Effect of maternal separation on mitochondrial function and role of exercise in a rat model of Parkinson’s disease

Metabolic Brain Disease, Volume 27, No. 3, Year 2012

Interpretation

Early life stress, such as maternal separation, causes adaptive changes in neural mechanisms that have adverse effects on the neuroplasticity of the brain in adulthood. As a consequence, children who are exposed to stress during developmentmay be predisposed to neurodegenerative disorders in adulthood. A possible mechanism for increased vulnerability to neurodegeneration may be dysfunctional mitochondria. Protection from neurotoxins, such as 6- hydroxydopamine (6-OHDA), has been observed following voluntary exercise. The mechanism of this neuroprotection is not understood and mitochondria may play a role. The purpose of this study was to determine the effects of maternal separation and exercise on mitochondrial function in a rat model of Parkinson’s disease. Maternally separated (pups separated from the dam for 3 h per day from postnatal day (P) 2-14) and non-separated rats were placed in individual cages with or without attached running wheels for 1 week prior to unilateral infusion of 6-OHDA (5 μg/4 μl, 0.5 μl/min) into the leftmedial forebrain bundle at P60. After 2 h recovery, rats were returned to their cages and wheel revolutions recorded for a further 2 weeks. On P72, the rats’ motor function was assessed using the forelimb akinesia test. On P74, rats were sacrificed for measurement of mitochondrial function. Exercise increased the respiratory control index (RCI) in the non-lesioned hemisphere of 6-OHDA-lesioned rats. This effect was evident in the striatum of non-separated rats and the prefrontal cortex of maternally separated rats. These results suggest that early life stress may reduce the adaptive response to exercise in the striatum, a major target of dopamine neurons, but not the prefrontal cortex in this model of Parkinson’s disease. © The Author(s) 2012. Thirty-nine male Sprague–Dawley rats (Rattus Norvegicus) weighing between 180 g and 280 g were used in the study. Rats were housed in a temperature-controlled room (21–24°C) in the Satellite Animal Facility at the University of Cape Town. Animals had access to standard rat chow and water ad libitum. The housing facility was maintained on a 12-hour light/dark cycle (lights on at 06 h00). The study was approved by the Faculty of Health Sciences Animal Research Ethics Committee of the University of Cape Town and adhered to international guidelines. On postnatal day 1 (P1), rats were sexed and culled to 8 males per litter. If the litter had less than 8 males, female littermates were added to standardize litter size and to allow for equal suckling from the dam. Maternal separation was performed as described by Daniels et al. (2004). For the experimental group the mother was physically removed from the home cage and placed in a separate clean plexiglass cage with clean bedding from P2 to P14. A small amount of bedding from the home cage was placed in the holding cage to decrease the stress the dam might be exposed to due to the separation. The pups were taken to a different room (separation room) to prevent communication with the dam (by means of ultrasound vocalization) for a period of 3 h from 09 h00 to 12 h00 daily. The temperature in the separation room was maintained between 31 and 34°C to prevent hypothermia. After the 3-hour separation period the pups were returned to the Satellite Animal Facility and reunited with their dams. The home cage was cleaned every fourth day and great care was taken not to physically disturb the pups and to minimize other factors (smell, sound) that could cause stress to the rat pups. During the cleaning of the home cages, the dam was removed and about half of the bedding which was not occupied by the pups was changed to ensure that the dam recognised the odour of her cage and her litter when returned to her home cage. The non-separated pups were kept with their dams in their home cages, under normal housing conditions in the Satellite Animal Facility. After P14 the litters were left with their dams until P21 when the litters were weaned. From P21 to P48 the rats were reared under normal housing conditions (standard rat chow and water ad libitum). On P48 rats were transferred to a room with a 23 h00-11 h00 light/dark cycle in order to facilitate recording and observation of their activity. After 6 days of adaptation to the new light/dark cycle, on P54, 20 maternally separated rats and 19 non-maternally separated rats were weighed and further divided into exercised (runners) and non-exercised (non-runners) groups. Ten maternally separated (MS) rats, and 9 non-separated (NS) rats were placed in cages with attached running wheels with a counter device that recorded the number of revolutions. One complete revolution measured one meter in distance. The remaining maternally separated rats (MS non-runners, n = 10) and non-separated rats (NS non-runners, n = 10) were placed in plexiglass cages that allowed 2 rats to be housed separately using a divider. The number of revolutions the rats made in the running wheels was recorded daily between 10 h00 and 11 h00 prior to the onset of their dark cycle. Stereotaxic surgery was performed according to Mabandla et al. (2004). On P60, the