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Restrepo-Méndez MC, Barros AJ, Wong KL, Johnson HL, Pariyo G, França GV, Wehrmeister FC, Victora CG. Inequalities in full immunization coverage: trends in low- and middle-income countries. Bull World Health Organ 2016; 94:794-805B. [PMID: 27821882 PMCID: PMC5096343 DOI: 10.2471/blt.15.162172] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 05/21/2016] [Accepted: 06/01/2016] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate disparities in full immunization coverage across and within 86 low- and middle-income countries. Methods In May 2015, using data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys, we investigated inequalities in full immunization coverage – i.e. one dose of bacille Calmette-Guérin vaccine, one dose of measles vaccine, three doses of vaccine against diphtheria, pertussis and tetanus and three doses of polio vaccine – in 86 low- or middle-income countries. We then investigated temporal trends in the level and inequality of such coverage in eight of the countries. Findings In each of the World Health Organization’s regions, it appeared that about 56–69% of eligible children in the low- and middle-income countries had received full immunization. However, within each region, the mean recorded level of such coverage varied greatly. In the African Region, for example, it varied from 11.4% in Chad to 90.3% in Rwanda. We detected pro-rich inequality in such coverage in 45 of the 83 countries for which the relevant data were available and pro-urban inequality in 35 of the 86 study countries. Among the countries in which we investigated coverage trends, Madagascar and Mozambique appeared to have made the greatest progress in improving levels of full immunization coverage over the last two decades, particularly among the poorest quintiles of their populations. Conclusion Most low- and middle-income countries are affected by pro-rich and pro-urban inequalities in full immunization coverage that are not apparent when only national mean values of such coverage are reported.
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Affiliation(s)
- María Clara Restrepo-Méndez
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro 1160 - 3° Piso, Pelotas (RS), CEP:96020220, Brazil
| | - Aluísio Jd Barros
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Kerry Lm Wong
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro 1160 - 3° Piso, Pelotas (RS), CEP:96020220, Brazil
| | | | - George Pariyo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Giovanny Va França
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro 1160 - 3° Piso, Pelotas (RS), CEP:96020220, Brazil
| | | | - Cesar G Victora
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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102
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Raman S, Nicholls R, Ritchie J, Razee H, Shafiee S. How natural is the supernatural? Synthesis of the qualitative literature from low and middle income countries on cultural practices and traditional beliefs influencing the perinatal period. Midwifery 2016; 39:87-97. [DOI: 10.1016/j.midw.2016.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/03/2016] [Accepted: 05/07/2016] [Indexed: 11/26/2022]
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103
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Agha S, Williams E. Quality of antenatal care and household wealth as determinants of institutional delivery in Pakistan: Results of a cross-sectional household survey. Reprod Health 2016; 13:84. [PMID: 27430518 PMCID: PMC4950643 DOI: 10.1186/s12978-016-0201-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 07/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Pakistan has a high burden of maternal and newborn mortality, which would be largely preventable through appropriate antenatal and delivery care. While the influence of socio-economic status on institutional delivery is well established in the literature, relatively little is known about the relationship between the quality of antenatal care and institutional delivery. Methods A household survey of 4,000 currently married women who had given birth in the two years before the survey was conducted in Sindh province in 2013. The survey collected data on socio-economic and demographic variables, the quality of antenatal care provided during a woman’s last pregnancy and whether she delivered at a health facility. Logistic regression was used to estimate adjusted odds ratios and 95 % confidence intervals around independent variables for institutional delivery. Results In the multivariate analysis, a variable measuring quality of antenatal care showed the strongest association with institutional delivery. Moreover, there was a dose-response relationship between the number of elements of quality provided and the odds of institutional delivery: receiving one element of quality increased the odds of institutional delivery 1.7 times, receiving three elements increased the odds 3.8 times and receiving seven elements increased the odds 10.6 times. Household wealth had a statistically significant relationship with institutional delivery but the effect was weaker than that of quality of care. Urban-rural differentials in institutional delivery did not remain significant after adjusting for household wealth and education. Conclusions The quality of antenatal care provided to a woman during her pregnancy is more strongly associated with institutional delivery than household wealth. Improving the quality of care at health facilities in Sindh should be the foremost priority. Improving the quality of antenatal care services is likely to contribute to rapid increases in skilled birth attendance and better health outcomes for women and children.
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Affiliation(s)
- Sohail Agha
- The Bill and Melinda Gates Foundation, Seattle, USA
| | - Emma Williams
- Jhpiego, 1615 Thames St., Baltimore, MD, 21231, USA.
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104
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Song P, Ren Z, Chang X, Liu X, An L. Inequality of Paediatric Workforce Distribution in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E703. [PMID: 27420083 PMCID: PMC4962244 DOI: 10.3390/ijerph13070703] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/09/2016] [Accepted: 07/07/2016] [Indexed: 11/17/2022]
Abstract
Child health has been addressed as a priority at both global and national levels for many decades. In China, difficulty of accessing paediatricians has been of debate for a long time, however, there is limited evidence to assess the population- and geography-related inequality of paediatric workforce distribution. This study aimed to analyse the inequality of the distributions of the paediatric workforce (including paediatricians and paediatric nurses) in China by using Lorenz curve, Gini coefficient, and Theil L index, data were obtained from the national maternal and child health human resource sampling survey conducted in 2010. In this study, we found that the paediatric workforce was the most inequitable regarding the distribution of children <7 years, the geographic distribution of the paediatric workforce highlighted very severe inequality across the nation, except the Central region. For different professional types, we found that, except the Central region, the level of inequality of paediatric nurses was higher than that of the paediatricians regarding both the demographic and geographic distributions. The inner-regional inequalities were the main sources of the paediatric workforce distribution inequality. To conclude, this study revealed the inadequate distribution of the paediatric workforce in China for the first time, substantial inequality of paediatric workforce distribution still existed across the nation in 2010, more research is still needed to explore the in-depth sources of inequality, especially the urban-rural variance and the inner- and inter-provincial differences, and to guide national and local health policy-making and resource allocation.
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Affiliation(s)
- Peige Song
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Zhenghong Ren
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Xinlei Chang
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Xuebei Liu
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Lin An
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100191, China.
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Scott H, Danel I. Accountability for improving maternal and newborn health. Best Pract Res Clin Obstet Gynaecol 2016; 36:45-56. [PMID: 27473405 DOI: 10.1016/j.bpobgyn.2016.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 05/14/2016] [Indexed: 11/28/2022]
Abstract
In 2010, the United Nations (UN) launched the Global Strategy for Women's and Children's Health to accelerate progress on maternal and child health. A UN Commission on Information and Accountability, established to ensure oversight and accountability on women's and children's health, outlined a framework with three processes: monitor, review, and act. This paper assesses progress on these processes. Effective monitoring depends on a functional civil registration and vital statistics system. Review requires counting all deaths and identifying contributing factors. The final, critical step is action to prevent similar deaths. Maternal death surveillance and response includes these steps and strengthens accountability. Strategies are underway to improve accountability for severe maternal morbidity and perinatal mortality. The post-2015 agenda adds greater focus on reducing inequalities, increasing availability of quality, disaggregated data, and accountability for human rights. This agenda requires engagement with communities and health providers - the foundation of accountability for women's and children's health.
