th:80/psukb/handle/2016/19303
Title: Effect of exposure to goats and raw goat products on adverse pregnancy outcomes and perceptions of healthcare providers in Songkhla province, southern Thailand
Authors: Kan Kledmanee
Abstract: Background:
Miscarriage, stillbirth, preterm birth and low birth weight newborn are the most common adverse pregnancy outcomes reflecting the health of women and fetus in utero. Previous studies suggested that these adverse outcomes multifactorial health problems with associated risk factors commonly derived from both maternal and fetal conditions including infections. In many studies, the risk of animal exposures related to adverse pregnancy outcomes were commonly hypothesized especially in endemic areas of some zoonosis such as brucellosis, coxiellosis, and toxoplasmosis which can be carried by small ruminants including goats. However, those studies did not show clear explanation how animal exposure affects pregnancy outcomes. Moreover, perception of healthcare providers, who play a key role in health promotion and disease prevention, is valuable for quality of care by preventing maternal health problems during pregnancy. Health problems in pregnancy due to zoonosis are generally neglected, particularly, by healthcare providers, as healthcare providers' perspective is important for identifying the exposure risk and prevention of zoonosis.
Objectives:
This study aimed to i) determine the association of history of exposure
to goats and their raw products on adverse pregnancy outcomes, ii) assess the seroprevalence of brucellosis, coxiellosis, and toxoplasmosis among pregnant women, and iii) assess the perceptions of healthcare providers on the risk of exposure to goats and their raw products on adverse pregnancy outcomes and their intention to perform risk screening among pregnant women. Methods:
To achieve the objectives of the study, the methodology was divided into two parts, which were a prospective cohort study among pregnant women (Part I) and a cross-sectional study among healthcare providers (Part II). Part I was conducted from July 2015 to July 2016 in four districts of Songkhla province. Women who came for their first antenatal care visit, at health centers or hospitals in Thepha, Chana, Saba Yoi, and Na Thawee districts, were invited to participate in the study. Information including a history of exposure to goat or raw goat products (meat or milk) and blood samples were revealed from included women. Adverse pregnancy outcomes were then followed-up. Blood samples of included women were randomly tested for anti- Brucella abortus IgG, but only samples of pregnant women with adverse pregnancy outcome were tested for anti-Coxiella burnetii IgG and anti-Toxoplasma gondii IgG. The association between exposure status (exposed vs non-exposed) and occurrence of adverse pregnancy outcome was analyzed using multiple logistic regression. Part II was also carried out in the same districts which were anonymized as districts A, B, C and D, during October to November 2016. The perception of healthcare providers toward risk of exposure to goat or raw goat products and intention to do risk screening regarding the Health Belief Model components were evaluated.
Results:
Of 666 pregnant women included in study Part I, the majority of them (74.4%) were aged 20-34 years and Muslim (89.2%). Two hundred and four women (30.6%) had been exposed to goat or raw goat products and 115 (17.3%) had adverse pregnancy outcomes. Of 465 women with blood test, 17 women (3.7%) had seropositive results for anti-Brucella abortus IgG. The association with any adverse pregnancy outcomes was not shown in the exposed group. Higher odds ratios of adverse pregnancy outcomes were found in women having their first antenatal care visit in their first trimester, with a history of preterm birth and low birth weight newborn (adj.OR (95% CI) 2.0 (1.1-3.7), 2.4 (1.0-5.7), and 2.6 (1.3-4.9), respectively). Of 105 serum samples of pregnant women with adverse pregnancy outcomes, 33 samples (31.4%) were seropositive for anti-Toxoplasma gondii IgG, and 2 samples (1.9%) were seropositive for anti-Coxiella burnetii IgG. None of the women were found to be co-seropositive for antibodies against coxiellosis and toxoplasmosis. For Part II of the study, a total of 46 healthcare providers were included. Intention to perform screening, perceived barriers, self-efficacy and cues to action of healthcare providers among the four districts were not significantly different. While perceived susceptibility, perceived seriousness and perceived benefits were significantly different across the four districts with healthcare providers in two districts (districts B and D) rating these items at high levels compared to the other two districts (districts A and C). Perceptions in all components of Health Belief Model of healthcare providers, except perceived barrier, were highly correlated with intention to perform risk screening. Cues to action was the most significant component (p =0.018) correlated with intention to perform risk screening for pregnant women in the linear regression, while the other factors were not related. Conclusion:
Although no association between past exposure to goats and their raw products and adverse pregnancy outcomes was found, women with past exposure showed positive anti-Brucella abortus IgG. One-third of pregnant women with adverse pregnancy outcomes were seropositive for toxoplasmosis and a very low prevalence of women with seropositive for coxiellosis was found. Healthcare providers in the study settings had positive perceptions and intention to perform risk screening for exposure to goat or raw goat products in pregnant women. However, specific education and warning of the dangers of endemic zoonosis were strengthening cues to action needed for them. Effective counseling about appropriate animal handling particularly goats is beneficial to prevent relevant health problems of pregnant women.
