How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveysby Bohren MA. et al.
The authors aimed to develop and implement evidence-informed, validated tools to measure mistreatment during childbirth, and report results from a cross-sectional study in four low-income and middle-income countries. Findings suggest that more than a third of women experienced mistreatment and were particularly vulnerable around the time of birth. Women who were younger and less educated were most at risk, suggesting inequalities in how women are treated during childbirth. Understanding drivers and structural dimensions of mistreatment, including gender and social inequalities, is essential to ensure that interventions adequately account for the broader context.
Impact of group antenatal care (G-ANC) versus individual antenatal care (ANC) on quality of care, ANC attendance and facility-based delivery: A pragmatic cluster-randomized controlled trialby Grenier L. et al
Low quality and frequency of antenatal care (ANC) are associated with lower uptake of facility-based deliveries-a key intervention to reduce maternal and neonatal mortality. The authors implemented group ANC (G-ANC), an alternative service delivery model, in Kenya and Nigeria, to assess its impact on quality and attendance at ANC and uptake of facility-based delivery. Findings suggest that G-ANC was associated with higher facility-based delivery rates in Nigeria, where those rates associated with individual ANC were low. In both Kenya and Nigeria it was associated with a higher proportion of women receiving quality ANC and higher frequency of ANC visits.
Associations between maternal social capital and infant birth weight in three developing countries: a cross-sectional multilevel analysis of Young Lives databy Hwa-Young Lee et al
A cross-sectional analyses of the first wave of Young Lives Survey data collected in 2002 from India (Andhra Pradesh state), Peru and Vietnam were analysed to explore how three indicators of social capital (ie, group membership, social support and cognitive social capital and specific types within each type) are associated with infant birth weight.
Risk of adverse perinatal outcomes among women with pharmacologically treated and untreated depression during pregnancy: A retrospective cohort studyby Adhikari et al
This study examined the risks of adverse perinatal outcomes associated with antidepressant use during pregnancy. Both depression and antidepressant use were independently associated with the risk of adverse perinatal outcomes; however, the risk associated with antidepressants was higher over and above the risk associated with depression. This may reflect the biological effects of antidepressants, greater severity of depression in those treated, or both.
Home childbirth among young mothers aged 15-24 years in Nigeria: a national population-based cross-sectional studyby Adewuyi et al
A secondary analysis of cross-sectional data from the 2013 Nigeria Demographic and Health Survey (NDHS) was done to estimate the prevalence and identify factors associated with home childbirth (delivery) among young mothers aged 15-24 years in Nigeria. Findings suggest that young mothers aged 15-24 years had a higher prevalence of home delivery than the national average for all women of reproductive age in Nigeria.
Post-partum family planning in Burkina Faso (Yam Daabo): a two group, multi-intervention, single-blinded, cluster-randomised controlled trial.by Taon Tran et al
This study assessed the effect of a family planning intervention package on modern contraceptive use at 12 months post partum in predominantly rural Burkina Faso. Findings suggest that a package of six low-technology interventions, aimed at strengthening existing primary health-care services and enhancing demand for these services, can effectively increase modern contraceptive use for up to a year post partum in rural settings in Burkina Faso and has the potential to be suitable in similar settings in this country and others.
Does facility birth reduce maternal and perinatal mortality in Brong Ahafo, Ghana? A secondary analysis using data on 119 244 pregnancies from two cluster-randomised controlled trialsby Gabrysch et al
This study is a secondary analysis of surveillance data on 119 244 pregnancies from two large population-based cluster-randomised controlled trials in Brong Ahafo, Ghana. Findings suggest that facility birth does not necessarily convey a survival benefit for women or babies and should only be recommended in facilities capable of providing emergency obstetric and newborn care and capable of safe-guarding uncomplicated births.
Trends of caesarean delivery from 2008 to 2017, Mexicoby Uribe-Leitz et al
Caesarean delivery rates in Mexico are among the highest in the world. Given heightened public and professional awareness of this problem and the updated 2014 national guidelines to reduce the frequency of caesarean delivery, the authors analysed trends in caesarean delivery by type of facility in Mexico from 2008 to 2017. Findings suggest that since 2014, rates of caesarean delivery have fallen slightly in all sectors, but they remain high at 45.5%. Policies with appropriate interventions are needed to reduce the caesarean delivery rate in Mexico, particularly in private-sector hospitals.
Screening for HIV Infection in Pregnant Women: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.by Selph et al
The US Preventive Services Task Force (USPSTF) previously found strong evidence that prenatal HIV screening reduced risk of mother-to-child transmission. The previous evidence review was conducted in 2012. Findings suggest that combination ART was highly effective at reducing risk of mother-to-child HIV transmission. Use of certain ART regimens during pregnancy was associated with increased risk of harms that may be mitigated by selection of ART regimen. The 2012 review found that avoidance of breastfeeding and cesarean delivery in women with viremia also reduced risk of transmission and that prenatal screening accurately diagnosed HIV infection.
Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trialby Knight et al
The authors aimed to investigate whether antibiotic prophylaxis prevented maternal infection after operative vaginal birth. In a blinded, randomised controlled trial done at 27 UK obstetric units, women (aged ≥16 years) were allocated to receive a single dose of intravenous amoxicillin and clavulanic acid or placebo (saline) following operative vaginal birth at 36 weeks gestation or later. The primary outcome was confirmed or suspected maternal infection within 6 weeks of delivery defined by a new prescription of antibiotics for specific indications, confirmed systemic infection on culture, or endometritis. This trial shows benefit of a single dose of prophylactic antibiotic after operative vaginal birth and guidance from WHO and other national organisations should be changed to reflect this.
Meeting the SDG challenge to end fistula and preventable childbirth-related morbidity and mortalityby Romanzi et al
Lack of safe, affordable, medically indicated caesarean delivery is a primary contributor to global health inequity. In low-income and middle-income countries (LMICs), it perpetuates preventable morbidity and mortality caused by prolonged or obstructed labour. Adequate intervention alone would avert 1 million disability-adjusted life-years (DALYs), with a median benefit-to-cost ratio of 6·0 at US$304 per DALY averted, reflecting an eradicable burden of disease that undermines sustainable development, economic growth, and human rights.
National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysisby Blencowe et al.
The authors aimed to assist in setting a baseline against which to assess progress towards the achievement of the World Health Assembly targets for reductions in low birth weight (LBW) prevalence. The authors collated data on 1447 country-years of birthweight data (281 million births) for 148 countries of 195 UN member states (47 countries had no data meeting inclusion criteria). The estimated worldwide LBW prevalence in 2015 was 14·6% compared with 17·5% in 2000 (average annual reduction rate 1·23%). In 2015, an estimated 20·5 million livebirths were LBW, 91% from low-and-middle income countries, mainly southern Asia (48%) and sub-Saharan Africa (24%).
A Randomized Trial of Progesterone in Women with Bleeding in Early Pregnancyby Coomarasamy et al.
The authors conducted a multicenter, randomized, double-blind, placebo-controlled trial to evaluate progesterone, as compared with placebo, in women with vaginal bleeding in early pregnancy. The findings suggest that among women with bleeding in early pregnancy, progesterone therapy administered during the first trimester did not result in a significantly higher incidence of live births than placebo.
Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomesby LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group
The objective of the study was to examine the association of ranges of gestational weight gain with risk of adverse maternal and infant outcomes and estimate optimal gestational weight gain ranges across prepregnancy body mass index categories. Individual participant-level meta-analysis using data from 196 670 participants within 25 cohort studies from Europe and North America (main study sample) was conducted. In this meta-analysis of pooled individual participant data from 25 cohort studies, the risk for adverse maternal and infant outcomes varied by gestational weight gain and across the range of prepregnancy weights. The estimates of optimal gestational weight gain may inform prenatal counseling; however, the optimal gestational weight gain ranges had limited predictive value for the outcomes assessed.
An mHealth SMS intervention on Postpartum Contraceptive Use Among Women and Couples in Kenya: A Randomized Controlled Trialby Harrington et al.
The objective of this study was to assess the effect of 2-way short message service (SMS) with a nurse on postpartum contraceptive use among individual women and couples. The authors conducted a randomized controlled trial at 2 public hospitals in western Kenya. Findings suggest that the two-way SMS with a nurse, including optional male participation, increased postpartum contraceptive use.
Effect of Addition of an Intimate Partner Violence Intervention to a Nurse Home Visitation Program on Maternal Quality of Life A Randomized Clinical Trialby Jack et al
This cluster randomised trial assessed whether augmentation of a nurse home visitation program with an intimate partner violence intervention, starting in pregnancy, compared with the home visitation program alone, leads to improved maternal quality of life at 24 months after infant delivery? The trial included 492 pregnant women, randomization to the augmented program compared with nurse home visitation alone resulted in maternal quality-of-life scores at 24 months postdelivery of 311.3 vs 316.2 (measured using the WHOQOL-BREF scale; range, 0-400)—a difference that was not statistically significant. These findings do not support augmenting a nurse home visitation program with this complex, multifaceted intimate partner violence intervention.
What maternal morbidities are and what they mean for women: A thematic analysis of twenty years of qualitative research in low and lower-middle income countriesby Lange et al
As part of the WHO’s Maternal Morbidity Working Group’s efforts to define and measure maternal morbidity, the authors carried out a thematic analysis of the qualitative literature published between 1998 and 2017 on how women experience maternal morbidity in low and lower-middle income countries. Analysis of the 71 papers included in this study shows that women’s status, their marital relationships, cultural attitudes towards fertility and social responses to infertility and pregnancy trauma are fundamental to determining how they will experience morbidity in the pregnancy and postpartum periods.
Maternal and perinatal mortality and complications associated with caesarean section in low-income and middle-income countries: a systematic review and meta-analysisby Sobhy S. et al
Universal and timely access to a caesarean section is a key requirement for safe childbirth. This review identified the burden of maternal and perinatal mortality and morbidity, and the risk factors following caesarean sections in low-income and middle-income countries (LMICs). The review included 196 studies from 67 LMICs. The risk of maternal death in women who had a caesarean section was 7·6 per 1000 procedures; the highest burden was in sub-Saharan Africa (10·9 per 1000). A quarter of all women who died in LMICs had undergone a caesarean section. Maternal deaths and perinatal deaths following caesarean sections are disproportionately high in LMICs. The timing and urgency of caesarean section pose major risks.
Community health workers to improve uptake of maternal healthcare services: A cluster-randomized pragmatic trial in Dar es Salaam, Tanzaniaby Geldsetzer P. et al
This cluster-randomized trial aimed to determine the impact of a community health worker (CHW) intervention on the proportion of women who (i) visit ANC fewer than 4 times during their pregnancy and (ii) deliver at home. A home-based CHW intervention in urban Tanzania significantly reduced the proportion of women who reported having delivered at home, in an area that already has very high uptake of facility-based delivery. The intervention did not affect self-reported ANC attendance. Policy makers should consider piloting, evaluating, and scaling interventions to lessen the economic burden and inconvenience of ANC.
Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort studyby Bishop et al
A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. Findings suggest that maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa.
Measuring quality of care for all women and newborns: how do we know if we are doing it right? A review of facility assessment toolsby Brizuela et al
The authors aimed to assess the capacity of globally used, large-scale facility assessment tools to measure quality of maternal and newborn care as per the WHO framework. Findings suggest that existing facility assessment tools provide a valuable way to assess quality of maternal and newborn care as one element within the national measurement toolkit. Guidance is clearly needed on priority measures and for better harmonisation across tools to reduce measurement burden and increase data use for quality improvement. Targeted development of measurement modules to address important gaps is a key priority for research.
Assessing the role of women's autonomy and acceptability of intimate-partner violence in maternal health-care utilization in 63 low- and middle-income countries.by Sripad et al
This study investigates the associations between women's autonomy and attitudes toward the acceptability of intimate-partner violence against women (IPVAW) and maternal health-care utilization outcomes. The findings suggest that strong and significant associations exist between autonomy, acceptability of IPVAW and utilization of maternal health-care services.
Effect of a novel vital sign device on maternal mortality and morbidity in low-resource settings: a pragmatic, stepped-wedge, cluster-randomised controlled trialby Vousdin et al
The primary aim of this trial was to determine whether implementation of the CRADLE Vital Sign Alert and an education package into community and facility maternity care in low-resource settings could reduce a composite of all-cause maternal mortality or major morbidity (eclampsia and hysterectomy) across Africa, India, and Haiti. There was an absolute 8% reduction in primary outcome during the trial, with no change in resources or staffing, but this reduction could not be directly attributed to the intervention due to variability. The authors encountered unanticipated methodological challenges with this trial design, which can provide valuable learning for future research and inform the trial design of future international stepped-wedge trials.
Utilization of Long-Acting Reversible Contraceptives in the United States After vs Before the 2016 US Presidential Electionby Pace LE et al
Using data from a large sample of commercially insured women, the authors sought to assess whether there was an increase in long-acting reversible contraceptive (LARC) utilization among commercially insured women during the 30 days after the election, compared with the 30 days before the election and the same period in 2015.
Inherited predisposition to stillbirth: an intergenerational analysis of 26,788 mother-daughter pairsby Woolner AMF et al
The aim of the study was to investigate if there is an inherited predisposition to stillbirth transmitted from mother to daughter. The findings suggest that among the daughters, 384 had a history of one or more stillbirths (cases) while 26,404 only ever had livebirths (controls). We found no statistically significant association between mothers' history of stillbirth (adjusted Odds Ratio (aOR) 0.63; 95% CI 0.24-1.63) or miscarriage (aOR 1.01; 95% CI 0.71-1.42) and stillbirth in daughters.
Quality of care in early detection and management of pre-eclampsia/eclampsia in health facilities in Afghanistanby Ansari N et al
The 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment assessed quality of early detection and management of PE/E in health facilities and skilled birth attendants' (SBAs) perceptions of their working environment. Notable gaps in SBAs' knowledge and clinical practices in detection and management of PE/E in various health facilities increase the risk of maternal and perinatal mortality. Continuing education of health care providers and increased investment in focused quality improvement initiatives will be critical to improve the quality of health care services in Afghanistan.
Capacities of women and men to improve maternal and newborn health: Effect of a community-based intervention package in rural Bangladeshby Rahman AE et al
A community-based intervention package was initiated in 2009 in Netrokona, a rural district in Bangladesh, to engage individuals, families and communities to improve maternal and newborn health. In this article, the authors present the effect of the intervention package on improvement of women's capacities with regard to maternal and newborn health, their husbands' capacities to effectively support them and use of skilled services during pregnancy, childbirth and after childbirth. The authors conclude that the intervention package was effective in building the capacities of women and in engaging their husbands positively in maternal and newborn health. This may have translated into increased use of skilled care during pregnancy.
Indicators for monitoring maternal and neonatal quality care: a systematic reviewby Saturno-Hernández PJ et al
The objective was to perform a systematic review of indicators for the central phases of the maternal and child healthcare continuum of care (pregnancy, childbirth, newborn care and postpartum). Findings suggest that there is a broad choice of indicators for maternal and child healthcare. However, most indicators lack demonstrated scientific soundness and refer to particular continuum phases and levels within the healthcare system. Additional efforts are needed to identify good indicators for a comprehensive maternal and child healthcare monitoring system.
Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and Indiaby Afulani et al
The authors examined data from four cross-sectional surveys with 3625 women aged 15-49 years who had recently given birth in Kenya, Ghana, and India (surveys were done from August, 2016, to October, 2017). Fndings suggest that regardless of the setting, women are not getting adequate PCMC. Efforts are needed to improve the quality of facility-based maternity care.
Maternal mortality ratios in 2852 Chinese counties, 1996–2015, and achievement of Millennium Development Goal 5 in China: a subnational analysis of the Global Burden of Disease Study 2016by Liang et al
Using a national registration system of maternal mortality at the county level, the authors estimated the maternal mortality ratios for 2852 counties in China between 1996 and 2015. Findings suggest that in the past two decades, maternal mortality ratios have reduced rapidly and universally across China at the county level. Fast improvement in maternal mortality ratios is possible even in less economically developed places with resource constraints. This finding has important implications for improving maternal mortality ratios in developing countries in the Sustainable Development Goal era.
The conducted a scoping review of indicators proposed by global multi-stakeholder groups to suggest next steps to further support maternal and newborn measurement and monitoring. The authors identified 140 indicators linked to maternal and newborn health topics across the continuum of service provision. Fifty-five indicators relate to inputs and processes, 30 indicators relate to outputs, outcomes comprise 37 indicators in the database, and 18 impact indicators. A quarter of indicators proposed by global groups is either under development/discussion or is considered "aspirational", highlighting the currently evolving monitoring landscape. Although considerable efforts have been made to harmonize indicator recommendations, there are still relatively few indicators shared across key monitoring initiatives and some of those that are shared may have definitional variation.
