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In: Disease control priorities in developing countries. 2nd ed., edited by Dean T. Jamison, Joel G. Breman, Anthony R. Measham, George Alleyne, Mariam Claeson et al. Washington, D.C., World Bank, 2006. 531-549.This chapter provides an overview of neonatal deaths, presenting the epidemiology as a basis for program priorities and summarizing the evidence for interventions within a health systems framework, providing cost and impact estimates for packages that are feasible for universal scale-up. The focus of the chapter is restricted to interventions during the neonatal period. The priority interventions identified here are largely well known, yet global coverage is extremely low. The chapter concludes with a discussion of implementation in country programs with examples of scaling up, highlighting gaps in knowledge. (excerpt)
Indian Pediatrics. 2007 Nov 17; 44(11):814-816.Globally, 9.7 million children died last year, about 3.6 million of them during the neonatal period (WHO mortality database). Because of its large population and relatively high neonatal mortality rate, India contributes about a quarter of all neonatal deaths in the world. It is particularly important to note that more than two thirds of these neonatal deaths occur in the first week of life. It is well known that majority of neonatal deaths can be prevented with low-technology, low-cost interventions delivered across two continua of care-the first from pregnancy, birth, through neonatal period and childhood, and the second from home, through primary health facilities to hospitals. It has been estimated that optimal treatment of neonatal illness can avert up to half of all preventable neonatal deaths. (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)
Geneva, Switzerland, World Health Organization [WHO], 2006. 37 p. (Moving Towards Universal Coverage. Issues in Maternal-Newborn Health and Poverty No. 2)The aim of this paper is to provide a systematic review of the estimation of the cost of illness (COI) related to maternal-newborn ill-health (MNIH). The methodology used for the review includes a systematic search on electronic databases for published literature and manual searches for the identification of grey (unpublished) literature. Searches are based on the major electronic databases and also on the home pages of some major international organizations. While the problems of MNIH are well known and the importance of conducting COI studies is understood, knowledge is still lacking about the magnitude of the costs of MNIH at the societal level. After a search of the existing electronic databases, only one published paper was found to be relevant for the review; four grey studies (using REDUCE Safe Motherhood model) were also directly relevant. The published study estimates most of the cost components associated with a particular complication of MNIH -- emergency obstetric care (EmOC) -- and reports a total average cost per user of EmOC in the range of US$ 177-369 in Bangladesh. The unpublished studies based on the REDUCE model illustrate the MNIH issue more directly and elaborately; however, they estimate merely the productivity cost for four African countries. The model estimates a huge amount of productivity losses associated with MNIH: an annual total of about US$ 95 million for Ethiopia and about US$ 85 million for Uganda. To formulate an idea of issues related to data, measurement and methodology the present study also reviews COI studies on other related diseases that are similar to those on MNIH. The review reveals some difficulties in measurement and proposes to incorporate some relevant cost components that MNIH cause society and also suggests probable data sources for COI studies of MNIH. Although it is evident that MNIH results in suffering for women and children and hinders economic development through its huge burden for society, in order to stimulate further policy debate regarding its significance future research efforts should be directed towards theoretically sound and comprehensive COI studies with use of longitudinal and experimental data. (author's)
Communication for immunization campaigns for maternal and neonatal tetanus elimination. A guide to mobilizing demand and increasing coverage.
