Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational studyby Ashish Kc et al
The authors aimed to assess the number of institutional births, their outcomes (institutional stillbirth and neonatal mortality rate), and quality of intrapartum care before and during the national COVID-19 lockdown in Nepal. Findings suggest that institutional childbirth reduced by more than half during lockdown, with increases in institutional stillbirth rate and neonatal mortality, and decreases in quality of care. Some behaviours improved, notably hand hygiene and keeping the baby skin-to-skin with their mother. An urgent need exists to protect access to high quality intrapartum care and prevent excess deaths for the most vulnerable health system users during this pandemic period.
Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID-19 in Brazil: a surveillance database analysisby Takemoto et al
The objective of this study was to describe clinical characteristics of pregnant and postpartum women with severe COVID-19 in Brazil and to examine risk factors for mortality. The authors identified 124 maternal deaths, corresponding to a case fatality rate among COVID-19 Acute Respiratory Distress Syndrome (ARDS) cases in the obstetric population of 12.7%. At least one comorbidity was present in 48.4% of fatal cases compared to 24.9% in survival cases. Among women who died, 58.9% were admitted to ICU, 53.2% had invasive ventilation and 29.0% had no respiratory support. The multivariate logistic regression showed that the main risk factors for maternal death by COVID-19 were postpartum at onset of ARDS, obesity, diabetes, and cardiovascular disease, while white ethnicity had a protective effect.
Effect of pregnancy prolongation in early-onset preeclampsia on postpartum maternal cardiovascular, renal and metabolic function in primiparous women: an observational studyby Mulder et al
The objective of this study was to evaluate the association between deferred delivery in early-onset preeclampsia and offspring outcome and maternal cardiovascular, renal and metabolic function in the postpartum period. Findings suggest that pregnancy prolongation in early-onset preeclampsia is associated with improved offspring outcome and survival. These effects do not appear to be deleterious to short-term maternal cardiovascular and metabolic function, but are associated with a modest increase in risk of residual albuminuria.
Effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low-birthweight babies in Kenya and Uganda: a cluster-raby Walker et al
The authors aimed to assess the effect of a quality improvement package for intrapartum and immediate newborn care on stillbirth and preterm neonatal survival in Kenya and Uganda, where evidence-based practices are often underutilised. This unblinded cluster-randomised controlled trial was done in western Kenya and eastern Uganda at facilities that provide 24-h maternity care with at least 200 births per year. Findings suggests that fresh stillbirth and neonatal mortality among low-birthweight and preterm babies can be decreased using a package of interventions that reinforces evidence-based practices and invests in health system strengthening.
Pregnancy and Postpartum Outcomes in a Universally Tested Population for SARS-CoV-2 in New York City: A Prospective Cohort Studyby Prabhu et al
This prospective cohort study aimed to describe differences in outcomes between pregnant women with and without COVID-19. Among pregnant women with COVID-19 at delivery, the study observed increased cesarean delivery rates and increased frequency of maternal complications in the postpartum period. Additionally, intraplacental thrombi may have maternal and fetal implications for COVID-19 infections remote from delivery.
A continuous quality improvement intervention to improve the effectiveness of community health workers providing care to mothers and children: a cluster randomised controlled trial in South Africaby Horwood et al
Community health workers (CHWs) play key roles in delivering health programmes in many countries worldwide. CHW programmes can improve coverage of maternal and child health services for the most disadvantaged and remote communities, leading to substantial benefits for mothers and children. This is a cluster randomised controlled trial to investigate the effectiveness of a continuous quality improvement (CQI) intervention amongst CHWs providing home-based education and support to pregnant women and mothers. Findings suggest that improved training and CQI-based mentoring of CHWs can improve quantity and quality of CHW-mother interactions at household level, leading to improvements in mothers’ knowledge and infant feeding practices.
Summarizes evidence on the impact of community-based programs for improving reproductive, maternal, newborn, and child health (RMNCH) by (1) describing contextual factors affecting implementation; (2) considering issues of cost-effectiveness; and (3) highlighting research gaps, the challenges of scaling up, and the way forward.
Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic reviewby Gilmore et al
This review reports findings on a systematic review analysing effectiveness of preventive interventions delivered by Community Health Workers for Maternal and Child Health in low- and middle-income countries. Community Health Workers were shown to provide a range of preventive interventions for Maternal and Child Health in low- and middle-income countries with some evidence of effective strategies, though insufficient evidence is available to draw conclusions for most interventions and further research is needed.
In this podcast Dr Jacob McKnight talks about his experiences in neonatal nursing delivery and research in Kenya.
Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysisby Popova s et al
Alcohol use during pregnancy is the direct cause of fetal alcohol syndrome (FAS). The authors aimed to estimate the prevalence of alcohol use during pregnancy and FAS in the general population and, by linking these two indicators, estimate the number of pregnant women that consumed alcohol during pregnancy per one case of FAS. Alcohol use during pregnancy is common in many countries and as such, FAS is a relatively prevalent alcohol-related birth defect. More effective prevention strategies targeting alcohol use during pregnancy and surveillance of FAS are urgently needed.
Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countriesby Bizu Gelaye et al
This review is intended to summarise findings from the existing literature, identify important knowledge gaps, and set the research agenda for creating new generalisable knowledge pertinent to increasing our understanding of the prevalence, determinants, and infant and childhood health outcomes associated with perinatal depression. This review is also intended to set the stage for subsequent work aimed at reinforcing and accelerating investments toward providing services to manage maternal depression in low-income and middle-income countries.
Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5?by Moucheraud et al
This paper aims to identify cross-cutting themes on how and why these countries achieved or did not achieve MDG progress.
After the fall of the Taliban in 2001, Afghanistan experienced a tumultuous period of democracy overshadowed by conflict, widespread insurgency, and an inflow of development assistance. Although there have been several cross-sectional assessments of health gains over the last decade, there has been no systematic analysis of progress and factors influencing maternal and child health in Afghanistan. Despite conflict and poverty, Afghanistan has made reasonable progress in its reproductive, maternal, newborn, and child health indicators over the last decade based on contributions of factors within and outside the health sector. However, equitable access to health care remains a challenge and present delivery models have high transactional costs, affecting sustainability.
Reproductive, maternal, newborn, and child health: key messages from Disease Control Priorities 3rd Editionby Black et al
As part of Disease Control Priorities 3rd Edition, the World Bank will publish a volume on Reproductive, Maternal, Newborn, and Child Health that identifies essential cost-effective health interventions that can be scaled up to reduce maternal, newborn, and child deaths, and stillbirths. This Review summarises the volume's key findings and estimates the effect and cost of expanded implementation of these interventions. Recognising that a continuum of care from the adolescent girl, woman, or mother to child is needed, the volume includes details of preventive and therapeutic health interventions in integrated packages: Maternal and Newborn Health and Child Health (along with folic acid supplementation, a key reproductive health intervention).
Community based reproductive health interventions for young married couples in resource-constrained settings: a systematic reviewby Sarkar et al
This paper presents a review of the available evidence on the effectiveness of community-based health interventions to improve the reproductive health status of young married couples in LMICs. Review suggests that multi-layered community-based interventions, targeting young married women, their families and the health system can improve utilization of reproductive health services among young couples in resource-constrained settings. The paper emphasizes the need for further research to fill the knowledge gaps that exist about improving utilization of reproductive healthcare services, especially safe abortion care among young married women in LMICs.
Dr Nat Segaren - Medical Director of the Caris Foundation, presents on 'The Haiti National Early Infant Diagnosis of HIV Program'
Determinants of unmet need for family planning among currently married women in Dangila town administration, Awi Zone, Amhara regional state; a cross sectional studyby Genet et al
Evidences about unmet need for family planning and associated factors are not enough in Dangila town. Therefore, this study was done to assess the magnitude and determinants of unmet need for family planning among currently married women in Dangila town. Findings suggest that the level of unmet need for family planning in the study area is still high compared to the target set (10 %) in the national family planning guide plan of Ethiopia to be achieved by the end of 2015. Therefore, it is important to strengthen counseling and partner involvement in Dangila town to reduce unmet need for family planning.
