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Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health.
BMC Pregnancy and Childbirth. 2018 Nov 20; 18(1):449.BACKGROUND: Twin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes, especially for the second twin. In addition, the maternal complications (potentially life-threatening conditions-PLTC, maternal near miss-MNM, and maternal mortality-MM) are directly related to twin pregnancy and independently associated with adverse perinatal outcome. The objective of the preset study is to evaluate perinatal outcomes associated with twin pregnancies, stratified by severe maternal morbidity and order of birth. METHODS: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), a cross-sectional study implemented in 29 countries. Data from 8568 twin deliveries were compared with 308,127 singleton deliveries. The occurrence of adverse perinatal outcomes and maternal complications were assessed. Factors independently associated with adverse perinatal outcomes were reported with adjusted PR (Prevalence Ratio) and 95%CI. RESULTS: The occurrence of severe maternal morbidity and maternal death was significantly higher among twin compared to singleton pregnancies in all regions. Twin deliveries were associated with higher rates of preterm delivery (37.1%), Apgar scores less than 7 at 5th minute (7.8 and 10.1% respectively for first and second twins), low birth weight (53.2% for the first and 61.1% for the second twin), stillbirth (3.6% for the first and 5.7% for the second twin), early neonatal death (3.5% for the first and 5.2% for the second twin), admission to NICU (23.6% for the first and 29.3% for the second twin) and any adverse perinatal outcomes (67% for the first twin and 72.3% for the second). Outcomes were consistently worse for the second twin across all outcomes. Poisson multiple regression analysis identified several factors independently associated with an adverse perinatal outcome, including both maternal complications and twin pregnancy. CONCLUSION: Twin pregnancy is significantly associated with severe maternal morbidity and with worse perinatal outcomes, especially for the second twin.
Use of Service Provision Assessments and Service Availability and Readiness Assessments for monitoring quality of maternal and newborn health services in low-income and middl-income countries.
BMJ Global Health. 2018 Dec 1; 3(6):e001011.Improving the quality of maternal and newborn health (MNH) services is key to reducing adverse MNH outcomes in low-income and middle-income countries (LMICs). The Service Provision Assessment (SPA) and Service Availability and Readiness Assessment (SARA) are the most widely employed, standardised tools that generate health service delivery data in LMICs. We ascertained the use of SPA/SARA surveys for assessing the quality of MNH services using a two-step approach: a SPA/SARA questionnaire mapping exercise in line with WHO’s Quality of Care (QoC) Framework for pregnant women and newborns and the WHO quality standards for care around the time of childbirth; and a scoping literature review, searching for articles that report SPA/SARA data. SPA/SARA surveys are well suited to assess the WHO Framework’s cross-cutting dimensions (physical and human resources); SPA also captures elements in the provision and experience of care domains for antenatal care and family planning. Only 4 of 31 proposed WHO quality indicators around the time of childbirth can be fully generated using SPA and SARA surveys, while 19 and 23 quality indicators can be partially obtained from SARA and SPA surveys, respectively; most of these are input indicators. Use of SPA/SARA data is growing, but there is considerable variation in methods employed to measure MNH QoC. With SPA/SARA data available in 30 countries, MNH QoC assessments could benefit from guidance for creating standard metrics. Adding questions in SPA/SARA surveys to assess the WHO QoC Framework’s provision and experience of care dimensions would fill significant data gaps in LMICs.
Geneva, Switzerland, World Health Organization [WHO], 2018. 116 p.The guideline uses state-of-the-art evidence to identify effective policy options to strengthen community health worker (CHW) programme performance through their proper integration in health systems and communities. The development of this guideline followed the standardized WHO approach. This entailed a critical analysis of the available evidence, including 16 systematic reviews of the evidence, a stakeholder perception survey to assess feasibility and acceptability of the policy options under consideration, and the deliberations of a Guideline Development Group which comprised representation from policy makers and planners from Member States, experts, labour unions, professional associations and CHWs. Critical to the success of these efforts will be ensuring appropriate labour conditions and opportunities for professional development, as well as creating a health ecosystem in which workers at different levels collaborate to meet health needs. Adapted to context, the guideline is a tool that supports optimizing health policies and systems to achieve significant gains to meet the ambition of universal access to primary health care services.
