Africa Knowledge Hub for Children

Peer-reviewed articleEurope PMC3 Mar 2026

Labour and delivery characteristics, maternal birth satisfaction and early relational health among COVID-19 pandemic-born children.

Aims/background Medical events during birth and self-reported birth experience may influence early relational health (ERH) in the postpartum period. Limited longitudinal work has been conducted in this area, particularly among women who gave birth during the COVID-19 pandemic. The goal of this study was to assess labour and delivery characteristics and maternal birth satisfaction as predictors of ERH domains of mother-reported bonding and observed emotional connection in the first year of life among women who gave birth during the COVID-19 pandemic. Design/methods Participants included mothers (n = 384) with and without SARS-CoV-2 infection during pregnancy who gave birth at three U.S.-based academic medical centres who were enrolled in the Epidemiology of Severe Acute Respiratory Syndrome Coronavirus-2 in Pregnancy and Infancy COVID-19 Mother Baby Outcomes (ESPI COMBO) Study. Labour and delivery information was abstracted from medical records. Mothers completed surveys assessing birth satisfaction (2 months) and bonding (4 months postpartum). A remote (Zoom) video visit was conducted at 4-6 months postpartum and observed mother-infant emotional connection was coded using the Welch Emotional Connection Screen. We evaluated study aims using structural equation models. Results Maternal and infant medical risks (e.g. maternal complications, unplanned caesarean deliveries, care escalation) were associated with lower maternal birth satisfaction, which in turn predicted lower mother-reported bonding and observed emotional connection in infancy. Conclusion Results provide insight into perinatal determinants of early relational health among infants born during the COVID-19 pandemic and inform transdisciplinary clinical care approaches to support families and children in the transition to motherhood.

Warmingham JM, Lavallée A, Lanoff M et al.

Peer-reviewed articleEurope PMC19 Dec 2025

Mental health-related sickness absences in parents of children with mental disorders or neurodevelopmental conditions.

Aims Having a child with a psychiatric diagnosis is associated with parents' greater risk of subsequent mental disorders but no immediate change in their annual labour market metrics. This discrepancy could be explained by shorter absences from work. We examined first-time psychiatric sickness absences in parents whose children have psychiatric diagnoses. Methods Using several linked nationwide Finnish registers, in this cohort study we examined time to first psychiatric sickness absence in parents whose children were born in 2001-2012 (early-childhood-onset diagnoses) or 2005-2016 (late-childhood-onset diagnoses). Exposure was having a child with a psychiatric diagnosis. Follow-up started when the parent's eldest turned 1 (early-childhood-onset diagnoses) or 5 (late-childhood-onset diagnoses) and ended at psychiatric sickness absence, emigration, 68th birthday, death, or 31 December 2020, whichever occurred first. Results The 2001-2012 and 2005-2016 cohorts included 357 135 and 397 874 parents followed for 3.31 and 3.70 million person-years. Having a diagnosed child was associated with greater risk of psychiatric sickness absence in all except men whose children had substance use or psychotic disorder diagnoses. Time-varying analyses showed the greatest associations for women (HR: 4.92; 95% CI: 3.97-6.10) and men (HR: 2.48; 95% CI: 1.61-3.80) within 6 months of a child's eating disorder diagnosis. Conclusions Parents of children with psychiatric diagnoses may be at a greater risk of a psychiatric sickness absence. Associations differed by child's diagnosis, parent's gender and time since diagnosis.

Gutvilig M, Komulainen K, Niemi R et al.

FIRead at source

Peer-reviewed articleEurope PMC13 Aug 2025

The OPTION trial: outpatient induction of labour - study protocol for a prospective, non-inferiority, multicentre randomised controlled trial.