Birth preparedness and complication readiness among recently delivered women in chamwino district, central Tanzania: a cross sectional studyby Bintabara et al
Birth Preparedness and Complication Readiness is among the key interventions that can reduce maternal mortality. Despite this, its status in Tanzania is not well documented. The authors assessed the practice and determinants of Birth preparedness and complication readiness among recently delivered women in Chamwino district, Central Tanzania. Findings suggest that the proportion of women who prepared for birth and its complications were found to be low. District reproductive and child health coordinator should emphasis on early and frequent antenatal care visits, since they were among predictors of birth preparedness and complication readiness.
Levels, trends and reasons for unmet need for family planning among married women in Botswana: a cross-sectional studyby Letamo et al
The objectives of this study were to estimate the prevalence of unmet need for family planning among married women using Botswana Family Health Survey 2007 data and to identify risk factors for unmet need for family planning among married women.Findings suggest that the prevalence of unmet need for family planning was low in Botswana compared to other sub-Saharan African countries. The findings from this study reemphasise the importance of women's empowerment and men's involvement in women's sexual and reproductive healthcare needs and services. Different approaches are needed to satisfy the demand for family planning for spacing and limiting.
Smoking in pregnancy is known to be associated with a range of adverse pregnancy outcomes, yet there is a high prevalence of smoking among pregnant women in many countries, and it remains a major public health concern. The authors have conducted a systematic review and meta-analysis to provide contemporary estimates of the association between maternal smoking in pregnancy and the risk of stillbirth. The review findings confirm a dose-response effect of maternal smoking in pregnancy on risk of stillbirth. To minimise the risk of stillbirth, reducing current smoking prevalence in pregnancy should continue to be a key public health high priority.
Rubella remains an important pathogen worldwide, with roughly 100 000 cases of congenital rubella syndrome estimated to occur every year. This seminar present results regarding rubella control, elimination, and eradication policies, and a brief review of new laboratory diagnostics.
Maternal and perinatal health research priorities beyond 2015: an international survey and prioritization exerciseby Souza JP et al
Maternal mortality has declined by nearly half since 1990, but over a quarter million women still die every year of causes related to pregnancy and childbirth. Maternal-health related targets are falling short of the 2015 Millennium Development Goals and a post-2015 Development Agenda is emerging. In connection with this, setting global research priorities for the next decade is now required. The authors in this paper adapted the methods of the Child Health and Nutrition Research Initiative (CHNRI) to identify and set global research priorities for maternal and perinatal health for the period 2015 to 2025.
Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery: Analyses of a National US Hospital Discharge Databaseby Kozhimannil et al
The authors in this study used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. Findings suggest that variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses.
Intermittent Preventive Treatment of Malaria in Pregnancy with Mefloquine in HIV-Negative Women: A Multicentre Randomized Controlled Trialby González et al
Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended by WHO to prevent malaria in African pregnant women. The spread of SP parasite resistance has raised concerns regarding long-term use for IPT. Mefloquine (MQ) is the most promising of available alternatives to SP based on safety profile, long half-life, and high efficacy in Africa. This study evaluated the safety and efficacy of MQ for IPTp compared to those of SP in HIV-negative women. Women taking MQ IPTp (15 mg/kg) in the context of long lasting insecticide treated nets had similar prevalence rates of low birth weight as those taking SP IPTp. MQ recipients had less clinical malaria than SP recipients, and the pregnancy outcomes and safety profile were similar. MQ had poorer tolerability even when splitting the dose over two days. These results do not support a change in the current IPTp policy.
