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In this issue: Research abstracts and articles Please note that sections and headings are bookmarked for easy navigation. | ||
| Research articles | ||
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Validation of community health workers’ assessment of neonatal illness in rural Bangladesh Darmstadt GL, Baqui AH, Choi Y, Bari S, Rahman SM, Mannan I, Ahmed NU, Saha SK, Rahman R, Chang S, Winch PJ, Black RE, Santosham M, Arifeen SE & for the Bangladesh Projahnmo-2 (Mirzapur) StudyGroup Bulletin of the World Health Organization, January 2009; 87(1):1-80 Conclusion: We found that Community Health Workers (CHWs) were able to identify key clinical signs and symptoms of severe illness with a high level of validity in the context of routine, population-based household surveillance. The use of CHWs to identify and refer neonates with severe illness in the home using an IMCI algorithm is a promising strategy for improving neonatal health and survival in low-resource developing country settings. In certain settings with poor access to facility-based health care, CHWs can also manage sick neonates. CHWs’ assessments showed high validity for recognizing neonates with severe illness needing referral-level care. Home-based recognition and management – including referral of neonates with severe illness by CHWs – show promise as a strategy for improving neonatal health and survival in low-resource developing country settings. Human resources for health in the low-resource world: Collaborative practice and task shifting in maternal and neonatal care FIGO Safe Motherhood and Newborn Health Committee International Journal of Gynecology & Obstetrics, January 2009 Abstract: An important barrier to the attainment of Millennium Development Goals (MDGs) 4 and 5 in many countries is the lack of trained and skilled clinical staff who can provide timely and high-quality care to mothers with pregnancy complications. This article discusses the roles being played by various Mid-Level Providers in relation to maternal and neonatal care, as well as the role of the specialist obstetrician-gynecologist. The Committee concludes their report with a series of policy and programming recommendations of strategies to improve access to care for women with certain pregnancy complications. Application of evidence-based teaching in maternal and child health in remote Vietnam Hirst JE, Jeffery HE, Morrisa J, Foster K, Elliott EJ International Journal of Gynecology and Obstetrics, February 2009; 104(2):152-155 Objective: To develop, implement, and evaluate an evidence-based multidisciplinary teaching program to improve maternal and infant health in remote Vietnam. Methods: Needs assessments identified prevention of infection, neonatal resuscitation, and prevention of postpartum hemorrhage as primary targets. A 3-day workshop based on the small group, interactive, skills-based SCORPIO method was developed. Participants underwent formative written and performance-based assessments. Qualitative and quantitative evaluation of course content and teaching method was conducted. Results: Two annual workshops were conducted for 58 health professionals, all of whom demonstrated skills acquisition to an adequate standard on completion. The workshops were rated as good or excellent overall by 100% of the participants, who reported that the content would help with their clinical work and that the teaching method was acceptable and easy to understand. Conclusion: We demonstrated the SCORPIO method can be adapted to teach knowledge and clinical skills in remote Vietnam. Further work is needed to demonstrate an effect on health outcomes. Neonatal hypothermia in low resource settings: a review Kumar V, Shearer JC, Kumar A, Journal of Perinatology, January 2009 [Epub ahead of print] Background: Hypothermia is increasingly recognized as a major cause of neonatal morbidity and mortality in resource poor settings. High prevalence of hypothermia has been reported widely from warmer high mortality regions of Africa and South Asia. The World Health Organization recognizes newborn thermal care as a critical and essential component of essential newborn care; however, hypothermia continues to remain under-documented, under-recognized and under-managed. Objective: This review aims to provide a thorough patho-physio-epidemiological discussion of neonatal hypothermia applied to local risk factors within the developing country context with particular emphasis on prevention, recognition and management. Method: All available published literature on neonatal hypothermia relevant to resource poor settings were reviewed. Studies from the developing country settings were primarily reviewed for epidemiology, domiciliary risk factors as well as potential interventions for thermal care. Result and Discussion: Functional