Trends in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and vaccine antibody prevalence in a multi-ethnic inner-city antenatal population: A cross-sectional surveillance study.

OBJECTIVE: To determine severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in pregnancy in an inner-city setting and assess associations with demographic factors and vaccination timing. DESIGN: Repeated cross-sectional surveillance study. SETTING: London maternity centre. SAMPLE: A total of 906 pregnant women attending nuchal scans, July 2020-January 2022. METHODS: Blood samples were tested for IgG antibodies against SARS-CoV-2 nucleocapsid (N) and spike (S) proteins. Self-reported vaccination status and coronavirus disease 2019 (COVID-19) infection were recorded. Multivariable regression models determined demographic factors associated with seroprevalence and antibody titres. MAIN OUTCOME MEASURES: Immunoglobulin G N- and S-protein antibody titres. RESULTS: Of the 960 women, 196 (20.4%) were SARS-CoV-2 seropositive from previous infection. Of these, 70 (35.7%) self-reported previous infection. Among unvaccinated women, women of black ethnic backgrounds were most likely to be SARS-CoV-2 seropositive (versus white adjusted risk ratio [aRR] 1.88, 95% CI 1.35-2.61, p < 0.001). Women from black and mixed ethnic backgrounds were least likely to have a history of vaccination with seropositivity to S-protein (versus white aRR 0.58, 95% CI 0.40-0.84, p = 0.004; aRR 0.56, 95% CI 0.34-0.92, p = 0.021, respectively). Double vaccinated, previously infected women had higher IgG S-protein antibody titres than unvaccinated, previously infected women (mean difference 4.76 fold-change, 95% CI 2.65-6.86, p < 0.001). Vaccination timing before versus during pregnancy did not affect IgG S-antibody titres (mean difference -0.28 fold-change, 95% CI -2.61 to 2.04, p = 0.785). CONCLUSIONS: This cross-sectional study demonstrates high rates of asymptomatic SARS-CoV-2 infection with women of black ethnic backgrounds having higher infection risk and lower vaccine uptake. SARS-CoV-2 antibody titres were highest among double-vaccinated, infected women.

Women's health in post-COVID era: a report from the 11th international conference on women's health

This article discussed the importance of women's health in the growth and development of societies and emphasized the need to prioritize women's health challenges in health programs. The Health Policy Research Center in Shiraz, Iran, had launched the International Conference on Women's Health in 2011 to address interdisciplinary approaches to women's health. The Islamic World Educational, Scientific, and Cultural Organization had recommended the tagline "Healthy Women, Healthy World" and emphasized the priority of women's health in their activities. The article outlines the topics that were discussed at the 11th International Conference on Women's Health (ICWH 2022), including maternal health during the pandemic, new approaches to maternal health, sustainable development goals and maternal health, mental and physical health during the pandemic, intimate partner violence against women, and health systems and women's health. The article highlights the need for research-informed policies, continuous evaluation, and implementation of programs to promote women's health.

Quality of maternal and newborn care in Switzerland during the COVID-19 pandemic: A cross-sectional study based on WHO quality standards.

OBJECTIVE: To explore quality of maternal and newborn care (QMNC) in healthcare facilities during the COVID-19 pandemic in Switzerland. METHODS: Women giving birth in Switzerland answered a validated online questionnaire including 40 WHO standards-based quality measures. QMNC score was calculated according to linguistic region and mode of birth. Differences were assessed using logistic regression analysis adjusting for relevant variables. RESULTS: A total of 1175 women were included in the analysis. Limitations in QMNC during the pandemic were reported by 328 (27.9%) women. Several quality measures, such as deficient communication (18.0%, n = 212), insufficient number of healthcare professionals (19.7%, n = 231), no information on the newborn after cesarean (26.5%, n = 91) or maternal and newborn danger signs (34.1%, n = 401 and 41.4% n = 487, respectively) suggested preventable gaps in QMNC. Quality measures significantly differed by linguistic region and mode of birth. Multivariate analysis established a significantly lower QMNC for women in French- and Italian-speaking regions compared with the German-speaking region. Moreover, in several quality indicators reflecting communication with healthcare providers, women who did not answer the questionnaire in one of the Swiss national languages had significantly worse scores than others. A significant lower QMNC was also found for young and primiparous women and for those who experienced cesarean or instrumental vaginal birth. CONCLUSION: Women giving birth in Switzerland during the pandemic reported notable gaps in QMNC. Providers should be attuned to women who are younger, primiparous, and those who had an emergency cesarean or instrumental vaginal birth given the lower QMNC reported by these groups. Women who did not respond in a Swiss national language may need improved communication strategies.