Engaging young people for health and sustainable development. Strategic opportunities for the World Health Organization and partners.
Geneva, Switzerland, WHO, 2018. 72 p. (WHO/CDS/TB/2018.22)This report builds on WHO’s long-standing work on young people’s health and rights, including the Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030), the Global Accelerated Action for the Health of Adolescents (AA-HA!) guidance, and contribution to the new UN Youth Strategy. It was developed as part of the roadmap towards the development of a WHO strategy for engaging young people and young professionals. The world today has the largest generation of young people in history with 1.8 billion between the ages of 10 and 24 years. Many of them already are driving transformative change, and many more are poised to do so, but lack the opportunity and means. This cohort represents a powerhouse of human potential that could transform health and sustainable development. A priority is to ensure that no young person is left behind and all can realize their right to health equitably and without discrimination or hindrance. This force for change represents an unparalleled opportunity for the WHO and partners to transform the way they engage with young people, including to achieve the 2030 Agenda for Sustainable Development. This report describes strategic opportunities to meaningfully engage young people in transforming health and sustainable development. This will mean providing opportunities for young people’s leadership and for their engagement with national, regional and global programmes.
Private sector: Who is accountable? for women’s, children’s and adolescents’ health. 2018 report. Summary of recommendations.
Geneva, Switzerland, World Health Organization [WHO], 2018. 12 p.This report presents five recommendations, which are addressed to governments, parliaments, the judiciary, the United Nations (UN) system, the UN Global Compact, the Every Woman Every Child (EWEC) partners, donors, civil society and the private sector itself. Recommendations include: 1) Access to services and the right to health. To achieve universal access to services and protect the health and related rights of women, children and adolescents, governments should regulate private as well as public sector providers. Parliaments should strengthen legislation and ensure oversight for its enforcement. The UHC2030 partnership should drive political leadership at the highest level to address private sector transparency and accountability. 2) The pharmaceutical industry and equitable access to medicines. To ensure equitable, affordable access to quality essential medicines and related health products for all women, children and adolescents, governments and parliaments should strengthen policies and regulation governing the pharmaceutical industry. 3) The food industry, obesity and NCDs. To tackle rising obesity and NCDs among women, children and adolescents, governments and parliaments should regulate the food and beverage industry, and adopt a binding global convention. Ministries of education and health should educate students and the public at large about diet and exercise, and set standards in school-based programmes. Related commitments should be included in the next G20 Summit agenda. 4) The UN Global Compact and the EWEC partners. The UN Global Compact and the EWEC partners should strengthen their monitoring and accountability standards for engagement of the business sector, with an emphasis on women’s, children’s and adolescents’ health. They should advocate for accountability of the for-profit sector to be put on the global agenda for achieving UHC and the SDGs, including at the 2019 High-Level Political Forum on Sustainable Development and the Health Summit. The UN H6 Partnership entities and the GFF should raise accountability standards in the country programmes they support. 5) Donors and business engagement in the SDGs. Development cooperation partners should ensure that transparency and accountability standards aligned with public health are applied throughout their engagement with the for-profit sector. They should invest in national regulatory and oversight capacities, and also regulate private sector actors headquartered in their countries.
Geneva, Switzerland, World Health Organization [WHO], 2018. 80 p.In line with the mandate from the UN Secretary-General, every year the IAP issues a report that provides an independent snapshot of progress on delivering promises to the world’s women, children and adolescents for their health and well-being. Recommendations are included on ways to help fast-track action to achieve the Global Strategy for Women’s, Children’s and Adolescents’ Health 2016-2030 and the Sustainable Development Goals - from the specific lens of accountability, of who is responsible for delivering on promises, to whom, and how. The theme of the IAP’s 2018 report is accountability of the private sector. The 2030 Agenda for Sustainable Development will not be achieved without the active and meaningful involvement of the private sector. Can the private sector be held accountable for protecting women’s, children’s and adolescents’ health? And if so, who is responsible for holding them to account, and what are the mechanisms for doing so? This report looks at three key areas of private sector engagement: health service delivery the pharmaceutical industry and access to medicines the food industry and its significant influence on health and nutrition, with a focus NCDs and rising obesity.