Breastfeeding Progression in Preterm Infants Is Influenced by Factors in Infants, Mothers and Clinical Practice: The Results of a National Cohort Study with High Breastfeeding Initiation Ratesby Maastrup et al
Many preterm infants are not capable of exclusive breastfeeding from birth. To guide mothers in breastfeeding, it is important to know when preterm infants can initiate breastfeeding and progress. The aim of this study was to analyse postmenstrual age at breastfeeding milestones in different preterm gestational age groups, to describe rates of breastfeeding duration at pre-defined times, as well as analyse factors associated with PMA at the establishment of exclusive breastfeeding. The study concludes that breastfeeding competence is not developed at a fixed postmenstrual age, but is influenced by multiple factors in infants, mothers and clinical practice. Admitting mothers together with their infants to the NICU and minimising the use of pacifiers may contribute to earlier establishment of exclusive breastfeeding.
This series of five papers assesses and summarizes information from relevant systematic reviews on the impact of various approaches to improve the quality of care for women and newborns.
Use of antenatal corticosteroids and tocolytic drugs in preterm births in 29 countries: an analysis of the WHO Multicountry Survey on Maternal and Newborn Healthby Vogel JP et al
Despite the global burden of morbidity and mortality associated with preterm birth, little evidence is available for use of antenatal corticosteroids and tocolytic drugs in preterm births in low-income and middle-income countries. The authors in thsi study analysed data from the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS) to assess coverage for these interventions in preterm deliveries. Use of interventions was generally poor, despite evidence for their benefit for newborn babies. A substantial proportion of antenatal corticosteroid use occurred at gestational ages at which benefit is controversial, and use of less effective or potentially harmful tocolytic drugs was common. Implementation research and contextualised health policies are needed to improve drug availability and increase compliance with best obstetric practice.
Worldwide, 250,000–280,000 women die during pregnancy and childbirth every year and an estimated 6.55 million children die under the age of five. The majority of maternal deaths occur during or immediately after childbirth, while 43% of child death occurs during the first 28 days of life. However, the progress in limiting these has been slow and sporadic. In this supplement of five papers, teh authors aim to systematically assess and summarize essential interventions for reproductive, maternal, newborn and child health from relevant systematic reviews.
Intrauterine growth restriction (IUGR) is responsible for the higher rates of fetal, perinatal, and neonatal morbidity and mortality. This review details the IUGR risk factors, its short and long-term sequel, themechanism underlying the long-term consequences, and the strategies to tackle IUGR burden.
Cesarean Section and Rate of Subsequent Stillbirth, Miscarriage, and Ectopic Pregnancy: A Danish Register-Based Cohort Studyby Jai K Das
With cesarean section rates increasing worldwide, clarity regarding negative effects is essential. This study aimed to investigate the rate of subsequent stillbirth, miscarriage, and ectopic pregnancy following primary cesarean section, controlling for confounding by indication. This study found that cesarean section is associated with a small increased rate of subsequent stillbirth and ectopic pregnancy. Underlying medical conditions, however, and confounding by indication for the primary cesarean delivery account for at least part of this increased rate. These findings will assist women and health-care providers to reach more informed decisions regarding mode of delivery.
Maternal Overweight and Obesity and Risks of Severe Birth-Asphyxia-Related Complications in Term Infants: A Population-Based Cohort Study in Swedenby Jai K Das
Maternal overweight and obesity increase risks of pregnancy and delivery complications and neonatal mortality, but the mechanisms are unclear. The objective of this study was to investigate associations between maternal body mass index (BMI) in early pregnancy and severe asphyxia-related outcomes in infants delivered at term (≥37 weeks).
Food fortification is safe and cost-effective in the prevention of micronutrient deficiencies and has been widely practiced in developed countries for well over a century. The findings in this report clearly support the utilization of food fortification strategies at scale, which could build on the recent success of the iodized salt programme. Given the widespread prevalence in Pakistan of deficiencies in iron and in vitamins A and D, food fortification strategies offer a tangible option for delivering these micronutrients on a large scale.