Changes of trends in contraception in pandemic – A hospital-based study

Background: With the onset of COVID-19 pandemic, the life of humankind had changed a lot. With a change in health-care approach, contraception became a non-essential service and faced a downfall. Aims and Objective: This study objective is to find out the changes in contraceptive usage in a tertiary care center. Materials and Methods: The study is a retrospective observational study, in which contraceptive usage was compared between 2019 and 2020. Data obtained from record section of the institute were used as source. Attendance in Gynecological Outpatient Department, admission in maternity ward, and delivery rates were also compared between 2 years. Results: Total contraceptive usage was decreased by 11.1% in 2020. Long-acting reversible contraceptives or short-acting both types were decreased in 2020, but maximum decrease was barrier method condom by 25.1% and oral contraceptive pills by 24.9%. Hospital maternity ward admission was less by 7% and delivery rates by 2.4%. Only medical termination of pregnancy showed an increased trend in 2020. Conclusion: Pandemic also had caused a toll in family planning, and thus, overall decrease in usage was seen which can be detrimental to population control. [ FROM AUTHOR]

Maternity services' responses to the COVID-19 pandemic: how Public Health England guidance was implemented in practice.

INTRODUCTION: The rapidly evolving COVID-19 pandemic required systemic change in how healthcare was delivered to minimize virus transmission whilst maintaining safe service delivery. Deemed at 'moderate-high risk', maternity patients are an important patient group that require consideration. Public Health England (PHE) issued national guidance on how to adjust these services. AIM: To explore how maternity units in England implemented PHE guidance. METHODS: An online survey of 22 items was distributed to individuals that had worked on an England-based maternity unit during the COVID-19 pandemic. The questionnaire was designed and tested by the multidisciplinary research team. Data was collected from November 2020 to July 2021. FINDINGS: Forty-four participants across 33 maternity units responded. Ninety-three percent were able to test all women requiring an overnight stay for COVID-19. Only 27% reported birth partners were tested for COVID-19. Only 73% reported they were able to isolate all COVID-19-positive patients in single rooms. Eighty-four percent stated they were aware of current PHE guidance on personal protective equipment (PPE) and 82% felt 'confident' in donning/doffing of PPE. Priorities for the future include rapid testing and a focus on community service provision. CONCLUSIONS: PHE COVID-19 guidance was implemented differently in maternity units across England due to the varying resources available at each trust leading to variable ability to test and isolate patients as recommended. More specific, tailored guidance for infection control measures against COVID-19 is needed for maternity settings due to their unique position.

Burnout among Indian maternity care providers during COVID-19 pandemic

Background: Occupational burnout among healthcare providers has been a matter of focus since many years. Burnout can involve emotional and physical exhaustion and cause reduced acknowled-gement of personal accomplishment. Burnout can be accentuated in times of increased stress on healthcare system, like during the current episode of COVID-19 pandemic. Maternity care providers (MCP) face unique challenge in the given context owing to longer duty hours, high exposure to emergency situations and high expectation of deliverance. Subjects and Method: An online, nationwide, invited survey was conducted involving 198 MCP (28 interns, 52 residents, 82 consultant/faculty, 36 staff nurses) who were assessed for burnout and professional fulfillment using Professional fulfillment index (PFI), for self-preparedness regarding COVID-19 using Knowledge attitude and practice (KAP) questionnaire and for family support using another questionnaire.

Impact of COVID-19 on maternal and perinatal outcomes in Harare, Zimbabwe: a comparative maternal audit

Background: The COVID-19 pandemic lockdown resulted in the disruption of health services in Zimbabwe. The objectives of this study were two-fold. First, the study sought to determine the impact of the lockdown on maternal and perinatal outcomes at two tertiary hospitals in Harare, Zimbabwe, using a maternal audit. Second, the study sought to estimate the potential effect of COVID-19 related decreases in coverage of maternal and newborn health interventions on maternal, and neonatal mortality in Zimbabwe using the Lives Saved Tool (LiST).

Viral kinetics in SARS-CoV-2 infected asymptomatic patients

Introduction: As the daily number of patients diagnosed with SARS-CoV-2 infection by PCR increases, the necessity to identify truly infectious cases becomes more significant. We aimed to identify a cut-off Ct value of the COVID-19 RT-PCR assay for likely infectivity by assessing the COVID-19 IgG status and investigating the utility of the Rapid Antigen Test (RAT) in identifying infectious cases among asymptomatic individuals.

