Medicine and Health Sciences Commons^™

Facility-Based Audit System With Integrated Community Engagement To Improve Maternal And Perinatal Health Outcomes In Rural Pakistan: Protocol For A Mixed Methods Implementation Study, Zahid Memon, Wardah Ahmed, Shah Muhammad, Sajid Bashir Soofi, Shanti Chohan, Arjumand Rizvi, Paul Barach, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

Background: Maternal and newborn mortality in Pakistan remains as a major public health challenge. Pakistan faces significant infrastructure challenges and inadequate access to quality health care, exacerbated by sociocultural factors. Facility-based audit systems coupled with community engagement are key elements in achieving improved health system performance. We describe an implementation approach adapted from the World Health Organization audit cycle in real-world settings, with a plan to scale-up through mixed methods evaluation plan.
Objective: This study aims to implement a locally acceptable and relevant audit system and evaluate its feasibility within the rural health system of Pakistan for scale-up.
Methods: The …

Maternal Age Extremes And Adverse Pregnancy Outcomes In Low-Resourced Settings, Paul Nyongesa, Osayame Ekhaguere, Irene Marete, Constance Tenge, Milsort Kemoi, Carla Bann, Sherri Bucher, Archana Patel, Patricia Hibberd, Farnaz Naqvi, Sarah Saleem, Robert Goldenberg, Shivaprasad Goudar, Richard Derman, Nancy Krebs, Ana Garces, Elwyn Chomba, Waldemar Carlo, Musaku Mwenechanya, Adrien Lokangaka, Antoinette Tshefu, Melissa Bauserman, Marion Koso-Thomas, Janet Moore, Elizabeth Mcclure, Edward Liechty, Fabian Esamai

Global Health Articles

INTRODUCTION: Adolescent (years) and advanced maternal age (>35 years) pregnancies carry adverse risks and warrant a critical review in low- and middle-income countries where the burden of adverse pregnancy outcomes is highest.

OBJECTIVE: To describe the prevalence and adverse pregnancy (maternal, perinatal, and neonatal) outcomes associated with extremes of maternal age across six countries.

PATIENTS AND METHODS: We performed a historical cohort analysis on prospectively collected data from a population-based cohort study conducted in the Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia between 2010 and 2020. We included pregnant women and their neonates. We describe the …

Short-Term Neonatal Outcomes Of Pregnancies Complicated By Maternal Obesity, Mara J Dinsmoor, Lynda G Ugwu, Jennifer L Bailit, Uma M Reddy, Ronald J Wapner, Michael W Varner, John M Thorp, Steve N Caritis, Mona Prasad, Alan T N Tita, George R Saade, Yoram Sorokin, Dwight J Rouse, Sean C Blackwell, Jorge E Tolosa, Eunice Kennedy Shriver National Institute Of Child Health And Human Development Maternal-Fetal Medicine Units (Mfmu) Network

Student and Faculty Publications

BACKGROUND: Maternal obesity complicates a high number of pregnancies. The degree to which neonatal outcomes are adversely affected is unclear.

OBJECTIVE: This study aimed to evaluate neonatal outcomes of pregnancies complicated by maternal obesity.

STUDY DESIGN: This study was a secondary analysis of a cohort of deliveries occurring on randomly selected days at 25 hospitals from 2008 to 2011. Data were collected by certified abstractors. This analysis included singleton deliveries between 24 and 42 weeks of gestation. Body mass index was calculated on the basis of maternal height and most recent weight before delivery. Normal and overweight (reference group; body …

Vertical Transmission Of Sars-Cov-2 In A Twin Pregnancy, Tiffany C. Chang, Rebecca F. Herbert, Stacey N. Tran, Victoria M. Weprinsky, Bhaskari Burra, Chi Dola

HCA Healthcare Journal of Medicine

Transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in 2019 and rapidly evolved into the global coronavirus disease 2019 (COVID-19) pandemic. The emergence of a highly morbid disease has posed ongoing challenges in the diagnosis, management, and prevention of COVID-19. The uncertainty underlying medical decision making is further compounded by preexisting conditions, including pregnancy. Here, we report a twin pregnancy complicated by maternal COVID-19 and the vertical transmission of SARS-CoV-2. We hope that our experiences contribute to a better understanding of the disease in pregnancy and, ultimately, guide the development of effective treatment and prevention …

