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The impact of "Option B" on HIV transmission from mother to child in Rwanda: An interrupted time series analysis.
PloS One. 2018; 13(2):e0192910.BACKGROUND: Nearly a quarter of a million children have acquired HIV, prompting the implementation of new protocols-Option B and B+-for treating HIV+ pregnant women. While efficacy has been demonstrated in randomized trials, there is limited real-world evidence on the impact of these changes. Using longitudinal, routinely collected data we assessed the impact of the adoption of WHO Option B in Rwanda on mother to infant transmission. METHODS: We used interrupted time series analysis to evaluate the impact of Option B on mother-to-child HIV transmission in Rwanda. Our primary outcome was the proportion of HIV tests in infants with positive results at six weeks of age. We included data for 20 months before and 22 months after the 2010 policy change. RESULTS: Of the 15,830 HIV tests conducted during our study period, 392 tested positive. We found a significant decrease in both the level (-2.08 positive tests per 100 tests conducted, 95% CI: -2.71 to -1.45, p < 0.001) and trend (-0.11 positive tests per 100 tests conducted per month, 95% CI: -0.16 to -0.07, p < 0.001) of test positivity. This represents an estimated 297 fewer children born without HIV in the post-policy period or a 46% reduction in HIV transmission from mother to child. CONCLUSIONS: The adoption of Option B in Rwanda contributed to an immediate decrease in the rate of HIV transmission from mother to child. This suggests other countries may benefit from adopting these WHO guidelines.
Global Call to Action: Maximize the public health impact of intermittent preventive treatment of malaria in pregnancy in sub-Saharan Africa.
Malaria Journal. 2015; 14:207.Intermittent preventive treatment of malaria in pregnancy is a highly cost-effective intervention which significantly improves maternal and birth outcomes among mothers and their newborns who live in areas of moderate to high malaria transmission. However, coverage in sub-Saharan Africa remains unacceptably low, calling for urgent action to increase uptake dramatically and maximize its public health impact. The ‘Global Call to Action’ outlines priority actions that will pave the way to success in achieving national and international coverage targets. Immediate action is needed from national health institutions in malaria-endemic countries, the donor community, the research community, members of the pharmaceutical industry and private sector, along with technical partners at the global and local levels, to protect pregnant women and their babies from the preventable, adverse effects of malaria in pregnancy © 2015 Chico et al. Open Access.
International Journal of Gynaecology and Obstetrics. 2008 Aug; 102(2):189-90.Recent articles in these pages have referred to the Millennium Development Goals (MDGs). These goals were set in 2000 by the General Assembly of the United Nations to be achieved by 2015. While aimed primarily at development and poverty reduction, 3 goals refer to measures of health. Of the 8 goals, the one of interest to this section of IJGO is MDG5, which refers to maternal health: Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio; Achieve, by 2015, universal access to reproductive health care; A related goal is MDG4, which is to: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2007.  p.Since the advent of penicillin, syphilis is not only preventable but also treatable. Despite this, it remains a global problem with an estimated 12 million people infected each year. Pregnant women who are infected with syphilis can transmit the infection to their fetus, causing congenital syphilis with serious adverse effects on the pregnancy in up to 80% of the cases. Yet simple, cost-effective screening and treatment options could prevent and eventually eliminate congenital syphilis. With the current international focus on the Millennium Development Goals (MDGs), there exists a unique opportunity to mobilize action to prevent, and subsequently eliminate, congenital syphilis. Congenital syphilis is a serious but preventable disease, which can be eliminated through effective screening of pregnant women for syphilis and treatment of those infected. More newborn infants are affected by congenital syphilis than by any other neonatal infection, including human immunodeficiency virus (HIV) infection and tetanus, which are currently receiving global attention. Yet the burden of congenital syphilis is still under-appreciated at both international and national levels. Unlike many neonatal infections, congenital syphilis can be effectively prevented by testing and treatment of pregnant women, which also provides immediate benefits to the mother and allows potentially infected partners to be traced and offered treatment. It has been clearly shown that screening of pregnant women for reactive syphilis serology, followed by treatment of seropositive women, is a cost-effective, inexpensive and feasible intervention for the prevention of congenital syphilis and improvement of child health. In 1995, the Pan American Health Organization (PAHO) began a regional campaign to reduce the rate of congenital syphilis in the Americas to less than 50 cases per 100 000 live births. The strategy was to: (1) increase the availability of antenatal care; (2) establish routine serological testing for syphilis during antenatal careand at delivery; and (3) promote the rapid treatment of infected pregnant women. (excerpt)
