217 results on '"Blencowe H"'
Search Results
2. Counting the smallest : data to estimate global stillbirth, preterm birth and low birthweight rates
- Author
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Blencowe, H. and Blencowe, H.
- Subjects
362.1983 - Abstract
Background: Stillbirth, preterm birth and low birthweight are important indicators of global burden of disease, status of maternal health and healthcare, and predictors of health throughout the life-course. Data are available through Civil Registration and Vital Statistics (CRVS), Health Management Information Systems (HMIS) and household surveys. Comparisons of data by country or over time requires standard definitions and comparable data quality. Data gaps and inconsistencies necessitate adjustments and use of modelled estimates in many settings. Methods: Systematic data searches were undertaken to compile available data on these outcomes for 195 countries. Where no reliable data were available, statistical models were used to generate national estimates. Data quantity and quality were summarised for each outcome, with implications for improvement and research. Results: The estimated burden remains large: 2.6 million stillbirths (2015), 14.9 million preterm births (2010) and 20.5 million low birthweight babies (2015) based on 4,392 data-points from 148 countries. Common data quality challenges include use of non-standard definitions, omission, and misclassification. Targeted data quality assessments are required to detect these. Five data gaps identified to address are: (1) coverage of data systems (2) accurate assessment of vital status at birth, birthweight and gestational age for every birth, (3) accurate recording of these key data elements (4) comparable collation within and across data systems and (5) use of data to inform programmes and policy. Evidence exists across all data platforms of examples of solutions to close these gaps. Systematic data linkage could increase efficiency. Conclusion: Data availability has increased over the last decade, even in the poorest countries. Data quality issues currently hamper the use of these data to improve outcomes in many settings, but could be addressed with political will and targeted investment. Ending preventable deaths among the world's smallest babies requires that these data are accurate, available and used.
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- 2020
- Full Text
- View/download PDF
3. Estimating the birth prevalence and pregnancy outcomes of congenital malformations worldwide
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Moorthie, Sowmiya, Blencowe, Hannah, Darlison, Matthew W., Lawn, Joy, Morris, Joan K., Modell, Bernadette, Congenital Disorders Expert Group, Bittles, A. H., Blencowe, H., Christianson, A., Cousens, S., Darlison, M. W., Gibbons, S., Hamamy, H., Khoshnood, B., Howson, C. P., Lawn, J., Mastroiacovo, P., Modell, B., Moorthie, S., Morris, J. K., Mossey, P. A., Neville, A. J., Petrou, M., Povey, S., Rankin, J., Schuler-Faccini, L., Wren, C., and Yunnis, K. A.
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- 2018
- Full Text
- View/download PDF
4. Making stillbirths visible: a systematic review of globally reported causes of stillbirth
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Reinebrant, HE, Leisher, SH, Coory, M, Henry, S, Wojcieszek, AM, Gardener, G, Lourie, R, Ellwood, D, Teoh, Z, Allanson, E, Blencowe, H, Draper, ES, Erwich, JJ, Frøen, JF, Gardosi, J, Gold, K, Gordijn, S, Gordon, A, Heazell, AEP, Khong, TY, Korteweg, F, Lawn, JE, McClure, EM, Oats, J, Pattinson, R, Pettersson, K, Siassakos, D, Silver, RM, Smith, GCS, Tunçalp, Ö, and Flenady, V
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- 2018
- Full Text
- View/download PDF
5. The PRECISE-DYAD protocol : linking maternal and infant health trajectories in sub-Saharan Africa
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Craik, R, Volvert, ML, Koech, A, Jah, H, Pickerill, K, Abubakar, A, D'Alessandro, U, Barratt, B, Blencowe, H, Bone, JN, Chandna, J, Gladstone, M, Khalil, A, Li, L, Magee, LA, Makacha, L, Mistry, HD, Moore, S, Roca, A, Salisbury, TT, Temmerman, Marleen, Toudup, D, Vidler, M, and von Dadelszen, Peter
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neurodevelopment ,pregnancy complications ,Medicine and Health Sciences ,child health ,Medicine (miscellaneous) ,global health ,Maternal health ,biorepository ,air quality ,General Biochemistry, Genetics and Molecular Biology - Abstract
Background: PRECISE-DYAD is an observational cohort study of mother-child dyads running in urban and rural communities in The Gambia and Kenya. The cohort is being followed for two years and includes uncomplicated pregnancies and those that suffered pregnancy hypertension, fetal growth restriction, preterm birth, and/or stillbirth. Methods: The PRECISE-DYAD study will follow up ~4200 women and their children recruited into the original PRECISE study. The study will add to the detailed pregnancy information and samples in PRECISE, collecting additional biological samples and clinical information on both the maternal and child health. Women will be asked about both their and their child’s health, their diets as well as undertaking a basic cardiology assessment. Using a case-control approach, some mothers will be asked about their mental health, their experiences of care during labour in the healthcare facility. In a sub-group, data on financial expenditure during antenatal, intrapartum, and postnatal periods will also be collected. Child development will be assessed using a range of tools, including neurodevelopment assessments, and evaluating their home environment and quality of life. In the event developmental milestones are not met, additional assessments to assess vision and their risk of autism spectrum disorders will be conducted. Finally, a personal environmental exposure model for the full cohort will be created based on air and water quality data, combined with geographical, demographic, and behavioural variables. Conclusions: The PRECISE-DYAD study will provide a greater epidemiological and mechanistic understanding of health and disease pathways in two sub-Saharan African countries, following healthy and complicated pregnancies. We are seeking additional funding to maintain this cohort and to gain an understanding of the effects of pregnancies outcome on longer-term health trajectories in mothers and their children.
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- 2022
6. The effect of coverings, including plastic bags and wraps, on mortality and morbidity in preterm and full-term neonates
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Oatley, H K, Blencowe, H, and Lawn, J E
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- 2016
- Full Text
- View/download PDF
7. Counting the smallest: data to estimate global stillbirth, preterm birth and low birthweight rates
- Author
-
Blencowe, H and Blencowe, H
- Abstract
Background: Stillbirth, preterm birth and low birthweight are important indicators of global burden of disease, status of maternal health and healthcare, and predictors of health throughout the life-course. Data are available through Civil Registration and Vital Statistics (CRVS), Health Management Information Systems (HMIS) and household surveys. Comparisons of data by country or over time requires standard definitions and comparable data quality. Data gaps and inconsistencies necessitate adjustments and use of modelled estimates in many settings. Methods: Systematic data searches were undertaken to compile available data on these outcomes for 195 countries. Where no reliable data were available, statistical models were used to generate national estimates. Data quantity and quality were summarised for each outcome, with implications for improvement and research. Results: The estimated burden remains large: 2.6 million stillbirths (2015), 14.9 million preterm births (2010) and 20.5 million low birthweight babies (2015) based on 4,392 data-points from 148 countries. Common data quality challenges include use of non-standard definitions, omission, and misclassification. Targeted data quality assessments are required to detect these. Five data gaps identified to address are: (1) coverage of data systems (2) accurate assessment of vital status at birth, birthweight and gestational age for every birth, (3) accurate recording of these key data elements (4) comparable collation within and across data systems and (5) use of data to inform programmes and policy. Evidence exists across all data platforms of examples of solutions to close these gaps. Systematic data linkage could increase efficiency. Conclusion: Data availability has increased over the last decade, even in the poorest countries. Data quality issues currently hamper the use of these data to improve outcomes in many settings, but could be addressed with political will and targeted investment. Ending preventable deaths among the world’s smallest babies requires that these data are accurate, available and used.