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Affiliation(s)
- Heather Scott
- IWK Health Centre, 5980 University Ave, Halifax, Nova Scotia, B3J 3G9, Canada.
| | - Isabella Danel
- Pan American Health Organization, 525 23rd Street NW, Washington, DC, 20037, USA
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106
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Adolphson K, Axemo P, Högberg U. Midwives' experiences of working conditions, perceptions of professional role and attitudes towards mothers in Mozambique. Midwifery 2016; 40:95-101. [PMID: 27428104 DOI: 10.1016/j.midw.2016.06.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 06/04/2016] [Accepted: 06/13/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND low- and middle-income countries still have a long way to go to reach the fifth Millennium Development Goal of reducing maternal mortality. Mozambique has accomplished a reduction of maternal mortality since the 1990s, but still has among the highest in the world. A key strategy in reducing maternal mortality is to invest in midwifery. AIM the objective was to explore midwives' perspectives of their working conditions, their professional role, and perceptions of attitudes towards mothers in a low-resource setting. SETTING midwives in urban, suburban, village and remote areas; working in central, general and rural hospitals as well as health centres and health posts were interviewed in Maputo City, Maputo Province and Gaza Province in Mozambique. METHOD the study had a qualitative research design. Nine semi-structured interviews and one follow-up interview were conducted and analysed with qualitative content analysis. RESULTS two main themes were found; commitment/devotion and lack of resources. All informants described empathic care-giving, with deep engagement with the mothers and highly valued working in teams. Lack of resources prevented the midwives from providing care and created frustration and feelings of insufficiency. CONCLUSIONS the midwives perceptions were that they tried to provide empathic, responsive care on their own within a weak health system which created many difficulties. The great potential the midwives possess of providing quality care must be valued and nurtured for their competency to be used more effectively.
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Affiliation(s)
- Katja Adolphson
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden.
| | - Pia Axemo
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden.
| | - Ulf Högberg
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden.
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McConnell M, Ettenger A, Rothschild CW, Muigai F, Cohen J. Can a community health worker administered postnatal checklist increase health-seeking behaviors and knowledge?: evidence from a randomized trial with a private maternity facility in Kiambu County, Kenya. BMC Pregnancy Childbirth 2016; 16:136. [PMID: 27260500 PMCID: PMC4893209 DOI: 10.1186/s12884-016-0914-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 05/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the 2009 WHO and UNICEF recommendation that women receive home-based postnatal care within the first three days after birth, a growing number of low-income countries have explored integrating postnatal home visit interventions into their maternal and newborn health strategies. This randomized trial evaluates a pilot program in which community health workers (CHWs) visit or call new mothers three days after delivery in peri-urban Kiambu County, Kenya. METHODS Participants were individually randomized to one of three groups: 1) early postnatal care three days after delivery provided in-person with a CHW using a simple checklist, 2) care provided by phone with a CHW using the same checklist, or 3) a standard of care group. Surveys were conducted ten days and nine weeks postnatal to measure outcomes related to compliance with referrals, self-reported health problems for mother and baby, care-seeking behaviors, and postnatal knowledge and practices around the recognition of danger signs, feeding, nutrition, infant care and family planning. RESULTS The home visit administration of the checklist increased the likelihood that women recognized postnatal problems for themselves and their babies and increased the likelihood that they sought care to address those problems identified for the child. In both the home visit and mobile phone implementation of the checklist, actions taken for postnatal problems happened earlier, particularly for infants. Knowledge was found to be high across all groups, with limited evidence that the checklist impacted knowledge and postnatal practices around the recognition of danger signs, feeding, nutrition, infant care and family planning. CONCLUSION We find evidence that CHW-administered postnatal checklists can lead to better recognition of postnatal problems and more timely care-seeking. Furthermore, our results suggest that CHWs can affordably deliver many of the benefits of postnatal checklists. TRIAL REGISTRATION ClinicalTrials.gov NCT02104635 ; registered April 2, 2014.
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Affiliation(s)
- Margaret McConnell
- Harvard T. H. Chan School of Public Health, Building 1, Room 1217, 665 Huntington Ave, Boston, MA, 02115, USA.
| | | | | | - Faith Muigai
- Jacaranda Health, P.O. Box 42844 - 00100, Nairobi, Kenya
| | - Jessica Cohen
- Harvard T. H. Chan School of Public Health, Building 1, Room 1217, 665 Huntington Ave, Boston, MA, 02115, USA
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108
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Affiliation(s)
- Zulfiqar A Bhutta
- Robert Harding Chair in Global Child Health and Policy, Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan.
| | - Mickey Chopra
- Lead Health Specialist, World Bank, Washington DC, USA
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109
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Victora CG, Requejo JH, Barros AJD, Berman P, Bhutta Z, Boerma T, Chopra M, de Francisco A, Daelmans B, Hazel E, Lawn J, Maliqi B, Newby H, Bryce J. Countdown to 2015: a decade of tracking progress for maternal, newborn, and child survival. Lancet 2016; 387:2049-59. [PMID: 26477328 PMCID: PMC7613171 DOI: 10.1016/s0140-6736(15)00519-x] [Citation(s) in RCA: 286] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Conceived in 2003 and born in 2005 with the launch of its first report and country profiles, the Countdown to 2015 for Maternal, Newborn, and Child Survival has reached its originally proposed lifespan. Major reductions in the deaths of mothers and children have occurred since Countdown's inception, even though most of the 75 priority countries failed to achieve Millennium Development Goals 4 and 5. The coverage of life-saving interventions tracked in Countdown increased steadily over time, but wide inequalities persist between and within countries. Key drivers of coverage such as financing, human resources, commodities, and conducive health policies also showed important, yet insufficient increases. As a multistakeholder initiative of more than 40 academic, international, bilateral, and civil society institutions, Countdown was successful in monitoring progress and raising the visibility of the health of mothers, newborns, and children. Lessons learned from this initiative have direct bearing on monitoring progress during the Sustainable Development Goals era.
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Affiliation(s)
| | | | | | - Peter Berman
- Harvard School of Public Health, Boston, MA, USA
| | - Zulfiqar Bhutta
- Robert Harding Chair in Global Child Health and Policy, Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ties Boerma
- World Health Organization, Geneva, Switzerland
| | | | | | | | - Elizabeth Hazel
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joy Lawn
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Holly Newby
- United Nations Children's Fund, New York, NY, USA
| | - Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Amouzou A, Hazel E, Shaw B, Miller NP, Tafesse M, Mekonnen Y, Moulton LH, Bryce J, Black RE. Effects of the integrated Community Case Management of Childhood Illness Strategy on Child Mortality in Ethiopia: A Cluster Randomized Trial. Am J Trop Med Hyg 2016; 94:596-604. [PMID: 26787148 PMCID: PMC4775896 DOI: 10.4269/ajtmh.15-0586] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/29/2015] [Indexed: 12/01/2022] Open
Abstract
We conducted a cluster randomized trial of the effects of the integrated community case management of childhood illness (iCCM) strategy on careseeking for and coverage of correct treatment of suspected pneumonia, diarrhea, and malaria, and mortality among children aged 2-59 months in 31 districts of the Oromia region of Ethiopia. We conducted baseline and endline coverage and mortality surveys approximately 2 years apart, and assessed program strength after about 1 year of implementation. Results showed strong iCCM implementation, with iCCM-trained workers providing generally good quality of care. However, few sick children were taken to iCCM providers (average 16 per month). Difference in differences analyses revealed that careseeking for childhood illness was low and similar in both study arms at baseline and endline, and increased only marginally in intervention (22.9-25.7%) and comparison (23.3-29.3%) areas over the study period (P = 0.77). Mortality declined at similar rates in both study arms. Ethiopia's iCCM program did not generate levels of demand and utilization sufficient to achieve significant increases in intervention coverage and a resulting acceleration in reductions in child mortality. This evaluation has allowed Ethiopia to strengthen its strategic approaches to increasing population demand and use of iCCM services.
