127 results on '"Blencowe H"'
Search Results
2. Counting the smallest : data to estimate global stillbirth, preterm birth and low birthweight rates
- Author
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Blencowe, H. and Blencowe, H.
- Subjects
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.
- Published
- 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.
- Published
- 2018
- Full Text
- View/download PDF
4. The PRECISE-DYAD protocol : linking maternal and infant health trajectories in sub-Saharan Africa
- Author
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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
- Subjects
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.
- Published
- 2022
5. The effect of coverings, including plastic bags and wraps, on mortality and morbidity in preterm and full-term neonates
- Author
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Oatley, H K, Blencowe, H, and Lawn, J E
- Published
- 2016
- Full Text
- View/download PDF
6. Counting the smallest: data to estimate global stillbirth, preterm birth and low birthweight rates
- Author
-
Blencowe, H and Blencowe, H
- 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.
- Published
- 2020
- Full Text
- View/download PDF
7. Review: Addressing the challenge of neonatal mortality
- Author
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Blencowe, H. and Cousens, S.
- Published
- 2013
- Full Text
- View/download PDF
8. 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, 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.
- Published
- 2019
9. An overview of concepts and approaches used in estimating the burden of congenital disorders globally
- Author
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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
10. 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.
- Published
- 2016
11. Setting research priorities to improve global newborn health and prevent stillbirths by 2025
- Author
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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
12. Setting research priorities to improve global newborn health and prevent stillbirths by 2025
- Author
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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
- Subjects
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
13. 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
-
Seale, AC, Blencowe, H, Manu, AA, Nair, H, Bahl, R, Qazi, SA, Zaidi, AK, Berkley, JA, Cousens, SN, and Lawn, JE
- Subjects
Infectious Diseases - 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.
- Published
- 2014
14. 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
- Author
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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
- Subjects
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
15. 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
- Author
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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
- Subjects
SEXE ,MALADIE ,ENQUETE ,GROUPE D'AGE ,INVALIDITE ,SANTE PUBLIQUE ,MORBIDITE ,REPARTITION GEOGRAPHIQUE ,MODELISATION ,VARIATION PLURIANNUELLE ,PREVALENCE - Published
- 2012
16. Setting up Kangaroo Mother Care at Queen Elizabeth Hospital, Blantyre - A practical approach
- Author
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Blencowe, H and Molyneux, E
- Published
- 2005
17. Antibiotics for pre-term pre-labour rupture of membranes: prevention of neonatal deaths due to complications of pre-term birth and infection
- Author
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Cousens, S., primary, Blencowe, H., additional, Gravett, M., additional, and Lawn, J. E., additional
- Published
- 2010
- Full Text
- View/download PDF
18. Tetanus toxoid immunization to reduce mortality from neonatal tetanus
- Author
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Blencowe, H., primary, Lawn, J., additional, Vandelaer, J., additional, Roper, M., additional, and Cousens, S., additional
- Published
- 2010
- Full Text
- View/download PDF
19. Folic acid to reduce neonatal mortality from neural tube disorders
- Author
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Blencowe, H., primary, Cousens, S., additional, Modell, B., additional, and Lawn, J., additional
- Published
- 2010
- Full Text
- View/download PDF
20. Setting up kangaroo mother care at Queen Elizabeth Central Hospital, Blantyre - a practical approach
- Author
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Blencowe, H, primary and Molyneux, EM, additional
- Published
- 2005
- Full Text
- View/download PDF
21. The effect of coverings, including plastic bags and wraps, on mortality and morbidity in preterm and full-term neonates
- Author
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Oatley, HK, Blencowe, H, and Lawn, JE
- Abstract
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.
22. Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect
- Author
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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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23. 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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24. 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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25. 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.
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- 2022
26. 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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27. National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis
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Julia Krasevec, Luca Cegolon, Diana Estevez, Victoria Ponce Hardy, Chika Hayashi, Gretchen A Stevens, Joy E Lawn, Simon Cousens, Suhail Shiekh, Robert E. Black, Elaine Borghi, Hannah Blencowe, Mercedes de Onis, Xiaoyi An, Blencowe, H., Krasevec, J., de Onis, M., Black, R. E., An, X., Stevens, G. A., Borghi, E., Hayashi, C., Estevez, D., Cegolon, L., Shiekh, S., Ponce Hardy, V., Lawn, J. E., and Cousens, S.
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Databases, Factual ,030231 tropical medicine ,Population ,Global Health ,World health ,Article ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,Global health ,medicine ,Prevalence ,Birth Weight ,Humans ,030212 general & internal medicine ,education ,Baseline (configuration management) ,Investment fund ,education.field_of_study ,Likelihood Functions ,lcsh:Public aspects of medicine ,Infant, Newborn ,Regression analysis ,lcsh:RA1-1270 ,General Medicine ,Infant, Low Birth Weight ,Random effects model ,Health Surveys ,Nutrition Disorders ,Low birth weight ,Geography ,Regression Analysis ,medicine.symptom - Abstract
Summary Background Low birthweight (LBW) of less than 2500 g is an important marker of maternal and fetal health, predicting mortality, stunting, and adult-onset chronic conditions. Global nutrition targets set at the World Health Assembly in 2012 include an ambitious 30% reduction in LBW prevalence between 2012 and 2025. Estimates to track progress towards this target are lacking; with this analysis, we aim to assist in setting a baseline against which to assess progress towards the achievement of the World Health Assembly targets. Methods We sought to identify all available LBW input data for livebirths for the years 2000–16. We considered population-based national or nationally representative datasets for inclusion if they contained information on birthweight or LBW prevalence for livebirths. A new method for survey adjustment was developed and used. For 57 countries with higher quality time-series data, we smoothed country-reported trends in birthweight data by use of B-spline regression. For all other countries, we estimated LBW prevalence and trends by use of a restricted maximum likelihood approach with country-level random effects. Uncertainty ranges were obtained through bootstrapping. Results were summed at the regional and worldwide level. Findings We collated 1447 country-years of birthweight data (281 million births) for 148 countries of 195 UN member states (47 countries had no data meeting inclusion criteria). The estimated worldwide LBW prevalence in 2015 was 14·6% (uncertainty range [UR] 12·4–17·1) compared with 17·5% (14·1–21·3) in 2000 (average annual reduction rate [AARR] 1·23%). In 2015, an estimated 20·5 million (UR 17·4–24·0 million) livebirths were LBW, 91% from low-and-middle income countries, mainly southern Asia (48%) and sub-Saharan Africa (24%). Interpretation Although these estimates suggest some progress in reducing LBW between 2000 and 2015, achieving the 2·74% AARR required between 2012 and 2025 to meet the global nutrition target will require more than doubling progress, involving both improved measurement and programme investments to address the causes of LBW throughout the lifecycle. Funding Bill & Melinda Gates Foundation, The Children's Investment Fund Foundation, United Nations Children's Fund (UNICEF), and WHO.
