64 results on '"Kerber, K."'
Search Results
2. Orts- und temperaturabhängige Wärmeübergangskoeffizienten bei der Sprühkühlung von AlSi10Mg-Gussplatten
- Author
-
Rodman, D., Kerber, K., Yu, Z., Mozgova, I., Nürnberger, F., and Bach, F.-W.
- Published
- 2011
- Full Text
- View/download PDF
3. Status of birth and pregnancy outcome capture in Health Demographic Surveillance Sites in 13 countries
- Author
-
Waiswa, P, Akuze, J, Moyer, C, Kwesiga, D, Arthur, S, Sankoh, O, Welaga, P, Bangha, M, Eminas, J, Muuo, S, Ziraba, A, Kerber, K, McLean, E, Afolabi, S, Twine, R, Lele, P, Juvekar, S, Abera, M, Tessema, F, Obor, D, Verani, J, Kajungu, D, Galiwango, E, Kouanda, S, Baguiya, A, Sifuna, P, Otieno, W, Scott, JAG, Otiende, M, May, M, Price, J, Beguy, D, Assefa, N, Kone, S, Utzinger, J, Gebru, AA, Abraham, L, Kant, S, Haldar, P, Fisker, A, Rodrigues, A, Andargie, G, Alemu, K, Newton, R, Asiki, G, Gyapong, M, Kukula, V, Tinto, H, Derra, K, Azongo, D, Mekonen, W, Molla, M, Soura, AB, Sanog, S, Nabukalu, D, Lutalo, T, Enuameh, Y, Manu, A, Nettey, OE, Wahab, A, Wilopo, SA, Rerimoi, A, Jasseh, M, Ouattara, M, Diboulo, E, and Mwangangi, MN
- Subjects
Identification methods ,Adult ,Male ,medicine.medical_specialty ,Health (social science) ,Asia ,Population ,National planning ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Neonatal ,Health care ,Infant Mortality ,medicine ,Humans ,Demographic Surveillance Sites ,030212 general & internal medicine ,Maternal Newborn Child Health Working Group ,Mortality ,education ,Birth Rate ,Africa South of the Sahara ,Perinatal mortality ,education.field_of_study ,030505 public health ,business.industry ,Public health ,Mortality rate ,Public Health, Environmental and Occupational Health ,Infant, Newborn ,Pregnancy Outcome ,Infant ,Stillbirth ,medicine.disease ,Infant mortality ,INDEPTH Network ,Population Surveillance ,Female ,Original Article ,0305 other medical science ,business ,Demography ,Forecasting - Abstract
Objectives We compared pregnancy identification methods and outcome capture across 31 Health Demographic Surveillance System (HDSS) sites in 14 countries in sub-Saharan Africa and Asia. Methods From 2009 to 2014, details on the sites and surveillance systems including frequency of update rounds, characteristics of enumerators and interviewers, acceptable respondents were collected and compared across sites. Results The 31 HDSS had a combined population of over 2,905,602 with 165,820 births for the period. Stillbirth rate ranged from 1.9 to 42.6 deaths per 1000 total births and the neonatal mortality rate from 2.6 to 41.6 per 1000 live births. Three quarters (75.3%) of recorded neonatal deaths occurred in the first week of life. The proportion of infant deaths that occurred in the neonatal period ranged from 8 to 83%, with a median of 53%. Sites that registered pregnancies upon locating a live baby in the routine household surveillance round had lower recorded mortality rates. Conclusions Increased attention and standardization of pregnancy surveillance and the time of birth will improve data collection and provide platforms for evaluations and availability of data for decision-making with implications for national planning. Electronic supplementary material The online version of this article (10.1007/s00038-019-01241-0) contains supplementary material, which is available to authorized users.
- Published
- 2017
4. Implementing Newborn Care Services in Humanitarian Settings: Barriers and Facilitators to Implementation at the Community and Facility Level in Displaced Person Camps in South Sudan
- Author
-
Sami, S., primary, Kenyi, S., additional, Amsalu, R., additional, Tomczyk, B., additional, Jackson, D., additional, Meyers, J., additional, Greeley, M., additional, Dimiti, A., additional, Scudder, E., additional, and Kerber, K., additional
- Published
- 2017
- Full Text
- View/download PDF
5. Newborn survival: a multi-country analysis of a decade of change
- Author
-
Lawn, J. E., primary, Kinney, M. V., additional, Black, R. E., additional, Pitt, C., additional, Cousens, S., additional, Kerber, K., additional, Corbett, E., additional, Moran, A. C., additional, Morrissey, C. S., additional, and Oestergaard, M. Z., additional
- Published
- 2013
- Full Text
- View/download PDF
6. Expenditures in the elderly with peripheral neuropathy: Where should we focus cost-control efforts?
- Author
-
Callaghan, B. C., primary, Burke, J. F., additional, Rodgers, A., additional, McCammon, R., additional, Langa, K. M., additional, Feldman, E. L., additional, and Kerber, K. A., additional
- Published
- 2013
- Full Text
- View/download PDF
7. Value of thyroid and rheumatologic studies in the evaluation of peripheral neuropathy
- Author
-
Gallagher, G., primary, Rabquer, A., additional, Kerber, K., additional, Calabek, B., additional, and Callaghan, B., additional
- Published
- 2013
- Full Text
- View/download PDF
8. Depression Treatment in Patients With General Medical Conditions: Results From the CO-MED Trial
- Author
-
Morris, D. W., primary, Budhwar, N., additional, Husain, M., additional, Wisniewski, S. R., additional, Kurian, B. T., additional, Luther, J. F., additional, Kerber, K., additional, Rush, A. J., additional, and Trivedi, M. H., additional
- Published
- 2012
- Full Text
- View/download PDF
9. The evaluation of a patient with dizziness
- Author
-
Kerber, K. A., primary and Baloh, R. W., additional
- Published
- 2011
- Full Text
- View/download PDF
10. Long-Term Clinical Outcomes of Care Management for Chronically Depressed Primary Care Patients: A Report From the Depression in Primary Care Project
- Author
-
Klinkman, M. S., primary, Bauroth, S., additional, Fedewa, S., additional, Kerber, K., additional, Kuebler, J., additional, Adman, T., additional, and Sen, A., additional
- Published
- 2010
- Full Text
- View/download PDF
11. Triglycerides and amputation risk in patients with diabetes: ten-year follow-up in the DISTANCE study.
- Author
-
Callaghan BC, Feldman E, Liu J, Kerber K, Pop-Busui R, Moffet H, Karter AJ, Callaghan, Brian C, Feldman, Eva, Liu, Jennifer, Kerber, Kevin, Pop-Busui, Rodica, Moffet, Howard, and Karter, Andrew J
- Abstract
Objective: To determine the association between triglyceride levels and lower-extremity amputation (LEA) risk in a large diabetic cohort.Research Design and Methods: This is a 10-year survey follow-up study (from 1995-2006) of 28,701 diabetic patients with a baseline triglyceride measure. All patients were fully insured members of the Kaiser Permanente Medical Care Program and responded to a survey at baseline that included information on ethnicity, socioeconomic status, education, behavioral factors, and information required to determine type of diabetes. The relationship between triglycerides and time to incident nontraumatic LEA, defined by primary hospitalization discharge or procedures, was evaluated using Cox proportional hazards models.Results: Triglyceride level was an independent, stepwise risk factor for nontraumatic LEAs within this large diabetic cohort: triglycerides 150-199 mg/dL, hazard ratio (HR) 1.10 (95% CI 0.92-1.32); 200-499 mg/dL, 1.27 (1.10-1.47); >500 mg/dL, 1.65 (1.30-2.10) (reference <150 mg/dL).Conclusions: Hypertriglyceridemia is a significant risk factor for LEA in diabetic patients even after controlling for known socioeconomic, health behavioral, and clinical factors. This previously unrecognized clinical risk needs to be further investigated to determine if treatment of triglycerides can reduce amputation risk. [ABSTRACT FROM AUTHOR]- Published
- 2011
- Full Text
- View/download PDF
12. Are adverse events higher among patients with acute optic neuritis prescribed glucocorticoids? A retrospective, longitudinal cohort study.
- Author
-
De Lott LB, Brennan B, Wallace B, Kerber K, Burke JF, Roslin C, Terman S, Andrews C, Waljee AK, and Banerjee M
- Subjects
- Humans, Female, Male, Retrospective Studies, Longitudinal Studies, Adult, Middle Aged, United States epidemiology, Acute Disease, Propensity Score, Optic Neuritis drug therapy, Optic Neuritis chemically induced, Optic Neuritis epidemiology, Glucocorticoids adverse effects, Glucocorticoids therapeutic use, Glucocorticoids administration & dosage
- Abstract
Objective: Optic neuritis (ON) is an acute focal inflammation of the optic nerve routinely treated with glucocorticoids. We aimed to compare adverse events (AE) among glucocorticoid-treated and untreated patients in the real world to guide clinical decision making about treatment tradeoffs., Design: Retrospective, longitudinal cohort study., Setting: Claims study from a large, private insurer in the USA (2005-2019)., Participants: Adults≥18 years old with ≥1 ICD9/10 ON diagnosis with an evaluation/management visit code, and ≥6 months continuous enrolment prior to and following ON diagnosis., Intervention: Glucocorticoid prescription exposure., Primary and Secondary Outcome Measures: Primary outcome was any AE within 90 days of glucocorticoid prescription. Secondary outcome was AE assessment by severity. Generalised estimating equations with logit link assessed relationships between glucocorticoid prescription and AEs. High-dimensional propensity score analyses accounted for potential confounding (eg, sociodemographics and comorbidities). Sensitivity analyses restricted the cohort to high-dose prescriptions (≥100 mg prednisone equivalent, injection/infusion), AEs within 30 days, highly specific ON definition and traditional propensity score match., Results: Of the 14 311 people with 17 404 ON claims, 66.3% were women (n=9481), predominantly White (78.2%; n=9940), with median age (IQR)=48 (37,60) years. Within 90 days of the claim, 15.7% (n=2733/17 404) were prescribed glucocorticoids. The median (IQR) prescription duration=10 (6,20) days. Any and severe AEs were higher among patients prescribed glucocorticoids versus none (any AEs: n=437/2733 (16.0%) vs n=1784/14 671 (12.2%), adjusted OR 1.33 (95% CI: 1.18 to 1.50); severe AEs: n=72/2733 (2.6%) vs n=273/14 671 (1.9%), adjusted OR 1.82 (95% CI: 1.37 to 2.35)). Sensitivity analyses were similar., Conclusions: Real-world glucocorticoid prescriptions among ON patients were short-term, associated with a 30% relative increase in potentially serious AEs captured within healthcare encounters, including those not previously observed, such as VTE. These results can inform treatment decisions, particularly for ON patients likely to experience only marginal benefits., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2024
- Full Text
- View/download PDF
13. Benign paroxysmal positional vertigo: A practical approach for emergency physicians.
- Author
-
Edlow JA and Kerber K
- Subjects
- Child, Humans, Patient Positioning methods, Dizziness, Brain, Benign Paroxysmal Positional Vertigo diagnosis, Benign Paroxysmal Positional Vertigo therapy, Physicians
- Abstract
Benign paroxysmal positional vertigo (BPPV) is a very common condition in the population and an important cause of acute vertigo or dizziness in patients presenting to an emergency department (ED). Despite this, abundant evidence shows that current ED management of patients with BPPV is suboptimal. Common ED management processes include brain imaging and treatment with vestibular suppressant medications such as meclizine, neither of which is recommended by current guidelines. The most efficient management of BPPV is to perform a bedside test (Dix-Hallpike test) and then to treat the patients with a bedside positional (the Epley) maneuver. In this practical review we emphasize the efficient management for the most common form of BPPV-posterior canal BPPV. Using this management will reduce resource utilization (laboratory testing, brain imaging, specialist consultation), reduce ED length of stay, and reduce use of ineffective mediations that have side effects but little therapeutic effect. Application of these practices would improve important patient-centered outcomes such as symptom reduction, radiation exposure, side effects from medications, and less need for urgent follow-up with another health care provider. The article also discusses the approach to patients in whom the Dix-Hallpike and/or Epley maneuvers do not seem to work. This includes a discussion the second most common variant of BPPV (horizontal canal BPPV) and criteria for safe discharge of patients. Another important advantage of learning BPPV best practices is that it is enormously satisfying for the clinician, not unlike treating a child with a nursemaid's elbow., (© 2022 Society for Academic Emergency Medicine.)
