197 results on '"Blencowe H"'
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2. Counting the smallest : data to estimate global stillbirth, preterm birth and low birthweight rates
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Blencowe, H. and Blencowe, H.
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362.1983 - Abstract
Background: Stillbirth, preterm birth and low birthweight are important indicators of global burden of disease, status of maternal health and healthcare, and predictors of health throughout the life-course. Data are available through Civil Registration and Vital Statistics (CRVS), Health Management Information Systems (HMIS) and household surveys. Comparisons of data by country or over time requires standard definitions and comparable data quality. Data gaps and inconsistencies necessitate adjustments and use of modelled estimates in many settings. Methods: Systematic data searches were undertaken to compile available data on these outcomes for 195 countries. Where no reliable data were available, statistical models were used to generate national estimates. Data quantity and quality were summarised for each outcome, with implications for improvement and research. Results: The estimated burden remains large: 2.6 million stillbirths (2015), 14.9 million preterm births (2010) and 20.5 million low birthweight babies (2015) based on 4,392 data-points from 148 countries. Common data quality challenges include use of non-standard definitions, omission, and misclassification. Targeted data quality assessments are required to detect these. Five data gaps identified to address are: (1) coverage of data systems (2) accurate assessment of vital status at birth, birthweight and gestational age for every birth, (3) accurate recording of these key data elements (4) comparable collation within and across data systems and (5) use of data to inform programmes and policy. Evidence exists across all data platforms of examples of solutions to close these gaps. Systematic data linkage could increase efficiency. Conclusion: Data availability has increased over the last decade, even in the poorest countries. Data quality issues currently hamper the use of these data to improve outcomes in many settings, but could be addressed with political will and targeted investment. Ending preventable deaths among the world's smallest babies requires that these data are accurate, available and used.
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- 2020
- Full Text
- View/download PDF
3. Estimating the birth prevalence and pregnancy outcomes of congenital malformations worldwide
- Author
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Moorthie, Sowmiya, Blencowe, Hannah, Darlison, Matthew W., Lawn, Joy, Morris, Joan K., Modell, Bernadette, Congenital Disorders Expert Group, Bittles, A. H., Blencowe, H., Christianson, A., Cousens, S., Darlison, M. W., Gibbons, S., Hamamy, H., Khoshnood, B., Howson, C. P., Lawn, J., Mastroiacovo, P., Modell, B., Moorthie, S., Morris, J. K., Mossey, P. A., Neville, A. J., Petrou, M., Povey, S., Rankin, J., Schuler-Faccini, L., Wren, C., and Yunnis, K. A.
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- 2018
- Full Text
- View/download PDF
4. Making stillbirths visible: a systematic review of globally reported causes of stillbirth
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Reinebrant, HE, Leisher, SH, Coory, M, Henry, S, Wojcieszek, AM, Gardener, G, Lourie, R, Ellwood, D, Teoh, Z, Allanson, E, Blencowe, H, Draper, ES, Erwich, JJ, Frøen, JF, Gardosi, J, Gold, K, Gordijn, S, Gordon, A, Heazell, AEP, Khong, TY, Korteweg, F, Lawn, JE, McClure, EM, Oats, J, Pattinson, R, Pettersson, K, Siassakos, D, Silver, RM, Smith, GCS, Tunçalp, Ö, and Flenady, V
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- 2018
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5. The PRECISE-DYAD protocol : linking maternal and infant health trajectories in sub-Saharan Africa
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Craik, R, Volvert, ML, Koech, A, Jah, H, Pickerill, K, Abubakar, A, D'Alessandro, U, Barratt, B, Blencowe, H, Bone, JN, Chandna, J, Gladstone, M, Khalil, A, Li, L, Magee, LA, Makacha, L, Mistry, HD, Moore, S, Roca, A, Salisbury, TT, Temmerman, Marleen, Toudup, D, Vidler, M, and von Dadelszen, Peter
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neurodevelopment ,pregnancy complications ,Medicine and Health Sciences ,child health ,Medicine (miscellaneous) ,global health ,Maternal health ,biorepository ,air quality ,General Biochemistry, Genetics and Molecular Biology - Abstract
Background: PRECISE-DYAD is an observational cohort study of mother-child dyads running in urban and rural communities in The Gambia and Kenya. The cohort is being followed for two years and includes uncomplicated pregnancies and those that suffered pregnancy hypertension, fetal growth restriction, preterm birth, and/or stillbirth. Methods: The PRECISE-DYAD study will follow up ~4200 women and their children recruited into the original PRECISE study. The study will add to the detailed pregnancy information and samples in PRECISE, collecting additional biological samples and clinical information on both the maternal and child health. Women will be asked about both their and their child’s health, their diets as well as undertaking a basic cardiology assessment. Using a case-control approach, some mothers will be asked about their mental health, their experiences of care during labour in the healthcare facility. In a sub-group, data on financial expenditure during antenatal, intrapartum, and postnatal periods will also be collected. Child development will be assessed using a range of tools, including neurodevelopment assessments, and evaluating their home environment and quality of life. In the event developmental milestones are not met, additional assessments to assess vision and their risk of autism spectrum disorders will be conducted. Finally, a personal environmental exposure model for the full cohort will be created based on air and water quality data, combined with geographical, demographic, and behavioural variables. Conclusions: The PRECISE-DYAD study will provide a greater epidemiological and mechanistic understanding of health and disease pathways in two sub-Saharan African countries, following healthy and complicated pregnancies. We are seeking additional funding to maintain this cohort and to gain an understanding of the effects of pregnancies outcome on longer-term health trajectories in mothers and their children.
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- 2022
6. The effect of coverings, including plastic bags and wraps, on mortality and morbidity in preterm and full-term neonates
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Oatley, H K, Blencowe, H, and Lawn, J E
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- 2016
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7. Stillbirth in Australia 1: The road to now: Two decades of stillbirth research and advocacy in Australia
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Flenady VJ, Middleton P, Wallace E, Morris J, Gordon A, Boyle FM, Homer C, Henry S, Brezler L, Wojcieszek AM, Davies-Tuck M, Coory M, Callander E, Kumar S, Clifton V, Leisher SH, Blencowe H, Forbes M, Sexton J, and Ellwood D
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population characteristics ,Obstetrics & Reproductive Medicine ,female genital diseases and pregnancy complications ,reproductive and urinary physiology ,11 Medical and Health Sciences - Abstract
© 2020 Australian College of Midwives Stillbirth is a major public health problem with an enormous mortality burden and psychosocial impact on parents, families and the wider community both globally and in Australia. In 2015, Australia's late gestation stillbirth rate was over 30% higher than that of the best-performing countries globally, highlighting the urgent need for action. We present an overview of the foundations which led to the establishment of Australia's NHMRC Centre of Research Excellence in Stillbirth (Stillbirth CRE) in 2017 and highlight key activities in the following areas: Opportunities to expand and improve collaborations between research teams; Supporting the conduct and development of innovative, high quality, collaborative research that incorporates a strong parent voice; Promoting effective translation of research into health policy and/or practice; and the Regional and global work of the Stillbirth CRE. We highlight the first-ever Senate Inquiry into Stillbirth in Australia in 2018. These events ultimately led to the development of a National Stillbirth Action and Implementation Plan for Australia with the aims of reducing stillbirth rates by 20% over the next five years, reducing the disparity in stillbirth rates between advantaged and disadvantaged communities, and improving care for all families who experience this loss.
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- 2020
8. Review: Addressing the challenge of neonatal mortality
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Blencowe, H. and Cousens, S.
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- 2013
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9. Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: a systematic review and meta-analysis
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Seale, A, Blencowe, H, and Berkley, J
- Abstract
Bacterial infections are a leading cause of the 2·9 million annual neonatal deaths. Treatment is usually based on clinical diagnosis of possible severe bacterial infection (pSBI). To guide programme planning, we have undertaken the first estimates of neonatal pSBI, by sex and by region, for sub-Saharan Africa, south Asia, and Latin America.We included data for pSBI incidence in neonates of 32 weeks' gestation or more (or birthweight ≥1500 g) with livebirth denominator data, undertaking a systematic review and forming an investigator group to obtain unpublished data. We calculated pooled risk estimates for neonatal pSBI and case fatality risk, by sex and by region. We then applied these risk estimates to estimates of livebirths in sub-Saharan Africa, south Asia, and Latin America to estimate cases and associated deaths in 2012.We included data from 22 studies, for 259 944 neonates and 20 196 pSBI cases, with most of the data (18 of the 22 studies) coming from the investigator group. The pooled estimate of pSBI incidence risk was 7·6% (95% CI 6·1-9·2%) and the case-fatality risk associated with pSBI was 9·8% (7·4-12·2). We estimated that in 2012 there were 6·9 million cases (uncertainty range 5·5 million-8·3 million) of pSBI in neonates needing treatment: 3·5 million (2·8 million-4·2 million) in south Asia, 2·6 million (2·1 million-3·1 million) in sub-Saharan Africa, and 0·8 million (0·7 million-1·0 million) in Latin America. The risk of pSBI was greater in boys (risk ratio 1·12, 95% CI 1·06-1·18) than girls. We estimated that there were 0·68 million (0·46 million-0·92 million) neonatal deaths associated with pSBI in 2012.The need-to-treat population for pSBI in these three regions is high, with ten cases of pSBI diagnosed for each associated neonatal death. Deaths and disability can be reduced through improved prevention, detection, and case management.The Wellcome Trust and the Bill & Melinda Gates Foundation through grants to Child Health Epidemiology Reference Group (CHERG) and Save the Children's Saving Newborn Lives programme.