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- 2018
28. 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.
29. 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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30. 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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31. 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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32. 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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33. 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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34. Psychosocial effects of adverse pregnancy outcomes and their influence on reporting pregnancy loss during surveys and surveillance: narratives from Uganda.
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Kwesiga D, Wanduru P, Eriksson L, Malqvist M, Waiswa P, and Blencowe H
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- Male, Infant, Newborn, Pregnancy, Female, Humans, Pregnancy Outcome, Stillbirth epidemiology, Cross-Sectional Studies, Uganda epidemiology, Surveys and Questionnaires, Abortion, Spontaneous epidemiology, Perinatal Death
- Abstract
Background: In 2021, Uganda had an estimated 25,855 stillbirths and 32,037 newborn deaths. Many Adverse Pregnancy Outcomes (APOs) go unreported despite causing profound grief and other mental health effects. This study explored psychosocial effects of APOs and their influence on reporting these events during surveys and surveillance settings in Uganda., Methods: A qualitative cross-sectional study was conducted in September 2021 in Iganga Mayuge health and demographic surveillance system site, eastern Uganda. Narratives were held with 44 women who had experienced an APO (miscarriage, stillbirth or neonatal death) and 7 men whose spouses had undergone the same. Respondents were purposively selected and the sample size premised on the need for diverse respondents. Reflexive thematic analysis was undertaken, supported by NVivo software., Results: 60.8% of respondents had experienced neonatal deaths, 27.4% stillbirths, 11.8% miscarriages and almost half had multiple APOs. Theme one on psychosocial effects showed that both women and men suffered disbelief, depression, shame and thoughts of self-harm. In theme two on reactions to interviews, most respondents were reminded about their loss. Indeed, some women cried and a few requested termination of the interview. However, many said they eventually felt better, especially where interviewers comforted and advised them. In theme three about why people consent to such interviews, it was due to the respondents' need for sensitization on causes of pregnancy loss and danger signs, plus the expectation that the interview would lead to improved health services. Theme four on suggestions for improving interviews highlighted respondents' requests for a comforting and encouraging approach by interviewers., Conclusion: Psychosocial effects of APOs may influence respondents' interest and ability to effectively engage in an interview. Findings suggest that a multi-pronged approach, including interviewer training in identifying and dealing responsively with grieving respondents, and meeting needs for health information and professional counselling could improve reporting of APOs in surveys and surveillance settings. More so, participants need to understand the purpose of the interview and have realistic expectations., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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35. Maternal mortality, stillbirths, and neonatal mortality: a transition model based on analyses of 151 countries.
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Boerma T, Campbell OMR, Amouzou A, Blumenberg C, Blencowe H, Moran A, Lawn JE, and Ikilezi G
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- Infant, Newborn, Adolescent, Humans, Female, Pregnancy, Maternal Mortality, Cesarean Section, Infant Mortality, Stillbirth epidemiology, Perinatal Death
- Abstract
Background: Maternal mortality, stillbirths, and neonatal mortality account for almost 5 million deaths a year and are often analysed separately, despite having overlapping causes and interventions. We propose a comprehensive five-phase mortality transition model to improve analyses of progress and inform strategic planning., Methods: In this empirical data-driven study to develop a model transition, we used UN estimates for 151 countries to assess changes in maternal mortality, stillbirths, and neonatal deaths. On the basis of ratios of maternal to stillbirth and neonatal mortality, we identified five phases of transition, in which phase 1 has the highest mortality and phase 5 has the lowest. We used global databases to examine phase-specific characteristics during 2000-20 for causes of death, fertility rates, abortion policies, health workforce and financing, and socioeconomic indicators. We analysed 326 national surveys to assess service coverage and inequalities by transition phase., Findings: Among 116 countries in phases 1 to 4 in 2000, 73 (63%) progressed at least one phase by 2020, six advanced two phases, and three regressed. The ratio of stillbirth and neonatal deaths to maternal deaths increased from less than 10 in phase 1 to well over 50 in phase 4 and phase 5. Progression was associated with a declining proportion of deaths caused by infectious diseases and peripartum complications, declining total and adolescent fertility rates, changes in health-workforce densities and skills mix (ie, ratio of nurses or midwives to physicians) from phase 3 onwards, increasing per-capita health spending, and reducing shares of out-of-pocket health expenditures. From phase 1 to 5, the median coverage of first antenatal care visits increased from 66% to 98%, four or more antenatal care visits from 44% to 94%, institutional births from 36% to 99%, and caesarean section rates from 2% to 25%. The transition out of high-mortality phases involved a major increase in institutional births, primarily in lower-level health facilities, whereas subsequent progress was characterised by rapid increases in hospital births. Wealth-related inequalities reduced strongly for institutional birth coverage from phase 3 onwards., Interpretation: The five-phase maternal mortality, stillbirth, and neonatal mortality transition model can be used to benchmark the current indicators in comparison to typical patterns in the transition at national or sub-national level, identify outliers to better assess drivers of progress, and inform strategic planning and investments towards Sustainable Development Goal targets. It can also facilitate programming for integrated strategies to end preventable maternal mortality and neonatal mortality and stillbirths., Funding: Bill & Melinda Gates Foundation., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
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- 2023
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36. Ending preventable stillbirths and improving bereavement care: a scorecard for high- and upper-middle income countries.