Rates and determinants of seasonal influenza vaccination in pregnancy and association with neonatal outcomesby Jai K Das
There is growing evidence that seasonal influenza vaccination in pregnancy has benefits for mother and baby. The authors in this paper determined influenza vaccination rates among pregnant women during the 2 nonpandemic influenza seasons following the 2009 H1N1 pandemic, explored maternal factors as predictors of influenza vaccination status and evaluated the association between maternal influenza vaccination and neonatal outcomes. This study and others have shown an association between maternal influenza vaccination and improved neonatal outcomes, which supports stronger initiatives to promote vaccination during pregnancy.
Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trialby Jai K Das
Delayed cord clamping allows for the passage of blood from the placenta to the baby and reduces the risk of iron deficiency in infancy. To hold the infant for more than 1 min at the level of the vagina (as is presently recommended), on the assumption that gravity affects the volume of placental transfusion, is cumbersome, might result in low compliance, and interferes with immediate contact of the infant with the mother. This study aimed to assess whether gravity affects the volume of placental transfusion.
Can food vouchers improve nutrition and reduce health inequalities in low-income mothers and young children: a multi-method evaluationby Jai K Das
Good nutrition is important during pregnancy, breastfeeding and early life to optimise the health of women and children. It is difficult for low-income families to prioritise spending on healthy food. Healthy Start is a targeted United Kingdom (UK) food subsidy programme that gives vouchers for fruit, vegetables, milk, and vitamins to low-income families. This paper reports an evaluation of Healthy Start from the perspectives of women and health practitioners.
In 2013, the WHO released a new set of guidelines on the prevention of mother to child transmission (PMTCT) of HIV/AIDS. The new guidelines suggests that all pregnant women who test positive for HIV should immediately begin a course of triple ARVs, regardless of CD4 cell levels.
A Risk Prediction Model for the Assessment and Triage of Women with Hypertensive Disorders of Pregnancy in Low-Resourced Settings: The miniPIERS Multi-country Prospective Cohort Studyby Jai K Das
Pre-eclampsia/eclampsia are leading causes of maternal mortality and morbidity, particularly in low- and middle- income countries (LMICs). The authors developed the miniPIERS risk prediction model to provide a simple, evidence-based tool to identify pregnant women in LMICs at increased risk of death or major hypertensive-related complications.
Moleen Zunza is a member of the Global Research Nurses' network and is part of the team that has published this systematic review.
Though many countries are on-track in reducing poverty, less than a quarter of developing countries are on-track for achieving the goal of halving undernutrition. Maternal undernutrition is widely prevalent among women in the developing countries and encompasses both chronic energy as well as micronutrient deficiencies. Maternal undernutrition leads to intrauterine growth restriction and consequent low birth weight, stunting, wasting, underweight and other micronutrient deficiencies along with conditions predisposing to mortality. There are no effective therapies to reverse intrauterine growth restriction; hence focus should be on preventive strategies. In developing countries, the interventions likely to have the largest impact on intrauterine growth include caloric and micronutrient supplementation before and during pregnancy, coupled with supportive strategies for improving nutrition.
Antenatal Syphilis Screening Using Point-of-Care Testing in Sub-Saharan African Countries: A Cost-Effectiveness Analysisby Jai K Das
The objective of this analysis was to evaluate the cost-effectiveness and budget impact of antenatal syphilis screening for 43 countries in SSA and estimate the impact of universal screening on stillbirths, neonatal deaths, congenital syphilis, and disability-adjusted life years (DALYs) averted.
Effect on Postpartum Hemorrhage of Prophylactic Oxytocin (10 IU) by Injection by Community Health Officers in Ghana: A Community-Based, Cluster-Randomized Trialby Jai K Das
Oxytocin is the drug of choice for prevention of postpartum hemorrhage. Its use has generally been restricted to medically trained staff in health facilities. The authors in this paper assessed the effectiveness, safety, and feasibility of PPH prevention using oxytocin injected by peripheral health care providers without midwifery skills at home births.
This systematic review of the current evidence assessed the effectiveness of food fortification with single micronutrients (iron, folic acid, vitamin A, vitamin D, iodine, zinc) as well as MMN when compared with no fortification on the health and nutrition of women and children.