Effect Of Dexamethasone On Newborn Survival At Different Administration-To-Birth Intervals: A Secondary Analysis Of The Who Action (Antenatal Corticosteroids For Improving Outcomes In Preterm Newborn)-I Trial, Who Action Trials Collaborators, Olufemi T. Oladapo, Joshua P. Vogel, Gilda Piaggio, My Huong Nguyen, Fernando Althabe, Rajiv Bahl, Suman P. N. Rao, Shabina Ariff, Sajid Bashir Soofi, Lumaan Sheikh

Department of Paediatrics and Child Health

Background: The WHO ACTION-I trial demonstrated that dexamethasone significantly reduced neonatal mortality when administered to women at risk of early preterm birth in low-resource countries. We conducted a secondary analysis to determine how these benefits can be optimised, by evaluating the effect of dexamethasone compared to placebo on newborn mortality and severe respiratory distress outcomes at different administration-to-birth intervals, and identifying the interval with the greatest benefits.
Methods: The WHO ACTION-I trial was a multi-country, individually-randomised, parallel-group, double-blind, placebo-controlled trial. It was conducted in 29 hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan. Women with a viable singleton or multiple …

Effect Of Community-Based Kangaroo Mother Care Package On Neonatal Mortality Among Preterm And Low Birthweight Infants In Rural Pakistan: Protocol For A Cluster Randomized Controlled Trial, Shabina Ariff, Atif Habib, Zahid Memon, Tayyaba Arshad, Tariq Samejo, Ikram Maznani, Muhammad Umer, Amjad Hussain, Arjumand Rizvi, Imran Ahmed, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Neonatal mortality due to preterm birth and low birthweight remains a significant challenge in Pakistan. Kangaroo mother care (KMC) is a unique, low-cost intervention proven to reduce neonatal mortality and morbidity and increase exclusive breastfeeding rates. However, KMC has not been attempted in community settings in Pakistan. We aim to implement and evaluate the effectiveness of a community-based KMC package to reduce neonatal morbidity and mortality among preterm and low birthweight (LBW) infants, which will provide evidence for policy development and the large-scale implementation of KMC across the country.
Objective: The primary objective of this trial is to reduce …

Regional Trends In Birth Weight In Low- And Middle-Income Countries 2013-2018, Irene Marete, Osayame Ekhaguere, Carla M. Bann, Sherri L. Bucher, Paul Nyongesa, Archana B. Patel, Patricia L. Hibberd, Sarah Saleem, Robert L. Goldenberg, Shivaprasad S. Goudar

Community Health Sciences

Background: Birth weight (BW) is a strong predictor of neonatal outcomes. The purpose of this study was to compare BWs between global regions (south Asia, sub-Saharan Africa, Central America) prospectively and to determine if trends exist in BW over time using the population-based maternal and newborn registry (MNHR) of the Global Network for Women'sand Children's Health Research (Global Network).
Methods: The MNHR is a prospective observational population-based registryof six research sites participating in the Global Network (2013-2018), within five low- and middle-income countries (Kenya, Zambia, India, Pakistan, and Guatemala) in threeglobal regions (sub-Saharan Af rica, south Asia, Central America). The …

Institutional Deliveries And Stillbirth And Neonatal Mortality In The Global Network's Maternal And Newborn Health Registry, Shivaprasad S. Goudar, Norman Goco, Manjunath S. Somannavar, Avinash Kavi, Sunil S. Vernekar, Antoinette Tshefu, Elwyn Chomba, Ana L. Garces, Sarah Saleem, Farnaz Naqvi

