Browsing by Author "Alati, Rosa"
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    Exploring the Risks of Repeated Pregnancy Among Adolescents and Young Women in the Philippines
    (Maternal and Child Health Journal, 2019-01-05) Maravilla, Joemer C. ; Betts, Kim S. ; Alati, Rosa
    Objective Knowledge of the factors which influence repeat pregnancy can inform much needed evidence-based prevention programs. This study aims to identify correlates of repeat pregnancy in the Philippines. Methods We used data from five Philippine Demographic and Health Surveys (1993–2013). A total of 4757 women 15–24 years old who had experienced ≥ 1 pregnancy were included. Individual and partner-related factors were fitted into a series of logistic regression stepwise models with deformalized survey weights. Stratified analyses using two age groups (15–19, 20–24) were also conducted. Interaction terms were included to test for statistical differences between the groups. Results Lower wealth quintiles [odds ratio (OR) 1.71, 95% confidence interval (CI) 1.17–2.49] and partner characteristics such as age of ≥ 30 years (OR = 1.99, CI = 1.41–2.82), multiple partners (OR = 4.19, CI = 1.57–11.19) and live-in status (OR = 1.38, CI = 1.02–1.87) were found to be highly correlated with repeat pregnancy in fully adjusted analysis. Receiving prenatal care from traditional healers (OR = 1.93, CI = 1.02–3.63) during the first pregnancy and giving birth for the first time before 18 years of age (OR = 1.12, CI = 1.04–1.20) showed increased risks among 15–19 years old compared to 20–24 years old in stratified analysis. Conclusions for practice In general, partner characteristics were associated with repeat pregnancy among young women suggesting male involvement, especially older partners, in family planning. High risks for repeat pregnancy were observed among adolescent women who reported younger age at first birth and received prenatal care from a traditional healer which entail promotion of trained prenatal care. Further analysis is needed to validate these findings in other developing countries.
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    Influence of Depression on Contraceptive Use among Adolescents
    (BMJ, 2019-11-18) Maravilla, Joemer C. ; Salom, Caroline ; Betts, Kim S. ; Alati, Rosa
    Aim Despite the extensive health promotion interventions to improve contraceptive uptake among sexually active adolescents, well-informed adolescents may still undertake poor contraceptive choices due to poor mental health. This study primarily sought to examine the effect of depression in adolescence on future use of modern contraception in young adulthood. Methods We used three (i.e. 2002, 2005 and 2007) waves of the Cebu Longitudinal Health and Nutrition Survey, which used multi-stage sample of mother-child dyads from a metropolitan area in the Philippines. In our analysis, we inlcuded a total of 453 male and nonpregnant female index children (IC) who ever had sexual activity and were not using any modern contraceptives at 18 years of age. Depression was measured when IC were approximately 18, 21 and 24 years old using the 16-item Center for Epidemiologic Studies-Depression (CES-D) Scale. We employed a series of multivariate logistic regression analyses to examine the longitudinal effect of depression on contraceptive use. All estimates obtained were adjusted for sex, age at first intercourse, family planning awareness, religiosity, number of past pregnancies for adolescent girls or times impregnated someone for adolescent boys, number of sexual partners, and school enrolment. Results Approximately one out of three sexually active adolescents exhibited depressive symptoms at 18 years old (CESD 10). High proportion of non-users at 21 years were observed among those with depression (91.06%) unlike those without (79.29%) at 18 years. Adjusted analyses showed a strong link between depressive symptoms and non-use of contraception. Adolescents with depressive symptoms at 18 years were approximately 3 times more likely not to use modern contraception at 21 years of ag [adjusted odds ratio (AOR)=3.01; 95% Confidence Interval (95% CI)= 1.44-6.23) and to consistently not use contraception at 21 and 24 years (AOR=2.91; 95% CI=1.03-8.22). Persistent depression at 21 years increased the risk of contraceptive non-use at 21 years by 3.36 times (Adjusted Risk Ratio=3.36; 95% CI=1.04-10.84). Conclusion Depressive symptoms strongly predicts young people’s decision to use modern contraception. Our study highlights the importance of early detection of depression and of addressing mental health issues to assure non-altered cognition in making contraceptive choices particularly during education and family planning counselling activities.
