The human gut is the habitat for diverse and dynamic microbial ecosystem. The human microbiota plays a critical role in functions that sustain health and is a positive asset in host defenses. Establishment of the human intestinal microbiota during infancy may be influenced by multiple factors including delivery mode. Present review compiles existing evidences on the effect of delivery mode on the diversity and colonization pattern of infants gut microbiota. Two investigators searched for relevant scientific publications from four databases (Pubmed, Medline, Embase, and Web of Science). The last search was performed on September 21, 2015, using key terms ((delivery mode OR caesarean delivery OR cesarean section OR vaginal delivery) AND (gut microbiota OR gut microbiome OR gut microflora OR intestinal microflora OR microbial diversity) AND (infants OR children)). All included studies described at least two types of gut microbiota in relation to delivery mode (caesarean section vs vaginal delivery) and used fecal samples to detect gut microbiota. Seven out of 652 retrieved studies met inclusion criteria, were included in systematic analysis. Caesarean Section (CS) was associated with both lower abundance and diversity of the phyala Actinobacteria and Bacteroidetes, and higher abundance and diversity of the phylum Firmicute from birth to 3 months of life. At the colonization level, Bifidobacterium, and Bacteroides genera seems to be significantly more frequent in vaginally delivered infants compared with CS delivered. These infants were more colonized by the Clostridium, and Lactobacillus genera. From the reports, it is tempting to say that delivery mode has less effect on colonization and diversity of Bifidobacteria, Bacteroides, Clostridium, and Lactobacillus genera from the age of 6 to 12 months of life. The diversity and colonization pattern of the gut microbiota were significantly associated to the mode of delivery during the first three months of life, however the observed significant differences disappears after 6 months of infants life. The healthy gut microbiota is considered to promote development and maturation of the immune system while abnormal gut is considered as the major cause of severe gastrointestinal infections during the infancy. Further studies should investigate the diversity and colonization levels of infant gut microbiota in relation to the mode of delivery and its broad impact on infants’ health at each stage of life.

The increase rates of cesarean section (CS) occurred at the same period as the dramatic increase of childhood overweight/obesity. In China, cesarean section rates have exponentially increased in the last 20 years and they now exceed World Health Organization (WHO) recommendation. Such high rates demand an understanding to the long-term consequences on child health. We aim to examine the association between CS and risk of overweight and obesity among preschool children. We recruited 9103 children from 35 kindergartens in 4 cities located in East China. Children anthropometric measurements were taken in person by trained personnel. The mode of delivery was classified as vaginal or CS, in sub-analyses we divided cesarean delivery into elective or non-elective. The mode of delivery and other parental information were self-reported by parents. Multivariate logistic regression analysis was used to examine the associations. In our cross-sectional study of 8900 preschool children aged 3–6 years, 67.3 % were born via CS, of whom 15.7 % were obese. Cesarean delivery was significantly associated with the risk of overweight [OR 1.24; (95 % CI 1.07–1.44); p = 0.003], and the risk of obesity [OR 1.29; (95 % CI 1.13–1.49); p < 0.001] in preschool children. After adjusted for child characteristics, parental factors and family income, the odd of overweight was 1.35 and of obesity was 1.25 in children delivered by elective CS. The associations between CS and overweight/obesity in preschool children are influenced by potential confounders. Both children delivered by elective or non-elective CS are at increased risk of overweight/obesity. Potential consequences of CS on the health of the children should be discussed among both health care professionals and childbearing women.

Supplementation with folic acid (FA) was proven to prevent neural tube defects (NTDs) and was recommended worldwide before and during early pregnancy. However, much less is known regarding the role of FA after the 12th gestational week (GW). This study aimed to investigate the related effects of continued FA supplementation after the first trimester of pregnancy on fetal growth. The study subjects came from the Ma’anshan-Anhui Birth Cohort Study (MABC) that recruited 3474 pregnant women from the city of Ma’anshan in Anhui Province in China during the period of May 2013 to September 2014. The information on use of vitamin and mineral supplements was recorded in different periods (the first/second/third trimester of pregnancy). Small-for-gestational-age (SGA) births were live-born infants that were <10th percentile of birth weight, and large-for-gestational-age (LGA) births were live-born infants that were ≥90th percentile of birth weight according to nomograms based on gender and gestational age from the latest standards. We used multivariable logistic regression to evaluate the effects of FA supplement consumption in the second/third trimester of pregnancy on the risk of LGA and SGA. In addition, propensity score analysis was also performed to examine the effects. In this prospective birth cohort study conducted in Chinese women who had taken FA in the first trimester of pregnancy, we found that continued FA supplementation with 400 micrograms/day in the second and third trimesters of pregnancy significantly increased the risk of LGA (RR = 1.98 (1.29, 3.04)). This relation was strong or monotonic after adjusting for maternal age, newborn’s gender, maternal pre-pregnancy BMI, maternal education level, smoking, alcohol consumption and calcium supplementation. We did not observe that continuing FA supplementation after the first trimester of pregnancy remarkably decreased the risk of SGA. The propensity score analysis showed similar results. To confirm these findings, additional investigations or trials with a large sample and the tracking of folate status throughout pregnancy are recommended.