Introduction Sweden, as many other high-income countries, has adopted guidelines to offer induction of labour at 41+0 gestational weeks to decrease the risk for perinatal death. As more than 20% of the pregnant population reach this gestational age, and along with other contributing factors, induction rates have increased up to 30% in many countries. Both women and care providers have raised the question if outpatient induction could be a convenient, safe and economic alternative, reducing the burden on inpatient care in maternity hospitals. Before introducing outpatient induction into clinical routine, studies need to assure safety for the child and woman as well as efficacy of the method. Method and analysis A register-based randomised controlled multicentre non-inferiority trial to study if outpatient induction in low-risk inductions is (1) as safe for the child (perinatal composite of mortality and morbidity) and (2) as effective (proportion of vaginal deliveries) as inpatient induction at the hospital. Secondary outcomes are further health outcomes, experiences of pregnant women, partners and care providers, health economics and future pregnancy outcome. Participating women with a singleton pregnancy and unripe cervix between 37+0 and 41+6 gestational weeks planned for low-risk induction will undergo induction of labour with either a balloon catheter or oral misoprostol according to clinical practice at the study site and the woman's informed choice. Randomisation will allocate women to either outpatient (home or patient hotel) or inpatient induction (standard care). Women undergoing outpatient induction can remain at home for up to 2 days, with an assessment after 24 hours including cardiotocography. Once active labour ensues, all women will receive standard care in the hospital.The assessment of non-inferiority will involve a two-sided 95% CI and 80% power, requiring randomisation of 8891 women to ensure a probability of at least 0.80 that the upper limit of a two-sided 95.7% CI for a difference in the primary safety outcome is below the non-inferiority margin of 1.5%. 31 of the 45 delivery units in Sweden are currently recruiting. Data will be collected from the electronic case report form and Swedish healthcare registers. Questionnaire and qualitative interview-based studies will be performed to explore experiences of pregnant women, partners and care providers. Additionally, a health economic evaluation will be performed. Ethics and dissemination The Swedish Ethical Review Authority approved the study (3 June 2020; 2020-02675 with amendments 2021-03045, 2022-00865-02, 2023-01252-02, 2024-00560-02, 2024-2024-04597-02). The Swedish Medical Products Agency approved the study for the medication arm (25 August 2020, EudraCT number: 2020-000233-41; 5.1-2020-60240 with amendments 5.1-2022-73500, 5.1-2023-630). Due to changed regulation, in 2023, the study medication arm was transferred and approved by the European Medicines Agency (23 October 2023, EU CT Number: 2023-507164-39-00; CTIS 5.1.2-2023-099775 with amendments 5.1.2-2024-081916, 5.1.2-2025-036291). The Swedish Medical Products Agency approved the study for the medical device arm (6 April 2021, CIV-ID: CIV-20-09-034712; 5.1-2021-14812 with amendments 5.1-2022-14252, 5.1-2023-596, 5.1-2024-8886, 5.1-2024-55554). The medical device arm was transferred to Regulation (EU) 2017/745 (23 December 2024, 5.1-2025-24242 and amendment 5.1-2025-6050). The study will involve more than 80% of all delivery units in Sweden, which will allow for a smooth implementation of any new routine after the study's conclusion. Results will be published in relevant scientific journals, presented at national and international conferences, and communicated to participants and relevant institutions through the Outpatient Induction study homepage (www.optionstudien.se), the webinars of the Swedish Network for National Clinical Studies in Obstetrics and Gynecology (www.snaks.se) as well as social and public media. Trial registration number EudraCT No: 2020-000233-41, after transfer to the European Medicines Agency EU CT Number: 2023-507164-39-00; CIV-ID 20-09-034712.

Sengpiel V, Sangskär H, Wennerholm UB et al.

SERead at source

Peer-reviewed articleEurope PMC23 Nov 2025

The use of Childbirth Experience Questionnaire (CEQ) and Birth Satisfaction Scale-Revised (BSS-R) in comparing the experiences of mothers with and without HIV in Tanzania.

Introduction Mothers' experiences at birth and respectful maternal care are critical to achieving Sustainable Development Goal number 3 in Tanzania. However, little is known about the differences in perinatal experience quality between women with and without HIV. To address this gap, we compared mothers' experience at birth among women with and without HIV. Methods This cross-sectional study was conducted in four Reproductive and Child Health Clinics in Mbeya, Tanzania between June and August 2022. Childbirth experience was assessed among mothers with and without HIV 1 week after birth using the Child Birth Experience Questionnaire (CEQ) and Birth Satisfaction Scale-Revised (BSS-R) questionnaires translated to Swahili. Higher scores reflected better experiences. Using this baseline assessment, bivariate and multivariate linear regression analyses tested the associations between HIV status and other patient factors and child-birth experience scores. Results A total of 1252 mothers were invited, of which 626 (288 (46%) with HIV, mean (SD age 31.9±7.8 years)), were included. Mothers with HIV had lower scores in most CEQ and BSS-R domains compared with mothers without HIV. Significant mean CEQ score differences between mothers with and without HIV were observed in both CEQ and BSS-R scores: After adjusting for demographic factors, regression coefficients, β for CEQ scores were higher among mothers without HIV compared with mothers with HIV for: 'own capacity' 0.73, p<0.001, 'Professional support' 0.94, p<0.001 and 'Participation' 0.33, p<0.001. Similarly, β for BSS-R scores were higher among mothers without HIV for 'Quality of care provision' 0.87, p<0.001), 'Women's personal attributes' 0.27, p=0.002 and 'Stress experienced' 0.1, p=0.1. Conclusions Mothers with HIV in the postpartum period reported poorer CEQ and BSS-R scores compared with mothers without HIV. These results suggest a need to improve respectful maternity care at birth among the mothers with HIV.