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- 2020
- Full Text
- View/download PDF
8. Stillbirth in Australia 1: The road to now: Two decades of stillbirth research and advocacy in Australia
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Flenady VJ, Middleton P, Wallace E, Morris J, Gordon A, Boyle FM, Homer C, Henry S, Brezler L, Wojcieszek AM, Davies-Tuck M, Coory M, Callander E, Kumar S, Clifton V, Leisher SH, Blencowe H, Forbes M, Sexton J, and Ellwood D
- Subjects
population characteristics ,Obstetrics & Reproductive Medicine ,female genital diseases and pregnancy complications ,reproductive and urinary physiology ,11 Medical and Health Sciences - Abstract
© 2020 Australian College of Midwives Stillbirth is a major public health problem with an enormous mortality burden and psychosocial impact on parents, families and the wider community both globally and in Australia. In 2015, Australia's late gestation stillbirth rate was over 30% higher than that of the best-performing countries globally, highlighting the urgent need for action. We present an overview of the foundations which led to the establishment of Australia's NHMRC Centre of Research Excellence in Stillbirth (Stillbirth CRE) in 2017 and highlight key activities in the following areas: Opportunities to expand and improve collaborations between research teams; Supporting the conduct and development of innovative, high quality, collaborative research that incorporates a strong parent voice; Promoting effective translation of research into health policy and/or practice; and the Regional and global work of the Stillbirth CRE. We highlight the first-ever Senate Inquiry into Stillbirth in Australia in 2018. These events ultimately led to the development of a National Stillbirth Action and Implementation Plan for Australia with the aims of reducing stillbirth rates by 20% over the next five years, reducing the disparity in stillbirth rates between advantaged and disadvantaged communities, and improving care for all families who experience this loss.
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- 2020
9. Review: Addressing the challenge of neonatal mortality
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Blencowe, H. and Cousens, S.
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- 2013
- Full Text
- View/download PDF
10. Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: a systematic review and meta-analysis
- Author
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Seale, A, Blencowe, H, and Berkley, J
- Abstract
Bacterial infections are a leading cause of the 2·9 million annual neonatal deaths. Treatment is usually based on clinical diagnosis of possible severe bacterial infection (pSBI). To guide programme planning, we have undertaken the first estimates of neonatal pSBI, by sex and by region, for sub-Saharan Africa, south Asia, and Latin America.We included data for pSBI incidence in neonates of 32 weeks' gestation or more (or birthweight ≥1500 g) with livebirth denominator data, undertaking a systematic review and forming an investigator group to obtain unpublished data. We calculated pooled risk estimates for neonatal pSBI and case fatality risk, by sex and by region. We then applied these risk estimates to estimates of livebirths in sub-Saharan Africa, south Asia, and Latin America to estimate cases and associated deaths in 2012.We included data from 22 studies, for 259 944 neonates and 20 196 pSBI cases, with most of the data (18 of the 22 studies) coming from the investigator group. The pooled estimate of pSBI incidence risk was 7·6% (95% CI 6·1-9·2%) and the case-fatality risk associated with pSBI was 9·8% (7·4-12·2). We estimated that in 2012 there were 6·9 million cases (uncertainty range 5·5 million-8·3 million) of pSBI in neonates needing treatment: 3·5 million (2·8 million-4·2 million) in south Asia, 2·6 million (2·1 million-3·1 million) in sub-Saharan Africa, and 0·8 million (0·7 million-1·0 million) in Latin America. The risk of pSBI was greater in boys (risk ratio 1·12, 95% CI 1·06-1·18) than girls. We estimated that there were 0·68 million (0·46 million-0·92 million) neonatal deaths associated with pSBI in 2012.The need-to-treat population for pSBI in these three regions is high, with ten cases of pSBI diagnosed for each associated neonatal death. Deaths and disability can be reduced through improved prevention, detection, and case management.The Wellcome Trust and the Bill & Melinda Gates Foundation through grants to Child Health Epidemiology Reference Group (CHERG) and Save the Children's Saving Newborn Lives programme.
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- 2019
11. An overview of concepts and approaches used in estimating the burden of congenital disorders globally
- Author
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Moorthie, S, Blencowe, H, W Darlison, M, Lawn, JE, Mastroiacovo, P, Morris, JK, Modell, B, and Congenital Disorders Expert Group
- Abstract
Congenital disorders are an important cause of pregnancy loss, premature death and life-long disability. A range of interventions can greatly reduce their burden, but the absence of local epidemiological data on their prevalence and the impact of interventions impede policy and service development in many countries. In an attempt to overcome these deficiencies, we have developed a tool-The Modell Global Database of Congenital Disorders (MGDb) that combines general biological principles and available observational data with demographic data, to generate estimates of the birth prevalence and effects of interventions on mortality and disability due to congenital disorders. MGDb aims to support policy development by generating country, regional and global epidemiological estimates. Here we provide an overview of the concepts and methodological approach used to develop MGDb.
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- 2017
12. Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21 st standard: Analysis of CHERG datasets
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Schmiegelow, C., Sania, A., Velaphi, S.C., Kolsteren, P., Fawzi, W., Silveira, M.F., Adair, L.S., Christian, P., Ezzati, M., Baqui, A.H., Mullany, L.C., Tielsch, J.M., Lawn, J.E., Caulfield, L.E., Saville, N., Lee, A.C.C., Huybregts, L., Barros, F.C., Stevens, G.A., Ndyomugyenyi, R., Victora, C.G., Roberfroid, D., Mongkolchati, A., Blencowe, H., Terlouw, D.J., Watson-Jones, D., Humphrey, J., Nien, J.K., Willey, B.A., Manandhar, D., Gonzalez, R., Black, R.E., Rosen, H.E., Kariuki, S., Bhutta, Z.A., Lusingu, J., Clarke, S.E., Kozuki, N., Cousens, S., and Katz, J.