Maternal immunisation to improve the health of HIV-exposed infantsby Bengtson AM et al
HIV-exposed but uninfected (HEU) infants are at an increased risk of many infectious diseases that can contribute to the high mortality seen among HEU children. Maternal immunisation could be a promising strategy to reduce infections in HEU infants. However, very little research has explored the effect of HIV on the immunogenicity and effectiveness of vaccines given during pregnancy. The authors reviewed the available evidence on maternal immunisation among women living with HIV (WLWH) for all vaccines recommended, considered, or being investigated for routine or risk-based use during pregnancy. Of the 11 vaccines included, only three have been investigated in WLWH. Available evidence suggests that maternal HIV infection limits the immunogenicity of several vaccines, leaving HEU infants more susceptible to infection during their first few months of life. Whether maternal immunisation reduces the infectious morbidity and mortality associated with infectious diseases in HEU children remains unknown.
Health systems' capacity to provide post-abortion care: a multicountry analysis using signal functionsby Owolabi OO et al
The study authors did a multicountry analysis of data from nationally representative Service Provision Assessment surveys done between 2007 to 2017 in ten countries across three regions (Bangladesh, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda). Findings suggest that there are critical gaps in the provision of post-abortion care at all facilities that offer delivery services. In seven (70%) of ten countries, less than 10% of primary-level facilities could provide basic post-abortion care, and in eight (80%) of ten countries less than 40% of referral-level facilities could provide comprehensive post-abortion care. In no country could all referral facilities provide all the essential services that need to be included in basic post-abortion care. Increasing the provision of good-quality post-abortion care is essential to reduce the level of abortion-related morbidity and mortality.
Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Healthby Santana et al
The objective of the preset study is to evaluate perinatal outcomes associated with twin pregnancies, stratified by severe maternal morbidity and order of birth. Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), a cross-sectional study implemented in 29 countries. Data from 8568 twin deliveries were compared with 308,127 singleton deliveries. The occurrence of adverse perinatal outcomes and maternal complications were assessed. Factors independently associated with adverse perinatal outcomes were reported with adjusted PR (Prevalence Ratio) and 95%CI. Findings suggest that twin pregnancy is significantly associated with severe maternal morbidity and with worse perinatal outcomes, especially for the second twin.
National estimates and risk factors associated with early mother-to-child transmission of HIV after implementation of option B+: a cross-sectional analysisby Beth A Tippett Barr et al
Malawi's Ministry of Health led the National Evaluation of Malawi's PMTCT Program to obtain nationally representative data on maternal ART coverage and prevention of mother-to-child transmission (MTCT) effectiveness. This paper presents the early transmission data for infants aged 4–12 weeks. In multivariable logistic regression analysis, the odds of early MTCT were higher in mothers starting ART post partum (adjusted odds ratio 16·7, 95% CI 1·6–171·5; p=0·022) and in those not on ART with an unknown HIV status during pregnancy (19·1, 8·5–43·0; p<0·0001) than in mothers on ART before pregnancy. Among HIV-exposed infants, 98·0% (95% CI 96·9–99·1) were reported by the mother to have received infant nevirapine prophylaxis, and only 45·6% (34·8–56·4) were already enrolled in an exposed infant HIV care clinic at the time of study screening. These data suggest that Malawi's decentralisation of ART services has resulted in higher ART coverage and lower early MTCT. However, the uptake of services for HIV-exposed infants remains suboptimal.
Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysisby Chawanpaiboon S et al
These findings suggest that preterm birth remains a crucial issue in child mortality and improving quality of maternal and newborn care. To better understand the epidemiology of preterm birth, the quality and volume of data needs to be improved, including standardisation of definitions, measurement, and reporting.
Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study.by The Alliance for Maternal and Newborn Health Improvement (AMANHI) mortality study group
In this prospective cohort study done in 11 community-based research sites in south Asia and sub-Saharan Africa, between July, 2012, and February, 2016, the authors conducted population-based surveillance of women of reproductive age (15-49 years) to identify pregnancies, which were followed up to birth and 42 days post partum. These results will contribute to improved global estimates of rates, timing, and causes of maternal and newborn deaths and stillbirths. The findings imply that programmes in sub-Saharan Africa and south Asia need to further intensify their efforts to reduce mortality rates, which continue to be high. The focus on improving the quality of maternal intrapartum care and immediate newborn care must be further enhanced. Efforts to address perinatal asphyxia and newborn infections, as well as preterm birth, are critical to achieving survival goals in the Sustainable Development Goals era.
Short interpregnancy intervals and adverse perinatal outcomes in high-resource settings: An updated systematic reviewby Ahrens et al
This systematic review summarises association between short interpregnancy intervals and adverse perinatal health outcomes in high-resource settings to inform recommendations for healthy birth spacing for the United States. In high-resource settings, there is some evidence showing interpregnancy intervals <6 months since last livebirth are associated with increased risks for preterm birth, small-for-gestational age and infant death; however, results were inconsistent. Additional research controlling for confounding would further inform recommendations for healthy birth spacing for the United States.
Equity in antenatal care quality: an analysis of 91 national household surveys.by Arsenault C et al
Using the most recent (2007-16) Demographic and Health Surveys and Multiple Indicator Cluster Surveys in 91 low middle income countries (LMICs), the authors described antenatal care quality based on receipt of three essential services (blood pressure monitoring and urine and blood testing) among women who had at least one visit with a skilled antenatal-care provider. FIndings suggest that many LMICs that have reached high levels of antenatal care coverage had much lower and inequitable levels of quality. Achieving ambitious maternal, newborn, and child health goals will require greater focus on the quality of health services and their equitable distribution. Equity in effective coverage should be used as the new metric to monitor progress towards universal health coverage.
Interventions to reduce unnecessary caesarean sections in healthy women and babiesby Betran AP et al
In this Series paper, the author describe the factors for caesarean section (CS) use that are associated with women, families, health professionals, and health-care organisations and systems, and we examine behavioural, psychosocial, health system, and financial factors. Approaches such as labour companionship and midwife-led care have been associated with higher proportions of physiological births, safer outcomes, and lower health-care costs relative to control groups without these interventions, and with positive maternal experiences, in high-income countries. Such approaches need to be assessed in middle-income and low-income countries. Educational interventions for women should be complemented with meaningful dialogue with health professionals and effective emotional support for women and families. Investing in the training of health professionals, eliminating financial incentives for CS use, and reducing fear of litigation is fundamental. Safe, private, welcoming, and adequately resourced facilities are needed. At the country level, effective medical leadership is essential to ensure CS is used only when indicated. We conclude that interventions to reduce overuse must be multicomponent and locally tailored, addressing women's and health professionals' concerns, as well as health system and financial factors.
Treatment modalities for pregnant women with opioid use disorderby Wang MJ et al
the authors compared the efficacy and safety of detoxification from opioids compared with opioid replacement therapy (ORT) during pregnancy. indings suggest an increased risk of relapse with detoxification treatment compared with ORT; however, detoxification does not alter the risk of preterm birth or neonatal abstinece syndrome. Further studies should confirm our findings and explore mechanisms to fight the current opioid epidemic.
Global Abortion Policies Database: a new approach to strengthening knowledge on laws, policies, and human rights standardsby Ronald Johnson Jr et al
The GAPD is a comprehensive tool that can be used to strengthen knowledge, inform law and policy research to generate evidence on the impact of laws and policies in practice, and facilitate greater awareness of the many challenges to creating enabling policy environments for safe abortion.
Trends in adolescent first births in five countries in Latin America and the Caribbean: disaggregated data from demographic and health surveysby Neal et al
The study draws on Demographic and Health Survey data from five countries where three surveys are available since 1990, with the most recent after 2006. It examines trends in adolescent births by wealth status and urban/rural residence. The study draws on Demographic and Health Survey data from five countries where three surveys are available since 1990, with the most recent after 2006. It examines trends in adolescent births by wealth status and urban/rural residence.
Measuring health inequalities in the context of sustainable development goalsby Hosseinpoor et al
The World Health Organization has developed a multistep approach to health inequality monitoring consisting of: (i) determining the scope of monitoring; (ii) obtaining data; (iii) analysing data; (iv) reporting results; and (v) implementing changes. This paper presents some technical considerations for developing or strengthening health inequality monitoring, with the aim of encouraging more robust, systematic and transparent practices. It discusses key aspects of measuring health inequalities that are relevant to steps (i) and (iii).
Population-level factors associated with maternal mortality in the United States, 1997–2012by Nelson et al
The authors analyzed state-level maternal mortality for the years 1997–2012 using multilevel mixed-effects regression grouped by state, using publicly available data including whether a state had adopted the 2003 U.S. Standard Certificate of Death, designed to simplify identification of pregnant and recently pregnant decedents. Findings indicate that, in addition to better case ascertainment of maternal deaths, adverse changes in chronic diseases, insufficient healthcare access, and social determinants of health represent identifiable risks for maternal mortality that merit prompt attention in population-directed interventions and health policies.
Clinicians’ views of factors influencing decision-making for caesarean section: A systematic review and metasynthesis of qualitative, quantitative and mixed methods studiesby Panda et al
This systematic review aimed to offer insight and understanding, through aggregation, summary, synthesis and interpretation of findings from studies that report obstetricians’ and midwives’ views on the factors that influence the decision to perform caesarean section. This systematic review and metasynthesis identified clinicians’ personal beliefs as a major factor that influenced the decision to perform caesarean section, further contributed by the influence of factors related to the health care system and clinicians’ characteristics. Obstetricians and midwives are directly involved in the decision to perform a caesarean section, hence their perspectives are vital in understanding various factors that have influence on decision-making for caesarean section. These results can help clinicians identify and acknowledge their role as crucial members in the decision-making process for caesarean section within their organisation, and to develop intervention studies to reduce caesarean section rates in future.
The magnitude and severity of abortion-related morbidity in settings with limited access to abortion services: a systematic review and meta-regressionby Calvert et al
This systematic review aims to estimate the magnitude and severity of complications associated with abortion in areas where access to abortion is limited, with a particular focus on potentially life-threatening complications. In spite of the challenges on how near miss morbidity has been defined and measured in the included studies, our results suggest that a substantial percentage of abortion-related hospital admissions have potentially life-threatening complications. Estimates that are more reliable will only be obtained with increased use of standard definitions such as the WHO near-miss criteria and/or better reporting of clinical criteria applied in studies.
Impact of integrating a postpartum family planning program into a community-based maternal and newborn health program on birth spacing and preterm birth in rural Bangladeshby Baqui et al
In a quasi-experimental trial design, unions with an average population of about 25 000 and a first level health facility were allocated to an intervention arm (n = 4) to receive integrated post-partum family planning and maternal and newborn health (PPFP-MNH) interventions, or to a control arm (n = 4) to receive the MNH interventions only. Study findings demonstrate the feasibility and effectiveness of integrating PPFP interventions into a community based MNH intervention package. Thus, MNH programs should consider systematically integrating PPFP as a service component to improve pregnancy spacing and reduce the risk of preterm birth.
Involving male partners in maternity care in Burkina Faso: a randomized controlled trialby Daniele et al
The aim of this study was to determine whether an intervention designed to involve the male partners of pregnant women in Burkina Faso in facility-based maternity care influences care-seeking and healthy practices after childbirth. The hypothesis was that the intervention would increase postnatal care attendance, the duration of exclusive breastfeeding and the use of postpartum contraception. Findings suggest that the intervention to involve male partners in maternity care was associated with an increase in attendance at postnatal care consultations, in the duration of exclusive breastfeeding and in the use of postpartum contraception, especially long-acting, reversible contraception. The intervention also had a positive effect on communication between the couple and shared decision-making related to reproductive health.
This large trial compared a novel formulation of heat-stable carbetocin with oxytocin. The study enrolled women across 23 sites in 10 countries in a randomized, double-blind, noninferiority trial comparing intramuscular injections of heat-stable carbetocin (at a dose of 100 μg) with oxytocin (at a dose of 10 IU) administered immediately after vaginal birth. Findings suggest that heat-stable carbetocin was noninferior to oxytocin for the prevention of blood loss of at least 500 ml or the use of additional uterotonic agents. Noninferiority was not shown for the outcome of blood loss of at least 1000 ml; low event rates for this outcome reduced the power of the trial.
Low dose aspirin is associated with reduced spontaneous preterm birth in nulliparous womenby Andrikopoulou,et al
The objective was to determine whether low dose aspirin reduces the rate of spontaneous PTB in nulliparous women without medical co-morbidities. This is a secondary analysis of a randomized, placebo-controlled trial of low dose aspirin for prevention of preeclampsia in healthy, low-risk, nulliparous women. Low dose aspirin is associated with a substantial decrease in spontaneous PTB <34wks in healthy nulliparous women without co-morbidities. These findings suggest a new therapeutic option for PTB prevention that requires further study.
Improvement in the active management of the third stage of labor for the prevention of postpartum hemorrhage in Tanzania: a cross-sectional studyby Bishanga et al
A cross-sectional study was conducted in 52 health facilities in Tanzania utilizing direct observations of women during labor and delivery. Findings suggets that the quality of PPH prevention increased substantially in facilities that implemented competency-based training and quality improvement interventions, with the most dramatic improvement seen at lower-level facilities. As Tanzania continues with efforts to increase facility births, it is imperative that the quality of care also be improved by promoting use of up-to-date guidelines and ensuring regular training and mentoring for health care providers so that they adhere to the guidelines for care of women during labor. These measures can reduce maternal and newborn mortality.
National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysisby Lange et al
Smoking during pregnancy has been linked to numerous adverse health consequences for both the developing fetus and mother. This study estimated the prevalence of smoking during pregnancy by country, WHO region, and globally and the proportion of pregnant women who smoked during pregnancy, by frequency and quantity, on a global level. The findings suggest that smoking during pregnancy is still a prevalent behaviour in many countries. These findings should inform smoking prevention programmes and health promotion strategies, as well as draw attention to the need for improved access to smoking cessation programmes for pregnant women.
Burden of physical, psychological and social ill-health during and after pregnancy among women in India, Pakistan, Kenya and Malawiby McCauley et al
For every woman who dies during pregnancy and childbirth, many more suffer ill-health, the burden of which is highest in low-resource settings. The study sought to assess the extent and types of maternal morbidity. Findings from this study suggests that women suffer significant ill-health which is still largely unrecognised. Current antenatal and postnatal care packages require adaptation if they are to meet the identified health needs of women.
Induction of labour for improving birth outcomes for women at or beyond termby Middleton et al
The objective of this review is to assess the effects of a policy of labour induction at or beyond term compared with a policy of awaiting spontaneous labour or until an indication for birth induction of labour is identified) on pregnancy outcomes for infant and mother. A policy of labour induction at or beyond term compared with expectant management is associated with fewer perinatal deaths and fewer caesarean sections; but more operative vaginal births. NICU admissions were lower and fewer babies had low Apgar scores with induction. No important differences were seen for most of the other maternal and infant outcomes.
Effectiveness of a WHO Safe Childbirth Checklist Coaching-based intervention on the availability of Essential Birth Supplies in Uttar Pradesh, Indiaby Maisonneuve et al
The objective of this study was to evaluate the impact of a World Health Organization Safe Childbirth Checklist coaching-based intervention (BetterBirth Program) on availability and procurement of essential childbirth-related supplies. Implementation of the BetterBirth Program, incorporating supply availability, resulted in modest improvements with catch-up by control facilities by 12 months. Supply-chain coaching may be most beneficial in sites starting with lower supply availability. Efforts are needed to reduce reliance on patient-funding for some critical medications.
Increased risk of cardiovascular disease in women with prior gestational diabetes: A systematic review and meta-analysisby Li et al
This study aims to investigate the effect of gestational diabetes mellitus (GDM) on the long-term risk of cardiovascular disease (CVD). Seven cohort studies with 3,417,020 pregnant women including 14,146 incident CVD events were retrieved. In the pooled analysis, women with previous GDM had a higher risk of CVD than those without.
Not just a number: examining coverage and content of antenatal care in low-income and middle-income countriesby Benova et al
Antenatal care (ANC) provides a critical opportunity for women and babies to benefit from good-quality maternal care. Using 10 countries as an illustrative analysis, this study described ANC coverage (number of visits and timing of first visit) and operationalised indicators for content of care as available in population surveys, and examined how these two approaches are related. Findings suggest that even among women with patterns of care that complied with global recommendations, the content of care was poor. Efficient and effective action to improve care quality relies on development of suitable content of care indicators.
The effect of Kenya’s free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilitiesby Gitobu et al
This paper aims to provide a brief overview of this policy’s effect on health facility delivery service utilization and maternal mortality ratio and neonatal mortality rate in Kenyan public health facilities. The findings suggest that cost is a deterrent to health facility delivery service utilization in Kenya and thus free delivery services are an important strategy to promote utilization of health facility delivery services; however, there is a need to simultaneously address other factors that contribute to pregnancy-related and neonatal deaths.