Washington, D.C., Save the Children, Saving Newborn Lives, 2006.  p. (Saving Newborn Lives: Tools for Newborn Health)The purpose of this guide is to describe how to design and carry out a social mobilization program to create demand and increase participation during immunization campaigns and routine immunizations, and thereby improve the health of communities in developing countries. The approach described here was developed and used by the Saving Newborn Lives initiative (SNL) of Save the Children/USA in maternal and neonatal tetanus (MNT) immunization campaigns in Ethiopia, Mali, and Pakistan. Communication and social mobilization activities helped these countries achieve high coverage by building community demand. This guide has collected the best practices and lessons learned from designing and carrying out the campaigns, focusing on communication activities, and presents these lessons here so they can be used in other immunization programs for women and children. (excerpt)
Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. [Tasas de cesáreas y resultados de embarazos: la encuesta mundial de la OMS del año 2005 sobre salud materna y perinatal en América Latina]
Lancet. 2006 Jun 3; 367(9525):1819-1829.Caesarean delivery rates continue to increase worldwide. Our aim was to assess the association between caesarean delivery and pregnancy outcome at the institutional level, adjusting for the pregnant population and institutional characteristics. For the 2005 WHO global survey on maternal and perinatal health, we assessed a multistage stratified sample, comprising 24 geographic regions in eight countries in Latin America. We obtained individual data for all women admitted for delivery over 3 months to 120 institutions randomly selected from of 410 identified institutions. We also obtained institutional-level data. We obtained data for 97 095 of 106 546 deliveries (91% coverage). The median rate of caesarean delivery was 33% (quartile range 24--43), with the highest rates of caesarean delivery noted in private hospitals (51%, 43--57). Institution-specific rates of caesarean delivery were affected by primiparity, previous caesarean delivery, and institutional complexity. Rate of caesarean delivery was positively associated with postpartum antibiotic treatment and severe maternal morbidity and mortality, even after adjustment for risk factors. Increase in the rate of caesarean delivery was associated with an increase in fetal mortality rates and higher numbers of babies admitted to intensive care for 7 days or longer even after adjustment for preterm delivery. Rates of preterm delivery and neonatal mortality both rose at rates of caesarean delivery of between 10% and 20%. High rates of caesarean delivery do not necessarily indicate better perinatal care and can be associated with harm. (author's)
Lancet. 2006 Jun 3; 367(9525):1799-1800.In today's Lancet, the WHO study group report a multicentre prospective study of the obstetric outcome in women who have had genital mutilation. Their study strengthens the evidence base about complications of such mutilation. For a subject with many important confounding factors, we congratulate the researchers for the study design and tenacity in execution. The finding of a causal relation between complications and type of mutilation indicates that the more brutal the type of procedure, the worse the complication. Yet, as has been advocated, there can be no justification for even excision of the prepuce in type I female genital mutilation. Advocating mild forms of cutting can raise the possibility of a dubious refocusing to appease cultural sensitivity sentiments. (excerpt)
Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries. Achieving the Millennium Development Goals for health.
BMJ. British Medical Journal. 2005 Nov 12; 331(7525):1107.The objective was to determine the costs and benefits of interventions for maternal and newborn health to assess the appropriateness of current strategies and guide future plans to attain the millennium development goals. Design: Cost effectiveness analysis. Setting: Two regions classified by the World Health Organization according to their epidemiological grouping: Afr-E, those countries in sub-Saharan Africa with very high adult and high child mortality, and Sear-D, comprising countries in South East Asia with high adult and high child mortality. Data sources: Effectiveness data from several sources, including trials, observational studies, and expert opinion. For resource inputs, quantities came from WHO guidelines, literature, and expert opinion, and prices from the WHO choosing interventions that are cost effective database. Main outcome measures: Cost per disability adjusted life year (DALY) averted in year 2000 international dollars. The most cost effective mix of interventions was similar in Afr-E and Sear-D. These were the community based newborn care package, followed by antenatal care (tetanus toxoid, screening for pre-eclampsia, screening and treatment of asymptomatic bacteriuria and syphilis); skilled attendance at birth, offering first level maternal and neonatal care around childbirth; and emergency obstetric and neonatal care around and after birth. Screening and treatment of maternal syphilis, community based management of neonatal pneumonia, and steroids given during the antenatal period were relatively less cost effective in Sear-D. Scaling up all of the included interventions to 95% coverage would halve neonatal and maternal deaths. Preventive interventions at the community level for newborn babies and at the primary care level for mothers and newborn babies are extremely cost effective, but the millennium development goals for maternal and child health will not be achieved without universal access to clinical services as well. (author's)
Lancet. 2005 Mar 26; 365:1147-1152.Child survival efforts can be effective only if they are based on accurate information about causes of deaths. Here, we report on a 4-year effort by WHO to improve the accuracy of this information. WHO established the external Child Health Epidemiology Reference Group (CHERG) in 2001 to develop estimates of the proportion of deaths in children younger than age 5 years attributable to pneumonia, diarrhoea, malaria, measles, and the major causes of death in the first 28 days of life. Various methods, including single-cause and multi-cause proportionate mortality models, were used. The role of undernutrition as an underlying cause of death was estimated in collaboration with CHERG. In 2000–03, six causes accounted for 73% of the 10.6 million yearly deaths in children younger than age 5 years: pneumonia (19%), diarrhoea (18%), malaria (8%), neonatal pneumonia or sepsis (10%), preterm delivery (10%), and asphyxia at birth (8%). The four communicable disease categories account for more than half (54%) of all child deaths. The greatest communicable disease killers are similar in all WHO regions with the exception of malaria; 94% of global deaths attributable to this disease occur in the Africa region. Undernutrition is an underlying cause of 53% of all deaths in children younger than age 5 years. Achievement of the millennium development goal of reducing child mortality by two-thirds from the 1990 rate will depend on renewed efforts to prevent and control pneumonia, diarrhoea, and undernutrition in all WHO regions, and malaria in the Africa region. In all regions, deaths in the neonatal period, primarily due to preterm delivery, sepsis or pneumonia, and birth asphyxia should also be addressed. These estimates of the causes of child deaths should be used to guide public-health policies and programmes. (author's)
Washington, D.C., Population Reference Bureau [PRB], 2003 Apr.  p.This policy brief presents two rationales for investing in neonatal health services: investing in newborn health and survival helps achieve health and development goals, and honoring newborns' human rights.
