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IntroductionFifteen million babies are born prematurely, before 37 weeks gestational age, globally. More than 80% of these are in sub-Saharan Africa and Asia. 35% of all deaths in the first month of life are due to prematurity and the neonatal mortality rate is eight times higher in low-income and middle-income countries (LMICs) than in Europe. Early Warning Scores (EWS) are a way of recording vital signs using standardised charts to easily identify adverse clinical signs and escalate care appropriately. A range of EWS have been developed for neonates, though none in LMICs. This paper reports the findings of early work to examine if the use of EWS is feasible in LMICs.MethodsWe conducted an observational study to understand current practices for monitoring of preterm infants at a large national referral hospital in Nairobi, Kenya. Using hospital records, data were collected over an 8-week period in 2019 on all live born infants born at <37 weeks and/or <2500 g (n=294, 255 mothers) in the first week of life. Using a chart adopted from the EWS developed by the British Association of Perinatal Medicine, we plotted infants’ vital signs. In addition, we held group discussions with stakeholders in Kenya to examine opinions on use of EWS.ResultsRecording of vital signs was variable; only 63% of infants had at least one temperature recorded and 53% had at least one heart rate and respiratory rate recorded. Stakeholders liked the traffic-light system and simplicity of the chart, though recognised challenges, such as staffing levels and ability to print in colour, to its adoption.ConclusionEWS may standardise documentation and identify infants who are at higher risk of an adverse outcome. However, human and non-human resource issues would need to be explored further before development of an EWS for LMICs.

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ObjectivesPrematurity is the leading cause of global neonatal and infant mortality. Many babies could survive by the provision of essential newborn care. This qualitative study was conducted in order to understand, from a family and professional perspective, the barriers and facilitators to essential newborn care. The study will inform the development of an early warning score for preterm and low birthweight infants in low and middle income countries (LMICs).SettingSingle-centre, tertiary referral hospital in Nairobi, Kenya.ParticipantsNineteen mothers and family members participated in focus group discussions and 20 key-informant interviews with professionals (healthcare professionals and policy-makers) were conducted. Focus group participants were identified via postnatal wards, the newborn unit and Kangaroo Mother Care (KMC) unit. Convenience and purposive sampling was used to identify professionals.Outcome measuresUnderstanding facilitators and barriers to provision of essential newborn care in preterm infants.ResultsFrom 27 themes, three global themes emerged from the data: mothers’ physical and psychological needs, system pillars and KMC.ConclusionMeeting mothers’ needs in the care of their babies is important to mothers, family members and professionals, and deserves greater attention. Functioning system pillars depended on a standardised approach to care and low cost, universally applicable interventions are needed to support the existing care structure. KMC was effective in both meeting mothers’ needs, supporting existing care structures and also provided a space for the resolution of the dialectical relationship between families and hospital procedures. Lessons learnt from the implementation of KMC could be applied to the development of an early warning score in LMICs.

Introduction About 2.6 million stillbirths per year occur globally with 98% occurring in low‐ and middle‐income countries including Kenya, where an estimated 35 000 stillbirths occur annually. Most studies have focused on the direct causes of stillbirth. The aim of this study was to determine the association between antenatal care utilization and quality with stillbirth in a Kenyan set up. This information is key when planning strategies to reduce the stillbirth burden. Material and methods This was a case‐control study in four urban tertiary hospitals carried out between August 2018 and April 2019. A total of 214 women with stillbirths (cases) and 428 with livebirths (controls) between 28 and 42 weeks were enrolled. Information was obtained through interviews and data abstracted from medical records. Antenatal care utilization was assessed by the proportions of women not attending antenatal care; booking first antenatal care visit in first trimester and not making the requisite four antenatal care visits. Quality of antenatal care was assessed using individual surrogate indicators (antenatal profile testing, weight/blood pressure/urinalysis testing in each antenatal visit, utilization of early obstetric ultrasound, completeness of antenatal records) and a codified indicator made up of seven parameters (attending antenatal care, booking first antenatal care in the first trimester, making four or more antenatal visits, having all antenatal profile tests, having a complete antenatal record, having blood pressure and weight measured at all visits). The association between antenatal care utilization and quality with stillbirth was assessed using univariate and multivariate analysis using logistic regression. Statistical significance was defined as a two‐tailed P value ≤ .05. Results Women with stillbirth were likely to have a parity ≥4 (19.6% vs 12.6%, P = .02), have an obstetric complication (36% vs 8.6%, P = .001) and have a medical disorder (5.6% vs 1.6%, P = .01). The odds of a stillbirth were four times higher among those who did not attend antenatal care ( odds ratio [OR] 4.1, 95% confidence interval [CI] 1.6‐10, P < .003). Compared with four antenatal care visits, those who had one or two visits had higher odds of a stillbirth: OR 2.96 (95% CI 1.4‐6.1), P = .003, and OR 2.9 (95% CI 1.7‐5), P = .003, respectively. As per the individual surrogate indicators, the likelihood of a stillbirth was lower in women who received good quality antenatal care: Hemoglobin testing (OR 0.6, 95% CI 0.4‐0.8, P = .03), blood group test (OR 0.4, 95% CI 0.2‐0.6, P < .001), HIV test (OR 0.3, 95% CI 0.2‐0.5, P = .001), venereal disease research laboratory test (OR 0.2, 95% CI 0.1‐0.4, P = .001), weight measurement (OR 0.7, 95% CI 0.5‐1.0, P = .047). As per the composite indicator, the quality of antenatal care was poor across the board and there was no association between this surrogate indicator and stillbirth. Conclusions Lack of antenatal care, attending fewer than four antenatal visits and poor quality antenatal care as ...