Description: Doctor of Philosophy (Epidemiology (International Program)), 20192019-01-01T00:00:00ZEvaluation of a Model Demonstration Program for the Control of Cervical Cancer in Rural China
http://kb.psu.ac.th:80/psukb/handle/2016/19077
Title: Evaluation of a Model Demonstration Program for the Control of Cervical Cancer in Rural China
Authors: Jun Zhao
Abstract: Background: Since 2009, a nationwide free cervical cancer screening project in rural China has been gradually expanded. The rapid expansion of cervical screening programs in China requires monitoring its progress and evaluating its results to improve the quality and effectiveness of control of cervical cancer. Here, we evaluated a demonstration screening program in rural China with a special focus on the coverage and outcome impact. We also explored practical factors that affect participation rate. Our ultimate goal was to facilitate the development of the comprehensive guidelines for quality assurance for cervical cancer screening in Rural
China.
Methods: The organized cervical cancer screening program in Zhushan county was evaluated for both ongoing activities and outcome impact from 2009 through 2014. A descriptive analysis of performance indicators and outcome measures related to screening was conducted. Performance indicators used in this study include screening coverage, recall rate, percentage of abnormal smears, precancer and cancer detection rate, treatment rate, incidence rate. The individual screening information from 2009 through 2014 was extracted from the screening institution in Zhushan county. Cervical cancer patients' information was collected from two county-level hospitals and three tertiary hospitals. Screening data were also linked to the population and the climate data to explore the practical factors that affect participation rate in the screening program.
Results: Of the 73,847 pap tests performed in 2009-2014, 69127 (93.6%) were in the target age group (25-64). The screening coverage by township was between 10% and 30% in each 2-year screening round. About half of eligible women underwent at least once Pap test over the six-year period. The recall rates for the second and third period were 11.3% and 17.2%, respectively. The annual truncated age-standardized incidence rate varied among the first four years after the initiation of the organized screening program and dropped in the latter two years. After adjusting for other variables, the monthly maximum temperature interval had a significant association with the participation rate. When screening practice was implemented in low-temperature seasons (< 15 degrees), the participation rate would drop about 11 percent on average comparing to that in moderate temperature seasons. While screening practice was implemented in high-temperature seasons > 28 degrees), the participation rate would drop about 4 percent on average comparing to that in moderate temperature
Conclusion: Our results indicate that the cervical cancer screening program in Zhushan county was successful in terms of decreasing the cervical cancer burden. Participation in organized screening programs and further expansion of the national-based screening programs should be encouraged. Cervical screening institutions should plan screening practice in moderate temperatures seasons (spring and autumn) in advance. There is an urgent need to develop the comprehensive national guideline for quality assurance for cervical cancer screening utilizing the important findings of this study.
Description: Thesis (Ph.D., Epidemiology)--Prince of Songkla University, 20182018-01-01T00:00:00ZComparison of maternal socioeconomic status and anxiety and child development between adolescent and adult pregnancies in Thailand
http://kb.psu.ac.th:80/psukb/handle/2016/19045
Title: Comparison of maternal socioeconomic status and anxiety and child development between adolescent and adult pregnancies in Thailand
Authors: Rukmanee Butchon
Abstract: Background:
Adolescent pregnancy has become a worldwide public health concern because the rate has been increasing. Adolescent pregnancy is associated with poor physical and mental health as well as socioeconomic constraints. Most adolescent pregnancies occur at school ages, which leads to adverse educational and economic outcomes. As a result, most studies focus more on negative consequences among adolescent mothers; however, these negative consequences are influenced by other factors related to the time and methods of measurement, socio-economic status, social norms, and country contexts. Because of a lack of comprehensive studies, adverse consequences of adolescent compared to adult pregnancy are inconclusive. Furthermore, long-term consequences of anxiety and socioeconomic status of adolescent pregnancy in mothers as well as child development of the adolescent pregnancy are lacking. Such information is essential for policy development and decision making in Thailand.
Objectives:
This study aimed to 1) compare the education, work and income status at subsequent pregnancy of pregnant adolescent and adult pregnancy, 2) assess the transition in school or work status at first pregnancy between adolescent and adult pregnancies, 3) explore factors associated with adverse socioeconomic status at subsequent pregnancy, 4) compare the anxiety levels between adolescent and adult pregnancies and between women who ended up with termination and delivery, and 5) compare the childhood development of the first born child from adolescent and adult pregnancy.
Method:
A historical cohort study was conducted among pregnant women who gave birth from April to September 2014 at the Maharat Nakhon Ratchasima Hospital, a tertiary care hospital, in Nakhon Ratchasima province. The participants were multiparous Thai women aged 15-34 years who gave birth in the study hospital and had a single baby at the first pregnancy not longer than 5 years before regardless of delivery status. The interval of five years was chosen to minimize recall bias of important factors of the first pregnancy. Those, who had physical disabilities, neurological disorders, psychiatric disorders, inability to communicate, mental retardation or hearing loss, were excluded. Women who agreed to participate in the study were categorized into two groups based on their ages at their first pregnancy: those who had their first pregnancy at ag10-19 years and 20-29 years. All eligible women were interviewed using a structured questionnaire in private area of postpartum ward. The data were analyzed using univariate analysis and multiple logistic regression. A p-valaue less than 0.05 was considered as statistical significance.