- Published
- 2023
- Full Text
- View/download PDF
14. An analytic perspective of a mixed methods study during humanitarian crises in South Sudan: translating facility- and community-based newborn guidelines into practice.
- Author
-
Sami S, Amsalu R, Dimiti A, Jackson D, Kenneth K, Kenyi S, Meyers J, Mullany LC, Scudder E, Tomczyk B, and Kerber K
- Abstract
Background: In South Sudan, the civil war in 2016 led to mass displacement in Juba that rapidly spread to other regions of the country. Access to health care was limited because of attacks against health facilities and workers and pregnant women and newborns were among the most vulnerable. Translation of newborn guidelines into public health practice, particularly during periods of on-going violence, are not well studied during humanitarian emergencies. During 2016 to 2017, we assessed the delivery of a package of community- and facility-based newborn health interventions in displaced person camps to understand implementation outcomes. This case analysis describes the challenges encountered and mitigating strategies employed during the conduct of an original research study., Discussion: Challenges unique to conducting research in South Sudan included violent attacks against humanitarian aid workers that required research partners to modify study plans on an ongoing basis to ensure staff and patient safety. South Sudan faced devastating cholera and measles outbreaks that shifted programmatic priorities. Costs associated with traveling study staff and transporting equipment kept rising due to hyperinflation and, after the July 2016 violence, the study team was unable to convene in Juba for some months to conduct refresher trainings or monitor data collection. Strategies used to address these challenges were: collaborating with non-research partners to identify operational solutions; maintaining a locally-based study team; maintaining flexible budgets and timelines; using mobile data collection to conduct timely data entry and remote quality checks; and utilizing a cascade approach for training field staff., Conclusions: The case analysis provides lessons that are applicable to other humanitarian settings including the need for flexible research methods, budgets and timelines; innovative training and supervision; and a local research team with careful consideration of sociopolitical factors that impact their access and safety. Engagement of national and local stakeholders can ensure health services and data collection continue and findings translate to public health action, even in contexts facing severe and unpredictable insecurity.
- Published
- 2021
- Full Text
- View/download PDF
15. "It might be a statistic to me, but every death matters.": An assessment of facility-level maternal and perinatal death surveillance and response systems in four sub-Saharan African countries.
- Author
-
Kinney MV, Ajayi G, de Graft-Johnson J, Hill K, Khadka N, Om'Iniabohs A, Mukora-Mutseyekwa F, Tayebwa E, Shittu O, Lipingu C, Kerber K, Nyakina JD, Ibekwe PC, Sayinzoga F, Madzima B, George AS, and Thapa K
- Subjects
- Africa South of the Sahara epidemiology, Cross-Sectional Studies, Female, Humans, Infant, Newborn, Maternal Death statistics & numerical data, Maternal Mortality, Perinatal Care statistics & numerical data, Perinatal Mortality, Pregnancy, Professional Practice Gaps statistics & numerical data, Qualitative Research, Epidemiological Monitoring, Health Plan Implementation statistics & numerical data, Maternal Death prevention & control, Perinatal Care organization & administration, Perinatal Death prevention & control
- Abstract
Background: Maternal and perinatal death surveillance and response (MPDSR) systems aim to understand and address key contributors to maternal and perinatal deaths to prevent future deaths. From 2016-2017, the US Agency for International Development's Maternal and Child Survival Program conducted an assessment of MPDSR implementation in Nigeria, Rwanda, Tanzania, and Zimbabwe., Methods: A cross-sectional, mixed-methods research design was used to assess MPDSR implementation. The study included a desk review, policy mapping, semistructured interviews with 41 subnational stakeholders, observations, and interviews with key informants at 55 purposefully selected facilities. Using a standardised tool with progress markers defined for six stages of implementation, each facility was assigned a score from 0-30. Quantitative and qualitative data were analysed from the 47 facilities with a score above 10 ('evidence of MPDSR practice')., Results: The mean calculated MPDSR implementation progress score across 47 facilities was 18.98 out of 30 (range: 11.75-27.38). The team observed variation across the national MPDSR guidelines and tools, and inconsistent implementation of MPDSR at subnational and facility levels. Nearly all facilities had a designated MPDSR coordinator, but varied in their availability and use of standardised forms and the frequency of mortality audit meetings. Few facilities (9%) had mechanisms in place to promote a no-blame environment. Some facilities (44%) could demonstrate evidence that a change occurred due to MPDSR. Factors enabling implementation included clear support from leadership, commitment from staff, and regular occurrence of meetings. Barriers included lack of health worker capacity, limited staff time, and limited staff motivation., Conclusion: This study was the first to apply a standardised scoring methodology to assess subnational- and facility-level MPDSR implementation progress. Structures and processes for implementing MPDSR existed in all four countries. Many implementation gaps were identified that can inform priorities and future research for strengthening MPDSR in low-capacity settings., Competing Interests: The authors declare that they have no competing interests.
- Published
- 2020
- Full Text
- View/download PDF
16. Opportunities for improving patient experiences among medical travellers from Canada's far north: a mixed-methods study.
- Author
-
Kerber K, Kolahdooz F, Otway M, Laboucan M, Jang SL, Lawrence S, Aronyk S, Quinn M, Irlbacher-Fox S, Milligan C, Broadhead S, DeLancey D, Corriveau A, and Sharma S
- Subjects
- Adolescent, Adult, Aged, Canada, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Northwest Territories, Patient Satisfaction, Quality Improvement, Young Adult, Health Services Accessibility standards, Health Services Accessibility statistics & numerical data, Travel
- Abstract
Objectives: This paper explores patient experiences and identifies barriers and opportunities for improving access to healthcare for patients from the Canadian north who travel to receive medical care in a Southern province., Design: A mixed-methods, cross-sectional study involved one-on-one interviews, focus group discussions and key informant interviews., Participants: 52 one-on-one interviews with Northwest Territories (NWT) patients and patient escorts and two focus group discussions (n=10). Fourteen key informant interviews were conducted with health workers, programme managers and staff of community organisations providing services for out-of-province patients. A Community Advisory Board guided the development of the questionnaires and interpretation of results., Results: Respondents were satisfied with the care received overall, but described unnecessary burdens and bureaucratic challenges throughout the travel process. Themes relating to access to healthcare included: plans and logistics for travel; level of communication between services; clarity around jurisdiction and responsibility for care; indirect costs of travel and direct costs of uninsured services; and having a patient escort or advocate available to assist with appointments and navigate the system. Three themes related to healthcare experiences included: cultural awareness, respect and caring, and medical translation. Respondents provided suggestions to improve access to care., Conclusions: Patients from NWT need more information and support before and during travel. Ensuring that medical travellers and escorts are prepared before departing, that healthcare providers engage in culturally appropriate communication and connecting travellers to support services on arrival have the potential to improve medical travel experiences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2019
- Full Text
- View/download PDF
17. Status of birth and pregnancy outcome capture in Health Demographic Surveillance Sites in 13 countries.
- Author
-
Waiswa P, Akuze J, Moyer C, Kwesiga D, Arthur S, Sankoh O, Welaga P, Bangha M, Eminas J, Muuo S, Ziraba A, and Kerber K
- Subjects
- Adult, Africa South of the Sahara epidemiology, Asia epidemiology, Female, Forecasting, Humans, Infant, Infant, Newborn, Male, Pregnancy, Birth Rate trends, Infant Mortality trends, Population Surveillance methods, Pregnancy Outcome epidemiology, Stillbirth epidemiology
- Abstract
Objectives: We compared pregnancy identification methods and outcome capture across 31 Health Demographic Surveillance System (HDSS) sites in 14 countries in sub-Saharan Africa and Asia., Methods: From 2009 to 2014, details on the sites and surveillance systems including frequency of update rounds, characteristics of enumerators and interviewers, acceptable respondents were collected and compared across sites., Results: The 31 HDSS had a combined population of over 2,905,602 with 165,820 births for the period. Stillbirth rate ranged from 1.9 to 42.6 deaths per 1000 total births and the neonatal mortality rate from 2.6 to 41.6 per 1000 live births. Three quarters (75.3%) of recorded neonatal deaths occurred in the first week of life. The proportion of infant deaths that occurred in the neonatal period ranged from 8 to 83%, with a median of 53%. Sites that registered pregnancies upon locating a live baby in the routine household surveillance round had lower recorded mortality rates., Conclusions: Increased attention and standardization of pregnancy surveillance and the time of birth will improve data collection and provide platforms for evaluations and availability of data for decision-making with implications for national planning.