Community Health Sciences

Background: Few studies have shown how the move toward institutional delivery in low and middle-income countries (LMIC) impacts stillbirth and newborn mortality.
Objectives: The study evaluated trends in institutional delivery in research sites in Belagavi and Nagpur India, Guatemala, Kenya, Pakistan, and Zambia from 2010 to 2018 and compared them to changes in the rates of neonatal mortality and stillbirth.
Methods: We analyzed data from a nine-year interval captured in the Global Network (GN) Maternal Newborn Health Registry (MNHR). Mortality rates were estimated from generalized estimating equations controlling for within-cluster correlation. Cluster-level analyses were performed to assess the association between …

Why Are The Pakistani Maternal, Fetal And Newborn Outcomes So Poor Compared To Other Low And Middle-Income Countries?, Aleha Aziz, Sarah Saleem, Tracy L. Nolen, Nousheen Akber Pradhan, Elizabeth M. Mcclure, Saleem Jessani, Ana L. Garces, Patricia L. Hibberd, Janet L. Moore, Sameen Siddiqi

Community Health Sciences

Background: Pakistan has among the poorest pregnancy outcomes worldwide, significantly worse than many other low-resource countries. The reasons for these differences are not clear. In this study, we compared pregnancy outcomes in Pakistan to other low-resource countries and explored factors that might help explain these differences.
Methods: The Global Network (GN) Maternal Newborn Health Registry (MNHR) is a prospective, population-based observational study that includes all pregnant women and their pregnancy outcomes in defined geographic communities in six low-middle income countries (India, Pakistan, Democratic Republic of Congo, Guatemala, Kenya, Zambia). Study staff enroll women in early pregnancy and follow-up soon after …

The Relationship Between Birth Intervals And Adverse Maternal And Neonatal Outcomes In Six Low And Lower-Middle Income Countries, Melissa Bauserman, Kayla Nowak, Tracy L. Nolen, Jackie Patterson, Adrien Lokangaka, Antoinette Tshefu, Archana B. Patel, Patricia L. Hibberd, Sarah Saleem, Saleem Jessani

Community Health Sciences

Background: Due to high fertility rates in some low and lower-middle income countries, the interval between pregnancies can be short, which may lead to adverse maternal and neonatal outcomes.
Methods: We analyzed data from women enrolled in the NICHD Global Network Maternal Newborn Health Registry (MNHR) from 2013 through 2018. We report maternal characteristics and outcomes in relationship to the inter-delivery interval (IDI, time from previous delivery [live or stillborn] to the delivery of the index birth), by category of 6-17 months (short), 18-36 months (reference), 37-60 months, and 61-180 months (long). We used non-parametric tests for maternal characteristics, and …

Neonatal Deaths In Infants Born Weighing ≥ 2500 G In Low And Middle-Income Countries, Sarah Saleem, Farnaz Naqvi, Elizabeth M. Mcclure, Kayla J. Nowak, Shiyam Sunder Tikmani, Ana L. Garces, Patricia L. Hibberd, Janet L. Moore, Tracy L. Nolen, Sameen Siddiqi

Community Health Sciences

Background: Babies born weighing ≥ 2500 g account for more than 80% of the births in most resource-limited locations and for nearly 50% of the 28-day neonatal deaths. In contrast, in high-resource settings, 28-day neonatal mortality among this group represents only a small fraction of the neonatal deaths. Yet mortality risks for birth weight of ≥ 2500 g is limited. Knowledge regarding the factors associated with mortality in these babies will help in identifying interventions that can reduce mortality.
Methods: The Global Network's Maternal Newborn Health Registry (MNHR) is a prospective, population-based observational study that includes all pregnant women and …

Hemoglobin Concentrations And Adverse Birth Outcomes In South Asian Pregnant Women: Findings From A Prospective Maternal And Neonatal Health Registry, Sumera Aziz Ali, Shiyam Sunder Tikmani, Sarah Saleem, Archana B. Patel, Patricia L. Hibberd, Shivaprasad S. Goudar, Sangappa Dhaded, Richard J. Derman, Janet L. Moore, Elizabeth M. Mcclure, Robert L. Goldenberg