Background: Preterm birth is one of the key causes of morbidity and mortality among neonates in low-income countries. In Rwanda, at least 35,000 babies are born prematurely each year, and 2600 children under the age of five die due to direct complications of prematurity each year. A limited number of studies have been conducted locally, many of which are not nationally representative. Thus, this study determined the prevalence as well as the maternal, obstetric, and gynecological factors associated with preterm birth in Rwanda at the national level. Methods: A longitudinal cohort study was conducted from July 2020 to July 2021 among first-trimester pregnant women. A total of 817 women from 30 health facilities in 10 districts were included in the analysis. A pre-tested questionnaire was used to collect data. In addition, medical records were reviewed to extract relevant data. Ultrasound examination was used to assess and confirm gestational age on recruitment. A multivariable logistic regression analysis was performed to determine the independent maternal, obstetric, and gynecological factors associated with preterm birth. Results: The prevalence of preterm births was 13.8%. Older maternal age- 35 to 49 years [Adjusted odds ratio (AOR) = 2.00; 95% Confidence Interval (CI) = 1.13–3.53)], secondhand smoke exposure during pregnancy (AOR = 1.91; 95% CI = 1.04–3.51), a history of abortion (AOR = 1.89; 95% CI = 1.13–3.15), premature membrane rupture (AOR = 9.30; 95% CI = 3.18–27.16), and hypertension during pregnancy (AOR = 4.40; 95% CI = 1.18–16.42) were identified as independent risk factors for preterm birth. Conclusion: Preterm birth remains a significant public health issue in Rwanda. The associated risk factors for preterm birth were advanced maternal age, secondhand smoke, hypertension, history of abortion, and preterm membrane rupture. This study therefore recommends routine antenatal screening to identify and closely follow-up of those high-risk groups, in order to avoid the short- and long-term effects of preterm birth.

Globally, the prevalence of childhood obesity has substantially increased at an alarming rate. This study investigated associations between dietary patterns and overweight/obesity in 3- to 6-year-old children. Recruited children were from four prefecture-level cities in Eastern China. Childhood overweight and obesity were defined according to WHO Child Growth Standards. Individual dietary patterns were assessed by a comprehensive self-administered FFQ using thirty-five food items. Using factor analysis two dietary patterns were derived: the traditional Chinese pattern was characterised by high consumption of cereals, vegetables and fresh juices while the modern pattern was characterised by high consumption of Western fast food, Chinese fast food, sweets/sugary foods and carbonated beverages. The associations of dietary patterns with overweight/obesity were evaluated by logistic regression models. Data of 8900 preschool children from thirty-five kindergartens recruited from March to June 2015 were used in the final analysis. Adherence to the modern dietary pattern was positively associated with children's age while adherence to the traditional dietary pattern was positively associated with maternal education; these associations were statistically significant. After adjustment, we found that being in the highest tertile of any identified dietary patterns was not significantly associated with overweight and obesity. Dietary patterns are not associated with overweight/obesity in Chinese preschool children. Prospective studies are needed to establish a causal link between dietary patterns and childhood obesity.

Background Hand hygiene is critical to the prevention of Healthcare Acquired Infections. Compliance of health care workers to hand hygiene in developing countries is reportedly low. Objective The aim of this study was to assess predictors of hand hygiene compliance among healthcare workers in Rwanda Methods This cross-sectional study was conducted in 26 selected hospitals. Trained hospital IPC focal points anonymously observed 1380 hand hygiene opportunities from 341 healthcare workers. Logistic regression analysis was used to identify predictors of compliance to hand hygiene among health care workers using Stata. Results The overall compliance to HH was 72.4%. It was respectively 70%, 77% and 60% less likely in labor (AOR=0.30, 95% CI: 0.19-0.49), maternity (AOR= 0.27, 95% CI: 0.17-0.43), and neonatology (AOR= 0.40 95% CI: 0.25-0.65) departments than in theater. Other clinical staff than nurses/midwives were 35% less likely to comply than did medical doctors. The availability of water source and soap at hand washing station was associated with 2.5 times higher odds of compliance (AOR=2.46, 95% CI: 1.27-4.77). Conclusion The compliance to HH is associated with the availability of hand hygiene facilities. Well-maintained water sources and soap at hand washing stations should be a priority in health care settings. Rwanda J Med Health Sci 2022;5(2):170-179