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- 2019
10. An overview of concepts and approaches used in estimating the burden of congenital disorders globally
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Moorthie, S, Blencowe, H, W Darlison, M, Lawn, JE, Mastroiacovo, P, Morris, JK, Modell, B, and Congenital Disorders Expert Group
- Abstract
Congenital disorders are an important cause of pregnancy loss, premature death and life-long disability. A range of interventions can greatly reduce their burden, but the absence of local epidemiological data on their prevalence and the impact of interventions impede policy and service development in many countries. In an attempt to overcome these deficiencies, we have developed a tool-The Modell Global Database of Congenital Disorders (MGDb) that combines general biological principles and available observational data with demographic data, to generate estimates of the birth prevalence and effects of interventions on mortality and disability due to congenital disorders. MGDb aims to support policy development by generating country, regional and global epidemiological estimates. Here we provide an overview of the concepts and methodological approach used to develop MGDb.
- Published
- 2017
11. Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21 st standard: Analysis of CHERG datasets
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Schmiegelow, C., Sania, A., Velaphi, S.C., Kolsteren, P., Fawzi, W., Silveira, M.F., Adair, L.S., Christian, P., Ezzati, M., Baqui, A.H., Mullany, L.C., Tielsch, J.M., Lawn, J.E., Caulfield, L.E., Saville, N., Lee, A.C.C., Huybregts, L., Barros, F.C., Stevens, G.A., Ndyomugyenyi, R., Victora, C.G., Roberfroid, D., Mongkolchati, A., Blencowe, H., Terlouw, D.J., Watson-Jones, D., Humphrey, J., Nien, J.K., Willey, B.A., Manandhar, D., Gonzalez, R., Black, R.E., Rosen, H.E., Kariuki, S., Bhutta, Z.A., Lusingu, J., Clarke, S.E., Kozuki, N., Cousens, S., and Katz, J.
- Abstract
Objectives To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21 st birth weight standard. Design Secondary analysis of data from the Child Health Epidemiology Reference Group (CHERG), including 14 birth cohorts with gestational age, birth weight, and neonatal follow-up. Small for gestational age was defined as infants weighing less than the 10th centile birth weight for gestational age and sex with the multiethnic, INTERGROWTH-21 st birth weight standard. Prevalence of small for gestational age and neonatal mortality risk ratios were calculated and pooled among these datasets at the regional level. With available national level data, prevalence of small for gestational age and population attributable fractions of neonatal mortality attributable to small for gestational age were estimated. Setting CHERG birth cohorts from 14 population based sites in low and middle income countries. Main outcome measures In low and middle income countries in the year 2012, the number and proportion of infants born small for gestational age; number and proportion of neonatal deaths attributable to small for gestational age; the number and proportion of neonatal deaths that could be prevented by reducing the prevalence of small for gestational age to 10%. Results In 2012, an estimated 23.3 million infants (uncertainty range 17.6 to 31.9; 19.3% of live births) were born small for gestational age in low and middle income countries. Among these, 11.2 million (0.8 to 15.8) were term and not low birth weight (���2500 g), 10.7 million (7.6 to 15.0) were term and low birth weight (
- Published
- 2017
- Full Text
- View/download PDF
12. Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: A systematic review and meta-analysis
- Author
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Seale, A, Blencowe, H, Manu, A, Nair, H, Bahl, R, Qazi, SA, Zaidi, A, Berkley, J, Cousens, SN, Lawn, J, Agustian, D, Althabe, F, Azziz-Baumgartner, E, Baqui, A, Bausch, D, Belizan, J, Qar Bhutta, Z, Black, R, Broor, S, Bruce, N, Buekens, P, Campbell, H, Carlo, W, Chomba, E, and Costello, A
- Abstract
Background: Bacterial infections are a leading cause of the 2·9 million annual neonatal deaths. Treatment is usually based on clinical diagnosis of possible severe bacterial infection (pSBI). To guide programme planning, we have undertaken the first estimates of neonatal pSBI, by sex and by region, for sub-Saharan Africa, south Asia, and Latin America. Methods: We included data for pSBI incidence in neonates of 32 weeks' gestation or more (or birthweight ≥1500 g) with livebirth denominator data, undertaking a systematic review and forming an investigator group to obtain unpublished data. We calculated pooled risk estimates for neonatal pSBI and case fatality risk, by sex and by region. We then applied these risk estimates to estimates of livebirths in sub-Saharan Africa, south Asia, and Latin America to estimate cases and associated deaths in 2012. Findings: We included data from 22 studies, for 259 944 neonates and 20 196 pSBI cases, with most of the data (18 of the 22 studies) coming from the investigator group. The pooled estimate of pSBI incidence risk was 7·6% (95% CI 6·1-9·2%) and the case-fatality risk associated with pSBI was 9·8% (7·4-12·2). We estimated that in 2012 there were 6·9 million cases (uncertainty range 5·5 million-8·3 million) of pSBI in neonates needing treatment: 3·5 million (2·8 million-4·2 million) in south Asia, 2·6 million (2·1 million-3·1 million) in sub-Saharan Africa, and 0·8 million (0·7 million-1·0 million) in Latin America. The risk of pSBI was greater in boys (risk ratio 1·12, 95% CI 1·06-1·18) than girls. We estimated that there were 0·68 million (0·46 million-0·92 million) neonatal deaths associated with pSBI in 2012. Interpretation: The need-to-treat population for pSBI in these three regions is high, with ten cases of pSBI diagnosed for each associated neonatal death. Deaths and disability can be reduced through improved prevention, detection, and case management. Funding: The Wellcome Trust and the Bill and Melinda Gates Foundation through grants to Child Health Epidemiology Reference Group (CHERG) and Save the Children's Saving Newborn Lives programme. © 2014 Seale et al.
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- 2016
13. Setting research priorities to improve global newborn health and prevent stillbirths by 2025
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Yoshida, S, Martines, J, Lawn, JE, Wall, S, Souza, JP, Rudan, I, Cousens, S, Aaby, P, Adam, I, Adhikari, RK, Ambalavanan, N, Arifeen, SE, Aryal, DR, Asiruddin, S, Baqui, A, Barros, AJ, Benn, CS, Bhandari, V, Bhatnagar, S, Bhattacharya, S, Bhutta, ZA, Black, RE, Blencowe, H, Bose, C, Brown, J, Bührer, C, Carlo, W, Cecatti, JG, Cheung, PY, Clark, R, Colbourn, T, Conde-Agudelo, A, Corbett, E, Czeizel, AE, Das, A, Day, LT, Deal, C, Deorari, A, Dilmen, U, English, M, Engmann, C, Esamai, F, Fall, C, Ferriero, DM, Gisore, P, Hazir, T, Higgins, RD, Homer, CS, Hoque, DE, Irgens, L, Islam, MT, de Graft-Johnson, J, Joshua, MA, Keenan, W, Khatoon, S, Kieler, H, Kramer, MS, Lackritz, EM, Lavender, T, Lawintono, L, Luhanga, R, Marsh, D, McMillan, D, McNamara, PJ, Mol, BW, Molyneux, E, Mukasa, GK, Mutabazi, M, Nacul, LC, Nakakeeto, M, Narayanan, I, Olusanya, B, Osrin, D, Paul, V, Poets, C, Reddy, UM, Santosham, M, Sayed, R, Schlabritz-Loutsevitch, NE, Singhal, N, Smith, MA, Smith, PG, Soofi, S, Spong, CY, Sultana, S, Tshefu, A, van Bel, F, Gray, LV, Waiswa, P, Wang, W, Williams, SL, Wright, L, Zaidi, A, Zhang, Y, Zhong, N, Zuniga, I, and Bahl, R
- Abstract
In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013-2025.We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts.Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour.These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.
- Published
- 2016
14. 744. CAP-BADGE, EAST YORKSHIRE REGIMENT
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Blencowe, H. A.
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- 1947
15. 746. CAP-BADGE, YORK AND LANCASTER REGIMENT
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Blencowe, H. A.
- Published
- 1947
16. 789. GRENADES OF FUSILIER REGIMENTS
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Blencowe, H. A.
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- 1950
17. Setting research priorities to improve global newborn health and prevent stillbirths by 2025
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Yoshida, S., Martines, J., Lawn, J. E., Wall, S., Souza, J. P., Rudan, I., Cousens, S., Aaby, P., Adam, I., Adhikari, R. K., Ambalavanan, N., Arifeen, S. E. I., Aryal, D. R., Asiruddin, S. K., Baqui, A., Barros, A. J. D., Benn, C. S., Bhandari, V., Bhatnagar, S., Bhattacharya, S., Bhutta, Z. A., Black, R. E., Blencowe, H., Bose, C., Brown, J., Bührer, C., Carlo, W., Cecatti, J. G., Cheung, P., Clark, R., Colbourn, T., Conde-Agudelo, A., Corbett, E., Czeizel, A. E., Abhik Das, Day, L. T., Deal, C., Deorari, A., Dilmen, U., English, M., Engmann, C., Esamai, F., Fall, C., Ferriero, D. M., Gisore, P., Hazir, T., Higgins, R. D., Homer, C. S. E., Hoque, D. E., Irgens, L., Islam, M. T., Graft-Johnson, J., Joshua, M. A., Keenan, W., Khatoon, S., Kieler, H., Kramer, M. S., Lackritz, E. M., Lavender, T., Lawintono, L., Luhanga, R., Marsh, D., Mcmillan, D., Mcnamara, P. J., Mol, B. J., Molyneux, E., Mukasa, G. K., Mutabazi, M., Nacul, L. C., Nakakeeto, M., Narayanan, I., Olusanya, B., Osrin, D., Paul, V., Poets, C., Reddy, U. M., Santosham, M., Sayed, R., Schlabritz-Loutsevitch, N. E., Singhal, N., Smith, M. A., Smith, P. G., Soofi, S., Spong, C. Y., Sultana, S., Tshefu, A., Bel, F., Gray, L. V., Waiswa, P., Wang, W., Williams, S. L. A., Wright, L., Zaidi, A., Zhang, Y., Zhong, N., Zuniga, I., Bahl, R., and APH - Amsterdam Public Health
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priorities ,newborn ,Research ,lcsh:Public aspects of medicine ,lcsh:R ,Research Theme: Global Health Research Priorities ,lcsh:Medicine ,health ,lcsh:RA1-1270 ,improve - Abstract
Background In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013–2025. Methods We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. Results Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. Conclusion These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.
