Journal of Preventive Medicine and Public Health

Original Articles

Institutional Delivery in the Philippines: Does a Minimum of 8 Antenatal Care Visits Matter?: Felly Philipus Senewe, Agung Dwi Laksono, Roy Glenn Albert Massie, Leny Latifah, Syarifah Nuraini, Rozana Ika Agustiya, Jane Kartika Propiana, Wahyu Pudji Nugraheni; J Prev Med Public Health. 2025;58(1):44-51. Published online October 22, 2024; DOI: https://doi.org/10.3961/jpmph.24.245

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Abstract Summary PDF: Objectives
This cross-sectional study investigated the association between the utilization of 8 antenatal care (ANC) visits and delivery in a healthcare institution in the Philippines, using data from the 2022 National Demographic and Health Survey.
Methods
A sample of women who had given birth within the past 3 years was selected for analysis (n=4452). The association between ANC utilization and institutional delivery was assessed using logistic regression models, covariates by relevant socio-demographic factors, and childbirth history.
Results
We found that 97.2% of respondents who completed ANC opted for institutional delivery. A higher proportion of rural residents did not undergo institutional delivery than urban residents (12.9 vs. 6.9%). The group aged 20-24 years had the highest coverage (92.8%), and the group aged 40-44 years had the lowest. Higher education levels, employment, and greater wealth were associated with higher institutional delivery rates. Divorced or widowed mothers (85.1%) and grand multiparous mothers had lower rates than other groups. Multivariable logistic regression analysis showed a significant positive association between ANC utilization and institutional deliveries after adjusting for covariates (adjusted odds ratio, 2.486; 95% confidence interval, 2.485 to 2.487; p<0.001).
Conclusions
ANC visits were associated with deliveries in institutions in the Philippines. Policymakers should promote ANC by ensuring 8 World Health Organization-recommended visits, strengthening programs, conducting community outreach, addressing access barriers, and integrating maternal health services to increase institutional births and improve maternal and infant health.; Summary

Key Message
This study examines the determinants of institutional delivery in the Philippines, with a focus on compliance with the WHO-recommended eight antenatal care (ANC) visits. Analysis of data from the 2022 National Demographic and Health Survey reveals a strong positive correlation between completing the recommended ANC visits and choosing institutional delivery, alongside significant influences from maternal age, education, marital status, employment, socioeconomic status, and parity. Findings underscore the importance of expanding ANC access and targeted interventions, particularly in underserved areas, to increase institutional delivery rates and improve maternal and neonatal health outcomes.

Postpartum Depression in Young Mothers in Urban and Rural Indonesia: Alifa Syamantha Putri, Tri Wurisastuti, Indri Yunita Suryaputri, Rofingatul Mubasyiroh; J Prev Med Public Health. 2023;56(3):272-281. Published online May 7, 2023; DOI: https://doi.org/10.3961/jpmph.22.534

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Objectives
Young mothers are vulnerable to postpartum depression due to role transition-related stress. Understanding the causes underlying these stressors is essential for developing effective interventions.
Methods
This study analyzed the 2018 Indonesian Basic Health Research data. The Mini International Neuropsychiatric Interview was used to assess postpartum depression symptoms in mothers aged 15-24 years with infants aged 0-6 months. In 1285 subjects, the risk factors for postpartum depression were evaluated using multivariate logistic regression.
Results
The overall prevalence of depression in the 6 months postpartum was 4.0%, with a higher prevalence in urban areas (5.7%) than in rural areas (2.9%). Urban and rural young mothers showed distinct postpartum depression risk factors. In urban areas, living without a husband (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.24 to 11.76), experiencing preterm birth (OR, 4.67; 95% CI, 1.50 to 14.50), having pregnancy complications (OR, 3.03; 95% CI, 1.20 to 7.66), and having postpartum complications (OR, 5.23; 95% CI, 1.98 to 13.80) were associated with a higher risk of postpartum depression. In rural areas, postpartum depression was significantly associated with a smaller household size (OR, 3.22; 95% CI, 1.00 to 10.38), unwanted pregnancy (OR, 4.40; 95% CI, 1.15 to 16.86), and pregnancy complications (OR, 3.41; 95% CI, 1.31 to 8.88).
Conclusions
In both urban and rural contexts, postpartum depression relates to the availability of others to accompany young mothers throughout the postpartum period and offer support with reproductive issues. Support from the family and the healthcare system is essential to young mothers’ mental health. The healthcare system needs to involve families to support young mothers’ mental health from pregnancy until the postpartum period.

