Background: Travel time to care is known to influence uptake of health services. Generally, pregnant women who take longer to transit to health facilities are the least likely to deliver in facilities. It is not clear if modelled access predicts fairly the vulnerability in women seeking maternal care across different spatial settings. Objectives: This cross-sectional analysis aimed to (i) compare travel times to care as modelled in a GIS environment with self-reported travel times by women seeking maternal care in Community Level Interventions for Pre-eclampsia: Mozambique, India and Pakistan; and (ii) investigate the assumption that women would seek care at the closest health facility. Methods: Women were interviewed to obtain estimated travel times to health facilities (R). Travel time to the closest facility was also modelled (P) (closest facility tool (ArcGIS)) and time to facility where care was sought estimated (A) (route network layer finder (ArcGIS)). Bland-Altman analysis compared spatial variation in differences between modelled and self-reported travel times. Variations between travel times to the nearest facility (P) with modelled travel times to the actual facilities accessed (A) were analysed. Log-transformed data comparison graphs for medians, with box plots superimposed distributions were used. Results: Modelled geographical access (P) is generally lower than self-reported access (R), but there is a geography to this relationship. In India and Pakistan, potential access (P) compared fairly with self-reported travel times (R) [P (H 0 : Mean difference = 0)] < .001, limits of agreement: [− 273.81; 56.40] and [− 264.10; 94.25] respectively. In Mozambique, mean differences between the two measures of access were significantly different from 0 [P (H 0 : Mean difference = 0) = 0.31, limits of agreement: [− 187.26; 199.96]]. Conclusion: Modelling access successfully predict potential vulnerability in populations. Differences between modelled (P) and self-reported travel times (R) are partially a result of women not seeking care at their closest facilities.

Surveys to estimate the daily growth rate of harbour seal (Phoca vitulina) pups from birth to weaning and to determine the distribution of births were carried out from early May to late August 1998, 1999, and 2000 at two haulout areas in the St. Lawrence River estuary, Canada. Pups gained mass at a rate of 0.544 kg/day (standard error (SE) = 0.141, range 0.118–0.875 kg/day, N = 110). Births began between 12 and 17 May. The median dates of birth were 28 May (95% confidence interval (CI), 27–30 May) in 1998, 25 May (95% CI, 24–28 May) in 1999, and 26 May (95% CI, 24–27 May) in 2000. Births followed a normal distribution in 2000, but late pupping led to an extended tail in both 1998 and 1999. Pupping occurred at the same time in the St. Lawrence River estuary as at Sable Island, a colony located 600 km to the south, but occurred earlier than predicted by the relationship of Temte et al. (1991). The estimated median dates of weaning were 1 July (95% CI, 20 June to 12 July) in 1998, 30 June (95% CI, 19 June to 11 July) in 1999, and 26 June (95% CI, 20 June to 2 July) in 2000. Pooling years resulted in an average lactation duration of 34 days (SE = 1.8).

Background Pre-eclampsia is a leading cause of maternal mortality and morbidity that involves pregnancy-related stressors on the maternal cardiovascular and metabolic systems. As nutrition is important to support optimal development of the placenta and for the developing fetus, maternal diets may play a role in preventing pre-eclampsia. The purpose of this scoping review is to map the maternal nutritional deficiencies and imbalances associated with pre-eclampsia incidence and discuss evidence consistency and linkages with current understandings of the etiology of pre-eclampsia. Methods A narrative scoping review was conducted to provide a descriptive account of available research, summarize research findings and identify gaps in the evidence base. Relevant observational studies and reviews of observational studies were identified in an iterative two-stage process first involving electronic database searches then more sensitive searches as familiarity with the literature increased. Results were considered in terms of their consistency of evidence, effect sizes and biological plausibility. Results The review found evidence for associations between nutritional inadequacies and a greater risk of pre-eclampsia. These associations were most likely mediated through oxidative stress, inflammation, maternal endothelial dysfunction and blood pressure in the pathophysiology of pre-eclampsia. Maternal nutritional risk factors for pre-eclampsia incidence with the strongest consistency, effect and biological plausibility include vitamin C and its potential relationship with iron status, vitamin D (both on its own and combined with calcium and magnesium), and healthy dietary patterns featuring high consumption of fruits, vegetables, whole grains, fish, seafood and monounsaturated vegetable oils. Foods high in added sugar, such as sugary drinks, were associated with increased risk of pre-eclampsia incidence. Conclusion A growing body of literature highlights the involvement of maternal dietary factors in the development of pre-eclampsia. Our review findings support the need for further investigation into potential interactions between dietary factors and consideration of nutritional homeostasis and healthy dietary patterns. Further research is recommended to explore gestational age, potential non-linear relationships, dietary diversity and social, cultural contexts of food and meals.