- Published
- 2019
- Full Text
- View/download PDF
18. Two decades of antenatal and delivery care in Uganda: a cross-sectional study using Demographic and Health Surveys.
- Author
-
Benova L, Dennis ML, Lange IL, Campbell OMR, Waiswa P, Haemmerli M, Fernandez Y, Kerber K, Lawn JE, Santos AC, Matovu F, Macleod D, Goodman C, Penn-Kekana L, Ssengooba F, and Lynch CA
- Subjects
- Adult, Cesarean Section statistics & numerical data, Cross-Sectional Studies, Delivery of Health Care statistics & numerical data, Delivery, Obstetric statistics & numerical data, Facilities and Services Utilization, Female, Humans, Infant, Newborn, Maternal Health Services statistics & numerical data, Maternal Mortality trends, Pregnancy, Pregnancy Outcome, Prenatal Care statistics & numerical data, Private Sector statistics & numerical data, Public Sector statistics & numerical data, Rural Health, Socioeconomic Factors, Uganda, Young Adult, Delivery, Obstetric trends, Maternal Health Services trends
- Abstract
Background: Uganda halved its maternal mortality to 343/100,000 live births between 1990 and 2015, but did not meet the Millennium Development Goal 5. Skilled, timely and good quality antenatal (ANC) and delivery care can prevent the majority of maternal/newborn deaths and stillbirths. We examine coverage, equity, sector of provision and content of ANC and delivery care between 1991 and 2011., Methods: We conducted a repeated cross-sectional study using four Uganda Demographic and Health Surveys (1995, 2000, 2006 and 2011).Using the most recent live birth and adjusting for survey sampling, we estimated percentage and absolute number of births with ANC (any and 4+ visits), facility delivery, caesarean sections and complete maternal care. We assessed socio-economic differentials in these indicators by wealth, education, urban/rural residence, and geographic zone on the 1995 and 2011 surveys. We estimated the proportions of ANC and delivery care provided by the public and private (for-profit and not-for-profit) sectors, and compared content of ANC and delivery care between sectors. Statistical significance of differences were evaluated using chi-square tests., Results: Coverage with any ANC remained high over the study period (> 90% since 2001) but was of insufficient frequency; < 50% of women who received any ANC reported 4+ visits. Facility-based delivery care increased slowly, reaching 58% in 2011. While significant inequalities in coverage by wealth, education, residence and geographic zone remained, coverage improved for all indicators among the lowest socio-economic groups of women over time. The private sector market share declined over time to 14% of ANC and 25% of delivery care in 2011. Only 10% of women with 4+ ANC visits and 13% of women delivering in facilities received all measured care components., Conclusions: The Ugandan health system had to cope with more than 30,000 additional births annually between 1991 and 2011. The majority of women in Uganda accessed ANC, but this contact did not result in care of sufficient frequency, content, and continuum of care (facility delivery). Providers in both sectors require quality improvements. Achieving universal health coverage and maternal/newborn SDGs in Uganda requires prioritising poor, less educated and rural women despite competing priorities for financial and human resources.
- Published
- 2018
- Full Text
- View/download PDF
19. Understanding health systems to improve community and facility level newborn care among displaced populations in South Sudan: a mixed methods case study.
- Author
-
Sami S, Amsalu R, Dimiti A, Jackson D, Kenyi S, Meyers J, Mullany LC, Scudder E, Tomczyk B, and Kerber K
- Subjects
- Adult, Community Health Workers, Delivery of Health Care, Female, Focus Groups, Health Facilities, Health Personnel, Hospitals, Humans, Infant Health, Infant, Newborn, Leadership, Male, Midwifery, Nurses, Organizational Case Studies, Quality of Health Care, South Sudan, Child Health Services standards, Community Health Services, Implementation Science, Infant Care standards, Primary Health Care, Quality Improvement, Refugee Camps
- Abstract
Background: Targeted clinical interventions have been associated with a decreased risk of neonatal morbidity and mortality. In conflict-affected countries such as South Sudan, however, implementation of lifesaving interventions face barriers and facilitators that are not well understood. We aimed to describe the factors that influence implementation of a package of facility- and community-based neonatal interventions in four displaced person camps in South Sudan using a health systems framework., Methods: We used a mixed method case study design to document the implementation of neonatal interventions from June to November 2016 in one hospital, four primary health facilities, and four community health programs operated by International Medical Corps. We collected primary data using focus group discussions among health workers, in-depth interviews among program managers, and observations of health facility readiness. Secondary data were gathered from documents that were associated with the implementation of the intervention during our study period., Results: Key bottlenecks for implementing interventions in our study sites were leadership and governance for comprehensive neonatal services, health workforce for skilled care, and service delivery for small and sick newborns. Program managers felt national policies failed to promote integration of key newborn interventions in donor funding and clinical training institutions, resulting in deprioritizing newborn health during humanitarian response. Participants confirmed that severe shortage of skilled care at birth was the main bottleneck for implementing quality newborn care. Solutions to this included authorizing the task-shifting of emergency newborn care to mid-level cadre, transitioning facility-based traditional birth attendants to community health workers, and scaling up institutions to upgrade community midwives into professional midwives. Additionally, ongoing supportive supervision, educational materials, and community acceptance of practices enabled community health workers to identify and refer small and sick newborns., Conclusions: Improving integration of newborn interventions into national policies, training institutions, health referral systems, and humanitarian supply chain can expand emergency care provided to women and their newborns in these contexts.
- Published
- 2018
- Full Text
- View/download PDF
20. State of newborn care in South Sudan's displacement camps: a descriptive study of facility-based deliveries.
- Author
-
Sami S, Kerber K, Kenyi S, Amsalu R, Tomczyk B, Jackson D, Dimiti A, Scudder E, Meyers J, Umurungi JPC, Kenneth K, and Mullany LC
- Subjects
- Delivery, Obstetric, Humans, Infant Welfare, Infant, Newborn, Midwifery, Postnatal Care, Refugee Camps, Sudan, Health Services Accessibility, Infant Health
- Abstract
Background: Approximately 2.7 million neonatal deaths occur annually, with highest rates of neonatal mortality in countries that have recently experienced conflict. Constant instability in South Sudan further strains a weakened health system and poses public health challenges during the neonatal period. We aimed to describe the state of newborn facility-level care in displaced person camps across Juba, Malakal, and Maban., Methods: We conducted clinical observations of the labor and delivery period, exit interviews with recently delivered mothers, health facility assessments, and direct observations of midwife time-use. Study participants were mother-newborn pairs who sought services and birth attendants who provided delivery services between April and June 2016 in five health facilities., Results: Facilities were found to be lacking the recommended medical supplies for essential newborn care. Two of the five facilities had skilled midwives working during all operating hours, with 6.2% of their time spent on postnatal care. Selected components of thermal care (62.5%), infection prevention (74.8%), and feeding support (63.6%) were commonly practiced, but postnatal monitoring (27.7%) was less consistently observed. Differences were found when comparing the primary care level to the hospital (thermal: relative risk [RR] 0.48 [95% CI] 0.40-0.58; infection: RR 1.28 [1.11-1.47]; feeding: RR 0.49 [0.40-0.58]; postnatal: RR 3.17 [2.01-5.00]). In the primary care level, relative to newborns delivered by traditional birth attendants, those delivered by skilled attendants were more likely to receive postnatal monitoring (RR 1.59 [1.09-2.32]), but other practices were not statistically different. Mothers' knowledge of danger signs was poor, with fever as the highest reported (44.8%) followed by not feeding well (41.0%), difficulty breathing (28.9%), reduced activity (27.7%), feeling cold (18.0%) and convulsions (11.2%)., Conclusions: Addressing health service delivery in contexts affected by conflict is vital to reducing the global newborn mortality rate and reaching the Sustainable Development Goals. Gaps in intrapartum and postnatal care, particularly skilled care at birth, suggest a critical need to build the capacity of the existing health workforce while increasing access to skilled deliveries.
- Published
- 2017
- Full Text
- View/download PDF
21. "You have to take action": changing knowledge and attitudes towards newborn care practices during crisis in South Sudan.
- Author
-
Sami S, Kerber K, Tomczyk B, Amsalu R, Jackson D, Scudder E, Dimiti A, Meyers J, Kenneth K, Kenyi S, Kennedy CE, Ackom K, and Mullany LC
- Subjects
- Adult, Breast Feeding methods, Female, Humans, Infant, Newborn, Kangaroo-Mother Care Method methods, Male, Postnatal Care organization & administration, Quality of Health Care organization & administration, South Sudan, Community Health Workers education, Health Knowledge, Attitudes, Practice, Maternal-Child Health Services organization & administration, Refugees
- Abstract
Highest rates of neonatal mortality occur in countries that have recently experienced conflict. International Medical Corps implemented a package of newborn interventions in June 2016, based on the Newborn health in humanitarian settings: field guide, targeting community- and facility-based health workers in displaced person camps in South Sudan. We describe health workers' knowledge and attitudes toward newborn health interventions, before and after receiving clinical training and supplies, and recommend dissemination strategies for improved uptake of newborn guidelines during crises. A mixed methods approach was utilised, including pre-post knowledge tests and in-depth interviews. Study participants were community- and facility-based health workers in two internally displaced person camps located in Juba and Malakal and two refugee camps in Maban from March to October 2016. Mean knowledge scores for newborn care practices and danger signs increased among 72 community health workers (pre-training: 5.8 [SD: 2.3] vs. post-training: 9.6 [SD: 2.1]) and 25 facility-based health workers (pre-training: 14.2 [SD: 2.7] vs. post-training: 17.4 [SD: 2.8]). Knowledge and attitudes toward key essential practices, such as the use of partograph to assess labour progress, early initiation of breastfeeding, skin-to-skin care and weighing the baby, improved among skilled birth attendants. Despite challenges in conflict-affected settings, conducting training has the potential to increase health workers' knowledge on neonatal health post-training. The humanitarian community should reinforce this knowledge with key actions to shift cultural norms that expand the care provided to women and their newborns in these contexts.
- Published
- 2017
- Full Text
- View/download PDF
22. Overview, methods and results of multi-country community-based maternal and newborn care economic analysis.
- Author
-
Daviaud E, Owen H, Pitt C, Kerber K, Bianchi Jassir F, Barger D, Manzi F, Ekipara-Kiracho E, Greco G, Waiswa P, and Lawn JE
- Subjects
- Africa, Bolivia, Child Health Services organization & administration, Community Health Services economics, Community Health Services organization & administration, Community Health Workers organization & administration, Female, Humans, Infant, Infant, Newborn, Maternal Health Services organization & administration, Pregnancy, Child Health Services economics, Community Health Workers economics, Cost-Benefit Analysis, House Calls economics, Maternal Health Services economics
- Abstract
Home visits for pregnancy and postnatal care were endorsed by the WHO and partners as a complementary strategy to facility-based care to reduce newborn and maternal mortality. This article aims to synthesise findings and implications from the economic analyses of community-based maternal and newborn care (CBMNC) evaluations in seven countries. The evaluations included five cluster randomized trials (Ethiopia, Ghana, South Africa, Tanzania, Uganda) and programmatic before/after assessments (Bolivia, Malawi). The economic analyses were undertaken using a standardized, comparable methodology the 'Cost of Integrated Newborn Care' Tool, developed by the South African Medical Research Council, with Saving Newborn Lives and a network of African economists. The main driver of costs is the number of community health workers (CHWs), determined by their time availability, as fixed costs per CHW (equipment, training, salary/stipend, supervision and management), independent from the level of activity (number of mothers visited) represented over 96% of economic and financial costs in five of the countries. Unpaid volunteers are not necessarily a cheap option. An integrated programme with multi-purpose paid workers usually has lower costs per visit but requires innovative management, including supervision to ensure that coverage, or quality of care are not compromised since these workers have many other responsibilities apart from maternal and newborn health. If CHWs reach 95% of pregnant women in a standardized 100 000 population, the additional financial cost in all cases would be under USD1 per capita. In five of the six countries, the programme would be highly cost-effective (cost per DALY averted < GDP/capita) by WHO threshold even if they only achieved a reduction of 1 neonatal death per 1000 live births. These results contribute useful information for implementation planning and sustainability of CBMNC programmes., (© The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2017
- Full Text
- View/download PDF
23. Multi-country analysis of the cost of community health workers kits and commodities for community-based maternal and newborn care.
