Can Available Interventions End Preventable Deaths in Mothers, Newborn Babies, and Stillbirths, and at What Cost?

Bhutta, Zulfiqar Ahmed; Das, Jai K; Bahl, Rajiv; Lawn, Joy; Salam, Rehana A; Paul, Vinod K.; Sankar, Mari Jeeva; Blencowe, Hannah; Rizvi, Arjumand; Chou, Victoria B; Walker, Neff

doi:10.1097/ogx.0000000000000124

Cited by 118 publications

(162 citation statements)

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“…2 For example, simulation-based studies have estimated that up to one third of maternal deaths, and up to half of newborn deaths, may be prevented by increasing coverage rates for skilled attendance at delivery (Bhutta et al 2014;Goldie et al 2010;Graham, Bell & Bullough 2001). 3 There is, therefore a strong global push to increase rates of use of maternal and child health services, particularly antenatal care, institutional deliveries, and postnatal care.…”

Section: Introductionmentioning

confidence: 99%

Better Obstetrics in Rural Nigeria study: evaluating the Nigerian Midwives Service Scheme

Okeke¹,

Glick²,

Abubakar³

et al. 2017

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The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding, producing and synthesising high-quality evidence of what works, how, why and at what cost. We believe that better and policy-relevant evidence will make development more effective and improve people's lives. 3ie impact evaluations3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design, use the most appropriate mix of methods to capture outcomes and are useful in complex development contexts. About this report SummaryLimited availability of skilled providers, particularly in rural areas, is thought to be an important constraint to increasing rates of use of maternal and child health services in low-and middle-income countries. There are, however, few well-identified studies of the relationship between the supply of skilled workers and outcomes. In this project, we studied the effects of a government program in Nigeria that sought to alleviate supply-side constraints by deploying skilled midwives to primary health facilities in rural communities, to provide round-the-clock access to skilled care.We evaluate the impact of the Midwives Service Scheme (MSS), a government program introduced in 2009 to increase access to skilled care in underserved rural areas in Nigeria. At rollout, the MSS deployed nearly 2,500 midwives to 652 primary health care centers across 36 states. To evaluate the impact of the program, we surveyed 7,104 women with a birth within the preceding five years in 386 communities across 12 states. The intervention group consisted of communities that participated in the initial rollout; the comparison group consisted of communities that would receive the program approximately three years later. To understand implementation challenges and contextualize the quantitative results, we carried out a nested qualitative study in three states, consisting of in-depth interviews and focus group discussions with policymakers, providers, childbearing women, and community stakeholder groups.Overall, we found that the program's effects were smaller than anticipated. The main effect was a 7.3-percentage-point increase in antenatal care use in program clinics (about 12 percent relative to baseline levels) and a 5-percentage-point increase in overall use of antenatal care (6 percent relative to baseline levels) within the first year of the program. We found suggestive but not conclusive evidence of a small increase in skilled birth attendance, but this was confined to the south, where there were fewer challenges with midwife retention. We did not find any significant improvements in postnatal visits or child immunizations. Given this, it is not surprising that we did not find any evidence of improvements in maternal and child health.Our data allow us to shed some light on why ...

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Section: Introductionmentioning

confidence: 99%

Better Obstetrics in Rural Nigeria study: evaluating the Nigerian Midwives Service Scheme

Okeke¹,

Glick²,

Abubakar³

et al. 2017

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“…Studies in South Africa have shown that 20.0% of deaths in rural areas are preventable, 8 with processes such as labor management, fetal monitoring, and neonatal resuscitation. 8,9 A systematic review of interventions with modeling of effect and cost 10 showed that it is possible to avert 71% of neonatal deaths by increasing coverage and quality of health interventions with most of the effect attributable to facility-based care. Neonatal deaths can be reduced through interventions for obstetric complications (41%), followed by care of small and newborn babies (30%).…”

Section: Introductionmentioning

confidence: 99%

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Wichaidit

Alam

Halder

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Bangladesh's maternal mortality and neonatal mortality remain unacceptably high. We assessed the availability and quality of emergency obstetric care (EmOC) and emergency newborn care (EmNC) services at health facilities in Bangladesh. We randomly sampled 50 rural villages and 50 urban neighborhoods throughout Bangladesh and interviewed the director of eight and nine health facilities nearest to each sampled area. We categorized health facilities into different quality levels (high, moderate, low, and substandard) based on staffing, availability of a phone or ambulance, and signal functions (six categories for EmOC and four categories for EmNC). We interviewed the directors of 875 health facilities. Approximately 28% of health facilities did not have a skilled birth attendant on call 24 hours per day. The least commonly performed EmOC signal function was administration of anticonvulsants (67%). The quality of EmOC services was high in 33% and moderate in 52% of the health facilities. The least common EmNC signal function was kangaroo mother care (7%). The quality of EmNC was high in 2% and moderate in 33% of the health facilities. Approximately one-third of health facilities lack 24-hour availability of skilled birth attendants, increasing the risk of peripartum complications. Most health facilities offered moderate to high quality services for EmOC and low to substandard quality for EmNC.