Mbwele B, Joctan ZZ, Hawkins C et al.

SurvivalDevelopmentTZRead at source

Peer-reviewed articleEurope PMC8 Oct 2025

A cost analysis comparing seasonal malaria chemoprevention with and without Vitamin A supplementation among under-5 children in Nigeria.

Background Child mortality in Nigeria, significantly affected by malaria and malnutrition, remains a public health concern in the country. Seasonal Malaria Chemoprevention (SMC) and Vitamin A supplementation (VAS) are effective interventions that can be delivered through integrated health campaigns to reduce this mortality. This study assesses the cost implications of integrating these two interventions among under-5 children in Northeast Nigeria. Methods A cost analysis compared standalone SMC (Cycle 1 in July 2021) with SMC-VAS integrated campaign (Cycle 4 in October 2023) in two Local Government Areas (LGAs) in Bauchi State. The number of children reached by the SMC-only campaign was 168,820 and for the SMC + Vit A campaign, the number was 170,681. Data collection utilized a mixed-methods approach, drawing from primary and secondary sources, including programmatic, financial, and coverage records. Costs were categorized into distribution, Sulphadoxine-Pyrimethamine plus Amodaiquine (SPAQ) for SMC, Vitamin A, training, supplies, meetings, labor, supervision, and social mobilization costs. Sensitivity analyses evaluated the effect of a 10% fluctuation in the costs of distribution, labor, SPAQ, and supplies on the cost per child. Results The total cost for the SMC standalone campaign was US$158,934, and the SMC-VAS integration was US$186,426. Distribution and drug costs were the largest contributors in the integrated and SMC-only campaign. The SMC-only cost per child was $0.94 and $1.18 when eligible children received both SMC and VAS. The integration of VAS into the SMC campaign cycle incurred an additional US$27,492 over Cycle 1 cost (US$186,426 - US$158,934). Fluctuations in distribution costs were the most influential component of the cost per child. Conclusion Integrating VAS with SMC campaigns increases the cost by US$0.24 per child, a modest increment considering the potential health benefits. The results support the feasibility of this integration, in terms of cost, to combat child mortality from malaria and malnutrition in Nigeria. Further research is recommended to explore the cost-effectiveness of this integrated distribution model.

Oresanya OB, Arije O, Fadipe J et al.

SurvivalNGRead at source

Peer-reviewed articleEurope PMC19 Feb 2026

District-Level Estimates of Child Mortality in Uttar Pradesh, India.

The study examines district-wise variations in child mortality across Uttar Pradesh using the National Family Health Survey (NFHS)-5 dataset for Uttar Pradesh, by estimating the neonatal mortality rate (NMR), post-neonatal mortality rate (PNMR), child mortality rate (CMR), and under-five mortality rate (U5MR). Findings suggest that Uttar Pradesh continues to exhibit one of India's highest child mortality burdens, as the estimates are above the national average. Neonatal mortality, averaging about 36 deaths per 1,000 live births, remains the largest contributor to child deaths. Several central and western districts, such as Amethi, Mainpuri, and Shahjahanpur, record NMRs above 60, while some eastern districts like Ballia and Deoria have achieved rates below 12, nearing the 2030 Sustainable Development Goals (SDG). Post-neonatal mortality averages around 15 per 1,000, with high levels in Agra, Hardoi, and Kheri, indicating gaps in infant care and immunization coverage. In contrast, districts such as Kushinagar and Muzaffarnagar have PNMRs under 3, reflecting effective community-level health programs. Child mortality (ages 1-4) has declined significantly, with a state average near 10 per 1,000. Most districts report single-digit CMRs, but outliers like Fatehpur and Allahabad remain high, suggesting persistent issues related to nutrition and healthcare quality. The composite U5MR stands at nearly 60 deaths per 1,000 live births, still more than twice the SDG target. Extremes range from 111 in Amethi and 101 in Shahjahanpur to below 25 in Jaunpur, Muzaffarnagar, and Deoria. This divergence highlights both successful interventions and critical shortfalls within the state. The eight aspirational districts Bahraich, Balrampur, Chandauli, Chitrakoot, Fatehpur, Shravasti, Siddharthnagar, and Sonbhadra perform marginally better than the state average (U5MR 56.5 vs. 59.9), suggesting positive effects of targeted development initiatives. However, internal variation persists, with Siddharthnagar performing exceptionally well and Fatehpur lagging behind. Overall, Uttar Pradesh's child mortality has declined but remains uneven. Sustained improvements in neonatal care, maternal health, nutrition, and equitable healthcare delivery, especially in high-mortality districts, are crucial for meeting national and SDG by 2030.

