A seminar presented by Dr Jalemba Aluvaala in the Centre for Tropical Medicine and Global Health, University of Oxford
In celebration of Global Health Trials' fifth birthday (May 11th 2015) Professor Trudie Lang, Principal Investigator of the programme, talks to us about why Global Health Trials was started, why people should share their experience, and what the future holds.
Demonstrating the Efficacy of the FoneAstra Pasteurization Monitor for Human Milk Pasteurization in Resource-Limited Settingsby Mageshree Naicker, Anna Coutsoudis, Kiersten Israel, Rohit Chaudhri, Noah Perin, Koleka Mlisana
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.
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.
Stillbirth is strongly related to impaired fetal growth. However, the relationship between fetal growth and stillbirth is difficult to determine because of uncertainty in the timing of death and confounding characteristics affecting normal fetal growth. The study authors conducted a population-based case–control study of all stillbirths and a representative sample of live births in 59 hospitals in five geographic areas in the US. The study found that stillbirth is associated with both growth restriction and excessive fetal growth. These findings suggest that, contrary to current practices and recommendations, stillbirth prevention strategies should focus on both severe SGA and severe LGA pregnancies.
Accumulating evidence implicates early life factors in the aetiology of non-communicable diseases, including asthma/wheezing disorders. We undertook a systematic review investigating risks of asthma/wheezing disorders in children born preterm, including the increasing numbers who, as a result of advances in neonatal care, now survive very preterm birth.
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.
Application of emollients is a widespread traditional newborn care practice in many low and middle-income countries (LMICs) and may have the potential to decrease infection and consequent mortality in preterm neonates. We systematically reviewed literature published up to December 2012 to identify studies describing the effectiveness of emollient therapy.
The recent BMC Public Health supplement “The Lives Saved Tool in 2013: new capabilities and applications” has been published. The series comprise of 30 papers focusing on various domains of maternal child health with a special focus on the interventions reviewed for the prevention and management of childhood diarrhea and penumonia.
A qualitative study exploring factors associated with mothers’ decisions to formula-feed their infants in Newfoundland and Labrador, Canadaby Jai K Das
The primary aim of this qualitative study was to examine individual factors that shaped mothers’ decisions to formula-feed their infants.
Opportunities for Africa's newborns: Practical data, policy and programmatic support for newborn care in Africaby Jai K Das
Each year at least 1.16 million newborns die in Sub-Saharan Africa. The African region has the highest rates of neonatal mortality in the world, and has shown the slowest progress so far in reducing neonatal deaths. However there is hope. Under the umbrella of the Partnership for Maternal, Newborn and Child Health (PMNCH), 9 organizations, 60 authors and over 40 reviewers, drawn from policymakers and programme leaders for MNCH in Africa, have been involved and contributed to this publication. The book provides an overview of the continuum of care through the lifecycle and opportunities to address gaps at all levels - family and community care, outreach services and health care facilities.
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.
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.
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.
Measuring Coverage in MNCH: Challenges in Monitoring the Proportion of Young Children with Pneumonia Who Receive Antibiotic Treatmentby Jai K Das
Pneumonia remains a major cause of child death globally, and improving antibiotic treatment rates is a key control strategy. The third paper in the PLOS series of 'Measuring Coverage in MNCH', the authors show that the performance of survey tools could be improved by increasing the survey recall period or by improving either overall discriminative power or specificity.
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 second paper of the collection. It focuses on the development of the indicators and standard measurement tools that are needed to measure coverage of key newborn interventions.
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
The Lancet Series on Childhood Pneumonia and Diarrhoea, led by Aga Khan University, Pakistan, provides evidence for integrated control efforts for childhood pneumonia and diarrhoea.The series of four papers assesses the global burden of these two illnesses and identifies a set of highly cost-effective interventions that can prevent most diarrhoea deaths and nearly two thirds of pneumonia deaths by 2025, if delivered at scale. It also highlights the findings from consultations with several hundred frontline workers in high-burden countries and explores the barriers and enablers they face in dealing with these two diseases and potential ways forward. The final paper represents a call to action and discusses the global and country-level remedies needed to eliminate preventable deaths from these illnesses by 2025.