- Abstract
Objectives To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21 st birth weight standard. Design Secondary analysis of data from the Child Health Epidemiology Reference Group (CHERG), including 14 birth cohorts with gestational age, birth weight, and neonatal follow-up. Small for gestational age was defined as infants weighing less than the 10th centile birth weight for gestational age and sex with the multiethnic, INTERGROWTH-21 st birth weight standard. Prevalence of small for gestational age and neonatal mortality risk ratios were calculated and pooled among these datasets at the regional level. With available national level data, prevalence of small for gestational age and population attributable fractions of neonatal mortality attributable to small for gestational age were estimated. Setting CHERG birth cohorts from 14 population based sites in low and middle income countries. Main outcome measures In low and middle income countries in the year 2012, the number and proportion of infants born small for gestational age; number and proportion of neonatal deaths attributable to small for gestational age; the number and proportion of neonatal deaths that could be prevented by reducing the prevalence of small for gestational age to 10%. Results In 2012, an estimated 23.3 million infants (uncertainty range 17.6 to 31.9; 19.3% of live births) were born small for gestational age in low and middle income countries. Among these, 11.2 million (0.8 to 15.8) were term and not low birth weight (���2500 g), 10.7 million (7.6 to 15.0) were term and low birth weight (
- Published
- 2017
- Full Text
- View/download PDF
13. Parents’ and healthcare professionals’ experiences of care after stillbirth in low‐ and middle‐income countries: a systematic review and meta‐summary
- Author
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Shakespeare, C, primary, Merriel, A, additional, Bakhbakhi, D, additional, Baneszova, R, additional, Barnard, K, additional, Lynch, M, additional, Storey, C, additional, Blencowe, H, additional, Boyle, F, additional, Flenady, V, additional, Gold, K, additional, Horey, D, additional, Mills, T, additional, and Siassakos, D, additional
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- 2018
- Full Text
- View/download PDF
14. Every Woman, Every Child's ‘Progress in Partnership’ for stillbirths: a commentary by the stillbirth advocacy working group
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Ateva, E, primary, Blencowe, H, additional, Castillo, T, additional, Dev, A, additional, Farmer, M, additional, Kinney, M, additional, Mishra, SK, additional, Hopkins Leisher, S, additional, Maloney, S, additional, Ponce Hardy, V, additional, Quigley, P, additional, Ruidiaz, J, additional, Siassakos, D, additional, Stoner, JE, additional, Storey, C, additional, and Tejada de Rivero Sawers, ML, additional
- Published
- 2018
- Full Text
- View/download PDF
15. Making stillbirths visible: a systematic review of globally reported causes of stillbirth
- Author
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Reinebrant, HE, primary, Leisher, SH, additional, Coory, M, additional, Henry, S, additional, Wojcieszek, AM, additional, Gardener, G, additional, Lourie, R, additional, Ellwood, D, additional, Teoh, Z, additional, Allanson, E, additional, Blencowe, H, additional, Draper, ES, additional, Erwich, JJ, additional, Frøen, JF, additional, Gardosi, J, additional, Gold, K, additional, Gordijn, S, additional, Gordon, A, additional, Heazell, AEP, additional, Khong, TY, additional, Korteweg, F, additional, Lawn, JE, additional, McClure, EM, additional, Oats, J, additional, Pattinson, R, additional, Pettersson, K, additional, Siassakos, D, additional, Silver, RM, additional, Smith, GCS, additional, Tunçalp, Ö, additional, and Flenady, V, additional
- Published
- 2017
- Full Text
- View/download PDF
16. Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: A systematic review and meta-analysis
- Author
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Seale, A, Blencowe, H, Manu, A, Nair, H, Bahl, R, Qazi, SA, Zaidi, A, Berkley, J, Cousens, SN, Lawn, J, Agustian, D, Althabe, F, Azziz-Baumgartner, E, Baqui, A, Bausch, D, Belizan, J, Qar Bhutta, Z, Black, R, Broor, S, Bruce, N, Buekens, P, Campbell, H, Carlo, W, Chomba, E, and Costello, A
- Abstract
Background: Bacterial infections are a leading cause of the 2·9 million annual neonatal deaths. Treatment is usually based on clinical diagnosis of possible severe bacterial infection (pSBI). To guide programme planning, we have undertaken the first estimates of neonatal pSBI, by sex and by region, for sub-Saharan Africa, south Asia, and Latin America. Methods: We included data for pSBI incidence in neonates of 32 weeks' gestation or more (or birthweight ≥1500 g) with livebirth denominator data, undertaking a systematic review and forming an investigator group to obtain unpublished data. We calculated pooled risk estimates for neonatal pSBI and case fatality risk, by sex and by region. We then applied these risk estimates to estimates of livebirths in sub-Saharan Africa, south Asia, and Latin America to estimate cases and associated deaths in 2012. Findings: We included data from 22 studies, for 259 944 neonates and 20 196 pSBI cases, with most of the data (18 of the 22 studies) coming from the investigator group. The pooled estimate of pSBI incidence risk was 7·6% (95% CI 6·1-9·2%) and the case-fatality risk associated with pSBI was 9·8% (7·4-12·2). We estimated that in 2012 there were 6·9 million cases (uncertainty range 5·5 million-8·3 million) of pSBI in neonates needing treatment: 3·5 million (2·8 million-4·2 million) in south Asia, 2·6 million (2·1 million-3·1 million) in sub-Saharan Africa, and 0·8 million (0·7 million-1·0 million) in Latin America. The risk of pSBI was greater in boys (risk ratio 1·12, 95% CI 1·06-1·18) than girls. We estimated that there were 0·68 million (0·46 million-0·92 million) neonatal deaths associated with pSBI in 2012. Interpretation: The need-to-treat population for pSBI in these three regions is high, with ten cases of pSBI diagnosed for each associated neonatal death. Deaths and disability can be reduced through improved prevention, detection, and case management. Funding: The Wellcome Trust and the Bill and Melinda Gates Foundation through grants to Child Health Epidemiology Reference Group (CHERG) and Save the Children's Saving Newborn Lives programme. © 2014 Seale et al.
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- 2016
17. Setting research priorities to improve global newborn health and prevent stillbirths by 2025
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Yoshida, S, Martines, J, Lawn, JE, Wall, S, Souza, JP, Rudan, I, Cousens, S, Aaby, P, Adam, I, Adhikari, RK, Ambalavanan, N, Arifeen, SE, Aryal, DR, Asiruddin, S, Baqui, A, Barros, AJ, Benn, CS, Bhandari, V, Bhatnagar, S, Bhattacharya, S, Bhutta, ZA, Black, RE, Blencowe, H, Bose, C, Brown, J, Bührer, C, Carlo, W, Cecatti, JG, Cheung, PY, Clark, R, Colbourn, T, Conde-Agudelo, A, Corbett, E, Czeizel, AE, Das, A, Day, LT, Deal, C, Deorari, A, Dilmen, U, English, M, Engmann, C, Esamai, F, Fall, C, Ferriero, DM, Gisore, P, Hazir, T, Higgins, RD, Homer, CS, Hoque, DE, Irgens, L, Islam, MT, de Graft-Johnson, J, Joshua, MA, Keenan, W, Khatoon, S, Kieler, H, Kramer, MS, Lackritz, EM, Lavender, T, Lawintono, L, Luhanga, R, Marsh, D, McMillan, D, McNamara, PJ, Mol, BW, Molyneux, E, Mukasa, GK, Mutabazi, M, Nacul, LC, Nakakeeto, M, Narayanan, I, Olusanya, B, Osrin, D, Paul, V, Poets, C, Reddy, UM, Santosham, M, Sayed, R, Schlabritz-Loutsevitch, NE, Singhal, N, Smith, MA, Smith, PG, Soofi, S, Spong, CY, Sultana, S, Tshefu, A, van Bel, F, Gray, LV, Waiswa, P, Wang, W, Williams, SL, Wright, L, Zaidi, A, Zhang, Y, Zhong, N, Zuniga, I, and Bahl, R
- Abstract
In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013-2025.We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts.Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour.These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.
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- 2016
18. 744. CAP-BADGE, EAST YORKSHIRE REGIMENT
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Blencowe, H. A.
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- 1947
19. 746. CAP-BADGE, YORK AND LANCASTER REGIMENT
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Blencowe, H. A.
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- 1947
20. 789. GRENADES OF FUSILIER REGIMENTS
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Blencowe, H. A.
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- 1950
21. Setting research priorities to improve global newborn health and prevent stillbirths by 2025
- Author
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Yoshida, S., Martines, J., Lawn, J. E., Wall, S., Souza, J. P., Rudan, I., Cousens, S., Aaby, P., Adam, I., Adhikari, R. K., Ambalavanan, N., Arifeen, S. E. I., Aryal, D. R., Asiruddin, S. K., Baqui, A., Barros, A. J. D., Benn, C. S., Bhandari, V., Bhatnagar, S., Bhattacharya, S., Bhutta, Z. A., Black, R. E., Blencowe, H., Bose, C., Brown, J., Bührer, C., Carlo, W., Cecatti, J. G., Cheung, P., Clark, R., Colbourn, T., Conde-Agudelo, A., Corbett, E., Czeizel, A. E., Abhik Das, Day, L. T., Deal, C., Deorari, A., Dilmen, U., English, M., Engmann, C., Esamai, F., Fall, C., Ferriero, D. M., Gisore, P., Hazir, T., Higgins, R. D., Homer, C. S. E., Hoque, D. E., Irgens, L., Islam, M. T., Graft-Johnson, J., Joshua, M. A., Keenan, W., Khatoon, S., Kieler, H., Kramer, M. S., Lackritz, E. M., Lavender, T., Lawintono, L., Luhanga, R., Marsh, D., Mcmillan, D., Mcnamara, P. J., Mol, B. J., Molyneux, E., Mukasa, G. K., Mutabazi, M., Nacul, L. C., Nakakeeto, M., Narayanan, I., Olusanya, B., Osrin, D., Paul, V., Poets, C., Reddy, U. M., Santosham, M., Sayed, R., Schlabritz-Loutsevitch, N. E., Singhal, N., Smith, M. A., Smith, P. G., Soofi, S., Spong, C. Y., Sultana, S., Tshefu, A., Bel, F., Gray, L. V., Waiswa, P., Wang, W., Williams, S. L. A., Wright, L., Zaidi, A., Zhang, Y., Zhong, N., Zuniga, I., Bahl, R., and APH - Amsterdam Public Health
- Subjects
priorities ,newborn ,Research ,lcsh:Public aspects of medicine ,lcsh:R ,Research Theme: Global Health Research Priorities ,lcsh:Medicine ,health ,lcsh:RA1-1270 ,improve - Abstract
Background In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013–2025. Methods We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. Results Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. Conclusion These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.