- Author
-
Barger D, Owen H, Pitt C, Kerber K, Sitrin D, Mayora C, Guenther T, Daviaud E, and Lawn JE
- Subjects
- Africa, Bolivia, Child Health Services organization & administration, Community Health Services economics, Community Health Workers organization & administration, Female, Health Promotion, House Calls economics, Humans, Infant, Newborn, Maternal Health Services organization & administration, Pregnancy, Child Health Services economics, Community Health Workers economics, Equipment and Supplies economics, Maternal Health Services economics
- Abstract
Community-based maternal and newborn care with home visits by community health workers (CHWs) are recommended by WHO to complement facility-based care. As part of multi-country economic and systems analyses, we aimed to compare the content and financial costs associated with equipping CHWs or 'home visit kits' from seven studies in Bolivia, Ethiopia, Ghana, Malawi, South Africa, Tanzania and Uganda. We estimated the equivalent annual costs (EACs) of home visit kits per CHW in constant 2015 USD. We estimated EAC at scale in a population of 100 000 assuming four home visits per mother during the pregnancy and postnatal period. All seven packages were designed for health promotion; six included clinical assessments and one included curative care. The items used by CHWs differed between countries, even for the same task. The EAC per home visit kit ranged from $15 in Tanzania to $116 in South Africa. For health promotion and preventive care, between 82 and 100% of the cost of CHW commodities did not vary with the number of home visits conducted; however, in Ethiopia, the majority of EAC associated with curative care varied with the number of visits conducted. The EAC of equipping CHWs to meet the needs of 95% of expectant mothers in a catchment area of 100 000 people was highest in Bolivia, $40 260 for 633 CHWs, due to mothers being in hard-to-reach areas with CHW conducting few visits per year per, and lowest in Tanzania ($2693 for 172 CHWs), due to the greater number of CHW visits per week and lower EAC of items. To inform and ensure sustainable implementation at scale, national discussions regarding the cadre of CHWs and their workload should also consider carefully the composition and cost of equipping CHWs to carry out their work effectively and efficiently., (© The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2017
- Full Text
- View/download PDF
24. Uganda Newborn Study (UNEST) trial: Community-based maternal and newborn care economic analysis.
- Author
-
Ekirapa-Kiracho E, Barger D, Mayora C, Waiswa P, Lawn JE, Kalungi J, Namazzi G, Kerber K, Owen H, and Daviaud E
- Subjects
- Child Health Services organization & administration, Community Health Services economics, Community Health Services organization & administration, Community Health Workers economics, Community Health Workers organization & administration, Female, Humans, Infant, Newborn, Maternal Health Services organization & administration, Pregnancy, Uganda, Volunteers, Child Health Services economics, Cost-Benefit Analysis, House Calls economics, Maternal Health Services economics
- Abstract
The Uganda Newborn Study (UNEST) was a two-arm cluster Randomized Control Trial to study the effect of pregnancy and postnatal home visits by local community health workers called 'Village Health Teams' (VHT) coupled with health systems strengthening. To inform programme planning and decision making, additional economic and financial costs of community and facility components were estimated from the perspective of the provider using the Excel-based Cost of Integrating Newborn Care Tool. Additional costs excluded costs already paid by the government for the routine health system and covered design, set-up, and 1-year implementation phases. Improved efficiency was modelled by reducing the number of VHT per village from two to one and varying the number of home visits/mother, the programme's financial cost at scale was projected (population of 100 000). 92% of expectant mothers (n = 1584) in the intervention area were attended by VHTs who performed an average of three home visits per mother. The annualized additional financial cost of the programme was $83 360 of which 4% ($3266) was for design, 24% ($20 026) for set-up and 72% ($60 068) for implementation. 56% ($47 030) went towards health facility strengthening, whereas 44% ($36 330) was spent at the community level. The average cost/mother for the community programme, excluding one-off design costs, amounted to $22.70 and the average cost per home visit was $7.50. The additional cost of the preventive home visit programme staffed by volunteer VHTs represents $1.04 per capita, 1.8% of Uganda's public health expenditure per capita ($59.00). If VHTs were to spend an average of 6 h a week on the programme, costs per mother would drop to $13.00 and cost per home visit to $3.20, in a population of 100 000 at 95% coverage. Additional resources are needed to rollout the government's VHT strategy nationally, maintaining high quality and linkages to quality facility-based care., (© The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2017
- Full Text
- View/download PDF
25. Comparing performance of methods used to identify pregnant women, pregnancy outcomes, and child mortality in the Iganga-Mayuge Health and Demographic Surveillance Site, Uganda.
- Author
-
Kadobera D, Waiswa P, Peterson S, Blencowe H, Lawn J, Kerber K, and Tumwesigye NM
- Subjects
- Adolescent, Adult, Cross-Sectional Studies, Female, Humans, Infant, Infant, Newborn, Medical Assistance, Middle Aged, Pregnancy, Prospective Studies, Surveys and Questionnaires, Uganda epidemiology, Young Adult, Infant Mortality, Population Surveillance methods, Pregnancy Outcome
- Abstract
Background: In most low and middle-income countries vital events registration for births and child deaths is poor, with reporting of pregnancy outcomes highly inadequate or non-existent. Health and Demographic Surveillance System (HDSS) sites and periodic population-based household-level surveys can be used to identify pregnancies and retrospectively capture pregnancy outcomes to provide data for decision making. However, little is known about the performance of different methods in identifying pregnancy and pregnancy outcomes, yet this is critical in assessing improvements in reducing maternal and newborn mortality and stillbirths., Objective: To explore differences between a population-based household pregnancy survey and prospective health demographic surveillance system in identifying pregnancies and their outcomes in rural eastern Uganda., Methods: The study was done within the Iganga-Mayuge HDSS site, a member centre of the INDEPTH Network. Prospective data about pregnancies and their outcomes was collected in the routine biannual census rounds from 2006 to 2010 in the HDSS. In 2011 a cross-sectional survey using the pregnancy history survey (PHS) tool was conducted among women aged 15 to 49 years in the HDSS area. We compared differences between the HDSS biannual census updates and the PHS capture of pregnancies identified as well as neonatal and child deaths, stillbirths and abortions., Findings: A total of 10,540 women aged 15 to 49 years were interviewed during the PHS. The PHS captured 12.8% more pregnancies than the HDSS in the most recent year (2010-2011), though between 2006 and 2010 (earlier periods) the PHS captured only 137 (0.8%) more pregnancies overall. The PHS also consistently identified more stillbirths (18.2%), spontaneous abortions (94.5%) and induced abortions (185.8%) than the prospective HDSS update rounds., Conclusions: Surveillance sites are designed to prospectively track population-level outcomes. However, the PHS identified more pregnancy-related outcomes than the HDSS in this study. Asking about pregnancy and its outcomes may be a useful way to improve measurement of pregnancy outcomes. Further research is needed to identify the most effective methods of improving the capture of pregnancies and their outcomes within HDSS sites, household surveys and routine health information systems.
- Published
- 2017
- Full Text
- View/download PDF
26. Reduction in child mortality in Ethiopia: analysis of data from demographic and health surveys.
- Author
-
Doherty T, Rohde S, Besada D, Kerber K, Manda S, Loveday M, Nsibande D, Daviaud E, Kinney M, Zembe W, Leon N, Rudan I, Degefie T, and Sanders D
- Subjects
- Child, Ethiopia epidemiology, Growth Disorders, Health Surveys, Humans, Infant, Child Health, Child Mortality, Infant Mortality
- Abstract
Background: To examine changes in under-5 mortality, coverage of child survival interventions and nutritional status of children in Ethiopia between 2000 and 2011. Using the Lives Saved Tool, the impact of changes in coverage of child survival interventions on under-5 lives saved was estimated., Methods: Estimates of child mortality were generated using three Ethiopia Demographic and Health Surveys undertaken between 2000 and 2011. Coverage indicators for high impact child health interventions were calculated and the Lives Saved Tool (LiST) was used to estimate child lives saved in 2011., Results: The mortality rate in children younger than 5 years decreased rapidly from 218 child deaths per 1000 live births (95% confidence interval 183 to 252) in the period 1987-1991 to 88 child deaths per 1000 live births in the period 2007-2011 (78 to 98). The prevalence of moderate or severe stunting in children aged 6-35 months also declined significantly. Improvements in the coverage of interventions relevant to child survival in rural areas of Ethiopia between 2000 and 2011 were found for tetanus toxoid, DPT3 and measles vaccination, oral rehydration solution (ORS) and care-seeking for suspected pneumonia. The LiST analysis estimates that there were 60 700 child deaths averted in 2011, primarily attributable to decreases in wasting rates (18%), stunting rates (13%) and water, sanitation and hygiene (WASH) interventions (13%)., Conclusions: Improvements in the nutritional status of children and increases in coverage of high impact interventions most notably WASH and ORS have contributed to the decline in under-5 mortality in Ethiopia. These proximal determinants however do not fully explain the mortality reduction which is plausibly also due to the synergistic effect of major child health and nutrition policies and delivery strategies.
- Published
- 2016
- Full Text
- View/download PDF
27. Approaches to Evaluate the Impact of Community-Based Delivery Strategies.
- Author
-
Doherty T, Kerber K, Kinney M, and Mason J
- Subjects
- Case Management, Child, Delivery of Health Care, Humans, Malawi, Community Health Services
- Published
- 2016
- Full Text
- View/download PDF
28. Niger's Child Survival Success, Contributing Factors and Challenges to Sustainability: A Retrospective Analysis.
- Author
-
Besada D, Kerber K, Leon N, Sanders D, Daviaud E, Rohde S, Rohde J, van Damme W, Kinney M, Manda S, Oliphant NP, Hachimou F, Ouedraogo A, Yaroh Ghali A, and Doherty T
- Subjects
- Child, Preschool, Female, Health Surveys, Humans, Infant, Niger, Retrospective Studies, Child Health trends, Child Mortality trends, Infant Mortality trends, Maternal Health trends
- Abstract
Background: Household surveys undertaken in Niger since 1998 have revealed steady declines in under-5 mortality which have placed the country 'on track' to reach the fourth Millennium Development goal (MDG). This paper explores Niger's mortality and health coverage data for children under-5 years of age up to 2012 to describe trends in high impact interventions and the resulting impact on childhood deaths averted. The sustainability of these trends are also considered., Methods and Findings: Estimates of child mortality using the 2012 Demographic and Health Survey were developed and maternal and child health coverage indicators were calculated over four time periods. Child survival policies and programmes were documented through a review of documents and key informant interviews. The Lives Saved Tool (LiST) was used to estimate the number of child lives saved and identify which interventions had the largest impact on deaths averted. The national mortality rate in children under-5 decreased from 286 child deaths per 1000 live births (95% confidence interval 177 to 394) in the period 1989-1990 to 128 child deaths per 1000 live births in the period 2011-2012 (101 to 155), corresponding to an annual rate of decline of 3.6%, with significant declines taking place after 1998. Improvements in the coverage of maternal and child health interventions between 2006 and 2012 include one and four or more antenatal visits, maternal Fansidar and tetanus toxoid vaccination, measles and DPT3 vaccinations, early and exclusive breastfeeding, oral rehydration salts (ORS) and proportion of children sleeping under an insecticide-treated bed net (ITN). Approximately 26,000 deaths of children under-5 were averted in 2012 due to decreases in stunting rates (27%), increases in ORS (14%), the Hib vaccine (14%), and breastfeeding (11%). Increases in wasting and decreases in vitamin A supplementation negated some of those gains. Care seeking at the community level was responsible for an estimated 7,800 additional deaths averted in 2012. A major policy change occurred in 2006 enabling free health care provision for women and children, and in 2008 the establishment of a community health worker programme., Conclusion: Increases in access and coverage of care for mothers and children have averted a considerable number of childhood deaths. The 2006 free health care policy and health post expansion were paramount in reducing barriers to care. However the sustainability of this policy and health service provision is precarious in light of persistently high fertility rates, unpredictable GDP growth, a high dependence on donor support and increasing pressures on government funding.