Global Health, Science and Practice. 2018 Jun 27; 6(2):247-248.Add to my documents.
Global Health, Science and Practice. 2018 Mar 21; 6(1):8-16.Add to my documents.
Global Health, Science and Practice. 2018 Jun 27; 6(2):257-259.Add to my documents.
NewsCAP: The WHO releases Consolidated Guideline on Sexual and Reproductive Health and Rights of Women Living with HIV.
American Journal of Nursing. 2018 Jul; 118(7):17.Add to my documents.
Recommendations to Promote Safe and Effective Use of Contraceptives: World Health Organization [letter]
CHRISMED Journal of Health and Research. 2017 Oct-Dec; 4(4):291.The authors discuss the need to support and strengthen national family planning programs through more investment and better awareness to address the 220 million women who have an unmet need for family planning.
Washington, D.C., World Bank, 2018. 91 p.he Atlas of Sustainable Development Goals 2018 is a visual guide to the trends, challenges and measurement issues related to each of the 17 Sustainable Development Goals. The Atlas features maps and data visualizations, primarily drawn from World Development Indicators (WDI) - the World Bank’s compilation of internationally comparable statistics about global development and the quality of people’s lives. Given the breadth and scope of the SDGs, the editors have been selective, emphasizing issues considered important by experts in the World Bank’s Global Practices and Cross Cutting Solution Areas. Nevertheless, The Atlas aims to reflect the breadth of the Goals themselves and presents national and regional trends and snapshots of progress towards the UN’s seventeen Sustainable Development Goals related to: poverty, hunger, health, education, gender, water, energy, jobs, infrastructure, inequalities, cities, consumption, climate, oceans, the environment, peace, institutions, and partnerships.
Geneva, Switzerland, WHO, 2017. 12 p. (Summary Brief WHO/RHR/17.20)Contraception is an inexpensive and cost-effective intervention, but health workforce shortages and restrictive policies on the roles of mid- and lower-level cadres limit access to effective contraceptive methods in many settings. Expanding the provision of contraceptive methods to other health worker cadres can significantly improve access to contraception for all individuals and couples. Many countries have already enabled mid- and lower-level cadres of health workers to deliver a range of contraceptive methods, utilizing these cadres either alone or as part of teams within communities and/or health care facilities. The WHO recognizes task sharing as a promising strategy for addressing the critical lack of health care workers to provide reproductive, maternal and newborn care in low-income countries. Task sharing is envisioned to create a more rational distribution of tasks and responsibilities among cadres of health workers to improve access and cost-effectiveness.
Health Research Policy and Systems. 2018 May 22; 16(1):42.BACKGROUND: As countries continue to improve their family planning (FP) programmes, they may draw on WHO's evidence-based FP guidance and tools (i.e. materials) that support the provision of quality FP services. METHODS: To better understand the use and perceived impact of the materials and ways to strengthen their use by countries, we conducted qualitative interviews with WHO regional advisors, and with stakeholders in Ethiopia and Senegal who use WHO materials. RESULTS: WHO uses a multi-faceted strategy to directly and indirectly disseminate materials to country-level decision-makers. The materials are used to develop national family planning guidelines, protocols and training curricula. Participants reported that they trust the WHO materials because they are evidence based, and that they adapt materials to the country context (e.g. remove content on methods not available in the country). The main barrier to the use of national materials is resource constraints. CONCLUSIONS: Although the system and processes for dissemination work, improvements might contribute to increased use of the materials. For example, providers may benefit from additional guidance on how to counsel women with characteristics or medical conditions where contraceptive method eligibility criteria do not clearly rule in or rule out a method.
Effect of mHealth in improving antenatal care utilization and skilled birth attendance in low- and middle-income countries: a systematic review protocol.