- Published
- 2016
22. Parents' and healthcare professionals' experiences of care after stillbirth in low- and middle-income countries: a systematic review and meta-summary.
- Author
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Shakespeare, C, Merriel, A, Bakhbakhi, D, Baneszova, R, Barnard, K, Lynch, M, Storey, C, Blencowe, H, Boyle, F, Flenady, V, Gold, K, Horey, D, Mills, T, and Siassakos, D
- Subjects
STILLBIRTH ,SYSTEMATIC reviews ,META-analysis ,BEREAVEMENT ,MEDICAL personnel-caregiver relationships ,PERINATAL death & psychology ,ATTITUDE (Psychology) ,DEVELOPING countries ,MEDICAL personnel ,PSYCHOLOGY of parents ,POSTNATAL care ,STEREOTYPES ,QUALITATIVE research - Abstract
Background: Stillbirth has a profound impact on women, families, and healthcare workers. The burden is highest in low- and middle-income countries (LMICs). There is need for respectful and supportive care for women, partners, and families after bereavement.Objective: To perform a qualitative meta-summary of parents' and healthcare professionals' experiences of care after stillbirth in LMICs.Search Strategy: Search terms were formulated by identifying all synonyms, thesaurus terms, and variations for stillbirth. Databases searched were AMED, EMBASE, MEDLINE, PsychINFO, BNI, CINAHL.Selection Criteria: Qualitative, quantitative, and mixed method studies that addressed parents' or healthcare professionals' experience of care after stillbirth in LMICs.Data Collection and Analysis: Studies were screened, and data extracted in duplicate. Data were analysed using the Sandelowski meta-summary technique that calculates frequency and intensity effect sizes (FES/IES).Main Results: In all, 118 full texts were screened, and 34 studies from 17 countries were included. FES range was 15-68%. Most studies had IES 1.5-4.5. Women experience a broad range of manifestations of grief following stillbirth, which may not be recognised by healthcare workers or in their communities. Lack of recognition exacerbates negative experiences of stigmatisation, blame, devaluation, and loss of social status. Adequately developed health systems, with trained and supported staff, are best equipped to provide the support and information that women want after stillbirth.Conclusions: Basic interventions could have an immediate impact on the experiences of women and their families after stillbirth. Examples include public education to reduce stigma, promoting the respectful maternity care agenda, and investigating stillbirth appropriately.Tweetable Abstract: Reducing stigma, promoting respectful care and investigating stillbirth have a positive impact after stillbirth for women and families in LMICs. [ABSTRACT FROM AUTHOR]- Published
- 2019
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23. Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: A systematic review and meta-analysis
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Seale, AC, Blencowe, H, Manu, AA, Nair, H, Bahl, R, Qazi, SA, Zaidi, AK, Berkley, JA, Cousens, SN, Lawn, JE, Agustian, D, Althabe, F, Azziz-Baumgartner, E, Baqui, AH, Bausch, DG, Belizan, JM, Qar Bhutta, Z, Black, RE, Broor, S, Bruce, N, Buekens, P, Campbell, H, Carlo, WA, Chomba, E, Costello, A, Derman, RJ, Dherani, M, El-Arifeen, S, Engmann, C, Esamai, F, Ganatra, H, Garcés, A, Gessner, BD, Gill, C, Goldenberg, RL, Goudar, SS, Hambidge, KM, Hamer, DH, Hansen, NI, Hibberd, PL, Khanal, S, Kirkwood, B, Kosgei, P, Koso-Thomas, M, Liechty, EA, McClure, EM, Mitra, D, Mturi, N, Mullany, LC, Newton, CR, Nosten, F, Parveen, S, Patel, A, Romero, C, Saville, N, Semrau, K, Simões, AF, Soofi, S, Stoll, BJ, Sunder, S, Syed, S, Tielsch, JM, Tinoco, YO, Turner, C, and Vergnano, S
- Abstract
Background: Bacterial infections are a leading cause of the 2·9 million annual neonatal deaths. Treatment is usually based on clinical diagnosis of possible severe bacterial infection (pSBI). To guide programme planning, we have undertaken the first estimates of neonatal pSBI, by sex and by region, for sub-Saharan Africa, south Asia, and Latin America. Methods: We included data for pSBI incidence in neonates of 32 weeks' gestation or more (or birthweight ≥1500 g) with livebirth denominator data, undertaking a systematic review and forming an investigator group to obtain unpublished data. We calculated pooled risk estimates for neonatal pSBI and case fatality risk, by sex and by region. We then applied these risk estimates to estimates of livebirths in sub-Saharan Africa, south Asia, and Latin America to estimate cases and associated deaths in 2012. Findings: We included data from 22 studies, for 259 944 neonates and 20 196 pSBI cases, with most of the data (18 of the 22 studies) coming from the investigator group. The pooled estimate of pSBI incidence risk was 7·6% (95% CI 6·1-9·2%) and the case-fatality risk associated with pSBI was 9·8% (7·4-12·2). We estimated that in 2012 there were 6·9 million cases (uncertainty range 5·5 million-8·3 million) of pSBI in neonates needing treatment: 3·5 million (2·8 million-4·2 million) in south Asia, 2·6 million (2·1 million-3·1 million) in sub-Saharan Africa, and 0·8 million (0·7 million-1·0 million) in Latin America. The risk of pSBI was greater in boys (risk ratio 1·12, 95% CI 1·06-1·18) than girls. We estimated that there were 0·68 million (0·46 million-0·92 million) neonatal deaths associated with pSBI in 2012. Interpretation: The need-to-treat population for pSBI in these three regions is high, with ten cases of pSBI diagnosed for each associated neonatal death. Deaths and disability can be reduced through improved prevention, detection, and case management. Funding: The Wellcome Trust and the Bill and Melinda Gates Foundation through grants to Child Health Epidemiology Reference Group (CHERG) and Save the Children's Saving Newborn Lives programme. © 2014 Seale et al.
