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Souza JP, Day LT, Rezende-Gomes AC, Zhang J, Mori R, Baguiya A, Jayaratne K, Osoti A, Vogel JP, Campbell O, Mugerwa KY, Lumbiganon P, Tunçalp Ö, Cresswell J, Say L, Moran AC, Oladapo OT. A global analysis of the determinants of maternal health and transitions in maternal mortality. Lancet Glob Health 2024; 12:e306-e316. [PMID: 38070536 DOI: 10.1016/s2214-109x(23)00468-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 01/22/2024]
Abstract
The reduction of maternal mortality and the promotion of maternal health and wellbeing are complex tasks. This Series paper analyses the distal and proximal determinants of maternal health, as well as the exposures, risk factors, and micro-correlates related to maternal mortality. This paper also examines the relationship between these determinants and the gradual shift over time from a pattern of high maternal mortality to a pattern of low maternal mortality (a phenomenon described as the maternal mortality transition). We conducted two systematic reviews of the literature and we analysed publicly available data on indicators related to the Sustainable Development Goals, specifically, estimates prepared by international organisations, including the UN and the World Bank. We considered 23 frameworks depicting maternal health and wellbeing as a multifactorial process, with superdeterminants that broadly affect women's health and wellbeing before, during, and after pregnancy. We explore the role of social determinants of maternal health, individual characteristics, and health-system features in the production of maternal health and wellbeing. This paper argues that the preventable deaths of millions of women each decade are not solely due to biomedical complications of pregnancy, childbirth, and the postnatal period, but are also tangible manifestations of the prevailing determinants of maternal health and persistent inequities in global health and socioeconomic development. This paper underscores the need for broader, multipronged actions to improve maternal health and wellbeing and accelerate sustainable reductions in maternal mortality. For women who have pregnancy, childbirth, or postpartum complications, the health system provides a crucial opportunity to interrupt the chain of events that can potentially end in maternal death. Ultimately, expanding the health sector ecosystem to mitigate maternal health determinants and tailoring the configuration of health systems to counter the detrimental effects of eco-social forces, including though increased access to quality-assured commodities and services, are essential to improve maternal health and wellbeing and reduce maternal mortality.
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Affiliation(s)
- João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil; BIREME, Department of Evidence and Intelligence for Action in Health, Pan American Health Organization (PAHO)-World Health Organization Americas Regional Office, São Paulo, Brazil.
| | - Louise Tina Day
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Clara Rezende-Gomes
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Jun Zhang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rintaro Mori
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Adama Baguiya
- Kaya Health and Demographic Surveillance System (Kaya-HDSS), Research Institute for Health Sciences (IRSS), Ouagadougou, Burkina Faso
| | | | - Alfred Osoti
- Department of Obstetrics, University of Nairobi, Nairobi, Kenya; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Oona Campbell
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kidza Y Mugerwa
- Department of Obstetrics and Gynecology, Makerere University, Kampala, Uganda
| | - Pisake Lumbiganon
- Department of Obstetrics & Gynecology, Khon Kaen University, Khon Kaen, Thailand
| | - Özge Tunçalp
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Jenny Cresswell
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Lale Say
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Allisyn Carol Moran
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Olufemi T Oladapo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Galle A, Moran AC, Bonet M, Graham K, Muzigaba M, Portela A, Day LT, Tuabu GK, Silva BDSÉ, Moller AB. Measures to assess quality of postnatal care: A scoping review. PLOS Glob Public Health 2023; 3:e0001384. [PMID: 36963034 PMCID: PMC10021656 DOI: 10.1371/journal.pgph.0001384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/27/2023] [Indexed: 02/19/2023]
Abstract
High quality postnatal care is key for the health and wellbeing of women after childbirth and their newborns. In 2022, the World Health Organization (WHO) published global recommendations on maternal and newborn care for a positive postnatal care experience in a new WHO PNC guideline. Evidence regarding appropriate measures to monitor implementation of postnatal care (PNC) according to the WHO PNC guideline is lacking. This scoping review aims to document the measures used to assess the quality of postnatal care and their validity. The review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Five electronic bibliographic databases were searched together with a grey literature search. Two reviewers independently screened and appraised identified articles. All data on PNC measures were extracted and mapped to the 2022 WHO PNC recommendations according to three categories: i) maternal care, ii) newborn care, iii) health system and health promotion interventions. We identified 62 studies providing measures aligning with the WHO PNC recommendations. For most PNC recommendations there were measures available and the highest number of recommendations were found for breastfeeding and the assessment of the newborn. No measures were found for recommendations related to sedentary behavior, criteria to be assessed before discharge, retention of staff in rural areas and use of digital communication. Measure validity assessment was described in 24 studies (39%), but methods were not standardized. Our review highlights a gap in existing PNC measures for several recommendations in the WHO PNC guideline. Assessment of the validity of PNC measures was limited. Consensus on how the quality of PNC should be measured is needed, involving a selection of priority measures and the development of new measures as appropriate.