Community Health Sciences

Background: While the relationship between hemoglobin (Hb) concentrations and pregnancy outcomes has been studied often, most reports have focused on a specific Hb cutoff used to define anemia. Fewer studies have evaluated pregnancy outcomes across the entire range of Hb values. Moreover, to date, most studies of the relationship of Hb concentrations to pregnancy outcomes have been done in high-income countries. Thus, we have sought to determine the relationship between the range of maternal Hb concentrations and adverse birth outcomes among South Asian pregnant women.
Methods: For this study, we used data collected from two South Asian countries (Pakistan - …

The Global Network Maternal Newborn Health Registry: A Multi-Country, Community-Based Registry Of Pregnancy Outcomes, Elizabeth M. Mcclure, Ana L. Garces, Patricia L. Hibberd, Janet L. Moore, Shivaprasad S. Goudar, Sarah Saleem, Fabian Esamai, Archana Patel, Elwyn Chomba, Adrien Lokangaka

Community Health Sciences

Background: The Global Network for Women's and Children's Health Research (Global Network) conducts clinical trials in resource-limited countries through partnerships among U.S. investigators, international investigators based in in low and middle-income countries (LMICs) and a central data coordinating center. The Global Network's objectives include evaluating low-cost, sustainable interventions to improve women's and children's health in LMICs. Accurate reporting of births, stillbirths, neonatal deaths, maternal mortality, and measures of obstetric and neonatal care is critical to determine strategies for improving pregnancy outcomes. In response to this need, the Global Network developed the Maternal Newborn Health Registry (MNHR), a prospective, population-based registry …

Predictive Modeling For Perinatal Mortality In Resource-Limited Settings, Vivek V. Shukla, Barry Eggleston, Namasivayam Ambalavanan, Elizabeth M. Mcclure, Musaku Mwenechanya, Elwyn Chomba, Carl Bose, Melissa Bauserman, Antoinette Tshefu, Sarah Saleem

Community Health Sciences

Importance: The overwhelming majority of fetal and neonatal deaths occur in low- and middle-income countries. Fetal and neonatal risk assessment tools may be useful to predict the risk of death.
Objective: To develop risk prediction models for intrapartum stillbirth and neonatal death.
Design, setting, and participants: This cohort study used data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Global Network for Women's and Children's Health Research population-based vital registry, including clinical sites in South Asia (India and Pakistan), Africa (Democratic Republic of Congo, Zambia, and Kenya), and Latin America (Guatemala). A total of 502 …

Effect Of Access To Health Services On Neonatal Mortality In Uganda, Imelda Atai Madgalene Musana

Walden Dissertations and Doctoral Studies

Since 2006, Uganda has experienced a nonchanging neonatal mortality rate of 27 out of 1,000 live births, which is higher than the global average of 19 deaths for every 1,000 live births. The purpose of this retrospective cross-sectional study was to determine factors affecting access to health services and their impact on newborn deaths in Uganda. Mosley and Chen's model for child survival in developing nations provided the framework for the study. Secondary data from the 2016 demographic and health survey (UDHS) collected by the Uganda Bureau of Statistics (UBOs) was used. A total of 7,538 cases were used and …

Improving Pregnancy Outcomes In Low- And Middle-Income Countries, Robert L. Goldenberg, Elizabeth M. Mcclure, Sarah Saleem

Community Health Sciences

This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal mortality, stillbirth and neonatal mortality in low-and middle-income countries. Next, we explore the medical interventions that were associated with the very rapid and very large declines in maternal, fetal and neonatal mortality rates in the last eight decades in high-income countries. The medical interventions likely to achieve similar declines in pregnancy-related mortality in low-income countries are considered. Finally, the quality of providers and the data to be collected necessary to achieve these reductions are discussed. It …

Improving Data Collection To Reduce Maternal And Infant Mortality And Morbidity In Malawi: Evaluating Chimwemwe Mu'bereki, A Community Based Intervention, Alexandra E. H. Jones