- Published
- 2016
18. Parents' and healthcare professionals' experiences of care after stillbirth in low- and middle-income countries: a systematic review and meta-summary.
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Shakespeare, C, Merriel, A, Bakhbakhi, D, Baneszova, R, Barnard, K, Lynch, M, Storey, C, Blencowe, H, Boyle, F, Flenady, V, Gold, K, Horey, D, Mills, T, and Siassakos, D
- Subjects
STILLBIRTH ,SYSTEMATIC reviews ,META-analysis ,BEREAVEMENT ,MEDICAL personnel-caregiver relationships ,PERINATAL death & psychology ,ATTITUDE (Psychology) ,DEVELOPING countries ,MEDICAL personnel ,PSYCHOLOGY of parents ,POSTNATAL care ,STEREOTYPES ,QUALITATIVE research - Abstract
Background: Stillbirth has a profound impact on women, families, and healthcare workers. The burden is highest in low- and middle-income countries (LMICs). There is need for respectful and supportive care for women, partners, and families after bereavement.Objective: To perform a qualitative meta-summary of parents' and healthcare professionals' experiences of care after stillbirth in LMICs.Search Strategy: Search terms were formulated by identifying all synonyms, thesaurus terms, and variations for stillbirth. Databases searched were AMED, EMBASE, MEDLINE, PsychINFO, BNI, CINAHL.Selection Criteria: Qualitative, quantitative, and mixed method studies that addressed parents' or healthcare professionals' experience of care after stillbirth in LMICs.Data Collection and Analysis: Studies were screened, and data extracted in duplicate. Data were analysed using the Sandelowski meta-summary technique that calculates frequency and intensity effect sizes (FES/IES).Main Results: In all, 118 full texts were screened, and 34 studies from 17 countries were included. FES range was 15-68%. Most studies had IES 1.5-4.5. Women experience a broad range of manifestations of grief following stillbirth, which may not be recognised by healthcare workers or in their communities. Lack of recognition exacerbates negative experiences of stigmatisation, blame, devaluation, and loss of social status. Adequately developed health systems, with trained and supported staff, are best equipped to provide the support and information that women want after stillbirth.Conclusions: Basic interventions could have an immediate impact on the experiences of women and their families after stillbirth. Examples include public education to reduce stigma, promoting the respectful maternity care agenda, and investigating stillbirth appropriately.Tweetable Abstract: Reducing stigma, promoting respectful care and investigating stillbirth have a positive impact after stillbirth for women and families in LMICs. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
19. Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: A systematic review and meta-analysis
- Author
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Seale, AC, Blencowe, H, Manu, AA, Nair, H, Bahl, R, Qazi, SA, Zaidi, AK, Berkley, JA, Cousens, SN, Lawn, JE, Agustian, D, Althabe, F, Azziz-Baumgartner, E, Baqui, AH, Bausch, DG, Belizan, JM, Qar Bhutta, Z, Black, RE, Broor, S, Bruce, N, Buekens, P, Campbell, H, Carlo, WA, Chomba, E, Costello, A, Derman, RJ, Dherani, M, El-Arifeen, S, Engmann, C, Esamai, F, Ganatra, H, Garcés, A, Gessner, BD, Gill, C, Goldenberg, RL, Goudar, SS, Hambidge, KM, Hamer, DH, Hansen, NI, Hibberd, PL, Khanal, S, Kirkwood, B, Kosgei, P, Koso-Thomas, M, Liechty, EA, McClure, EM, Mitra, D, Mturi, N, Mullany, LC, Newton, CR, Nosten, F, Parveen, S, Patel, A, Romero, C, Saville, N, Semrau, K, Simões, AF, Soofi, S, Stoll, BJ, Sunder, S, Syed, S, Tielsch, JM, Tinoco, YO, Turner, C, and Vergnano, S
- Abstract
Background: Bacterial infections are a leading cause of the 2·9 million annual neonatal deaths. Treatment is usually based on clinical diagnosis of possible severe bacterial infection (pSBI). To guide programme planning, we have undertaken the first estimates of neonatal pSBI, by sex and by region, for sub-Saharan Africa, south Asia, and Latin America. Methods: We included data for pSBI incidence in neonates of 32 weeks' gestation or more (or birthweight ≥1500 g) with livebirth denominator data, undertaking a systematic review and forming an investigator group to obtain unpublished data. We calculated pooled risk estimates for neonatal pSBI and case fatality risk, by sex and by region. We then applied these risk estimates to estimates of livebirths in sub-Saharan Africa, south Asia, and Latin America to estimate cases and associated deaths in 2012. Findings: We included data from 22 studies, for 259 944 neonates and 20 196 pSBI cases, with most of the data (18 of the 22 studies) coming from the investigator group. The pooled estimate of pSBI incidence risk was 7·6% (95% CI 6·1-9·2%) and the case-fatality risk associated with pSBI was 9·8% (7·4-12·2). We estimated that in 2012 there were 6·9 million cases (uncertainty range 5·5 million-8·3 million) of pSBI in neonates needing treatment: 3·5 million (2·8 million-4·2 million) in south Asia, 2·6 million (2·1 million-3·1 million) in sub-Saharan Africa, and 0·8 million (0·7 million-1·0 million) in Latin America. The risk of pSBI was greater in boys (risk ratio 1·12, 95% CI 1·06-1·18) than girls. We estimated that there were 0·68 million (0·46 million-0·92 million) neonatal deaths associated with pSBI in 2012. Interpretation: The need-to-treat population for pSBI in these three regions is high, with ten cases of pSBI diagnosed for each associated neonatal death. Deaths and disability can be reduced through improved prevention, detection, and case management. Funding: The Wellcome Trust and the Bill and Melinda Gates Foundation through grants to Child Health Epidemiology Reference Group (CHERG) and Save the Children's Saving Newborn Lives programme. © 2014 Seale et al.
- Published
- 2014
20. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010 : a systematic analysis for the global burden of disease study 2010
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Murray, C.J.L., Vos, T., Lozano, R., Naghavi, M., Flaxman, A.D., Michaud, C., Ezzati, M., Shibuya, K., Salomon, J.A., Abdalla, S., Aboyans, V., Abraham, J., Ackerman, I., Aggarwal, R., Ahn, S.Y., Ali, M.K., Alvarado, M., Anderson, H.R., Anderson, L.M., Andrews, K.G., Atkinson, C., Baddour, L.M., Barker-Collo, S., Barrero, L.H., Bartels, D.H., Basanez, M.G., Baxter, A., Bell, M.L., Benjamin, E.J., Bennett, D., Bernabé, D., Bhalla, K., Bandari, B., Bikbov, B., Abdulhak, A.B., Birbeck, G., Black, J.A., Blencowe, H., Blore, J.D., Blyth, F., Bolliger, I., Bonaventure, A., Boufous, S., Bourne, R., and Boussinesq, Michel
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MODELE MATHEMATIQUE ,EPIDEMIOLOGIE ,MALADIE ,CAUSE DE DECES ,FACTEUR DE RISQUE ,AGE PHYSIOLOGIQUE ,POLITIQUE DE SANTE ,SEXE ,MORTALITE ,ETUDE COMPARATIVE ,SYSTEME DE SANTE ,ANALYSE SYSTEMIQUE ,SANTE PUBLIQUE ,EDUCATION SANITAIRE - Published
- 2012
21. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010 : a systematic analysis for the global burden of disease study 2010
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Vos, T., Flaxman, A.D., Naghavi, M., Lozano, R., Michaud, C., Ezzati, M., Shibuya, K., Salomon, J. A., Abdalla, S., Aboyans, V., Abraham, J., Ackerman, I., Aggarwal, R., Ahn, S., Ali, M.K., Alvarado, M., Ross Anderson, H., Anderson, L.M., Andrews, K.G., Atkinson, C., Baddour, L.M., Bahalim, A.N., Barker Collo, S., Barrero, L.H., Bartels, D.H., Basanez, M.G., Baxter, A., Bell, M.L., Benjamin, E.J., Bennett, D., Bernabé, E., Bhalla, K., Bhandari, B., Bikbov, B., Abulhak, A.B., Birbeck, G., Black, J.A., Blencowe, H., Blore, J.D., Blyth, F., Bolliger, I., Bonaventure, A., Boufous, S., Bourne, R., and Boussinesq, Michel
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SEXE ,MALADIE ,ENQUETE ,GROUPE D'AGE ,INVALIDITE ,SANTE PUBLIQUE ,MORBIDITE ,REPARTITION GEOGRAPHIQUE ,MODELISATION ,VARIATION PLURIANNUELLE ,PREVALENCE - Published
- 2012
22. Setting up Kangaroo Mother Care at Queen Elizabeth Hospital, Blantyre - A practical approach
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Blencowe, H and Molyneux, E
- Published
- 2005
23. Every Woman, Every Child's 'Progress in Partnership' for stillbirths: a commentary by the stillbirth advocacy working group.
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Ateva, E., Blencowe, H., Castillo, T., Dev, A., Farmer, M., Kinney, M., Mishra, S. K., Hopkins Leisher, S., Maloney, S., Ponce Hardy, V., Quigley, P., Ruidiaz, J., Siassakos, D., Stoner, J. E., Storey, C., and Tejada de Rivero Sawers, M. L.