Women's experiences of mistreatment during childbirth: A comparative view of home- and facility-based births in Pakistanby Hameed et al
The aim of this epidemiological study was to estimate the prevalence of mistreatment and types of mistreatment among women giving birth in facility- and home-based settings in Pakistan in order to address the lack of empirical evidence on this topic. There were no significant differences in manifestations of mistreatment between facility- and home-based childbirths. Approximately 97% of women reported experiencing at least one disrespectful and abusive behaviour. Experiences of mistreatment by type were as follows: non-consented care (81%); right to information (72%); non-confidential care (69%); verbal abuse (35%); abandonment of care (32%); discriminatory care (15%); and physical abuse (15%).
Demand for family planning satisfied with modern methods among sexually active women in low- and middle-income countries: who is lagging behind?by Ewerling et al
The objective was to identify groups of sexually active women with extremely low demand for family planning satisfied with modern methods (mDFPS) in low- and middle-income countries, at national and subnational levels to inform the improvement and expansion of programmatic efforts to narrow the gaps in mDFPS coverage. Analyses were based on Demographic and Health Survey and Multiple Indicator Cluster Survey data. Almost half of the women in need were not using an effective family planning method. Subgroups requiring special attention include women who are poor, uneducated/illiterate, young, and living in rural areas. Efforts to increase mDFPS must address not only the supply side but also tackle the need to change social norms that might inhibit uptake of contraception.
Designing programs to improve diets for maternal and child health: estimating costs and potential dietary impacts of nutrition-sensitive programs in Ethiopia, Nigeria, and Indiaby Masters et al
Improving maternal and child nutrition in resource-poor settings requires effective use of limited resources, but priority-setting is constrained by limited information about program costs and impacts, especially for interventions designed to improve diet quality. This study utilized a mixed methods approach to identify, describe and estimate the potential costs and impacts on child dietary intake of 12 nutrition-sensitive programs in Ethiopia, Nigeria and India. Findings suggest that existing evidence on cost-effectiveness for nutrition improvement focuses on interventions to address specific diseases. Future work using these data will analyse net cost-effectiveness.
Active management of the third stage of labor (AMTSL) describes interventions with the common goal to prevent postpartum hemorrhage (PPH). A systematic search was conducted in five databases in September 2015 to identify intervention studies of AMTSL implemented by unskilled birth attendants or pregnant women themselves. Task shifting of AMTSL has thus far been evaluated for administration of uterotonics (misoprostol tablets and oxytocin injected by CHWs and auxiliary midwives) and resulted in reduction of PPH, high rates of appropriate use and satisfaction among users.
Involving men to improve maternal and newborn health: A systematic review of the effectiveness of interventionsby Tokhi et al
The objective of thsi review was to determine the effect of interventions to engage men during pregnancy, childbirth and infancy on mortality and morbidity, as well as effects on mechanisms by which male involvement is hypothesised to influence mortality and morbidity outcomes: home care practices, care-seeking, and couple relationships. Findings suggets that interventions to engage men in maternal and newborn health can increase care-seeking, improve home care practices, and support more equitable couple communication and decision-making for maternal and newborn health. These findings support engaging men as a health promotion strategy, although evidence gaps remain around effects on mortality and morbidity. Findings also indicate that interventions to increase male involvement should be carefully designed and implemented to mitigate potential harmful effects on couple relationship dynamics.
Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child healthby Countdown to 2030 Collaboration
To achieve the Sustainable Development Goals by 2030, the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than 5 years of age needs to accelerate considerably compared with progress since 2000. Countdown to 2030 is investing in improvements in measurement in several areas, such as quality of care and effective coverage, nutrition programmes, adolescent health, early childhood development, and evidence for conflict settings, and is prioritising its regional networks to enhance local analytic capacity and evidence for RMNCH.
Institutional setting and wealth gradients in cesarean delivery rates: Evidence from six developing countriesby Sepheri et al 2018
This study examined wealth-related variations in cesarean rates in six lower- and upper-middle income countries: the Dominican Republic, Egypt, Guatemala, Jordan, Pakistan, and the Philippines. Large wealth-related variations in the mode of delivery across government and private hospitals suggest the need for well-developed guidelines and standards to achieve a more appropriate selection of cases for cesarean delivery.
The Effect of the Removal of User Fees for Delivery at Public Health Facilities on Institutional Delivery in Urban Kenyaby Calhoun et al
This study determines the effect of the policy to remove user fees on institutional delivery in a population-based sample of women from urban Kenya. Multivariate findings show that women were significantly more likely to deliver at a public facility as compared to a private facility after the policy. Among the poor, the results show that poor women were significantly more likely to deliver in a public facility compared to home or a private facility after policy change.
Long-term risk of diabetes in women at varying durations after gestational diabetes: a systematic review and meta-analysis with more than 2 million womenby Song et al 2017
This study aims to investigate the impact of gestational diabetes mellitus (GDM) on the long-term risks of diabetes in women with prior GDM, including the effect at different time periods after GDM. Thirty cohort studies with 2,626,905 pregnant women were included. Women with prior GDM had 7.76-fold (95% confidence intervals: 5.10–11.81) unadjusted pooled risk of diabetes as compared with women without GDM, whilst the adjusted risk was 17.92-fold (16.96–18.94). The adjusted ORs of GDM for diabetes among women at <3, ≥3 – <6 and ≥6 – <10 years after GDM were 5.37 (3.51–9.34), 16.55 (16.08–17.04) and 8.20 (4.53–14.86), respectively. Women with prior GDM had substantially increased risk of diabetes, with the risk highest during the 3–6 years after GDM.
Randomized controlled pilot of a group antenatal care model and the sociodemographic factors associated with pregnancy-related empowerment in sub-Saharan Africaby Patil et al
The study compares pregnancy-related empowerment for women randomly assigned to the standard of care versus CenteringPregnancy-based group ANC (intervention) in two sub-Saharan countries, Malawi and Tanzania. Pregnant women in Malawi (n = 112) and Tanzania (n = 110) were recruited into a pilot study and randomized to individual ANC or group ANC. The findings suggest that Group ANC empowers pregnant women in some contexts. More research is needed to identify the ways that models of ANC can affect pregnancy-related empowerment in addition to perinatal outcomes globally.
Aspirin for the prevention of preterm and term preeclampsia: Systematic review and meta-analysisby Roberge et al
The authors performed a systematic review and meta-analysis that evaluated the prophylactic effect of aspirin during pregnancy. Sixteen trials including 18,907 participants provided data for preterm and term preeclampsia. Findings suggest that Aspirin reduces the risk of preterm preeclampsia but not term preeclampsia, and only when it is initiated at ≤16 weeks of gestation and at a daily dose of ≥100 mg.
Racial disparities in comorbidity and severe maternal morbidity/mortality in the United States: an analysis of temporal trendsby Metcalfe A et al
Severe maternal morbidity and mortality have increased in the USA in recent years. This trend has not been consistent across all racial groups. The reasons behind this, and the relationship between pre-existing conditions, pregnancy-associated disease and Severe maternal morbidity/mortality, have not been fully explored. The findings suggest that the rate of both pre-existing comorbidities and pregnancy-associated disease is increasing in pregnant women in the USA and varies substantially by race. These trends provide valuable insight into the increasing complexity of pregnancy in the USA and explain a proportion of the observed increase in Severe maternal morbidity/mortality.
Institutional maternal and perinatal deaths: a review of 40 low and middle income countriesby Bailey et al
This paper draws on secondary data from 40 low and middle income countries that conducted emergency obstetric and newborn care assessments over the last 10 years. We reviewed 6.5 million deliveries, surveyed in 15,411 facilities. Most of the data were extracted from reports and aggregated with excel. Findings suggest that to a large extent, facility-based findings mirror what population-based systematic reviews have also documented. As coverage of a skilled attendant at birth increases, proportionally more deaths will occur in facilities, making improvements in record-keeping and health management information systems, especially for stillbirths and early neonatal deaths, all the more critical.
A look back on how far to walk: Systematic review and meta-analysis of physical access to skilled care for childbirth in Sub-Saharan Africaby Wong et al
The objectives of this review were to (i) summarize the methods undertaken to measure physical accessibility as the spatial separation between women and health services, and (ii) establish the extent to which distance to skilled care for childbirth affects utilization in Sub-Saharan Africa. Findings suggest that although the reporting and measurements of spatial separation in low-resource settings needs further development, we found evidence that a lack of geographic access impedes use. Utilization is conditioned on access, researchers and policy makers should therefore prioritize quality data for the evidence-base to ensure that women everywhere have the potential to access obstetric care.
Early antenatal care visit: a systematic analysis of regional and global levels and trends of coverage from 1990 to 2013by Moller et al
Systematic global analysis of early antenatal care visits has not been done previously. This study reports on regional and global estimates of the coverage of early antenatal care visits from 1990 to 2013. Findings suggest that progress in the coverage of early antenatal care visits has been achieved but coverage is still far from universal. Substantial inequity exists in coverage both within regions and between income groups. The absence of data in many countries is of concern and efforts should be made to collect and report coverage of early antenatal care visits to enable better monitoring and evaluation.
Professionals’ mof intimate partner violence in young people: a qualitative study in northern Spainby Maquibar et al
The aim of the study reported here is to explore professionals’ perceptions regarding intimate partner violence (IPV) among young people, focusing on the characteristics of the phenomenon and their perceptions about existing programmes and campaigns aimed at addressing it. The study participants showed good knowledge of the characteristics IPV has among young people. This knowledge was reflected in locally implemented IPV prevention projects, which they considered successful in addressing young people’s needs. However, these interventions lacked formal evaluation, political support and continuation. The study participants did not believe that nationwide mass media campaigns realistically reflected the specific characteristics of IPV among young people. Thus, participants perceived these campaigns to be ineffective.
Consequences of maternal morbidity on health-related functioning: a systematic scoping reviewby Machiyama et al
The aim of this review was to assess the scope of the published literature on the consequences of maternal morbidity on health-related functioning at the global level and identify key substantive findings as well as research and methodological gaps. Many assessments have not been comprehensive and have paid little attention to important functioning domains for pregnant and postpartum women. The development of a comprehensive instrument specific to maternal health would greatly advance our understanding of burden of ill health associated with maternal morbidity and help set priorities. The lack of attention to consequences on functioning associated with the main direct obstetric complications is of particular concern.
Measuring women’s childbirth experiences: a systematic review for identification and analysis of validated instrumentsby Nilver et al
Women’s childbirth experience can have immediate as well as long-term positive or negative effects on their life, well-being and health. When evaluating and drawing conclusions from research results, women’s experiences of childbirth should be one aspect to consider. Researchers and clinicians need help in finding and selecting the most suitable instrument for their purpose. The aim of this study was therefore to systematically identify and present validated instruments measuring women’s childbirth experience. This systematic review provides an overview of existing instruments measuring women’s childbirth experiences and can support researchers to identify appropriate instruments to be used, and maybe adapted, in their specific contexts and research purpose.
FIGO's updated recommendations for misoprostol used alone in gynecology and obstetricsby Morris et al
In 2012, the International Federation of Obstetrics and Gynecology (FIGO) produced a chart detailing recommended dosages of misoprostol when used alone, for a variety of obstetric and gynecologic indications. In light of new evidence and through expert deliberation, this chart has now been revised and expanded. The present commentary explain the changes and the decisions made.
The experiences of women with maternal near miss and their perception of quality of care in Kelantan, Malaysia: a qualitative studyby Norhayati et al
Maternal mortality has been the main way of ascertaining the outcome of maternal and obstetric care. However, maternal morbidities occur more frequently than maternal deaths; therefore, maternal near miss was suggested as a more useful indicator for the evaluation and improvement of maternal health services. This study aimed to explore the experiences of women with maternal near miss and their perception of the quality of care in Kelantan, Malaysia. Self-appraisal of maternal near miss, their perception of the quality of care, their predisposition to seek healthcare and the social support received were the four major themes that emerged from the experiences and perceptions of women with maternal near miss. The women with maternal near miss viewed their experiences as frightening and that they experienced other negative emotions and a sense of imminent death. The factors influencing women’s perceptions of quality of care should be of concern to those seeking to improve services at healthcare facilities. The addition of a maternal near miss case review programme, allows for understanding on the factors related to providing care or to the predisposition to seek care; if addressed, may improve future healthcare and patient outcomes.
Validating the WHO maternal near miss tool: comparing high- and low-resource settingsby Witteveen et al
WHO proposed the WHO Maternal Near Miss (MNM) tool, classifying women according to several (potentially) life-threatening conditions, to monitor and improve quality of obstetric care. The objective of this study is to analyse merged data of one high- and two low-resource settings where this tool was applied and test whether the tool may be suitable for comparing severe maternal outcome (SMO) between these settings. Applying solely organ dysfunction-based criteria may lead to underreporting of SMO. Therefore, a tool based on defining MNM only upon establishing organ failure is of limited use for comparing settings with varying resources. In low-resource settings, lowering the threshold of transfused units of blood leads to a higher detection rate of MNM. We recommend refined disease-based criteria, accompanied by a limited set of intervention- and organ dysfunction-based criteria to set a measure of severity.
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.
Quality of antenatal care predicts retention in skilled birth attendance: a multilevel analysis of 28 African countriesby Chukwuma et al
This paper explores predictors of retention of antenatal care clients in skilled birth attendance across Africa, including sociodemographic factors and quality of antenatal care received. Higher quality of ANC predicts retention in SBA in Africa. Improving quality of skilled care received prenatally may increase client retention during delivery, reducing maternal mortality.
Towards a consensus definition of maternal sepsis: results of a systematic review and expert consultationby Bonet et al
There is a need for a clear and actionable definition of maternal sepsis, in order to better assess the burden of this condition, trigger timely and effective treatment and allow comparisons across facilities and countries. The objective of this study was to review maternal sepsis definitions and identification criteria and to report on the results of an expert consultation to develop a new international definition of maternal sepsis. The operationalization of the new maternal sepsis definition requires generation of a set of practical criteria to identify women with sepsis. These criteria should enable clinicians to focus on the timely initiation of actionable elements of care (administration of antimicrobials and fluids, support of vital organ functions, and referral) and improve maternal outcomes.
Defining disrespect and abuse of newborns: a review of the evidence and an expanded typology of respectful maternity careby Sacks E et al
The review revealed examples of mistreatment of newborns in six of the seven categories. Common occurrences were failure to meet a professional standard of care, stigma and discrimination, and health system constraints. Many instances of mistreatment of newborns related to neglect and non-consented care rather than outright physical or verbal abuse. Two additional categories were also identified for newborns related to legal accountability and bereavement care.
Evidence-based policy responses to strengthen health, community and legislative systems that care for women in Australia with female genital mutilation / cuttingby Varol N et al
This article reviews the literature on research on FGM/C in Australia, which focuses on health system response to women and girls with FGM/C. Recommendations are made for policy reform in health, legislation, and community programs to provide the best healthcare, protect children, and help communities abandon this harmful practice. Findings suggest that countries of migration can be part of the solution for abandonment of FGM/C through community interventions and implementation of national and coordinated training in FGM/C of experts involved in the care and protection of children and women. The global focus on collaboration on research, training and prevention programs should be fostered between countries of FGM/C prevalence and migration.
The effect of health insurance and health facility-upgrades on hospital deliveries in rural Nigeria: a controlled interrupted time-series studyby Brals et al
Access to quality obstetric care is considered essential to reducing maternal and new-born mortality. The authors evaluated the effect of the introduction of a multifaceted voluntary health insurance programme on hospital deliveries in rural Nigeria. Voluntary health insurance combined with quality healthcare services is highly effective in increasing hospital deliveries in rural Nigeria, by improving access to healthcare for insured and uninsured women in the programme area.
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.
New NIHR Themed Review: Better Beginningsby National Institute for Health Research
This themed review brings together NIHR research on different aspects of health before, during and after pregnancy. It features:
- 46 published studies
- 28 ongoing studies or interim results
- Questions for clinicians, commissioners, public health professionals and othe
This short film shows the impact of the CHAPAS trial on patient health and future possibilities of a small boy from Malawi.
The effect of a transition into poverty on child and maternal mental health: a longitudinal analysis of the UK Millennium Cohort Studyby Wickham et al
To inform policy, the authors explore the association between transitions into poverty and subsequent mental health among children and their mothers. In a contemporary UK cohort, first transition into income poverty during early childhood was associated with an increase in the risk of child and maternal mental health problems. These effects were independent of changes in employment status. Transitions to income poverty do appear to affect children's life chances and actions that directly reduce income poverty of children are likely to improve child and maternal mental health.
This is a great video of a talk given at the Oxford Martin School by Professor Kevin Marsh.
In this podcast Dr Jacob McKnight talks about his experiences in neonatal nursing delivery and research in Kenya.