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    Intrauterine exposure to pre-eclampsia and the risk of autism spectrum disorder in offering: A meta-analysis
    (European Psychiatry, 2018-03-06) Dachew, Berihun ; Maravilla, Joemer ; Alati, Rosa ; Mamun, Abdullah
    Background: Evidence about the effect of intrauterine exposure to pre-eclampsia on offspring autism-spectrum disorder (ASD) is not well established. Aims To examine the association between pre-eclampsia and ASD. Method: PubMed, Embase and PsycINFO databases were searched. Pooled relative risks (RR) with 95% confidence intervals were calculated. Subgroup and sensitivity analyses were performed. Heterogeneity was assessed using Cochran's Q- and the I 2-test. The presence of publication bias was evaluated by Egger's test and visual inspection of the symmetry in funnel plots. Results: Ten studies meet the inclusion criteria. The risk of ASD was 32% higher in offspring who had intrauterine exposure to pre-eclampsia compared with those not exposed (RR = 1.32, 95% CI 1.20-1.45). Sensitivity analysis revealed consistent pooled estimates ranging from RR = 1.30 (95% CI 1.17-1.44) to RR = 1.37 (95% CI 1.26-1.48). We found no significant heterogeneity and evidence of publication bias. Conclusion: Pre-eclampsia increased the risk of ASD in offspring. The finding suggests a need for early screening for ASD in offspring of women with pre-eclampsia. Declaration of interest None.
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    Stunting of Children Under Two from Repeated Pregnancy Among Young Mothers
    (Scientific Reports Nature Research, 2020-08-31) Maravilla, Joemer C. ; Betts, Kim ; Adair, Linda ; Alati, Rosa
    Repeated pregnancy leaves young mothers nutritionally deprived which may in turn lead to poor infant growth. We measure the occurrence and persistence of stunting among offspring of young mothers who experienced repeated pregnancies using data from the Cebu Longitudinal Health and Nutrition Survey. We selected mothers aged 14–24 years (n = 1,033) with singleton birth. We determined the length-for-age z scores (LAZ) at 12 and 24 months of the index child using the World Health Organisation 2007 growth standard. We fitted LAZ, stunting occurrence (i.e. LAZ < − 2) and persistence from 12 to 24 months into regression models and tested for the mediating effect of low birthweight and feeding practices. In these models, repeated pregnancy was analysed in an ordinal approach using number of past pregnancies of young mothers at birth of the index child. Compared to infants born to young mothers aged 14–24 years who had no previous pregnancies, those born to young mothers with repeated pregnancies have at least 0.15 (95% CI − 0.23, − 0.08) LAZ lower and are at higher chance of stunting by at least 40% (95% CI 1.19, 1.67) at 12 and 24 months. Similar cohorts of infants showed an elevated risk of persistent stunting from 12 through 24 months with a relative risk ratio of 1.51 (95% CI 1.21, 1.88). Optimal feeding practices substantially mediated stunting outcomes by further reducing the effects of repeated pregnancy to stunting occurrence and persistence by 19.95% and 18.09% respectively. Mediation tests also showed low birthweight in the causal pathway between repeated pregnancy and stunting. Repeated pregnancy in young mothers is a predictor of stunting among children under 2 years. Secondary pregnancy prevention measures and addressing suboptimal feeding practices are beneficial to mitigate the negative impact of repeated adolescent pregnancy on children.
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    Trends in repeated pregnancy among adolescents in the Philippines from 1993 to 2013
    (BMC, 2018-11-06) Maravilla, Joemer C. ; Betts, Kim S. ; Alati, Rosa
    Objective: The extent of repeated pregnancy (RP) and repeated birth (RB) among adolescents aged 15–19 is still unknown in the Philippines despite the health and socio-economic consequences. This study aims to investigate the RP and RB prevalence trends in the Philippines from 1993 to 2013. Methods: A total of 7091 women aged 15–24 who experienced at least one pregnancy were captured in the Philippine demographic health surveys from 1993 to 2013. Annual RP and RB prevalence per age group in three and five categories were calculated and stratified by region, type of residence and wealth index. Cochran–Armitage tests and multivariate logistic regression were applied to determine trend estimates. Results: Compared to women aged 19–21 years and 22–24 years, for which decreasing patterns were found, RP ([Adjusted Odds ratio (AOR =0.96; 95%Confidence interval (CI) =0.82–1.11) and RB (AOR = 0.90; CI = 0.73–1.10) trends among 15–18 year olds showed negligible reduction over the 20 years. From a baseline prevalence of 20.39% in 1993, the prevalence of RP among adolescents had only reduced to 18.06% by 2013. Moreover, the prevalence of RB showed a negligible decline from 8.49% in 1993 to 7.80% in 2013. Although RP and RB prevalence were generally found more elevated in poorer communities, no differences in trends were noted across wealth quintiles. Conclusion: For two decades, the Philippines has shown a constant and considerably high RP prevalence. Further investigation, not only in the Philippines but also in other developing countries, is necessary to enable development of secondary prevention programs.