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- *
STILLBIRTH , *LABOR complications (Obstetrics) , *WOMEN'S health , *CHILDREN'S health , *PRENATAL care - Abstract
The authors discuss prevalence and prevention of stillbirths in response to the 2017 Every Woman Every Child (EWEC) progress report on the global strategy developed for women's and children's health. Topics explored include the occurrence of stillbirths in low- and middle-income nations, the integration of health interventions into maternal and newborn care practices, and the need to acknowledge psychological and psychosocial impact of stillbirths.
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- 2018
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24. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications.
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Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, Adler A, Vera Garcia C, Rohde S, Say L, and Lawn JE
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- 2012
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25. Introduction of bubble CPAP in a teaching hospital in Malawi.
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Van Den Heuvel, M, Blencowe, H, Mittermayer, K, Rylance, S, Couperus, A, Heikens, G T, and Bandsma, R H J
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- *
CONTINUOUS positive airway pressure , *RESPIRATORY distress syndrome , *PEDIATRICS , *NEWBORN infants , *MECHANICAL ventilators , *TEACHING hospitals ,DEVELOPING countries - Abstract
Background: Continuous positive airway pressure (CPAP) is relatively inexpensive and can be easily taught; it therefore has the potential to be the optimal respiratory support device for neonates in developing countries. Objective: The possibility of implementing bubble CPAP in a teaching hospital with a large neonatology unit but very limited resources was investigated. Methods: A CPAP system was developed consisting of a compressor, oxygen concentrator, water bottle to control the pressure and binasal prongs. Neonates with birthweights between 1 and 2·5 kg with persistent respiratory distress 4 hours after birth were eligible for bubble CPAP. Results: In the 7-week introduction period from 11 March until 27 April 2008, 11 neonates were treated with CPAP. Five of these neonates met the inclusion criteria and six neonates did not meet these criteria. Of the five neonates who received CPAP and met the inclusion criteria, three survived. The six infants who did not meet the inclusion criteria included three preterm infants with apnoea (all died), two with birthweights <1 kg (both died) and a firstborn twin (1.2 kg) who survived. No major complications of CPAP occurred. Bubble CPAP could be used independently by nurses after a short training period. Conclusion: Successful long-term implementation of CPAP depends on the availability of sufficient trained nursing staff. [ABSTRACT FROM AUTHOR] - Published
- 2011
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26. I044 BORN TOO SOON: A GLOBAL ACTION REPORT FOR 15 MILLION PRETERM BIRTHS
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Blencowe, H., Bhutta, Z., Althabe, F., Lawn, J., and Howson, C.
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- 2012
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27. The effect of coverings, including plastic bags and wraps, on mortality and morbidity in preterm and full-term neonates
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Oatley, HK, Blencowe, H, and Lawn, JE
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Neonatal hypothermia is an important risk factor for mortality and morbidity, and is common even in temperate climates. We conducted a systematic review to determine whether plastic coverings, used immediately following delivery, were effective in reducing the incidence of mortality, hypothermia and morbidity. A total of 26 studies (2271 preterm and 1003 term neonates) were included. Meta-analyses were conducted as appropriate. Plastic wraps were associated with a reduction in hypothermia in preterm (⩽29 weeks; risk ratio (RR)=0.57; 95% confidence interval (CI) 0.46 to 0.71) and term neonates (RR=0.76; 95% CI 0.60 to 0.96). No significant reduction in neonatal mortality or morbidity was found; however, the studies were underpowered for these outcomes. For neonates, especially preterm, plastic wraps combined with other environmental heat sources are effective in reducing hypothermia during stabilization and transfer within hospital. Further research is needed to quantify the effects on mortality or morbidity, and investigate the use of plastic coverings outside hospital settings or without additional heat sources.
28. Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect
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Blencowe Hannah, Cousens Simon, Mullany Luke C, Lee Anne CC, Kerber Kate, Wall Steve, Darmstadt Gary L, and Lawn Joy E
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Annually over 520,000 newborns die from neonatal sepsis, and 60,000 more from tetanus. Estimates of the effect of clean birth and postnatal care practices are required for evidence-based program planning. Objective To review the evidence for clean birth and postnatal care practices and estimate the effect on neonatal mortality from sepsis and tetanus for the Lives Saved Tool (LiST). Methods We conducted a systematic review of multiple databases. Data were abstracted into standard tables and assessed by GRADE criteria. Where appropriate, meta-analyses were undertaken. For interventions with low quality evidence but a strong GRADE recommendation, a Delphi process was conducted. Results Low quality evidence supports a reduction in all-cause neonatal mortality (19% (95% c.i. 1–34%)), cord infection (30% (95% c.i. 20–39%)) and neonatal tetanus (49% (95% c.i. 35–62%)) with birth attendant handwashing. Very low quality evidence supports a reduction in neonatal tetanus mortality with a clean birth surface (93% (95% c.i. 77-100%)) and no relationship between a clean perineum and tetanus. Low quality evidence supports a reduction of neonatal tetanus with facility birth (68% (95% c.i. 47-88%). No relationship was found between birth place and cord infections or sepsis mortality. For postnatal clean practices, all-cause mortality is reduced with chlorhexidine cord applications in the first 24 hours of life (34% (95% c.i. 5–54%, moderate quality evidence) and antimicrobial cord applications (63% (95% c.i. 41–86%, low quality evidence). One study of postnatal maternal handwashing reported reductions in all-cause mortality (44% (95% c.i. 18–62%)) and cord infection ((24% (95% c.i. 5-40%)). Given the low quality of evidence, a Delphi expert opinion process was undertaken. Thirty experts reached consensus regarding reduction of neonatal sepsis deaths by clean birth practices at home (15% (IQR 10–20)) or in a facility (27% IQR 24–36)), and by clean postnatal care practices (40% (IQR 25–50)). The panel estimated that neonatal tetanus mortality was reduced by clean birth practices at home (30% (IQR(20–30)), or in a facility (38% (IQR 34–40)), and by clean postnatal care practices (40% (IQR 30–50)). Conclusion According to expert opinion, clean birth and particularly postnatal care practices are effective in reducing neonatal mortality from sepsis and tetanus. Further research is required regarding optimal implementation strategies.
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- 2011
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29. Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality
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Berman Stuart, Kamb Mary, Cousens Simon, Blencowe Hannah, and Lawn Joy E
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Globally syphilis is an important yet preventable cause of stillbirth, neonatal mortality and morbidity. Objectives This review sought to estimate the effect of detection and treatment of active syphilis in pregnancy with at least 2.4MU benzathine penicillin (or equivalent) on syphilis-related stillbirths and neonatal mortality. Methods We conducted a systematic literature review of multiple databases to identify relevant studies. Data were abstracted into standardised tables and the quality of evidence was assessed using adapted GRADE criteria. Where appropriate, meta-analyses were undertaken. Results Moderate quality evidence (3 studies) supports a reduction in the incidence of clinical congenital syphilis of 97% (95% c.i 93 – 98%) with detection and treatment of women with active syphilis in pregnancy with at least 2.4MU penicillin. The results of meta-analyses suggest that treatment with penicillin is associated with an 82% reduction in stillbirth (95% c.i. 67 – 90%) (8 studies), a 64% reduction in preterm delivery (95% c.i. 53 – 73%) (7 studies) and an 80% reduction in neonatal deaths (95% c.i. 68 – 87%) (5 studies). Although these effect estimates were large and remarkably consistent across studies, few of the studies adjusted for potential confounding factors and thus the overall quality of the evidence was considered low. However, given these large observed effects and a clear biological mechanism for effectiveness the GRADE recommendation is strong. Conclusion Detection and appropriate, timely penicillin treatment is a highly effective intervention to reduce adverse syphilis-related pregnancy outcomes. More research is required to identify the most cost-effective strategies for achieving maximum coverage of screening for all pregnant women, and access to treatment if required.
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- 2011
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30. Care during labor and birth for the prevention of intrapartum-related neonatal deaths: a systematic review and Delphi estimation of mortality effect
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Moran Neil F, Pattinson Robert, Blencowe Hannah, Darmstadt Gary L, Cousens Simon, Lee Anne CC, Hofmeyr G, Haws Rachel A, Bhutta Shereen, and Lawn Joy E
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Our objective was to estimate the effect of various childbirth care packages on neonatal mortality due to intrapartum-related events (“birth asphyxia”) in term babies for use in the Lives Saved Tool (LiST). Methods We conducted a systematic literature review to identify studies or reviews of childbirth care packages as defined by United Nations norms (basic and comprehensive emergency obstetric care, skilled care at birth). We also reviewed Traditional Birth Attendant (TBA) training. Data were abstracted into standard tables and quality assessed by adapted GRADE criteria. For interventions with low quality evidence, but strong GRADE recommendation for implementation, an expert Delphi consensus process was conducted to estimate cause-specific mortality effects. Results We identified evidence for the effect on perinatal/neonatal mortality of emergency obstetric care packages: 9 studies (8 observational, 1 quasi-experimental), and for skilled childbirth care: 10 studies (8 observational, 2 quasi-experimental). Studies were of low quality, but the GRADE recommendation for implementation is strong. Our Delphi process included 21 experts representing all WHO regions and achieved consensus on the reduction of intrapartum-related neonatal deaths by comprehensive emergency obstetric care (85%), basic emergency obstetric care (40%), and skilled birth care (25%). For TBA training we identified 2 meta-analyses and 9 studies reporting mortality effects (3 cRCT, 1 quasi-experimental, 5 observational). There was substantial between-study heterogeneity and the overall quality of evidence was low. Because the GRADE recommendation for TBA training is conditional on the context and region, the effect was not estimated through a Delphi or included in the LiST tool. Conclusion Evidence quality is rated low, partly because of challenges in undertaking RCTs for obstetric interventions, which are considered standard of care. Additional challenges for evidence interpretation include varying definitions of obstetric packages and inconsistent measurement of mortality outcomes. Thus, the LiST effect estimates for skilled birth and emergency obstetric care were based on expert opinion. Using LiST modelling, universal coverage of comprehensive obstetric care could avert 591,000 intrapartum-related neonatal deaths each year. Investment in childbirth care packages should be a priority and accompanied by implementation research and further evaluation of intervention impact and cost. Funding This work was supported by the Bill and Melinda Gates Foundation through a grant to the US Fund for UNICEF, and to Saving Newborn Lives Save the Children, through Save the Children US.