Barriers to accessing adequate maternal care in Central and Eastern European countries: A systematic literature reviewby Miteniece et al
In this study service-related indicators of access to maternal care in CEE are examined. These include availability, appropriateness, affordability, approachability and acceptability of maternal care. Fndings indicate that major gaps in evidence exist and that more representative and better quality data should be collected. Governments in CEE countries need to establish a reliable system for measuring and monitoring a suitable set of indicators, as well as deal with the general social and economic problem of informality. Medical curricula in the CEE region need to be overhauled and there should be a focus on improving the allocation of medical staff and institutions as well as protecting vulnerable population groups to ensure universal access to care.
Factors associated with the utilization of institutional delivery services in Bangladeshby Yaya et al
Effective policymaking to promote the utilization of MHS can be greatly facilitated by the identification of the factors that hinder service uptake. In this study, the authors aim to measure the prevalence of institutional delivery services and explore the factors associated with their utilization in Bangladesh. Results suggest that efforts towards reducing national maternal mortality in Bangladesh could be aided by investments into education, poverty reduction and the strengthening of reproductive healthcare services through community clinics, with particular focus on rural areas.
The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weightby Kiserud et al
WHO made it a high priority to provide the present fetal growth charts for estimated fetal weight (EFW) and common ultrasound biometric measurements intended for worldwide use. This study provides WHO fetal growth charts for EFW and common ultrasound biometric measurements, and shows variation between different parts of the world.
Customised and Noncustomised Birth Weight Centiles and Prediction of Stillbirth and Infant Mortality and Morbidity: A Cohort Study of 979,912 Term Singleton Pregnancies in Scotlandby Iliodromiti et al
This is a population-based linkage study of 979,912 term singleton pregnancies in Scotland, United Kingdom, between 1992 and 2010. At term, birth weight remains strongly associated with the risk of stillbirth and infant death and neonatal morbidity. Partial customisation does not improve prediction performance. Consideration of early term delivery or closer surveillance for those with a predicted birth weight ≤25th or ≥85th centile may reduce adverse outcomes. Replication of the analysis with fully customised centiles accounting for ethnicity is warranted.
Health research capacity development in low and middle income countries: reality or rhetoric?by The Editorial Team
There has been steady progress in LMIC health research capacity, but major barriers to research persist and more empirical evidence on development strategies is required.
Simplified antibiotic regimens for treatment of clinical severe infection in the outpatient setting when referral is not possible for young infants in Pakistan (Simplified Antibiotic Therapy Trial)by Mir F et al
Parenteral antibiotic therapy for young infants (aged 0–59 days) with suspected sepsis is sometimes not available or feasible in countries with high neonatal mortality. Outpatient treatment could save lives in such settings. The authors in this study aimed to assess the equivalence of two simplifi ed antibiotic regimens, comprising fewer injections and oral rather than parenteral administration, compared with a reference treatment for young infants with clinical severe infection. Two simplifi ed antibiotic regimens requiring fewer injections are equivalent to a reference treatment for young infants with signs of clinical severe infection but without signs of critical illness. The use of these simplifi ed regimens has the potential to increase access to treatment for sick young infants who cannot be referred to hospital.
Prevalence and determinants of acute diarrhea among children younger than five years old in Jabithennan District, Northwest Ethiopia, 2014by Anteneh ZA et al
The aim of this study was to assess the prevalence and factors associated with diarrhea among children younger than five years old. Approximately one-fifth of the children included in the study reported diarrheal disease. Residence, sex of the child, type of water storage container, methods of complementary feeding, and cleansing materials to wash the hands were the most important variables that affected the occurrence of diarrhea in children. Therefore, families, the government and nongovernmental organizations working in the area must cooperate in interventions and prevention to minimize the risk of disease.
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.
National and subnational all-cause and cause-specific child mortality in China, 1996–2015: a systematic analysis with implications for the Sustainable Development Goalsby He 2016
In this systematic analysis, the authors adjusted empirical data on levels and causes of child mortality collected in the China Maternal and Child Health Surveillance System to generate representative estimates at the national and subnational levels. China has achieved a rapid reduction in child mortality in 1996–2015. The decline has been widespread across regions, urban and rural areas, age groups, and cause-of-death categories, but great disparities remain. The western region and rural areas and especially western rural areas should receive most attention in improving child survival through enhanced policy and programmes in the Sustainable Development Goals era. Continued investment is crucial in primary and secondary prevention of deaths due to congenital abnormalities, preterm birth complications, and injuries nationally, and of deaths due to pneumonia in western rural areas. The study also has implications for improving child survival and civil registration and vital statistics in other low-income and middle-income countries.
Become a Cochrane citizen scientist. Anyone can join their collaborative volunteer effort.
Mass deworming to improve developmental health and wellbeing of children in low-income and middle-income countries: a systematic review and network meta-analysisby Welch et al
Soil-transmitted helminthiasis and schistosomiasis, considered among the neglected tropical diseases by WHO, affect more than a third of the world's population, with varying intensity of infection. The authors aimed to evaluate the effects of mass deworming for soil-transmitted helminths (with or without deworming for schistosomiasis or co-interventions) on growth, educational achievement, cognition, school attendance, quality of life, and adverse effects in children in endemic helminth areas. Mass deworming for soil-transmitted helminths with or without deworming for schistosomiasis had little effect. For schistosomiasis, mass deworming might be effective for weight but is probably ineffective for height, cognition, and attendance. Future research should assess which subset of children do benefit from mass deworming, if any, using individual participant data meta-analysis.
The causes of maternal mortality in adolescents in low and middle income countries: a systematic review of the literatureby Neal et al
This study systematically reviews the literature on cause of maternal death in adolescence. Where possible the authors have attempted to compare the main causes for adolescents with those for older women to ascertain differences and similarity in mortality patterns. The main causes of maternal mortality in adolescents are broadly similar to those for older women, although the findings suggest some heterogeneity between countries and regions. However there is evidence that the relative importance of specific causes may differ for this younger age group compared to women over the age of 20 years. In particular hypertensive conditions make up a larger share of maternal deaths in adolescents than older women. Further, large scale studies are needed to investigate this question further.
The Effects of Ghana’s National Health Insurance Scheme on Maternal and Infant Health Care Utilizationby Igna Bonfrer et al
The Ghanaian government implemented the National Health Insurance Scheme in 2004 and the aim of this study is to evaluate its early effects on maternal and infant healthcare use. The authors conclude that in the first years of operation, the National Health Insurance Scheme had a modest impact on the use of antenatal and delivery care. This is important for other African countries currently introducing or considering a national health insurance as a means towards universal health coverage.
Effectiveness of the WHO SCC on improving adherence to essential practices during childbirth, in resource constrained settingsby Kumar et al
In collaboration with the Ministry of Health SCC was modified for Indian context and introduced in 101 intervention facilities in Rajasthan, India and 99 facilities served as comparison to study if it reduces mortality. This Quasi experimental Observational intervention-comparison was embedded in this larger program to test whether a program for introduction of SCC with simple implementation package was associated with increased adherence to 28 evidence-based practices. se of the SCC and provider performance of best practices increased in intervention facilities reflecting improvement in quality of facility childbirth care for women and new-born in low resource settings.
It is time to revise the international Good Clinical Practices guidelines: recommendations from non-commercial North–South collaborative trialsby GHN Editors
The Good Clinical Practices (GCP) codes of the WHO and the International Conference of Harmonization set international standards for clinical research. But critics argue that they were written without consideration for the challenges faced in low and middle income countries (LMICs).
Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic modelsby Marc Brisson et al
The authors did a systematic review and meta-analysis of model predictions of the long-term population-level effectiveness of vaccination against HPV 16, 18, 6, and 11 infection in women and men, to examine the variability in predicted herd effects, incremental benefit of vaccinating boys, and potential for HPV-vaccine-type elimination. Although HPV models differ in structure, data used for calibration, and settings, our population-level predictions were generally concordant and suggest that strong herd effects are expected from vaccinating girls only, even with coverage as low as 20%. Elimination of HPV 16, 18, 6, and 11 is possible if 80% coverage in girls and boys is reached and if high vaccine efficacy is maintained over time.
Interventions to Address Adolescent Health and Well-Being: Current State of the Evidenceby Salam et al
The momentum to bring adolescents and young adults to center stage in global health and international development is palpable. Adolescents are increasingly seen as a crucial group for the success of the newly adopted Agenda for Sustainable Development. The recent supplement in the "Journal of Adolescent Health" titled "Interventions to Address Adolescent Health and Well-Being: Current State of the Evidence" focuses on evaluating the effectiveness of various interventions targeting adolescent age group including sexual reproductive health, nutrition, immunisation, substance abuse, menatl health and injury prevention.
Risk of poor development in young children in low-income and middle-income countries: an estimation and analysis at the global, regional, and country levelby Lu et al
The authors used country-level prevalence of stunting in children younger than 5 years based on the 2006 Growth Standards proposed by WHO and poverty ratios from the World Bank to estimate children who were either stunted or lived in extreme poverty for 141 low-income and middle-income countries in 2004 and 2010. Progress has been made in reducing the number of children exposed to stunting or poverty between 2004 and 2010, but this is still not enough. Scaling up of effective interventions targeting the most vulnerable children is urgently needed.
Efficacy of a Russian-backbone live attenuated influenza vaccine among children in Senegal: a randomised, double-blind, placebo-controlled trialby Victor et al
In Senegal, the authors assessed the efficacy and safety of a live attenuated influenza vaccine based on Russian-derived master donor viruses and licensed as a single dose. Live attenuated influenza vaccine was well tolerated in young children in Senegal, but did not provide protection against influenza. Further study in such populations, which might experience extended periods of influenza circulation, is warranted.
Around half of the clinical trials done on medicines we use today are not published; a tragic truth that needs to be changed.
Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015by GBD 2015 Maternal Mortality Collaborators
This study aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population.
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.
The global network antenatal corticosteroids trial: impact on stillbirthby Goldenberg et al
Antenatal corticosteroids are commonly used to reduce neonatal mortality, but most research to date has been in high-resource settings and few studies have evaluated its impact on stillbirth. In the Antenatal Corticosteroids Trial (ACT), a multi-country trial to assess impact of a multi-faceted intervention including antenatal corticosteroids to reduce neonatal mortality associated with preterm birth, we found an overall increase in 28-day neonatal mortality and stillbirth associated with the intervention.
Maternal morbidity associated with violence and maltreatment from husbands and in-laws: findings from Indian slum communitiesby Silverman et al 2016
This study aims to determine the prevalence of non-violent forms of gender-based household maltreatment by husbands and in-laws (GBHM), and violence from in-laws (ILV) and husbands (IPV) against women during the peripregnancy period (during and in the year prior to pregnancy); to assess relative associations of GBHM, ILV and IPV with maternal health. After adjusting for ILV and IPV, peripregnancy GBHM remained significantly associated with multiple forms of maternal morbidity, suggesting that GBHM is a prevalent and reliable indicator of maternal health risk.
Rational use of antibiotics by community health workers and caregivers for children with suspected pneumonia in Zambia: a cross-sectional mixed methods studyby Graham et al
This study provides evidence on antibiotic use by community health workers (CHWs) and caregivers to inform iCCM programmes, safeguarding current treatments whilst maximising access to care. The findings suggest that CHWs are capable of prescribing treatment corresponding to their assessment of respiratory rate. However, rational use of antibiotics could be strengthened through improved respiratory rate assessment, and better diagnostic tools. Furthermore, a shorter course of dispersible amoxicillin could potentially improve caregiver adherence, reducing risk of resistance and cost.
Daily co-trimoxazole prophylaxis to prevent mortality in children with complicated severe acute malnutrition: a multicentre, double-blind, randomised placebo-controlled trialby Berkley et al
Children with complicated severe acute malnutrition (SAM) have a greatly increased risk of mortality from infections while in hospital and after discharge. In HIV-infected children, mortality and admission to hospital are prevented by daily co-trimoxazole prophylaxis, despite locally reported bacterial resistance to co-trimoxazole. This study aimed to assess the efficacy of daily co-trimoxazole prophylaxis on survival in children without HIV being treated for complicated SAM. This study suggest that daily co-trimoxazole prophylaxis did not reduce mortality in children with complicated SAM without HIV. Other strategies need to be tested in clinical trials to reduce deaths in this population.
Young adolescent girls are at high risk for adverse pregnancy outcomes in sub-Saharan Africa: an observational multicountry studyby Mombo-Ngoma et al
This study assessed whether young adolescent girls constitute a group at increased risk for adverse birth outcomes among pregnant women in sub-Saharan Africa. Young maternal age increases the risk for adverse pregnancy outcomes and it is a stronger predictor for low birth weight and preterm delivery than other established risk factors in sub-Saharan Africa. This finding highlights the need to improve adolescent reproductive health in sub-Saharan Africa.
Obstetric fistula is an important global health issue that negatively affects the lives of countless women, and the team highlight what can be done to prevent and treat fistula.
Achieving maternal and child health gains in Afghanistan: a Countdown to 2015 country case studyby Akseer et al 2016
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).
Exploring the relationship between socioeconomic factors, method of contraception and unintended pregnancyby Metcalfe et al
This study aimed to assess the impact of socioeconomic variables and method of contraception on the decision to either terminate or continue and unintended pregnancy. Low educational attainment was associated with not using any form of contraception among women with unintended pregnancies. However, as unintended pregnancy occurs across all socio-demographic groups, care providers are encouraged to have an open discussion regarding fertility goals and contraception with all patients and refer them to appropriate resource materials.
Understanding the Zika virusby Center for Strategic & International Studies
U.S. efforts to combat the Zika virus in the US and abroad
Travel Medicine and Infectious Diseases have evolved rapidly in recent decades as outbreaks such as SARS, Avian Influenza, Ebola, MERS, Chikungunya, and Zika virus have demonstrated how quickly infections can cross international borders.
Public Health Degrees.org is a comprehensive search engine designed for students who are interested in learning more about Public Health and Health Sciences programs around the United States.
Global Research Nurses is proud to announce skills sharing workshops at Mumbai and Gujarat, India in March 2016
This Week In Global Health (TWiGH) - Skills and Competencies for Public Healthby The Editorial Team
Greg Martin talks about four areas of competencies needed to be effective in public health and global health. He places particular importance on management, leadership and governance.
Development of composite outcomes for individual patient data (IPD) meta-analysis on the effects of diet and lifestyle in pregnancy: a Delphi surveyby Rogozinska et al
The objective of the study was to develop maternal, fetal, and neonatal composite outcomes relevant to the evaluation of diet and lifestyle interventions in pregnancy by individual patient data (IPD) meta-analysis.A two-generational Delphi survey involving members of the i–WIP collaborative network (26 members in 11 countries) was undertaken to prioritise the individual outcomes for their importance in clinical care. The final components of the composite outcomes were identified using pre-specified criteria. The study has identified the components of maternal, fetal, and neonatal composite outcomes required for the assessment of diet and lifestyle interventions in pregnancy by IPD meta-analysis.
The Zika virus is another wild card dealt to us by nature. It was first discovered in 1947.
Video seminar by Chelsea McMullen, Operational Support Officer, International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), presented at the University of Oxford, 21st October 2015
The use of routine case record data to evaluate quality of inpatient hospital care in Kenyaby The Editorial Team
Quality of care assessment is one of the ways of evaluating what the health system is providing, however, such monitoring depends on an ability to measure quality with the availability of high quality data.
Malaria remains a major global health threat. In the last fifteen years there has been remarkable progress in reducing cases and deaths due to malaria.
Contraceptive use before first pregnancy by women in India (2005–2006): determinants and differentialsby Pandey et al 2015
This study attempts to identify the socio demographic determinants and differentials of contraceptive use or non use by a woman in India, before she proceeds to have her first child. The analysis was done using data from the third National Family Health Survey (2005–2006), India.
A cluster-randomised controlled trial integrating a community-based water, sanitation and hygiene programme, with mass distribution of albendazole to reduce intestinal parasites in Timor-Leste: the WAby Vaz Nery et al 2016
There is limited evidence demonstrating the benefits of community-based water, sanitation and hygiene (WASH) programmes on infections with soil-transmitted helminths (STH) and intestinal protozoa. Our study aims to contribute to that evidence base by investigating the effectiveness of combining two complementary approaches for control of STH: periodic mass administration of albendazole, and delivery of a community-based WASH programme.
Reporting missing participant data in randomised trials: systematic survey of the methodological literature and a proposed guideby Akl et al 2016
Authors conducted a systematic survey of the methodological literature to identify recommended approaches for how and what randomised clinical trial (RCT) authors should report on missing participant data and, on the basis of these approaches, to propose guidance for RCT authors. Most identified approaches invite trial authors to report the extent of MPD and the underlying reasons. Fewer approaches focus on reporting missingness patterns, methods for handling MPD and implications of MPD on results.
This talk covers several research projects we are undertaking to assess the Electronic Health Record landscape in Kenya and current large-scale projects to roll out Open Source EHR systems to public hospitals.
