A Qualitative Research Study on Needs, Attitudes and Practices Related to Pregnancy Prevention, Abortion Care, Pregnancy Care, and Care for Children Affected by Zika Virus

A Qualitative Research Study
to explore the needs, attitudes and practices
of
women, men and healthcare service providers
related to
pregnancy prevention, abortion care, pregnancy care,
and care for children affected
by
Zika Virus

Table of Contents
1. Introduction (2 – 5)
1.1 Background
1.2 Diagnosis
1.3 Indian Scenario
1.4 Need for Research
2. Research Methodology (6)
2.1 Problem Statement
2.2 Aim of the research
2.3 Sampling Method
2.4 Research Design and Technique
2.5 Ethical Consideration
3. Research Analysis (7-11)
4. Conclusions (12)
5. Recommendations (12)
6. References (13)
Appendix 1: Questionnaire (14)
6.1
1

1. INTRODUCTION AND BACKGROUND
1.1 Background
Zika virus is an arthropod-borne flavivirus transmitted by mosquitoes. Clinical signs of Zika
virus infection can be acute onset low-grade fever with rash, notably small joints of hands and
feet, or conjunctivitis (non-purulent). Congenital Zika virus infection is associated with
anomalies such as congenital microcephaly (along with other developmental problems among
infants born to women infected during pregnancy), Guillain-Barré syndrome, myelitis, and
meningoencephalitis (Besnard M et al. 2016).
Since its detection in Brazil in 2015, Zika virus has emerged as a growing concern, it is endemic
in parts of Africa, has been reported in South East Asia and there is an ongoing Zika virus
outbreak in the Americas, the Caribbean, and the Pacific.
1.1.1 Microcephaly
The World Health Organization (WHO), the United States Centers for Disease Control and
Prevention, and other scientific groups have concluded that the Zika virus can cause
microcephaly. In some cases, congenitally infected offspring of women with first or second
trimester Zika virus infection have a normal head circumference at birth but subsequently
develop microcephaly in the first year of life. Definition of microcephaly given by WHO is:
Occipitofrontal circumference (head circumference) greater than two standard deviations below
the mean or less than the third percentile based on standard growth charts for sex, age, and
gestational age at birth.
1.1.2 Adverse Pregnancy Outcomes
Adverse pregnancy outcomes include miscarriage, stillbirth and impaired fetal growth.
1.1.3 Pregnancy Management
There is no specific treatment known to cure ZIKV infection. Its management includes rest and
fluids intake to prevent dehydration and medicines are administered to relieve pain and fever.
The World Health Organization (WHO) has issued initial guidance for infected persons and their
families. Ultrasound is the major screening method for congenital Zika virus infection. Magnetic
resonance imaging is more sensitive for diagnosis of fetal brain abnormalities. In women
infected early in pregnancy, ultrasound findings associated with fetal infection may be detected
as early as 18 to 20 weeks of gestation but are usually detected in the late second and early third
trimesters of pregnancy. The United States Centers for Disease Control and Prevention (CDC)
suggest fetal ultrasound examination every three to four weeks to look for signs of congenital
Zika virus infection and monitor fetal growth in pregnant women with laboratory evidence of
recent Zika virus infection. If the ultrasound report shows something not normal, amniocentesis
for diagnosis of fetal infection should be considered.
1.1.4 Delivery
Timing and route of delivery are determined according to routine obstetric policies and
standards. The appropriate location for delivery should be decided by late third trimester
Breast Feeding
Transmission of Zika virus through breast milk has not
been reported [42], although the virus has been detected
2

Breast Feeding
Transmission of Zika virus through breast milk has not
been reported [42], although the virus has been detected
Breast Feeding
Transmission of Zika virus through breast milk has not
been reported [42], although the virus has been detected
Breast Feeding
Transmission of Zika virus through breast milk has not
been reported [42], although the virus has been detected
Breast Feeding
Transmission of Zika virus through breast milk has not
been reported [42], although the virus has been detected
1.1.5 Breast Feeding
There are no reported cases of transmission of Zika virus through breast milk, although the virus
has been detected in breast milk in some studies (Blohm GM et al, 2018).
1.2 Diagnosis
The diagnosis of Zika virus infection should be suspected in individuals with typical clinical
manifestations and relevant exposure (residence in or travel to an area where mosquito-borne
transmission of Zika virus infection has been reported, or unprotected sexual contact with a
person who meets these criteria) The differential diagnosis of Zika virus infection includes:
Dengue fever, Chikungunya, Parvovirus, Rubella, Measles, Leptospirosis, Malaria, Rickettsia
infection, group A Streptococcus. Health care providers should screen pregnant woman for
possible exposure to Zika virus. Mother has one or more of the symptoms or she is residing in or
travelled to an area where mosquito-borne transmission of Zika virus infection has been reported.
Serum and urine are the primary diagnostic specimens; whole blood is an approved specimen for
some nucleic acid tests. For individuals presenting more than 14 days after persistent symptoms,
blood and urine tests for detection of Zika virus RNA should be performed. Any positive result
establishes a diagnosis of Zika virus infection and in such cases no further testing is done.
Negative results do not exclude the chances of infection and Zika virus serologic test should be
done. The diagnostic approach is different in pregnant and non-pregnant women because Zika
virus RNA can persist longer in a pregnant woman's serum and because of the potential for
congenital infection. The risk of transmission to unborn child is there throughout the pregnancy
in both symptomatic and asymptomatic mothers.
1.2.1 Prevention
It is suggested that pregnant women should not travel to areas where mosquito transmission of
Zika virus is well acknowledged. Protective measures should be taken to avoid mosquito bite as
well as sexual transmission of the virus, stick to specific directions regarding blood donation and
standard infection precautions. No vaccine is there for prevention of Zika virus infection, but a
vaccine is under development.
1.3 Indian Scenario
Since 2013, with the first reported Zika virus (ZIKV) outbreak in the Marquesas Islands and its
subsequent spread to Brazil in May 2015, health agencies in India have been on alert and kept a
watch on the Zika situation in India. There is an anticipation that ZIKV outbreak in India is
3