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- 2011
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31. Measurement of stillbirths and neonatal deaths in standardised population-based surveys
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Akuze Waiswa, J., Blencowe, H., Cousens, S., and Waiswa, P.
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Background: Worldwide, 4.4 million stillbirths and neonatal deaths (SB&NND) are estimated to occur annually. Household surveys, notably the Demographic and Health Surveys (DHS), are an important source of SB&NND data. This PhD aimed to review the DHS's evolution for SB&NND data capture and compare the full birth history with additional questions on pregnancy losses (FBH+) and full pregnancy history (FPH) approaches in terms of data quality and potential measurement errors. Methods: A literature and programmatic review of the DHS programme and HDSS pregnancy surveillance system was conducted. A randomised comparison of FBH+ versus FPH modules (the EveryNewborn-INDEPTH (EN-INDEPTH) survey) was undertaken in five health and demographic surveillance sites (HDSS). Reported stillbirth rates (SBR) and neonatal mortality rates (NMR); time for completion of survey modules; evidence for heterogeneity between sites; patterns of corrections between question types and structures, and modules were assessed. Survey data were compared to and HDSS data in four sites. Results: Both FPH and FBH+ modules have been used within the DHS programme, but there is limited evidence concerning their accuracy for SB&NND. The FBH+ was the core model questionnaire between DHS-phases I-VII. A total of 69,176 women consented. 34,805 (50·3%) were randomised to FBH+ and 34,371 (49·7%) to FPH. There was little difference between the average time to administer questions in FBH+ (9.1 minutes) and FPH (10.5 minutes). The SBR was 15.2/1000 and 17.4/1000 total births for FBH+ and FPH, respectively. SBR was 21% (95% CI (-10% - 62%)) higher in FPH than in FBH+ with strong evidence of heterogeneity across the sites (I-squared=80·9% (p < 0.001)). The NMR was similar in FPH (25.1/1000 births) and FBH+ (25.4/1000 births) with no evidence of heterogeneity between the sites (I-squared=0.0% (p=0.48)). Corrections were similar by survey module and occurred in 84% of survey interviews. Single corrections were the most common, multiple-select, and free-text questions increased response time by two minutes on average and had the most corrections. Pregnancy surveillance systems differed between sites (frequency of surveillance visits, main respondent reporting pregnancy outcomes, pregnancy testing, and data capture and surveillance modes). In three of the four sites, both arms of the EN-INDEPTH survey reported more pregnancies than the HDSS Matlab being the exception. Overall, the survey data produced higher estimated SBRs (FBH+: RR=1.13, 95%CI (0.79, 1.63), p=0.519; FPH: RR=1.20, 95%CI (0.76, 1.90), p=0.444) and NMRs (FBH+: RR=1.19, 95%CI (0.98, 1.43), p=0.071; FPH: RR=1.15, 95%CI (1.01, 1.30), p=0.030) than the HDSS data. In Matlab, the HDSS recorded more stillbirths and miscarriages than the survey in the FPH arm only. In Kintampo, the HDSS recorded more stillbirths than the survey, even though the HDSS recorded fewer pregnancies. Conclusions: Evidence from this PhD of improved capture of stillbirths using the FPH influenced the DHS's switch to the FPH module in its eighth phase; however, limited evidence concerning SB&NND data accuracy and quality in standardised surveys is available. Therefore, additional efforts towards improved survey implementation of the FPH approach, including training, interviewer prompts, translations, and developing and testing standard data quality criteria for SB&NND in surveys and routine data, are warranted.
- Published
- 2022
32. Preventing Preterm Births.
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Chang, H.h., Larson, J., Blencowe, H., Spong, C.y., Howson, C.p., Cairns-Smith, S., Lackritz, E.m., Lee, S.k., Mason, E., Serazin, A.c., Walani, S., Simpson, J.l., and Lawn, J.e.
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- 2014
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33. Service readiness for inpatient care of small and sick newborns : improving measurement in low- and middle-income settings
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Moxon, Sarah, Lawn, J., and Blencowe, H.
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362.19892 - Abstract
Background: In 2018, 2.5 million newborns died; mainly from prematurity, infections, and intrapartum events. Preventing these deaths requires health systems to provide routine and emergency care at birth, and quality inpatient care for small and sick newborns. Despite high potential impact, inpatient newborn care is not consistently measured. Methods: For this PhD, I conducted a bottleneck analysis using data from 12 national workshops regarding delivery of inpatient newborn care in low- and middle-income countries (LMIC). Using WHO guidelines, grey literature and expert consultation, I mapped the components required to deliver inpatient care and reviewed these against three health facility assessment tools. Finally, I carried out an online survey to elicit global practitioner opinions regarding levels of newborn care, paralleling those used for monitoring emergency obstetric care in LMIC. Results: In 12 high-burden countries in sub-Saharan Africa and Asia, health financing and workforce were identified as the greatest bottlenecks to scaling up quality inpatient care, followed by community ownership. My review identified 654 components required to deliver inpatient care. These are inconsistently measured by existing health facility assessments. The 262 survey respondents agreed on 12 interventions to comprise a package of care for small and sick newborns; selected levels of care varied by clinical background and experience in LMIC. Conclusion: Inpatient newborn care faces multiple health system challenges, particularly to ensure funding and skilled staffing. Standard facility numbers and staffing ratios by defined levels of care are important for countries to benchmark service delivery progress. Due to the large number of components required for delivering quality care, newborn “signal functions” could be selected by level of care to parallel emergency obstetric care indicators. Improved measurement of service readiness requires sustained focus on interoperability of routine measurement systems, and further research to better capture the experience of newborn inpatient care for families.
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- 2020
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34. National, Regional, and Worldwide Estimates of Preterm Birth Rates in the Year 2010 With Time Trends Since 1990 for Selected Countries.
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Blencowe, H., Cousens, S., Oestergaard, M.z., Chou, D., Moller, A.b., Narwal, R., Adler, A., Vera Garcia, C., Rohde, S., Say, L., and Lawn, J.e.
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- 2013
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35. IS ANTENATAL CLINIC ATTENDANCE ASSOCIATED WITH ESSENTIAL NEWBORN CARE PRACTICES IN WOMEN WHO DELIVER AT HOME IN FIVE DISTRICTS OF SOUTHERN TANZANIA?
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Blencowe, H. J. and Schellenberg, J.
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- 2011
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36. Service readiness for inpatient care of small and sick newborns:\ud Improving measurement in low- and middle-income settings
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Moxon, SG, Lawn, J, and Blencowe, H
- Abstract
Background: In 2018, 2.5 million newborns died; mainly from prematurity, infections, and intrapartum events. Preventing these deaths requires health systems to provide routine and emergency care at birth, and quality inpatient care for small and sick newborns. Despite high potential impact, inpatient newborn care is not consistently measured. Methods: For this PhD, I conducted a bottleneck analysis using data from 12 national workshops regarding delivery of inpatient newborn care in low- and middle-income countries (LMIC). Using WHO guidelines, grey literature and expert consultation, I mapped the components required to deliver inpatient care and reviewed these against three health facility assessment tools. Finally, I carried out an online survey to elicit global practitioner opinions regarding levels of newborn care, paralleling those used for monitoring emergency obstetric care in LMIC. Results: In 12 high-burden countries in sub-Saharan Africa and Asia, health financing and workforce were identified as the greatest bottlenecks to scaling up quality inpatient care, followed by community ownership. My review identified 654 components required to deliver inpatient care. These are inconsistently measured by existing health facility assessments. The 262 survey respondents agreed on 12 interventions to comprise a package of care for small and sick newborns; selected levels of care varied by clinical background and experience in LMIC. Conclusion: Inpatient newborn care faces multiple health system challenges, particularly to ensure funding and skilled staffing. Standard facility numbers and staffing ratios by defined levels of care are important for countries to benchmark service delivery progress. Due to the large number of components required for delivering quality care, newborn “signal functions” could be selected by level of care to parallel emergency obstetric care indicators. Improved measurement of service readiness requires sustained focus on interoperability of routine measurement systems, and further research to better capture the experience of newborn inpatient care for families.
37. Content and design of respectful maternity care training packages for health workers in sub-Saharan Africa: Scoping review.
