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Reproductive Health Program Planning in Public Health: What's the Evidence?

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Reproductive Health Program Planning in Public Health: What's the Evidence?

  1. 1. This webinar has been made possible with support from the Canadian Institutes of Health Research Welcome! Reproductive Health Program Planning: What’s the evidence? You will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the line.
  2. 2. The Health Evidence Team Maureen Dobbins Kara DeCorby Daiva Tirilis Scientific Director Administrative Director Research Coordinator Tel: 905 525-9140 ext 22481 Tel: (905) 525-9140 ext. 20461 Tel: (905) 525-9140 ext. 20460 E-mail: dobbinsm@mcmaster.ca E-mail: kdecorby@health-evidence.ca E-mail: dtirilis@health-evidence.ca Lori Greco Heather Husson Robyn Traynor Lyndsey McRae Knowledge Broker Project Manager Research Coordinator Research Assistant
  3. 3. What is www.health-evidence.ca? Evidence inform Decision Making
  4. 4. Why use www.health-evidence.ca? 1. Saves you time 2. Relevant & current evidence 3. Transparent process 4. Supports for EIDM available 5. Easy to use
  5. 5. Questions?
  6. 6. Meetings, Planning & Dissemination Project
  7. 7. CIHR-Funded Reviews  Kramer, M.S., & Kakuma, R. (2002). Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews,2002 (Issue 1), Art. No. CD003517. DOI: 10.1002/14651858.CD003517.  Kramer, M.S., Kakuma, R. (2003). Energy and protein intake in pregnancy. Cochrane Database of Systematic Reviews,2003 (Issue 4), Art. No.: CD000032. DOI: 10.1002/14651858.CD000032.
  8. 8. Summary Statement: Kramer (2002)
  9. 9. Overall Considerations 1 2 3 4 5 6 7
  10. 10. Interpreting the Evidence Growth among EBF infants for 6 months vs. EBF for 3-4 months and MBF thereafter through 6 months What’s the evidence? Implications for practice & policy Weight Gain (4 studies) • Public health activities should • Weight gain at 3-8 months was significantly higher in acknowledge evidence indicating that MBF compared to EBF infants (WMD – 12.45, 95% MBF infants gain slightly more weight CI -23.46 to -1.44 g/mo). than EBF infants at 3-12 months, although there are no differences in Weight for age (2 studies) weight gain at any other time points. • EBF infants had significantly lower scores for weight for age at six months (WMD -0.09, 95% CI -0.16 to -0.02), nine months (WMD -0.10, 95% CI -0.18 to - 0.02), and 12 months (WMD -0.09, 95% CI -0.17 to -0.01) compared to MBF infants.
  11. 11. Weight Gain  Weight gain at 3-8 months was significantly higher in MBF compared to EBF infants (WMD – 12.45, 95% CI -23.46 to -1.44 g/mo).
  12. 12. Weight Gain  No impact for EBF vs. MBF infants on weight gain at 8-12 months.
  13. 13. Interpreting the Evidence Morbidity and mortality among infants EBF for 6 months vs. EBF for 3-4 months and MBF thereafter through 6 months What’s the evidence? Implications for practice & policy Gastrointestinal infections (1 study) • Public health messages and programs should indicate that infants who are EBF • EBF infants were 33% less likely to have GI infection are less likely to have gastrointestinal in the first 12 months compared to MBF infants infections compared to MBF infants (RR 0.67, 95% CI 0.46 to 0.97). • There was no reduction in risk of hospitalization
  14. 14. Gastrointestinal Infections • EBF infants were 33% less likely to have GI infection in the first 12 months compared to MBF infants (RR 0.67, 95% CI 0.46 to 0.97).
  15. 15. Interpreting the Evidence Morbidity and mortality among infants EBF for 6 months vs. EBF for 3-4 months and MBF thereafter through 6 months What’s the evidence? Implications for practice & policy Acute otitis media (ear infections) (2 studies) • Public health messages and programs should indicate that infants who are EBF • MBF infants were 28% more likely to have one or are less likely to have otitis media more episodes of otitis media compared to EBF compared to MBF infants; infants (RR 1.28, 95% CI 1.04 to 1.57).
  16. 16. Acute Otitis Media (ear infection) • MBF infants were 28% more likely to have one or more episodes of otitis media compared to EBF infants (RR 1.28, 95% CI 1.04 to 1.57).
  17. 17. Overall Considerations 1 2 3 4 5 6 7
  18. 18. Questions?
  19. 19. Summary Statement: Kramer (2003)