Washington, D.C., Population Reference Bureau [PRB], 2007 Dec.  p.With continuing political turmoil, emergency rule declared, and concerns about how free and fair January elections will be, Pakistan has been under the spotlight recently. But the political arena isn't the only area where challenges persist. Beneath the surface, more problems are brewing in the sixth most populous country in the world. Some of the challenges are fueled by the country's rapidly growing population, which is making increasing demands on social services, especially the health care system. A comparison of population pyramids reflects how Pakistan has grown and how its needs will multiply. Between 1970 and 2000, Pakistan more than doubled in population to 144 million from 60 million. Its population ages 15 to 49 more than tripled to 68 million from 14 million. As the number of people in that age group rose, so did demand for maternal and child health care. And health care needs are likely to grow as the 2025 projection for those ages 15 to 49 rises to 121 million, nearly double the 2000estimate. (excerpt)
Workshop on Gender and Rights in Reproductive and Maternal Health, convened by World Health Organization, Regional Office for the Western Pacific, Kuala Lumpur, Malaysia, 28 November - 2 December 2005. Report.
Manila, Philippines. WHO, Regional Office for the Western Pacific, 2006 Mar. 40 p. ((WP)RPH/ICP/RPH/3.4/001/RPH(3)/2005-E; Report Series No. RS/2005/GE/43(MAA))More than a decade after the International Conference on Population and Development (ICPD) in 1994 and the Fourth World Conference on Women in 1995, governments are expressing their commitment to women's health, in particular to sexual and reproductive health. Unfortunately, high maternal and neonatal mortality remains a feature in many countries in the Western Pacific Region. The complex issues of reproductive and maternal health extend beyond technical and medical factors. Social determinants, such as gender and rights, though recognized as important factors in maternal mortality and morbidity, have not been considered in health services planning, perhaps because of a lack of understanding and inadequate capacity to operationalize the concepts. To achieve the Millennium Development Goals (MDG), it is essential that the gender and rights dimensions are fully understood and mainstreamed in policy, programmes and services. Recognizing the urgency of the situation, the WHO Western Pacific Regional Office decided to organize a workshop in collaboration with the Ministry of Health Malaysia as the host in Kuala Lumpur from 28 November to 2 December 2005. The Workshop on Gender and Rights in Reproductive and Maternal Health was the first ever organized by the Regional Office. Unlike other workshops, this was a training workshop aimed at introducing Concepts as well as some basics kills and tools to enable participants to bring a gender and rights perspective in to their programme services. (excerpt)
Journal of Health, Population and Nutrition. 2006 Dec; 24(4):377-379.A new target-universal access to reproductive health by 2015-was endorsed in October 2006 under Millennium Development Goal 5 (MDG 5) to improve maternal health. And while the international reproductive health community could finally celebrate this official recognition of reproductive health on "centre stage of international efforts to defeat poverty and preventable illness" (1), the field reality is far from the target. What does it take to improve sexual and reproductive healthcare practices, including self-care practices at the home and use of services? Generated by a call for papers on these topics, this issue of the Journal contains selected papers describing current practices, examining specific barriers to improved practices, and providing results of interventions aimed at improving self-care practices or use of services. Most practices described relate to improving maternal and newborn* health or care; only two articles provide information on practices in other sexual and reproductive health areas-one on male sexuality and another on women with HIV/AIDS. No papers were received concerning care-seeking for family planning, menstrual regulation, or abortion care-a red flag perhaps signaling the marginalization of these topics in the current day. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2006. 32 p. (Moving Towards Universal Coverage. Issues in Maternal-Newborn Health and Poverty No. 3)The aim of this paper is to provide a systematic review of the evidence of the impact on economic growth of investments in maternal--newborn health (MNH). The methodology used for the review includes a systematic search for published literature in relevant electronic databases. In the paper, we review five studies: four empirical and one theoretical. One of the empirical papers measures health by infant mortality. The study finds that a 1/1000-point reduction in the infant mortality rate leads to an increase in the level of State Domestic Product by Indian Rs 2.70 and an increase in the average growth rate per year of 0.145%. Similar results are reported for other health measures in other studies. Our main conclusion, however, is that the area lacks research and that considerably more is needed before any advice can be provided to policy-makers about the contribution to growth of investments in MNH. Specifically, first and foremost, studies are needed that explicitly analyse the impact of MNH on level and growth of output. Second, we suggest the use of more comprehensive MNH measures that consider the health of both mothers and newborns and aspects of ill-health other than death, such as measures of quality of life, functional limitations, mental health and sickness absenteeism. Third, estimates of the effects of MNH on growth need to be controlled for other health dimensions, i.e. aspects that may confound the impact of MNH. Fourth, studies are needed of the effects on determinants of growth in order to understand better the links between MNH and growth. Fifth, studies based on smaller geographical areas within countries and longer time series are needed, in order to obtain more precise estimates and also better estimates of the long-term growth paths. Finally, we suggest compilation of other data sets on microeconomic data, for example, to study effects at firm level of MNH on labour productivity through inability to work, disability, sick days, etc. (author's)
Serial Issue. Sanger File. 2001 Jul 19; (2): p..The world's literature is filled with images of women dying in childbirth. Catherine in "Wuthering Heights." Lolita in the novel of the same name. And even the first feminist herself in real life, Mary Wollstonecraft, died in childbirth of septicemia. Women die in childbirth; "always have, always will" seems to be the world's attitude to this phenomenon. In a week when the world's attention was drawn to new U.N. resolutions to eliminate or reduce deaths from AIDS, I recall that, not so long ago, similar U.N. meetings in Cairo and Beijing resolved to eliminate or reduce maternal deaths. What progress have we made since then? The World Health Organization (WHO) recently provided the answer in a sobering report on maternal mortality worldwide. Their answer: not much. According to the WHO, more than 500,000 women die annually from pregnancy-related complications. This figure has remained stubbornly high throughout the 1990s and shows no signs of decreasing. The actual figure is probably much higher, according to the WHO, due to frequent official misclassifications of the causes of women's pregnancy-related deaths, including deaths from abortion, early pregnancy deaths (from ectopic pregnancies), and deaths from diseases that pregnancy aggravates, such as heart conditions, malaria or TB. Studies in Mexico and Argentina indicate that officially reported levels of maternal mortality may be underreported by as much as 50 percent. (excerpt)
Exclusion, inequity and health system development: the critical emphases for maternal, neonatal and child health [editorial]
Bulletin of the World Health Organization. 2005 Jun; 83(6):402.The World health report 2005 provides a powerful analysis of the global scandal of mothers’ and children’s ill-health (1). Every year, over half a million women die from pregnancy-related causes and over 10 million children die under five years of age. These deaths are largely preventable. The report correctly identifies the causes as lying primarily in failures within health systems to provide appropriate frameworks and resources to deliver the technical interventions, and in broader social and cultural factors. Evidence on technical interventions is well covered. Midwifery-led care at the first level of services, with accessible back-up in hospitals, is essential for reducing maternal and neonatal mortality. The report is crystal clear on this, acknowledging past failures of training traditional birth attendants and problems of over-medicalization of childbirth. Universal access, both financial and geographical, to care by skilled attendants is emphasized, although a description of the requirements of referral systems to ensure timely access to obstetric care would have been helpful. Issues too often ignored are included: violence, discrimination and marginalization during pregnancy, sex selection, and the need for evidence to develop policy on postpartum care. (excerpt)