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Yargawa J, Daniele M, Pickerill K, Vidler M, Koech A, Jah H, Mwashigadi G, Mwaniki M, von Dadelszen P, Temmerman M, Filippi V, and Blencowe H
- Abstract
Background: Training health workers might facilitate respectful maternity care (RMC); however, the content and design of RMC training remain unclear., Objective: To explore the content and design of RMC training packages for health workers in sub-Saharan Africa., Search Strategy: MEDLINE, EMBASE, CINAHL Complete, Web of Science Core Collections, SCOPUS, and grey literature sources (including websites of RMC-focused key organizations and Ministries of Health) were searched for journal papers, reports, and training guides from January 2006 up to August 2022., Selection Criteria: There were no restrictions on study designs, language, or health-worker cadre. Two reviewers independently screened results., Data Collection and Analysis: Key data, including training content and methods used, were extracted and summarized., Main Results: Thirty-two citations from 26 studies/programs were identified (24 journal papers, 5 manuals/guides, 2 reports and 1 PhD thesis), with 27 citations from 22 studies informing the review findings. About half of all conducted studies were from East Africa. The most common topics in RMC trainings were communication, privacy and confidentiality, and human resources. Most trainings were multicomponent and appear to be largely in-service training. Health workers providing direct care to women, compared with non-clinical staff such as receptionists and cleaners, were the only recipients of training in most studies (81.8%). Two broad categories of training methods/tools were identified: workshop-based and action-based. Over 90% of the studies assessed impact of the training, with a majority focused on impacts on maternal health and care; however, half of the latter studies did not appear to have feedback mechanisms in place for implementing change., Conclusions: The content and design of RMC training in sub-Saharan Africa are multifaceted, suggesting the complexity of implementing/promoting RMC. Some progress has been made; however, missed opportunities in training remain with respect to study populations, training topics, cadres, and feedback mechanisms., (© 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)
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- 2024
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38. Parents', Families', Communities' and Healthcare Professionals' Experiences of Care Following Neonatal Death in Healthcare Facilities in LMICs: A Systematic Review and Meta-Ethnography.
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Wilson C, Atkins B, Molyneux R, Storey C, and Blencowe H
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Background: Ninety-eight percent of neonatal deaths worldwide occur in low- and middle-income countries (LMICs), yet there is little bereavement care guidance available for these settings., Objectives: To explore parents', families' and healthcare professionals' experiences of care after neonatal death in healthcare facilities in LMICs., Search Strategy and Selection Criteria: Four databases were searched for peer-reviewed literature, meeting the inclusion criteria of qualitative studies exploring the experiences of people who provided or received bereavement care following neonatal death in a LMIC healthcare setting., Data Collection and Analysis: Data were collected by two independent reviewers, collated through line-by-line coding and then reciprocal and refutational translation, and analysed through Noblit and Hare's seven-step meta-ethnography approach to create first-, second- and third-order themes., Main Results: Seven first-order themes extracted from the literature included emotional responses, social relationships, staff and systems, religion, connecting with the baby, coping strategies and economic concerns. From these data, three third-order themes arose: The individual, the healthcare setting and the community/context., Conclusions: Overarching themes in bereavement care shape grief responses and are often similar across geographical locations. Analysing these similarities allows a deeper understanding of the important elements of bereavement care and may be helpful to inform the creation of high-quality, bereavement care guidelines suitable for use in LMIC settings., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
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- 2024
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39. Definitions, terminology and standards for reporting of births and deaths in the perinatal period: International Classification of Diseases (ICD-11).
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Blencowe H, Hug L, Moller AB, You D, and Moran AC
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Despite efforts to reduce stillbirths and neonatal deaths, inconsistent definitions and reporting practices continue to hamper global progress. Existing data frequently being limited in terms of quality and comparability across countries. This paper addresses this critical issue by outlining the new International Classification of Disease (ICD-11) recommendations for standardized recording and reporting of perinatal deaths to improve data accuracy and international comparison. Key advancements in ICD-11 include using gestational age as the primary threshold to for reporting, clearer guidance on measurement and recording of gestational age, and reporting mortality rates by gestational age subgroups to enable country comparisons to include similar populations (e.g., all births from 154 days [22
+0 weeks] or from 196 days [28+0 weeks]). Furthermore, the revised ICD-11 guidance provides further clarification around the exclusion of terminations of pregnancy (induced abortions) from perinatal mortality statistics. Implementing standardized recording and reporting methods laid out in ICD-11 will be crucial for accurate global data on stillbirths and perinatal deaths. Such high-quality data would both allow appropriate regional and international comparisons to be made and serve as a resource to improve clinical practice and epidemiological and health surveillance, enabling focusing of limited programmatic and research funds towards ending preventable deaths and improving outcomes for every woman and every baby, everywhere., (© 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)- Published
- 2024
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40. The PRECISE-DYAD Neurodevelopmental substudy protocol: neurodevelopmental risk in children of mothers with pregnancy complications.
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Magai DN, Chandna J, Volvert ML, Craik R, Jah H, Kongira F, Bojang K, Koech A, Mwashigadi G, Mutua AM, Blencowe H, D'Alessandro U, Roca A, Temmerman M, von Dadelszen P, Abubakar A, and Gladstone M
- Abstract
Background: Over 250 million children are not reaching their developmental potential globally. The impact of prenatal factors and their interplay with postnatal environmental factors on child neurodevelopment, is still unclear-particularly in low- and middle-income settings. This study aims to understand the impact of pregnancy complications as well as environmental, psychosocial, and biological predictors on neurodevelopmental trajectories., Methods: This is an observational cohort study of female and male children (≈3,950) born to women (≈4,200) with and without pregnancy complications (pregnancy-induced hypertension, foetal growth restriction, and premature birth) previously recruited into PREgnancy Care Integrating Translational Science, Everywhere study with detailed biological data collected in intrapartum and post-partum periods. Children will be assessed at six weeks to 6 months, 11-13 months, 23-25 months and 35-37 months in rural and semi-urban Gambia (Farafenni, Illiasa, and Ngayen Sanjal) and Kenya (Mariakani and Rabai). We will assess children's neurodevelopment using Prechtls General Movement Assessment, the Malawi Development Assessment Tool (primary outcome), Observation of Maternal-Child Interaction, the Neurodevelopmental Disorder Screening Tool, and the Epilepsy Screening tool. Children screening positive will be assessed with Cardiff cards (vision), Modified Checklist for Autism in Toddlers Revised, and Pediatric Quality of Life Inventory Family Impact. We will use multivariate logistic regression analysis to investigate the impact of pregnancy complications on neurodevelopment and conduct structural equation modelling using latent class growth to study trajectories and relationships between biological, environmental, and psychosocial factors on child development., Conclusions: We aim to provide information regarding the neurodevelopment of infants and children born to women with and without pregnancy complications at multiple time points during the first three years of life in two low-resource African communities. A detailed evaluation of developmental trajectories and their predictors will provide information on the most strategic points of intervention to prevent and reduce the incidence of neurodevelopmental impairments., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Magai DN et al.)
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- 2024
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41. Stillbirth risk by fetal size among 126.5 million births in 15 countries from 2000 to 2020: A fetuses-at-risk approach.
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Okwaraji YB, Suárez-Idueta L, Ohuma EO, Bradley E, Yargawa J, Pingray V, Cormick G, Gordon A, Flenady V, Horváth-Puhó E, Sørensen HT, Abuladze L, Heidarzadeh M, Khalili N, Yunis KA, Al Bizri A, Barranco A, van Dijk AE, Broeders L, Alyafei F, Olukade TO, Razaz N, Söderling J, Smith LK, Matthews RJ, Wood R, Monteath K, Pereyra I, Pravia G, Lisonkova S, Wen Q, Lawn JE, and Blencowe H
- Abstract
Objective: To compare stillbirth rates and risks for small for gestational age (SGA), large for gestational age (LGA) and appropriate for gestational age (AGA) pregnancies at 24-44 completed weeks of gestation using a birth-based and fetuses-at-risk approachs., Design: Population-based, multi-country study., Setting: National data systems in 15 high- and middle-income countries., Population: Live births and stillbirths., Methods: A total of 151 country-years of data, including 126 543 070 births across 15 countries from 2000 to 2020, were compiled. Births were categorised into SGA, AGA and LGA using INTERGROWTH-21st standards. Gestation-specific stillbirth rates, with total births as the denominator, and gestation-specific stillbirth risks, with fetuses still in utero as the denominator, were calculated from 24 to 44 weeks of gestation., Main Outcome Measures: Gestation-specific stillbirth rates and risks according to size at birth., Results: The overall stillbirth rate was 4.22 per 1000 total births (95% CI 4.22-4.23) across all gestations. Applying the birth-based approach, the stillbirth rates were highest at 24 weeks of gestation, with 621.6 per 1000 total births (95% CI 620.9-622.2) for SGA pregnancies, 298.4 per 1000 total births (95% CI 298.1-298.7) for AGA pregnancies and 338.5 per 1000 total births (95% CI 337.9-339.0) for LGA pregnancies. Applying the fetuses-at-risk approach, the gestation-specific stillbirth risk was highest for SGA pregnancies (1.3-1.4 per 1000 fetuses at risk) prior to 29 weeks of gestation. The risk remained stable between 30 and 34 weeks of gestation, and then increased gradually from 35 weeks of gestation to the highest rate of 8.4 per 1000 fetuses at risk (95% CI 8.3-8.4) at ≥42 weeks of gestation. The stillbirth risk ratio (RR) was consistently high for SGA compared with AGA pregnancies, with the highest RR observed at ≥42 weeks of gestation (RR 9.2, 95% CI 15.2-13.2), and with the lowest RR observed at 24 weeks of gestation (RR 3.1, 95% CI 1.9-4.3). The stillbirth RR was also consistently high for SGA compared with AGA pregnancies across all countries, with national variability ranging from RR 0.70 (95% CI 0.43-0.97) in Mexico to RR 8.6 (95% CI 8.1-9.1) in Uruguay. No increased risk for LGA pregnancies was observed., Conclusions: Small for gestational age (SGA) was strongly associated with stillbirth risk in this study based on high-quality data from high- and middle-income countries. The highest RRs were seen in preterm gestations, with two-thirds of the stillbirths born as preterm births. To advance our understanding of stillbirth, further analyses should be conducted using high-quality data sets from low-income settings, particularly those with relatively high rates of SGA., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
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- 2024
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42. National routine data for low birthweight and preterm births: Systematic data quality assessment for United Nations member states (2000-2020).
