Maternal, neonatal, and child health in southeast Asia: towards greater regional collaboration

Acuin, Cecilia; Khor, Geok Lin; Liabsuetrakul, Tippawan; Achadi, Endang; Htay, Thein Thein; Firestone, Rebecca; Bhutta, Zulfiqar Ahmed

doi:10.1016/s0140-6736(10)62049-1

Cited by 86 publications

(81 citation statements)

References 29 publications

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“…[33]. In the rural based population described here haemorrhage (27.9%) was also the most common cause of maternal death, but indirect causes were responsible for over half of the deaths (52.9%) and were mainly caused by sepsis and malaria.…”

Section: Discussionmentioning

confidence: 71%

Effect of Early Detection and Treatment on Malaria Related Maternal Mortality on the North-Western Border of Thailand 1986–2010

et al. 2012

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IntroductionMaternal mortality is high in developing countries, but there are few data in high-risk groups such as migrants and refugees in malaria-endemic areas. Trends in maternal mortality were followed over 25 years in antenatal clinics prospectively established in an area with low seasonal transmission on the north-western border of Thailand.Methods and FindingsAll medical records from women who attended the Shoklo Malaria Research Unit antenatal clinics from 12th May 1986 to 31st December 2010 were reviewed, and maternal death records were analyzed for causality. There were 71 pregnancy-related deaths recorded amongst 50,981 women who attended antenatal care at least once. Three were suicide and excluded from the analysis as incidental deaths. The estimated maternal mortality ratio (MMR) overall was 184 (95%CI 150–230) per 100,000 live births. In camps for displaced persons there has been a six-fold decline in the MMR from 499 (95%CI 200–780) in 1986–90 to 79 (40–170) in 2006–10, p<0.05. In migrants from adjacent Myanmar the decline in MMR was less significant: 588 (100–3260) to 252 (150–430) from 1996–2000 to 2006–2010. Mortality from P.falciparum malaria in pregnancy dropped sharply with the introduction of systematic screening and treatment and continued to decline with the reduction in the incidence of malaria in the communities. P.vivax was not a cause of maternal death in this population. Infection (non-puerperal sepsis and P.falciparum malaria) accounted for 39.7 (27/68) % of all deaths.ConclusionsFrequent antenatal clinic screening allows early detection and treatment of falciparum malaria and substantially reduces maternal mortality from P.falciparum malaria. No significant decline has been observed in deaths from sepsis or other causes in refugee and migrant women on the Thai–Myanmar border.

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Section: Discussionmentioning

confidence: 71%

Effect of Early Detection and Treatment on Malaria Related Maternal Mortality on the North-Western Border of Thailand 1986–2010

et al. 2012

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“…61 Although evidence on the effectiveness of SSC in community-based settings is scarce, 40,62 it is estimated that SSC can avert up to 20% of newborn deaths. 63 In the large Gadchiroli trial in India on home-based neonatal care assessing the outcome of sepsis management, case management included thermal protection of the newborn, and health care workers were given a thermometer, baby clothes and head cover, a blanket and a sleeping bag. Although the study included other interventions and was not specifically designed to prove a particular effect for hypothermia management, it showed a reduction in neonatal and infant mortality by nearly 50% among a malnourished, illiterate and rural study population.…”

Section: Diagnosismentioning

confidence: 99%

Thermal protection of the newborn in resource-limited environments

2012

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Appropriate thermal protection of the newborn prevents hypothermia and its associated burden of morbidity and mortality. Yet, current global birth practices tend to not adequately address this challenge. Here, we discuss the pathophysiology of hypothermia in the newborn, its prevention and therapeutic options with particular attention to resource-limited environments. Newborns are equipped with sophisticated mechanisms of body temperature regulation. Neonatal thermoregulation is a critical function for newborn survival, regulated in the hypothalamus and mediated by endocrine pathways. Hypothermia activates cellular metabolism through shivering and nonshivering thermogenesis. In newborns, optimal temperature ranges are narrow and thermoregulatory mechanisms easily overwhelmed, particularly in premature and low-birth weight infants. Hyperthermia most commonly is associated with dehydration and potentially sepsis. The lack of thermal protection promptly leads to hypothermia, which is associated with detrimental metabolic and other pathophysiological processes. Simple thermal protection strategies are feasible at community and institutional levels in resource-limited environments. Appropriate interventions include skin-to-skin care, breastfeeding and protective clothing or devices. Due to poor provider training and limited awareness of the problem, appropriate thermal care of the newborn is often neglected in many settings. Education and appropriate devices might foster improved hypothermia management through mothers, birth attendants and health care workers. Integration of relatively simple thermal protection interventions into existing mother and child health programs can effectively prevent newborn hypothermia even in resource-limited environments.

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“…3 Specifi c treatment guidelines or prevention strategies for malaria in pregnancy either do not exist or have only recently been introduced. [4][5][6] Interventions recommended by WHO for the control of P falciparum malaria during pregnancy are largely based on fi ndings from sub-Saharan Africa, where P falciparum is the dominant species, transmission is high, and Anopheles gambiae is the main vector. 7 Strategies for the Asia-Pacifi c region are complicated by several factors: diversity in malaria transmission and vector behaviour, 8 coexistence of P vivax, 9 multidrug-resistant parasites, 10,11 substandard and counterfeit drugs, 12 cross-border movement of migrants, 2 ethnic minorities that have little access to health care, 2 and the political climate in some countries.…”

Section: Introductionmentioning

confidence: 99%