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Affiliation(s)
- Agbessi Amouzou
- Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Alliance for Better Health Services Private Limited Company, Addis Ababa, Ethiopia; Mela Research Private Limited Company, Addis Ababa, Ethiopia
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Kien VD, Lee HY, Nam YS, Oh J, Giang KB, Van Minh H. Trends in socioeconomic inequalities in child malnutrition in Vietnam: findings from the Multiple Indicator Cluster Surveys, 2000-2011. Glob Health Action 2016; 9:29263. [PMID: 26950558 PMCID: PMC4780091 DOI: 10.3402/gha.v9.29263] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Child malnutrition is not only a major contributor to child mortality and morbidity, but it can also determine socioeconomic status in adult life. The rate of under-five child malnutrition in Vietnam has significantly decreased, but associated inequality issues still need attention. OBJECTIVE This study aims to explore trends, contributing factors, and changes in inequalities for under-five child malnutrition in Vietnam between 2000 and 2011. DESIGN Data were drawn from the Viet Nam Multiple Indicator Cluster Survey for the years 2000 and 2011. The dependent variables used for the study were stunting, underweight, and wasting of under-five children. The concentration index was calculated to see the magnitude of child malnutrition, and the inequality was decomposed to understand the contributions of determinants to child malnutrition. The total differential decomposition was used to identify and explore factors contributing to changes in child malnutrition inequalities. RESULTS Inequality in child malnutrition increased between 2000 and 2011, even though the overall rate declined. Most of the inequality in malnutrition was due to ethnicity and socioeconomic status. The total differential decomposition showed that the biggest and second biggest contributors to the changes in underweight inequalities were age and socioeconomic status, respectively. Socioeconomic status was the largest contributor to inequalities in stunting. CONCLUSIONS Although the overall level of child malnutrition was improved in Vietnam, there were significant differences in under-five child malnutrition that favored those who were more advantaged in socioeconomic terms. The impact of socioeconomic inequalities in child malnutrition has increased over time. Multifaceted approaches, connecting several relevant ministries and sectors, may be necessary to reduce inequalities in childhood malnutrition.
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Affiliation(s)
- Vu Duy Kien
- Center for Population Health Sciences, Hanoi School of Public Health, Hanoi, Vietnam
- Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; ;
| | - Hwa-Young Lee
- JW Lee Center for Global Medicine, Seoul National University College of Medicine, Seoul, Korea; ;
| | - You-Seon Nam
- JW Lee Center for Global Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Juhwan Oh
- JW Lee Center for Global Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kim Bao Giang
- Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Hoang Van Minh
- Center for Population Health Sciences, Hanoi School of Public Health, Hanoi, Vietnam
- Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam
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Michael IJ, Kim TH, Sunkara V, Cho YK. Challenges and Opportunities of Centrifugal Microfluidics for Extreme Point-of-Care Testing. MICROMACHINES 2016; 7:mi7020032. [PMID: 30407405 PMCID: PMC6190358 DOI: 10.3390/mi7020032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/21/2016] [Accepted: 02/14/2016] [Indexed: 12/18/2022]
Abstract
The advantages offered by centrifugal microfluidic systems have encouraged its rapid adaptation in the fields of in vitro diagnostics, clinical chemistry, immunoassays, and nucleic acid tests. Centrifugal microfluidic devices are currently used in both clinical and point-of-care settings. Recent studies have shown that this new diagnostic platform could be potentially used in extreme point-of-care settings like remote villages in the Indian subcontinent and in Africa. Several technological inventions have decentralized diagnostics in developing countries; however, very few microfluidic technologies have been successful in meeting the demand. By identifying the finest difference between the point-of-care testing and extreme point-of-care infrastructure, this review captures the evolving diagnostic needs of developing countries paired with infrastructural challenges with technological hurdles to healthcare delivery in extreme point-of-care settings. In particular, the requirements for making centrifugal diagnostic devices viable in developing countries are discussed based on a detailed analysis of the demands in different clinical settings including the distinctive needs of extreme point-of-care settings.
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Affiliation(s)
- Issac J Michael
- Department of Biomedical Engineering, School of Life Sciences, Ulsan National Institute of Science and Technology (UNIST), 100 Banyeon-ri, Eonyang-eup, Ulju-gun, Ulsan 689-798, Korea.
| | - Tae-Hyeong Kim
- Department of Biomedical Engineering, School of Life Sciences, Ulsan National Institute of Science and Technology (UNIST), 100 Banyeon-ri, Eonyang-eup, Ulju-gun, Ulsan 689-798, Korea.
| | - Vijaya Sunkara
- Department of Biomedical Engineering, School of Life Sciences, Ulsan National Institute of Science and Technology (UNIST), 100 Banyeon-ri, Eonyang-eup, Ulju-gun, Ulsan 689-798, Korea.
| | - Yoon-Kyoung Cho
- Department of Biomedical Engineering, School of Life Sciences, Ulsan National Institute of Science and Technology (UNIST), 100 Banyeon-ri, Eonyang-eup, Ulju-gun, Ulsan 689-798, Korea.
- Center for Soft and Living Matter, Institute for Basic Science (IBS), UNIST-gil 50, Ulsan 689-798, Korea.
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Caesarean Section in Peru: Analysis of Trends Using the Robson Classification System. PLoS One 2016; 11:e0148138. [PMID: 26840693 PMCID: PMC4740461 DOI: 10.1371/journal.pone.0148138] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/13/2016] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Cesarean section rates continue to increase worldwide while the reasons appear to be multiple, complex and, in many cases, country specific. Over the last decades, several classification systems for caesarean section have been created and proposed to monitor and compare caesarean section rates in a standardized, reliable, consistent and action-oriented manner with the aim to understand the drivers and contributors of this trend. The aims of the present study were to conduct an analysis in the three Peruvian geographical regions to assess levels and trends of delivery by caesarean section using the Robson classification for caesarean section, identify the groups of women with highest caesarean section rates and assess variation of maternal and perinatal outcomes according to caesarean section levels in each group over time. MATERIAL AND METHODS Data from 549,681 pregnant women included in the Peruvian Perinatal Information System database from 43 maternal facilities in three Peruvian geographical regions from 2000 and 2010 were studied. The data were analyzed using the Robson classification and women were studied in the ten groups in the classification. Cochran-Armitage test was used to evaluate time trends in the rates of caesarean section rates and; logistic regression was used to evaluate risk for each classification. RESULTS The caesarean section rate was 27% and a yearly increase in the overall caesarean section rates from 2000 to 2010 from 23.5% to 30% (time trend p<0.001) was observed. Robson groups 1, 3 (nulliparous and multiparas, respectively, with a single cephalic term pregnancy in spontaneous labour), 5 (multiparas with a previous uterine scar with a single, cephalic, term pregnancy) and 7 (multiparas with a single breech pregnancy with or without previous scars) showed an increase in the caesarean section rates over time. Robson groups 1 and 3 were significantly associated with stillbirths (OR 1.43, CI95% 1.17-1.72; OR 3.53, CI95% 2.95-4.2) and maternal mortality (OR 3.39, CI95% 1.59-7.22; OR 8.05, CI95% 3.34-19.41). DISCUSSION The caesarean section rates increased in the last years as result of increased CS in groups with spontaneous labor and in-group of multiparas with a scarred uterus. Women included in groups 1 y 3 were associated to maternal perinatal complications. Women with previous cesarean section constitute the most important determinant of overall cesarean section rates. The use of Robson classification becomes an useful tool for monitoring cesarean section in low human development index countries.
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Abstract
Considerable progress has been made towards reducing under-5 childhood mortality in the Millennium Development Goals era. Reduction in newborn mortality has lagged behind maternal and child mortality. Effective implementation of innovative, evidence-based, and cost-effective interventions can reduce maternal and newborn mortality. Interventions aimed at the most vulnerable group results in maximal impact on mortality. Intervention coverage and scale-up remains low, inequitable and uneven in low-income countries due to numerous health-systems bottle-necks. Innovative service delivery strategies, increased integration and linkages across the maternal, newborn, child health continuum of care are vital to accelerate progress towards ending preventable maternal and newborn deaths.
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115
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Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387:475-90. [PMID: 26869575 DOI: 10.1016/s0140-6736(15)01024-7] [Citation(s) in RCA: 3642] [Impact Index Per Article: 455.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823,000 annual deaths in children younger than 5 years and 20,000 annual deaths from breast cancer. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor.