Pandey A, Sharma R

SurvivalDevelopmentINRead at source

Peer-reviewed articleEurope PMC13 Jan 2021

[Psychological Strain due to Female Genital Mutilation: An Explorative Analysis in the Context of Medical Counselling].

Female genital mutilation (FGM) is a procedure that injures or removes parts of the external female genitals for nonmedical reasons and without the consent of the affected girls. Often this procedure leads to severe consequences for the women's physical and mental health. Reconstructive surgery can reduce these symptoms. In an exploratory study of 97 women seeking medical counselling, characteristics of the sample were analysed descriptively, reasons for reconstructive surgery were examined and agreement between the women's knowledge with the results of the medical examination was assessed. 56.7% (n=55) of the women examined were suspected to suffer from PTSD. Relief of pain was the reason most frequently mentioned for reconstructive surgery (45.4%; n=44). Accordance between women's knowledge of anatomic structures and the degree of mutilation with the results of the medical examination was low (κ=0.09). In addition to surgical measures, women suffering from FGM should be offered psychotherapeutic assistance. To improve the understanding on the effect of psychotherapy after FGM, sound longitudinal studies are indispensable.

Wulfes N, Kröhl N, Strunz C et al.

ProtectionRead at source

Peer-reviewed articleEurope PMC14 Aug 2020

Knowledge, attitude, practice, and predictors of female genital mutilation in Degadamot district, Amhara regional state, Northwest Ethiopia, 2018.

Background Female genital mutilation is defined as all procedures that involve partial or total removal of external female genitalia, or other injuries to the female genital organs for cultural and religious purposes. In Ethiopia, the prevalence of female genital mutilation practice was 70.8% according to Ethiopian demographic and health survey 2016. This practice is against females' reproductive health rights with many serious consequences in physical, mental, social and psychological makeup. Therefore, this study aimed to assess knowledge, attitude, practice, and predictors of female genital mutilation in Degadamot district. Methods A community-based cross-sectional study design was conducted. Three hundred twenty-five mothers who had under 5 years old female children were selected using systematic random sampling from seven kebeles of Degadamot district. Data were collected using an adapted semi-structured face to face interview questionnaire. Data were entered into Epi-data version 3.1 and then exported to SPSS version 20 for analysis. Logistic regression analysis with 95% confidence intervals was carried out to determine the associations between predictor variables and outcome variables. Result The finding of this study revealed that 56.6% of mothers had good knowledge about female genital mutilation and 54.2% of participants had a favorable attitude about female genital mutilation. 70.8% of under 5 years old female children's had female genital mutilation. Marital status AOR = 7.19(95%CI3.22-16.03), monthly income AOR = 1.97(95% CI 0.26-3.81), custom AOR = 2.13(95% CI 1.20-3.78), belief AOR =2.47(95% CI 1.39-4.39), value AOR = 0.37(95% CI 0.22-0.63), and attitude AOR = 24.4(95% CI 20.01-34.76) towards female genital mutilation had significant association with female genital mutilation practice. Conclusion Prevalence of FGM practices among female children of under 5 years of age was found to be high as compared to the national level (64%). 56.6% of mothers had good knowledge about FGM. The majority of the women had a favorable attitude to keep FGM practice among their under 5 years old daughters. Marital status, monthly income, custom, belief, value, and attitude had a significant association with FGM practice.

Melese G, Tesfa M, Sharew Y et al.

ProtectionETRead at source

Peer-reviewed articleEurope PMC28 Mar 2025

Neonatal Mortality and Associated Factors at a Tertiary-Level Neonatal Intensive Care Unit in Mogadishu, Somalia: A Retrospective Study.

