Maternal health in the year 2076

Hussein, Julia; Braunholtz, David; D’Ambruoso, Lucia

doi:10.1016/s0140-6736(08)60130-0

Cited by 5 publications

(5 citation statements)

References 2 publications

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“…Formal scientific evaluations or operations research to test the effect of such efforts, as exemplified by the Dinajpur project, need to be conducted more widely. Secondly, the slow progress in reducing maternal mortality in this region 41 has led to a sense of urgency amongst those implementing maternal health programmes, despite the lack of evaluation as to whether what they are doing is actually beneficial. Undue haste to ‘scale‐up’ initiatives needs to be tempered by experience of how to implement actions that we know work (such as provision of emergency obstetric care), by starting small, and learning from experience.…”

Section: Discussionmentioning

confidence: 99%

Identifying practices and ideas to improve the implementation of maternal mortality reduction programmes: findings from five South Asian countries

Hussein

Newlands

D’Ambruoso

et al. 2010

BJOG

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Please cite this paper as: Hussein J, Newlands D, D’Ambruoso L, Thaver I, Talukder R, Besana G. Identifying practices and ideas to improve the implementation of maternal mortality reduction programmes: findings from five South Asian countries. BJOG 2010;117:304–313. Objective The successful implementation of programmes to reduce maternal mortality is constrained by a ‘know–do’ gap: the disparity between what is known and the application of that knowledge in policy and practice. This study identified innovations, practices and ideas aimed to improve project and programme implementation. Design Cross‐sectional. Setting Five South Asian countries: Afghanistan, Bangladesh, India, Nepal and Pakistan. Sample Sixteen projects and programmes, and 100 key informants. Methods In‐depth review of documents, key informant interviews and focus‐group discussions. Main outcome measures Innovations and ideas to improve programme implementation, and their perceived effects. Results Delegation of duties to intermediate‐level health workers, incentivisation of health workers, providing the means to overcome financial barriers for accessing care, quality improvements and knowledge transfer were examples of ideas put into practice to improve programme implementation. There was a perception that these improved service use and availability, but objective evidence was lacking. Conclusions Some innovations, practices and ideas are supported by evidence of effect, and could be replicated, whereas others have not been formally evaluated. Testing of these innovations is required before more widespread adoption can be recommended, although experiences should be shared to narrow the ‘know–do’ gap, even though the evidence on beneficial effects remains unclear.

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Section: Discussionmentioning

confidence: 99%

Identifying practices and ideas to improve the implementation of maternal mortality reduction programmes: findings from five South Asian countries

Hussein

Newlands

D’Ambruoso

et al. 2010

BJOG

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“…At present, progress towards MDG-5 is seriously off target. 3,4 Between 1990 and 2005 there was a decline in maternal mortality across Latin America and the Caribbean, with the MMR decreasing from 179 maternal deaths per 100 000 live births to 132 per 100 000, and across Asia, with a decrease from 410 to 329 per 100 000. However, MMRs in sub-Saharan Africa have remained high, at over 900 maternal deaths per 100 000 live births.…”

Section: Introductionmentioning

confidence: 99%

What you count is what you target: the implications of maternal death classification for tracking progress towards reducing maternal mortality in developing countries

Cross¹,

Bell²,

Graham³

2010

Bull World Health Org

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The first target of the fifth United Nations Millennium Development Goal is to reduce maternal mortality by 75% between 1990 and 2015. This target is critically off track. Despite difficulties inherent in measuring maternal mortality, interventions aimed at reducing it must be monitored and evaluated to determine the most effective strategies in different contexts. In some contexts, the direct causes of maternal death, such as haemorrhage and sepsis, predominate and can be tackled effectively through providing access to skilled birth attendance and emergency obstetric care. In others, indirect causes of maternal death, such as HIV/AIDS and malaria, make a significant contribution and require alternative interventions. Methods of planning and evaluating maternal health interventions that do not differentiate between direct and indirect maternal deaths may lead to unrealistic expectations of effectiveness or mask progress in tackling specific causes. Furthermore, the need for additional or alternative interventions to tackle the causes of indirect maternal death may not be recognized if all-cause maternal death is used as the sole outcome indicator. This article illustrates the importance of differentiating between direct and indirect maternal deaths by analysing historical data from England and Wales and contemporary data from Ghana, Rwanda and South Africa. The principal aim of the paper is to highlight the need to differentiate deaths in this way when evaluating maternal mortality, particularly when judging progress towards the fifth Millennium Development Goal. It is recommended that the potential effect of maternity services failing to take indirect maternal deaths into account should be modelled.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬

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“…Even though a projection that far into the future may be unreliable (the rate of change is unlikely to be constant), common sense would suggest that the goal is unlikely to be reached during this century. A similar projection of data from South Asian countries suggests that MDG‐5 will be achieved there in the year 2076 2 . It is not known when individual countries in SSA might reach the target because no precise estimates of the national MMR have been established over the 20‐year period.…”

Section: Introductionmentioning

confidence: 97%

“…A similar projection of data from South Asian countries suggests that MDG-5 will be achieved there in the year 2076. 2 It is not known when individual countries in SSA might reach the target because no precise estimates of the national MMR have been established over the 20-year period. To monitor change, a country would have needed at least two precise estimates during the 20 years.…”

Section: Introductionmentioning

confidence: 99%

Joining the dots: a plea for precise estimates of the maternal mortality ratio in sub‐Saharan Africa

2009

BJOG

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Monitoring of maternal mortality levels in sub‐Saharan Africa (SSA) to assess the achievements of safe motherhood programmes and for MDG‐5 has been made difficult because of the lack of precise estimates of the maternal mortality ratio (MMR). Projections based on the slow rate of decline of the MMR indicate that MDG‐5 may not be reached before the end of this century in this region. Measurements done using demographical and health surveys, statistical modelling and censuses are imprecise and do not allow trends in individual countries to be established. SSA countries should be encouraged to measure mortality levels from their own resources, using methods that produce precise estimates such as population‐based surveys. Establishment of the trends will lead to country‐specific program targets. The less frequent but more precise measurements can be afforded by SSA countries, as a case study from Zimbabwe shows.

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Maternal health in the year 2076

Cited by 5 publications

References 2 publications

Identifying practices and ideas to improve the implementation of maternal mortality reduction programmes: findings from five South Asian countries

Identifying practices and ideas to improve the implementation of maternal mortality reduction programmes: findings from five South Asian countries

What you count is what you target: the implications of maternal death classification for tracking progress towards reducing maternal mortality in developing countries

Joining the dots: a plea for precise estimates of the maternal mortality ratio in sub‐Saharan Africa

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