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Affiliation(s)
- Cesar G Victora
- International Center for Equity in Health, Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health (MCA), WHO, Geneva, Switzerland
| | - Aluísio J D Barros
- International Center for Equity in Health, Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Giovanny V A França
- International Center for Equity in Health, Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Susan Horton
- Department of Economics, University of Waterloo, ON, Canada
| | - Julia Krasevec
- Data and Analytics Section, Division of Data, Research, and Policy, UNICEF, New York, NY, USA
| | - Simon Murch
- University Hospital Coventry and Warwickshire, Coventry, UK
| | - Mari Jeeva Sankar
- WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Neff Walker
- Institute for International Programs, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nigel C Rollins
- Department of Maternal, Newborn, Child and Adolescent Health (MCA), WHO, Geneva, Switzerland
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Hon HH, Sheref Kousari YM, Papadimos TJ, Tsavoussis A, Jeanmonod R, Stawicki SP. What's new in critical illness and injury science? Nonaccidental burn injuries, child abuse awareness and prevention, and the critical need for dedicated pediatric emergency specialists: Answering the global call for social justice for our youngest citizens. Int J Crit Illn Inj Sci 2016; 5:223-6. [PMID: 26807388 PMCID: PMC4705565 DOI: 10.4103/2229-5151.170854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Heidi H Hon
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | | | - Thomas J Papadimos
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | - Rebecca Jeanmonod
- Department of Emergency Medicine, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Stanislaw P Stawicki
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
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Kanyuka M, Ndawala J, Mleme T, Chisesa L, Makwemba M, Amouzou A, Borghi J, Daire J, Ferrabee R, Hazel E, Heidkamp R, Hill K, Martínez Álvarez M, Mgalula L, Munthali S, Nambiar B, Nsona H, Park L, Walker N, Daelmans B, Bryce J, Colbourn T. Malawi and Millennium Development Goal 4: a Countdown to 2015 country case study. LANCET GLOBAL HEALTH 2016; 4:e201-14. [PMID: 26805586 DOI: 10.1016/s2214-109x(15)00294-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/26/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Several years in advance of the 2015 endpoint for the Millennium Development Goals (MDGs), Malawi was already thought to be one of the few countries in sub-Saharan Africa likely to meet the MDG 4 target of reducing under-5 mortality by two-thirds between 1990 and 2015. Countdown to 2015 therefore selected the Malawi National Statistical Office to lead an in-depth country case study, aimed mainly at explaining the country's success in improving child survival. METHODS We estimated child and neonatal mortality for the years 2000-14 using five district-representative household surveys. The study included recalculation of coverage indicators for that period, and used the Lives Saved Tool (LiST) to attribute the child lives saved in the years from 2000 to 2013 to various interventions. We documented the adoption and implementation of policies and programmes affecting the health of women and children, and developed estimates of financing. FINDINGS The estimated mortality rate in children younger than 5 years declined substantially in the study period, from 247 deaths (90% CI 234-262) per 1000 livebirths in 1990 to 71 deaths (58-83) in 2013, with an annual rate of decline of 5·4%. The most rapid mortality decline occurred in the 1-59 months age group; neonatal mortality declined more slowly (from 50 to 23 deaths per 1000 livebirths), representing an annual rate of decline of 3·3%. Nearly half of the coverage indicators have increased by more than 20 percentage points between 2000 and 2014. Results from the LiST analysis show that about 280,000 children's lives were saved between 2000 and 2013, attributable to interventions including treatment for diarrhoea, pneumonia, and malaria (23%), insecticide-treated bednets (20%), vaccines (17%), reductions in wasting (11%) and stunting (9%), facility birth care (7%), and prevention and treatment of HIV (7%). The amount of funding allocated to the health sector has increased substantially, particularly to child health and HIV and from external sources, but remains below internationally agreed targets. Key policies to address the major causes of child mortality and deliver high-impact interventions at scale throughout Malawi began in the late 1990s and intensified in the latter half of the 2000s and into the 2010s, backed by health-sector-wide policies to improve women's and children's health. INTERPRETATION This case study confirmed that Malawi had achieved MDG 4 for child survival by 2013. Our findings suggest that this was achieved mainly through the scale-up of interventions that are effective against the major causes of child deaths (malaria, pneumonia, and diarrhoea), programmes to reduce child undernutrition and mother-to-child transmission of HIV, and some improvements in the quality of care provided around birth. The Government of Malawi was among the first in sub-Saharan Africa to adopt evidence-based policies and implement programmes at scale to prevent unnecessary child deaths. Much remains to be done, building on this success and extending it to higher proportions of the population and targeting continued high neonatal mortality rates. FUNDING Bill & Melinda Gates Foundation, WHO, The World Bank, Government of Australia, Government of Canada, Government of Norway, Government of Sweden, Government of the UK, and UNICEF.
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Affiliation(s)
| | | | - Tiope Mleme
- Malawi National Statistics Office, Zomba, Malawi
| | | | | | | | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rufus Ferrabee
- University College London, Institute for Global Health, London, UK; Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Elizabeth Hazel
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca Heidkamp
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth Hill
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melisa Martínez Álvarez
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Leslie Mgalula
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Spy Munthali
- Chancellor College, University of Malawi, Zomba, Malawi
| | - Bejoy Nambiar
- University College London, Institute for Global Health, London, UK
| | | | - Lois Park
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neff Walker
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bernadette Daelmans
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tim Colbourn
- University College London, Institute for Global Health, London, UK.
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Social and economic determinants of pediatric health inequalities: the model of chronic kidney disease. Pediatr Res 2016; 79:159-68. [PMID: 26466076 DOI: 10.1038/pr.2015.194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/09/2015] [Indexed: 12/29/2022]
Abstract
Purpose of this review is to deal with priorities and strategies to significantly tackle inequalities in the management of pediatric diseases in low-middle-income countries. This issue has become a focal point of epidemiological and public health, with special reference to chronic nontransmissible diseases. We will provide our readership with an essential overview of the cultural, institutional, and political events, which have occurred over the last 20 y and which have produced the current general framework for epidemiology and public health. Then the most recent epidemiological data will be evaluated, in order to quantify the interaction between the medical components of the disease profiles and their socioeconomic determinants. Finally, a focus will be added on models of pediatric chronic kidney diseases, which are in our opinion amongst the most sensitive markers of the interplay between health and society. Collaborative, pediatrician-initiated, multicentre projects in these fields should be given priority in calls for grants supported by public agencies. The involvement of a critical mass of those working in the "fringes" of pediatric care is a final, essential mean by which significant results can be produced under the sole responsibility and research interest of centers of excellence.
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Krubiner CB, Salmon M, Synowiec C, Lagomarsino G. Investing in nursing and midwifery enterprise: Empowering women and strengthening health systems—A landscaping study of innovations in low- and middle-income countries. Nurs Outlook 2016; 64:17-23. [DOI: 10.1016/j.outlook.2015.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/08/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
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Persson LÅ. Numbering the uncounted, focusing the unseen. Acta Paediatr 2015; 104:1206-7. [PMID: 26768776 DOI: 10.1111/apa.13249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Lars Åke Persson
- Department of Women's and Children's Health; International Maternal and Child Health; Uppsala University; Uppsala Sweden
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Onubi OJ, Marais D, Aucott L, Okonofua F, Poobalan AS. Maternal obesity in Africa: a systematic review and meta-analysis. J Public Health (Oxf) 2015; 38:e218-e231. [PMID: 26487702 PMCID: PMC5072166 DOI: 10.1093/pubmed/fdv138] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Maternal obesity is emerging as a public health problem, recently highlighted together with maternal under-nutrition as a ‘double burden’, especially in African countries undergoing social and economic transition. This systematic review was conducted to investigate the current evidence on maternal obesity in Africa. Methods MEDLINE, EMBASE, Scopus, CINAHL and PsycINFO were searched (up to August 2014) and identified 29 studies. Prevalence, associations with socio-demographic factors, labour, child and maternal consequences of maternal obesity were assessed. Pooled risk ratios comparing obese and non-obese groups were calculated. Results Prevalence of maternal obesity across Africa ranged from 6.5 to 50.7%, with older and multiparous mothers more likely to be obese. Obese mothers had increased risks of adverse labour, child and maternal outcomes. However, non-obese mothers were more likely to have low-birthweight babies. The differences in measurement and timing of assessment of maternal obesity were found across studies. No studies were identified either on the knowledge or attitudes of pregnant women towards maternal obesity; or on interventions for obese pregnant women. Conclusions These results show that Africa's levels of maternal obesity are already having significant adverse effects. Culturally adaptable/sensitive interventions should be developed while monitoring to avoid undesired side effects.