integrity and efficiency of biological systems is critically dependent on an optimal and very narrow range of core body temperature. Risk factors for neonatal hypothermia differ markedly within low resource settings. A combination of physiological, behavioral and environmental factors universally put all newborns, irrespective of birth weight, at risk of hypothermia. The knowledge deficit along the continuum from health providers to primary care givers has sustained the silent epidemic of hypothermia. The challenges of recognition, understanding of local risk factors and communication have meant a lack of informed thermal care for newborns. Simple, feasible interventions exist, but need to be applied, based on local risk factors that disrupt the warm chain. Further research is needed to document local risk factors, develop better techniques for recognition, evaluation of thermal care within essential newborn care and communication strategies for program effectiveness. Evaluating child survival programs Victora CG, Black RE, Bryce J Bulletin of the World Health Organizaion, February 2009; 87(2):1-160 Excerpt: Renewed global interest in newborn and child survival has generated many programs in low- and middle-income countries. There is an urgent need for a common evaluation framework to allow comparison of health outcomes and costs within and across these countries. The current generation of child survival programs aims to deliver defined sets of biological and behavioural interventions that have proven effective in smaller-scale trials. Unlike efficacy studies, effectiveness evaluations assess whether interventions result in expected health improvements when scaled up under routine conditions. Also, in contrast to efficacy studies, political considerations often prevent investigators from controlling where these programs are implemented, so that non-randomized designs are often the only option. A major change in approach is needed if future evaluations are to meet the needs of national governments and donors for rigorous assessments of the results of their investments both in child survival, in particular, and in health in general. A systematic review of randomized controlled trials of prenatal and postnatal vitamin A supplementation of HIV-infected women Kongnyuy EJ, Wiysonge CS, Sheyc MS International Journal of Gynecology and Obstetrics, January 2009; 104(1):5-8 Abstract: We searched the Cochrane Library, MEDLINE, EMBASE, AIDSearch, and Gateway to assess the effect of prenatal and/or postnatal vitamin A supplementation on the risk of mother-to-child transmission (MTCT) of HIV and other pregnancy outcomes. We included 5 trials totaling 7528 women (4 trials of prenatal and 1 trial of postnatal supplementation). Overall, there was no evidence of an effect of prenatal and/or postnatal vitamin A supplementation on the risk of MTCT of HIV (Relative Risk [RR] 1.06, 95% Confidence Interval [CI] 0.89–1.26). However, prenatal vitamin A supplementation significantly improved birth weight (weighted mean difference 89.78; 95% CI, 84.73–94.83), but there was no evidence of an effect on stillbirths (RR 0.99; 95% CI, 0.68–1.43), preterm births (RR 0.88; 95% CI, 0.65–1.19), death before 24months among live births (RR 1.08; 95% CI, 0.91–1.29), and maternal death (RR 0.83; 95% CI, 0.59–1.17). The available evidence does not support vitamin A supplementation of HIV-infected pregnant and lactating women, despite improvement in birth weight. ____________________________________ | ||
| Resources | ||
| Abuja : Federal Ministry of Health, Save the Children, ACCESS; 2009
Excerpt: The Federal Ministry of Health of Nigeria (FMOH) recently reviewed the situation of maternal, newborn and child health (MNCH) in Nigeria and developed an Integrated Maternal, Newborn and Child Health (IMNCH) Strategy to address gaps in care. Roll-out of the IMNCH Strategy has begun at zonal, state and local government authority levels. The IMNCH strategy provides opportunities to integrate services and programs, overcoming competing interests in the implementation of evidence-based interventions for MNCH. The IMNCH Strategy has helped to bring recognition of the massive burden of newborn deaths in Nigeria, but there is recognition that compared to maternal and child health, there is less consensus on the priority actions to reduce newborn deaths. The main objective of this report is to provide a more comprehensive understanding of newborn survival and health in Nigeria, analyze the data of relevance by state and present concrete steps to accelerate action to save newborn lives in Nigeria in the context of the IMNCH strategy. ChildInfo: Monitoring the Situation of Children and Women UNICEF This website contains UNICEF’s statistical information, including data used in UNICEF’s flagship publications, The State of the World’s Children and Progress for Children. Also here are technical resources for conducting UNICEF-supported Multiple Indicator Cluster Surveys (MICS), which are a major source of global development data. Mother Support Task Force (MSTF) Newsletter Volume 6 Number 3, September – December 2008 This newsletter contains breastfeeding updates, news, events, stories and policy changes from around the world. Available in English, Spanish, French and Portuguese ____________________________________ | ||