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Affiliation(s)
- Anna Galle
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Allisyn C Moran
- World Health Organization Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Mercedes Bonet
- World Health Organization Department of Sexual and Reproductive Health and Research, Development and Research Training in Human Reproduction (HRP), UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Geneva, Switzerland
| | - Katriona Graham
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, Ghent University, Belgium
| | - Moise Muzigaba
- World Health Organization Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Anayda Portela
- World Health Organization Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Louise Tina Day
- Department of Infectious Disease Epidemiology, Maternal Newborn Health Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Godwin Kwaku Tuabu
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, Ghent University, Belgium
| | - Bianca De Sá É Silva
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, Ghent University, Belgium
| | - Ann-Beth Moller
- World Health Organization Department of Sexual and Reproductive Health and Research, Development and Research Training in Human Reproduction (HRP), UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Geneva, Switzerland
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Okafor O, Roos N, Abdosh AA, Adesina O, Alaoui Z, Romero WA, Assarag B, Aworinde O, de Bernis L, Castro R, Chrifi H, Day LT, Demissew R, Aceituno MGF, Gadama L, Gashawbeza B, Keke SG, Govule P, Gwako G, Jayaratne K, Komboigo EB, Lara B, Madziyire MG, Mathai M, Moulki R, Moutaouadia I, Munjanja S, Fletes CAO, Ortiz EI, Ouedraogo HG, Qureshi Z, Recidoro ZD, Senanayake H, Soma-Pillay P, Tin KN, Sedami P, Worku D, Bonet M. International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries - case report series and suggested actions. BMC Pregnancy Childbirth 2022; 22:431. [PMID: 35606709 PMCID: PMC9128080 DOI: 10.1186/s12884-022-04731-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/27/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Obstetric infections are the third most common cause of maternal mortality, with the largest burden in low and middle-income countries (LMICs). We analyzed causes of infection-related maternal deaths and near-miss identified contributing factors and generated suggested actions for quality of care improvement. METHOD An international, virtual confidential enquiry was conducted for maternal deaths and near-miss cases that occurred in 15 health facilities in 11 LMICs reporting at least one death within the GLOSS study. Facility medical records and local review committee documents containing information on maternal characteristics, timing and chain of events, case management, outcomes, and facility characteristics were summarized into a case report for each woman and reviewed by an international external review committee. Modifiable factors were identified and suggested actions were organized using the three delays framework. RESULTS Thirteen infection-related maternal deaths and 19 near-miss cases were reviewed in 20 virtual meetings by an international external review committee. Of 151 modifiable factors identified during the review, delays in receiving care contributed to 71/85 modifiable factors in maternal deaths and 55/66 modifiable factors in near-miss cases. Delays in reaching a GLOSS facility contributed to 5/85 and 1/66 modifiable factors for maternal deaths and near-miss cases, respectively. Two modifiable factors in maternal deaths were related to delays in the decision to seek care compared to three modifiable factors in near-miss cases. Suboptimal use of antibiotics, missing microbiological culture and other laboratory results, incorrect working diagnosis, and infrequent monitoring during admission were the main contributors to care delays among both maternal deaths and near-miss cases. Local facility audits were conducted for 2/13 maternal deaths and 0/19 near-miss cases. Based on the review findings, the external review committee recommended actions to improve the prevention and management of maternal infections. CONCLUSION Prompt recognition and treatment of the infection remain critical addressable gaps in the provision of high-quality care to prevent and manage infection-related severe maternal outcomes in LMICs. Poor uptake of maternal death and near-miss reviews suggests missed learning opportunities by facility teams. Virtual platforms offer a feasible solution to improve routine adoption of confidential maternal death and near-miss reviews locally.
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Affiliation(s)
| | - Nathalie Roos
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden
| | | | - Olubukola Adesina
- Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
| | - Zaynab Alaoui
- Regional Directorate of Health, Settat region Casablanca, Morocco
| | - William Arriaga Romero
- Department of the Gynecology and Obstetrics, Hospital Regional de Occidente, Quetzaltenango, Guatemala
| | | | - Olufemi Aworinde
- Department of Obstetrics and Gynecology, Bowen University, Iwo, Nigeria
| | - Luc de Bernis
- Independent Consultant in International Maternal and Perinatal Health, 47300, Bias, France
| | | | | | - Louise Tina Day
- Department of Infectious Disease Epidemiology, Maternal and Newborn Health Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Rahel Demissew
- Department of Obstetrics and Gynecology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Luis Gadama
- Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Zomba, Malawi
| | - Biruck Gashawbeza
- Department of Obstetrics and Gynecology, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Philip Govule
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - George Gwako
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | | | | | - Bredy Lara
- Ministry of Health of Honduras, Tegucigalpa, Honduras
| | - Mugove Gerald Madziyire
- Clinical Trials Research Centre, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Matthews Mathai
- Independent Consultant in International Maternal and Perinatal Health, St John's, Newfoundland and Labrador, Canada
| | | | | | - Stephen Munjanja
- Department of Obstetrics and Gynecology, University of Zimbabwe, Harare, Zimbabwe
| | | | - Edgar Ivan Ortiz
- Department of Obstetrics and Gynecology, University of Valle, Cali, Colombia
| | - Henri Gautier Ouedraogo
- National Center for Scientific and Technological Research: Ouagadougou, Center, Ouagadougou, Burkina Faso
| | - Zahida Qureshi
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Zenaida Dy Recidoro
- Department of Health, Disease Prevention and Control Bureau, Manila, Philippines
| | - Hemantha Senanayake
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Priya Soma-Pillay
- Department of Obstetrics and Gynecology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Khaing Nwe Tin
- Department of Public Health, Maternal and Reproductive Health Division, Ministry of Health and Sports, Naypyitaw, Myanmar
| | | | - Dawit Worku
- Department of Obstetrics and Gynecology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 27 CH-1211, Geneva, Switzerland.