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Affiliation(s)
- Ojochenemi J Onubi
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Debbi Marais
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Lorna Aucott
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Friday Okonofua
- Department of Obstetrics and Gynaecology, College of Medical Sciences, University of Benin, Benin City, Edo State, Nigeria
| | - Amudha S Poobalan
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
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Belaid L, Dumont A, Chaillet N, De Brouwere V, Zertal A, Hounton S, Ridde V. Protocol for a systematic review on the effect of demand generation interventions on uptake and use of modern contraceptives in LMIC. Syst Rev 2015; 4:124. [PMID: 26420571 PMCID: PMC4589108 DOI: 10.1186/s13643-015-0102-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 08/18/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite a global increase in contraception use, its prevalence remains low in low- and middle-income countries. One strategy to improve uptake and use of contraception, as an essential complement to policies and supply-side interventions, is demand generation. Demand generation interventions have reportedly produced positive effects on uptake and use of family planning services, but the evidence base remains poorly documented. To reduce this knowledge gap, we will conduct a systematic review on the impact of demand generation interventions on the use of modern contraception. The objectives of the review will be as follows: (1) to synthesize evidence on the impacts and costs of family planning demand generation interventions and on their effectiveness in improving modern contraceptive use and (2) to identify the indicators used to assess effectiveness, cost-effectiveness, and impacts of demand generation interventions. METHODS/DESIGN We will systematically review the public health and health promotion literature in several databases (e.g., CINAHL, Medline, EMBASE) as well as gray literature. We will select articles from 1970 to 2015, in French and in English. The review will include studies that assess the impact of family planning programs or interventions on changes in contraception use. The studied interventions will be those with a demand generation component, even if a supply component is implemented. Two members of the team will independently search, screen, extract data, and assess the quality of the studies selected. Different tools will be used to assess the quality of the studies depending on the study design. If appropriate, a meta-analysis will be conducted. The analysis will involve comparing odd ratios (OR) DISCUSSION: The systematic review results will be disseminated to United Nations Population Fund program countries and will contribute to the development of a guidance document and programmatic tools for planning, implementing, and evaluating demand generation interventions in family planning. Improving the effectiveness of family planning programs is critical for empowering women and adolescent girls, improving human capital, reducing dependency ratios, reducing maternal and child mortality, and achieving demographic dividends in low- and middle-income countries. SYSTEMATIC REVIEW REGISTRATION This protocol is registered in PROSPERO (CRD 42015017549).
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Affiliation(s)
- Loubna Belaid
- Maternal and Reproductive Health Unit, Public Health Department, Institute of Tropical Medicine, 155 Nationalestraat, 2000, Antwerp, Belgium.
| | - Alexandre Dumont
- UMR 216 IRD-Université Paris Descartes, 4 Avenue de l'Observatoire, 75 006, Paris, France.
| | - Nils Chaillet
- Département d'obstétrique et gynécologie et département de Médecine de famille et médecine d'urgence, Faculté de médecine et des sciences de la santé, Centre de recherche du CHUS: Axe Santé: populations, organisation, pratiques, Université de Sherbrooke, Sherbrooke, Canada.
| | - Vincent De Brouwere
- Maternal and Reproductive Health Unit, Public Health Department, Institute of Tropical Medicine, 155 Nationalestraat, 2000, Antwerp, Belgium.
| | - Amel Zertal
- Centre de recherche du CHUM, Axe Évaluation, Systèmes de soins et services, Université de Montréal, 850, rue Saint Denis-Tour S, Local S03-814, Montréal, QC, H2X 0A9, Canada.
| | - Sennen Hounton
- Commodity Security Branch, Technical Division, United Nations Population Fund, 605 3rd Avenue, New York, NY, 10158, USA.
| | - Valéry Ridde
- Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), 7101 Avenue du Parc, bureau 3187-03, Montréal, Québec, H3N1X9, Canada. .,ESPUM (école de santé publique de l'Université de Montréal), Montréal, Canada.
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Starrs A. A Lancet Commission on sexual and reproductive health and rights: going beyond the Sustainable Development Goals. Lancet 2015; 386:1111-2. [PMID: 26461889 DOI: 10.1016/s0140-6736(15)00250-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ann Starrs
- Guttmacher Institute, New York, NY 10038, USA.
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Moxon SG, Ruysen H, Kerber KJ, Amouzou A, Fournier S, Grove J, Moran AC, Vaz LME, Blencowe H, Conroy N, Gülmezoglu A, Vogel JP, Rawlins B, Sayed R, Hill K, Vivio D, Qazi SA, Sitrin D, Seale AC, Wall S, Jacobs T, Ruiz Peláez J, Guenther T, Coffey PS, Dawson P, Marchant T, Waiswa P, Deorari A, Enweronu-Laryea C, Arifeen S, Lee ACC, Mathai M, Lawn JE. Count every newborn; a measurement improvement roadmap for coverage data. BMC Pregnancy Childbirth 2015; 15 Suppl 2:S8. [PMID: 26391444 PMCID: PMC4577758 DOI: 10.1186/1471-2393-15-s2-s8] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. Methods In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. Results ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. Conclusions The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks.
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Alkenbrack S, Chaitkin M, Zeng W, Couture T, Sharma S. Did Equity of Reproductive and Maternal Health Service Coverage Increase during the MDG Era? An Analysis of Trends and Determinants across 74 Low- and Middle-Income Countries. PLoS One 2015; 10:e0134905. [PMID: 26331846 PMCID: PMC4558013 DOI: 10.1371/journal.pone.0134905] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 07/16/2015] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Despite widespread gains toward the 5th Millennium Development Goal (MDG), pro-rich inequalities in reproductive health (RH) and maternal health (MH) are pervasive throughout the world. As countries enter the post-MDG era and strive toward UHC, it will be important to monitor the extent to which countries are achieving equity of RH and MH service coverage. This study explores how equity of service coverage differs across countries, and explores what policy factors are associated with a country's progress, or lack thereof, toward more equitable RH and MH service coverage. METHODS We used RH and MH service coverage data from Demographic and Health Surveys (DHS) for 74 countries to examine trends in equity between countries and over time from 1990 to 2014. We examined trends in both relative and absolute equity, and measured relative equity using a concentration index of coverage data grouped by wealth quintile. Through multivariate analysis we examined the relative importance of policy factors, such as political commitment to health, governance, and the level of prepayment, in determining countries' progress toward greater equity in RH and MH service coverage. RESULTS Relative equity for the coverage of RH and MH services has continually increased across all countries over the past quarter century; however, inequities in coverage persist, in some countries more than others. Multivariate analysis shows that higher education and greater political commitment (measured as the share of government spending allocated to health) were significantly associated with higher equity of service coverage. Neither country income, i.e., GDP per capita, nor better governance were significantly associated with equity. CONCLUSION Equity in RH and MH service coverage has improved but varies considerably across countries and over time. Even among the subset of countries that are close to achieving the MDGs, progress made on equity varies considerably across countries. Enduring disparities in access and outcomes underpin mounting support for targeted reforms within the broader context of universal health coverage (UHC).