CVI FORUM. 1994 Nov; (8):6-9.Neonatal tetanus (NT) kills an estimated 500,000 newborn infants every year, as well as 30,000 mothers, who die from infection-related complications. The World Bank's 1993 World Development Report noted that among Expanded Program on Immunization (EPI) diseases, the human and social toll of NT is second only to measles. Given the global public health burden of NT, the World Health Organization's governing body, the World Health Assembly, has called for the elimination of NT globally by 1995. To protect newborn infants against tetanus, anti-tetanus shots must be given to their mothers either during or before their pregnancies. The mothers then pass their antibodies against tetanus along to their fetuses. Only 45% of babies are born with the protective antibodies they need against NT. NT is clearly a disease of poverty, poor hygiene, and non-existent health services. In 50-80% of cases, Clostridium tetani, the causative organism, kills the infants its infects within approximately 1 week of birth. As such, routine surveillance systems generally record less than 5% of neonatal tetanus cases and deaths. Even though many countries have rid themselves of NT without relying exclusively upon vaccination, EPI officials believe vaccination is the most cost-effective, fastest way to achieve the goal of NT elimination.
MODERN MIDWIFE. 1997 Oct; 7(10):26-30.Almost half of the 8.1 million infant deaths which occurred globally in 1993 were neonatal deaths and worldwide, an estimated 8 newborn babies die every minute. Levels of infant mortality have been declining steadily all around the world, but changes in neonatal mortality have been much slower. Neonatal mortality is so common in some societies that completion of birth with its naming ceremonies may not be recognized until the infant has survived for 1 week to 40 days. Neonatal mortality may therefore be underreported by up to a factor of 10 in such contexts. Many of the factors which contribute to neonatal morbidity and mortality are at work long before an infant is born. Some of the interventions designed to lower perinatal or neonatal mortality must therefore address maternal health problems and women's position in society, but not at the expense of providing newborn care. Failure to prevent or treat health problems during the perinatal period will affect a child's subsequent growth and physical and mental abilities. Many of the conditions which result in neonatal death could be prevented or treated with low technology, improved labor and delivery care, and attention to the physiological needs of the newborn. The causes of neonatal mortality, the organization and coverage of delivery care, resuscitation, low birth weight, hypothermia, low-technology warming, reducing infection, and essential interventions are discussed.
[Unpublished], 1993. Background paper for Informal Technical Working Group Meeting on STD Activities in GPA, Geneva, Switzerland, February 15-17, 1993. 28 p.Although preventable, congenital syphilis remains a major health problem worldwide. In many developing countries, maternal syphilis is a common cause of fetal loss, stillbirth, prenatal mortality, and congenital abnormalities. The most important contributing factor for congenital syphilis is poor prenatal care. If pregnant women are serologically screened and maternal syphilis is adequately treated, the risk to the infant becomes minimal. Most developing countries provide antenatal care, but the opportunity to address the issue of syphilis and its consequences in pregnancy has been poorly seized. Guidelines are presented on the prevention and control of syphilis in pregnancy with the goal of preventing congenital syphilis. The epidemiology and natural history of syphilis, whether preventing congenital syphilis is cost-effective, the objectives of controlling syphilis in a pregnancy program, strategies, situation analysis, intervention and support, monitoring and evaluation, and program management are discussed.
WORLD HEALTH. 1995 Jan-Feb; 48(1):4-5.In order to assure that all children become protected from preventable death and disability by making the best vaccines available and using them in the most effective manner, the World Health Organization has created a new Global Programme on Vaccines and Immunization (GPV). This new approach will build upon the success of the Expanded Programme on Immunization (EPI) which increased immunization coverage from 5% of children born each year to more than 75% of infants born in 1993 and 45% of pregnant women (immunized against tetanus). The EPI prevents an estimated 2,900,000 deaths from measles, neonatal tetanus, and whooping cough as well as 560,000 cases of polio each year. The new approach is needed to counteract the falling coverage rates seen in some countries and to raise low rates which persist in others. Also, the new program will introduce additional vaccines, ensure that only safe and effective vaccines are used, and apply an epidemiological approach to the 3 target diseases of the EPI. Finally, global research and development of vaccines will be channeled to appropriate new and/or improved vaccines for developing countries (such as the development of a more thermostable oral polio vaccine). Therefore, the 3 operational units of the GPV will be the EPI, Vaccine Supply and Quality, and Vaccine Research and Development.