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Peven K, Day LT, Bick D, Purssell E, Taylor C, Akuze J, Mallick L. Household Survey Measurement of Newborn Postnatal Care: Coverage, Quality Gaps, and Internal Inconsistencies in Responses. Glob Health Sci Pract 2021; 9:737-751. [PMID: 34933972 PMCID: PMC8691891 DOI: 10.9745/ghsp-d-21-00209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
Reliable measurement of postnatal content of care is currently lacking despite the critical importance of care in this vulnerable period. We found that there is a large quality-coverage gap with missed opportunities for quality care as well as internal inconsistencies in responses to newborn questions. Background: Reliable measurement of newborn postnatal care is essential to understand gaps in coverage and quality and thereby improve outcomes. This study examined gaps in coverage and measurement of newborn postnatal care in the first 2 days of life. Methods: We analyzed Demographic and Health Survey data from 15 countries for 71,366 births to measure the gap between postnatal contact coverage and content coverage within 2 days of birth. Coverage was a contact with the health system in the first 2 days (postnatal check or newborn care intervention), and quality was defined as reported receipt of 5 health worker-provided interventions. We examined internal consistency between interrelated questions regarding examination of the umbilical cord. Results: Reported coverage of postnatal check ranged from 13% in Ethiopia to 78% in Senegal. Report of specific newborn care interventions varied widely by intervention within and between countries. Quality-coverage gaps were high, ranging from 26% in Malawi to 89% in Burundi. We found some internally inconsistent reporting of newborn care. The percentage of women who reported that a health care provider checked their newborn's umbilical cord but responded “no” to the postnatal check question was as high as 16% in Malawi. Conclusion: Reliable measurement of coverage and content of early postnatal newborn care is essential to track progress in improving quality of care. Postnatal contact coverage is challenging to measure because it may be difficult for women to distinguish postnatal care from intrapartum care and it is a less recognizable concept than antenatal care. Co-coverage measures may provide a useful summary of contact and content, reflecting both coverage and an aspect of quality.
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Affiliation(s)
- Kimberly Peven
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom. .,Maternal and Newborn Health Group, Department of Infectious Disease Epidemiology and Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Louise Tina Day
- Maternal and Newborn Health Group, Department of Infectious Disease Epidemiology and Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | | | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Joseph Akuze
- Maternal and Newborn Health Group, Department of Infectious Disease Epidemiology and Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom.,Department of Health Policy, Planning and Management and Centre of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
| | - Lindsay Mallick
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA.,Avenir Health, Glastonbury, CT, USA
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Kinney MV, Day LT, Palestra F, Biswas A, Jackson D, Roos N, de Jonge A, Doherty P, Manu AA, Moran AC, George AS. Overcoming blame culture: key strategies to catalyse maternal and perinatal death surveillance and response. BJOG 2021; 129:839-844. [PMID: 34709701 PMCID: PMC9298870 DOI: 10.1111/1471-0528.16989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 11/29/2022]
Affiliation(s)
- M V Kinney
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - L T Day
- Maternal Newborn Health Group, Maternal Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK.,Maternal Newborn Health Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - F Palestra
- World Health Organization, Geneva, Switzerland
| | | | - D Jackson
- School of Public Health, University of the Western Cape, Bellville, South Africa.,Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - N Roos
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - A de Jonge
- Midwifery Science, AVAG (Academy Midwifery Amsterdam and Groningen), Amsterdam Public Health Research Institute, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands
| | - P Doherty
- Options Consultancy Services Ltd, St Magnus House, London, UK
| | - A A Manu
- Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - A C Moran
- Department of Maternal, Newborn, Child, Adolescent Health & Ageing, World Health Organization, Geneva, Switzerland
| | - A S George
- School of Public Health, University of the Western Cape, Bellville, South Africa
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Bjorklund A, Slusher T, Day LT, Yola MM, Sleeth C, Kiragu A, Shirk A, Krohn K, Opoka R. Pediatric Critical Care in Resource Limited Settings-Lessening the Gap Through Ongoing Collaboration, Advancement in Research and Technological Innovations. Front Pediatr 2021; 9:791255. [PMID: 35186820 PMCID: PMC8851601 DOI: 10.3389/fped.2021.791255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/21/2021] [Indexed: 12/02/2022] Open
Abstract
Pediatric critical care has continued to advance since our last article, "Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned" was written just 3 years ago. In that article, we reviewed the history, current state, and gaps in level of care between low- and middle-income countries (LMICs) and high-income countries (HICs). In this article, we have highlighted recent advancements in pediatric critical care in LMICs in the areas of research, training and education, and technology. We acknowledge how the COVID-19 pandemic has contributed to increasing the speed of some developments. We discuss the advancements, some lessons learned, as well as the ongoing gaps that need to be addressed in the coming decade. Continued understanding of the importance of equitable sustainable partnerships in the bidirectional exchange of knowledge and collaboration in all advancement efforts (research, technology, etc.) remains essential to guide all of us to new frontiers in pediatric critical care.