| News you may have missed | ||
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NEPAL: Maternal, neonatal mortality “too high” February 10, 2009 IRIN Humanitarian News Excerpts: “The annual neonatal death rate (under 28 days) is 32 per 1,000 live births, one of the highest in the world, according to the government’s Demographic Health Survey. Many newborns die at home due to hypothermia, asphyxia, or complications resulting from low birth weight and infection… In 1996 the maternal mortality ratio (MMR) was 539 per 100,000 live births, according to the government’s Demographic and Health Survey, and there is uncertainty among experts about how the deaths have been reduced by over half when the percentage of deliveries by skilled birth attendants (SBA) is still very low.” 2009 Annual Letter from Bill Gates: Childhood Deaths Excerpt: “Over the past 50 years childhood deaths have dropped dramatically…. Despite this progress, 10 million children dying is still 10 million too many. Each death is a tragedy. In the United States we don’t think much about young people dying because it is so rare. It would be a huge breakthrough to cut that 10 million in half again, which I believe can be done in the next 20 years.” Child survival and health programs fund progress report: fiscal year 2007 Progress to date:
Key results reported in 2007:
USAID helped countries adopt and expand essential newborn care and implement interventions such as exclusive breastfeeding, clean delivery, umbilical cord care, and early recognition of and referral for newborn complications. In Bangladesh, community health workers in a community-based maternal and newborn program reached about 15,000 mothers and newborns within the first week of life to provide them with essential newborn care in their homes. USAID- supported research has shown that such simple home- and community-based interventions can reduce neonatal mortality by approximately 34 percent.” Africa: Need to Focus on Maternal, Child Health - Top AU Official IRIN Reducing neonatal tetanus and measles mortality by 2015 February 03, 2009 Hackman A, Yemen Times Excerpt: “In a bid to reduce the mortality rate for children under five years-old in Yemen, the Ministry of Health plans to eradicate neonatal tetanus and measles by 2010 and immunization campaigns are already under way.” World Breastfeeding Week 2009: The World Alliance for Breastfeeding Action (WABA) has announced the 2009 WBW theme: Breastfeeding: A Vital Emergency Response. Are you ready? For more information, check regularly at the WABA website www.waba.org.my Join the One Million Campaign – Support Women To Breastfeed “This campaign, initiated by the International Baby Food Action Network-Asia (IBFAN-Asia) will bring together people from all over the world in supporting women to breastfeed, from signing petitions, to pledging to support one woman (friend, neighbor, relative, co-worker), to endorsing the Global Initiative for Mother Support (GIMS for Breastfeeding). Information on the Campaign is at www.onemillioncampaign.org and information on GIMS is at http://www.waba.org.my/whatwedo/gims/index.htm” To save the child’s life January 11, 2009 George A, The Hindu Excerpt: “A sustained nationwide campaign is crucial to dispel socio-cultural inhibitions and create awareness about breast feeding. The recently released India Report of the World Breast Feeding Trends Initiative (WBTi) 2008, highlights the role of breast feeding in ensuring child health and reducing infant and child mortality. India has an infant mortality rate of 55 per 1000 live births (SRS 2008) which accounts for 72 per cent of the country’s under-five mortality rate. Breast feeding is the most important intervention to prevent newborn infections, diarrhea and pneumonia, which cause child deaths in the month after birth till the end of the first year of life. Initial breast feeding in the first hour after birth and exclusive breast feeding in the first six months after birth can go a long way in preventing most neonatal and infant deaths in India. Save the Children UK’s Report on Saving Children’s Lives (2008) points out that infants who are exclusively breast fed for the first six months after birth are ten times less likely to die of diarrhea and 15 times less likely to die of pneumonia.” http://www.hindu.com/mag/2009/01/11/stories/2009011150190500.htm ____________________________________ (top) | ||