Master's Projects and Capstones

Maternal and infant death rates in Malawi are among the highest in the world. Over 17 million people live in this small country in sub-Saharan Africa, where the country’s life expectancy is just 60.6 years (World Bank, 2015). These deaths can be attributed to many complex factors, including cultural practices, lack of adequate medical equipment, long travel distances to health facilities, low staffing at hospitals and clinics, extreme poverty, and malnutrition. Without government support and intervention, community groups must fill in the gaps to make needed improvements to maternal and infant health outcomes. African Mothers Health Initiative (AMHI) enrolls high …

The Complexity Of Non-Profit Administration In Global Development: A Case-Study On Neonatal Mortality, Paul D. Glantz

Master's Projects and Capstones

In 2015, 5.9 million children died with 44% of those deaths occurring in the most vulnerable period of life: the neonatal period (first 28 days of life). Because this is such a pervasive problem, in order to meet the United Nation’s third Sustainable Development Goal of reducing the global neonatal mortality rate down from 27 to 12 deaths per 1,000 live births, there needs to be more evidence-based, effective interventions. Thrive Networks addresses newborn mortality by improving facility-based care in low-resource settings via intensive training and lifesaving medical equipment built to operate in these conditions. Despite all of the evidence …

Sociodemographic And Geospatial Correlates Of Stillbirths And Neonatal Mortality In Indonesia (1993–2007), Alka Dev

Dissertations, Theses, and Capstone Projects

Little research has focused on the determinants of stillbirth and neonatal mortality in Indonesia despite the fact that the country has one of the highest rates of stillbirths in the world and one of the highest rates of neonatal mortality in Asia. Several areas have not been explored due to data limitations, such as shared risk factors and measurement challenges, which can inform health policy and interventions and guide future research. This dissertation addresses this gap by comparing measurement challenges for stillbirth and neonatal mortality and identifying risk factors for both using Indonesian reproductive health survey data. Differences in estimates …

The Antenatal Corticosteroids Trial (Act): A Secondary Analysis To Explore Site Differences In A Multi-Country Trial., Karen Klein, Elizabeth M. Mcclure, Daniela Colaci, Vanessa Thorsten, Patricia L. Hibberd, Fabian Esamai, Ana Garces, Archana Patel, Sarah Saleem, Omrana Pasha, Elwyn Chomba, Waldemar A. Carlo, Nancy F. Krebs, Shivaprasad Goudar, Richard J. Derman, Edward A. Liechty, Marion Koso-Thomas, Pierre M. Buekens, José M. Belizán, Robert L. Goldenberg, Fernando Althabe

Community Health Sciences

BACKGROUND:

The Antenatal Corticosteroid Trial (ACT) assessed the feasibility, effectiveness, and safety of a multifaceted intervention to increase the use of antenatal corticosteroids (ACS) in mothers at risk of preterm birth at all levels of care in low and middle-income countries. The intervention effectively increased the use of ACS but had no overall impact on neonatal mortality in the targeted <5(th) percentile birth weight infants. Being in the intervention clusters was also associated with an overall increase in neonatal deaths. We sought to explore plausible pathways through which this intervention increased neonatal mortality.

METHODS:

We conducted secondary analyses to assess site differences in outcome and potential explanations for the differences in outcomes if found. By site, and in the intervention and control clusters, we evaluated characteristics of the mothers and care systems, the …

The Antenatal Corticosteroids Trial (Act)'S Explanations For Neonatal Mortality - A Secondary Analysis., Fernando Althabe, Vanessa Thorsten, Karen Klein, Elizabeth M. Mcclure, Patricia L. Hibberd, Robert L. Goldenberg, Waldemar A. Carlo, Ana Garces, Archana Patel, Omrana Pasha, Elwyn Chomba, Nancy F. Krebs, Shivaprasad Goudar, Richard J. Derman, Fabian Esamai, Edward A. Liechty, Nellie I. Hansen, Sreelatha Meleth, Dennis D. Wallace, Marion Koso-Thomas, Alan H. Jobe, Pierre M. Buekens, José M. Belizán

Community Health Sciences

BACKGROUND:

The Antenatal Corticosteroid Trial assessed the feasibility, effectiveness, and safety of a multifaceted intervention to increase the use of antenatal corticosteroids (ACS) in mothers at risk of preterm birth at all levels of care in low and middle-income countries. The intervention effectively increased the use of ACS but was associated with an overall increase in neonatal deaths. We aimed to explore plausible pathways through which this intervention increased neonatal mortality.