rats were weighed and taken to the surgery room. A norepinephrine transporter blocker, desipramine (15 mg/kg, Sigma St. Louis, MO, U.S.A), was injected intraperitoneally 30 min before surgery to prevent uptake of the neurotoxin, 6-OHDA, by noradrenergic neurons. Rats were deeply anaesthetised with a mixture of halothane and oxygen administered by means of a calibrated Blease Vaporiser (DATUM). All rats received 6-OHDA.HCl (5 μg/4 μl saline, Sigma, St. Louis, MO, U.S.A) infusion unilaterally (0.4 μl/min) into the left medial forebrain bundle at the following stereotaxic co-ordinates: 4.7 mm anterior to lambda, 1.6 mm lateral to midline and 8.4 mm ventral to dura, according to the rat brain atlas of Paxinos and Watson (1986). The infusion needle remained in the medial forebrain bundle for a period of 4 min post infusion to allow the neurotoxin to disperse into the tissue. Following gentle retraction of the needle, the burr-hole was sealed with sterile bone-wax and the scalp incision was swabbed with betadine/alcohol solution and sutured. The rats were allowed to recover from anaesthesia before they were returned to their respective cages. The number of revolutions made by the rats in cages with attached running wheels was recorded for a further 14 days after the surgery. On P72 (twelve days post lesion), the rats were assessed for motor function deficit. The rats were taken from the Satellite Facility at least 1 h before testing so as to enable the rats to acclimatize to the new conditions in the behavioural testing room. The light intensity in the behavioural testing room was 48 lux. The step test provides a robust measure of impairment in movement initiation, and thus measures the severity of the effect of the 6-OHDA lesion on limb function (Tillerson et al. 2001). The rat was supported by its torso, such that the hindquarters and the forelimb not being tested were held above the testing surface, allowing the rat to transfer its bodyweight onto the forelimb being tested. With the use of the thumb and index finger, the forelimb not being tested and head were held firmly to minimize head movement and to simultaneously gently propel the rat forward. The length of step of each forelimb was recorded in 3 successive trials and the mean step length was calculated. On P74, rats were sacrificed and their brains rapidly removed from the skull for measurement of mitochondrial function using an Oxygraph oxygen electrode (Hansatech Instruments, UK). Left and right prefrontal cortex and striatum were rapidly dissected from the brain, on an ice-cold glass plate, weighed and homogenized in 20 mM phosphate buffer (20 mM potassium phosphate, 20 mM potassium chloride, 1.6 mM EDTA, 5 mM magnesium chloride, 1 mM sodium malate, 10 mM sodium pyruvate 123 mM sucrose, 2 mM Tris, pH 7.4) and oxygen consumption measured in an Oxygraph, as an index of mitochondrial function. Two ml of homogenate was placed in the Oxygraph chamber and allowed to equilibrate to 39°C. Basal respiration was recorded for 5–10 s prior to addition of 1 mM adenosine diphosphate (ADP) to the chamber and oxygen tension was recorded until depletion. Respiratory control index (RCI) which indicates the tightness of coupling between respiration and phosphorylation, was calculated from the rate of oxygen consumption during ADP oxidation to ATP relative to the rate of oxygen consumption after ADP depletion. The phosphate:oxygen ratio (P:O) was also calculated from the oxygen consumption data. The P:O ratio provides a measure of the relationship between ATP synthesised and oxygen consumed. The validity of the technique was demonstrated by addition of NADH to the brain tissue homogenate prior to the measurement of oxygen consumption which did not alter the rate of respiration, thus confirming that the mitochondria were intact. The rate of oxygen consumption was not influenced by aeration of the homogenate, indicating that sufficient oxygen was present in the sample to measure mitochondrial respiration. The mean RCI was 10.8 which compares favourably with reported values of 2.2–4.9 for isolated brain mitochondria (Sugiyama and Fujita 1985; Xiong et al. 1999; Costa and Colleoni 2000). Protein concentration was determined according to the method described by Bradford (1976). Briefly, the Bradford protein assay is a colorimetric assay. A series of protein standards were prepared (0–1500 μg BSA/ml). Serial dilutions of the sample to be measured were also prepared. Each sample (standard and unknown) was pipetted into a spectrophotometer tube before adding a dye for the color reaction. The absorbance was measured using a spectrophotometer. The absorbance of the standards versus their concentration was plotted on graph paper following which the concentration of the unknown sample was extrapolated. Statistica (Statsoft Inc., Oklahoma, USA) was used for statistical analysis of the data. The t-test for dependent variables was used to determine differences between lesioned and non-lesioned hemispheres. Two-way analysis of variance (ANOVA) was performed to detect significant differences between treatment groups. Significant difference was accepted at p < 0.05. When the ANOVA showed a significant difference, the Newman-Keuls post-hoc test was used. Results are reported as mean ± standard error of the mean (mean ± SEM).

