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Koné S, Probst-Hensch N, Dao D, Utzinger J, Fink G. Improving coverage of antenatal iron and folic acid supplementation and malaria prophylaxis through targeted information and home deliveries in Côte d'Ivoire: a cluster randomised controlled trial. BMJ Glob Health 2023; 8:bmjgh-2022-010934. [PMID: 37076197 PMCID: PMC10124199 DOI: 10.1136/bmjgh-2022-010934] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/20/2022] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION Coverage of antenatal iron and folic acid (IFA) supplementation and malaria chemoprophylaxis remains low in many low-income and middle-income settings. We assessed the effectiveness of personal information (INFO) sessions and personal information session plus home deliveries (INFO+DELIV) to increase coverage of IFA supplementation and intermittent preventive treatment in pregnancy (IPTp), and their effectiveness on postpartum anaemia and malaria infection. METHODS We included 118 clusters randomised to a control (39), INFO (39) and INFO+DELIV (40) arm, in a trial conducted between 2020 and 2021 with pregnant women (age ≥15 years) in their first or second trimester of pregnancy in Taabo, Côte d'Ivoire. We used generalised linear regression models to assess intervention impact in postpartum anaemia and malaria parasitaemia, and displayed resulting estimates as prevalence ratios. RESULTS Overall, 767 pregnant women were enrolled and 716 (93.3%) were followed up after delivery. Neither intervention had an impact on postpartum anaemia, with estimated adjusted prevalence ratios (aPRs) of 0.97 (95% CI 0.79 to 1.19, p=0.770) for INFO and 0.87 (95% CI 0.70 to 1.09, p=0.235) for INFO+DELIV. While INFO had no effect on malaria parasitaemia (aPR=0.95, 95% CI 0.39 to 2.31, p=0.915), INFO+DELIV reduced malaria parasitaemia by 83% (aPR=0.17, 95% CI 0.04 to 0.75, p=0.019). No improvements in antenatal care (ANC) coverage (aPR=1.05, 95% CI 0.81 to 1.36, p=0.692), IFA (aPR=2.00, 95% CI 0.89 to 4.46, p=0.093) and IPTp (aPR=1.03, 95% CI 0.87 to 1.21, p=0.728) compliance were found for INFO. INFO+DELIV increased ANC attendance (aPR=1.35, 95% CI 1.02 to 1.78, p=0.037) and compliance with IPTp (aPR=1.60, 95% CI 1.41 to 1.80, p<0.001) and IFA recommendations (aPR=7.06, 95% CI 3.68 to 13.51, p<0.001). CONCLUSIONS INFO+DELIV can substantially increase compliance with IFA supplementation and improve malaria prevention. However, the increases in IFA supplementation are likely insufficient to address the prevalence of often severe anaemia in this population. TRIAL REGISTRATION NUMBER NCT04250428.
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Affiliation(s)
- Siaka Koné
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoires, Abidjan, Côte d'Ivoire
- Swiss Tropical and Public Health Institute, allschwill, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, allschwill, Switzerland
- University of Basel, Basel, Switzerland
| | - Daouda Dao
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoires, Abidjan, Côte d'Ivoire
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, allschwill, Switzerland
- University of Basel, Basel, Switzerland
| | - Günther Fink
- Swiss Tropical and Public Health Institute, allschwill, Switzerland
- University of Basel, Basel, Switzerland
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Shukla VV, Carlo WA, Niermeyer S, Guinsburg R. Neonatal resuscitation from a global perspective. Semin Perinatol 2022; 46:151630. [PMID: 35725655 DOI: 10.1016/j.semperi.2022.151630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The majority of perinatal and neonatal mortality occurs in low-resource settings in low- and middle-income countries. Access and quality of care at delivery are major determinants of the health and survival of newborn infants. Availability of basic neonatal resuscitation care at birth has improved, but basic neonatal resuscitation at birth or high-quality care continues to be inaccessible in some settings, leading to persistently high perinatal and neonatal mortality. Low-resource settings of high-income countries and socially disadvantaged communities also suffer from inadequate access to quality perinatal healthcare. Quality improvement, implementation research, and innovation should focus on improving the quality of perinatal healthcare and perinatal and neonatal outcomes in low-resource settings. The current review presents an update on issues confronting universal availability of optimal resuscitation care at birth and provides an update on ongoing efforts to address them.
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Affiliation(s)
- Vivek V Shukla
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Waldemar A Carlo
- University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Susan Niermeyer
- University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Ruth Guinsburg
- Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brazil.
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Gai Tobe R, Haque SE, Mubassara S, Rahman R, Ikegami K, Mori R. Maternal and child health handbook to improve continuum of maternal and child care in rural Bangladesh: Findings of a cluster randomized controlled trial. PLoS One 2022; 17:e0266074. [PMID: 35385542 PMCID: PMC8986009 DOI: 10.1371/journal.pone.0266074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/11/2022] [Indexed: 11/19/2022] Open
Abstract
This study aimed to evaluate the effectiveness of maternal and child health handbook (MCH) enhanced by mobile tools and to generate evidence informing the adoption of the program in Bangladesh. A cluster randomized controlled trial (RCT) has been implemented in Lohagora of Narail District and Dhamrai of Dhaka District. Unions of the study settings were randomly allocated in either one of three groups: (1) Intervention 1 using both mobile platform and MCH, (2) Intervention 2 using MCH alone, or (3) the Control. A total of 3,002 participants were recruited. The interventions were designed to promote two-way communications between pregnant women/their families and community health workers by an empowering approach. A total of 3,002 pregnant women were recruited. As the results, the interventions both significantly improved the utilization of CoC, although the overall proportion of CoC was relevantly low: 2.79% in the Control (95% CI: 1.37–3.54%), 6.16% in Intervention 2 (95% CI: 4.67–7.86%), and 7.89% in Intervention 1 (95% CI: 6.29–9.90%). Neonatal mortality rate with and without CoC was 5.43 per 1,000 (95% CI: 3.63–9.57 per 1,000) and 34.8 per 1,000 (95% CI: 24.3–45.4 per 1,000), respectively. Our study indicated the effectiveness of the interventions by leveraging MCH and a mobile platform to promote uptake of CoC throughout prepartum, intrapartum and postpartum/neonatal periods, potentially bringing long-lasting benefits to mothers and their offspring. The explicit approach is expected to guide policy makers to adopt MCH interventions in primary healthcare strengthening at the community level. Trial registration:UMIN000025628 Registered June 13, 2016.