- Published
- 2016
- Full Text
- View/download PDF
29. Assessment of Malawi's success in child mortality reduction through the lens of the Catalytic Initiative Integrated Health Systems Strengthening programme: Retrospective evaluation.
- Author
-
Doherty T, Zembe W, Ngandu N, Kinney M, Manda S, Besada D, Jackson D, Daniels K, Rohde S, van Damme W, Kerber K, Daviaud E, Rudan I, Muniz M, Oliphant NP, Zamasiya T, Rohde J, and Sanders D
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Female, Health Policy, Health Promotion, Humans, Infant, Insecticide-Treated Bednets statistics & numerical data, Malawi, Male, Middle Aged, Pneumococcal Vaccines administration & dosage, Pregnancy, Program Evaluation, Retrospective Studies, Surveys and Questionnaires, Young Adult, Child Mortality trends, Delivery of Health Care methods, Infant Mortality trends
- Abstract
Background: Malawi is estimated to have achieved its Millennium Development Goal (MDG) 4 target. This paper explores factors influencing progress in child survival in Malawi including coverage of interventions and the role of key national policies., Methods: We performed a retrospective evaluation of the Catalytic Initiative (CI) programme of support (2007-2013). We developed estimates of child mortality using four population household surveys undertaken between 2000 and 2010. We recalculated coverage indicators for high impact child health interventions and documented child health programmes and policies. The Lives Saved Tool (LiST) was used to estimate child lives saved in 2013., Results: The mortality rate in children under 5 years decreased rapidly in the 10 CI districts from 219 deaths per 1000 live births (95% confidence interval (CI) 189 to 249) in the period 1991-1995 to 119 deaths (95% CI 105 to 132) in the period 2006-2010. Coverage for all indicators except vitamin A supplementation increased in the 10 CI districts across the time period 2000 to 2013. The LiST analysis estimates that there were 10 800 child deaths averted in the 10 CI districts in 2013, primarily attributable to the introduction of the pneumococcal vaccine (24%) and increased household coverage of insecticide-treated bednets (19%). These improvements have taken place within a context of investment in child health policies and scale up of integrated community case management of childhood illnesses., Conclusions: Malawi provides a strong example for countries in sub-Saharan Africa of how high impact child health interventions implemented within a decentralised health system with an established community-based delivery platform, can lead to significant reductions in child mortality.
- Published
- 2015
- Full Text
- View/download PDF
30. Tanzania's countdown to 2015: an analysis of two decades of progress and gaps for reproductive, maternal, newborn, and child health, to inform priorities for post-2015.
- Author
-
Afnan-Holmes H, Magoma M, John T, Levira F, Msemo G, Armstrong CE, Martínez-Álvarez M, Kerber K, Kihinga C, Makuwani A, Rusibamayila N, Hussein A, and Lawn JE
- Subjects
- Child, Child Mortality, Delivery of Health Care trends, Delivery, Obstetric, Family Planning Services, Female, Humans, Immunization, Infant, Infant Mortality, Infant, Newborn, Insecticide-Treated Bednets, Maternal Mortality, Pregnancy, Social Class, Socioeconomic Factors, Tanzania epidemiology, Child Health, Delivery of Health Care standards, Infant Health, Maternal Health, Maternal-Child Health Services standards, Mortality, Reproductive Health
- Abstract
Background: Tanzania is on track to meet Millennium Development Goal (MDG) 4 for child survival, but is making insufficient progress for newborn survival and maternal health (MDG 5) and family planning. To understand this mixed progress and to identify priorities for the post-2015 era, Tanzania was selected as a Countdown to 2015 case study., Methods: We analysed progress made in Tanzania between 1990 and 2014 in maternal, newborn, and child mortality, and unmet need for family planning, in which we used a health systems evaluation framework to assess coverage and equity of interventions along the continuum of care, health systems, policies and investments, while also considering contextual change (eg, economic and educational). We had five objectives, which assessed each level of the health systems evaluation framework. We used the Lives Saved Tool (LiST) and did multiple linear regression analyses to explain the reduction in child mortality in Tanzania. We analysed the reasons for the slower changes in maternal and newborn survival and family planning, to inform priorities to end preventable maternal, newborn, and child deaths by 2030., Findings: In the past two decades, Tanzania's population has doubled in size, necessitating a doubling of health and social services to maintain coverage. Total health-care financing also doubled, with donor funding for child health and HIV/AIDS more than tripling. Trends along the continuum of care varied, with preventive child health services reaching high coverage (≥85%) and equity (socioeconomic status difference 13-14%), but lower coverage and wider inequities for child curative services (71% coverage, socioeconomic status difference 36%), facility delivery (52% coverage, socioeconomic status difference 56%), and family planning (46% coverage, socioeconomic status difference 22%). The LiST analysis suggested that around 39% of child mortality reduction was linked to increases in coverage of interventions, especially of immunisation and insecticide-treated bednets. Economic growth was also associated with reductions in child mortality. Child health programmes focused on selected high-impact interventions at lower levels of the health system (eg, the community and dispensary levels). Despite its high priority, implementation of maternal health care has been intermittent. Newborn survival has gained attention only since 2005, but high-impact interventions are already being implemented. Family planning had consistent policies but only recent reinvestment in implementation., Interpretation: Mixed progress in reproductive, maternal, newborn, and child health in Tanzania indicates a complex interplay of political prioritisation, health financing, and consistent implementation. Post-2015 priorities for Tanzania should focus on the unmet need for family planning, especially in the Western and Lake regions; addressing gaps for coverage and quality of care at birth, especially in rural areas; and continuation of progress for child health., Funding: Government of Canada, Foreign Affairs, Trade, and Development; US Fund for UNICEF; and the Bill & Melinda Gates Foundation., (Copyright © 2015 Afnan-Holmes et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
31. Cost and impact of scaling up interventions to save lives of mothers and children: taking South Africa closer to MDGs 4 and 5.
- Author
-
Chola L, Pillay Y, Barron P, Tugendhaft A, Kerber K, and Hofman K
- Subjects
- Breast Feeding, Child, Child Mortality, Delivery, Obstetric methods, Female, HIV Infections drug therapy, HIV Infections prevention & control, HIV Infections transmission, Hand Disinfection, Health Education, Health Knowledge, Attitudes, Practice, Health Services Accessibility, Humans, Infant, Infant Mortality, Labor, Obstetric, Maternal Mortality, Maternal-Child Health Services economics, Mothers, Pregnancy, Pregnancy Complications epidemiology, Pregnancy Complications prevention & control, Primary Prevention economics, Quality of Health Care, South Africa, Maternal-Child Health Services organization & administration, Mortality, Primary Prevention organization & administration
- Abstract
Background: South Africa has made substantial progress on child and maternal mortality, yet many avoidable deaths of mothers and children still occur. This analysis identifies priority interventions to be scaled up nationally and projects the potential maternal and child lives saved., Design: We modelled the impact of maternal, newborn and child interventions using the Lives Saved Tools Projections to 2015 and used realistic coverage increases based on expert opinion considering recent policy change, financial and resource inputs, and observed coverage change. A scenario analysis was undertaken to test the impact of increasing intervention coverage to 95%., Results: By 2015, with realistic coverage, the maternal mortality ratio (MMR) can reduce to 153 deaths per 100,000 and child mortality to 34 deaths per 1,000 live births. Fifteen interventions, including labour and delivery management, early HIV treatment in pregnancy, prevention of mother-to-child transmission and handwashing with soap, will save an additional 9,000 newborns and children and 1,000 mothers annually. An additional US$370 million (US$7 per capita) will be required annually to scale up these interventions. When intervention coverage is increased to 95%, breastfeeding promotion becomes the top intervention, the MMR reduces to 116 and the child mortality ratio to 23., Conclusions: The 15 interventions identified were adopted by the National Department of Health, and the Health Minister launched a campaign to encourage Provincial Health Departments to scale up coverage. It is hoped that by focusing on implementing these 15 interventions at high quality, South Africa will reach Millennium Development Goal (MDG) 4 soon after 2015 and MDG 5 several years later. Focus on HIV and TB during early antenatal care is essential. Strategic gains could be realised by targeting vulnerable populations and districts with the worst health outcomes. The analysis demonstrates the usefulness of priority setting tools and the potential for evidence-based decision making in the health sector.
- Published
- 2015
- Full Text
- View/download PDF
32. Services for mothers and newborns during the ebola outbreak in liberia: the need for improvement in emergencies.
- Author
-
Iyengar P, Kerber K, Howe CJ, and Dahn B
- Abstract
Background: The magnitude of the Ebola outbreak in West Africa is unprecedented. Liberia, Guinea, and Sierra Leone are in the bottom ten countries in the Human Development Index, but all had made gains in child survival prior to the outbreak. With closure of healthcare facilities and the loss of health workers secondary to the outbreak, the region risks reversing survival gains achieved in maternal and newborn health., Methods: Anonymized service utilization data were downloaded from the Liberia District Health Information Software (DHIS) 2 for selected maternal health services at PHC facilities in Margibi and Bong Counties from March 2014, when the first case of Ebola was reported in Liberia, through December 2014. Absolute numbers are provided instead of percentage measures because of the lack of a population-based denominator., Results: Overall, the data show a decrease in absolute utilization from the start of the outbreak, followed by a slow recovery after October or November. In Bong County, totals were less than 14% of the peak numbers during the outbreak for number of antenatal visits and pregnant women receiving intermittent preventive treatment for malaria in pregnancy (IPTp). For total deliveries, utilization was less than 33% of the highest month. In Margibi County, during what now appears to be the height of the outbreak, numbers dropped to less than 9% of peak utilization for antenatal care visits and 4% for IPTp. Total health facility deliveries dropped to less than 9% of peak utilization., Conclusion: It is clear that Bong and Margibi Counties in Liberia experienced a large drop in utilization of maternal health care services during what now appears to be the peak of the Ebola outbreak. As the health of women and their babies is being promoted in the post-2015 sustainable development agenda, it is critical that the issue of maternal and newborn survival in humanitarian emergency settings, like the Ebola outbreak, is prioritized.
- Published
- 2015
- Full Text
- View/download PDF
33. Special issue: newborn health in Uganda.
- Author
-
Kerber K, Peterson S, and Waiswa P
- Subjects
- Female, Humans, Infant, Infant, Newborn, Organizational Innovation, Pregnancy, Uganda, Young Adult, Child Health Services organization & administration, Community Health Services organization & administration, Infant Care organization & administration, Infant Mortality trends, Maternal Health Services organization & administration, Quality of Health Care organization & administration
- Published
- 2015
- Full Text
- View/download PDF
34. 'As soon as the umbilical cord gets off, the child ceases to be called a newborn': sociocultural beliefs and newborn referral in rural Uganda.
