Trial profile: community enabled readiness for first 1000-days learning ecosystem (CRADLE)

BackgroundThe first 1000 days presents a unique opportunity to enhance a child’s ability to grow, learn and thrive which will have a long term impact in a child’s future.ObjectivesThe Community enabled ReAdiness for first 1000-Days Learning Ecosystem (CRADLE) is a trial designed to develop a self-learning eco-community from pregnancy to early-childhood to promote parenting self-efficacy (PSE) and improve health outcomes for first-time families. Here, we describe the trial protocol and provide updates thus far.MethodsCRADLE is a parallel, three-arm randomised controlled trial which targets to recruit 750 pregnant women from KK Women’s and Children’s Hospital (KKH), Singapore. Participants are randomly assigned to receive: (1) standard routine care;(2) behavioural nudges and engagement via a social media platform;or (3) midwife-led continuity care involving direct individual engagement with midwives throughout pregnancy, to 6-month post-delivery.We hypothesize that the use of virtual targeted nudging tool in the form of text messages along with social media (arm 2), or face-to-face care from midwives supplemented with individualised teleconferencing sessions (arm 3) in the first 1000 days will lead to a better maternal PSE and health outcomes in both mother-child, compared with those who are receiving standard routine care (arm 1).The primary outcome is PSE, while the secondary outcomes include birth experience, mental wellness, feeding practice and nutritional status of mother-child. Participants are followed-up from recruitment visit (early-mid pregnancy) until child turns two years of age. Intention-to-treat and per-protocol analyses will be performed using general linear models to test the effects of interventions across three arms.ResultsThe trial was launched on 1 July 2020. As of 21 December 2020, a total of 60 participants were recruited with 2 of them withdrawn due to miscarriage. Currently, 14 participants have reached the postnatal stages. Participants’ baseline socio-demographic characteristics were similar across three arms, with the mean age of 31 years old, and the mean gestation of 18.1 weeks, at the time of recruitment. In terms of ethnicity, majority of recruited patients were Chinese (71.7%), followed by Malay (8.3%), Others (11.7%) and Indian (8.3%). 90% of the participants were employed, and over 70% of the participants attained tertiary education qualifications.ConclusionsDespite recruitment delay of a few months due to COVID-19, the team was able to recruit 60 participants over 5 months with strict safe distancing measures. Multiple strategies have been established to facilitate the recruitment including extending publicity of the programme within and outside of KKH. The team will initiate preliminary data once 100 participants have been recruited. To engage existing participants, CRADLE will hold its first health education webinar in January 2021. This study may identify a sustainable strategy in the community by helping first-time parents to have a positive experience during the pregnancy, childbirth and parenthood, leading to enhanced PSE and health outcomes for both mother and child.

Validation of self-collected buccal swab and saliva as a diagnostic tool for COVID-19.

BACKGROUND: Effective management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires large-scale testing to identify and isolate infectious carriers. Self-administered buccal swab and saliva collection are convenient, painless, and safe alternatives to the current healthcare worker (HCW)-collected nasopharyngeal swab (NPS). METHODS: A cross-sectional single-centre study was conducted on 42 participants who had tested positive for SARS-CoV-2 via an NPS within the past 7 days. Real-time polymerase chain reaction (RT-PCR) was performed and cycle threshold (Ct) values were obtained for each test. The positive percent agreement (PPA), negative percent agreement (NPA), and overall agreement (OA) were calculated for the saliva samples and buccal swabs, and compared with NPS. RESULTS: Among the 42 participants, 73.8% (31/42) tested positive by any one of the three tests. With reference to NPS, the saliva test had PPA 66.7%, NPA 91.7%, and OA 69.0%; the buccal swab had PPA 56.7%, NPA 100%, and OA 73.8%. CONCLUSION: Self-collected saliva tests and buccal swabs showed only moderate agreement with HCW-collected NPS. Primary screening for SARS-CoV-2 may be performed with a saliva test or buccal swab, with a negative test warranting a confirmatory NPS to avoid false-negatives, minimize discomfort, and reduce the risk of spread to the community and HCWs.

Attitudes and precaution practices towards COVID-19 among pregnant women in Singapore: a cross-sectional survey.

BACKGROUND: COVID-19 may predispose pregnant women to higher risks of severe disease and poorer neonatal outcome. Psychological sequalae of this pandemic may pose a greater conundrum than its clinical aspects. It is currently unknown that how pregnant women cope with this global pandemic and its ramifications. The aims of the study are to understand the attitudes and precaution practices of non-infected pregnant women towards the COVID-19 outbreak in Singapore. METHODS: An online cross-sectional survey of COVID-19 awareness among pregnant women attending antenatal clinics in Singapore was conducted. An internet link was provided to complete an online electronic survey on Google platform using a quick response (QR) code on mobile devices. The online survey consists of 34 questions that were categorized into 4 main sections, namely 1) social demographics 2) attitude on safe distancing measures 3) precaution practices and 4) perceptions of COVID-19. Multiple linear regression analysis was performed to examine women's precaution practices among six independent socio-demographic variables, including age, ethnicity, education, front-line jobs, history of miscarriage and type of antenatal clinic (general, high risk). RESULTS: A total of 167 survey responses were obtained over 8 weeks from April to June 2020. The majority of women were aged ≤35 years (76%, n = 127), were of Chinese ethnicity (55%, n = 91), attained tertiary education (62%, n = 104) and were not working as frontline staff (70%). Using multiple linear regression models, Malay ethnicity (vs. Chinese, ß 0.24; 95% CI 0.04, 0.44) was associated with higher frequency of practicing social distancing. Malay women (ß 0.48; 95% CI 0.16, 0.80) and those who worked as frontline staff (ß 0.28; 95% CI 0.01, 0.56) sanitized their hands at higher frequencies. Age of ≥36 years (vs. ≤30 years, ß 0.24; 95% CI 0.01, 0.46), Malay (vs. Chinese, ß 0.27; 95% CI 0.06, 0.48) and Indian ethnicity (vs. Chinese, ß 0.41; 95% CI 0.02, 0.80), and attendance at high-risk clinic (vs. general clinic, ß 0.20; 95% CI 0.01, 0.39) were associated with higher frequency of staying-at-home. CONCLUSION: Social demographical factors including age > 36 years old, Malay ethnicity, employment in front line jobs and attendance at high-risk clinics are likely to influence the attitudes and precaution practices among pregnant women towards COVID-19 in Singapore. Knowledge gained from our cross-sectional online survey can better guide clinicians to communicate better with pregnant women. Hence, it is important for clinicians to render appropriate counselling and focused clarification on the effect of COVID-19 among pregnant women for psychological support and mental well being.

