A Color-Coded Tape for Uterine Height Measurement: A Tool to Identify Preterm Pregnancies in Low Resource Settings

Althabe, Fernando; Berrueta, Mabel; Hemingway-Foday, Jennifer; Mazzoni, Agustina; Bonorino, Carolina Astoul; Gowdak, Andrea; Gibbons, Luz; Bellad, Mrutyunjaya; Metgud, Mrityunjay C; Goudar, Shivaprasad S.; Kodkany, Bhala; Derman, Richard J.; Saleem, Sarah; Iqbal, Samina; Hasan, Syed Mahfuz Al; Goldenberg, Robert L.; Chomba, Elwyn; Manasyan, Albert; Chiwila, Melody; Imenda, Edna; Mbewe, Florence; Tshefu, Antoinette; Lokomba, Victor; Bose, Carl; Moore, Janet; Meleth, Sreelatha; McClure, Elizabeth M; Koso‐Thomas, Marion; Buekens, Pierre; Belizán, José M.

doi:10.1371/journal.pone.0117134

Cited by 7 publications

(12 citation statements)

References 24 publications

(27 reference statements)

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“…Universal access to ultrasonography is unlikely to be available to large numbers of women in LMIC in the shorter term, and/or mothers who present late in pregnancy, when ultrasound dating is inaccurate (+/- 3 weeks). Current work is looking at the potential for simplified tools for more accurate assessment of gestational age [ 77 ], including simplified clinical tools, and surrogate anthropometric measures that could be used by community health workers [ 78 - 80 ]. Validation of new methods in cohorts with early accurate ultrasonography dating is a critical need.…”

Section: Discussionmentioning

confidence: 99%

Count every newborn; a measurement improvement roadmap for coverage data

Moxon

Ruysen

Kerber

et al. 2015

BMC Pregnancy Childbirth

129

154

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BackgroundThe Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity.MethodsIn a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout.ResultsENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care.ConclusionsThe ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks.

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Section: Discussionmentioning

confidence: 99%

Count every newborn; a measurement improvement roadmap for coverage data

Moxon

Ruysen

Kerber

et al. 2015

BMC Pregnancy Childbirth

129

154

View full text Add to dashboard Cite

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“…Capturing the population in need (to measure an appropriate population level denominator) is particularly challenging for KMC [ 2 ], especially where countries may have limited capacity to identify and record LBW [ 37 ] and assess gestational age. For example, in some settings fewer than 50% of babies are weighed at birth and even fewer have access to first trimester ultrasound for accurate gestational age assessment [ 38 ]. Finally, maternal reporting of KMC is not currently carried out by routine household survey platforms due to difficulties with the sample size and the achievement of sufficient sampling power through a representative national survey.…”

Section: Monitoring and Evaluation Of Kangaroo Mother Care At A Natiomentioning

confidence: 99%

Report on an international workshop on kangaroo mother care: lessons learned and a vision for the future

Cattaneo

Amani

Charpak³

et al. 2018

BMC Pregnancy Childbirth

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BackgroundGlobally, complications of prematurity are the leading cause of death in children under five. Preterm infants who survive their first month of life are at greater risk for various diseases and impairments in infancy, childhood and later life, representing a heavy social and economic burden for families, communities and health and social systems. Kangaroo mother care (KMC) is recommended as a beneficial and effective intervention for improving short- and long-term preterm birth outcomes in low- and high-income settings. Nevertheless, KMC is not as widely used as it should be. The International Network on KMC runs biennial workshops and congresses to help improve the coverage and quality of KMC worldwide. This paper reports the results of the two-day workshop held in November 2016, where 92 participants from 33 countries shared experiences in a series of round tables, group work sessions and plenaries.FindingsBarriers to and enablers of KMC are discussed with regard to parents, health workers and the health system. Key factors for effective implementation and uptake relate to appropriate training for health staff, adherence to protocols and the creation of a welcoming environment for families. Recommendations for planning for national programmes are made according to a six-stage change model. Resources and the cost of making progress are discussed in terms of investment, maintenance, and acceleration and scaling-up costs. KMC training requirements are presented according to three levels of care. To ensure quality KMC, key requisites are proposed for the different KMC components and for sensitive communication with caregivers. The group attending to the monitoring and evaluation of KMC at a national and subnational level highlight the lack of standard indicator definitions. Key priorities for investment include health services research, harmonisation of indicators, development of a costing tool, programming and scaling up, and the follow-up of preterm infants.ConclusionIt is hoped that this report will help to further scale-up and sustain KMC through a systematic approach that includes raising commitment, identifying key strategies to address the main barriers and using existing facilitators, ensuring training and quality, agreeing on indicators for monitoring and evaluation, and advancing implementation research.