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de Graaff EC, Leisher SH, Blencowe H, Lawford H, Cassidy J, Cassidy PR, Draper ES, Heazell AEP, Kinney M, Quigley P, Ravaldi C, Storey C, Vannacci A, and Flenady V
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- Female, Humans, Pregnancy, Developing Countries, Risk Factors, Stillbirth epidemiology, Bereavement
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Background: Despite progress, stillbirth rates in many high- and upper-middle income countries remain high, and the majority of these deaths are preventable. We introduce the Ending Preventable Stillbirths (EPS) Scorecard for High- and Upper Middle-Income Countries, a tool to track progress against the Lancet's 2016 EPS Series Call to Action, fostering transparency, consistency and accountability., Methods: The Scorecard for EPS in High- and Upper-Middle Income Countries was adapted from the Scorecard for EPS in Low-Income Countries, which includes 20 indicators to track progress against the eight Call to Action targets. The Scorecard for High- and Upper-Middle Income Countries includes 23 indicators tracking progress against these same Call to Action targets. For this inaugural version of the Scorecard, 13 high- and upper-middle income countries supplied data. Data were collated and compared between and within countries., Results: Data were complete for 15 of 23 indicators (65%). Five key issues were identified: (1) there is wide variation in stillbirth rates and related perinatal outcomes, (2) definitions of stillbirth and related perinatal outcomes vary widely across countries, (3) data on key risk factors for stillbirth are often missing and equity is not consistently tracked, (4) most countries lack guidelines and targets for critical areas for stillbirth prevention and care after stillbirth and have not set a national stillbirth rate target, and (5) most countries do not have mechanisms in place for reduction of stigma or guidelines around bereavement care., Conclusions: This inaugural version of the Scorecard for High- and Upper-Middle Income Countries highlights important gaps in performance indicators for stillbirth both between and within countries. The Scorecard provides a basis for future assessment of progress and can be used to help hold individual countries accountable, especially for reducing stillbirth inequities in disadvantaged groups., (© 2023. The Author(s).)
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- 2023
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37. Systematic estimates of the global, regional and national under-5 mortality burden attributable to birth defects in 2000-2019: a summary of findings from the 2020 WHO estimates.
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Perin J, Mai CT, De Costa A, Strong K, Diaz T, Blencowe H, Berry RJ, Williams JL, and Liu L
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- Humans, World Health Organization, Infant, Child, Preschool, Infant, Newborn, Global Burden of Disease, Global Health statistics & numerical data, Congenital Abnormalities mortality
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Objectives: To examine the potential for bias in the estimate of under-5 mortality due to birth defects recently produced by the WHO and the Maternal and Child Epidemiology Estimation research group., Design: Systematic analysis., Methods: We examined the estimated number of under-5 deaths due to birth defects, the birth defect specific under-5 mortality rate, and the per cent of under-5 mortality due to birth defects, by geographic region, national income and under-5 mortality rate for three age groups from 2000 to 2019., Results: The under-5 deaths per 1000 live births from birth defects fell from 3.4 (95% uncertainty interval (UI) 3.1-3.8) in 2000 to 2.9 (UI 2.6-3.3) in 2019. The per cent of all under-5 mortality attributable to birth defects increased from 4.6% (UI 4.1%-5.1%) in 2000 to 7.6% (UI 6.9%-8.6%) in 2019. There is significant variability in mortality due to birth defects by national income level. In 2019, the under-5 mortality rate due to birth defects was less in high-income countries than in low-income and middle-income countries, 1.3 (UI 1.2-1.3) and 3.0 (UI 2.8-3.4) per 1000 live births, respectively. These mortality rates correspond to 27.7% (UI 26.6%-28.8%) of all under-5 mortality in high-income countries being due to birth defects, and 7.4% (UI 6.7%-8.2%) in low-income and middle-income countries., Conclusions: While the under-5 mortality due to birth defects is declining, the per cent of under-5 mortality attributable to birth defects has increased, with significant variability across regions globally. The estimates in low-income and middle-income countries are likely underestimated due to the nature of the WHO estimates, which are based in part on verbal autopsy studies and should be taken as a minimum estimate. Given these limitations, comprehensive and systematic estimates of the mortality burden due to birth defects are needed to estimate the actual burden., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)
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- 2023
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38. Global Stillbirth Policy Review - Outcomes And Implications Ahead of the 2030 Sustainable Development Goal Agenda.
