Papers by Affette McCaw-Binns
2015 APHA Annual Meeting & Expo (Oct. 31 - Nov. 4, 2015), Nov 2, 2015
CABI eBooks, 2012
Medical conditions can have a major effect on the woman before, during and after pregnancy, some ... more Medical conditions can have a major effect on the woman before, during and after pregnancy, some of which have particular importance to her offspring. The conditions are often exacerbated by pregnancy. Infectious conditions are common in developing country settings, with antenatal care providing an opportunity for detection of many conditions: * Human immunodeficiency virus (HIV) infection affects a woman's chance of surviving pregnancy. The condition can be transmitted to her offspring. * Sexually transmissible infections cause infertility and damage to the fetus. * While the mother's immunity is compromised during pregnancy, she is at risk from varicella, influenza and malaria and may transmit congenital infections to the fetus - syphilis, genital herpes, rubella, toxoplasmosis, cytomegalovirus, listerosis and parvovirus B19. Chronic and non-communicable medical conditions may be identified for the first time in pregnancy and include: * Nutritional deficiencies such as anaemia, other micronutrients and caloric restrictions. * Circulatory disorders, such as heart disease, chronic hypertension. * Gestational, Type I or Type II diabetes. * Haematological conditions such as sickle cell anaemia and thalassaemia, which have implications for the long-term health of offspring if both parents carry the trait and for the health of the mother if she is homozygous for the condition. The management of medical conditions in pregnancy can be categorized in the following stages: * Preconceptually, couples planning to have children should be educated about immunization, improving diet and general health. * Antenatal care provides the opportunity to diagnose, manage and treat HIV, sexually transmitted infections, anaemia and other pre-existing medical conditions such as sickle cell disease, thalassaemia, heart disease and diabetes, to limit the effect of these problems. * Childbirth can be stressful physiologically. Acute management of conditions such as anaemia, diabetes and heart conditions may be necessary. Hygienic practices and HIV prophylaxis are also important. * Postpartum management of infant feeding will reduce HIV transmission, and use of insecticidetreated nets by the mother and child will contribute to preventing the consequences of malaria. Longterm management of medical conditions after pregnancy and planning for the next pregnancy are necessary.
Bjog: An International Journal Of Obstetrics And Gynaecology, Jun 3, 2018
Bjog: An International Journal Of Obstetrics And Gynaecology, Dec 26, 2014
Millennium Development Goals 4 and 5 challenged lowand middle-income countries (LMICs) to vastly ... more Millennium Development Goals 4 and 5 challenged lowand middle-income countries (LMICs) to vastly improve the access to and quality of maternal and newborn health care to reduce maternal and child mortality. Within months of the deadline for these goals, achievements vary widely with the maternal health goal being the most elusive. Hideki Higashi and colleagues examined four maternal and one newborn outcome avertable by access to emergency obstetric surgery, and determined from the Global Burden of Disease (GBD) database that 37% of maternal and perinatal deaths and newborn morbidity could be prevented by universal access to obstetric surgery. This will provide a useful guide as the package of interventions to further improve maternal and perinatal outcomes in the post-2015 agenda is being developed. The regions with the greatest global burden of maternal death, sub-Saharan African (62%) and Southern Asia (24%), should benefit the most. Recognising the dearth of data from the countries most in need, they used the risk in high-income countries as their baseline of what is possible. This may be setting the bar too high. Over the medium term it may have been more realistic to use the situation among upper middle-income countries as a more appropriate index of potentially feasible goals. Such countries have the advantage of vital registration systems, which produce acceptable mortality data for monitoring impact. Given the model outlined, and existing evidence, a cost-effective strategy for first-line district hospitals could be to train interested general practitioners to manage the most common surgical emergencies, including obstetric interventions (Hounton et al. Human Resources for Health 2009;7:34). Appropriate retention incentives (Gosselin et al. World J Surg 2011; 35:258–61) alongside inbuilt redundancy are needed to avoid high attrition and collapse of services if a team member is away for any reason (De Brouwere et al. Reprod Health Matters 2009;17:32–44). I will ignore the need to address the legal status of abortion in many of these countries. Averting maternal or neonatal morbidity or mortality among mothers requiring caesarean section or instrumental delivery, however, depends on their early identification (Ellis et al. BMJ 2000;320:1229–36) and timely access to care. Quality intrapartum care will be critical to the effectiveness of an adequately staffed surgical service, whether run by assistant medical officers (McCord et al. Health Affairs 2009;28:w876– 85) or surgically trained general practitioners. The facilities will need well-maintained basic equipment, including diagnostic capability, consistent supplies, and reliable water and electricity. Although task-shifting is a laudable goal, politicians must support such strategies with resources to upgrade and maintain these rural hospitals. In 2007 Johns et al. (Bull WHO 2007;85:256–63) estimated that the 75 countries most in need would require a minimum of $39 billion to provide comprehensive care from pregnancy through to the postnatal period. The prediction of what needs to be done must give way to harnessing the resources to implement these recommendations, or papers such as this will remain mere academic exercises.
