Obstetric care in low-resource settings: What, who, and how to overcome challenges to scale up?

Abstract

While intrapartum care aims to avert intrapartum-related hypoxic injury, rigorous evidence is lacking, especially in the settings where most deaths occur. Effective care at birth could save hundreds of thousands of lives a year, with investment in health infrastructure, personnel, and research--both for innovation and to improve implementation.

Pesquisa Nascer no Brasil: perfil da mortalidade neonatal e avaliação da assistência à gestante e ao recém-nascido

“…Prematurity and low birth weight (especially extremely low birth weight) were the main factors associated with neonatal death. The predominant characteristics of neonatal deaths (very low birth weight and prematurity, followed by congenital malformation) approximate Brazil to more developed countries, where the vast majority of infant deaths occur among newborns with lesser likelihood of survival 4,28,29 . Variables indicating greater severity in newborns were maintained associated to neonatal death.…”

Stillbirths: how can health systems deliver for mothers and babies?

“…Costs of visits were estimated to be 9% higher in regions with 80-95% coverage, and 24% higher in regions with 95-99% coverage, than were visits in regions with less than 80% coverage. Cost assumptions are detailed in webappendix pp [3][4][5][6][7][8][9][10][11][12][13][14][15] Eff ect estimates refer to the reduction in deaths due to a specifi c cause as a result of intervention-eg, 0·41 for stillbirths due to neural tube defects means that 41% of stillbirths due to neural tube defects could be averted with introduction of folic acid supplementation or fortifi cation. Postnatal interventions are not included so the estimates do not represent the full eff ect on neonatal deaths.…”

“…Some interventions are applicable only for health systems with high capacityeg, routine induction of labour at 41 weeks might not be justifi ed in low-resource settings because calculation of gestational age might not be accurate, and induction with poor intrapartum monitoring could result in uterine hyperstimulation or even uterine rupture. 6 Five further interventions might not reduce stillbirths, but they have substantial health benefi ts specifi cally for mothers and neonates, and can be feasibly delivered at the same time as other stillbirth-specifi c interventions: tetanus toxoid immunisation during pregnancy (two or more vaccine doses), antibiotics for preterm premature rupture of membranes, antenatal corti costeroids for preterm labour, active management of the third stage of labour, and neonatal resuscitation. Increasing evidence suggests that when interventions are packaged and provided through linked service delivery methods that are tailored to suit existing healthcare systems, cost-eff ectiveness is heightened and available human resources are maximised.…”

A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons

“…models for simulation, a continuum process for mentorship through phone or email, and time for quality mentorship is a key priority [27, 28]. Motivation of the local mentors through compensation of their time and ensuring that they were also mentored continuously by the external mentors and encouraged to refresh their own knowledge and skills in EmONC was also found to be critical [29].…”