Summary

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Scoping Review

Pre-pregnancy Diet to Maternal and Child Health Outcome: A Scoping Review of Current Evidence: Fadila Wirawan, Desak Gede Arie Yudhantari, Aghnaa Gayatri; J Prev Med Public Health. 2023;56(2):111-127. Published online March 13, 2023; DOI: https://doi.org/10.3961/jpmph.22.472

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Abstract PDF Supplementary Material

Objectives
Pre-pregnancy diet has an important role in preparing for healthy generation. However, evidence on this issue has been scarce. A scoping review synthesising current evidence will support the demand to map ‘what has been researched’ on pre-pregnancy diet and maternal and child health.
Methods
Systematic search was performed using PICOS (Population, Intervention, Comparison, Outcomes, and Study design) framework in electronic databases. Articles were screened for eligibility, summarized, and the quality was assessed using the National Institute of Health assessment tool. The review structure complies with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guide.
Results
Forty-two articles were included after full-text screening. Twenty-five studies were in high-income countries (HICs), six in each upper-middle income, five in lower-middle income countries (LMICs), and one in low-income countries (LIC). Based on the regions: North America (n=16), Europe (n=5), South America (n=4), Australia (n=4), Asia (n=5), Middle East (n=2), and sub-Saharan Africa (n=1). The two-most observed diet-related exposures were dietary pattern (n=17) and dietary quality (n=12). The most assessed outcome was gestational diabetes mellitus (n=28) and fetal and newborn anthropometry (n=7). The average quality score±standard deviation was 70±18%.
Conclusions
Research related to pre-pregnancy diet is still concentrated in HICs. The context of diet may vary; therefore, future research is encouraged in LMICs and LICs context, and Mediterranean, South-East Asia, Pacific, and African regions. Some maternal and child nutrition-related morbidity, such as anemia and micronutrient deficiencies, have not been discussed. Research on these aspects will benefit to fill in the gaps related to pre-pregnancy diet and maternal and child health.

Summary

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Original Article

A Regionalization Model to Increase Equity of Access to Maternal and Neonatal Care Services in Iran: Zahra Mohammadi Daniali, Mohammad Mehdi Sepehri, Farzad Movahedi Sobhani, Mohammad Heidarzadeh; J Prev Med Public Health. 2022;55(1):49-59. Published online December 28, 2021; DOI: https://doi.org/10.3961/jpmph.21.401

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Abstract PDF Supplementary Material

Objectives
Access to maternal and neonatal care services (MNCS) is an important goal of health policy in developing countries. In this study, we proposed a 3-level hierarchical location-allocation model to maximize the coverage of MNCS providers in Iran.
Methods
First, the necessary criteria for designing an MNCS network were explored. Birth data, including gestational age and birth weight, were collected from the data bank of the Iranian Maternal and Neonatal Network national registry based on 3 service levels (I, II, and III). Vehicular travel times between the points of demand and MNCS providers were considered. Alternative MNCS were mapped in some cities to reduce access difficulties.
Results
It was found that 130, 121, and 86 MNCS providers were needed to respond to level I, II, and III demands, respectively, in 373 cities. Service level III was not available in 39 cities within the determined travel time, which led to an increased average travel time of 173 minutes to the nearest MNCS provider.
Conclusions
This study revealed inequalities in the distribution of MNCS providers. Management of the distribution of MNCS providers can be used to enhance spatial access to health services and reduce the risk of neonatal mortality and morbidity. This method may provide a sustainable healthcare solution at the policy and decision-making level for regional, or even universal, healthcare networks.