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Affiliation(s)
- Sarah Alkenbrack
- Health Policy Project, Center for Policy and Advocacy, Futures Group, Washington, DC, United States of America
| | - Michael Chaitkin
- Health Policy Project, Center for Policy and Advocacy, Futures Group, Washington, DC, United States of America
| | - Wu Zeng
- Health Policy Project, Center for Policy and Advocacy, Futures Group, Washington, DC, United States of America
| | - Taryn Couture
- Health Policy Project, Center for Policy and Advocacy, Futures Group, Washington, DC, United States of America
| | - Suneeta Sharma
- Health Policy Project, Center for Policy and Advocacy, Futures Group, Washington, DC, United States of America
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Shimamoto K, Gipson JD. The relationship of women's status and empowerment with skilled birth attendant use in Senegal and Tanzania. BMC Pregnancy Childbirth 2015; 15:154. [PMID: 26205512 PMCID: PMC4514446 DOI: 10.1186/s12884-015-0591-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 07/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal mortality remains unacceptably high in sub-Saharan Africa with 179,000 deaths occurring each year, accounting for 2-thirds of maternal deaths worldwide. Progress in reducing maternal deaths and increasing Skilled Birth Attendant (SBA) use at childbirth has stagnated in Africa. Although several studies demonstrate the important influences of women's status and empowerment on SBA use, this evidence is limited, particularly in Africa. Furthermore, few studies empirically test the operationalization of women's empowerment and incorporate multidimensional measures to represent the potentially disparate influence of women's status and empowerment on SBA use across settings. METHODS This study examined the relationship of women's status and empowerment with SBA use in two African countries--Senegal and Tanzania--using the 2010 Demographic and Health Surveys (weighted births n = 10,688 in SN; 6748 in TZ). Factor analysis was first conducted to identify the structure and multiple dimensions of empowerment. Then, a multivariate regression analysis was conducted to examine associations between these empowerment dimensions and SBA use. RESULTS Overall, women's status and empowerment were positively related to SBA use. Some sociodemographic characteristics showed similar effects across countries (e.g., age, wealth, residence, marital relationship, parity); however, women's status and empowerment influence SBA use differently by setting. Namely, women's education directly and positively influenced SBA use in Tanzania, but not in Senegal. Further, each of the dimensions of empowerment influenced SBA use in disparate ways. In Tanzania women's higher household decision-making power and employment were related to SBA use, while in Senegal more progressive perceptions of gender norms and older age at first marriage were related to SBA use. CONCLUSIONS This study provides evidence of the disparate influences of women's status and empowerment on SBA use across settings. Results indicate that efforts to increase SBA use and to reduce maternal mortality through the improvement of women's status and empowerment should focus both on improving girls' education and delaying marriage, as well as transforming gender norms and decision-making power. However, given the multi-dimensional and contextual nature of women's status and empowerment, it is critical to identify key drivers to increase SBA use in a given setting for contextually tailored policy and programming.
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Affiliation(s)
- Kyoko Shimamoto
- Fielding School of Public Health, Center for Health Sciences, University of California, Los Angeles, 650 Charles E. Young Dr. South, 16-035, Los Angeles, CA, 90095-1772, USA.
| | - Jessica D Gipson
- Fielding School of Public Health, Center for Health Sciences, University of California, Los Angeles, 650 Charles E. Young Dr. South, 16-035, Los Angeles, CA, 90095-1772, USA.
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Koffi AK, Libite PR, Moluh S, Wounang R, Kalter HD. Social autopsy study identifies determinants of neonatal mortality in Doume, Nguelemendouka and Abong-Mbang health districts, Eastern Region of Cameroon. J Glob Health 2015; 5:010413. [PMID: 26171142 PMCID: PMC4459092 DOI: 10.7189/jogh.05.010413] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Reducing preventable medical causes of neonatal death for faster progress toward the MGD4 will require Cameroon to adequately address the social factors contributing to these deaths. The objective of this paper is to explore the social, behavioral and health systems determinants of newborn death in Doume, Nguelemendouka and Abong–Mbang health districts, in Eastern Region of Cameroon, from 2007–2010. Methods Data come from the 2012 Verbal/Social Autopsy (VASA) study, which aimed to determine the biological causes and social, behavioral and health systems determinants of under–five deaths in Doume, Nguelemendouka and Abong–Mbang health districts in Eastern Region of Cameroon. The analysis of the data was guided by the review of the coverage of key interventions along the continuum of normal maternal and newborn care and by the description of breakdowns in the care provided for severe neonatal illnesses within the Pathway to Survival conceptual framework. Results One hundred sixty–four newborn deaths were confirmed from the VASA survey. The majority of the deceased newborns were living in households with poor socio–economic conditions. Most (60–80%) neonates were born to mothers who had one or more pregnancy or labor and delivery complications. Only 23% of the deceased newborns benefited from hygienic cord care after birth. Half received appropriate thermal care and only 6% were breastfed within one hour after birth. Sixty percent of the deaths occurred during the first day of life. Fifty–five percent of the babies were born at home. More than half of the deaths (57%) occurred at home. Of the 64 neonates born at a health facility, about 63% died in the health facility without leaving. Careseeking was delayed for several neonates who became sick after the first week of life and whose illnesses were less serious at the onset until they became more severely ill. Cost, including for transport, health care and other expenses, emerged as main barriers to formal care–seeking both for the mothers and their newborns. Conclusions This study presents an opportunity to strengthen maternal and newborn health by increasing the coverage of essential and low cost interventions that could have saved the lives of many newborns in eastern Cameroon.
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Affiliation(s)
- Alain K Koffi
- Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD, USA
| | | | | | | | - Henry D Kalter
- Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD, USA
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129
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Kimani-Murage EW, Muthuri SK, Oti SO, Mutua MK, van de Vijver S, Kyobutungi C. Evidence of a Double Burden of Malnutrition in Urban Poor Settings in Nairobi, Kenya. PLoS One 2015; 10:e0129943. [PMID: 26098561 PMCID: PMC4476587 DOI: 10.1371/journal.pone.0129943] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 05/14/2015] [Indexed: 01/09/2023] Open
Abstract
Background Many low- and middle-income countries are undergoing a nutrition transition associated with rapid social and economic transitions. We explore the coexistence of over and under- nutrition at the neighborhood and household level, in an urban poor setting in Nairobi, Kenya. Methods Data were collected in 2010 on a cohort of children aged under five years born between 2006 and 2010. Anthropometric measurements of the children and their mothers were taken. Additionally, dietary intake, physical activity, and anthropometric measurements were collected from a stratified random sample of adults aged 18 years and older through a separate cross-sectional study conducted between 2008 and 2009 in the same setting. Proportions of stunting, underweight, wasting and overweight/obesity were dettermined in children, while proportions of underweight and overweight/obesity were determined in adults. Results Of the 3335 children included in the analyses with a total of 6750 visits, 46% (51% boys, 40% girls) were stunted, 11% (13% boys, 9% girls) were underweight, 2.5% (3% boys, 2% girls) were wasted, while 9% of boys and girls were overweight/obese respectively. Among their mothers, 7.5% were underweight while 32% were overweight/obese. A large proportion (43% and 37%%) of overweight and obese mothers respectively had stunted children. Among the 5190 adults included in the analyses, 9% (6% female, 11% male) were underweight, and 22% (35% female, 13% male) were overweight/obese. Conclusion The findings confirm an existing double burden of malnutrition in this setting, characterized by a high prevalence of undernutrition particularly stunting early in life, with high levels of overweight/obesity in adulthood, particularly among women. In the context of a rapid increase in urban population, particularly in urban poor settings, this calls for urgent action. Multisectoral action may work best given the complex nature of prevailing circumstances in urban poor settings. Further research is needed to understand the pathways to this coexistence, and to test feasibility and effectiveness of context-specific interventions to curb associated health risks.