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Mensah Abrampah NA, Okwaraji YB, You D, Hug L, Maswime S, Pule C, Blencowe H, and Jackson D
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- Humans, Infant, Newborn, Infant Mortality, Policy, Stillbirth epidemiology, Sustainable Development
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Background: Globally, data on stillbirth is limited. A call to action has been issued to governments to address the data gap by strengthening national policies and strategies to drive urgent action on stillbirth reduction. This study aims to understand the policy environment for stillbirths to advance stillbirth recording and reporting in data systems., Methods: A systematic three-step process (survey tool examination, identifying relevant study questions, and reviewing country responses to the survey and national documents) was taken to review country responses to the global 2018-2019 World Health Organization (WHO) Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) Policy Survey. Policy Survey responses were reviewed to identify if and how stillbirths were included in national documents. This paper uses descriptive analyses to identify and describe the relationship between multiple variables., Results: Responses from 155 countries to the survey were analysed, and over 800 national policy documents submitted by countries in English reviewed. Fewer than one-fifth of countries have an established stillbirth rate (SBR) target, with higher percentages reported for under-5 (71.0%) and neonatal mortality (68.5%). Two-thirds (65.8%) of countries reported a national maternal death review panel. Less than half (43.9%) of countries have a national policy that requires stillbirths to be reviewed. Two-thirds of countries have a national policy requiring review of neonatal deaths. WHO websites and national health statistics reports are the common data sources for stillbirth estimates. Countries that are signatories to global initiatives on stillbirth reduction have established national targets. Globally, nearly all countries (94.8%) have a national policy that requires every death to be registered. However, 45.5% of reviewed national policy documents made mention of registering stillbirths. Only 5 countries had national policy documents recommending training of health workers in filling out death certificates using the International Classification of Diseases (ICD)-10 for stillbirths., Conclusion: The current policy environment in countries is not supportive for identifying stillbirths and recording causes of death. This is likely to contribute to slow progress in stillbirth reduction. The paper proposes policy recommendations to make every baby count., (© 2023 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)
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- 2023
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39. Impact of secondary and tertiary neonatal interventions on neonatal mortality in a low- resource limited setting hospital in Uganda: a retrospective study.
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Kirabira VN, Nakaggwa F, Nazziwa R, Nalunga S, Nasiima R, Nyagabyaki C, Sebunya R, Latigi G, Pirio P, Ahmadzai M, Ojom L, Nabwami I, Burgoine K, and Blencowe H
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- Asphyxia, Female, Hospitals, Humans, Infant Mortality, Infant, Newborn, Pregnancy, Retrospective Studies, Uganda epidemiology, Asphyxia Neonatorum, Infant, Newborn, Diseases, Sepsis
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Objective: To assess the impact of secondary and tertiary level neonatal interventions on neonatal mortality over a period of 11 years., Design: Interrupted time series analysis., Setting: Nsambya Hospital, Uganda., Interventions: Neonatal secondary interventions (phase I, 2007-2014) and tertiary level interventions (phase II, 2015-2020)., Participants: Neonates., Primary and Secondary Outcome Measures: Primary outcome: neonatal mortality., Secondary Outcome: case fatality rate (CFR) for prematurity, neonatal sepsis and asphyxia., Results: During the study period, a total of 25 316 neonates were admitted, of which 1853 (7.3%) died. The average inpatient mortality reduced from 8.2% during phase I to 5.7% during phase II (p=0.001). The CFR for prematurity reduced from 16.2% to 9.2% (p=0.001). There was a trend in reduction for the CFR of perinatal asphyxia from 14.9% to 13.0% (p=0.34). The CFR for sepsis had a more than a twofold increase (3%-6.8% p=0.001) between phase I and phase II., Conclusion: Implementation of secondary and tertiary neonatal care in resource-limited settings is feasible. This study shows that these interventions can significantly reduce the neonatal mortality, with the largest impact seen in the reduction of deaths from perinatal asphyxia and prematurity. An increase in sepsis related deaths was observed, suggesting emphasis on infection control is key., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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40. Study protocol for UNICEF and WHO estimates of global, regional, and national low birthweight prevalence for 2000 to 2020.
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Krasevec J, Blencowe H, Coffey C, Okwaraji YB, Estevez D, Stevens GA, Ohuma EO, Conkle J, Gatica-Domínguez G, Bradley E, Muthamia BK, Dalmiya N, Lawn JE, Borghi E, and Hayashi C
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Background Reducing low birthweight (LBW, weight at birth less than 2,500g) prevalence by at least 30% between 2012 and 2025 is a target endorsed by the World Health Assembly that can contribute to achieving Sustainable Development Goal 2 (Zero Hunger) by 2030. The 2019 LBW estimates indicated a global prevalence of 14.6% (20.5 million newborns) in 2015. We aim to develop updated LBW estimates at global, regional, and national levels for up to 202 countries for the period of 2000 to 2020. Methods Two types of sources for LBW data will be sought: national administrative data and population-based surveys. Administrative data will be searched for countries with a facility birth rate ≥80% and included when birthweight data account for ≥80% of UN estimated live births for that country and year. Surveys with birthweight data published since release of the 2019 edition of the LBW estimates will be adjusted using the standard methodology applied for the previous estimates. Risk of bias assessments will be undertaken. Covariates will be selected based on a conceptual framework of plausible associations with LBW, covariate time-series data quality, collinearity between covariates and correlations with LBW. National LBW prevalence will be estimated using a Bayesian multilevel-mixed regression model, then aggregated to derive regional and global estimates through population-weighted averages. Conclusion Whilst availability of LBW data has increased, especially with more facility births, gaps remain in the quantity and quality of data, particularly in low-and middle-income countries. Challenges include high percentages of missing data, lack of adherence to reporting standards, inaccurate measurement, and data heaping. Updated LBW estimates are important to highlight the global burden of LBW, track progress towards nutrition targets, and inform investments in programmes. Reliable, nationally representative data are key, alongside investments to improve the measurement and recording of an accurate birthweight for every baby., Competing Interests: No competing interests were disclosed., (Copyright: © 2022 Krasevec J et al.)
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- 2022
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41. Zooming in and out: a holistic framework for research on maternal, late foetal and newborn survival and health.