Understanding and improving hospital care for low birth weight neonates in a low resource settingby The Editorial Team
A seminar presented by Dr Jalemba Aluvaala in the Centre for Tropical Medicine and Global Health, University of Oxford
Damalie Nakanjako (MBChB, MMED, PhD) is an internist whose work focuses on optimizing HIV treatment outcomes and reducing HIV-associated morbidity and mortality in sub-Saharan Africa.
eSeminar: Research papers that make a difference: discussing research waste, reproducibility and impactby Iveta Simera, the EQUATOR Network
Dr Iveta Seimer, Deputy Director of the UK EQUATOR Centre, discusses research waste, reproducibility, and how to use reporting guidelines to make an impact. Poor reporting seriously affects the integrity of health research literature and critically limits the use and impact of published studies.
East African Leaders Join Together to Develop Country-Specific Plans for Point-of-Care Testing.
New articles from the African Society for Laboratory Medicine (ASLM).
When children play, they feel better: organized activity participation and health in adolescentsby Badura et al
Participation in organized leisure-time activities (OLTA) has been linked to healthy youth development. This study aimed to assess whether participation in OLTA is associated with both physical and mental health in adolescents, and whether this association differs by pattern of activity participation, age and gender. Participation in OLTA is associated with better physical and mental health in adolescents. The association varies by pattern of activity participation and is partly gender- and age-specific.
Professor Lang talks about doing difficult trials in difficult places - including malaria and ebola trials.
An RCT to improve behaviour and communication in Kenyan children with Neurodevelopmental Disordersby The Editorial Team
Difficulties in behaviour and communication are core problems in children with neurodevelopmental disorders, and often cause the most stress to parents and families living in resource poor areas of Africa.
Postnatal growth standards for preterm infants: the Preterm Postnatal Follow-up Study of the INTERGROWTH-21st Projectby INTERGROWTH-21st
The first international stnadards for monitroing the growth of preterm babies have now been published in the Lancet Global Health (October 2015).
Men in their roles as fathers, husbands, community and religious leaders may play a pivotal part in the continuation of female genital mutilation (FGM). However, the research on their views of FGM and their potential role in its abandonment are not well described. This systematic review suggests that the level of education of men was one of the most important indicators for men’s support for abandonment of FGM. Social obligation and the lack of dialogue between men and women were two key issues that men acknowledged as barriers to abandonment. Advocacy by men and collaboration between men and women’s health and community programs may be important steps forward in the abandonment process.
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.
The EMPOWER Program (EMpowering Progress in Obstetric and Women's hEalth Research) is now accepting research proposals related to preeclampsia and other hypertensive disorders of pregnancy from young investigators in low resource settings. Letters of Intent are due November 15, 2015. Thereafter, projects deemed feasible will be invited to submit full applications by April 15, 2016. The grant recipient will be announced in October 2016 at the World Congress of the International Society for the Study of Hypertension in Pregnancy (ISSHP).
Women’s, children’s, and adolescents’ healthby The BMJ
The articles in this collection examine the evidence and the thinking that form the basis of the new global strategy.
This study aim to estimate the 10- and 20-year mortality from breast cancer following a diagnosis of DCIS and to establish whether the mortality rate is influenced by age at diagnosis, ethnicity, and initial treatment received. Findings suggest that important risk factors for death from breast cancer following a DCIS diagnosis include age at diagnosis and black ethnicity. The risk of death increases after a diagnosis of an ipsilateral second primary invasive breast cancer, but prevention of these recurrences by radiotherapy does not diminish breast cancer mortality at 10 years.
This study focuses on reduction of needle stick injuries in Indraprstha Apollo Hospitals, Delhi.
International Fetal Growth Standards - latest charts availableby INTERGROWTH-21st
New INTERGROWTH-21st Fetal Growth Standards charts for measurements of head circumference (HC), bi-parietal diameter (BPD), occipito-frontal diameter (OFD), femur length (FL) and abdominal circumference (AC) are now available for download.
Individual Participant Data (IPD) Meta-analyses of Randomised Controlled Trials: Guidance on Their Useby Tierney et al
Systematic reviews involving the central collection and analysis of individual participant data (IPD) usually are larger-scale, international, collaborative projects that can bring about substantial improvements to the quantity and quality of data, give greater scope in the analyses, and provide more detailed and robust results. Following this step-by-step guide will help reviewers and users of IPD meta-analyses to understand them better and recognise those that are well designed and conducted and so help ensure that policy, practice, and research are informed by robust evidence about the effects of interventions.
Economic interventions are increasingly recognised as a mechanism to address perinatal health outcomes among disadvantaged groups. In the US, the earned income tax credit (EITC) is the largest poverty alleviation programme. Little is known about its effects on perinatal health among recipients and their children. The authors exploit quasi-random variation in the size of EITC payments to examine the effects of income on perinatal health. Findings suggest that EITC payment size is associated with better levels of several indicators of perinatal health. Instrumental variables analysis, however, does not reveal a causal association between household income and these health measures.
The SWAT and SWAR programme is identifying issues about the methods of trials and systematic reviews about which there is sufficient uncertainty to justify research to support well-informed decision making about future designs and choices.
Using parasite population genetics to understand transmission dynamics in NTDsby The Editorial Team
Schistosomiasis, is a chronic, debilitating disease. Uganda began a National Control Programme in 2003 with annual MDA of praziquantel. MDA on this scale provides strong selective pressures on the parasite population with an associated risk of drug resistance developing.
Women and Health: the key for sustainable developmentby Langer A et al
Girls' and women's health is in transition and, although some aspects of it have improved substantially in the past few decades, there are still important unmet needs. Population ageing and transformations in the social determinants of health have increased the coexistence of disease burdens related to reproductive health, nutrition, and infections, and the emerging epidemic of chronic and non-communicable diseases (NCDs). Simultaneously, worldwide priorities in women's health have themselves been changing from a narrow focus on maternal and child health to the broader framework of sexual and reproductive health and to the encompassing concept of women's health, which is founded on a life-course approach.
What is the optimal rate of caesarean section at population level? A systematic review of ecologic studiesby Betran et al
The authors conducted a systematic review to identify, critically appraise and synthesize the analyses of the ecologic association between CS rates and maternal, neonatal and infant outcomes. The findings suggest that at CS rates below this threshold, socio-economic development may be driving the ecologic association between CS rates and mortality. On the other hand, at rates higher than this threshold, there is no association between CS and mortality outcomes regardless of adjustment. The ecological association between CS rates and relevant morbidity outcomes needs to be evaluated before drawing more definite conclusions at population level.
Association between maternal age at childbirth and child and adult outcomes in the off spring: a prospective study in fi ve low-income and middle-income countries (COHORTS collaboration)by Fall et al
The study aimes to assess both child and adult outcomes in five LMICs. Children of young mothers in LMICs are disadvantaged at birth and in childhood nutrition and schooling. Efforts to prevent early childbearing should be strengthened. After adjustment for confounders, children of older mothers have advantages in nutritional status and schooling. Extremes of maternal age could be associated with disturbed off spring glucose metabolism.
The Early Childhood Obesity Prevention Program (ECHO): an ecologically-based intervention delivered by home visitors for newborns and their mothersby Cloutier et al
The goals of the Early Childhood Obesity Prevention Program (ECHO) are to examine the 12-month efficacy of a primary obesity prevention program targeting the first year of life that is delivered by home visitors and that engages mothers as agents of change to modify their own behavior and their infant’s behavior through education and skill-building around nutrition, physical activity, and wellness, and then “echoes” her training with linkages to neighborhood programs and resources. ECHO will provide important information about whether an enhanced behavior change curriculum integrated into an existing home visitation program, focused on the mother as the agent of change and linked to neighborhood resources is effective in changing energy balance behaviors in the infant and in the mother. If effective, the intervention could be widely disseminated to prevent obesity in young children.
Does the type of abortion provider influence contraceptive uptake after abortion? An analysis of longitudinal data from 64 health facilities in Ghanaby Maxwell et al
The objectives of this study were to estimate the relationship between the type of abortion provider (consultant physician, house officer, or midwife) and two separate outcomes: (1) the likelihood of adopting postabortion contraception; (2) postabortion contraceptors’ likelihood of receiving a long-acting and permanent versus a short-acting contraceptive method.
Associations between objectively assessed and questionnaire-based sedentary behaviour with BMI-defined obesity among general population children and adolescents living in Englandby Coombs et al
The objective of this study was to examine associations between a range of objectively measured and questionnaire-based SB indicators with obesity and body mass index (BMI) to assess whether these associations were independent of physical activity. TV time (but not non-TV sitting or objectively-measured SB) was consistently associated with higher levels of obesity and BMI SD score, even after adjusting for MVPA and other potential confounders. Weaker associations were observed for total sitting time.
In June 2015, FHI 360 launched two new resources designed to increase access to information about contraceptive research and development (R&D) and to promote global knowledge sharing.
INTERGROWTH-21st Fetal Growth Standardsby INTERGROWTH-21st
Fetal Growth Standards for ultrasound measurements of head circumference (HC), bi-parietal diameter (BPD), occipito-frontal diameter (OFD), femur length (FL) and abdominal circumference (AC) are now available for download. For information about how to perform these measurements, or for other information on standards in ultrasound imaging, please see the ultrasound training toolkit.
In this video of a seminar delivered at the University of Oxford in June 2014, Professor Nicholas White talks about the challenge of antimalarial resistance.
Has the prevalence of stunting in South African children changed in 40 years? A systematic reviewby Said-Mohamed et al
The objective of this systematic review is to investigate the changes in the prevalence of stunting, a chronic form of undernutrition, in South Africa over 40 years, and to derive lessons from the South African experience, a country in an advanced process of transition in sub-Saharan Africa.
Efficacy of Handwashing with Soap and Nail Clipping on Intestinal Parasitic Infections in School-Aged Children: A Factorial Cluster Randomized Controlled Trialby Mahmud et al
Intestinal parasitic infections are highly endemic among school-aged children in resource-limited settings. To lower their impact, preventive measures should be implemented that are sustainable with available resources. The aim of this study was to assess the impact of handwashing with soap and nail clipping on the prevention of intestinal parasite reinfections.
Are you a research scientist working in Global Health? Or an institution looking for partners to run a clinical trial? Site Finder is for you.
Maternal nutrition: how is Eastern and Southern Africa faring and what needs to be done?by Salam et al
The progress in key maternal health indicators in the Eastern and Southern Africa Region (ESAR) over the past two decades has been slow. This paper analyzed available information on nutrition programs and nutrition-specific interventions targeting maternal nutrition in the ESAR and proposes steps to improve maternal nutrition in this region. Findings from the review suggest that multiple nutrition programs are in place in the ESAR; including programs that directly address nutrition indicators and those that integrate corresponding sectors like agriculture, health, education, and water and sanitation. However, their scale and depth differ considerably. These programs have been implemented by a diverse range of players including respective government ministries, international agencies, non government organisations and the private sector in the region. Most of these programs are clustered in a few countries like Kenya, Uganda and Ethiopia while others e.g. Comoros, Somalia and Swaziland have only had a limited number of initiatives.
In this seminar from January 2014, Dr Jane Crawley talks about clinical standardisation in PERCH (Pneumonia Etiology Research for Child Health), a large case-control study of the causes of and risk factors for severe pneumonia.
Dr Nat Segaren - Medical Director of the Caris Foundation, presents on 'The Haiti National Early Infant Diagnosis of HIV Program'
Mechanisms of clonal evolution in childhood acute lymphoblastic leukemiaby Swaminathan et al
Childhood acute lymphoblastic leukemia (ALL) can often be traced to a pre-leukemic clone carrying a prenatal genetic lesion. Postnatally acquired mutations then drive clonal evolution toward overt leukemia. The enzymes RAG1-RAG2 and AID, which diversify immunoglobulin-encoding genes, are strictly segregated in developing cells during B lymphopoiesis and peripheral mature B cells, respectively. Here we identified small pre-BII cells as a natural subset with increased genetic vulnerability owing to concurrent activation of these enzymes. Consistent with epidemiological findings on childhood ALL etiology, susceptibility to genetic lesions during B lymphopoiesis at the transition from the large pre-BII cell stage to the small pre-BII cell stage was exacerbated by abnormal cytokine signaling and repetitive inflammatory stimuli. We demonstrated that AID and RAG1-RAG2 drove leukemic clonal evolution with repeated exposure to inflammatory stimuli, paralleling chronic infections in childhood.
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.
New Public Management (public sector reforms which draw on business ideology) are increasingly seen in African ministries of health. This talk concentrates on the effects of NPM reform on Ethiopian hospitals and how efforts to be 'more business-like' have many unintended consequences for hospitals and patients.
Professor Bongani M Mayosi from the Department of Medicine, Groote Schuur Hospital & University of Cape Town describes the transofmation of the science cohort in South Africa.
Professor Mike English explains how KEMRI-Wellcome are ''working with government to generate patient level data from a network of Kenyan hospitals as a platform for research'.
Between-hospital variation in outcomes among extremely preterm infants is largely unexplained and may reflect differences in hospital practices regarding the initiation of active lifesaving treatment as compared with comfort care after birth. Differences in hospital practices regarding the initiation of active treatment in infants born at 22, 23, or 24 weeks of gestation explain some of the between-hospital variation in survival and survival without impairment among such patients.
A Review of e-Health Interventions for Maternal and Child Health in Sub-Sahara Africaby OI Obasola et al
A review of e-health interventions for maternal and child health (MCH) to explore their influence on MCH practices in sub-Sahara Africa found a total of 18 relevant articles. Findings suggeswt that there is a need to move the application of ICT for MCH care from pilot initiatives to interventions involving all stakeholders on a sub-regional scale. These interventions should also adopt an integrated approach that takes care of the information needs at every stage along the continuum of care. It is anticipated that the study would be useful in the evolution and implementation of future ICT-based programmes for MCH in the region.
Research Priorities to Improve the Management of Acute Malnutrition in Infants Aged Less Than Six Months (MAMI)by Angood et al
To prioritise the many possible research questions on infant <6m malnutrition, this paper used the systematic, transparent, well-established Child Health and Nutrition Research Initiative (CHNRI) approach. Sixty-four experts scored 60 research questions on the basis of their answerability, likelihood of intervention efficacy, effectiveness, deliverability, sustainability, impact on disease burden, and impact on equity.
Understanding sexual and reproductive health needs of adolescents: evidence from a formative evaluation in Wakiso district, Ugandaby Atuyambe et al
Adolescents are frequently reluctant to seek sexual and reproductive health services (SRH). In Uganda, adolescent health and development is constrained by translation of the relevant policies to practice. This study aimed to assess the sexual reproductive health needs of the adolescents and explored their attitudes towards current services available. Adolescents in Uganda have multiple sexual and reproductive health needs that require special focus through adolescent friendly services. This calls for resource support in terms of health provider training, information education and communication materials as well as involvement of key stakeholders that include parents, teachers and legislators.
Associations between parents’ subjective time pressure and mental health problems among children in the Nordic countries: a population based studyby Gunnarsdottir et al
The purpose of this study was to examine the association between parents’ subjective time pressure and mental health problems among children in the Nordic countries as well as potential disparities between boys and girls in different age groups. In this study an association between parents’ subjective time pressure and increased mental health problems among children was found.
Systematic reviews on selected nutrition interventions: descriptive assessment of conduct and methodological challengesby Rehana A Salam
Rigorous and transparent systematic reviews are recognized internationally as a credible source for evidence of effectiveness. However, in the field of nutrition, despite attempts at developing consensus on actions and interventions to reduce undernutrition and micronutrient deficiencies, there is lack of coordination among various groups. Each of these methodological choices influences the findings of the reviews, and lack of standardization across these domains increases the complexity for users of systematic reviews in interpreting results. There is a need to develop a consensus on methodologies for nutrition reviews, criteria for assessing the evidence and possibly facilitating development and collation of the evidence in the subject area.
Despite the close interrelation between these infections and nutrition conditions, key nutrition interventions for prevention of childhood diarrhea and pneumonia have not received deserved attention, especially in low- and middle-income countries. Several interventions and strategies can effectively address these issues but are not available to those in need. This article discusses in detail the burden and trends of global under-5 mortality, infections, and nutrition conditions; etiology and associated risk factors; biological plausibility and the interrelation between infections, nutrition, and growth; and existing interventions and strategies to reduce major childhood infections and improve nutrition and growth and implications.
Special Issue: Newborn Health in Ugandaby Lawn et al
The nine-article special issue, titled Newborn Health in Uganda, details results of a community randomized trial, the Uganda Newborn Study (UNEST), which evaluated an integrated care package linking homes, clinics and hospitals and involving visits during pregnancy and the postnatal period at home by a designated member of the village health team. The UNEST results demonstrate that these home visits in pregnancy and soon after delivery were possible to achieve, and that life-saving behaviors could be improved by this interaction. UNEST was influenced by the previously published neonatal survival series in the Lancet which identified cost-effective interventions that could prevent the majority of deaths in the newborn period.
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.