Cancer Causes & Control, May 1, 2020
CABI eBooks, 2012
PART I: THE GLOBAL CONTEXT 1. An introduction to maternal and perinatal health 2. The millennium ... more PART I: THE GLOBAL CONTEXT 1. An introduction to maternal and perinatal health 2. The millennium development goals 3. The politics of progress: the story of maternal mortality 4. The epidemiology of maternal mortality 5. The epidemiology of stillbirths and early neonatal deaths PART II: PROGRAME IMPLEMENTATION 6. Health systems 7. Financing maternity care 8. Implementing clinical interventions within maternal health programmes 9. Medical conditions in pregnancy: preventing and managing indirect obstetric morbidity 10. Improving the availability of services 11. Geographical access, transport and referral systems 12. Demand for maternity care: beliefs, behaviour and social access 13. Empowering the community: BRAC's approach in Bangladesh 14. Quality of care 15. Monitoring and evaluation 16. Addressing maternal health in emergency settings.
CABI eBooks, 2012
Safe and effective fective interventions exist to prevent and treat the major causes of maternal ... more Safe and effective fective interventions exist to prevent and treat the major causes of maternal mortality and morbidity which are: postpartum haemorrhage, sepsis, pre-eclampsia/eclampsia, obstructed labour and unsafe abortion. To successfully introduce and adopt evidence-based clinical interventions within maternal health programmes, integrated care modalities, a functioning health system, the policy environment and legal and cultural factors have to be considered. An enhanced knowledge base for implementation is also required. The evidence-based clinical interventions for prevention and treatment of obstetric complications are detailed.
Maternal and perinatal health in developing countries, 2012
To ensure adequate coverage of care for maternal and perinatal health goals, maternity services (... more To ensure adequate coverage of care for maternal and perinatal health goals, maternity services (of good quality) must be made available. The availability of maternity services is dependent upon the health system and cannot be planned in isolation. Clear policies which draw upon principles of the primary health-care approach can guide identification of service availability needs. Geographical availability and distribution of health facilities influence the use of health services. Benchmarks for the catchment populations of different levels of maternity services vary across countries, but for emergency obstetric care a minimum of five facilities in a population of half a million is recommended. Once a network of maternity facilities has been established at the various levels of the health system, specification of the packages of interventions (for antenatal, delivery and postnatal care) that should be made available at each level is necessary. Human resources, physical infrastructure...
Reproductive Health, Feb 19, 2021
Plain English summary: The World Health Organization (WHO) provides a framework (ICD-MM) to class... more Plain English summary: The World Health Organization (WHO) provides a framework (ICD-MM) to classify pregnancy-related deaths systematically, which enables global comparison among countries. We compared the classification of pregnancy-related deaths in Suriname by the attending physician and by the national maternal death review (MDR) committee and among the MDR committees of Suriname, Jamaica and the Netherlands. There were 89 possible pregnancy-related deaths in Suriname between 2010 and 2014. Nearly half (47%) were classified differently by the Surinamese MDR committee as compared to the classification of the attending physicians. All three MDR committees agreed that 18% (n = 16/89) of the cases were no maternal deaths. Out of the remaining 73 cases, there was disagreement regarding whether 15% (n = 11) were maternal deaths. The Surinamese and Jamaican MDR committees achieved greater consensus in classification than the Surinamese and the Netherlands MDR committees. The Netherlands MDR committee classified more deaths as unspecified than Surinamese and the Jamaican MDR committees. Underlying causes that achieved a high level of agreement among the three committees were abortive outcomes and obstetric hemorrhage, while little agreement was reported for unspecified and other direct causes. The issues encountered during maternal death classification using the ICD-MM guidelines included classification of suicide during early pregnancy; when to assume pregnancy without objective evidence; how to count maternal deaths occurring outside the country of residence; the relevance of direct or indirect cause attribution; and how to select the underlying cause when direct and indirect conditions or multiple comorbidities co-occur. Addressing these classification barriers in future revisions of the ICD-MM guidelines could enhance the feasibility of maternal death classification and facilitate global comparison. Background: Insight into the underlying causes of pregnancy-related deaths is essential to develop policies to avert preventable deaths. The WHO International Classification of Diseases-Maternal Mortality (ICD-MM) guidelines provide a framework to standardize maternal death classifications and enable comparison in and among countries over time. However, despite the implementation of these guidelines, differences in classification remain. We evaluated consensus on maternal death classification using the ICD-MM guidelines.