AI Digest

Study Justification:

– Early life stress, such as maternal separation, can have long-term effects on brain function and increase the risk of neurodegenerative disorders in adulthood.
– Mitochondrial dysfunction may play a role in the increased vulnerability to neurodegeneration.
– Exercise has been shown to provide neuroprotection, but the mechanism is not fully understood.
– This study aims to investigate the effects of maternal separation and exercise on mitochondrial function in a rat model of Parkinson’s disease.

Study Highlights:

– Maternally separated and non-separated rats were placed in cages with or without running wheels for 1 week prior to the infusion of a neurotoxin.
– Exercise increased mitochondrial function in the non-lesioned hemisphere of rats with Parkinson’s disease.
– Maternal separation reduced the adaptive response to exercise in the striatum, a major target of dopamine neurons.
– These findings suggest that early life stress may affect the response to exercise in Parkinson’s disease.

Recommendations for Lay Reader:

– Early life stress can have long-term effects on brain health and increase the risk of neurodegenerative disorders.
– Exercise may provide protection against neurodegeneration, but more research is needed to understand how it works.
– Mitochondria, the energy-producing structures in cells, may play a role in the effects of stress and exercise on brain health.
– This study suggests that early life stress may reduce the benefits of exercise in Parkinson’s disease.

Recommendations for Policy Maker:

– Early life stress prevention and intervention programs should be prioritized to reduce the risk of neurodegenerative disorders.
– Further research is needed to understand the mechanisms by which exercise provides neuroprotection.
– Funding should be allocated to support studies investigating the role of mitochondria in neurodegenerative disorders and the effects of stress and exercise on brain health.

Key Role Players:

– Researchers and scientists specializing in neurodegenerative disorders, stress, exercise, and mitochondrial function.
– Animal care and research facility staff.
– Ethics committees and regulatory bodies overseeing animal research.

Cost Items for Planning Recommendations:

– Research funding for conducting the study, including personnel salaries, equipment, and supplies.
– Animal care and housing costs.
– Ethical review and compliance costs.
– Data analysis and publication costs.
– Outreach and dissemination of study findings.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong, but there are some areas for improvement. The study design is well-described, including the number of rats used, the housing conditions, and the experimental procedures. The abstract also provides clear results, indicating that exercise increased mitochondrial function in certain brain regions. However, there are some limitations to consider. The abstract does not mention any control group without maternal separation or exercise, which makes it difficult to assess the specific effects of these factors. Additionally, the abstract does not provide any statistical analysis or p-values to support the significance of the findings. To improve the evidence, the authors should include a control group and perform appropriate statistical analysis to determine the significance of the results.