INTERGROWTH-21st Newborn Size at Birth Chartby INTERGROWTH-21st
Practical chart for health practitioners to use to assess newborn size (weight, length, head circumference) at birth against global standards. This version of the chart is being piloted within the University of Oxford hospital network, and plans to pilot in the INTERGROWTH-21st study sites and in Boston area hospitals are developing quickly. Practitioners can download and use this version of the chart freely. To connect with the INTERGROWTH-21st team regarding your experience with piloting this chart, or to request modifications to the chart (e.g. language; different institutional logo), please contact firstname.lastname@example.org.
Risk factors for postneonatal, infant, child and under-5 mortality in Nigeria: a pooled cross-sectional analysisby Ezah et al
The study aims to identify common factors associated with post-neonatal, infant, child and under-5 mortality in Nigeria. This study found that no formal education, poor households and living in rural areas increased the risk of postneonatal, infant, child and under-5 mortality among Nigerian children. Community-based interventions for reducing under-5 deaths are needed and should target children born to mothers of low socioeconomic status.
Supporting adolescent girls to stay in school, reduce child marriage and reduce entry into sex work as HIV risk prevention in north Karnataka, India: protocol for a cluster randomised controlled trialby Beattie et al
Low caste adolescent girls living in rural northern Karnataka are at increased risk of school drop-out, child marriage, and entry into sex-work, which enhances their vulnerability to HIV, early pregnancy and adverse maternal and child health outcomes. This protocol describes the evaluation of Samata, a comprehensive, multi-level intervention designed to address these structural drivers of HIV risk and vulnerability.
Associations between parental BMI, socioeconomic factors, family structure and overweight in Finnish children: a path model approachby Parikka et al
The aim of this study was to assess the less studied interrelationships and pathways between parental BMI, socioeconomic factors, family structure and childhood overweight. The observed pathways between parental BMI and education and childhood overweight emphasize a need for evidence-based health promotion interventions tailored for families identified with parental overweight and low level of education.
INTERGROWTH-21st Newborn Birth Length Standards and Z Scoresby INTERGROWTH-21st
Global standards and z scores for length at birth, with information related to their use. Online calculators will be available shortly.
INTERGROWTH-21st Newborn Head Circumference Standards and Z Scoresby INTERGROWTH-21st
Global standards and z scores for head circumference at birth, with information related to their use. Online calculators will be available shortly.
INTERGROWTH-21st Newborn Birth Weight Standards and Z Scoresby INTERGROWTH-21st
Global standards and z scores for birth weight at birth, with information related to their use. Online calculators will be available shortly.
Association between gender inequality index and child mortality rates: a cross-national study of 138 countriesby Brinda et al
Gender inequality weakens maternal health and harms children through many direct and indirect pathways. The global impact of Gender Inequality Index (GII) on the child mortality rates remains uncertain. The study authors have documented statistically significant positive associations between GII and child mortality rates. The authors suggest that initiatives to curtail child mortality rates should extend beyond medical interventions and should prioritize women’s rights and autonomy.
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.
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
Rubellaby Lambert et al
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.
Motor development following in utero exposure to organochlorines: a follow-up study of children aged 5–9 years in Greenland, Ukraine and Polandby Hoyer et al
Study findings suggest that In utero exposure to CB-153 and p,p′-DDE was not associated with parentally retrospectively assessed developmental milestones in infancy or parentally assessed motor skills at young school age. The use of a more sensitive outcome measure may be warranted if subtle effects should be identified.
We repeated, 10 years apart, the retrospective treatment-outcome study on 400 children with presumed malaria in the same area (Argemone mexicana decoction).
Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statementby Moher et al
The authors in this paper describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysisby Liu et al 2015
Trend data for causes of child death are crucial to inform priorities for improving child survival by and beyond 2015. We report child mortality by cause estimates in 2000–13, and cause-specific mortality scenarios to 2030 and 2035. The authors in this study estimated the distributions of causes of child mortality separately for neonates and children aged 1–59 months
Effects of bed nets and anti-malaria drugs use on childhood mortality in Kenya’s malaria endemic and epidemic areasby K ’Oyugi et al 2015
This study seeks to establish differentials in childhood mortality rates by these interventions in three malaria prone areas defined as highland epidemic, coast endemic and lake endemic. It also seeks to determine the effects of these interventions on childhood mortality. This study underscore the need for increasing uptake of malaria interventions and complementing them with longer breastfeeding duration and improved toilet facility in efforts towards reducing infant and child mortality rates in Kenya?s malaria prone areas. There is also need to improve quality of individual household data for malaria module in future KDHS undertakings.
WHO Global Nutrition Targets 2025: low birth weight policy briefby INTERGROWTH-21st
This WHO policy brief is part of a series on six global nutrition targets for 2025. This brief covers the third target: a 30% reduction in low birth weight. The purpose of the brief is to increase attention to, investment in, and action for a set of cost effective interventions and policies that can help WHO Member States and their partners in reducing rates of low birth weight. INTERGROWTH-21st Chief Investigators Stephen Kennedy and Jose Villar provided expert review of these strategies, contributing the unique perspective that data from the Project, and the resulting growth standards and tools as part of overall strategies for reducing rates of low birth weight in settings across the globe. The full policy brief series can be found here: http://www.who.int/nutrition/publications/globaltargets2025_policybrief_overview/en/
Reviews: Rapid! Rapid! Rapid! ...and systematicby Schünemann et al
The methodology of systematic reviews—although laid out three or more decades ago—is continuously and rapidly updated by scientists specializing in research synthesis. Now, Systematic Reviews is publishing a series of articles including methods and examples of accelerating approaches to conducting literature reviews.
Association between Respiratory Syncytial Virus Activity and Pneumococcal Disease in Infants: A Time Series Analysis of US Hospitalization Databy Weinberger DM et al
The importance of bacterial infections following respiratory syncytial virus (RSV) remains unclear. The authors in this study evaluated whether variations in RSV epidemic timing and magnitude are associated with variations in pneumococcal disease epidemics and whether changes in pneumococcal disease following the introduction of seven-valent pneumococcal conjugate vaccine (PCV7) were associated with changes in the rate of hospitalizations coded as RSV. These analyses provide evidence for an interaction between RSV and pneumococcal pneumonia. Future work should evaluate whether treatment for secondary bacterial infections could be considered for pneumonia cases even if a child tests positive for RSV.
The increase in childhood obesity is a serious public health concern. Several studies have indicated that breastfed children have a lower risk of childhood obesity than those who were not breastfed, while other studies have provided conflicting evidence. The objective of this meta-analysis was to investigate the association between breastfeeding and the risk of childhood obesity. Results of our meta-analysis suggest that breastfeeding is a significant protective factor against obesity in children.
Protective efficacy of prolonged co-trimoxazole prophylaxis in HIV-exposed children up to age 4 years for the prevention of malaria in Uganda: a randomised controlled open-label trialby Dr Jaco Homsy
WHO recommends daily co-trimoxazole for children born to HIV-infected mothers from 6 weeks of age until breastfeeding cessation and exclusion of HIV infection. We have previously reported on the effectiveness of continuation of co-trimoxazole prophylaxis up to age 2 years in these children. We assessed the protective efficacy and safety of prolonging co-trimoxazole prophylaxis until age 4 years in HIV-exposed children.
The INTERGROWTH-21st Project Neurodevelopment Package: A Novel Method for the Multi-Dimensional Assessment of Neurodevelopment in Pre-School Age Childrenby INTERGROWTH-21st
The INTERGROWTH-21st Neurodevelopment Package is a multi-dimensional instrument measuring early childhood development (ECD). Its developmental approach may be useful to those involved in large-scale ECD research and surveillance efforts. This paper describes neurodevelopment tools for preschoolers and the systematic approach leading to the development of the Package. The Package measures vision; cortical auditory processing; and cognition, language skills, behavior, motor skills, and attention in 35-45 minutes. Sleep-wake patterns are also assessed. Tablet-based applications with integrated quality checks and automated, wireless electroencephalography make the Package easy to administer in the field by non-specialist staff. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0113360
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.
Contribution of respiratory tract infections to child deaths: a data linkage studyby Hardelid P et al
Respiratory tract infections (RTIs) are an important cause of death in children, and often contribute to the terminal decline in children with chronic conditions. RTIs are often underrecorded as the underlying cause of death; therefore the overall contribution of RTIs to child deaths and the potential preventability of RTI-related deaths have not been adequately quantified. The authors in this study conclude that RTI-related deaths have not declined in the last decade among children in England, except in infants. Targeted strategies to prevent the winter excess of RTIs and to treat RTIs in children, particularly children with chronic conditions, may reduce RTI-related deaths.
Hepatitis B vaccination status and Needle-stick and Sharps-related Injuries among medical school students in Nepal: a cross-sectional studyby Suraj Bhattarai, Smriti KC, Pranil MS Pradhan, Sami Lama, Suman Rijal
Background Hepatitis B is a dreadful infectious disease and a major global health problem. Health-care workers including clinical students are more vulnerable to such infections and non-sterile occupational exposures as their daily activities are closely related to patient's blood and body fluids.
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.
Treatment of Infections in Young Infants in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis of Frontline Health Worker Diagnosis and Antibiotic Accessby Lee ACC et al
Inadequate illness recognition and access to antibiotics contribute to high case fatality from infections in young infants (<2 months) in low- and middle-income countries (LMICs). This study aimed to address three questions regarding access to treatment for young infant infections in LMICs: (1) Can frontline health workers accurately diagnose possible bacterial infection (pBI)?; (2) How available and affordable are antibiotics?; (3) How often are antibiotics procured without a prescription?
Ebola PPE guidelines - urgent need to revise WHO and CDC guidelines. This video shows an excerpt from keynote address 'The fuss about face masks', Professor Raina MacIntyre from the School of Public Health and Community Medicine, UNSW Australia.
WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6–9-year-old children from school year 2007/2008 to school year 2009/2010by Wijnhoven et al
The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obesity Surveillance Initiative (COSI) to monitor changes in overweight in primary-school children. The aims of this paper are to present the anthropometric results of COSI Round 2 (2009/2010) and to explore changes in body mass index (BMI) and overweight among children within and across nine countries from school years 2007/2008 to 2009/2010. Changes in BMI and prevalence of overweight over a two-year period varied significantly among European countries. It may be that countries with higher prevalence of overweight in COSI Round 1 have implemented interventions to try to remedy this situation.
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.
International standards for early fetal size and pregnancy dating based on ultrasound measurement of crown-rump length in the first trimesterby INTERGROWTH-21st
The INTERGROWTH-21st Project has produced the first, international standards for relating fetal crown-rump length to gestational age.
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.
International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Projectby INTERGROWTH-21st
Using the same methods and conceptual approach as the WHO child growth standards, the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project developed international growth and size standards for fetuses for clinical interpretation of routinely taken ultrasound measurements and for comparisons across populations.
Hand Sanitiser Provision for Reducing Illness Absences in Primary School Children: A Cluster Randomised Trialby Priest P et al
The potential for transmission of infectious diseases offered by the school environment are likely to be an important contributor to the rates of infectious disease experienced by children. This study aimed to test whether the addition of hand sanitiser in primary school classrooms compared with usual hand hygiene would reduce illness absences in primary school children in New Zealand. The authors found that the provision of hand sanitiser in addition to usual hand hygiene in primary schools in New Zealand did not prevent disease of severity sufficient to cause school absence.
Observational Studies: Getting Clear about Transparencyby The PLOS Medicine Editors
When publishing observational research, what information should journals make available to the medical community before a result can be considered sufficiently reliable to inform patient care or health policy? The PLOS Medicine editors, in recent consultation with our editorial board, endorse measures in four areas to advance transparency in the analysis and reporting of observational studies.
Breastfeeding practice and associated factors among female nurses and midwives at North Gondar Zone, Northwest Ethiopia. A Cross sectional institution based study.by Berihun Assefa Dachew, Behanu Boru Bifftu
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.
On the 8th of July 2014 The Global Health Network launched the Global Health Research Process Map, the first digital toolkit designed to enable researchers anywhere in the world to conduct rigorous global health research.
Seven principles for strengthening research capacity in low- and middle-income countries: simple ideas in a complex worldby ESSENCE on Health Research Initiative
This good practice document of the ESSENCE on Health Research initiative is designed to provide broad guidance on how best to strengthen research capacity with the maximum possible benefit.
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.
The prevalence of obesity has substantially increased in the past 3 decades in both developed and developing countries and may lead to an increase in high blood pressure (BP) at an early age. This study aimed to determine the prevalence of obesity and its association with blood pressure among primary school children in central Thailand. Obesity among school children was positively associated with higher BP. Prevention of childhood obesity should be strengthened to prevent the risk of early high BP including cardiovascular risk factors.
INTERGROWTH-21st Study Formsby INTERGROWTH-21st
All of the forms that the INTERGROWTH-21st Project used to implement their studies can be downloaded here.
Mobile phones support adherence and retention of Indigenous participants in a randomised controlled trial: strategies and lessons learntby Jai K Das
Ensuring adherence to treatment and retention is important in clinical trials, particularly in remote areas and minority groups. This paper describes a novel approach to improve adherence, retention and clinical review rates of Indigenous children. the use of mobile phones within an Indigenous-appropriate framework has been an effective strategy to support a clinical trial involving Australian Indigenous children in urban and remote Australia. Further research is required to explore other applications of this approach, including the impact on clinical outcomes.
Pediatric Oncology as the Next Global Child Health Priority: The Need for National Childhood Cancer Strategies in Low- and Middle-Income Countriesby Jai K Das
While the last several decades have witnessed tremendous advances in cure rates for childhood cancer, these improvements have not translated to low-and-middle-income countries (LMICs), where the majority of children reside. In this article, the authors outline why pediatric cancer should now be considered a global child health priority, describe the need for national childhood cancer strategies (NCCS), and highlight necessary policy components to reduce LMIC pediatric cancer mortality rates.
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).
Methods for Specifying the Target Difference in a Randomised Controlled Trial: The Difference ELicitation in TriAls (DELTA) Systematic Reviewby Jai K Das
Randomised controlled trials (RCTs) are widely accepted as the preferred study design for evaluating healthcare interventions. When the sample size is determined, a (target) difference is typically specified that the RCT is designed to detect. This provides reassurance that the study will be informative, i.e., should such a difference exist, it is likely to be detected with the required statistical precision. The aim of this review was to identify potential methods for specifying the target difference in an RCT sample size calculation.
Pakistan Food Fortification Scoping Studyby MQSUN and Pakistan food fortification study team
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.
Novel biomarkers for predicting intrauterine growth restriction: a systematic review and meta-analysisby INTERGROWTH-21st
Several biomarkers for predicting intrauterine growth restriction (IUGR) have been proposed in recent years. However, the predictive performance of these biomarkers has not been systematically evaluated. This objective of this paper is to determine the predictive accuracy of novel biomarkers for IUGR in women with singleton gestations. http://www.ncbi.nlm.nih.gov/pubmed/23398929
Intra- and interobserver variability in fetal ultrasound measurementsby INTERGROWTH-21st
This paper assess the intra- and interobserver variability of fetal biometry measurements throughout pregnancy. Authors concluded that although intra- and interobserver variability increases with advancing gestation when expressed in milimeters, both are constant as a percentage of the fetal dimensions or when reported as a Z-score. Thus, measurement variability should be considered when interpreting fetal growth rates. http://www.ncbi.nlm.nih.gov/pubmed/22535628
The preterm birth syndrome: issues to consider in creating a classification systemby INTERGROWTH-21st
A comprehensive classification system for preterm birth requires expanded gestational boundaries that recognize the early origins of preterm parturition and emphasize fetal maturity over fetal age. This paper explores the issues to consider in creating a classification system for preterm birth syndrome. http://www.ncbi.nlm.nih.gov/pubmed/22177186
Symposium on Maternal and Child Health and Nutrition in Emerging Markets: Reportby INTERGROWTH-21st
The University of Oxford's Emerging Markets Symposium convened a gathering of health and nutrition experts, leading economists, and policymakers to discuss actionable priorities for improving maternal and child health and nutrition in emerging market countries. Universal adoption of the INTERGROWTH-21st Project's new global indicators at birth to capture differences in population-level nutritional and environmental exposures during pregnancy was one of their recommendations. http://ems.gtc.ox.ac.uk/sites/ems.gtc.ox.ac.uk/files/findings_and_recommendations_ems2014.pdf
The evidence-based management of Postpartum Haemorrhageby INTERGROWTH-21st
Source: The Nuffield Department of Obstetrics and Gynaecology at the University of Oxford and the Geneva Foundation for Medical Education and Research Language: English, Spanish, Russian Overview: This course provides key information on postpartum hemorrhage for health care professionals. It covers basic clinical issues, as well as background information, such as the global burden of postpartum hemorrhage.The course is accompanied by key articles and documents for further reading. Certification is available to those who qualify.
