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BMC Pregnancy and Childbirth

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Open Access 01-12-2016 | Debate

‘Tweaking’ the model for understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries: “inserting new ideas into a timeless wine skin”

Authors: Michael K. Mwaniki, Evaline J. Baya, Faith Mwangi-Powell, Peter Sidebotham

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

Abstract

Background

Maternal and neonatal morbidity and mortality in Low Income Countries, especially in sub-Saharan Africa involves numerous interrelated causes. The three-delay model/framework was advanced to better understand the causes and associated

Contextual factors. It continues to inform many aspects of programming and research on combating maternal and child morbidity and mortality in the said countries. Although this model addresses some of the core areas that can be targeted to drastically reduce maternal and neonatal morbidity and mortality, it potentially omits other critical facets especially around primary prevention, and pre- and post-hospitalization continuum of care.

Discussion

The final causes of Maternal and Neonatal mortality and morbidity maybe limited to a few themes largely centering on infections, preterm births, and pregnancy and childbirth related complications. However, to effectively tackle these causes of morbidity and mortality, a broad based approach is required. Some of the core issues that need to be addressed include:-i) prevention of vertically transmitted infections, intra-partum related adverse events and broad primary prevention strategies, ii) overall health care seeking behavior and delays therein, iii) quality of care at point of service delivery, and iv) post-insult treatment follow up and rehabilitation. In this article we propose a five-pronged framework that takes all the above into consideration. This frameworks further builds on the three-delay model and offers a more comprehensive approach to understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries

Conclusion

In shaping the post 2015 agenda, the scope of engagement in maternal and newborn health need to be widened if further gains are to be realized and sustained. Our proposed five pronged approach incorporates the need for continued investment in tackling the recognized three delays, but broadens this to also address earlier aspects of primary prevention, and the need for tertiary prevention through ongoing follow up and rehabilitation. It takes into perspective the spectrum of new evidence and how it can be used to deepen overall understanding of prevention strategies for maternal and neonatal morbidity and mortality in LICS.

World Health Organization. The partnership for Maternal and Newborn Health, “‘Opportunities for Africa’s Newborns’: Practical data, policy and programmatic support for newborn care in Africa.,” 2006. [Online]. Available: <http://www.who.int/pmnch/media/publications/oanfullreport.pdf>. [Accessed : 16-May 2013].

Okiro EA, Hay SI, Gikandi PW, Sharif SK, Noor AM, Peshu N, et al. The decline in paediatric malaria admissions on the coast of Kenya. Malar J. 2007;6:151.CrossRefPubMedPubMedCentral

Bhattarai A, Ali AS, Kachur SP, Mårtensson A, Abbas AK, Khatib R, et al. Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar. PLoS Med. 2007;4(11):e309.CrossRefPubMedPubMedCentral

Lawn JE, Kerber K, Enweronu-Laryea C, Cousens S. 3.6 million neonatal deaths--what is progressing and what is not? Semin Perinatol. 2010;34(6):371–86.CrossRefPubMed

Oestergaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, Cousens S, et al. Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities. PLoS Med. 2011;8(8):e1001080.CrossRefPubMedPubMedCentral

Mwaniki MK, Gatakaa HW, Mturi FN, Chesaro CR, Chuma JM, Peshu NM, et al. An increase in the burden of neonatal admissions to a rural district hospital in Kenya over 19 years. BMC Public Health. 2010;10:591.CrossRefPubMedPubMedCentral

“The Millenium development goals: Where do we stand? | UNDP.” [Online]. Available: http://www.undp.org/content/undp/en/home/mdgoverview/mdg_goals/mdg6/where_do_we_stand.html. [Accessed: 03-Jul-2012].

WHO. “Maternal mortality Fact sheet.” [Online]. Available: http://www.who.int/mediacentre/factsheets/fs348/en/. [Accessed: 13-May-2014].

WHO. “Trends in maternal mortality: 1990-2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division”. 2014. [Online]. Available: http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2013/en/. [Accessed: 14-May-2014].

10.

Rosenfield A, Maine D. Maternal mortality--a neglected tragedy. Where is the M in MCH? Lancet. 1985;2(8446):83–5.CrossRefPubMed

11.

Oestergaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, et al. Neonatal mortality levels for 193 Countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities. PLoS Med. 2011;8(8):e1001080. doi:10.1371/journal.pmed.1001080.CrossRefPubMedPubMedCentral

12.

Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(8):1091–110.CrossRefPubMed

13.

C. Schaffnit-Chatterjee. “Sub-Saharan Africa A bright spot in spite of key challenges.” 2013. [Online]. Available: https://www.dbresearch.com/PROD/DBR_INTERNET_EN-PROD/PROD0000000000317226/Sub-Saharan+Africa%3A+A+bright+spot+in+spite+of+key+.pdf. [Accessed: 13-May-2014].

14.