Triangulating evidence from different study designs is needed. 8,9 Randomised trials on quitting alcohol at different levels will be ethical, informative, and warranted.Braillon 8 proposed the term moderate alcohol use should be replaced with low risk of drinking, where appropriate, to show that there is a health risk associated with drinking at any level. We further advocate that the term harmful use should no longer be used.The WHO voluntary global non-communicable diseases target for 2025 of a 10% reduction in harmful alcohol use (which is ill-defined) is unachievable with current approaches. Alcohol control is complex and stronger policies are required. The alcohol industry is thriving and should be regulated in a similar way to the tobacco industry. 10,11 Since the WHO FCTC has been successful, we advocate for a Framework Convention for Alcohol Control (FCAC) 10,11 and urge WHO to start the process as soon as possible. We also propose a stage of alcohol epidemic model (SAEM) with reference to the stage of tobacco epidemic model and the stage of obesity epidemic model. 12 At present, alcohol use is increasing in all countries. The SAEM forewarns that alcohol-attributable diseases will continue to increase, even when alcohol prevalence has reached the peak (ie, 0% increase) and begins to decline. The lag between the peak of alcohol prevalence and alcohol-induced diseases, which could be several decades, might confuse policy makers, and be used by the alcohol industry and related interests to argue against more stringent control measures by claiming that moderate drinkers should not be deprived of the supposed health benefits. We need to learn from tobacco control and unite to advocate for a FCAC.

Background Postnatal depression (PND) is a universal mental health problem that prevents mothers’ optimal existence and mothering. Although research has shown high PND prevalence rates in Africa, including Kenya, little research has been conducted to determine the contributing factors, especially in low-resource communities. Objective This study aimed to investigate the PND risk factors among mothers attending Lang’ata and Riruta Maternal and Child Health Clinics (MCH) in the slums, Nairobi. Methods This study was cross-sectional. It is part of a large study that investigated the effectiveness of a brief psychoeducational intervention on PND. Postnatal mothers (567) of 6-10 weeks postanatal formed the study population. Depression rate was measured using the original 1961 Beck’s Depression Inventory (BDI). In addition, a sociodemographic questionnaire (SDQ) was used to collect hypothesized risk variables. Multivariable logistic regression analysis was used to explore predictors of PND. Results The overall prevalence of PND in the sample of women was 27.1%. Women aged 18-24 (β = 2.04 95% C.I.[0.02; 4.05], p = 0.047), dissatisfied with body image (β = 4.33 95% C.I.[2.26; 6.41], p < 0.001), had an unplanned pregnancy (β = 2.31 95% C.I.[0.81; 3.80], p = 0.003 and felt fatigued (β = − 1.85 95% C.I.[− 3.50; 0.20], p = 0.028) had higher odds of developing PND. Participants who had no stressful life events had significantly lower depression scores as compared to those who had stressful life events (β = − 1.71 95% C.I.[− 3.30; − 0.11], p = 0.036) when depression was treated as a continuous outcome. Sensitivity analysis showed that mothers who had secondary and tertiary level of education had 51 and 73% had lower likelihood of having depression as compared to those with a primary level of education (A.O.R = 0.49 95% C.I.[0.31-0.78], p = 0.002) and (A.O.R = 0.27 95% C.I.[0.09-0.75], p = 0.013) respectively. Conclusion This study reveals key predictors/risk factors for PND in low-income settings building upon the scanty data. Identifying risk factors for PND may help in devising focused preventive and treatment strategies.

BackgroundPostnatal depression (PND) is a universal mental health problem that prevents mothers' optimal existence and mothering. Although research has shown high PND prevalence rates in Africa, including Kenya, little research has been conducted to determine the contributing factors, especially in low-resource communities.ObjectiveThis study aimed to investigate the PND risk factors among mothers attending Maternal and Child Health Clinics (MCH) in the slums, Nairobi.MethodsThis study is cross-sectional, which is a part of a larger study. A sample of 567 mothers of 6-10 weeks postnatal from two Maternal and Child Health (MCH) formed the study population. The Depression rate was measured using the original 1961 Beck's Depression Inventory (BDI). In addition, a sociodemographic questionnaire (SDQ) was used to collect hypothesized risk variables. Results The PND prevalence rate was 27.1%. Women with: unplanned pregnancy (AOR=1.87, 95% CI 1.02, 3.43), unemployed (AOR=4.43, 95% CI 1.01, 19.76), dissatisfied with body image (AOR=2.51, 95% CI 1.21, 5.19) and feeling fatigued (AOR=2.02, 95% CI 1.06, 3.85) had higher odds of developing PND. ConclusionThis study builds upon scarce previous studies on PND from low-income countries. Identifying specific PND risk factors may help in devising targeted prophylactic and therapeutic strategies.