Attitudes and precaution practices towards COVID-19 among pregnant women in Singapore: A cross-sectional survey (preprint)

Background: COVID-19 may predispose pregnant women to higher risks of severe disease and poorer neonatal outcome. Psychological sequalae of this pandemic may pose a greater conundrum than its clinical aspects. It is currently unknown that how pregnant women cope with this global pandemic and its ramifications. The aims of the study are to understand the attitudes and precaution practices of non-infected pregnant women towards the COVID-19 outbreak in Singapore. Methods: An online cross-sectional survey of COVID-19 awareness among pregnant women attending antenatal clinics in Singapore was conducted. An internet link was provided to complete an online electronic survey on Google platform using a quick response (QR) code on mobile devices. The online survey consists of 34 questions that were categorized into 4 main sections, namely 1) social demographics 2) attitude on safe distancing measures 3) precaution practices and 4) perceptions of COVID-19. Multiple linear regression analysis was performed to examine women’s precaution practices among six independent socio-demographic variables, including age, ethnicity , education , front-line jobs, history of miscarriage and type of antenatal clinic (general , high risk). Results: A total of 167 survey responses were obtained over eight weeks from April to June 2020. The majority of women were aged ≤35 years (76%, n=127), were of Chinese ethnicity (55%, n=91), attained tertiary education (62%, n=104) and were not working as frontline staff (70%). Using multiple linear regression models, Malay ethnicity (vs. Chinese, β 0.24; 95% CI 0.04, 0.44) was associated with higher frequency of practicing social distancing. Malay women (β 0.48; 95% CI 0.16, 0.80) and those who worked as frontline staff (β 0.28; 95% CI 0.01, 0.56) sanitized their hands at higher frequencies. Age of ≥36 years (vs. ≤30 years, β 0.24; 95% CI 0.01, 0.46), Malay (vs. Chinese, β 0.27; 95% CI 0.06, 0.48) and Indian ethnicity (vs. Chinese, β 0.41; 95% CI 0.02, 0.80), and attendance at high-risk clinic (vs. general clinic, β 0.20; 95% CI 0.01, 0.39) were associated with higher frequency of staying-at-home. Conclusion: Social demographical factors including age > 36 years old, Malay ethnicity, employment in front line jobs and attendance at high-risk clinics are likely to influence the attitudes and precaution practices among pregnant women towards COVID-19 in Singapore. Knowledge gained from our cross-sectional online survey can better guide clinicians to communicate better with pregnant women. Hence, it is important for clinicians to render appropriate counselling and focused clarification on the effect of COVID-19 among pregnant women for psychological support and mental wellbeing.

Attitude and perceptions towards COVID-19 among pregnant women in Singapore: A cross-sectional survey (preprint)

Background COVID-19 may predispose pregnant women to higher risks of severe disease and poorer neonatal outcome. Psychological sequalae of this pandemic may pose a greater conundrum than its clinical aspects.  It is currently unknown that how pregnant women cope with this global pandemic and its ramifications. The aims of the study are to understand the attitude and perceptions of non-infected  pregnant women towards the COVID-19 outbreak in Singapore. Methods  An online cross-sectional survey of COVID-19 awareness among pregnant women attending antenatal clinics in Singapore was conducted. An internet link was provided to complete an online electronic survey on Google platform using a quick response (QR) code on mobile devices. The online survey consists of 34 questions that were categorized into 4 main sections, namely 1) social demographics 2) attitude on safe distancing measures 3) precaution practices and 4) perceptions of COVID-19. Results A total of 167 survey responses were obtained over eight weeks from April to June 2020. The majority of women were aged ≤35 years (76%, n=127), were of Chinese ethnicity (55%, n=91), attained tertiary education (62%, n=104) and were not working as frontline staff (70%). Using multiple linear regression models, Malay ethnicity (vs. Chinese, β 0.24; 95% CI 0.04, 0.44) was associated with higher frequency of practicing social distancing. Malay women (β 0.48; 95% CI 0.16, 0.80) and those who worked as frontline staff (β 0.28; 95% CI 0.01, 0.56) sanitized their hands at higher frequencies. Age of ≥36 years (vs. ≤30 years, β 0.24; 95% CI 0.01, 0.46), Malay (vs. Chinese, β 0.27; 95% CI 0.06, 0.48) and Indian ethnicity (vs. Chinese, β 0.41; 95% CI 0.02, 0.80), and attendance at high-risk clinic (vs. general clinic, β 0.20; 95% CI 0.01, 0.39) were associated with higher frequency of staying-at-home.Conclusion It is important for clinicians to render appropriate counselling and focused clarification on the effect of COVID-19 among pregnant women for psychological support and mental wellbeing.