Summary

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Perspective

Group Antenatal Care: A Paradigm Shift to Explore for Positive Impacts in Resource-poor Settings: Bhanu Pratap Singh Gaur, Jyothi Vasudevan, Bhabani Pegu; J Prev Med Public Health. 2021;54(1):81-84. Published online December 8, 2020; DOI: https://doi.org/10.3961/jpmph.20.349

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Abstract PDF

The delivery of high-quality antenatal care is a perennial global concern for improving maternal and neonatal outcomes. Antenatal care is currently provided mainly on a one-to-one basis, but growing evidence has emerged to support the effectiveness of group antenatal care. Providing care in a small group gives expectant mothers the opportunity to have discussions with their peers about certain issues and concerns that are unique to them and to form a support system that will improve the quality and utilization of antenatal care services. The aim of this article is to promote group antenatal care as a means to increase utilization of healthcare.

Summary

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Qualitative evaluation of a package of implementation strategies codesigned to support the introduction of multiple micronutrient supplementation (MMS) for pregnant women in Bamako, Mali
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Belonging: a meta-theme analysis of women’s community-making in group antenatal and postnatal care
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Original Article

Effects of Socio-demographic Factors on the Decreasing Trend in the Sex Ratio at Birth in Korea, 1997-2017: Jisuk Bae; J Prev Med Public Health. 2020;53(5):371-380. Published online August 7, 2020; DOI: https://doi.org/10.3961/jpmph.20.282

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Abstract PDF Supplementary Material: Objectives
This study investigated the effects of socio-demographic factors on the decreasing trend in the sex ratio at birth from 1997 to 2017 in Korea.
Methods
Data from 10 349 602 live births registered with Statistics Korea from 1997 to 2017 were analyzed. The secondary sex ratio (SSR), defined as the ratio of male to female live births, during the study period (1997-1999 [phase I], 2000-2002 [phase II], 2003-2005 [phase III], 2006-2008 [phase IV], 2009-2011 [phase V], 2012-2014 [phase VI], and 2015-2017 [phase VII]) was calculated according to selected socio-demographic factors, such as parental age, education, occupation, and birth order. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals for a male birth after adjusting for potential confounders.
Results
The SSR gradually decreased from 1.10 (in 1998-2000 and 2002) to 1.05 (in 2013-2016). While a decreasing trend in the SSR was not noted among first births, male-biased sex ratios were prominent among third and higher-order births, for which the highest SSR was 1.46 in 1998. Higher birth order was significantly associated with an excess of male births in phases I-VI (≥third vs. first, OR range, 1.03 to 1.35). Advanced maternal age was significantly associated with an excess of female births in phases II, III, and V (≥40 vs. 20-24 years, OR range, 0.92 to 0.95).
Conclusions
This study demonstrated that advanced maternal age and reduction of the artificially-biased SSR among third and higher-order births may partially explain the decreasing trend in the SSR from 1997 to 2017 in Korea.; Summary

Review

The Protective Effect of Maternal Folic Acid Supplementation on Childhood Cancer: A Systematic Review and Meta-analysis of Case-control Studies: Wan Rosmawati Wan Ismail, Raudah Abdul Rahman, Nur Ashiqin Abd Rahman, Azman Atil, Azmawati Mohammed Nawi; J Prev Med Public Health. 2019;52(4):205-213. Published online July 2, 2019; DOI: https://doi.org/10.3961/jpmph.19.020

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Abstract PDF

Objectives
Maternal folic acid supplementation is considered mandatory in almost every country in the world to prevent congenital malformations. However, little is known about the association of maternal folic acid intake with the occurrence of childhood cancer. Hence, this study aimed to determine the effects of maternal folic acid consumption on the risk of childhood cancer.
Methods
A total of 158 related articles were obtained from PubMed, Google Scholar, Scopus, and ProQuest using standardized keywords, of which 17 were included in the final review.
Results
Eleven of the 17 articles showed a significant protective association between maternal folic acid supplementation and childhood cancer. Using a random-effects model, pooled odds ratios (ORs) showed a protective association between maternal folic acid supplementation and childhood acute lymphoblastic leukaemia (OR, 0.75; 95% confidence interval [CI], 0.66 to 0.86). However, there was no significant association between maternal folic acid supplementation and acute myeloid leukaemia (OR, 0.70; 95% CI, 0.46 to 1.06) or childhood brain tumours (OR, 1.02; 95% CI, 0.88 to 1.19).
Conclusions
Maternal folic acid supplementation was found to have a protective effect against childhood acute lymphoblastic leukaemia. Thus, healthcare professionals are recommended to provide regular health education and health promotion to the community on the benefits of folic acid supplementation during pregnancy.