Results:
A total of 180 women with the first pregnancy at age 10-19 years and 267 women with the first pregnancy at age 20-29 years were included in the study. At subsequent pregnancy, women with adolescent pregnancy, who had low education (junior high school and lower), had higher odds (AOR 2.15; 95% CI 1.02-4.55). Those women, who were unemployed, had lower odds compared with adult mothers. For personal income, the result was not statistically significant. Adolescent pregnancy, intention of pregnancy, and continuing pregnancy to delivery were statistically significant and associated with negative changes in school or working status at the first pregnancy. A high prevalence of antenatal anxiety among women during their first pregnancy was revealed in both adolescent and adult pregnancy. The level of anxiety increased in subsequent pregnancies among women who were at a high risk of experiencing anxiety in their first pregnancy. There are three strong risk factors of anxiety in pregnant women. Those were unplanned pregnancy, high stress and low social support. A higher prevalence of suspected delayed child development was found among children aged above 36 months while poor growth was common in children younger than 24 months. Hyperactivity was more common in pre-school- aged boys. The prevalence of delayed language development was similar in children from adolescent and adult pregnancy. The prevalence of delayed personal-social development was higher in children of mothers with adult pregnancy but the difference was not statistically significant.
Conclusion:
This study showed evidence that adolescent pregnancy was associated with low socioeconomic status in later life. There was not sufficient evidence to show the differences in prevalences of anxiety in mothers and delay in child development between adolescent and adult pregnancies. One quarter of children faced one of the domains of delay development which was a concern. A national policy to support educational continuation among pregnant adolescents should be considered.
Description: Thesis (Ph.D., Epidemiology)--Prince of Songkla University, 20182018-01-01T00:00:00ZPatterns of Domestic Violence against women during Pregnancy and the Postpartum Period in Kathmandu, Nepal
http://kb.psu.ac.th:80/psukb/handle/2016/19018
Title: Patterns of Domestic Violence against women during Pregnancy and the Postpartum Period in Kathmandu, Nepal
Authors: Narayan Bhatta
Abstract: Background: Domestic violence is most pervasive yet underrecognized
human rights violation in the world. It is also a profound public health
problem which affects anyone irrespective of age, sex, religion, and economic status.
All pregnant and postpartum period women are at high risk of developing an
unpredictable complication and if they suffered from violence then condition becomes
worse. Domestic violence against woman during pregnancy and the postpartum period,
not only affects the health of the mother but also to the fetus and child. It is rooted in
social norms, socialization practices and structural factors against women in Nepal.
This study aims to examine the prevalence and patterns of domestic violence during
pregnancy and the postpartum period, determine the association between domestic
violence against women and husband’s alcohol consumption across the periods of
pregnancy and postpartum and to identify associated factors in a Nepalese society.
Methods: A cross-sectional study was conducted in the antenatal care
and immunization clinics of Paropakar maternity and women’s hospital in Kathmandu
district, Nepal. The study was conducted from December 2017 to March 2018. The
sample of the study were all women aged 15-49, who attended antenatal care clinic and
immunization clinic to immunized their children from Paropakar maternity and
women’s hospital. In each trimester of pregnancy and the postpartum period, 165
women aged 15-49 years were consecutively recruited (660 altogether). Domestic
violence information was elicited using a questionnaire adapted from a WHO multicountry
study on women’s health and domestic violence and modified some
questionnaire after the pilot study. The characteristic of women, their husband and mother-in-law were analyzed using chi square or fisher exact test as appropriate.
Multiple logistic regression models were used to identify the associated factors of
domestic violence.
Results: The overall prevalence of domestic violence among women
during pregnancy and the postpartum period was 26.2% (17.6%, 34.5%, 32.7% and
20.0% in the first trimester, second trimester, and third trimester of pregnancy and the
postpartum period, respectively). The patterns of domestic violence experienced by
women has fluctuated during the period of pregnancy and postpartum. High prevalence
of domestic violence was found in the second trimester of pregnancy. Among all types
of violence, the most common form experienced by women was sexual violence (16%),
followed by psychological violence (15%) and physical violence (9.4%). Women who
belong to Janjati ethnicity (AOR= 1.94, CI: 1.22-3.09), whose family preference of new
born child gender (AOR= 2, CI: 1.07-3.47), who had a history of domestic violence
(AOR= 26.32, CI: 14.86-46.63),whose husbands were illiterate (AOR= 1.77, CI=1.06-
2.96) and whose mother-in-law’s had controlling behavior (AOR=5.69, CI: 2.51-12.9)
were associated with domestic violence during pregnancy and the postpartum period.
Conclusion: The study findings suggest that domestic violence during
pregnancy and the postpartum period is common in Nepalese women, especially in the
second trimester of pregnancy. Women were mostly experienced by sexual violence
during their pregnancy and postpartum periods. Screening for domestic violence in
women during their pregnancy and postpartum is warranted to prevent from adverse
consequences of violence.
Description: Master of Science (Epidemiology (International Program)), 20182018-01-01T00:00:00Z