- Published
- 2014
24. G266 Stillbirth prevention – A call for paediatricians to be advocates
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Qureshi, ZU, primary, Blencowe, H, additional, Amouzou, A, additional, Calderwood, C, additional, Cousens, S, additional, Flenady, V, additional, Fr…en, JF, additional, Hogan, D, additional, Jassir, FB, additional, Mathai, M, additional, Mathers, C, additional, McClure, EM, additional, Shiekh, S, additional, Waiswa, P, additional, You, D, additional, and Lawn, JE, additional
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- 2016
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25. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010 : a systematic analysis for the global burden of disease study 2010
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Murray, C.J.L., Vos, T., Lozano, R., Naghavi, M., Flaxman, A.D., Michaud, C., Ezzati, M., Shibuya, K., Salomon, J.A., Abdalla, S., Aboyans, V., Abraham, J., Ackerman, I., Aggarwal, R., Ahn, S.Y., Ali, M.K., Alvarado, M., Anderson, H.R., Anderson, L.M., Andrews, K.G., Atkinson, C., Baddour, L.M., Barker-Collo, S., Barrero, L.H., Bartels, D.H., Basanez, M.G., Baxter, A., Bell, M.L., Benjamin, E.J., Bennett, D., Bernabé, D., Bhalla, K., Bandari, B., Bikbov, B., Abdulhak, A.B., Birbeck, G., Black, J.A., Blencowe, H., Blore, J.D., Blyth, F., Bolliger, I., Bonaventure, A., Boufous, S., Bourne, R., and Boussinesq, Michel
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MODELE MATHEMATIQUE ,EPIDEMIOLOGIE ,MALADIE ,CAUSE DE DECES ,FACTEUR DE RISQUE ,AGE PHYSIOLOGIQUE ,POLITIQUE DE SANTE ,SEXE ,MORTALITE ,ETUDE COMPARATIVE ,SYSTEME DE SANTE ,ANALYSE SYSTEMIQUE ,SANTE PUBLIQUE ,EDUCATION SANITAIRE - Published
- 2012
26. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010 : a systematic analysis for the global burden of disease study 2010
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Vos, T., Flaxman, A.D., Naghavi, M., Lozano, R., Michaud, C., Ezzati, M., Shibuya, K., Salomon, J. A., Abdalla, S., Aboyans, V., Abraham, J., Ackerman, I., Aggarwal, R., Ahn, S., Ali, M.K., Alvarado, M., Ross Anderson, H., Anderson, L.M., Andrews, K.G., Atkinson, C., Baddour, L.M., Bahalim, A.N., Barker Collo, S., Barrero, L.H., Bartels, D.H., Basanez, M.G., Baxter, A., Bell, M.L., Benjamin, E.J., Bennett, D., Bernabé, E., Bhalla, K., Bhandari, B., Bikbov, B., Abulhak, A.B., Birbeck, G., Black, J.A., Blencowe, H., Blore, J.D., Blyth, F., Bolliger, I., Bonaventure, A., Boufous, S., Bourne, R., and Boussinesq, Michel
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SEXE ,MALADIE ,ENQUETE ,GROUPE D'AGE ,INVALIDITE ,SANTE PUBLIQUE ,MORBIDITE ,REPARTITION GEOGRAPHIQUE ,MODELISATION ,VARIATION PLURIANNUELLE ,PREVALENCE - Published
- 2012
27. Setting up Kangaroo Mother Care at Queen Elizabeth Hospital, Blantyre - A practical approach
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Blencowe, H and Molyneux, E
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- 2005
28. Preventing Preterm Births
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Chang, H.H., primary, Larson, J., additional, Blencowe, H., additional, Spong, C.Y., additional, Howson, C.P., additional, Cairns-Smith, S., additional, Lackritz, E.M., additional, Lee, S.K., additional, Mason, E., additional, Serazin, A.C., additional, Walani, S., additional, Simpson, J.L., additional, and Lawn, J.E., additional
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- 2014
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29. National, Regional, and Worldwide Estimates of Preterm Birth Rates in the Year 2010 With Time Trends Since 1990 for Selected Countries
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Blencowe, H., primary, Cousens, S., additional, Oestergaard, M.Z., additional, Chou, D., additional, Moller, A.B., additional, Narwal, R., additional, Adler, A., additional, Vera Garcia, C., additional, Rohde, S., additional, Say, L., additional, and Lawn, J.E., additional
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- 2013
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30. I044 BORN TOO SOON: A GLOBAL ACTION REPORT FOR 15 MILLION PRETERM BIRTHS
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Blencowe, H., primary, Bhutta, Z., additional, Althabe, F., additional, Lawn, J., additional, and Howson, C., additional
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- 2012
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31. Is antenatal clinic attendance associated with essential newborn care practices in women who deliver at home in five districts of southern tanzania?
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Blencowe, H. J., primary and Schellenberg, J., additional
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- 2011
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32. Prevalence of wasting among under 6-month-old infants in developing countries and implications of new case definitions using WHO growth standards: a secondary data analysis
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Kerac, M., primary, Blencowe, H., additional, Grijalva-Eternod, C., additional, McGrath, M., additional, Shoham, J., additional, Cole, T. J., additional, and Seal, A., additional
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- 2011
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33. Introduction of bubble CPAP in a teaching hospital in Malawi
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Van Den Heuvel, M, primary, Blencowe, H, additional, Mittermayer, K, additional, Rylance, S, additional, Couperus, A, additional, Heikens, G T, additional, and Bandsma, R H J, additional
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- 2011
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34. Antibiotics for pre-term pre-labour rupture of membranes: prevention of neonatal deaths due to complications of pre-term birth and infection
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Cousens, S., primary, Blencowe, H., additional, Gravett, M., additional, and Lawn, J. E., additional
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- 2010
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35. Tetanus toxoid immunization to reduce mortality from neonatal tetanus
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Blencowe, H., primary, Lawn, J., additional, Vandelaer, J., additional, Roper, M., additional, and Cousens, S., additional
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- 2010
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36. Folic acid to reduce neonatal mortality from neural tube disorders
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Blencowe, H., primary, Cousens, S., additional, Modell, B., additional, and Lawn, J., additional
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- 2010
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37. Safety, Effectiveness and Barriers to Follow-up Using an 'Early Discharge' Kangaroo Care Policy in a Resource Poor Setting
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Blencowe, H., primary, Kerac, M., additional, and Molyneux, E., additional
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- 2009
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38. Setting up kangaroo mother care at Queen Elizabeth Central Hospital, Blantyre - a practical approach
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Blencowe, H, primary and Molyneux, EM, additional
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- 2005
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39. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications.
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Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, Adler A, Vera Garcia C, Rohde S, Say L, and Lawn JE
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- 2012
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40. The effect of coverings, including plastic bags and wraps, on mortality and morbidity in preterm and full-term neonates
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Oatley, HK, Blencowe, H, and Lawn, JE
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Neonatal hypothermia is an important risk factor for mortality and morbidity, and is common even in temperate climates. We conducted a systematic review to determine whether plastic coverings, used immediately following delivery, were effective in reducing the incidence of mortality, hypothermia and morbidity. A total of 26 studies (2271 preterm and 1003 term neonates) were included. Meta-analyses were conducted as appropriate. Plastic wraps were associated with a reduction in hypothermia in preterm (⩽29 weeks; risk ratio (RR)=0.57; 95% confidence interval (CI) 0.46 to 0.71) and term neonates (RR=0.76; 95% CI 0.60 to 0.96). No significant reduction in neonatal mortality or morbidity was found; however, the studies were underpowered for these outcomes. For neonates, especially preterm, plastic wraps combined with other environmental heat sources are effective in reducing hypothermia during stabilization and transfer within hospital. Further research is needed to quantify the effects on mortality or morbidity, and investigate the use of plastic coverings outside hospital settings or without additional heat sources.
41. Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect
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Blencowe Hannah, Cousens Simon, Mullany Luke C, Lee Anne CC, Kerber Kate, Wall Steve, Darmstadt Gary L, and Lawn Joy E
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Annually over 520,000 newborns die from neonatal sepsis, and 60,000 more from tetanus. Estimates of the effect of clean birth and postnatal care practices are required for evidence-based program planning. Objective To review the evidence for clean birth and postnatal care practices and estimate the effect on neonatal mortality from sepsis and tetanus for the Lives Saved Tool (LiST). Methods We conducted a systematic review of multiple databases. Data were abstracted into standard tables and assessed by GRADE criteria. Where appropriate, meta-analyses were undertaken. For interventions with low quality evidence but a strong GRADE recommendation, a Delphi process was conducted. Results Low quality evidence supports a reduction in all-cause neonatal mortality (19% (95% c.i. 1–34%)), cord infection (30% (95% c.i. 20–39%)) and neonatal tetanus (49% (95% c.i. 35–62%)) with birth attendant handwashing. Very low quality evidence supports a reduction in neonatal tetanus mortality with a clean birth surface (93% (95% c.i. 77-100%)) and no relationship between a clean perineum and tetanus. Low quality evidence supports a reduction of neonatal tetanus with facility birth (68% (95% c.i. 47-88%). No relationship was found between birth place and cord infections or sepsis mortality. For postnatal clean practices, all-cause mortality is reduced with chlorhexidine cord applications in the first 24 hours of life (34% (95% c.i. 5–54%, moderate quality evidence) and antimicrobial cord applications (63% (95% c.i. 41–86%, low quality evidence). One study of postnatal maternal handwashing reported reductions in all-cause mortality (44% (95% c.i. 18–62%)) and cord infection ((24% (95% c.i. 5-40%)). Given the low quality of evidence, a Delphi expert opinion process was undertaken. Thirty experts reached consensus regarding reduction of neonatal sepsis deaths by clean birth practices at home (15% (IQR 10–20)) or in a facility (27% IQR 24–36)), and by clean postnatal care practices (40% (IQR 25–50)). The panel estimated that neonatal tetanus mortality was reduced by clean birth practices at home (30% (IQR(20–30)), or in a facility (38% (IQR 34–40)), and by clean postnatal care practices (40% (IQR 30–50)). Conclusion According to expert opinion, clean birth and particularly postnatal care practices are effective in reducing neonatal mortality from sepsis and tetanus. Further research is required regarding optimal implementation strategies.
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- 2011
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42. Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality
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Berman Stuart, Kamb Mary, Cousens Simon, Blencowe Hannah, and Lawn Joy E
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Globally syphilis is an important yet preventable cause of stillbirth, neonatal mortality and morbidity. Objectives This review sought to estimate the effect of detection and treatment of active syphilis in pregnancy with at least 2.4MU benzathine penicillin (or equivalent) on syphilis-related stillbirths and neonatal mortality. Methods We conducted a systematic literature review of multiple databases to identify relevant studies. Data were abstracted into standardised tables and the quality of evidence was assessed using adapted GRADE criteria. Where appropriate, meta-analyses were undertaken. Results Moderate quality evidence (3 studies) supports a reduction in the incidence of clinical congenital syphilis of 97% (95% c.i 93 – 98%) with detection and treatment of women with active syphilis in pregnancy with at least 2.4MU penicillin. The results of meta-analyses suggest that treatment with penicillin is associated with an 82% reduction in stillbirth (95% c.i. 67 – 90%) (8 studies), a 64% reduction in preterm delivery (95% c.i. 53 – 73%) (7 studies) and an 80% reduction in neonatal deaths (95% c.i. 68 – 87%) (5 studies). Although these effect estimates were large and remarkably consistent across studies, few of the studies adjusted for potential confounding factors and thus the overall quality of the evidence was considered low. However, given these large observed effects and a clear biological mechanism for effectiveness the GRADE recommendation is strong. Conclusion Detection and appropriate, timely penicillin treatment is a highly effective intervention to reduce adverse syphilis-related pregnancy outcomes. More research is required to identify the most cost-effective strategies for achieving maximum coverage of screening for all pregnant women, and access to treatment if required.
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- 2011
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43. Care during labor and birth for the prevention of intrapartum-related neonatal deaths: a systematic review and Delphi estimation of mortality effect
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Moran Neil F, Pattinson Robert, Blencowe Hannah, Darmstadt Gary L, Cousens Simon, Lee Anne CC, Hofmeyr G, Haws Rachel A, Bhutta Shereen, and Lawn Joy E
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Our objective was to estimate the effect of various childbirth care packages on neonatal mortality due to intrapartum-related events (“birth asphyxia”) in term babies for use in the Lives Saved Tool (LiST). Methods We conducted a systematic literature review to identify studies or reviews of childbirth care packages as defined by United Nations norms (basic and comprehensive emergency obstetric care, skilled care at birth). We also reviewed Traditional Birth Attendant (TBA) training. Data were abstracted into standard tables and quality assessed by adapted GRADE criteria. For interventions with low quality evidence, but strong GRADE recommendation for implementation, an expert Delphi consensus process was conducted to estimate cause-specific mortality effects. Results We identified evidence for the effect on perinatal/neonatal mortality of emergency obstetric care packages: 9 studies (8 observational, 1 quasi-experimental), and for skilled childbirth care: 10 studies (8 observational, 2 quasi-experimental). Studies were of low quality, but the GRADE recommendation for implementation is strong. Our Delphi process included 21 experts representing all WHO regions and achieved consensus on the reduction of intrapartum-related neonatal deaths by comprehensive emergency obstetric care (85%), basic emergency obstetric care (40%), and skilled birth care (25%). For TBA training we identified 2 meta-analyses and 9 studies reporting mortality effects (3 cRCT, 1 quasi-experimental, 5 observational). There was substantial between-study heterogeneity and the overall quality of evidence was low. Because the GRADE recommendation for TBA training is conditional on the context and region, the effect was not estimated through a Delphi or included in the LiST tool. Conclusion Evidence quality is rated low, partly because of challenges in undertaking RCTs for obstetric interventions, which are considered standard of care. Additional challenges for evidence interpretation include varying definitions of obstetric packages and inconsistent measurement of mortality outcomes. Thus, the LiST effect estimates for skilled birth and emergency obstetric care were based on expert opinion. Using LiST modelling, universal coverage of comprehensive obstetric care could avert 591,000 intrapartum-related neonatal deaths each year. Investment in childbirth care packages should be a priority and accompanied by implementation research and further evaluation of intervention impact and cost. Funding This work was supported by the Bill and Melinda Gates Foundation through a grant to the US Fund for UNICEF, and to Saving Newborn Lives Save the Children, through Save the Children US.
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- 2011
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44. Measurement of stillbirths and neonatal deaths in standardised population-based surveys
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Akuze Waiswa, J., Blencowe, H., Cousens, S., and Waiswa, P.
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Background: Worldwide, 4.4 million stillbirths and neonatal deaths (SB&NND) are estimated to occur annually. Household surveys, notably the Demographic and Health Surveys (DHS), are an important source of SB&NND data. This PhD aimed to review the DHS's evolution for SB&NND data capture and compare the full birth history with additional questions on pregnancy losses (FBH+) and full pregnancy history (FPH) approaches in terms of data quality and potential measurement errors. Methods: A literature and programmatic review of the DHS programme and HDSS pregnancy surveillance system was conducted. A randomised comparison of FBH+ versus FPH modules (the EveryNewborn-INDEPTH (EN-INDEPTH) survey) was undertaken in five health and demographic surveillance sites (HDSS). Reported stillbirth rates (SBR) and neonatal mortality rates (NMR); time for completion of survey modules; evidence for heterogeneity between sites; patterns of corrections between question types and structures, and modules were assessed. Survey data were compared to and HDSS data in four sites. Results: Both FPH and FBH+ modules have been used within the DHS programme, but there is limited evidence concerning their accuracy for SB&NND. The FBH+ was the core model questionnaire between DHS-phases I-VII. A total of 69,176 women consented. 34,805 (50·3%) were randomised to FBH+ and 34,371 (49·7%) to FPH. There was little difference between the average time to administer questions in FBH+ (9.1 minutes) and FPH (10.5 minutes). The SBR was 15.2/1000 and 17.4/1000 total births for FBH+ and FPH, respectively. SBR was 21% (95% CI (-10% - 62%)) higher in FPH than in FBH+ with strong evidence of heterogeneity across the sites (I-squared=80·9% (p < 0.001)). The NMR was similar in FPH (25.1/1000 births) and FBH+ (25.4/1000 births) with no evidence of heterogeneity between the sites (I-squared=0.0% (p=0.48)). Corrections were similar by survey module and occurred in 84% of survey interviews. Single corrections were the most common, multiple-select, and free-text questions increased response time by two minutes on average and had the most corrections. Pregnancy surveillance systems differed between sites (frequency of surveillance visits, main respondent reporting pregnancy outcomes, pregnancy testing, and data capture and surveillance modes). In three of the four sites, both arms of the EN-INDEPTH survey reported more pregnancies than the HDSS Matlab being the exception. Overall, the survey data produced higher estimated SBRs (FBH+: RR=1.13, 95%CI (0.79, 1.63), p=0.519; FPH: RR=1.20, 95%CI (0.76, 1.90), p=0.444) and NMRs (FBH+: RR=1.19, 95%CI (0.98, 1.43), p=0.071; FPH: RR=1.15, 95%CI (1.01, 1.30), p=0.030) than the HDSS data. In Matlab, the HDSS recorded more stillbirths and miscarriages than the survey in the FPH arm only. In Kintampo, the HDSS recorded more stillbirths than the survey, even though the HDSS recorded fewer pregnancies. Conclusions: Evidence from this PhD of improved capture of stillbirths using the FPH influenced the DHS's switch to the FPH module in its eighth phase; however, limited evidence concerning SB&NND data accuracy and quality in standardised surveys is available. Therefore, additional efforts towards improved survey implementation of the FPH approach, including training, interviewer prompts, translations, and developing and testing standard data quality criteria for SB&NND in surveys and routine data, are warranted.