METHODS:

We conducted a series of secondary analyses to assess whether ACS or other components of the multifaceted intervention that might have affected the quality of care contributed to …

The Emergence And Effectiveness Of Global Health Networks: Findings And Future Research, Jeremy Shiffman, Hans Peter Schmitz, David Berlan, Stephanie L. Smith, Kathryn Quissell, Uwe Gneiting, David Pelletier

School of Leadership and Education Sciences: Faculty Scholarship

Global health issues vary in the amount of attention and resources they receive. One reason is that the networks of individuals and organizations that address these issues differ in their effectiveness. This article presents key findings from a research project on the emergence and effectiveness of global health networks addressing tobacco use, alcohol harm, maternal mortality, neonatal mortality, tuberculosis and pneumonia. Although networks are only one of many factors influencing priority, they do matter, particularly for shaping the way the problem and solutions are understood, and convincing governments, international organizations and other global actors to address the issue. Their national-level …

A Framework On The Emergence And Effectiveness Of Global Health Networks, Jeremy Shiffman, Kathryn Quissell, Hans Peter Schmitz, David L. Pelletier, Stephanie L. Smith, David Berlan, Uwe Gneiting, David Van Slyke, Ines Mergel, Mariela Rodriguez, Gill Walt

School of Leadership and Education Sciences: Faculty Scholarship

Since 1990 mortality and morbidity decline has been more extensive for some conditions prevalent in low- and middle-income countries than for others. One reason may be differences in the effectiveness of global health networks, which have proliferated in recent years. Some may be more capable than others in attracting attention to a condition, in generating funding, in developing interventions and in convincing national governments to adopt policies. This article introduces a supplement on the emergence and effectiveness of global health networks. The supplement examines networks concerned with six global health problems: tuberculosis (TB), pneumonia, tobacco use, alcohol harm, maternal mortality …

Socioeconomic, Bio-Demographic And Health/Behavioral Determinants Of Neonatal Mortality In Nigeria: A Multilevel Analysis Of 2013 Demographic And Health Survey, Emmanuel O. Adewuyi, Yun Zhao, Reeta Lamichhane

Research outputs 2014 to 2021

Background:

Nigeria ranks as one of the countries in the world with considerable burden of neonatal mortality. This study aims to investigate the association of socioeconomic, bio-demographic and health/behavioural factors with neonatal mortality in the country using the most current available evidence.

Methods:

The 2013 Nigeria demographic and health survey (NDHS) dataset was analyzed. Multiple logistic regression analysis was applied to identify determinants associated with neonatal mortality. The role of breastfeeding was examined by conducting analyses with and without adjustment for ‘breastfeeding status’. Complex sample analysis was used to control for the complex sampling design used in NDHS.

Results:

Neonatal …

Evaluation Of Active And Passive Neonatal Tetanus Surveillance Systems In Katsina State, Nigeria, Shafique Sani Nass

Walden Dissertations and Doctoral Studies

The incidence and mortality rates of neonatal tetanus (NNT) remain underreported in Nigeria. This cross-sectional study was guided by the Mosley and Chen's model for the elements of child survival in developing countries. The goals of the study were twofold: (a) to compare the NNT prevalence and the mortality rates from the existing surveillance system and active surveillance of health facility records in 7 selected health facilities from 2010 to 2014 in Katsina state, Nigeria and (b) to assess the associations between selected NNT risk factors, number of maternal tetanus toxoid injections, frequency of antenatal visits, place of delivery, and …

Prevalence Of Neonatal Tetanus In Northeastern Nigeria, Jalal-Eddeen Abubakar Saleh