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Affiliation(s)
- Ashley Bjorklund
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States.,Global Pediatric Program, Division of Pediatric Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Tina Slusher
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States.,Global Pediatric Program, Division of Pediatric Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Louise Tina Day
- Maternal and Newborn Health Group, Department of Infectious Disease Epidemiology, London School Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Clark Sleeth
- Department of Pediatrics, Tenwek Hospital, Bomet, Kenya
| | - Andrew Kiragu
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States.,Global Pediatric Program, Division of Pediatric Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States.,Childrens Hospital of Minnesota, Minneapolis, MN, United States
| | - Arianna Shirk
- Department of Pediatrics, Africa Inland Church Kijabe Hospital, Kijabe, Kenya
| | - Kristina Krohn
- Global Pediatric Program, Division of Pediatric Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States.,Department of Internal Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Robert Opoka
- Department of Pediatrics, Makerere University, Kampala, Uganda
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7
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Day LT, Sadeq-Ur Rahman Q, Ehsanur Rahman A, Salim N, Kc A, Ruysen H, Tahsina T, Masanja H, Basnet O, Gore-Langton GR, Zaman SB, Shabani J, Jha AK, Gordeev VS, Ameen S, Shamba D, Jha B, Boggs D, Hossain T, Shirima K, Bastola RC, Peven K, Siddique AB, Mbaruku G, Paudel R, Baschieri A, Hossain AT, Kong S, Paudel A, Ahmed A, Cousens S, El Arifeen S, Lawn JE. Assessment of the validity of the measurement of newborn and maternal health-care coverage in hospitals (EN-BIRTH): an observational study. Lancet Glob Health 2020; 9:e267-e279. [PMID: 33333015 DOI: 10.1016/s2214-109x(20)30504-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 09/29/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Progress in reducing maternal and neonatal deaths and stillbirths is impeded by data gaps, especially regarding coverage and quality of care in hospitals. We aimed to assess the validity of indicators of maternal and newborn health-care coverage around the time of birth in survey data and routine facility register data. METHODS Every Newborn-BIRTH Indicators Research Tracking in Hospitals was an observational study in five hospitals in Bangladesh, Nepal, and Tanzania. We included women and their newborn babies who consented on admission to hospital. Exclusion critiera at admission were no fetal heartbeat heard or imminent birth. For coverage of uterotonics to prevent post-partum haemorrhage, early initiation of breastfeeding (within 1 h), neonatal bag-mask ventilation, kangaroo mother care (KMC), and antibiotics for clinically defined neonatal infection (sepsis, pneumonia, or meningitis), we collected time-stamped, direct observation or case note verification data as gold standard. We compared data reported via hospital exit surveys and via hospital registers to the gold standard, pooled using random effects meta-analysis. We calculated population-level validity ratios (measured coverage to observed coverage) plus individual-level validity metrics. FINDINGS We observed 23 471 births and 840 mother-baby KMC pairs, and verified the case notes of 1015 admitted newborn babies regarding antibiotic treatment. Exit-survey-reported coverage for KMC was 99·9% (95% CI 98·3-100) compared with observed coverage of 100% (99·9-100), but exit surveys underestimated coverage for uterotonics (84·7% [79·1-89·5]) vs 99·4% [98·7-99·8] observed), bag-mask ventilation (0·8% [0·4-1·4]) vs 4·4% [1·9-8·1]), and antibiotics for neonatal infection (74·7% [55·3-90·1] vs 96·4% [94·0-98·6] observed). Early breastfeeding coverage was overestimated in exit surveys (53·2% [39·4-66·8) vs 10·9% [3·8-21·0] observed). "Don't know" responses concerning clinical interventions were more common in the exit survey after caesarean birth. Register data underestimated coverage of uterotonics (77·9% [37·8-99·5] vs 99·2% [98·6-99·7] observed), bag-mask ventilation (4·3% [2·1-7·3] vs 5·1% [2·0-9·6] observed), KMC (92·9% [84·2-98·5] vs 100% [99·9-100] observed), and overestimated early breastfeeding (85·9% (58·1-99·6) vs 12·5% [4·6-23·6] observed). Inter-hospital heterogeneity was higher for register-recorded coverage than for exit survey report. Even with the same register design, accuracy varied between hospitals. INTERPRETATION Coverage indicators for newborn and maternal health care in exit surveys had low accuracy for specific clinical interventions, except for self-report of KMC, which had high sensitivity after admission to a KMC ward or corner and could be considered for further assessment. Hospital register design and completion are less standardised than surveys, resulting in variable data quality, with good validity for the best performing sites. Because approximately 80% of births worldwide take place in facilities, standardising register design and information systems has the potential to sustainably improve the quality of data on care at birth. FUNDING Children's Investment Fund Foundation and Swedish Research Council.
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Affiliation(s)
- Louise Tina Day
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nahya Salim
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Ashish Kc
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Harriet Ruysen
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Honorati Masanja
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Omkar Basnet
- Research Division, Golden Community, Lalitpur, Kathmandu, Nepal
| | - Georgia R Gore-Langton
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Vladimir Sergeevich Gordeev
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK; The Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Bijay Jha
- Nepal Health Research Council, Kathmandu, Nepal
| | - Dorothy Boggs
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Kizito Shirima
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Ram Chandra Bastola
- Pokhara Academy of Health Science, Pokhara, Nepal; Ministry of Health and Population, Kathmandu, Nepal
| | - Kimberly Peven
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK; Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Abu Bakkar Siddique
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Godfrey Mbaruku
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Rajendra Paudel
- Research Division, Golden Community, Lalitpur, Kathmandu, Nepal
| | - Angela Baschieri
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Stefanie Kong
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Asmita Paudel
- Research Division, Golden Community, Lalitpur, Kathmandu, Nepal
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Simon Cousens
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
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Day LT, Gore-Langton GR, Rahman AE, Basnet O, Shabani J, Tahsina T, Poudel A, Shirima K, Ameen S, K.C. A, Salim N, Zaman SB, Shamba D, Blencowe H, Ruysen H, El Arifeen S, Boggs D, Gordeev VS, Rahman QSU, Hossain T, Joshi E, Thapa S, Poudel RP, Poudel D, Chaudhary P, Karki R, Chitrakar B, Mkopi N, Wisiko A, Kitende AP, Shirati MR, Chingalo C, Semhando AO, Mtei C, Mwenisongole V, Bakuza JM, Kombo J, Mbaruku G, Lawn JE. Labour and delivery ward register data availability, quality, and utility - Every Newborn - birth indicators research tracking in hospitals (EN-BIRTH) study baseline analysis in three countries. BMC Health Serv Res 2020; 20:737. [PMID: 32787852 PMCID: PMC7422224 DOI: 10.1186/s12913-020-5028-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 02/24/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Countries with the highest burden of maternal and newborn deaths and stillbirths often have little information on these deaths. Since over 81% of births worldwide now occur in facilities, using routine facility data could reduce this data gap. We assessed the availability, quality, and utility of routine labour and delivery ward register data in five hospitals in Bangladesh, Nepal, and Tanzania. This paper forms the baseline register assessment for the Every Newborn-Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study. METHODS We extracted 21 data elements from routine hospital labour ward registers, useful to calculate selected maternal and newborn health (MNH) indicators. The study sites were five public hospitals during a one-year period (2016-17). We measured 1) availability: completeness of data elements by register design, 2) data quality: implausibility, internal consistency, and heaping of birthweight and explored 3) utility by calculating selected MNH indicators using the available data. RESULTS Data were extracted for 20,075 births. Register design was different between the five hospitals with 10-17 of the 21 selected MNH data elements available. More data were available for health outcomes than interventions. Nearly all available data elements were > 95% complete in four of the five hospitals and implausible values were rare. Data elements captured in specific columns were 85.2% highly complete compared to 25.0% captured in non-specific columns. Birthweight data were less complete for stillbirths than live births at two hospitals, and significant heaping was found in all sites, especially at 2500g and 3000g. All five hospitals recorded count data required to calculate impact indicators including; stillbirth rate, low birthweight rate, Caesarean section rate, and mortality rates. CONCLUSIONS Data needed to calculate MNH indicators are mostly available and highly complete in EN-BIRTH study hospital routine labour ward registers in Bangladesh, Nepal and Tanzania. Register designs need to include interventions for coverage measurement. There is potential to improve data quality if Health Management Information Systems utilization with feedback loops can be strengthened. Routine health facility data could contribute to reduce the coverage and impact data gap around the time of birth.
