Papers by Alessandra N Bazzano
The Design Journal , 2017
Over the last two decades, as the disciplinary boundaries for the application of design have diss... more Over the last two decades, as the disciplinary boundaries for the application of design have dissolved, public health has emerged as one area within the social sector where design thinking and human-centred design have been applied more frequently. With that increased activity comes a need to understand how, why, for whom, and with what level of impact design thinking has been used. Many health projects receive public funding, and those that include design thinking approaches may thus be subject to evaluation more typically used in traditional biomedical research, with the potential for errors in translation between disciplines. The present paper considers the limitations and potential to further incorporate the two disciplinary approaches in order to improve progress
Assessment of the quality and content of national and international guidelines on hypertensive disorders of pregnancy using the AGREE II instrument
BMJ Open, 2016
High-quality evidence-based clinical practice guidelines can guide diagnosis and treatment to opt... more High-quality evidence-based clinical practice guidelines can guide diagnosis and treatment to optimise outcomes. The purpose of this study was to evaluate the quality and content of national and international guidelines on hypertensive disorders of pregnancy. The MEDLINE database, the National Guideline Clearinghouse and several international databases were searched for appropriate guidelines from the past 10 years. Six guidelines met inclusion and exclusion criteria and were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. A total of 695 records were identified and screened by two authors. Disorder definitions, classifications, preventive measures and treatment recommendations were evaluated and compared among guidelines. AGREE II results varied widely across domains and categories. Only two guidelines received consistently high ratings across domains and few demonstrated a high level of methodological rigour. Recommendations regarding classification and treatment were similar across guidelines, while assessment of preventive measures varied widely. Clinical practice guidelines for hypertensive disorders of pregnancy vary significantly in quality and with respect to assessment of preventive measures.
Understanding newborn hygiene practices in the home and community in rural Cambodia
The Role and Use of Misoprostol in Private Sector Reproductive Health Services in Cambodia
Misoprostol is an inexpensive synthetic prostaglandin, heat-stable at room temperature, and appro... more Misoprostol is an inexpensive synthetic prostaglandin, heat-stable at room temperature, and approved for treatment of gastric ulcers. Off-label use under supervision of health providers has been effective for post-partum hemorrhage and medical abortion in low resource settings. In countries where misoprostol is widely available without proper instruction and supervision of health providers, there may be an increase in complications and misuse, potentially impacting maternal health. In such locations, it may also be difficult to document use. Cambodia is a country with a consistently high maternal mortality rate where the private sector is preferred for reproductive health care services. Abortion is widely available in the private sector, and has been legal since 1997; medical abortion was only introduced in 2007. Analysis of worldwide sales of misoprostol-containing drugs indicates that the availability of misoprostol is increasing in low-income regions in Asia. Significant increase...
Trials, 2015
Background: Newborn health is a key issue in addressing the survival of children under five years... more Background: Newborn health is a key issue in addressing the survival of children under five years old, particularly in low and middle income countries, and the evidence base for newborn health interventions continues to evolve. Over the last decade, maternal and under five-year-old mortality and morbidity rates have been successfully reduced in Cambodia, but newborn health has lagged behind. Evidence suggests that an important proportion of newborn mortality both globally and in Cambodia is attributable to infections and sepsis. While initiatives are being implemented to address some causes of newborn illness (related to pre-term birth and asphyxia), a country-level approach to reducing infections has not been formulated. The Newborn Infection Control and Care Initiative (NICCI) is a community and health facility linked intervention to improve health outcomes for newborns.
International Journal of Environmental Research and Public Health, 2015
Infection contributes to a significant proportion of neonatal death and disability worldwide, wit... more Infection contributes to a significant proportion of neonatal death and disability worldwide, with the major burden occurring in the first week of life. Environmental conditions and gaps in water, sanitation and hygiene (WASH) practices may contribute to the risk of infection, particularly in settings where health centers are expanding to meet the growing demand for skilled care at birth and homes do not have adequate access to water and sanitation. A qualitative approach was used to understand the environmental context for infection prevention and control (IPC) and WASH associated behaviors in health centers where women give birth, and in homes of newborns, in a rural Cambodian province. Structured observations and focus group discussions revealed important gaps in optimal practices, and both structural and social barriers to maintaining IPC during delivery and postpartum. Solutions are available to address the issues identified, and tackling these could result in marked environmental improvement for quality of care and neonatal outcomes. Water, sanitation and hygiene in home and health center environments are likely to be important contributors to health and should be addressed in strategies to improve neonatal survival.