Impact of COVID-19 on maternal newborn child health services in Federal Medical Centre Gusau, Zamfara State

Background: Infectious diseases have been a constant threat to people's health and survival, at least thirty re-emerging and emerging diseases (Parks, 2009) are known to be of public health importance posing a burden to the health system;in addition, emergence of COVID-19 further tested the resilience of the health system to respond to public health emergencies (NCDC, 2020). This study assessed the effect of COVID-19 on use of maternal and child health (MNCH) services with objectives being the impact on family planning use, antenatal care visits, facility-based delivery and child related services such as immunization, child nutrition and outpatient clinic in FMC Gusau. Data from units offering MNCH services for six months, three months pre-covid-19 index case (January to March) and three months post covid-19 index case (April to June), corresponding to the period of lockdown, in addition same periods in the previous year (2019) was retrieved and entered into Statically package for social sciences (SPSS) now IBM statistic, comparison was made using comparable period of the year as well as a pre and post Covid index case. Over the six-months period, aggregate data shows that hospital visit for all categories of maternal newborn and child health reduced three months (April, May and June) post covid index case in the facility and subsequent proclamation of lockdown in the State, as compared to three-months pre-covid (January, February and first three weeks of March) Despite the additional burden imposed by the emergence of COVID-19 in FMC Gusau and the Attendant stretched on health system, the resilience of the health system was brought to fore, however with support from Federal ministry of health, National Centre for disease control and other agencies, FMC Gusau was able to use the COVID-19 emergency to strengthen service provision.

The COVID-19 pandemic and disruptions in a district quality improvement initiative: Experiences from the CLEVER Maternity Care programme.

BACKGROUND: Many health systems were poorly prepared for the coronavirus disease 2019 (COVID-19) pandemic and found it difficult to protect maternity and reproductive health services. The aim of the study was to explore the influence of the COVID-19 pandemic on the ability of maternity healthcare providers to maintain the positive practices introduced by the CLEVER Maternity Care programme and to elicit information on their support needs. METHODS: This multimethod study was conducted in midwife-led obstetric units (MOUs) and district hospitals in Tshwane District, South Africa and included a survey questionnaire and qualitative reports and reflections by the CLEVER implementation team. Two five-point Likert-scale items were supplemented by open-ended questions to provide suggestions on improving health systems and supporting healthcare workers. RESULTS: Most of the 114 respondents were advanced midwives or registered nurses (86%). Participants from MOUs rated the maintenance of quality care practices significantly higher than those from district hospitals (p = 0.0130). There was a significant difference in perceptions of support from the district management between designations (p = 0.0037), with managers having the most positive perception compared with advanced midwives (p = 0.0018) and registered nurses (p = 0.0115). The interpretation framework had three main themes: working environment and health-system readiness; quality of patient care and service provision; and healthcare workers' response to the pandemic. Health-facility readiness is described as proactive, reactive or lagging. CONCLUSION: Lessons learned from this pandemic should be used to build responsive health systems that will enable primary healthcare workers to maintain quality patient care, services and communication.

Women's experiences of maternity and perinatal mental health services during the first Covid-19 lockdown

This article presents evidence relating to the effects of Covid-19 on perinatal wellbeing, pregnancy and maternity. It describes findings from a qualitative project with 14 pregnant women and new mothers, conducted in England during the spring lockdown of 2020. It reveals that those who have additional vulnerabilities, such as financial insecurities, poor social relationships, experiences of birth trauma or physical and mental health difficulties have experienced the pandemic and social distancing measures with heightened effects on their wellbeing. Infant feeding support, health visits and baby weigh-in sessions were the three services most missed in their in-person formats and there was a near unanimous assertion that these are sorely needed. There was wide variation in accessing digital support;some were significantly unaware of sources of online support, with others using informal connections, some being supported extensively, remotely, by perinatal mental health services.

Experiences of Perinatal Mental Health Care among Minority Ethnic Women during the COVID-19 Pandemic in London: A Qualitative Study.