JBI Database of Systematic Reviews and Implementation Reports. 2017 Jul; 15(7):1778-1782.REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify and synthesize the best available evidence on the effect of mobile health (mHealth) interventions in antenatal care utilization and skilled birth attendance in low- and middle-income countries.More specifically, the review questions are as follows.
Geneva, Switzerland, WHO, 2018. 100 p.The World Health Statistics series is WHO’s annual snapshot of the state of the world’s health. This 2018 edition contains the latest available data for 36 health-related Sustainable Development Goal (SDG) indicators. It also links to the three SDG-aligned strategic priorities of the WHO’s 13th General Programme of Work: achieving universal health coverage, addressing health emergencies and promoting healthier populations.
[Washington, D.C.], MCSP, 2018 Mar. 6 p.In 2016, the World Health Organization (WHO) published Recommendations on Antenatal Care for a Positive Pregnancy Experience (WHO 2016), which outlines a new set of evidence-based global guidelines on recommended content and scheduling for antenatal care (ANC). These recommendations are the first set of ANC guidelines created under WHO’s current approved process for development of clinical guidelines. This FAQ addresses commonly asked questions about the implementation of IPTp programs in the context of the 2016 ANC recommendations, as well as reminders about technical considerations for intermittent preventive treatment of malaria in pregnancy programs.
Geneva, Switzerland, World Health Organization [WHO], 2018. 458 p.Girls and women who have been subjected to female genital mutilation (FGM) need high quality, empathetic and appropriate health care to meet their specific needs. This handbook is for health care providers involved in the care of girls and women who have been subjected to any form of FGM. This includes obstetricians and gynaecologists, surgeons, general medical practitioners, midwives, nurses and other country-specific health professionals. Health-care professionals providing mental health care, and educational and psychosocial support – such as psychiatrists, psychologists, social workers and health educators – will also find this handbook helpful. It includes advice on how to: 1) communicate effectively and sensitively with girls and women who have developed health complications due to FGM; 2) communicate effectively and sensitively with the husbands or partners and family members of those affected; 3) provide quality health care to girls and women who have health problems due to FGM, including immediate and short-term urogynaecological or obstetric complications; 4) provide support to women who have mental health and sexual health complications caused by FGM; 5) make informed decisions on how and when to perform deinfibulation; 6) identify when and where to refer patients who need additional support and care; and 7) work with patients and families to prevent the practice of FGM.
Lancet. HIV. 2016 Jul; 3(7):e286-8.Add to my documents.
Baltimore, Maryland, Jhpiego, 2018. 92 p. (USAID Award No. HRN-A-00-98-00043-00; USAID Leader with Associates Cooperative Agreement No.GHS-A-00-04-00002-00)The Malaria in Pregnancy reference manual and clinical learning materials are intended for skilled providers who provide antenatal care, including midwives, nurses, clinical officers, and medical assistants. The clinical learning materials can be used to conduct a 2-day workshop designed to provide learners with the knowledge and skills needed to prevent, recognize, and treat malaria in pregnancy as they provide focused antenatal care services.
Strengthening health systems to respond to women subjected to intimate partner violence or sexual violence: a manual for health managers.
Geneva, Switzerland, WHO, 2017. 172 p.This manual is intended for health managers at all levels of the health systems. The manual is based on the World Health Organization (WHO) guideline Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines, 2013. Those guidelines inform this manual and its companion clinical handbook for healthcare providers, Health care for women subjected to intimate partner violence or sexual violence, 2014. The manual draws on the WHO health systems building blocks as outlined in Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action..
Contraceptive method considerations for clients with HIV including those on ART: provider reference tool.
[Washington, D.C.], FHI 360, 2017 Nov. 2 p.This is an at-a-glance resource for clinical providers to determine whether clients with HIV, including those on antiretroviral therapy (ART), may initiate or continue using common contraceptive methods. This chart is based on the World Health Organization's Medical Eligibility Criteria for Contraceptive Use (2016). The tool provides foundational information for clinical providers on how the effectiveness of different types of hormonal contraceptive methods is affected by interaction with antiretroviral drugs. It also provides guidance on how to promote informed decision-making and help women with HIV who are taking antiretroviral drugs use their chosen hormonal contraceptive method successfully.