VACCINE WEEKLY. 1995 Jan 2; 12-3.Neonatal tetanus (NT), which results from the effect of the neurotropic toxin of Clostridium tetani, is a leading cause of neonatal mortality in many parts of the world. The US Centers for Disease Control and Protection (CDC) in Atlanta, Georgia, has stated that "although progress toward eliminating NT as a public health problem has been made, current resources and commitments must be increased and activities greatly accelerated if the 1995 goal is to be achieved by all countries." In order to accomplish and maintain elimination of NT, 80% or more of infants require protection at birth through the vaccination of their mothers with at least two doses of tetanus toxoid (TT2+) or through hygienic delivery and umbilical cord-care procedures. Effective surveillance systems also need to be developed that will detect cases of NT and enable timely investigation of such cases. To eliminate NT, "each country must identify areas where the incidence rate is higher than 1/1000 live births, coverage levels are low, or there is limited access to clean deliveries or trained birth attendants. These high-risk areas must be targeted for intensified vaccination efforts, including the use of mass vaccination campaigns..." Surveillance activities must be intensified in all areas. To ensure long-term elimination of NT, countries need to develop adequate health care delivery systems to reach those at greatest risk.
[Unpublished] 1991. 13 p. (WHO/VDT/91.455)The epidemiology, determining factors, prevention, detection, treatment, and programmatic aspects of maternal and congenital syphilis are discussed. Syphilis can be an acute or chronic infection, but is entirely curable; yet, it is one of the most damaging of all STDs to the fetus. Prevalence in maternal serum ranges from about 0.03% in the UK to 13-16% in some African urban areas. The adverse effects of untreated maternal syphilis to the fetus include abortion, intrauterine death, prematurity, congenital syphilis, and tardive infection. The infant is at greater risk if his mother's syphilis infection is acute; he may escape infection if her syphilis is chronic. Common barriers to effective control of syphilis in developing countries are late prenatal care, lack of screening or treatment, and, especially, failure to find a new infection after earlier prenatal screening. To prevent syphilis in pregnancy, the most important program approaches are health education and promotion of prenatal screening, adequate treatment, partner tracing, and treatment. Both in developing and Westernized settings, it is highly cost-effective to screen and treat maternal syphilis. In developing countries, the VDRL or rapid plasma reagin (RPR) card tests are adequate for screening. Programs should include the management techniques of training, evaluation, regular reporting, quality control of testing, and surveillance of maternal syphilis rates. All these systems can be linked to HIV testing and surveillance programs.
AIDS. 1988; 2 Suppl 1:S247-52.This update on world prevalence of HIV infections and patterns of transmission begins with definitions of AIDS, and an evaluation of efficiency of reporting, and ends with tentative projections and global impact of the pandemic. In developed countries the CDC/WHO clinical and serological definition of AIDS as formulated in 1985 and modified in 1987 is used, but in rural Africa the WHO clinical definition of AIDS is appropriate. AIDS reporting has improved, and is considered 80% complete from the U.S. Reporting is variable among some European and Latin American countries, and is only preliminary in Eastern Europe, Middle East, Asia and the Pacific. Estimates of 10-20% reporting in Africa is given. About 250,000 cases are probably ongoing. ELISA tests are now considered very accurate. Global transmission patterns fall into 3 classes: I. homosexual and bisexual men, iv drug users, their partners, with a male to female ratio of 10-15:1, in industrialized countries. Here overall prevalence is 1%, but may be as high as 50% susceptible groups. Pattern II. heterosexuals, sex ratio 1:1, common perinatal transmission, significant transmission by syringes and blood products, in Central and Eastern Africa and parts of the Caribbean and Latin America. Pattern III. both homosexuals and heterosexuals, infected after mid-1980s, most cases transmitted by foreign travellers, some by imported blood products, in Eastern Europe, North Africa, the Middle East, Asia and the Pacific Islands excluding Australia and New Zealand. WHO estimates that up to 10 million people are already infected with HIV, and that by 1991 1 million will develop AIDS. The average incubation time is 8-9 years. The majority of cases will appear within 4-5 years. Since most cases are adults aged 20-49 years, and many are urban, more educated adults, economic and political destabilization may be possible in some areas.
Manila, World Health Organization, Nov. 1976. 72 p.Add to my documents.