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“…Antenatal corticosteroids (ACS) for pregnant women at high risk of preterm delivery are among the most effective hospital-based interventions in high resource settings to reduce neonatal mortality among preterm newborns [ 1 – 7 ] Despite the burden of preterm-related morbidity and mortality, as well as the effectiveness of ACS, global uptake of this intervention has been relatively low [ 8 – 12 ]. To that purpose, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)’s Global Network for Women and Children’s Health Research Antenatal Corticosteroids Trial (ACT) [ 13 – 15 ] assessed the feasibility, effectiveness, and safety of a complex intervention to increase the use of ACS at all levels of care at seven study sites in low and middle-income countries (LMIC) (Argentina, Guatemala, Kenya, Zambia, Pakistan and India [2 sites]). The results showed that the intervention did not significantly reduce neonatal mortality for <5th percentile infants, a proxy for preterm birth, and was associated with an overall 12 % increase in neonatal deaths compared to the control group [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Use of antenatal corticosteroids at health facilities and communities in low-and-middle income countries

et al. 2016

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BackgroundAntenatal corticosteroids (ACS) for women at high risk of preterm birth is an effective intervention to reduce neonatal mortality among preterm babies delivered in hospital settings, but has not been widely used in low-middle resource settings. We sought to assess the rates of ACS use at all levels of health care in low and middle income countries (LMIC).MethodsWe assessed rates of ACS in 7 sites in 6 LMIC participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s Global Network for Women and Children’s Health Research Antenatal Corticosteroids Trial (ACT), a cluster-randomized trial to assess the feasibility, effectiveness, and safety of a multifaceted intervention designed to increase the use of ACS. We conducted this analysis using data from the control clusters, which did not receive any components of the intervention and intended to follow usual care. We included women who delivered an infant with a birth weight <5th percentile, a proxy for preterm birth, and were enrolled in the Maternal Newborn Health (MNH) Registry between October 2011 and March 2014 in all clusters. A survey of the site investigators regarding existing policies on ACS in health facilities and for health workers in the community was part of pre-trial activities.ResultsOverall, of 51,523 women delivered in control clusters across all sites, the percentage of <5th percentile babies ranged from 3.5 % in Kenya to 10.7 % in Pakistan. There was variation among the sites in the use of ACS at all hospitals and among those hospitals having cesarean section and neonatal care capabilities (bag and mask and oxygen or mechanical ventilation). Rates of ACS use for <5th percentile babies in all hospitals ranged from 3.8 % in the Kenya sites to 44.5 % in the Argentina site, and in hospitals with cesarean section and neonatal care capabilities from 0 % in Zambia to 43.5 % in Argentina. ACS were rarely used in clinic or home deliveries at any site. Guidelines for ACS use at all levels of the health system were available for most of the sites.ConclusionOur study reports an overall low utilization of ACS among mothers of <5th percentile infants in hospital and clinic deliveries in LMIC.Trial Registrationclinicaltrials.gov (NCT01084096)

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A Color-Coded Tape for Uterine Height Measurement: A Tool to Identify Preterm Pregnancies in Low Resource Settings

Cited by 7 publications

References 24 publications

Count every newborn; a measurement improvement roadmap for coverage data

Count every newborn; a measurement improvement roadmap for coverage data

Report on an international workshop on kangaroo mother care: lessons learned and a vision for the future

Use of antenatal corticosteroids at health facilities and communities in low-and-middle income countries

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