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Okwaraji YB, Bradley E, Ohuma EO, Yargawa J, Suarez-Idueta L, Requejo J, Blencowe H, and Lawn JE
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- Humans, Infant, Newborn, Female, Pregnancy, United Nations, United States epidemiology, Routinely Collected Health Data, Infant, Low Birth Weight, Premature Birth epidemiology, Data Accuracy
- Abstract
Objective: Low birthweight (<2500 g) and preterm birth (<37 weeks) are markers of newborn vulnerability. To facilitate informed decisions about investments in prevention and care, it is imperative to enhance data quality and use. Hence, the objective of this study is to systematically assess the quality of data concerning low birthweight and preterm births within routine administrative data sources., Design: Systematic data quality assessment by adopting the WHO Data Quality Framework., Setting: National routine data system from UN member states., Population: Livebirths., Methods: National routine administrative data on low birthweight and preterm births for 195 countries from 2000 to 2020 were systematically collated, totalling >700 million live births. The WHO data quality framework was adapted to undertake standardised data quality assessments., Main Outcome Measures: Availability, reporting quality, internal and external consistency of low birthweight and preterm data., Results: Most United States Member States (64%: 124/195) had national data on low birthweight and (40%: 82/195) had data on preterm birth. Routine data system reporting was highest in North America, Australasia and Europe, where more than 95% live births had data on low birthweight and over 75% had data preterm births. In contrast, data reporting was lowest in sub-Saharan Africa (13% for low birthweight, 8% for preterm births) and Southern Asia (16% for low birthweight, 5% for preterm births). Most countries collect individual-level data; but, aggregate data reporting from hospital-based systems remain common in sub-Saharan Africa and Southern Asia. While data quality was generally high in North America, Australasia and Europe, gaps remain in the availability of gestational age metadata. Consistency between low birthweight and preterm rates were poor in Southern Asia and sub-Saharan Africa regions across time. There was high external consistency between low birthweight rates obtained from routine administrative data compared with low birthweight rates obtained from survey data for countries with high data quality., Conclusions: Sub-Saharan Africa and South Asia countries have data gaps but also opportunities for rapid progress. Most births occure in facilities, electronic health information systems already include low birthweight, and adding accurate gestational age including with ultrasound assessment is becoming increasingly attainable. Moving toward the collection of individual level data would enable monitoring of quality of care and longer-term outcomes. This is crucial for every child and family and essential for measuring progress towards relevant sustainable development goals. The assessment will inform countries' actions for data quality improvement at national level and use of data for impact., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
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- 2024
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43. Prevalence and risk of stillbirth according to biologic vulnerability phenotypes in the municipality of São Paulo, Brazil: A population-based cohort study.
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Marques LJP, Silva ZPD, Alencar GP, Paixão ESD, Blencowe H, and de Almeida MF
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- Infant, Newborn, Female, Pregnancy, Humans, Birth Weight, Retrospective Studies, Cohort Studies, Brazil epidemiology, Prevalence, Infant, Small for Gestational Age, Fetal Growth Retardation, Gestational Age, Stillbirth epidemiology, Biological Products
- Abstract
Objective: To estimate the prevalence and risk of stillbirths by biologic vulnerability phenotypes in a cohort of pregnant women in the municipality of São Paulo, Brazil, 2017-2019., Methods: Retrospective population-based cohort study. Fetuses were assessed as small for gestational age (SGA), large for gestational age (LGA), adequate for gestational age (AGA), preterm (PT) as less than 37 weeks of gestation, non-PT (NPT) as 37 weeks of gestation or more, low birth weight (LBW) as less than 2500 g, and non-LBW (NLBW) as 2500 g or more. Relative risks (RR) with robust variance were estimated using Poisson regression., Results: In all 442 782 pregnancies, including 2321 (0.5%) stillbirths, were included. About 85% (n = 1983) of stillbirths had at least one characteristic of vulnerability, compared with 21% (n = 92524) of live births. Fetuses with all three markers of vulnerability had the highest adjusted RR of stillbirth-SGA + LBW + PT (RR 155.00; 95% confidence interval [CI] 136.29-176.30) and LGA + LBW + PT (RR 262.04; 95% CI 206.10-333.16) when compared with AGA + NLBW + NPT., Conclusion: Our findings show that the simultaneous presence of prematurity, low birth weight, and abnormal intrauterine growth presented a higher risk of stillbirths. To accelerate progress towards reducing preventable stillbirths, one must identify the circumstances of greatest biologic vulnerability., (© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)
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- 2024
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44. The PRECISE-DYAD protocol: linking maternal and infant health trajectories in sub-Saharan Africa.
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Craik R, Volvert ML, Koech A, Jah H, Pickerill K, Abubakar A, D'Alessandro U, Barratt B, Blencowe H, Bone JN, Chandna J, Gladstone MJ, Khalil A, Li L, Magee LA, Makacha L, Mistry HD, Moore SE, Roca A, Salisbury TT, Temmerman M, Toudup D, Vidler M, and von Dadelszen P
- Abstract
Background: PRECISE-DYAD is an observational cohort study of mother-child dyads running in urban and rural communities in The Gambia and Kenya. The cohort is being followed for two years and includes uncomplicated pregnancies and those that suffered pregnancy hypertension, fetal growth restriction, preterm birth, and/or stillbirth., Methods: The PRECISE-DYAD study will follow up ~4200 women and their children recruited into the original PRECISE study. The study will add to the detailed pregnancy information and samples in PRECISE, collecting additional biological samples and clinical information on both the maternal and child health.Women will be asked about both their and their child's health, their diets as well as undertaking a basic cardiology assessment. Using a case-control approach, some mothers will be asked about their mental health, their experiences of care during labour in the healthcare facility. In a sub-group, data on financial expenditure during antenatal, intrapartum, and postnatal periods will also be collected. Child development will be assessed using a range of tools, including neurodevelopment assessments, and evaluating their home environment and quality of life. In the event developmental milestones are not met, additional assessments to assess vision and their risk of autism spectrum disorders will be conducted. Finally, a personal environmental exposure model for the full cohort will be created based on air and water quality data, combined with geographical, demographic, and behavioural variables., Conclusions: The PRECISE-DYAD study will provide a greater epidemiological and mechanistic understanding of health and disease pathways in two sub-Saharan African countries, following healthy and complicated pregnancies. We are seeking additional funding to maintain this cohort and to gain an understanding of the effects of pregnancies outcome on longer-term health trajectories in mothers and their children., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Craik R et al.)
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- 2024
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45. National, regional, and global estimates of low birthweight in 2020, with trends from 2000: a systematic analysis.
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Okwaraji YB, Krasevec J, Bradley E, Conkle J, Stevens GA, Gatica-Domínguez G, Ohuma EO, Coffey C, Estevez Fernandez DG, Blencowe H, Kimathi B, Moller AB, Lewin A, Hussain-Alkhateeb L, Dalmiya N, Lawn JE, Borghi E, and Hayashi C
- Subjects
- Child, Adolescent, Infant, Newborn, Humans, Female, Birth Weight, Bayes Theorem, Africa South of the Sahara, Global Health, Infant, Low Birth Weight
- Abstract
Background: Low birthweight (LBW; <2500 g) is an important predictor of health outcomes throughout the life course. We aimed to update country, regional, and global estimates of LBW prevalence for 2020, with trends from 2000, to assess progress towards global targets to reduce LBW by 30% by 2030., Methods: For this systematic analysis, we searched population-based, nationally representative data on LBW from Jan 1, 2000, to Dec 31, 2020. Using 2042 administrative and survey datapoints from 158 countries and areas, we developed a Bayesian hierarchical regression model incorporating country-specific intercepts, time-varying covariates, non-linear time trends, and bias adjustments based on data quality. We also provided novel estimates by birthweight subgroups., Findings: An estimated 19·8 million (95% credible interval 18·4-21·7 million) or 14·7% (13·7-16·1) of liveborn newborns were LBW worldwide in 2020, compared with 22·1 million (20·7-23·9 million) and 16·6% (15·5-17·9) in 2000-an absolute reduction of 1·9 percentage points between 2000 and 2020. Using 2012 as the baseline, as this is when the Global Nutrition Target began, the estimated average annual rate of reduction from 2012 to 2020 was 0·3% worldwide, 0·85% in southern Asia, and 0·59% in sub-Saharan Africa. Nearly three-quarters of LBW births in 2020 occurred in these two regions: of 19 833 900 estimated LBW births worldwide, 8 817 000 (44·5%) were in southern Asia and 5 381 300 (27·1%) were in sub-Saharan Africa. Of 945 300 estimated LBW births in northern America, Australia and New Zealand, central Asia, and Europe, approximately 35·0% (323 700) weighed less than 2000 g: 5·8% (95% CI 5·2-6·4; 54 800 [95% CI 49 400-60 800]) weighed less than 1000 g, 9·0% (8·7-9·4; 85 400 [82 000-88 900]) weighed between 1000 g and 1499 g, and 19·4% (19·0-19·8; 183 500 [180 000-187 000]) weighed between 1500 g and 1999 g., Interpretation: Insufficient progress has occurred over the past two decades to meet the Global Nutrition Target of a 30% reduction in LBW between 2012 and 2030. Accelerating progress requires investments throughout the lifecycle focused on primary prevention, especially for adolescent girls and women living in the most affected countries. With increasing numbers of births in facilities and advancing electronic information systems, improvements in the quality and availability of administrative LBW data are also achievable., Funding: The Children's Investment Fund Foundation; the UNDP-UNFPA-UNICEF-WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction; and the Bill & Melinda Gates Foundation., Competing Interests: Declaration of interests We declare no competing interests., (© 2024 World Health Organization. Published by Elsevier Ltd. All rights reserved. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.)