Walden Dissertations and Doctoral Studies

Although efforts have been made towards improving the health of children across the globe with notable results, neonatal tetanus (NNT) remains a major contributor to the neonatal death rates in Nigeria. This problem calls for a concerted effort by the government to achieve the revised global NNT elimination deadline of 2015. The purpose of this cross-sectional quantitative study using secondary data was to establish the prevalence of NNT in Nigeria's northeast region and to ascertain if there was any significant difference in frequency of antenatal care (ANC), trained traditional birth attendants (TBAs), and umbilical cord treatments, using single sample proportions …

Pelayanan Kesehatan Ibu Dan Kematian Neonatal, Desy Fitri Yani, Artha Budi Susila Duarsa

Kesmas

Indonesia bersama seluruh negara berkembang berupaya mencapai kesepakatan Millenium Development Goals (MDGs) dengan salah satu sasaran menurunkan angka kematian neonatal dari 20 per 1.000 kelahiran hidup menjadi 15 per 1.000 kelahiran hidup. Penelitian ini bertujuan mengetahui hubungan pelayanan kesehatan ibu dengan kematian neonatal di Kabupaten Lampung Timur tahun 2011. Penelitian dengan desain studi kasus kontrol ini mengamati kasus ibu yang mengalami kematian neonatal dan kontrol ibu yang tidak mengalami kematian neonatal. Analisis multivariat menemukan pelayanan antenatal dan pertolongan persalinan berhubungan secara signifikan dengan kematian neonatal, setelah mengendalikan variabel umur ibu dan riwayat kehamilan (OR = 16,32; nilai p = 0,000); …

Community-Based Intervention Packages For Reducing Maternal And Neonatal Morbidity And Mortality And Improving Neonatal Outcomes, Zohra S. Lassi, Batool A. Haider, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: While maternal, infant and under-five child mortality rates in developing countries have declined significantly in the past two to three decades, newborn mortality rates have reduced much more slowly. While it is recognised that almost half of the newborn deaths can be prevented by scaling up evidence-based available interventions such as tetanus toxoid immunisation to mothers, clean and skilled care at delivery, newborn resuscitation, exclusive breastfeeding, clean umbilical cord care, management of infections in newborns, many require facility based and outreach services. It has also been stated that a significant proportion of these mortalities and morbidities could also be …

Comparing Modelled Predictions Of Neonatal Mortality Impacts Using List With Observed Results Of Community-Based Intervention Trials In South Asia, Ingrid K. Friberg, Zulfiqar Ahmed Bhutta, Gary L. Darmstadt, Abhay Bang, Simon Cousens, Abdullah H. Baqui, Vishwajeet Kumar, Neff Walker, Joy E. Lawn

Woman and Child Health

Background:There is an increasing body of evidence from trials suggesting that major reductions in neonatal mortality are possible through community-based interventions. Since these trials involve packages of varying content, determining how much of the observed mortality reduction is due to specific interventions is problematic. The Lives Saved Tool (LiST) is designed to facilitate programmatic prioritization by modelling mortality reductions related to increasing coverage of specific interventions which may be combined into packages.
Methods: To assess the validity of LiST outputs, we compared predictions generated by LiST with observed neonatal mortality reductions in trials of packages which met inclusion criteria …

Kunjungan Rumah Pasca Persalinan, Sebuah Strategi Meningkatkan Kelangsungan Hidup Neonatal, Sudarto Ronoatmodjo

Kesmas

Dalam beberapa dekade terakhir telah terlihat penurunan angka kematian anak di bawah umur lima tahun. Tetapi, penurunan pada angka kematian neonatal tidak menunjukkan penurunan yang bermakna. Kematian neonatal merupakan komponen penting jika ingin menurunkan angka kematian anak di bawah umur lima tahun. Kematian anak di bawah umur lima tahun merupakan tujuan ke-4 dari Pembangunan Milenium. Pada tahun 2000 sebanyak 130 juta kelahiran, sebanyak 4 juta mati pada masa neonatal, yang ini merupakan 2/3 dari kematian bayi. Dua pertiga kematian neonatal terjadi pada minggu pertama setelah kelahirannya. Dan 99%-nya terjadi di negara berkembang. Konsentrasi waktu terjadinya kematian neonatal mirip dengan waktu …