Background Neonatal mortality is a significant global health challenge, particularly in sub-Saharan Africa. In Somalia, there is a notable absence of comprehensive reports or data on neonatal mortality rates within tertiary-level neonatal intensive care units (NICU). This study aims to identify key factors associated with neonatal mortality in Mogadishu, Somalia. Materials and methods A retrospective review of medical records was conducted for neonates admitted to the Neonatal Intensive Care Unit (NICU) of Mogadishu Somali Turkish Training and Research Hospital from August 2017 to September 2019. Logistic regression analysis was employed using SPSS (version 25) to compute adjusted odds ratios (aORs) along with 95% confidence intervals (CIs). Results Of 1043 neonates, 63.8% (n=665) were male, with a mean age of 1.48 days. Most neonates were full-term (55.3%, n=577), while 25.8% (n=269) were preterm (<32 weeks), and 11.9% (n=124) were late preterm (33-37 weeks). In total, 25.5% (n=266) had very low birth weight (<1500 grams). The average length of stay in the NICU was 7.38 days, and the overall mortality rate was 18.7% (n=195). Indications for NICU admissions were prematurity 27.0% (n=282), followed by birth asphyxia (18.0%, n=188), neonatal sepsis (14.6%, n=152), and acute respiratory distress syndrome (12.2%, n=127). Preterm neonates had significantly higher mortality rates (OR=2.14, 95% CI: 1.32-3.47, p=0.002), and those with a birth weight of <1500 grams had an even higher risk of mortality (OR=3.85, 95% CI: 2.50-5.92, p<0.001). Lack of ANC visits was associated with increased mortality risk (OR=1.67, 95% CI: 1.09-2.54, p=0.019), while cesarean delivery was also linked to higher mortality risk (OR=1.92, 95% CI: 1.29-2.85, p=0.002). Conclusion The study identified a Neonatal Mortality Rate that is acceptable compared to the mortality rates in other studies in Somalia and the sub-Saharan African region. These findings inform care strategies and resource allocation in prenatal and neonatal health services.

Ali ME, Hassan YO, Ahmed MAM et al.

SurvivalSORead at source

Peer-reviewed articleEurope PMC4 Jun 2024

Assessing attitudes towards violence against women and girls, their determinants and health-seeking behaviour among women and men in South Sudan: a cross-sectional national survey.

Objective Investigating attitudes accepting two categories of violence against women and girls (VAWG) (intimate partner violence-IPV-and other expressions of VAWG) and their association with seven demographic/social determinants and health-seeking behaviours in South Sudan. Design Cross-sectional study using data from the South Sudan National Household Survey 2020. Setting South Sudan. Participants and methods 1741 South Sudanese women and 1739 men aged 15-49 years; data captured between November 2020 and February 2021 and analysed using binary logistic regression. Results People with secondary or higher education displayed attitudes rejecting acceptance of IPV (OR 0.631, 95% CI 0.508 to 0.783). Women and men living in states with more numerous internally displaced people (IDP) or political/military violence had attitudes accepting IPV more than residents of less violence-affected regions (OR 1.853, 95% CI 1.587 to 2.164). Women had a higher odd of having attitudes accepting IPV than men (OR 1.195, 95% CI 1.014 to 1.409). People knowing where to receive gender-based violence healthcare and psychological support (OR 0.703, 95% CI 0.596 to 0.830) and with primary (OR 0.613, 95% CI 0.515 to 0.729), secondary or higher education (OR 0.596, 95% CI 0.481 to 0.740) displayed attitudes rejecting acceptance of other expressions of VAWG. People residing in states with proportionately more IDP and who accepted IPV were more likely to have attitudes accepting other expressions of VAWG (OR 1.699, 95% CI 1.459 to 1.978; OR 3.195, 95% CI 2.703 to 3.775, respectively). Conclusion Attitudes towards accepting VAWG in South Sudan are associated with women's and men's education, gender, residence and knowledge about health-seeking behaviour. Prioritising women's empowerment and gender transformative programming in the most conflict-affected areas where rates of VAWG are higher should be prioritised along with increasing girls' access to education. A less feasible strategy to decrease gender inequalities is reducing insecurity, military conflict, and displacement, and increasing economic stability.

Lamadrid A, Jeffery C, Anguyo R et al.

ProtectionSSRead at source

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