Global AIDSLink. 2004 Aug-Sep; (87):16-17.The importance of addressing HIV/AIDS from a stronger sexual and reproductive health and rights perspective has over the past few months been gaining increased global momentum and recognition. Earlier this year, the All Party Parliamentary Group on Population, Development and Reproductive Health in the UK commenced their hearings into the very question of integration: its successes, failures and contextual realities. The Glion Call to Action (see page 8)— released in June — specifically addressed the integration aspects involved in PMTCT programs and policies. And in May, UNFPA hosted a series of technical meetings that aimed to explore some of the broader technicalities of integration. This advocacy document was launched in July at the Bangkok XV International AIDS Conference. Clearly, the question of when, where and how to integrate HIV/AIDS with reproductive health has been plaguing programmers and policy makers, donors and service providers. Answering these questions with meaningful action is not only long overdue but — in the age of increased awareness, and treatment access increasingly becoming a reality — it is unarguably the most unexplored terrain of our international response. For it is only with the concerted effort and coordinated involvement of the sexual and reproductive health community that the lofty Millennium Development Goals; the UN General Assembly's Special Session on HIV/AIDS Commitments; the '3 by 5' targets; and even new modalities of reducing HIV/AIDS-related stigma, will be achieved. The mainstreaming of HIV/AIDS is perhaps not only an untapped avenue, but it also has the potential to awake the full potential of a by-and-large under used resource. Getting there, however, would involve a change in mind-set of all the role players involved. A 'business as usual' approach that does not move beyond rhetoric will have damning consequences. The exceptionality of HIV/AIDS as a largely sexually transmitted infection requires an exceptional response — especially from sexual and reproductive health providers. (excerpt)
In: Shaping policy for maternal and newborn health: a compendium of case studies, edited by Sandra Crump. Baltimore, Maryland, JHPIEGO, 2003 Oct. 83-90.Malaria during pregnancy is a significant public health problem, especially in sub-Saharan Africa. Effective strategies have been identified to address this problem, but few countries have been able to translate these strategies into national-level policies and programs. Those countries that have made significant policy changes have engaged in a dynamic process of translating research results into relevant policy. Both locally collected data and data collected in the subregion and region are essential to this process. Each year, approximately 24 million pregnancies occur among women living in malaria-endemic areas. Malaria during pregnancy can result in maternal anemia, abortion, stillbirth, prematurity, intrauterine growth retardation, and low birthweight. Severe maternal anemia increases the risk for maternal mortality, and anemia caused by malarial infection is estimated to result in approximately 10,000 maternal deaths per year. Low birthweight is one of the greatest risk factors for infant mortality. As many as 75 percent of the 2.7 million malaria-related deaths each year occur among children in sub-Saharan Africa. (excerpt)
In: An agenda for people: the UNFPA through three decades, edited by Nafis Sadik. New York, New York, New York University Press, 2002. 24-46.The solemn commitment that was made in Cairo in 1994 to make reproductive health care universally available was a culmination of efforts made by the United Nations Population Fund (UNFPA) and all those concerned about a people-centred and human rights approach to population issues. The commitment posed important challenges to national governments and the international community, to policy makers, programme planners and service providers, and to the civil society at large. The role of UNFPA in building up the consensus for the reproductive health approach before Cairo had to continue after Cairo if the goals of the International Conference on Population and Development (ICPD) were to be achieved. UNFPA continues to be needed to strengthen the commitment, maintain the momentum, mobilize the required resources, and help national governments and the international community move from word to action, and from rhetoric to reality. Reproductive health, including family planning and sexual health, is now one of three major programme areas for UNFPA. During 1997, reproductive health accounted for over 60 per cent of total programme allocations by the Fund. (excerpt)