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Affiliation(s)
- Ruoyan Gai Tobe
- Department of Social Security Empirical Research, National Institute of Population and Social Security Research, Tokyo, Japan
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
- * E-mail:
| | | | - Sanzida Mubassara
- Department of Botany, Faculty of Biological Sciences, Jahangirnagar University, Dhaka, Bangladesh
| | - Rushdana Rahman
- Department of Obstetrics & Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Kiyoko Ikegami
- School of Tropical Medicine and Global Health, Nagasaki University NCGM Satellite, Tokyo, Japan
| | - Rintaro Mori
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Guinsburg R, Sanudo A, Kiffer CRV, Marinonio ASS, Costa-Nobre DT, Areco KN, Kawakami MD, Miyoshi MH, Bandiera-Paiva P, Balda RDCX, Konstantyner T, Morais LC, Freitas RM, Teixeira ML, Waldvogel B, Almeida MFB. Annual trend of neonatal mortality and its underlying causes: population-based study - São Paulo State, Brazil, 2004-2013. BMC Pediatr 2021; 21:54. [PMID: 33499817 PMCID: PMC7836582 DOI: 10.1186/s12887-021-02511-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/19/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Population-based studies analyzing neonatal deaths in middle-income countries may contribute to design interventions to achieve the Sustainable Development Goals, established by United Nations. This study goal is to analyze the annual trend of neonatal mortality in São Paulo State, Brazil, over a 10-year period and its underlying causes and to identify maternal and neonatal characteristics at birth associated with neonatal mortality. METHOD A population-based study of births and deaths from 0 to 27 days between 2004 and 2013 in São Paulo State, Brazil, was performed. The annual trend of neonatal mortality rate according to gestational age was analyzed by Poisson or by Negative Binomial Regression models. Basic causes of neonatal death were classified according to ICD-10. Association of maternal demographic variables (block 1), prenatal and delivery care variables (block 2), and neonatal characteristics at birth (block 3) with neonatal mortality was evaluated by Poisson regression analysis adjusted by year of birth. RESULTS Among 6,056,883 live births in São Paulo State during the study period, 48,309 died from 0 to 27 days (neonatal mortality rate: 8.0/1,000 live births). For the whole group and for infants with gestational age 22-27, 28-31, 32-36, 37-41 and ≥ 42 weeks, reduction of neonatal mortality rate was, respectively, 18 %, 15 %, 38 %, 53 %, 31 %, and 58 %. Median time until 50 % of deaths occurred was 3 days. Main basic causes of death were respiratory disorders (25 %), malformations (20 %), infections (17 %), and perinatal asphyxia (7 %). Variables independently associated with neonatal deaths were maternal schooling, prenatal care, parity, newborn sex, 1st minute Apgar, and malformations. Cesarean delivery, compared to vaginal, was protective against neonatal mortality for infants at 22-31 weeks, but it was a risk factor for those with 32-41 weeks. CONCLUSIONS Despite the significant decrease in neonatal mortality rate over the 10-year period in São Paulo State, improved access to qualified health care is needed in order to avoid preventable neonatal deaths and increase survival of infants that need more complex levels of assistance.
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Affiliation(s)
- Ruth Guinsburg
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil.
| | - Adriana Sanudo
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Carlos Roberto V Kiffer
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Ana Sílvia S Marinonio
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Daniela T Costa-Nobre
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Kelsy N Areco
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Mandira D Kawakami
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Milton H Miyoshi
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Paulo Bandiera-Paiva
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Rita de Cássia X Balda
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Tulio Konstantyner
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Liliam Cc Morais
- Fundação Sistema Estadual de Análise de Dados, São Paulo, Brazil
| | - Rosa Mv Freitas
- Fundação Sistema Estadual de Análise de Dados, São Paulo, Brazil
| | | | | | - Maria Fernanda B Almeida
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
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Sachs JD. The urgent case for expanded development assistance for health. Int Health 2019; 11:321-323. [PMID: 31529115 DOI: 10.1093/inthealth/ihz059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/05/2019] [Accepted: 08/05/2019] [Indexed: 11/12/2022] Open
Abstract
The low-income developing countries require increased development assistance for health (DAH) to achieve Sustainable Development Goal 3, 'Healthy Lives for All'. DAH has a proven track record. DAH expanded during 2001-2008, with significant health gains in the LIDCs, but then stopped expanding in the wake of the 2008 financial crisis. The Global Fund to Fight AIDS, TB and Malaria requires around US$31.8 billion during 2021-2023 to maintain a trajectory to end the three epidemics by 2030, yet donors have so far signaled that they are prepared to offer less than half that sum, around US$14 billion.
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Affiliation(s)
- Jeffrey D Sachs
- Earth Institute, Columbia University, 475 Riverside Drive, Suite 1040, NY, New York
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