Abstract

Thirty-nine male Sprague–Dawley rats (Rattus Norvegicus) weighing between 180 g and 280 g were used in the study. Rats were housed in a temperature-controlled room (21–24°C) in the Satellite Animal Facility at the University of Cape Town. Animals had access to standard rat chow and water ad libitum. The housing facility was maintained on a 12-hour light/dark cycle (lights on at 06 h00). The study was approved by the Faculty of Health Sciences Animal Research Ethics Committee of the University of Cape Town and adhered to international guidelines. On postnatal day 1 (P1), rats were sexed and culled to 8 males per litter. If the litter had less than 8 males, female littermates were added to standardize litter size and to allow for equal suckling from the dam. Maternal separation was performed as described by Daniels et al. (2004). For the experimental group the mother was physically removed from the home cage and placed in a separate clean plexiglass cage with clean bedding from P2 to P14. A small amount of bedding from the home cage was placed in the holding cage to decrease the stress the dam might be exposed to due to the separation. The pups were taken to a different room (separation room) to prevent communication with the dam (by means of ultrasound vocalization) for a period of 3 h from 09 h00 to 12 h00 daily. The temperature in the separation room was maintained between 31 and 34°C to prevent hypothermia. After the 3-hour separation period the pups were returned to the Satellite Animal Facility and reunited with their dams. The home cage was cleaned every fourth day and great care was taken not to physically disturb the pups and to minimize other factors (smell, sound) that could cause stress to the rat pups. During the cleaning of the home cages, the dam was removed and about half of the bedding which was not occupied by the pups was changed to ensure that the dam recognised the odour of her cage and her litter when returned to her home cage. The non-separated pups were kept with their dams in their home cages, under normal housing conditions in the Satellite Animal Facility. After P14 the litters were left with their dams until P21 when the litters were weaned. From P21 to P48 the rats were reared under normal housing conditions (standard rat chow and water ad libitum). On P48 rats were transferred to a room with a 23 h00-11 h00 light/dark cycle in order to facilitate recording and observation of their activity. After 6 days of adaptation to the new light/dark cycle, on P54, 20 maternally separated rats and 19 non-maternally separated rats were weighed and further divided into exercised (runners) and non-exercised (non-runners) groups. Ten maternally separated (MS) rats, and 9 non-separated (NS) rats were placed in cages with attached running wheels with a counter device that recorded the number of revolutions. One complete revolution measured one meter in distance. The remaining maternally separated rats (MS non-runners, n = 10) and non-separated rats (NS non-runners, n = 10) were placed in plexiglass cages that allowed 2 rats to be housed separately using a divider. The number of revolutions the rats made in the running wheels was recorded daily between 10 h00 and 11 h00 prior to the onset of their dark cycle. Stereotaxic surgery was performed according to Mabandla et al. (2004). On P60, the rats were weighed and taken to the surgery room. A norepinephrine transporter blocker, desipramine (15 mg/kg, Sigma St. Louis, MO, U.S.A), was injected intraperitoneally 30 min before surgery to prevent uptake of the neurotoxin, 6-OHDA, by noradrenergic neurons. Rats were deeply anaesthetised with a mixture of halothane and oxygen administered by means of a calibrated Blease Vaporiser (DATUM). All rats received 6-OHDA.HCl (5 μg/4 μl saline, Sigma, St. Louis, MO, U.S.A) infusion unilaterally (0.4 μl/min) into the left medial forebrain bundle at the following stereotaxic co-ordinates: 4.7 mm anterior to lambda, 1.6 mm lateral to midline and 8.4 mm ventral to dura, according to the rat brain atlas of Paxinos and Watson (1986). The infusion needle remained in the medial forebrain bundle for a period of 4 min post infusion to allow the neurotoxin to disperse into the tissue. Following gentle retraction of the needle, the burr-hole was sealed with sterile bone-wax and the scalp incision was swabbed with betadine/alcohol solution and sutured. The rats were allowed to recover from anaesthesia before they were returned to their respective cages. The number of revolutions made by the rats in cages with attached running wheels was recorded for a further 14 days after the surgery. On P72 (twelve days post lesion), the rats were assessed for motor function deficit. The rats were taken from the Satellite Facility at least 1 h before testing so as to enable the rats to acclimatize to the new conditions in the behavioural testing room. The light intensity in the behavioural testing room was 48 lux. The step test provides a robust measure of impairment in movement initiation, and thus measures the severity of the effect of the 6-OHDA lesion on limb function (Tillerson et al. 2001). The rat was supported by its torso, such that the hindquarters and the forelimb not being tested were held above the testing surface, allowing the rat to transfer its bodyweight onto the forelimb being tested. With the use of the thumb and index finger, the forelimb not being tested and head were held firmly to minimize head movement and to simultaneously gently propel the rat forward. The length of step of each forelimb was recorded in 3 successive trials and the mean step length was calculated. On P74, rats were sacrificed and their brains rapidly removed from the skull for measurement of mitochondrial function using an Oxygraph oxygen electrode (Hansatech Instruments, UK). Left and right prefrontal cortex and striatum were rapidly dissected from the brain, on an ice-cold glass plate, weighed and homogenized in 20 mM phosphate buffer (20 mM potassium phosphate, 20 mM potassium chloride, 1.6 mM EDTA, 5 mM magnesium chloride, 1 mM sodium malate, 10 mM sodium pyruvate 123 mM sucrose, 2 mM Tris, pH 7.4) and oxygen consumption measured in an Oxygraph, as an index of mitochondrial function. Two ml of homogenate was placed in the Oxygraph chamber and allowed to equilibrate to 39°C. Basal respiration was recorded for 5–10 s prior to addition of 1 mM adenosine diphosphate (ADP) to the chamber and oxygen tension was recorded until depletion. Respiratory control index (RCI) which indicates the tightness of coupling between respiration and phosphorylation, was calculated from the rate of oxygen consumption during ADP oxidation to ATP relative to the rate of oxygen consumption after ADP depletion. The phosphate:oxygen ratio (P:O) was also calculated from the oxygen consumption data. The P:O ratio provides a measure of the relationship between ATP synthesised and oxygen consumed. The validity of the technique was demonstrated by addition of NADH to the brain tissue homogenate prior to the measurement of oxygen consumption which did not alter the rate of respiration, thus confirming that the mitochondria were intact. The rate of oxygen consumption was not influenced by aeration of the homogenate, indicating that sufficient oxygen was present in the sample to measure mitochondrial respiration. The mean RCI was 10.8 which compares favourably with reported values of 2.2–4.9 for isolated brain mitochondria (Sugiyama and Fujita 1985; Xiong et al. 1999; Costa and Colleoni 2000). Protein concentration was determined according to the method described by Bradford (1976). Briefly, the Bradford protein assay is a colorimetric assay. A series of protein standards were prepared (0–1500 μg BSA/ml). Serial dilutions of the sample to be measured were also prepared. Each sample (standard and unknown) was pipetted into a spectrophotometer tube before adding a dye for the color reaction. The absorbance was measured using a spectrophotometer. The absorbance of the standards versus their concentration was plotted on graph paper following which the concentration of the unknown sample was extrapolated. Statistica (Statsoft Inc., Oklahoma, USA) was used for statistical analysis of the data. The t-test for dependent variables was used to determine differences between lesioned and non-lesioned hemispheres. Two-way analysis of variance (ANOVA) was performed to detect significant differences between treatment groups. Significant difference was accepted at p < 0.05. When the ANOVA showed a significant difference, the Newman-Keuls post-hoc test was used. Results are reported as mean ± standard error of the mean (mean ± SEM).