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Affiliation(s)
- Louise Tina Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Georgia R. Gore-Langton
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Kizito Shirima
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashish K.C.
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Nahya Salim
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dorothy Boggs
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Vladimir S. Gordeev
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Population Health Sciences, Queen Mary University of London, Mile End Road, London, E1 4NS UK
| | - Qazi Sadeq-ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | | | | | | | | | | | - Namala Mkopi
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
| | - Anna Wisiko
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Alodear Patrick Kitende
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Christostomus Chingalo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Cleopatra Mtei
- Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
| | | | - John Mathias Bakuza
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Japhet Kombo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Godfrey Mbaruku
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Joy E. Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
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9
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Semaan A, Audet C, Huysmans E, Afolabi B, Assarag B, Banke-Thomas A, Blencowe H, Caluwaerts S, Campbell OMR, Cavallaro FL, Chavane L, Day LT, Delamou A, Delvaux T, Graham WJ, Gon G, Kascak P, Matsui M, Moxon S, Nakimuli A, Pembe A, Radovich E, van den Akker T, Benova L. Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic. BMJ Glob Health 2020; 5:e002967. [PMID: 32586891 PMCID: PMC7335688 DOI: 10.1136/bmjgh-2020-002967] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has substantially impacted maternity care provision worldwide. Studies based on modelling estimated large indirect effects of the pandemic on services and health outcomes. The objective of this study was to prospectively document experiences of frontline maternal and newborn healthcare providers. METHODS We conducted a global, cross-sectional study of maternal and newborn health professionals via an online survey disseminated through professional networks and social media in 12 languages. Information was collected between 24 March and 10 April 2020 on respondents' background, preparedness for and response to COVID-19 and their experience during the pandemic. An optional module sought information on adaptations to 17 care processes. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregating by low-income and middle-income countries (LMICs) and high-income countries (HICs). RESULTS We analysed responses from 714 maternal and newborn health professionals. Only one-third received training on COVID-19 from their health facility and nearly all searched for information themselves. Half of respondents in LMICs received updated guidelines for care provision compared with 82% in HICs. Overall, 47% of participants in LMICs and 69% in HICs felt mostly or completely knowledgeable in how to care for COVID-19 maternity patients. Facility-level responses to COVID-19 (signage, screening, testing and isolation rooms) were more common in HICs than LMICs. Globally, 90% of respondents reported somewhat or substantially higher levels of stress. There was a widespread perception of reduced use of routine maternity care services, and of modification in care processes, some of which were not evidence-based practices. CONCLUSIONS Substantial knowledge gaps exist in guidance on management of maternity cases with or without COVID-19. Formal information-sharing channels for providers must be established and mental health support provided. Surveys of maternity care providers can help track the situation, capture innovations and support rapid development of effective responses.
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Affiliation(s)
- Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- Center for Research on Population and Health, American University of Beirut Faculty of Health Sciences, Beirut, Lebanon
| | - Constance Audet
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Elise Huysmans
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Bosede Afolabi
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Bouchra Assarag
- National School of Public Health, Ministry of Health, Rabat, Morocco
| | | | - Hannah Blencowe
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Séverine Caluwaerts
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Oona Maeve Renee Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Leonardo Chavane
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Louise Tina Day
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Alexandre Delamou
- Africa Centre of Excellence for Prevention and Control of Transmissible Diseases (CEA-PCMT), Universite Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Therese Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Wendy Jane Graham
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Giorgia Gon
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Kascak
- Department of Obstetrics and Gynaecology, General Hospital Trencin, Trencin, Slovakia
| | - Mitsuaki Matsui
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Sarah Moxon
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Annettee Nakimuli
- Department of Obstetrics & Gynaecology, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Andrea Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Emma Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Vrije Universiteit Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, VU Amsterdam Athena Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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10
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Kc A, Lawn JE, Zhou H, Ewald U, Gurung R, Gurung A, Sunny AK, Day LT, Singhal N. Not Crying After Birth as a Predictor of Not Breathing. Pediatrics 2020; 145:peds.2019-2719. [PMID: 32398327 DOI: 10.1542/peds.2019-2719] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Worldwide, every year, 6 to 10 million infants require resuscitation at birth according to estimates based on limited data regarding "nonbreathing" infants. In this article, we aim to describe the incidence of "noncrying" and nonbreathing infants after birth, the need for basic resuscitation with bag-and-mask ventilation, and death before discharge. METHODS We conducted an observational study of 19 977 infants in 4 hospitals in Nepal. We analyzed the incidence of noncrying or nonbreathing infants after birth. The sensitivity of noncrying infants with nonbreathing after birth was analyzed, and the risk of predischarge mortality between the 2 groups was calculated. RESULTS The incidence of noncrying infants immediately after birth was 11.1%, and the incidence of noncrying and nonbreathing infants was 5.2%. Noncrying after birth had 100% sensitivity for nonbreathing infants after birth. Among the "noncrying but breathing" infants, 9.5% of infants did not breathe at 1 minute and 2% did not to breathe at 5 minutes. Noncrying but breathing infants after birth had almost 12-fold odds of predischarge mortality (adjusted odds ratio 12.3; 95% confidence interval, 5.8-26.1). CONCLUSIONS All nonbreathing infants after birth do not cry at birth. A proportion of noncrying but breathing infants at birth are not breathing by 1 and 5 minutes and have a risk for predischarge mortality. With this study, we provide evidence of an association between noncrying and nonbreathing. This study revealed that noncrying but breathing infants require additional care. We suggest noncrying as a clinical sign for initiating resuscitation and a possible denominator for measuring coverage of resuscitation.