Effect of Facilitation of Local Maternal-and-Newborn Stakeholder Groups on Neonatal Mortality: Cluster-Randomized Controlled Trialby Jai K Das
Facilitation of local women's groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can improve perinatal outcomes. This study hypothesised that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery, and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam.
Risk of Early-Onset Neonatal Infection with Maternal Infection or Colonization: A Global Systematic Review and Meta-Analysisby Jai K Das
Neonatal infections cause a significant proportion of deaths in the first week of life, yet little is known about risk factors and pathways of transmission for early-onset neonatal sepsis globally. This review aimed to estimate the risk of neonatal infection (excluding sexually transmitted diseases [STDs] or congenital infections) in the first seven days of life among newborns of mothers with bacterial infection or colonization during the intrapartum period.
India, with a population of more than 1.21 billion, has the highest maternal mortality in the world (estimated to be 56000 in 2010); and adolescent (aged 15–19) mortality shares 9% of total maternal deaths. Addressing the maternity care needs of adolescents may have considerable ramifications for achieving the Millennium Development Goal (MDG)–5. This paper assesses the socioeconomic differentials in accessing full antenatal care and professional attendance at delivery by adolescent mothers (aged 15–19) in India during 1990–2006.
The authors propose four arguments for why cervical cancer screening and treatment should be included when it comes to operationalizing these two goals and thus to improving reproductive and maternal health outcomes. Each of the four arguments is illustrative of a larger framework that has equity and socioeconomic, gender, public health, and health services dimensions.
Factors Affecting the Delivery, Access, and Use of Interventions to Prevent Malaria in Pregnancy in Sub-Saharan Africa: A Systematic Review and Meta-Analysisby Jai K Das
Malaria in pregnancy has important consequences for mother and baby. Coverage with the World Health Organization–recommended prevention strategy for pregnant women in sub-Saharan Africa of intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated nets (ITNs) is low. This systematic review explores factors affecting delivery, access, and use of IPTp and ITNs among healthcare providers and women
Recent research has established linkages of preconception interventions with improved maternal, perinatal and neonatal health outcomes and it has been suggested that several proven interventions recommended during pregnancy may be even more effective if implemented before conception. The authors in this report have collated and synthesized relevant information on interventions available during the preconception period by using standard methods.
The Effect of Intermittent Antenatal Iron Supplementation on Maternal and Infant Outcomes in Rural Viet Nam: A Cluster Randomised Trialby Jai K Das
Intermittent antenatal iron supplementation is an attractive alternative to daily dosing; however, the impact of this strategy on infant outcomes remains unclear. This study compared the effect of intermittent antenatal iron supplementation with daily iron supplementation on maternal and infant outcomes in rural Viet Nam.
This study suggests that to achieve a substantial reduction in maternal mortality, a comprehensive approach to emergency care, and overall improvements in the quality of maternal health care will be needed.
Changes in Association between Previous Therapeutic Abortion and Preterm Birth in Scotland, 1980 to 2008: A Historical Cohort Studyby Jai K Das
The authors in this study hypothesized that the association between previous abortion and the risk of preterm first birth changed in Scotland between 1 January 1980 and 31 December 2008.
Little is known about factors contributing to inequities in antenatal care use in Ethiopia. This study aimed to assess inequities in the use of antenatal care on the basis of area of residence, administrative region, economic status and education.
Malnutrition still remains one of the major public health challenges, particularly in developing countries. Major risk factors for undernutrition such as suboptimal breastfeeding and micronutrient deficiencies (vitamin A and zinc) are responsible for more than one-third of all under five child deaths and 11% of the global total disease burden. Several strategies have been employed to supplement micronutrients. These include education, dietary modification, food provision, supplementation and fortification either alone or in combination.