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- 2024
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46. District health management and stillbirth recording and reporting: a qualitative study in the Ashanti Region of Ghana.
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Mensah Abrampah NA, Okwaraji YB, Oteng KF, Asiedu EK, Larsen-Reindorf R, Blencowe H, and Jackson D
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- Infant, Newborn, Humans, Female, Pregnancy, Ghana epidemiology, Infant Mortality, Qualitative Research, Stillbirth epidemiology, Midwifery
- Abstract
Background: Despite global efforts to reduce maternal and neonatal mortality, stillbirths remain a significant public health challenge in many low- and middle-income countries. District health systems, largely seen as the backbone of health systems, are pivotal in addressing the data gaps reported for stillbirths. Available, accurate and complete data is essential for District Health Management Teams (DHMTs) to understand the burden of stillbirths, evaluate interventions and tailor health facility support to address the complex challenges that contribute to stillbirths. This study aims to understand stillbirth recording and reporting in the Ashanti Region of Ghana from the perspective of DHMTs., Methods: The study was conducted in the Ashanti Region of Ghana. 15 members of the regional and district health directorates (RHD/DHD) participated in semi-structured interviews. Sampling was purposive, focusing on RHD/DHD members who interact with maternity services or stillbirth data. Thematic analyses were informed by an a priori framework, including theme 1) experiences, perceptions and attitudes; theme 2) stillbirth data use; and theme 3) leadership and support mechanisms, for stillbirth recording and reporting., Results: Under theme 1, stillbirth definitions varied among respondents, with 20 and 28 weeks commonly used. Fresh and macerated skin appearance was used to classify timing with limited knowledge of antepartum and intrapartum stillbirths. For theme 2, data quality checks, audits, and the district health information management system (DHIMS-2) data entry and review are functions played by the DHD. Midwives were blamed for data quality issues on omissions and misclassifications. Manual entry of data, data transfer from the facility to the DHD, limited knowledge of stillbirth terminology and periodic closure of the DHIMS-2 were seen to proliferate gaps in stillbirth recording and reporting. Under theme 3, perinatal audits were acknowledged as an enabler for stillbirth recording and reporting by the DHD, though audits are mandated for only late-gestational stillbirths (> 28 weeks). Engagement of other sectors, e.g., civil/vital registration and private health facilities, was seen as key in understanding the true population-level burden of stillbirths., Conclusion: Effective district health management ensures that every stillbirth is accurately recorded, reported, and acted upon to drive improvements. A large need exists for capacity building on stillbirth definitions and data use. Recommendations are made, for example, terminology standardization and private sector engagement, aimed at reducing stillbirth rates in high-mortality settings such as Ghana., (© 2024. The Author(s).)
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- 2024
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47. Exploring women's interpretations of survey questions on pregnancy and pregnancy outcomes: cognitive interviews in Iganga Mayuge, Uganda.
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Kwesiga D, Malqvist M, Orach CG, Eriksson L, Blencowe H, and Waiswa P
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- Pregnancy, Infant, Newborn, Child, Female, Humans, Uganda epidemiology, Surveys and Questionnaires, Cognition, Stillbirth epidemiology, Abortion, Spontaneous epidemiology
- Abstract
Background: In 2021, Uganda's neonatal mortality rate was approximately 19 deaths per 1000 live births, with an estimated stillbirth rate of 15.1 per 1000 total births. Data are critical for indicating areas where deaths occur and why, hence driving improvements. Many countries rely on surveys like Demographic and Health Surveys (DHS), which face challenges with respondents' misinterpretation of questions. However, little is documented about this in Uganda. Cognitive interviews aim to improve questionnaires and assess participants' comprehension of items. Through cognitive interviews we explored women's interpretations of questions on pregnancy and pregnancy outcomes., Methods: In November 2021, we conducted cognitive interviews with 20 women in Iganga Mayuge health and demographic surveillance system site in eastern Uganda. We adapted the reproductive section of the DHS VIII women's questionnaire, purposively selected questions and used concurrent verbal probing. Participants had secondary school education and were English speaking. Cognition was measured through comparing instructions in the DHS interviewers' manual to participants' responses and researcher's knowledge. A qualitative descriptive approach to analysis was undertaken., Results: We report findings under the cognitive aspect of comprehension. Some questions were correctly understood, especially those with less technical terms or without multiple sections. Most participants struggled with questions asking whether the woman has her living biological children residing with her or not. Indeed, some thought it referred to how many living children they had. There were comprehension difficulties with long questions like 210 that asks about miscarriages, newborn deaths, and stillbirths together. Participants had varying meanings for miscarriages, while many misinterpreted stillbirth, not linking it to gestational age. Furthermore, even amongst educated women some survey questions were misunderstood., Conclusions: Population surveys may misclassify, over or under report events around pregnancy and pregnancy outcomes. Interviewers should begin with a standard definition of key terms and ensure respondents understand these. Questions can be simplified through breaking up long sentences, while interviewer training should be modified to ensure they thoroughly understand key terms. We recommend cognitive interviews while developing survey tools, beyond basic pre-testing. Improving respondents' comprehension and thus response accuracy will increase reporting and data quality., (© 2024. The Author(s).)
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- 2024
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48. Determinants of stillbirths in sub-Saharan Africa: A systematic review.
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Mukherjee A, Di Stefano L, Blencowe H, and Mee P
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- Pregnancy, Female, Humans, Infant, Stillbirth epidemiology, Prenatal Care, Africa South of the Sahara epidemiology, Perinatal Death, Pregnancy Complications
- Abstract
Background: Sub-Saharan African (SSA) countries have high stillbirth rates compared with high-income countries, yet research on risk factors for stillbirth in SSA remain scant., Objectives: To identify the modifiable risk factors of stillbirths in SSA and investigate their strength of association using a systematic review., Search Strategy: CINAHL Plus, EMBASE, Global Health and MEDLINE databases were searched for literature., Selection Criteria: Observational population- and facility-level studies exploring stillbirth risk factors, published in 2013-2019 were included., Data Collection and Analysis: A narrative synthesis of data was undertaken and the potential risk factors were classified into subgroups., Main Results: Thirty-seven studies were included, encompassing 20 264 stillbirths. The risk factors were categorised as: maternal antepartum factors (0-4 antenatal care visits, multiple gestations, hypertension, birth interval of >3 years, history of perinatal death); socio-economic factors (maternal lower wealth index and basic education, advanced maternal age, grand multiparity of ≥5); intrapartum factors (direct obstetric complication); fetal factors (low birthweight and gestational age of <37 weeks) and health systems factors (poor quality of antenatal care, emergency referrals, ill-equipped facility). The proportion of unexplained stillbirths remained very high. No association was found between stillbirths and body mass index, diabetes, distance from the facility or HIV., Conclusions: The overall quality of evidence was low, as many studies were facility based and did not adjust for confounding factors. This review identified preventable risk factors for stillbirth. Focused programmatic strategies to improve antenatal care, emergency obstetric care, maternal perinatal education, referral and outreach systems, and birth attendant training should be developed. More population-based, high-quality research is needed., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
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- 2024
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49. The AlignMNH 2023 Conference: progress in raising parents' voices in stillbirth advocacy.
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Mwashigadi G, Lwantale T, Wojcieszek AM, Blencowe H, Leisher SH, Kiunga CW, Wanjala D, and Storey C
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- Female, Pregnancy, Humans, Qualitative Research, Stillbirth epidemiology, Parents
- Abstract
Competing Interests: We report no competing interests.
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- 2024
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50. Effects of size at birth on health, growth and developmental outcomes in children up to age 18: an umbrella review.
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Jamaluddine Z, Sharara E, Helou V, El Rashidi N, Safadi G, El-Helou N, Ghattas H, Sato M, Blencowe H, and Campbell OMR
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- Infant, Newborn, Pregnancy, Female, Adolescent, Child, Humans, Birth Weight, Infant, Small for Gestational Age, Growth Disorders, Pregnancy Outcome, Fetal Growth Retardation epidemiology, Fetal Growth Retardation etiology
- Abstract
Background: Size at birth, an indicator of intrauterine growth, has been studied extensively in relation to subsequent health, growth and developmental outcomes. Our umbrella review synthesises evidence from systematic reviews and meta-analyses on the effects of size at birth on subsequent health, growth and development in children and adolescents up to age 18, and identifies gaps., Methods: We searched five databases from inception to mid-July 2021 to identify eligible systematic reviews and meta-analyses. For each meta-analysis, we extracted data on the exposures and outcomes measured and the strength of the association., Findings: We screened 16 641 articles and identified 302 systematic reviews. The literature operationalised size at birth (birth weight and/or gestation) in 12 ways. There were 1041 meta-analyses of associations between size at birth and 67 outcomes. Thirteen outcomes had no meta-analysis.Small size at birth was examined for 50 outcomes and was associated with over half of these (32 of 50); continuous/post-term/large size at birth was examined for 35 outcomes and was consistently associated with 11 of the 35 outcomes. Seventy-three meta-analyses (in 11 reviews) compared risks by size for gestational age (GA), stratified by preterm and term. Prematurity mechanisms were the key aetiologies linked to mortality and cognitive development, while intrauterine growth restriction (IUGR), manifesting as small for GA, was primarily linked to underweight and stunting., Interpretation: Future reviews should use methodologically sound comparators to further understand aetiological mechanisms linking IUGR and prematurity to subsequent outcomes. Future research should focus on understudied exposures (large size at birth and size at birth stratified by gestation), gaps in outcomes (specifically those without reviews or meta-analysis and stratified by age group of children) and neglected populations., Prospero Registration Number: CRD42021268843., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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