Summary

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Original Articles

Impact of Changes in Maternal Age and Parity Distribution on the Increasing Trends in the Low Birth Weight and Very Low Birth Weight Rates in South Korea, 2005-2015: Yujin Oh, Jisuk Bae; J Prev Med Public Health. 2019;52(2):123-130. Published online March 14, 2019; DOI: https://doi.org/10.3961/jpmph.18.247

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Abstract Summary PDF

Objectives
The aim of this study was to evaluate the impact of shifts in maternal age and parity on the increasing trends in the low birth weight (LBW) and very low birth weight (VLBW) rates from 2005 to 2015 in South Korea.
Methods
Data from 4 993 041 live births registered with Statistics Korea during the period between 2005 and 2015 were analyzed. Applying a modified standardization method, we partitioned the total increment in the LBW and VLBW rates into (1) the increase in the LBW and VLBW rates due to changes in the maternal age and parity distribution (AP-dis) and (2) the increase due to changes in the age-specific and parity-specific rates (AP-spe) of LBW and VLBW for singleton and multiple births, respectively.
Results
During the study period, the total increment in the LBW and VLBW rates was 1.43%p and 0.25%p, respectively. Among singleton births, changes in the AP-dis accounted for 79% (0.34%p) and 50% (0.06%p) of the total increment in the LBW and VLBW rates, respectively. Meanwhile, among multiple births, changes in the AP-dis did not contribute to the increase in the LBW and VLBW rates, with 100% of the increase in the LBW (1.00%p) and VLBW (0.13%p) rates being attributed to changes in the AP-spe.
Conclusions
This study demonstrated that shifts in maternal age and parity were prominent contributors to the increase in the LBW and VLBW rates among singleton births between 2005 and 2015 in South Korea.

Summary

Korean summary
우리나라 출생자료를 이용하여 2005년부터 2015년까지 한국인 저출생체중아 및 극소저출생체중아 발생률 증가에서 1) 산모연령 및 출산순위 분포변화에 기인하는 부분과 2) 이들 분포변화 이외의 요인에 기인하는 부분을 수정된 표준화법을 적용하여 평가하였다. 분석 결과, 단태아에서 저출생체중아 발생률 증가량의 79% (0.34%p), 극소저출생체중아 발생률 증가량의 50% (0.06%p)가 산모연령 및 출산순위 분포변화에 기인한 것으로 나타났다. 반면, 다태아에서는 저출생체중아 및 극소저출생체중아 발생률 증가량의 100% (저출생체중아 1.00%p, 극소저출생체중아 0.13%p)가 이들 분포변화 이외의 요인에 기인한 것으로 나타났다.

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Changes in the Distribution of Maternal Age and Parity and Increasing Trends in the Low Birth Weight Rate in Korea Between 1995 and 2005: Jisuk Bae, Jung Han Park, Yoo Keun Park, Jong-Yeon Kim, Sang-Won Lee, Soon-Woo Park; J Prev Med Public Health. 2011;44(3):111-117. Published online May 17, 2010; DOI: https://doi.org/10.3961/jpmph.2011.44.3.111

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Abstract PDF

Objectives

This study measured the impact of shifts in maternal age and parity on the increase in the low birth weight (LBW) rate in Korea.

Methods

We obtained raw data for all 6 397 945 live births registered at the Korea National Statistical Office between 1995 and 2005. We calculated the proportion of increment in the LBW rate due to changes in the distribution of maternal age and parity (AP-dis) and the proportion due to changes in the age- and parity-specific LBW rate (AP-spe).