The evidence-based management of Pre-Eclampsia and Eclampsiaby INTERGROWTH-21st
Source: The Nuffield Department of Obstetrics and Gynaecology at the University of Oxford and the Geneva Foundation for Medical Education and Research Language: English, Spanish Overview: Course content includes both a basic module covering critical recommendations on prevention and treatment of pre-eclampsia/eclampsia (PE/E) for those unfamiliar with PE/E, and an advanced version for users interested in learning the evidence behind the recommendations, and is accompanied by key articles and documents for further reading. Certification is available to those who qualify.
Translating research into practice: the introduction of the INTERGROWTH-21st package of clinical standards, tools and guidelines into policies, programmes and servicesby INTERGROWTH-21st
This paper describes the approach to translating the findings, tools and resources generated by the INTERGROWTH-21st Project into practice. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12416/abstract
A rapid questionnaire assessment of environmental exposures to pregnant women in the INTERGROWTH-21st Projectby INTERGROWTH-21st
Impaired fetal growth and preterm birth are the leading causes of neonatal and infant mortality worldwide and there is a growing scientific literature suggesting that environmental exposures during pregnancy may play a causal role in these outcomes. This paper describes the creation of a global tool for screening pregnant women for environmental exposures in the Fetal Growth Longitudinal Study, a component of the INTERGROWTH-21st Project. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12430/abstract
Implementation of the INTERGROWTH-21st Project in the United Statesby INTERGROWTH-21st
This paper describes the implementation of the INTERGROWTH-21st Project in Seattle, USA. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12126/abstract
Implementation of the INTERGROWTH-21st Project in the UKby INTERGROWTH-21st
This paper describes the implementation of the INTERGROWTH-21st Project in Oxford, UK. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12033/abstract
Implementation of the INTERGROWTH-21st Project in Omanby INTERGROWTH-21st
This paper describes the implementation of the INTERGROWTH-21st Project in Muscat, Oman. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12043/abstract
Implementation of the INTERGROWTH-21st Project in Kenyaby INTERGROWTH-21st
This paper describes the implementation of the INTERGROWTH-21st Project in Nairobi, Kenya. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12045/abstract
Implementation of the INTERGROWTH-21st Project in Italyby INTERGROWTH-21st
This paper describes the implementation of the INTERGROWTH-21st Project in Turin, Italy. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12124/abstract
Implementation of the INTERGROWTH-21st Project in Indiaby INTERGROWTH-21st
This paper describes the implementation of the INTERGROWTH-21st Project in Nagpur, India. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12058/abstract
Implementation of the INTERGROWTH-21st Project in Chinaby INTERGROWTH-21st
This paper describes the implementation of the INTERGROWTH-21st Project in Beijing, China. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12044/abstract
Implementation of the INTERGROWTH-21st Project in Brazilby INTERGROWTH-21st
This paper describes the implementation of the INTERGROWTH-21st Project in Pelotas, Brazil. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12046/abstract
Ethical issues arising from the INTERGROWTH-21st Fetal Growth Longitudinal Studyby INTERGROWTH-21st
The INTERGROWTH-21st Project presented a complex set of ethical challenges given the involvement of health institutions in geographically and culturally diverse areas of the world, with differing attitudes to pregnancy. This paper addresses how the research team dealt with some of those issues. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12030/abstract
Statistical considerations for the development of prescriptive fetal and newborn growth standards in the INTERGROWTH-21st Projectby INTERGROWTH-21st
This paper considers the statistical aspects of the three components of the INTERGROWTH-21st Project - the Fetal Growth Longitudinal Study, the Preterm Postnatal Follow-up Study, and the Newborn Corss-Sectional Study - as they relate to the construction of the INTERGROWTH-21st standards, in particular, the sample size. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12031/abstract
Managing data for the international, multicentre INTERGROWTH-21st Projectby INTERGROWTH-21st
The INTERGROWTH-21st Project data management was structured incorporating both a centralise and decentralised system for the eight study centres, which all used the same database and standardised data collection instruments, manual and processes. This paper describes the data collection, entry and management processes that ensure that the data collected in the INTERGROWTH-21st Project were of exceptionally high quality. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12080/abstract
Standardisation of neonatal clinical practiceby INTERGROWTH-21st
Given the multicentre nature of the INTERGROWTH-21st Project and the expected number of preterm births, it is vital that all centres follow the same standardised clinical care protocols to assess and manage preterm infants, so as to ensure maximum validity of the resulting standards as indicators of growth and nutrition with minimal confounding. Moreover, it is well known that evidence-based clinical practice guidelines can reduce the delivery of inappropriate care and support the introduction of new knowledge into clinical practice. The INTERGROWTH-21st Neonatal Group produced an operations manual, which reflects the consensus reached by members of the group regarding standardised definitions of neonatal morbidities and the minimum standards of care to be provided by all centres taking part in the project. This paper describes the process of developing the Basic Neonatal Care Manual, as well as the morbidity definitions and standardised neonatal care protocols applied across all the INTERGROWTH-21st participating centres. Thoughts about implementation strategies are presented. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12312/abstract
Anthropometric standardisation and quality control protocols for the construction of new, international, fetal and newborn growth standards: the INTERGROWTH-21st Projectby INTERGROWTH-21st
The INTERGROWTH-21st Project involved taking anthropometric measurements, including head circumference, recumbent length and weight of infants, and the stature and weight of parents. In a large, international, multicentre project, it is critical that all study sites follow standardised protocols to ensure maximal validity of the growth and nutrition indicators used. This paper describes, in detal, the anthropometric training, standardisation and quality control procedures used to collect data for these new standards. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12127/abstract
Anthropometric protocols for the construction of new international fetal and newborn growth standards: the INTERGROWTH-21st Projectby INTERGROWTH-21st
The INTERGROWTH-21st Project involved taking anthropometric measurements, including head circumference, recumbent length and weight of infants, and the stature and weight of parents. In a large, international, multicentre project, it is critical that all study sites follow standardised protocols to ensure maximal validity of the growth and nutrition indicators used. This paper describes, in detal, the selection of anthropometric personnel, equipment, measurement and calibration protocols used to construct the new INTERGROWTH-21st standards. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12125/abstract
Standardisation of crown-rump length measurementby INTERGROWTH-21st
Correct estimation of gestational age is essential for any study of ultrasound biometry and for everyday clinical practice. However, inconsistency in pregnancy dating may occur through differences in measurement methods or errors during measurement. This paper describes the standardised crown-rump length (CRL) measurement methodology and interpretation used across study sites in the INTERGROWTH-21st Project. These methods should minimise potential systematic errors in dating associated with pooling data drom different health institutions, and represent a model for standardising CRL measurement in future studies. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12056/abstract
Standardisation and quality control of ultrasound measurements taken in the INTERGROWTH-21st Projectby INTERGROWTH-21st
Meticulous standardisation and ongoing monitoring of adherence to measurement protocols during data collection are essential to ensure consistency and to minimise systematic error in multicentre studies. Strict ultrasound fetal biometric measurement protocols are used in the INTERGROWTH-21st Project so that data of the highest quality from different centres can be compared and potentially pooled. A central Ultrasound Quality Unit (USQU) has been set up to oversee this standardisation, training and quality control process. This paper describes the procedures used, which can form a model for research settings involving ultrasound measurements.
Ultrasound methodology used to construct the fetal growth standards in the INTERGROWTH-21st Projectby INTERGROWTH-21st
A unified protocol is essential to ensure that fetal ultrasound measurements taken in multicentre research studies are accurate and reproducible. This paper describes the methodology used to take two-dimensional, ultrasound measurements in the longitudinal, fetal growth component of the INTERGROWTH-21st Project. These standardised methods should minimise the systematic errors associated with pooling data from different sites. They represent a model for carrying out similar research studies in the future. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12313/abstract
The objectives, design and implementation of the INTERGROWTH-21st Projectby INTERGROWTH-21st
This paper outlines the objectives, design and implementation of the INTERGROWTH-21st Project, a multicentre, multiethnic, population-based project conducted in eight geographical areas (Brazil, China, India, Italy, Kenya, Oman, UK and USA), with technical support from four global specialised units, to study growth, health and nutrition from pregnancy to early infancy. It aims to produce prescriptive growth standards, which conceptually extend the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) to cover fetal and newborn life. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12047/abstract
Conceptual basis for prescriptive growth standards from conception to early childhood: present and futureby INTERGROWTH-21st
Healthy growth in utero and after birth is fundamental for lifelong health and wellbeing. Current fetal growth charts in use are not true standards, since they are based on cross-sectional measurements of attained size under conditions that do not accurately reflect normal growth. The development of prescriptive intrauterine and newborn growth standards derived from the INTERGROWTH-21st Project provides the data that will allow us for the first time to establish what 'normal' fetal growth is. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12057/abstract
Introduction to INTERGROWTH-21st Methodologyby INTERGROWTH-21st
Zulfiqar Bhutta, Chair of the INTERGROWTH-21st Steering Committee, introduces the rationale for the INTERGROWTH-21st Project. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12032/abstract
Preface to INTERGROWTH-21st Methodologyby INTERGROWTH-21st
Professor Sir Sabaratnam Arulkumaran, President of FIGO, introduces the methods of the INTERGROWTH-21st Project. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12314/abstract
The preterm birth syndrome: a prototype phenotypic classificationby INTERGROWTH-21st
Preterm birth is a syndrome with many causes and phenotypes. We propose a classification system that is based on clinical phenotypes that are defined by >1 characteristics of the mother, the fetus, the placenta, the signs of parturition, and the pathway to delivery. Risk factors and mode of delivery are not included. There are 5 components in a preterm birth phenotype:
- Maternal conditions that are present before presentation for delivery,
- Fetal conditions that are present before presentation for delivery,
- Placental pathologic conditions,
- Signs of the initiation of parturition, and,
- The pathway to delivery
Challenges in defining and classifying the preterm birth syndromeby INTERGROWTH-21st
In 2009, the Global Alliance to Prevent Prematurity and Stillbirth Conference charged the authors to propose a new comprehensive, consistent, and uniform classification system for preterm birth. This first article reviews issues related to measurement of gestational age, clinical vs etiologic phenotypes, inclusion vs exclusion of multifetal and stillborn infants, and separation vs combination of pathways to preterm birth. http://www.ncbi.nlm.nih.gov/pubmed/22118964
Novel biomarkers for the prediction of the spontaneous preterm birth phenotype: a systematic review and meta-analysisby INTERGROWTH-21st
Being able to predict preterm birth is important, as it may allow a high-risk population to be selected for future interventional studies and help in understanding the pathways that lead to preterm birth. This paper investigates the accuracy of novel biomarkers to predict spontaneous preterm birth in women with singleton pregnancies and no symptoms of preterm labour. http://www.ncbi.nlm.nih.gov/pubmed/21401853
Systematic review of methodology used in ultrasound studies aimed at creating charts of fetal sizeby INTERGROWTH-21st
Reliable ultrasound charts are necessary for the prenatal assessment of fetal size, yet there is a wide variation of methodologies for the creation of such charts. This paper evaluates the methodological quality of studies of fetal biometry using a set of predefined quality criteria of study design, statistical analysis and reporting methods. Eighty-three studies met the inclusion criteria, and although multiple regression analysis shows that quality of studies has improved over time, there is considerable heterogeneity in study methodology still observed today. Standardisation of methodologies is necessary in order to make correct interpretations and comparisons between different charts. A checklist of recommended methodologies in proposed. http://www.ncbi.nlm.nih.gov/pubmed/22882780
Standardization of fetal ultrasound biometry measurements: improving the quality and consistency of measurementsby INTERGROWTH-21st
The objective of this paper was to assess whether a standardization exercise prior to commencing a fetal growth study involving multiple sonographers can reduce interobserver variation. http://www.ncbi.nlm.nih.gov/pubmed/22411446
Effects of postnatal interventions for the reduction of vertical HIV transmission on infant growth and non-HIV infections: a systematic reviewby Moleen Zunza, Gareth D Mercer, Lehana Thabane, Monika Esser, Mark F Cotton
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.
INTERGROWTH-21st Study Protocolby INTERGROWTH-21st
This study protocol descibes the the objectives, design and implementation of the Fetal Growth Longitudinal Study (FGLS), the Preterm Postnatal Followup Study (PPFS), and the Newborn Cross Sectional Study (NCSS). Data from these studies inform new, international fetal and newborn growth standards and a package of accompanying resources, including a new international equation for estimating gestational age through ultrasound. http://www.medscinet.net/Intergrowth/patientinfodocs/Intergrowth%20Protocol%20Sept%202009.pdf
Fetal Growth Longitudinal Study Operation Manualby INTERGROWTH-21st
This operation manual was used to implement the Fetal Growth Longitudinal Study (FGLS), which involved screening healthy women between 9 and 14 weeks gestation at the time of their early antenatal visit, and followed-up with standard clinical and 2D ultrasound examinations every 5 weeks, i.e. up to six times during a term pregnancy. The results of the FGLS inform new, international fetal and newborn growth standards and a package of supportive tools, guidelines and resources, including a new international equation for estimating gestational age through ultrasound. http://www.medscinet.net/Intergrowth/patientinfodocs/FGLS%20Manual%2015-09.pdf
Pregnancy and Delivery Form Instructionsby INTERGROWTH-21st
This resource was used to train health professionals on how to record key data on pregnancies and deliveries for women participating in the Fetal Growth Longitudinal Study (FGLS) and Newborn Cross Sectional Study (NCSS). http://www.medscinet.net/Intergrowth/patientinfodocs/Pregnancy%20and%20Delivery%20Form%20Instructions.pdf
Basic Neonatal Care Manualby INTERGROWTH-21st
The INTERGROWTH-21st Project used this manual to standardize definitions, treatment and management recommendations of neonatal morbidities. http://www.medscinet.net/Intergrowth/patientinfodocs/Neonatal%20Manual%20Final.pdf
Anthropometry Handbookby INTERGROWTH-21st
This handbook describes the methods used to perform accurate, precise and standardized anthropometric measurements for all components of the INTERGROWTH-21st study, including:
- height and weight of pregnant mothers
- birth weight, length and head circumference of newborns
- weight, length and head circumference of preterm babies
Measurement of Symphysis Fundus Height Protocolby INTERGROWTH-21st
This protocol outlines the technique for measuring symphysis fundus height. http://www.medscinet.net/Intergrowth/patientinfodocs/Measurement%20of%20Symphysis%20Fundus%20Height.pdf
Blood Pressure Measurement Protocolby INTERGROWTH-21st
This protocol outlines the technique for taking a pregnant woman's blood pressure. http://www.medscinet.net/Intergrowth/patientinfodocs/BP%20protocol.pdf
Ultrasound Operations Manualby INTERGROWTH-21st
The aims of this manual are to ensure all trained ultrasonographers are familiar with the standardized way measurements should be taken for the purposes of using the INTERGROWTH-21st growth standards, including standardization of the way the equipment should be used, ultrasound findings are recorded, data is entered and transfered, and how to train, asesses and certify these standardized techniques. http://www.medscinet.net/Intergrowth/patientinfodocs/US%20Manual%20FINAL.pdf
Correct Measurement of Fetal Crown Rump Length and Standardization of Ultrasonographersby INTERGROWTH-21st
The aim of this manual is to ensure all trained ultrasonographers are familiar with the standardized way crown-rump length measurements should be taken for the purposes of using the INTERGROWTH-21st fetal growth standards. http://www.medscinet.net/Intergrowth/patientinfodocs/CRLstandardisation_Website.pdf
Vision Assessment Manualby INTERGROWTH-21st
This manual details the technique for administering the Cardiff Acuity Tests and Cardiff Contrast tests for vision assessment in children. http://www.medscinet.net/Intergrowth/patientinfodocs/Vision%20manual%20-%20July%202014.pdf
Sleep-Wake Cycle Assessment Manualby INTERGROWTH-21st
This manual details the technique for assessing sleep-wake cycles in children. http://www.medscinet.net/Intergrowth/patientinfodocs/Sleep-wake%20cycle%20assessment%20manual%20July%202014.pdf
There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias. In this essay, the author discusses the implications of these problems for the conduct and interpretation of research.
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.
Factors associated with non-utilization of child immunization in Pakistan: evidence from the Demographic and Health Survey 2006-07by Jai K Das
The proportion of incompletely immunized children in Pakistan varies from 37-58%, and this has recently resulted in outbreaks of measles and polio. The aim of this paper is to determine the factors associated with incomplete immunization among children aged 12-23 months in Pakistan.
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.
The latest report by 'Save the Children' highlights that the world has made remarkable progress in the fight to end child mortality in recent years. Since 1990, we have almost halved the number of children who die every year before the age of five – from 12.6 million to 6.6 million. And yet, in spite of this progress, child mortality remains one of the great shames of our modern world. Every day, 18,000 children under five die, and most from preventable causes. See the attach report to discover how 2 million newborn babies who could be saved each year if we end preventable newborn mortality.
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.
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.