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- 2022
45. Service readiness for inpatient care of small and sick newborns : improving measurement in low- and middle-income settings
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Moxon, Sarah, Lawn, J., and Blencowe, H.
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362.19892 - Abstract
Background: In 2018, 2.5 million newborns died; mainly from prematurity, infections, and intrapartum events. Preventing these deaths requires health systems to provide routine and emergency care at birth, and quality inpatient care for small and sick newborns. Despite high potential impact, inpatient newborn care is not consistently measured. Methods: For this PhD, I conducted a bottleneck analysis using data from 12 national workshops regarding delivery of inpatient newborn care in low- and middle-income countries (LMIC). Using WHO guidelines, grey literature and expert consultation, I mapped the components required to deliver inpatient care and reviewed these against three health facility assessment tools. Finally, I carried out an online survey to elicit global practitioner opinions regarding levels of newborn care, paralleling those used for monitoring emergency obstetric care in LMIC. Results: In 12 high-burden countries in sub-Saharan Africa and Asia, health financing and workforce were identified as the greatest bottlenecks to scaling up quality inpatient care, followed by community ownership. My review identified 654 components required to deliver inpatient care. These are inconsistently measured by existing health facility assessments. The 262 survey respondents agreed on 12 interventions to comprise a package of care for small and sick newborns; selected levels of care varied by clinical background and experience in LMIC. Conclusion: Inpatient newborn care faces multiple health system challenges, particularly to ensure funding and skilled staffing. Standard facility numbers and staffing ratios by defined levels of care are important for countries to benchmark service delivery progress. Due to the large number of components required for delivering quality care, newborn “signal functions” could be selected by level of care to parallel emergency obstetric care indicators. Improved measurement of service readiness requires sustained focus on interoperability of routine measurement systems, and further research to better capture the experience of newborn inpatient care for families.
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- 2020
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46. National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis
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Julia Krasevec, Luca Cegolon, Diana Estevez, Victoria Ponce Hardy, Chika Hayashi, Gretchen A Stevens, Joy E Lawn, Simon Cousens, Suhail Shiekh, Robert E. Black, Elaine Borghi, Hannah Blencowe, Mercedes de Onis, Xiaoyi An, Blencowe, H., Krasevec, J., de Onis, M., Black, R. E., An, X., Stevens, G. A., Borghi, E., Hayashi, C., Estevez, D., Cegolon, L., Shiekh, S., Ponce Hardy, V., Lawn, J. E., and Cousens, S.
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Databases, Factual ,030231 tropical medicine ,Population ,Global Health ,World health ,Article ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,Global health ,medicine ,Prevalence ,Birth Weight ,Humans ,030212 general & internal medicine ,education ,Baseline (configuration management) ,Investment fund ,education.field_of_study ,Likelihood Functions ,lcsh:Public aspects of medicine ,Infant, Newborn ,Regression analysis ,lcsh:RA1-1270 ,General Medicine ,Infant, Low Birth Weight ,Random effects model ,Health Surveys ,Nutrition Disorders ,Low birth weight ,Geography ,Regression Analysis ,medicine.symptom - Abstract
Summary Background Low birthweight (LBW) of less than 2500 g is an important marker of maternal and fetal health, predicting mortality, stunting, and adult-onset chronic conditions. Global nutrition targets set at the World Health Assembly in 2012 include an ambitious 30% reduction in LBW prevalence between 2012 and 2025. Estimates to track progress towards this target are lacking; with this analysis, we aim to assist in setting a baseline against which to assess progress towards the achievement of the World Health Assembly targets. Methods We sought to identify all available LBW input data for livebirths for the years 2000–16. We considered population-based national or nationally representative datasets for inclusion if they contained information on birthweight or LBW prevalence for livebirths. A new method for survey adjustment was developed and used. For 57 countries with higher quality time-series data, we smoothed country-reported trends in birthweight data by use of B-spline regression. For all other countries, we estimated LBW prevalence and trends by use of a restricted maximum likelihood approach with country-level random effects. Uncertainty ranges were obtained through bootstrapping. Results were summed at the regional and worldwide level. Findings We collated 1447 country-years of birthweight data (281 million births) for 148 countries of 195 UN member states (47 countries had no data meeting inclusion criteria). The estimated worldwide LBW prevalence in 2015 was 14·6% (uncertainty range [UR] 12·4–17·1) compared with 17·5% (14·1–21·3) in 2000 (average annual reduction rate [AARR] 1·23%). In 2015, an estimated 20·5 million (UR 17·4–24·0 million) livebirths were LBW, 91% from low-and-middle income countries, mainly southern Asia (48%) and sub-Saharan Africa (24%). Interpretation Although these estimates suggest some progress in reducing LBW between 2000 and 2015, achieving the 2·74% AARR required between 2012 and 2025 to meet the global nutrition target will require more than doubling progress, involving both improved measurement and programme investments to address the causes of LBW throughout the lifecycle. Funding Bill & Melinda Gates Foundation, The Children's Investment Fund Foundation, United Nations Children's Fund (UNICEF), and WHO.
- Published
- 2018
47. Service readiness for inpatient care of small and sick newborns:\ud Improving measurement in low- and middle-income settings
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Moxon, SG, Lawn, J, and Blencowe, H
- Abstract
Background: In 2018, 2.5 million newborns died; mainly from prematurity, infections, and intrapartum events. Preventing these deaths requires health systems to provide routine and emergency care at birth, and quality inpatient care for small and sick newborns. Despite high potential impact, inpatient newborn care is not consistently measured. Methods: For this PhD, I conducted a bottleneck analysis using data from 12 national workshops regarding delivery of inpatient newborn care in low- and middle-income countries (LMIC). Using WHO guidelines, grey literature and expert consultation, I mapped the components required to deliver inpatient care and reviewed these against three health facility assessment tools. Finally, I carried out an online survey to elicit global practitioner opinions regarding levels of newborn care, paralleling those used for monitoring emergency obstetric care in LMIC. Results: In 12 high-burden countries in sub-Saharan Africa and Asia, health financing and workforce were identified as the greatest bottlenecks to scaling up quality inpatient care, followed by community ownership. My review identified 654 components required to deliver inpatient care. These are inconsistently measured by existing health facility assessments. The 262 survey respondents agreed on 12 interventions to comprise a package of care for small and sick newborns; selected levels of care varied by clinical background and experience in LMIC. Conclusion: Inpatient newborn care faces multiple health system challenges, particularly to ensure funding and skilled staffing. Standard facility numbers and staffing ratios by defined levels of care are important for countries to benchmark service delivery progress. Due to the large number of components required for delivering quality care, newborn “signal functions” could be selected by level of care to parallel emergency obstetric care indicators. Improved measurement of service readiness requires sustained focus on interoperability of routine measurement systems, and further research to better capture the experience of newborn inpatient care for families.
