This study intended to investigate barriers to implementing evidence-based intrapartum care during vaginal births, from maternity care providers’ point of view.

A descriptive qualitative study was conducted using in-depth interviews, with data analysed through thematic analysis.

The labour room of a major tertiary care hospital in Central Sri Lanka.

Purposively selected 17 maternity care providers including doctors, nurse managers, nurse-midwives and midwives.

Three major themes and twelve sub-themes were generated: (1) barriers related to care providers (lack of human resources, negative attitudes of care providers, poor relationship among care providers, poor relationship between women and care providers, lack of knowledge on evidence-based practice in childbirth care); (2) barriers related to organisational environment (gaps in management, heavy workload, inadequate physical resources, insufficient in-service training and lack of availability/use of updated guidelines) and (3) barriers related to women’s birth preparedness (women’s limited knowledge on childbirth and intrapartum practices and women’s limited engagement during labour and childbirth). Many maternity care providers perceived that prevailing challenges to implement evidence-based childbirth care were one of the major reasons that impacted the quality of current childbirth care in the labour room.

The findings showed that an integrative approach may be essential to address the diverse barriers to the implementation of evidence-based intrapartum care. It is necessary to engage healthcare administrators, healthcare professionals and care recipients to enhance the quality of current childbirth care in the setting through the successful implementation of evidence-based care.

This study assessed the association between fine particulate matter (PM_2.5) exposure during pregnancy and stillbirth in Pakistan. We hypothesised that higher PM_2.5 exposure is linked to increased stillbirth risk.

A cross-sectional study using secondary data from the 2017 to 2018 Pakistan Demographic and Health Survey (PDHS), combined with satellite-derived PM_2.5 exposure data.

The study covered urban and rural areas across Pakistan, including all four provinces (Punjab, Sindh, Khyber Pakhtunkhwa and Baluchistan) and administrative regions (Gilgit-Baltistan (GB), Islamabad, Federally Administered Tribal Areas and Azad Jammu Kashmir).

The study included 9172 married women aged 15–49 with at least one birth in the past 5 years. Women with incomplete pregnancy outcome data were excluded.

PM_2.5 exposure was estimated using satellite data, matching PDHS clusters with the nearest air quality point via MATLAB. Monthly average exposure was categorised into quartiles.

Stillbirth, defined as pregnancy loss at ≥28 weeks gestation.

Multivariable logistic regression was used to assess the association between PM_2.5 and stillbirth, adjusting for maternal age, gravidity, wealth index, birth interval, previous adverse pregnancy outcome and region of residence. The stillbirth rate in Pakistan for the most recent pregnancy was 17.0 (14.5–19.9) per 1000 births, with highest rates (28.9) in Baluchistan province. The mean level of PM_2.5 exposure in Pakistan was 53.96 (SD 20.42; range 5.9–209.4) µg/m³. PM_2.5 exposure was higher for urban (56.43) than rural (51.87) pregnancies, highest in Sindh (78.06) and lowest in GB (13.41) provinces. For every 1 µg/m³ average increase in PM_2.5 during the pregnancy period, there was approximately 1% increase in stillbirth.

Increased PM_2.5 exposure was strongly associated with stillbirth risk. This underscores the need for targeted public health interventions, such as government regulations, emission controls and clean energy initiatives to protect pregnant women in high-risk areas.

Bangladesh is highly prone to recurrent flooding that disrupts all four pillars of food security. This study aimed to explore the effect of household food insecurity on the underweight status of women in flood-affected areas of Bangladesh, which remains underexplored.

This is a cross-sectional analysis.

This study was conducted in eight sub-districts (upazilas) across eight districts in Bangladesh that experience severe to moderate river flooding, flash floods and substantial tidal surges.

A total of 532 women participated in the study. The inclusion criteria for participation were as follows: (1) being at least 18 years of age, (2) residing in the household for at least 1 year and (3) having experienced limited food access in the 4 weeks before data collection due to flood-related constraints.

Household food insecurity was measured using the U.S. Agency for International Development Household Food Insecurity Access Scale questionnaire. An underweight status was evaluated through anthropometric measurements of women. Adjusted prevalence ratios (aPRs) were estimated using robust log-linear models.

Moderate food insecurity was the most common (58.3%) among the participants. The prevalence of underweight was the highest (52.1%) in the severely food-insecure group and decreased significantly with improved food security. Severe household food insecurity was strongly associated with a higher prevalence of underweight individuals (aPR = 4.12; 95% CI, 1.60 to 10.60). An underweight status was also prevalent in women from moderately food-insecure households (aPR = 1.75; 95% CI, 0.68 to 4.55).

This study reveals a significant association between household food insecurity and underweight status, highlighting the major challenges faced by women living in flood-prone areas of Bangladesh. These findings emphasise the urgent need to address household food insecurity to improve nutritional outcomes for women in vulnerable communities.

To evaluate the effectiveness of nutrition care delivered by general practitioners (GPs) compared with usual or no care on dietary and health outcomes in adults with diet-related chronic conditions or risk states and to examine which intervention components are associated with effectiveness.

A systematic review of randomised controlled trials (RCTs).

CINAHL, Embase, MEDLINE and ProQuest Nursing and Allied Health databases were searched in October 2021 and updated in February 2024 for articles related to GPs, nutrition care and diet-related health outcomes.

Published RCTs were included according to the following criteria: adults with or at risk of diet-related chronic conditions; nutrition care delivered by GPs in the primary care setting; usual or no care as comparators; and dietary and/or health outcomes with a minimum 3-month follow-up. No restriction was placed on the date of publication.

Duplicates were reconciled in EndNote. Two reviewers independently screened the titles, abstracts and full texts in Covidence. Two independent reviewers completed the critical appraisal and data extraction. Disagreements were resolved through discussion or with a third reviewer. The Motivation Actions and Prompts (MAP) framework was used to analyse the behaviour change components of study interventions. Results were reported using narrative synthesis and certainty in findings was summarised using GRADEpro GDT software.

Seven RCTs met the inclusion criteria (5744 patients). The trials were conducted in Australia, Italy and the USA from 1991 to 2013, with follow-up periods from 3 to 12 months. A consistent effect in favour of the intervention was found for diet scores (2 RCTs, 3038 participants). Other outcomes had mixed effects: (1) fat intake (2 RCTs, 2299 participants) – one study with an effect in favour of the intervention and one with mixed effects; (2) blood pressure (3 RCTs, 3063 participants) – one study with mixed effects and two with no effect; (3) body mass index (6 RCTs, 5538 participants) – two studies with an effect in favour of the intervention, two with no effect and two reporting no between group differences; (4) body weight (2 RCTs, 511 participants) – one study with an effect in favour of the intervention and one with no effect and (5) cholesterol (4 RCTs, 2505 participants) – one study with an effect in favour of the intervention and three with mixed effects and/or limited reporting. All studies had a motivation and action route to behaviour change and two had a prompted component, according to the MAP framework. The interventions spanned nine behaviour change groupings and 16 behaviour change techniques. There was a very low certainty of findings in all cases and the studies were of low to moderate methodological quality.

There is mixed evidence of the effectiveness of GP-delivered nutrition care among adults with diet-related chronic conditions or risk states. Additionally, most interventions did not include prompting and had a limited range of behaviour change techniques. The effectiveness of nutrition care delivered by GPs is an understudied area that warrants greater experimental investigation and requires more robust methods and reporting.

CRD42021289011.