Materials

N/A

Innovations

Based on the provided information, it is not clear what specific innovations or recommendations can be made to improve access to maternal health. The provided text describes a study on the effects of maternal separation and exercise on mitochondrial function in a rat model of Parkinson’s disease. It does not directly address access to maternal health or provide innovations in this area.

To improve access to maternal health, some potential innovations and recommendations could include:

1. Telemedicine and remote monitoring: Implementing telemedicine services and remote monitoring technologies can allow pregnant women to receive prenatal care and consultations from healthcare providers without the need for in-person visits. This can be particularly beneficial for women in remote or underserved areas.

2. Mobile health applications: Developing mobile health applications that provide information, reminders, and support for pregnant women can help improve access to maternal health resources. These apps can provide guidance on prenatal care, nutrition, exercise, and other important aspects of pregnancy.

3. Community health workers: Training and deploying community health workers who can provide basic prenatal care, education, and support to pregnant women in their communities can help improve access to maternal health services, especially in areas with limited healthcare infrastructure.

4. Maternal health clinics: Establishing dedicated maternal health clinics or integrating maternal health services into existing healthcare facilities can help ensure that pregnant women have access to specialized care and resources.

5. Financial incentives: Implementing financial incentives, such as subsidies or cash transfers, for pregnant women to seek prenatal care and deliver in healthcare facilities can help overcome financial barriers to accessing maternal health services.

6. Public awareness campaigns: Conducting public awareness campaigns to educate communities about the importance of maternal health and the available services can help increase demand and utilization of maternal health services.

These are just a few examples of innovations and recommendations that can be explored to improve access to maternal health. It is important to consider the specific context and needs of the target population when implementing these interventions.

AI Innovations Description

The description provided is a research study on the effects of maternal separation and exercise on mitochondrial function in a rat model of Parkinson’s disease. It does not directly address improving access to maternal health. However, based on the information provided, here is a recommendation that can be used to develop an innovation to improve access to maternal health:

Recommendation: Develop a mobile health (mHealth) application that provides pregnant women with access to information, resources, and support for maternal health.

