Global Maternal, Newborn, and Child Health — So Near and Yet So Far

Abstract

little more than 13 years ago, world leaders assembled in New York to sign the Millennium Declaration to address some of the greatest moral dilemmas of our times-unequal global health, poverty, and inequities in development-and to establish a set of interrelated goals and targets to be met by 2015. Key goals included the Millennium Development Goal (MDG) 4 targeting a reduction in mortality among children younger than 5 years of age by two thirds and MDG 5 targeting a reduction in maternal mortality by three quarters, both from 1990 base figures. With less than 3 years to go, despite overall global progress, these two MDGs are seriously off target for many countries. 1 Recent assessment of global statistics suggests that despite major gains, among the 75 so-called Countdown countries that have 98% of all maternal deaths and deaths among children younger than 5 years of age, only 17 are on track to reach the MDG 4 target for child mortality and only 9 are on track to reach the MDG 5 target for maternal mortality. 2 However, estimates from the Institute for Health Metrics and Evaluation suggest that 31 countries will achieve MDG 4, 13 countries will achieve MDG 5, and only 9 countries will achieve both targets. 3 As we celebrate the fact that the annual number of deaths among children younger than 5 years of age has fallen to 6.6 million (uncertainty range, 6.3 to 7.0 million), which is a 48% reduction from the 12.6 million deaths (uncertainty range, 12.4 to 12.9 million) in 1990, despite an increased number of births in many high-burden countries during the same time period, 4 the sobering realization is that even in countries that will reach their MDG 4 and 5 targets, many will still have high numbers of deaths, with much scope for improvement.

Pilot manikin study showed that a supraglottic airway device improved simulated neonatal ventilation in a low‐resource setting

“…Bhutta and Black 3 have suggested that a strategy based on low‐cost training materials and standardised training manuals and equipment such as manikins and resuscitation bags may help to reach this goal. However, the quality of educational interventions needs to be assessed in simulated as well as clinical settings.…”

Assessing the Incremental Value of Blood Oxygen Saturation (SpO2) in the miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) Risk Prediction Model

“…Taskshifting aspects of pregnancy care to community-based health workers has been proposed as a means to save maternal lives. 3 In low-resource settings, current approaches to assessing the severity of HDP-related illness and guiding clinical decisions are based on assessment of blood pressure and symptoms alone. 4 The goal of the "mini" Pre-eclampsia Integrated Estimate of RiSk (miniPIERS) project was to reduce adverse pregnancy outcomes by providing community-based health workers in low-resource settings with an evidence-based and low-cost tool to improve diagnosis and initial management of preeclampsia.…”

Neurodevelopment, Nutrition, and Inflammation: The Evolving Global Child Health Landscape

“…It is now estimated that at least 40% of the global burden of maternal and child mortality lies in countries affected by national or subnational conflict and population displacement. 57 The growing knowledge of the biology of typical and atypical child and brain development, and the potential impact of interventions during sensitive periods of brain development may ameliorate the global burden of adversity and risk. The key focus on the first 1000 days of life points to the importance of the period of fetal development, during which the adverse effects on brain development and linear growth are maximal and the potential for interventions is at a maximum.…”