No abstract

Understanding the impact of neighborhood characteristics is crucial given its multigenerational impact. However, there is low availability of validated instruments measuring neighborhood dimensions, particularly in pregnant women, and a lack of cross-country validation of neighborhood-related scales. In this study, we used data from the [masked] study to assess the conceptual and measurement equivalence of the community domains of neighborhood cohesion, intergenerational closure, and neighborhood and social disorder, testing for measurement invariance across eight low- and middle-income countries (LMICs). Following this, we examined patterns of associations with prenatal maternal stress, well-being, and depressive symptoms through the use of nomological networks. We found that the conceptual and measurement equivalence of the neighborhood domains were good across the eight LMICs, although some adjustments had to be made to improve the model fit in two of the sites. Moreover, our results suggest that, in general, higher levels of neighborhood and social disorder, and lower levels of cohesion and intergenerational closure in the community were similarly associated with adverse maternal outcomes across the included sites. The results of this study emphasize the importance of exploring the community context when assessing maternal well-being and supports the need to advocate for community-based interventions that promote safer physical and social environments within maternal programs.

Background: Previous research shows that 61% of children younger than six months, in low-and middle-income countries (LMICs) are not exclusively breastfed. While data on the role of pre- and postnatal depression on breastfeeding exclusivity is mixed, foeto-maternal attachment might foster breastfeeding exclusivity. Thus, we tested the potential mediating role of foeto-maternal attachment and postnatal depression in the relationship between maternal prenatal depression and exclusive breastfeeding. Methods: Data were collected as part of a prospective, cross-cultural project, Evidence-for-Better-Lives-Study, which enrolled N=1208 expectant mothers, in their third trimester of pregnancy across eight sites, from LMICs. Of the whole sample, N=1185 women (Mage=28.32, SD=5.77) completed Computer-Aided-Personal-Interviews on prenatal depressive symptoms, foeto-maternal attachment and socio-economic status. N=1054 women provided follow-up data at 3-6 months after birth, about postnatal depressive symptoms, exclusive breastfeeding and infant health indicators. Path analysis was used to assess parallel mediation. Results: In the whole sample, the effect of prenatal depression on breastfeeding exclusivity was completely mediated by postnatal depression, while foeto-maternal attachment did not mediate the relationship. The full mediation effect was replicated individually in Pakistan and Sri Lanka.Conclusion: The study results indicate that prenatal depression symptoms contributed to the development of depressive symptoms after birth, negatively affecting the probability of exclusive breastfeeding. Future research should explore this in early prevention interventions, increasing the chances of healthy child development in LMICs. Considering the mixed results around the sites, it is important to better understand the relationship between maternal depression, foeto-maternal attachment and breastfeeding behavior in each site’s socio-cultural context. Abbreviations: LMICs, low- and middle-income countries

Background Kagami–Ogata syndrome is a rare genetic imprinting disorder involving the 14q32.2 genomic location of chromosome 14. The estimated incidence is less than 1 per 1 million. Here we report a male neonate with Kagami–Ogata syndrome presenting with severe respiratory distress requiring mechanical ventilation since birth. Case presentation A Sri Lankan male neonate born at term via caesarean section to a mother with type 1 diabetes mellitus and hypothyroidism developed respiratory distress immediately after birth. On examination, the baby had facial dysmorphism with a hirsute forehead, full cheeks, flat nasal bridge, elongated protruding philtrum, and micrognathia. His chest was small and bell shaped, and he had severe intercostal and subcostal recessions. His abdominal wall was lax and thin, with evidence of divarication of the recti. Bowel peristalsis was easily visible through the abdominal wall. The chest x-ray showed narrowing of the rib cage with crowding of the ribs in a “coat-hanger” appearance. The coat-hanger angle was 32°, and the mid-to-widest thoracic diameter was 68%. On the basis of facial dysmorphism, chest and anterior abdominal wall abnormalities, coat-hanger appearance of the rib cage, increased coat-hanger angle, and reduced mid-to-widest thoracic diameter, a clinical diagnosis of Kagami–Ogata syndrome was made. Owing to severe respiratory distress, the baby required intubation and ventilation immediately after birth. He was ventilator-dependent for 3 weeks; however, he was successfully weaned off the ventilator on day 22 after several failed extubation attempts. At 3-month follow-up, he had generalized hypotonia and mild global developmental delay. His developmental age corresponded to 2 months. Conclusions We report a patient with Kagami–Ogata syndrome presenting with respiratory distress immediately after birth. This case report highlights the importance of being aware of this rare condition, which could present as severe respiratory distress in term and preterm newborns. A positive diagnosis could avoid unnecessary treatment and aid in accurate prognostication.