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Singh NS, Blanchard AK, Blencowe H, Koon AD, Boerma T, Sharma S, and Campbell OMR
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- Female, Humans, Infant, Newborn, Maternal Health, Infant Health, Infant Mortality
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Research is needed to understand why some countries succeed in greater improvements in maternal, late foetal and newborn health (MNH) and reducing mortality than others. Pathways towards these health outcomes operate at many levels, making it difficult to understand which factors contribute most to these health improvements. Conceptual frameworks provide a cognitive means of rendering order to these factors and how they interrelate to positively influence MNH. We developed a conceptual framework by integrating theories and frameworks from different disciplines to encapsulate the range of factors that explain reductions in maternal, late foetal and neonatal mortality and improvements in health. We developed our framework iteratively, combining our interdisciplinary research team's knowledge, experience and review of the literature. We present a framework that includes health policy and system levers (or intentional actions that policy-makers can implement) to improve MNH; service delivery and coverage of interventions across the continuum of care; and epidemiological and behavioural risk factors. The framework also considers the role of context in influencing for whom and where health and non-health efforts have the most impact, to recognize 'the causes of the causes' at play at the individual/household, community, national and transnational levels. Our framework holistically reflects the range of interrelated factors influencing improved MNH and survival. The framework lends itself to studying how different factors work together to influence these outcomes using an array of methods. Such research should inform future efforts to improve MNH and survival in different contexts. By re-orienting research in this way, we hope to equip policy-makers and practitioners alike with the insight necessary to make the world a safer and fairer place for mothers and their babies., (© The Author(s) 2021. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)
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- 2022
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42. Adverse pregnancy outcome disclosure and women's social networks: a qualitative multi-country study with implications for improved reporting in surveys.
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Kwesiga D, Eriksson L, Orach CG, Tawiah C, Imam MA, Fisker AB, Enuameh Y, Lawn JE, Blencowe H, Waiswa P, Bradby H, and Malqvist M
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- Adolescent, Adult, Female, Humans, Infant, Newborn, Male, Middle Aged, Pregnancy, Qualitative Research, Social Networking, Surveys and Questionnaires, Young Adult, Disclosure, Pregnancy Outcome
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Background: Globally, approximately 6,700 newborn deaths and 5,400 stillbirths occur daily. The true figure is likely higher, with under reporting of adverse pregnancy outcomes (APOs) noted. Decision-making in health is influenced by various factors, including one's social networks. We sought to understand APOs disclosure within social networks in Uganda, Ghana, Guinea-Bissau and Bangladesh and how this could improve formal reporting of APOs in surveys. METHODS: A qualitative, exploratory multi-country study was conducted within four health and demographic surveillance system sites. 16 focus group discussions were held with 147 women aged 15-49 years, who had participated in a recent household survey. Thematic analysis, with both deductive and inductive elements, using three pre-defined themes of Sender, Message and Receiver was done using NVivo software., Results: Disclosure of APOs was a community concern, with news often shared with people around the bereaved for different reasons, including making sense of what happened and decision-making roles of receivers. Social networks responded with comfort, providing emotional, in-kind and financial support. Key decision makers included men, spiritual and traditional leaders. Non-disclosure was usually to avoid rumors in cases of induced abortions, or after a previous bad experience with health workers, who were frequently excluded from disclosure, except for instances where a woman sought advice on APOs., Conclusions: Communities must understand why they should report APOs and to whom. Efforts to improve APOs reporting could be guided by diffusion of innovation theory, for instance for community entry and sensitization before the survey, since it highlights how information can be disseminated through community role models. In this case, these gatekeepers we identified could promote reporting of APOs. The stage at which a person is in decision-making, what kind of adopter they are and their take on the benefits and other attributes of reporting are important. In moving beyond survey reporting to getting better routine data, the theory would be applicable too. Health workers should demonstrate a more comforting and supportive response to APOs as the social networks do, which could encourage more bereaved women to inform them and seek care., (© 2022. The Author(s).)
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- 2022
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43. Risk of mortality for small newborns in Brazil, 2011-2018: A national birth cohort study of 17.6 million records from routine register-based linked data.
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Paixao ES, Blencowe H, Falcao IR, Ohuma EO, Rocha ADS, Alves FJO, Costa MDCN, Suárez-Idueta L, Ortelan N, Smeeth L, Rodrigues LC, Lawn JE, de Almeida MF, Ichihara MY, Silva RCR, Teixeira MG, and Barreto ML
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Background: Preterm birth (<37 weeks), low birth weight (LBW,<2500g), and small for gestational age (SGA,<10th centile of birth weight for gestational age and sex) are markers of newborn vulnerability with a high risk of mortality. We estimated the prevalence of phenotypes combining these three markers and quantified the mortality risk associated with them., Methods: Population-based cohort study using routine register-based linked data on all births and deaths in Brazil from January 1, 2011, to December 31, 2018. We estimated the prevalence of preterm, LBW, and SGA individually and for phenotypes combining these characteristics. The mortality risk associated with each phenotype: early neonatal, late neonatal, neonatal, post-neonatal, infant, 1-4 years, and under five years was quantified using mortality rates and hazard ratios (HRs) with 95% confidence interval (CI) were estimated using Cox proportional hazard models., Findings: 17,646,115 live births were included. Prevalence of preterm birth, LBW and SGA were 9.4%, 9.6% and 9.2%, respectively. Neonatal mortality risk was 16-fold (HR=15.9; 95% CI:15.7-16.1) higher for preterm compared to term, 3 times higher (HR=3.4; (95% CI:3.3-3.4) for SGA compared to adequate for gestational age (AGA), and >25 times higher for LBW (HR=25.8; (95% CI:25.5-26.1) compared to normal birth weight (NBW). 18% of all live births were included in one of the small vulnerable newborn phenotypes. Of those 8.2% were term-SGA (4.7%NBW, 3.5%LBW), 0.6% were term-AGA-LBW, 8.3% preterm-AGA (3.8%NBW, 4.5%LBW) and 1.0% preterm-SGA-LBW. Compared to term-AGA-NBW, the highest mortality risk was for preterm-LBW phenotypes (HR=36.2(95%CI 35.6-36.8) preterm-AGA-LBW, HR=62.0(95%CI 60.8-63.2) preterm-SGA-LBW). The increased mortality risk associated with vulnerable newborn phenotypes was highest in the first month of life, with attenuated but continued high risk in the post-neonatal period and 1-4 years of age., Interpretation: Our findings support the value of using more detailed phenotypes to identify those at highest risk. More granular data can inform care at the individual level, advance research, especially for prevention, and accelerate progress towards global targets such as the Sustainable Development Goals., Funding: Wellcome Trust., Competing Interests: We declare no competing interests. This research was funded in part by the Wellcome Trust. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission., (© 2021 The Author(s).)