- Author
-
Nalwadda CK, Waiswa P, Guwatudde D, Kerber K, Peterson S, and Kiguli J
- Subjects
- Adult, Child Health Services organization & administration, Female, Focus Groups, Humans, Infant, Infant, Newborn, Male, Middle Aged, Mother-Child Relations, Parents psychology, Patient Acceptance of Health Care, Rural Population, Socioeconomic Factors, Terminology as Topic, Uganda, Young Adult, Cultural Characteristics, Health Knowledge, Attitudes, Practice, Infant Care organization & administration, Perinatal Care organization & administration, Umbilical Cord
- Abstract
Background: The first week of life is the time of greatest risk of death and disability, and is also associated with many traditional beliefs and practices. Identifying sick newborns in the community and referring them to health facilities is a key strategy to reduce deaths. Although a growing area of interest, there remains a lack of data on the role of sociocultural norms and practices on newborn healthcare-seeking in sub-Saharan Africa and the extent to which these norms can be modified., Objective: This study aimed to understand the community's perspective of potential sociocultural barriers and facilitators to compliance with newborn referral., Method: In this qualitative study, focus group discussions (n=12) were conducted with mothers and fathers of babies aged less than 3 months. In addition, in-depth interviews (n=11) were also held with traditional birth attendants and mothers who had been referred by community health workers to seek health-facility-based care. Participants were purposively selected from peri-urban and rural communities in two districts in eastern Uganda. Data were analysed using latent content analysis., Results: The community definition of a newborn varied, but this was most commonly defined by the period between birth and the umbilical cord stump falling off. During this period, newborns are perceived to be vulnerable to the environment and many mothers and their babies are kept in seclusion, although this practice may be changing. Sociocultural factors that influence compliance with newborn referrals to seek care emerged along three sub-themes: community understanding of the newborn period and cultural expectations; the role of community health actors; and caretaker knowledge, experience, and decision-making autonomy., Conclusion: In this setting, there is discrepancy between biomedical and community definitions of the newborn period. There were a number of sociocultural factors that could potentially affect compliance to newborn referral. The widely practised cultural seclusion period, knowledge about newborn sickness, individual experiences in households, perceived health system gaps, and decision-making processes were facilitators of or barriers to compliance with newborn referral. Designers of newborn interventions need to address locally existing cultural beliefs at the same time as they strengthen facility care.
- Published
- 2015
- Full Text
- View/download PDF
35. Designing for action: adapting and implementing a community-based newborn care package to affect national change in Uganda.
- Author
-
Waiswa P, Namazzi G, Kerber K, and Peterson S
- Subjects
- Adult, Developing Countries, Evidence-Based Medicine organization & administration, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Poverty, Pregnancy, Rural Population, Uganda, Child Health Services organization & administration, Community Health Services organization & administration, Health Policy, Infant Care organization & administration, Maternal Health Services organization & administration, Postnatal Care organization & administration
- Abstract
Background: There is a lack of literature on how to adapt new evidence-based interventions for maternal and newborn care into local health systems and policy for rapid scale-up, particularly for community-based interventions in low-income settings. The Uganda Newborn Study (UNEST) was a cluster randomised control trial to test a community-based care package which was rapidly taken up at national level. Understanding this process may help inform other studies looking to design and evaluate with scale-up in mind., Objective: This study aimed to describe the process of using evidence to design a community-based maternal and newborn care package in rural eastern Uganda, and to determine the dissemination and advocacy approaches used to facilitate rapid policy change and national uptake., Design: We reviewed UNEST project literature including meeting reports and minutes, supervision reports, and annual and midterm reports. National stakeholders, project and district staff were interviewed regarding their role in the study and perceptions of what contributed to uptake of the package under evaluation. Data related to UNEST formative research, study design, implementation and policy influence were extracted and analysed., Results: An advisory committee of key players in development of maternal and newborn policies and programmes in Uganda was constituted from many agencies and disciplines. Baseline qualitative and quantitative data collection was done at district, community and facility level to examine applicability of aspects of a proposed newborn care package to the local setting. Data were summarised and presented to stakeholders to adapt the intervention that was ultimately tested. Quarterly monitoring of key activities and events around the interventions were used to further inform implementation. The UNEST training package, home visit schedule and behaviour change counselling materials were incorporated into the national Village Health Team and Integrated Community Case Management packages while the study was ongoing., Conclusions: Designing interventions for national scale-up requires strategies and planning from the outset. Use of evidence alongside engagement of key stakeholders and targeted advocacy about the burden and potential solutions is important when adapting interventions to local health systems and communities. This approach has the potential to rapidly translate research into policy, but care must be taken not to exceed available evidence while seizing the policy opportunity.
- Published
- 2015
- Full Text
- View/download PDF
36. Differences in essential newborn care at birth between private and public health facilities in eastern Uganda.
- Author
-
Waiswa P, Akuze J, Peterson S, Kerber K, Tetui M, Forsberg BC, and Hanson C
- Subjects
- Adolescent, Adult, Child Health Services organization & administration, Female, Humans, Infant, Infant, Newborn, Maternal Health Services organization & administration, Pregnancy, Prenatal Care organization & administration, Rural Population, Socioeconomic Factors, Uganda, Young Adult, Infant Care methods, Infant Care organization & administration, Obstetrics and Gynecology Department, Hospital organization & administration, Postnatal Care organization & administration, Private Sector organization & administration, Public Sector organization & administration
- Abstract
Background: In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth., Objective: To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda., Design: Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted., Results: The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007). Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (p<0.001). Women delivering in private facilities were more likely to have higher parity, lower socio-economic status, less education, to seek antenatal care later in pregnancy, and to have a normal delivery compared to women delivering in public facilities., Conclusions: In this setting, private health facilities serve a vulnerable population and provide access to service for those who might not otherwise have it. However, provision of essential newborn care practices was slightly lower in private compared to public facilities, calling for quality improvement in both private and public sector facilities, and a greater emphasis on tracking access to and quality of care in private sector facilities.
- Published
- 2015
- Full Text
- View/download PDF
37. Weeping in silence: community experiences of stillbirths in rural eastern Uganda.
- Author
-
Kiguli J, Namusoko S, Kerber K, Peterson S, and Waiswa P
- Subjects
- Adaptation, Psychological, Adult, Aged, Aged, 80 and over, Disclosure, Female, Humans, Male, Middle Aged, Pregnancy, Rural Population, Uganda epidemiology, Bereavement, Maternal Health Services organization & administration, Parents psychology, Stillbirth epidemiology, Stillbirth psychology, Stress, Psychological therapy
- Abstract
Background: Stillbirths do not register amongst national or global public health priorities, despite large numbers and known solutions. Although not accounted in statistics - these deaths count for families. Part of this disconnect is that very little is known about the lived experiences and perceptions of those experiencing this neglected problem., Objective: This study aimed to explore local definitions and perceived causes of stillbirths as well as coping mechanisms used by families affected by stillbirth in rural eastern Uganda., Design: A total of 29 in-depth interviews were conducted with women who had a stillbirth (14), men whose wives experienced a stillbirth (6), grandmothers (4), grandfathers (1), and traditional birth attendants (TBAs) (4). Participants were purposively recruited from the hospital maternity ward register, with additional recruitment done through community leaders and other participants. Data were analysed using content analysis., Results: Women and families affected by stillbirth report pregnancy loss as a common occurrence. Definitions and causes of stillbirth included the biomedical, societal, and spiritual. Disclosure of stillbirth varies with women who experience consecutive or multiple losses, subject to potential exclusion from the community and even the family. Methods for coping with stillbirth were varied and personal. Ritual burial practices were common, yet silent and mainly left to women, as opposed to public mourning for older children. There were no formal health system mechanisms to support or care for families affected by stillbirths., Conclusion: In a setting with strong collective ties, stillbirths are a burden borne by the affected family, and often just by the mother, rather than the community as a whole. Strategies are needed to address preventable stillbirths as well as to follow up with supportive services for those affected.
- Published
- 2015
- Full Text
- View/download PDF
38. Improving newborn care practices through home visits: lessons from Malawi, Nepal, Bangladesh, and Uganda.
- Author
-
Sitrin D, Guenther T, Waiswa P, Namutamba S, Namazzi G, Sharma S, Ashish KC, Rubayet S, Bhadra S, Ligowe R, Chimbalanga E, Sewell E, Kerber K, and Moran A
- Subjects
- Adult, Bangladesh, Cross-Sectional Studies, Female, Health Promotion organization & administration, Humans, Infant, Infant Care methods, Infant, Newborn, Malawi, Male, Middle Aged, Nepal, Pilot Projects, Postpartum Period, Pregnancy, Uganda, Young Adult, Child Health Services organization & administration, Community Health Workers organization & administration, House Calls, Infant Care organization & administration, Women's Health Services organization & administration
- Abstract
Background: Nearly all newborn deaths occur in low- or middle-income countries. Many of these deaths could be prevented through promotion and provision of newborn care practices such as thermal care, early and exclusive breastfeeding, and hygienic cord care. Home visit programmes promoting these practices were piloted in Malawi, Nepal, Bangladesh, and Uganda., Objective: This study assessed changes in selected newborn care practices over time in pilot programme areas in four countries and evaluated whether women who received home visits during pregnancy were more likely to report use of three key practices., Design: Using data from cross-sectional surveys of women with live births at baseline and endline, the Pearson chi-squared test was used to assess changes over time. Generalised linear models were used to assess the relationship between the main independent variable - home visit from a community health worker (CHW) during pregnancy (0, 1-2, 3+) - and use of selected practices while controlling for antenatal care, place of delivery, and maternal age and education., Results: There were statistically significant improvements in practices, except applying nothing to the cord in Malawi and early initiation of breastfeeding in Bangladesh. In Malawi, Nepal, and Bangladesh, women who were visited by a CHW three or more times during pregnancy were more likely to report use of selected practices. Women who delivered in a facility were also more likely to report use of selected practices in Malawi, Nepal, and Uganda; association with place of birth was not examined in Bangladesh because only women who delivered outside a facility were asked about these practices., Conclusion: Home visits can play a role in improving practices in different settings. Multiple interactions are needed, so programmes need to investigate the most appropriate and efficient ways to reach families and promote newborn care practices. Meanwhile, programmes must take advantage of increasing facility delivery rates to ensure that all babies benefit from these practices.
- Published
- 2015
- Full Text
- View/download PDF
39. Uganda Newborn Study (UNEST): learning from a decade of research in Uganda to accelerate change for newborns especially in Africa.