(1) Background: Approximately one in five women will experience mental health difficulties in the perinatal period. Women from ethnic minority backgrounds face a variety of barriers that can prevent or delay access to appropriate perinatal mental health care. COVID-19 pandemic restrictions created additional obstacles for this group of women. This study aims to explore minority ethnic women's experiences of perinatal mental health services during COVID-19 in London. (2) Methods: Eighteen women from ethnic minority backgrounds were interviewed, and data were subject to a thematic analysis. (3) Results: Three main themes were identified, each with two subthemes: 'Difficulties and Disruptions to Access' (Access to Appointments; Pandemic Restrictions and Disruption), 'Experiences of Remote Delivery' (Preference for Face-to-Face Contact; Advantages of Remote Support); and 'Psychosocial Experiences' linked to COVID-19 (Heightened Anxiety; Social Isolation). (4) Conclusions: Women from ethnic minority backgrounds experienced disrupted perinatal mental health care and COVID-19 restrictions compounding their mental health difficulties. Services should take women's circumstances into account and provide flexibility regarding remote delivery of care.

COVID-19 Effect on Access to Maternal Health Services in Kenya.

Introduction: Maternal mortality continues to be one of the biggest challenges of the health system in Kenya. Informal settlements in Kenya have been known to have higher rates of maternal mortality and also receive maternity services of varied quality. Data assessing progress on key maternal health indicators within informal settlements are also often scarce. The COVID-19 pandemic hit Kenya in March this year and so far, the impact of the pandemic on access to maternal health has not been established. This study aims to add to the body of knowledge by investigating the effects of the COVID-19 pandemic and mitigation strategies on access to health care services in informal settlements. Methods: Qualitative methods using in-depth interviews were used to assess women's experiences of maternity care during the COVID-19 era and the impact of proposed mitigation strategies such as the lockdown and the curfew. Other aspects of the maternity experience such as women's knowledge of COVID-19, their perceived risk of infection, access to health facilities, perceived quality of care were assessed. Challenges that women facing as a result of the lockdown and curfew with respect to maternal health access and quality were also assessed. Results: Our findings illustrate that there was a high awareness of the symptoms and preventative measures for COVID-19 amongst women in informal settlements. Our findings also show that women's perception of risk to themselves was high, whereas risk to family and friends, and in their neighborhood was perceived as low. Less than half of women reported reduced access due to fear of contracting Coronavirus, Deprioritization of health services, economic constraints, and psychosocial effects were reported due to the imposed lockdown and curfew. Most respondents perceived improvements in quality of care due to short-waiting times, hygiene measures, and responsive health personnel. However, this was only reported for the outpatient services and not in-patient services. Conclusion: The most important recommendation was for the Government to provide food followed by financial support and other basic amenities. This has implications for the Government's mitigation measures that are focused on public health measures and lack social safety-net approaches for the most vulnerable communities.

Restoring and maintaining robust maternity services in the COVID-19 era: a public health dilemma in Zimbabwe.

Lockdown policies, travel restrictions and reduced provision of healthcare in Zimbabwe in response to the COVID-19 pandemic have brought unprecedented challenges for healthcare delivery. Maternity services, including antenatal care, labour and delivery as well as postnatal care have been affected directly and indirectly by the pandemic and resultant control interventions, with delays introduced at several points across the continuum of care. Unfortunately, maternity conditions are time-sensitive, and delays can negatively impact feto-maternal outcomes, with increased maternal, fetal or neonatal morbidity and mortality. An audit at central hospitals revealed reduced utilisation of maternity services and a trend towards an increase in maternal mortality. A formal evaluation is required; however, mitigating public health interventions are required, especially as the burden of COVID-19 in the country has considerably come down. The World Health Organisation offers useful technical guidance for maintaining essential health services in pandemic times in low-resources settings, and rationalising the use of personal protective equipment, which can be contextualised and adopted to restore and maintain essential health services. Restoration of essential maternity services is urgently required in an environment that protects healthcare workers and their clients, minimising their risk of contracting COVID-19 whilst optimising fetomaternal outcomes. Thus, the various stakeholders involved in maternity care must urgently come together and find ways of achieving this goal.

Caring for the carers: Ensuring the provision of quality maternity care during a global pandemic.

The COVID-19 pandemic is impacting health systems worldwide. Maternity care providers must continue their core business in caring and supporting women, newborns and their families whilst also adapting to a rapidly changing health system environment. This article provides an overview of important considerations for supporting the emotional, mental and physical health needs of maternity care providers in the context of the unprecedented crisis that COVID-19 presents. Cooperation, planning ahead and adequate availability of PPE is critical. Thinking about the needs of maternity providers to prevent stress and burnout is essential. Emotional and psychological support needs to be available throughout the response. Prioritising food, rest and exercise are important. Healthcare workers are every country's most valuable resource and maternity providers need to be supported to provide the best quality care they can to women and newborns in exceptionally trying circumstances.