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Affiliation(s)
| | | | - Samuel O. Oti
- African Population and Health Research Center, Nairobi, Kenya
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Martin K. Mutua
- African Population and Health Research Center, Nairobi, Kenya
| | - Steven van de Vijver
- African Population and Health Research Center, Nairobi, Kenya
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
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130
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Goldenberg RL, McClure EM, Bose CL, Jobe AH, Belizán JM. Research results from a registry supporting efforts to improve maternal and child health in low and middle income countries. Reprod Health 2015; 12:54. [PMID: 26032486 PMCID: PMC4451746 DOI: 10.1186/s12978-015-0045-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 05/27/2015] [Indexed: 11/13/2022] Open
Abstract
The National Institute of Child Health and Human Development created and continues to support the Global Network for Women's and Children's Health Research, a partnership between research institutions in the US and low-middle income countries. This commentary describes a series of 15 papers emanating from the Global Network's Maternal and Newborn Health Registry. Using data from 2010 to 2013, the series of papers describe nearly 300,000 pregnancies in 7 sites in 6 countries - India (2 sites), Pakistan, Kenya, Zambia, Guatemala and Argentina. These papers cover a wide range of topics including several dealing with efforts made to ensure data quality, and others reporting on specific pregnancy outcomes including maternal mortality, stillbirth and neonatal mortality. Topics ranging from antenatal care, adolescent pregnancy, obstructed labor, factors associated with early initiation of breast feeding and maintenance of exclusive breast feeding and contraceptive usage are presented. In addition, case studies evaluating changes in mortality over time in 3 countries - India, Pakistan and Guatemala - are presented. In order to make progress in improving pregnancy outcomes in low-income countries, data of this quality are needed.
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Affiliation(s)
- Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA.
| | | | - Carl L Bose
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Alan H Jobe
- Cincinnati Children's Hospital, Cincinnati, OH, USA.
| | - José M Belizán
- Editor-in-Chief of Reproductive Health, Institute for Clinical Effectiveness, Buenos Aires, Argentina.
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131
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Abstract
Progress in reducing the mortality of young children cannot be maintained without prioritization, funding, and implementation of neonatal interventions worldwide. Efforts to develop and deliver successful interventions must take a local perspective on problems and solutions, work through local policy processes and health care providers, and link to broader multisector efforts.
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Affiliation(s)
- Zulfiqar A Bhutta
- Center for Global Child Health, Sick Kids, Toronto, Ontario M5G 0A4, Canada. Center of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan.
| | - Gary L Darmstadt
- Global Development Division, Bill & Melinda Gates Foundation, Seattle, WA 98102, USA
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132
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Bhan MK, Paul VK. Outpatient treatment for neonates and young infants with clinically suspected severe infection. LANCET GLOBAL HEALTH 2015; 3:e245-6. [PMID: 25841892 DOI: 10.1016/s2214-109x(15)70109-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Maharaj K Bhan
- Department of Biotechnology, Government of India, New Delhi, India.
| | - Vinod K Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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133
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Gülmezoglu AM, Lawrie TA. Impact of training on emergency resuscitation skills: Impact on Millennium Development Goals (MDGs) 4 and 5. Best Pract Res Clin Obstet Gynaecol 2015; 29:1119-25. [PMID: 25937556 DOI: 10.1016/j.bpobgyn.2015.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/18/2015] [Accepted: 03/18/2015] [Indexed: 01/21/2023]
Abstract
Although significant progress has been made towards Millennium Development Goal (MDG) 4 and 5 targets, maternal and neonatal mortality rates remain unacceptably high in low- and middle-income countries (LMICs). The potential for improvements in maternal and neonatal health outcomes with increased facility utilization in these countries is undermined by a lack of appropriate and timely treatment. Skilful emergency resuscitation can be the difference between life and death; therefore, training in emergency resuscitation is essential for health-care practitioners at all levels, with regular refresher sessions to ensure skill retention. Whilst there is little robust evidence on the impact of resuscitation training interventions on practitioner skills or patient outcomes, such training interventions are likely to have the greatest impact if integrated into a broader approach to improve the quality of care. Accelerated investments in training must go hand in hand with ensuring the availability of quality equipment and upgrading infrastructure to reduce the gap between current MDG status and what is achieved by the end of 2015; and to accelerate reductions in mortality rates beyond 2015 towards new Countdown targets.
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Affiliation(s)
- A Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1201 Geneva, Switzerland
| | - Theresa A Lawrie
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1201 Geneva, Switzerland.
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134
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Guerrera G. Neonatal and pediatric healthcare worldwide: A report from UNICEF. Clin Chim Acta 2015; 451:4-8. [PMID: 25771105 DOI: 10.1016/j.cca.2015.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 03/04/2015] [Accepted: 03/05/2015] [Indexed: 11/16/2022]
Abstract
The 2013 UNICEF annual report on child mortality concluded that between 1990 and 2013, the annual number of deaths among children under-5 years of age has fallen to 6.6 million (uncertainty range, 6.3 to 7.0 million), corresponding to a 48% reduction from the 12.6 million deaths in 1990 (uncertainty range, 12.4 to 12.9 million). About half of under-5 deaths occur in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan and China. By 2050, close to 40% of all live births will take place in Sub-Saharan Africa and 37% of the world's children under age five will live in the region. Most deaths can be attributable to preventable diseases. Pneumonia, diarrhea and malaria together killed roughly 2.2 million children under age five in 2012, accounting for a third of all under-five deaths. Emerging evidence has shown that children are at greater risk of dying before age five if they are born in rural areas, poor households, or to a mother denied basic education. While under-5 mortality was consistently reduced over the past 20 years, few progresses in reducing neonatal mortality as well as maternal mortality have been done. UNICEF is a leading partner in the Global Alliance for Vaccines and Immunization (GAVI), a far-reaching public-private partnership dedicated to increasing children's access to vaccines in poor countries. Early diagnosis and appropriate low-cost therapy of maternal and neonatal diseases are the challenges of the coming years. Therefore, there is the need to promote new experimental and clinical researches and to translate results in clinical practice. Laboratory medicine is strategic for promoting and validating innovative methods for managing the most important causes of maternal, neonatal and under-5 deaths, as well as to consistently reduce the gap between bench and bedside. This may be achieved by a close cooperation between laboratory medicine and industries for the development of new diagnostic tools, especially low-cost disposables easily usable by everyone, namely mothers, for an earlier and specific therapeutic treatments of such diseases like sepsis and infections.
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Affiliation(s)
- Giacomo Guerrera
- Press Office UNICEF Italian Nat Com, via Palestro 68, 00185 Roma, Italy.
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135
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Michalow J, Chola L, McGee S, Tugendhaft A, Pattinson R, Kerber K, Hofman K. Triple return on investment: the cost and impact of 13 interventions that could prevent stillbirths and save the lives of mothers and babies in South Africa. BMC Pregnancy Childbirth 2015; 15:39. [PMID: 25879579 PMCID: PMC4337184 DOI: 10.1186/s12884-015-0456-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/27/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The time of labor, birth and the first days of life are the most vulnerable period for mothers and children. Despite significant global advocacy, there is insufficient understanding of the investment required to save additional lives. In particular, stillbirths have been neglected. Over 20 000 stillbirths are recorded annually in South Africa, many of which could be averted. This analysis examines available South Africa specific stillbirth data and evaluates the impact and cost-effectiveness of 13 interventions acknowledged to prevent stillbirths and maternal and newborn mortality. METHODS Multiple data sources were reviewed to evaluate changes in stillbirth rates since 2000. The intervention analysis used the Lives Saved tool (LiST) and the Family Planning module (FamPlan) in Spectrum. LiST was used to determine the number of stillbirths and maternal and neonatal deaths that could be averted by scaling up the interventions to full coverage (99%) in 2030. The impact of family planning was assessed by increasing FamPlan's default 70% coverage of modern contraception to 75% and 80% coverage. Total and incremental costs were determined in the LiST costing module. Cost-effectiveness measured incremental cost effectiveness ratios per potential life years gained. RESULTS Significant variability exists in national stillbirth data. Using the international stillbirth definition, the SBR was 17.6 per 1 000 births in 2013. Full coverage of the 13 interventions in 2030 could reduce the SBR by 30% to 12.4 per 1 000 births, leading to an MMR of 132 per 100 000 and an NMR of 7 per 1 000 live births. Increased family planning coverage reduces the number of deaths significantly. The full intervention package, with 80% family planning coverage in 2030, would require US$420 million (US$7.8 per capita) annually, which is less than baseline costs of US$550 million (US$10.2 per capita). All interventions were highly cost-effective. CONCLUSION This is the first analysis in South Africa to assess the impact of scaling up interventions to avert stillbirths. Improved coverage of 13 interventions that are already recommended could significantly impact the rates of stillbirth and maternal and neonatal mortality. Family planning should also be prioritized to reduce mortality and overall costs.