There have been significant improvements in the performance of the Expanded Programme on Immunization (EPI) in Africa since its inception in 1974. However, there exist wide inter- and intra-country differences.
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.
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.
Addressing inequity to achieve the maternal and child health millennium development goals: looking beyond averagesby Jai K Das
Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania.
Anemia, malnutrition and their correlations with socio-demographic characteristics and feeding practices among infants aged 0--18 months in rural areas of Shaanxi province in northwestern Chinaby Jai K Das
Anemia and malnutrition occurring in early childhood have serious implications in rural areas in developing country. This paper is a cross sectional study conducted as the baseline survey to provide data for developing a policy-based approach to controlling infant anemia and malnutrition in rural areas of Shaanxi province in northwestern China.
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.
Previously we have shared the guidelines pertaining to the early initiation and continuation of breast feeding and complementary feeding for newborns and infants. However there are concerns regarding breast feeding for women living with HIV. In particular, evidence has been reported that antiretroviral (ARV) interventions to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of postnatal transmission of HIV through breastfeeding. This evidence has major implications for how women living with HIV might feed their infants, and how health workers should counsel these mothers. In light of this, the World Health Organization (WHO) commenced a guideline development process, culminating in a Guideline Development Group meeting in Geneva on 22–23 October 2009. We share here the revised guidelines by WHO for principles and recommendations for infant feeding inthe context of HIV.
Kangaroo mother care to reduce morbidity and mortality and improve growth in low birth weight infants-The Guidelinesby Jai K Das
For many small preterm infants, receiving prolonged medical care is important. However, kangaroo mother care (KMC) is an effective way to meet baby’s needs for warmth, breastfeeding, protection from infection, stimulation, safety and love. Kangaroo mother care is care of preterm infants carried skin-to-skin with the mother. It is a powerful, easy-to-use method to promote the health and well-being of infants born preterm as well as full-term. We share the WHO guidleines regarding KMC.
Low birth weight (LBW) has been defined by the World Health Organization (WHO) as weight at birthless than 2500 g. LBW infants are at higher risk of early growth retardation, infectious disease, developmental delay and death during infancy and childhood. Experience from developed and low- and middle-income countries has clearly shown that appropriate care of LBW infants, including feeding, temperature maintenance, hygienic cord and skin care, and early detection and treatment of complications, can substantially reduce mortality in this highly vulnerable group. Interventions to improve feeding are likely to improve the immediate and longerterm health and well-being of the individual infant and have a significant impact on neonatal and infant mortality levels in the population. We share the WHO guidelines for feeeding in LBW infants.
About one third of deaths in children under 5 years of age are due to underlying undernutrition, which includes stunting, severe wasting, deficiencies of vitamin A and zinc, and suboptimum breastfeeding. Childhood malnutrition is prevalent in low and middle income countries (LMICs). According to an estimate, 19.4% of children <5 years of age in these countries are underweight (weight-for-age Z score <-2) and about 29.9% are stunted in the year 2011 (height-for-age Z score <-2). The prevalence of both underweight and stunting was highest in Africa and South-Central Asia and stunting and wasting along with intrauterine growth restriction (IUGR) are responsible for about 2.1 million deaths worldwide in children <5 years of age. It is well recognized that the period of 6-24 months of age is one of the most critical time periods in the growth of the infant. The incidence of stunting is the highest in this period as children have high demand for nutrients and there are limitations in the quality and quantity of available foods, especially after exclusive breastfeeding.
The attached report by World Health Organization and UNICEF reports that Maternal mortality has declined dramatically, but faster progress is needed. The report further highlights geographical disparaties in maternal, newborn and child survival.