| Upcoming events | ||
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Perinatal Priorities Conference Description: “The Priorities in Perinatal Care Association is proud to announce the following invited guest speakers: Prof Jason Gardosi, Director of the West Midlands Perinatal Institute in Birmingham, England and local guest speaker: Prof Justus Hofmeyr - Head of the Department of Obstetrics and Gynecology at the East London Hospital Complex and Director of the Effective Care Research Unit (ECRU).” International Stillbirth Date: March 8 – 10, 2009 Location: South Africa Description: “The International Stillbirth Alliance will hold its annual conference as a satellite meeting to the Priorities in Perinatal Care Annual conference at Champagne Sports Resort in the Drakensberg in Kwazulu Natal. This two-day meeting will focus on audit and preventions strategies for stillbirth and newborn deaths and providing bereavement care in developing countries. The main program themes will include:
Community Case Management: Improving the Health of the Most Vulnerable Children Date: March 11, 2009; 2:00 PM Organizations: USAID/BASICS Global Maternal and Child Health Conference Date: March 20, 2009 Location: Description: “One-day symposium addressing mother, newborn, and child health issues with a family perspective. Highlights include data and information gleaned from studies by some of the best researchers and practitioners in the field presented in a series of maternal, neonatal, and child survival articles published in The Lancet.” Unite for Sight 6th Annual Global Health & Development Conference Date: April 18 – 19, 2009 Location: Description: “Convenes 2,500 participants interested in international health and development, public health, eye care, medicine, social entrepreneurship, nonprofits, philanthropy, microfinance, human rights, anthropology, health policy, advocacy, public service, environmental health, and education.” Date: April 20 – 24, 2009 Location: Theme: Communities: The Keystone for Health System Strengthening Description: “The CORE Group Spring Meeting focus for 2009 is Communities: Keystone for Health System Strengthening. Participants will have opportunities to share specific resources and technical information that will benefit program quality, scale-up efforts, and evaluation. CORE Group Working Groups will have ample opportunities to meet to develop workplans for the year and share information and technical recommendations with colleagues.” Save the Children Advocacy Day Date: April 21 – 22, 2009 Location: “Join policymakers, Save the Children leadership, staff, and supporters from across the country and around the world to give voice to our common goal of creating real and lasting change in the lives of children in need. This year Save the Children's Advocacy Day will focus on two issues. - Pressing for American leadership to save the millions of children under five who die each year from preventable causes through adoption of the U.S. Commitment to Global Child Survival Act, which would permit greater investment in low-cost, highly effective, lifesaving interventions, such as vitamins, antibiotics and vaccines. - On the domestic side, our efforts will be on educating Members of Congress on the crucial role afterschool programs play in the lives of children, families and communities in the United States supporting legislation to improve afterschool programs through grant funding.” Pediatric Academic Societies Meeting Date: May 2 – 5, 2009 Location: Date: May 4 – 5, 2009 Location: Description: “PGPR’s eighth symposium will be held Date: May 26 – 30, 2009 Location: Washington, DC, USA Theme: New technologies ___________________________________ | ||
| Notes | ||
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“Newborn Research eUpdates” is compiled from various newsletters, listserves, as well as other sources and contains hyperlinks to Web sites and resources. These links are provided solely for your convenience and the information accessed through these links and references do not necessarily reflect the views of the Saving Newborn Lives program nor Save the Children. Save the Children is not responsible for the availability nor accuracy of the external sites and resources linked to this newsletter. Save the Children is not responsible nor liable for any content, advertising, products or other materials on or available from such sites or resources. Transactions that occur between you and any third party are strictly between you and the third party and are not the responsibility of Save the Children. You should review the terms, conditions and privacy policies of these linked sites, as their policies may differ from ours. If you have comments, feedback, or want to be removed from this mailing list, please send an e-mail to savingnewbornlives@savechildren.org | ||
