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Reliable and rigorously collected sexual, reproductive, maternal, newborn, child, and adolescent (SRMNCAH) data from humanitarian settings are often sparse and variable in quality across different settings due to the lack of a standardised set of indicators across the different agencies working in humanitarian settings. This paper aims to summarise a WHO-led global initiative to develop and scale up an SRMNCAH monitoring and evaluation framework for humanitarian settings.This research revolved around three phases. The first and the last phase involved global consultations with lead international agencies active in SRMNCAH in humanitarian settings. The second phase tested the feasibility of the proposed indicators in Afghanistan, Bangladesh, the Democratic Republic of the Congo, and Jordan, using different qualitative research methods (interviews with 92 key informants, 26 focus group discussions with 142 key stakeholders, facility assessments and observations at 25 health facilities or sites).Among the 73 proposed indicators, 47 were selected as core indicators and 26 as additional indicators. Generally, there were no major issues in collecting the proposed indicators, except for those indicators that relied on death reviews or population-level data. Service availability and morbidity indicators were encouraged. Abortion and SGBV indicators were challenging to collect due to political and sociocultural reasons. The HIV and PMTCT indicators were considered as core indicators, despite potential sensitivity in some settings. Existing data collection and reporting systems across the four assessed humanitarian settings were generally fragmented and inconsistent, mainly attributed to the lack of coordination among different agencies.Implementing agencies need to collaborate effectively to scale up this agreed-upon set of SRMNCAH framework to enhance accountability and transparency in humanitarian settings.

Background: Stillbirths are a major public health issue and a sensitive marker of the quality of care around pregnancy and birth. The UN Global Strategy for Women’s, Children’s and Adolescents’ Health and the Every Newborn Action Plan (ENAP) call for ending preventable stillbirths. A first step to prevent stillbirths is obtaining standardized measurement of stillbirth levels and trends across countries. We estimated levels and trends in stillbirth rates at 28 weeks or more of gestation from 2000 to 2019 and assessed progress over time. Methods: Our dataset contained 2,800 country-year datapoints from 171 countries relevant to stillbirth rates, including data from registration systems, household-based surveys and population-based studies. We estimated country-specific stillbirth rates for all countries from 2000 to 2019 using a Bayesian hierarchical temporal sparse regression model. Our model combined covariates with a temporal smoothing process such that estimates were informed by data in country-periods with high-quality data and covariate-based for country-periods with limited or no data on stillbirth rates. Bias and additional uncertainty associated with observations using alternative stillbirth definitions, source types and observations that were subject to non-sampling errors were included in the model. Results: In 2019, an estimated 2.0 [90 percent uncertainty interval: 1.9, 2.2] million babies were stillborn at 28 weeks or more of gestation, with a global stillbirth rate of 13.9 [13.5, 15.4] stillbirths per 1,000 total births. Stillbirth rates varied widely across the world from 22.8 [19.8, 27.7] per 1,000 total births in West and Central Africa to 2.9 [2.7, 3.0] per 1,000 total births in Western Europe, with West and Central Africa, Eastern and Southern Africa and South Asia having the highest stillbirth rates in 2019. The global annual rate of reduction in the stillbirth rate was estimated at 2.3 [1.7, 2.7] per cent from 2000 to 2019, lower than the 2.9 [2.5, 3.2] percent reduction in the neonatal mortality rate and the 4.3 [3.8, 4.7] percent reduction in the mortality rate among children aged 1–59 months over the same period. Based on point estimates, 14 countries halved their stillbirth rate since 2000, and 115 countries reduced the stillbirth rate by more than 25 per cent. The remaining 80 countries for which we made estimates reduced their stillbirth rate by less than 25 percent since 2000, with the majority located in Sub-Saharan Africa. Interpretation: in reducing the stillbirth rate has been slow compared with declines in the mortality rate among children under 5 years of age. Accelerated improvements are most needed in the regions and countries with high stillbirth rates, particularly in sub-Saharan Africa where the increases in number of births has outpaced modest progress and declines in stillbirth rates, leading to a stagnation in the number of stillbirths since 2000. Increased efforts are needed to raise public awareness of stillbirths, to improve data collection and to prevent stillbirths. It’s not possible to assess progress going forward or understand public health priorities locally unless there is investment in gathering information about stillbirths. Funding Statement: UNICEF’s stillbirth estimation work was supported by the Bill & Melinda Gates Foundation (OPP1180460 OP190601 and INV-001395). We also acknowledge the Foreign, Commonwealth & Development Office (United Kingdom) for helping to initiate this work. Declaration of Interests: We declare that we have no conflicts of interest.

This study investigated the performance of community-based management of severe acute malnutrition (CMAM) within routine healthcare services in Ghana. This was a retrospective cohort study of n = 488 children (6-59 months) who had received CMAM. Data for recovery default and mortality rates were obtained from enrolment cards in 56 outpatient centers in Upper East region Ghana. Satisfactory rates of recovery of 71.8% were reported. Children who were enrolled with higher mid-upper arm circumference (MUAC) =11.5 cm had seven times greater chance of recovery compared with children who were enrolled with lower MUAC

Objective to conduct and describe results from a process evaluation of home-based life saving skills (HBLSS) one year post-implementation. Design a non-experimental, descriptive design was utilised employing both qualitative and quantitative techniques for data collection including: (1) key informant interviews, (2) group discussions, (3) performance testing, and (4) review of programme data. Setting rural Matlab, Bangladesh in the sub-district of Chandpur. Participants 41 community health research workers (CHRW), five pregnant women, 14 support persons and four programme co-ordinators. Intervention HBLSS is a family-centred approach to improving recognition of and referral for potentially life-threatening maternal and newborn complications. In June 2007, four HBLSS meetings were implemented in Matlab by 41 CHRW with all pregnant women in the study area. Measurements (1) knowledge retention among CHRW, (2) programme coverage, and (3) strengths and challenges in HBLSS implementation. Findings results revealed rapid integration of the programme into the Matlab community with nearly 4500 HBLSS contacts with 2409 pregnant women between 15 June 2007 and 31 March 2008. Over 51% of pregnant women attended all four HBLSS meetings. Knowledge testing of CHRW showed strong retention with an increase in mean scores between immediate post-training and one-year post-training (from 78.7% to 92.7% and from 77.8% to 97.7% for two different HBLSS modules). Strengths of the HBLSS programme include high satisfaction among pregnant women, dedication of CHRW to the community, and strong organisation and supervision by programme staff. Challenges include lack of involvement of men, loss of two master trainers, and limited access to comprehensive emergency obstetric care at some referral sites. Key conclusions the HBLSS programme was successfully implemented as a result of the high level of support and supervision by the maternal, newborn and child health staff at ICDDR,B. This evaluation highlights the value of community health workers in the fight against maternal and newborn mortality. Findings emphasise the strength of the HBLSS training approach in transferring knowledge from trainer to HBLSS guide.