Results

The LBW rate increased from 3.02% in 1995 to 4.28% in 2005. The multiple birth rate increased from 1.32% to 2.19% during the same period. Of the 1.26% points increment in the LBW rate, 0.64% points occurred among singleton births and 0.62% points occurred among multiple births. Changes in the AP-dis accounted for 50% of the increase in the LBW rate among singleton births, but did not contribute to the increase in the LBW rate among multiple births. The remainder of the total increment in the LBW rate was explained by the increase in the AP-spe.

Conclusions

This study demonstrated that shifts in maternal age and parity among singleton births and increased multiple births were important contributors to the increment in the LBW rate. This study also revealed that the increase in the AP-spe was an equally important contributor as the shifts in maternal age and parity to the increment in the LBW rate among singleton births and was a major contributor among multiple births.

Summary

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Impact of Changes in Maternal Age and Parity Distribution on the Increasing Trends in the Low Birth Weight and Very Low Birth Weight Rates in South Korea, 2005-2015
Yujin Oh, Jisuk Bae
Journal of Preventive Medicine and Public Health.2019; 52(2): 123. CrossRef
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Research Support, Non-U.S. Gov't

Differential Parental Transmission of Markers in BCL3 among Korean Cleft Case-parent Trios.: Beyoung Yun Park, Jae Woong Sull, Jung Yong Park, Sun Ha Jee, Terri H Beaty; J Prev Med Public Health. 2009;42(1):1-4.; DOI: https://doi.org/10.3961/jpmph.2009.42.1.1

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48 Download
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Abstract PDF

OBJECTIVES
Isolated cleft lip with or without cleft palate (CL/P) is among the most common human birth defects, with a prevalence of approximately 1 in 700 live births. The B-Cell Leukemia/lymphoma 3 (BCL3) gene has been suggested as a candidate gene for CL/P based on association and linkage studies in some populations. This study tests for an association between markers in BCL3 and isolated, non-syndromic CL/P using a case-parent trio design, while considering parent-of-origin effects. METHODS: Forty case-parent trios were genotyped for two single nucleotide polymorphisms (SNPs) in the BCL3 gene. We performed a transmission disequilibrium test (TDT) on individual SNPs, and the FAMHAP package was used to estimate haplotype frequencies and to test for excess transmission of multi-SNP haplotypes. RESULTS: The odds ratio for transmission of the minor allele, OR (transmission), was significant for SNP rs8100239 (OR=3.50, p=0.004) and rs2965169 (OR=2.08, p=0.027) when parent-of-origin was not considered. Parent-specific TDT revealed that SNP rs8100239 showed excess maternal transmission. Analysis of haplotypes of rs2965169 and rs8100239 also suggested excess maternal transmission. CONCLUSIONS: BCL3 appears to influence risk of CL/P through a parent-of-origin effect with excess maternal transmission.

Summary

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Original Article

A Survey on Prenatal Environmental Risk Factors for Mothers of Low Birth Weight Infants in Asan-City.: Heeyoung Lee, Seok Jun Yoon, Hyungsik Ahn, Mina Ha, Kyung Sim Koh, Kyung Ja June; J Prev Med Public Health. 2004;37(1):11-16.

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Abstract PDF: OBJECTIVE
In this study, we aimed to produce basic data on the prenatal environmental risk factors of low birth weight infants at a community level. METHODS: In 2000, we conducted the direct interview using questionnaire about prenatal environmental risk factors with low birth weight infant-delivered mothers and normal weight infant-delivered mothers in Asan-city, Chungcheongnamdo Province, Korea. The questions given to the mothers included past pregnancy history, menstrual status, disease history before and during the pregnancy, family history, environmental risk factors and exposure history. The responses of the two groups were compared to calculate the prenatal environmental risk factors of each group. RESULTS: Mothers' smoking was significantly associated with low birth weight infants (adjusted odds ratio (AOR) 3.27; 95% confidence interval (CI) 1.25-8.56) and preterm baby (AOR 4.20; 95% CI, 1.21-14.61). Other environmental risk factors were not significantly different between the two groups. CONCLUSION: Smoking of mothers can be a risk factor for the delivery of low birth weight infants. These results could provide the basic data on prenatal environmental risk factors of mothers of low birth weight infants and suggest research topics for further community-based evaluation.; Summary

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