WHO recommendations on antenatal care for a positive pregnancy experience: Ultrasound examination. Highlights and key messages from the World Health Organization’s 2016 Global Recommendations.
Geneva, Switzerland, WHO, 2018 Jan. 4 p. (WHO/RHR/18.01; USAID Cooperative Agreement No. AID-OAA-A-14-00028)This brief highlights the WHO recommendation on routine antenatal ultrasound examination and the policy and program implications for translating this recommendation into action at the country level.
WHO recommendations on antenatal care for a positive pregnancy experience: Summary. Highlights and key messages from the World Health Organization’s 2016 Global Recommendations for Routine Antenatal Care.
Geneva, Switzerland, WHO, 2018 Jan. 10 p. (WHO/RHR/18.02; USAID Cooperative Agreement No. AID-OAA-A-14-00028)This brief highlights the WHO’s 2016 ANC recommendations and offers countries policy and program considerations for adopting and implementing the recommendations. The recommendations include universal and context-specific interventions. The recommended interventions span five categories: routine antenatal nutrition, maternal and fetal assessment, preventive measures, interventions for the management of common physiologic symptoms in pregnancy, and health system-level interventions to improve the utilization and quality of ANC.
Shortages of benzathine penicillin for prevention of mother-to-child transmission of syphilis: An evaluation from multi-country surveys and stakeholder interviews.
PLoS Medicine. 2017 Dec; 14(12):e1002473.BACKGROUND: Benzathine penicillin G (BPG) is the only recommended treatment to prevent mother-to-child transmission of syphilis. Due to recent reports of country-level shortages of BPG, an evaluation was undertaken to quantify countries that have experienced shortages in the past 2 years and to describe factors contributing to these shortages. METHODS AND FINDINGS: Country-level data about BPG shortages were collected using 3 survey approaches. First, a survey designed by the WHO Department of Reproductive Health and Research was distributed to 41 countries and territories in the Americas and 41 more in Africa. Second, WHO conducted an email survey of 28 US Centers for Disease Control and Prevention country directors. An additional 13 countries were in contact with WHO for related congenital syphilis prevention activities and also reported on BPG shortages. Third, the Clinton Health Access Initiative (CHAI) collected data from 14 countries (where it has active operations) to understand the extent of stock-outs, in-country purchasing, usage behavior, and breadth of available purchasing options to identify stock-outs worldwide. CHAI also conducted in-person interviews in the same 14 countries to understand the extent of stock-outs, in-country purchasing and usage behavior, and available purchasing options. CHAI also completed a desk review of 10 additional high-income countries, which were also included. BPG shortages were attributable to shortfalls in supply, demand, and procurement in the countries assessed. This assessment should not be considered globally representative as countries not surveyed may also have experienced BPG shortages. Country contacts may not have been aware of BPG shortages when surveyed or may have underreported medication substitutions due to desirability bias. Funding for the purchase of BPG by countries was not evaluated. In all, 114 countries and territories were approached to provide information on BPG shortages occurring during 2014-2016. Of unique countries and territories, 95 (83%) responded or had information evaluable from public records. Of these 95 countries and territories, 39 (41%) reported a BPG shortage, and 56 (59%) reported no BPG shortage; 10 (12%) countries with and without BPG shortages reported use of antibiotic alternatives to BPG for treatment of maternal syphilis. Market exits, inflexible production cycles, and minimum order quantities affect BPG supply. On the demand side, inaccurate forecasts and sole sourcing lead to under-procurement. Clinicians may also incorrectly prescribe BPG substitutes due to misperceptions of quality or of the likelihood of adverse outcomes. CONCLUSIONS: Targets for improvement include drug forecasting and procurement, and addressing provider reluctance to use BPG. Opportunities to improve global supply, demand, and use of BPG should be prioritized alongside congenital syphilis elimination efforts.