West Indian Medical Journal, Dec 1, 2008
The Ministry of Health and the University of the West Indies have collaborated over 25 years to d... more The Ministry of Health and the University of the West Indies have collaborated over 25 years to develop the evidence base to improve maternal health. The experience is reviewed as a model to accelerate Jamaica's progress toward achieving the Millennium Development Goals (MDGs). The process included measuring the disease burden due to maternal morbidity and mortality; developing and field testing interventions to manage the leading problems, national scale-up, monitoring and evaluation. This began with developing clinical guidelines to manage the hypertensive disorders of pregnancy while establishing high risk (referral) antenatal clinics, expansion and upgrading of referral facilities, and audits to identify barriers to quality healthcare, including establishing maternal mortality surveillance. As we succeed, research funds have become scarce, limiting support to postgraduate students, a reliable, cost effective resource pool capable of undertaking the research needed to provide the evidence base to influence public policy more widely. A locally financed resource pool is needed to support fellowships for graduate students to accelerate their training and availability to contribute to national development. The model from Thailand is put forward for consideration. The operations research model for maternal health can be transferred to other MDG objectives. As Jamaica pursues its goal of developed nation status, and international grant financing shrinks, local civil society will need to fill the vacancy and invest in the most abundant natural resource, young people. Indies to initiate the year long celebration of its 60 th anniversary.
WHOâ ERC Approval. (DOC 563 kb)
Dimension 1: Symptom, Sign, Investigations & Management (Direct Maternal Morbidity). (DOCX 21 kb)
Reason for the study The study team was asked to review current evidence on the effect of the HIV... more Reason for the study The study team was asked to review current evidence on the effect of the HIV/AIDS epidemic on the education sector in Jamaica, given reports of its impact in sub-Saharan Africa.
eClinicalMedicine, 2022
Summary Background Sickle cell disease (SCD) affects 2.8% of Jamaican antenatal women. Between 19... more Summary Background Sickle cell disease (SCD) affects 2.8% of Jamaican antenatal women. Between 1998–2007 their maternal mortality ratio was 7–11 times higher than women without these disorders. We aim to determine if outcomes improved between 2008 and 17 amid declining fertility and changes in referral obstetric care. Methods Maternal deaths in Jamaica's maternal mortality surveillance database (assembled since 1998) with SCD reported as underlying or associated cause of death were compared to those without known SCD, over two decades from 1998 to 2017. Social, demographic and health service variables were analysed using SPSS and EpiInfo Open. Findings Over the two decades from 1998 to 2017, 806 (74%) of the 1082 pregnancy-associated deaths documented by the Jamaican Ministry of Health and Wellness were maternal deaths. The maternal mortality ratio (MMR) did not statistically change over the two periods for women with (p = 0.502) and without SCD (p = 0.629). The MMR among women with and without SCD in 2008–17 was 378.1 (n = 41) and 89.2/100,000 live births (n = 336) respectively, an odds ratio of 4.24 (95% CI: 3.07–5.87). When deaths due to their blood disorders were excluded, risk remained elevated at 2.17 (95% CI: 1.36–3.32). There was an upward trend in direct deaths over the two decades (p [trend]=0.051). Interpretation MMRs were unchanged over two decades for Jamaicans with SCD. The high contribution to maternal mortality by women with SCD may explain some of the persistently higher mortality experience of women in the African diaspora. Multi-disciplinary evidence-based strategies need to be developed and tested which improve survival for women with SCD who want to have children. Funding No external funding was provided.
A erobic exercise training in stroke has been shown to increase lower extremity strength, 1 impro... more A erobic exercise training in stroke has been shown to increase lower extremity strength, 1 improve aerobic capacity, 2 and functional abilities. 3 Although these outcomes may impact health-related quality of life (HRQL), 4 the effect of aerobic exercise on HRQL has been much less investigated. Improvement in HRQL after combined aerobic and strengthening exercise has been reported, 5 whereas others have shown no effect. 6 Aerobic training alone was investigated in only 1 study with no effect. 7 Previous studies used mainly treadmill and cycle ergometers, with none examining more accessible and less expensive modes of aerobic training such as overground walking. The purpose of this study was to determine the effect of a community-based, 12-week aerobic (walking) exercise program on functional status and HRQL in community-dwelling stroke survivors. A single-blind randomized controlled trial was done. The study received ethics approval, and subjects gave written informed consent. Subje...
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Papers by Affette McCaw-Binns