- Author
-
Lawn JE, Kerber K, Sankoh O, and Claeson M
- Subjects
- Child, Preschool, Humans, Infant, Infant, Newborn, Leadership, Organizational Innovation, Poverty, Uganda, Child Care organization & administration, Child Health Services organization & administration, Community Health Services organization & administration, Delivery of Health Care, Integrated organization & administration, Quality of Health Care organization & administration, Rural Health Services organization & administration
- Published
- 2015
- Full Text
- View/download PDF
40. Effect of the Uganda Newborn Study on care-seeking and care practices: a cluster-randomised controlled trial.
- Author
-
Waiswa P, Pariyo G, Kallander K, Akuze J, Namazzi G, Ekirapa-Kiracho E, Kerber K, Sengendo H, Aliganyira P, Lawn JE, and Peterson S
- Subjects
- Adolescent, Adult, Cluster Analysis, Developing Countries, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Pregnancy, Rural Population, Socioeconomic Factors, Uganda, Young Adult, Child Health Services organization & administration, Community Health Services organization & administration, House Calls, Infant Care organization & administration, Maternal Health Services organization & administration, Patient Acceptance of Health Care statistics & numerical data, Rural Health Services organization & administration
- Abstract
Background: Care for women and babies before, during, and after the time of birth is a sensitive measure of the functionality of any health system. Engaging communities in preventing newborn deaths is a promising strategy to achieve further progress in child survival in sub-Saharan Africa., Objective: To assess the effect of a home visit strategy combined with health facility strengthening on uptake of newborn care-seeking, practices and services, and to link the results to national policy and scale-up in Uganda., Design: The Uganda Newborn Study (UNEST) was a two-arm cluster-randomised controlled trial in rural eastern Uganda. In intervention villages volunteer community health workers (CHWs) were trained to identify pregnant women and make five home visits (two during pregnancy and three in the first week after birth) to offer preventive and promotive care and counselling, with extra visits for sick and small newborns to assess and refer. Health facility strengthening was done in all facilities to improve quality of care. Primary outcomes were coverage of key essential newborn care behaviours (breastfeeding, thermal care, and cord care). Analyses were by intention to treat. This study is registered as a clinical trial, number ISRCTN50321130., Results: The intervention significantly improved essential newborn care practices, although many interventions saw major increases in both arms over the study period. Immediate breastfeeding after birth and exclusive breastfeeding were significantly higher in the intervention arm compared to the control arm (72.6% vs. 66.0%; p=0.016 and 81.8% vs. 75.9%, p=0.042, respectively). Skin-to-skin care immediately after birth and cord cutting with a clean instrument were marginally higher in the intervention arm versus the control arm (80.7% vs. 72.2%; p=0.071 and 88.1% vs. 84.4%; p=0.023, respectively). Half (49.6%) of the mothers in the intervention arm waited more than 24 hours to bathe the baby, compared to 35.5% in the control arm (p<0.001). Dry umbilical cord care was also significantly higher in intervention areas (63.9% vs. 53.1%, p<0.001). There was no difference in care-seeking for newborn illness, which was high (around 95%) in both arms. Skilled attendance at delivery increased in both the intervention (by 21%) and control arms (by 19%) between baseline and endline, but there was no significant difference in coverage across arms at endline (79.6% vs. 78.9%; p=0.717). Home visits were pro-poor, with more women in the poorest quintile visited by a CHW compared to families in the least poor quintile, and more women who delivered at home visited by a CHW after birth (73.6%) compared to those who delivered in a hospital or health facility (59.7%) (p<0.001). CHWs visited 62.8% of women and newborns in the first week after birth, with 40.2% receiving a visit on the critical first day of life., Conclusion: Consistent with results from other community newborn care studies, volunteer CHWs can be effective in changing long-standing practices around newborn care. The home visit strategy may provide greater benefit to poorer families. However, CHW strategies require strong linkages with and concurrent improvement of quality through health system strengthening, especially in settings with high and increasing demand for facility-based services.
- Published
- 2015
- Full Text
- View/download PDF
41. Triple return on investment: the cost and impact of 13 interventions that could prevent stillbirths and save the lives of mothers and babies in South Africa.
- Author
-
Michalow J, Chola L, McGee S, Tugendhaft A, Pattinson R, Kerber K, and Hofman K
- Subjects
- Cost-Benefit Analysis, Costs and Cost Analysis, Family Planning Services methods, Female, Humans, Infant, Newborn, Maternal Death economics, Maternal Health Services, Perinatal Care methods, Pregnancy, Pregnancy Complications economics, Prenatal Care methods, South Africa, Treatment Outcome, Family Planning Services economics, Health Care Costs, Maternal Death prevention & control, Perinatal Care economics, Perinatal Death prevention & control, Pregnancy Complications therapy, Prenatal Care economics, Stillbirth
- Abstract
Background: The time of labor, birth and the first days of life are the most vulnerable period for mothers and children. Despite significant global advocacy, there is insufficient understanding of the investment required to save additional lives. In particular, stillbirths have been neglected. Over 20 000 stillbirths are recorded annually in South Africa, many of which could be averted. This analysis examines available South Africa specific stillbirth data and evaluates the impact and cost-effectiveness of 13 interventions acknowledged to prevent stillbirths and maternal and newborn mortality., Methods: Multiple data sources were reviewed to evaluate changes in stillbirth rates since 2000. The intervention analysis used the Lives Saved tool (LiST) and the Family Planning module (FamPlan) in Spectrum. LiST was used to determine the number of stillbirths and maternal and neonatal deaths that could be averted by scaling up the interventions to full coverage (99%) in 2030. The impact of family planning was assessed by increasing FamPlan's default 70% coverage of modern contraception to 75% and 80% coverage. Total and incremental costs were determined in the LiST costing module. Cost-effectiveness measured incremental cost effectiveness ratios per potential life years gained., Results: Significant variability exists in national stillbirth data. Using the international stillbirth definition, the SBR was 17.6 per 1 000 births in 2013. Full coverage of the 13 interventions in 2030 could reduce the SBR by 30% to 12.4 per 1 000 births, leading to an MMR of 132 per 100 000 and an NMR of 7 per 1 000 live births. Increased family planning coverage reduces the number of deaths significantly. The full intervention package, with 80% family planning coverage in 2030, would require US$420 million (US$7.8 per capita) annually, which is less than baseline costs of US$550 million (US$10.2 per capita). All interventions were highly cost-effective., Conclusion: This is the first analysis in South Africa to assess the impact of scaling up interventions to avert stillbirths. Improved coverage of 13 interventions that are already recommended could significantly impact the rates of stillbirth and maternal and neonatal mortality. Family planning should also be prioritized to reduce mortality and overall costs.
- Published
- 2015
- Full Text
- View/download PDF
42. Helping small babies survive: an evaluation of facility-based Kangaroo Mother Care implementation progress in Uganda.
- Author
-
Aliganyira P, Kerber K, Davy K, Gamache N, Sengendo NH, and Bergh AM
- Subjects
- Cross-Sectional Studies, Data Collection, Female, Hospitals standards, Hospitals statistics & numerical data, Humans, Infant, Infant, Newborn, Infant, Premature, Program Development, Uganda, Health Services Accessibility, Infant Mortality, Kangaroo-Mother Care Method organization & administration, Quality of Health Care
- Abstract
Introduction: Prematurity is the leading cause of newborn death in Uganda, accounting for 38% of the nation's 39,000 annual newborn deaths. Kangaroo mother care is a high-impact; cost-effective intervention that has been prioritized in policy in Uganda but implementation has been limited., Methods: A standardised, cross-sectional, mixed-method evaluation design was used, employing semi-structured key-informant interviews and observations in 11 health care facilities implementing kangaroo mother care in Uganda., Results: The facilities visited scored between 8.28 and 21.72 out of the possible 30 points with a median score of 14.71. Two of the 3 highest scoring hospitals were private, not-for-profit hospitals whereas the second highest scoring hospital was a central teaching hospital. Facilities with KMC services are not equally distributed throughout the country. Only 4 regions (Central 1, Central 2, East-Central and Southwest) plus the City of Kampala were identified as having facilities providing KMC services., Conclusion: KMC services are not instituted with consistent levels of quality and are often dependent on private partner support. With increasing attention globally and in country, Uganda is in a unique position to accelerate access to and quality of health services for small babies across the country.
- Published
- 2014
- Full Text
- View/download PDF
43. Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa.
- Author
-
Bergh AM, Kerber K, Abwao S, de-Graft Johnson J, Aliganyira P, Davy K, Gamache N, Kante M, Ligowe R, Luhanga R, Mukarugwiro B, Ngabo F, Rawlins B, Sayinzoga F, Sengendo NH, Sylla M, Taylor R, van Rooyen E, and Zoungrana J
- Subjects
- Adult, Cross-Sectional Studies, Female, Health Services Research, Humans, Malawi, Mali, Program Development, Program Evaluation, Quality Improvement, Rwanda, Uganda, Kangaroo-Mother Care Method
- Abstract
Background: Some countries have undertaken programs that included scaling up kangaroo mother care. The aim of this study was to systematically evaluate the implementation status of facility-based kangaroo mother care services in four African countries: Malawi, Mali, Rwanda and Uganda., Methods: A cross-sectional, mixed-method research design was used. Stakeholders provided background information at national meetings and in individual interviews. Facilities were assessed by means of a standardized tool previously applied in other settings, employing semi-structured key-informant interviews and observations in 39 health care facilities in the four countries. Each facility received a score out of a total of 30 according to six stages of implementation progress., Results: Across the four countries 95 per cent of health facilities assessed demonstrated some evidence of kangaroo mother care practice. Institutions that fared better had a longer history of kangaroo mother care implementation or had been developed as centres of excellence or had strong leaders championing the implementation process. Variation existed in the quality of implementation between facilities and across countries. Important factors identified in implementation are: training and orientation; supportive supervision; integrating kangaroo mother care into quality improvement; continuity of care; high-level buy in and support for kangaroo mother care implementation; and client-oriented care., Conclusion: The integration of kangaroo mother care into routine newborn care services should be part of all maternal and newborn care initiatives and packages. Engaging ministries of health and other implementing partners from the outset may promote buy in and assist with the mobilization of resources for scaling up kangaroo mother care services. Mechanisms for monitoring these services should be integrated into existing health management information systems.
- Published
- 2014
- Full Text
- View/download PDF
44. Neonatal survival in complex humanitarian emergencies: setting an evidence-based research agenda.
- Author
-
Morof DF, Kerber K, Tomczyk B, Lawn J, Blanton C, Sami S, and Amsalu R
- Abstract
Background: Over 40% of all deaths among children under 5 are neonatal deaths (0-28 days), and this proportion is increasing. In 2012, 2.9 million newborns died, with 99% occurring in low- and middle-income countries. Many of the countries with the highest neonatal mortality rates globally are currently or have recently been affected by complex humanitarian emergencies. Despite the global burden of neonatal morbidity and mortality and risks inherent in complex emergency situations, research investments are not commensurate to burden and little is known about the epidemiology or best practices for neonatal survival in these settings., Methods: We used the Child Health and Nutrition Research Initiative (CHNRI) methodology to prioritize research questions on neonatal health in complex humanitarian emergencies. Experts evaluated 35 questions using four criteria (answerability, feasibility, relevance, equity) with three subcomponents per criterion. Using SAS 9.2, a research prioritization score (RPS) and average expert agreement score (AEA) were calculated for each question., Results: Twenty-eight experts evaluated all 35 questions. RPS ranged from 0.846 to 0.679 and the AEA ranged from 0.667 to 0.411. The top ten research priorities covered a range of issues but generally fell into two categories- epidemiologic and programmatic components of neonatal health. The highest ranked question in this survey was "What strategies are effective in increasing demand for, and use of skilled attendance?", Conclusions: In this study, a diverse group of experts used the CHRNI methodology to systematically identify and determine research priorities for neonatal health and survival in complex humanitarian emergencies. The priorities included the need to better understand the magnitude of the disease burden and interventions to improve neonatal health in complex humanitarian emergencies. The findings from this study will provide guidance to researchers and program implementers in neonatal and complex humanitarian fields to engage on the research priorities needed to save lives most at risk.