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Affiliation(s)
- Julia Michalow
- Priority Cost-Effective Lessons for Systems Strengthening-South Africa (PRICELESS SA), Medical Research Council/Wits Rural Public Health and Health Transition Research Unit (Agincourt), Johannesburg, South Africa.
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, 2193, Johannesburg, South Africa.
| | - Lumbwe Chola
- Priority Cost-Effective Lessons for Systems Strengthening-South Africa (PRICELESS SA), Medical Research Council/Wits Rural Public Health and Health Transition Research Unit (Agincourt), Johannesburg, South Africa.
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, 2193, Johannesburg, South Africa.
| | - Shelley McGee
- Priority Cost-Effective Lessons for Systems Strengthening-South Africa (PRICELESS SA), Medical Research Council/Wits Rural Public Health and Health Transition Research Unit (Agincourt), Johannesburg, South Africa.
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, 2193, Johannesburg, South Africa.
| | - Aviva Tugendhaft
- Priority Cost-Effective Lessons for Systems Strengthening-South Africa (PRICELESS SA), Medical Research Council/Wits Rural Public Health and Health Transition Research Unit (Agincourt), Johannesburg, South Africa.
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, 2193, Johannesburg, South Africa.
| | - Robert Pattinson
- Department of Obstetrics and Gynecology, Medical Research Council Maternal and Infant Health Care Strategies Research Unit, University of Pretoria, Pretoria, South Africa.
| | | | - Karen Hofman
- Priority Cost-Effective Lessons for Systems Strengthening-South Africa (PRICELESS SA), Medical Research Council/Wits Rural Public Health and Health Transition Research Unit (Agincourt), Johannesburg, South Africa.
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, 2193, Johannesburg, South Africa.
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Time trends in socio-economic inequalities in stunting prevalence: analyses of repeated national surveys. Public Health Nutr 2014; 18:2097-104. [PMID: 25521530 DOI: 10.1017/s1368980014002924] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Much is known about national trends in child undernutrition, but there is little information on how socio-economic inequalities are evolving over time. We aimed to assess socio-economic inequalities in stunting prevalence over time. DESIGN We selected nationally representative surveys carried out since the mid-1990s for which information was available on asset indices and on child anthropometry. We identified twenty-five countries that had at least two surveys over an interval of 10 years or more, totalling eighty-seven surveys. Stunting prevalence was calculated according to wealth quintiles. Absolute and relative inequalities were calculated and time trends were obtained by regression. Setting Nationally representative household surveys from twenty-five low- and middle-income countries. SUBJECTS Children <5 years of age. RESULTS National prevalence declined significantly in twenty-two of the twenty-five countries. In eighteen out of twenty-five countries, relative reductions were higher among the rich than among the poor. Overall, there was no indication that inequalities improved. Striking examples are Nepal, with a 17·0 percentage points decline in stunting per decade, but where inequalities increased sharply; and Brazil, where stunting fell by 6·7 percentage points and inequalities were all but eliminated. CONCLUSIONS Global progress in reducing stunting has not been accompanied by improved equity, but countries varied markedly in how successful they were in reducing prevalence among the poorest children. It is important to document how some countries were able to reduce inequalities, so that these lessons can be used to foster global progress, particularly in light of the increased importance of within-country inequalities in the post-2015 agenda.
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137
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Belizán JM, Salaria N, Valanzasca P, Mbizvo M. How can we improve the use of essential evidence-based interventions? Reprod Health 2014; 11:69. [PMID: 25214358 PMCID: PMC4247776 DOI: 10.1186/1742-4755-11-69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/05/2014] [Indexed: 11/10/2022] Open
Abstract
Between 250,000-280,000 women die worldwide during pregnancy and childbirth each year and children in low- and middle-income countries are 56 times more likely to die before the age of 5 than children in high-income countries. This Editorial discusses the publishing of a supplement within Reproductive Health titled Essential interventions for maternal, newborn and child health which aims to provide a scientific basis to the recommended interventions along with implementation strategies and proposed packages of care.
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Affiliation(s)
- José M Belizán
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.
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138
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Kuruvilla S, Schweitzer J, Bishai D, Chowdhury S, Caramani D, Frost L, Cortez R, Daelmans B, de Francisco A, Adam T, Cohen R, Alfonso YN, Franz-Vasdeki J, Saadat S, Pratt BA, Eugster B, Bandali S, Venkatachalam P, Hinton R, Murray J, Arscott-Mills S, Axelson H, Maliqi B, Sarker I, Lakshminarayanan R, Jacobs T, Jacks S, Mason E, Ghaffar A, Mays N, Presern C, Bustreo F. Success factors for reducing maternal and child mortality. Bull World Health Organ 2014; 92:533-44B. [PMID: 25110379 PMCID: PMC4121875 DOI: 10.2471/blt.14.138131] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/07/2014] [Indexed: 11/27/2022] Open
Abstract
Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women's and Children's Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula--fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches in addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results over time. This evidence synthesis contributes to global learning on accelerating improvements in women's and children's health towards 2015 and beyond.
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Affiliation(s)
- Shyama Kuruvilla
- Partnership for Maternal, Newborn & Child Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Julian Schweitzer
- Results for Development Institute, Washington, United States of America (USA)
| | - David Bishai
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | | | | | | | - Andres de Francisco
- Partnership for Maternal, Newborn & Child Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Taghreed Adam
- Alliance for Health Policy and Systems Research, Geneva, Switzerland
| | - Robert Cohen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | | | | | | | | | | | - Rachael Hinton
- Partnership for Maternal, Newborn & Child Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | | | | | | | | | - Rama Lakshminarayanan
- Partnership for Maternal, Newborn & Child Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | | | | | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, Geneva, Switzerland
| | - Nicholas Mays
- London School of Hygiene & Tropical Medicine, London, England
| | - Carole Presern
- Partnership for Maternal, Newborn & Child Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - on behalf of the Success Factors for Women’s and Children’s Health study groups
- Partnership for Maternal, Newborn & Child Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
- Results for Development Institute, Washington, United States of America (USA)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- BRAC Institute of Global Health, Dhaka, Bangladesh
- University of St Gallen, St Gallen, Switzerland
- Global Health Insights, New York, USA
- World Bank, Washington, USA
- World Health Organization, Geneva, Switzerland
- Alliance for Health Policy and Systems Research, Geneva, Switzerland
- Independent Consultant, Seattle, USA
- Options Consultancy, London, England
- Cambridge Economic Policy Associates, Delhi, India
- Independent Consultant, Iowa City, USA
- ICF International, Fairfax, USA
- World Health Organization, Phnom Penh, Cambodia
- USAID, Washington, USA
- University of Otago, Dunedin, New Zealand
- London School of Hygiene & Tropical Medicine, London, England
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139
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Presern C, Bustreo F, Evans T, Ghaffar A. Accelerating progress on women's and children's health. Bull World Health Organ 2014; 92:467-467A. [PMID: 25110368 PMCID: PMC4121877 DOI: 10.2471/blt.14.142398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Carole Presern
- Partnership for Maternal, Newborn & Child Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Tim Evans
- World Bank, Washington, United States of America
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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