Gray KJ, Bennett SL, French N, Phiri AJ, Graham SM. Invasive group B streptococcal infection in infants, Malawi. Emerg Infect Dis. 2007;13(2):223–9.CrossRefPubMedPubMedCentral

15.

Seale AC, Mwaniki M, Newton CRJC, Berkley JA. Maternal and early onset neonatal bacterial sepsis: burden and strategies for prevention in sub-Saharan Africa. Lancet Infect Dis. 2009;9(7):428–38.CrossRefPubMedPubMedCentral

16.

Mwaniki MK, Talbert AW, Njuguna P, English M, Were E, Lowe BS, et al. Clinical indicators of bacterial meningitis among neonates and young infants in rural Kenya. BMC Infect Dis. 2011;11:301.CrossRefPubMedPubMedCentral

17.

Talbert AWA, Mwaniki M, Mwarumba S, Newton CRJC, Berkley JA. Invasive bacterial infections in neonates and young infants born outside hospital admitted to a rural hospital in Kenya. Pediatr Infect Dis J. 2010;29(10):945–9.CrossRefPubMedPubMedCentral

18.

Milledge J, Calis JCJ, Graham SM, Phiri A, Wilson LK, Soko D, et al. Aetiology of neonatal sepsis in Blantyre, Malawi: 1996-2001. Ann Trop Paediatr. 2005;25(2):101–10.CrossRefPubMed

19.

Rivera L, Sáez-Llorens X, Feris-Iglesias J, Ip M, Saha S, Adrian PV, et al. Incidence and serotype distribution of invasive group B streptococcal disease in young infants: a multi-country observational study. BMC Pediatr. 2015;15:143.CrossRefPubMedPubMedCentral

20.

B. A. Darlow, L. Voss, D. R. Lennon, K. Grimwood. “Early-onset neonatal group B streptococcus sepsis following national risk-based prevention guidelines.” Aust New Zeal J Obstet Gynaecol. 2015 Jul 14. doi: 10.1111/ajo.12378.

21.

Ginsberg GM, Eidelman AI, Shinwell E, Anis E, Peyser R, Lotan Y. Should Israel screen all mothers-to-be to prevent early-onset of neonatal group B streptococcal disease? A cost-utility analysis. Isr J Health Policy Res. 2013;2(1):6.CrossRefPubMedPubMedCentral

22.

Shane AL, Stoll BJ. Neonatal sepsis: progress towards improved outcomes. J Infect. 2014;68:S24–32.CrossRefPubMed

23.

Stanton C, Lawn JE, Rahman H, Wilczynska-Ketende K, Hill K. Stillbirth rates: delivering estimates in 190 countries. Lancet. 2006;367(9521):1487–94.CrossRefPubMed

24.

Lawn JE, Bahl R, Bergstrom S, Bhutta ZA, Darmstadt GL, Ellis M, et al. Setting research priorities to reduce almost one million deaths from birth asphyxia by 2015. PLoS Med. 2011;8(1):e1000389.CrossRefPubMedPubMedCentral

25.

Douglas-Escobar M, Weiss MD. Biomarkers of hypoxic-ischemic encephalopathy in newborns. Front Neurol. 2012;3:144.CrossRefPubMedPubMedCentral

26.

Douglas-Escobar M, Yang C, Bennett J, Shuster J, Theriaque D, Leibovici A, et al. A pilot study of novel biomarkers in neonates with hypoxic-ischemic encephalopathy. Pediatr Res. 2010;68(6):531–6.CrossRefPubMed

27.

Morales P, Bustamante D, Espina-Marchant P, Neira-Peña T, Gutiérrez-Hernández MA, Allende-Castro C, et al. Pathophysiology of perinatal asphyxia: can we predict and improve individual outcomes? EPMA J. 2011;2(2):211–30.CrossRefPubMedPubMedCentral

28.

Azzopardi D, Brocklehurst P, Edwards D, Halliday H, Levene M, Thoresen M, et al. The TOBY Study. Whole body hypothermia for the treatment of perinatal asphyxial encephalopathy: a randomised controlled trial. BMC Pediatr. 2008;8:17.CrossRefPubMedPubMedCentral

29.

Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev. 2013;1:CD003311.

30.

Tsui AO, McDonald-Mosley R, Burke AE. Family planning and the burden of unintended pregnancies. Epidemiol Rev. 2010;32(1):152–74.CrossRefPubMedPubMedCentral

31.

Karlsen S, Say L, Souza J-P, Hogue CJ, Calles DL, Gülmezoglu AM, et al. The relationship between maternal education and mortality among women giving birth in health care institutions: analysis of the cross sectional WHO Global Survey on Maternal and Perinatal Health. BMC Public Health. 2011;11:606.CrossRefPubMedPubMedCentral

32.