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Affiliation(s)
- Ashish Kc
- Uppsala University, Uppsala, Sweden; .,Society of Public Health Physicians Nepal, Kathmandu, Nepal.,Contributed equally as co-first authors
| | - Joy E Lawn
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,Contributed equally as co-first authors
| | - Hong Zhou
- Peking University Health Science Center, Peking University, Beijing, China
| | | | | | | | | | - Louise Tina Day
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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11
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Moxon SG, Blencowe H, Bailey P, Bradley J, Day LT, Ram PK, Monet JP, Moran AC, Zeck W, Lawn JE. Categorising interventions to levels of inpatient care for small and sick newborns: Findings from a global survey. PLoS One 2019; 14:e0218748. [PMID: 31295262 PMCID: PMC6623953 DOI: 10.1371/journal.pone.0218748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/08/2019] [Indexed: 12/22/2022] Open
Abstract
Background In 2017, 2.5 million newborns died, mainly from prematurity, infections, and intrapartum events. Preventing these deaths requires health systems to provide routine and emergency care at birth, and quality inpatient care for small and sick newborns. Defined levels of emergency obstetric care (EmOC) and standardised measurement of “signal functions” has improved tracking of maternal care in low- and middle-income countries (LMICs). Levels of newborn care, particularly for small and sick newborns, and associated signal functions are still not consistently defined or tracked. Methods Between November 2016-November 2017, we conducted an online survey of professionals working in maternal and newborn health. We asked respondents to categorise 18 clinical care interventions that could act as potential signal functions for small and sick newborns to 3 levels of care they thought were appropriate for health systems in LMICs to provide: “routine care at birth”, “special care” and “intensive care”. We calculated the percentage of respondents that classified each intervention at each level of care and stratified responses to look at variation by respondent characteristics. Results Six interventions were classified to specific levels by more than 50% of respondents as “routine care at birth,” three interventions as “special care” and one as “intensive care”. Eight interventions were borderline between these care levels. Responses were more consistent for interventions with relevant WHO clinical care guidelines while more variation in respondents’ classification was observed in complex interventions that lack standards or guidelines. Respondents with experience in lower-income settings were more likely to assign a higher level of care for more complex interventions. Conclusions Results were consistent with known challenges of scaling up inpatient care in lower-income settings and underline the importance of comprehensive guidelines and standards for inpatient care. Further work is needed to develop a shortlist of newborn signal functions aligned with emergency obstetric care levels to track universal health coverage for mothers and their newborns.
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Affiliation(s)
- Sarah G. Moxon
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Hannah Blencowe
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Patricia Bailey
- Averting Maternal Death & Disability, Mailman School of Public Health, Columbia University, New York, United States of America
| | - John Bradley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Louise Tina Day
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pavani K. Ram
- Office of Maternal and Child Health and Nutrition, US Agency for International Development, Washington DC, United States of America
| | - Jean-Pierre Monet
- Technical Division, United Nations Population Fund (UNFPA), New York, United States of America
| | - Allisyn C. Moran
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | - Willibald Zeck
- UNICEF Health Section, United Nations Children’s Fund (UNICEF), New York, United States of America
| | - Joy E. Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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12
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Slusher TM, Day LT, Ogundele T, Woolfield N, Owa JA. Filtered sunlight, solar powered phototherapy and other strategies for managing neonatal jaundice in low-resource settings. Early Hum Dev 2017; 114:11-15. [PMID: 28919246 DOI: 10.1016/j.earlhumdev.2017.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Challenges in treating severe neonatal jaundice in low and middle-income country settings still exist at many levels. These include: a lack of awareness of causes and prevention by families, communities and even sometimes health care professionals; insufficient, ineffective, high quality affordable diagnostic and therapeutic options; limited availability of rehabilitation provision for kernicterus. Collectively these challenges lead to an unacceptably high global morbidity and mortality from severe neonatal jaundice. In the past decade, there has been an explosion of innovations addressing some of these issues and these are increasingly available for scale up. Scientists, healthcare providers, and communities are joining hands to explore educational tools, low cost screening and diagnostic options including at point-of-care and treatment modalities including filtered sunlight and solar powered phototherapy. For the first time, the possibility of eliminating the tragedy of preventable morbidity and mortality from severe NNJ is on the horizon, for all.