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- 2021
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44. Study protocol for WHO and UNICEF estimates of global, regional, and national preterm birth rates for 2010 to 2019.
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De Costa A, Moller AB, Blencowe H, Johansson EW, Hussain-Alkhateeb L, Ohuma EO, Okwaraji YB, Cresswell J, Requejo JH, Bahl R, Oladapo OT, Lawn JE, and Moran AC
- Subjects
- Bayes Theorem, Bias, Databases, Factual, Epidemiologic Studies, Female, Gestational Age, Global Health, Humans, Infant, Newborn, Infant, Premature, Pregnancy, Systematic Reviews as Topic, United Nations, World Health Organization, Medical Records standards, Premature Birth epidemiology
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Background: Preterm birth is a leading cause of death among children under five years. Previous estimates indicated global preterm birth rate of 10.6% (14.8 million neonates) in 2014. We aim to update preterm birth estimates at global, regional, and national levels for the period 2010 to 2019., Methods: Preterm birth is defined as a live birth occurring before 37 completed gestational weeks, or <259 days since a woman's last menstrual period. National administrative data sources for WHO Member States with facility birth rates of ≥80% in the most recent year for which data is available will be searched. Administrative data identified for these countries will be considered if ≥80% of UN estimated live births include gestational age information to define preterm birth. For countries without eligible administrative data, a systematic review of studies will be conducted. Research studies will be eligible if the reported outcome is derived from an observational or intervention study conducted at national or sub-national level in population- or facility-based settings. Risk of bias assessments will focus on gestational age measurement method and coverage, and inclusion of special subgroups in published estimates. Covariates for inclusion will be selected a priori based on a conceptual framework of plausible associations with preterm birth, data availability, and quality of covariate data across many countries and years. Global, regional and national preterm birth rates will be estimated using a Bayesian multilevel-mixed regression model., Discussion: Accurate measurement of preterm birth is challenging in many countries given incomplete or unavailable data from national administrative sources, compounded by limited gestational age assessment during pregnancy to define preterm birth. Up-to-date modelled estimates will be an important resource to measure the global burden of preterm birth and to inform policies and programs especially in settings with a high burden of neonatal mortality., Trial Registration: PROSPERO registration: CRD42021237861., Competing Interests: The authors have declared that no competing interests exist.
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- 2021
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45. Galvanizing Collective Action to Accelerate Reductions in Maternal and Newborn Mortality and Prevention of Stillbirths.
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Gibson A, Noguchi L, Kinney MV, Blencowe H, Freedman L, Mofokeng T, Chopra M, Dube Q, Ntirushwa D, Nguku A, Banerjee A, Rajbhandari S, Galadanci H, Baye ML, Zyaee P, Tadesse L, Eltayeb D, Gogoi A, Arifeen SE, Sow S, and Kuma-Aboagye P
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- Female, Humans, Infant, Newborn, Maternal Mortality, Pregnancy, Infant Mortality, Stillbirth epidemiology
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- 2021
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46. Birthweight measurement processes and perceived value: qualitative research in one EN-BIRTH study hospital in Tanzania.
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Gladstone ME, Salim N, Ogillo K, Shamba D, Gore-Langton GR, Day LT, Blencowe H, and Lawn JE
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- Adult, Data Accuracy, Female, Gestational Age, Health Information Systems statistics & numerical data, Health Knowledge, Attitudes, Practice, Hospitals statistics & numerical data, Humans, Infant, Newborn, Middle Aged, Pregnancy, Professional Practice Gaps statistics & numerical data, Qualitative Research, Tanzania, Time Factors, Young Adult, Birth Weight, Infant, Low Birth Weight, Perinatal Care organization & administration, Weights and Measures instrumentation
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Background: Globally an estimated 20.5 million liveborn babies are low birthweight (LBW) each year, weighing less than 2500 g. LBW babies have increased risk of mortality even beyond the neonatal period, with an ongoing risk of stunting and non-communicable diseases. LBW is a priority global health indicator. Now almost 80% of births are in facilities, yet birthweight data are lacking in most high-mortality burden countries and are of poor quality, notably with heaping especially on values ending in 00. We aimed to undertake qualitative research in a regional hospital in Dar es Salaam, Tanzania, observing birthweight weighing scales, exploring barriers and enablers to weighing at birth as well as perceived value of birthweight data to health workers, women and stakeholders., Methods: Observations were undertaken on type of birthweight scale availability in hospital wards. In-depth semi-structured interviews (n = 21) were conducted with three groups: women in postnatal and kangaroo mother care wards, health workers involved in birthweight measurement and recording, and stakeholders involved in data aggregation in Temeke Hospital, Tanzania, a site in the EN-BIRTH study. An inductive thematic analysis was undertaken of translated interview transcripts., Results: Of five wards that were expected to have scales, three had functional scales, and only one of the functional scales was digital. The labour ward weighed the most newborns using an analogue scale that was not consistently zeroed. Hospital birthweight data were aggregated monthly for reporting into the health management information system. Birthweight measurement was highly valued by all respondents, notably families and healthcare workers, and local use of data was considered an enabler. Perceived barriers to high quality birthweight data included: gaps in availability of precise weighing devices, adequate health workers and imprecise measurement practices., Conclusion: Birthweight measurement is valued by families and health workers. There are opportunities to close the gap between the percentage of babies born in facilities and the percentage accurately weighed at birth by providing accurate scales, improving skills training and increasing local use of data. More accurate birthweight data are vitally important for all babies and specifically to track progress in preventing and improving immediate and long-term care for low birthweight children.