Maternal and child undernutrition Series was launched in The Lancet in 2008. Five years after the initial series, the issue was re-evaluated including the growing problems of overweight and obesity for women and children, and their consequences in low-income and middle-income countries. Many of these countries are said to have the double burden of malnutrition: continued stunting of growth and deficiencies of essential nutrients along with the emerging issue of obesity. The national progress in nutrition programmes and international efforts toward previous recommendations were also evaluated
The Lancet publishes a special themed issue to coincide with the third Women Deliver conference in Kuala Lumpur, Malaysia on May 28–30, 2013. Women Deliver brings together voices from around the world to generate political commitment and resource investments to improve the health and well-being of girls and women and achieve universal access to reproductive health. The studies published in The Lancet's themed issue use different methods to show the multidimensional nature of reproductive health and the influence of social determinants and health systems.
The PLOS Medicine “Measuring Coverage in MNCH” Collection of research studies and reviews presents systematic assessments of the validity of health intervention coverage measurement based on household surveys, the primary method for estimating population-level intervention coverage in low- and middle-income countries. This is the first paper of the collection
Over the last decade, a number of influential organisations have called for the integration of mental, neurological and substance use (MNS) disorders into large scale public health programmes. Although progress at the implementation level has been slow, the development of a number of evidence-based, potentially scalable interventions in the MNS field provides new impetus to develop strategies for integration with broader programmes. Integrating maternal mental health care will help advance maternal and child health (MCH) status.
e have recently added a Canadian cohort study from PLOS Medicine providing valuable new evidence on preeclampsia (PEC) and the impetus for discussing whether it is now time to consider screening women with a history of hypertensive pregnancy disorders. This paper discusses the feasibility of systematic screening of women with a history of Hypertensive Pregnancyand its mangement.
Women with preeclampsia (PEC) and gestational hypertension (GH) exhibit insulin resistance during pregnancy, independent of obesity and glucose intolerance. The authors in this paper aim to determine whether women with PEC or GH during pregnancy have an increased risk of developing diabetes after pregnancy, and whether the presence of PEC/GH in addition to gestational diabetes (GDM) increases the risk of future (postpartum) diabetes.
Young Children's Probability of Dying Before and After Their Mother's Death: A Rural South African Population-Based Surveillance Studyby Jai K Das
There is evidence that a young child's risk of dying increases following the mother's death, but little is known about the risk when the mother becomes very ill prior to her death. We hypothesized that children would be more likely to die during the period several months before their mother's death, as well as for several months after her death. Therefore the authors in this paper investigated the relationship between young children's likelihood of dying and the timing of their mother's death and, in particular, the existence of a critical period of increased risk.
It is estimated that 41.8% of pregnant women worldwide are anaemic. Approximately 60% of these cases in non-malarious areas, and 50% in malaria-endemic settings, are assumed to be due to iron deficiency. We share the WHO guideline providing global, evidence-informed recommendations on the use of multiple micronutrient powders for home fortification of foods consumed by pregnant women.
The use of mobile phones has grown exponentially in the last decade including in some of the most remote and low-resource regions of the world. The use of mobile technology in health care is known as mHealth. mHealth interventions are being used internationally to improve maternal and child health. Be it the use of a mobile phone to call for emergency transport, remote consultation, or large-scale short message service (SMS)-based community education programs, mHealth is demonstrating its utility in reproductive health programs throughout the world. This article describes the evolution and challenges of mHealth, discusses the role of mHealth in achieving Millennium Development Goals 4 and 5, and addresses the potential impact of mHealth for midwives
The universal coverage with the full package of these proven interventions at observed levels of program effectiveness could prevent about one quarter of child deaths under 36 months of age and reduce the prevalence of stunting at 36 months by about one third. I attach my recent review on the possible strategies to combat malnutrition include promotion of breastfeeding, dietary supplementation of micronutrients, prevention of protein-energy malnutrition, and hygiene of available weaning foods and how best topackage these intevrentions for universal scale-up.