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Affiliation(s)
- Tina M Slusher
- Division of Global Pediatrics, University of Minnesota, Minneapolis, MN 55415, USA; Pediatric Intensive Care Unit, Hennepin County Medical Center, 701 Park Ave., MC G7, Minneapolis, MN 55415, USA.
| | - Louise Tina Day
- Paediatrics, LAMB Integrated Rural Health & Development, Parbatipur, Dinajpur, Bangladesh
| | - Tolulope Ogundele
- Department of Paediatrics, University of Medical Sciences, Nigeria.; State Specialist Hospital, Ondo City, Ondo, Nigeria
| | - Nick Woolfield
- UNICEF, Kyrgyzstan; 63 Elliott St., Caboolture, Queensland, Australia
| | - Joshua Aderinsola Owa
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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13
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Yoshida S, Martines J, Lawn JE, Wall S, Souza JP, Rudan I, Cousens S, Aaby P, Adam I, Adhikari RK, Ambalavanan N, Arifeen SE, Aryal DR, Asiruddin S, Baqui A, Barros AJ, Benn CS, Bhandari V, Bhatnagar S, Bhattacharya S, Bhutta ZA, Black RE, Blencowe H, Bose C, Brown J, Bührer C, Carlo W, Cecatti JG, Cheung PY, Clark R, Colbourn T, Conde-Agudelo A, Corbett E, Czeizel AE, Das A, Day LT, Deal C, Deorari A, Dilmen U, English M, Engmann C, Esamai F, Fall C, Ferriero DM, Gisore P, Hazir T, Higgins RD, Homer CS, Hoque DE, Irgens L, Islam MT, de Graft-Johnson J, Joshua MA, Keenan W, Khatoon S, Kieler H, Kramer MS, Lackritz EM, Lavender T, Lawintono L, Luhanga R, Marsh D, McMillan D, McNamara PJ, Mol BWJ, Molyneux E, Mukasa GK, Mutabazi M, Nacul LC, Nakakeeto M, Narayanan I, Olusanya B, Osrin D, Paul V, Poets C, Reddy UM, Santosham M, Sayed R, Schlabritz-Loutsevitch NE, Singhal N, Smith MA, Smith PG, Soofi S, Spong CY, Sultana S, Tshefu A, van Bel F, Gray LV, Waiswa P, Wang W, Williams SLA, Wright L, Zaidi A, Zhang Y, Zhong N, Zuniga I, Bahl R. Setting research priorities to improve global newborn health and prevent stillbirths by 2025. J Glob Health 2015; 6:010508. [PMID: 26401272 PMCID: PMC4576458 DOI: 10.7189/jogh.06.010508] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013–2025. Methods We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. Results Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. Conclusion These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.
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Affiliation(s)
- Sachiyo Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - José Martines
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Norway
| | - Joy E Lawn
- London School of Hygiene and Tropical Medicine, London, UK ; Saving Newborn Lives, Save the Children, Washington, USA
| | - Stephen Wall
- Saving Newborn Lives, Save the Children, Washington, USA
| | - Joăo Paulo Souza
- Department of Social Medicine, Ribeirăo Preto School of Medicine, University of Săo Paulo, Brazil
| | - Igor Rudan
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh Medical School, Scotland, UK
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Peter Aaby
- Bandim Health Project, Indepth Network, Guinea-Bissau
| | - Ishag Adam
- Faculty of Medicine, University of Khartoum, Sudan
| | | | | | - Shams Ei Arifeen
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Dhana Raj Aryal
- Department of Neonatology Paropakar Maternity and women's Hospital, Nepal
| | - Sk Asiruddin
- TRAction Bangladesh Project, University Research Co., LLC
| | | | - Aluisio Jd Barros
- Centro de Pesquisas Epidemiológicas, Universidade Federal de Pelotas, Brazil
| | - Christine S Benn
- Research Center for Vitamins and Vaccines, Statens Serum Institut, and University of Southern Denmark/Odense University Hospital, Denmark
| | - Vineet Bhandari
- Program in Perinatal Research, Yale University School of Medicine, USA
| | - Shinjini Bhatnagar
- Pediatric Biology Centre, Translational Health Science and Technology Institute, India
| | | | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Robert E Black
- Institute of International Programs, Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Carl Bose
- The University of North Carolina at Chapel Hill School of Medicine, USA
| | | | - Christoph Bührer
- Department of Neonatology, Charité University Medical Center, Germany
| | | | - Jose Guilherme Cecatti
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Brazil
| | - Po-Yin Cheung
- Departments of Pediatrics, Pharmacology & Surgery, University of Alberta, Canada
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- University College London Institute for Global Health, UK
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, Maryland and Detroit, Michigan, USA
| | - Erica Corbett
- Independent consultant maternal health research, Rwanda
| | - Andrew E Czeizel
- Foundation for the Community Control of Hereditary Diseases, Hungary
| | - Abhik Das
- Biostatistics and Epidemiology, RTI International, USA
| | | | - Carolyn Deal
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases National Institute of Health, USA
| | | | - Uğur Dilmen
- Pediatrics and Neonatology, Yıldırım Beyazıt University Medical Faculty, Turkey
| | - Mike English
- Nuffield Department of Medicine & Department of Paediatrics, University of Oxford, UK and KEMRi-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Cyril Engmann
- Newborn Health, Family Health Division, The Bill & Melinda Gates Foundation and the University of North Carolina Schools of Medicine and Public Health, USA
| | | | - Caroline Fall
- International Paediatric Epidemiology; Affiliations: Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, UK
| | | | - Peter Gisore
- School of Medicine, Child Health and Pediatrics, Moi University, Kenya
| | - Tabish Hazir
- Children's Hospital, Pakistan Institute of Medical Sciences, Pakistan
| | - Rosemary D Higgins
- Eunice Kennedy Shriver NICHD Neonatal Research Network, Pregnancy and Perinatology, Branch, National Institute of Health, USA
| | - Caroline Se Homer
- Centre for Midwifery, Child and Family Health, University of Technology, Sydney, Australia
| | - D E Hoque
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Lorentz Irgens
- University of Bergen and Norwegian Institute of Public Health, Norway
| | - M T Islam
- Japan International Cooperation Agency (JICA), Bangladesh
| | | | | | | | - Soofia Khatoon
- Paediatrics and Head of Department Shaheed Suhrawardy Medical College, Bangladesh