Byrne A, Morgan A, Soto EJ, Dettrick Z. Context-specific, evidence-based planning for scale-up of family planning services to increase progress to MDG 5: health systems research. Reprod Health. 2012;9:27.CrossRefPubMedPubMedCentral

33.

UNFPA. “Giving Special Attention to Girls and Adolescents.” 2014. [Online]. Available: http://www.unfpa.org/gender/girls.htm.

34.

Neal S, Matthews Z, Frost M, Fogstad H, Camacho AV, Laski L. Childbearing in adolescents aged 12-15 years in low resource countries: a neglected issue. New estimates from demographic and household surveys in 42 countries. Acta Obstet Gynecol Scand. 2012;91(9):1114–8.CrossRefPubMed

35.

WHO. “Adolescent Pregnancies.” [Online]. Available: http://www.who.int/mediacentre/factsheets/fs364/en/. [Accessed: 12-Aug-2013].

36.

PEPFAR Kenya Operational Plan Report FY 2012. Available from: http://www.pepfar.gov/documents/organization/212148.pdf. [Accessed: 12-Aug-2013].

37.

Warren C, Abuya T, Obare F, Sunday J, Njue R, Askew I, et al. Evaluation of the impact of the voucher and accreditation approach on improving reproductive health behaviors and status in Kenya. BMC Public Health. 2011;11:177.CrossRefPubMedPubMedCentral

38.

Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? Where? Why? Lancet. 2005;365(9462):891–900.CrossRefPubMed

39.

“Monitoring The Building Blocks of Health Sttems.” [Online]. Available: http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf?ua=1. [Accessed: 14-May-2014].

40.

Frenk J. The global health system: strengthening national health systems as the next step for global progress. PLoS Med. 2010;7(1):e1000089.CrossRefPubMedPubMedCentral

41.

Huber TP, Godfrey MM, Nelson EC, Mohr JJ, Campbell C, Batalden PB. Microsystems in health care: Part 8. Developing people and improving work life: what front-line staff told us. Jt Comm J Qual Saf. 2003;29(10):512–22.CrossRefPubMed

42.

McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–45.CrossRefPubMed

43.

Haines A, Kuruvilla S, Borchert M. Bridging the implementation gap between knowledge and action for health. Bull World Health Organ. 2004;82(10):724–31. discussion 732.PubMedPubMedCentral

44.

Franco LM, Marquez L. Effectiveness of collaborative improvement: evidence from 27 applications in 12 less-developed and middle-income countries. BMJ Qual Saf. 2011;20(8):658–65.CrossRefPubMed

45.

Mwaniki MK, Vaid S, Chome IM, Amolo D, Tawfik Y. Improving service uptake and quality of care of integrated maternal health services: the Kenya Kwale District improvement collaborative. BMC Health Serv Res. 2014;14:416.CrossRefPubMedPubMedCentral

46.

Hermida J, Salas B, Sloan NL. Sustainable scale-up of active management of the third stage of labor for prevention of postpartum hemorrhage in Ecuador. Int J Gynaecol Obstet. 2012;117(3):278–82.CrossRefPubMed

47.

Mittman BS. Creating the evidence base for quality improvement collaborative. Ann Intern Med. 2004;140(11):897-901.

48.

Mwaniki MK, Atieno M, Lawn JE, Newton CRJC. Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review. Lancet. 2012;379(9814):445–52.CrossRefPubMedPubMedCentral

49.

Moïsi JC, Gatakaa H, Berkley JA, Maitland K, Mturi N, Newton CR, et al. Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis. Bull World Health Organ. 2011;89(10):725–32, 732A.CrossRefPubMedPubMedCentral

50.

Wiens MO, Pawluk S, Kissoon N, Kumbakumba E, Ansermino JM, Singer J, et al. Pediatric post-discharge mortality in resource poor countries: a systematic review. PLoS One. 2013;8(6):e66698.CrossRefPubMedPubMedCentral

51.

Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. 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. Lancet. 2012;380(9859):2197–223.CrossRefPubMed

52.

Hilton P. Vesico-vaginal fistulas in developing countries. Int J Gynaecol Obstet. 2003;82(3):285–95.CrossRefPubMed

53.

Wall LL. Dead mothers and injured wives: the social context of maternal morbidity and mortality among the Hausa of northern Nigeria. Stud Fam Plann. 1998;29(4):341–59.CrossRefPubMed

54.

Adler AJ, Ronsmans C, Calvert C, Filippi V. Estimating the prevalence of obstetric fistula: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2013;13(1):246.CrossRefPubMedPubMedCentral

Title: ‘Tweaking’ the model for understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries: “inserting new ideas into a timeless wine skin”
Authors: Michael K. Mwaniki
Evaline J. Baya
Faith Mwangi-Powell
Peter Sidebotham
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-016-0803-5

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‘Tweaking’ the model for understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries: “inserting new ideas into a timeless wine skin”

Abstract

Background

Discussion

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Discussion

Conclusion

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