International Journal of Women's Health, 2015
Minor Side Effects, Tolerance and Discontinuation of Oral Contraception among Women in Rural Cambodia
British Journal of Medicine and Medical Research, 2014
Nutrients, 2014
Hormonal contraceptives may produce side effects that deter women from their use as a method of f... more Hormonal contraceptives may produce side effects that deter women from their use as a method of family planning. In nutritionally vulnerable populations these effects may be more pronounced due to micronutrient deficiencies and health status. Previous studies have been unable to resolve whether micronutrient supplementation may reduce such side effects. Aim: In a longitudinal study, 1011 women obtaining oral contraception through the public health system in rural Cambodia were allocated to either intervention or control groups, receiving either daily Vitamin B6 supplement or care as usual (without placebo). Results: The intervention participants (n = 577) reported fewer side effects in three categories: nausea/no appetite, headache, and depression compared with control group participants (n = 434). Conclusion: Women taking Vitamin B6 supplement were less likely to report side effects in a nutritionally vulnerable population. Underlying nutrition status should be considered by clinicians and reproductive health policy makers in the context of providing contraceptive services. Further investigation into micronutrient supplementation, particularly with B6, in reproductive-aged women using hormonal contraception should be conducted in other settings to determine the potential for widespread adoption. OPEN ACCESS Nutrients 2014, 6 3354
Tropical Medicine & International Health, 2008
objectives To assess newborn care-seeking practices in a rural area of Ghana where most births ta... more objectives To assess newborn care-seeking practices in a rural area of Ghana where most births take place at home in order to inform potential strategies for reducing newborn mortality.
Journal of Perinatology, 2008
To explore why women in Ghana initiate breast-feeding early or late, who gives advice about initi... more To explore why women in Ghana initiate breast-feeding early or late, who gives advice about initiation and what foods or fluids are given to babies when breast-feeding initiation is late. Qualitative data were collected through 52 semistructured interviews with recent mothers, 8 focus group discussions with women of child-bearing age and 13 semistructured interviews with health workers, policy makers and implementers. The major reasons for delaying initiation of breast-feeding were the perception of a lack of breast milk, performing postbirth activities such as bathing, perception that the mother and the baby need rest after birth and the baby not crying for milk. Facilitating factors for early initiation included delivery in a health facility, where the staff encouraged early breast-feeding, and the belief in some ethnic groups that putting the baby to the breast encourages the milk. Policy makers tended to focus on exclusive breast-feeding rather than early initiation. Most activities for the promotion of early initiation of breast-feeding were focused on health facilities with very few community activities. It is important to raise awareness about early initiation of breastfeeding in communities and in the policy arena. Interventions should focus on addressing barriers to early initiation and should include a community component.
International Journal of Women's Health, 2014
International Journal of Women's Health Dovepress submit your manuscript | www.dovepress.com Dove... more International Journal of Women's Health Dovepress submit your manuscript | www.dovepress.com Dovepress 389 P e r s P e c t I v e s open access to scientific and medical research Open Access Full text Article
International Journal of Gynecology & Obstetrics, 2008
Objective: To examine the social costs to women of skilled attendance at birth in rural Ghana. Me... more Objective: To examine the social costs to women of skilled attendance at birth in rural Ghana. Method: Ethnographic data were obtained through participant observation, interviews, case histories, and focus groups and were analyzed alongside data from a birth cohort of 2878 singletons born in the Kintampo study district between July 2003 and June 2004. Results: Most women delivered at home. Home delivery raises a woman's status in her community, while seeking skilled attendance lowers it. Women feel that seeking assistance in childbirth wastes other people's time and they value secrecy in labor. Negative treatment by health providers and expensive supplies needed for delivery also act as barriers. Conclusion: The social costs of obtaining skilled attendance at birth must be offset by community level strategies such as mobilization of older women and husbands, and ensuring health providers extend professional, humane care to laboring women.
Global Health Promotion, 2012
Skin-to-skin contact (STSC) for low birth weight newborns in community settings may greatly impro... more Skin-to-skin contact (STSC) for low birth weight newborns in community settings may greatly improve survival, especially where access to health facilities is limited. Community STSC has been implemented in large-scale trials in Asia and is recommended by WHO and UNICEF. In countries where the practice is entirely new, such as Ghana, STSC may need special educational approaches. Objective: The dual aims of this study were to understand the acceptance and barriers to STSC in an African community setting and to use in-depth formative research to contribute to the success of a behavior-based health intervention. Design: A rapid qualitative study with an intentionally small sample. Setting: Kintampo, Ghana, a predominately rural, agrarian area in the center of the country with diverse ethnic groups in a forest-savannah transition zone. Method: Key informants were consulted through in-depth interviews and focus group discussions to develop the pilot. Five mothers participated in pilot instruction (four refused), which included counseling and used a trials-ofimproved-practices methodology; data from group discussion with traditional birth attendants were also included. Results: It was difficult to overcome barriers to the practice (post partum pain, fear of harming the umbilicus), and less intractable barriers (traditional carrying practices, fear of causing harm, lack of back support, time constraints, breast feeding issues) were reported. Conclusion: Some study participants tried STSC but none did it continuously. As promotion of STSC could be vital for improving newborn survival in low resource settings, tackling perceived barriers may be an important way to increase acceptability of this practice. (Global Health Promotion, 2012; 19(3): 42-49)
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Papers by Alessandra N Bazzano