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“…Las estrategias preventivas deben por lo tanto focalizar factores de riesgo maternos (adolescencia, edad avanzada, déficit nutricional, obesidad, hipertensión y pre-eclampsia, adicciones e infecciones), fetales (malformaciones genéticas y cromosómicas, infecciones, embarazo múltiple) y placentarios (placenta pequeña, placenta previa, anomalías vasculares o del cordón fetal, trombosis, desprendimiento, sangrado, trombofilia y restricción del flujo placentario). 54,55 El control de estos factores también redunda en la disminución de la prevalencia de la asfixia perinatal ya que, aunque durante mucho tiempo se atribuyó su la etiología a dificultades surgidas durante el momento del parto, 56 actualmente se conoce que esto no es así y que es importante tener también en cuenta la desproporción feto pélvica e indicar la realización de monitoreos y ecografías de rutina. 60 Luego del nacimiento deberán diagnosticarse y tratarse precozmente las complicaciones de este cuadro en el neonato: hipoglucemias, lesiones del plexo braquial, entre otras.…”

Section: Discussionunclassified

Riesgo neurológico en el niño de mediano riesgo neonatal

Vericat

Orden

2017

Acta Pediatr Mex

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255www.actapediatrica.org.mx Artículo de revisión Acta Pediatr Mex. 2017 jul;38(4):255-266. Riesgo neurológico en el niño de mediano riesgo neonatalResumen INTRODUCCIÓN: los neonatos de mediano riesgo suelen presentar alteraciones del neurodesarrollo, sutiles o inaparentes, que pueden evidenciarse a mediano y a largo plazos; es por ello que se les considera niños de riesgo neurológico. La identificación de los factores de riesgo asociados con los problemas del neurodesarrollo es un primer paso para prevenir o reducir sus efectos.OBJETIVO: con esta revisión cualitativa de la literatura especializada pretendemos describir las características de un grupo de neonatos denominados colectivamente recién nacidos de mediano riesgo neonatal y que, al nacer, no presentan compromiso evidente del desarrollo neurológico. Indagamos, también sobre los factores etiológicos asociados con esta condición. MATERIALES Y MÉTODOS:realizamos una búsqueda bibliográfica en las bases Scientific Electronic Library Online (SciELO), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), la Biblioteca Nacional de Medicina de Estados Unidos de Norte América (NLM-Medline) y la Red de Revistas Científicas de América Latina y el Caribe, España y Portugal (RedALyC) centrada en factores de riesgo neurológico.RESULTADOS: el incremento de los controles prenatales, la reducción de los nacimientos pretérmino y del parto por cesárea son factores relevantes para el óptimo neurodesarrollo. Luego del parto es necesario extremar los cuidados del neonato en las Unidades de Cuidado Intensivo Neonatal controlando cuadros tales como la hiperbilirrubinemia, la sepsis neonatal y la dificultad respiratoria, asociados con alteraciones del desarrollo en los neonatos de mediano riesgo.CONCLUSIONES: las intervenciones para evitar o reducir el riesgo neurológico en los neonatos de mediano riesgo deben establecerse desde el inicio de la gestación y continuar durante toda la permanencia en las Unidades de Cuidado Intensivo Neonatal.PALABRAS CLAVE: recién nacido, trastornos del neurodesarrollo, factores de riesgo, neonatología, desarrollo infantil. OBJECTIVE:To describe the characteristics of a group of newborns collectively referred to as moderate-risk neonates, who at birth do not show neurodevelopmental disorders, and to investigate the etiological factors associated with this condition. METHODS:We carried a bibliographic search was performed in the SciELO, LILACS, Medline and RedALyC databases focused on neurological risk factors. RESULTS:Increased prenatal control and the reduction of preterm and cesarean delivery are important factors for optimal neurodevelopment. After delivery, newborn care in NICUs is critical, by controlling pathologies such as hyperbilirubinemia, neonatal sepsis, and respiratory distress associated with developmental abnormalities in MRN. CONCLUSIONS:Interventions to avoid or reduce neurological risk in MRN must be established from the beginning of pregnancy and continued during the NICU stay.

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Can Available Interventions End Preventable Deaths in Mothers, Newborn Babies, and Stillbirths, and at What Cost?

Cited by 118 publications

References 0 publications

Better Obstetrics in Rural Nigeria study: evaluating the Nigerian Midwives Service Scheme

Better Obstetrics in Rural Nigeria study: evaluating the Nigerian Midwives Service Scheme

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Riesgo neurológico en el niño de mediano riesgo neonatal

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