Perceived family support regarding condom use and condom use among secondary school female students in Limbe urban city of Cameroonby Jai K Das
In this cross sectional survey it is hypothesized that adolescents' perceptions of family support for condom use, would encourage condom use among female students in Limbe urban city of Cameroon.
The current difficulties in keeping systematic reviews up to date leads to considerable inaccuracy, hampering the translation of knowledge into action. Incremental advances in conventional review updating are unlikely to lead to substantial improvements in review currency. A new approach is needed. The authors propose living systematic review as a contribution to evidence synthesis that combines currency with rigour to enhance the accuracy and utility of health evidence.
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.
Systematic review; Journal of International AIDS Societyby Moleen Zunza
Moleen Zunza is a member of the Global Research Nurses' network and is part of the team that has published this systematic review.
Non-Specialist Psychosocial Interventions for Children and Adolescents with Intellectual Disability or Lower-Functioning Autism Spectrum Disorders: A Systematic Reviewby Jai K Das
The development of effective treatments for use by non-specialists is listed among the top research priorities for improving the lives of people with mental illness worldwide. The purpose of this review is to appraise which interventions for children with intellectual disabilities or lower-functioning autism spectrum disorders delivered by non-specialist care providers in community settings produce benefits when compared to either a no-treatment control group or treatment-as-usual comparator
Managing health worker migration: a qualitative study of the Philippine response to nurse brain drainby Roland M Dimaya, Mary M McEwan, Leslie A Currie, Elizabeth H Bradley
A qualitative study investigating causes and effects of nurse migration in the Philippines.
Five keys to improving research costing in low- and middle-income countriesby ESSENCE on Health Research Initiative
ESSENCE on Health Research have created a good practice document on research costing. It includes a review of the funding practices related to the definition and funding of direct and indirect costs.
When to Start Antiretroviral Therapy in Children Aged 2–5 Years: A Collaborative Causal Modelling Analysis of Cohort Studies from Southern Africaby Jai K Das
There is limited evidence on the optimal timing of antiretroviral therapy (ART) initiation in children 2–5 y of age. This study uses a causal modelling analysis using the International Epidemiologic Databases to Evaluate AIDS–Southern Africa (IeDEA-SA) collaborative dataset to determine the difference in mortality when starting ART in children aged 2–5 y immediately (irrespective of CD4 criteria), as recommended in the World Health Organization (WHO) 2013 guidelines, compared to deferring to lower CD4 thresholds, for example, the WHO 2010 recommended threshold of CD4 count <750 cells/mm3 or CD4 percentage (CD4%) <25%
Design of a quasi-experiment on the effectiveness and cost-effectiveness of using the child-interview intervention during the investigation following a report of child abuse and/or neglectby Jai K Das
The primary aim of this study is to examine the effect of the participation of maltreated children aged 6-18 years in the Child-Interview intervention on their mental health and quality of life. As a second aim, this study also examines the balance between additional costs and effects of the Child-Interview intervention in comparison with AMK investigation without the Child-Interview intervention (adult-only intervention).
This guide, developed by the WHO and released in December 2013, aims to facilitate implementation research in LMICs.
Psychosocial Interventions for Perinatal Common Mental Disorders Delivered by Providers Who Are Not Mental Health Specialists in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysisby Jai K Das
Perinatal common mental disorders (PCMDs) are a major cause of disability among women. Psychosocial interventions are one approach to reduce the burden of PCMDs. Working with care providers who are not mental health specialists, in the community or in antenatal health care facilities, can expand access to these interventions in low-resource settings. The authors in this study assessed effects of such interventions compared to usual perinatal care, as well as effects of interventions based on intervention type, delivery method, and timing.
Ethnicity and outcome of young breast cancer patients in the United Kingdom: the POSH studyby Jai K Das
Black ethnic groups have a higher breast cancer mortality than Whites. American studies have identified variations in tumour biology and unequal health-care access as causative factors. This study compared tumour pathology, treatment and outcomes in three ethnic groups in young breast cancer patients treated in the United Kingdom and concluded that despite equal access to health care, young Black women in the United Kingdom have a significantly poorer outcome than White patients. Black ethnicity is an independent risk factor for reduced DRFS particularly in ER-positive patients.
E-health: potential benefits and challenges in providing and accessing sexual health servicesby Jai K Das
E-health has become a burgeoning field in which health professionals and health consumers create and seek information. E-health refers to internet-based health care and information delivery and seeks to improve health service locally, regionally and worldwide. E-sexual health presents new opportunities to provide online sexual health services irrespective of gender, age, sexual orientation and location. This paper used the dimensions of the RE-AIM model (reach, efficacy, adoption, implementation and maintenance) as a guiding principle to discuss potentials of E-health in providing and accessing sexual health services.
Research Link Nurseby Nicola McHugh
The Political Economy of Under-Nutrition in Pakistanby Shehla Zaidi
This report and brief is based on the study 'The Political Economy of Under-Nutrition in Pakistan'. The authors highlight challenges faced for mainstreaming nutrition as an inter-sectoral development priority and provide strategic recommendations using Acosta and Fanzo’s nutrition governance framework.
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.
Scale-up plan for essential medicines for child health: Diarrhea, Pneumonia and Malaria in Pakistanby Jai K Das
With an under-five mortality rate of 89 per 1000 live births, Pakistan is lagging behind the desired MDG 4. There is still a need to reduce the under-five mortality rate by 45 percentage points in order to achieve the MDG target by 2015. Each year around 91,000 and 53,300 children die from pneumonia and diarrhea respectively, in Pakistan. Diarrhea, pneumonia and malaria collectively contribute to around 50% of deaths in children. These three diseases, thus, represent a challenging but surmountable obstacle towards achieving the MDG 4 target. Implementation of large-scale interventions and scale-up plan focusing on these three major killers of children in Pakistan is essential. This report identifies the major barriers towards accessing essential medicines by care givers.
Micronutrient fortification of food and its impact on woman and child health: a systematic reviewby Jai K Das
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.
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.
Despite the global initiative to eliminate mother-to-child transmission of HIV, 210,000 new pediatric infections were added worldwide in 2012 to the existing pool of 3.4 million children living with the virus.Children are more vulnerable to HIV infection and have higher morbidity and mortality. Without treatment, one half of those children infected will die before the age of 2 years, yet only one third of those eligible for treatment are currently receiving antiretroviral therapy. Current initiatives focus on interventions within the traditional prevention of mother-to-child transmission cascade, but the scope of the elimination agenda must be broadened in order to ensure access to care and treatment for all children living with HIV.
A recent editorial in PLoS discusses the significance of transparency in reporting and publishing the studies and how scientific studies guidelines have evolved over time.
The Effect of Intermittent Antenatal Iron Supplementation on Maternal and Infant Outcomes in Rural Viet Nam: A Cluster Randomised Trialby Jai K Das
Anemia affects over 500 million women, and in pregnancy is associated with impaired maternal and infant outcomes. 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.
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.
Effect of Household-Based Drinking Water Chlorination on Diarrhoea among Children under Five in Orissa, India: A Double-Blind Randomised Placebo-Controlled Trialby Jai K Das
Boiling, disinfecting, and filtering water within the home can improve the microbiological quality of drinking water among the hundreds of millions of people who rely on unsafe water supplies. However, the impact of these interventions on diarrhoea is unclear. The aim of this study was to measure the effect of in-home water disinfection on diarrhoea among children under five.
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.
Reproductive and Maternal Health in the Post-2015 Era: Cervical Cancer Must Be a Priorityby Jai K Das
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.
Risk Prediction for Breast, Endometrial, and Ovarian Cancer in White Women Aged 50 y or Older: Derivation and Validation from Population-Based Cohort Studiesby Jai K Das
Breast, endometrial, and ovarian cancers share some hormonal and epidemiologic risk factors. While several models predict absolute risk of breast cancer, there are few models for ovarian cancer in the general population, and none for endometrial cancer. Using data on white, non-Hispanic women aged 50+ y from two large population-based cohorts, the authors estimated relative and attributable risks and combined them with age-specific US-population incidence and competing mortality rates.
Global Burden of Sickle Cell Anaemia in Children under Five, 2010–2050: Modelling Based on Demographics, Excess Mortality, and Interventionsby Jai K Das
The purpose of this study is to estimate trends in the future number of newborns with Sickle Cell Anemia (SCA) and the number of lives that could be saved in under-five children with SCA by the implementation of different levels of health interventions.
Presentations from D Groups
The Effect of Intermittent Antenatal Iron Supplementation on Maternal and Infant Outcomes in Rural Viet Nam: A Cluster Randomised Trialby Jai K Das
Anemia affects over 500 million women, and in pregnancy is associated with impaired maternal and infant outcomes. 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.
The World Health Organization’s recommendations on optimizing the roles of health workers aim to help address critical health workforce shortages that slow down progress towards the health-related Millennium Development Goals. These recommendations are intended for health policy-makers, managers and other stakeholders at a regional, national and international level.
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.
Health data include many gaps, particularly relating to poorer areas of the world, so complex estimation techniques are needed to get overall global pictures. Estimates of population health, however, carry their own uncertainties and may be flawed in some instances. Here we present a range of reflections on the Global Burden of Disease 2010 estimates, highlighting their strengths as well as challenges for potential users. In the long term, there can be no substitute for properly counting and accounting for all the world's citizens, so that complex estimation techniques are not needed.
Evaluation of Nutrition Surveys in Flood-affected Areas of Pakistan: Seeing the Unseen!by Rehana A Salam
In 2010 Pakistan experienced the worst floods recorded in its history; millions of people were affected and thousands lost their lives. Nutrition assessment surveys led by UNICEF were conducted in flood-affected areas of Punjab and Sindh provinces to assess the nutrition status of children between 6–59 months while Aga Khan University (AKU) undertook a parallel assessment including micronutrient status in their project areas within Balochistan, Sindh and Punjab.
Disparities in the use of antenatal care service in Ethiopia over a period of fifteen yearsby Jai K Das
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.
Adherence to antiretroviral therapy among HIV infected children measured by caretaker report, medication return, and drug level in Dar Es Salaam, Tanzaniaby Jai K Das
Adherence to antiretroviral drugs in the treatment of paediatric HIV infection is complicated because of many factors including stigma and drug intake logistics. It is therefore important to identify children with non-adherence in order to intervene before they become at risk of developing treatment failure or drug resistance. The aim of this study was to determine the level of adherence to antiretroviral therapy (ART), measured by caretaker report, medication return and nevirapine plasma concentration.
Grand Challenges: Integrating Maternal Mental Health into Maternal and Child Health Programmesby Jai K Das
Integrating maternal mental health care will help advance maternal and child health (MCH) status. This paper is the second in a series of five articles providing a global perspective on integrating mental health.
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.
IV Therapyby Editor
Pedagogy is a US provider of Continuing Education for Nurses. They have produced posters that can be downloaded, showing recent guidlines in the management of Intra Venous therapy.
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.
Measuring Coverage in MNCH: New Findings, New Strategies, and Recommendations for Actionby Jai K Das
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
Grand Challenges: Integrating Maternal Mental Health into Maternal and Child Health Programmesby Jai K Das
Integrating maternal mental health care will help advance maternal and child health (MCH) status. This paper is the second in a series of five articles providing a global perspective on integrating mental health.
Decline in Diarrhea Mortality and Admissions after Routine Childhood Rotavirus Immunization in Brazil: A Time-Series Analysisby Jai K Das
In 2006, Brazil began routine immunization of infants <15 wk of age with a single-strain rotavirus vaccine. The authors in this paper evaluated whether the rotavirus vaccination program was associated with declines in childhood diarrhea deaths and hospital admissions by monitoring disease trends before and after vaccine introduction in all five regions of Brazil with varying disease burden and distinct socioeconomic and health indicators.
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.
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.
Despite published guidance on writing the abstract in the PRISMA Statement guiding the reporting of systematic reviews in general and elsewhere, evaluations show that reporting of systematic reviews in journal and conference abstracts is poor. Teh authors developed consensus-based reporting guidelines as an extension to the PRISMA Statement on good reporting of systematic reviews and meta-analyses in abstracts.
Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young peopleNumbers of street-connected children and young people run into manyby Jai K Das
This systematic review summarises the effectiveness of interventions for street-connected children and young people that promote inclusion and reintegration and reduce harms. It also explores the processes of successful intervention and models of change in this area, and to understand how intervention effectiveness may vary in different contexts.
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.
In this article, the authors illustrate five basic statistical concepts that can significantly impact the interpretation of the medical literature and its application to the care of patients, drawing examples from the vaccine literature: (i) consider clinical and statistical significance separately, (ii) evaluate absolute risks rather than relative risks, (iii) examine confidence intervals rather than p values, (iv) use caution when considering isolated significant p values in the setting of multiple testing, and (v) keep in mind that statistically nonsignificant results may not exclude clinically important benefits or harms.
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.
The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysisby Jai K Das
Vitamin D insufficiency together with high serum levels of vitamin A increases the risk for osteoporosis in postmenopausal womenby Jai K Das
This is a cross-sectional study to evaluate the association between vitamin D deficiency/insufficiency and excess of vitamin A intake as an osteoporosis risk factor in healthy postmenopausal women.
Vitamin K Supplementation in Postmenopausal Women with Osteopenia (ECKO Trial): A Randomized Controlled Trialby Jai K Das
Vitamin K has been widely promoted as a supplement for decreasing bone loss in postmenopausal women, but the long-term benefits and potential harms are unknown. This study was conducted to determine whether daily high-dose vitamin K1 supplementation safely reduces bone loss, bone turnover, and fractures.
Home fortification with multiple micronutrient powders for pregnant women-The Guidelinesby Jai K Das
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.
Helminth infections impose a great burden on poor populations in the developing world – yet robust, low-cost and effective public health interventions are available to relieve that burden and provide a better quality of life for people in poor settings. We share the WHO Guidleines for the Preventive chemotherapy in human helminthiasis.
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.
These guidelines help address the urgent need to develop tests that can work in children, ideally using non-sputum based samples. It is vital that these reference standards are endorsed and implemented by the major donors, researchers and diagnostic developers.
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.
Severe acute malnutrition remains a major killer of children under five years of age. Until recently, treatment has been restricted to facility-based approaches, greatly limiting its coverage and impact. New evidence suggests, however, that large numbers of children with severe acute malnutrition can be treated in their communities without being admitted to a health facility or a therapeutic feeding centre. We share the guidleines of for the management of children with SAM
Use of multiple micronutrient powders for home fortification of foods consumed by infants and children 6–23 months of age-The Guidelinesby Jai K Das
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.
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.
We share the WHO 2009 guideline that provides a framework for integrating nutrition support into the routine care of HIV-infected children (6 months-14 years). HIV-infected children deserve special attention because of their additional needs to ensure growth and development and their dependency on adults for adequate care including nutrition care and support for treatment. Vertical implementation of HIV programmes, such as PMTCT and ART, have resulted in missed opportunities to gain synergy with other existing services.
Contraception matters: Indicators of poor usage of contraception in sexually active women attending family planning clinics in Victoria, Australiaby Jai K Das
Unintended pregnancy remains an important health issue for women. This cross sectional survey recruited women from family planning clinics to determine the prevalence of and factors associated with risk of unintended pregnancy in Victoria, Australia.
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.
Half the developing world population lack access to flush toilets and other forms of improved sanitation; 1.1 billion people defecate in the open. An estimated 750 million people still live without improved water sources. There are serious adverse health consequences of poor access to water, sanitation and hygiene (WASH), particularly in children, including diarrhoea, respiratory illness, trachoma, and death. Access to safe drinking-water is essential to health, a basic human right and a component of effective policy for health protection. We share the guidelines for Drinking water quality and water safety manual.
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.
Whether breast cancer screening does more harm than good has been debated extensively. The main questions are how large the benefit of screening is in terms of reduced breast cancer mortality and how substantial the harm is in terms of overdiagnosis, which is defined as cancers detected at screening that would not have otherwise become clinically apparent in the woman's lifetime.
Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Healthby Jai K Das
Research reporting guidelines are standard statements that provide guidance on how to report research methodology and findings. These are in the form of checklists, flow diagrams or texts. Most of the biomedical journals require authors to comply with these guidelines. Guidelines are available for reporting various study designs:
- CONSORT Statement (reporting of randomized controlled trials)
- STARD (reporting of diagnostic accuracy studies)
- STROBE (reporting of observational studies in epidemiology)
- PRISMA (reporting of systematic reviews)
- MOOSE (reporting of meta-analyses of observational studies)
The Effect of Adding Ready-to-Use Supplementary Food to a General Food Distribution on Child Nutritional Status and Morbidity: A Cluster-Randomized Controlled Trialby Jai K Das
Serious and Life-Threatening Pregnancy-Related Infections: Opportunities to Reduce the Global Burdenby Courtney A. Gravett
This Policy Forum article aims to highlight opportunities for screening and appropriate treatment of life-threatening pregnancy-related interventions.
This article is an introduction to cluster randomised trials.