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- 2021
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47. Survey of women's report for 33 maternal and newborn indicators: EN-BIRTH multi-country validation study.
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Ameen S, Siddique AB, Peven K, Rahman QS, Day LT, Shabani J, Kc A, Boggs D, Shamba D, Tahsina T, Rahman AE, Zaman SB, Hossain AT, Ahmed A, Basnet O, Malla H, Ruysen H, Blencowe H, Arnold F, Requejo J, Arifeen SE, and Lawn JE
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- Adult, Bangladesh, Female, Humans, Infant, Newborn, Nepal, Perinatal Care organization & administration, Pregnancy, Tanzania, Data Accuracy, Health Surveys statistics & numerical data, Perinatal Care statistics & numerical data, Quality Indicators, Health Care statistics & numerical data
- Abstract
Background: Population-based household surveys, notably the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), remain the main source of maternal and newborn health data for many low- and middle-income countries. As part of the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study, this paper focuses on testing validity of measurement of maternal and newborn indicators around the time of birth (intrapartum and postnatal) in survey-report., Methods: EN-BIRTH was an observational study testing the validity of measurement for selected maternal and newborn indicators in five secondary/tertiary hospitals in Bangladesh, Nepal and Tanzania, conducted from July 2017 to July 2018. We compared women's report at exit survey with the gold standard of direct observation or verification from clinical records for women with vaginal births. Population-level validity was assessed by validity ratios (survey-reported coverage: observer-assessed coverage). Individual-level accuracy was assessed by sensitivity, specificity and percent agreement. We tested indicators already in DHS/MICS as well as indicators with potential to be included in population-based surveys, notably the first validation for small and sick newborn care indicators., Results: 33 maternal and newborn indicators were evaluated. Amongst nine indicators already present in DHS/MICS, validity ratios for baby dried or wiped, birthweight measured, low birthweight, and sex of baby (female) were between 0.90-1.10. Instrumental birth, skin-to-skin contact, and early initiation of breastfeeding were highly overestimated by survey-report (2.04-4.83) while umbilical cord care indicators were massively underestimated (0.14-0.22). Amongst 24 indicators not currently in DHS/MICS, two newborn contact indicators (kangaroo mother care 1.00, admission to neonatal unit 1.01) had high survey-reported coverage amongst admitted newborns and high sensitivity. The remaining indicators did not perform well and some had very high "don't know" responses., Conclusions: Our study revealed low validity for collecting many maternal and newborn indicators through an exit survey instrument, even with short recall periods among women with vaginal births. Household surveys are already at risk of overload, and some specific clinical care indicators do not perform well and may be under-powered. Given that approximately 80% of births worldwide occur in facilities, routine registers should also be explored to track coverage of key maternal and newborn health interventions, particularly for clinical care.
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- 2021
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48. Birthweight: EN-BIRTH multi-country validation study.
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Kong S, Day LT, Zaman SB, Peven K, Salim N, Sunny AK, Shamba D, Rahman QS, K C A, Ruysen H, El Arifeen S, Mee P, Gladstone ME, Blencowe H, and Lawn JE
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- Adult, Bangladesh epidemiology, Female, Hospitals statistics & numerical data, Humans, Infant, Newborn, Middle Aged, Nepal epidemiology, Pregnancy, Prevalence, Qualitative Research, Registries statistics & numerical data, Sensitivity and Specificity, Stillbirth, Surveys and Questionnaires statistics & numerical data, Tanzania epidemiology, Time Factors, Young Adult, Birth Weight, Data Accuracy, Infant, Low Birth Weight, Perinatal Care organization & administration, Quality Indicators, Health Care statistics & numerical data
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Background: Accurate birthweight is critical to inform clinical care at the individual level and tracking progress towards national/global targets at the population level. Low birthweight (LBW) < 2500 g affects over 20.5 million newborns annually. However, data are lacking and may be affected by heaping. This paper evaluates birthweight measurement within the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study., Methods: The EN-BIRTH study took place in five hospitals in Bangladesh, Nepal and Tanzania (2017-2018). Clinical observers collected time-stamped data (gold standard) for weighing at birth. We compared accuracy for two data sources: routine hospital registers and women's report at exit interview survey. We calculated absolute differences and individual-level validation metrics. We analysed birthweight coverage and quality gaps including timing and heaping. Qualitative data explored barriers and enablers for routine register data recording., Results: Among 23,471 observed births, 98.8% were weighed. Exit interview survey-reported weighing coverage was 94.3% (90.2-97.3%), sensitivity 95.0% (91.3-97.8%). Register-reported coverage was 96.6% (93.2-98.9%), sensitivity 97.1% (94.3-99%). Routine registers were complete (> 98% for four hospitals) and legible > 99.9%. Weighing of stillbirths varied by hospital, ranging from 12.5-89.0%. Observed LBW rate was 15.6%; survey-reported rate 14.3% (8.9-20.9%), sensitivity 82.9% (75.1-89.4%), specificity 96.1% (93.5-98.5%); register-recorded rate 14.9%, sensitivity 90.8% (85.9-94.8%), specificity 98.5% (98-99.0%). In surveys, "don't know" responses for birthweight measured were 4.7%, and 2.9% for knowing the actual weight. 95.9% of observed babies were weighed within 1 h of birth, only 14.7% with a digital scale. Weight heaping indices were around two-fold lower using digital scales compared to analogue. Observed heaping was almost 5% higher for births during the night than day. Survey-report further increased observed birthweight heaping, especially for LBW babies. Enablers to register birthweight measurement in qualitative interviews included digital scale availability and adequate staffing., Conclusions: Hospital registers captured birthweight and LBW prevalence more accurately than women's survey report. Even in large hospitals, digital scales were not always available and stillborn babies not always weighed. Birthweight data are being captured in hospitals and investment is required to further improve data quality, researching of data flow in routine systems and use of data at every level.