Background: Travel time and healthcare financing are critical determinants of the provision of quality maternal health care in low resource settings. Despite the availability of pregnancy-related mHealth and smart travel applications, there is a lack of evidence on their usage to travel to health facilities for routine antenatal care and emergencies. There is a shortage of information about the feasibility of using a custom-made mobile technology that integrates smart travel and mHealth. This paper explores the feasibility of implementing a custom-made geographically enabled mobile technology-based tool (RoadMApp) to counter the adverse effects of long travel times for maternal care in Kwekwe District, Zimbabwe. Methods: We frame the paper using the first two steps (listen & plan) of the Spiral Technology Action Research (STAR model). The paper uses an exploratory case study design and Participatory Learning Approaches (PLA) with stakeholders (community members) and in-depth interviews with key informants (health care service providers, pregnant women, transport operators). One hundred ninety-three participants took part in the study. We conducted focus group discussions with pregnant women, women of childbearing age, men (household heads), and elderly women. The discussion questions centered on travel time, availability of transport, cellular network coverage, and perceptions of the RoadMApp application. Data were analysed thematically using Nvivo Pro 12. Results: Most parts of rural Kwekwe are far from health facilities and have an inefficient road and telecommunications network. Hence, it is hard to predict if RoadMApp will integrate into the lives of the community-especially those in rural areas. Since these issues are pillars of the design of the RoadMApp mHealth, the implementation will probably be a challenge.

Background: Travel time and health care financing are key determinants to the provision of quality maternal health care in low resource settings. Despite the availability of pregnancy-related mHealth and smart travel applications, there is a lack of evidence on their usage to travel to health facilities for routine antenatal care and emergencies in low resource settings like Zimbabwe. Little is known about the feasibility of the usage of custom-made mobile technologies that integrate smart travel and mHealth. This paper explores the feasibility of implementing a custom-made geographically enabled mobile technology-based tool (RoadMApp) to counter the negative effects of long travel times and poor financing strategies for maternal care in Kwekwe District, Zimbabwe. Methods: Focus group discussions were conducted with pregnant women, women of childbearing age, men (household heads) and elderly women. Participatory learning approaches with stakeholders (community members) and in-depth interviews with key informants (health care service providers, transport operators) were utilised. In total 193 people took part in the study. The discussion questions centred on travel time, availability of transport, cellular network coverage and perceptions of the RoadMApp application. Data was analysed thematically using Nvivo Pro 12.Results: Most parts of rural Kwekwe have long distances to health facilities and an inefficient road and telecommunications network. Hence, it is hard to predict if RoadMApp will integrate into the lives of the community - especially those in rural areas. Since these issues are pillars of the design of the RoadMApp application, the implementation is likely to be challenging.Conclusion: Communities are keen to embrace the RoadMApp application. However, the feasibility of implementing RoadMApp in Kwekwe District will be challenging due to maternal health care barriers such as poor road network, poor phone network and the high cost of transport. There is, therefore, a need to investigate the social determinants of access to maternity services in order to inform the RoadMApp implementation.