In response to the unacceptable maternal health situation, WHO has developed the Pilot Edition of the Safe Childbirth Checklist, to support the delivery of essential maternal and perinatal care practices. The WHO Safe Childbirth Checklist contains 29 items addressing the major causes of maternal death (namely, haemorrhage, infection, obstructed labour and hypertensive disorders), intrapartum-related stillbirths (namely, inadequate intrapartum care), and neonatal deaths (namely birth asphyxia, infection and complications related to prematurity) in low-income countries. It was developed following a rigorous methodology and tested for usability in ten countries across Africa and Asia. Please have a look at the below link:
Translating Coverage Gains into Health Gains for All Women and Children: The Quality Care Opportunityby Jai K Das
The health outcomes of women and children have not matched expectations from the gains in the coverage of care. Robust evidence exists for one explanatory factor: the poor–rich gaps in coverage found along the continuum of care for women and children, and particularly for the crucial period around childbirth. The more-neglected explanation for the mismatch between coverage and health outcomes is the quality of the care provided to women and children. The following paper is structured around a key cause and a consequence of the neglect of quality—weak measurement and poor evidence for action—and concludes with priorities for seizing the quality care opportunity.
Women of reproductive age are at increased risk of anaemia because of chronic iron depletion during the menstrual cycle. It is estimated that worldwide there are 469 million anaemic women of reproductive age. At least half of the cases are attributed to iron deficiency. We share the WHO guidleines for Intermittent iron and folic acid supplementation in menstruating women.
Maternal, newborn, and child health indices in Nigeria vary widely across geopolitical zones and between urban and rural areas, mostly due to variations in the availability of skilled attendance at birth. To improve these indices, the Midwives Service Scheme (MSS) in Nigeria engaged newly graduated, unemployed, and retired midwives to work temporarily in rural areas. This paper describes the structure, processes, challanges and the outcomes acheived through MSS.
Comprehensive Approach to Improving Maternal Health and Achieving MDG 5: Report from the Mountains of Lesothoby Jai K Das
The emerging consensus is that improvement in women's health cannot be made through simple, vertical strategies; rather, it requires broad-based health system strengthening at every level of care, from the community to the clinic to the hospital. This paper reports experience in rural Lesotho, where a pilot program was implemented that provided comprehensive care of pregnant women from the community to the health center level, linking key primary care services (include HIV testing and treatment) to antenatal care (ANC) and facility-based delivery.
Antenatal care (ANC) provides a crucial opportunity to reach high risk women and prevent pregnancy related complications and the consequent mortalities. We share a study conducted in Zambia that evaluates the role health service factors. The study objective was to assess how distance to facilities and level of service provision at ANC facilities in Zambia influenced the number and timing of ANC visits and the quality of care received.
Among the hypertensive disorders that complicate pregnancy, pre-eclampsia and eclampsia stand out as major causes of maternal and perinatal mortality and morbidity. The majority of deaths due to pre-eclampsia and eclampsia are avoidable through the provision of timely and effective care to the women presenting with these complications.We share the recent WHO guidelines for the prevention and management of Pre-Eclampsia/Eclampsia
Post Partum Haemorrhage (PPH) is generally defined as blood loss greater than or equal to 500 ml within 24 hours after birth, while severe PPH is blood loss greater than or equal to 1000 ml within 24 hours. PPH is the most common cause of maternal death worldwide. We share the WHO guidelines for the mangement of PPH. It recommends that active management at the third stage of labour should include: (i) administration of a uterotonic soon after the birth of the baby; (ii) clamping of the cord following the observation of uterine contraction (at around 3 minutes); and (iii) delivery of the placenta by controlled cord traction, followed by uterine massage.
Comparing HIV prevalence estimates from prevention of mother-to-child HIV transmission programme and the antenatal HIV surveillance in Addis Abababy Jai K Das
Currently multiple vertical and integrated programs are running concurrently to provide estimates for HIV prevalances in epidemic areas. These programs require careful evaluations and comparisons.This study was conducted in Addis Ababa to compare HIV prevalence estimates from routine PMTCT programme and antenatal surveillance with the aim to come up with evidence based recommendation.
Repository on maternal child health: Health portal to improve access to information on maternal child health in Indiaby Jai K Das
This article describes a health portal developed in India aimed at providing one-stop access to efficiently search, organize and share maternal child health information relevant from public health perspective in the country.