- Published
- 2014
- Full Text
- View/download PDF
45. High frequency oscillations mirror disease activity in patients with focal cortical dysplasia.
- Author
-
Kerber K, LeVan P, Dümpelmann M, Fauser S, Korinthenberg R, Schulze-Bonhage A, and Jacobs J
- Subjects
- Adolescent, Adult, Brain Diseases classification, Brain Diseases surgery, Child, Electrodes, Implanted, Electroencephalography, Electromyography, Epilepsy physiopathology, Epilepsy surgery, Female, Humans, Male, Malformations of Cortical Development classification, Malformations of Cortical Development surgery, Malformations of Cortical Development, Group I, Middle Aged, Outcome Assessment, Health Care, Signal Processing, Computer-Assisted, Statistics as Topic, Young Adult, Brain Diseases physiopathology, Brain Mapping, Brain Waves physiology, Malformations of Cortical Development physiopathology
- Abstract
Purpose: The study analyzes the occurrence of high frequency oscillations in different types of focal cortical dysplasia in 22 patients with refractory epilepsy. High frequency oscillations are biomarkers for epileptic tissue, but it is unknown whether they can reflect increasingly dysplastic tissue changes as well as epileptic disease activity., Methods: High frequency oscillations (80-450 Hz) were visually marked by two independent reviewers in all channels of intracranial implanted grid, strips, and depth electrodes in patients with focal cortical dysplasia and refractory epilepsy. Rates of high frequency oscillations in patients with pathologically confirmed focal cortical dysplasia of Palmini type 1a and b were compared with those in type 2a and b., Key Findings: Patients with focal cortical dysplasia type 2 had significantly more seizures than those with type 1 (p < 0.001). Rates of high frequency oscillations were significantly higher in patients with focal cortical dysplasia type 2 versus type 1 (p < 0.001). In addition, it could be confirmed that rates of high frequency oscillations were significantly higher in presumed epileptogenic areas than outside (p < 0.001)., Significance: Activity of high frequency oscillations mirrors the higher epileptogenicity of focal cortical dysplasia type 2 lesions compared to type 1 lesions. Therefore, rates of high frequency oscillations can reflect disease activity of a lesion. This has implications for the use of high frequency oscillations as biomarkers for epileptogenic areas, because a detailed analysis of their rates may be necessary to use high frequency oscillations as a predictive tool in epilepsy surgery., (Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.)
- Published
- 2013
- Full Text
- View/download PDF
46. Measuring coverage in MNCH: indicators for global tracking of newborn care.
- Author
-
Moran AC, Kerber K, Sitrin D, Guenther T, Morrissey CS, Newby H, Fishel J, Yoder PS, Hill Z, and Lawn JE
- Subjects
- Adult, Consensus, Family Characteristics, Female, Global Health, Guideline Adherence, Health Services Accessibility trends, Health Services Research methods, Humans, Infant Mortality, Infant, Newborn, Male, Maternal Behavior, Patient Acceptance of Health Care, Practice Guidelines as Topic, Program Evaluation, Research Design, Surveys and Questionnaires, Time Factors, Child Health Services trends, Developing Countries, Health Care Surveys trends, Health Services Research trends, Quality Indicators, Health Care trends
- Abstract
Neonatal mortality accounts for 43% of under-five mortality. Consequently, improving newborn survival is a global priority. However, although there is increasing consensus on the packages and specific interventions that need to be scaled up to reduce neonatal mortality, there is a lack of clarity on the indicators needed to measure progress. In 2008, in an effort to improve newborn survival, the Newborn Indicators Technical Working Group (TWG) was convened by the Saving Newborn Lives program at Save the Children to provide a forum to develop the indicators and standard measurement tools that are needed to measure coverage of key newborn interventions. The TWG, which included evaluation and measurement experts, researchers, individuals from United Nations agencies and non-governmental organizations, and donors, prioritized improved consistency of measurement of postnatal care for women and newborns and of immediate care behaviors and practices for newborns. In addition, the TWG promoted increased data availability through inclusion of additional questions in nationally representative surveys, such as the United States Agency for International Development-supported Demographic and Health Surveys and the United Nations Children's Fund-supported Multiple Indicator Cluster Surveys. Several studies have been undertaken that have informed revisions of indicators and survey tools, and global postnatal care coverage indicators have been finalized. Consensus has been achieved on three additional indicators for care of the newborn after birth (drying, delayed bathing, and cutting the cord with a clean instrument), and on testing two further indicators (immediate skin-to-skin care and applications to the umbilical cord). Finally, important measurement gaps have been identified regarding coverage data for evidence-based interventions, such as Kangaroo Mother Care and care seeking for newborn infection.
- Published
- 2013
- Full Text
- View/download PDF
47. Influence of cobalt on the properties of load-sensitive magnesium alloys.
- Author
-
Klose C, Demminger C, Mroz G, Reimche W, Bach FW, Maier HJ, and Kerber K
- Abstract
In this study, magnesium is alloyed with varying amounts of the ferromagnetic alloying element cobalt in order to obtain lightweight load-sensitive materials with sensory properties which allow an online-monitoring of mechanical forces applied to components made from Mg-Co alloys. An optimized casting process with the use of extruded Mg-Co powder rods is utilized which enables the production of magnetic magnesium alloys with a reproducible Co concentration. The efficiency of the casting process is confirmed by SEM analyses. Microstructures and Co-rich precipitations of various Mg-Co alloys are investigated by means of EDS and XRD analyses. The Mg-Co alloys' mechanical strengths are determined by tensile tests. Magnetic properties of the Mg-Co sensor alloys depending on the cobalt content and the acting mechanical load are measured utilizing the harmonic analysis of eddy-current signals. Within the scope of this work, the influence of the element cobalt on magnesium is investigated in detail and an optimal cobalt concentration is defined based on the performed examinations.
- Published
- 2012
- Full Text
- View/download PDF
48. Introduction of newborn care within integrated community case management in Uganda.
- Author
-
Nalwadda Kayemba C, Naamala Sengendo H, Ssekitooleko J, Kerber K, Källander K, Waiswa P, Aliganyira P, Guenther T, Gamache N, Strachan C, Ocan C, Magumba G, Counihan H, Mbonye AK, and Marsh DR
- Subjects
- Caregivers, Cross-Sectional Studies, Female, Focus Groups, Humans, Infant, Newborn, Male, Rural Population, Uganda, Case Management, Community Health Services, Community Health Workers, Infant Care
- Abstract
Uganda's Ministry of Health, together with partners, has introduced integrated community case management (iCCM) for children under 5 years. We assessed how the iCCM program addresses newborn care in three midwestern districts through document reviews, structured interviews, and focus group discussions with village health team (VHT) members trained in iCCM, caregivers, and other stakeholders. Almost all VHT members reported that they refer sick newborns to facilities and could identify at least three newborn danger signs. However, they did not identify the most important clinical indicators of severe illness. The extent of compliance with newborn referral and quality of care for newborns at facilities is not clear. Overall iCCM is perceived as beneficial, but caregivers, VHTs, and health workers want to do more for sick babies at facilities and in communities. Additional research is needed to assess the ability of VHTs to identify newborn danger signs, referral compliance, and quality of newborn treatment at facilities.
- Published
- 2012
- Full Text
- View/download PDF
49. Neonatal survival interventions in humanitarian emergencies: a survey of current practices and programs.
- Author
-
Lam JO, Amsalu R, Kerber K, Lawn JE, Tomczyk B, Cornier N, Adler A, Golaz A, and Moss WJ
- Abstract
Background: Neonatal deaths account for over 40% of all deaths in children younger than five years of age and neonatal mortality rates are highest in areas affected by humanitarian emergencies. Of the ten countries with the highest neonatal mortality rates globally, six are currently or recently affected by a humanitarian emergency. Yet, little is known about newborn care in crisis settings. Understanding current policies and practices for the care of newborns used by humanitarian aid organizations will inform efforts to improve care in these challenging settings., Methods: Between August 18 and September 25, 2009, 56 respondents that work in humanitarian emergencies completed a web-based survey either in English or French. A snow ball sampling technique was used to identify organizations that provide health services during humanitarian emergencies to gather information on current practices for maternal and newborn care in these settings. Information was collected about continuum-of-care services for maternal, newborn and child health, referral services, training and capacity development, health information systems, policies and guidelines, and organizational priorities. Data were entered into MS Excel and frequencies and percentages were calculated., Results: The majority of responding organizations reported implementing components of neonatal and maternal health interventions. However, multiple barriers exist in providing comprehensive care, including: funding shortages (63.3%), gaps in training (51.0%) and staff shortages and turnover (44.9%)., Conclusions: Neonatal care is provided by most of the responding humanitarian organizations; however, the quality, breadth and consistency of this care are limited.
- Published
- 2012
- Full Text
- View/download PDF
50. Newborn survival: a multi-country analysis of a decade of change.
- Author
-
Lawn JE, Kinney MV, Black RE, Pitt C, Cousens S, Kerber K, Corbett E, Moran AC, Morrissey CS, and Oestergaard MZ
- Subjects
- Africa South of the Sahara epidemiology, Delivery of Health Care, Developing Countries statistics & numerical data, Health Expenditures trends, Health Policy, Humans, Infant Care economics, Infant Care organization & administration, Infant Care standards, Infant Care trends, Infant, Newborn, Infant Mortality trends
- Abstract
Neonatal deaths account for 40% of global under-five mortality and are ever more important if we are to achieve the Millennium Development Goal 4 (MDG 4) on child survival. We applied a results framework to evaluate global and national changes for neonatal mortality rates (NMR), healthy behaviours, intervention coverage, health system change, and inputs including funding, while considering contextual changes. The average annual rate of reduction of NMR globally accelerated between 2000 and 2010 (2.1% per year) compared with the 1990s, but was slower than the reduction in mortality of children aged 1-59 months (2.9% per year) and maternal mortality (4.2% per year). Regional variation of NMR change ranged from 3.0% per year in developed countries to 1.5% per year in sub-Saharan Africa. Some countries have made remarkable progress despite major challenges. Our statistical analysis identifies inter-country predictors of NMR reduction including high baseline NMR, and changes in income or fertility. Changes in intervention or package coverage did not appear to be important predictors in any region, but coverage data are lacking for several neonatal-specific interventions. Mortality due to neonatal infection deaths, notably tetanus, decreased, and deaths from complications of preterm birth are increasingly important. Official development assistance for maternal, newborn and child health doubled from 2003 to 2008, yet by 2008 only 6% of this aid mentioned newborns, and a mere 0.1% (US$4.56m) exclusively targeted newborn care. The amount of newborn survival data and the evidence based increased, as did recognition in donor funding. Over this decade, NMR reduction seems more related to change in context, such as socio-economic factors, than to increasing intervention coverage. High impact cost-effective interventions hold great potential to save newborn lives especially in the highest burden countries. Accelerating progress requires data-driven investments and addressing context-specific implementation realities.
- Published
- 2012
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.