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- 2021
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49. Stillbirths including intrapartum timing: EN-BIRTH multi-country validation study.
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Peven K, Day LT, Ruysen H, Tahsina T, Kc A, Shabani J, Kong S, Ameen S, Basnet O, Haider R, Rahman QS, Blencowe H, and Lawn JE
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- Adolescent, Adult, Bangladesh epidemiology, Female, Gestational Age, Humans, Infant, Newborn, Live Birth, Nepal epidemiology, Pregnancy, Sensitivity and Specificity, Tanzania epidemiology, Young Adult, Data Accuracy, Hospitals statistics & numerical data, Registries statistics & numerical data, Stillbirth
- Abstract
Background: An estimated >2 million babies stillborn around the world each year lack visibility. Low- and middle-income countries carry 84% of the burden yet have the least data. Most births are now in facilities, hence routine register-recording presents an opportunity to improve counting of stillbirths, but research is limited, particularly regarding accuracy. This paper evaluates register-recorded measurement of hospital stillbirths, classification accuracy, and barriers and enablers to routine recording., Methods: The EN-BIRTH mixed-methods, observational study took place in five hospitals in Bangladesh, Nepal and Tanzania (2017-2018). Clinical observers collected time-stamped data on perinatal care and birth outcomes as gold standard. To assess accuracy of routine register-recorded stillbirth rates, we compared birth outcomes recorded in labour ward registers to observation data. We calculated absolute rate differences and individual-level validation metrics (sensitivity, specificity, percent agreement). We assessed misclassification of stillbirths with neonatal deaths. To examine stillbirth appearance (fresh/macerated) as a proxy for timing of death, we compared appearance to observed timing of intrauterine death based on heart rate at admission., Results: 23,072 births were observed including 550 stillbirths. Register-recorded completeness of birth outcomes was > 90%. The observed study stillbirth rate ranged from 3.8 (95%CI = 2.0,7.0) to 50.3 (95%CI = 43.6,58.0)/1000 total births and was under-estimated in routine registers by 1.1 to 7.3 /1000 total births (register: observed ratio 0.9-0.7). Specificity of register-recorded birth outcomes was > 99% and sensitivity varied between hospitals, ranging from 77.7-86.1%. Percent agreement between observer-assessed birth outcome and register-recorded birth outcome was very high across all hospitals and all modes of birth (> 98%). Fresh or macerated stillbirth appearance was a poor proxy for timing of stillbirth. While there were similar numbers of stillbirths misclassified as neonatal deaths (17/430) and neonatal deaths misclassified as stillbirths (21/36), neonatal deaths were proportionately more likely to be misclassified as stillbirths (58.3% vs 4.0%). Enablers to more accurate register-recording of birth outcome included supervision and data use., Conclusions: Our results show these routine registers accurately recorded stillbirths. Fresh/macerated appearance was a poor proxy for intrapartum stillbirths, hence more focus on measuring fetal heart rate is crucial to classification and importantly reduction in these preventable deaths.
- Published
- 2021
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50. Parent mediated intervention programmes for children and adolescents with neurodevelopmental disorders in South Asia: A systematic review.
- Author
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Koly KN, Martin-Herz SP, Islam MS, Sharmin N, Blencowe H, and Naheed A
- Subjects
- Activities of Daily Living psychology, Adolescent, Asia epidemiology, Attention Deficit Disorder with Hyperactivity therapy, Autism Spectrum Disorder therapy, Cerebral Palsy therapy, Child, Child, Preschool, Communication, Female, Humans, Infant, Intellectual Disability therapy, Male, Parent-Child Relations, Social Skills, Early Medical Intervention methods, Neurodevelopmental Disorders therapy, Parents psychology
- Abstract
Objective: Parent-mediated programmes have been found to be cost effective for addressing the needs of the children and adolescents with Neurodevelopmental Disorders (NDD) in high-income countries. We explored the impact of parent-mediated intervention programmes in South Asia, where the burden of NDD is high., Methods: A systematic review was conducted using the following databases; PUBMED, MEDLINE, PsycINFO, Google Scholar and Web of Science. Predefined MeSH terms were used, and articles were included if published prior to January 2020. Two independent researchers screened the articles and reviewed data., Outcomes Measures: The review included studies that targeted children and adolescents between 1 and 18 years of age diagnosed with any of four specific NDDs that are commonly reported in South Asia; Autism Spectrum Disorder (ASD), Intellectual Disability (ID), Attention Deficit Hyperactivity Disorder (ADHD) and Cerebral Palsy (CP). Studies that reported on parent or child outcomes, parent-child interaction, parent knowledge of NDDs, or child activities of daily living were included for full text review., Results: A total of 1585 research articles were retrieved and 23 studies met inclusion criteria, including 9 Randomized Controlled Trials and 14 pre-post intervention studies. Of these, seventeen studies reported effectiveness, and six studies reported feasibility and acceptability of the parent-mediated interventions. Three studies demonstrated improved parent-child interaction, three studies demonstrated improved child communication initiations, five studies reported improved social and communication skills in children, four studies demonstrated improved parental knowledge about how to teach their children, and four studies reported improved motor and cognitive skills, social skills, language development, learning ability, or academic performance in children., Conclusion: This systematic review of 23 studies demonstrated improvements in parent and child skills following parent-mediated intervention in South Asia. Additional evaluations of locally customized parent-mediated programmes are needed to support development of feasible interventions for South Asian countries., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2021
- Full Text
- View/download PDF
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