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Karolinska Institute, Sweden
| | - Michael S Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Eve M Lackritz
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), USA
| | - Tina Lavender
- University of Manchester School of Nursing Midwifery & Social Work, University of Manchester, UK
| | | | | | | | | | - Patrick J McNamara
- Departments of Paediatrics & Physiology, University of Toronto; Physiology & Experimental Medicine program, Hospital for Sick Children, Toronto, Canada
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, the Netherlands
| | | | - G K Mukasa
- International Baby Food Action Network, Uganda
| | - Miriam Mutabazi
- STRIDES for Family Health, Management Sciences for Health, Uganda
| | - Luis Carlos Nacul
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK
| | - Margaret Nakakeeto
- Kampala Children's Hospital Limited and Childhealth Advocacy International, Uganda
| | - Indira Narayanan
- United States Agency for International Development /Maternal and Child Health Integrated Program, USA
| | | | - David Osrin
- Wellcome Trust Senior Research Fellow in Clinical Science, Institute for Global Health, University College London, UK
| | - Vinod Paul
- All India Institute of Medical Sciences, India
| | | | - Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, USA
| | - Mathuram Santosham
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, USA
| | | | | | | | - Mary Alice Smith
- Environmental Health Science Department, University of Georgia, USA
| | - Peter G Smith
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Sajid Soofi
- Department of Pediatrics & Child Health, Women & Child Health Division, Aga Khan University, Pakistan
| | - Catherine Y Spong
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, USA
| | - Shahin Sultana
- National Institute of Population Research and Training (NIPORT), Ministry of Health and Family Welfare, Bangladesh
| | - Antoinette Tshefu
- Kinshasa School of Public Health, School of Medicine, University of Kinshasa, Democratic Republic of Congo
| | - Frank van Bel
- Department of Neonatology, University of Utrecht, the Netherlands
| | | | - Peter Waiswa
- Division of Global Health, Karolinska Institutet, Sweden
| | - Wei Wang
- School of Medical Sciences, Edith Cowan University, Australia and School of Public Health, Capital Medical University, China
| | | | - Linda Wright
- Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, USA
| | | | - Yanfeng Zhang
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, China
| | - Nanbert Zhong
- Developmental Genetics Laboratory, New York State Institute for Basic Research in Developmental Disabilities, USA
| | | | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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14
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Sharma G, Mathai M, Dickson KE, Weeks A, Hofmeyr GJ, Lavender T, Day LT, Mathews JE, Fawcus S, Simen-Kapeu A, de Bernis L. Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy Childbirth 2015; 15 Suppl 2:S2. [PMID: 26390886 PMCID: PMC4577867 DOI: 10.1186/1471-2393-15-s2-s2] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Good outcomes during pregnancy and childbirth are related to availability, utilisation and effective implementation of essential interventions for labour and childbirth. The majority of the estimated 289,000 maternal deaths, 2.8 million neonatal deaths and 2.6 million stillbirths every year could be prevented by improving access to and scaling up quality care during labour and birth. METHODS The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for skilled birth attendance and basic and comprehensive emergency obstetric care. RESULTS Across 12 countries the most critical bottlenecks identified by workshop participants for skilled birth attendance were health financing (10 out of 12 countries) and health workforce (9 out of 12 countries). Health service delivery bottlenecks were found to be the most critical for both basic and comprehensive emergency obstetric care (9 out of 12 countries); health financing was identified as having critical bottlenecks for comprehensive emergency obstetric care (9 out of 12 countries). Solutions to address health financing bottlenecks included strengthening national financing mechanisms and removing financial barriers to care seeking. For addressing health workforce bottlenecks, improved human resource planning is needed, including task shifting and improving training quality. For health service delivery, proposed solutions included improving quality of care and establishing public private partnerships. CONCLUSIONS Progress towards the 2030 targets for ending preventable maternal and newborn deaths is dependent on improving quality of care during birth and the immediate postnatal period. Strengthening national health systems to improve maternal and newborn health, as a cornerstone of universal health coverage, will only be possible by addressing specific health system bottlenecks during labour and birth, including those within health workforce, health financing and health service delivery.
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Affiliation(s)
- Gaurav Sharma
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Matthews Mathai
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Kim E Dickson
- Health Section, Programme Division, UNICEF Headquarters, 3 United Nations Plaza, New York, 10017, USA
| | - Andrew Weeks
- Sanyu Research Unit, University of Liverpool, c/o Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, UK
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, East London, South Africa
| | - Tina Lavender
- University of Manchester School of Nursing, Midwifery & Social Work, Jean McFarlane Building University Place, Oxford Road, Manchester, M13 9PL, UK
| | - Louise Tina Day
- LAMB, Integrated Rural Health & Development, Dinajpur, 5250, Bangladesh
| | - Jiji Elizabeth Mathews
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sue Fawcus
- Department of Obstetrics & Gynaecology, University of Cape Town, Observatory 7925, Cape Town, South Africa
| | - Aline Simen-Kapeu
- Health Section, Programme Division, UNICEF Headquarters, 3 United Nations Plaza, New York, 10017, USA
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