48. Definitions, terminology and standards for reporting of births and deaths in the perinatal period: International Classification of Diseases (ICD-11).
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Blencowe H, Hug L, Moller AB, You D, and Moran AC
- Abstract
Despite efforts to reduce stillbirths and neonatal deaths, inconsistent definitions and reporting practices continue to hamper global progress. Existing data frequently being limited in terms of quality and comparability across countries. This paper addresses this critical issue by outlining the new International Classification of Disease (ICD-11) recommendations for standardized recording and reporting of perinatal deaths to improve data accuracy and international comparison. Key advancements in ICD-11 include using gestational age as the primary threshold to for reporting, clearer guidance on measurement and recording of gestational age, and reporting mortality rates by gestational age subgroups to enable country comparisons to include similar populations (e.g., all births from 154 days [22
+0 weeks] or from 196 days [28+0 weeks]). Furthermore, the revised ICD-11 guidance provides further clarification around the exclusion of terminations of pregnancy (induced abortions) from perinatal mortality statistics. Implementing standardized recording and reporting methods laid out in ICD-11 will be crucial for accurate global data on stillbirths and perinatal deaths. Such high-quality data would both allow appropriate regional and international comparisons to be made and serve as a resource to improve clinical practice and epidemiological and health surveillance, enabling focusing of limited programmatic and research funds towards ending preventable deaths and improving outcomes for every woman and every baby, everywhere., (© 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)- Published
- 2024
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49. The PRECISE-DYAD Neurodevelopmental substudy protocol: neurodevelopmental risk in children of mothers with pregnancy complications.
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Magai DN, Chandna J, Volvert ML, Craik R, Jah H, Kongira F, Bojang K, Koech A, Mwashigadi G, Mutua AM, Blencowe H, D'Alessandro U, Roca A, Temmerman M, von Dadelszen P, Abubakar A, and Gladstone M
- Abstract
Background: Over 250 million children are not reaching their developmental potential globally. The impact of prenatal factors and their interplay with postnatal environmental factors on child neurodevelopment, is still unclear-particularly in low- and middle-income settings. This study aims to understand the impact of pregnancy complications as well as environmental, psychosocial, and biological predictors on neurodevelopmental trajectories., Methods: This is an observational cohort study of female and male children (≈3,950) born to women (≈4,200) with and without pregnancy complications (pregnancy-induced hypertension, foetal growth restriction, and premature birth) previously recruited into PREgnancy Care Integrating Translational Science, Everywhere study with detailed biological data collected in intrapartum and post-partum periods. Children will be assessed at six weeks to 6 months, 11-13 months, 23-25 months and 35-37 months in rural and semi-urban Gambia (Farafenni, Illiasa, and Ngayen Sanjal) and Kenya (Mariakani and Rabai). We will assess children's neurodevelopment using Prechtls General Movement Assessment, the Malawi Development Assessment Tool (primary outcome), Observation of Maternal-Child Interaction, the Neurodevelopmental Disorder Screening Tool, and the Epilepsy Screening tool. Children screening positive will be assessed with Cardiff cards (vision), Modified Checklist for Autism in Toddlers Revised, and Pediatric Quality of Life Inventory Family Impact. We will use multivariate logistic regression analysis to investigate the impact of pregnancy complications on neurodevelopment and conduct structural equation modelling using latent class growth to study trajectories and relationships between biological, environmental, and psychosocial factors on child development., Conclusions: We aim to provide information regarding the neurodevelopment of infants and children born to women with and without pregnancy complications at multiple time points during the first three years of life in two low-resource African communities. A detailed evaluation of developmental trajectories and their predictors will provide information on the most strategic points of intervention to prevent and reduce the incidence of neurodevelopmental impairments., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Magai DN et al.)
- Published
- 2024
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50. Stillbirth risk by fetal size among 126.5 million births in 15 countries from 2000 to 2020: A fetuses-at-risk approach.
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Okwaraji YB, Suárez-Idueta L, Ohuma EO, Bradley E, Yargawa J, Pingray V, Cormick G, Gordon A, Flenady V, Horváth-Puhó E, Sørensen HT, Abuladze L, Heidarzadeh M, Khalili N, Yunis KA, Al Bizri A, Barranco A, van Dijk AE, Broeders L, Alyafei F, Olukade TO, Razaz N, Söderling J, Smith LK, Matthews RJ, Wood R, Monteath K, Pereyra I, Pravia G, Lisonkova S, Wen Q, Lawn JE, and Blencowe H
- Abstract
Objective: To compare stillbirth rates and risks for small for gestational age (SGA), large for gestational age (LGA) and appropriate for gestational age (AGA) pregnancies at 24-44 completed weeks of gestation using a birth-based and fetuses-at-risk approachs., Design: Population-based, multi-country study., Setting: National data systems in 15 high- and middle-income countries., Population: Live births and stillbirths., Methods: A total of 151 country-years of data, including 126 543 070 births across 15 countries from 2000 to 2020, were compiled. Births were categorised into SGA, AGA and LGA using INTERGROWTH-21st standards. Gestation-specific stillbirth rates, with total births as the denominator, and gestation-specific stillbirth risks, with fetuses still in utero as the denominator, were calculated from 24 to 44 weeks of gestation., Main Outcome Measures: Gestation-specific stillbirth rates and risks according to size at birth., Results: The overall stillbirth rate was 4.22 per 1000 total births (95% CI 4.22-4.23) across all gestations. Applying the birth-based approach, the stillbirth rates were highest at 24 weeks of gestation, with 621.6 per 1000 total births (95% CI 620.9-622.2) for SGA pregnancies, 298.4 per 1000 total births (95% CI 298.1-298.7) for AGA pregnancies and 338.5 per 1000 total births (95% CI 337.9-339.0) for LGA pregnancies. Applying the fetuses-at-risk approach, the gestation-specific stillbirth risk was highest for SGA pregnancies (1.3-1.4 per 1000 fetuses at risk) prior to 29 weeks of gestation. The risk remained stable between 30 and 34 weeks of gestation, and then increased gradually from 35 weeks of gestation to the highest rate of 8.4 per 1000 fetuses at risk (95% CI 8.3-8.4) at ≥42 weeks of gestation. The stillbirth risk ratio (RR) was consistently high for SGA compared with AGA pregnancies, with the highest RR observed at ≥42 weeks of gestation (RR 9.2, 95% CI 15.2-13.2), and with the lowest RR observed at 24 weeks of gestation (RR 3.1, 95% CI 1.9-4.3). The stillbirth RR was also consistently high for SGA compared with AGA pregnancies across all countries, with national variability ranging from RR 0.70 (95% CI 0.43-0.97) in Mexico to RR 8.6 (95% CI 8.1-9.1) in Uruguay. No increased risk for LGA pregnancies was observed., Conclusions: Small for gestational age (SGA) was strongly associated with stillbirth risk in this study based on high-quality data from high- and middle-income countries. The highest RRs were seen in preterm gestations, with two-thirds of the stillbirths born as preterm births. To advance our understanding of stillbirth, further analyses should be conducted using high-quality data sets from low-income settings, particularly those with relatively high rates of SGA., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
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- 2024
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