Explanation: A mobile health application can be developed to provide pregnant women with easy access to information and resources related to maternal health. The application can include features such as:

1. Educational content: Provide information on prenatal care, nutrition, exercise, and other important aspects of maternal health. This can help pregnant women make informed decisions and take appropriate actions for their health and the health of their baby.

2. Appointment reminders: Send reminders for prenatal check-ups, vaccinations, and other important appointments. This can help pregnant women stay on track with their healthcare schedule and ensure timely access to necessary services.

3. Symptom tracker: Allow pregnant women to track their symptoms and report any concerns to healthcare providers. This can help identify potential issues early on and facilitate timely intervention.

4. Community support: Create a platform for pregnant women to connect with each other, share experiences, and seek support. This can help reduce feelings of isolation and provide a sense of community during pregnancy.

5. Emergency contacts: Provide a list of emergency contacts, including healthcare providers, hospitals, and helplines. This can ensure that pregnant women have quick access to help in case of any emergencies.

By developing a mobile health application with these features, pregnant women can have easy access to information, resources, and support for their maternal health. This can help improve their overall health outcomes and contribute to better access to maternal healthcare.

AI Innovations Methodology

The provided description is about a study on the effects of maternal separation and exercise on mitochondrial function in a rat model of Parkinson’s disease. The study aimed to determine the impact of these factors on neuroprotection and the development of neurodegenerative disorders. The methodology involved the use of male Sprague-Dawley rats, maternal separation, exercise, and the infusion of a neurotoxin. Motor function tests and measurements of mitochondrial function were conducted to assess the outcomes.

To improve access to maternal health, it is important to focus on innovations that address barriers and challenges faced by pregnant women and new mothers. Here are some potential recommendations:

1. Telemedicine and mobile health (mHealth) solutions: Implementing telemedicine and mHealth platforms can provide remote access to healthcare professionals, allowing pregnant women and new mothers to receive medical advice, consultations, and follow-up care without the need for physical visits to healthcare facilities.

2. Community-based healthcare services: Establishing community-based healthcare services, such as mobile clinics or community health centers, can bring essential maternal health services closer to underserved areas. These services can provide prenatal care, postnatal care, family planning, and health education to pregnant women and new mothers who may face geographical or transportation barriers.

3. Maternal health education programs: Developing and implementing comprehensive maternal health education programs can empower women with knowledge about pregnancy, childbirth, postpartum care, and newborn care. These programs can be delivered through various channels, including community workshops, mobile apps, and online platforms.

4. Financial incentives and support: Providing financial incentives, such as cash transfers or subsidies, can help alleviate the financial burden associated with maternal healthcare. Additionally, offering support services, such as transportation vouchers or childcare assistance, can help women overcome logistical challenges in accessing healthcare facilities.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could involve the following steps:

1. Define the target population: Identify the specific population group that the recommendations aim to benefit, such as pregnant women in rural areas or low-income communities.

2. Collect baseline data: Gather data on the current state of maternal health access in the target population, including factors such as healthcare utilization rates, distance to healthcare facilities, and financial barriers.

3. Model the interventions: Use mathematical modeling or simulation techniques to estimate the potential impact of each recommendation on improving access to maternal health. This could involve considering factors such as the number of women reached, the reduction in travel time or costs, and the increase in healthcare utilization.

4. Validate the model: Validate the model by comparing the simulated results with real-world data or expert opinions to ensure its accuracy and reliability.

5. Assess the outcomes: Evaluate the simulated outcomes of the recommendations, such as the increase in prenatal care visits, the reduction in maternal mortality rates, or the improvement in overall maternal health indicators.

6. Refine and iterate: Based on the simulated outcomes, refine the recommendations and iterate the simulation process to further optimize the interventions and their impact on improving access to maternal health.

By following this methodology, policymakers and healthcare stakeholders can gain insights into the potential effectiveness of different innovations and interventions in improving access to maternal health. This can inform decision-making and resource allocation to prioritize and implement the most impactful strategies.

Author

Dima Health

Statistics:

Citations: 12

Identifiers:

DOI: 10.1007/s11011-012-9305-y

ISSN: 08857490

Research Areas:

Environmental, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Substance Abuse

Study Design:

randomised-control-trial

Study Approach:

Quantitative

Participants Gender:

Male & Female