  20. 20. Overall Considerations Considerations for Public Health Practice Conclusions from Health Evidence General Implications This well done review is based on low quality Public health programs should include: studies. • nutritional advice to women (but not as a sole strategy) Balanced energy/protein supplementation • encourage balanced energy/protein • improves fetal growth supplements • may reduce the risk of fetal and neonatal Public health programs should not encourage: death • isocaloric protein supplements for pregnant • equally likely to have a very minimal or women quite large impact on preterm birth • high protein supplements for pregnant • has no impact on gestational diabetes, women preeclampsia, and growth and development • energy/protein restriction for overweight • may result in possible harms (e.g. reduced pregnant women fetal growth) The findings should be used cautiously given the low quality of the evidence. *Note: The results presented are our own interpretation for increasing energy intake.
  21. 21. Interpreting the Evidence Nutritional advice to increase energy and protein intake What’s the evidence? Implications for practice & policy • Effective in reducing the risk of preterm • Public health organizations should not birth (by 54% with the true risk reduced include nutritional advice as a sole from 2-79%). intervention. • Public health messaging should emphasize that increased energy and protein intake is associated with a decreased risk of preterm birth.
  22. 22. Preterm birth • Effective in reducing the risk of preterm birth (by 54% with the true risk reduced from 2-79%).
  23. 23. Interpreting the Evidence High protein supplementation What’s the evidence? Implications for practice & policy • Increased risk of small for gestational age • Public health programs should not promote (by 58% with the true risk reduced from 3- or provide high protein supplementation as 141%). it has no impact on most maternal, fetal, and • No impact on all other outcome infant health outcomes and may, in fact, have adverse outcomes.
  24. 24. Small-for-gestational Age • Increased risk of small for gestational age (by 58% with the true risk reduced from 3-141%).
  25. 25. Interpreting the Evidence Energy/protein restriction in women with overweight or high weight gain What’s the evidence? Implications for practice & policy • Resulted in small head circumference at • Public health programs should not include birth (by 1cm with a range from 0.14 cm to energy/protein restriction as a means of 1.86 cm smaller). improving maternal, fetal, or infant health outcomes, since energy/protein restriction is not likely to be beneficial for maternal or infant health and may lead to smaller head circumference among infants.
  26. 26. Head Circumference • Resulted in small head circumference at birth (by 1cm with a range from 0.14 cm to 1.86 cm smaller).
  27. 27. Overall Considerations Considerations for Public Health Practice Conclusions from Health Evidence General Implications This well done review is based on low quality Public health programs should include: studies. • nutritional advice to women (but not as a sole strategy) Balanced energy/protein supplementation • encourage balanced energy/protein • improves fetal growth supplements • may reduce the risk of fetal and neonatal Public health programs should not encourage: death • isocaloric protein supplements for pregnant • equally likely to have a very minimal or women quite large impact on preterm birth • high protein supplements for pregnant • has no impact on gestational diabetes, women preeclampsia, and growth and development • energy/protein restriction for overweight • may result in possible harms (e.g. reduced pregnant women fetal growth) The findings should be used cautiously given the low quality of the evidence.
  28. 28. Questions?
  29. 29. Discussion Forum Please continue to discuss this topic and other topics on our discussion forum. www.health-evidence.ca/forum/ Login with your health-evidence username and password or register if you aren’t a member yet. Join us for a LIVE on Monday, November 7 at 1:00 pm EST to have your questions answered in real time!
  30. 30. Evaluation Please check your emails for the evaluation link. If you do not receive one, e-mail Jennifer McGugan at mcgugj@mcmaster.ca Thank you for your participation!

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